BB84 quantum key distribution transmitter utilising broadband sources and a narrow spectral filter.

The secure nature of Quantum Key Distribution (QKD) protocols makes it necessary to ensure that the single photon sources are indistinguishable. Any spectral, temporal or spatial discrepancy between the sources would lead to a breach in the security proofs of the QKD protocols. Traditional, weak-coherent pulse implementations of polarization-based QKD protocols have relied on identical photon sources obtained through tight temperature control and spectral filtering. However, it can be challenging to keep the temperature of the sources stable over time, particularly in a real-world setting, meaning photon sources can become distinguishable. In this work, we present an experimental demonstration of a QKD system capable of achieving spectral indistinguishability, over a 10°C range, using a combination of broadband sources, super-luminescent light emitting diodes (SLEDs), along with a narrow band-pass filter. The temperature stability could be useful in a satellite implementation, where there may be temperature gradients over the payload, particularly on a CubeSat.

Multicore fiber beacon system for reducing back-reflection in satellite quantum key distribution.

Optical beaconing is an important part of the acquisition, pointing and tracking system necessary for free-space quantum key distribution (QKD). However, uplink beacon back-reflections from the receiver architecture can result in noise. Wavelength- and time-division multiplexing has been used, but neither is yet sufficient to make back-reflection negligible. The use of additional telescopes increases complexity and pointing error. Here, we propose the use of a 2-by-2 multicore fiber, to act as an optical uplink beacon source. This spatially separates the QKD channel and optical uplink beacon. Up to 50 dB improvement in noise rejection over a purely spectrally divided system was demonstrated. The route to further improvements through greater fiber core separation is described. Beacon systems designed in this way could provide a combination of reduced complexity and improved noise performance to free-space and satellite QKD and optical communications.

Quantum bit error rate timing jitter dependency on multi-mode fibers.

The full time-jitter response of a single-photon detector can make a significant contribution to the quantum bit error rate (QBER) of high repetition rate quantum key distribution (QKD) implementations. Although there have been studies into understanding the contribution for single-mode optical fiber coupled single-photon detectors, the contribution of larger, multimode core diameters to the QBER have not been explored in detail. With the growing importance of free-space QKD, which typically use multimode fibers to reduce coupling loss, it is vitally important to understand how the multimode fiber coupling will impact the total QBER. This work studies the impact of the time-jitter contribution to QBER when coupling a commercial off-the-shelf silicon single-photon avalanche diode with various multimode fibers while simulating operating at 1 GHz with empirical measurements taken at 1 MHz repetition rate. It was found that step-index multimode fibers can significantly increase the QBER, while graded-index fibers can provide an QBER contribution similar to a single-mode fiber. The results highlight that there is a significant benefit in using graded index multimode fibers for a free-space QKD receiver, particularly for high repetition rate applications.

Experimental demonstration of a reconfigurable free-space receiver implementing polarization routing and filtering for daytime quantum key distribution.

Free-space quantum key distribution (QKD) systems are often designed to implement polarization-encoding protocols. Alternatively, time-bin/phase-encoding protocols are considerably more challenging to perform over a channel experiencing atmospheric turbulence. However, over the last decade, new and improved optical platforms have revived the interest in them. In this paper, we present a free-space multi-protocol receiver designed to work with three different time-bin/phase-encoding protocols highlighting its interoperability with different systems and architectures for potential satellite-based communications. We also present a detailed analysis of different experimental configurations when implementing the coherent one-way (COW) protocol in a free-space channel, as well as a polarization filtering technique showing how time-bin/phase-encoding protocols could be used for QKD applications in daylight conditions. We demonstrate secret key rates of several kbps for channels with a total 30 dB attenuation even with moderately high QBERs of ≈3.5%. Moreover, a 2.6 dB improvement in the signal to noise ratio is achieved by filtering background light in the polarization degree of freedom, a technique that could be used in daylight QKD.

Time-division technique for quantum optical receivers utilizing single-photon detector array technology and spatial-multiplexing.

Free-space quantum key distribution (QKD) has been gaining popularity in recent years due to its advantages in creating networking options for the quantum internet. One of the main challenges to be addressed in QKD is the achievable secret key rate, which must meet current and future demand. Some of the existing solutions include the use of higher bandwidth electronics, untrusted relay architectures such as Twin-Field QKD, or high dimensional QKD. In this work, we proposed the use of a combination of spatial-multiplexing and time-division techniques, together with the use of 2D single-photon avalanche diode arrays to increase the final throughput. The main challenge in a free-space scenario is the effects introduced by turbulence. This paper demonstrates how appropriate time-division of the spatial-modes can reduce the quantum bit error rate due to optical crosstalk from 36% to 0%. With this technique, we believe the future need for superconducting nanowires single photon detectors, in some free-space QKD applications, can be relaxed, obtaining more cost-effective receiver systems.

In-lab demonstration of coherent one-way protocol over free space with turbulence simulation.

Over the last decade, free-space quantum key distribution (QKD), a secure key sharing protocol, has risen in popularity due the adaptable nature of free-space networking and the near-term potential to share quantum-secure encryption keys over a global scale. While the literature has primarily focused on polarization based-protocols for free-space transmission, there are benefits to implementing other protocols, particularly when operating at fast clock-rates, such as in the GHz. In this paper, we experimentally demonstrate a time-bin QKD system, implementing the coherent one-way (COW) at 1 GHz clock frequency, utilizing a free-space channel and receiver. We demonstrate the receiver's robustness to atmospheric turbulence, maintaining an operational visibility of 92%, by utilizing a lab-based turbulence simulator. With a fixed channel loss of 16 dB, discounting turbulence, we obtain secret key rate (SKR) of 6.4 kbps, 3.4 kbps, and 270 bps for three increasing levels of turbulence. Our results highlight that turbulence must be better accounted for in free-space QKD modelling due to the additional induced loss.

Utilizing broadband wavelength-division multiplexing capabilities of hollow-core fiber for quantum communications.

One of the major challenges in the deployment of quantum communications (QC) over solid-core silica optical fiber is the performance degradation due to the optical noise generated with co-propagating classical optical signals. To reduce the impact of the optical noise, research teams are turning to new and novel architectures of solid-core and hollow-core optical fiber. We studied the impact when co-propagating a single-photon level (850 nm) and two classical optical signals (940 nm and 1550 nm) while utilizing a nested antiresonant nodeless fiber (NANF) with two low-loss windows. The 940 nm signal was shown to impact the single-photon measurement due to the silicon detector technology implemented; however, multiplexing techniques and filtering could reduce the impact. The 1550 nm signal was shown to have no detrimental impact. The results highlight that both high bandwidth optical traffic at 1550 nm and a QC channel at 850 nm could co-propagate without degradation to the QC channel.

Towards combined quantum bit detection and spatial tracking using an arrayed single-photon sensor.

Experimental quantum key distribution through free-space channels requires accurate pointing-and-tracking to co-align telescopes for efficient transmission. The hardware requirements for the sender and receiver could be drastically reduced by combining the detection of quantum bits and spatial tracking signal using two-dimensional single-photon detector arrays. Here, we apply a two-dimensional CMOS single-photon avalanche diode detector array to measure and monitor the single-photon level interference of a free-space time-bin receiver interferometer while simultaneously tracking the spatial position of the single-photon level signal. We verify an angular field-of-view of 1.28° and demonstrate a post-processing technique to reduce background noise. The experimental results show a promising future for two-dimensional single-photon detectors in low-light level free-space communications, such as quantum communications.

Thermoreversible Reverse-Phase-Shift Foam for Treatment of Noncompressible Torso Hemorrhage.

BACKGROUND: Noncompressible torso hemorrhage (NCTH) is a leading cause of traumatic exsanguination, requiring emergent damage control surgery performed by a highly trained surgeon in a sterile operating environment. A self-expanding, intraabdominally deployed, thermoreversible foam is one proposed method to potentially task shift temporizing hemostasis to earlier providers and additional settings. The purpose of this study was to assess the feasibility of using Fast Onset Abdominal Management (FOAM) in a lethal swine model of NCTH. METHODS: This was a proof-of-concept study comparing FOAM intervention in large Yorkshire swine to historical control animals in the established Ross-Burns model of NCTH. After animal preparation, a Grade IV liver laceration was surgically induced, followed by a free bleed period of 10 min. FOAM was then deployed to a goal intraabdominal pressure of 60 mm Hg for 5 min, followed by a total 60-min observation period following injury. RESULTS: At the end of the experiment, the FOAM agent was found to be distributed throughout the peritoneal cavity in all animals, without signs of iatrogenic injury. The FOAM group demonstrated a significantly higher mean arterial pressure compared with historical controls and a trend toward improved survival: 82% (9/11) compared with 50% for controls (7/14; P = 0.082). CONCLUSIONS: This is the first study to describe the use of a thermoresponsive foam to manage NCTH and successfully demonstrated proof-of-concept feasibility of FOAM deployment. These results provide strong support for future, higher-powered studies to confirm improved survival with this novel intervention.

On-chip implementation of the probabilistic quantum optical state comparison amplifier.

Propagation losses in transmission media limit the transmission distance of optical signals. In the case where the signal is made up of quantum optical states, conventional deterministic optical amplification schemes cannot be used to increase the transmission distance as the copying of an arbitrary and unknown quantum state is forbidden. One strategy that can offset propagation loss is the use of probabilistic, or non-deterministic, amplification schemes - an example of which is the state comparison amplifier. Here we report a state comparison amplifier implemented in a compact, fiber-coupled femtosecond laser-written waveguide chip as opposed to the large, bulk-optical components of previous designs. This pathfinder on-chip implementation of the quantum amplifier has resulted in several performance improvements: the polarization integrity of the written waveguides has resulted in improved visibility of the amplifier interferometers; the potential of substantially-reduced losses throughout the amplifier configuration; and a more compact and environmentally-stable amplifier which is scalable to more complex networks.

Experimental implementation of a quantum optical state comparison amplifier.

We present an experimental demonstration of a practical nondeterministic quantum optical amplification scheme that employs two mature technologies, state comparison and photon subtraction, to achieve amplification of known sets of coherent states with high fidelity. The amplifier uses coherent states as a resource rather than single photons, which allows for a relatively simple light source, such as a diode laser, providing an increased rate of amplification. The amplifier is not restricted to low amplitude states. With respect to the two key parameters, fidelity and the amplified state production rate, we demonstrate significant improvements over previous experimental implementations, without the requirement of complex photonic components. Such a system may form the basis of trusted quantum repeaters in nonentanglement-based quantum communications systems with known phase alphabets, such as quantum key distribution or quantum digital signatures.

Analysis of trauma care education in the South Sudan community health worker training curriculum.

INTRODUCTION: Trauma is a leading cause of morbidity and mortality worldwide, with the majority occurring in low- and middle-income countries (LMICs). Allied health workers are often on the front lines of caring for trauma patients; this is the case in South Sudan, where a system of community health workers (CHWs) and clinical officers (COs) form an essential part of the health care structure. However, curricula for these workers vary, and it is unclear how much these training programs include trauma education. HYPOTHESIS/METHODS: The CHW training curriculum in South Sudan was reviewed to evaluate the degree to which it incorporates trauma education, according to established guidelines from the World Health Organization (WHO). To the authors' knowledge, this is the first formal comparison of a CHW curriculum with established WHO trauma guidelines. RESULTS: The curriculum incorporated a number of essential components of the WHO guidelines; however, the concepts taught were limited in scope. The curriculum only covered about 50% of the content required for basic providers, with major deficiencies being in the management of head and spinal injuries, safety protocols for health care personnel, and in the management of pediatric patients. DISCUSSION/CONCLUSION: The CHW training curriculum lacks the requisite content to provide adequately a basic level of trauma care and requires amending to ensure that all South Sudan citizens receive appropriate treatment. It is recommended that other LMICs review their existing training curricula in order to improve their ability to provide adequate trauma care and to ensure they meet the basic WHO guidelines.

