Adolescent Vaping-Associated Trauma in the Western United States.

INTRODUCTION: Electronic cigarettes (e-cigarettes) are handheld, battery-powered vaporizing devices. It is estimated that more than 25% of youth have used these devices recreationally. While vaping-associated lung injury is an increasingly recognized risk, little is known about the risk of traumatic injuries associated with e-cigarette malfunction. METHODS: A multi-institutional retrospective study was performed by querying the electronic health records at nine children's hospitals. Patients who sustained traumatic injuries while vaping from January 2016 through December 2019 were identified. Patient demographics, injury characteristics, and the details of trauma management were reviewed. RESULTS: 15 children sustained traumatic injuries due to e-cigarette explosion. The median age was 17 y (range 13-18). The median injury severity score was 2 (range 1-5). Three patients reported that their injury coincided with their first vaping experience. Ten patients required hospital admission, three of whom required intensive care unit admission. Admitted patients had a median length of stay of 3 d (range 1-6). The injuries sustained were: facial burns (6), loss of multiple teeth (5), thigh and groin burns (5), hand burns (4), ocular burns (4), a radial nerve injury, a facial laceration, and a mandible fracture. Six children required operative intervention, one of whom required multiple operations for a severe hand injury. CONCLUSIONS: In addition to vaping-associated lung injury, vaping-associated traumatic injuries are an emerging and worrisome injury pattern sustained by adolescents in the United States. This report highlights another means by which e-cigarettes pose an increasing risk to a vulnerable youth population.

Protect Our Kids: a novel program bringing hemorrhage control to schools.

BACKGROUND: Following the shooting at Sandy Hook Elementary School, the Hartford Consensus produced the Stop the Bleed program to train bystanders in hemorrhage control. In our region, the police bureau delivers critical incident training to public schools, offering instruction in responding to violent or dangerous situations. Until now, widespread training in hemorrhage control has been lacking. Our group developed, implemented and evaluated a novel program integrating hemorrhage control into critical incident training for school staff in order to blunt the impact of mass casualty events on children. METHODS: The staff of 25 elementary and middle schools attended a 90-minute course incorporating Stop the Bleed into the critical incident training curriculum, delivered on-site by police officers, nurses and doctors over a three-day period. The joint program was named Protect Our Kids. At the conclusion of the course, hemorrhage control kits and educational materials were provided and a four-question survey to assess the quality of training using a ten-point Likert scale was completed by participants and trainers. RESULTS: One thousand eighteen educators underwent training. A majority were teachers (78.2%), followed by para-educators (5.8%), counselors (4.4%) and principals (2%). Widely covered by local and state media, the Protect Our Kids program was rated as excellent and effective by a majority of trainees and all trainers rated the program as excellent. CONCLUSIONS: Through collaboration between trauma centers, police and school systems, a large-scale training program for hemorrhage control and critical incident response can be effectively delivered to schools.

Three-Dimensional Printed Ventilators: A Rapid Solution to Coronavirus Disease 2019-Induced Supply-Chain Shortages.

OBJECTIVE: To examine rapidly emerging ventilator technologies during coronavirus disease 2019 and highlight the role of CRISIS, a novel 3D printed solution. DATA SOURCES: Published articles, literature, and government guidelines that describe and review emergency use ventilator technologies. STUDY SELECTION: Literature was chosen from peer-reviewed journals and articles were limited to recent publications. DATA EXTRACTION: All information regarding ventilator technology was extracted from primary sources. DATA SYNTHESIS: Analysis of technology and relevance to coronavirus disease 2019 physiology was collectively synthesized by all authors. CONCLUSIONS: The coronavirus disease 2019 pandemic has placed massive stress on global supply chains for ventilators due to the critical damage the virus causes to lung function. There is an urgent need to increase supply, as hospitals become inundated with patients requiring intensive respiratory support. Coalitions across the United States have formed in order to create new devices that can be manufactured quickly, with minimal resources, and provide consistent and safe respiratory support. Due to threats to public health and the vulnerability of the U.S. population, the Food and Drug Administration released Emergency Use Authorizations for new or repurposed devices, shortening the approval timeline from years to weeks. The list of authorized devices varies widely in complexity, from automated bagging techniques to repurposed sleep apnea machines. Three-dimensional printed ventilators, such as "CRISIS," propose a potential solution to increase the available number of vents for the United States and abroad, one that is dynamic and able to absorb the massive influx of hospitalized patients for the foreseeable future.