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Transient stress lymphocytosis (TSL) is an under-recognized phenomenon associated with an acute stressful event such as physical trauma or various emergency medical conditions. Lymphocytosis generally resolves within several hours to days of the stressor. While most reports of TSL predominantly involve adult patients, it has only rarely been reported in pediatric patients. Here, we describe the clinical course of a 9-year-old male who developed TSL following a traumatic fall from a second-story balcony and provide a systematic literature review of TSL. [ABSTRACT FROM AUTHOR]

Airway management is a cornerstone of emergency medical care. This project aimed to create evidence-based guidelines based on the systematic review recently conducted by the Agency for Healthcare Research and Quality (AHRQ). A technical expert panel was assembled to review the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The panel made specific recommendations on the different PICO (population, intervention, comparison, outcome) questions reviewed in the AHRQ review and created good practice statements that summarize and operationalize these recommendations. The recommendations address the use of ventilation with bag-valve mask ventilation alone vs. supraglottic airways vs. endotracheal intubation for adults and children with cardiac arrest, medical emergencies, and trauma. Additional recommendations address the use of video laryngoscopy and drug-assisted airway management. These recommendations, and the associated good practice statements, offer EMS agencies and clinicians an opportunity to review the available evidence and incorporate it into their airway management strategies. [ABSTRACT FROM AUTHOR]

Introduction: Acute upper gastrointestinal bleeding is one of the most common medical emergencies that present to the hospital, and delineating the underlying etiology is essential to provide adequate definitive treatment. The purpose of this case report was to review the diagnosis and treatment of a rare complication known as radiation-induced hemorrhagic gastritis (RIHG) that can occur in patients with prior radiation exposure. The motivation for this study arose from the identification of a case within our institution. Case Presentation: The study involved a review of the diagnosis and management of a patient who presented with anemia and recurrent episodes of gastrointestinal bleeding at our institution after undergoing treatment for metastatic biliary adenocarcinoma. With the advent of new therapies, we aimed to investigate the various techniques utilized to manage these patients and highlight the importance of maintaining a high index of suspicion for RIHG as a potential etiology of gastrointestinal bleeding in patients with a relevant medical history of radiation exposure. Despite the literature review, we found that there is a lack of guidelines in the approach to the management of these patients. Conclusion: This case report underscores the rarity of radiation-induced gastritis and the complications that may arise from its diagnosis, including recurrent GI bleeding. Further investigation into identifying definitive treatment and creating guidelines for its management is desperately needed. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Continuous medical education (CME) is an essential component of postgraduate education to improve trainees' competencies level to be at par with the current clinical practice thereby improving overall quality of patient healthcare delivery. As a postgraduate trainee in addition to being a part of hospital workforce, providing a compact CME session is essential albeit the learning challenges. Therefore, a framework for the trauma CME program was developed to integrate trainee-led immersive active learning (AL) activities based on our emergency medicine postgraduate training curriculum. It comprised of three components which were mini-conferences on trauma management principles updates; hands-on skill stations session utilizing pre-prepared learning packages, simulated scenarios, manikins and phantoms; and immersive trauma simulation on prehospital response, radio communication and patient resuscitation combined with formative assessments and debriefing session. Google Form platform was used to gather the trainees' self-appraisals of the learning experience. Feedbacks from the trainees revealed that the sessions were engaging and appropriate to their level of training. In conclusion, by incorporating AL activities into immersive trauma CME, it promotes trainees' engagement towards teaching and learning activities thus consolidating their knowledge and skills on handling trauma patients. [ABSTRACT FROM AUTHOR]

Background: Amidst a rising tide of trauma-related emergencies, emergency departments worldwide grapple with the challenges of overcrowding and prolonged patient wait times. Addressing these challenges, the integration of prehospital intensive care units has appeared as a promising solution, streamlining trauma care and enhancing patient safety. Nevertheless, the feasibility of such an initiative becomes murky when considered globally. This review delves into the intricacies of prehospital intensive care units' deployment for trauma care, scrutinizing their configurations, operational practices, and the inherent challenges and research priorities. Methods: A scoping review was performed for eligible studies. The result was uploaded to the RAYYAN research platform, facilitating simultaneous evaluation of the studies by all researchers. Results: A total of 42 studies were initially selected. Four studies were duplicates, and 25 studies were unanimously removed as irrelevant. The remaining studies (n = 13) were included in the review, and the outcomes were categorized into diverse subgroups. Conclusions: A country's emergency medical services must achieve specific milestones in education, competency, resource availability, and performance to effectively harness the potential of a prehospital intensive care unit. While certain nations are equipped, others lag, highlighting a global disparity in readiness for such advanced care modalities. [ABSTRACT FROM AUTHOR]

Introduction: Over the last few decades, road accidents have become one of the biggest problems worldwide. Despite improved road infrastructure and potential measures to address the problem, developing countries are experiencing an alarming increase in morbidity and mortality from accidents for pedestrians, drivers, and passengers. Most of the cars involved in accidents involved pedestrians and passengers. Pillion riders are the most common. To find ways to prevent these traffic accidents, this study aims to identify many types and patterns in pedestrian, driver, and passenger accidents. Aim: To understand the pattern of Injuries in Road Traffic Accidents and to prevent associated morbidity and mortality. Method: 1085 instances in all were utilized for the investigation, and information was gathered from the Dr. Ram Manohar Lohia Institute of Medical Sciences Emergency Department, records, and police records for the six months from October 2022 to March 2023. Result: Male Pillion Riders of the group of 15-35 years without wearing Safety precautions and having been drunk were most common among the affected. Conclusion: Education, adherence to traffic regulations, road improvement, and instruction on safety precautions like wearing helmets or seat belts while traveling can minimize the risk associated with RTA. [ABSTRACT FROM AUTHOR]

