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Although primary prevention of mass shootings would be a laudable goal, these incidents continue to occur frequently and they represent a potential threat to the life of every citizen where [...], Background: Early hemorrhage control after interpersonal violence is the most urgent requirement to preserve life and is now recognized as a responsibility of law enforcement. Although earlier entry of first responders is advocated, many shooting scenes remain unsafe for humans, necessitating first responses conducted by robots. Thus, robotic hemorrhage control warrants study as a care-under-fire treatment option. Methods: Two bomb disposal robots (Wolverine and Dragon Runner) were retrofitted with hemostatic wound clamps. The robots&apos; ability to apply a wound clamp to a simulated extremity exsanguination while controlled by 4 experienced operators was tested. The operators were randomly assigned to perform 10 trials using 1 robot each. A third surveillance robot (Stair Climber) provided further visualization for the operators. We assessed the success rate of the application of the wound clamp to the simulated wound, the time to application of the wound clamp and the amount of fluid loss. We also assessed the operators&apos; efforts to apply the wound clamp after an initial attempt was unsuccessful or after the wound clamp was dropped. Results: Remote robotic application of a wound clamp was demonstrated to be feasible, with complete cessation of simulated bleeding in 60% of applications. This finding was consistent across all operators and both robots. There was no difference in the success rates with the 2 robots (p = 1.00). However, there were differences in fluid loss (p = 0.004) and application time (p < 0.001), with the larger (Wolverine) robot being faster and losing less fluid. Conclusion: Law enforcement tactical robots were consistently able to provide partial to complete hemorrhage control in a simulated extremity exsanguination. Consideration should be given to using this approach in care-under-fire and care-behind-the-barricade scenarios as well as further developing the technology and doctrine for robotic hemorrhage control. Contexte : Le contrdle precoce d&apos;une hemorragie apres un acte de violence inter-personnelle est la condition la plus urgente pour preserver la vie et est desormais considere comme une responsabilite des forces de l&apos;ordre. Une intervention plus precoce des premiers repondants est donc preconisee, mais comme de nombreuses scenes de fusillade sont trop dangereuses pour les humains, on utilise des robots. Par consequent, le contrdle robotique des hemorragies merite d&apos;etre etudie en tant qu&apos;option de traitement sous les tirs. Methodes : Deux robots de neutralisation d&apos;explosifs (Wolverine et Dragon Runner) ont ete munis de clamps hemostatiques. La capacite des robots--contrdles par 4 operateurs experimentes--a appliquer un clamp sur une exsanguination de membre simulee a ete testee. Les operateurs etaient affectes au hasard pour effectuer 10 essais a l&apos;aide d&apos;un robot chacun. Un troisieme robot << de surveillance >> (Stair Climber) leur procurait une vue supplementaire. Nous avons evalue le taux de reussite de l&apos;application du clamp sur la plaie simulee, le delai d&apos;application du clamp et la quantite de liquide perdu. Nous avons egalement evalue les efforts deployes par les operateurs pour appliquer le clamp apres une premiere tentative infructueuse ou apres la chute d&apos;un clamp. Resultats : Il a ete conclu que l&apos;application robotique de clamp a distance etait faisable, un arret complet du saignement simule ayant ete obtenu dans 60 % des applications. Cette conclusion s&apos;est averee pour tous les operateurs et les 2 robots. Il n&apos;y a eu aucune difference sur le plan du taux de reussite des 2 robots (p = 1,00). Cependant, des differences ont ete observees au chapitre de la perte de liquide (p = 0,004) et du delai d&apos;application (p < 0,001), une plus grande rapidite et une perte de liquide moindre ayant ete enregistrees pour le plus grand robot (Wolverine). Conclusion : Les robots tactiques des forces de l&apos;ordre ont ete systematiquement en mesure d&apos;offrir un contrdle partiel ou complet des hemorragies lors de simulations d&apos;exsanguination de membre. Il faudrait envisager d&apos;utiliser cette approche dans des situations critiques dangereuses, et de favoriser le developpement des technologies et de la theorie du contrdle robotique des hemorragies.

