Trauma Scene Research Articles

Empowering paramedics to save teeth: a comprehensive assessment of their knowledge and skills in managing dental traumas

Aims: Dental traumas are prevalent injury types worldwide, and the time of the first intervention is crucial for a favorable prognosis. Paramedics are often the first to arrive at the scene of dental trauma. The significance of paramedics’ knowledge of dental trauma cannot be overstated, yet studies on this subject are limited. This study aims to assess the level of dental trauma knowledge among paramedics. Methods: A Google Forms link measuring dental trauma knowledge level consisting of 17 questions was sent to 1576 participants via WhatsApp. The forms were fully and consistently completed by 300 participants (19.3%). The data collected through Google Forms were imported into Microsoft Excel for statistical analysis. Statistical Analysis: The Mann-Whitney U test was used to determine whether there was a difference between the categories. The Kruskal-Wallis H test was used to determine whether there was a difference between the categories of the qualitative variable and more than two categories in the quantitative variable since average distribution as sumptions were not met. The statistical significance level was taken as 0.05. Results: There are 300 paramedics, with 159 males and 141 females. 87% of the participants did not receive any training regarding dental trauma. According to 85.3% of paramedics, dental traumas are considered an emergency situation. The most important type of dental trauma is avulsion. Only 21.7% of paramedics knew reimplantation was possible, while 78.4% believed that a dentist should do it. Research shows that 38.4% of paramedics prefer using a sterile sponge when storing avulsed teeth, while 10.7% prefer milk. 82.7% of the paramedics reported lacking the knowledge to handle dental traumas, and 84% expressed interest in receiving training. Conclusion: The research revealed that paramedics have insufficient knowledge regarding dental trauma. Most participants stated their preference not to intervene in cases of dental trauma. They believed that a dentist or emergency physician should handle it.

The Relationship Between Pre-hospital High Blood Pressure and Mortality Risk in Trauma Patients

<strong data-sider-select-id="c592b0bd-4e99-45cf-92c2-2b0907fcc491">Objectives: To identify and manage the factors that reduce the duration of time patients spend in the hospital or are associated with mortality rates are important. Therefore, this study was conducted to investigate the relationship between high blood pressure before admission to the hospital and mortality rates in trauma patients. <strong data-sider-select-id="dbbdc2e2-5a9a-4112-a19f-5447ee9a5abe">Design: A cross sectional descriptive study this is a cross sectional descriptive study which was done in emergency department of Imam Reza hospital Setting(s): Emergency department of Imam Reza hospital, Tabriz, Iran. Participants: All the trauma patients admitted to the emergency department of Imam Reza Hospital in Tabriz by emergency medical services over 12 months were included in this study using the complete enumeration method. Outcome Measures: Vital signs, including blood pressure, were recorded in vital sign sheets and forms designed by researchers. Other outcomes such as admission, discharge from the hospital, and death were also recorded Results: From a total of 331 trauma patients, 251 (75.8 %) were men, and the rest were women; moreover, the average age of women and men was 46.8±17.7 and 41.4±16.0, respectively. In addition, 41.3% of women and 18.3% of men (23.9% of all the patients) had a history of hypertension. Furthermore, gender and high blood pressure in the scene of trauma did not exhibit any relationship with patients’ outcomes (P>0.05), while age had a significant relationship with the death of the patients (P=0.002). <strong data-sider-select-id="b148f088-c44d-40fc-bff2-8f9fd3d9fa99">Conclusions: A positive correlation between the probability of death and age in trauma patients was found, while high blood pressure in the scene did not seem to affect the mortality rates in trauma patients in the ED or the ward.

The translation of childhood trauma—Taking the English and Chinese translation of Michikusa as an example