COVID-19 has had significant secondary effects on health care systems, including effects on emergency medical services (EMS) responses for time-sensitive emergencies. We evaluated the correlation between COVID-19 hospitalizations and EMS responses for time-sensitive emergencies in a large EMS system. This was a retrospective study using data from the Los Angeles County EMS Agency. We abstracted data on EMS encounters for stroke, ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA), and trauma from April 5, 2020 to March 6, 2021 and for the same time period in the preceding year. We also abstracted daily hospital admissions and censuses (total and intensive care unit [ICU]) for COVID-19 patients. We designated November 29, 2020 to February 27, 2021 as the period of surge. We calculated Spearman's correlations between the weekly averages of daily hospital admissions and census and EMS responses overall and for stroke, STEMI, OHCA, and trauma. During the study period, there were 70,616 patients admitted for confirmed COVID-19, including 12,467 (17.7%) patients admitted to the ICU. EMS responded to 899,794 calls, including 9,944 (1.1%) responses for stroke, 3,325 (0.4%) for STEMI, 11,207 (1.2%) for OHCA, and 114,846 (12.8%) for trauma. There was a significant correlation between total hospital COVID-19 positive patient admissions and EMS responses for all time-sensitive emergencies, including a positive correlation with stroke (0.41), STEMI (0.37), OHCA (0.78), and overall EMS responses (0.37); and a negative correlation with EMS responses for trauma (-0.48). ICU COVID-19 positive patient admissions also correlated with increases in EMS responses for stroke (0.39), STEMI (0.39), and OHCA (0.81); and decreased for trauma (-0.53). Similar though slightly weaker correlations were found when evaluating inpatient census. During the period of surge, the correlation with overall EMS responses increased substantially (0.88) and was very strong with OHCA (0.95). We found significant correlation between COVID-19 hospitalizations and the frequency of EMS responses for time-sensitive emergencies in this regional EMS system. EMS systems should consider the potential effects of this and future pandemics on EMS responses and prepare to meet non-pandemic resource needs during periods of surge, particularly for time-sensitive conditions. [ABSTRACT FROM AUTHOR]

Objective: To investigate patients presenting to EDs following the recent introduction of a shared electric scooter (e‐scooter) scheme in Northern Territory (NT). Methods: We conducted a prospective observational cohort study in Darwin, a regional city in NT, Australia with a population of approximately 150 000. Any patient who disclosed involvement of an e‐scooter in the reason for their presentation to the ED was included. A descriptive analysis was derived for age, sex, triage time, alcohol level, injury type and the requirement of operating theatre, inpatient stay or ED discharge. Categorical variables were analysed using χ2‐tests, with odds ratios (ORs), 95% confidence intervals (CIs) and P‐values reported. Costing analysis to ED of attendances and inpatient hospital admissions was undertaken. Results: There were 111 presentations over the 8‐month study period (January–September 2021). Forty‐nine percent (n = 51) of patients were male and 51% (n = 54) were female. Extremity (n = 70) and craniofacial (n = 61) injuries were most common and approximately a quarter of patients (n = 24) required operative management for injuries sustained. Approximately half (n = 51) of patients were intoxicated and the average alcohol level of those tested was 0.18% (range 0.05–0.49%). The average cost per ED attendance was AU$777 and total cost of inpatient admissions being AU$352 255. All inpatient admissions were a result of injury while intoxicated. Conclusion: Harm minimisations strategies targeting implementation of alcohol testing and penalties for riders may be able to reduce the effect that the introduction of e‐scooters on the strained health system in the NT. [ABSTRACT FROM AUTHOR]

About one in seven accidents involving children occurs at school. Roughly 70% of these accidents involve children under the age of 12 years. Thus, primary school teachers may be confronted with accidents where first aid could improve the outcome. Despite the importance of first-aid knowledge among teachers, little is known about this topic. To fill this gap, we conducted case-based survey research on the objective and subjective first-aid knowledge of primary school and kindergarten teachers in Flanders, Belgium. An online survey was distributed to primary school and kindergarten teachers. It included 14 hypothetical first-aid scenarios in a primary school context to assess objective knowledge, along with one item to assess subjective knowledge. A total of 361 primary school and kindergarten teachers completed the questionnaire. The participants achieved an average knowledge score of 66%. Those who had completed a first-aid course had significantly higher scores. Knowledge regarding child CPR was amongst the lowest, with only 40% correct answers. Structural equation modeling showed that only previous first-aid training, recent experience with first aid, and subjective first-aid knowledge were linked to teachers' objective first-aid knowledge—particularly for basic first aid. This study shows that completing a first-aid course and completing a refresher course can predict objective first-aid knowledge. We therefore recommend that first-aid training and regular refresher courses should be mandatory in teacher training, given that a large share of teachers may need to apply first aid to a pupil at some point during their career. [ABSTRACT FROM AUTHOR]

Background: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods: Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. Results: A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion: Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions. [ABSTRACT FROM AUTHOR]

Introduction: Ocular injury is the commonest ocular emergency and can vary across geographical and socioeconomic regions. This study was conducted to determine the pattern of ocular injuries presenting to our tertiary care hospital located in Puducherry, Southern India. Methods: A retrospective hospital-based study was performed and analyzed the records of the patients who presented with ocular injuries to the emergency department between January 2016 and December 2017. Data were collected using a structured format and noted the demographic profile and clinical profile of ocular injury. Results: Of the 392 ocular emergencies, 318 (81.1%) were caused by ocular trauma. Mechanical trauma was most common (306; 96.2%). Males were more frequently affected (ratio; 3.7:1). Most cases of trauma belonged to the 21–30 years age group (86, 28.1%) and were caused by road traffic accidents (RTAs) (197; 64.4%). Adnexal injuries were commonest (285; 93.1%). The ocular injury was close globe type in 93 (30.4%) and the open globe in three (1.0%). Serious lid injury was present in 71 cases (23.2%). Serious injuries such as globe rupture and traumatic optic neuropathy were present in three (1.0%) and eleven (3.6%) cases, respectively. Conclusion: Ocular trauma is the most common cause of ocular emergencies and RTA is the commonest cause of ocular trauma. We need to explore strategies to minimize ocular trauma as a priority. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Paediatric button battery injuries present a challenge in the general practice setting. Although some children present with history or parental suspicion of button battery ingestion (BBI) or insertion, unwitnessed cases may present with non-specific symptoms that can mimic many respiratory and gastrointestinal pathologies. Objective The aim of this article is to increase awareness of the fast onset of lifethreatening tissue injury from BBI and the importance of timely referral as well as provide an update on current management, including first aid management in the general practice setting. Discussion BBI is a medical emergency. The button battery requires urgent removal as it can cause caustic burn injury to its surrounding tissues in as little as 15 minutes. Limited awareness of the time-critical nature of this presentation has been reported in multiple triage settings. Studies have shown a role for consumption of honey or sucralfate in delaying tissue injury while awaiting surgical removal. [ABSTRACT FROM AUTHOR]

