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1.
Injury ; 53(11): 3605-3612, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36167687

RESUMEN

INTRODUCTION: Following a motor vehicle collision some patients will remain trapped. Traditional extrication methods are time consuming and focus on movement minimisation and mitigation. 'Chain cabling' is an alternative method of extrication used in some countries. The optimal extrication strategy and the effect of extrication methods on spinal movement is unknown. This study compares 'chain cabling' to the established roof removal method of extrication on spinal movement. METHODS: Biomechanical data were collected using Inertial Measurement Units on a single healthy volunteer during multiple experiments. The extrication types examined were chain cabling and roof removal. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LR) planes. Total movement (travel), maximal movement, mean, standard deviation and confidence intervals are reported. RESULTS: Eight experiments were performed using each technique. The smallest mean overall movements were recorded during roof-off extrication (cervical spine 0.6 mm for AP and LR, lumbar spine 3.9 mm AP and 0.3 mm LR). The largest overall mean movements were seen with chain cabling extrication (cervical spine AP 5.3 mm. LR 6.1 mm and lumbar spine 6.8 mm AP and 6.3 mm LR). CONCLUSION: In this study of a healthy volunteer, roof-off extrication was associated with less movement than chain cabling. The movement associated with chain cabling extrication was similar to that previously collected for other extrication types.


Asunto(s)
Accidentes de Tránsito , Vértebras Cervicales , Humanos , Voluntarios Sanos , Movimientos de la Cabeza
2.
BMJ Open ; 12(9): e063798, 2022 09 20.
Artículo en Inglés | MEDLINE | ID: mdl-36127106

RESUMEN

OBJECTIVE: To explore patient's experience of entrapment and subsequent extrication following a motor vehicle collision and identify their priorities in optimising this experience. DESIGN: Semistructured interviews exploring the experience of entrapment and extrication conducted at least 6 weeks following the event. Thematic analysis of interviews. SETTING: Single air ambulance and spinal cord injury charity in the UK. PARTICIPANTS: 10 patients were recruited and consented; six air ambulance patients and two spinal cord injury charity patients attended the interview. 2 air ambulance patients declined to participate following consent due to the perceived potential for psychological sequelae. RESULTS: The main theme across all participants was that of the importance of communication; successful communication to the trapped patient resulted in a sense of well-being and where communication failures occurred this led to distress. The data generated three key subthemes: 'on-scene communication', 'physical needs' and 'emotional needs'. Specific practices were identified that were of use to patients during entrapment and extrication. CONCLUSIONS: Extrication experience was improved by positive communication, companionship, explanations and planned postincident follow-up. Extrication experience was negatively affected by failures in communication, loss of autonomy, unmanaged pain, delayed communication with remote family and onlooker use of social media. Recommendations which will support a positive patient-centred extrication experience are the presence of an 'extrication buddy', the use of clear and accessible language, appropriate reassurance in relation to co-occupants, a supportive approach to communication with family and friends, the minimisation of onlooker photo/videography and the provision of planned (non-clinical) follow-up.


Asunto(s)
Accidentes de Tránsito , Traumatismos de la Médula Espinal , Comunicación , Humanos , Vehículos a Motor , Investigación Cualitativa
3.
Scand J Trauma Resusc Emerg Med ; 30(1): 41, 2022 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-35725580