Michikusa (1915) is an autobiographical novel penned by the renowned Japanese writer, Natsume Sōseki. Researchers typically employ it to probe the intricate interplay between the author/protagonist's evolution and the historical milieu of Meiji-era Japan. Scholars such as Chiaki Ishihara have advocated for a new avenue of inquiry, advocating the application of psychoanalytic perspectives in exploring Natsume Sōseki's corpus. Surprisingly, this direction remains relatively uncharted, with the scholarly realm notably lacking discussions on its Chinese and English translations through the lens of literary criticism. This article undertakes an in-depth investigation into the translation of Michikusa's portrayal of childhood trauma into English and Chinese, facilitated by the construction of a comprehensive trilingual corpus. Employing a psychoanalytic framework for interpretation, it discerns that the childhood scenes play a foundational role in shaping the protagonist's post-traumatic personality facets, significantly influencing his relationships with his immediate and extended family. The findings underscore a critical gap: despite the pivotal nature of childhood trauma scenes, the conflict, sorrow, and torment within the source texts are often inadequately conveyed. Translations frequently involve undue omissions, adaptations, or distortions, thereby potentially obstructing the target audience's accurate comprehension and interpretation. Furthermore, this study establishes that a nuanced understanding of trauma and post-traumatic stress disorder (PTSD) studies equips translators to convey trauma with greater fidelity. This contribution to literary criticism holds promise for enhancing existing translations, providing a nuanced perspective on the significance of accurately representing trauma in literary works.

Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challenges

BackgroundThe application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma resuscitation, including for profound shock and cardiac arrest, has gained prominence. This study aimed to determine the...

Navigating Peril: Unraveling the Consequences of violation of Lane by bike riders on Traumatic Brain Injury Outcomes in a Developing Country's Neurosurgical department

Objective: To infer the impact of violation of lane by the bike riders on the severity of injury and clinical outcome. Materials & Methods: prospective observational study conducted from 1st January 2023 to 30th June 2023.50 patients who met inclusion criteria were studied for impact of violation of lane on the severity of injury and clinical outcome. Data was analyzed for gender distribution, valid driving license, helmet wearing, trauma scene violation of lane, duration of stay in ward, severity of injury, mode of injury and outcome was assessed by Glasgow outcome scale extended after 1 month. Results: In our study 49(98%) patients were male and 1(2%) female. 37 (74%) patients had documented evidence by 1122 regarding lane violation group while 13(26%) patients of lane non violation group. 14(28%) patients had STBI, and 18(36%) patients were categorized in moderate and mild traumatic brain injury each. Neuro monitoring was done in 14(28%) patients. Operative intervention was done in 31(62%) patients and 9(64%) patients were those who had STBI.11(78%) out of 14 patients with severe injury were from lane violation group. Patients of lane violation group were having higher disability i.e. 12 (32.4%). Conclusion: Violation of lane is an aberrant driving behavior. It has emerged as a common cause of bike related road traffic accidents leading to mortality. A prevailing disregard for traffic norms adds fuel to this perilous fire, paving the way for grave outcome. Key words: Severe Traumatic brain injury (STBI), Road traffic accident (RTA), Violation of lane, Bike rider, Intracranial pressure (ICP), Glasgow outcome scale extended.

Kaolin loaded gelatin sponges for rapid and effective hemostasis and accelerated wound healing

Severe trauma with massive active blood loss, including liver and spleen rupture, arterial bleeding and pelvic fracture, will lead disability, malformation and even death. Therefore, it is very important to develop new, fast and efficient hemostatic materials. In this study, a novel Gelatin/Kaolin (GE/KA) composite sponge was developed. Meanwhile, to further investigate the effect of kaolin content on sponge properties, we prepared four types of sponges: GE/5% KA, GE/10% KA, GE/15% KA and GE/20% KA. The results of coagulation test in vitro showed that compared to the other groups, there were more activated adhered platelets and red blood cells on the surface of GE/15% KA. The results of hemostasis test in vivo showed that compared to other experimental groups, the GE/15% KA group had significantly less hemostasis time (liver hemostasis model: 69.50 ± 2.81 s; femoral artery hemostasis model: 75.17 ± 3.06 s) and bleeding volume (liver hemostasis model: 219.02 ± 10.39 mg; femoral artery hemostasis model: 948.00 ± 50.69 mg), and was similar to the commercial hemostasis material group. Additionally, the material properties of the sponge were characterized and its biocompatibility was verified as well through cell experiments and in vivo embedding experiments. All these results indicate that the optimal content of kaolin is 15%, which provides a theoretical basis for subsequent research. All in all, the novel GE/KA composite sponge prepared in this study can be used as a multifunctional hemostatic wound dressing for the treatment of complex wounds under various trauma scenes.

