Triage and trauma workload in mass casualty: a computer model.

Background: The aim of this study was to quantitatively analyze the impact of hospital triage on the workload of trauma teams in the Emergency Department during a mass casualty incident, using a computer model.

Methods: The inflow and triage of casualties into an Emergency Department with 5 trauma teams was modeled using the Monte Carlo method. Triage was represented as a binary classification task performed in one or two sequential steps.

Comparison of conservative and operative treatment for blunt carotid injuries: analysis of the National Trauma Data Bank.

Objectives: Blunt carotid injury (BCI) is uncommon but potentially devastating. The best treatment modality for this injury remains undetermined. We conducted this study to better understand the hospital course and treatment outcomes for patients with BCI who received different interventions.

Disasters and mass casualties: II. explosive, biologic, chemical, and nuclear agents.

Terrorists' use of explosive, biologic, chemical, and nuclear agents constitutes the potential for catastrophic events. Understanding the unique aspects of these agents can help in preparing for such disasters with the intent of mitigating injury and loss of life. Explosive agents continue to be the most common weapons of terrorists and the most prevalent cause of injuries and fatalities.

Disasters and mass casualties: I. General principles of response and management.

Disaster planning and response to a mass casualty incident pose unique demands on the medical community. Because they would be required to confront many casualties with bodily injury and surgical problems, surgeons in particular must become better educated in disaster management. Compared with routine practice, triage principles in disasters require an entirely different approach to evaluation and care and often run counter to training and ethical values.

Timing of fluid resuscitation shapes the hemodynamic response to uncontrolled hemorrhage: analysis using dynamic modeling.

Background: Timing of fluid resuscitation with respect to intrinsic hemostasis is an unexplored aspect of uncontrolled hemorrhage, because most animal models do not allow direct monitoring of blood loss. The aim of this study was to define how timing of crystalloid administration affects the bleeding patient's hemodynamic response to fluids, using a computer model of blood volume changes during uncontrolled hemorrhage.

Methods: A multi-compartment lumped-parameter deterministic model of intravascular volume changes in a bleeding adult patient was developed and implemented.

Early aggressive closure of the open abdomen.

Background: The aim of this series is to describe a new and aggressive approach to definitive closure of the open abdomen.

Methods: A retrospective review of 37 patients who underwent definitive abdominal closure using a combination of vacuum pack, vacuum-assisted wound management and human acellular dermal matrix (HADM).

Results: All patients' open abdomens were maintained with vacuum assisted wound management in attempts for primary closure.

Impact of the 80-hour work week on resident emergency operative experience.

Background: The goal of this study was to analyze the impact of the 80-hour work week on the emergency operative experience of surgical residents.

Methods: A 2-year retrospective comparison of the operative experience in emergency abdominal procedures of postgraduate year 4 and 5 residents in a city hospital before (group 1) and after (group 2) duty hour restriction.

Results: There was no difference between groups in the mean number of procedures performed as the primary surgeon, but group 2 showed a 40% decrease in technically advanced procedures with a 44% increase in basic procedures.

How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis.

Background: The aim of this modeling study was to examine how casualty load affects the level of trauma care in multiple casualty incidents and to define the surge capacity of the hospital trauma assets.

Methods: The disaster plan of a U.S.

Patterns of microbiology in intra-abdominal packing for trauma.

Introduction: This study tracks the microbiology of packs and infections in damage-control trauma patients to determine whether the packs cause infections.

Methods: The peritoneum and abdominal packs were cultured in patients who survived to re-operation. The study recorded all positive cultures, pack count, packing duration, number of operations, and infections.

Minimizing dilutional coagulopathy in exsanguinating hemorrhage: a computer simulation.

Background: Current massive transfusion guidelines are derived from washout equations that may not apply to bleeding trauma patients. Our aim was to analyze these guidelines using a computer simulation.

Methods: A combined hemodilution and hemodynamic model of an exsanguinating patient was developed to calculate the changes in prothrombin time (PT), fibrinogen, and platelets with bleeding.

Bullet trajectory predicts the need for damage control: an artificial neural network model.

Background: Effective use of damage control in trauma hinges on an early decision to use it. Bullet trajectory has never been studied as a marker for damage control. We hypothesize that this decision can be predicted by an artificial neural network (ANN) model based on the bullet trajectory and the patient's blood pressure.