Ergonomic assessment of future methods of ballistic neck protection.

INTRODUCTION: Neck injuries from explosively propelled fragments are present in 11% of injured U.K. soldiers and result in significant mortality and long-term morbidity. U.S. forces in contrast sustain only neck wounds in 3 to 4% of those injured, which is believed to be because of their greater acceptance in the wearing of issued neck protection. METHOD: A three-piece neck collar, two-piece neck collar, a nape pad, a ballistic scarf, and an enhanced protection under body armor shirt (EP-UBACS) reinforced at the collar were objectively compared during a treadmill test using physiological measurements. Designs were subjectively compared regarding their effect on soldier performance using representative military tasks. RESULTS: Both neck collars and the EP-UBACS prototype demonstrated 90% acceptability in terms of military task performance. No statistical difference in tympanic temperature and heart rate was found between prototypes. The statistically significant higher skin temperatures found for prototypes lying close to the skin (EP-UBACS and ballistic scarf) were unrelated to perceived comfort. DISCUSSION: Neck collars remain the most successful design in terms of military performance, comfort, and potential levels of ballistic protection. However the EP-UBACS concept should also be developed further, with future iterations potentially removing the zip and increasing skin standoff.

Anthropometric assessment of cervical neurovascular structures using CTA to determine zone-specific vulnerability to penetrating fragmentation injuries.

AIM: To determine military-specific cervical neurovascular and external anthropometric data to scale future numerical injury models of the neck and improve body armour design with a view to prevention or mitigation of combat neck injury. MATERIALS AND METHODS: Contrast-enhanced computed tomography (CT) angiograms of 50 UK servicemen were analysed. Mean diameters and distances from the skin surface were determined for the carotid artery (CA), internal jugular vein (IJV), vertebral artery (VA) and spinal cord (SC) at the three surgical neck zones. Horizontal neck circumference at C6 and three potential vertical cervical anthropometric measurements were analysed to determine which had the least variability between subjects. RESULTS: The diameters of cervical vascular structures are greater and the vessels more superficial as the anatomical plane moves caudally. The SC and VA are better protected than the IJV and CA due to their greater depth and bony coverage, except for the VA in zone 1. CONCLUSION: Future cervical anthropometric assessments should use the vertical angle of mandible to mid-claviclular distance in combination with the horizontal neck circumference as these demonstrated the least variability. Cervical neurovascular structures are least vulnerable posterosuperiorly and therefore extending the posterior aspect of a ballistic helmet inferiorly or adding a nape protector would appear to be less justified. Cervical vessels are most vulnerable in zone 1 and a circumferential collar of ballistic material at least 75 mm high would cover this area in 95% of this population.

Large animal-related injury requiring hospital admission: injury pattern disparities.

BACKGROUND: Due to the infrequent occurrence of large animal-related injury (LARI) in many areas, their significance as a public health problem could be overlooked. The purpose of this study was to examine the demographics and injury disparities associated with LARI. METHODS: The Healthcare Cost and Utilization Project Nationwide Inpatient Survey from 2001 was used to construct a cohort of patients admitted after LARI. Patients were stratified by age, gender, race, and median household income of patient's zip code. Where available total hospital charges were converted to cost using the hospital's cost-to-charge ratio. To determine variables associated with injury type, univariable and multivariable logistic regression analysis were used. RESULTS: 2424 LARI admissions were identified within the database. The largest proportion of admitted patients were female (53.8%), Caucasian (64.6%), and from areas with median income >$45,000 (41.8%). Average hospital cost was $5062. Overall, the most common injuries were rib fractures (15.2%), vertebral fractures (11.6%) and haemo-pneumothorax (9%). Multivariable logistic regression analysis revealed that age disparities with older patients receiving more rib fractures, haemo-pneumothorax, vertebral fractures, and pelvic fractures. Skull fractures and head injuries are disproportionately seen in younger patients. Gender disparities were also present, with females more likely to have vertebral fractures but less likely to have rib fractures and heart and lung injuries. CONCLUSIONS: Disparities based on age and gender are associated with hospital admission for LARI in the United States. These admissions have a significant impact on the healthcare system with nationwide cost estimates of nearly $60 million. These findings represent potential areas for targeted prevention efforts.

A novel method for artery detection in laparoscopic surgery.

BACKGROUND: One of the most important difficulties in laparoscopic surgery is intraoperative blood vessel detection. An accidental injury to a blood vessel may cause serious complications and could result in changing from a laparoscopic procedure to open surgery. Moreover, differentiating arteries from veins is necessary in all surgical cases. In this study we evaluate a new image-processing method for artery detection that would be useful during laparoscopic and endoscopic procedures. It is possible to install the program on any ordinary laparoscopy set and it displays the artery's region on the monitor. METHODS: This method uses the artery's pulse to detect an artery and distinguish it from veins. By subtracting the systolic and diastolic images, the change regions are detected and shown on a monitor. The performance of this method in detecting arteries in simulation and in real laparoscopic surgery is evaluated. Artery detection in different pulse rates, different artery depths, and different blood pressures is tested via the simulation phase. It is also tested in two laparoscopic surgeries, one on a kidney and one on a stomach. RESULTS: In simulation phase the method can correctly detect all arteries that are not too deep and can move superficial tissues with zero false-negative and false-positive rates. In real laparoscopy, the false-positive rate was 8% and the false-negative rate was 5%. CONCLUSION: This method is a noninvasive, reliable, and cost-effective technique to detect artery regions, even if some of them are covered with fat or other tissues, while suppressing veins and other tissues.

The epidemiology, evaluation, and management of stingray injuries.

A descriptive analysis and review of the world's salient scientific literature on stingray injuries was conducted in light of recent high-profile cases of fatal and near-fatal thoracic stingray injuries to guide clinicians in evaluating and managing stingray injuries. Data was extracted from observational and longitudinal studies over the period, 1950-2006, to permit (1) a stratification of stingray injuries as bites, penetrating lacerations with and without envenoming, and combinations of deeply penetrating and envenoming wounds; and (2) an assessment of new management strategies for thoracoabdominal penetrating trauma and non-healing, necrotic stingray wounds. Unlike their Chondrichthyes classmates, the sharks, stingrays are docile and non-aggressive; and will not attack with their spined tails, unless provoked. Although some occupations are predisposed to stingray injuries, most stingray injuries can be avoided by observing seafloors and adopting simple practices when wading, swimming, diving, or fishing in temperate oceans and some tropical freshwater river systems. All stingray injuries should be managed initially with wound irrigation to dislodge retained spine fragments and envenoming tissues and warm water immersion to inactivate heat-labile toxins.

Bloodborne pathogen exposure in the OR--what research has taught us and where we need to go.

Contracting a disease from bloodborne pathogens has been identified as an occupational hazard for perioperative personnel for more than two decades. Perioperative staff members are particularly vulnerable to percutaneous exposure. Despite known hazards, research has shown that perioperative staff members continue to take risks by not consistently complying with standard precautions and not reporting all percutaneous injuries. Health care workers (HCWs) and their employers need to work together to ensure that workplaces are safe. This article discusses mechanisms of bloodborne pathogen transmission, compliance with standard guidelines, and the social and economic costs of contracting a bloodborne illness. Steps to ensure that HCWs are protected also are outlined.

The role of sub-lethal weapons in human rights abuse.

This article is based on two recent reports contracted by the European Parliament (EP), which assessed sub-lethal weapons as flexible tools of political control. It analyses the role and function of existing weapons systems in human rights abuses using examples from Indonesia, Israel, Kenya, Northern Ireland and Turkey. These weapons are designed to 'appear' rather than 'be' safe and, since they augment rather than replace lethal technologies, their use can distort conflicts and actually bridge the firewall between use of less-lethal and lethal technologies.

Occupational injuries and exposures among Canadian dentists: the results of a national survey.

OBJECTIVES: To measure the frequency of occupational exposures reported by dentists in Canada and to identify factors associated with occupational exposure. DESIGN: A national mailed survey of a stratified random sample of 6,444 dentists with three follow-up attempts. Weighted data were analyzed using t tests, analysis of variance, and multiple logistic regression. RESULTS: The response rate was approximately 66%. Occupational exposures, percutaneous injuries, and mucous membrane exposures in the last year were reported by 67%, 62%, and 29% of respondents, respectively. Fewer than 1% reported exposure to human immunodeficiency virus or hepatitis B virus (HBV). Respondents reported means of 1.5 mucous membrane and 3.0 percutaneous exposures per year. HBV immunization was reported by 91% of dentists, but of these 28% reported no post-immunization serology. Other reports of suboptimal compliance included use of a postexposure protocol by only 41% and HBV vaccination of all assistants or of hygienists by 74% and 77% of respondents, respectively. Factors associated with percutaneous exposure included non-use of postexposure protocol or puncture-proof containers for sharps disposal, treating > or =20 patients per day, and male gender. Risk factors for mucous membrane exposure included non-use of eye protection or masks. CONCLUSION: This study provides evidence of the protective effect of puncture-proof containers, eye protection, and masks and raises concerns related to HBV post-immunization serology and postexposure protocols. To reduce risk of infection, educational interventions are required to improve compliance with Universal Precautions, with emphasis on comprehensive HBV immunization and post-immunization serology, the use of barriers, puncture-proof containers for sharps disposal, and postexposure protocols.

Spinal cord injury. A preventable public burden.

BACKGROUND: Spinal cord injury (SCI) is a devastating occurrence with important consequences for the individual and society. Previous studies have documented the epidemiology and costs of SCI and the rehabilitation needs after SCI; however, data about the preventability of SCI are lacking. OBJECTIVE: To test the hypotheses that most SCIs are preventable and that much of the cost of SCI is borne by the public. DESIGN: Retrospective review of medical records and trauma registry data. SETTING: A 417-bed county hospital with a level I trauma center. METHODS: To evaluate the preventability of SCI, the records of trauma patients sustaining SCI from July 1, 1990, through June 30, 1995, were reviewed. The criteria for preventability of blunt injuries included the following: failure to use restraint devices; intoxication of drivers, motorcyclists, or pedestrians; and falls or diving accidents involving the use of drugs or alcohol. The criteria for preventability of penetrating injuries included the following: illegal possession of a firearm, accidental discharge of a weapon, and suicide attempts. Statistics were performed with the paired Student t test and chi 2 with significance attributed to a P value less than .05. RESULTS: Spinal cord injury occurred in 150 patients; 71% of the injuries were the result of blunt trauma. Injury was potentially preventable in 74% of the blunt injuries and 66% of the penetrating injuries (P = .15). Patients with a penetrating SCI were younger (P < .001) and relied more on public funding than did those with a blunt SCI (65% vs 81%; P = .05). CONCLUSIONS: Most SCIs are preventable with strict enforcement of existing statutes. Furthermore, the financial burden of these preventable injuries is largely borne by the public.

The epidemic of penetrating trauma: a national dilemma.

Available literature on penetrating trauma in the USA was reviewed to determine the prevalence, etiological factors, and societal cost of penetrating trauma. Penetrating injuries accounted for 39,888 deaths in 1989 and was the eighth leading cause of death. Etiological factors include increasing ownership of firearms, alcohol consumption, recreational drug use and trafficking, occupational risks, and socioeconomic factors. These injuries account for the fourth leading cause of estimated years of potential life lost. Corrective strategies and research are severely limited by the disproportionately low research funding.

Impact of a rigid, puncture resistant container system upon needlestick injuries.

Needlestick injuries in a 720-bed tertiary care hospital were analyzed before and after the introduction of a rigid, puncture resistant, needle disposal system. Following implementation of the system, disposal-related injuries decreased from 0.9 per 100 full-time equivalent employees/year to 0.3 per 100 full-time equivalent employees/year (p less than .005). However, needlesticks associated with procedures (2.2 vs. 4.4 per 100 full-time equivalent employees/year, p less than .0005), and those resulting from loose needles (0.5 vs. 1.9 per 100 full-time equivalent employees/year, p less than .0005), increased. Injuries occurring during needle recapping or the carrying of needles were not significantly altered. Total needlestick injuries increased from 6.0 to 8.7 per 100 full-time equivalent employees/year (p less than .0005). We concluded that a rigid, puncture resistant, needle disposal system can reduce disposal-related needlestick injuries, but must also be perceived as convenient to impact substantially upon needlesticks associated with other activities.