Curso teórico online de primeiros socorros na escola: percepção dos professores da educação básica / In-school first aid online theoretical course: perception of basic education teachers

Introdução: Na escola os acidentes normalmente são testemunhados pelo professor, que é a figura responsável pelas crianças e adolescentes. Embora a literatura indique a relevância dos cursos em primeiros socorros, torna-se necessário entender a visão dos cursistas, como protagonistas do processo de aprendizagem, para adequar as ações formativas e as tecnologias utilizadas, uma vez que a educação em saúde pode reduzir drasticamente as taxas de lesões não intencionais. Objetivo: Conhecer as percepções dos professores de uma escola de educação básica privada a respeito do curso online de fundamentos teóricos de primeiros-socorros. Método: Trata-se de um estudo qualitativo e descritivo. O estudo foi realizado em um centro de educação básica privado do Sul de Minas Gerais, Brasil. A coleta de dados ocorreu entre os meses de janeiro a março de 2022. A população de estudo foi constituída por dez professores, que realizaram o curso de extensão online ''Fundamentos teóricos de primeiros-socorros na escola''. A coleta de dados foi realizada por meio de entrevista semiestruturada, mediada por tecnologia remota e a análise foi feita por meio da Análise Temática. Resultados: O trabalho interpretativo resultou em dois temas e um subtema respectivamente: ''Primeiros socorros como um novo objeto para os professores da educação básica''; ''Contribuições do curso online: novas aprendizagens em primeiros socorros''; ''A falta de aulas práticas como limite da estratégia de ensino''. Conclusão: O curso online despontou-se como recurso útil para capacitação de professores em primeiros socorros, amplia o conhecimento e abre um campo para reflexão sobre a segurança do ambiente escolar. Contudo, a ausência de conteúdo prático é apontada como um limite da estratégia, porque não oportuniza o desenvolvimento das habilidades psicomotoras.

Introducción: En la escuela, los accidentes suelen ser presenciados por la persona docente, quien es el responsable de la persona menor de edad. Aunque la literatura indica la relevancia de los cursos de primeros auxilios, es necesario comprender la visión de quienes participan del curso. Al ser protagonistas del proceso de aprendizaje, se deben adaptar las acciones de formación y las tecnologías utilizadas, ya que la educación en salud puede reducir drásticamente las tasas de lesiones no intencionales. Objetivo: Conocer las percepciones del cuerpo docente de una escuela privada de educación básica sobre el curso en línea de fundamentos teóricos de primeros auxilios. Metodología: Se trata de un estudio cualitativo y descriptivo que se llevó a cabo en un centro privado de educación básica en el sur de Minas Gerais, Brasil. La recopilación de datos tuvo lugar de enero a marzo de 2022. La población de estudio estuvo constituida por diez docentes, que participaron del curso de extensión en línea ''Fundamentos teóricos de los primeros auxilios en la escuela''. La recolección de datos se realizó a través de una entrevista semiestructurada, mediada por tecnología remota y el análisis de los datos se llevó a cabo mediante análisis temático. Resultados: El trabajo interpretativo resultó en dos temas y un subtema respectivamente: ''Los primeros auxilios como objeto nuevo para los docentes de educación básica'', ''Aportes del curso en línea: nuevos aprendizajes en primeros auxilios''y ''La falta de clases prácticas como límite de la estrategia docente''. Conclusión: El curso en línea surgió como un recurso útil para la capacitación de profesores en primeros auxilios, ampliando el conocimiento y abriendo un campo para la reflexión sobre la seguridad escolar. Sin embargo, la falta de contenido práctico se señala como una limitación de la estrategia, ya que no ofrece oportunidades para el desarrollo de habilidades psicomotoras.

Introduction: At school, accidents are often witnessed by the teacher, who is responsible for the children and adolescents. Although the literature indicates the relevance of first aid courses, it is necessary to understand the perceptions of course participants, as the protagonists in this learning process, to adapt the training actions and the technologies used, since health education can drastically reduce unintentional injury rates. Objective: To understand the teacher perceptions in a private elementary school regarding the online course on first aid theoretical fundamentals. Methods: This is a qualitative and descriptive study that was developed in a private elementary school in the south of Minas Gerais, Brazil. the data collection was from January to March 2022. The study population consisted of ten teachers, who participated in the online extension course ''Theoretical Fundamentals of first aid in schools''. The data collection was done through a semi-structured interview, mediated by remote technology, and the information was analyzed using Thematic Analysis. Results: The analysis resulted in two themes and a subtheme respectively: ''First aid as a new topic for elementary school teachers''; ''Contributions of the online course: new learning in first aid''and ''The lack of practical classes as a limitation of the teaching strategy''. Conclusion: The online course has emerged as a useful resource for training teachers in first aid, expanding knowledge, and disclosing a field for reflection on school safety. However, the lack of practical content is identified as a limitation of the strategy, as it does not provide opportunities for the development of psychomotor skills.

