Emergency Trauma Care Research Articles

A Comparative Analysis of ChatGPT, ChatGPT-4, and Google Bard Performances at the Advanced Burn Life Support Exam.

Artificial intelligence and large language models (LLMs) have recently gained attention as promising tools in various healthcare domains, offering potential benefits in clinical decision-making, medical education, and research. The Advanced Burn Life Support (ABLS) program is a didactic initiative endorsed by the American Burn Association, aiming to provide knowledge on the immediate care of severely burn patients. The aim of the study was to compare the performance of three LLMs (ChatGPT-3.5, ChatGPT-4, and Google Bard) on the ABLS exam. The ABLS exam consists of 50 questions with 5 multiple-choice answers. The passing threshold is 80% of correct answers. The 3 LLMs were queried with the 50 questions included in the latest version of the ABLS exam, on July 18th, 2023. ChatGPT-3.5 scored 86% (43 out of 50), ChatGPT-4 scored 90% (45 out of 50), and Bard scored 70% (35 out of 50). No difference was measured between ChatGPT-3.5 and ChatGPT-4 (P = .538) and between ChatGPT-3.5 and Bard (P = .054), despite the borderline P-value. ChatGPT-4 performed significantly better than Bard (P = .012). Out of the 50 questions, 78% (n = 39) were direct questions, while 12% (n = 11) were presented as clinical scenarios. No difference in the rate of wrong answers was found based on the type of question for the 3 LLMs. ChatGPT-3.5 and ChatGPT-4 demonstrated high accuracy at the ABLS exam and outperformed Google Bard. However, the potential multiple applications of LLMs in emergency burn and trauma care necessitate appropriate surveillance and most likely should represent a tool to complement human cognition.

Artificial Intelligence in Emergency Trauma Care: A Preliminary Scoping Review.

This study aimed to analyze the use of generative artificial intelligence in the emergency trauma care setting through a brief scoping review of literature published between 2014 and 2024. An exploration of the NCBI repository was performed using a search string of selected keywords that returned N=87 results; articles that met the inclusion criteria (n=28) were reviewed and analyzed. Heterogeneity sources were explored and identified by a significance threshold of P < 0.10 or an I2 value exceeding 50%. If applicable, articles were categorized within three primary domains: triage, diagnostics, or treatment. Findings suggest that CNNs demonstrate strong diagnostic performance for diverse traumatic injuries, but generalized integration requires expanded prospective multi-center validation. Injury scoring models currently experience calibration gaps in mortality quantification and lesion localization that can undermine clinical utility by permitting false negatives. Triage predictive models now confront transparency, explainability, and healthcare ecosystem integration barriers limiting real-world translation. The most significant literature gap centers on treatment-oriented generative AI applications that provide real-time guidance for urgent trauma interventions rather than just analytical support.

