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1.
J Spec Oper Med ; 21(3): 126-133, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529820

RESUMO

Venezuela is living in a delicate social and political crisis that has taken thousands of lives. Beginning in March 2017, a series of continuous and increasingly violent demonstrations has taken place, with a high number of civilian casualties. These demonstrations typically have been outside the range of action of the government prehospital services. In addition, the number of casualties frequently overwhelmed the abilities of the available rescue services. Out of the need for a first aid team that could operate in this violent scenario, First Aid UCV (Central University of Venezuela) was created. A large number of professionals with medical, rescue, and tactical medicine experience integrated this new team, modifying their training and practice to adapt to a scenario in which unarmed medical students and medical doctors performed extractions, provided first aid, and managed the transport of demonstration casualties, doing so even when team members were sometimes targeted by the government police and military forces. This method has had successful results in all 60 operations conducted to date, with a total of 5,000 casualties being extracted among civilians, the military, and the police force. Only one member of the team was injured during the operations, and no deaths were reported during the process.


Assuntos
Serviços Médicos de Emergência , Medicina Militar , Militares , Primeiros Socorros , Humanos
2.
Enferm. foco (Brasília) ; 12(2): 360-364, set. 2021. ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1291781

RESUMO

Objetivo: Avaliar o efeito de uma intervenção educativa, no contexto do ensino médio, sobre o tema parada cardiorrespiratória em adultos. Método: Trata-se de um estudo quase-experimental, do tipo antes e depois, com abordagem quantitativa desenvolvido entre fevereiro a novembro de 2019 em uma escola da rede pública do município de Fortaleza, Ceará. Resultados: Inicialmente foram recrutados 30 estudantes, porém 10 estudantes se encaixavam dentro dos critérios de inclusão, sendo esta a amostra final. Para a realização do estudo foi utilizado um questionário estruturado, de autoria dos pesquisadores, composto por 10 perguntas objetivas. Após a intervenção educativa e análise dos dados, foi obtida uma média de acertos de 7,225 no pós-teste comprovando através dos números a eficiência da educação em saúde realizada, pois inicialmente a média apresentada foi 4,375. Conclusão: Constatou-se que os estudantes possuíam conhecimento referente ao suporte básico de vida insuficiente, porém com grande capacidade para aprendizagem, sendo a escola um ambiente favorável para práticas educativas sobre a temática. (AU)


Objective: To evaluate the effect of an educational intervention, in the context of high school, on the theme cardiorespiratory arrest in adults. Methods: Quasi-experimental study, before and after, with quantitative approach developed between February and November 2019 in a public school in the city of Fortaleza, Ceará. Results: Initially, 30 students were recruited, but 10 met the inclusion criteria, which was the final sample. To carry out the study, a structured questionnaire was used, authored by the researchers, composed of 10 objective questions. After the educational intervention and data analysis, an average of 7,225 correct answers were obtained in the post-test, proving through the numbers the efficiency of health education performed, since initially the average presented was 4,375. Conclusion: It was found that the students had knowledge related to insufficient basic life support, but with great learning capacity, and the school was a favorable environment for educational practices on the subject. (AU)


Objetivo: Evaluar el efecto de una intervención educativa, en el contexto de la escuela secundaria, sobre el tema del paro cardiorrespiratorio en adultos. Métodos: Estudio cuasiexperimental, antes y después, con un enfoque cuantitativo desarrollado entre febrero y noviembre de 2019 en una escuela pública de la ciudad de Fortaleza, Ceará. Resultados: Inicialmente, se reclutaron 30 estudiantes, pero 10 cumplieron con los criterios de inclusión, que fue la muestra final. Para llevar a cabo el estudio, se utilizó un cuestionario estructurado, escrito por los investigadores, compuesto por 10 preguntas objetivas. Luego de la intervención educativa y el análisis de datos, se obtuvo un promedio de 7,225 respuestas correctas en la prueba posterior, demostrando a través de los números la eficiencia de la educación en salud realizada, ya que inicialmente el promedio presentado fue de 4,375. Conclusión: Se encontró que los estudiantes tenían conocimientos relacionados con un apoyo básico insuficiente para la vida, pero con una gran capacidad de aprendizaje, y la escuela era un ambiente favorable para las prácticas educativas sobre el tema. (AU)


Assuntos
Parada Cardíaca , Educação em Saúde , Enfermagem , Primeiros Socorros
3.
Aust J Rural Health ; 29(4): 521-529, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34423511

RESUMO

OBJECTIVE: Early intervention with appropriate first aid following burn injury improves clinical outcomes. Previous evidence suggests geographic remoteness may be a barrier to receiving appropriate burns first aid. This study investigated the prevalence of gold standard first aid in patients managed in Australian burn services and whether geographic remoteness was associated with receiving gold standard first aid. DESIGN: Registry-based cohort study. SETTING: Binational clinical quality registry. PARTICIPANTS: Burn-injured patients admitted to a specialist Australian burn service. MAIN OUTCOME MEASURES: Receiving gold standard first aid following a burn injury. RESULTS: Approximately two-thirds of patients received gold standard first aid. Patients whose burns were sustained in very remote regions had a greater risk of receiving no first aid, compared to gold standard first aid, relative to patients who sustained their burn injuries in major cities. CONCLUSIONS: Nearly two-thirds of patients received gold standard burns first aid following injury. However, patients who were injured in the most remote regions of Australia were at an increased risk of not receiving gold standard first aid treatment within 3 hours of injury. Further examination of factors contributing to poorer first aid standards in remote areas is required.


Assuntos
Queimaduras , Primeiros Socorros , Qualidade da Assistência à Saúde , Serviços de Saúde Rural , Austrália/epidemiologia , Queimaduras/epidemiologia , Queimaduras/terapia , Estudos de Coortes , Hospitalização , Humanos
4.
Medicine (Baltimore) ; 100(34): e27051, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449493

RESUMO

ABSTRACT: School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.This prospective, single-centre, pre-post study included 140 students (11-13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students' role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.Few students had prior first aid training (14%). After adjusting for student's age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.


Assuntos
Primeiros Socorros/métodos , Educação em Saúde/organização & administração , Serviços de Saúde Escolar/organização & administração , Adolescente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Estudos Prospectivos
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 878-880, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412762

RESUMO

In the trend of global warming and the increasing number of participating in high-intensity sports, the incidence of heat stroke is increasing year by year. Heat stroke is categorized to the class of heat emergent diseases. If there is no quick and effective treatment, the mortality rate is as high as 50%. Early, rapid, and effective cooling is the key point in the treatment of heat stroke. The early recognition and rapid lowering the core body temperature to 38.9 centigrade within 30 minutes of exertional heat stroke results in better clinical outcome with the fewest complications, however, the "golden 30 minutes" is far from enough to complete emergency transport and evaluation. Therefore, it is urgent to develop a first aid suit for heat stroke suitable for field treatment and transportation, so as to achieve the treatment goal of early rapid and effective cooling in field environment. For this purpose, the medical staff of the department of critical care medicine of the Eighth Medical Center of the Chinese People's Liberation Army General Hospital designed and developed the split first aid suit, which is suitable for heat stroke patient in the harsh environment lacking medical supplies and water during transportation. The medical staff who designed the first aid suit obtained a National Utility Model Patent of China (ZL 2020 2 1627326.4). The split heat stroke first aid suit is composed of four main parts: a sleeveless coat, a hat, sleeves and wrapped pants. All of them are made by temperature changeable fabric which is a composite material made by fine porous silica gel particles and potassium nitrate. The cuffs of the sleeveless top of the clothes part and the sleeves are connected as a whole by the connecting pieces; and the front end of the hem of the clothes part and the wrapped trousers are also connected as a whole by the connecting pieces, which is convenient for fixing and transportation. In order to control the water injection quantity, the water injection bag and the corresponding components are designed to ensure the same amount of water can be injected to the heat stroke first aid suit at each time, so the same frigorific effect can be attainable. The service temperature is 14-18 centigrade, so it will not cause local frostbite to patients when used for a long time. This split-type first aid suit can be used in the movement, rescue and transportation of heat stroke patients. It is easy to carry and use with accurate cooling effect with low cost, moreover, it is reusable and can be widely used for on-site emergency and transportation of heat stroke patients.