Realization of quantum digital signatures without the requirement of quantum memory.

Digital signatures are widely used to provide security for electronic communications, for example, in financial transactions and electronic mail. Currently used classical digital signature schemes, however, only offer security relying on unproven computational assumptions. In contrast, quantum digital signatures offer information-theoretic security based on laws of quantum mechanics. Here, security against forging relies on the impossibility of perfectly distinguishing between nonorthogonal quantum states. A serious drawback of previous quantum digital signature schemes is that they require long-term quantum memory, making them impractical at present. We present the first realization of a scheme that does not need quantum memory and which also uses only standard linear optical components and photodetectors. In our realization, the recipients measure the distributed quantum signature states using a new type of quantum measurement, quantum state elimination. This significantly advances quantum digital signatures as a quantum technology with potential for real applications.

Use of artificial intelligence to support prehospital traumatic injury care: A scoping review.

Background: Artificial intelligence (AI) has transformative potential to support prehospital clinicians, emergency physicians, and trauma surgeons in acute traumatic injury care. This scoping review examines the literature evaluating AI models using prehospital features to support early traumatic injury care. Methods: We conducted a systematic search in August 2023 of PubMed, Embase, and Web of Science. Two independent reviewers screened titles/abstracts, with a third reviewer for adjudication, followed by a full-text analysis. We included original research and conference presentations evaluating AI models-machine learning (ML), deep learning (DL), and natural language processing (NLP)-that used prehospital features or features available immediately upon emergency department arrival. Review articles were excluded. The same investigators extracted data and systematically categorized outcomes to ensure consistency and transparency. We calculated kappa for interrater reliability and descriptive statistics. Results: We identified 1050 unique publications, with 49 meeting inclusion criteria after title and abstract review (kappa 0.58) and full-text review. Publications increased annually from 2 in 2007 to 10 in 2022. Geographic analysis revealed a 61% focus on data from the United States. Studies were predominantly retrospective (88%), used local (45%) or national level (41%) data, focused on adults only (59%) or did not specify adults or pediatrics (27%), and 57% encompassed both blunt and penetrating injury mechanisms. The majority used machine learning (88%) alone or in conjunction with DL or NLP, and the top three algorithms used were support vector machine, logistic regression, and random forest. The most common study objectives were to predict the need for critical care and life-saving interventions (29%), assist in triage (22%), and predict survival (20%). Conclusions: A small but growing body of literature described AI models based on prehospital features that may support decisions made by dispatchers, Emergency Medical Services clinicians, and trauma teams in early traumatic injury care.

A novel, reverse-phase-shifting, thermoreversible foaming hydrogel containing antibiotics for the treatment of thermal burns in a swine model - A pilot study.

BACKGROUND: This study compared a novel topical hydrogel burn dressing (CI-PRJ012) to standard of care (silver sulfadiazine) and to untreated control in a swine thermal burn model, to assess for wound healing properties both in the presence and absence of concomitant bacterial inoculation. METHODS: Eight equal burn wounds were created on six Yorkshire swine. Half the wounds were randomized to post-burn bacterial inoculation. Wounds were subsequently randomized to three treatments groups: no intervention, CI-PRJ012, or silver sulfadiazine cream. At study end, a blinded pathologist evaluated wounds for necrosis and bacterial colonization. RESULTS: When comparing CI-PRJ012 and silver sulfadiazine cream to no treatment, both agents significantly reduced the amount of necrosis and bacteria at 7 days after wound creation (p < 0.01, independently for both). Further, CI-PRJ012 was found to be significantly better than silver sulfadiazine (p < 0.02) in reducing bacterial colonization. For wound necrosis, no significant difference was found between silver sulfadiazine cream and CI-PRJ012 (p = 0.33). CONCLUSIONS: CI-PRJ012 decreases necrosis and bacterial colonization compared to no treatment in a swine model. CI-PRJ012 appeared to perform comparably to silver sulfadiazine. CI-PRJ012, which is easily removed with the application of room-temperature water, may provide clinical advantages over silver sulfadiazine.

Novel Thermoreversible Reverse-Phase-Shift Foam With Deployment System for Treatment of Penetrating Globe Trauma in a Newly Described Porcine Model.

INTRODUCTION: The initial management of penetrating ocular injuries is a major sight-threatening problem for both civilian and military medicine. A novel device (Eye-Aid) temporarily tamponades leakage from such injuries while being easy to remove upon arrival to specialized ophthalmologic care. Eye-Aid consists of a protective eye shield with an adhesive backing that connects to a portable canister containing rapidly deployable thermoresponsive foam. The aim of this study was to compare the use of the novel Eye-Aid device to control in a new live swine ocular injury model. MATERIALS AND METHODS: Bilateral penetrating ocular injuries were created on 14 male Yorkshire swine in a standardized manner using a 16-gauge needle device to puncture the central cornea and cause a full-thickness wound. Researchers randomized eye intervention side, with the contralateral eye used as paired control. Two minutes after the injury, the eye shield components of the Eye-Aid system, which has a sticky pad for attachment to the skin and a luer-lock for foam deployment, were placed bilaterally. Eight minutes after the injury, foam was deployed for the intervention eye according to the device instructions for use. For the control eye, no additional procedures were performed. Six hours post-injury, end A-scan and intraocular pressure (IOP) were measured. Primary study outcome was change in axial length of the globe. Secondary outcomes were as follows: (1) Presence of full anterior chamber collapse, defined as a lack of measurable anterior lens capsule-reflex (ALC-reflex) on A-scan and (2) change in IOP. Outcomes were analyzed as paired intra-animal data, with intervention and control data for each animal. A paired t-test was used to analyze the difference in axial length change and IOP change between treatment groups, whereas a conditional logistic regression was used to analyze dichotomous ALC-reflex outcome and estimate the odds ratio associated with the Eye-Aid device. RESULTS: A significant difference (P < .0001) in mean change in axial length between intervention (-210 µm) and control (-1,202 µm) groups was found. There was a significant difference in ALC-reflex presence, with 79% of eyes having an ALC-reflex in the intervention group, compared to 14% in the control (P = .008). IOP remained higher in the intervention group, with a mean change of -1.5 mmHg for the intervention group compared to -4.0 mmHg in the control (P = .0001). CONCLUSIONS: This study describes the first development of an in vivo large animal ocular injury model that realistically approximates the emergent time course and pathophysiology of patients with full-thickness corneal open globe injuries. It also gives the first description of using thermoreversible hydrogel foam for such injuries. Eye-Aid was found to be significantly better than control for treatment of such injuries, based on measurements of both structure and pressure. Assuming that the absence of an ALC-reflex demonstrates complete anterior chamber collapse, the Eye-Aid group demonstrated a 79% eye "save" rate compared to only 14% in the control group, as described earlier. This results in a Number Needed to Treat of 3 for this finding. Eye-Aid additionally demonstrated several characteristics that would be beneficial in a device targeted for emergent deployment by non-ophthalmologists.

Development of a Novel Epidural Hemorrhage Model in Swine.

