Deliberate self-harm and trauma - A descriptive analysis from a London major trauma centre.

Objectives: The objective of this study is to present a retrospective analysis of patients presenting to a Major Trauma Centre (MTC) following deliberate self-harm (DSH) and identifying the precipitants of DSH and psychiatric morbidity that will serve to inform the provision of care for these patients.

Patients And Methods: This was a retrospective observational study from a London Major Trauma Centre that identified all injured patients that presented with deliberate self-harm. Data was analysed from our established trauma database.

Learning from terrorist mass casualty incidents: a global survey.

Background: Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses.

Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline.

Background: Penetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients.

London 2017: Lessons learned in transfusion emergency planning.

Background And Objectives: Hospitals prepare for emergencies, but the impact on transfusion staff is rarely discussed. We describe the transfusion response to four major incidents (MIs) during a 6-month period. Three events were due to terrorist attacks, and the fourth was the Grenfell Tower fire.

Functional inclusivity of trauma networks: a pilot study of the North West London Trauma Network.

Background: Metrics exist to assess and validate trauma system outcomes; however, these are clinically focused and do not evaluate the appropriateness of admission patterns, relative to geography and triage category. We propose the term "functional inclusivity", defined as the number and proportion of triage-negative, and/or nonseverely injured patients, who were injured in proximity to a level II/III trauma center but admitted to a level I facility. The aim of this study was to evaluate this metric in the North West London Trauma Network.

Pearls and pitfalls in imaging of blunt traumatic thoracic aortic injury: a pictorial review.

Blunt thoracic aortic injury (TAI) occurs most frequently as a sequelae of high impact deceleration such as high-velocity road traffic accidents and falls from height. The burden of mortality and morbidity is high, however advances in pre-hospital care, diagnostic imaging and endovascular therapies have improved outcomes in this group of patients. Emergent treatment depends on accurate, early diagnosis by the radiologist.

Trauma in the elderly patient.

Major Trauma Centres and Emergency Departments are treating an increasing number of elderly trauma patients in the UK. Elderly patients, defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of elderly trauma cases is rising yearly, accounting for >25% of all major trauma nationally.

Bomb blast imaging: bringing order to chaos.

Blast injuries are complex, severe, and outside of our everyday clinical practice, but every radiologist needs to understand them. By their nature, bomb blasts are unpredictable and affect multiple victims, yet require an immediate, coordinated, and whole-hearted response from all members of the clinical team, including all radiology staff. This article will help you gain the requisite expertise in blast imaging including recognising primary, secondary, and tertiary blast injuries.

Virtual-world hospital simulation for real-world disaster response: Design and validation of a virtual reality simulator for mass casualty incident management.

Background: Mass casualty incidents are unfortunately becoming more common. The coordination of mass casualty incident response is highly complex. Currently available options for training, however, are limited by either lack of realism or prohibitive expense and by a lack of assessment tools.

Nontechnical skills performance and care processes in the management of the acute trauma patient.

Background: Acute trauma management is a complex process, with the effective cooperation among multiple clinicians critical to success. Despite this, the effect of nontechnical skills on performance on outcomes has not been investigated previously in trauma.

Methods: Trauma calls in an urban, level 1 trauma center were observed directly.

A growing problem: implications of obesity on the provision of trauma care.

The incidences of both trauma and obesity are rapidly on the rise. Whilst dedicated trauma centres exist, these may not be equipped to manage obese and super-obese patients' unique medical and surgical demands. This review assesses the impact of trauma on the obese patient and the specialist considerations required in their management throughout pre-hospital, acute and inpatient phases of trauma care.

Tactical and operational response to major incidents: feasibility and reliability of skills assessment using novel virtual environments.

Objectives: To determine feasibility and reliability of skills assessment in a multi-agency, triple-site major incident response exercise carried out in a virtual world environment.

Methods: Skills assessment was carried out across three scenarios. The pre-hospital scenario required paramedics to triage and treat casualties at the site of an explosion.

Identifying and addressing preventable process errors in trauma care.

Background: Management of the acute trauma patient is complex, with potential for error and adverse events. Avoidable injuries and deaths are not well understood. Analysis of error incidence, type, and severity can aid in greater understanding of the root causes and guide future development of error reduction strategies.

Major incident preparation for acute hospitals: current state-of-the-art, training needs analysis, and the role of novel virtual worlds simulation technologies.

Background: There is growing evidence that health systems in developed countries are poorly prepared to deal with major incidents.

Study Objectives: This study aimed to determine the skills required for successful major incident response, the factors that contribute to a successful major incident exercise, and whether there is a role for using novel simulation training (virtual worlds) in preparing for major incidents.

Methods: This was a qualitative semi-structured interview study.

Emergency preparedness in the 21st century: training and preparation modules in virtual environments.

Objectives: To determine the feasibility of evidence-based design and use of low-cost virtual world environments for preparation and training in multi-agency, multi-site, major incident response.

Methods: A prospective cohort feasibility study was carried out. One pre-hospital, and two in-hospital major incident scenarios, were created in an accessible virtual world environment.

Single and multi-user virtual patient design in the virtual world.

This research addresses the need for the flexible creation of immersive clinical training simulations for multiple interacting participants and virtual patients by using scalable open source virtual world technologies. Initial development of single-user surgical virtual patients has been followed by that of multi-user multiple casualties in a field environment and an acute hospital emergency department. The authors aim to validate and extend their reproducible framework for eventual application of virtual worlds to whole hospital major incident response simulation and to multi-agency, pan-geographic mass casualty exercises.

Resuscitation room blood alcohol concentrations: one-year cohort study.

Objective: To clarify the relationship between presenting clinical condition and blood alcohol concentration (BAC) among adult patients admitted to a resuscitation room (RR) of an emergency department (ED) in order to help guide clinical practice.

Method: Single-site prospective cohort study of all patients admitted to the RR of an inner-city hospital over a one-year period. The study sample comprised all those aged 16 years and over from whom a blood sample was taken, with BAC (results not known to ED staff), pathology by International Classification of Diseases (ICD) version 10 coding, injury severity score for trauma, return visit to hospital and mortality during the subsequent 6-month period, being recorded.

Use of blood alcohol concentration in resuscitation room patients.

Objective: To clarify the use of blood alcohol concentration (BAC) in the emergency department resuscitation room, by comparing it with a subsequent alcohol questionnaire and by surveying patients' attitudes to BAC testing.

Design: Observational study.

Participants: 273 resuscitation room patients at St Mary's Hospital, Paddington between August 2005 and February 2006.

Episodic asystole and apnoea as the presenting features of a diffuse glioma.

A case of asystolic collapse and subsequent progression to apnoea as a presenting feature of cerebral glioma is presented. The pathophysiological mechanism is likely to have been a focal seizure within subcortical regions affecting autonomic function. This example and others in the literature illustrate that severe and life-threatening cardiorespiratory manifestations may be the presenting feature of neurological disease.

Clinicians taking pictures--a survey of current practice in emergency departments and proposed recommendations of best practice.

The primary objective of this survey was to establish current practice in emergency departments in the UK. Variation in obtaining consent, how image collection is achieved, and the images stored were considered to be important outcomes. An initial postal questionnaire followed by phone survey posed questions about practical and procedural issues when capturing clinical images in emergency departments in the UK.

Treatment of uncomplicated subungual haematoma.

A short cut review was carried out to establish whether nail removal and nail bed repair is better than simple trephining in patients with significant subungual haematoma. Altogether 312 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated.