bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Novel Commercial Tourniquet Systems in Extremity Hemorrhage Control - An Ultrasound and Generated Force Study
Authors: Ellis Joshua , Morrow Melissa , Sztajnkrycer Luke , Belau Alec , Wood Jeffrey , Kummer Tobias , Sztajnkrycer Matthew 
Published: May 2019

Introduction:Tourniquets (TQ) save lives. Although military-approved TQ are more effective than improvised TQ in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers.Aim:The purpose of the current study was to compare the efficacy of 3 novel commercial TQ to a military-approved TQ.Methods:A convenience sample of EM residents was utilized. Four different TQ were evaluated: Gen 7 Combat Application Tourniquet (CAT; control), Stretch Wrap and Tuck Tourniquet (SWAT-T), Gen 2 Rapid Application Tourniquet System (RATS), and Tourni-Key (TK). Popliteal artery occlusion was determined using a ZONARE ZS3 ultrasound. Steady-state maximal generated force was measured for 30 seconds with a thin-film force sensor (Singletract). Opinions were solicited at the conclusion of the study.Results:Nine residents participated in the study (7 male, 2 female). Success rates for complete arterial occlusion were 89% CAT, 67% SWAT-T, 89% RATS, and 78% TK (H 0.89, p = 0.83). Mean (± SD) times to achieve occlusion were 10.4 ± 1.7 sec CAT, 23.1 ± 9.0 sec SWAT-T, 11.1 ± 3.8 sec RATS, and 20.0 ± 7.1 sec TK (F 9.71, p < 0.001). Steady-state maximal forces were 29.9 ± 1.2 N CAT, 23.4 ± 0.8 N SWAT-T, 33.0 ± 1.3 N RATS, and 41.9 ± 1.3 N TK. Participants felt that the CAT was easiest to apply (61%), followed by the RATS (33%). Participants were most likely to select the TK (44%) for EDC, followed by the RATS (33%).Discussion:In this small convenience sampling, all novel TQ systems were non-inferior to the military-approved CAT TQ. Mean application times were less than 30 seconds. The size and unique nature of these novel TQs may make them more conducive to lay-provider EDC, thereby improving the response to high threat events.
Remote Highschool Hemorrhage Control (RHHECON) - Methods of a Randomized Control Trial
Authors: De Jager Elzerie , McCarty Justin , O’Sullivan Sarah , Rahim Fatima , Ezeibe Chibuike , Caterson Edward J. , Haider Adil , Levy-Carrick Nomi , Goralnick Eric 
Published: May 2019

Introduction:Uncontrolled bleeding is a leading cause of preventable death in trauma. The “Stop the Bleed” campaign has trained over 130,000 lay people in the US to act to control bleeding. Current hemorrhage control courses, the most well-known being the American College of Surgeon’s Basic Bleeding Control (ACS B-con) course, require in-person training. Scaling this course nationwide is time and resource intensive. Furthermore, groups have advocated that young people, who are disproportionately affected by physical trauma, be universally trained in hemorrhage control.Aim:Compare the effectiveness of teaching the ACS B-con course to high school (HS) students utilizing three different delivery mechanisms: in-person live, video-recorded, and virtual-live training.Methods:432 students (aged 15-18) will be recruited from two HS settings: 300 from a local HS and 132 from a national online HS platform. Local HS students will be randomized into two arms: a control arm (in-person live training) and virtual training through a pre-recorded lecture. Online HS students will undergo virtual-live training. The primary outcome is correct tourniquet application following training. Secondary outcomes are the acquisition of personal resilience-associated traits using a validated instrument, motivation for further training, and perception of the importance of live training. Tourniquet application data will be assessed using a non-inferiority design using two pairwise comparisons of the intervention arms to the control (in-person). Pre- to post-training survey data will be assessed using paired univariates tests. Sub-analysis of the impact of demographic variables on these relationships will be assessed.Discussion:In addition to integration of cardiopulmonary resuscitation courses into HS curricula, there is momentum to develop effective programs to educate HS students to provide care for the injured and control bleeding before first responders arrive. This trial will help determine the most effective delivery mechanism to teach a hemorrhage control course to HS students at scale.
A Fresh Look at Whether the Human Appendix Should Be Considered “Friend or Foe” in the Context of Long-duration Remote Expeditionary Medicine (Benivolem aut Insidiator?)
Authors: Christiansen Rowena 
Published: May 2019

Introduction:Traditional belief holds that the human appendix is a vestigial organ devoid of any purpose, and consequently, surgical appendectomy has been the “gold standard” treatment for suspected appendicitis. Prophylactic (preventative) appendectomy remains the policy of the Australian Antarctic Division for wintering medical practitioners and has been discussed in the context of long-duration non-orbital space flight.Aim:New research around appendiceal function, increasing adoption of non-surgical treatment modalities for acute appendicitis, and emerging research on the long-term consequences of appendicectomy have recently enabled researchers to challenge this paradigm.Methods:This novel project set out to test the hypothesis that a “one size fits all” prophylactic appendectomy policy may not be in the best interest of individual expeditioners, and utilized a “mindmap” to identify several key areas for a scoping literature review. This enabled disparate research to be drawn together in an innovative way.Results:A growing body of research has discovered that the appendix plays an important role in the gut immune system and maintaining gut health. It acts as a reservoir of good bacteria that repopulates the gut after pathogenic challenge. This is particularly important for people with impaired immune systems, such as those that occur in extreme environments. Appendicitis can often be successfully treated with intravenous antibiotics. Prophylactic appendectomy is not without risk, as 1:4 to 1:3 people will encounter some sort of postoperative complication. After an appendectomy, there is an increased risk of many serious medical conditions, including intra-abdominal adhesions, ischaemic heart disease, inflammatory and irritable bowel diseases, rheumatoid arthritis, and many others.Discussion:The increased morbidity and mortality associated with appendectomy is costly for individuals (the burden of disease) and society (health economics). It also poses a currently unappreciated health risk for long-term off-world expeditions.
Application of Game-Based Learning in the Teaching Process of Disaster Medicine for Medical Students
Authors: Hu Hai 
Published: May 2019

Introduction:Classroom instruction of disaster medicine for medical students is complicated and lacks attraction. Nowadays a novel method, which is named Game-Based Learning (GBL), has been used in other fields and received good feedback.Aim:To apply GBL to the teaching process of disaster medicine and discuss the effect of its application.Methods:A computer game was devised based on a syllabus of disaster medicine and employed it in classes of disaster medicine for medical students. Then a questionnaire about the application of GBL in education was used inquiring the demands of medical students for the designing of GBL in disaster medicine, including their platform and game mode preferences. Feedback was collected and data was analyzed after the class.Results:201 questionnaires were issued, and the valid rate was 100%. From the responses, 77% of medical students considered the application of GBL in education on disaster medicine was necessary, and 73% of the respondents thought it was practical. Furthermore, over 90% of medical students expressed their expectation for the adoption of GBL. According to another survey of 51 medical students we conducted, after attending a class about knowledge of injury classification with one board game adopted, most of the students believed GBL was better than traditional methods of teaching.Discussion:There is a high approbation degree among medical students to the adoption of GBL in the teaching process of disaster medicine, which suggests a great possibility for the application of GBL in medical education. It is concluded that GBL can be used in the teaching process of disaster medicine.
Are They Qualified and Trained to Manage Disasters?
Authors: Rowe-Rowe Kevin 
Published: May 2019

Introduction:In the South African environment, the possibility of lack in the disaster response education and training fraternity was attempted to be mitigated with legislation. The National Disaster Management Framework (2005:162-169) states that national, provincial, and municipal organs of state need to plan, organize, and implement training programs relevant to their respective areas of responsibility. The South African Disaster Management Act (South Africa, 2002:19) encourages a broad-based culture of risk avoidance and the promotion of disaster management education and training throughout South Africa.Aim:As an organ of the state and a role-player in disaster management the Free State Emergency Medical Services (FS EMS) is responsible for making strategic decisions. Managers and supervisors are obliged to be trained and educated in disaster management. The study ascertained whether managers and supervisors are being trained and educated in disaster management as required by legislation.Methods:The project made use of quantitative data whereby fifty EMS managers and supervisors in the Free State Provincial Government (FSPG) were assessed by using a questionnaire.Results:The study found that 66% of the respondents did not receive training to equip them to fulfill their disaster management functions. The remaining 34% indicated that they did receive aspects of disaster management training.Discussion:Based on the quantitative scores for the different indicators, the research found that there are shortcomings in disaster management qualifications and training among the EMS supervisors and managers in the FSPG EMS. However, the findings make it clear that there are several positive aspects in the already established practice of disaster management education and training in the FS EMS. The results indicated that there is an opportunity for revision and improvement that will contribute and empower the FS EMS managers and supervisors to meet legislative requirements towards disaster management training and education.
Awareness, Perspective, and Reasons Behind Patients’ Rejection of Emergency Medical Services in Thailand
Authors: Sirisamutr Teera , Wachiradilok Porntip 
Published: May 2019