RESUMEN

BACKGROUND: Approximately 1.3 million people die each year globally as a direct result of motor vehicle collisions (MVCs). Following an MVC some patients will remain trapped in their vehicle; these patients have worse outcomes and may require extrication. Following new evidence, updated multidisciplinary guidance for extrication is needed. METHODS: This Delphi study has been developed, conducted and reported to CREDES standards. A literature review identified areas of expertise and appropriate individuals were recruited to a Steering Group. The Steering Group formulated initial statements for consideration. Stakeholder organisations were invited to identify subject matter experts (SMEs) from a rescue and clinical background (total 60). SMEs participated over three rounds via an online platform. Consensus for agreement / disagreement was set at 70%. At each stage SMEs could offer feedback on, or modification to the statements considered which was reviewed and incorporated into new statements or new supporting information for the following rounds. Stakeholders agreed a set of principles based on the consensus statements on which future guidance should be based. RESULTS: Sixty SMEs completed Round 1, 53 Round 2 (88%) and 49 Round 3 (82%). Consensus was reached on 91 statements (89 agree, 2 disagree) covering a broad range of domains related to: extrication terminology, extrication goals and approach, self-extrication, disentanglement, clinical care, immobilisation, patient-focused extrication, emergency services call and triage, and audit and research standards. Thirty-three statements did not reach consensus. CONCLUSION: This study has demonstrated consensus across a large panel of multidisciplinary SMEs on many key areas of extrication and related practice that will provide a key foundation in the development of evidence-based guidance for this subject area.


Asunto(s)
Accidentes de Tránsito , Servicios Médicos de Urgencia , Consenso , Técnica Delphi , Humanos , Vehículos a Motor
4.
Br J Anaesth ; 129(2): 191-199, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35597623

RESUMEN

BACKGROUND: Women are less likely than men to receive some emergency treatments. This study examines whether the effect of tranexamic acid (TXA) on mortality in trauma patients varies by sex and whether the receipt of TXA by trauma patients varies by sex. METHODS: First, we conducted a sex-disaggregated analysis of data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH)-2 and CRASH-3 trials. We used interaction tests to determine whether the treatment effect varied by sex. Second, we examined data from the Trauma and Audit Research Network (TARN) to explore sex differences in the receipt of TXA. We used logistic regression models to estimate the odds ratio for receipt of TXA in females compared with males. Results are reported as n (%), risk ratios (RR), and odds ratios (OR) with 95% confidence intervals. RESULTS: Overall, 20 211 polytrauma patients (CRASH-2) and 12 737 patients with traumatic brain injuries (CRASH-3) were included in our analysis. TXA reduced the risk of death in females (RR=0.69 [0.52-0.91]) and in males (RR=0.80 [0.71-0.90]) with no significant heterogeneity by sex (P=0.34). We examined TARN data for 216 364 patients aged ≥16 yr with an Injury Severity Score ≥9 with 98 879 (46%) females and 117 485 (54%) males. TXA was received by 7198 (7.3% [7.1-7.4%]) of the females and 19 697 (16.8% [16.6-17.0%]) of the males (OR=0.39 [0.38-0.40]). The sex difference in the receipt of TXA increased with increasing age. CONCLUSIONS: Administration of TXA to patients with bleeding trauma reduces mortality to a similar extent in women and men, but women are substantially less likely to be treated with TXA.


Asunto(s)
Antifibrinolíticos , Ácido Tranexámico , Heridas y Lesiones , Antifibrinolíticos/uso terapéutico , Femenino , Hemorragia/tratamiento farmacológico , Humanos , Masculino , Sistema de Registros , Ácido Tranexámico/uso terapéutico , Reino Unido/epidemiología , Heridas y Lesiones/complicaciones , Heridas y Lesiones/tratamiento farmacológico
5.
BMJ Open ; 12(5): e061076, 2022 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-35504646

RESUMEN

OBJECTIVES: To identify the differences between women and men in the probability of entrapment, frequency of injury and outcomes following a motor vehicle collision. Publishing sex-disaggregated data, understanding differential patterns and exploring the reasons for these will assist with ensuring equity of outcomes especially in respect to triage, rescue and treatment of all patients. DESIGN: We examined data from the Trauma Audit and Research Network (TARN) registry to explore sex differences in entrapment, injuries and outcomes. We explored the relationship between age, sex and trapped status using multivariate logistical regression. SETTING: TARN is a UK-based trauma registry covering England and Wales. PARTICIPANTS: We examined data for 450 357 patients submitted to TARN during the study period (2012-2019), of which 70 027 met the inclusion criteria. There were 18 175 (26%) female and 51 852 (74%) male patients. PRIMARY AND SECONDARY OUTCOME MEASURES: We report difference in entrapment status, injury and outcome between female and male patients. For trapped patients, we examined the effect of sex and age on death from any cause. RESULTS: Female patients were more frequently trapped than male patients (female patients (F) 15.8%, male patients (M) 9.4%; p<0.0001). Trapped male patients more frequently suffered head (M 1318 (27.0%), F 578 (20.1%)), face, (M 46 (0.9%), F 6 (0.2%)), thoracic (M 2721 (55.8%), F 1438 (49.9%)) and limb injuries (M 1744 (35.8%), F 778 (27.0%); all p<0.0001). Female patients had more injuries to the pelvis (F 420 (14.6%), M 475 (9.7%); p<0.0001) and spine (F 359 (12.5%), M 485 (9.9%); p=0.001). Following adjustment for the interaction between age and sex, injury severity score, Glasgow Coma Scale and the Charlson Comorbidity Index, no difference in mortality was found between female and male patients. CONCLUSIONS: There are significant differences between female and male patients in the frequency at which patients are trapped and the injuries these patients sustain. This sex-disaggregated data may help vehicle manufacturers, road safety organisations and emergency services to tailor responses with the aim of equitable outcomes by targeting equal performance of safety measures and reducing excessive risk to one sex or gender.


Asunto(s)
Accidentes de Tránsito , Vehículos a Motor , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Sistema de Registros , Reino Unido/epidemiología
6.
Scand J Trauma Resusc Emerg Med ; 30(1): 14, 2022 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-35248129

RESUMEN

BACKGROUND: Motor vehicle collisions (MVCs), particularly those associated with entrapment, are a common cause of major trauma. Current extrication methods are focused on spinal movement minimisation and mitigation, but for many patients self-extrication may be an appropriate alternative. Older drivers and passengers are increasingly injured in MVCs and may be at an increased risk of entrapment and its deleterious effects. The aim of this study is to describe the injuries, trapped status, outcomes, and potential for self-extrication for patients following an MVC across a range of age groups. METHODS: This is a retrospective study using the Trauma Audit and Research Network (TARN) database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2019. Patients were excluded when their outcomes were not known or if they were secondary transfers. Simple descriptive analysis was used across the age groups: 16-59, 60-69, 70-79 and 80+ years. Logistic regression was performed to develop a model with known confounders, considering the odds of death by age group, and examining any interaction between age and trapped status with mortality. RESULTS: 70,027 patients met the inclusion criteria. Older patients were more likely to be trapped and to die following an MVC (p < 0.0001). Head, abdominal and limb injuries were more common in the young with thoracic and spinal injuries being more common in older patients (all p < 0.0001). No statistical difference was found between the age groups in relation to ability to self-extricate. After adjustment for confounders, the 80 + age group were more likely to die if they were trapped; adjusted OR trapped 30.2 (19.8-46), not trapped 24.2 (20.1-29.2). CONCLUSIONS: Patients over the age of 80 are more likely to die when trapped following an MVC. Self-extrication should be considered the primary route of egress for patients of all ages unless it is clearly impracticable or unachievable. For those patients who cannot self-extricate, a minimally invasive extrication approach should be employed to minimise entrapment time.


Asunto(s)
Accidentes de Tránsito , Traumatismos Vertebrales , Adolescente , Anciano , Humanos , Sistema de Registros , Estudios Retrospectivos , Traumatismos Vertebrales/epidemiología , Traumatismos Vertebrales/terapia , Reino Unido/epidemiología
7.
Scand J Trauma Resusc Emerg Med ; 30(1): 4, 2022 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-35033151