Metodologias educativas na aprendizagem de primeiros socorros em escolas: Revisão de Escopo / Educational methodologies in learning first aid in schools: scope review / Metodologías educativas en el aprendizaje de los primeros auxilios en la escuela: revisión del alcance

Objetivo: descrever as metodologias educativas e seus resultados no ensino de primeiros socorros para professores e estudantes do Ensino Fundamental. Método: revisão de escopo com artigos publicados em português, inglês ou espanhol. Incluíram-se artigos originais, artigos de revisão e relatos de experiência sobre metodologias de ensino-aprendizagem em primeiros socorros. A revisão abrangeu 21 estudos publicados entre os anos de 2015 e 2020. Resultados: abordagens educativas tradicionais do tipo treinamento teórico-prático predominaram; entretanto, como mais efetivas, foram apontadas as metodologias que oportunizam a participação ativa dos educandos na construção dos cenários e desafios de aprendizagem. As competências para educação em primeiros socorros demandam domínio de habilidades, conhecimentos e atitudes, podendo ser desenvolvidas por leigos (professores e estudantes), desde que eles recebam o devido treinamento. Aplicação pré e pós-teste foi o recurso utilizado para aferir os resultados da relação ensino-aprendizagem, com expressiva variabilidade quanto aos critérios amostrais e temporais. Conclusão: independente da metodologia educativa e do método avaliativo utilizados, a aprendizagem de primeiros socorros nas escolas produz impacto positivo na autoeficácia das respostas às situações de emergência, tanto para estudantes quanto para professores. O ensino deve ser estimulado no ambiente escolar, de acordo com as especificidades de faixa etária e com periodicidade anual.(AU)

Objective: to describe educational methodologies and their results in teaching first aid to elementary school teachers and students. Method: scoping review with articles published in Portuguese, English or Spanish. Original articles, review articles and experience reports on teaching-learning methodologies in first aid were included. The review covered 21 studies published between 2015 and 2020. Results: traditional educational approaches of the theoretical-practical training type predominated; however, as more effective, methodologies that provide the active participation of students in the construction of learning scenarios and challenges were highlighted. Competencies for first aid education require mastery of skills, knowledge, and attitudes, and can be developed by lay people (teachers and students) if they receive the appropriate training. Pre- and post-test application was the resource used to assess the results of the teaching-learning relationship, with significant variability in terms of sampling and temporal criteria. Conclusion: regardless of the educational methodology and evaluation method used, learning first aid in schools has a positive impact on self-efficacy in responding to emergency situations, both for students and teachers. Teaching must be encouraged in the school environment, according to the specificities of the age group and on an annual basis.(AU)

Objetivo: describir metodologías educativas y sus resultados en la enseñanza de primeros auxilios a profesores y alumnos de enseñanza primaria. Método: revisión exploratoria con artículos publicados en portugués, inglés o español. Se incluyeron artículos originales, artículos de revisión e informes de experiencias sobre metodologías de enseñanza-aprendizaje en primeros auxilios. Resultados: la revisión abarcó 21 estudios publicados entre 2015 y 2020. Predominaron los enfoques educativos tradicionales de tipo formativo teórico-práctico, sin embargo, las metodologías que brindan oportunidades para la participación activa de los estudiantes en la construcción de escenarios y desafíos de aprendizaje fueron señaladas como las más efectivas. Las competencias para la enseñanza de primeros auxilios exigen el dominio de habilidades, conocimientos y actitudes, y pueden ser desarrolladas por personas legas (profesores y alumnos), siempre que estén debidamente cualificadas. La aplicación de pre y postest fue el recurso utilizado para evaluar los resultados de la relación enseñanza-aprendizaje, con variabilidad significativa en cuanto a los criterios de muestra y tiempo. Conclusión: independientemente de la metodología educativa y del método de evaluación utilizados, el aprendizaje de primeros auxilios en la escuela tiene un impacto positivo en la autoeficacia para responder a situaciones de emergencia, tanto para los alumnos como para los profesores. La enseñanza debe estimularse en el medio escolar de acuerdo con las especificidades del grupo de edad, con periodicidad anual.(AU)

Epistaxis first-aid management: a needs assessment among healthcare providers.

PURPOSE: To perform a needs assessment of epistaxis first-aid measures practiced by family physicians and Emergency Department (ED) staff in London, Ontario, Canada. METHODS: Paper-based multiple-choice questionnaires were distributed to participants. Participant recruitment was conducted in two parts: 1) 28 Emergency Medicine (EM) attending physicians, 21 resident physicians training in the ED, and 26 ED nurses were surveyed while on duty in the ED; 2) 27 family physicians providing walk-in or urgent care and attending a continuing medical education (CME) event were also surveyed. Respondents were asked to identify where to apply compression to the nose and how patients should be positioned during acute epistaxis. RESULTS: Regarding where to apply compression, 19% of family physicians, 43% of EM physicians, 24% of residents, and 8% of ED nurses responded correctly. Regarding positioning, all groups responded similarly with 54-62% responding correctly. Twenty-one percent of emergency physicians, 19% of residents, 11% of family physicians, and 4% of nurses responded correctly to both questions. CONCLUSIONS: Most family physicians, EM attending physicians, ED nurses, and residents could not correctly identify basic first-aid measures for acute epistaxis. This study identifies an area where knowledge is lacking and the potential for improvement in patient management and education.

The Safety and Feasibility of a Family First Aid Approach for the Management of Postpartum Hemorrhage in Home Births: A Pre-post Intervention Study in Rural Pakistan.