Introduction:Emergency Medical Service (EMS) increases survival rates and reduces possible disability among emergency patients. However, the number of requests is relatively low in Thailand.Aim:To inspect the awareness, perspective, and reasons behind the rejection of EMS by patients or their relatives who visit the emergency room.Methods:Responses were analyzed in 45 government, university, and private hospitals from December 2015 to February 2016. The hospitals were scattered in 7 provinces with the sample group including 2,028 patients, whereby 646 patients visited using EMS and 1,368 did not. The key reasons for self-visit or other means are the convenience of personal transportation (76.0%), not wanting to wait for an ambulance (31.0%), and anxiety caused by the emergency situation (28.9%). Most misconceptions about the service include; 1) Ambulances are used only for casualties from accidents and 2) Ambulance service are not free. In terms of perspective, most patients or relatives hold a negative view towards the emergency medical service, especially the idea that they can help themselves when the condition is not severe or if there are medications or relief devices available. Another view is that the service will delay them from getting to the hospital. These perspectives are from non-users.Discussion:The study indicated that the cause of non-user involved misunderstandings, poor perspectives, lack of awareness, and the ignorance of the threat of the particular emergency condition. Thus, they do not realize the benefit of using EMS. As a result, regional agencies, the National Institute of Emergency Medicine, and the Ministry of Public Health should discuss the solutions to raise public awareness and improve the perspective towards emergency medical services to promote more usage.
Basic Principles in Complex Humanitarian Emergency: A Pilot Course
Authors: Bajow Nidaa , Alawad yousef , Aloraifi Samer 
Published: May 2019

Introduction:The international and national response team faces many challenges during a complex humanitarian emergency. These include difficult organization, an unprepared national disaster plan, and a disrupted political system. Previous studies showed a reactive approach in earlier disasters in Saudi Arabia and the need for greater involvement of health professionals in disaster management. As a result, several medical education and training institutes began to introduce courses which were mainly about Major Incidents Response, but with less attention to Humanitarian Assistance and Disaster Relief.Aim:The course provides Basic Principles in Complex Humanitarian Emergency for healthcare providers in the kingdom and is focused on the aspect of community awareness for disaster and humanitarian relief.Methods:The interactive competencies-based course in Basic Principles of Complex Humanitarian Emergency was implemented. The course was designed by 5 experts in disaster medicine and humanitarian relief and was piloted over five days at officers club of Minister of Interior in Riyadh, sponsored by King Fahd Security College. The participants (n=30) were from different health disciplines. They completed the pre- and post-tests and presented three pilot workshops for disaster community awareness.Results:The overall scores were 44.19% for the pre-test and 62.85% for the post-test (Wilcoxon test for paired sample: z = 3.729, p<0.001). There were no significant statistical differences among professions of healthcare providers for both pre- and post-tests.Discussion:Delivering competencies-based course in Basic Principles of Complex Humanitarian Emergency for health care providers can help in the improvement of knowledge and skills for humanitarian assistance and disaster relief in Saudi Arabia, which is important for disaster preparedness augmentation in the kingdom. The next course for the same group may be recommended for achieving the level that will train them to participate in the National Disaster Assistance team.
Chemical Response Emergency Medical Information System in Chemical Disaster
Authors: Wang Soon-Joo , Yoon Seongyong 
Published: May 2019

Introduction:There are many database sets and websites which provide chemical information, but they do not perform an adequate role for emergency medical support in a chemical disaster.Aim:To make the basis of a chemical emergency medical information system.Methods:We reviewed the database sets, mobile applications and websites in the world which provide chemical database and emergency medical response information from a chemical accident or disaster site to hospitals. Also, we examined chemical accident cases which developed during disasters. A chemical database set for emergency medical response was proposed and the algorithm for elicitation of chemicals suitable for emergency medical response and information providing. We performed a survey about chemical emergency medical information system to related personnel.Results:By four steps of elicitation of chemicals, the number of chemicals more than 100,000 was decreased to less than 1,000. The standard of steps includes accident preparedness, toxicity and circulating amount and expert consultation. Algorithm for elicitation of chemicals was made and 82% of related personnel supported the chemical emergency response algorithm. The emergency medical real-time consultation system for chemical disaster was placed under control of the call center.Discussion:When mass exposure by toxic chemicals occurs, the chemical emergency medical information system will be helpful for acute identification of chemicals, protection of related personnel and emergency medical response. Also, it can be possible to guide citizens immediately in case of a chemical disaster.
Comparison of Traumatic Brain Injury Patients by Age Group in Emergency Department
Authors: Huh Kwang-Real , Kim Jung-youn , Yoon Young-Hoon , Moon Sung-Woo , Lee Eu-Sun , Shim Bosun 
Published: May 2019