RESUMEN

BACKGROUND: Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack "real world" context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury. We propose the metric 'travel' (total movement) and suggest that our understanding of movement related risk of injury could be improved if travel was routinely reported. We report maximal movement and travel for collar application in vehicle and subsequent self-extrication. METHODS: Biomechanical data on application of cervical collar with the volunteer sat in a vehicle were collected using Inertial Measurement Units on 6 healthy volunteers. Maximal movement and travel are reported. These data and a re-analysis of previously published work is used to demonstrate the utility of travel and maximal movement in the context of self-extrication. RESULTS: Data from a total of 60 in-vehicle collar applications across three female and three male volunteers was successfully collected for analysis. The mean age across participants was 50.3 years (range 28-68) and the BMI was 27.7 (range 21.5-34.6). The mean maximal anterior-posterior movement associated with collar application was 2.3 mm with a total AP travel of 4.9 mm. Travel (total movement) for in-car application of collar and self-extrication was 9.5 mm compared to 9.4 mm travel for self-extrication without a collar. CONCLUSION: We have demonstrated the application of 'travel' in the context of self-extrication. Total travel is similar across self-extricating healthy volunteers with and without a collar. We suggest that where possible 'travel' is collected and reported in future biomechanical studies in this and related areas of research. It remains appropriate to apply a cervical collar to self-extricating casualties when the clinical target is that of movement minimisation.


Asunto(s)
Vértebras Cervicales , Traumatismos de la Médula Espinal , Accidentes de Tránsito , Adulto , Anciano , Femenino , Voluntarios Sanos , Humanos , Inmovilización , Masculino , Persona de Mediana Edad
8.
Scand J Trauma Resusc Emerg Med ; 30(1): 7, 2022 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-35033160

RESUMEN

BACKGROUND: Motor vehicle collisions are a common cause of death and serious injury. Many casualties will remain in their vehicle following a collision. Trapped patients have more injuries and are more likely to die than their untrapped counterparts. Current extrication methods are time consuming and have a focus on movement minimisation and mitigation. The optimal extrication strategy and the effect this extrication method has on spinal movement is unknown. The aim of this study was to evaluate the movement at the cervical and lumbar spine for four commonly utilised extrication techniques. METHODS: Biomechanical data was collected using inertial Measurement Units on 6 healthy volunteers. The extrication types examined were: roof removal, b-post rip, rapid removal and self-extrication. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LAT) planes. Total movement (travel), maximal movement, mean, standard deviation and confidence intervals are reported for each extrication type. RESULTS: Data from a total of 230 extrications were collected for analysis. The smallest maximal and total movement (travel) were seen when the volunteer self-extricated (AP max = 2.6 mm, travel 4.9 mm). The largest maximal movement and travel were seen in rapid extrication extricated (AP max = 6.21 mm, travel 20.51 mm). The differences between self-extrication and all other methods were significant (p < 0.001), small non-significant differences existed between roof removal, b-post rip and rapid removal. Self-extrication was significantly quicker than the other extrication methods (mean 6.4 s). CONCLUSIONS: In healthy volunteers, self-extrication is associated with the smallest spinal movement and the fastest time to complete extrication. Rapid, B-post rip and roof off extrication types are all associated with similar movements and time to extrication in prepared vehicles.


Asunto(s)
Accidentes de Tránsito , Vértebras Cervicales , Voluntarios Sanos , Humanos
9.
Scand J Trauma Resusc Emerg Med ; 29(1): 108, 2021 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-34332623

