[PROBLEMATIC ISSUES OF EQUIPPING SEA VESSELS IN TERMS OF STAFFING THE SHIP'S FIRST AID KIT IN THE CONTEXT OF THE NEW CORONAVIRUS INFECTION COVID-19].

Today, the presence of specifics in the organization of the work of sea cargo, fishing and passenger ships is indisputable, which affects the difficulties in providing qualified timely medical care in case of need. This issue is especially urgent in the context of the pandemic caused by the new coronavirus infection COVID-19. The article carried out a detailed analysis of the regulatory framework governing the formation of the list of ship's first aid kit and formulated the appropriate conclusions and recommendations. In addition, the article developed recommendations for supplementing the ship's list with drugs necessary for the treatment of COVID-19.

Prehospital tourniquet use: An evaluation of community application and outcome.

BACKGROUND: There is substantial investment in layperson and first responder training involving tourniquet use for hemorrhage control. Little is known however about prehospital tourniquet application, field conversion, or outcomes in the civilian setting. We describe the experience of a metropolitan region with prehospital tourniquet application. METHODS: We conducted a retrospective cohort study characterizing prehospital tourniquet use treated by emergency medical services (EMS) in King County, Washington, from January 2018 to June 2019. Emergency medical services and hospital records were abstracted for demographics, injury mechanism, tourniquet details, clinical care, and outcomes. We evaluated the incidence of tourniquet application, who applied the device (EMS, law enforcement, or layperson), and subsequent course. RESULTS: A total of 168 patients received tourniquet application, an incidence of 5.1 per 100,000 person-years and 3.48 per 1,000 EMS responses for trauma. Tourniquets were applied for penetrating trauma (64%), blunt trauma (30%), and bleeding ateriovenous fistulas (7%). A subset was critically ill: 13% had systolic blood pressures of <90 mm Hg, 8% had Glasgow Coma Scale score of <13, and 3% had cardiac arrest. Among initial applications, 48% were placed by law enforcement, 33% by laypersons, and 18% by EMS. Among tourniquets applied by layperson or law enforcement (n = 137), EMS relied solely on the original tourniquet in 45% (n = 61), placed a second tourniquet in 20% (n = 28), and removed the tourniquet without replacement in 35% (n = 48). Overall, 24% required massive transfusion, 59% underwent urgent surgery, and 21% required vascular surgery. Mortality was 3% (n = 4). At hospital discharge, the tourniquet limb was fully functional in 81%, partially functional in 10%, and nonfunctional in 9%; decreased function was not attributed to tourniquet application. CONCLUSION: The high rate of application, need for urgent hospital intervention in a subset, and low incidence of apparent complication suggest that efforts to increase access and early tourniquet use can provide public health benefit. LEVEL OF EVIDENCE: Therapeutic, level IV.

Gincana educativa ­ como salvar uma vida: estratégia sobre primeiros socorros para adolescentes / Educative Gymkhana --How to save a life: strategy on first aid for adolescents / Gincana Educativa -Cómo salvar una vida: estrategia de primeros auxilios para adolescentes

Introdução:Verifica-se que a educação em saúde é uma estratégia de ensino e aprendizagem com objetivo de melhorar a qualidade de vida e de saúde da população.Objetivo:Descrever uma estratégia educativa sobre primeiros socorros para adolescentes. Metodologia:Trata-se de uma pesquisa ação realizada em maio de 2019 com 27 adolescentes, estudantes de uma escola situada nacidade de Itapajé, Ceará. A pesquisa seguiu as seguintes etapas: Iniciação do Projeto de Pesquisa Ação; A Definição da Estrutura Conceitual Teórica; Definição do Contexto e Propósito da Pesquisa; eColeta de dados, que se deu em quatro momentos, por meio de um Instrumento de Coleta de Dados semiestruturado e aplicação da Gincana Educativa ­Como salvar uma vida. Pesquisa aprovada pelo Comitê de Ética em Pesquisa da Universidade Estadual Vale do Acaraú com número 3.241.797. Resultados:A Gincana foi organizada em seis etapas: Torta na cara, Jogo de Cooperação, Desafio, Resistência física, Quiz e Demonstração, buscando deixar o momento descontraído,dinâmico, competitivo e de aprendizado. Verificou-se que os participantes tiveram interesse na aprendizagem sobre primeiros socorros, principalmente quando acompanhadas pela utilização de tecnologias educativas.Conclusões:A gincana contribuiu no aprendizado sobre primeiros socorros dos escolares, o que lhes permitiu prevenir possíveis agravos em saúde,além de torná-los possíveis disseminadores de conhecimento (AU).

Introduction:It appears that health education is a teaching and learning strategy aimed at improving the quality of life and health of the population. Objective:Describe an educative strategy on first aid for adolescents. Methodology:This is an action research carried out in May 2019 with 27 adolescents, students from a school located in the city of Itapajé, Ceará. The research followed thesteps:Initiation of the Action Research Project; The Definition of Theoretical Conceptual Framework; Definition of the Context and Purpose of the Research; and data collection, which took place in four moments, using a semi-structured Data Collection Instrument and application of the Educational Gymkhana -How to save a life.Research approved by the Research Ethics Committee of theState University Vale do Acaraú with number 3,241,797. Results:The Gymkhana was organized in six stages: Pie in the face, Cooperation Game, Challenge,Physical resistance, Quiz and Demo, seeking to leave the moment relaxed, dynamic, competitive and learning. It was found that the participants had interested in learning about first aid, mainly when accompanied by the use of educative Technologies. Conclusions:The gymkhana contributed to the students' first aid learning, which allowed them to prevent possible health problems, in addition to making them possible disseminators of knowledge (AU).

Introducción: Verifica que la educación para la salud es una estrategia de enseñanza y aprendizaje dirigida a mejorar la calidad de vida y la salud de la población. Objetivo: Describir una estrategia educativa sobre primeros auxilios para adolescentes.Metodología: Se trata de una investigación-acción realizada en mayo de 2019 con 27 adolescentes,estudiantes de una escuela ubicada en la ciudad de Itapajé, Ceará.La investigación siguió los siguientes pasos: Inicio del proyecto de investigación-acción; La definición de marco conceptual teórico; Definición del contexto y propósito de la investigación;y Recopilación de datos, que tuvo lugar en cuatro momentos, a través de un Instrumento de Recolección de Datos semi-estructurado y aplicación de la Gymkhana Educativa -Cómo salvar una vida.Investigación aprobada por el Comité de Ética en Investigación de la Universidad Estatal Vale do Acaraú con el número 3.241.797.Resultados: La Gymkhana se organizó en seis etapas: Torta en la cara, Juego de cooperación, Desafío, Resistencia física,Quizy Demostración,buscando salir del momento relajado, dinámico, competitivo y aprendiendo. Se encontró que los participantes tenían interesados en aprender sobre primeros auxilios, especialmente cuando se acompañan del uso de tecnologías educativas.Conclusiones: La gymkana contribuyó al aprendizaje de los estudiantes en primeros auxilios, lo que les permitió prevenir posibles problemas de salud, además de hacerlos posibles divulgadores de conocimientos (AU).

Compression Wrapping for Acute Closed Extremity Joint Injuries: A Systematic Review.

OBJECTIVE: Current prehospital recommendations for an acute closed extremity joint injury (ACEJI) are to apply compression in some manner. However, the effectiveness of compression is unclear. We performed a systematic review to summarize and synthesize the evidence for the use of a compression bandage for ACEJI in the prehospital setting. DATA SOURCES: Cochrane Library, PubMed, and Embase were searched for relevant literature in November 2019. STUDY SELECTION: Controlled trials involving adults in the prehospital setting with a recent ACEJI were included when compressive, nonimmobilizing interventions, feasible in a first aid setting, were applied and compared with no compression or any noncompressive intervention, such as braces, splints, or noncompressive stockings. Articles in all languages were included if an English abstract was available. DATA EXTRACTION: Data on study design, study population, intervention, outcome measures, and methodologic quality were extracted from each included article. DATA SYNTHESIS: Eight studies out of 1193 possibly relevant articles were included. All authors examined compression in the treatment of acute ankle sprains; no studies involved compression for the treatment of other ACEJIs. No difference in the major outcomes of pain reduction or swelling, ankle-joint function, or range of motion could be demonstrated. For the outcome of recovery time, no benefit was shown when comparing compression with no compression. Evidence was insufficient to inform a conclusion about the outcomes of time to return to work or sport. All evidence was of low to very low certainty. CONCLUSIONS: The evidence for the use of a compression wrap was limited to patients with closed ankle injuries. In this systematic review, we could not demonstrate either a beneficial or harmful effect from the application of a compression or elastic bandage compared with no compression or a noncompressive stocking, splint, or brace as a first aid treatment in the prehospital environment.

Application of Bleeding Control Training in Occupational Settings.

Background: Uncontrolled blood loss is a primary source of preventable death after injury. Workplace injuries and fatalities are common, with most occurring in the agricultural/fishing/forestry/hunting or transportation/warehousing industries. Stop the Bleed (STB) training provides instruction on application of bleeding control methods to injured persons and is available to the general public. Method: We provided an overview of high-risk injury industries that could benefit from STB training. We also provided a review of the application of STB training and bleeding control methods in occupational settings with an emphasis on the role of the occupational health nurse. Findings: Suggested guidelines for occupational health nurses and employees in occupational settings who may respond to injured colleagues are provided. Implications for occupational health nurses are reviewed, including implementing STB training in the workplace and obtaining/storing bleeding control supplies. Resources for STB training, purchasing and storing bleeding control supplies, and general emergency response information are provided. Conclusions/application to practice: Occupational health nurses play a crucial role in emergency response in the workplace and have the ability to drive the implementation of STB training in their institution. Occupational health nurses often work in isolation or in small teams and serve as a primary resource for treatment of injured employees. Implementation of STB training for all employees is highly recommended given the limited availability of occupational health nurses in large or rural settings. Such training may reduce the morbidity and mortality associated with workplace injuries.

The Challenge of Implementing the "Stop the Bleed" Campaign in Latin America.

BACKGROUND: Currently, several initiatives have emerged to empower the public to act as immediate responders in front of hemorrhaging victims. We aimed to evaluate the effectiveness of implementing the Stop the Bleed campaign and the association between the instructors' background and the theoretical and practical competences achieved by the participants in Latin America. METHODS: Medical students and general surgeons taught both allied health students and nonallied health students at a local university; the training had a master class followed by a practical component and a written test, as well as tourniquet placement was tested. RESULTS: 265 individuals received the training, and data were available for 243. Of these, 126 (52.07%) were women and the median age was 21 (IQR: 20-22) years. 121 (49.79%) were trained by general surgeons (group A) and 122 (50.21%) by medical students (group B). After the training, more than 98% of all participants perceived that they would most likely be capable of aiding correctly a bleeding victim by applying direct pressure and more than 90% of them felt confident in being able to apply a tourniquet. There were no statistically significant differences among both groups when comparing their post-training competence evaluations [Theoretical test score: group A = 5 (IQR: 4-5); group B = 5 (IQR: 4-5); P = 0.41] and [Practical competency of tourniquet deployment: group A = 119 (66.39%) versus group B = 120 (65.83%); P = 0.93]. CONCLUSIONS: The Stop the Bleed campaign can be effectively implemented in Latin America, and it can be taught by prequalified medical students without altering the learning objectives of the course.