OBJECTIVE: To evaluate the safety and feasibility of a Family First Aid approach whereby women and their families are provided misoprostol in advance to manage postpartum hemorrhage (PPH) in home births. METHODS: A 12-month prospective, pre-post intervention study was conducted from February 2017 to February 2018. Women in their second and third trimesters were enrolled at home visits. Participants and their families received educational materials and were counseled on how to diagnose excessive bleeding and the importance of seeking care at a facility if PPH occurs. In the intervention phase, participants were also given misoprostol and counselled on how to administer the four 200 mcg tablets for first aid in case of PPH. Participants were followed-up postpartum to collect data on use of misoprostol for Family First Aid at home deliveries (primary outcome) and record maternal and perinatal outcomes. RESULTS: Of the 4008 participants enrolled, 97% were successfully followed-up postpartum. Half of the participants in each phase delivered at home. Among home deliveries, the odds of reporting PPH almost doubled among in the intervention phase (OR 1.98; CI 1.43, 2.76). Among those reporting PPH, women in the intervention phase were significantly more likely to have received PPH treatment (OR 10.49; CI 3.37, 32.71) and 90% administered the dose correctly. No maternal deaths, invasive procedures or surgery were reported in either phase after home deliveries. CONCLUSIONS: The Family First Aid approach is a safe and feasible model of care that provides timely PPH treatment to women delivering at home in rural communities.

Conhecimento dos agentes comunitários de saúde sobre trauma de extremidades / Knowledge of community health agents on extremities trauma / Conocimiento de agentes de salud comunitarios en trauma de extremidades

Objetivo: caracterizar o conhecimento dos agentes comunitários de saúde sobre trauma de extremidades. Método: trata-se de um estudo quantitativo, descritivo, realizado a partir do banco de dados da pesquisa intitulada "conhecimento de agentes comunitários de saúde sobre atendimento pré-hospitalar no suporte básico de vida - impacto das ações de extensão". os dados foram coletados por meio de questionário. a amostra foi composta por 15 agentes comunitários de saúde de uma unidade de saúde da família integrada em João Pessoa, paraíba, brasil. analisaram-se os dados por meio de estatística descritiva e foram apresentados os resultados em tabelas. Resultados: observa-se que a média de acertos no pós-teste sobre conhecimento no trauma de extremidades foi de 69,3%. Conclusão: evidenciou-se que o conhecimento dos agentes comunitários de saúde sobre traumas de extremidades, teve um aumento significativo após as intervenções educativas

Objective: to characterize the knowledge of community health agents about trauma to the extremities. Method: this is a quantitative, descriptive study, carried out from the research database titled "knowledge of community health agents on pre-hospital care in basic life support-impact of extension actions". data were collected through a questionnaire. the sample consisted of 15 community health agents from a integrated family health unit in João Pessoa, Paraíba, Brazil. data were analyzed using descriptive statistics and the results were presented in tables. Results: it was observed that the average of post-test hits in knowledge of extremity trauma was 69.3%. Conclusion: it was evidenced that the knowledge of community health agents on trauma of the extremities, had a significant increase after the educational interventions

Objetivo: caracterizar el conocimiento de los agentes de salud de la comunidad sobre trauma en las extremidades. Método: se trata de un estudio cuantitativo y descriptivo, realizado a partir de la base de datos de investigación titulada "conocimiento de los agentes sanitarios comunitarios sobre la atención prehospitalaria en las acciones básicas de apoyo a la vida-impacto de las acciones de extensión". los datos se recopilaron a través de un cuestionario. la muestra consistió en 15 agentes de salud comunitarios de una unidad integrada de salud familiar en joao pessoa, paraíba, brasil. los datos se analizaron utilizando estadísticas descriptivas y los resultados se presentaron en tablas. Resultados: se observó que el promedio de aciertos posteriores a la prueba en el conocimiento del trauma en las extremidades fue del 69,3%. Conclusión: se evidenizó que el conocimiento de los agentes de salud comunitarios sobre trauma de las extremidades, tuvo un aumento significativo después de las intervenciones educativas

Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football March 2-3, 2019; Atlanta, GA.

Sport-related spine injury can be devastating and have long-lasting effects on athletes and their families. Providing evidence-based care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidence-based medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations.

Prehospital plasma in injured patients is associated with survival principally in blunt injury: Results from two randomized prehospital plasma trials.

INTRODUCTION: Recent evidence demonstrated that prehospital plasma in patients at risk of hemorrhagic shock was safe for ground transport and resulted in a 28-day survival benefit for air medical transport patients. Whether any beneficial effect of prehospital plasma varies across injury mechanism remains unknown. METHODS: We performed a secondary analysis using a harmonized data set derived from two recent prehospital plasma randomized trials. Identical inclusion/exclusion criteria and primary/secondary outcomes were used for the trials. Prehospital time, arrival shock parameters, and 24-hour transfusion requirements were compared across plasma and control groups stratified by mechanism of injury. Stratified survival analysis and Cox hazard regression were performed to determine the independent survival benefits of plasma across blunt and penetrating injury. RESULTS: Blunt patients had higher injury severity, were older, and had a lower Glasgow Coma Scale. Arrival indices of shock and coagulation parameters were similar across blunt and penetrating injury. The percentage of patients with a prehospital time less than 20 minutes was significantly higher for penetrating patients relative to blunt injured patients (28.0% vs. 11.6%, p < 0.01). Stratified Kaplan-Meier curves demonstrated a significant separation for blunt injured patients (n = 465, p = 0.01) with no separation demonstrated for penetrating injured patients (n = 161, p = 0.60) Stratified Cox hazard regression verified, after controlling for all important confounders, that prehospital plasma was associated with a 32% lower independent hazard for 28-day mortality in blunt injured patients (hazard ratio, 0.68; 95% confidence interval, 0.47-0.96; p = 0.03) with no independent survival benefit found in penetrating patients (hazard ratio, 1.16; 95% confidence interval, 0.4-3.1; p = 0.78). CONCLUSION: A survival benefit associated with prehospital plasma at 24 hours and 28 days exists primarily in blunt injured patients with no benefit shown in penetrating trauma patients. No detrimental effects attributable to plasma are demonstrated in penetrating injury. These results have important relevance to military and civilian trauma systems. LEVEL OF EVIDENCE: Therapeutic, I.

