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preventable prehospital death

Christine A DeForest, Virginia Blackman, John E Alex, Lauren Reeves, Alejandra Mora, Crystal Perez, Joseph Maddry, Domenique Selby, Benjamin Walrath
Introduction: Military prehospital and en route care (ERC) directly impacts patient morbidity and mortality. Provider knowledge and skills are critical variables in the effectiveness of ERC. No Navy doctrine defines provider choice for patient transport or requires standardized provider training. Frequently, Search and Rescue Medical Technicians (SMTs) and Navy Nurses (ERC RNs) are tasked with this mission though physicians have also been used. Navy ERC provider training varies greatly by professional role...
March 14, 2018: Military Medicine
T D Reid, P D Strassle, J Gallaher, J Grudziak, C Mabedi, A G Charles
INTRODUCTION: Trauma is a large contributor to morbidity and mortality in developing countries. We sought to determine which anatomic injury locations and mechanisms of injury predispose to prehospital mortality in Malawi to help target preventive and therapeutic interventions. We hypothesized that head injury would result in the highest prehospital mortality. METHODS: This was a retrospective analysis of all trauma patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, from 2008 to 2015...
March 14, 2018: World Journal of Surgery
Molly P Jarman, Elliott R Haut, Frank C Curriero, Renan C Castillo
BACKGROUND: Many rural, low income, and historically underrepresented minority communities lack access to trauma center services, including surgical care and injury prevention efforts. Along with features of the built and social environment at injury incident locations, geographic barriers to trauma center services may contribute to injury disparities. This study sought to classify injury event locations based on features of the built and social environment at the injury scene, and to examine patterns in individual patient demographics, injury characteristics, and mortality by location class...
March 12, 2018: Journal of Trauma and Acute Care Surgery
David Macku, Pavel Hedvicak, John Quinn, Vladimir Bencko
Due to the hybrid warfare currently experienced by multiple NATO coalition and NATO partner nations, the tactical combat casualty care (TCCC) paradigm is greatly challenged. One of the major challenges to TCCC is the ad hoc extension phase in resource-poor environments, referred to as prolonged field care (PFC) and forward resuscitative care (FRC). The nuanced clinical skills with limited resources required by warfighters and auxiliary health care professionals to mitigate death on the battlefield and prevent morbidity and mortality in the PFC phase represent a balance that is still under review...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Erik N Vu, Wilson C Y Wan, Titus C Yeung, David W Callaway
BACKGROUND: Uncontrolled hemorrhage remains a leading cause of preventable death in tactical and combat settings. Alternate routes of delivery of tranexamic acid (TXA), an adjunct in the management of hemorrhagic shock, are being studied. A working group for the Committee for Tactical Emergency Casualty Care reviewed the available evidence on the potential role for intramuscular (IM) administration of TXA in nonhospital settings as soon as possible from the point of injury. METHODS: EMBASE and MEDLINE/PubMed databases were sequentially searched by medical librarians for evidence of TXA use in the following contexts and/or using the following keywords: prehospital, trauma, hemorrhagic shock, optimal timing, optimal dose, safe volume, incidence of venous thromboembolism (VTE), IM bioavailability...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Megan B Blackburn, Maj Michael D April, Cpt Derek J Brown, Robert A DeLorenzo, Kathy L Ryan, August N Blackburn, Maj Steven G Schauer
BACKGROUND: Airway management is of critical importance in combat trauma patients. Airway compromise is the second leading cause of potentially survivable death on the battlefield and accounts for approximately 1 in 10 preventable deaths. Reports from the Iraq and Afghanistan wars indicate 4-7% incidence of airway interventions on casualties transported to combat hospitals. The goal of this study was to describe airway management in the prehospital combat setting and document airway devices used on the battlefield...
March 8, 2018: Journal of Trauma and Acute Care Surgery
Jennifer M Gurney, Philip C Spinella
PURPOSE OF REVIEW: Hemorrhage remains the primary cause of preventable death on the battlefield and in civilian trauma. Hemorrhage control is multifactorial and starts with point-of-injury care. Surgical hemorrhage control and time from injury to surgery is paramount; however, interventions in the prehospital environment and perioperative period affect outcomes. The purpose of this review is to understand concepts and strategies for successful management of the bleeding military patient...