Compreensão dos acadêmicos de medicina sobre os princípios de atendimento inicial aos pacientes queimados / Understanding of medical students about the principles of initial assistance for burn patients

OBJETIVO: Avaliar a compreensão dos acadêmicos de medicina sobre o atendimento inicial a pacientes queimados, bem como o aprendizado sobre a temática ao longo do curso. MÉTODO: Trata-se de um estudo transversal descritivo realizado em uma instituição de ensino superior de Minas Gerais, por meio da aplicação de um questionário validado por Balan e colaboradores. A coleta de dados ocorreu entre março e outubro de 2020, com 92 acadêmicos do 1° ano e 45 acadêmicos do 6° ano de medicina. As análises foram realizadas no software R versão 4.0.3. Descritas por frequências absolutas e relativas, desvio-padrão, teste Exato de Fisher, teste Qui-quadrado e teste de Mann-Whitney. RESULTADOS: Constatou-se que 6,67% dos acadêmicos do 6° ano acertaram acima de 80% das questões e 2,17% do 1° ano. A média de acertos, em porcentagem, no 6° ano foi 63,1±10,3 versus 47,0±16,9 no 1° ano. O tema de maior desconhecimento foi reanimação volêmica, cujo, 93,3% acadêmicos do 6° ano contra 96,7% no 1° ano erraram. O exame básico, cuidados iniciais, cálculo da superfície corporal queimada e triagem foram áreas do conhecimento com maior percentual de acerto no 6° ano: 93,3%, 85,6±25,3%, 80% e 85,2±19,5%, respectivamente, enquanto os do 1° ano tiveram menos acertos. CONCLUSÃO: Verificou-se, pelo presente trabalho, que apesar do aumento de acertos em comparação com o 1° ano, algumas condutas médicas iniciais necessárias aos pacientes queimados como reposição volêmica, cuidados locais e antibioticoterapia não são compreendidas pelos acadêmicos do 6° ano, na maior parte da amostra estudada.

OBJECTIVE: To evaluate the understanding of medical students about the initial care for burn patients, as well as learning about the theme throughout the course. METHOD: This is a cross-sectional descriptive study carried out in a higher education institution in Minas Gerais, through the application of a questionnaire validated by Balan and collaborators. Data collection took place between March and October 2020, with 92 students from the 1st year and 45 students from the 6th year of medicine. The variables were presented by absolute and relative frequencies and standard deviation. RESULTS: It was found that 6.67% of the 6th grade students answered correctly above 80% of the questions and 2.17% of the 1st year. The average number of correct answers in the 6th year was 63.1±10.3 versus 47.0±16.9 in the 1st year. The theme of greatest ignorance was volemic resuscitation, whose 93.3% 6th graders against 96.7% in 1st grade missed. The basic exam, initial care, calculation of the burned body surface and screening were fields of knowledge with the greatest percentage of correct answers in the 6th year: 93.3%, 85.6±25.3%, 80%, and 85.2±19.5%, respectively, while those in the 1st year had less correct answers. CONCLUSION: It was found, in the study, that despite the increase in correct answers compared to the 1st year, some initial medical procedures necessary for burned patients, such as: volume replacement, local care and antibiotic therapy, are not understood by 6th graders, in most of the studied sample.

Desarrollo del botiquín individual de combate en las Fuerzas Armadas españolas / Development of individual combat first aid kit in Spanish Armed Forces

Introducción: El botiquín individual de combate es el material sanitario específico con el que se dota a cada uno de los militares para que, en caso de resultar herido, se puedan realizar los primeros auxilios aunque carezca de formación sanitaria. Objetivo: Diseñar el nuevo botiquín individual de combate para el ejército español determinando su contenido y requisitos técnicos. Material y método: Se han realizado entrevistas a responsables sanitarios de las unidades militares más operativas del Ejército de Tierra Español. Estudio físico de cada uno de los elementos componentes del actual BIC y comparación de los botiquines existentes en los ejércitos de los países de nuestro entorno. Se ha realizado una revisión bibliográfica con metodología sistemática en las principales bases de datos científicas. Para verificar la validez de los textos seleccionados se aplicaron programas de lectura crítica. Resultados y conclusión: Realización de una propuesta de nuevo botiquín de combate así como de su contenedor, con adición y eliminación de elementos

Introduction: The individual combat kit is the specific sanitary material with which each one of the soldiers is provided so that, in case of being injured, the first aid can be carried out even if it lacks health training. Objectives: The objective is to design the new individual combat kit for the Spanish Army and the specific one to determine its content and technical requirements. Material and method: Interviews were carried out to health officials of the most operational military units of the Spanish Army. Physical study of each of the component elements of the current BIC and comparison of the medicine kits existing in the armies of the countries of our environment. A bibliographic review with a systematic methodology was carried out in the main scientific databases. In order to verify the validity of the selected texts, critical reading programs were applied. Results and conclusion: Proposal of addition and elimination of elements in the possible new combat kit as well as the container

Missing expectations: Windlass tourniquet use without formal training yields poor results.

BACKGROUND: Despite significant attempts to educate civilians in hemorrhage control, the majority remain untrained. We sought to determine if laypersons can successfully apply one of three commercially available tourniquets; including those endorsed by the United States Military and the American College of Surgeons. METHODS: Preclinical graduate health science students were randomly assigned a commercially available windless tourniquet: SAM XT, Combat Application Tourniquet (CAT), or Special Operation Forces Tactical Tourniquet (SOFT-T). Each was given up to 1 minute to read package instructions and asked to apply it to the HapMed Leg Tourniquet Trainer. Estimated blood loss was measured until successful hemostatic pressure was achieved or simulated death occurred from exsanguination. Simulation survival, time to read instructions and stop bleeding, tourniquet pressure, and blood loss were analyzed. RESULTS: Of the 150 students recruited, 55, 46, and 49 were randomized to the SAM XT, CAT, SOFT-T, respectively. Mean overall simulation survival was less than 66% (65%, 72%, 61%; p = 0.55). Of survivors, all three tourniquets performed similarly in median pressure applied (319, 315, and 329 mm Hg; p = 0.54) and median time to stop bleeding (91, 70, 77 seconds; p = 0.28). There was a statistical difference in median blood loss volume favoring SOFT-T (SAM XT, 686 mL; CAT, 624 mL; SOFT-T, 433 mL; p = 0.03). All 16 participants with previous experience were able to successfully place the tourniquet compared with 81 (62%) of 131 first-time users (p = 0.008). CONCLUSION: No one should die of extremity hemorrhage, and civilians are our first line of defense. We demonstrate that when an untrained layperson is handed a commonly accepted tourniquet, failure is unacceptably high. Current devices are not intuitive and require training beyond the enclosed instructions. Plans to further evaluate this cohort after formal "Stop the Bleed" training are underway.

Limb Tourniquet Configuration: Preliminary Investigation of Problems and Principles.

BACKGROUND: A tourniquet's readiness during emergencies depends on how it is configured. We investigated configuration so ways of improving readiness can be developed. METHODS: This study was conducted at the Institute of Surgical Research in 2018 as sequential investigations by one user of Combat Application Tourniquets (C-A-Ts) in a band-and-rod design. RESULTS: Each tourniquet comes packaged with paper instructions for use, which include directions on how to configure it in preparation for caregiving. The paper and video instructions for use omit tensioning of the tourniquet in configuration, and the video misconfigured a time strap over the rod. In first-aid classrooms, we saw unwitting learners troubleshoot that misconfiguration. Problems with configuration were also seen in caregiving and with tourniquets stowed in kits. In deliberate practice, we self-applied a tourniquet to a thigh. In configuration after each of 100 uses, tourniquet elongation due to tensioning averaged 2.4 in was important for restoring the tourniquet to its full length. During configuration, if the C-A-T's stabilization plate slid along the band, out of position, the user slid the plate back into position. In various ways of testing other C-A-Ts, elongations averaged from 0.4 in to 0.9 in, depending on whether the tourniquet was self-applied or applied to a firm manikin. Elongation increments accrued as the tourniquet's band flattened. Configuration time averaged 22 seconds, and accrued experience improved the compactness of configuration. CONCLUSION: People are too often unreliable at putting C-A-Ts into the optimal configuration for use. That ready-to-use configuration includes the tourniquet being at its full length, having the stabilization plate positioned correctly along the band, and having the strap fastened to its clip of origin. When used, tourniquets had normal, small elongations in part due to band flattening. This tourniquet study showed the importance of optimal configuration to first-aid readiness practices.

Are Kentucky Farmers Prepared for Farm-Related Emergencies?

OBJECTIVES: Farming is a hazardous occupation with a high incidence of fatal and non-fatal injuries. Little is known about the preparedness of Kentucky farmers to respond to farm emergencies. The purpose of this study was to determine the knowledge, preparation, and concerns of Kentucky farmers relative to being prepared to take appropriate action in the event of a farm emergency. METHODS: For this descriptive study, a 36-item questionnaire was used to assess the farmer's education and training, access to supplies/equipment to deal with farm emergencies, and their concern regarding emergency preparedness. Data were collected from a sample of 115 farmers attending an agricultural related conference or meeting in the Commonwealth of Kentucky. RESULTS: A majority of the farmers reported: 1) limited CPR/first aid training, 2) minimal access to first aid kits/fire extinguishers on the farm, and 3) concern that EMS could not locate their farms. A large majority of the farmers reported use of a smartphone with a GPS locator; however, some farms were reported to be without cell service. The farmers were interested in attending training on emergency preparedness if training sessions were scheduled at a convenient time. CONCLUSION: Information obtained from this survey will guide the development of a multi-component community-based program to prepare farmers to take appropriate action and receive quick emergency medical services (EMS) in farm emergencies. New community partnerships will be established to identify, implement, and evaluate creative strategies to ensure that Kentucky farmers are prepared for emergency events.

Medical kit for single-handed offshore yacht races.

BACKGROUND: The medical kit is the basis of medical support in maritime environment; it is defined by international or national regulations and guidelines. For offshore races, rules and recommendations are proposed by national or international sailing federations. Sailing and racing offshore alone presents specificities that sometimes make it difficult to apply the usual recommendations. The epidemiology of single-handed offshore race is dominated by traumatic risks. Medical events are relatively rare because competitors are high-level athletes, generally young and subject to complete medical assessments. The scarcity of available scientific data makes it necessary to choose appropriate methods for developing recommendations. The purpose of this work is to propose a medical kit adapted and applicable to these situations. MATERIALS AND METHODS: The method used was that of "Professional recommendations by formal consensus of experts" derived from the Rand/UCLA method. After a critical analysis of the literature, a panel of 19 experts having expertise in medicine in maritime environment was gathered from various medical specialties (cardiologist, internist, intensivist and emergency physician, ear-nose-throat physician and general practitioner) and from varied medical activities. They had not declared any direct conflict of interest. RESULTS: A medical kit proposal has been developed. The choice of drugs was based on the analysis of the epidemiology of medical events observed during the last offshore races. The experts' choice was to reduce the quantity of medication and medical devices in order to limit the risk of confusion of medicines and dosages. Drugs with significant side effects or requiring third party monitoring have been removed. Medical devices designed to do an intervention impossible to perform on oneself have also been eliminated. CONCLUSIONS: Solo sailing remains a marginal maritime activity with specific risks. The development of single-handed races requires an adaptation of medical support through the development of a specific medical kit and adapted training. The formalised consensus of experts seems to be an appropriate method for developing recommendations in the field of maritime medicine.

Contents of a Bug-Out Bag.

A large number of civilian agencies have published guides and recommendations on how to assemble personal and family emergency kits. However, the kits resulting from following these guidelines are impractical, particularly in the event evacuation becomes necessary. This report describes an alternative approach to assembling an emergency kit. OstrovskiyG, ShemeshAJ. Contents of a bug-out bag. Prehosp Disaster Med. 2018;33(6):647-649.

Nurses' knowledge and practices in the face of the challenge of using the systematization of nursing care as an instrument of assistance in a first aid in Brazil.