RESUMEN

BACKGROUND: Motor vehicle collisions account for 1.3 million deaths and 50 million serious injuries worldwide each year. However, the majority of people involved in such incidents are uninjured or have injuries which do not prevent them exiting the vehicle. Self-extrication is the process by which a casualty is instructed to leave their vehicle and completes this with minimal or no assistance. Self-extrication may offer a number of patient and system-wide benefits. The efficacy of routine cervical collar application for this group is unclear and previous studies have demonstrated inconsistent results. It is unknown whether scripted instructions given to casualties on how to exit the vehicle would offer any additional utility. The aim of this study was to evaluate the effect of cervical collars and instructions on spinal movements during self-extrication from a vehicle, using novel motion tracking technology. METHODS: Biomechanical data on extrications were collected using Inertial Measurement Units on 10 healthy volunteers. The different extrication types examined were: i) No instructions and no cervical collar, ii) No instructions, with cervical collar, iii) With instructions and no collar, and iv) With instructions and with collar. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LAT) planes. Total movement, mean, standard deviation and confidence intervals are reported for each extrication type. RESULTS: Data were recorded for 392 extrications. The smallest cervical spine movements were recorded when a collar was applied and no instructions were given: mean 6.9 mm AP and 4.4 mm LAT. This also produced the smallest movements at the lumbar spine with a mean of 122 mm AP and 72.5 mm LAT. The largest overall movements were seen in the cervical spine AP when no instructions and no collar were used (28.3 mm). For cervical spine lateral movements, no collar but with instructions produced the greatest movement (18.5 mm). For the lumbar spine, the greatest movement was recorded when instructions were given and no collar was used (153.5 mm AP, 101.1 mm LAT). CONCLUSIONS: Across all participants, the most frequently occurring extrication method associated with the least movement was no instructions, with a cervical collar in situ.


Asunto(s)
Vértebras Cervicales , Inmovilización , Accidentes de Tránsito/prevención & control , Voluntarios Sanos , Humanos , Vehículos a Motor
10.
Scand J Trauma Resusc Emerg Med ; 29(1): 17, 2021 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-33446210

RESUMEN

BACKGROUND: Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. METHODS: We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. RESULTS: This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p < 0.001). Spinal cord injuries were rare (0.71% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were trapped (p < 0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10-29) vs 13 (IQR 9-22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow Coma Scale, GCS (all p < 0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001). CONCLUSION: Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Puntaje de Gravedad del Traumatismo , Accidentes de Tránsito/mortalidad , Adulto , Presión Sanguínea , Femenino , Escala de Coma de Glasgow , Hemorragia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Neumotórax/epidemiología , Sistema de Registros , Estudios Retrospectivos , Traumatismos Vertebrales/epidemiología , Reino Unido/epidemiología , Heridas y Lesiones/epidemiología
11.
Emerg Med J ; 35(11): 669-674, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30154141

RESUMEN

INTRODUCTION: Paediatric traumatic cardiac arrest (TCA) is a high acuity, low frequency event. Traditionally, survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population, there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable with that seen from medical out-of-hospital cardiac arrests. Key to this survival has been the adoption of a standardised approach to resuscitation. The aim of this study was, by a process of consensus, to develop an algorithm for the management of paediatric TCA for adoption in the UK. METHODS: A modified consensus development meeting of UK experts involved in the management of paediatric TCA was held. Statements discussed at the meeting were drawn from those that did not reach consensus (positive/negative) from a linked three-round online Delphi study. 19 statements relating to the diagnosis, management and futility of paediatric TCA were initially discussed in small groups before each participant anonymously recorded their agreement with the statement using 'yes', 'no' or 'don't know'. In keeping with our Delphi study, consensus was set a priori at 70%. Statements reaching consensus were included in the proposed algorithm. RESULTS: 41 participants attended the meeting. Of the 19 statements discussed, 13 reached positive consensus and were included in the algorithm. A single statement regarding initial rescue breaths reached negative consensus and was excluded. Consensus was not reached for five statements, including the use of vasopressors and thoracotomy for haemorrhage control in blunt trauma. CONCLUSION: In attempt to standardise our approach to the management of paediatric TCA and to improve outcomes, we present the first consensus-based algorithm specific to the paediatric population. While this algorithm was developed for adoption in the UK, it may be applicable to similar healthcare systems internationally.


Asunto(s)
Guías como Asunto/normas , Paro Cardíaco/etiología , Órdenes de Resucitación , Heridas y Lesiones/complicaciones , Adolescente , Algoritmos , Niño , Preescolar , Técnica Delphi , Femenino , Paro Cardíaco/epidemiología , Humanos , Lactante , Masculino , Paro Cardíaco Extrahospitalario/epidemiología , Reino Unido/epidemiología
12.
Emerg Med J ; 35(7): 434-439, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29705730

RESUMEN

AIMS: Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients. METHODS: An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy. RESULTS: 73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation. CONCLUSION: This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians.