Severity-Driven Trends in Mortality in a Large Regionalized Critical Care Transport Service

ObjectiveThe epidemiology accompanying helicopter emergency medical services (HEMS) transport has evolved as agencies have matured and become integrated into regionalized health systems, as evidenced primarily by nationwide systems in Europe. System-level congruence between Europe and the United States, where HEMS is geographically fragmentary, is unclear. In this study, we provide a temporal, epidemiologic characterization of the largest standardized private, nonprofit HEMS system in the United States, STAT MedEvac. MethodsWe obtained comprehensive timing, procedure, and vital signs data from STAT MedEvac prehospital electronic patient care records for all adult patients transported to UPMC Health System hospitals in the period of January 2012 through October 2021. We linked these data with hospital electronic health records available through June 2018 to establish length of stay and vital status at discharge. ResultsWe studied 90,960 transports and matched 62.8% (n = 57,128) to the electronic health record. The average patient age was 58.6 years ( 19 years), and most were male (57.9%). The majority of cases were interfacility transports (77.6%), and the most common general medical category was nontrauma (72.7%). Sixty-one percent of all patients received a prehospital intervention. Overall, hospital mortality was 15%, and the average hospital length of stay (LOS) was 8.8 days ( 10.0 days). Observed trends over time included increases in nontrauma transports, level of severity, and in-hospital mortality. In multivariable models, case severity and medical category correlated with the outcomes of mortality and LOS. ConclusionIn the largest standardized nonprofit HEMS system in the United States, patient mortality and hospital LOS increased over time, whereas the proportion of trauma patients and scene runs decreased.

Reverse Shock Index multiplied by Glasgow Coma Scale score as a point-of-care severity assessment for initial trauma management: a nationwide cohort study

BackgroundSevere trauma patients often require emergent interventions, such as massive transfusion, resuscitative procedures, and surgical procedures, and consume considerable human and medical resources. However, few practical indices can be easily used for emergent interventions. In recent years, it has become clear that rSIG (Reverse Shock Index multiplied by Glasgow Coma Scale [GCS] score), which can be easily calculated from vital signs, is a promising predictor of mortality. However, it is unclear whether rSIG is useful for emergent interventions. MethodsData collected by the Japan Trauma Data Bank for adult patients admitted directly from the scene of trauma between April 2019 and December 2020 were analysed. The outcomes were massive transfusion, resuscitative procedures, surgical procedures and emergent interventions. Emergent interventions were defined as the composite outcome of massive transfusion, resuscitative procedures, and surgical procedures. The ability of rSIG to predict massive transfusion was compared with that of the ABC score and FASILA score by receiver-operating characteristic curve analysis. The ability of rSIG to predict resuscitative and surgical procedures was compared with that of the Shock Index (SI), GCS, Triage Revised Trauma score (T-RTS), and Previous Simple Prediction (PSP) score. The ability of rSIG to predict emergent interventions was compared with that of T-RTS, PSP, ABC, and FASILA. In addition to rSIG, rSIM (Reverse Shock Index multiplied by best motor response score) was also analysed as a supplement. ResultsThe study included 32,201 patients, 6,371 of whom required emergent interventions. The area under the receiver-operating characteristic curve (AUROC) for massive transfusion was highest for rSIG (0.846 [95% confidence interval 0.832–0.859]) and significantly higher for rSIG than for rSIM, ABC and FASILA (all p<0.0001). AUROCs for resuscitative and surgical procedures were highest for rSIG (0.777 [0.769–0.785] and 0.731 [0.720–0.741], respectively) and significantly higher than those for rSIM, SI, GCS, T-RTS, and PSP (all p<0.0001). The AUROC for emergent interventions was highest for rSIG (0.760 [0.753–0.768]) and significantly higher for rSIG than for rSIM, T-RTS, PSP, ABC, or FASILA (all p<0.0001). ConclusionsrSIG is a simple and effective point-of-care predictor of emergent interventions during initial management of trauma.

"Big, Black, and Dangerous": Primal Scene Of Racial Trauma?

Based on a presentation given at the thirtieth anniversary conference of the International Association for Forensic Psychotherapy in London, May 2022, this article identifies the transgenerational racial archetype "Big, Black, and Dangerous". It is suggested that this unconscious construct is most accurately regarded as a dangerous state of mind, contributing to the disproportionate rates of adultification, criminalisation, and deaths of vulnerable and distressed Black people by law enforcement agents in the UK, the US, and beyond. Well known to Black people, but not typically mentalized outside of the Black community, I argue that "Big, Black, and Dangerous" non-thinking functions as a primal scene of racial trauma. In the absence of a shared mentalization around this, high profile examples from the media are reviewed in order to elucidate and support this idea. Ideas about how forensic psychotherapy might potentially help address this stubborn dimension of racial trauma are suggested.