OBJECTIVE: To analyze the performance of nurses in the implementation of nursing care systematization (NCS). This study is a descriptive research developed from a qualitative approach. The content analysis (CA) must be developed through 3 chronological poles allowing the researcher to construct an analysis structure that corresponds to the needs of the research and the objectives of the proposed research; The chronological poles of CA are described as: Phase 1-preanalysis, phase 2-exploration of the material: phase 3-treatment of the results obtained and interpretation. Only a semistructured interview will be conducted with the research subjects who meet the inclusion criteria of the study, preserving the identity of the individuals and guaranteeing the right to quit the research at any time during the interview. The Research Ethics Committee of Hospital of the clinics of Acre, Brazil (Amazon region) under the opinion no. 1.460.960 approved this protocol. The clinical protocol was registered in the "Brazilian Registry of Clinical Trials" validated by the World Health Organization, and received clinical trials "RBR-882rg2."

Assessment of User, Glove, and Device Effects on Performance of Tourniquet Use in Simulated First Aid.

BACKGROUND: The effects of users, glove types, and tourniquet devices on the performance of limb tourniquet use in simulated first aid were measured. MATERIALS AND METHODS: Four users conducted 180 tests of tourniquet performance in eight glove groups compared with bare hands as a control. RESULTS: Among tests, 99% (n = 179) had favorable results for each of the following: effectiveness (i.e., bleeding control), distal pulse stoppage, and tourniquet placement at the correct site. However, only 90% of tests ended with a satisfactory result, which is a composite outcome of aggregated metrics if all (patient status is stable, tourniquet placement is good, and pressure is good) are satisfactory. Of 18 unsatisfactory results, 17 (94%) were due to pressure problems. Most of the variance of the majority of continuous metrics (time to determination of bleeding control, trial time, overall time, pressure, and blood loss) could be attributed to the users (62%, 55%, 61%, 8%, and 68%, respectively). Glove effects impaired and slowed performance; three groups (cold gloves layered under mittens, mittens, and cold gloves) consistently had significant effects and five groups (examination gloves, flight gloves, leather gloves, glove liners, and glove liners layered under leather gloves) did not. For time to bleeding control and blood loss, performance using these same three glove groups had worse results compared with bare hands by 26, 18, and 17 seconds and by 188, 116, and 124mL, respectively. Device effects occurred only with continuous metrics and were often dominated by user effects. CONCLUSION: In simulated first aid with tourniquets used to control bleeding, users had major effects on most performance metrics. Glove effects were significant for three of eight glove types. Tourniquet device effects occurred only with continuous metrics and were often dominated by user effects.

Conocimientos y disposición para realizar soporte vital básico por agentes de la policía local / Knowledge and willingness to perform basic life support by local police officers

Fundamento: Determinar los conocimientos de los agentes de la policía local (PL) sobre la reanimación cardiopulmonar (RCP) y su disposición para realizarla, así como explorar la asociación entre la formación en RCP y estas variables. Sujetos y método: Estudio transversal sobre una muestra de 390 agentes de la PL de Asturias (España). Se utilizó un cuestionario anónimo que midió nueve aspectos básicos sobre la RCP del Consejo Europeo de Reanimación y cuatro indicadores de la disposición para realizarla en situaciones reales. También se recogió información sobre la formación en RCP y su periodicidad, así como variables sociodemográficas y laborales básicas. Resultados: El 19,7% de los PL no había recibido formación en RCP y el 36,4% la había recibido hacía más de dos. El 24,1% habían realizado al menos una RCP en situación real, de los cuales el 9,6% no estaba formado. Los aspectos de la RCP menos recordados fueron la profundidad (11%) y la frecuencia de las compresiones (24,4%). El 49,7% de los agentes se siente con suficiente preparación para realizar una RCP. Los conocimientos y la disposición se asociaron significativamente con haber realizado cursos de formación con una periodicidad menor de dos años. Conclusiones: Dado que los agentes de PL deben intervenir con frecuencia en situaciones de parada cardiorrespiratoria como primeros intervinientes, la formación específica en RCP de los agentes de PL debería ser obligatoria y periódica, con al menos un curso cada dos años. Sería interesante determinar qué instrumentación didáctica es más eficiente para difundir estos cursos entre los policías (AU)

