Surgical Safety Does Not Happen By Accident: Learning From Perioperative Near Miss Case Studies.

Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.

Infant Electrocution Due to Smartphone Charge Cable-A Hidden Public Health Risk.

ABSTRACT: The report examines the autopsy and scene of accident findings of a 9-month-old male infant who died from electric shock when he bit a telephone charge cable plugged into a 3-socket extension lead.At the time of the incident, the infant's father was working outside and his mother had gone to the bathroom, leaving the infant alone in the sitting room. The infant crawled across the floor, reached a telephone charge cable that was plugged into a 3-socket extension lead, and bit the end of the cable. He was found lying motionless on the floor, holding the cable in his hand. He was sent to center for the medicolegal autopsy, during which burns and electric shock entry wounds were found on his mouth, tongue, and right hand. Histopathological examination of the samples taken from the wounds garnered findings consistent with electric shock and thermal effect.This article presents findings of an electric shock entry wound on the tongue, which is rarely seen as the result of a domestic accident. Education is needed to increase awareness among parents about accidents in the home involving children and to encourage preference for electrical products that have shown high success in safety tests.

Costs of preventing and supressing wildfires in Victoria, Australia.

Land managers around the world are increasingly under pressure to demonstrate that the actions being used to moderate wildfire risk are effective and cost-efficient. However, little research to date has focused on determining cost-efficiency of management actions or identified the factors which increase the costs of performing such actions. Here, we aimed to identify the key drivers of cost for fuel management (prescribed burning, mulching, and slashing), fuel breaks, and suppression using data from the state of Victoria, Australia. We utilise generalised additive models to understand how environmental factors, terrain, location, and management decisions influence the cost of implementing wildfire management efforts. These models show that cost per unit declines as the area treated or the area of the fire increases for all four management approaches. Therefore, preventative, and responsive management actions represent economies of scale that reduce in cost with larger treatments. We also found that there were regional differences in the cost of fuel management and fuel breaks, potentially related to the structure of resourcing treatments in each region and the availability of land on which it is feasible to implement management. Cost of suppression per fire increased with the number of fire fighters and when there were more fires occurring concurrently in the landscape. Identifying the key drivers of cost for preventative and responsive management actions could enable managers to allocate resources to these actions more efficiently in future. Understanding drivers of cost-efficiency could be critical for adapting management to shifts in wildfire risk, particularly given climate change will alter the window in which it is safe to apply some preventative fuel management actions and reduce suppression effectiveness.

[Clinical characteristics of acute occupational poisoning caused by carbon dioxide leakage from a cargo ship].

Carbon dioxide is a simple asphyxial gas, with low concentrations having an excitatory effect on the respiratory center, while high concentrations have an inhibitory effect on the respiratory center. Simple carbon dioxide poisoning is rarely seen clinically. This article reviews and analyzes the treatment process of 9 cases of acute inhalation carbon dioxide poisoning in a cargo ship carbon dioxide leakage accident in May 2019, summarizes clinical treatment experience, and provides timely and effective treatment for acute pulmonary edema caused by acute inhalation carbon dioxide poisoning. In particular, the application of hormones has a good prognosis, improving clinicians' understanding of the disease.

Research on Aviation Safety Prediction Based on Variable Selection and LSTM.

Accurate prediction of aviation safety levels is significant for the efficient early warning and prevention of incidents. However, the causal mechanism and temporal character of aviation accidents are complex and not fully understood, which increases the operation cost of accurate aviation safety prediction. This paper adopts an innovative statistical method involving a least absolute shrinkage and selection operator (LASSO) and long short-term memory (LSTM). We compiled and calculated 138 monthly aviation insecure events collected from the Aviation Safety Reporting System (ASRS) and took minor accidents as the predictor. Firstly, this paper introduced the group variables and the weight matrix into LASSO to realize the adaptive variable selection. Furthermore, it took the selected variable into multistep stacked LSTM (MSSLSTM) to predict the monthly accidents in 2020. Finally, the proposed method was compared with multiple existing variable selection and prediction methods. The results demonstrate that the RMSE (root mean square error) of the MSSLSTM is reduced by 41.98%, compared with the original model; on the other hand, the key variable selected by the adaptive spare group lasso (ADSGL) can reduce the elapsed time by 42.67% (13 s). This shows that aviation safety prediction based on ADSGL and MSSLSTM can improve the prediction efficiency of the model while keeping excellent generalization ability and robustness.

Health Care Utilization and Outcomes Associated with Accidental Poisonous Mushroom Ingestions - United States, 2016-2018.