Assuntos
Golpe de Calor , Hipotermia Induzida , Militares , Temperatura Baixa , Primeiros Socorros , Golpe de Calor/terapia , Humanos
6.
Rev Bras Enferm ; 74(6): e20201107, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34431938

RESUMO

OBJECTIVES: to validate the content and appearance of an educational game about first aid for schoolchildren with experts in education and health. METHODS: this is a methodological, quantitative and descriptive research, carried out using the Delphi technique, using an online collection instrument, covering 55 items of the game. Content and appearance assessment was performed by 26 judges. The data were analyzed using Content Validity index. RESULTS: the final prototype is presented in a board format, composed of four buildable pawns and 117 cards between questions, alerts and challenges. Overall Content Validity index of 0.95 and greater than 0.8 was obtained for all items in two Delphi rounds. CONCLUSIONS: the educational game validated by experts is a pedagogical tool for teaching first aid to schoolchildren as an option to traditional educational practices.


Assuntos
Primeiros Socorros , Criança , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-34360444

RESUMO

Allergies are among the most common chronic diseases in Europe. The most serious complication is anaphylactic shock. Most cases occur outside the hospital; thus, knowledge of symptoms and first aid is crucial. This study aimed to evaluate the awareness of anaphylaxis and the ability to use adrenaline auto-injectors among medical students, and to determine an improvement after training based on non-formal education. The research was conducted among 364 medicine students (years 1-5) from the Medical University of Gdansk, with year-specific curriculum-based general medical knowledge. Training consisted of pre-test, practical training and post-test. Descriptive statistics were used to reveal the characteristics of students from different grades. A Mann-Whitney U test was used for statistical analysis. The tested students did not have sufficient knowledge to provide first aid in cases of anaphylaxis before training. There was an increase in knowledge (on average, 28.6%, p = 0.005) after training. Almost all (99.4%) of the respondents believed that they would be able to use an adrenaline auto-injector in case of emergency after the training. The training based on non-formal education was effective. The use of the subject-performed task method helped students to remember the stages of action in stressful situations.


Assuntos
Anafilaxia , Anafilaxia/tratamento farmacológico , Epinefrina , Primeiros Socorros , Humanos , Estudantes , Inquéritos e Questionários
8.
Rev Infirm ; 70(273): 19-20, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34446228

RESUMO

The practice of pre-hospital care, whether you are a professional rescuer, a nurse, a doctor or a simple citizen, sometimes exposes you to the management of a patient who presents an acute hemorrhage. The prognosis is quickly life-threatening if the safety, assessment, life-saving gestures and activation of the rescue chain are not carried out. A basic, inexpensive first aid kit can further reduce morbidity and mortality. Training first responders in life-saving techniques is a public health issue.


Assuntos
Serviços Médicos de Emergência , Primeiros Socorros , Hemorragia , Humanos
9.
Rev Esc Enferm USP ; 55: e20210025, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34464434

RESUMO

OBJECTIVE: To assess the early childhood education teachers' knowledge about first aid before and after the participation in an educational action. METHOD: Quantitative research with a quasi-experimental pre- and post-test design, carried out with 45 teachers from four early childhood education schools. For data collection, an instrument with questions regarding the characterization of the participants and knowledge about first aid was used. Data were analyzed through statistical techniques, using the Shapiro Wilk and Wilcoxon tests. RESULTS: There was an increase in the number of correct answers to the questions and improvement regarding grades, with an increase in the score from pre- to post-test by 5.17 points and with a significant comparison of sums. CONCLUSION: Carrying out educational actions on first aid increases the knowledge of early childhood education teachers on the subject and the nurses' role as health educators is highlighted.


