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"Trauma" AND ("Pre-Hospital" OR "Pre Hospital")

Guyon J Hill, Michael D April, Joseph K Maddry, Steven G Schauer
BACKGROUND: Head injuries frequently occur in combat. Tactical Combat Casualty Care (TCCC) guidelines recommend pre-hospital use of ketamine for analgesia. Yet the use of this medication in patients with head injuries remains controversial, particularly among pediatric patients. We compare survival to hospital discharge rates among pediatric head injury subjects who received prehospital ketamine versus those who did not. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric (<18 years of age) subjects from January 2007 to January 2016...
October 22, 2018: American Journal of Emergency Medicine
D J Hepple, J W Durrand, O Bouamra, P Godfrey
The deployment of physician-led pre-hospital enhanced care teams capable of critical care interventions at the scene of injury may confer a survival benefit to victims of major trauma. However, the evidence base for this widely adopted model is disputed. Failure to identify a clear survival benefit has been attributed to several factors, including an inherently more severely injured patient group who are attended by these teams. We undertook a novel retrospective analysis of the impact of a regional enhanced care team on observed vs...
December 5, 2018: Anaesthesia
Alicia M Bonanno, Todd L Graham, Lauren N Wilson, Brianne M Madtson, James D Ross
BACKGROUND: Hemorrhage is the most common cause of preventable death in the pre-hospital phase in trauma, with a critical capability gap optimizing pre-hospital resuscitation in austere environments. One promising avenue is the concept of a multi-functional resuscitation fluid (MRF) that contains a blood product backbone with agents that promote clotting and enhance oxygen delivery. Oxygen therapeutics, such as hemoglobin based oxygen carriers(HBOCs) and perfluorocarbons(PFCs), may be a critical MRF component...
2018: PloS One
J C de Schoutheete, I Fourneau, F Waroquier, L De Cupere, M O'Connor, K Van Cleynenbreugel, J C Ceccaldi, S Nijs
Background: The present paper describes three cases where ER-REBOA® was used with partial aorta occlusion (AO), by performing a partial resuscitative endovascular balloon occlusion of the aorta or pREBOA, in an austere pre-hospital military environment.In addition, because no specific REBOA algorithm for pre-hospital environment exists yet, this paper seeks to fill this gap, proposing a new pragmatic REBOA algorithm. Methods: Belgian Special Operations Surgical Team applied REBOA in three patients according to a decisional algorithm, based on the MIST acronym used for trauma patients...
2018: World Journal of Emergency Surgery: WJES
Alicia A Heelan Gladden, Erik D Peltz, Robert C McIntyre, Stephanie Vega, Regina Krell, Catherine Velopulos, Lisa Ferrigno, Franklin L Wright
BACKGROUND: Early blood product resuscitation reduces trauma patient mortality from hemorrhage. This mortality benefit depends on a system that can rapidly identify actively bleeding patients, initiate massive transfusion protocol (MTP), and mobilize resources to the bedside. We hypothesized that process improvement efforts that identify patients early and mobilize appropriate blood products to the bedside for immediate use would improve mortality. STUDY DESIGN: Pre-implementation, MTP activation was at the discretion of the trauma surgeon and only PRBCs were immediately available...
November 23, 2018: Journal of the American College of Surgeons
Andrea Fabbri, Giuseppe Carpinteri, Germana Ruggiano, Elisabetta Bonafede, Antonella Sblendido, Alberto Farina, Amedeo Soldi
INTRODUCTION: Low-dose methoxyflurane, administered via a hand-held inhaler, has been used for short-term pain relief in emergency medicine in Australia and New Zealand for over 40 years, and was recently approved in Europe for the rapid relief of moderate-to-severe trauma-related pain in adults. There is currently a lack of data for methoxyflurane versus active comparators, therefore this trial will investigate the efficacy and safety of inhaled methoxyflurane compared with standard of care (SoC) in the treatment of acute trauma-related pain in pre-hospital and ED settings in Italy...
November 22, 2018: Advances in Therapy
J E Griggs, J Jeyanathan, M Joy, M Q Russell, N Durge, D Bootland, S Dunn, E D Sausmarez, G Wareham, A Weaver, R M Lyon
BACKGROUND: Major haemorrhage is a leading cause of mortality following major trauma. Increasingly, Helicopter Emergency Medical Services (HEMS) in the United Kingdom provide pre-hospital transfusion with blood products, although the evidence to support this is equivocal. This study compares mortality for patients with suspected traumatic haemorrhage transfused with pre-hospital packed red blood cells (PRBC) compared to crystalloid. METHODS: A single centre retrospective observational cohort study between 1 January 2010 and 1 February 2015...