Diastolic blood pressure in hemorrhagic shock, the disregarded parameter

The management of trauma and hemorrhagic shock (T/HS) is a critical aspect of emergency medicine and trauma care. The use of whole blood for fluid resuscitation is considered the gold standard when available because it provides a balanced combination of red blood cells, plasma, and clotting factors. However, whole blood is not always readily available, and alternative options must be considered. In such cases, various fluid replacements and vasoactive drugs can be used to help stabilize patients with T/HS. The goal of our study was to compare several fluid therapies and vasoactive drugs for blood pressure stabilization after T/HS. Male Wistar rats (±400g) were subjected to laparotomy and hypotension (a mean arterial blood pressure (MAP) of 35-40mmHg) was induced by blood withdrawal for 90 min. Following the hypotensive period, animals were resuscitated with candidate solutions and/or vasoactive drugs in an effort to increase MAP to at least 60mmHg for 120min. Lactated Ringers (LR) with 5% dextrose was used as control fluid and in combination with vasopressors; whole blood resuscitation was considered the positive control. Among the studied medications, only vasopressin (60.0mmHg*) and resveratrol (60.2mmHg*) were able to achieve the target MAP. (Packed) red blood cells (70.4mmHg***), polymerized hemoglobin (74.4mmHg***), and whole blood (84.4mmHg****) increased MAP closer to baseline levels. While all of the groups studied were capable of restoring systolic pressure not significantly different from to baseline (SHAM =108.5mmHg), the inability to recover MAP was almost exclusively due to low diastolic arterial pressure (DAP). Using the SHAM DAP as reference (65.2mmHg) and the LR-reperfusion group as control (31.7mmHg), there was no increase in effcacy upon addition of angiotensin II (25.4mmHg), phenylephrine (27.9mmHg), vasopressin (37.8mmHg), L-NAME (35.7mmHg), resveratrol (41.1mmHg), sphingosine-1-phosphate (33.0mmHg), or naloxone (31.8mmHg). There was a similar lack of effcacy found using different fluid therapies: Hetastarch increased DAP to only 33.9mmHg, and 10% Albumin (41.0mmHg), and plasma (38.6mmHg) were only slightly superior to control. Only oxygen-carrying solutions were able to increase DAP: polymerized hemoglobin (55.7mmHg***), red blood cells (55.5mmHg***), and whole blood (67.8mmHg***). These findings underscore the complexity of T/HS management and the challenges in restoring and maintaining perfusing blood pressure, e.g. MAP, in these situations. This study provides valuable insights into the comparative effectiveness of various resuscitative approaches, shedding light on potential strategies to enhance outcomes after T/HS. Many shock studies often concentrate only on mean arterial pressure, potentially overlooking a crucial aspect of hemorrhage resuscitation—low diastolic pressure. Our study emphasizes that low diastolic pressure constitutes the primary component contributing to low MAP after reperfusion in T/HS. This result is likely associated with inadequate oxygen availability to the tissues, as only oxygen carriers, such as polymerized hemoglobin, red blood cells, and whole blood were capable of improving DAP. Future therapies should be directed towards preferentially improving DBP as an approach to achieving optimal hemodynamics after T/HS.(*p&lt;0.05, **p&lt;0.01, ***p&lt;0.001, ****p&lt;0.0001 compared to LR control). Department of Defense Award W81XWH-17-2-0047. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A 5-year comprehensive evaluation of maxillofacial injuries in polytrauma patients at a tertiary hospital - an epidemiological study.

To report and analyze the pattern of maxillofacial injuries in trauma victims and to define the role of a maxillofacial surgeon in an emergency trauma care team. Trauma patients reported and reporting to the casualty of a tertiaryhospital with facial injuries and other suspected concomitant injuries in the body were included in this study. The complete medical and radiographic records of each patient were reviewed and data was collected in a standard proforma in this 5-year clinical study (3 year of retrospective and 2 year of prospective study). The complete data related to the facial injuries and associated systemic trauma was recorded and statistical analysis conducted. A total of 18,369 patients with trauma were admitted to the hospital from May 2018 to April 2023. Out of these, 11,277 (61.4%) were males and 7,092 (38.6%) were females. Seventy percent of the reported cases with trauma were in the age group of 14-40 years. The incidence of trauma during the monsoon season was highest (n = 7,927, 43%). The commonest etiological factor leading to trauma was road traffic accident (n = 4,510, 40%). Among facial injuries, the mandibular fractures (n = 1,821, 41%) were predominant. The management of polytrauma patients should be undertaken by a team of specialists which should include a maxillofacial surgeon as facial injuries were common. This data is essential in developing and assessing the preventative strategies aimed at decreasing the frequency of facial and other injuries.

Education and training of prehospital first responders in low- and middle-income countries

Prehospital emergency medical services play a vital role in providing essential emergency medical and trauma care. However, in many low- and middle-income countries, there is a significant lack of adequate emergency medical services coverage, a problem compounded by a profound deficit of first responder training programs. The African Federation of Emergency Medicine classifies prehospital emergency care into 2 categories: tier-1, which includes laypersons, and tier-2, consisting of professionals equipped with dispatch capabilities. Both tier-1 and tier-2 first responders require protocolized training, integration, and coordination to varying degrees, with tier-1 programs focusing primarily on immediate stabilization and hospital transportation and tier-2 programs dedicating increased focus toward formal dispatch and advanced life support interventions. Training for both tiers of emergency medical services typically involves in-person didactic lectures with practical skills sessions. However, the content of these courses is highly context-dependent, and there is no international consensus regarding pedagogical methods or curriculum content for first responder training in low- and middle-income countries.Similarly, there is a lack of consensus in monitoring and evaluating training programs, including assessment methods, passing scores, and certification requirements. Although many programs use knowledge or skills acquisition testing, the content and depth of these examinations vary greatly, and long-term follow-up reporting is limited. As such, the educational landscape of both tier-1 and tier-2 emergency medical services in low- and middle-income countries remains highly varied and often faces a dual challenge of lacking clear international guidelines while still maintaining local appropriateness. Modular curricula developed in conjunction with standardized needs assessments, accompanied by the adoption of the training of trainers model, may present a pathway for local adaptability by leveraging local community members to inform and proliferate training. Although there have been notable improvements in prehospital training programs in resource-limited settings during the past 3 decades, challenges related to maintaining fidelity in monitoring and evaluation, expanding programs within resource constraints, and adapting to specific contexts continue to offer opportunities for further development in the future.

Resilience in terror and disaster medicine through consolidation of institutional memory - National Hospital Sri Lanka Easter Sunday 2019 experience

Suicide bombing generates a significantly larger number of casualties per attack than other uses of force by terrorist groups. Acts of terrorism are evolving and becoming more complex. Health emergency trauma care systems should advance and be resilient to withstand shocks of terror mass casualty event while catering routine community care. Easter Sunday emergency and trauma care response at the Accident Services National Hospital Sri Lanka accrued invaluable lessons to be learned and shared with global emergency care fraternity.

A modified chain-based sponge dressing controls junctional hemorrhage in the tactical combat casualty care simulation of pigs

BackgroundHemorrhage has always been the focus of battlefield and pre-hospitalization treatment. With the increasing fatality rates associated with junctional bleeding, treatment of bleeding at junctional sites has gradually gained attention in battlefield trauma emergency care. We designed a modified chain-based sponge dressing with a medical polyvinyl alcohol sponge that can be used to treat junctional hemorrhage and tested its hemostatic efficacy and biocompatibility.MethodsTwenty adult Bama miniature pigs were randomly divided into the modified chain-based sponge dressing (MCSD) and standard gauze (SG) groups. The right femoral artery of the pigs was shot at after anesthesia. The Bama miniature pigs were moved to the safety zone immediately to assess the condition according to the MARCH strategy, which evaluates massive hemorrhaging, airway obstruction, respiratory status, circulatory status, head injury & hypothermia. Hemoglobin and coagulation status were checked during the experiment.Among the pigs in which the inguinal hemorrhagic model based on bullet penetrating wounds was successfully established, those in the MCSD group received a disinfected MCSD for hemostasis, while those in the SG group received standard gauze in an imbricate manner to pack the bullet exit and entrance wounds to stop bleeding until the wound was filled, followed by compression for 3 min at sufficient pressure. CT scanning, transmission electron microscopy, and HE staining were conducted after experiment.ResultsThe MCSD group showed lower hemostasis time and blood loss than the gauze group. The MCSD group also showed a higher success rate of treatment,more stable vital signs and hemoglobin level. The CT scanning results showed tighter packing without large gaps in the MCSD group. The histopathological assessments and the transmission electron microscopy and HE staining findings indicated good biocompatibility of the polyvinyl alcohol sponge.ConclusionThe MCSD met the battlefield’s requirements of speedy hemostasis and biosafety for junctional hemorrhage in Bama miniature pigs. Moreover, in comparison with the conventional approach for hemostasis, it showed more stable performance for deep wound hemostasis. These findings provide the theoretical and experimental basis for the application of MCSD in the treatment of hemorrhage in the battlefield in the future.

Indicators to measure the performance of emergency trauma care

The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. A total of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data.

Injury pattern of road traffic accident cases attending trauma centre of tertiary care hospital of North India

Introduction: Injury is a significant global health burden and can result in mortality if not attended to on time. Trauma system refers to a collection of services provided by various super-specialties. According to the WHO-World Bank Report, RTA will rise from ninth place to the third biggest cause of mortality. Materials and Methods: The study was done at Advanced Trauma Centre (ATC) at PGIMER, a teaching hospital of north India. Study included area from most of the patient come for treatment (rural/urban) and injury patterns seen in these patients, which included mode of injury, type of injury, type of road accidents and location of injury. Results and Observations: In maximum cases, 60.2% (245) of the mode of injury was RTA. It was seen that the maximum number of patients, 44.4%, (115) had motorbike/scooter collisions with vehicles. In most patients, the type of injury seen was 35.9% (147) head, neck and back injuries, and in maximum cases, the location of the accident site was road/street 63.2%. Discussion: In our country, where the trauma delivery system is poorly developed, teaching hospitals have to bear the burden of treating many patients. No concept of emergency medicine or trauma care is in use, even in urban areas. As a result, teaching hospitals’ emergency departments receive many referrals for emergency conditions.

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients.

The majority of potentially preventable mortality in trauma patients is related to bleeding; therefore, early recognition and effective treatment of hemorrhagic shock impose a cardinal challenge for trauma teams worldwide. The reduction in mesenteric perfusion (MP) is among the first compensatory responses to blood loss; however, there is no adequate tool for splanchnic hemodynamic monitoring in emergency patient care. In this narrative review, (i) methods based on flowmetry, CT imaging, video microscopy (VM), measurement of laboratory markers, spectroscopy, and tissue capnometry were critically analyzed with respect to their accessibility, and applicability, sensitivity, and specificity. (ii) Then, we demonstrated that derangement of MP is a promising diagnostic indicator of blood loss. (iii) Finally, we discussed a new diagnostic method for the evaluation of hemorrhage based on exhaled methane (CH4) measurement. Conclusions: Monitoring the MP is a feasible option for the evaluation of blood loss. There are a wide range of experimentally used methodologies; however, due to their practical limitations, only a fraction of them could be integrated into routine emergency trauma care. According to our comprehensive review, breath analysis, including exhaled CH4 measurement, would provide the possibility for continuous, non-invasive monitoring of blood loss.

Health-Care Facilities and Road Traffic Injuries in Thiruvananthapuram City

Background: Road traffic injuries (RTIs) are a growing public health concern in India. Despite good health infrastructure and better-connected roads, Kerala has the fifth highest incidence of RTI in India. The spatiotemporal analysis of RTI in Trivandrum is undertaken in this context. Methods: RTI data for 2016 was obtained from the State Crime Records Bureau, Thiruvananthapuram and the population data were taken from the Census 2011. Spatial statistical analysis was used to look for geographical distribution and spatiotemporal clustering of RTIs. Health-care facilities providing emergency trauma care services in the city were identified from secondary sources. Results: A total of 2,319 people, including pedestrians, got injured in 1,926 accidents in Thiruvananthapuram city in 2016. A Moran’s I value of 0.23 signifies spatial autocorrelation (clustering) of RTIs in Trivandrum. The rates of RTIs were significantly high among senior citizens, male sex, two-wheeler users, and during daytime. Most deaths (48.2%) occur among the active age group of 30 to 60 years. A severity map was generated and using LISA, local hotspots were identified. Eight significant cluster locations were identified among the 100 wards. The mean distance from the accident hotspots to the nearest health-care facility was 1.2 km for the public and private facilities. Conclusion: There is a significant spatial-temporal clustering of RTIs in Thiruvananthapuram city. Proportionally higher deaths occur among pedestrians, 2-wheeler users, and women, which needs further exploration. The study results could be used to plan and build RTI prevention strategies in Thiruvananthapuram city

Validity of Trauma and Injury Severity Score Scoring in India.

Sir, Trauma is one of the leading causes of death in India. Prediction of survival following trauma is an important field of research, particularly in India where traditional scoring systems have failed to produce satisfactory results. The origin of the trauma and injury severity score (TRISS) can be traced back to the major trauma outcome study (MTOS) which was conducted in the United States during the 1980s. The TRISS uses the revised trauma score (RTS), injury severity score (ISS), age of the patient, and nature of the injury to predict the mortality of the patient in an emergency trauma care setting. The validity of TRISS scoring has always been put to the test in various countries with diverse patient populations. In the Indian scenario, studies have shown an unsatisfactory correlation of observed patient mortality with the values predicted using the TRISS scoring system. In one such study, the predicted mortality was 10.89% using the TRISS scoring but the observed mortality was found to be 21.26%.[1] The authors concluded that the TRISS scoring, which had its origins in the United States of America, may only be valid for specific conditions in the originating country or countries with similar patient populations. Another Indian study observed mortality of 33.3% as compared to predicted mortality of 15.7% by the TRISS scoring system.[2] The authors concluded that the TRISS methodology with the MTOS coefficients does not accurately predict mortality in developing countries such as India. One of the reasons for the poor correlation of the predicted mortality rates with the observed ones may be the inclusion of ISS. The ISS is a score that requires labor-intensive calculations with specially trained staff, which is unsustainable in low- and middle-income countries.[3,4] The ISS also does not consider multiple severe injuries in the same body region, thereby giving a higher score to a patient with two moderate injuries in two different regions versus someone who has two severe injuries in the same region of the body.[5] The RTS too may not be perfectly accurate since no time adjustment is added to the score since the time of injury. In India, there is no uniform time interval for calculating the RTS after injury. This may introduce bias as fluctuating vital signs and resuscitation efforts tend to normalize physiological parameters giving falsely low predictive mortality rates.[3] Another limitation of the TRISS score would be the fact that often it is a retrospective calculation. This is because an accurate calculation of ISS is usually done retrospectively and is not feasible in the acute setting. Therefore, it is not a viable option to predict probable adverse outcomes on admission.[4] A national trauma registry/database to develop new coefficients suitable in the Indian scenario for predicting adverse patient outcomes in the emergency setting will help to overcome these limitations.[1,2] Research quality and ethics statement The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Risk factors of deterioration in patients of head injury with non-operative management on first neurosurgical consultation.

In most of the emergency trauma intensive care units (ICUs) of India, neurosurgical opinion is sought for patients presenting with head trauma after earliest possible resuscitation to determine the further line of management. This study aimed to identify common risk factors, leading to neurological deterioration in conservatively managed patients of traumatic brain injury (TBI). This retrospective study analyzed patients admitted with acute TBI and traumatic intracranial hematoma under emergency trauma care ICU who did not require neurosurgical operation within 48 h of trauma. The recorded data were analyzed to determine the predictors of neurological deterioration using univariate and binary logistic regression analysis in SPSS-16 software. Medical records of consecutive 275 patients of acute TBI presenting to the emergency department were studied. One hundred and ninety-three patients were afflicted with mild TBI (70.18%), 49 patients had moderate TBI (17.81%), and 33 had severe TBI (12%). In the outcome, 74.54% of patients were discharged, and operative decision was made on 6.18% of patients and 19.27% died. Severe TBI is the independent predictor of neurological deterioration during their stay in ICU. Progressive hemorrhagic injury (PHI) showed neurological deterioration in 86.5% of patients. Systemic inflammatory response syndrome (SIRS) was present in 93.5% of patients who had deteriorated neurologically. Dyselectrolytemia was the biochemical derangements seen in 24.36% of cases. This study revealed severe TBI, PHI, and SIRS to be strong and independent risk factors of neurological deterioration.

Anesthetic considerations and care management of children with traumatic brain injury

Abstract Traumatic brain injury (TBI) in the pediatric population persists to be a global health burden contributing to significant morbidity and mortality. The in-hospital management of pediatric TBI differs from adult TBI due to the various inherent age-specific anatomical, physiological, and pathological differences. Their peri-operative care encompasses initial stabilization in the emergency room, sedation for diagnostic imaging, medical management in the intensive care unit, anesthesia for emergent decompressive craniotomies in the operating room, support of recovery from anesthesia in the postoperative suite, and postoperative management in the emergency trauma care unit until hospital discharge. Disturbed cerebral autoregulation and compromised intracranial compliance predispose to cerebral ischemia and edema. Refractory intracranial hypertension is observed to be the most important predictor of poor outcome and mortality in these patients. Multimodal neuromonitoring paves the way for a better contemplation of the underlying intracranial pressure, cerebral hemodynamics, cerebral oxygenation, and neuronal electrical activity. The peri-operative goals revolve around the maintenance of cerebral and systemic homeostasis, the key components of which are discussed here. This review also discusses the key recommendations and practice guidelines proposed by the Brain Trauma Foundation for the critical care management of pediatric patients with severe TBI. A thorough knowledge about pediatric neuroanatomy and neuropathophysiology of TBI in concordance with the multidisciplinary application of best management practices fosters the best possible neurocognitive outcome among pediatric TBI survivors.

Editorial Comment on the Article by Belenkiy I.G. et al. “Strategies of Osteosynthesis: Problems and Perspectives”

The commentary discusses the advantages and disadvantages of the model proposed by the authors of the article for performing osteosynthesis for urgent indications within 24 hours after the patients admission to the hospital, and also focuses on the need for comprehensive assessment of treatment outcomes and financial costs of the healthcare system. The determination of indications for emergency osteosynthesis and the identification of patients groups depending on the pattern and localization of the fracture are also important issues in justifying the shortening of the time before surgery. It is necessary to justify the priority localization of fractures for urgent fixation based on the analysis of the authors own experience and literature data. Changes in the system of emergency trauma care will require a revision of the standards of staffing and financing in the system of compulsory medical insurance. Therefore, the commentary emphasizes the expediency of a preliminary assessment of the new model effectiveness in some medical institutions by comparing it with the traditional system.

Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit.

Severe traumatic injury is one of the main global health issues which annually causes more than 5.8 million worldwide deaths. Uncontrolled haemorrhage is the main avoidable cause of death among severely injured individuals. Management of trauma patients is the greatest challenge in trauma emergency care, and its proper diagnosis and early management of bleeding trauma patients, including blood transfusion, are critical for patient outcomes. Aim: We aimed to describe the epidemiology of transfusion practices in severe trauma patients admitted into Spanish Intensive Care Units. Material and Methods: We performed a multicenter cross-sectional study in 111 Intensive Care Units across Spain. Adult patients with moderate or severe trauma were eligible. Distribution of frequencies was used for qualitative variables and the mean, with its 95% CI, for quantitative variables. Transfusion programmes, the number of transfusions performed, and the blood component transfused were recorded. Demographic variables, mortality rate, hospital stay, SOFA-score and haemoglobin levels were also gathered. Results: We obtained results from 109 patients. The most transfused blood component was packet red blood cells with 93.8% of total transfusions versus 43.8% of platelets and 37.5% of fresh plasma. The main criteria for transfusion were analytical criteria (43.75%), and acute anaemia with shock (18.75%) and without haemodynamic impact (18.75%). Conclusion: Clinical practice shows a ratio of red blood cells, platelets, and Fresh Frozen Plasma (FFP) of 2:1:1. It is necessary to implement Massive Transfusion Protocols as they appear to improve outcomes. Our study suggests that transfusion of RBC, platelets and FFP in a 2:1:1 ratio could be beneficial for trauma patients.

