First Aid Measures Research Articles

Knowledge, attitudes, and first-aid measures about epilepsy among primary school teachers in northern Iran

To assess knowledge, attitudes, and first-aid measures about epilepsy among primary school teachers. This cross-sectional study was conducted with participation of 342 primary school teachers during September 2016 to January 2017 in cities of Babol and Qaem-Shahr in Mazandaran Province in northern Iran. Primary schools were selected using simple random sampling. Data were collected through interviews using a structured questionnaire. The knowledge section included general knowledge, causes, symptoms, seizure triggers, first-aid measures, and recommended treatments. The Likert scale was used for the attitudes section. Answers about first-aid measures were categorized as helpful or harmful. The level of total knowledge score of 25 (7.7%) teachers was very high, 140 (43.3%) high, 141 (43.8%) moderate, and 17 (5.2%) low. The mean score about general knowledge was as follows: 6.1 (1.9), range = 0-9; causes 6.3 (1.9), range = 0-10; symptoms of seizures 8.5 (2.5), range = 0-12; and first-aid measures 6.8 (2.0), range = 0-11. Some 83% knew not taking anticonvulsants regularly could trigger seizures, and all teachers said a person with epilepsy should go see a physician. Attitudes were generally positive except for marriage and having children. The level of first-aid measures score of 8 (7.2) teachers was very high, 79 (70.5) high, 25 (22.3) low. Teachers with teaching experience at special schools took more helpful measures CONCLUSIONS: The knowledge of teachers about epilepsy was insufficient, attitudes toward people with epilepsy were generally positive, and first-aid measures at the last witnessed seizure were fairly helpful. Having teaching experience in special schools had a positive influence over knowledge and taking appropriate first-aid measure at time of the last witnessed seizure.

First-aid management of tonic-clonic seizures among healthcare personnel: A survey by the Apulian section of the Italian League Against Epilepsy

IntroductionTo evaluate the knowledge of healthcare workers about first-aid measures to be performed during and after a tonic–clonic seizure. MethodsOne hundred and fifty-four healthcare workers (86 physicians) working at 8 tertiary hospitals in the Apulia region, Italy, responded to a questionnaire comprising of 28 questions based on available Italian and international recommendations about what to do during a tonic–clonic seizure. ResultsOne hundred and fifty-four healthcare workers completed and returned surveys with a response rate of 96.25%. There were 55 nurses (35.7%), 86 physicians (55.8%), and 13 healthcare workers with different roles (Electroencephalograph technicians, psychologists, social workers). Among physicians, there were 7 cardiologists, 3 surgeons, 12 infectious-disease specialists, 11 internal medicine specialists, 2 psychiatrists, 2 gynecologists, 27 specialists working in the emergency department, and 22 physicians with different specializations. Nearly 90% of the respondents identified head protection as important first aid, while 100% responded to not keep the legs elevated. To avoid tongue bite, both physicians and other healthcare workers would put something in the mouth (54.0%), like a Guedel cannula (71.0%) fingers (29.5%). Grabbing arms and legs, trying to stop the seizure, would be potentially performed by 11.6% of our sample. Physicians would administer a benzodiazepine during the seizure (65.7%) and during the postictal phase (29.2%), even if the patient is known to have epilepsy (23.7%), and in this case, 11.3% of respondents would administer the usual antiepileptic medications. More than half of respondents would call the emergency telephone number, because of necessary hospitalization in case of tonic–clonic seizure, even if it is experienced by a patient known to have epilepsy. ConclusionOur survey suggests the need for epilepsy educational programs on first-aid management of seizures among healthcare workers.

A study of 200 skull fracture cases following vehicular accidents in the City of Guwahati: The gateway to North-East India

