Injured Persons Research Articles

Psychological Distress and Quality of Life Among Military Trauma Patients.

Military trauma has a significant impact on soldiers, affecting many aspects of their lives, with the highest impact on their quality of life and psychological wellness. This study aimed to measure psychological distress and its relationship with the quality of life among Jordanian military trauma patients. A descriptive cross-sectional study was conducted in The Hashemite Protection Departments for military causalities in Amman, Irbid, and Al-Karuk. The authors used the WHO Quality of Life Scale-Brief and Trauma Symptoms Checklist-40 scales for assessing the quality of life and psychological distress among Jordanian military trauma patients. A total of 145 trauma survivors participated in the study and responded to all questionnaires out of 173 distributed. The study was approved by the institutional review board of Al-Zaytoonah University. The result of this study revealed that military trauma survivors had high levels of psychological distress with a mean of 85.66 (SD = 19.418). The subscale of "Dissociation symptoms" had the highest rating (M = 19.92, SD = 5.096), while the "sleep disorders" subscale had the lowest rating (M = 10.000, SD = 3.501). On the quality of life scale, a moderate level of quality of life resulted among the participants with a mean of 61.620 (SD = 17.190). The "general health" subscale scored the highest among the other domains (M = 18.241, SD = 5.434), while the "physical health" domain scored the lowest (M = 4.910, SD = 2.078). Furthermore, a statistically significant negative relationship between psychological distress and quality of life was reported (r =-0.178, P < .05). Jordanian injured military persons had a moderate quality of life level and high level of psychological distress. A structured follow-up program is required to be developed to improve those patients' health and quality of life. Furthermore, additional research is needed to investigate the impact of military trauma and services on soldiers in Jordan and the Middle East.

Association between the number of individuals injured in a traumatic event and posttraumatic stress disorder among hospitalized trauma patients.

Posttraumatic stress disorder (PTSD) often occurs following mass casualty events, yet the connection between the number of individuals injured in an event and PTSD risk in smaller-scale events (i.e., involving one or several injured persons)remains unclear. We conducted a registries-based study cross-referencing three databases across the continuum of care for military trauma patients hospitalized for traumatic injuries. The study population was categorized into three groups based on the number of injured individuals involved (i.e., single injured person, two to four [2-4] injured people, and five or more [≥ 5] injured people), and PTSD prevalence was assessed using long-term disability claim diagnoses. Overall, 4,030 military personnel were included (age at injury: Mdn = 20 years), and 18.3% were subsequently diagnosed with PTSD, with the highest prevalence in events involving ≥ 5 injured individuals (35.8%). Regression analyses adjusted for potential confounders revealed that being injured in an event with 2-4 injured persons, OR = 1.68, 95% CI [1.31, 2.15], or ≥ 5 injured persons, OR = 2.36, 95% CI [1.79, 3.13], was associated with increased odds of developing PTSD compared to being the sole injured person. The findings suggest a direct association between the number of injured individuals in an event and PTSD prevalence among traumatic injury survivors. The results underscore the importance of early diagnosis and interventions to prevent PTSD in individuals injured in multicasualty and mass casualty events.

Evacuation of the Injured Using Unmanned Systems

This article explores the use of unmanned systems for evacuating wounded personnel from the battlefield. It focuses on conclusions drawn from conventional medical evacuation methods, particularly when wounded soldiers are still in the enemy’s operational zone, following the principles of Tactical Combat Casualty Care (TCCC). Then, general conditions of the injured were determined, which would require evacuation to a safe zone. This allowed us to define the critical capabilities needed for unmanned systems to perform these tasks. The ability of the unmanned system to pick up an injured person who is unconscious and unable to cooperate was identified as crucial. In the further part of the work, existing unmanned systems intended for rescue tasks were collected and critically analysed.

The Role of Nursing in Crises and Disasters

The current study aims what is the meaning of disasters, what is the relationship between national disasters and high rates of disease and mortality? what is the relationship between nursing care during emergencies and disasters? Is there a specialized department concerned with disasters and crises in Saudi Arabia? Are there courses and training plans dealing with disasters and crises in the workplaces? A questionnaire was prepared via Google Drive and distributed to the population aged 25-55 years, men and women in city of mecca. As for the questionnaire, it was distributed via the social networking program (WhatsApp) for the purpose of distancing for fear of the presence of the Corona virus. 380 questionnaires were distributed, 365 responses were obtained via email to the principal researcher. This study concluded that nursing provides many nursing services to the injured during emergencies, crises, and natural disasters, checking for fractures or dislocations in the body or limbs, and if the bones are visible, they must be covered with a clean, sterile bandage, and not move the injured person if the fracture is in the spine. Apply clean, sterile bandages to other wounds. The patient should also be closely monitored and given any possible nursing care with any type of belt and chemical, manual, or mechanical restraints according to the doctor’s orders and instructions, according to the opinions of 94.4% of participants.

Combined treatment of wounded with traumatic aneurysm of posterior communicating artery complicated by intraventricular hemorrhage

Cerebral blood vessel trauma (CBVT) is a serious condition of craniocerebral injury. According to literature data, different varieties of CBVT in penetrating gunshot craniocerebral injuries are found in 30–45 % of cases. Traumatic pseudoaneurysms are the most common finding in late evaluation and can lead to life-threatening episodes of intracranial hemorrhage.In addition, CBVT includestraumatic occlusion, dissection of vessels, rupture of cerebral arteries, formation of arteriovenous fistulas (carotid-cavernous anastomoses), venous stasis, etc. Injured persons with traumatic dissection and injury of vertebrobasilar pool have the highest risks of lethal outcome. There are no largerandomised trials and national recommendations for the treatment of CBVT, individual observations and small series of clinical cases have been published. In this connection, there is a need for a detailed analysis of all clinical cases, the development of tactics for early diagnosis and an algorithm for the treatment of wounded with CBVT.The article presents a review of the literature data that characterizes the current understanding of CBVT, and a clinical case of traumatic occlusion of the middle cerebral artery and pseudoaneurysm of the posterior communicating artery in a wounded man with a gunshot penetrating cranioorbital wound, who was treated at the neurosurgical center of the N.N. Burdenko Main Military Clinical Hospital.In the early period after the injury, the patient underwent endovasal occlusion of a traumatic aneurysm of the posterior connective artery by microspirals followed by local thrombolysis of intraventricular hematomas through a ventricular catheter. The catamnesis was 150 days, the score on the modified Rankin scale was 3, the Glasgow outcome scale extended was 5.

A note on using the workability index (WAI) to predict future earnings capacity losses in moderate to severe partial disability cases

Purpose Disability experts are often called upon to analyze the economic impact of an injury. Determining future economic loss in cases of disabilities is difficult, particularly when the disabilities are considered partial in nature, and the individuals have some capacity to mitigate their future income losses. This paper examines one possible approach for examining reduced future income capacity in cases of partial disabilities, the use of the Work Ability Index (WAI) and Work Ability Scale (WAS). Materials and Methods Empirical data from one-hundred six cases is analyzed using a censored tobit regression to determine the relationship between scores on the WAI/WAS and verified long-term income losses for individuals who suffered disabling events. Results The study found a high correlation between the scores obtained on both the WAI and WAS measures, and future economic loss. The results suggest that these scales may be very useful in analyzing reduced future income capacity in situations involving partial disabilities. Conclusions This study assists the rehabilitation and disability expert to better understand the implications of a moderate to severe disability on the future income capacity of an injured person. It also provides additional support for the validity of the WAI/WAS scales.

The zero responder: a definition and report of current literature.

The term 'zero responder' was initially devised in 2010 to describe those passing by or unharmed in a mass casualty incident, who provide life-saving care for injured persons before qualified professionals arrive. This review aims to determine how the literature defines the role of the zero responder and to explore how they can be better integrated into the emergency response. Current definitions of the zero responder in a medical setting were found through a literature search of several databases and online libraries using defined search terms. Additionally, a manual search of citations in included articles was performed to yield more results. In total, 16 papers defining the zero responder were included. These definitions were evaluated, and a revised definition was suggested to clarify the role in a medical setting relating to mass casualty incidents. The role of the zero responder can be facilitated through authority recognition and adequate equipment provision. Familiarisation with the term and role of zero responders among ambulance services is essential for effective collaboration. Further research and clarity on the integration of these two groups is necessary to facilitate effective and safe working between them.