Asunto(s)
Consenso , Paro Cardíaco Extrahospitalario/clasificación , Pediatría/métodos , Heridas y Lesiones/clasificación , Adulto , Técnica Delphi , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pediatría/clasificación
14.
Prehosp Disaster Med ; 31(4): 459-60, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-27226288

RESUMEN

Horne S , Nutbeam T . You can't make a silk purse out of a sow's ear: time to start again with MCI triage. Prehosp Disaster Med. 2016;31(4):459-460.


Asunto(s)
Incidentes con Víctimas en Masa , Triaje , Humanos
15.
BMC Med ; 13: 98, 2015 Apr 27.
Artículo en Inglés | MEDLINE | ID: mdl-25927426

RESUMEN

Sepsis is associated with significant morbidity and mortality if not promptly recognized and treated. Since the development of early goal-directed therapy, mortality rates have decreased, but sepsis remains a major cause of death in patients arriving at the emergency department or staying in hospital. In this forum article, we asked clinicians and researchers with expertise in sepsis care to discuss the importance of rapid detection and treatment of the condition, as well as special considerations in different patient groups.


Asunto(s)
Sepsis/diagnóstico , Sepsis/terapia , Adulto , Niño , Femenino , Humanos , Masculino
16.
Injury ; 46(7): 1262-9, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25835528

RESUMEN

INTRODUCTION: Challenges exist in how to deliver enhanced care to patients suffering severe injury in geographically remote areas within regionalised trauma networks at night. The physician led Enhanced Care Teams (ECTs) in the West Midlands region of England do not currently utilise helicopters to respond to incidents at night. This study describes this remote trauma workload at night within the regional network in terms of incident location; injury profile and patient care needs and discusses various solutions to the delivery of ECTs to such incidents, including the need for helicopter based platforms. METHODS: We present a retrospective analysis of incidents involving Major Trauma occurring in the West Midlands Regional Trauma Network in England over a one year period (1st April 2012 until the 31st March 2013). Anonymised patient records from the Trauma Audit and Research Network (TARN) for patients that had been conveyed to hospital by ambulance/air ambulance were cross-referenced with the West Midlands Ambulance Service NHS Foundation Trust (WMAS) Computer Assisted Dispatch (CAD) archive for the same period. Data were abstracted from the combined dataset relating to injury severity (ISS/ICU admission/death at scene or as inpatient); ECT resource activations/scene attendances; incident location and the need for enhanced level care. RESULTS: A total of 603 incidents involving Major Trauma were identified during night time hours. Enhanced Care Team resources attended scene in 167 cases (27.7%). Of the incidents not attended by an ECT 179 (41.1%) were due to falls and 91 (20.9%) involved a 'Road Traffic Collision'. A total of 36 incidents (6.0% of total at night) occurred in locations identified as being greater than 45min by road from the nearest major trauma centre. In these cases 13 patients had enhanced care needs that could not be addressed at scene by the attending ambulance service personnel. CONCLUSIONS: There is limited evidence to support the need for night HEMS operations in the West Midlands regional trauma network. The potential role of night HEMS in other regional trauma networks in England requires further evaluation with specific reference to the incidence of Major Trauma and efficiency of existing road based systems.


