In Israel, 280,000 pupils travel daily to school and back home by means of school transportation. In an effort to increase school transportation safety, the installation of lap belts in school transportation vehicles is required since September 1, 2006. In Israel, laws are often passed with good intentions, but frequently without exploring the potential outcomes. Traffic regulation 364a states that "lap belts or other seatbelts" are required in all vehicles used for school transportation. The objective of this study is to review the world-wide literature regarding seatbelts on school buses with an emphasis to identify the risks associated with lap restraints. Over 50 studies, articles and position papers referring to the efficacy of seatbelts, with an emphasis on school transportation, were reviewed. According to the literature, this new traffic regulation could produce more devastating outcomes than previously. Seatbelts were designed to prevent passenger injuries during a motor vehicle crash. Researchers have not proven efficacy of seatbelts in school buses. Lap-only belts have shown to increase the risk of severe injury among children, even in mild crashes. Since young children are not adequately developed to take the force of a lap-only restraint, these belts have been associated with internal injuries, lumbar fracture-dislocations, abdominal contusions and head injuries. The National Highway Traffic Safety Administration (NHTSA) in the USA has reported that lap belts are not effective in preventing injury among children traveling by bus. Children have a two to three fold risk of severe injury when using lap only restraints. On the contrary, lap-shoulder belts may reduce the risk of abdominal injuries by up to 50% relative to lap-only belts. In conclusion, policy makers aimed to implement regulations which will reduce injuries and fatalities. However, neglecting to carry out an in-depth professional review has brought about a regulation requiring lap belts in school buses; a decision which, according to international research studies, can potentially increase the injury risks among pupils.
Recent explosions of suicide bombers introduced new and unique profiles of injury. Explosives frequently included small metal parts, increasing severity of injuries, challenging both physicians and healthcare systems. Timely detonation in crowded and confined spaces further increased explosion effect.Israel National Trauma Registry data on hospitalized terror casualties between October 1, 2000 and December 31, 2004 were analyzed.A total of 1155 patients injured by explosion were studied. Nearly 30% suffered severe to critical injuries (ISS > or = 16); severe injuries (AIS > or = 3) were more prevalent than in other trauma. Triage has changed as metal parts contained in bombs penetrate the human body with great force and may result in tiny entry wounds easily concealed by hair, clothes etc. A total of 36.6% had a computed tomography (CT), 26.8% had ultrasound scanning, and 53.2% had an x-ray in the emergency department. From the emergency department, 28.3% went directly to the operating room, 10.1% to the intensive care unit, and 58.4% directly to the ward. Injuries were mostly internal, open wounds, and burns, with an excess of injuries to nerves and to blood vessels compared with other trauma mechanisms. A high rate of surgical procedures was recorded, including thoracotomies, laparotomies, craniotomies, and vascular surgery. In certain cases, there were simultaneous multiple injuries that required competing forms of treatment, such as burns and blast lung.Bombs containing metal fragments detonated by suicide bombers in crowded locations change patterns and severity of injury in a civil population. Specific injuries will require tailored approaches, an open mind, and close collaboration and cooperation between trauma surgeons to share experience, opinions, and ideas. Findings presented have implications for triage, diagnosis, treatment, hospital organization, and the definition of surge capacity.
In Brief Objective: To characterize the injuries to children by acts against civilian populations (AACP). Summary Background Data: Only 2 articles have focused on the spectrum and severity of injuries to children by AACP. Methods: A retrospective case study of children 0 to 18 years old who were entered into the Israel National Trauma Registry as a result of AACP between September 29, 2000, and June 30, 2002. Results: A total of 158 children were hospitalized for injuries caused by AACP, accounting for 1.4% of all hospitalized injured children but for 10.9% of all in-hospital deaths for trauma. Explosions injured 114 (72.2%); shootings, 34 (21.5%); and other mechanisms such as stoning or stabbing, 10 (6.3%). Older children were injured by explosions more frequently than younger children (86.1% of 15- to 18-year-olds, 73.7% of 10- to 14-year-olds, 63.2% of 0- to 9-year-olds, P = 0.02). A higher percentage of children injured by explosions rather than by shootings were severely or critically injured (33.9% versus 18.8%, P = 0.10). The most frequently injured body regions were extremities (62.8%), head/face (47.3%), chest and abdomen (37.2%), and brain (18.2%). More than 1 body region was injured in 63.0%. Children injured by explosions as compared with shootings had a lower incidence of abdominal trauma (14.9% versus 20.6%), a similar incidence of chest trauma (16.7% versus 14.7%), but a higher incidence of extremity trauma (65.8% versus 53.0%). There were 7 in-hospital deaths, 6 due to severe head injury and 1 due to severe abdominal trauma; 6 of the 7 deaths were caused by explosions, and all but 1 occurred in children 15 to 18 years old. Conclusions: AACP cause significant morbidity and mortality in children, especially adolescents. Injury severity is significantly higher among children who are injured by explosions rather than by shootings. Acts against civilian populations resulted in the hospitalization of 158 children during a 20-month period in Israel. Older children were more likely to be injured by explosions than by shooting and to be severely or critically injured. Multiple body regions were injured in 63%; although extremity, head/face, and torso injury predominated, death was usually due to massive brain injury.
Investigation of injury patterns epidemiology among car occupants may help to develop different therapeutic approach according to the seat position. The aim of the study was to evaluate and compare differences in the incidence of serious injuries, between occupants in different locations in private cars. A retrospective study including trauma patients who were involved in motor vehicle accidents and admitted alive to 20 hospitals (6 level Ⅰ trauma centers and 14 level Ⅱ trauma centers). We examined the incidence of injures with abbreviated injury score 3 and more, and compared their occurrence between seat locations. The study included 28,653 trauma patients, drivers account for 60.8% (17,417). Front passenger mortality was 0.47% higher than in drivers. Rear seat passengers were at greater risk (10.26%) for traumatic brain injuries than front seat passengers (7.48%) and drivers (7.01%). Drivers are less likely to suffer from serious abdominal injuries (3.84%) compared to the passengers (front passengers - 5.91%, rear passengers – 5.46%). Out of victims who arrived alive to the hospital, highest mortality was found in front seat passengers. The rate of serious chest injuries was higher as well. Rear seat passengers are at greater risk for serious traumatic brain injuries. All passengers have a greater incidence of abdominal injuries. These findings need to be addressed in order to develop "customized" therapeutic policy in trauma victims.
Background: Many patients with intracranial bleeding (ICB) are being evaluated in hospitals with no neurosurgical service. Some of the patients may be safely managed in the primary hospital without transferring them to a designated neurosurgical center. In Israel, there are three approaches to alert patients with ICB: mandatory transfer, remote telemedicine neurosurgical consultation, and clinical–radiologic guidelines. We evaluated the outcome of alert patients with low-risk ICB who were managed in centers without neurosurgical service. Methods: A retrospective cohort comparative study. Patients with ICB and a Glasgow Coma Score >12 were included. Low-risk ICB was defined as solitary brain contusion of <1 cm in diameter, limited small subarachnoid hemorrhage, or subdural hematoma of <5 mm in maximal width and length. The decision to transfer the patients to a neurosurgical center was based on one of the three models. Hospital A: mandatory transfer. Hospital B: telemedicine-based consultation with a remote neurosurgeon. Hospital C: clinical-radiologic algorithm-based guidelines. Primary endpoint was the neurologic outcome of patients at discharge. Results: There were 152 patients in group A, 98 patients in group B, and 73 patients in group C. All patients of group A were transferred to a neurosurgical center. Fifty-eight percent of patients from hospital B and 26% of patients from hospital C were hospitalized in the primary center despite a proven ICB. These patients were discharged without any neurologic sequel of their injury. Two patients from group B and one patient from group C needed a delayed transfer to a neurosurgical center. None of the patient needed delayed neurosurgical intervention. Conclusions: Despite the small sample size of this study, the presented data suggest that some patients with ICB can be safely and definitively managed in centers with no on-site neurosurgical service. The need for transfer may be based on telemedicine consultation or clinical –radiologic guidelines. Further larger scale studies are warranted.
Abstract Objective On April 15, 2013, two improvised explosive devices (IEDs) exploded at the Boston Marathon and 264 patients were treated at 26 hospitals in the aftermath. Despite the extent of injuries sustained by victims, there was no subsequent mortality for those treated in hospitals. Leadership decisions and actions in major trauma centers were a critical factor in this response. Methods The objective of this investigation was to describe and characterize organizational dynamics and leadership themes immediately after the bombings by utilizing a novel structured sequential qualitative approach consisting of a focus group followed by subsequent detailed interviews and combined expert analysis. Results Across physician leaders representing 7 hospitals, several leadership and management themes emerged from our analysis: communications and volunteer surges, flexibility, the challenge of technology, and command versus collaboration. Conclusions Disasters provide a distinctive context in which to study the robustness and resilience of response systems. Therefore, in the aftermath of a large-scale crisis, every effort should be invested in forming a coalition and collecting critical lessons so they can be shared and incorporated into best practices and preparations. Novel communication strategies, flexible leadership structures, and improved information systems will be necessary to reduce morbidity and mortality during future events. ( Disaster Med Public Health Preparedness . 2015;9:489–495)
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