Medical telementoring refers to remote guidance of a novice medical provider by an expert over distance. (1) Advances in information technology mean that telementoring is an increasingly attractive way to [...], Background: Telementoring facilitates the coordination of advanced medical care in rural, remote or austere environments. Because the interpersonal element of telementoring has been relatively underexplored, we conducted a scoping review to identify strategies to improve communication in telementoring. Methods: Two independent reviewers searched all English-language articles in MEDLINE and Scopus from 1964 to 2017, as well as reference lists of relevant articles to identify articles addressing telementored interactions between health care providers. Search results were gathered in June 2017 and updated in January 2018. Identified articles were categorized by theme. Results: We identified 144 articles, of which 56 met our inclusion criteria. Forty-one articles focused on improving dispatcher-directed cardiopulmonary resuscitation (CPR). Major themes included the importance of language in identifying out-of-hospital cardiac arrest and how to provide instructions to enable administration of effective CPR. A standardized approach with scripted questions was associated with improved detection of out-of-hospital cardiac arrest, and a concise script was associated with improved CPR quality compared to no mentoring, unscripted mentoring or more complex instructions. Six articles focused on physician--physician consultation. Use of a handover tool that highlighted critical information outperformed an unstructured approach regarding transmission of vital information. Nine articles examined telementoring in trauma resuscitation. A common theme was the need to establish an understanding between mentor and provider regarding the limitations of the provider and his or her environment. Conclusion: The available data suggest that standardization coupled with short, concise validated scripts could improve efficacy, safety and engagement. Improvements will require multidisciplinary input, practice and deliberate efforts to address barriers. Contexte: Le mentorat en ligne facilite la coordination des soins medicaux de pointe dans les environnements ruraux, eloignes ou rudimentaires. Toutefois, le facteur relationnel de ce type d&apos;interaction est reste plutot sous-explore. C&apos;est pourquoi nous avons realise une revue exploratoire pour degager des strategies d&apos;amelioration de la communication en contexte de mentorat en ligne. Methodes: Deux reviseurs independants ont cherche a recenser les articles portant sur les interactions de mentorat en ligne entre professionnels de la sante parmi tous les articles de langue anglaise publies entre 1964 et 2017 indexes dans les bases de donnees MEDLINE et Scopus, ainsi que dans les listes bibliographiques des articles pertinents. Les resultats de recherche ont ete recueillis en juin 2017 et actualises en janvier 2018, et les articles recenses ont ete regroupes par themes. Resultats: Nous avons retenu 144 articles, dont 56 repondant a nos criteres d&apos;inclusion. De ce total, 41 portaient sur l&apos;amelioration de la reanimation cardiorespiratoire (RCR) dirigee par un repartiteur. Parmi les themes principaux, on retrouve l&apos;importance du langage dans l&apos;identification des arrets cardiaques hors de l&apos;hopital, ainsi que la maniere de fournir des instructions permettant de pratiquer une RCR efficace. Une approche normalisee avec des questions scenarisees a ete associee a une meilleure detection des arrets cardiaques hors de l&apos;hopital, alors qu&apos;un scenario concis a ete associe a une amelioration de la qualite de la RCR comparativement a une approche sans mentorat, avec mentorat non scenarise ou avec des instructions plus complexes. Six des articles retenus portaient sur la consultation de type medecin--medecin. Ils ont conclu que l&apos;utilisation d&apos;un outil de transfert mettant en evidence l&apos;information importante etait plus efficace qu&apos;une approche non structuree pour la transmission de renseignements vitaux. Finalement, 9 articles portaient sur le mentorat en ligne en reanimation traumatologique. Un des themes communs de ces articles etait le besoin d&apos;etablir une comprehension mutuelle entre mentors et professionnels en ce qui concerne les restrictions de ces derniers et de leur environnement. Conclusion: Les donnees disponibles semblent indiquer que la normalisation associee a des scenarios courts, concis et eprouves pourrait ameliorer l&apos;efficacite, la securite et l&apos;engagement. Cependant, toute amelioration necessitera un encadrement multidisciplinaire, de la pratique et des efforts deliberes pour surmonter les obstacles.

Background: Craniomaxillofacial (CMF) injuries are very common in both civilian and military settings. Nearly half of all civilian trauma incidents include a scalp laceration and historical rates of CMF battle injuries increased from 16%-21% to 42.2%. The scalp is highly vascular tissue and uncontrolled bleeding can lead to hypotension, shock and death. Therefore, enabling on-scene providers, both military and civilian, to immediately manage scalp and face lacerations, in a manner that allows them to still function in a tactical way, offers operational advantages. This case series examines how effectively a wound-clamp (iTClamp) controlled bleeding from CMF injuries pre-hospital environment. Methods: The use of the iTClamp for CMF (scalp and face laceration) was extracted from iTrauma Care's post market surveillance database. Data was reviewed and a descriptive analysis was applied. Results: 216 civilian cases of iTClamp use were reported to iTrauma Care. Of the 216 cases, 37% (n=80) were for control of CMF hemorrhage (94% scalp and 6% face). Falls (n=24) and MVC (n=25) accounted for 61% of the mechanism of injury. Blunt accounted for 66% (n=53), penetrating 16% (n=13) and unknown 18% (n=14). Adequate hemorrhage control was reported in 87.5% (n=70) of cases, three respondents reported inadequate hemorrhage control and in seven cases hemorrhage control was not reported. Direct pressure and packing was abandoned in favor of the iTClamp in 27.5% (n=22) of cases. Conclusions: CMF injuries are common in both civilian and military settings. Current options like direct manual pressure (DMP) often do not work well, are formidable to maintain on long transports and Raney clips are a historical suggestion. The iTClamp offers a new option for control of external hemorrhage from open wounds within compressible zones. [ABSTRACT FROM AUTHOR]