Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries.

Early haemorrhage control and minimizing the time to definitive care have long been the cornerstones of therapy for patients exsanguinating from non-compressible haemorrhage (NCH) after penetrating injuries, as only basic treatment could be provided on scene. However, more recently, advanced on-scene treatments such as the transfusion of blood products, resuscitative thoracotomy (RT) and resuscitative endovascular balloon occlusion of the aorta (REBOA) have become available in a small number of pre-hospital critical care teams. Although these advanced techniques are included in the current traumatic cardiac arrest algorithm of the European Resuscitation Council (ERC), published in 2021, clear guidance on the practical application of these techniques in the pre-hospital setting is scarce. This paper provides a scoping review on how these advanced techniques can be incorporated into practice for the resuscitation of patients exsanguinating from NCH after penetrating injuries, based on available literature and the collective experience of several helicopter emergency medical services (HEMS) across Europe who have introduced these advanced resuscitation interventions into routine practice.

Hospital surge capacity in a tertiary emergency referral centre during the COVID-19 outbreak in Italy.

The first person-to-person transmission of the 2019 novel coronavirus in Italy on 21 February 2020 led to an infection chain that represents one of the largest known COVID-19 outbreaks outside Asia. In northern Italy in particular, we rapidly experienced a critical care crisis due to a shortage of intensive care beds, as we expected according to data reported in China. Based on our experience of managing this surge, we produced this review to support other healthcare services in preparedness and training of hospitals during the current coronavirus outbreak. We had a dedicated task force that identified a response plan, which included: (1) establishment of dedicated, cohorted intensive care units for COVID-19-positive patients; (2) design of appropriate procedures for pre-triage, diagnosis and isolation of suspected and confirmed cases; and (3) training of all staff to work in the dedicated intensive care unit, in personal protective equipment usage and patient management. Hospital multidisciplinary and departmental collaboration was needed to work on all principles of surge capacity, including: space definition; supplies provision; staff recruitment; and ad hoc training. Dedicated protocols were applied where full isolation of spaces, staff and patients was implemented. Opening the unit and the whole hospital emergency process required the multidisciplinary, multi-level involvement of healthcare providers and hospital managers all working towards a common goal: patient care and hospital safety. Hospitals should be prepared to face severe disruptions to their routine and it is very likely that protocols and procedures might require re-discussion and updating on a daily basis.

Impacto de la formación en gestión médica de desastres: resultados de un estudio piloto utilizando una nueva herramienta para la simulación in vivo / Impact of training in medical disaster management: a pilot study using a new tool for live simulation

OBJETIVOS: Probar la nueva aplicación de simulación de desastres (ASD) y evaluar su utilización durante el mismo tipo de ejercicio a gran escala, reproducido en dos ocasiones diferentes. MÉTODOS: Los jugadores (los médicos) fueron clasificados como entrenados (E) y no entrenados (NE), en base a su formación previa en medicina de desastres. La ASD es una herramienta informática basada en la web, diseñada para permitir una evaluación objetiva, sistemática, y cuantitativa del desempeño sanitario en diferentes entornos dinámicos, tales como ejercicios de atención a accidentes con múltiples víctimas. La hipótesis es que el sistema permite detectar diferencias entre los dos grupos durante la gestión de estos eventos.Hemos simulado el colapso de una estructura, el techo en una habitación llena de gente. El uso de la ASD, por vía electrónica recoge los datos relativos a los momentos clave prehospitalarios y hospitalarios, y a la precisión de triaje, del puesto de mando y control y del pretratamiento en el hospital. RESULTADOS: No hubo problemas durante su uso en las dos simulaciones. Los E fueron más rápidos que los NE en el envío de las víctimas desde la escena hasta el hospital [67,5 (50,0-111,0) frente a 145,0 (110,0-150,0) min, p < 0,001]. También trataron y dieron de alta a más pacientes desde las urgencias hospitalarias (32/38 vs 14/31, p < 0,001) y dieron un mejor rendimiento en la evaluación del puesto mando (31/44 vs 17/44 en E vs NE, respectivamente, p < 0,05). No se encontraron diferencias en cuanto a triaje prehospitalario y precisión del tratamiento. CONCLUSIÓN: El uso de la ASD en dos escenarios comparables permitió identificar diferencias en la respuesta ante un incidente con múltiples víctimas llevada a cabo por el personal E en comparación con el NE. Estos resultados pueden reflejar algunos de los objetivos específicos de la educación la medicina de catástrofes cuando se orienta a la gestión organizativa de las crisis en lugar del manejo clínico de las lesiones

OBJECTIVES: The aim of this study was to test a new disaster simulation suite (DSS). We aimed to evaluating its application during the same type of full-scale exercise on 2 different occasions. Our hypothesis was that the system would allow us to detect differences between trained and nontrained physicians during event management. METHODS: We simulated the collapse of a ceiling structure in a crowded room. Using the DSS, we lectronically collected data relative to prehospital and hospital times, triage accuracy, command-and-control and prehospital treatment accuracy. RESULTS: Players (physicians) were classed as trained or nonrained based on their background in disaster medicine training. No usability problems arose during either simulation. Trained physicians were faster than nontrained physicians in dispatching the victims from scene to hospital [median (interquartile range) times, 67.5 (50.0-111.0) vs 145.0 (110.0-150.0) min, P<0.001]; trained treated and discharged more patients in the emergency department (32/38 vs 14/31, P<0.001) and performed better on command-and-control items (31/44 vs 17/44 for trained and nontrained players respectively, P<0.05). No differences were found as regards triage or prehospital treatment accuracy. CONCLUSION: Using the DSS in 2 comparable scenarios allowed us to identify differences in mass casualty responses trained and nontrained physicians. These results may reflect of the some specific objectives of disaster medicine training oriented to the organizational management of health crises rather than to the clinical management of injuries