Asunto(s)
Ambulancias Aéreas/estadística & datos numéricos , Prestación Integrada de Atención de Salud/organización & administración , Servicios Médicos de Urgencia/organización & administración , Traumatismo Múltiple/terapia , Adulto , Anciano , Ambulancias Aéreas/economía , Aeronaves , Ambulancias , Prestación Integrada de Atención de Salud/economía , Servicios Médicos de Urgencia/economía , Inglaterra/epidemiología , Práctica Clínica Basada en la Evidencia , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Estudios Retrospectivos , Factores de Tiempo
17.
Emerg Med J ; 32(5): 401-3, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-24743587

RESUMEN

BACKGROUND: Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for extrication or the factors which affect this time. OBJECTIVE: To derive a tool to predict the time taken to extricate patients from MVCs. METHODS: A prospective, observational derivation study was carried out in the West Midland Fire Service's metropolitan area. An expert group identified factors that may predict extrication time-the presence and absence of these factors was prospectively recorded at eligible extrications for the study period. A step-down multiple regression method was used to identify important contributing factors. RESULTS: Factors that increased extrication times by a statistically significant extent were: a physical obstruction (10 min), patients medically trapped (10 min per patient) and any patient physically trapped (7 min). Factors that shortened extrication time were rapid access (-7 min) and the car being on its roof (-12 min). All these times were calculated from an arbitrary time (which assumes zero patients) of 8 min. CONCLUSIONS: This paper describes the development of a tool to predict extrication time for a trapped patient. A number of factors were identified which significantly contributed to the overall extrication time.


Asunto(s)
Accidentes de Tránsito , Servicios Médicos de Urgencia , Humanos , Estudios Prospectivos , Análisis de Regresión , Factores de Tiempo , Reino Unido
18.
Emerg Med J ; 31(12): 1006-8, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24005643

RESUMEN

BACKGROUND: Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for the various stages of extrication. OBJECTIVE: To report the time taken for the various stages of extrication. METHODS: A prospective, observational study carried out in the West Midland Fire Service's metropolitan area. Time points related to extrication were collected 'live' by two-way radio broadcast. Any missing data were actively gathered by fire control within 1 h of completion of extrication. This paper reports an interim analysis conducted after 1 year of data collection following a 3-month run-in and training period: data were analysed from 1 January 2011 to 31 December 2011 inclusive. RESULTS: During the study period 228 incidents were identified. Seventy-nine were excluded as they met the predetermined exclusion criteria or had incomplete data collection. This left 158 extrications that were suitable for analysis. The median time for extrication was 30 min, IQR 24-38 min. CONCLUSIONS: In patients requiring extrication following an MVC a median time of 8 min is typically required before initial limited patient assessment and intervention. A further 22 min is typically required before full extrication. Prehospital personnel should be aware of these times when planning their approach to a trapped patient.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Automóviles , Servicios Médicos de Urgencia/métodos , Primeros Auxilios/métodos , Administración del Tiempo/organización & administración , Femenino , Humanos , Masculino , Seguridad del Paciente , Estudios Prospectivos , Factores de Riesgo , Administración del Tiempo/métodos , Reino Unido
19.
Emerg Med J ; 29(3): 182-3, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21441272

RESUMEN

OBJECTIVE: For serious motor vehicle crashes (MVC) occurring in a rural area to quantify: how many occur more than 45 min by road to a major trauma centre (MTC); how many occur more than 45 min by helicopter to an MTC; and how many patients might have to be taken to a local trauma unit if their incident occurs more than 45 min by road from an MTC and when the helicopter cannot fly. METHODS: MVC occurring in Shropshire, in which patients were killed or seriously injured during 2006-9 (inclusive) were analysed using the following parameters: distance from MTC by road; distance from MTC by air; weather and visibility-related factors that affect the operation of a helicopter emergency medical service. RESULTS: 722 serious MVC occurred, of which 626 (87%) occurred more than 45 min by road from the MTC. Of these 626 incidents, 408 occurred in conditions in which the helicopter could fly. There were 218 incidents (30%), which were more than 45 min by road from the MTC and which occurred when the helicopter could not fly. CONCLUSIONS: The transportation of patients from remote and rural areas to MTC remains problematical. Further work is required to develop more efficient systems of retrieval and transfer, and in particular to consider how emergency medical helicopters might operate safely at night.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Transporte de Pacientes/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Inglaterra/epidemiología , Accesibilidad a los Servicios de Salud , Humanos , Incidencia , Factores de Tiempo
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