Commentary on Anne Aiyegbusi's "'Big, Black, and Dangerous': primal scene of racial trauma?"

Commentary on Anne Aiyegbusi's "'Big, Black, and Dangerous': primal scene of racial trauma?"

Blunt Thoracic Aortic Injury.

Blunt thoracic aortic injury (BTAI) is a potentially fatal condition that needs prompt recognition and expedited management. Clinical manifestations of BTAI are not straight forwarding and may be misdiagnosed. The grade of aortic injury is an important determinant of perioperative mortality and morbidity, as well as the indication of treatment, along with the presence of concomitant lesions of other involved organs. The mainstay of treatment nowadays for hemodynamically stable patients who survive the trauma scene is represented by delayed endovascular repair whenever anatomically and clinically feasible. Endovascular repair, in fact, is burdened by lower perioperative mortality and morbidity rates if compared to open surgical repair, but concerns remain about the need for long-term surveillance and radiation exposure in patients who are at a younger age than patients treated for the aneurysmal disease. The aim of the paper is to provide an update on the diagnostic modalities and strategies of treatment for patients affected by BTAI.

Prehospital Electroencephalography to Detect Traumatic Brain Injury during Helicopter Transport: A Pilot Observational Cohort Study

Objective Early recognition of traumatic brain injury (TBI) is important to facilitate time-sensitive care. Electroencephalography (EEG) can identify TBI, but feasibility of EEG has not been evaluated in prehospital settings. We tested the feasibility of obtaining single-channel EEG during air medical transport after trauma. We measured association between quantitative EEG features, early blood biomarkers, and abnormalities on head computerized tomography (CT). Methods We performed a pilot prospective, observational study enrolling consecutive patients transported by critical care air ambulance from the scene of trauma to a Level I trauma center. During transport, prehospital clinicians placed a sensor on the patient’s forehead to record EEG. We reviewed EEG waveforms and selected 90 seconds of recording for quantitative analysis. EEG data processing included fast Fourier transform to summarize component frequency power in the delta (0-4 Hz), theta (4-8 Hz), and alpha (8-13 Hz) ranges. We collected blood samples on day 1 and day 3 post-injury and measured plasma levels of two brain injury biomarkers (ubiquitin C-terminal hydrolase L1 [UCH-L1] and glial fibrillary acidic protein [GFAP]). We compared predictors between individuals with and without CT-positive TBI findings. Results Forty subjects were enrolled, with EEG recordings successfully obtained in 34 (85%). Reasons for failure included uncharged battery (n = 5) and user error (n = 1). Data were lost in three cases. Of 31 subjects with data, interpretable EEG signal was recorded in 26 (84%). Mean age was 48 (SD 16) years, 79% were male, and 50% suffered motor vehicle crashes. Eight subjects (24%) had CT-positive TBI. Subjects with and without CT-positive TBI had similar median delta power, alpha power, and theta power. UCH-L1 and GFAP plasma levels did not differ across groups. Delta power inversely correlated with UCH-L1 day 1 plasma concentration (r = -0.60, p = 0.03). Conclusions Prehospital EEG acquisition is feasible during air transport after trauma.

Prehospital and emergency management of pediatric traumatic brain injury: a multicenter site survey.

There is a paucity of information on pediatric traumatic brain injury (TBI) care in Asia and Latin America. In this study, the authors aimed to describe the clinical practices of emergency departments (EDs) participating in the Saline in Asia and Latin-America Neurotrauma in the Young (SALTY) study, by comparing designated trauma centers (DTCs) and nontrauma centers (NTCs) in their networks. The authors performed a site survey study on pediatric TBI management in the EDs in 14 countries. Two European centers joined other participating sites in Asia and Latin America. Questions were formulated after a critical review of current TBI guidelines and published surveys. The authors performed a descriptive analysis and stratified centers based on DTC status. Of 24 responding centers (70.6%), 50.0% were DTCs, 70.8% had academic affiliations, and all centers were in urban settings. Patients were predominantly transferred to DTCs by centralized prehospital services compared to those sent to NTCs (83.3% vs 41.7%, p = 0.035). More NTCs received a majority of their patients directly from the trauma scene compared to DTCs (66.7% vs 25.0%, p = 0.041). Ten centers (41.7%) reported the use of a TBI management guideline, and 15 (62.5%) implemented CT protocols. Ten DTCs reported implementation of intervention strategies for suspected raised intracranial pressure (ICP) before conducting a CT scan, and 6 NTCs also followed this practice (83.3% vs 50.0%, p = 0.083). ED management for children with TBI was comparable between DTCs and NTCs in the following aspects: neuroimaging, airway management, ICP monitoring, fluid resuscitation, anticoagulant therapy, and serum glucose control. Hyperventilation therapy for raised ICP was used by 33.3% of sites. This study evaluated pediatric TBI management and infrastructure among 24 centers. Limited differences in prehospital care and ED management for pediatric patients with TBI were observed between DTCs and NTCs. Both DTCs and NTCs showed variation in the implementation of current TBI management guidelines. There is an urgent need to investigate specific barriers to guideline implementation in these regions.

Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan.

In the current era of the coronavirus disease 2019 (COVID-19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID-19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID-19 case surges on EMS transport for patients with trauma during the COVID-19 states of emergency in Kobe, Japan. EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77-2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life-threatening group did not change. The number of request calls increased during the states of emergency. Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life-threatening group.

Helicopter Versus Ground Transport for Trauma Victims: A Scoping Review

<h3>Objectives</h3> Efforts to identify which patients benefit most from Helicopter Emergency Services (HEMS) activation can help guide clinical decisions around employing this costly and often risky resource. This scoping review seeks to identify trends in survival outcomes data comparing helicopter and ground emergency services (GEMS) transports directly from trauma scenes to definitive care, critically assess the quality of existing data, and generate questions for further directed study. <h3>Methods</h3> Pubmed was the primary database used for this review. Database search was conducted by a matrix approach utilizing MeSH search terms as well as general keyword search criteria. Included studies were published in 2010 or later and directly compared survival in HEMS and GEMS trauma transports from scene. Studies were evaluated by 3 independent reviewers to ensure inclusion criteria were met. <h3>Results</h3> Forty-one retrospective cohort studies were included for review. HEMS and GEMS survival outcomes were compared overall or based on patient physiologic criteria, injury type, injury severity, and patient age. HEMS activation was associated with improved survival overall in both nation-wide and single-institution studies. When comparing HEMS and GEMS survival based on type of injury, results were mixed with the exception of traumatic brain injury which benefited from HEMS activation across several studies. When patient characteristics were compared, those with unstable vital signs at the trauma scene appeared to benefit from HEMS activation. Patient age (pediatrics patients or those >55 years) was not consistently associated with mortality benefit. <h3>Conclusions</h3> After controlling for injury severity and patient characteristics, HEMS is associated with improved survival in patients transported from trauma scenes. Several studies reported that patients with unstable vital signs on scene and those with traumatic brain injuries benefit most from HEMS activation. The quality of the existing evidence is poor, in large part due to methodological limitations and confounding variables that cannot be controlled for on a trauma scene. Further study is needed to elucidate specific factors that lead to the possible survival benefit of HEMS.

Canceled Air Ambulance Trauma Scene Calls: A Prospective Observational Study of Causes and Outcomes of Trauma Auto-launch Cancellations

ObjectiveDirect transport, occasionally by helicopter, to a trauma hospital for severely injured patients is associated with decreased mortality. This study sought to determine causes for air ambulance trauma response cancellations and secondarily to identify patients who underwent secondary transfer to a trauma center after a canceled air ambulance dispatch. MethodsThis prospective cohort study used administrative databases from August 2020 to August 2021 to collect data related to canceled trauma calls. Frequencies of cancellation reasons and transferred patients were summarized, and the estimated delay to trauma center arrival was calculated. Subsequent probabilistic matching was performed to identify patients who underwent secondary transfer. ResultsOf 3,232 trauma calls, 1,924 were canceled for reasons including the trauma bypass criteria not being met, patient brought to trauma center, and patient refused transfer. Of the 1,117 patients for whom an air ambulance was canceled because they did not meet the trauma bypass criteria, 184 (16.5%) were later transferred to a lead trauma hospital, with a median delay of 4.12 hours (interquartile range = 2.57-7.35 hours). ConclusionsMost scene call cancellations were due to patients not meeting the trauma bypass criteria; yet, 16.5% of these patients were later transported to a trauma center. Interventions are needed in education, adherence, and modification of the trauma bypass criteria.