This article will review in detail the mechanisms and anatomy of injuries that lead to life-threatening emergencies from pelvic trauma, examining the facets of care for such cases from the point of injury through to the latest developments in hybrid operating strategies. Damage control resuscitation principles, the trauma mindset and the specialist vantage point for major trauma management will be covered to critically appraise the current concepts and explore where future improvements may be on the horizon. [ABSTRACT FROM AUTHOR]

Objective This study aimed to identify the types and frequency of acute medical events at a university with a collegiate-based emergency medical services (CBEMS) agency. Participants: Patients who requested assistance from the studied CBEMS agency, which provides emergency medical services coverage at a medium-sized urban university. Methods: This retrospective chart review examined requests for emergency service from August 2010-July 2017. Data abstracted include the type of medical event, frequency, call times/dates, and locations of reported medical events. Results: The studied agency received an average 889.4 (SD +/−68.6 calls) per year with the most common falling under the categories of "Substance Abuse" (231.7 calls/year, SD +/−15.7) and "Minor Trauma" (207.1 calls/year, SD+/−37.8). Most requests for acute medical attention occurred between the hours of 1800–0600 on Fridays and Saturdays. Implications/Conclusions: These results suggest that universities can potentially predict patterns and prepare for the types of acute medical issues that occur on campus. [ABSTRACT FROM AUTHOR]

Introduction: Road traffic injuries (RTIs) are increasing and have disproportionate impact on residents of low- and middle-income countries (LMICs) where 90% of deaths occur. RTIs are a leading cause of death for those aged 15 - 29 years with costs estimated to be up to 3% of GDP. Despite this fact, little primary research has been done on the household economic impact of these events.Methods: From July to October 2016, 860 consecutive emergency department patients were enrolled and followed up at 6-8 weeks to assess the household financial impacts of these emergency presentations. At follow-up, patients were queried regarding health status, lost wages or schooling, household costs incurred due to their injury or illness, and assets sold.Results: 860 patients were enrolled and 675 patients (78%) completed follow-up surveys. Of those, 660 had a confirmed reason for visit - 303 (45%) road traffic injuries, 357 (53%) other emergency presentations (non-RTI) - encompassing medical presentations and other types of injury, and reason for visit was missing for 15 patients (2%). More than 90% of RTI patients were working or in school prior to their injury. In the economically productive ages (15-44 years) RTI predominated (70%) vs non-RTI (39%). RTI patients were more likely to report residual disability (78.2% RTI vs 68.1% non-RTI, p=0.004). All emergency patients reported difficulty paying for basic needs (food, housing and medical expenses). More than ⅓ of emergency patients reported having to sell assets in order to meet basic needs after their illness or injury. Despite similar hospital costs and fewer lost days of work for both patients and caregivers, the mean financial impact on households of RTI patients was 37% more than for non-RTI patients. These costs equalled between 6-16 weeks of income for patients based on their occupation type and median reported pre-hospitalization income.Discussion: Ugandan emergency care patients suffered significant personal and household economic hardship. In addition to the need for policy and infrastructural changes to improve road safety, these findings highlight the need for basic emergency care systems to secure economic gains in vulnerable households and prevent medical impoverishment of marginal communities. [ABSTRACT FROM AUTHOR]

Introduction: From 2015 to 2019, the United States experienced a 17% increase in weather-related disasters. Objectives: We aimed to study the patterns of natural disaster-related traumatic injuries and fatalities across the United States from 2014 to 2019 and to provide recommendations that can serve to mitigate the impact these natural disasters have on trauma patient morbidity and mortality. Methods: A retrospective analysis of the National Safety Council (2014–2019) of natural disaster-related injuries and fatalities was conducted. Descriptive statistics and independent-samples t tests were performed, with significance defined as p <.05. Results: Floods produced significantly more mean fatalities per year than tornadoes (118 vs. 33; 95% CI [32.0, 139.0]), wildfires (118 vs. 43, 95% CI [24.8, 155.6]), hurricanes (118 vs. 13, 95% CI [51.5, 159.2]), and tropical storms (118 vs. 15, 95% CI [48.8, 158.2]). Tornadoes produced significantly more mean injuries per year than floods (528 vs. 43, 95% CI [255.9, 715.8]), wildfires (528 vs. 69, 95% CI [227.1, 691.2]), hurricanes (528 vs. 26, 95% CI [270.1, 734.2]), and tropical storms (528 vs. 4, 95% CI [295.9, 753.5]). Southern states experienced greater disaster-related morbidity and mortality over the 6-year study period than other regions with 2,752 injuries and 771 fatalities. Conclusions: The incidence of traumatic injuries and fatalities related to certain natural disasters in the United States has significantly increased from 2014 to 2019. Hospital leaders, public health, emergency preparedness personnel, and policy makers must collaborate to implement protocols and guidelines that ensure adequate training, supplies, and personnel to maintain trauma surge capacity, improve emergency preparedness response, and reduce associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

First aid is the temporary and immediate care given to the person who is injured or suddenly become ill. First aid can save a victim’s life especially if the victim is bleeding heavily and has stopped breathing it also prevents additional medical emergencies that can arise from an injury or illness. Anganwadi worker have an important role to play in child protection. Their role can only be properly carried out, if teachers are equipped with the relevant skills. Appropriate in servicers training in children protection for teacher is of key importance is both emphasizing child protecting issues and in promoting these skills in teachers. Method: Pre-experimental one group pre-test and post –test research design is used .Nonprobability convenience sampling is used . Sample size are 100 Anganwadi Workers. Tools are Structured questionnaire for assessing the knowledge. Results: 8% of the Anganwadi workers in pretest had average level of knowledge score, 51% in pre test had good, 38% in pre test and 13% in post test had very good and 3% in pre test and 87% in post test had excellent level of knowledge score. the planned teaching programme on overall knowledge regarding first aid measures for selected minor injury among Anganwadi workers in Anganwadi centre was effective Conclusion: Planned teaching significantly brought out their improvement in the knowledge regarding first aid measure for selected minor injuries among Anganwadi workers. Analysis of the data shows that there was significant difference between pre test and post test knowledge. [ABSTRACT FROM AUTHOR]