Assuntos
Primeiros Socorros , Conhecimentos, Atitudes e Prática em Saúde , Pré-Escolar , Humanos , Professores Escolares , Instituições Acadêmicas , Inquéritos e Questionários
10.
Curr Psychiatry Rep ; 23(9): 53, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34232405

RESUMO

PURPOSE OF REVIEW: Psychological first aid (PFA) has been widely disseminated and promoted as an intervention to support short-term coping and long-term functioning after disasters. Despite its popularity, earlier reviews cite a startling lack of empirical outcome studies. The current review explores recent studies of PFA, especially pertaining to its use with children. RECENT FINDINGS: Initial studies of PFA show that it is well received by youth, families, and providers as well as being linked to decreases in depressive and posttraumatic stress symptoms, improved self-efficacy, increased knowledge about disaster preparedness and recovery, and enhanced feelings of safety and connection. The flexibility of the modular style of PFA and cultural adaptations emerged as significant themes. Although the studies reviewed cast a favorable light on PFA, more research is needed regarding its use and outcomes. This review describes the challenges to conducting these studies as well as suggestions for paths forward.


Assuntos
Desastres , Transtornos de Estresse Pós-Traumáticos , Adaptação Psicológica , Adolescente , Criança , Primeiros Socorros , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia
11.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 799-803, 2021 Jun.
Artigo em Russo | MEDLINE | ID: mdl-34327966

RESUMO

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.


Assuntos
COVID-19 , Primeiros Socorros/instrumentação , Medicina Naval , Recursos Humanos , Humanos , Navios
12.
Ceska Slov Farm ; 70(1): 26-31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34237950

RESUMO

The paper compares the composition of selected types of first aid kits listed in the Czechoslovak branch standards editions (ON 84 6635 First Aid Kits, 1968, 1976, 1989). The authors focused only on evaluating the development of medicine representation. During the study period, a total of 17 medicinal products belonging to the four main ATC groups were represented in wall-mounted first-aid kits, five types of products from the three main ATC groups in travel first-aid kits, and ten types of products from the four main ATC groups in medical bags. The total number of medicinal products in the individual editions of the branch standard decreased.


Assuntos
Primeiros Socorros
13.
Bull World Health Organ ; 99(7): 514-528H, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34248224

RESUMO

Objective: To assess the individual and community health effects of task shifting for emergency care in low-resource settings and underserved populations worldwide. Methods: We systematically searched 13 databases and additional grey literature for studies published between 1984 and 2019. Eligible studies involved emergency care training for laypeople in underserved or low-resource populations, and any quantitative assessment of effects on the health of individuals or communities. We conducted duplicate assessments of study eligibility, data abstraction and quality. We synthesized findings in narrative and tabular format. Findings: Of 19 308 papers retrieved, 34 studies met the inclusion criteria from low- and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies). Targeted emergency conditions included trauma, burns, cardiac arrest, opioid poisoning, malaria, paediatric communicable diseases and malnutrition. Trainees included the general public, non-health-care professionals, volunteers and close contacts of at-risk populations, all trained through in-class, peer and multimodal education and public awareness campaigns. Important clinical and policy outcomes included improvements in community capacity to manage emergencies (14 studies), patient outcomes (13 studies) and community health (seven studies). While substantial effects were observed for programmes to address paediatric malaria, trauma and opioid poisoning, most studies reported modest effect sizes and two reported null results. Most studies were of weak (24 studies) or moderate quality (nine studies). Conclusion: First aid education and task shifting to laypeople for emergency care may reduce patient morbidity and mortality and build community capacity to manage health emergencies for a variety of emergency conditions in underserved and low-resource settings.