Accidental consumption of poisonous mushrooms can result in serious illness and death (1). Reports of severe poisonings from consumption of foraged mushrooms for food or hallucinogenic purposes increased during 1999-2016 (2), and approximately 7,500 poisonous mushroom ingestions were reported annually to poison control centers across the United States (1). To estimate the frequency of emergency department (ED) visits, hospitalizations, and severe adverse outcomes associated with accidental poisonous mushroom ingestion in the United States, CDC analyzed 2016 data from the Healthcare Cost and Utilization Project's* Nationwide Emergency Department Sample (HCUP-NEDS) and National Inpatient Sample (HCUP-NIS) databases as well as 2016-2018 data from three IBM MarketScan sources: Commercial Claims and Encounters (CCAE), Medicare Supplemental and Coordination of Benefits (Medicare), and Multi-State Medicaid databases. During 2016, 1,328 (standard error [SE] = 100) ED visits and 100 (SE = 22) hospitalizations (HCUP data) were associated with accidental poisonous mushroom ingestion. Among 556 patients with a diagnosis of accidental poisonous mushroom ingestion, 48 (8.6%) patients experienced a serious adverse outcome during 2016-2018 (MarketScan data). Serious adverse outcomes were more common among Medicaid-insured patients than among patients with commercial insurance or Medicare (11.5% versus 6.7%, p = 0.049). Because most mushroom poisonings are preventable, wild mushrooms should not be consumed unless they are identified by an expert; increased public health messaging about the potential dangers of mushroom poisoning is needed.

The water incident database (WAID) 2012 to 2019: a systematic evaluation of the documenting of UK drownings.

BACKGROUND: Death by drowning is a leading cause of accidental death in the United Kingdom (UK) and worldwide. The World Health Organization (WHO) states that effective documentation of drowning is required to describe drowning frequency and to underpin effective drowning prevention intervention, thus improving the quality of data describing drowning frequency represents a key initiative. The water incident database (WAID) has been used to document UK fatal and non-fatal water-based incidents since 2009. WAID has not undergone a systematic evaluation of its data or data collection procedures to establish if the database meets the WHO requirements. The present study investigated the characteristics of UK fatal drowning incidents and audited current WAID data capture procedures. METHODS: Data for the fatal drowning cases recorded between 2012 and 2019 were reviewed. Descriptive data were generated 1) to describe fatal drownings in the UK's WAID in this period; 2) a sub-set of drownings were audited i) for completeness of data entry and, based on source documents, ii) for quality of data entry; 3) these processes were used to make recommendations for onward revisions to WAID. RESULTS: A total of 5051 fatalities were recorded between 2012 and 2019. Drowning was most frequent amongst males aged 35 to 60 years (n = 1346), whilst suspected accidents and suicides accounted for 44 and 35% of fatalities. Suicide by drowning was at a peak in the most recent year of data analysed (i.e., 2019; 279 cases) highlighting an urgent need for targeted intervention. Audit part 2i) indicated that 16% of all fields were incomplete, thus indicating potential redundancy, duplication, or the need for onward review. Audit part 2ii) indicated high levels of agreement (80 ± 12%) between audited cases and the 'true' WAID entries. CONCLUSIONS: This study confirms WAID as a rigorous, transparent and effective means of documenting UK drownings thereby meeting WHO requirements for data quality; yet future improvements are recommended. Such findings allow researchers and policy makers to use WAID to further investigate UK drowning with a view to improving public safety measures and drowning prevention interventions. Observations alongside several expert recommendations have informed a revised version of WAID.

An Adaptive Game-Based Learning Strategy for Children Road Safety Education and Practice in Virtual Space.

Virtual reality (VR) has been widely used as a tool to assist people by letting them learn and simulate situations that are too dangerous and risky to practice in real life, and one of these is road safety training for children. Traditional video- and presentation-based road safety training has average output results as it lacks physical practice and the involvement of children during training, without any practical testing examination to check the learned abilities of a child before their exposure to real-world environments. Therefore, in this paper, we propose a 3D realistic open-ended VR and Kinect sensor-based training setup using the Unity game engine, wherein children are educated and involved in road safety exercises. The proposed system applies the concepts of VR in a game-like setting to let the children learn about traffic rules and practice them in their homes without any risk of being exposed to the outside environment. Thus, with our interactive and immersive training environment, we aim to minimize road accidents involving children and contribute to the generic domain of healthcare. Furthermore, the proposed framework evaluates the overall performance of the students in a virtual environment (VE) to develop their road-awareness skills. To ensure safety, the proposed system has an extra examination layer for children's abilities evaluation, whereby a child is considered fit for real-world practice in cases where they fulfil certain criteria by achieving set scores. To show the robustness and stability of the proposed system, we conduct four types of subjective activities by involving a group of ten students with average grades in their classes. The experimental results show the positive effect of the proposed system in improving the road crossing behavior of the children.