Stop the bleed: The impact of trauma first aid kits on post-training confidence among community members and medical professionals.

INTRODUCTION: Bystander training to control life-threatening hemorrhage is an important intervention to decrease preventable trauma deaths. We asked if receiving a trauma first aid (TFA) kit in addition to Bleeding Control (BC) 1.0 training improves self-reported confidence among community members (CM) and medical professionals (MP). METHODS: Anonymous pre- and post-course surveys assessed exposure to severe bleeding, BC knowledge, and willingness to intervene with and without TFA kits. Surveys were compared using chi-squared tests. RESULTS: 80 CM and 60 MP underwent BC training. Both groups demonstrated improved confidence in their ability to stop severe bleeding after the class; however, post-class confidence was significantly modified by receiving a TFA kit. After training, CM confidence was 36.1% without versus 57.0% with a TFA kit(p = 0.008) and MP confidence was 53.8% without versus 87.6% with a TFA kit(p = 0.001). CONCLUSION: Receiving a TFA kit was significantly associated with increased post-training confidence among CM and MP. SUMMARY: Stop the Bleed training improves confidence in stopping severe bleeding among both medical professionals and community members. By providing participants with a trauma first aid kit, post-class confidence improves significantly regardless of medical training.

Severity of hemorrhage and the survival benefit associated with plasma: Results from a randomized prehospital plasma trial.

BACKGROUND: Recent randomized clinical trial evidence demonstrated a survival benefit with the use of prehospital plasma in patients at risk of hemorrhagic shock. We sought to characterize the survival benefit associated with prehospital plasma relative to the blood transfusion volume over the initial 24 hours. We hypothesized that the beneficial effects of prehospital plasma would be most robust in those with higher severity of hemorrhage. METHODS: We performed a prespecified secondary analysis using data derived from a prospective randomized prehospital plasma trial. Blood component transfusion volumes were recorded over the initial 24 hours. Massive transfusion (MT) was defined a priori as receiving ≥10 units of red cells in 24 hours. We characterized the 30-day survival benefit of prehospital plasma and the need for MT and overall 24-hour red cell transfusion volume utilizing Kaplan-Meier survival analysis and Cox proportional hazard regression. RESULTS: There were 501 patients included in this analysis with 230 randomized to prehospital plasma with 104 patients requiring MT. Mortality in patients who received MT were higher compared with those that did not (MT vs. NO-MT, 42% vs. 26%, p = 0.001). Kaplan-Meier survival curves demonstrated early separation in the NO-MT subgroup (log rank p = 0.008) with no survival benefit found in the MT group (log rank p = 0.949). Cox regression analysis verified these findings. When 24-hour red cell transfusion was divided into quartiles, there was a significant independent association with 30-day survival in patients who received 4 to 7 units (hazard ratio, 0.33, 95% confidence interval, 0.14-0.80, p = 0.013). CONCLUSION: The survival benefits of prehospital plasma was demonstrated only in patients with red cell requirements below the transfusion level of MT. Patients who received 4 to 7 units of red cells demonstrated the most robust independent survival benefit attributable to prehospital plasma transfusion. Prehospital plasma may be most beneficial in those patients with moderate transfusion requirements and mortality risk. LEVEL OF EVIDENCE: Therapeutic, Level I.

Use of ketamine for prehospital pain control on the battlefield: A systematic review.

BACKGROUND: Intravenous ketamine is commonly used for pain management in the civilian prehospital setting. Several studies have evaluated its effectiveness in the military setting. To date, there has been no report reviewing the published data on the use of ketamine in this context. The objective of this systematic review was to analyze the content and quality of published data on the use of ketamine for prehospital pain management in military trauma. METHODS: The MEDLINE database was searched for studies on ketamine use in combat prehospital settings, at point of injury or during evacuation, published between 2000 and 2019. The systematic review was conducted following PRISMA guidelines, and the protocol was registered on PROSPERO (CRD42019115728). Civilian reports and case series lacking systematic data collection were excluded. RESULTS: Eight studies were included with 2029 casualties receiving ketamine. All but one were American reports from Afghanistan and Iraq conflicts. Studies implied retrospective cohorts or prospective observational analysis. Ketamine use rose from 3.9% during the period preceding its addition to the Tactical Combat Casualty Care guidelines in 2012 to 19.8% thereafter. It was the most common analgesic administered (up to 52% of casualties) in one of the studies. Ketamine was more likely given during tactical medical evacuation when no analgesic was provided at the point of injury. The median total intravenous dose was 50 mg. Pain intensity decreased from moderate or severe to mild or none, sometimes after only one dose. In one study, ketamine administration during tactical evacuation was associated with increased systolic blood pressure as opposed to morphine. Incoherent speech, extremity movements, and hallucinations were the main adverse events reported. CONCLUSION: Published data on ketamine use in military trauma are rare and heterogeneous. Though, all studies tend to strengthen the belief in the efficacy and safety of ketamine when given at 50-mg to 100-mg intravenous for prehospital analgesia in combat casualties. LEVEL OF EVIDENCE: Systematic Review, Level IV.

Atualização do atendimento do paciente em parada cardiorrespiratória: O que todo clínico deve saber? / Update of medical care in cardiorespiratory arrest: What should every clinician know?

O objetivo deste estudo foi apresentar uma revisão narrativa do atendimento à parada cardiorrespiratória, baseada nas diretrizes mais atuais e, também, uma análise crítica de informações de literatura recente, que vão além das recomendações gerais das diretrizes vigentes. A parada cardiorrespiratória, quando ocorre de forma inesperada, abrupta, em indivíduo que se encontrava estável horas antes do evento, é chamada de morte súbita. Essa condição é a principal causa de óbito extra-hospitalar não traumático e, dentre suas diversas causas, a síndrome coronariana aguda é a mais comum em adultos. Uma vez que a frequência de síndrome coronariana aguda tende a aumentar com o aumento da expectativa de vida e de prevalência de outros fatores de risco na população, a ocorrência de morte súbita também tende a aumentar nesse cenário. No intuito de orientar o atendimento de pacientes em parada cardiorrespiratória, há mais de quatro décadas foram criadas diretrizes internacionais, que evoluíram com o surgimento de novas evidências, especialmente nos últimos 20 anos. Todo médico deve estar preparado para atender uma situação de parada cardiorrespiratória, pois ele pode ser chamado para atender tais casos em diferentes cenários (emergência, unidade de internação ou em ambiente extra-hospitalar). Entretanto, apesar da importância da incorporação de novas evidências nessas diretrizes, mudanças frequentes nas recomendações representam grande desafio para os clínicos se manterem atualizados. Além da dificuldade na atualização permanente, há recomendações feitas pelas diretrizes de sociedades médicas que divergem entre si e são questionadas por especialistas, o que gera dúvida na tomada de decisão do clínico. Conforme pormenorizado neste artigo de atualização, as etapas do algoritmo de Suportes Básico e Avançado de Vida são apresentadas como uma sequência, para facilitar para o socorrista que atua sozinho a oferecer intervenções com impacto na sobrevivência do paciente, devendo priorizar a reanimação cardiopulmonar de qualidade e a desfibrilação precoce, se indicada.

The objective of this study was to present a narrative review of cardiac arrest care based on the most current guidelines, and also a critical analysis of recent literature information that goes beyond the general recommendations of the current guidelines. Cardiac arrest, when occurring unexpectedly, abruptly, in an individual who was stable hours before the event, is called sudden death. This condition is the leading cause of non-traumatic out-of-hospital death and, among its many causes, acute coronary syndrome is the most common in adults. Since the frequency of acute coronary syndrome tends to increase with increasing life expectancy and the prevalence of other risk factors in the population, sudden death also tends to increase in this scenario. In order to guide the care of patients with cardiopulmonary arrest, for over 4 decades, international guidelines have been created and have evolved with the emergence of new evidence, especially in the last 20 years. Every physician should be prepared to deal with a cardiac arrest situation as he or she may be called upon to treat such cases in different scenarios (emergency, inpatient unit or out-of-hospital setting). However, despite the importance of incorporating new evidence into these guidelines, frequent changes to the recommendations pose a major challenge for clinicians to update their knowledge. In addition to the difficulty of constantly updating, there are recommendations made by the guidelines of medical societies that differ from each other and are questioned by specialists, which creates doubt in the process of decision making among clinicians. As detailed in this update article, the stages of the algorithm of Basic and Advanced Life Support are presented in a sequence to help the rescuer who works alone to provide interventions that impact the patient's survival, and prioritize quality cardiopulmonary resuscitation and early defibrillation, if required.

Effect of first aid training on teams from special education schools / Efecto de la capacitación sobre primeros auxilios en accidentes para los equipos de escuelas de enseñanza especializada / Efeito de capacitação sobre primeiros socorros em acidentes para equipes de escolas de ensino especializado

ABSTRACT Objectives: Analyze the effect of first aid training on the knowledge of multidisciplinary teams from special education schools, in school accidents. Methods: A quasi-experimental, before-and-after study with a single comparison group. Descriptive statistics and McNemar's test were used to evaluate the effect of the intervention. Results: This study had the participation of 162 higher education professionals, predominantly teachers (82.1%), female (97.5%), aged over 40 (69.2%). An increase in correct answers was observed, with statistical significance (≤0.05), especially in proper handling in case of fall with traumatic brain injury, electric shock, and burn due to hot liquid (98.1%, 98.1% and 96.9% of proper response, respectively). Conclusions: First aid training for child accidents, through content exhibition, in a dialogical and practical way, proved to be efficient for multidisciplinary teams from special education schools for people with disabilities.

RESUMEN Objetivos: Evaluar el efecto de la capacitación sobre los primeros auxilios ante accidentes escolares en el conocimiento del equipo multidisciplinario de escuelas de enseñanza especializada. Métodos: Estudio cuasiexperimental con análisis antes y después de un único grupo de comparación. Se realizaron la estadística descriptiva y la prueba de McNemar para evaluar el efecto de la intervención. Resultados: Participaron 162 profesionales de nivel superior, principalmente profesores (82,1%). El sexo y el grupo de edad predominantes fueron el femenino (97,5%) y la edad superior a 40 años (69,2%). Se observó un incremento de aciertos con significancia estadística en todas las cuestiones abordadas (≤ 0,05). Se destacan el manejo correcto ante la caída con traumatismo craneal encefálico, el choque eléctrico y la quemadura por líquido caliente (con un 98,1%, un 98,1% y un 96,9% de aciertos, respectivamente). Conclusiones: La capacitación sobre primeros auxilios ante accidentes, por medio de exposición de contenido de forma dialogada y práctica, fue eficaz para el equipo multidisciplinario de escuelas de enseñanza especializada para personas con discapacidad.

RESUMO Objetivos: Analisar o efeito de uma capacitação no conhecimento da equipe multidisciplinar de escolas de ensino especializado sobre primeiros socorros diante de acidentes escolares. Métodos: Estudo quase experimental do tipo antes e depois com grupo único de comparação. Realizou-se estatística descritiva e teste de McNemar para avaliar o efeito da intervenção. Resultados: Participaram 162 profissionais de nível superior, predominantemente professores (82,1%). Sexo e faixa etária preponderante foram, respectivamente, feminino (97,5%) e idade acima de 40 anos (69,2%). Houve aumento de acerto em todas as questões abordadas com significância estatística (≤ 0,05). Destacam-se o correto manejo diante de queda com traumatismo craniano encefálico, choque elétrico e queimadura por líquido quente (respectivamente: 98,1%, 98,1% e 96,9% de acertos). Conclusões: A capacitação sobre primeiros socorros diante de acidentes, por meio de exposição de conteúdo de forma dialogada e prática, se mostrou eficiente para a equipe multidisciplinar de escolas de ensino especializado para pessoas com deficiência.

Human model of burn injury that quantifies the benefit of cooling as a first aid measure.

BACKGROUND: Burn injuries are a major cause of morbidity and mortality worldwide. Cooling is widely practised as a first aid measure, but the efficacy of cooling burns in human skin has not been demonstrated. A safe, consistent, ethically acceptable model of burning and cooling in live human skin in vivo was developed, and used to quantify the effects of cooling. METHODS: Novel apparatus was manufactured to create and cool burns in women who were anaesthetized for breast reconstruction surgery using a deep inferior epigastric artery perforator flap. Burns were excised between 1 and 3 h after creation, and analysed using histopathological assessment. RESULTS: All 25 women who were approached agreed to take part in the study. There were no adverse events. Increased duration of contact led to increased burn depth, with a contact time of 7·5 s at 70°C leading to a mid-dermal burn. Burn depth progressed over time following injury, but importantly this was modified by cooling the burn at 16°C for 20 min. On average, cooling salvaged 25·2 per cent of the dermal thickness. CONCLUSION: This study demonstrated the favourable effects of cooling on human burns. Public heath messaging should emphasize cooling as first aid for burns. This model will allow analysis of the molecular effects of cooling burns, and provide a platform for testing novel therapies aimed at reducing the impact of burn injury.

ANTECEDENTES: Las lesiones por quemadura son una causa importante de morbilidad y mortalidad en todo el mundo. El enfriamiento de las quemaduras se practica ampliamente como medida de primeros auxilios, pero no se ha demostrado su eficacia en la piel de los seres humanos. Para cuantificar los efectos del enfriamiento, se desarrolló un modelo de quemadura y enfriamiento en piel humana in vivo, seguro, estable y éticamente aceptable. MÉTODOS: Se construyó un dispositivo nuevo para crear y enfriar quemaduras en pacientes que fueron anestesiadas para una reconstrucción mamaria utilizando un colgajo perforante de la arteria epigástrica inferior profunda. Las quemaduras se extirparon entre una y tres horas después de su producción y se analizaron por evaluación histopatológica. Para determinar la significación estadística entre grupos se utilizó las pruebas de ANOVA o de t pareadas, según correspondiera. RESULTADOS: Aceptaron participar en el estudio las 25 pacientes a las que se propuso. No hubo efectos adversos. La mayor duración del contacto conllevó un aumento en la profundidad de la quemadura: con un tiempo de contacto de 7,5 segundos a 70°C se obtuvo una quemadura dérmica de segundo grado. La profundidad de la quemadura aumentó con el tiempo de exposición, pero mejoró de forma sustancial al enfriar la quemadura a 16°C durante 20 minutos. El enfriamiento salvó el 25% del espesor dérmico como promedio. CONCLUSIÓN: Este es el primer estudio que demuestra los efectos favorables del enfriamiento sobre las quemaduras humanas. Los consejos de salud deberían hacer más énfasis en el enfriamiento como forma de primeros auxilios en las quemaduras. Este modelo permitirá identificar los efectos moleculares del enfriamiento en las quemaduras y proporcionará una plataforma para probar nuevos tratamientos encaminados a reducir el impacto de las lesiones por quemadura.

The impact of first-aid dressing design on healing of porcine partial thickness wounds.

Literature describes that a well-maintained moist wound healing environment leads to faster healing by preventing scabbing and drying of the wound. A moist wound speeds healing by allowing for unimpeded movement of newly dividing epidermal cells in the wound. Contrary to what is described in literature and practiced by clinicians, first-aid dressings used at home by consumers advertise breathability and absorptivity as benefits. This manuscript examines the effects of dressing breathability and highly absorptive pads on healing and wound appearance in a porcine dermatome wound model, designed to mimic an abrasion injury. Partial thickness wounds were covered with an experimental silicone-polymer film dressing and various over-the-counter bandages for time frames ranging from 4 to 11 days. The progression of healing was quantified by histology and wound-size reduction measurements. The thickness and persistence of a scab or serocellular crust (SCC) over the injury was measured using both pixel density and optical coherence tomography to supplement visual observations, demonstrating new tools for quantification of SCC over wounds. The results of the experiments illustrate the impact of dressing features on the rate of wound reepithelialization and the formation of SCC. Both a low moisture vapor transmission rate (MVTR) and the absence of an absorptive layer were important in speeding wound healing. Surprisingly, use of a dressing with a low MVTR and a highly absorptive pad healed significantly more slowly than a comparative dressing with a low MVTR and no absorptive pad, even though both dressings had very little scab formation over the wound. This study shows that breathability and absorbency of dressings play independent roles in providing an optimal healing environment, and that these properties can vary widely among commercially available dressings.

