A critical analysis of on-scene helicopter transport on survival in a statewide trauma system

BACKGROUND: Recently, questions have been raised regarding the effectiveness of helicopters in trauma care. We conducted a retrospective study to evaluate the effect of on-scene helicopter transport on survival after trauma in a statewide trauma system. METHODS: Data were obtained from a statewide trauma registry of 162,730 patients treated at 28 accredited trauma centers. Patients transported from the scene by helicopter (15,938) were compared with those transported by ground with advanced life support (ALS) (6,473). Interhospital transfers and transports without ALS were excluded. Statistical analysis was performed using one-way analysis of variance and logistic regression. RESULTS: Patients transported by helicopter were significantly (p < 0.01) younger, were more seriously injured, and had lower blood pressure. They were also more likely to be male and to have systolic blood pressure < 90 mm Hg. Logistic regression analysis revealed that when adjusting for other risk factors, transportation by helicopter did not affect the estimated odds of survival. CONCLUSION: A reappraisal of the cost-effectiveness of helicopter triage and transport criteria, when access to ground ALS squads is available, may be warranted.     

Directed guide wire placement during ERCP using a papillotome

Considering the clinical and statistical data about injured children coming to the emergency department in the years between 1990 and 1995, the Authors hope better information, identification of risks, use of safety devices in order to successfully implement precautionary measures and the assistance in accidents which still are the first reason for death in children.     

Behavioral changes after closed head injury in children.

This study provides a longitudinal follow-up of the behavioral adjustment of 45 children with mild, moderate, and severe closed head injuries. Two measures of behavioral adjustment, the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS), were obtained from a parent at the time of injury and at 6 and 12 months postinjury. The severely injured children obtained significantly poorer VABS scores than children with mild and moderate injuries over the year-long follow-up. In addition, on the CBCL, severely injured children had more school problems and engaged in fewer social activities than mild and moderately injured children. These results show that severe head injury in children was associated with declines in adaptive functioning, whereas scores for children with mild and moderate injuries did not differ, nor did they deviate from average levels at any follow-up interval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Percutaneous core cutting needle biopsy compared with fine-needle aspiration in the diagnosis of peripheral lung malignant lesions: results in 156 patients

There is concern that the helmet display unit (HDU) used by AH-64 Apache helicopter pilots might contribute to facial injury in a crash. The US Army accident database was searched for HDU-related injuries in survivable Apache accidents 1985-1995. Four aviators in three crashes sustained HDU-related injury. These involved three periorbital contusions and two minor eye injuries. There were no sequelae. This equates to an incidence of 0.57 injured individuals per 100,000 flying hours or 8.0 injured aviators per 100 survivable Class A-C accidents in which the HDU was worn. Applying these data to the projected UK Army Apache flying hour programme suggests that one HDU-related injury might be encountered approximately every 10.1 years. This estimate should be interpreted with caution. Serious injury remains a possibility due to the proximity of the HDU to the eye and face.     

Teaching severely self-abusive and aggressive autistic residents to exit to fire alarms

Fifty-two case-hardened, severely self-abusive and aggressive autistic and retarded students, living in six different community residences, were trained to exit their residences, without the presence or assistance of staff, when a fire alarm sounded at night. On a pretest, prior to an 11-week period of intensive environmental and behavioral interventions, only 25% of the students exited within 2 1/2 minutes and independent of staff assistance. At posttest, 100% exited successfully, in a mean evacuation time of 60 seconds. The study was conducted at the Behavior Research Institute (BRI).     

Psychotherapy consultation service in a trauma hospital

Psychotherapeutic consultation work with victims of accidents is an integrating approach, which is aiming at the emotional care of injured people, who already had mental disturbances before accident and/or following the trauma. During 12 years as psychotherapeutic consultant at an Accident Hospital in Vienna the necessary interventions during traumatologic treatment of stationary patients are demonstrated.     

The hazard of spatial disorientation during helicopter flight using night vision devices

INTRODUCTION: Night Vision Devices (NVDs) provide an enormous advantage to the operational effectiveness of military helicopter flying by permitting flight throughout the night. However, compared with daytime flight, many of the depth perception and orientational cues are severely degraded. These degraded cues predispose aviators to spatial disorientation (SD), which is a serious drawback of these devices. METHODS: As part of an overall analysis of Army helicopter accidents to assess the impact of SD on military flying, we scrutinized the class A-C mishap reports involving night-aided flight from 1987 to 1995. The accidents were classified according to the role of SD by three independent assessors, with the SD group further analyzed to determine associated factors and possible countermeasures. RESULTS: Almost 43% of all SD-related accidents in this series occurred during flight using NVDs, whereas only 13% of non-SD accidents involved NVDs. An examination of the SD accident rates per 100,000 flying hours revealed a significant difference between the rate for day flying and the rate for flight using NVDs (mean rate for daytime flight = 1.66, mean rate for NVD flight = 9.00, p < 0.001). The most important factors associated with these accidents were related to equipment limitations, distraction from the task, and training or procedural inadequacies. CONCLUSIONS: SD remains an important source of attrition of Army aircraft. The more than fivefold increase in risk associated with NVD flight is of serious concern. The associated factors and suggested countermeasures should be urgently addressed.     

