Prehospital blood transfusion in the en route management of severe combat trauma: a matched cohort study.

Background: The value of prehospital blood transfusion (PHBTx) in the management of severe trauma has not been established. This study aimed to evaluate the effect of PHBTx on mortality in combat casualties.

Methods: This is a retrospective cohort study of casualties admitted to the field hospital at Camp Bastion, Afghanistan, by the Medical Emergency Response Team from May 2006 to March 2011.

Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility.

Aim: The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland.

Methods: We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification.

Performance improvement evaluation of forward aeromedical evacuation platforms in Operation Enduring Freedom.

Background: The following three helicopter-based medical evacuation platforms operate in Southern Afghanistan: the US Army emergency medical technician (basic)-led DUSTOFF, US Air Force paramedic-led PEDRO, and UK physician-led medical emergency response team (MERT). Nearly 90% of battlefield deaths occur in the prehospital phase, comparative outcomes for these en route care platforms are unknown. The objective of this investigation was to characterize the nature of injuries in patients transported by three evacuation platforms.

Demographic and geographical characteristics of pediatric trauma in Scotland.

Background: Trauma systems reduce mortality and improve functional outcomes. The aim of this study was to analyse the demographic and geospatial characteristics of pediatric trauma patients in Scotland, and determine the level of destination healthcare facility which injured children are taken to, to determine the need for, and general feasibility, of developing a pediatric trauma system for Scotland.

Methods: Retrospective analysis of incidents involving children aged 1-14 attended to by the Scottish Ambulance Service between 1 November 2008 and 31 October 2010.

MEDEVAC: survival and physiological parameters improved with higher level of flight medic training.

Objective: Determine if a higher level of Army flight medic (AFM) training was associated with improved physiological state on arrival to a combat support hospital (CSH).

Methods: A retrospective study comparing casualties who were evacuated by two AFM units with only Emergency Medical Technicians-Basic (EMT-Bs) to an Army National Guard unit with Critical Care Flight Paramedics (CCFPs) in Afghanistan with an injury severity score >16 in different time periods looking at their 48-hour mortality, hematocrit (HCT), base deficit (BD), oxygen saturation (SpO2), and physiological parameters on arrival to the CSH.

Results: The CCFP group had better HCT [36.

Improvements in the hemodynamic stability of combat casualties during en route care.

Three Forward Aeromedical Evacuation platforms operate in Southern Afghanistan: UK Medical Emergency Response Team (MERT), US Air Force Expeditionary Rescue Squadron (PEDRO), and US Army Medical Evacuation Squadrons (DUSTOFF), each with a different clinical capability. Recent evidence suggests that retrieval by a platform with a greater clinical capability (MERT) is associated with improved mortality in critical patients when compared with platforms with less clinical capability (PEDRO and DUSTOFF). It is unclear whether this is due to en route resuscitation or the dispatch procedure.

The UK military experience of thoracic injury in the wars in Iraq and Afghanistan.

Introduction: Thoracic injury during warfare is associated with a high incidence of morbidity and mortality. This study examines the pattern and mortality of thoracic wounding in the counter-insurgency conflicts of Iraq and Afghanistan, and outlines the operative and decision making skills required by the modern military surgeon in the deployed hospital setting to manage these injuries.

Methods: The UK Joint Theatre Trauma Registry was searched between 2003 and 2011 to identify all patients who sustained battle-related thoracic injuries admitted to a UK Field Hospital (Role 3).

Destination healthcare facility of shocked trauma patients in Scotland: analysis of transfusion and surgical capability of receiving hospitals.

Aims: Haemorrhage is a leading cause of death from trauma. Management requires a combination of haemorrhage control and resuscitation which may incur significant surgical and transfusion utilisation. The aim of this study is to evaluate the resource provision of the destination hospital of Scottish trauma patients exhibiting evidence of pre-hospital shock.

Evaluation of military trauma system practices related to complications after injury.

Background: The Joint Theater Trauma System (JTTS) was developed with the vision that every soldier, marine, sailor, and airman injured on the battlefield would have the optimal chance for survival and maximum potential for functional recovery. In this analysis, we hypothesized that injury and complication after injury surveillance information diffusion through the JTTS, via the dissemination of clinical practice guidelines and process improvements, would be associated with improved combat casualty clinical outcomes.