[Chinese expert consensus on the clinical application of innovative first-aid resuscitation technology for traumatic shock in 2019].

OBJECTIVE: To promote the clinical treatment technical training and popularization of traumatic shock and cardiac arrest, Health Emergency Committee of Chinese Research Hospital Association, Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association, Cardiopulmonary Resuscitation Specialized Committee of Henan Hospital Association jointly established "Chinese expert consensus on the clinical application of innovative first-aid resuscitation technology for traumatic shock in 2019". This consensus has solved the problem of volume resuscitated gel mix and ratio in the emergency situation of pre-hospital transfusion and blood products unable to be used in traumatic shock. Hypertonic gel compound liquid can treat traumatic shock with small dosage and good effect of stabilizing blood pressure, which can replace whole blood and other blood products, improve the safety of transport to hospital, and provide an opportunity for life-saving surgery. At the same time, abdominal lifting and compression cardiopulmonary resuscitation (CPR) has solved the difficulty of treating patients with post-traumatic cardiac arrest who cannot perform traditional chest compressive CPR, and greatly improved the success rate of pre-hospital treatment for patients with traumatic shock. In view of the actual demand of emergency medical treatment in China and the contraband of chest CPR for chest trauma, the combination of "administration, production, study, research and application" was adopted, and the abdominal lifting and compression CPR was successfully developed and popularized. This expert consensus summarized the scientific evidence on traumatic shock and traumatic cardiac arrest published at home and abroad so far, and put forward the expert consensus on the clinical application of innovative first-aid resuscitation technology for traumatic shock based on Chinese national conditions. This consensus incorporated the wisdom and philosophy of Chinese and foreign scholars in the training of traumatic shock and CPR, and would certainly make the training of traumatic shock and cardiac arrest in China entering a new stage with strong pertinence, quick onset, few side effects and high treatment rate.

Bringing Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Closer to the Point of Injury.

BACKGROUND: The management of noncompressible torso hemorrhage remains a significant issue at the point of injury. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used in the hospital to control bleeding and bridge patients to definitive surgery. Smaller delivery systems and wirefree devices may be used more easily at the point of injury by nonphysician providers. We investigated whether independent duty military medical technicians (IDMTs) could learn and perform REBOA correctly and rapidly as assessed by simulation. METHODS: US Air Force IDMTs without prior endovascular experience were included. All participants received didactic instruction and evaluation of technical skills. Procedural times and pretest/posttest examinations were administered after completion of all trials. The Likert scale was used to subjectively assess confidence before and after instruction. RESULTS: Eleven IDMTs were enrolled. There was a significant decrease in procedural times from trials 1 to 6. Overall procedural time (± standard deviation) decreased from 147.7 ± 27.4 seconds to 64 ± 8.9 seconds (ρ < .001). There was a mean improvement of 83.7 ± 24.6 seconds from the first to sixth trial (ρ < .001). All participants demonstrated correct placement of the sheath, measurement and placement of the catheter, and inflation of the balloon throughout all trials (100%). There was significant improvement in comprehension and knowledge between the pretest and posttest; average performance improved significantly from 36.4.6% ± 12.3% to 71.1% ± 8.5% (ρ < .001). Subjectively, all 11 participants noted significant improvement in confidence from 1.2 to 4.1 out of 5 on the Likert scale (ρ < .001). CONCLUSION: Technology for aortic occlusion has advanced to provide smaller, wirefree devices, making field deployment more feasible. IDMTs can learn the steps required for REBOA and perform the procedure accurately and rapidly, as assessed by simulation. Arterial access is a challenge in the ability to perform REBOA and should be a focus of further training to promote this procedure closer to the point of injury.

Feasibility and Proposed Training Pathway for Austere Application of Resuscitative Balloon Occlusion of the Aorta.

BACKGROUND: Noncompressible junctional and truncal hemorrhage remains a significant cause of combat casualty death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective treatment for many junctional and noncompressible hemorrhages. The current hospital standard for time of placement of REBOA is approximately 6 minutes. This study examined the training process and the ability of nonsurgical physicians to apply REBOA therapy in an austere field environment. METHODS: This was a skill acquisition and feasibility study. The participants for this experiment were two board-certified military emergency medicine physicians with no prior endovascular surgery exposure. Both providers attended two nationally recognized REBOA courses for training. A perfused cadaver model was developed for the study. Each provider then performed REBOA during different phases of prehospital care. Time points were recorded for each procedure. RESULTS: There were 28 REBOA catheter placement attempts in 14 perfused cadaver models in the nonhospital setting: eight placements in a field setting, eight placements in a static ambulance, four placements in a moving ambulance, and eight placements inflight on a UH-60 aircraft. No statistically significant differences with regard to balloon inflation time were found between the two providers, the side where the catheter was placed, or individual cadaver models. Successful placement was accomplished in 85.7% of the models. Percutaneous access was successful 53.6% of the time. The overall average time for REBOA placement was 543 seconds (i.e., approximately 9 minutes; median, 439 seconds; 95% confidence interval [CI], 429-657) and the average placement time for percutaneous catheters was 376 seconds (i.e., 6.3 minutes; 95% CI, 311-44 seconds) versus those requiring vascular cutdown (821 seconds; 95% CI, 655-986). Importantly, the time from the decision to convert to open cutdown until REBOA placement was 455 seconds (95% CI, 285-625). CONCLUSION: This study demonstrated that, with proper training, nonsurgical providers can properly place REBOA catheters in austere prehospital settings at speeds.