Interview With Brandy Mathews

BM: I began my nursing career as a staff nurse in the emergency department. For personal reasons, I left the university setting and returned to my hometown where I worked in the ICU and spent a couple of years as a flight nurse. Missing the academic medical center, I returned to the university and took my first non-direct patient care and supervisory position in a new department that was focused on throughput, capacity management, and organizational growth. I learned so much about managing people and processes during this time. I was also in a position to work with data, financial metrics, and capacity management strategies, which was an experience I was lacking from my clinical background. This prompted me to pursue an advanced degree with more of a business focus. From here, I became the department director, which led to the opportunity for my current role. Currently, I am a chief nursing officer of emergency services, trauma, surgical services, general and critical care medicine teams at both of our adult hospitals. I have been blessed to work with extremely talented people and to have supervisors and mentors who gave me opportunities but also pushed me to be my best! Roxane Spitzer, PhD, RN, MBA, MA, FAAN, is Editor Emeritus of Nurse Leader, in Madison Wisconsin, and a member of the board of directors of OnSomble. She can be reached at [email protected] .

The complexity of providing humanitarian surgical care in armed conflict: a framework to help categorize needs

Abstract Armed conflicts are increasing globally due to political unrest and the broader effects of climate change. Without resources to provide quality surgical care, it becomes nearly impossible to provide quality emergency surgery and trauma care similar to that in high-income countries. To understand and help aid organizations provide resources and address the surgical needs of populations facing armed conflict, a matrix to identify variables and help with interventions was envisioned. A previously published global surgery matrix based on the PIPES (Personnel, Infrastructure, Procedures, Equipment and Supplies) surgical capacity tool was adapted to this context. The novel matrix incorporates 108 variables. These variables are grossly divided into local and international agency components to address the issue of who is providing care. Using a time continuum of pre-conflict, conflict, and post-conflict allows organizations to concentrate on when during the conflict to target their intervention. In addition to the previously used personnel, infrastructure, procedures, equipment, and supplies categories, a sixth category called standards was included that addresses the issues such as information technology, data systems, quality improvement programs, and patient safety. Pilot testing of this matrix to obtain feedback from end users is the next step in development. Ultimately, peri-conflict preparedness should increase and improve surgical outcomes and reduce in death and disabilities around the world.

Focused research in emergency medical systems in Asia: a necessity for trauma system advancement

Abstract Since trauma is a growing health problem worldwide, emergency trauma care including emergency medical services (EMS) is becoming an integral part of the healthcare system. The optimal EMS which will improve access to trauma care, will be different in each country because of different healthcare systems, trauma etiology, and economic situations. To adopt models that have succeeded in developed countries is not always appropriate. In order to identify the optimal EMS model in developing countries, comparing the systems among many countries in detail and examining their advantages and disadvantages would be necessary. Therefore, this article tries to identify important elements of EMS to achieve mature EMS systems based on comparisons of 7 Asian countries, and discusses the need to conduct more detailed and extensive comparisons.

Injectable Self-Healing First-Aid Tissue Adhesives with Outstanding Hemostatic and Antibacterial Performances for Trauma Emergency Care.

Soft-tissue trauma emergency caused by natural disasters and traffic accidents is highly prevalent, which can result in massive bleeding, pathogen infection, and even death. Although numerous tissue adhesives can bind to tissue surfaces and cover wounds, most of them still have several deficiencies, including long gelation time, poor adhesive strength, and anti-infection, making them inappropriate for use as first-aid bandages. Herein, injectable and self-healing four-arm-PEG-CHO/polyethyleneimine (PEI) tissue adhesives as liquid first-aid supplies are developed via the dynamic Schiff base reaction for trauma emergency. It is found that the prepared hydrogel adhesives exhibit short and controlled gelation time (9∼88 s), strong adhesive strength, and excellent antibacterial ability. Their hemostatic and antimicrobial performances can be tailored by the mass ratio of four-arm-PEG-CHO/PEI. Moreover, in vitro biological assays display that the developed tissue adhesives possess satisfactory cyto/hemocompatibility. Importantly, in vivo the designed adhesives show fast hemostatic capacity and excellent anti-infection as compared to commercial Prontosan gel. Thus, this work indicates that the four-arm-PEG-CHO/PEI first-aid tissue adhesives display great potential for wound emergency management.