November 20, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Yohei Hirano, Toshikazu Abe, Hiroshi Tanaka
PURPOSE: The beneficial effect of the presence of an emergency physician in prehospital major trauma care is controversial. The aim in this study is to assess whether an emergency physician on scene can improve survival outcome of critical trauma patients. METHODS: This retrospective cohort study was conducted by using nationwide trauma registry data between 2004 and 2013 in Japan. Severe trauma patients (injury severity score (ISS) ≥ 16) who were transported directly to the hospital from the injury site were included in our analysis...
November 9, 2018: American Journal of Emergency Medicine
Loren K Liebrecht, Jason Newton, Erika J Martin, Nina Wickramaratne, Sudha Jayaraman, Jinfeng Han, Michel Aboutanos, Donald F Brophy, Martin J Mangino
BACKGROUND: Low volume resuscitation (LVR) in shock prevents deleterious effects of crystalloid loading in pre-hospital settings. Polyethylene glycol 20,000 (PEG-20k) based LVR solutions are 20-fold more effective at maintaining perfusion and survival in shock compared to conventional crystalloids. The aim of this study was to determine coagulation and platelet function of whole blood treated with 10% PEG-20k. METHODS: Citrated blood from volunteers (n = 25) or early admission severely injured trauma patients (n = 9) were diluted 10% with various LVR solutions in a matched design with a paired volume control (saline), and studied using thromboelastography (TEG)...
2018: PloS One
Zain G Hashmi, Molly P Jarman, Tarsicio Uribe-Leitz, Eric Goralnick, Craig D Newgard, Ali Salim, Edward Cornwell, Adil H Haider
BACKGROUND: Timely access to trauma center(TC) care is critical to achieve "Zero Preventable Deaths After Injury." However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, age-adjusted mortality and timely access to trauma center care. STUDY DESIGN: State-level analysis of adult trauma deaths reported to CDC WONDER (1999-2016)...
September 26, 2018: Journal of the American College of Surgeons
Shlaifer Amir, Siman-Tov Maya, Radomislensky Irina, Peleg Kobi, Klein Yoram, Glassberg Elon, Yitzhak Avraham
BACKGROUND: Hemorrhage is the most common preventable cause of death in both civilian and military trauma. There is no consensus regarding the appropriate fluid resuscitation protocol. Plasma, as a resuscitative fluid, has substantial benefits as a volume expander, owing to its relatively high oncotic pressure and its positive effect on trauma induced coagulopathy by replenishing the lost coagulation factors, rather than diluting the casualty's remaining factors. The Israel Defense Force Medical Corps decided to use Freeze dried plasma (FDP) as the fluid of choice for casualties in hemorrhagic shock in the prehospital setting...
October 23, 2018: Journal of Trauma and Acute Care Surgery
Alison A Smith, Joana E Ochoa, Sunnie Wong, Sydney Beatty, Jeffrey Elder, Chrissy Guidry, Patrick McGrew, Clifton McGinness, Juan Duchesne, Rebecca Schroll
BACKGROUND: Despite increasing popularity of pre-hospital tourniquet use in civilians, few studies have evaluated the efficacy and safety of tourniquet use. Furthermore, previous studies in civilian populations have focused on blunt trauma patients. The objective of this study was to determine if pre-hospital tourniquet use in patients with major penetrating trauma is associated with differences in outcomes compared to a matched control group. METHODS: An eight-year retrospective analysis of adult patients with penetrating major extremity trauma amenable to tourniquet use (major vascular trauma, traumatic amputation and near-amputation) was performed at a level I trauma center...
October 23, 2018: Journal of Trauma and Acute Care Surgery
Randhawa Muhammad Afzal, Muhammad Armughan, Muhammad Waqas Javed, Usman Ali Rizvi, Sajida Naseem
Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene...