April 2018: Current Opinion in Anaesthesiology
Jud C Janak, Jonathan A Sosnov, Joan M Bares, Zsolt T Stockinger, Harold R Montgomery, Russ S Kotwal, Frank K Butler, Stacy A Shackelford, Jennifer M Gurney, Mary Ann Spott, Louis N Finelli, Edward L Mazuchowski, David J Smith
Importance: Military and civilian trauma experts initiated a collaborative effort to develop an integrated learning trauma system to reduce preventable morbidity and mortality. Because the Department of Defense does not currently have recommended guidelines and standard operating procedures to perform military preventable death reviews in a consistent manner, these performance improvement processes must be developed. Objectives: To compare military and civilian preventable death determination methods to understand the existing best practices for evaluating preventable death...
February 21, 2018: JAMA Surgery
Isabelle Citron, Julia Amundson, Saurabh Saluja, Aline Guilloux, Hillary Jenny, Mario Scheffer, Mark Shrime, Nivaldo Alonso
BACKGROUND: The aim of this study was to describe the national epidemiology of burns in Brazil and evaluate regional access to care by defining the contribution of out-of-hospital mortality to total burn deaths. METHODS: We reviewed admissions data for Brazil's single-payer, free-at-point-of-care, public-sector provider and national death registry data abstracted from DATASUS for 2008-2014. Admissions, in-hospital mortality, hospital reimbursement, and total deaths from the death registry were assessed for records coded under ICD-10 codes corresponding to flame, scald, contact, and electrical burns...
February 8, 2018: Surgery
Christine M Leeper, Christine McKenna, Barbara A Gaines
BACKGROUND: Hypotension is a late finding in pediatric shock despite significant blood loss; consequently, recognition of hemodynamic compromise can be delayed. We sought to describe the impact of late stage shock in children, indicated by hypotension or trauma bay blood transfusion, and quantify the association with poor outcome. METHODS: Children age<18 from the Pennsylvania Trauma Outcome Study registry (2000-2013) were included. Primary outcome was mortality...
January 31, 2018: Journal of Trauma and Acute Care Surgery
Dorothea Eisenmann, Fabian Stroben, Jan D Gerken, Aristomenis K Exadaktylos, Mareen Machner, Wolf E Hautz
Introduction: Preventable mistakes occur frequently and can lead to patient harm and death. The emergency department (ED) is notoriously prone to such errors, and evidence suggests that improving teamwork is a key aspect to reduce the rate of error in acute care settings. Only a few strategies are in place to train team skills and communication in interprofessional situations. Our goal was to conceptualize, implement, and evaluate a training module for students of three professions involved in emergency care...
January 2018: Western Journal of Emergency Medicine
Marina Gaínza-Lein, Iván Sánchez Fernández, Michele Jackson, Nicholas S Abend, Ravindra Arya, J Nicholas Brenton, Jessica L Carpenter, Kevin E Chapman, William D Gaillard, Tracy A Glauser, Joshua L Goldstein, Howard P Goodkin, Kush Kapur, Mohamad A Mikati, Katrina Peariso, Robert C Tasker, Dmitry Tchapyjnikov, Alexis A Topjian, Mark S Wainwright, Angus Wilfong, Korwyn Williams, Tobias Loddenkemper
Importance: Treatment delay for seizures can lead to longer seizure duration. Whether treatment delay is associated with major adverse outcomes, such as death, remains unknown. Objective: To evaluate whether untimely first-line benzodiazepine treatment is associated with unfavorable short-term outcomes. Design, Setting, and Participants: This multicenter, observational, prospective cohort study included 218 pediatric patients admitted between June 1, 2011, and July 7, 2016, into the 11 tertiary hospitals in the United States within the Pediatric Status Epilepticus Research Group...
January 22, 2018: JAMA Neurology
B J D Tékpa, H C Diemer, P A Issa Mapouka, V Ndoma Ngatchokpo, B Gassima, M N Nali
The authors examined mortality during road traffic accidents (RTAs) to propose solutions for their prevention. This descriptive prospective study took place over a 12-month period (June 1, 2011, to May 30, 2012) and included all fatalities from RTAs brought to selected hospitals. These RTA fatalities were studied in the morgues and selected sites. An autopsy was conducted for each victim to clarify the cause of death. An injury severity score (ISS) was also calculated for each victim. The data were analyzed with Epi-Info 2008...