Childhood burn injuries: circumstances of occurrences and their prevention in Ribeir?o Preto, Brazil

The objectives of this study were to verify which circumstances are present in burn accidents of patients under 12 years of age and to gather information to ground strategies to prevent those accidents. Parents or guardians of 26 patients aged under 12 years, admitted to the burns unit of the Clinical Hospital of Ribeir?o Preto Medical School, Brazil, were interviewed, from March 1996 to March 1997. Fifty percent of the injured children were under 3 years of age and had suffered a scald. The kitchen and the backyard were identified as the places where the majority of accidents (84.6%) happened. At least one parent was present in 80.7% of cases. The results speak for the necessity of implementation of programs to prevent burn accidents, focusing on the domestic setting, chiefly activities in the kitchen.     

Evaluation of repatriation parameters: an analysis of patient data of the German Air Rescue

We investigated the medical history of 1468 patients of the German Air Rescue with regard to indications and rules that are used for the repatriation of sick or injured people by aircraft from abroad. Some 25.5% of the flights were domestic flights within Germany, 40.9% from the European continent, and 33.6% from outside Europe: North Africa, North America, the Middle and the Far East. Of the patients, 46% were non-surgical and 54% were surgical cases. The majority (90.3%) of international cases were flown home in ambulance airplanes (Learjet, Merlin); the remaining 9.7% were scheduled flights. The rate of false alert was 7-10%. According to the National Advisory Committee for Aeronautics (NACA) classification, the majority of patients had moderate to serious illnesses. Some 33% of the patients were repatriated purely on medical grounds with an accompanying doctor. The indications of 66% of the patients were a mixture of medical and social components. Lists of points are available on the basis of catalogues of medical and social indications.     

Blood alcohol levels in a series of injured patients with special reference to accident and type of injury

Blood alcohol was determined in 1012 injury victims. It was found that the alcohol involvement (AI) rate was 37% in the total number of patients, 19% in industrial, 38% in traffic, 36% in home, 45% in other freetime accidents, and 69% in the victims of fights, assaults, and suicide attempts. The most common external cause of injury was falling (447 cases) with an AI rate of 38%, while the 172 other nontraffic true accident cases had a rate of 24%. The road and stairs were the usual places of falls while intoxicated. Head injuries had a high (47%) and upper extremity injuries a low (25%) AI rate. Tibial and ankle fractures were also very often associated with alcohol intake. Contrarily to traffic and industrial accidents the slightly injured at home and in other freetime environments had been drinking more frequently than the severely injured. The data suggest that alcohol is a powerful contributing factor in leisure-time injuries. Head and low leg are especially vulnerable in drunken persons. Not only driving but even when walking while intoxicated means taking risks.     

Verbal rehearsal and memory in children with closed head injury: a quantitative and qualitative analysis

Nine closed head injured (CRI) children (mean age = 11.4 years) with post-onset intervals of seven months to eight years were studied. The CRI children ranged from mild-moderate to severely impaired. Nine normally developing children (mean age = 10.9 years) served as controls. An overt rehearsal free recall task was used. Subjects were instructed to "think aloud" following presentation of each item to-be-recalled. Quantitative analyses suggested impaired verbal recall and inefficient, passive rehearsal strategy use in severely injured subjects. Mild-moderate subjects performed similarly to controls and exhibited active rehearsal strategy use. Qualitative analysis revealed differences between CRI subjects and controls' range of rehearsal strategies, monitoring and metamemory. Implications for clinical assessment and intervention with respect to use of rehearsal strategies are discussed.     

Severe parachuting accident. Analysis of 122 cases

Based on a population of 122 severely injured patients the causes of paragliding accidents and the patterns of injury are analyzed. A questionnaire is used to establish a sport-specific profile for the paragliding pilot. The lower limbs (55.7%) and the lower parts of the spine (45.9%) are the most frequently injured parts of the body. There is a high risk of multiple injuries after a single accident because of the tremendous axial power. The standard of equipment is good in over 90% of the cases. Insufficient training and failure to take account of geographical and meteorological conditions are the main determinants of accidents sustained by paragliders, most of whom are young. Nevertheless, 80% of our patients want to continue paragliding. Finally some advice is given on how to prevent paragliding accidents and injuries.     

某炼钢企业工伤事故统计分析

运用统计分析方法对某炼钢企业2012至2013年的37起工伤事故典型案例进行分析,根据事故所在部门、地点、事故类别、事故原因、受伤部位、伤害程度等特点,采用直方图法对工伤事故进行统计分析：炼钢厂是该企业工伤事故发生率最高的部门;该钢铁企业发生次数最多的事故为机械伤害事故;违纪违章率为70.27%,是导致该企业事故发生的主要原因;头部和手脚受伤率为65%,工作环境艰苦,安全管理水平很低下,员工安全意识薄弱,是导致众多事故的根本原因等结论,为查找事故发生的规律和主要原因,预防和治理事故提供数据。     