Acute subtalar joint dislocations are simultaneous dislocations of talocalcaneal and talonavicular joints with a rare incidence in traumatology. These fractures usually occur as a result of high-energy traumas and are accompanied in high numbers by soft tissue injuries and ankle fractures. However, isolated medial sub-dislocations are very rare considering the fracture- dislocations. In this case report, we present a 32-year-old male patient who applied to the emergency service after falling from a height. Physical and radiographic examinations revealed an isolated medial subtalar dislocation in the left ankle. The patient underwent closed reduction under sedation in the emergency service and was discharged after 24 hours of follow-up. Three weeks later, rehabilitation was started. After 3 weeks of rehabilitation, the patient was started with partial weight bearing and switched to full weight bearing after eight weeks. At the end of 18 months, the patient did not present with any symptoms. Subtalar dislocations are emergency cases of traumatology. Medial dislocations are more frequently seen due to the instability caused by the inversion of the foot. Reduction should be provided as soon as possible. In the treatment of isolated medial subdural dislocations, immediate reduction offers excellent long-term functional outcomes particularly in cases that are not accompanied by additional bone and soft tissue pathologies. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to evaluate the differences in mortality between young and elderly polytrauma patients. Materials and Methods In the present study, all consecutive polytrauma patients treated at our hospital between January 2014 and December 2018 were reviewed retrospectively. Patients younger than 65 years old were classified as Group I (n = 60), and patients aged 65 years and older were classified as Group II (n = 60). Age, gender, mechanism of injury, time of injury, injury severity score (ISS), preclinical hemodynamics, hospitalization, operative treatment, intubation rate, intensive care unit (ICU) treatment, and 1-year mortality were analyzed. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI) were calculated. Results The mean age was 36.6 ± 13.0 (18-64) years in Group I and 73.5 ± 7.4 (56-91) years in Group II. There was no difference in mortality rates between groups. Elderly polytrauma patients tend to be female, and lower ISS and higher blood pressure, as well as low-energy injury types, typically in the summer. A statistically significant positive correlation was found between mortality and ISS scores in both Group I and Group II. There was no statistically significant difference was found between elderly and younger polytrauma patients in terms of NLR, MLR, and SIRI scores. Conclusion There are several differences between elderly polytrauma patients and their younger counterparts. It was found that mortality in the elderly patient group was affected by many system injuries. However, the current study presents no differences in mortality rates between young and elderly polytrauma patients. [ABSTRACT FROM AUTHOR]

Introduction: Bull-related injuries are commonly observed in rural areas of India as result of the animal’s use in sporting events as well as for agricultural purposes. These patients need early resuscitation due to complications from severe injuries. Previous work examining the epidemiology of bull-related injuries is limited, with most studies focusing on injuries in Spain and Latin America. There is scant literature examining the prevalence of such injuries in India. The objective of this study was to evaluate the demographic and clinical characteristics of bull-related injuries at a hospital in Tamil Nadu, India. Methods: This was a prospective, observational study of patients who presented to an emergency department (ED) in Madurai, India, with a reported history of bull-related injuries between June 2017 and March 2019. W e recorded information about patient demographics, location of injury, disposition, initial Injury Severity Score (ISS), and transport time. Results: Our sample included a total of 42 patients. Almost a third of patients who presented were between the ages of 20-30 years (31%, n = 13), and most were male (86%, n = 36). Approximately 59% of patients (n = 25) had provoked injuries, occurring as a result of active participation during sporting activities. Injuries to the trunk were most common (55%, n = 23), followed by injuries to the perineum (19%, n = 19). The majority of patients (59.5%) had penetrating injuries (n = 25), The mean ISS was 10.1 (standard deviation 6.3). Five (12%) patients had a complication after injury including intra-abdominal abscess formation, peritonitis, and sepsis. Two patients died as a result of septicemia from peritonitis. Conclusion: Bull-related injuries may result in significant morbidity and mortality. Education of the population about the dangers of bull injuries from sporting events and the need for early transportation to the ED have the potential for significant reduction in morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Trauma exposure is associated with adverse health-related correlates, including physical comorbidities, and is highly prevalent among public safety personnel (PSP). The current study (1) examined the association between context of index trauma exposure (part of job vs. other) and physical conditions and (2) established the prevalence of physical conditions according to PSP category (e.g., police, paramedic) and index trauma type (e.g., serious accident, physical assault) in a large Canadian sample of PSP.Methods: PSP completed an online survey between September 2016 and January 2017. Multivariable logistic regressions examined associations between context of index trauma exposure (i.e., part of job vs. other) and physical condition categories. Cross-tabulations with chi-square analyses examined whether the prevalence of physical conditions significantly differed according to PSP category and index trauma type.Results: There were 5,267 PSP included in the current study. Results from the most stringent model of logistic regressions demonstrated that, compared to PSP who experienced their index trauma in any other context, PSP who experienced it as part of their job had reduced odds of "other" physical conditions (adjusted odds ratio = 0.73, 95% confidence interval, 0.57 to 0.94, P < 0.05). Results also revealed significant differences in the prevalence of physical conditions across all PSP categories and select index trauma types.Conclusion: Results highlight the relevance of trauma exposure outside of an occupational context among PSP and may have implications for the positive impact of stress inoculation and resiliency training programs for PSP. [ABSTRACT FROM AUTHOR]

