To identify and describe the content of templates for reporting prehospital major incident medical management.Systematic literature review according to PRISMA guidelines.PubMed/MEDLINE, EMBASE, CINAHL, Scopus and Web of Knowledge. Grey literature was also searched.Templates published after 1 January 1990 and up to 19 March 2012. Non-English language literature, except Scandinavian; literature without an available abstract; and literature reporting only psychological aspects were excluded.The main database search identified 8497 articles, among which 8389 were excluded based on title and abstract. An additional 96 were excluded based on the full-text. The remaining 12 articles were included in the analysis. A total of 107 articles were identified in the grey literature and excluded. The reference lists for the included articles identified five additional articles. A relevant article published after completing the search was also included. In the 18 articles included in the study, 10 different templates or sets of data are described: 2 methodologies for assessing major incident responses, 3 templates intended for reporting from exercises, 2 guidelines for reporting in medical journals, 2 analyses of previous disasters and 1 Utstein-style template.More than one template exists for generating reports. The limitations of the existing templates involve internal and external validity, and none of them have been tested for feasibility in real-life incidents.The review is registered in PROSPERO (registration number: CRD42012002051).
Goals for the programme were recruitment of specialists and lowering turnover among them, generating new knowledge, quality assurance and professional development. Close to NOK 25 million were spent on this research programme in regional non-university hospitals over the 1992-2001 period.78 projects were funded, 77 responded to our questionnaire.36 (47%) of respondents claim to have completed their projects, 5 (7%) have not, whereas 36 (47%) have ongoing projects. 70% of the projects have led to publications, 39% as part of doctoral theses, 61% have been done locally and 43 % also had other funding. In relation to the aims of the programme, those responding were very positive and 75 out of 77 suggested that a low-threshold, supportive programme of this type should be continued.We conclude that the programme has had positive effects beyond the generation of new knowledge.
BACKGROUND Older trauma patients are reported to receive lower levels of care than younger adults. Differences in clinical management between adult and older trauma patients hold important information about potential trauma system improvement targets. The aim of this study was to compare prehospital and early in-hospital management of adult and older trauma patients, focusing on time-critical interventions and radiological examinations. METHODS Retrospective analysis of the Norwegian Trauma Registry for 2015 through 2018. Trauma patients 16 years or older met by a trauma team and with New Injury Severity Score of 9 or greater were included, dichotomized into age groups 16 years to 64 years and 65 years or older. Prehospital and emergency department clinical management, advanced airway management, chest decompression, and admission radiological examinations was compared between groups applying descriptive statistics and appropriate statistical tests. RESULTS There were 9543 patients included, of which 28% (n = 2711) were 65 years or older. Older patients, irrespective of injury severity, were less likely attended by a prehospital doctor/paramedic team (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.57–0.71), conveyed by air ambulance (OR, 0.65; 95% CI, 0.58–0.73), and transported directly to a trauma center (OR, 0.86; 95% CI, 0.79–0.94). Time-critical intervention and primary survey radiological examination rates only differed between age groups among patients with New Injury Severity Score of 25 or greater, showing lower rates for older adults (advanced airway management: OR, 0.60; 95% CI, 0.47–0.76; chest decompression: OR, 0.46; 95% CI, 0.25–0.85; x-ray chest: OR, 0.54; 95% CI, 0.39–0.75; x-ray pelvis: OR, 0.69; 95% CI, 0.57–0.84). However, for the patients attended by a doctor/paramedic team, there were no management differences between age groups. CONCLUSION Older trauma patients were less likely to receive advanced prehospital care compared with younger adults. Older patients with very severe injuries received fewer time-critical interventions and radiological examinations. Improved dispatch of doctor/paramedic teams to older adults and assessment of the impact the observed differences have on outcome are future research priorities. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
A suitable anaesthetic technique was needed for oral surgery in infants in a developing country. As an air compressor was present, and oxygen accessible, a continuous flow technique was chosen. Two Boyle's machines - useless due to lack of soda lime and nitrous oxide - were converted without increasing susceptibility to technical and supplemental deficiencies. The challenge to simplify techniques without reducing patient safety is discussed, and the solutions in an Ethiopian hospital are presented.