Negative regulation of local hepatocyte growth factor expression by angiotensin II and transforming growth factor-beta in blood vessels: potential role of HGF in cardiovascular disease

BACKGROUND: The death rate for fatal fire accidents in Denmark has doubled since 1951, mostly due to an increase in the number of fire accidents associated with smoking. The most common cause of residential fire deaths in Denmark today is smoking, often combined with alcohol intoxication or handicap. METHODS: This was a case-control study of fatal fire accidents in private homes in the municipality of Copenhagen from 1991 to 1996. The fatal fire accidents were identified from a police register, and the two non-fatal fire accidents registered immediately before and after each fatal fire were selected as a control group. Information about the circumstances surrounding the fires was derived from the police reports. Multivariate logistic regression analysis was used to estimate the risk associated with each variable after adjusting for confounders. The analysis was performed on the basis of the theoretical model in which the variables were part of a causal network. RESULTS: The following five variables seemed to be of most importance: (1) localization of the victim close to the source of ignition (OR = 11), (2) physical handicaps (OR = 5), (3) chronic alcoholism (OR = 7), (4) clothing fires (OR = 24), and (5) alarm being given by a person not present at the scene of fire (OR = 33). Preventive measures are discussed in the light of the results.     

Pattern of acute head injuries in Ibadan

A series of 525 patients with head injuries was analyzed. Males and young people, especially children under 10, predominated. More injuries were sustained on Sunday than any other day, and were mostly caused by road traffic accidents and domestic accidents. Limb injuries were the most common associated wounds. The more severely disturbed the level of consciousness on admission, the worse was the prognosis.     

Electric injuries--cardiac monitoring?

During the years 1980-1990, 49 patients (38 men and 11 women) were treated in the department for various electrical injuries. The average age was 27 years (2-78 years). Thirty-nine had suffered low voltage (less than 1000 volts) accidents and ten had suffered high voltage (more than 1000 volts) accidents. The incidence and type of cardiac arrest/loss of consciousness on the scene of the accident, myoglobinuria, acute fasciotomies, surgical interventions, amputations, cardiovascular complications and outcome is reported. The most important finding was that no cardiac abnormalities were seen even with the patients with a clinical primary cardiac arrest. In spite of this finding 18 of the patients were initially brought to a medical department for electrocardiographic monitoring. This could clearly delay surgical intervention, though it did not seem to affect the final outcome (with some reservations). It was concluded that only abnormal ECGs should indicate electrocardiographic monitoring. Otherwise an electrical injury is a surgical matter.     

A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene

INTRODUCTION: Comprehensive emergency medical services and helicopter aeromedical transport systems have been developed based on the principle that early definitive care improves outcome. The purpose of this study was to compare outcomes between patients transported by helicopter and those transported by ground. METHODS: Data were obtained from the North Carolina Trauma Registry for the period between 1987 and 1993 on all patients transported by helicopter and ground admitted to one of the eight state designated trauma centers. Study patients included only those who were transported directly from the scene of injury to the trauma center (interhospital transfers were excluded). Mortality (outcome) was compared after patient stratification by injury severity and transport time, using Cochran-Mantel-Haenszel statistics and logistic regression-derived probabilities of survival. RESULTS: One thousand three hundred forty-six patients (7.3% of the total) were transported from scene to trauma center by helicopter and 17,144 were transported by ground. In patients transported by helicopter, the mean Trauma Score was lower (12 +/- 3.6) versus 14.3 +/- 3.6 (p < 0.001) and the mean Injury Severity Score was higher (17 +/- 11.1) versus 10.8 +/- 8.4 (p < 0.001). A trend toward increased survival was observed among patients transported by helicopter with a higher Injury Severity Score. Statistical significance was achieved only for patients with a Trauma Score between 5 and 12 and Injury Severity Score between 21 and 30. CONCLUSION: The large majority of trauma patients transported by both helicopter and ground ambulance have low injury severity measures. Outcomes were not uniformly better among patients transported by helicopter. Only a very small subset of patients transported by helicopter appear to have any chance of improved survival based on their helicopter transport. This study suggests that further effort should be expended to try to better identify patients who may benefit from this expensive and risky mode of transport.     

Management of blunt liver trauma in children

INTRODUCTION: Management of liver trauma in childhood represents a rare but formidable challenge. METHODS: Clinical presentation, grade of liver injury and Injury Severity Score (ISS) were studied in 11 cases of blunt liver trauma to examine factors influencing outcome. RESULTS: Seven of the 11 children were injured severely and had an ISS greater than 16. Seven who were haemodynamically stable were treated without operation, but four required surgery for grade III, IV and V liver injuries. Two children had primary repair of hepatic lacerations. Perihepatic packing was employed in two other cases (grade IV and V injury) for uncontrollable haemorrhage. Delayed debridement and thrombectomy plus vena cava repair with suturing of liver lacerations in these patients obviated heroic efforts at primary repair. Nine children survived. There were two deaths from head and neck trauma. DISCUSSION: Selected children with liver trauma can be managed non-operatively using established trauma guidelines. Perihepatic packing is recommended in unstable patients with complex injuries, followed by delayed definitive repair.     

Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims

Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients.