Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data.

INTRODUCTION: In response to detonation of an improvised explosive device at the Manchester Arena on 22 May 2017, we aimed to use detailed information about injured patients flowing through hospital healthcare to objectively evaluate the preplanned responses of a regional trauma care system and to show how routinely collected hospital performance data can be used to assess impact on regional healthcare. METHODS: Data about injury severity, management and outcome for patients presenting to hospitals were collated using England's major trauma registry for 30 days following hospital attendance. System-wide data about hospital performance were collated by National Health Service England's North West Utilisation Management Unit and presented as Shewhart charts from 15 April 2017 to 25 June 2017. RESULTS: Detailed information was obtained on 153 patients (109 adults and 44 children) who attended hospital emergency departments after the incident. Within 6 hours, a network of 11 regional trauma care hospitals received a total of 138 patients (90%). For the whole patient cohort, median Injury Severity Score (ISS) was 1 (IQR 1-10) and median New ISS (NISS) was 2 (IQR 1-14). For the 75 patients (49%) attending a major trauma centre, median ISS was 7.5 (IQR 1-14) and NISS was 10 (IQR 3-22). Limb and torso body regions predominated when injuries were classified as major life threatening (Abbreviated Injury Scale>3). Ninety-three patients (61%) required hospital admission following emergency department management, with 21 (14%) requiring emergency damage control surgery and 24 (16%) requiring critical care. Three fatalities occurred during early resuscitative treatment and 150 (98%) survived to day 30. The increased system-wide hospital admissions and care activity was linked to increases in regional hospital care capacity through cancellations of elective surgery and increased community care. Consequently, there were sustained system-wide hospital service improvements over the following weeks. CONCLUSIONS: The systematic collation of injured patient and healthcare system data has provided an objective evaluation of a regional major incident plan and provided insight into healthcare system resilience. Hospital patient care data indicated that a prerehearsed patient dispersal plan at incident scene was implemented effectively.

Managerial behavior of sports facilities managers: an approach with public and non-profit organizations in São Paulo

Abstract Aim: The sports facilities development and use optimization has been one of the main objectives of sports organizations. To understand how the management is performed, the knowledge about the manager and his function is crucial and may aid to improve facilities management and impact service quality. This study aimed to analyze the functional profile of sport facilities managers and verify their managerial behavior. Methods: A survey was conducted, 76 managers of public and non-profit sports facilities of São Paulo answering a questionnaire regarding their personal data and tasks performed in five related areas (Economic-Administrative Management, Human Resources Management, Maintenance, Supply and Exploration, and Marketing and Promotion). The data was analyzed through an Exploratory Factorial Analysis using the principal component method. Results: The low participation of managers in tasks related to the Economic-Administrative Management area was identified. The manager's other areas of activity had their tasks divided into the following factors: Human Resources (Work organization; Communication and Training); Maintenance (Maintenance and monitoring; Expansion, Construction, and Renovation); Supply and Exploration (Activities Organization; Activity Planning for Groups; Assignment and organization of use); Marketing (Communication, supply and demand analysis; Operation and occupation analysis). Conclusion: There is no standard managerial behavior of sport facilities managers since their performance is not focused on the proactive or non-proactive characteristic of the task, but rather on the field that the organization and/or manager deems necessary to be planned and developed.

Geographic Information System as an aid instrument for public policies and management of sports facilities and programs

Abstract Aims: This paper sought to evaluate the infrastructure of public swimming pools in a countryside municipality of the state of São Paulo and to present the Geographic Information System (GIS) as a tool capable of assisting in the management of sports facilities and programs. Methods: This is a descriptive study since it intends to expose the characteristics of a certain context. First, documentary research was performed to map the facilities and their respective projects. After that, a field survey was conducted seeking to evaluate the infrastructure of public pools and their surroundings through observation. Lastly, using georeferencing software, the population, and socioeconomic data around these pools were obtained and analyzed. Results: It was identified ten public swimming pools, and in seven the offer of swimming projects was foreseen. The infrastructure of the pools is mainly unsatisfactory, making necessary the improvement of the installation itself and in its surroundings. According to the results of the GIS, each pool has its specific public target concerning the characteristics of the profile of the residents surrounding these facilities. Conclusion: Information regarding the public profile around sports facilities generated from a tool such as GIS showed it is possible to determine which sports projects should be prioritized in each facility, leading to improvement in the management of sports-related public policies.

Strategies for coaches' development in a football club: a learning organization

Abstract Aim: The aim of this study was to identify the strategies adopted in a football club to support coaches' development. Methods: Eight coaches and four technical coordinators from a Brazilian elite club participated. After transcribing data from semi-structured interviews with coaches and technical coordinators, they were analyzed using the QSR Nvivo 9.2 software. Results: Three support schemes and their respective pillars of action were identified: a) Mentoring and meeting - Assistance among coaches, discussions with coaching staff, and free theme meetings; b) Incentive for continuing education; c) Club Pillars - Club goals, continuity of coaches, evaluation of coaches. Conclusion: Data allowed us to identify the important contributions of this Club in continued ongoing coach development. Moreover, we may characterize the Club as an authentic learning organization due to the promotion of a safe work environment that stimulates coaches' engagement in the Club's organizational culture and enables adequate communication and the constant update through courses and meetings.

Exploring the effects of deep-defending vs high-press on footballers' tactical behaviour, physical and physiological performance: A pilot study

Abstract AIMS The aim of this study was to explore the effects of a deep-defending vs high-press defending strategy on footballers' tactical behaviour, physical and physiological responses, when in numerical difference. METHODS Nineteen elite professional footballers (outfield players) participated in this study, playing an 11vs10 match (simulating an early dismissal) for two halves of 10 minutes on a full-sized regulation pitch. The 11-men team was instructed by the head coach to defend closer to goal in the first half (deep-defending) and then defend higher up the pitch in the second half (high-press). Players' positional data were used to calculate the distance between team centroids, players' distance to own and to opponent centroid, teams' effective playing space (EPS), teams' length per width ratio, distance covered and player velocity. Heart rate was measured via short-range radio telemetry. RESULTS Relative-phase analysis of teams' EPS showed 61.6% of anti-phase synchronisation pattern (i.e. the values change in opposite directions) in the deep-defending game. In the high-press game, teams' centroid distances were closer (% difference in means; ±90% CL, -21.0%; ±9.5%), while players' distances to own and opponent centroids were 20% more regular. Distance covered (-19.8%; ±2.5%), player velocity (-20.0%; ±2.5%) and heart rates also decreased in the high-press game. CONCLUSION These findings suggest that, adopting a high-press defending strategy can elicit closer centroid distances, more regular movement patterns, decreased synchronisation patterns of EPS, lower distance covered, lower player velocity, and lower heart rates. Coaches may also consider adopting a high-press strategy, when in numerical superiority, to decrease players' physical and physiological demands.

Smokefree signage at New Zealand racecourses and sports facilities with outdoor stands.

Smokefree signage is crucial to the implementation of smokefree policies for outdoor venues and for facilitating smoking denormalisation. Such signage helps to communicate the expected norms for not smoking at venues. Therefore, we aimed to identify such signage at racecourses and sports facilities that had outdoor stands. We surveyed the entrances of 25 racecourse and 25 sport facilities with outdoor stands, across New Zealand. There were smokefree signs at the main entrances of 40% of the sports facilities with outdoor stands, and at 16% of the 25 other entrances. None of the horse/greyhound racecourses had smokefree signage at any of their entrances.