Some aspects of tactical medicine in service and combat activities of police officers under the conditions of the legal regime of martial state: problem issues in critical situations and combat conditions

The article highlights the problematic issues of tactical training of law enforcement officers in today’s conditions, considers the actual problems and challenges that law enforcement officers may face during the performance of official duties and the provision of first aid in combat conditions and emergency situations. The issue of the interaction of the National Police of Ukraine with other rescue services at the scene for the effective provision of first aid was considered. It is noted that the interaction of the police and other rescue services at the scene of the event in the conditions of martial law requires a special approach and careful planning. It is necessary to ensure a clear coordination of actions, an appropriate level of protection for the personnel of the rescue services, and to take into account the peculiarities of work in the conditions of hostilities. Effective interaction between different services will minimize the consequences of emergency situations and ensure the safety of the population in the conditions of martial law. The article highlights the algorithm of actions for providing assistance to injured persons by police officers under fire, considers the key issues of training law enforcement officers to provide effective first aid in conditions of martial law or extreme situations in general. The authors of the article emphasize the importance of unified training programs for police officers in tactical medicine, which should include both theoretical knowledge and practical skills. Special attention is paid to ensuring a high level of readiness of police officers for quick and effective response to emergency situations and saving lives in the conditions of an aggravated conflict. Service situations in which police officers may find themselves are often accompanied by conflicts and their escalation, up to “fire contact” with the offender. Therefore, for the training of police officers, the section of tactical medicine is the most relevant, which teaches the basic skills of providing self- and mutual aid in combat conditions, which are primarily aimed at eliminating the preventive causes of death, taking into account the threat from combat operations or an active shooter. Unfortunately, there are infamous cases of the death of police officers while performing law enforcement tasks, which indicates the need for mandatory integration of first aid standards into their training and operations in various tactical situations. In addition, it is important to note that training police officers in tactical medicine will not only help them provide effective care to victims, but will also increase their level of safety while performing their duties. Therefore, unified training programs for police officers in tactical medicine should be an integral part of the training of law enforcement officers.

Trauma-associated vascular injuries and the vascular surgical/interventional options for vascular reconstruction

The aim of this work is to illustrate the diversity of vascular injuries in terms of vascular segments or body regions, accident mechanisms and specific patient constellations. A representative case collection was compiled based on current and relevant scientific references in PubMed, own clinical experiences, vascular surgical and novel image-guided interventional options. The diagnostics of vascular injuries in the context of trauma and fractures are based on a thorough physical examination. In addition, the hard and soft signs preferred by the Western Trauma Association should be included in the decision. Doppler ultrasonography examination is the safest and gentlest noninvasive examination procedure for a suspected vascular injury due to repeatable and comparative measurements. The stabilization of a fracture, ideally using an external fixator, should be performed before vascular reconstruction whenever possible, unless massive bleeding, hypovolemic shock or a rapidly spreading hematoma represent an immediate indication for surgery. In pediatric supracondylar fractures, avascular injury without relevant ischemia has frequently been described (pink pulseless hand). In this case, the fracture should first be reduced as the pulse often recovers. Due to the increasing availability, good technical handling and high technical success rate as well as the relatively limited interventional trauma, endovascular treatment of traumatic vascular injuries has become widely accepted. Traumatic aortic ruptures are associated with a high mortality even at the accident site. Rapid endovascular treatment using a stent prosthesis significantly increases the injured person's chances of survival. Vascular injuries in connection with fractures or multiple injuries require interdisciplinary cooperation between the specialties involved.

Revisiting Older Drivers' Risks of At-fault Motor Vehicle Collisions in Japan.

In Japan, older drivers have been encouraged to surrender their driving licenses for traffic safety, despite the potential adverse social and health outcomes of driving cessation. We reconsidered such policies and social pressure by comparing the risk of at-fault motor vehicle collisions (MVCs) across the age groups of drivers. Using the national data of police-reported MVCs that occurred between 2016 and 2020, we examined the number of at-fault MVCs per licensed driver (MVC rate) and the number of fatally and non-fatally injured persons per at-fault MVC by the sex and age groups of at-fault drivers. The MVC rate of older drivers was higher than that of middle-aged drivers but lower than that of young drivers. The number of injured persons among the collided counterparts (collided car occupants, motorcyclists, bicyclists, and pedestrians) per MVC caused by older drivers was not greater than that by drivers in other age groups. In fatal MVCs caused by older drivers, drivers themselves or their passengers tend to be killed rather than their collided counterparts. Overall, the results were mostly consistent between male and female drivers. The risk of at-fault MVCs increased with the advancing age of drivers after middle age; however, this risk among older drivers did not exceed that among young drivers, without posing a high risk of injuries to their collided counterparts.

Traumatic tracheal rupture in closed chest trauma (a clinical case)

The purpose was to present a clinical case of a soldier with a rupture of the cervical and thoracic parts of the trachea due to closed chest trauma. Early and complete diagnosis of chest injuries, which includes mandatory X-ray and fibrobronchoscopy, can save the life of an injured person, helps choose the optimal method of treatment and improve its outcomes. When choosing the therapeutic approach in patients with traumatic tracheal injuries, it is extremely important to take into account the mechanism of injury, the nature of tracheal damage, the presence and severity of post-traumatic complications, the general condition of the patient, and capacities of a healthcare institution. Given the frequent occurrence in the acute period of life-threatening complications due to traumatic tracheal injury, the formation of gross scarring with the development of tracheal stenosis is possible in the long term, preference is given to active surgical correction of traumatic changes in the tracheal wall. Traumatic injury to the tracheobronchial tree should be suspected in all injured patients with subcutaneous emphysema, hemoptysis, and dyspnea. Adequate examination and treatment of patients with traumatic tracheal rupture requires highly specialized medical care that is based on knowledge, experience, and skills for managing such trauma. X-ray and fibrobronchoscopy must be included in the examination algorithm of such patients. When choosing the treatment approach in patients with traumatic tracheal injuries, it is extremely important to take into account the mechanism of injury, the general condition of the patient, the presence of post-traumatic complications, and capacities of a healthcare institution. Conservative treatment for traumatic tracheal rupture with timely use of minimal surgical interventions can be successful in complete ruptures of the membranous wall of the medium length without development of life-threatening complications.

Emergency services response to eCall System alerts: Observations from 2016–2022 in the National Fire and Rescue System

Objective Analysis of interventions by fire protection units in road traffic incidents alerted by the eCall system between 2016 and 2022. Materials and Methods Data from the State Fire Service Decision Support System (SFS DSS), provided by the Operational Planning Office, were used. Events from January 1, 2016, 00:00 to December 31, 2022, 23:59 were analyzed. Quantitative data were described using mean (Mean) and standard deviation (SD). Correlations and differences at a significance level of p < 0.05 were considered statistically significant. The analysis is anonymous for both victims and officers involved in the interventions. Results Between 2016 and 2022, firefighters were alerted by the e-call system 896 times. The shortest average intervention time was 47 ± 37 min and was recorded in 2021. In the comparative analysis of intervention time and factors conditioning the use of the eCall system, it was shown that this time was significantly statistically dependent on the number of cars involved in the incident (p < 0.001), the number of injured persons (p < 0.001), the type of intervention (p < 0.001),), and the occurrence of fuel leakage (p < 0.001). Conclusions ECall is a relevant system for reporting accidents and collisions on the road. While it proves reliable in road incidents, a significantly high number of false alarms initiated from eCall requires system refinement to avoid accidental alarms and user education about the possibility of unintentionally sending an alarm signal. The authors predict that as the number of vehicles with the eCall system introduced to the roads increases, so will the number of notifications from this system. Data from the analysis of false reports suggest that mechanics and electricians in facilities performing repairs and maintenance of vehicles with the eCall system may lack the necessary knowledge of the need to deactivate the system before starting work. The number of injured people had no impact on the intervention time, which may prove that the rescue services were properly prepared.