INTRODUCTION: Traumatic brain injury is a major public health concern. Among patients with severe traumatic brain injury, epidural hemorrhage is known to swiftly lead to brain herniation and death unless there is emergent neurosurgical intervention. However, immediate neurosurgeon availability is frequently a problem outside of level I trauma centers. In this context, the authors desired to test a novel device for the emergent management of life-threatening epidural hemorrhage. A review of existing animal models determined that all were inadequate for this purpose, as they were found to be either inappropriate or obsolete. Here, we describe the development of a new epidural hemorrhage model in swine (Sus scrofa, 18-26 kg) ideal for translational device testing. MATERIALS AND METHODS: Vascular access was achieved using an ultrasound-guided percutaneous Seldinger catheter-over-wire technique with 5 Fr catheters placed in the bilateral carotid arteries, for continuous blood pressure and to allow for withdrawal of blood for creation of epidural hemorrhage. To simulate an actively bleeding and life-threatening epidural hemorrhage, unadulterated autologous blood was infused from the vascular access point into the epidural space. To be useful for this application and clinical scenario, brain death needed to occur after the planned intervention time but before the end of the protocol period (if no intervention took place). An iterative approach to model development determined that this could be achieved with an initial infusion rate of 1.0 mL/min, slowed to 0.5 mL/min after the first 10 minutes, paired with an intervention time at 15 minutes. All experiments were performed at Oregon Health & Science University, an Association for Assessment and Accreditation of Laboratory Animal Care accredited facility. Oregon Health & Science University's Institutional Animal Care and Use Committee, as well as the United States Army Animal Care and Use Review Office, reviewed and approved this protocol before the initiation of experiments (respectively, protocol numbers IP00002901 and 18116010.e001). RESULTS: The final developed model allows for the infusion of a known volume of autologous, unadulterated blood directly into the epidural space, without the use of a balloon or other restricting membranes, and is rapidly fatal in the absence of intervention. CONCLUSIONS: This animal model is the first to mirror the expected clinical course of epidural hemorrhage in a physiologically relevant manner, while allowing translational testing of emergency devices. This model successfully allowed the initial testing of a novel interventional device for the emergent management of epidural hemorrhage that was designed for use in the absence of traditional neurosurgical capabilities.

Thermoreversible Reverse-Phase-Shift Foam for Treatment of Noncompressible Torso Hemorrhage, a Safety Trial in a Porcine Model.

INTRODUCTION: Noncompressible torso hemorrhage is the leading cause of exsanguination on the battlefield. A self-expanding, intraperitoneal deployed, thermoreversible foam has been developed that can be easily administered by a medic in austere settings to temporarily tamponade noncompressible torso hemorrhage. The purpose of this study was to assess the long-term safety and physical characteristics of using Fast Onset Abdominal Management (FOAM; Critical Innovations LLC) in swine. MATERIALS AND METHODS: Yorkshire swine (40-60 kg) were sedated, intubated, and placed on ventilatory support. An external jugular catheter was placed for sampling of blood. Continuous heart rate, temperature, saturation of peripheral oxygen, end-tidal carbon dioxide, and peak airway pressures were monitored for a 4-hour period after intervention (i.e., FOAM agent injection or a sham introducer without agent delivery). The FOAM agent was injected to obtain an intra-abdominal pressure of 60 mmHg for at least 10 minutes. After 4 hours, the animals were removed from ventilatory support and returned to their housing for a period of 7-14 days. Group size analysis was not performed, as this was a descriptive safety study. Blood samples were obtained at baseline and at 1-hour post-intervention and then on days 1, 3, 7, and 14. Euthanasia, necropsy, and harvesting of samples for histologic analysis (from kidneys, terminal ilium, liver, pancreas, stomach, spleen, and lungs) were performed upon expiration. Histologic scoring for evidence of ischemia, necrosis, and abdominal compartment sequela was blinded and reported by semi-quantitative scale (range 0-4; 0 = no change, 1 = minimal, 2 = mild, 3 = moderate, and 4 = marked). Oregon Health & Science University's Institutional Animal Care and Use Committee, as well as the U.S. Army Animal Care and Use Review Office, approved this protocol before the initiation of experiments (respectively, protocol numbers IP00003591 and MT180006.e002). RESULTS: Five animals met a priori inclusion criteria, and all of these survived to their scheduled endpoints. Two animals received sham injections of the FOAM agent (one euthanized on day 7 and one on day 14), and three animals received FOAM agent injections (one euthanized on day 7 and two on day 14). A transitory increase in creatinine and lactate was detected during the first day in the FOAM injected swine but resolved by day 3. No FOAM agent was observed in the peritoneal cavity upon necropsy at day 7 or 14. Histologic data revealed no clinically relevant differences in any organ system between intervention and control animals upon sacrifice at day 7 or 14. CONCLUSIONS: This study describes the characteristics, survival, and histological analysis of using FOAM in a porcine model. In our study, FOAM reached the desired intra-abdominal pressure endpoint while not significantly altering basic hematologic parameters, except for transient elevations of creatinine and lactate on day 1. Furthermore, there was no clinical or histological relevant evidence of ischemia, necrosis, or intra-abdominal compartment syndrome. These results provide strong support for the safety of the FOAM device and will support the design of further regulatory studies in swine and humans.