September 20, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
Mohammed-Najeeb Mahama, Ernest Kenu, Delia Akosua Bandoh, Ahmed Nuhu Zakariah
BACKGROUND: Every year, about 1.2 million people die through road traffic crashes worldwide. Majority of these deaths occur in Africa where most of their emergency medical services are underdeveloped. In 2004, Ghana established the National Ambulance Council to provide timely and efficient pre-hospital emergency medical care to the sick and injured. Pre-hospital emergency medical service is essential for accident victims since it has the potential of saving lives. The study sought to determine the relationship between pre-hospital trauma survival rate and response time to emergencies and factors associated to pre-hospital trauma survival  in Accra, Ghana...
October 3, 2018: BMC Emergency Medicine
James Vassallo, Melanie Webster, Edward B G Barnard, Mark D Lyttle, Jason E Smith
OBJECTIVE: To describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales. DESIGN: Population-based analysis of the UK Trauma Audit and Research Network (TARN) database. PATIENTS AND SETTING: All paediatric and adolescent patients with TCA recorded on the TARN database for a 10-year period (2006-2015). MEASURES: Patient demographics, Injury Severity Score (ISS), location of TCA ('prehospital only', 'in-hospital only' or 'both'), interventions performed and outcome...
September 27, 2018: Archives of Disease in Childhood
Mikko Heinänen, Tuomas Brinck, Rolf Lefering, Lauri Handolin, Tim Söderlund
PURPOSE: Serious thoracic injuries are associated with high mortality, morbidity, and costs. We compared patient populations, treatment, and survival of serious thoracic injuries in southern Finland and Germany. METHODS: Mortality, patient characteristics and treatment modalities were compared over time (2006-2015) in all patients with Abbreviated Injury Scale (AIS) thorax ≥ 3, Injury Severity Score (ISS) > 15, age > 15 years, blunt trauma mechanism, and treatment in Intensive Care Unit (ICU) in Level 1 hospitals included in the Helsinki Trauma Registry (HTR) and the TraumaRegister DGU® (TR-DGU)...
September 17, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Mohammad Reza Khajehaminian, Ali Ardalan, Abbasali Keshtkar, Sayed Mohsen Hosseini Boroujeni, Amir Nejati, Omid Mahdi Ebadati Ebadati E, Abbas Rahimi Foroushani
INTRODUCTION: Mass casualty incidents impose a large burden on the emergency medical systems, hospitals and community infrastructures. The pre-hospital and hospital capacities are usually bear the burden of casualties large numbers. One of the challenging issues in mass casualty incidents is the distribution of casualties among the suitable health care facilities. OBJECTIVE: To review models and criteria affecting the distribution of casualties during the trauma-related mass causality incidents...
November 2018: Injury
Pei-Yang Hu, Xin-Yi Chen, Xiong-Huan Chen, Yi-Min Chen
Severe trauma has the characteristics of complicated condition, multiple organs involved, limited auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to primary hospitals to receive treatments. But the traditional mode of separate discipline management can easily lead to delayed treatment, missed or wrong diagnosis and high disability, which causes a high mortality in severe trauma patients. Therefore, if the primary hospitals, especially county-level hospitals (usually the top general hospital within the administrative region of a county), can establish a scientific and comprehensive trauma care system, the success rate of trauma rescue in this region can be greatly improved...
October 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
Meng-Yu Wu, Yu-Long Chen, Giou-Teng Yiang, Chia-Jung Li, Amy Shu-Chuan Lin
Geriatric traumatic injuries in emergency departments are frequent and associated with higher mortality rates and catastrophic functional outcomes. Several prediction scores have been established to manage traumatic patients, including the shock index (SI), revised trauma score (RTS), injury severity score (ISS), trauma injury severity score (TRISS), and new injury severity score (NISS). However, it was necessary to investigate the effectiveness and efficiency of care for the geriatric traumatic population...
September 4, 2018: Journal of Clinical Medicine
Anna Jarosz, Paweł Podsiadło, Tomasz Darocha, Tomasz Sanak, Sylweriusz Kosiński, Robert Gałązkowski, Rafał Drwiła
OBJECTIVE: Introduction: The paper covers the problem of pre-hospital hypothermia recognition and management among lifeguards, board guards and policemen, who took part in e-learning course Academy of Hypothermia. PATIENTS AND METHODS: Materials and methods: The subject of analysis were the results of pre-test, post-test and lesson revision tests of Academy of Hypothermia e-learning course, taken by lifeguards (WOPR), board guards (SG) and policemen (POL). RESULTS: Results: 221 participants were enrolled in a study...
2018: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
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