Assuntos
Atenção à Saúde , Serviços Médicos de Emergência , Tratamento de Emergência , Área Carente de Assistência Médica , Primeiros Socorros , Humanos
14.
Indian Pediatr ; 58(6): 532-536, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34176794

RESUMO

OBJECTIVE: To determine the effectiveness of an educational intervention on the knowledge of adolescents on prevention of unintentional injuries and first aid. METHODS: The study used one group pre-post intervention design, without external controls. A two-stage (at schools and classes) cluster sampling was used to enroll 1944 high school students in Ujjain district. The intervention consisted of educational intervention using lectures presented through Power Point presentations, pictures, and videos. Sixty sessions each wherein a questionnaire to assess knowledge of participants was administered before and after the educational intervention. The outcome was a change in knowledge score. RESULTS: The study included 1944 school students [1105 (57%) boys] with mean (SD) age of 15.9 (1.3) years. The analysis of variance revealed the difference between the sum total of pre- and post-intervention scores was statistically significant (P <0.001), with a large effect size of 3.7. Younger students outperformed older students, boys outperformed girls, students of urban schools outperformed their rural counterparts, students of public schools outperformed those of private schools and students of Hindi medium schools outperformed students of English medium schools. CONCLUSIONS: This school-based educational intervention significantly increased the knowledge of students on the prevention of unintentional injuries and first aid.


Assuntos
Primeiros Socorros , Instituições Acadêmicas , Adolescente , Feminino , Humanos , Índia , Masculino , População Rural , Estudantes
15.
J Christ Nurs ; 38(3): E28-E31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34085665

RESUMO

ABSTRACT: Nurses who provided care to patients with coronavirus (COVID-19) and supported patients in their transition from life to death in the absence of patients' families have been especially needful of spiritual self-care. A spiritual first aid kit can help nurses cope with these difficult times. Spiritual self-care is vital for all nurses to renew and preserve the psychological, spiritual, and physical self.


Assuntos
COVID-19/psicologia , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Autocuidado/psicologia , Autoeficácia , Adaptação Psicológica , COVID-19/enfermagem , Cuidados Críticos/psicologia , Primeiros Socorros , Humanos , Espiritualidade
16.
J Pak Med Assoc ; 71(4): 1286-1287, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34125792

RESUMO

The concept of endocrine first aid refers to immediate assistance provided to preserve life, prevent worsening of clinical condition, and promote recovery, using endocrine-tropic interventions, both non-pharmacological and pharmacological in nature, by persons who may or may not be trained in endocrinology, until specialist endocrine care can be sought. The key vital measurements in endocrinology in addition to clinical examination are blood glucose levels, serum cortisol levels, blood pH and measurement of electrolytes including calcium when required. The patient may present with a primary endocrine emergency, or the endocrine dysfunction may accompany another serious illness, or an endocrine dysfunction may precede an unrelated medical emergency, or an endocrine emergency may follow another serious medical illness. The 5S mnemonic includes suspecting endocrine dysfunction, stratifying endocrine risks, sampling blood or urine, supporting endocrine vitals like glucose and cortisol and seeking expert opinion and help from endocrine specialists.


Assuntos
Endocrinologia , Primeiros Socorros , Emergências , Humanos , Especialização
17.
Enferm. foco (Brasília) ; 12(1): 147-153, jun. 2021. ilus, tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1255353

RESUMO

Objetivo: analisar as evidências científicas sobre a efetividade de intervenções educativas na aquisição de conhecimentos sobre primeiros socorros para população leiga. Método: revisão integrativa da literatura realizada a partir da questão norteadora: "Quais são as evidências científicas sobre o uso de intervenções educativas para aquisição de conhecimento sobre primeiros socorros entre a população leiga?". A busca foi realizada em nove bases de dados. Resultados: a amostra da revisão foi composta por dez estudos. Houve o predomínio de estudos em 2017, publicados principalmente no Brasil, com público-alvo formado por funcionários, professores e estudantes de escolas. As principais intervenções educativas foram: educação em saúde por meio de programa de treinamento, palestra, roda de conversa, aula teórico-prática. Os principais assuntos abordados foram: fraturas, parada cardiorrespiratória, hemorragia, convulsão e queimadura. Conclusão: as intervenções educativas foram efetivas na aquisição de conhecimento sobre primeiros socorros entre leigos. (AU)


