Injured People Research Articles

Care for Seriously Injured People in Military Conflicts

The current war in Ukraine has drawn public attention to the treatment of war injuries. Follow-up treatment in Germany is portrayed the clover leaf of the TraumaNetzwerke DGU, is largely based on the demands of the Federal Ministries for Defence and Health and is intended to enhance resilience in war.The present article presents the special features of the care of severely injured patients during hostilities and should provide insights into the expected results of treatment and the actual procedures. We emphasise the unpredictability of the care of the severely injured during hostilities.On the basis of a search of the literature for the deployment of the German Army in Afghanistan and for the current war in Ukraine, we present the challenges and the typical patterns of injuries. We discuss the factors that can influence the procedures and the quality of the results during hostilities and how these may differ from civil polytrauma care in Germany - which is well established and standardised.Even during deployment of the Federal Army or (as planned) NATO, care of the severely injured is under standardised conditions, as based on the algorithmic ATLS care and which is concentrated on bleeding control. The corresponding equipment and personnel are well established, well prepared and well trained.However, there may be special local conditions or special deployments that make it inevitable that emergency medical care will be more delayed than in the civil system in Germany and can only take place after protracted transport. The objective is always that soldiers in combat should be able to receive medical care that is equivalent to that received by all accident victims in Germany, whatever the time and site of the accident.

Descriptive Study of Earthquake-Related Spinal Cord Injury in Türkiye-Kahramanmaraş

Objective: We aimed to review the epidemiological data of patients who were rescued from under the rubble in the Kahramanmaraş earthquakes on February 6 and developed earthquake-related spinal vertebral fractures. Materials and Methods: Our study included 69 patients with spinal vertebral fractures and/or spinal cord injuries (SCIs) who were admitted to the Physical Medicine and Rehabilitation Clinic of Adana City Training and Research Hospital after the 6 February Kahramanmaraş Pazarcık and Elbistan earthquakes. Patients with peripheral nerve damage or loss of muscle strength due to pelvic and extremity fractures were not included in the study. Results: The mean age of the patients was 40.43±15.24 years (min=8-max=72). The median time of rescue from under the rubble was 15 (1-106) hours. The median visual analogue scale (VAS) pain score was 7 (0-10). 69.6% of the patients were female. Among the patients with a vertebral spinal injury, 72.5% had an incomplete SCI and 27.5% had a complete SCI. 84.5% of the patients underwent surgery, and posterior spinal instrumentation was performed in 56.5% of them. Conclusion: There has been a significant increase in the number of SCI cases after the Kahramanmaraş earthquakes. Rehabilitation centers should be established, patients' access to these centers should be facilitated, and complications should thus be prevented or optimized. Injured people should be helped to return to their social lives. Keywords: February 6th Kahramanmaraş, Earthquake, Spinal Cord Injury

Can We Help Stop Bleeding in Badly Injured People

Serious bleeding, known as major hemorrhage, is the most common cause of death in people with serious injuries. People with major hemorrhage often have a lower amount of an important protein called fibrinogen in their blood, which makes it more difficult to stop the bleeding. In a big randomized controlled trial called CRYOSTAT 2, we looked at whether giving people extra fibrinogen soon after their injury helped stop bleeding and increased the number of people who survived. We were surprised to find that fibrinogen did not help as much as we expected, and that it may even make some people more likely to die. In this article, we talk about the CRYOSTAT-2 experiment and how it shows we cannot treat all bleeding patients in the same way.

FDM: Effective and efficient incident detection on sparse trajectory data

Incident detection (ID), or the automatic discovery of anomalies from road traffic data (e.g., road sensor and GPS data), enables emergency actions (e.g., rescuing injured people) to be carried out in a timely fashion. Existing ID solutions based on data mining or machine learning often rely on dense traffic data; for instance, sensors installed in highways provide frequent updates of road information. In this paper, we ask the question: can ID be performed on sparse traffic data (e.g., location data obtained from GPS devices equipped on vehicles)? As these data may not be enough to describe the state of the roads involved, they can undermine the effectiveness of existing ID solutions. To tackle this challenge, we borrow an important insight from the transportation area, which uses trajectories (i.e., moving histories of vehicles) to derive incident patterns. We study how to obtain incident patterns from trajectories and devise a new solution (called Filter-Discovery-Match (FDM)) to detect anomalies in sparse traffic data. We have also developed a fast algorithm to support FDM. Experiments on a taxi dataset in Hong Kong and a simulated dataset show that FDM is more effective than state-of-the-art ID solutions on sparse traffic data, and is also efficient.

How Do Sick and Injured People Feel and Act?

This article discusses the six most common emotional responses that patients have to illness and hospitalization. Healthcare providers should recognize and respond to these emotional reactions by acknowledging patients’ feelings, answering their questions, and allowing them to participate in their treatment as much as possible. By understanding and responding to these emotional responses, healthcare providers can provide better care for their patients and improve patient outcomes.

Tapping on Collective National Trauma

Tapping on Collective National Trauma

Surgeon views on firearm safety counseling in clinical practice: A cross-sectional survey.

Firearms are commonplace in the United States, and one proposed strategy to decrease risk of firearm injury is to have physicians counsel their patients about safe firearm ownership. Current rates of firearm safety counseling by surgeons who care for injured people are unknown. This study used an anonymous cross-sectional survey derived from previously published survey instruments and was piloted (n = 13) at the annual meeting of the American Association for the Surgery of Trauma (2022). The finalized survey was distributed using a quick response code during two sessions at the 2022 American College of Surgeons Clinical Congress. Eligible participants included the surgeons and surgical trainees who attended these sessions. One hundred fourteen individuals completed the survey (20% response rate), and a majority were male (n = 71 [62.3%]), attending surgeons (n = 108 [94.7%]), and specialized in acute care surgery (n = 72 [63.2%]). Few participants (n = 43 [37.7%]) reported counseling patients on firearm safety as part of their routine clinical practice; however, the majority (n = 102 [89.5%]) believed that surgeons should provide firearm safety counseling. Counseling rates did not vary significantly by age, sex, surgical specialty, or region of practice, but attitudes toward counseling did differ by firearm safety counseling practices ( p = 0.03) and region of practice (0.04). Noted barriers to counseling included lack of time (n = 47 [41.2%]), perceived lack of training (n = 43 [37.7%]), and lack of firearm knowledge/experience (n = 36 [31.6%]). Most surgeon respondents did not provide firearm safety counseling to their patients despite the fact the majority believed they should. This suggests that counseling interventions that do not solely rely on surgeons for implementation could increase the number of patients who receive firearm safety guidance during clinical encounters. Prognostic and Epidemiological; Level III.

The Status and Use of Hospital Ships in Times of Peace and War: Law of the Sea, Maritime Law and the Law of Naval Warfare

Abstract Hospital ships are vessels that are designed or equipped and primarily used to provide medical and surgical treatment and nursing care for sick or in-jured people at sea. Under the law of the sea and maritime law, such ves-sels are not dealt with separately. Therefore, their status and the respective rules applicable to them depend on the entities operating them. If operated by the armed forces of a State for exclusively government non-commercial purposes they qualify as warships or, if they are under the command of a civilian master, other State ships (“auxiliaries”) that enjoy sovereign im-munity in all sea areas, including the internal waters of another State. If operated by private entities or individuals, they qualify as merchant vessels. The law of naval warfare distinguishes between military hospital ships op-erated by the parties to the conflict and private hospital ships. The latter may be operated by national Red Cross/Red Crescent Societies, officially recognized relief societies, or private persons either of the parties to an in-ternational armed conflict or of a neutral State. The protection of all hospital ships under the 1949 Geneva Convention II is subject to comparatively strict conditions, some of which may have become obsolete in light of contempo-rary technologies and novel threats.

Schusswaffenverletzungen und penetrierende Traumata

The acute medical care in Germany after gunshot and stab wounds in the pre-hospital and in-hospital setting is a rarity in an international comparison. The resulting lack of routine in the acute care of critically injured people after penetrating trauma should therefore be countered with regular theoretical and practical training. In addition to standardized care algorithms for the care of severely injured people, knowledge of kinetics and wound ballistics is required for focused treatment. The article focuses mainly on the early treatment phase.

Severe accidents on Peruvian national and regional roads

Peru is a country with a complex geography. Moreover, it lacks minimal safe roads, higher in Andean and jungle territories. Depending on the classification they might receive, the num-ber of kilometers without pavement can reach up to 80%. Such a rate is alarming, consider-ing that internationally the United Nations promotes actions for road security since road ac-cidents are among the most common causes of death causes in the world. Then, employing data from Sutran, the current research has analyzed how the severity of accidents can affect road administration in Peru roads in 2021. Hence, the multinomial logistic regression was employed due to the nature of the data. It was found that regional routes had a higher risk than national roads when estimating the probability of having many dead and injured people because of a road accident.

The health burden of natural and technological disasters in Brazil from 2013 to 2021

Disasters deeply impact the health of the affected population and the economy of a country. The health burden of disasters in Brazil is underestimated and more studies are needed to underpin policies and actions for disaster risk reduction. This study analyzes and describes disasters that occurred in Brazil from 2013 to 2021. The Integrated Disaster Information System (S2iD) was accessed to obtain demographic data, disaster data according to Brazilian Classification and Codification of Disasters (COBRADE), and health outcome data (number of dead, injured, sick, unsheltered, displaced, and missing individuals and other outcomes). Database preparation and analysis were performed in Tableau. In total, 98.62% (50,481) of the disasters registered in Brazil from 2013 to 2021 are natural, with a significant increase in 2020 and 2021 due to the COVID-19 pandemic, a biological disaster. This disaster group also caused the highest number of deaths (321,111), as well as injured (208,720) and sick (7,041,099) people. By analyzing data for each geographic region, we observed differences regarding disasters frequency and their health outcomes. In Brazil, climatological disasters are the most frequent (23,452 events) and occur mainly in the Northeast region. Geological disasters have the highest lethality, which are more common in the Southeast; however, the most common disasters in the South and Southeast are those of the meteorological and hydrological groups. Therefore, since the greatest health outcomes are associated with disasters predicted in time and space, public policies for the prevention and management of disasters can reduce the impacts of these events.

Application of cloud computing and big data in three-stage dynamic modeling of disaster relief logistics and wounded transportation: a case study.

Collecting and sharing information about affected areas is an important activity for optimal decision-making in relief processes. Defects such as over-sending some items to affected areas and mistakes in transferring injured people to medical centers in accidents are due to improper management of this information. Because cloud computing as a processing and storage platform for big data is independent of the device and location and can also perform high-speed processing, its use in disasters has been highly regarded by researchers. In this environment, a three-stage dynamic procedure for evacuation operations and logistics issues is presented. The first stage of the proposed model is image processing and tweet mining in a cloud center in order to determine the disaster parameters. In stage II, a mixed-integer multi-commodity model is presented for the relief commodity delivery, wounded people transportation with capacity constraints, and locating of the possible on-site clinics and local distribution centers near disaster areas. In stage III, by using a system of equations, detailed vehicle load/unload instructions are obtained. Finally, the effectiveness of the proposed model on the data of an earthquake disaster in Iran is investigated. The results of comparing the proposed approach with a two-stage algorithm show that the total number of unsatisfied demand for all types of commodities in the proposed approach was better than the other. Also, the number of survivors in the three-stage model is significantly higher than in the two-stage one. The better performance of the proposed algorithm is due to the fact that online data is continuously available and that decisions such as sending relief items and dispatching are made more effectively.

Acupuncture and physical therapy for spinal cord injury: Case report

BackgroundSpinal cord injury (SCI) is a major problem worldwide, which can result in partial or complete loss of sensory function and motor control. Injured people are 2–5 times more likely to suffer premature death than their uninjured counterparts. Case InformationThis case reports the injuries sustained by a 41-year-old woman who jumped from a building being bombed in Kyiv, Ukraine, and her subsequent treatment and recovery.The patient suffered a complete spinal cord injury (SCI), lower distal paraplegia, and dysfunction of pelvic organs, with orthopedist reporting she would likely never walk again. She substantially recuperated after the integration of acupuncture and physical therapy (PT) in her rehabilitation. Utilizing electrical, manual, and scalp acupuncture along with PT, the patient regained full bowel control, improved bladder function, and gained ability to support orthostatic position. ConclusionsAcupuncture is cost effective and easy to perform in hospital settings. It has an important role to play in the rehabilitation of injuries. The integration of acupuncture and PT may significantly improve motor and neurological functions for SCI patients.

Driving Assistance System for Ambulances to Minimise the Vibrations in Patient Cabin

The ambulance service is the main transport for diseased or injured people which suffers the same acceleration forces as regular vehicles. These accelerations, caused by the movement of the vehicle, impact the performance of tasks executed by sanitary personnel, which can affect patient survival or recovery time. In this paper, we have trained, validated, and tested a system to assess driving in ambulance services. The proposed system is composed of a sensor node which measures the vehicle vibrations using an accelerometer. It also includes a GPS sensor, a battery, a display, and a speaker. When two possible routes reach the same destination point, the system compares the two routes based on previously classified data and calculates an index and a score. Thus, the index balances the possible routes in terms of time to reach the destination and the vibrations suffered in the patient cabin to recommend the route that minimises those vibrations. Three datasets are used to train, validate, and test the system. Based on an Artificial Neural network (ANN), the classification model is trained with tagged data classified as low, medium, and high vibrations, and 97% accuracy is achieved. Then, the obtained model is validated using data from three routes of another region. Finally, the system is tested in two new scenarios with two possible routes to reach the destination. The results indicate that the route with less vibration is preferred when there are low time differences (less than 6%) between the two possible routes. Nonetheless, with the current weighting factors, the shortest route is preferred when time differences between routes are higher than 20%, regardless of the higher vibrations in the shortest route.

The load borne by the Achilles tendon during exercise: A systematic review of normative values.

The Achilles tendon (AT) can be exposed to considerable stress during athletic activities and is often subject to pathologies such as tendinopathies. When designing a prevention or rehabilitation protocol, mechanical loading is a key factor to consider. This implies being able to accurately determine the load applied to the AT when performing exercises that stress this tendon. A systematic review was performed to synthesize the load borne by the AT during exercises/activities. Three databases (Pubmed, Embase and Cochrane) were searched for articles up to May 2021, and only the studies assessing the AT load in newtons relative to body-weight (BW) on humans during activities or exercises were included. Most of the 11 included studies assessed AT load when running or walking (N=10), and only three tested exercises were usually performed during rehabilitation. The load on the tendon ranged from 2.7 to 3.95 BW when walking, from 4.15 to 7.71 BW when running, and from 0.41 to 7.3 BW according to the strengthening exercise performed. From the collected data, a progression of exercises progressively loading the Achilles tendon, as well as the possible connections with walking and running activities, could be defined. However, the trends highlighted in the relationship between tendon loading and walking or running speeds present some inconsistencies. Further research is still needed to clarify them, but also to complete the data set in healthy and injured people.

Resilience modeling and pre-hazard mitigation planning of transportation network to support post-earthquake emergency medical response

Earthquakes can cause traffic network disruption, extensive blacked-out traffic signals, considerable dislocation trips, and numerous injuries. To avoid injury-transporting private vehicles jamming on few routes on a first-come, first-served basis, existence of redundant routes is essential for transporting injured people to hospitals in a timely manner. To save as many lives as possible, a resilient transportation network with redundant paths between injured people and hospitals is crucial following major earthquakes. This study aims to support the emergency medical response through improving system resilience with a focus on redundancy by integrating post-hazard emergency response and pre-hazard mitigation planning holistically. First, a new methodology to quantify the resilience of transportation networks is developed with two main contributions: incorporating infrastructure fragility, seismic uncertainty, search-and-rescue activity, and life vitality decay of injured people to quantify the urgency of hospitalization trips; and introducing equivalent resistance theory to model the redundancy of road networks. Second, the feasibility of developing a resilience-based pre-hazard mitigation strategy of vulnerable infrastructures to proactively support post-earthquake emergency medical response is investigated. A comparison with existing resilience metrics is conducted to reveal the advantage of the proposed methodology. Shelby County, Tennessee, is selected as the prototype community to demonstrate the proposed framework.

Resilience assessment of the interdependent transportation–healthcare system during emergency response

The emergency medical response after a strong earthquake relies on a robust transportation–healthcare system and effective management. This article proposes a resilience assessment framework for the interdependent transportation–healthcare system (ITHS) integrating physical loss and organisational management during post-earthquake emergency response. Considering the earthquake-induced injured people, the seismic damage to transportation, and the quantification of the condition of the patients after being treated, a novel metric is proposed to evaluate the response effort during the first 72 h. Bi-objective optimisation is developed to solve the real-time dispatching and treating problems instead of overwhelming one single hospital. In addition, the separate impact of disrupted transportation and damaged healthcare on the interdependent system is calculated to measure the cascading effect. It is shown that proper resource allocation and practical management are crucial to guarantee the desired level of the response effort.

Inter and intra-examiner reliability of musculoskeletal ultrasound scanning of Anterior Talofibular Ligament and ankle muscles.

Although the function of subjects with chronic ankle instability (CAI) has been examined, structural analysis by ultrasound scanning of the structures surrounding the ankle is limited. Before such structural comparisons between injured and uninjured people can be made it is important to investigate a reliable measurement protocol of structures possibly related to CAI. The aim of this study was to investigate the inter-intra examiner reliability of ultrasonic characteristics of selected structures in healthy subjects. Eleven healthy participants were assessed by an experienced sonographer and inexperienced certificated examiner. Ultrasound images were collected of the ATFL length and ankle muscles of gastrocnemius medialis (GM), tibialis anterior (TA) and peroneals. Thickness was measured for the muscles, whilst cross-sectional area (CSA) was measured for the peroneals. Inexperienced examiner repeated the measurements a week later. Inter-examiner reliability was excellent for all structures (ICC3,1 = 0.91-0.98). Intra-examiner reliability shows excellent agreement for all structures (ICC3,1 = 0.92-0.98) except GM (good agreement) (ICC3,1 = 0.82). LoA, relative to structure size, ranged from 1.38 to 6.88% for inter-reliability and from 0.07 to 5.79% for intra-reliability. This study shows a high level of inter-intra examiner reliability in measuring the structures possibly related to CAI. Future research has been planned to investigate the structural analysis in CAI by using applied MSUS protocol.

Situation with Fires and the Effectiveness of Fire Alarm Systems at Shipping Facilities

Introduction. Shipping, as one of the infrastructural transport communications, is a strategic branch of the economy of the Russian Federation. The timely delivery of goods, equipment, materials and raw materials to consumers depends on the reliability of shipping facilities operation. Therefore, ensuring safety, preventing man-made and natural destructive events are urgent and priority tasks of the owners of such facilities. Among the incidents that can cause significant direct and indirect damage, the most dangerous are fires. In this regard, in order to make management decisions on fire safety, it is necessary to know the situation with fires, to understand their social and economic consequences, to be able to identify possible causes for fires both at construction infrastructure facilities (shipyards, docks, port facilities) and on watercraft. At the same time, an important component in making such decisions is the study of the effectiveness of the fire alarm as a primary element in the general technological systems of fire automation on shipping facilities.Problem Statement. The objective of the study is to analyze the causes of fires and the operation of fire alarm systems at shipping facilities.Theoretical Part. Based on statistical data on fires and their consequences for 2017-2021, the social (the number of dead and injured people) and economic (direct material damage) consequences of fires at shipyards, port facilities, watercraft (ships, boats, vessels) and docks are analyzed. Estimates of the effectiveness of fire alarm systems at shipping facilities are given.Conclusions. The efficiency of fire alarm systems at all shipping facilities is on average at the level of 90%. At the same time, for sea and river vessels, this figure is about 82%, for port facilities it is almost 100%. But despite such a high level of fire alarm systems, it is not possible to avoid social and material consequences of fires. In addition, it should be noted that most fires occur at shipping facilities that are privately owned. At shipyards, port facilities and docks, fires on private property account for 71% of the total number of fires. On private sea and river vessels, the proportion of fires reaches 90%.

Brain Neuroplasticity Effects on the Occurrence of Anterior Cruciate Ligament Injury and the Effect of this Injury on Brain Function and Structure: A Systematic Review

Objective: The present study aimed to investigate the effect of brain neuroplasticity on the incidence of anterior cruciate ligament (ACL) injury and on brain function and structure before and after ligament reconstruction and after a period of rehabilitation exercises. Materials & Methods: In this review study, a search was conducted in PubMed, Scopus, Web of Science, Google Scholar, ScienceDirect, MedLine, Pedro, CINAHL, SPORTDiscus, and Cochrane Databases as well as national databases on related studies published from 1970 to 2021 using keywords in Persian and English related to the research topic. Results: The initial search yielded 65 articles. Based on the inclusion and exclusion criteria, 24 articles were selected for review of which 5 articles prospectively examined the effect of brain neuroplasticity on the incidence of ACL injury. Their results showed that the brains of people with ACL injury was different from the uninjured people, especially in the motor-sensory part of the cerebral cortex and cerebellum, which caused errors during movement planning of these persons. Ten articles examined the effect of ACL injury before reconstruction on brain function and structure and reported that changes occur in the level of motor-sensory cortex of the brain at least two weeks after the injury; after one year, these structural and functional changes were widely increased in injured people compared to healthy people. These studies also showed that the ligament dysfunction and the damage to mechanical receptors cause the reorganization of the central nervous system. In injured people, the control activity of motor-visual areas and their need for visual feedback have increased. Seven articles examined these changes after ligament reconstruction and showed that the brain neuroplasticity or functional and structural changes resulting from the injury not only did not return to normal conditions, but also increased after a while despite the reconstruction. Two articles examined these changes after a period of rehabilitation exercises and showed that functional and Conclusion: The changes in the brain after ACL injury not only persist after ligament reconstruction, but also increase after reconstruction. The common rehabilitation exercises whose main focus is not on eliminating these functional and structural changes in the brain cannot overdrive this negative neuroplasticity after injury which is one of the important causes of secondary injury and subsequent complications. In developing exercises to prevent ACL injury and for rehabilitation, it is better to use the new principles of motor learning and exercises related to visual feedback along with conventional exercises to overdrive negative neuroplasticity created in the brain and create positive neuroplasticity to support ACL.