Introduction: Gradual increase in a number of vehicular accidents globally becomes a matter of concern, and adequate policies are required to reduce such incidents. This study was conducted in Guwahati city, the gateway to North-East India, to know the various factors related to such incidents associated with fractures of skull. Materials and Methods: A total of 200 cases were selected randomly over a period of 1 year. It was a cross-sectional study and data were collected from police, relatives of the deceased, and hospital records in an especially designed pro forma (questionnaire). Results obtained were tabulated and analyzed accordingly. Results: Results showed that almost 90% (89.5%) of the victims were male and 20–29 years was the most common age group involved. Fissured fracture was the most common skull fracture found in our study (56%), and temporal bone was involved in 56% of the cases. Occupants of two-wheelers were found more vulnerable to skull fracture. About 46% of the victims died before they could reach hospital, and in 71% of the cases, rural people were involved. Conclusion: Immediate and timely first-aid measure along with setting up of tertiary health-care centers in rural areas is absolutely necessary to prevent death due to vehicular accidents as the majority of the victims died before they could reach a well-equipped hospital. Public awareness about the use of protective gears, use of footpaths, and also safe usage of mobile phones while using roads would be of great help in reducing such incidents.

Assessing the Efficacy of First-Aid Measures in Physalia sp. Envenomation, Using Solution- and Blood Agarose-Based Models.

Stings from the hydrozoan species in the genus Physalia cause intense, immediate skin pain and elicit serious systemic effects. There has been much scientific debate about the most appropriate first aid for these stings, particularly with regard to whether vinegar use is appropriate (most current recommendations recommend against vinegar). We found that only a small percentage (≤1.0%) of tentacle cnidae discharge during a sting event using an ex vivo tissue model which elicits spontaneous stinging from live cnidarian tentacles. We then tested a variety of rinse solutions on both Atlantic and Pacific Physalia species to determine if they elicit cnidae discharge, further investigating any that did not cause immediate significant discharge to determine if they are able to inhibit cnidae discharge in response to chemical and physical stimuli. We found commercially available vinegars, as well as the recently developed Sting No More® Spray, were the most effective rinse solutions, as they irreversibly inhibited cnidae discharge. However, even slight dilution of vinegar reduced its protective effects. Alcohols and folk remedies, such as urine, baking soda and shaving cream, caused varying amounts of immediate cnidae discharge and failed to inhibit further discharge, and thus likely worsen stings.

Assessing knowledge of symptoms and first-aid care of epilepsy in Grenada, West Indies.

Epilepsy is a chronic neurological disorder that is increasingly prevalent in developing countries. It is critical to provide appropriate support to patients during seizures in order to prevent injuries. False beliefs regarding the etiology or pathogenesis of the epilepsy and inadequate health information may put patients with epilepsy or other seizure disorders at increased risk of injury. Our objective was to assess the level of epilepsy awareness amongst the general population in Grenada and educate the participants regarding proper first-aid measures. A pilot questionnaire containing a total of 25 items surveying the knowledge, attitudes, and first-aid care of epilepsy was presented to 200 adult residents of Grenada as face-to-face interviews. Study participants were recruited over a nine-month period on a voluntary basis at health fairs, in local communities, and on the campus of St. George's University. Our results indicate that 35 out of 198 (17.7%) respondents erroneously believed that medicine should be placed in a person's mouth during a seizure, and 83 out of 200 (41.5%) answered that a person who is convulsing should be held down. Furthermore, 128 out of 195 (65.6%) respondents erroneously believed that seizures occur when there is low brain activity and an additional 35 out of 199 (17.6%) regarded epilepsy as a contagious disorder. Our data suggest that persons with seizures and/or epilepsy may be at increased risk of injury in Grenada due to common misconceptions and false beliefs. It is critical that epilepsy awareness is promoted in developing countries, such as Grenada, where inadequate health information may be common.

Lip and tooth injuries at public swimming pools in Austria.

There is an increased risk of orofacial injuries in swimming pool facilities. Nevertheless, only a few studies have addressed this issue. The aim of this study was to identify the frequency of lip and tooth injuries at public swimming pools in Austria. A further aim was to examine which gender and age groups were affected, where and why these injuries occurred, and whether pool attendants had sufficient knowledge of dental first-aid measures. A total of 764 pool attendants in Austria were contacted by telephone and 689 participated in the study (90.2%). The attendants were interviewed retrospectively about accident occurrences in 2014 by a standardized questionnaire. Responses to the provision of first aid and choice of storage medium for avulsed teeth were subsequently evaluated. The frequency of lip injuries was 19.0%, and tooth injuries were 11.3%. Male bathers (P<.05) and children under 12years (P<.001) most frequently suffered injuries. The waterslide was the most common accident site. The most common cause of lip injuries was slipping on wet surfaces (39.0%), and for tooth injuries it was collisions with other persons or objects (each 28.1%). The pool attendants' responses were predominantly good or sufficient on first aid, with the exception of what storage medium to choose. Tooth rescue boxes were available in only 8.6% of all pool facilities. Orofacial injuries are a frequently occurring problem in swimming pool facilities. The pool attendants' knowledge on first-aid care of tooth injuries could still be improved.

Knowledge, attitudes, and practices among mothers of children with epilepsy: A study in a teaching hospital.

Knowledge about epilepsy and attitudes towards patients with epilepsy can affect measures taken to manage epilepsy and seizures. Support and understanding of mothers is invaluable in enabling children with epilepsy to develop normal life skills in living with epilepsy. In order to identify the educational needs of mothers of children with epilepsy, their knowledge, attitudes, and practices should be assessed. Therefore, we interviewed a group of mothers of children with epilepsy who were referred to a pediatric neurology clinic in a teaching hospital. The objective of this study was to assess knowledge, attitudes, and practices among mothers of children with epilepsy in order to identify their educational needs. In the period of August 2014 to January 2015, mothers whose children were diagnosed with epilepsy for at least six months participated in this cross sectional study, while returning to the neurology clinic of a pediatric hospital for usual follow-up. Data were collected through face-to-face interviews, held by trained female general practitioners. The interviewer used questions from a questionnaire. The knowledge section of the questionnaire included questions regarding prevalence and general knowledge about epilepsy, its etiology, symptoms, and seizure provoking factors. The attitudes section included statements regarding the mother's attitudes towards epilepsy and patients with the disease. The practice section included questions about first-aid measures taken by mothers who had witnessed generalized seizures by the time of interview. Responses of 206 participants were analyzed. At least 83% of mothers knew that epilepsy is a noncontagious neurological disorder which can be treated by regular drug therapy. In spite of demonstrating good knowledge scores, the majority of mothers felt the need for further training in epilepsy. More than 98% of mothers were against the idea that patients with epilepsy should hide their disease. Though having been referred to physicians, 84% of mothers had provided their children with at least one ineffective treatment, mostly based on superstitions. Mothers' level of knowledge of epilepsy was good, and their attitudes towards epilepsy were mainly positive. Regarding the right first-aid measures at time of the last seizure, mothers' practices were acceptable. However, there is still room for improvement regarding avoiding the wrong measures. It is suggested that both practice-related issues and other aspects of epilepsy be taken into account in epilepsy-related education programs.

Effect and accuracy of emergency dispatch telephone guidance to bystanders in trauma: post-hoc analysis of a prospective observational study

BackgroundEmergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved bystander first aid in trauma, and 2) to evaluate whether dispatchers and on-scene emergency medical services (EMS) crews identified the same first aid measures as indicated.MethodsFor 18 months, the crew on the first EMS crew responding to trauma calls used a standard form to assess bystander first aid. Audio recordings of the corresponding telephone calls from bystanders to the EMCC were reviewed.ResultsA total of 311 trauma calls were included. The on-scene EMS crew identified needs for the following first-aid measures: free airway in 26 patients, CPR in 6 patients, and hypothermia prevention in 179 patients. EMCC dispatchers advised these measures, respectively, in 16 (62%), 5 (83%), and 54 (30%) of these cases. Dispatcher guidance was not correlated with correctly performed bystander first aid. For potentially life saving first aid measures, all (20/20) callers who received dispatcher guidance attempted first aid, while only some few (4/22) of the callers who did not receive dispatcher guidance did not attempt first aid.DiscussionOverall, the EMCC dispatchers had low sensitivity and specificity for correctly identifying trauma patients requiring first-aid measures. Dispatcher guidance did not significantly influence whether on-scene bystander first aid was performed correctly or attempted in this study setting, with a remarkably high willingness to perform first-aid. However, the findings for potentially lifesaving measures suggests that there may be differences that this study was unable to detect.ConclusionThis study found a high rate of first-aid willingness and performance, even without dispatcher prompting, and a low precision in dispatcher advice. This underlines the need for further knowledge about how to increase EMCC dispatchers’ possibility to identify trauma patients in need of first aid. The correlation between EMCC-guidance and bystander first aid should be investigated in study settings with lower spontaneous first-aid rates.

웨어러블 기기를 사용한 심정지 환자 지원 시스템의 설계 및 구현

급성 심정지는 갑작스러운 심장 기능의 상실로 인하여 수 분 안에 뇌를 비롯하여 온 몸에 혈액 공급이 되지 않아 사망으로 이어지는 대표적인 중증응급질환이다. 특히 병원 밖에서 발생하는 병원외 심정지 환자는 생존율이 매우 낮다. 그 이유는 갑작스런 발병으로 인해 주변사람들이 심정지 환자라는 것을 인식하지 못할 뿐만 아니라 인식한다 하더라도 전문 의료지식이 없어 정확한 응급조치를 취하는 것이 어렵기 때문이다. 기존의 심정지 관련 연구는 대부분 심정지 발생 후의 치료법 방안에 집중되어 있었으나, 이는 근본적인 문제해결이 어려워 생존율을 높이는데 한계가 있었다. 이러한 문제를 해결하기 위해 본 논문에서는 널리 보급된 스마트폰을 활용하여 급성 심정지 환자를 위한 알림, 사전예방, 응급조치 등의 기능을 갖춘 솔루션을 개발하였다. 이 솔루션을 활용하면 급성 심정지를 사전에 예방할 수 있고, 설사 발병한다고 하더라도 주변사람에게 신속하게 알려 최대한 골든타임(4분)을 지킬 수 있으며, 1차 발견자가 신속하고 정확한 심폐소생술을 실시할 수 있어 생존율을 한층 더 높일 것으로 기대한다. Cardiac arrest is a serious intensive emergency disease that causes death within less than several minutes by depriving the body and brain of blood supply. Survival rate of cardiac arrest patients outside of hospitals is especially low. This is because pedestrians usually do not perceive the patient as a sick person, also, even if they do so, they have no medical knowledge to properly react to such emergency. The purpose of this study is to propose a solution that uses widely spread smart phones to alert pedestrians of the cardiac arrest patient, prevents cardiac arrest, and provides first-aid measures. By applying the proposed solution, cardiac arrest can be prevented in advance, pedestrians can be alerted to keep the golden time(4 minutes), and first witness can quickly proceed with CPR, ultimately enhancing the survival rate of the cardiac arrest patient.

A Comparative Study to Assess the Knowledge of Caregivers of People with Epilepsy and General Public Regarding Epilepsy and its First-Aid Management

Background and purpose: Epilepsy is an episodic illness which requires prompt treatment for good outcome. Seizures can develop at any time. Hence first-aid management of seizures is important. The aim of the study was to assess the knowledge of caregivers of people with epilepsy and general public regarding the first-aid management of seizures. Materials and methods: A descriptive cross-sectional survey was conducted from June 2009 to December 2009 in 200 subjects, i.e.100 caregivers of persons with epilepsy attending epilepsy OPD and 100 general public who were visiting the other general OPDs. The data was collected using a structured questionnaire. Results: The findings of the present study in relation to the demographic variables age (p=0.001), education (p=0.05) and type of family (p=0.002) showed a significant difference in two groups. On comparison of two groups in relation to knowledge about epilepsy and its first-aid management showed that they had inadequate knowledge. Myths regarding epilepsy were common in both the groups like epilepsy a contagious disease (general public 83%, caregivers 36%), marriage can cure the disease (general public 69%, caregivers 73%), and epilepsy is not treatable (general public 12%, caregivers 17%). The common wrong first-aid measures which are reported by both the groups include keeping an object between the teeth (caregivers-56%, general public-49%), pulling the tongue out (caregivers-67%, general public-74%) ,smelling the shoes (caregivers-52%, general public-45%). Among caregivers female gender had an influence on knowledge about epilepsy whereas no significant association was seen in caregivers between age, sex, educational status, monthly income and knowledge about first-aid. But in general public, age of the subjects showed an influence on the knowledge about epilepsy whereas knowledge about first-aid management of seizures was influenced by educational status. Conclusions: This study revealed that the both caregivers and general public had inadequate knowledge regarding epilepsy and its first-aid. They need continuous ongoing health education. The need of the hour is to provide necessary inputs via developing a module which will act as a reference material.

A Mini Health Analyzer: An Android Application

The aim of this work is to develop an Android application (a mini health analyzer) which focuses on some of the health problems of an individual's such as dizziness, rash, acne, ear infection asthma, diabetes, eczema, polycystic ovary syndrome (PCOS) and provides immediate information from first-aid measures to major health issues. This app will get the basic details as input, like their age, gender, blood group, allergies, body height and weight from the users while registering for the app, and then use these details to respond to the enquiry of the individual like their BMI, blood pressure (BP), calorie intake, etc. This app runs on android devices through internet. The linking of database with the application was successfully achieved thus storing user details and information about the diseases in the database which forms the backbone of this application as these information are later used by the app for its efficient performance. This app will come to the rescue in health related situations which we face in day to day life.

Knowledge of parents from public and private school students on emergency management of avulsed permanent teeth

To evaluate the level of general knowledge of parents with regards to first-aid measures for permanent tooth avulsion and to correlate such knowledge with their children’s school setting (public or private). A total of 179 parents answered a questionnaire containing 6 objective questions regarding the management of dental avulsion and emergency procedures. Data concerning the age and schooling of the respondents were also obtained. Parents from the private school group had higher levels of education and were more likely to have a correct attitude regarding the immediate replantation of the avulsed tooth as compared to parents of children studying in public schools (p < 0.05). However, the pattern of answers given for the questions concerning the cleaning of the avulsed tooth and the appropriate storage medium was very similar between both groups of parents, suggesting a lack of technical information among the participants. Parents were found to have low levels of knowledge regarding first-aid measures in an emergency related to permanent tooth avulsion and replantation, irrespective of their children’s school setting.

Epidemiologic characteristics, knowledge and risk factors of unintentional burns in rural children in Zunyi, Southwest China.

We investigated the knowledge level and risk factors for pediatric unintentional burns in rural Southwest China with an aim to provide basic evidence for the prevention strategies. A stratified sampling method was used to recruit 1842 rural children from 9 schools. Self-reported burns during the past 12 months and relevant risk factors were collected by questionnaires. The burn incidence of all surveyed children was 12.7% (95% confidence interval [95% CI] 11.2–14.2%). We found that burn incidence had a trend to increase with the increasing school grade level and a trend to decrease with increasing knowledge scores on burns. The top two causes of burns were hot liquids (36.3%) and hot object (29.5%). More than 30% of children had little knowledge about preventive measures and how to give first-aid after burns. The main risk factors for burns included female gender, left-behind children by parents who were working in cities, and poor mother school education level. As the incidence of pediatric unintentional burns was high in rural southwest China, schools, families, and local public health agencies should put efforts into health education targeting burn prevention and first-aid measures after burns, particularly in “left-behind” children and those with mothers with poor education.

Knowledge, attitude, and belief regarding burn first aid among caregivers attending pediatric emergency medicine departments

Background and objectivesEmergency departments witness many cases of burns that can be prevented with various first-aid measures. Immediate and effective burn first aid reduces morbidity and determines the outcome. Thus, it is imperative that measures of primary burn prevention and first-aid knowledge be improved. This descriptive study determines the current level of knowledge, attitude, and belief regarding burn first aid among caregivers. Materials and methodsCaregivers attending four pediatric emergency departments answered a structured questionnaire for demographic information, knowledge, and the burn first aid they provide including two case scenarios. Applying cold water for 15–20min, smothering burning clothes, and covering the pot of oil on fire with a wet cloth were considered appropriate responses. The main outcome measure was the proportion of caregivers who were aware of burn first aid and did not use inappropriate remedies. Additional questions regarding the best means of educating the public on burn first aid were included. Individual chi-squared tests and univariate logistic regressions were performed to correlate knowledge with demographic features, history of burns, and first-aid training. ResultsThe 408 interviewed caregivers (55% women) reflected a wide range of age, occupation, and educational level. Sixty percent (60%) of respondents had a large family, with 52% reporting a history of burns. Overall, 41% treated burns with cool or cold water, although 97% had inappropriate or no knowledge of the duration. Further, 32% treated burns with nonscientific remedies alone or in combination, including honey, egg white, toothpaste, white flour, tomato paste, yogurt, tea, sliced potato, butter, or ice. Only 15% had first-aid training. While 65% of caregivers covered a pot of oil on fire with a wet cloth, only 24% reported smothering burning clothes. Participants preferred learning more of first aid for burns via social media (41%), hospital visits (30%), and television (TV) (16%). No significant correlation was found between age, family size, language, history of burns, or training and knowledge; however, female gender and higher educational level were associated with increased awareness, although this was not statistically significant (p=0.05 and p=0.17, respectively). The logistic regression accounting for all significant variables showed that the history of burns had the greatest effect on knowledge of first aid (p<0.03). ConclusionKnowledge of burn first aid among caregivers is limited, with many resorting to non-scientific remedies. Use of social media, hospital visits, and TV for first-aid education might improve caregivers’ awareness. A nationwide educational program emphasizing first-aid application of only cold water and reduced use of inappropriate home remedies for burns is recommended.

