Manchester Arena bombing: lessons learnt from a mass casualty incident.

On 22 May 2017 Salman Abedi detonated an improvised explosive device in the Manchester Arena resulting in 23 deaths (including the attacker). This was the deadliest terrorist attack on UK soil since the 2005 London bombings, but was only one of five mass casualty terrorist attacks in the UK in 2017. Preparation for mass casualty incidents (MCI) is obligatory, involving such methods as multiagency tabletop exercises, mock hospital exercises, as well as simulation and training for clinicians in managing the injuries that would be anticipated in such an event. Even in the best prepared units, such an incident will pose significant challenges due to the unpredictable nature of these events with respect to timing and number of casualties. Following an MCI, local and national reviews are undertaken to assess the effectiveness of the response, but also to identify areas where lessons can be learnt and to disseminate these to allow inclusion in future planning. We present the experience following a mass casualty terrorist incident along with a number of lessons learnt from this event.

Curtain gastroplasty as an option in high risk emergency hiatus hernia repair.

INTRODUCTION: We describe a novel surgical technique used in the case of an 86-year-old Caucasian man with multiple comorbidities who presented with upper intestinal obstruction caused by a large paraoesophageal hiatus hernia and concurrent urinary sepsis. METHODS: The technique, which minimises both operative time and surgical trauma in this situation, uses the fundus of the stomach in a modified Dor anterior fundoplication as a gastric fundoplasty to close the defect. The total operative time was 70 minutes. RESULTS: The patient's recovery was complicated by a lower respiratory tract infection but he was discharged 14 days after surgery with a premorbid oral intake and activity level. CONCLUSIONS: We believe this curtain gastroplasty technique represents another surgical option to reduce operative time and trauma in a subgroup of high risk patients presenting with life threatening complications of a large hiatus hernia who have limited physiological reserve and evidence of current ongoing sepsis.

Short report. How provincial and territorial legislators view tobacco and tobacco control: findings from a Canadian study.

We report on legislators' attitudes and experiences regarding tobacco and tobacco control using findings from a 1996/97 telephone survey of provincial and territorial legislators in Canada. Across all jurisdictions, legislators showed support for a number of tobacco control policies and for a major government role in implementing programs and policies to discourage youth from smoking. Further, substantial numbers of legislators indicated they did not have enough tobacco-related contact with medical and non-profit health organizations. These findings can guide the activities of health agencies, researchers and advocates in support of effective strategies to reduce the public health impact of tobacco use in Canada.