Impact of Bronchoscopic Lavage and Aggressive Chest Physiotherapy on Clinical Pulmonary Infection Score of Patients of Severe Traumatic Brain Injury

Introduction: Traumatic brain injury patients present in the emergency room with a variable conscious status depending upon the severity of the injury. The process of aspiration starts from the scene of trauma as the patients with Traumatic brain injury and chest trauma have higher rates of aspiration pneumonia.&#x0D; Materials and Methods: We conducted a prospective study to assess the impact of bronchoscopy lavage and aggressive chest physiotherapy on the Critical Pulmonary Infection Score of Patients with Severe Traumatic Brain Injury in the Neurocritical Care Unit. Patients with severe traumatic brain injury who met the inclusion criteria were enrolled in the study. Patients of both genders, ages ranging from 05 – 70 years were included in the study.&#x0D; Results: 48 patients who met the inclusion criteria were enrolled in the study. 8 patients expired before 7 days and were excluded from the study. 88% were male and 12 % were females. Out of 40 patients, 30 were ventilated and 10 were managed without ventilation. Brain contusion was the most common CT scan finding. Out of 40 patients, 18 underwent surgical intervention, with decompressive hemicraniectomy being the most commonly performed procedure. Out of 40 patients, 32 patients underwent bronchoscopy. 8 patients out of 32 had more than two sessions of bronchoscopy.&#x0D; Conclusion: As Critical Pulmonary Infection Score is an important indicator for pneumonia in the neurocritical care unit, the importance of standardized chest care with the help of bronchoscopic lavage and chest physiotherapy in keeping the Critical Pulmonary Infection Score on the lower side can prevent patients from developing life-threatening pneumonia.

Prehospital emergency life-saving technicians promote the survival of trauma patients: A retrospective cohort study

ObjectiveAppropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of treatment by ELSTs compared to basic emergency medical technicians (BEMTs) remains unclear. The aim of this study is to determine whether treatment by ELSTs improves outcomes for trauma patients. MethodsWe retrospectively reviewed the Japan Trauma Data Bank for the years 2004 to 2017. Patients transferred to the hospital directly from the trauma scene and at least 16 years old were included in this study. The following criteria were used to exclude patients; presence of burns, untreatable severe traumas, unknown ELST attendance, and missing prognosis. We compared two groups (ELST group: patients transported by emergency medical services (EMS) with the presence of at least one ELST; BEMT group: patients transported only by BEMTs). Primary outcome was survival to discharge. Secondary outcomes were the need of definitive treatments defined by surgical intervention, intravascular radiology and blood transfusion at the receiving hospital within 24 h. A multivariable logistic regression model was used to calculate odds ratio (OR) and confidence intervals (CI) adjusted by age, sex, revised trauma score, and Injury severity score (ISS). ResultsOverall survival to discharge did not improve significantly (adjusted OR 1.13, 95% CI 0.99–1.30) with ELST intervention. In-hospital blood transfusion was more frequently required in the ELST group (adjusted OR 1.10, 95% CI 1.01–1.20). Emergency interventions (adjusted OR 1.03, 95% CI 0.97–1.09) were not different between the groups. In stratified analysis, the benefit of ELST attendance for survival was observed among patients with ISS <16 (adjusted OR 1.53, 95% CI 1.10–2.15), aged 65 years or older (adjusted OR 1.27, 95% CI 1.07–1.52), during the earlier study period (2004–2008, adjusted OR 1.50, 95% CI 1.14–1.97), and shorter transportation time (adjusted OR 1.21, 95% CI 1.03–1.41). ConclusionsDispatch systems with ELST should be considered for trauma transports, which may benefit elderly or moderate severity trauma groups, with shorter transportation time conditions.