Applicability of an Ionising Radiation Measuring System for Real-Time Effective-Dose-Optimised Route Finding Solution during Nuclear Accidents

The reduction in the effective dose of evacuated injured persons through contaminated areas of nuclear accidents is an essential emergency services requirement. In this context, there appeared a need to develop a dose-optimised route finding method for firefighting rescue vehicles, which includes the development of a real-time decision support measurement and evaluation system. This determines and visualises the radiation exposure of possible routes in a tested area. The system inside and outside of the vehicle measures the ambient dose equivalent rate, the gamma spectra, and also the airborne radioactive aerosol and iodine levels. The method uses gamma radiation measuring NaI(Tl) scintillation detectors mounted on the outside of the vehicle, to determine the dose rate inside the vehicle using the previously recorded attenuation conversation function, while continuously collecting the air through a filter and using an alpha, beta, and gamma radiation measuring NaI(Tl)+ PVT + ZnS(Ag) scintillator to determine the activity concentration in the air, using these measured values to determine the effective dose for all routes and all kinds of vehicles. The energy-dependent shielding effect of the vehicle, the filtering efficiency of the collective protection equipment, and the vehicle’s speed and travel time were taken into account. The results were validated by using gamma point sources with different activity and energy levels. The measurement results under real conditions and available real accident data used in our simulations for three different vehicles and pedestrians proved the applicability of the system. During a nuclear accident based on our model calculations, the inhalation of radioactive aerosols causes a dose almost an order of magnitude higher than the external gamma radiation caused by the fallout contamination. The selection of the appropriate vehicle and its route is determined by the spectrum that can be measured at the accident site but especially by the radioactive aerosol concentration in the air that can be measured in the area. In the case of radiation measuring detectors, the shielding effect of the carrier vehicle must be taken into account, especially in the case of heavy shielding vehicles. The method provides an excellent opportunity to reduce the damage to the health of accident victims and first responders during rescue operations.

Гибель и травмирование людей при пожарах на предприятиях промышленности с учетом их категории риска

The regulatory &amp; legal and scientific &amp; methodological aspects of developing risk-oriented approaches in the Russian Federation have been considered. The procedure and criteria for classifying protected facilities as a certain risk category in the field of fire safety are determined by the resolutions of the Government of the Russian Federation of October 12, 2020, № 1662, and September 14, 2023, № 1502. In the framework of the study, research to evaluate the efficiency of risk-oriented approaches in the industry has been conducted. For the period 2020–2022, the highest number of fires (33 %) in the Russian Federation occurred at the facilities not subject to classification. 25 % of fires occurred at facilities classified as low-risk, whereas only 2 % of fires occurred at high and extremely high-risk facilities. In order to evaluate the efficiency of rescue operations by firefighting divisions, the index «proportion of enterprise employees rescued during fires as compared with the total numbers of fatalities and rescued persons» has been applied. Based on the analysis, it has been concluded that the personnel of industrial facilities classified as low risk or not subject to classification have the least chance to escape the area exposed to fire hazards, 54 % and 57 %, respectively. The index of «proportion of injured persons during fires as compared with the total numbers of injured persons and fatalities» enables us to conclude that persons within the area exposed to fire hazardous factors survive but can be injured, which is damage to health. Persons within the area exposed to fire hazardous factors at low-risk facilities have the least chance of surviving. i.e., 46 %, whereas for the high-risk facilities, this index is 90 %. The probability of exposure to fire hazardous factors is to be evaluated by the relation of number of victims to the total number of exposed to the risk hazardous factors (evacuated, rescued persons, and fatalities). The highest probability of a fatality during a fire has been obtained for the personnel of low-risk category facilities: 85 fatalities per 1000 employees, whereas for high-risk faculties, the probability of fatalities is an order of magnitude less. The analysis of the results of social consequences of fire at industrial facilities indicates a need to enhance the role of occupational safety services at enterprises to implement measures of fire prevention, especially at low-risk industrial enterprises where the state fire supervision agencies take no scheduled control (supervision) measures.