Recent trends and variations in general practitioners' involvement in accident care in Switzerland: an analysis of claims data.

BACKGROUND: As in other countries, there is concern and some fragmentary evidence that GPs' central role in the Swiss healthcare system as the primary provider of care might be changing or even be in decline. Our study gives a systematic account of GPs' involvement in accident care from 2008 to 2016 and identifies changes in GPs' involvement in this typical field of primary care: how frequently GPs were involved along the care pathway, to what extent they figured as initial care provider, and what their role in the care pathway was. METHODS: Using a claims dataset from the largest Swiss accident insurer with two million accident cases, we constructed individual care pathways, i.e., when and from which providers patients received care. We calculated probabilities for the involvement of various care provider groups, for initial care provision, and for the role of GPs in patients' care pathways, adjusted for injury and patient characteristics using multinomial regression. RESULTS: In 2014, GPs were involved in 70% of all accident cases requiring outpatient care but no inpatient stay, and provided initial care in 56%. While involvement stayed at about the same level for accidents occurring from 2008 to 2014, the share of accidents where GPs provided initial care decreased by 4 percentage points. The share of cases where GPs acted as sole care provider decreased by 7 percentage points down to 44%. At the same time, accident cases involving care from an ED at any point in time increased from 38 to 46% and the share receiving initial care from an ED from 30 to 35 percentage points - apparently substituting for the declining involvement of GPs in initial care. GPs' involvement in accident care is higher in rural compared to urban regions, among elderly compared to younger patients, and among Swiss compared to non-Swiss citizens. CONCLUSIONS: GPs play a key role in accident care with considerable variation depending on region and patient profile. From 2008 to 2014, there is a remarkable decline in GPs' provision of initial care after an accident. This is a strong indication that the GPs' role in the Swiss healthcare system is changing.

Protecting the future: Fatal incidents on Australian farms involving children (2001-2019).

OBJECTIVES: To assess the demographic and causal factors, plus trends in rates of fatal farm incidents involving children (<15 years) in Australia over the 2001-2019 period. DESIGN: A descriptive retrospective epidemiological study of the National Coronial Information System. SETTING: Australia. PARTICIPANTS: Cases involving children (<15 years), where incidents have occurred on a farm (1 January 2001-31 December 2019). RESULTS: There has been essentially no change in the fatality rate for farm-related child injury deaths across Australia in the 2001-2019 period (-0.009/year). Men and children aged 0-4 years were significantly more likely to be involved in these incidents. Most cases were recreational in nature (81%), with seven agents (water bodies, quads [all-terrain vehicles], tractors, utes, cars, motorbikes and horses), accounting for 75% of cases. Water bodies were responsible for over 31% of deaths. CONCLUSION: The lack of progress addressing child farm injury mortality requires urgent attention. The overall rates and pattern of injury-related deaths have stagnated, necessitating new and innovative approaches to address the issue. The emerging National Injury Prevention Plan might provide scope to improve the focus on and implementation of evidence-based approaches.

First case of acute respiratory distress syndrome and alimentary tract hemorrhage following mass ingestion of methylisothiazolinone.

The frequency of methylisothiazolinone (MIT)-related health concerns regarding allergic contact dermatitis with a spongiotic reaction pattern and restrictive lung function indicating peripheral airway dysfunction caused by the use of humidifier disinfectant is increasingly rising. There is a limited number of evidences supporting the environmentally acute and mass exposure to MIT resulting in acute respiratory distress syndrome (ARDS). Here, we report the first case of ARDS and alimentary tract hemorrhage following mass ingestion of methylisothiazolinone.

Wearable Real-Time Heart Attack Detection and Warning System to Reduce Road Accidents.

Heart attack is one of the leading causes of human death worldwide. Every year, about 610,000 people die of heart attack in the United States alone-that is one in every four deaths-but there are well understood early symptoms of heart attack that could be used to greatly help in saving many lives and minimizing damages by detecting and reporting at an early stage. On the other hand, every year, about 2.35 million people get injured or disabled from road accidents. Unexpectedly, many of these fatal accidents happen due to the heart attack of drivers that leads to the loss of control of the vehicle. The current work proposes the development of a wearable system for real-time detection and warning of heart attacks in drivers, which could be enormously helpful in reducing road accidents. The system consists of two subsystems that communicate wirelessly using Bluetooth technology, namely, a wearable sensor subsystem and an intelligent heart attack detection and warning subsystem. The sensor subsystem records the electrical activity of the heart from the chest area to produce electrocardiogram (ECG) trace and send that to the other portable decision-making subsystem where the symptoms of heart attack are detected. We evaluated the performance of dry electrodes and different electrode configurations and measured overall power consumption of the system. Linear classification and several machine algorithms were trained and tested for real-time application. It was observed that the linear classification algorithm was not able to detect heart attack in noisy data, whereas the support vector machine (SVM) algorithm with polynomial kernel with extended time-frequency features using extended modified B-distribution (EMBD) showed highest accuracy and was able to detect 97.4% and 96.3% of ST-elevation myocardial infarction (STEMI) and non-ST-elevation MI (NSTEMI), respectively. The proposed system can therefore help in reducing the loss of lives from the growing number of road accidents all over the world.

Head impact in a snowboarding accident.

To effectively prevent sport traumatic brain injury (TBI), means of protection need to be designed and tested in relation to the reality of head impact. This study quantifies head impacts during a typical snowboarding accident to evaluate helmet standards. A snowboarder numerical model was proposed, validated against experimental data, and used to quantify the influence of accident conditions (speed, snow stiffness, morphology, and position) on head impacts (locations, velocities, and accelerations) and injury risk during snowboarding backward falls. Three hundred twenty-four scenarios were simulated: 70% presented a high risk of mild TBI (head peak acceleration >80 g) and 15% presented a high risk of severe TBI (head injury criterion >1000). Snow stiffness, speed, and snowboarder morphology were the main factors influencing head impact metrics. Mean normal head impact speed (28 ± 6 km/h) was higher than equivalent impact speed used in American standard helmet test (ASTM F2040), and mean tangential impact speed, not included in standard tests, was 13.8 (±7 km/h). In 97% of simulated impacts, the peak head acceleration was below 300 g, which is the pass/fail criteria used in standard tests. Results suggest that initial speed, impacted surface, and pass/fail criteria used in helmet standard performance tests do not fully reflect magnitude and variability of snowboarding backward-fall impacts.

Hyperbaric oxygen therapy for the prevention of arterial gas embolism in food grade hydrogen peroxide ingestion.

Food grade hydrogen peroxide ingestion is a relatively rare presentation to the emergency department. There are no defined guidelines at this time regarding the treatment of such exposures, and providers may not be familiar with the potential complications associated with high concentration hydrogen peroxide ingestions. In this case series, we describe four patients who consumed 35% hydrogen peroxide, presented to the emergency department, and were treated with hyperbaric oxygen therapy. Two of the four patients were critically ill requiring intubation. All four patients had evidence on CT or ultrasound of venous gas emboli and intubated patients were treated as if they had an arterial gas embolism since an exam could not be followed. After hyperbaric oxygen therapy each patient was discharged from the hospital neurologically intact with no other associated organ injuries related to vascular gas emboli. Hyperbaric oxygen therapy is an effective treatment for patients with vascular gas emboli after high concentration hydrogen peroxide ingestion. It is the treatment of choice for any impending, suspected, or diagnosed arterial gas embolism. Further research is needed to determine which patients with portal venous gas emboli should be treated with hyperbaric oxygen therapy.

[Surgical Repair for Blunt Cardiac Rupture].

Blunt cardiac injury is a life-threatening condition. We report 3 successful cases in which we performed surgery for blunt cardiac injury. Three individuals were injured, 2 in traffic accidents and the other being caught between a crane and a steel frame. Echocardiograms and computed tomography scans revealed pooling of bloody pericardial fluid in all 3 patients, who underwent emergency surgery. Two patients needed sutures to control persistent bleeding. Although a heart-lung machine was prepared at the start of surgery in all 3 cases, we did not need to use it for any patient. Thus, prior to performing such surgery, it is necessary to ascertain its need.

The Pretravel Consultation.

Key components of the pretravel consultation include intake questions regarding the traveler's anticipated itinerary and medical history; immunizations; malaria prophylaxis; and personal protection measures against arthropod bites, traveler's diarrhea, and injury. Most vaccinations that are appropriate for international travelers are included in the routine domestic immunization schedule; only a few travel-specific vaccines must also be discussed. The most common vaccine-preventable illnesses in international travelers are influenza and hepatitis A. Malaria prophylaxis should be offered to travelers to endemic regions. Personal protection measures, such as applying an effective insect repellent to exposed skin and permethrin to clothing and using a permethrin-impregnated bed net, should be advised for travelers to the tropics. Clinicians should offer an antibiotic prescription that travelers can take with them in case of traveler's diarrhea. Additional topics to address during the pretravel consultation include the risk of injury from motor vehicle crashes and travel-specific risks such as altitude sickness, safe sex practices, and emergency medical evacuation insurance.