True North by Gary Eller

Reviewed by: True North by Gary Eller Hank Nuwer, emeritus Gary Eller, True North. Plymouth, MI: BHC Press, 2021. 376 pp. Hardcover, $30; paper, $17.95; e-book, 376. A common theme in American fiction identified by critic Max Westbrook is the motif of revolt-and-search. This is a story where the hero rebels against a man-made institution and catches hell from society for his integrity. Westbrook maintained that Western fiction authors often employ the revolt-and-search motif and thus are allied with the best American fiction. To that end True North vaults Gary Eller’s novel into the status of a North Dakota main event and an earned place on bookstore shelves with distinguished authors Louise Erdrich, Wallace Stegner, and Gerald Haslam. Eller blends the stories of four families subsisting in and near the Turtle Mountain Reservation. The four families experiencing [End Page 87] life and death on the rugged Dakota landscape are the Little Shays, Breens, Morinvilles, and Peaveys. It is the poor and unassuming character Harold Peavey who steals the show. Reminiscent of heroes Tom Joad and Jim Casey in John Steinbeck’s Grapes of Wrath, Harold stands up to the United States government in World War II because he believes war is pointless nonsense caused because a Kaiser or president was eager to waste thousands of lives for vainglory. Harold serves a long stretch in federal prison and comes home to be beaten to a pulp by a soldier on leave named Sergeant Dale Aingher, later destined to become the sheriff pitted against Harold’s son, torn in the sixties between deployment to Vietnam or flight to Canada. The meeting of Sheriff Aingher and Richie Lee Peavey establishes the book’s penultimate final scene. Funny, compelling, and disturbing, True North introduces us to characters who endure despite poverty and cruel Fate, and I cheer for them because of and despite their desperation. Particularly well drawn are the Sioux and Chippewa characters, especially the women who endure hardship, rape, and a local Catholic school bent on beating the Native out of Indigenous girls. His hardscrabble county in North Dakota reminds me of the brilliant depiction of the dwellers of Raintree County invented by Ross Lockridge Jr. Eller creates bleak characters with his engaging literary voice. This fictive voice lures his readers into one tragic situation after another. He is unabashedly funny even in scenes of trauma and tragedy. Life for residents on the blurred and disputed US–Canada border is nasty, brutal, short, and funny as hell. The novel does have a definite fault in my opinion. The most despicable characters might read as more authentic if Eller presented more of their good sides. Eller knows the landscape well. He was reared in the North Dakota community of Rolla and owns a cabin there. His late mother survived a twister inside her demolished home. Thus, his depictions of Dakota scenery are stunning and always connected to action on the page. His research from goat raising to North Dakota geography is extensive. A graduate of the MFA program at Iowa, Eller’s fiction deserves a significant fan base. Particularly compelling is the conflict between [End Page 88] Native Americans who try to keep alive the old ways and the younger generation scoffing at what they see as nonsense. Whether it is Indigenous Natives in North Dakota suffering exploitation or the struggle of Harold Peavey to stick to his beliefs in spite of reckonings, Eller’s chapters conjured up this reader’s tears and venom. Eller, the author of numerous published short stories, is a storyteller, a Bard of the Badlands, but no mere regionalist. He writes with an angry scowl, then softens his narrative with snicker after snicker. This novel demonstrates Eller’s justified anger in the tradition of two masters of the revolt-and-search motif, Edward Abbey and Kurt Vonnegut. Hank Nuwer, emeritus Franklin College (Indiana) work cited Westbrook, Max. “The Themes of Western Fiction.” Southwest Review, vol. 43, no. 3, 1958, pp. 232–38, www.jstor.org/stable/43470857. Google Scholar Copyright © 2022 Western Literature Association

Another Bloody Clean-Up

South Africa has one of the highest violent crime rates globally, where physical and emotional trauma is used in homicides and suicides. While this is apparent to the ordinary South African, what is less clear is what happens after the police and forensics have done their job at a crime scene: Who cleans up the bloody mess? In South Africa, as in many other nations, trauma cleaners restore the scenes where homicides and suicides have been committed, and where industrial accidents have taken place. Little to no scholarly research has been conducted on the experiences of the cleaners of trauma scenes. Cleaning up these scenes consists of labour charged with violence that most cannot countenance, but which the cleaner must face. Drawing on 13 qualitative interviews, this article explores the challenges of cleaning up a site where violent and/or traumatic acts have occurred, and how the cleaners develop strategies to cope with their own concomitant trauma. The cleaners are exposed to various health and safety issues, as well as the emotional trauma associated with cleaning up horrific accidents and crimes. Findings show that trauma cleaners emotionally distance themselves from the violence to which they bear witness and use emotional labour, spirituality, humour, and debriefing as coping strategies. In its conclusion, this article suggests a greater acknowledgement of trauma cleaners’ responsibilities and recommends that proper physical and emotional training is necessary to ensure their wellbeing.