The accuracy of emergency management alerts about dangerous threats to public safety is key for the protection of life and property. When alerts of imminent threats are believed to be real, uncontrollable, and impossible to escape, people who receive them often experience fear and anxiety, especially as they await the threat's arrival (i.e., incubation of threat). However, what are the consequences when an alert turns out to be a false alarm? We explored psychological reactions (i.e., anxiety) to the 2018 Hawaii false ballistic missile alert using Twitter data from users across the state (1.2 million tweets, 14,830 users) 6 weeks before and 18 days after the event. We demonstrated that anxiety expressed on Twitter increased 4.6% on the day of the false alert and anxiety during the 38-min alert period increased 3.4% every 15 min. In addition, users who expressed either low, medium, or high prealert anxiety exhibited differential anxiety responses postalert, differential stabilization intervals (when anxiety stopped decreasing after the all-clear), and different postalert baselines relative to their prealert levels. Low prealert anxiety users expressed more anxiety at the onset of the alert and for longer relative to other groups. Moreover, anxiety remained elevated for at least 7 days postalert. Taken together, findings suggest that false alarms of inescapable and dangerous threats are anxiety-provoking and that this anxiety can persist for many people after the threat is dispelled. We offer several recommendations for how emergency management agencies should best communicate with the public after false alerts are transmitted. [ABSTRACT FROM AUTHOR]

Cloud-to-ground lightning is a common and dangerous natural atmospheric hazard in southern Canada. Previous research conducted by the author and colleagues, using data from 1994 to 2003, estimated that lightning directly or indirectly kills 9–10 people and injures 92–164 more each year in Canada. Repeating the analysis using data from the same government agency and media sources for the 2002–2017 period, the author found that lightning-related mortality decreased to 2–3 deaths per year, roughly 0.08 deaths per million population. An average of 180 lightning-related injuries each year (5.3 per million population) was estimated for the same period, slightly greater than the maximum documented in the 1994–2003 analysis. About half of the drop in mortality between periods may be attributed to the reduction in reported deaths associated with lightning-ignited municipal fires since 2000. The remainder may be due to a combination of greater availability and use of communication technology, faster emergency response and medical treatment, and increased public awareness of lightning hazards and safety. Further research is required to explain why lightning-related injury rates have remained stable; better understand the interaction of technological, behavioral and other factors; and to determine the efficacy of past and potential future safety interventions. [ABSTRACT FROM AUTHOR]

Objective: amidst the greatest health crisis in history triggered by COVID-19, this documental study was intended to understand the meanings individuals who have lost loved ones in this context assign to the phenomenon of suppressed funeral rituals. Method: based on the theory of grief, the corpus of this study was composed of documents published in digital media containing personal writings and reports of experiences freely and easily available to the public. Two researchers with expertise in the field used inductive thematic analysis to interpret data. Results: the experiences shared in the reports reflect the suffering experienced by the sudden death of a significant person, which is amplified by the absence or impediment to performing familial farewell rituals. The suppression or abbreviation of funeral rituals is a traumatic experience because family members are prevented from fulfilling their last homage to the loved one who has suddenly passed away, causing feelings of disbelief and indignation. Conclusion: alternatives and new ways to celebrate passage rituals in emergencies of strong social commotion such as a pandemic are needed to provide support and comfort to family members, friends, and relatives. These rituals help survivors to overcome the critical moment, decreasing the risk of developing complicated grief. [ABSTRACT FROM AUTHOR]

The perception that children and adolescents have of injury and illness may be influenced by their depiction in sport-related films. The objective of this study was to determine the depiction of injury and illness in a select number of running-related films. A sample of 31 running-related films were analyzed, with a total of 77 injuries/illnesses depicted. The most common injuries/illnesses depicted were categorized as exertional heat exhaustion/stroke (26%), lower leg muscle cramps/not heat related (12%), ankle sprain (9%), knee ligamentous/meniscus injury (6%), exercise-associated collapse/not heat related (6%), and blister of the toe/foot (6%). Overall, 48/67 (64%) of the injuries/illnesses were considered severe emergencies (injury/illness requiring prompt intervention and immediate discontinuation of sport participation). The disposition of 46% of severe emergencies was the immediate continuation of training/competition. Pediatric health care providers, coaching staff, and parents should stress the importance of injury/illness recognition/disclosure and realistic expectations for rehabilitation to pediatric runners. [ABSTRACT FROM AUTHOR]

Multiple fatality incidents involving more than one child of statistically same age (including twins) can be challenging from an identification standpoint. This case details an urban fire, in which four children perished. Age assessment on three of the victims utilizing maturity staging described by Moorrees, Fanning, and Hunt yielded insignificant results. However, a plot of the MFH data shows the difference between two identical twins and a third child. The twins share a similar growth pattern, whereas the other was different. Based on this graphical interpretation, the nontwin victim was positively identified through exclusion. These results were verified through statistical testing. This case demonstrates a method to repurpose age assessment data to graphically distinguish between child victims. Further, it is shown that radiographic and clinical presentation in childhood identical twins can elicit genetic versus acquired similarities and differences, which can be used for identification of individuals and exclusion of others. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate the efficacy and safety of sofosbuvir (SOF) plus daclatasvir (DCV) or simeprevir (SMV) in a randomized, open-label, noninferiority trial of patients infected with hepatitis C virus genotype 1, who were previously unresponsive to pegylated interferon and ribavirin or were treatment naive. Methods Patients were randomly assigned to receive SOF (400 mg once daily) plus DCV (60 mg once daily) or SMV (150 mg once daily) for 12 weeks. The analysis included all participants who received at least one dose of the study drugs. The primary endpoint was sustained virologic response 12 weeks after ending treatment (SVR12; hepatitis C virus RNA measured using COBAS TaqMan RT-PCR (lower limit of detection and quantification of 12 UI/mL)). This study was registered at ClinicalTrials.gov (NCT02624063). Results A total of 125 of 127 enrolled and randomized patients started treatment (n = 65 SOF + DCV; n = 60 SOF + SMV). SVR12 was attained in 121 patients (96.8%): 65 (100%) receiving SOF + DCV (95% confidence interval (CI), 94.5 to 100) and 56 (93.3%) receiving SOF + SMV (95% CI, 83.8 to 98.2; absolute difference, 6.6%; 95% CI, −15.0 to 0). The most common adverse events were fatigue (n = 32, 25.6%), headache (n = 27, 21.6%), and mood swings (n = 24, 19.2%). No patients discontinued therapy. Conclusions The overall SVR rate was 96.9%; SOF + DCV (100%) was higher than that of SOF + SMV (93.3%). Despite no statistically significant intergroup difference in SVR12 rates, the noninferiority of SOF + SMV to SOF + DCV could not be established because the difference in efficacy was clinically relevant. [ABSTRACT FROM AUTHOR]