Methods: The current analysis was designed to profile different aspects of trauma system performance improvement, including monitoring of frequent posttraumatic complications, the assessment of an emerging complication trend, and measurement of the impact of the system interventions to identify potential practices for future performance improvement.

Evaluation of military trauma system practices related to damage-control resuscitation.

Background: The Joint Theater Trauma System (JTTS) was developed with the vision that every soldier, marine, sailor, and airman injured on the battlefield would have the optimal chance for survival and maximum potential for functional recovery. In this analysis, we hypothesized that information diffusion through the JTTS, via the dissemination of clinical practice guidelines and process improvements, would be associated with the acceptance of evidence-based practices and decreases in trauma practice variability.

Methods: The current evaluation was designed as a single time-series quasi-experimental study as a preanalysis and postanalysis relative to the implementation of clinical practice guidelines and process improvement interventions.

Interpreting comparative died of wounds rates as a quality benchmark of combat casualty care.

Background: The died of wounds (DOW) rate is cited as a measure of combat casualty care effectiveness without the context of injury severity or insight into lethality of the battlefield. The objective of this study was to characterize injury severity and other factors related to variations in the DOW rate.

Methods: The highest monthly DOW (HDOW) and lowest monthly DOW (LDOW) rates from 2004 to 2008 were identified from analysis and casualty report databases and used to direct a search of the Joint Theater Trauma Registry.

Impact of critical care-trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan.

Background: The US Army pioneered medical evacuation (MEDEVAC) by helicopter, yet its system remains essentially unchanged since the Vietnam era. Care is provided by a single combat medic credentialed at the Emergency Medical Technician - Basic level. Treatment protocols, documentation, medical direction, and quality improvement processes are not standardized and vary significantly across US Army helicopter evacuation units.

Utilizing a trauma systems approach to benchmark and improve combat casualty care.

Background: Derived from the necessity to improve the outcomes of soldiers injured on the battlefield, the U.S. military forces developed and implemented the Joint Theater Trauma System (JTTS) and the Joint Theater Trauma Registry based on U.

Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006.

Background: The opinion that injuries sustained in Iraq and Afghanistan have increased in severity is widely held by clinicians who have deployed multiple times. To continuously improve combat casualty care, the Department of Defense has enacted numerous evidence-based policies and clinical practice guidelines. We hypothesized that the severity of wounds has increased over time.

Clinical experience with linezolid for the treatment of nocardia infection.

Linezolid is an oxazolidinone that has activity against most gram-positive bacteria, including in vitro activity against all Nocardia species and strains. We describe 6 clinical cases of nocardiosis that were successfully treated with linezolid. Two patients had underlying X-linked chronic granulomatous disease, and 2 patients were receiving chronic corticosteroid therapy.

Synaptophysin immunoreactivity in the aging rat pituitary gland.

The density of synaptophysin (SN)-immunoreactivity (IR) was examined in pituitary glands of aging male Sprague-Dawley rats. SN-IR was observed as dense dots among endocrine cells of the intermediate lobe, while the neural lobe contained numerous, highly dense immunopositive regions. Some anterior lobe secretory cells contained SN-IR within the cytoplasm, suggestive of the presence of the protein in secretory granules, but no dot-like staining was observed between endocrine cells of that region.

Alterations in GAP-43-immunoreactive innervation in the aging rat pituitary.

The levels and distribution of the growth-associated protein, GAP-43, were examined in the pituitary glands of young and aging Sprague-Dawley rats, using immunohistochemical techniques on tissue sections and Western blot analyses. GAP-43-immunoreactive innervation was observed in sections in the intermediate and neural lobes of animals aged 8-15 months, while in the oldest rats studied (17 months), stained fibers were observed mainly in the neural, but not the intermediate lobe. Western blots revealed reduced levels of GAP-43 in samples from 15 month old animals, as compared to 12 month old rats, in the neurointermediate lobes.

Regulation of pituitary beta-endorphin secretion in aging rats: in vitro responsiveness to dopamine.

The intermediate lobe of the mammalian pituitary is highly responsive to dopamine inhibition of beta-endorphin secretion. In this study, the ability of aged (12 months) intermediate lobes to respond to dopamine was compared to that of young (6 weeks) tissue, using a short-term in vitro incubation of isolated rat neurointermediate lobes, with measurement of peptide release by radioimmunoassay. Tissue from the aged rats released greater amounts of beta-endorphin peptide than amounts measured from young tissue at all time periods studied.