Peculiarities of the Formation of Basic Knowledge on the Emergency Pre-medical Assistance Providing by Persons without Special Medical Education

Starting from February 2022, with the beginning of the russian federation’s unprovoked aggression against Ukraine, the time requirements for the direction of the trainings and the contingent for which they are intended have changed significantly. In addition, the issue of rapid spread of knowledge and skills in providing first aid to the injured persons has become very acute. The active help of the international community of higher medical education institutions contributed to the quick and effective training of our teachers as trainers for Basic Life Support (BLS), Stop Bleeding and PHTF courses. The use of innovative digital technologies, modeling of clinical situations, in particular, with the help of distance learning tools, the possibilities of modern simulation technologies and simulators allowed applicants to acquire the necessary theoretical knowledge and master practical skills quickly and at the best level. The objective: to perform a comparative assessment of the quality of conducting simulation trainings on providing pre-medical care to persons without basic medical education using various teaching techniques. Materials and methods. The trainings were conducted in two formats - traditional offline study with the participation of an instructor and using the HybridLab method (introduced by the Lithuanian University of Medical Sciences, Kaunas, Republic of Lithuania) for 112 schoolchildren and 27 teachers. 58 students and 14 teachers were trained according to the usual method in groups of 5-6 persons, according to the HybridLab method – 54 schoolchildren and 13 teachers in groups of 3-4 individuals. The duration of the trainings was 42 hours. Efficiency was evaluated according to two criteria: the average score of the final test and the indicator of acquiring new knowledge. Results. A unique combination of methods of organizing the educational process, such as HybridLab, trainings on pre-medical care, which were developed on the basis of the trainings “First on the scene”, “Stop the bleeding” and BLS, and modern tools that allow to evaluate the effectiveness of training, contributed to the achievement a high level of mastery of all the necessary skills by as many people as possible in the shortest time, which is the leading goal of today. Conclusions. We consider the experience of implementing these knowledge/skills and training methods, as well as the further evaluation of their effectiveness, to be the second task of all medical education institutions and training centers operating in Ukraine, after teaching training on tactical medical training of combatants and emergency tactical medical assistance for medical specialists.

The Documentation of Injuries Caused by Traffic Accidents.

Persons injured in traffic accidents may have injuries of characteristic types that are of significance for the complex reconstruction of the accident and whose medicolegally sound clinical documentation is highly important. This is of particular relevance for the approximately 55 000 persons who are severely injured in traffic accidents in Germany each year. Gaps in documentation are often disadvantageous for the injured persons. This review is based on pertinent publications retrieved by a selective literature review, with additional consideration of relevant textbooks in traffic medicine and legal medicine, as well as the guidelines of the AWMF (Association of the Scientific Medical Societies in Germany). Injuries in traffic accidents typically differ depending on the mode of participation of the injured person in traffic. They must be examined with a view toward the sequence of events of the accident and documented in medicolegally sound fashion. In particular, because of the different mechanical forces involved, it is important to document the seat that the injured person occupied in the automobile, the nature of the collision (pedestrian vs. automobile; bicycle, e-bike, e-scooter, and motorcycle accidents), and the protective devices that were in use. The precise documentation of injuries and examination findings, with critical consideration of their plausibility in relation to the sequence of events of the accident as far as it is known, is an important duty of the physician. This documentation serves as the basis for further judicial steps leading to compensation when legally appropriate.

Factors for the occurrence of road traffic injuries and better care of injured persons

Factors for the occurrence of road traffic injuries and better care of injured persons

Evaluating the Effectiveness of a First Aid Training Programme for Individuals Without a Background in Medical Education.