Treatment of Convulsive Status Epilepticus: Evidence-Based Guidelines

Sponsoring Organization: American Epilepsy Society (AES) Target Audience: Neurologists, emergency care physicians, hospitalists, and intensive care specialists Background and Objective To update recommendations on the treatment of convulsive status epilepticus in children and adults since those published in 1993 as a consensus statement, the guideline subcommittee of the AES completed a systematic review of all relevant literature through September 2014. Treatment of refractory status epilepticus was not considered. Key Recommendations Initial treatment beyond stabilization of the patient and first-aid measures; recommendation level is “A” (established …

A study of sudden natural deaths in Imphal from 2010–2014

Sudden death is defined as death occurring within 24 hours of the onset of terminal symptoms. It is frequently associated with allegations of foul play. A retrospective study of sudden deaths in Imphal from 2010–2014 was conducted from the post mortem cases done at Regional Institute of Medical Sciences, Imphal. Out of a total of 1559 post mortem cases, 105 cases were of sudden deaths. Males constituted 91% and females only 9% of the cases. Maximum incidence was seen in the 30–40 year age group followed by 40–50 years. 30% were found dead, 25% had preceding illness, 30% were of collapse/unconsciousness, 15% died during sleep, 25% had preceding illness and 30% suddenly collapsed and died. Regarding the causes, maximum were related to the cardiovascular system (49.5%) followed by alimentary (25.7%), respiratory (14.3%), genitor-urinary (3.8%) & central nervous systems (1%) whereas the rest were miscellaneous causes(5.7%). Statistics on sudden deaths are useful to inform policy makers and scientists about its global burden and the need for prevention efforts, including screening protocols, identification of risk-stratification tools and availability of public-access first-aid measures and implementation of primary prevention strategies. Spreading awareness is important to clear the mystery surrounding a sudden death.

Bystander first aid in trauma - prevalence and quality: a prospective observational study.

BackgroundBystander first aid and basic life support can likely improve victim survival in trauma. In contrast to bystander first aid and out‐of‐hospital cardiac arrest, little is known about the role of bystanders in trauma response. Our aim was to determine how frequently first aid is given to trauma victims by bystanders, the quality of this aid, the professional background of first‐aid providers, and whether previous first‐aid training affects aid quality.MethodsWe conducted a prospective 18‐month study in two mixed urban–rural Norwegian counties. The personnel on the first ambulance responding to trauma calls assessed and documented first aid performed by bystanders using a standard form.ResultsA total of 330 trauma calls were included, with bystanders present in 97% of cases. Securing an open airway was correctly performed for 76% of the 43 patients in need of this first‐aid measure. Bleeding control was provided correctly for 81% of 63 patients for whom this measure was indicated, and prevention of hypothermia for 62% of 204 patients. Among the first‐aid providers studied, 35% had some training in first aid. Bystanders with documented first‐aid training gave better first aid than those where first‐aid training status was unknown.ConclusionsA majority of the trauma patients studied received correct pre‐hospital first aid, but still there is need for considerable improvement, particularly hypothermia prevention. Previous first‐aid training seems to improve the quality of first aid provided. The effect on patient survival needs to be investigated.

Association of dental trauma experience and first-aid knowledge among rugby players in Malaysia.