Objective: to analyze the scientific evidence on the effectiveness of educational interventions in acquiring knowledge about first aid for the lay population. Method: integrative literature review based on the guiding question: "What is the scientific evidence on the use of educational interventions to acquire knowledge about first aid among the lay population?". The search was carried out in nine databases. Results: the review sample consisted of ten studies. There was a predominance of studies in 2017, published mainly in Brazil with a target audience formed by school staff, teachers and students. The main educational interventions were: health education through a training program, lecture, conversation circle, theoretical-practical class. The main subjects covered were: fractures, cardiopulmonary arrest, hemorrhage, seizure and burn. Conclusion: educational interventions were effective in acquiring knowledge about first aid among laypeople. (AU)


Objetivo: analizar la evidencia científica sobre la efectividad de las intervenciones educativas en la adquisición de conocimientos sobre primeros auxilios para la población laica. Método: una revisión de literatura integradora basada en la pregunta guía: "¿Cuál es la evidencia científica sobre el uso de intervenciones educativas para adquirir conocimiento sobre primeros auxilios entre la población laica?". La búsqueda se realizó en nueve bases de datos. Resultados: la muestra de revisión consistió en diez estudios. Hubo un predominio de los estudios en 2017, publicados principalmente en Brasil con un público objetivo formado por personal escolar, maestros y estudiantes. Las principales intervenciones educativas fueron: educación para la salud a través de un programa de capacitación, conferencia, círculo de conversación, clase teórico-práctica. Los principales temas abordados fueron: fracturas, paro cardiorrespiratorio, hemorragia, convulsiones y quemaduras. Conclusión: las intervenciones educativas fueron efectivas para adquirir conocimiento sobre primeros auxilios entre los laicos. (AU)


Assuntos
Primeiros Socorros , Educação em Saúde , Enfermagem
18.
J Trauma Acute Care Surg ; 90(6): 1040-1047, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34016927

RESUMO

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.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Primeiros Socorros/instrumentação , Hemorragia/terapia , Técnicas Hemostáticas/instrumentação , Torniquetes/estatística & dados numéricos , Adulto , Idoso , Extremidades/irrigação sanguínea , Extremidades/lesões , Feminino , Primeiros Socorros/efeitos adversos , Primeiros Socorros/estatística & dados numéricos , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Torniquetes/efeitos adversos , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
20.
Front Public Health ; 9: 607127, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33959578

RESUMO

Injuries account for 9.2% of all deaths and 9.9% of the total disability-adjusted life years in Nepal. To date, there has not been a systematic assessment of the status of first response systems in Nepal. An online survey was cascaded through government, non-governmental organisations and academic networks to identify first response providers across Nepal. Identified organisations were invited to complete a questionnaire to explore the services, personnel, equipment, and resources in these organisations, their first aid training activities and whether the organisation evaluated their first response services and training. Of 28 organisations identified, 17 (61%) completed the questionnaire. The range of services offered varied considerably; 15 (88.2%) provided first aid training, 9 (52.9%) provided treatment at the scene and 5 (29.4%) provided full emergency medical services with assessment, treatment and transport to a health facility. Only 8 (47.1%) of providers had an ambulance, with 6 (35.3%) offering transportation without an ambulance. Of 13 first aid training providers, 7 (53.8%) evaluated skill retention and 6 (46.2%) assessed health outcomes of patients. The length of a training course varied from 1 to 16 days and costs from US$4.0 to 430.0 per participant. There was a variation among training providers in who they train, how they train, and whether they evaluate that training. No standardisation existed for either first aid training or provision of care at the scene of an injury. This survey suggests that coordination and leadership will be required to develop an effective first response system across the country.


Assuntos
Ambulâncias , Serviços Médicos de Emergência , Primeiros Socorros , Humanos , Nepal/epidemiologia , Inquéritos e Questionários
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