People without a medical education background who have the skills and knowledge to provide emergency care can be useful in emergencies, disasters, earthquakes, and pandemics to save or support the life of an injured person until hospitalization or the arrival of an emergency medical team. The purpose of the study is to assess the knowledge and skills of first aid in individuals without a medical education background within a year after training. The study sample included 643 people without a medical education background. The study participants attended basic first aid training, the sessions that lasted for 18 hours. Participants answered a 10-question skills test before and after completing the course, as well as 6 months and 1 year after training. SPSS version 20.0 (IBM Ireland Product Distribution Limited, Ireland) was used for the statistical assessment of data, employing Cochran's Q test. Pairwise comparisons were made between different periods using the Wilcoxon test with Bonferroni correction. The mean age of the participants was 36 for males, and 42 for females. In the sample, males accounted for 70% (n = 441) and females for 30% (n = 202). The first aid training provided to persons without a medical education background significantly increased their level of knowledge. After 6 and 12 months, their knowledge and abilities remained significantly higher than before the training. However, these results were lower than they had been immediately after training. The study demonstrated that first aid training significantly increased the knowledge level of non-medical individuals immediately after training and remained elevated after 6 and 12 months. However, there was a decline in the level of knowledge and skills over time, indicating the need for refresher training.

Особливості підготовки менеджерів в період дії воєнного стану

Today's main task is to preserve the life and health of everyone who resides, lives, works and studies in Ukraine. In the conditions of the war, the Ukrainian education system underwent many different transformations, as the situation in the country constantly required its adaptation to the extraordinary circumstances and needs of society. The purpose of the article is to reveal the peculiarities of the training of managers during the period of martial law. The transformational processes in the field of professional education in martial law conditions were characterized. The accumulated experience of distance education, which was obtained during the pandemic and can be useful in military operations period, was evaluated. It was found that the experience of using distance education provides valuable lessons regarding the organization of effective training of higher education students in conditions of limited opportunities. This experience can be an important reserve for a reliable and effective education system in difficult circumstances such as wartime. Inclusive education is of particular importance in the conditions of martial law and the post-war period. Inclusive education for injured persons provides an opportunity for quality education and contributes to their full social inclusion and sense of self-worth. Such an education emphasizes the capabilities of each person, not limitations. Based on the research results, the professional competencies of managers were proposed, which are based on the principles that allow the professional qualities of future managers to be formed, taking into account the challenges of wartime. The training of future managers must consider the complex and tragic challenges of today, and this involves quick adaptation to changes, profound social responsibility, a global view of international challenges, resource efficiency and rationality when making decisions, and effective crisis management skills. These traits will help future leaders at all levels to be competent and effective in solving our society's most complex challenges.

Identifying and prioritising barriers to injury care in Northern Malawi, results of a multifacility multidisciplinary health facility staff survey.

The burden of injuries globally and in Malawi is substantial. Optimising both access to, and quality of, care in health systems requires attention. We aimed to establish how health facility staff in Karonga, Malawi, perceive barriers to seeking (delay 1), reaching (delay 2) and receiving (delay 3) injury care. We conducted a cross-sectional survey of health facility staff who treat patients with injuries in all health facilities serving the Karonga Demographic Surveillance Site population. The primary outcome was participant perceptions of the importance of delays 1 to 3 following injury. Secondary outcomes were the barriers within each of these delays considered most important and which were considered the most important across all delays stages. 228 staff completed the survey: 36.8% (84/228) were female and 61.4% (140/228) reported being involved in caring for an injured person at least weekly. Delay 3 was most frequently considered the most important delay 35.1% (80/228), with 19.3% (44/228) and 16.6% (38/228) reporting delays 1 and 2 as the most important respectively; 28.9% (66/228) of respondents either did not know or answer. For delay 1 the barrier, "the perceived financial costs associated with seeking care are too great", was considered most important. For delay 2, the barrier "lack of timely affordable emergency transport (formal or informal)" was considered most important. For delay 3, the barrier, "lack of reliably available necessary physical resources (infrastructure, equipment and consumable material)" was considered most important. When considering the most important overall barrier across all delays, the delay 3 barrier, "lack of reliably available necessary physical resources" received the most nominations (41.7% [95/228]). Given the awareness of health facility staff of the issues facing their patients, these findings should assist in informing health system planning.