Antishock Garment Research Articles

Utilization Rate and Factors Associated with Non-Utilization of Non-Pneumatic Anti-Shock Garment in the Management of Obstetric Hemorrhage in Public Health Care Facilities of Northern Ethiopia: A Cross-Sectional Study.

BackgroundObstetric hemorrhage (OH) causes more than 25% of the maternal deaths across the world annually. A significant number of these deaths can essentially be prevented with a skilled birth attendant and having all-inclusive emergency obstetric care technologies. One of these promising technologies is to utilize non-pneumatic anti-shock garment (NASG). Despite this fact, there are limited studies on the utilization of NASG in Ethiopia.ObjectiveThe aim of this study was to assess the utilization rate and factors associated with non-utilization of NASG in the management of obstetric hemorrhage in public healthcare facilities of Northern Ethiopia.MethodsAn institution-based cross-sectional study was conducted from December 2017 to February 2018 involving 338 randomly selected healthcare providers working in the maternity healthcare facilities. Data were collected using pre-tested and self-administered questionnaires. Data were entered and analyzed using STATA version 14.0 statistical software package. The result was displayed using descriptive, bivariate, and multivariable logistic regression analysis to identify independent predictors of non-utilization of NASG at a P-value≤0.05.ResultsAbout 121 (35.80%; 95% CI=30.68–41.16%) of the health workers did not utilize NASG, and 217 (64.20%; 95% CI=58.84–69.32%) utilized NASG. Being females, with adjusted odds ratio (AOR)=2.21 (95% CI=1.06–4.63), use of NASG in previous works to manage OH, with AOR=0.1 (95% CI=0.02–0.48), having perceived skill to use the garment in the facility, with AOR=0.10 (95% CI=0.01–0.79), were significantly associated with the non-utilization of NASG.ConclusionThere was a lower rate of NASG utilization among the healthcare providers for the management of obstetric hemorrhage. Being a male care provider, having no experience of using NASG to manage PPH, and having perceived skill to use the garment in the healthcare facility were significantly associated factors for the non-utilization of the NASG. Due emphasis should be given to the utilization of NASG to manage obstetric hemorrhage by addressing the identified modifiable factors for non-utilization of NASG by healthcare workers.

Knowledge and utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage among Midwives in government hospitals in Ogun State, Nigeria

Objective: To assess the knowledge and determine the level of utilization of Non-Pneumatic Anti-Shock Garment (NASG) for the management of PPH among Midwives. Method: The study employed a descriptive cross-sectional study design, using a validated self-administered questionnaire. A total of 198 randomly selected midwives across three health facilities in Ogun State participated in the study. A 10-point knowledge scale was used to assess the knowledge of midwives on NASG. Descriptive statistics were used to determine the level of utilization of NASG among midwives, while Chi-square statistics were used to determine the relationship between the dependent and independent variables of interest at p<0.05 level of significance. Results: Most (88.9%) of the respondents were female with a mean age of 40.2±5.6years. Most (48.5%) had a BNS degree. The majority (74.7%) of the respondents were aware of NASG. Close to a half (49.3%) of the respondents had fair knowledge scores, 34.5% had good knowledge scores, while 16.2% had poor knowledge scores. Only 22.7% of the respondents had ever used NASG in the management of PPH; 77.3% never used it before. Also, 67.2% of the respondents reported NASG was not available in their facilities. There was a significant influence of knowledge of NASG on the utilization among midwives (X2=37.151, P<0.05, df=2). Conclusion: This study demonstrated that midwives in healthcare facilities were aware, but did not have good knowledge of NASG. The utilization of the garment for the management of PPH was also very poor, probably due to suboptimal knowledge and non-availability of the garment.

Cost-effectiveness of postpartum haemorrhage first response bundle and non-surgical interventions for refractory postpartum haemorrhage in India: an ex-ante modelling study

BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide and India accounts for approximately 19% of global maternal deaths, with PPH as the leading cause. In recent years, care bundles have been shown to increase adherence to clinical guidelines and improve patient outcomes. The objective of this study was to develop a PPH cost-effectiveness model to estimate the potential health impact and cost-effectiveness of a quality improvement programme for PPH management featuring a first response bundle and a set of refractory PPH interventions in health facilities in Uttar Pradesh, India. MethodsWe used a decision tree model to compare the status quo delivery of PPH care in Uttar Pradesh with two scenarios in which recommended bundles for PPH management were optimally applied. Status quo PPH care includes intravenous fluids, uterotonics, and uterine massage delivered with a setting-specific probability that increases with the level of health facility. In the strengthened PPH care scenario, status quo interventions are combined with tranexamic acid in a first response bundle which is used in all PPH cases, plus manual placenta removal and suturing when indicated. In the enhanced PPH care scenario, PPH care is further enhanced through implementation of non-surgical interventions for managing refractory PPH (including uterine balloon tamponade, aortic compression, and non-pneumatic anti-shock garment). For each scenario, we conducted a Monte Carlo simulation of cohorts of 1 million women delivering at home, subcentres, primary-health clinics, community-health centres, and district hospitals. The results were scaled to represent the annual number of deliveries in Uttar Pradesh and their distribution across health facilities. The main outcomes were PPH cases, PPH deaths, and PPH surgical procedures. FindingsCompared with status quo, perfect implementation of enhanced PPH care was predicted to reduce PPH-related maternal mortality in intervention facilities by 98%, from 10·7 to 0·3 per 100 000 deliveries, averting 450 deaths per year in Uttar Pradesh. Although enhanced PPH care would increase annual costs associated with the active management of the third stage of labour and non-surgical PPH management by US$190 000 and $300 000, respectively, service delivery costs were reduced by $1·42 million per year. Strengthened PPH care was predicted to prevent PPH deaths and reduce service delivery costs compared with status quo, but to have only 66% of the health impact and 63% of the cost-savings compared with enhanced PPH care. The upfront programme implementation costs and persistence of change in PPH management after implementation are uncertain. If enhanced PPH care were implemented with up to $2300 per facility, and the change in PPH management persisted for at least 2 years, the programme is estimated to be cost-effective (<0·5 GDP per capita per life year gained). InterpretationImplementation of an enhanced PPH care programme, including the first response bundle and non-surgical refractory PPH interventions, is likely to be cost-effective and life-saving in Uttar Pradesh, India. Moreover, enhanced PPH care is likely to generate more health impact and cost-savings compared with strengthened PPH care because of the greater reduction in number of surgeries needed. FundingBill & Melinda Gates Foundation

Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among health care professionals\u2019 in public hospitals of Jimma zone, south-West Ethiopia, 2019

BackgroundNon- pneumatic anti-shock garment is a unique, life -saving first -aid device made of neoprene and velcro, which is used for treatment of women with postpartum hemorrhage. Maternal mortality in the world still very high and postpartum hemorrhage is the leading cause of maternal mortality worldwide.ObjectiveThis study was aimed to assess the utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management.MethodsFacility based cross-sectional studies design both quantitative and qualitative data collection methods were employed among 210 health care professionals and 10 key informants respectively. Bivariable and multivariable logistic regression was done to identify factors associated with non-pneumatic anti-shock garment utilization. Qualitative data was transcribed, translated and triangulated with quantitative findings.ResultsSeventy six (36.2%) of the respondents used non-pneumatic anti-shock garment in their hospitals for management of post-partum hemorrhage. Having good knowledge [(AOR = 3.96, 95% CI: (1.67, 9.407)], having positive attitude [(AOR = 3.54, 95% CI: (1.37, 9.13)], attending training [AOR = 13.156, 95% CI: (4.81, 36.00], having two and above non-pneumatic anti-shock garment at their hospitals [AOR = 8.7, 95% CI: (2.89, 26.20)] were significantly associated with utilization of non-pneumatic anti-shock garment. … “I didn’t use non-pneumatic anti-shock garment for the management of postpartum hemorrhage complication before because I have no training and experience how to use it.”ConclusionThe utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage was low. Having positive attitude, having good knowledge and training on non-pneumatic anti-shock garment were statically associated with its use. The health care professionals that involved in the maternity service should be trained on how to use this important garment in the management of postpartum hemorrhage.

Hemodynamic response to non-pneumatic anti-shock compression garments in patients with renal dysfunction

BackgroundPatients with chronic kidney disease are at higher risk of developing cardiovascular disease. Chronic exposure to intermittent hemodialysis may be a source of added stress to the cardiovascular system; intradialytic hypotension is a common complication of hemodialysis, and repeated events may lead to hemodynamic stress and ischemic injuries. Administration of non-pneumatic compression stockings to the lower limbs has demonstrated hemodynamic stabilizing effects in other settings and may provide similar benefits in the kidney disease population. Therefore, we conducted this pilot study assessing the feasibility and tolerability of the application of non-pneumatic compression stockings to patients with kidney disease. We also assessed the changes in hemodynamic measurements following the application of the compression stockings to explore the biological feasibility of this being an effective intervention for intradialytic hypotension.MethodsFifteen individuals were enrolled in the study (5 healthy, 5 chronic kidney disease patients, and 5 dialysis patients). Outcomes including hemodynamic parameters such as cardiac output, peripheral vascular resistance, and blood pressure were measured using continuous pulse wave analysis. Changes in global longitudinal strain were measured via echocardiography. These outcome measurements were made before and after the application of compression stockings.ResultsAll study participants tolerated the compression garments well and without complication. Hemodynamic response to lower body compression caused varying effects on cardiac output, mean arterial pressure and global longitudinal strain. Some individuals saw large improvements in hemodynamic parameters while in others the opposite effect was observed. No consistent response was elicited.ConclusionsApplication of compression stockings to patients with renal dysfunction is well-tolerated. However, significant variations in hemodynamic outcomes exist, and may be a barrier for larger scale trials without prior identification of specific patient characteristics indicating likely benefit from the application of external compression.Trial registrationClinicalTrials.gov, Identifier: NCT02915627, Registration Date: Sept 27, 2016.

Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation.

ObjectiveTo systematically develop evidence‐based bundles for care of postpartum hemorrhage (PPH).MethodsAn international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated “GRADE Evidence‐to‐Decision” framework. Twenty‐three global maternal‐health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences. Over a 6‐month period, the expert panel met online and via teleconferences, culminating in a 2‐day in‐person meeting.ResultsThe consultation led to the definition of two care bundles for facility implementation. The “first response to PPH bundle” comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. The “response to refractory PPH bundle” comprises compressive measures (aortic or bimanual uterine compression), the non‐pneumatic antishock garment, and intrauterine balloon tamponade (IBT). Advocacy, training, teamwork, communication, and use of best clinical practices were defined as PPH bundle supporting elements.ConclusionFor the first response bundle, further research should assess its feasibility, acceptability, and effectiveness; and identify optimal implementation strategies. For the response to refractory bundle, further research should address pending controversies, including the operational definition of refractory PPH and effectiveness of IBT devices.

Differences in Life‐Saving Obstetric Hemorrhage Treatments for Women with Abortion Versus Nonabortion Etiologies in Tanzania

Complications from unsafe abortion are among the major causes of preventable maternal morbidity and mortality, which may be compounded by delays and disparities in treatment. We conducted a secondary analysis of women with symptoms of hypovolemic shock secondary to severe obstetric hemorrhage in Tanzania. We compared receipt of three lifesaving interventions among women with abortions versus other maternal hemorrhage etiologies. Interventions included: non-pneumatic anti-shock garment (NASG) (N = 393), blood transfusion (N = 249), and referral to a higher-capacity facility (N = 131). After controlling for severity of disease and other confounders, women with abortion-related hemorrhage and shock had 78percent decreased odds of receiving NASG (p < 0.001) and 77percent decreased odds of receiving a blood transfusion (p < 0.001) compared to women with hemorrhage and shock from other etiologies. Our findings suggest that, in Tanzania, women with abortion-related hemorrhage received lower quality of care than women with other hemorrhage etiologies.

An Integrating Model for Rapid Reduction of Maternal Mortality Due to Primary Postpartum Haemorrhage - Novel Use of the Catalyst Approach to Public Health.

On average 16%-53% of maternal deaths are from postpartum haemorrhage (PPH), with confidence intervals for Eastern Asia reaching beyond 60%. Success in preventing PPH mortality across many large low-resource populations has been fairly limited. Niger's government and an international non-governmental organization (NGO) have developed a model aiming to rapidly reduce primary postpartum haemorrhage mortality, combining relatively new technologies, misoprostol, condom tamponade, and non- inflatable anti-shock garment, with systematic measurement of blood loss and a set of traditional public health tools that constitute the Catalyst Approach to Public Health, with action steps for each phase if haemorrhage occurs. This paper describes each component and testing of the hypothesis that the model can effectively reduce PPH mortality on a national scale. The Niger model is a 'complex intervention' aiming to maximise impact from existing health system resources even in remote areas. The broad applicability of Niger's approach to address a serious global public health problem, and its innovative nature warrant describing the model itself, with results to be published separately. Combining this set of individually proven technologies and a set of organisational tools from disease eradication settings as a single 'complex intervention', has to our knowledge not been described before.

Experience of combined use of a Bakri uterine balloon and a non-pneumatic anti-shock garment in a university hospital in Colombia.

To compare the outcomes of women with postpartum hemorrhage (PPH) refractory to initial management and in a state of hypoperfusion between management with a non-pneumatic anti-shock garment (NASG) and Bakri balloon and management with other surgical interventions. A retrospective observational descriptive study of women with PPH and hemorrhagic shock who were treated at a high complexity obstetric unit in Columbia between 2011 and 2017. Clinical records were reviewed and women were divided in two groups by clinical management. Group 1 women were managed with surgical interventions; group 2 women were managed with NASG plus a Bakri balloon. Overall, 142 women were treated for PPH, with 69 in group 1 and 73 in group 2). There were differences between group 1 and group 2 in the degree of hypovolemic shock (shock index: 1.1 vs 0.9, P=0.02), indicators associated with hypoperfusion (lactic acid, 2.9 vs 1.9mmol/L, P=0.001), and frequency of transfusion of blood components (68% vs 44%, P<0.05). The joint use of NASG and Bakri balloon in PPH management seemed to improve hypoperfusion-related markers such as lactic acid and shock index, and reduce the frequency of additional blood transfusion.

Obstetric innovations in Kabala Hospital, Sierra Leone: the Bubble Operating Theatre and Non-Pneumatic Anti-Shock Garment

Obstetric innovations in Kabala Hospital, Sierra Leone: the Bubble Operating Theatre and Non-Pneumatic Anti-Shock Garment

Nonpneumatic Antishock Garment: A Promising Tool for Management of Obstetric Hemorrhage with Hypovolemic Shock

Nonpneumatic Antishock Garment: A Promising Tool for Management of Obstetric Hemorrhage with Hypovolemic Shock

Implementation of the Alliance for Innovation on Maternal Health Program to Reduce Maternal Mortality in Malawi

To evaluate maternal mortality and changes in the culture of safety before and after the implementation of the Alliance for Innovation on Maternal Health (AIM) Malawi program. This was a prospective cohort study at a central hospital and a district health center in Malawi from March 2016 to November 2017. The AIM Malawi program included classroom didactics on obstetric hemorrhage, teamwork protocols, skills laboratory activities, and simulation training. The time periods of comparison were preintervention, education period, and postintervention. Hospital birth paper records were used to collect data on patient demographics and obstetric and neonatal information. The Hospital Survey of Patient Safety was used to measure the culture of safety before and after the program. We trained 128 participants. In the postintervention period, 16 procedural interventions were performed to manage postpartum hemorrhage, including B-lynch sutures (n=7), condom balloon catheter (n=5), nonpneumatic antishock garment (n=3), and uterine artery ligation (n=1). There was a significant increase in the use of B-lynch sutures for the management of uterine atony in the postintervention compared with preintervention period (P=.014). In the postintervention period, the rate of maternal mortality from obstetric hemorrhage decreased significantly from 1.2% to 0.2% (P=.02), a relative decrease of 82.1% from the preintervention rate. Hospital safety culture scores improved significantly from baseline in four out of five domains after the AIM Malawi training. After implementation of the AIM Malawi program, we found an increased use of postpartum hemorrhage procedural interventions, a decreased rate of maternal mortality and an increase in Hospital Survey of Patient Safety composite safety scores. The AIM Malawi program may be an effective framework for adaptation to improve maternal mortality in a low-resource setting.

Survey of the Need for the Development of a Simulated Training Program that Reproduces Automobile Accidents

본 연구는 119 구급대원 60명과 응급구조학과 교수 9명을 대상으로 조사한 자동차 사고 시뮬레이션 교육 프로그램에 대한 요구도 조사이다. 연구결과 응급처치 항목에서 경추보호대 착용에 대한 시뮬레이션 교육 요구도가 가장 높았고(76.8%), 시나리오 주제 항목에서 머리 손상에 대한 시뮬레이션 교육 요구도가 가장 높았다(75.4%). 구급대원의 근무경력 43개월을 기준으로 두 그룹별 요구도 차이를 확인한 결과 응급처치 항목은 항쇼크바지 사용법과 KED 사용 및 신속 구출에 대한 요구도가 두 그룹에서 유의한 차이를 보였고(p = 0.01, p = 0.05), 시나리오 주제는 얼굴, 복부, 기타 손상에 대한 요구도가 두 그룹에서 통계적으로 유의한 차이가 있는 것으로 나타났다(p = 0.05, p = 0.04, p = 0.03). 자동차 사고 시뮬레이션 교육 프로그램에 대한 119 구급대원과 응급구조학과 교수의 요구도도 높게 나타났으므로 이를 기반으로 추후 시뮬레이션 프로그램 개발이 필요하다고 평가되었다.This study performed a survey on the need for an automobile accident-simulation training program for 60 emergency workers and nine emergency medical professors. The results showed that the need for cervical spine immobilization use was highest (76.8%) in first-aid requiring simulation training, and the need for head injury was highest (75.4%) in the scenario requiring simulation training. Based on the 43-month working experience of emergency workers, the uses of pneumatic anti-shock garment, KED, and the need for rapid extrication were significantly different between the two groups (p=0.01, p=0.05). In addition, the scenario showed statistically significant differences in the need for face, abdomen, and other injuries in both group (p=0.05, p=0.04, p=0.03). The needs of emergency workers and emergency medical professors for an automobile accident simulation-training program were high, and the development of a simulation program is needed.

Impact of nonpneumatic antishock garment in the management of patients with hypoperfusion due to massive postpartum hemorrhage

Objective: The objective of this article was to compare hemodynamic and perfusion parameters as well as the clinical outcomes in critically ill patients with postpartum hemorrhage (PPH) who received treatment with a nonpneumatic antishock garment (NASG) as part of an intervention package, with a group of patients in similar conditions who did not receive an NASG. Methods: This observational study analyzed a historic cohort of 154 patients with PPH, secondary hypovolemic shock and signs of hypoperfusion who were admitted to this institution from 2012 to 2015. Group 1 (n= 77) was managed with NASG and Group 2 (n = 77) received interventions other than NASG. Hypoperfusion markers and maternal outcomes were compared in both groups. Results: Of 154 patients included in the analysis, 36.4% required a total abdominal hysterectomy (TAH) to achieve hemorrhage control, 98.2% of whom belonged to Group 2 and 1.8% to Group 1 (p = .001). The use of blood products was more common in Group 2 (p < .001), as was the administration of vasoactive agents. The mean number of days of hospitalization at the Obstetric High Dependency Unit (OHDU) was significantly lower in Group 1 and reached a statistically significant p value. Only two cases of maternal death occurred in Group 2. Discussion: The use of NASG in the management of PPH is a cost-effective strategy for patients with severe shock and signs of hypoperfusion and is optimal in a limited-resource scenario. In this study, the use of NASG was related to better outcomes in a statistically significant manner with better results regarding maternal outcomes such as uterine preservation and decreased transfusion requirements and hospital days. Conclusions: NASG, associated with the use of uterotonic agents and other strategies for PPH control, is a safe tool that helps reduce morbimortality in critically ill patients with PPH.

Nonpneumatic Anti-Shock Garment versus Intermittent Sequential Compression Device for Prevention of Postspinal Hypotension in Patients Undergoing Cesarean Section: A Randomized Controlled Study.

Context:Postspinal hypotension remains a frequent complication of subarachnoid block during cesarean section causing further maternal and fetal adverse effects.Aims:This study aims to evaluate and compare a continuous pressure nonpneumatic anti-shock garment (NASG) and an intermittent sequential compression device (SCD) with a control group for prevention of postspinal hypotension in women undergoing elective cesarean section.Settings and Design:A randomized, observer blind, controlled study at single university hospital.Subjects and Methods:Ninety singleton term parturients between 18 and 35 years of age undergoing cesarean section with spinal anesthesia were randomly assigned to be applied with NASG, SCD, or no device; n = 30 in each group. A standardized protocol for cohydration and anesthetic technique was followed. The primary outcome measure was incidence of hypotension defined as a decrease in systolic blood pressure of more than 20% from baseline or an absolute value <100 mmHg, whichever was higher. The secondary outcome measures were median dose of ephedrine required, incidence of maternal nausea and vomiting, and neonatal Apgar scores.Statistical Analysis Used:Results were expressed as mean (±standard deviation), median (range), or number (%) as appropriate. Nominal data were compared using Chi-square/Fischer's exact test. Continuous data were compared using ANOVA one-way test. Nonparametric data were compared using Kruskal–Wallis test.Results:In Groups NASG, SCD, and C, incidence of hypotension was 60%, 83%, and 90%, respectively (P = 0.021), with significant reduction in incidence of hypotension in Group NASG versus Group C (P < 0.001, odds ratio 0.17, 95% confidence interval 0.04–0.68). Median (interquartile range) dose of ephedrine required was significantly less in Group NASG compared with Groups SCD and C, respectively (P = 0.002, P < 0.001).Conclusions:NASG proved to be a more effective device for prevention of postspinal hypotension when compared with application of SCD or no device.

Implementation project of the non-pneumatic anti-shock garment and m-communication to enhance maternal health care in rural Tanzania

BackgroundObstetric hemorrhage (OH) remains one of the leading causes of maternal mortality, particularly in rural Africa. Tanzania has a high maternal mortality ratio, and approximately 80% of the population accesses health care lower level facilities, unable to provide Comprehensive Emergency Obstetric Care (CEmOC). The non-pneumatic anti-shock garment (NASG) has been demonstrated to reduce mortality as it buys time for women in shock to be transported to or to overcome delays at referral facilities.MethodsThis report describes one component of an ongoing maternal health improvement project, Empower, implemented in 280 facilities in four regions in rural Tanzania. The NASG along with a Closed User Group (CUG) mobile phone network were implemented within the overall EmOC project. Simulation trainings, repeated trainings, and close hands-on supportive supervision via site visits and via the CUG network were the training/learning methods. Data collection was conducted via the CUG network, with a limited data collection form, which also included free text options for project improvement. One-to-one interviews were also conducted. Outcome Indicators included appropriate use of NASG for women with hypovolemic shock We also compared baseline case fatality rates (CFR) from OH with endline CFRs.Data were analyzed using cohort study Risk Ratio (RR). Qualitative data analysis was conducted by content analysis.ResultsOf the 1713 women with OH, 419 (24.5%) met project hypovolemic shock criteria, the NASG was applied to 70.8% (n = 297), indicating high acceptability and utilization. CFR at baseline (1.70) compared to CFR at endline (0.76) showed a temporal association of a 67% reduced risk for women during the project period (RR: 0.33, 95% CI = .19, .60). Qualitative feedback was used to make course corrections during the project to enhance training and implementation.ConclusionsThis implementation project with 280 facilities and over 1000 providers supported via CUG demonstrated that NASG can have high uptake and appropriate use for hypovolemic shock secondary to OH. With the proper implementation strategies, NASG utilization can be high and should be associated with decreased mortality among mothers at risk of death from obstetric hemorrhage.

Management of post-partum haemorrhage in the Timor Leste National Ambulance Service.

Timor Leste has one of the highest maternal death rates in the world at 215 per 100 000 live births.1 Post-partum haemorrhage (PPH) accounts for 27% of maternal deaths globally. Annually the Timor Leste National Ambulance Service (TLNAS) attends over 20 000 cases, of which 2% are diagnosed with PPH. The objective of this study was to evaluate prehospital care of PPH patients transported by the TLNAS. A retrospective audit of PPH patients transported between May 2015 and May 2017. The inclusion criteria were patients diagnosed with PPH and transported during the study period. Data from the patient care records of 214 TLNAS PPH patients were abstracted using the PPH care evaluation tool. Paramedics diagnosed 211 (97%) PPH patients, took observations on 181 (85%) and obtained a patient history from 193 (90%) patients. TLNAS paramedics did not regularly provide other treatment including oxygen 36 (17%), intravenous isotonic crystalloid fluid 117 (55%), uterine massage 0 (0%), external aortic compression 0 (0%) and non-pneumatic anti-shock garments 9 (4%). This research has shown that paramedics are not consistently using available clinical interventions.

Non-pneumatic anti-shock garment (NASG) as a first aid for preventing or reversing hypovolemic shock secondary to obstetric hemorrhage

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To quantify primarily the effect on hypovolemic shock of the non‐pneumatic anti‐shock garment (NASG) for pregnant women suffering hypovolemic shock secondary to obstetric hemorrhage of all stages: antepartum, intrapartum, and postpartum hemorrhages.

Historical Studies in the Societal Impact of Spaceflight ed. by Steven J. Dick

Reviewed by: Historical Studies in the Societal Impact of Spaceflight ed. by Steven J. Dick Jordan Bimm (bio) Historical Studies in the Societal Impact of Spaceflight. Edited by Steven J. Dick. Washington, DC: National Aeronautics and Space Administration, 2015. Pp. ix+664. $59.99. This third volume in NASA History’s Societal Impact series, a series that emerged from a 2006 conference and the subsequent publication Societal Impact of Spaceflight (2007), focuses mostly on the Agency’s impact on technologies beyond the usual rockets, planes, and space capsules. This brings space history out of its niche and into conversation with the histories of atomic batteries, integrated circuits, medical devices, miniature accelerometers, and communications technologies. However, despite editor Steven J. Dick’s hope in his brief introduction that these studies will address “the mutual interaction of space exploration and society” (p. vii), many remain focused on scientists, engineers, and machines, leaving one wondering when “society” will show up. Historians of technology may also be unsatisfied with the impact model, a limitation flagged at the initial conference by Glen Asner, who noted that “the concept of societal impact is problematic” and called for assessments of “the influence of society on spaceflight.”* The tome’s nine chapters are organized into three sections: “Opinion,” “Spinoff?” and “The World At Large.” “Opinion” contains just one chapter, sociologist William Sims Bainbridge’s analysis of polls tracking Americans’ evolving attitudes about the prospects and inherent value of space-flight from the late 1940s to the near present. Bainbridge also leads off “Spinoff”—the volume’s most valuable and cohesive section—busting the myth that space exploration greatly benefits society through the transfer of technologies to the public for non-aerospace uses. Through an examination of a handful of obscure medical technologies (a bone density analyzer, anti-shock garments, memory foam, and a braille reader) promoted in the Agency’s annual Spinoff report, Bainbridge finds that nearly every case fails to meet a strict definition of the term, with NASA acting not as sole origin of groundbreaking tech, but as one of many interrelated supportive conduits in the military-academic-industrial-complex that innovations of varying significance pass through. In the next two chapters, Andrew Butrica tackles additional cases of [End Page 183] purported NASA spinoff: the famed integrated circuit, which he argues has become something of an “urban legend” thanks to their use in the Apollo guidance and navigation computer, and the lesser-known case of micro-electromechanical systems (MEMs), tiny accelerometers now ubiquitous in smartphones. Both chapters border on book-length (100 and 71 pages, respectively), and despite an accidentally repeated quote (p. 184), they reveal the complexity of engineering and funding networks inside and outside NASA that the tidy concept of spinoff obfuscates. Butrica concludes that isolating NASA’s contributions here is difficult, as critical data has been lost or merged with other “defense” entities like the Central Intelligence Agency, Department of Defense, and Atomic Energy Commission. He laments that determining the extent to which NASA’s sizable purchases of integrated circuits and internal work on their reliability really drove their massive proliferation is like “trying to nail Jell-O to the wall.” (p. 244) In Chapter 5, Roger Launius offers a history of the radioisotope thermoelectric generator (RTG), the controversial nuclear power source NASA has used in many high-profile robotic spacecraft like Mars Pathfinder, Cassini, and the Voyager probes. Launius finally brings in “society,” explaining how atomic batteries debuted in space in 1961 but only became a touchstone for anti-nuclear and environmental protests in the late 1970s, following the uncontrolled reentry of the Soviet Kosmos 954 satellite, which scattered radioactive debris across northern Canada, and the Three Mile Island accident. Continuing the theme of planetary stewardship, W. Henry Lambright’s more general survey of space and environmentalism has only increased in importance since publication. He shows how NASA’s Earth Science program—now facing elimination by the Trump administration for conducting climate research—stemmed from astronaut Sally Ride’s 1987 recommendation for a “Mission to Planet Earth” (MTPE). The final three chapters include David J. Walen’s round-up of various types of commercial applications satellites (he argues communications satellites have the...

In Pursuit of Solving a Global Health Problem: Prototype Medical Device for Autotransfusing Life-Threatening Postpartum Hemorrhage in Resource-Limited Settings

The purpose of the review is to provide an overview of innovative technologies being developed to prevent and treat postpartum hemorrhage in resource-limited settings and to discuss a promising new device designed specifically to address the lack of safe blood supplies in many areas of the world. There are several new technologies being used or tested to address the significant global health problem of postpartum hemorrhage, the leading cause of maternal morbidity and mortality worldwide. None of these new technologies have addressed the persistent lack of safe blood supplies in low resource settings which is an essential pillar of comprehensive emergency obstetric care. With this aim in mind, a prototype obstetrical medical device was designed with the capability to autotransfuse women suffering life-threatening postpartum hemorrhage in low resource settings. Postpartum hemorrhage remains the leading cause of maternal morbidity worldwide and efforts are needed, more than ever, to achieve the Sustainable Development Goals of improving maternal mortality especially in resource-limited settings. Despite many effective new technologies such as the non-pneumatic anti-shock garment, improvised uterine balloon tamponade devices, and new drugs such as tranexamic acid, none has addressed the lack of safe blood supplies that are critical to treating PPH. A prototype medical device has been developed, and preliminary testing for functionality and filter function has been successful and shows great promise. Further testing is still needed and is ongoing in preparation for human clinical trials.