Background: Obtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients.Methods: We conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed (1961-August 2018) that had experimental or observational study design and involved adult trauma patients. Studies involving informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach.Results: A total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information.Conclusions: Many articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients. [ABSTRACT FROM AUTHOR]

Objective: The Vision Zero initiative pursues the goal of eliminating all traffic fatalities and severe injuries. Today's advanced driver assistance systems (ADAS) are an important part of the strategy toward Vision Zero. In Germany in 2018 more than 26,000 people were killed or severely injured by traffic accidents on motorways and rural roads due to road accidents. Focusing on collision avoidance, a simulative evaluation can be the key to estimating the performance of state-of-the-art ADAS and identifying resulting potentials for system improvements and future systems. This project deals with the effectiveness assessment of a combination of ADAS for longitudinal and lateral intervention based on German accident data. Considered systems are adaptive cruise control (ACC), autonomous emergency braking (AEB), and lane keeping support (LKS). Methods: As an approach for benefit estimation of ADAS, the method of prospective effectiveness assessment is applied. Using the software rateEFFECT, a closed-loop simulation is performed on accident scenario data from the German In-Depth Accident Study (GIDAS) precrash matrix (PCM). To enable projection of results, the simulative assessment is amended with detailed single case studies of all treated cases without PCM data. Results: Three categories among today's accidents on German rural roads and motorways are reported in this study: Green, grey, and white spots. Green spots identify accidents that can be avoided by state-of-the-art ADAS ACC, AEB, and LKS. Grey spots contain scenarios that require minor system modifications, such as reducing the activation speed or increasing the steering torque. Scenarios in the white category cannot be addressed by state-of-the-art ADAS. Thus, which situations demand future systems are shown. The proportions of green, grey, and white spots are determined related to the considered data set and projected to the entire GIDAS. Conclusions: This article describes a systematic approach for assessing the effectiveness of ADAS using GIDAS PCM data to be able to project results to Germany. The closed-loop simulation run in rateEFFECT covers ACC, AEB, and LKS as well as relevant sensors for environment recognition and actuators for longitudinal and lateral vehicle control. Identification of green spots evaluates safety benefits of state-of-the-art level 0-2 functions as a baseline for further system improvements to address grey spots. Knowing which accidents could be avoided by standard ADAS helps focus the evolution of future driving functions on white spots and thus aim for Vision Zero. [ABSTRACT FROM AUTHOR]

Objective: The objective of this research study is to estimate the benefit to pedestrians if all U.S. cars, light trucks, and vans were equipped with an automated braking system that had pedestrian detection capabilities. Methods: A theoretical automatic emergency braking (AEB) model was applied to real-world vehicle-pedestrian collisions from the Pedestrian Crash Data Study (PCDS). A series of potential AEB systems were modeled across the spectrum of expected system designs. Both road surface conditions and pedestrian visibility were accounted for in the model. The impact speeds of a vehicle without AEB were compared to the estimated impact speeds of vehicles with a modeled pedestrian detecting AEB system. These impacts speeds were used in conjunction with an injury and fatality model to determine risk of Maximum Abbreviated Injury Scale of 3 or higher (MAIS 3+) injury and fatality. Results: AEB systems with pedestrian detection capability, across the spectrum of expected design parameters, reduced fatality risk when compared to human drivers. The most beneficial system (time-to-collision [TTC] = 1.5 s, latency = 0 s) decreased fatality risk in the target population between 84 and 87% and injury risk (MAIS score 3+) between 83 and 87%. Conclusions: Though not all crashes could be avoided, AEB significantly mitigated risk to pedestrians. The longer the TTC of braking and the shorter the latency value, the higher benefits showed by the AEB system. All AEB models used in this study were estimated to reduce fatalities and injuries and were more effective when combined with driver braking. [ABSTRACT FROM AUTHOR]

Objective: Left turn across path with traffic from the opposite direction (LTAP/OD) is the second most frequent car-to-car intersection crash type after straight crossing path (SCP) in Germany and the United States. Intersection automated emergency braking (AEB) for passenger cars can address these crashes. This study investigates 2 implementation strategies of intersection AEB addressing LTAP/OD crashes: (1) only the turning car is equipped with an intersection AEB and (2) turning and straight-heading cars are equipped with an intersection AEB. For each strategy, the influence of a safety zone around the vehicles that should not be entered is evaluated in terms of accident avoidance, injury mitigation, and change in velocity (delta-V) of remaining accidents. Results are given as a function of market penetration. Methods: A total of 372 LTAP/OD crashes from the time series precrash matrix (PCM), a subsample of the German In-Depth Accident Study (GIDAS), were resimulated in the PRediction of Accident Evolution by Diversification of Influence factors in COmputer simulation (PRAEDICO) simulation framework. A Kudlich-Slibar rigid-body impact model and an injury risk curve derived from GIDAS were used to predict remaining moderate to fatal (Maximum Abbreviated Injury Scale [MAIS] 2 + F) injuries among car occupants. Results: With a safety zone of 0.2 m, when the turning vehicle only was equipped with an intersection AEB, 59% of the crashes were avoided at a 100% market penetration. With both vehicles equipped the percentage increased to 77%. MAIS 2 + F injured occupants were reduced by 60 and 76%, respectively. Considering both the turning and the straight-heading vehicles, the delta-V decreased strongly with market penetration in remaining left-side impacts but only slightly in remaining frontal and right-side impacts. Eliminating the safety zone substantially decreases effectiveness in all conditions. Conclusions: Implementation strategy and safety zone definition strongly influence the real-life performance of intersection AEB. AEB should be applied not only for the turning vehicle but also for the straight-going vehicle to benefit from the full potential. Situationally appropriate safety zone definitions, in line with human hazard perception, need more attention and are a key to balance true positive and false positive performance. Remaining delta-V does not decrease broadly; hence, there is no evidence that future LTAP/OD crashes will be generally of lower severity. This highlights the need for continuous development of in-crash protection. [ABSTRACT FROM AUTHOR]

Background: Functional outcome measures are important as most patients survive trauma. The aim of this study was to describe the long‐term impact of trauma within a healthcare region from a social perspective. Methods: People active in work or education and admitted to hospitals in Central Norway in the interval 1 June 2007 to 31 May 2010 after sustaining trauma were included in the study. Clinical data were linked to Norwegian national registers of cause of death, sickness and disability benefits, employment and education. Primary outcome measures were receipt of medical benefits and time to return to preinjury work level. Secondary outcome measures were mortality within 30 days or during follow‐up. Results: Some 1191 patients were included in the study, of whom 193 (16·2 per cent) were severely injured (Injury Severity Score greater than 15). Five years after injury, the prevalence of medical benefits was 15·6 per cent among workers with minor injuries, 22·3 per cent in those with moderate injuries and 40·5 per cent among workers with severe injuries. The median time after injury until return to work was 1, 4 and 11 months for patients with minor, moderate and severe injuries respectively. Twelve patients died within 30 days and an additional 17 (1·4 per cent) during follow‐up. Conclusion: Patients experiencing minor or major trauma received high levels of medical benefits; however, most recovered within the first year and resumed preinjury work activity. Patients with severe trauma were more likely to receive medical benefits and have a delayed return to work. Registration number: NCT02602405 (http://www.clinicaltrials.gov). Significant impact irrespective of severity [ABSTRACT FROM AUTHOR]

Proximal femoral fractures are a very common disease which affect elderly patients after low energy trauma, but can also affect the young population as a consequence of high energy trauma. Classification of sub trochanteric fractures has not yet been clearly defined representing a major issue in comparing different treatment techniques among the scientific literature.These fractures are well known by orthopaedic surgeons for intraoperative difficulties in reduction and post-operative high rate of non-unions and malunions.We present two clinical cases, one treated with an intramedullary device and one with an extramedullary device, both failed and revised with open surgery using a condylar angled bladeplate, following AO principles of anatomical reduction and stable fixation. [ABSTRACT FROM AUTHOR]

Background: While individual-level drinking pattern is an important risk factor for alcohol-related injury, societal-level pattern and alcohol policy are also important, and no research exists on the relationship of these variables with specific causes of injury.Methods: A probability sample of 14,142 emergency department (ED) patients from 32 ED studies in 28 countries included in the International Collaborative Alcohol and Injury Study (ICAIS) is analyzed using multilevel modeling of individual-level volume and pattern of drinking, country-level detrimental drinking pattern (DDP), and alcohol policy using the International Alcohol Policy and Injury Index (IAPII) on self-reported drinking prior to the injury event, categorized as traffic, violence, fall or other cause. The IAPII includes four domains: availability, vehicular, advertising, and drinking context.Results: Frequent heavy drinking was a strong predictor (p < .0.001) of injuries related to violence (OR = 2.57), falls (OR = 2.86), and other causes (OR = 1.71), while episodic heavy drinking was a significant predictor of injuries related to violence and falls. DDP was a significant predictor (p < 0.05) of traffic (OR = 1.54) and violence-related injuries (OR = 1.38) but lost significance when the IAPII was included. The IAPII was a significant predictor only for traffic injury (OR = 0.97, p < 0.001), and each domain with the exception of context were also significant.Conclusions: Findings here clearly point to the importance of targeted policies for specific causes of injury as well as the importance of individual and societal drinking patterns, the latter of which may be difficult to influence by preventive measures aimed to reduce alcohol-related injury. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine complication rates and possible risk factors of expert-performed endotracheal intubation (ETI) in patients with trauma, in both the prehospital setting and the emergency department. We also investigated how the occurrence of ETI-related complications affected the survival of trauma patients. This single-center retrospective observational study included all injured patients who underwent anesthesiologist-performed ETI from 2007 to 2017. ETI-related complications were defined as hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, dental trauma, cuff leak, and mainstem bronchus intubation. Of the 537 patients included, 23.5% experienced at least one complication. Multivariable logistic regression analysis revealed that low Glasgow Coma Scale Score (adjusted odds ratio [AOR], 0.93; 95% confidence interval [CI], 0.88–0.98), elevated heart rate (AOR, 1.01; 95% CI, 1.00–1.02), and three or more ETI attempts (AOR, 15.71; 95% CI, 3.37–73.2) were independent predictors of ETI-related complications. We also found that ETI-related complications decreased the likelihood of survival of trauma patients (AOR, 0.60; 95% CI, 0.38–0.95), independently of age, male sex, Injury Severity Score, Glasgow Coma Scale Score, and off-hours presentation. Our results suggest that airway management in trauma patients carries a very high risk; this finding has implications for the practice of airway management in injured patients. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria.Results: We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization.Conclusions: This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions. [ABSTRACT FROM AUTHOR]

Background: By identifying the geographical location for the crucial relief stations, it is possible to facilitate the accessibility of the medical services to the injured individuals in crisis situations. The main objective of this research is to study the possibility of combined application of the Analytical Hierarchy Process (AHP), ArcGIS and Transcad software to identify the factors which affect the vulnerability of infrastructure in a study region, to determine the relative importance of these factors in relation to each other, to identify the high risk regions, to identify appropriate health-care centers for relief purposes and to examine the capability of these centers for providing the services required in crisis conditions. Materials and Methods: This is a case study type of research, conducted in the central region of Isfahan, a large city located in the middle of Iran. The required data and information have been collected from the results of the "Population and Housing Census" comprising maps presenting the current status of Isfahan. They were then analyzed using Arc GIS and Transcad software and an AHP model developed by using the Expert Choice Software. Results: The obtained results revealed the possibility of successful application of the methodology proposed in this study. The results of this case study, conducted on 94 out of 186 traffic zones defined in the "Comprehensive Transportation Plan of Isfahan City," indicated that 10 zones, mainly located in the residential areas, are highly vulnerable to be exposed to the post-earthquake incidents. The results also showed that out of 19 medical centers located at the service area of the study region, which also contribute to the 80% of the medical services in Isfahan, four medical centers with the best accessibility in the shortest time, can provide services to these 10 zones. Conclusion: The results obtained from this case study indicated that the vulnerability of a traffic zone and its fatality rate in crisis events cannot be specified by only considering its physical conditions and other factors, e.g., population density and building density but also the lifetime of the buildings are also highly effective. In addition, due to the inappropriate positioning and being located in the narrow and vulnerable streets, some of the medical stations, such as Hojatieh Hospital and Amir-Al-Muminin Hospital, are vulnerable to postcrisis risk and there is a possibility of loss of access to these centers. [ABSTRACT FROM AUTHOR]