Background: To determine the knowledge and willingness of local police officers (PO) to perform cardiopulmonary resuscitation (CPR), as well as to explore the association between CPR training and these variables. Methods: Cross-sectional study with a sample of 390 PO from Asturias (Spain). An anonymous questionnaire was used to measure nine basic aspects of CPR from the European Resuscitation Council and four indicators of attitude towards performing CPR in a real context. Information on CPR training and its periodicity was also collected, as well as basic socio-demographic and occupational variables. Results: Lack of CPR training was seen in 19.7% of PO, and 36.4% had received such training more than two years ago. Almost one out of four PO had performed at least one CPR in a real situation (24.1%), of which 9.6% had not been trained. The least remembered aspects of CPR were depth (11%) and frequency of chest compressions (24.4%). Only 49.7% of the agents felt sufficiently prepared to perform a CPR. Knowledge and disposition were significantly associated with having received training with a periodicity of less than two years. Conclusions: Given that PO are frequently first responders in situations of out-of-hospital cardiorespiratory arrest, specific training in CPR should be mandatory and periodic, with at least one course every two years. It would be interesting to determine which didactic instrumentation is most efficient for disseminating these training courses among police officers (AU)

Mountain medical kits: epidemiology-based recommendations and analysis of medical supplies carried by mountain climbers in Colorado.

OBJECTIVE: : To provide medical kit recommendations for short mountain wilderness recreation trips (hiking, trekking, backpacking, mountaineering etc.) based on the epidemiology of injury and illness sustained and best treatment guidelines. Additionally, to compare these recommendations to the medical kit contents of mountain climbers in Colorado. METHODS: : A primary literature review concerning the epidemiology of injury and illness in mountain wilderness settings was performed. This information and literature on the efficacy of given treatments were used to derive recommendations for an evidence-based medical kit. The contents of 158 medical kits and the most likely demographics to carry them were compiled from surveys obtained from mountain climbers on 11 of Colorado's 14 000-foot peaks. RESULTS: : Musculoskeletal trauma, strains, sprains and skin wounds were the most common medical issues reported in the 11 studies, which met inclusion criteria. Adhesive bandages (Band-Aids) were the most common item and non-steroidal anti-inflammatory drugs were the most common medication carried in medical kits in Colorado. More than 100 distinct items were reported overall. CONCLUSION: : Mountain climbing epidemiology and current clinical guidelines suggest that a basic mountain medical kit should include items for body substance isolation, materials for immobilization, pain medications, wound care supplies, and medications for gastrointestinal upset and flu-like illness. The medical kits of Colorado mountain climbers varied considerable and often lacked essential items such as medical gloves. This suggests a need for increased guidance. Similar methodology could be used to inform medical kits for other outdoor activities, mountain rescue personnel, and travel to areas with limited formal medical care.

Comparative performance assessment of commercially available automatic external defibrillators: A simulation and real-life measurement study of hands-off time.

PURPOSE: Early and good quality cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) improve cardiac arrest patients' survival. However, AED peri- and post-shock/analysis pauses may reduce CPR effectiveness. METHODS: The time performance of 12 different commercially available AEDs was tested in a manikin based scenario; then the AEDs recordings from the same tested models following the clinical use both in Pavia and Ticino were analyzed to evaluate the post-shock and post-analysis time. RESULTS: None of the AEDs was able to complete the analysis and to charge the capacitors in less than 10s and the mean post-shock pause was 6.7±2.4s. For non-shockable rhythms, the mean analysis time was 10.3±2s and the mean post-analysis time was 6.2±2.2s. We analyzed 154 AED records [104 by Emergency Medical Service (EMS) rescuers; 50 by lay rescuers]. EMS rescuers were faster in resuming CPR than lay rescuers [5.3s (95%CI 5-5.7) vs 8.6s (95%CI 7.3-10). CONCLUSIONS: AEDs showed different performances that may reduce CPR quality mostly for those rescuers following AED instructions. Both technological improvements and better lay rescuers training might be needed.