November 1, 2017: Médecine et Santé Tropicales
Karen Stepanidis, Mads Klokker
Patients with acute central vestibular syndrome (AVS) can mimic acute peripheral vestibulopathy, which can mislead to a diagnosis of posterior fossa infarcts. Delayed diagnosis will prevent relevant treatment and may lead to severe disability and in worst case death. Understanding of AVS is extremely relevant for physicians in hospital and prehospital care to insure the right treatment. I this case report of a 35-year-old male patient with AVS the correct diagnosis was made relatively late.
January 1, 2018: Ugeskrift for Laeger
Steven G Schauer, Jason F Naylor, Guyon J Hill, Allyson A Arana, Jamie L Roper, Michael D April
INTRODUCTION: Airway compromise is the second leading cause of preventable death on the battlefield among US military casualties. Airway management is an important component of pediatric trauma care. Yet, intubation is a challenging skill with which many prehospital providers have limited pediatric experience. We compare mortality among pediatric trauma patients undergoing intubation in the prehospital setting versus a fixed-facility emergency department. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric encounters in Iraq and Afghanistan from January 2007 to January 2016...
December 1, 2017: American Journal of Emergency Medicine
Carmen Usero-Pérez, Valentín González Alonso, Luis Orbañanos Peiro, José Manuel Gómez Crespo, Sheima Hossain López
Recent terrorist attacks involving active shooters or improvised explosive devices have shown that traditionally sequenced emergency management leads to delays in attending victims and suboptimal outcomes. Tactical medicine, a new concept in prehospital care, emerged from experience attending the wounded in combat zones, where the Tactical Combat Casualty Care (TCCC) recommendations are applied. TCCC targets 3 main causes of preventable death in combat: bleeding from extremities, tension pneumothorax, and airway obstruction...
2017: Emergencias: revista de la Sociedad Española de Medicina de Emergencias
Frederike J C Haverkamp, Gordon G Giesbrecht, Edward C T H Tan
BACKGROUND: Accidental hypothermia concerns a body core temperature of less than 35°C without a primary defect in the thermoregulatory system. It is a serious threat to prehospital patients and especially injured patients, since it can induce a vicious cycle of the synergistic effects of hypothermia, acidosis and coagulopathy; referred to as the trauma triad of death. To prevent or manage deterioration of a cold patient, treatment of hypothermia should ideally begin prehospital. Little effort has been made to integrate existent literature about prehospital temperature management...
February 2018: Injury
B Ondruschka, C Baier, J Dreßler, A Höch, M Bernhard, C Kleber, C Buschmann
INTRODUCTION: More than half of all traumatic deaths happen in prehospital settings. Until now, there have been no long-term studies examining the actual additive treatment during trauma-associated cardiopulmonary resuscitation (tCPR), including pleural decompression, pericardiocentesis, tourniquets and external stabilization of the pelvis. The present cohort study evaluated forensic autopsy reports of trauma deaths occurring at the scene with respect to additive actions in preclinical tCPR as well as the potentially preventable nature of the individual death cases...
December 2017: Der Anaesthesist
Jeffrey T Howard, Russ S Kotwal, Alexis R Santos, Matthew J Martin, Zsolt T Stockinger
BACKGROUND: Most combat casualties who die, do so in the prehospital setting. Efforts directed toward alleviating prehospital combat trauma death, known as killed in action (KIA) mortality, have the greatest opportunity for eliminating preventable death. METHODS: 4,542 military casualties injured in Afghanistan from September 11, 2001 to March 31, 2014 were included in this retrospective analysis to evaluate proposed explanations for observed KIA reduction following a mandate by Secretary of Defense Robert M...
October 16, 2017: Journal of Trauma and Acute Care Surgery
Wakisa Mulwafu, Linda Chokotho, Nyengo Mkandawire, Hemant Pandit, Dan L Deckelbaum, Chris Lavy, Kathryn H Jacobsen
Injuries are a global public health concern because most are preventable yet they continue to be a major cause of death and disability, especially among children, adolescents, and young adults. This enormous loss of human potential has numerous negative social and economic consequences. Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury surveillance database compiling the data needed in order to develop and implement evidence-based prevention initiatives and guidelines to improve the quality of clinical care...
June 2017: Malawi Medical Journal: the Journal of Medical Association of Malawi
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