Background: Triage is the key for success in management of large numbers of injured and limited resources, and without preparedness of nurses to would seem an impossible task. This study has been conducted with the aim of determining the effect of training through the method of simulation on the knowledge and performance of nursing students in carrying out the pre-hospital triage. Materials and Methods: This semi-experimental study was conducted on 70 students of nursing who were selected based on the study's inclusion criteria and through the randomized sampling method. The researcher tools included "triage test having 10 questions of four options each and practical test including examining the correct performance of triage based on START criteria by using 10 designed simulated mockup models and based on the injury received by the victim and the level of injury". The validity of the test was verified through the formal and content validity method, and the reliability of the knowledge questionnaire based on the Cronbach-Alpha Coefficient was obtained to be equal to 0.87. After examining the level of knowledge on triage before training, the triage training workshop was held in two sessions of two hours each and through the simulation method, and again the scientific test and practical test were performed. For data analysis, the paired t-test and independent t-test were used, and the Kolmogorov Smirnov test was used to examine data normality. Data were analyzed using SPSS software-version 16. Results: The results of statistical analysis showed that the level of students' knowledge significantly increased from 4.6±1.94 before training to 7.40±1.35 after training. Their performance significantly increased from 4.90±1.6 to 8.30±1.5. Conclusion: The results of the study showed that training with the simulation method on mockup model was effective on the preparedness of nurses for triage when accidents and emergencies occur. It was also found that training improves their preparedness in this regard. It is recommended that for better preparedness of nurses in triage in case of accidents and medical emergencies, this training method should be used. [ABSTRACT FROM AUTHOR]

The article presents some multiple-answer questions on emergency preparedness in athletics. Some of the topics covered in this questionnaire are: Athletic emergency care; Sports medicine; Major components of the athletic trauma; Emergency communication and emergency personnel; Sports injuries; Airway adjuncts; High-risk sports; Balance Error Scoring System.

What's New in Emergencies, Trauma, and Shock - camel, cattle, borewell, or sewer injuries: Time for public health contextualization of injury prevention Public health on this planet seems to have evolved primarily through observation and the answers to most of our public health concerns have largely been dealt with using the principle of trial and error. While the use of helmets among camel workers is one such intervention, others such as injuries among sewer workers or injuries in open borewells, might just need a change of thought process. [Extracted from the article]

Introduction: Illegal gold mining is flourishing in French Guiana, existing outside the law due to both the high cost of gold mining permits and the challenges of law enforcement within the Amazon forest. We report the characteristics of, and the medical responses to, medical emergencies in illegal gold mining sites.Methods: We performed a retrospective study of all medical emergencies reported from illegal gold mining sites to the centralized call office of SAMU 973 from 1998 through 2000 and from 2008 through 2010. According to the national health care system, any medical emergency within the territory is handled by the prehospital emergency medical service (SAMU 973), irrespective of the patients' legal status. Data were extracted from the SAMU 973 notebook registry (1998-2000) or the SAMU 973 computerized database (2008-2010) and werre collected using a standardized questionnaire.Results: Of 71,932 calls for medical emergencies in French Guiana during the study periods, 340 (0.5%) originated from illegal gold mining sites. Of these, 196 (58%) led to medical evacuation by helicopter, whereas the overall rate of evacuation by helicopter after placing a call to SAMU 973 was only 4% (3020/71,932; P<0.0001 for comparison with illegal gold mining sites). Medical emergencies were classified as illness (48%, mostly infectious), trauma (44%, mostly weapon wounds), and miscellaneous (8%).Conclusions: Medical emergencies at illegal gold mining sites in the Amazon forest mostly include infectious diseases, followed by trauma, and often require medical evacuation by helicopter. Our study suggests that implementation of preventive medicine within gold mining sites, irrespective of their legal status, could be cost-effective and reduce morbidity. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine whether administration of valproic acid (VPA), a histone deacetylase inhibitor, inhibits proinflammatory mediators and ameliorate visceral vasopermeability both in a rat model of major burn, and also in rat cultured endothelial cells stimulated with permeability evoking mediators. SD rats were subjected to a 50% TBSA full-thickness scald injury, and treated with either saline or VPA (300 mg/kg) intraperitoneally. Pulmonary vascular endothelial growth factor (VEGF), myeloperoxidase (MPO), pulmonary microvascular permeability, water content, and acetylation of histone H3K9 of lungs were evaluated. In addition, pulmonary microvascular endothelial cells (PMECs) from male SD rats were cultured. With then, MPO, VEGF, histone acetylation, and the permeability of PMECs were investigated. Lethal scald injury resulted in a significant increase in microvascular permeability and water content of lung, accompanied by a significant elevation of the content of VEGF and activity of MPO, and a decrease of histone acetylation. VPA treatment significantly alleviated the microvascular permeability and water content of lung, lowered the levels of VEGF and MPO, and promoted acetylation of histone H3K9 following scald injury. Moreover, VPA reduced permeability of monolayer PMECs subjected to scald serum challenge, reduced the level of MPO and VEGF in supernatants, and promoted acetylation of histone H3K9 in PMECs. These results indicated that VPA can protect pulmonary microvascular endothelial barrier, alleviate proinflammatory mediators-evoked vascular hyperpermeability and tissue edema and improve the survival rate of rats subjected to lethal scald injury. [ABSTRACT FROM AUTHOR]