To assess and compare the knowledge of rugby players regarding first-aid measures for dental injuries. A cross-sectional study was conducted at rugby tournaments in 2009 and 2010 on players aged 16 and over. Convenient sampling was performed. A total of 456 self-administered questionnaires were returned. Data collected were analysed using SPSS 21. Descriptive analysis was undertaken for the demographic data. The subjects were classified according to their experience of sustaining each type of injury. Cross-tabulation and chi-square tests were carried out to compare the responses. When the expected cell count was less than five, Fisher's exact test was used. The level of significance was set at P < 0.05. The prevalence of self-reported dental injuries was as follows: tooth fracture (19.3%), luxation (6.6%) and avulsion (1.1%). Significant differences were found, whereby 52.2% of those who had no history of tooth fracture were more likely to seek immediate treatment (P < 0.001), whereas 42% of those who previously experienced tooth fracture claimed that they would only visit a dentist if they experienced pain (P = 0.001). Management of luxation and avulsion did not differ significantly between the groups. However, about half of those who did not have a history of tooth avulsion admitted to not knowing the correct answer, while three of five casualties would keep the tooth iced. Knowledge of the management of tooth fracture and storage medium differs between previous casualties and non-casualties. Overall, knowledge of dental trauma management was insufficient, suggesting the need to educate and train the players.

Vaccinations and malaria prophylaxis for international travelers

The prevention of infectious diseases by vaccination and by counselling about malaria prophylaxis is a central aspect of travel medicine. Besides mandatory vaccinations required for entry to certain countries various vaccinations may be indicated depending on destination and type of travel as well as on individual risks of the traveler. In addition, pre-travel counselling should always include a check-up of standard vaccinations. Protection against mosquito bites is the basis of malaria prophylaxis. The addition of chemoprophylaxis is warranted in high risk areas. When regular chemoprophylaxis is not applied it is recommended to carry an appropriate antimalarial drug which can be used for emergency stand-by treatment in case of unexplained fever and when medical attention is not available within 24 hours. Travelers should realize that self-treatment is a first-aid measure and that they should still seek medical advice as soon as possible.

Head, Neck and Dental Emergencies

This attractively presented little book is a further addition to the Oxford Handbook series. It is in the pocket reference format with a plastic flexicover to which we have become accustomed since the first Oxford Handbook of Clinical Medicine was first published 20 years ago and has matching ribbon page markers in yellow and red. It aims to provide the reader with a working approach to diagnosis and management of patients presenting in the accident and emergency department, concentrating as would be expected from the title on urgent and emergency problems above the collar bones. However, of necessity, the first three chapters covering general assessment, first aid measures and infections take a rather more whole body approach, as do the concluding glossary and last two sections on burns and miscellaneous conditions. The bulk of the book runs sequentially through trauma and other emergency conditions involving the head, neck, face, ears, eyes, mouth and salivary glands. The editor points out that many of the subjects covered are not true emergencies that may immediately threaten life, sight or limb but that, nevertheless, the text endeavours to cover the majority of conditions in the anatomical region for which patients regularly attend the casualty department. On average, one topic within each overall heading is covered over three pages with a system of four icons used throughout, to allow rapid identification of the degree of urgency. The explanatory key to the icons appears helpfully on both the inside front cover and again within the preface. Emergency care by its very nature should be as simple and as quick as possible. To this end, the layout comprising short notes, diagrams and photographs together with a remarkably comprehensive index provides the reader with an easily assimilated set of information, which should prove extremely valuable in an emergency situation. There is an emphasis on maintaining a high index of suspicion and on frequent re-assessment to ensure that pathology and potential complications are not missed. A minor disappointment was the quality of some of the photographs, the majority of which are in monochrome, that contrasts with those in colour printed on higher quality paper in the chapter devoted to the eye. The editor, who has extensive experience as a trauma team leader and who is now based in Belfast, has drawn together 14 contributors from a range of surgical specialties, together with ophthalmology and dentistry. The book is recommended mainly for junior doctors and also nurses in accident and emergency, oral and maxillofacial surgery, ENT, ophthalmology, anaesthetics and plastic surgery, as well as for undergraduates. However, it is likely to have wider appeal even to more senior colleagues, who may not regularly deal with emergencies around the head and neck but who occasionally may be called upon to do so.