Teachers' experiences about first aid at school / Vivencias de profesores acerca de los primeros auxilios en la escuela / Vivências de professores acerca dos primeiros socorros na escola

ABSTRACT Objective: To unveil the experiences of primary and elementary school teachers about first aid at school. Method: a descriptive, qualitative study, conducted in May 2014, from a focus group with nine teachers from the municipal network of Bom Jesus-PI. Audio recording occurred, content was transcribed, and data were processed by IRAMUTEQ software and analyzed from the Descendant Hierarchical Classification. Results: Three classes were obtained: Teachers' knowledge about first aid (influence of maternal experience, belief in popular myths and awareness of lack of preparation were indicated); Feelings in situations of urgency and emergency (anguish, fear and concern); First aid at school, (occurring in class or during break time, coming from collisions and syncope). Final considerations: The research evidenced experiences based on popular beliefs, family experiences and knowledge gaps. The lack of preparation was evidenced by the teachers' reports about having misconduct during first aid at school.

RESUMEN Objetivo: desvelar las vivencias de profesores de la enseñanza infantil y fundamental sobre primeros auxilios en la escuela. Método: estudio descriptivo, cualitativo realizado en mayo de 2014, a partir de un grupo focal con nueve profesores de la red municipal de Bom Jesús-PI. La grabación de audio, el contenido fue transcrito, los datos fueron procesados en el software IRAMUTEQ y analizados a partir de la Clasificación jerárquica descendente. Resultados: se obtuvieron tres clases: "Conocimiento de los profesores acerca de los primeros auxilios" (apuntó influencia de la experiencia materna, creencia en mitos populares y conciencia del despreparo); "Sentimientos en situaciones de urgencia y emergencia" (angustia, miedo y preocupación); y "Primeros auxilios vivenciados en la escuela", (ocurridos en el aula o durante la recreación, procedentes de golpes y síncope). Consideraciones finales: La investigación evidenció vivencias basadas en creencias populares, experiencias familiares y laguna de conocimientos. El despreparo fue evidenciado por el relato de los profesores acerca de haber realizado conductas inadecuadas durante primeros auxilios en la escuela.

RESUMO Objetivo: desvelar as vivências de professores do ensino infantil e fundamental sobre primeiros socorros na escola. Método: estudo descritivo, qualitativo realizado em maio de 2014, a partir de grupo focal com nove professores da rede municipal de Bom Jesus-PI. Ocorreu gravação de áudio, o conteúdo foi transcrito, os dados foram processados no software IRAMUTEQ e analisados a partir da Classificação Hierárquica Descendente. Resultados: foram obtidas três classes: "Conhecimento dos professores acerca dos primeiros socorros" (apontou influência da experiência materna, crença em mitos populares e consciência do despreparo); "Sentimentos em situações de urgência e emergência" (angústia, medo e preocupação); e "Primeiros socorros vivenciados na escola", (ocorridos em sala de aula ou durante recreação, oriundos de pancadas e síncope). Considerações finais: A pesquisa evidenciou vivências baseadas em crenças populares, experiências familiares e lacuna de conhecimentos. O despreparo foi evidenciado pelo relato dos professores acerca de terem realizado condutas inadequadas durante primeiros socorros na escola.

[Orthopedic surgery with limited resources after mass disasters and during armed conflicts : First international guidelines for the management of limb injuries and the experience of Doctors Without Borders]. / Unfallchirurgie mit eingeschränkten Ressourcen nach Katastrophen und während bewaffneter Konflikte : Erste internationale Leitlinien zur Versorgung von Extremitätenverletzungen und die Erfahrung von "Ärzte ohne Grenzen".

Disasters and armed conflicts are often the unfortunate basis for aid projects run by Doctors Without Borders/Médecins Sans Frontières (MSF). The nature of war and disasters means that surgery is an integral part of this medical emergency aid. In these situations, resources are usually limited. As a result, surgical work in these contexts differs significantly from the daily routine of a surgeon working in a highly resourced hospital. The principles of surgery do not change but surgeons must adapt their tactical approach to the changed context otherwise there is a high risk of failing to improve the health of patients and potentially jeopardizing their prospects for recovery. Every experienced war surgeon has learned new skills the hard way. The Field Guide to Manage Limb Injury in Disaster and Conflict has been written to help new surgeons who may face the challenges of disaster and war surgery and to avoid unnecessary suffering for patients ( https://icrc.aoeducation.org ). Under the guidance of the International Committee of the Red Cross (ICRC), with participation of the World Health Organization (WHO), financed by the AO Foundation, and featuring the experiences of experts from different organizations (amongst them MSF), the book details techniques and guidelines for surgery in low resource settings. The following article provides a short summary of some of the surgical challenges when working with limited resources and reflects on a few specific recommendations for so-called war surgery.