[Sarcopenia and bone mineral property with age].

In order to maintain functional activities in the elderly, promotion of musculoskeletal care is important toward successful aging and healthy longevity. In practice, reduction of falls and fall-related injuries together with treatment of osteoporosis is important to keep activities of daily living. Recent findings suggest the possibility that there is a relationship between skeletal muscle and bone mineral property, represented by pathophysiological linkage between sarcopenia and osteoporosis.

Legislation coverage for child injury prevention in China.

OBJECTIVE: To examine the extent to which effective interventions to prevent unintentional child injury are reflected in the laws and regulations of China. METHODS: We focused on the six common causes of fatal child injuries - drowning, road traffic injury, falls, poisoning, burns and suffocation. We investigated 27 interventions recommended by the United Nations Children's Fund, the World Health Organization or the European Child Safety Alliance. We searched China National Knowledge Infrastructure and Lawyee for Chinese legislations using keywords and synonyms for the 27 interventions. We reviewed the identified legislations for statements specifying the responsible implementation department. FINDINGS: Seven national laws, nine regulations of the State Council and 46 departmental regulations were found to relate to at least one of the interventions. Although seven of the 27 internationally recommended interventions were covered by Chinese laws, 10 were not covered by any current Chinese law or regulation. None of the interventions against drowning and falls that we investigated was covered by national laws. The implementation responsibilities for effective interventions were either not specified or were assigned to multiple governmental departments in 11 or 20 legislative documents, respectively. CONCLUSION: In Chinese laws and regulations, interventions proven to prevent major causes of unintentional child injuries are underrepresented and the associated implementation responsibilities are often poorly defined. China should include all such interventions in laws and regulations, and assign implementation responsibility for each to a single department of the national government.

Living for the moment: men situating risk-taking after the death of a friend.

The primary cause of death for men under the age of 30 is unintentional injury and, despite health-promotion efforts and programme interventions, male injury and death rates have not decreased in recent years. Drawing on 22 interviews from a study of men, risk and grief, we describe how a risk-related tragedy shaped the participants' understandings of and practices of risk-taking. The findings indicate that most participants did not alter their perceptions and engagement in risky practices, which reflected their alignment to masculine ideals within specific communities of practice where risk-taking was normalised and valorised. Continued reliance on risky practices following the death of a friend was predominantly expressed as 'living for the moment,' where caution and safety were framed as conservative practices that undermined and diluted the robustness ideally embodied by this subgroup of young men. Two main themes: living life, accepting death and upping the ante illustrate how risk-taking can persist following a death. A smaller group of participants articulated a different viewpoint; reining in risk practices, to describe their risk management approaches after the death of a male friend. This novel study confirms the ongoing challenge of reducing men's risk-taking practices, even after the death of a friend.

Supporting parents following childhood traumatic brain injury: a qualitative study to examine information and emotional support needs across key care transitions.

INTRODUCTION: Traumatic brain injury (TBI) is the leading cause of death and acquired disability in childhood. Research has demonstrated that TBI can lead to long-term physical, cognitive, emotional and behavioural difficulties for children and parental stress. Less is known about how parents experience a childhood brain injury and their information and support needs. This study aimed to examine parents' experiences and support needs following a childhood TBI from the time of the accident to their child's discharge home. METHODS: Qualitative semi-structured interviews were conducted with 29 parents/carers of children who had experienced a severe TBI. Participants were recruited from one children's tertiary centre in the UK. Data were analysed using the Framework approach. RESULTS: Parents had unmet information and emotional support needs across the care trajectory from the time of the accident to their child's return home. Information needs related to the impact of the TBI on their child; current and future treatment/rehabilitation plans; helping their child and managing their behaviour; accessing services/support. They lacked information and support for care transitions. In different settings parents faced particular barriers to having their information needs met. Parents' felt they needed emotional support in coming to terms with witnessing the accident and the loss of their former child. Lack of community support related not only to service availability but to a general lack of understanding of the impact of TBI on children, particularly when this was invisible. Overall parents felt unsupported in coping with children's behavioural and psychological difficulties. DISCUSSION: Taking a holistic approach to examining parents' experiences and support needs has enabled their changing needs to be highlighted across key care transitions within hospital and community settings and the service implications identified. Improvements in care co-ordination across care transitions are needed to ensure continuity of care and integration of support.