Introduction:Traumatic brain injury (TBI) is an important public health concern because of the high mortality rate of young people and a high proportion among the trauma. According to studies, patients visiting the emergency department (ED) with TBI comprise 1.4% of all ED patients.Aim:The authors think that the characteristics of patients with TBI will vary according to the age group. Therefore, the purpose of this study is to investigate the clinical and social characteristics of patients with TBI visiting the ED by age group.Methods:Trauma patients who conducted brain CT at the ED of Korean University Hospital (three hospitals) for 3 years from March 2013 to February 2016 were enrolled. Medical records were investigated retrospectively. The GCS scores were estimated at initial ED arrival. The primary outcome was to determine the characteristics of each age groups with gender, severity (by GSC score), trauma mechanism, and admission rate.Results:A total of 15,567 TBI patients received brain CT evaluation during the investigation period. Based on age, patients in their 50s were the most common (16.5%). Regarding the severity, the ratio of mild was higher in under patients under 9 (99.3%); the ratio of severe was higher for patients in their 20s (4.6%). In almost every age group, the male ratio of TBI was higher, except for females aged 70 or older. Under 19 years of age, the ambulance utilization rate was lower than any other age group. The most common injury mechanism was a collision, the next was a traffic accident, and in under 9, a fall was the most common. 70.1% of patients returned home after treatments.Discussion:Identifying the characteristics of patients with TBI visiting ED is fundamental. Therefore, it is necessary to continuously collect basic data on TBI among patients visiting the ED.
Cooperative System between NGOs and the Private Sector for Disaster Relief in Japan
Authors: Yamashita Kimiko 
Published: May 2019

Introduction:Disasters disturb the balance of medical supply and demand. Because normal supply chains break down in the wake of disasters, it is difficult to deliver daily necessities to affected areas. In addition, without a reliable supply of medical equipment and medicines, the number of sick and injured patients increases.Aim:We propose that emergency medical teams should bring medical equipment and daily necessities when responding to disasters.Methods:The Social Emergency Management Alliance (SEMA) was established in 2017. SEMA is a cooperative system between NGOs and the private sector for disaster relief in Japan. Humanitarian Medical Assistance (HuMA) utilized this system to provide emergency medical assistance during the Western Japan Floods in 2018.Results:After the flooding, increased amounts of dust caused many cases of conjunctivitis. There were also numerous cases of heat stroke and dehydration, especially in the elderly. We requested SEMA to bring eye drops to wash out dust and isotonic drinks to prevent dehydration and heat stroke to Mabi Town, Okayama. SEMA coordinated with the private sector to provide eye drops and isotonic drinks via a forwarding agent, and we were able to distribute them to affected people and prevent worsening disease.Discussion:NGOs working within affected areas can assess the exact needs of affected people in order to avoid waste. Such collaboration through SEMA will allow for more effective disaster relief in the future. It is our hope that more private companies join SEMA to reduce the suffering of disaster victims.
Description Analysis of Primary Care Issues in Puerto Rico after Hurricane Maria: Results from Federal Medical Shelter Manati
Authors: Ghosh Arnab , Daniel Pia 
Published: May 2019

Introduction:In September 2017, Hurricane Maria devastated Puerto Rico’s health care infrastructure. To meet the demands of ongoing primary care and medical emergencies, Federal Medical Shelters (FMS) were set up to serve local communities for the weeks after the hurricane. A team of health professionals from New York assisted federal authorities in the provision of healthcare in the FMS.Aim:To describe the population of patients requesting medical care in the aftermath of Hurricane Maria at FMS Manati and to categorize the range of problems faced by patients after the hurricane, and examine how this changed longitudinally over the course of the operation.Methods:Researchers collected basic data of patients at presentation to the FMS. Descriptive analyses were performed of the patient population and nature of presenting illnesses. Chi-squared analysis was performed to compare the change over time of presenting complaints. Ethics approval was granted by Columbia University.Results:Data was collected for a two-week period approximately three weeks after the hurricane made landfall. The FMS saw 2,154 patients over a 14-day period. The population of patients (median age = 43 years [IQR 39 years]) assessed was bimodal in distribution, with one peak in children at 1 year. A second peak occurred at age 53 years. 60.2% of presenting complaints were infection- or chronic disease-related. Musculoskeletal complaints were the third most common. Chi-squared tests revealed no statistically significant change in the frequency of specific types of complaints between the start and end of data collection.Discussion:In the weeks after Hurricane Maria, infants and elderly were seen to predominantly seek medical care. Likely related to the collapse of the healthcare infrastructure, there was a high prevalence of infection-related and chronic medical conditions. The data support the need to focus resources to treat vulnerable populations, infectious issues, and chronic medical conditions.