Time-resolved photoelectron imaging of excited state relaxation dynamics in phenol, catechol, resorcinol, and hydroquinone.

Time-resolved photoelectron imaging was used to investigate the dynamical evolution of the initially prepared S(1) (ππ*) excited state of phenol (hydroxybenzene), catechol (1,2-dihydroxybenzene), resorcinol (1,3-dihydroxybenzene), and hydroquinone (1,4-dihydroxybenzene) following excitation at 267 nm. Our analysis was supported by ab initio calculations at the coupled-cluster and CASSCF levels of theory. In all cases, we observe rapid (<1 ps) intramolecular vibrational redistribution on the S(1) potential surface. In catechol, the overall S(1) state lifetime was observed to be 12.1 ps, which is 1-2 orders of magnitude shorter than in the other three molecules studied. This may be attributed to differences in the H atom tunnelling rate under the barrier formed by a conical intersection between the S(1) state and the close lying S(2) (πσ*) state, which is dissociative along the O-H stretching coordinate. Further evidence of this S(1)/S(2) interaction is also seen in the time-dependent anisotropy of the photoelectron angular distributions we have observed. Our data analysis was assisted by a matrix inversion method for processing photoelectron images that is significantly faster than most other previously reported approaches and is extremely quick and easy to implement.

A survey of national physicians working in an active conflict zone: the challenges of emergency medical care in Iraq.

INTRODUCTION: There has been limited research on the perspectives and needs of national caregivers when confronted with large-scale societal violence. In Iraq, although the security situation has improved from its nadir in 2006-2007, intermittent bombings, and other hostilities continue. National workers remain the primary health resource for the affected populace. PROBLEM: To assess the status and challenges of national physicians working in the Emergency Departments of an active conflict area. METHODS: This study was a survey of civilian Iraqi doctors working in Emergency Departments (EDs) across Iraq, via a convenience sample of physicians taking the International Medical Corps (IMC) Doctor Course in Emergency Medicine, given in Baghdad from December 2008 through August 2009. RESULTS: The 148 physician respondents came from 11 provinces and over 50 hospitals in Iraq. They described cardiovascular disease, road traffic injuries, and blast and bullet injuries as the main causes of death and reasons for ED utilization. Eighty percent reported having been assaulted by a patient or their family member at least once within the last year; 38% reported they were threatened with a gun. Doctors reported seeing a median of 7.5 patients per hour, with only 19% indicating that their EDs had adequate physician staffing. Only 19% of respondents were aware of an established triage system for their hospital, and only a minority had taken courses covering ACLS- (16%) or ATLS-related (24%) material. Respondents reported a wide diversity of prior training, with only 3% having some type of specialized emergency medicine degree. CONCLUSIONS: The results of this study describe some of the challenges faced by national health workers providing emergency care to a violence-stricken populace. Study findings demonstrate high levels of violent behavior directed toward doctors in Iraqi Emergency Departments, as well as staffing shortages and a lack of formal training in emergency medical care.