Hospital Planning and Response to an Active Shooter Incident: Preparing for the n = 1.

Changing patterns of violence in the United States and around the world are increasingly manifest as acts of mass violence and acts of terrorism. Preventing such attacks, reducing harms, and maintaining operations following such events requires the bolstering of key infrastructure facilities, such as hospitals, and developing response plans capable of detecting and withstanding such attacks. Attacks occurring in a hospital or clinic present unique challenges that differ from workplaces or schools.

Use of Implementation Science for a Sustained Reduction of Central-Line-Associated Bloodstream Infections in a High-Volume, Regional Burn Unit.

OBJECTIVE We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line-associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN A single center observational quasi-experimental study. SETTING A regional BICU in Maryland serving 300-400 burn patients annually.

Use of Bronchoscopy in Percutaneous Dilational Tracheostomy.

Importance: A modified percutaneous dilational tracheostomy (PDT) is a relatively new alternative method of performing PDTs in which tissues overlying the trachea are dissected, but needle entry is still performed blindly. Many centers use bronchoscopy-assisted PDT, but the necessity of bronchoscope assistance for modified PDTs has not been examined. Discontinuing bronchoscopy for this procedure could potentially decrease cost and increase efficiency with similar outcomes compared with bronchoscopy-assisted PDT.

Cody.

Advances in burn management over the past 2 decades have resulted in improved survival and reduced morbidity. The treatment of a single patient following a 90% total body surface area injury illustrates the intensity of labour and coordinated hospital care required for such catastrophically injured patients. Data were extracted from the medical records and from personal recollections of the individual members of the multidisciplinary team as well as from the patient.

Review, clinical update, and practice guidelines for excited delirium syndrome.

Excited delirium syndrome (ExDS) is a term used to describe patients experiencing a clinical condition characterized by bizarre and aggressive behavior, often in association with the use of chronic sympathomimetic drug abuse. The agitated and disruptive behavior of persons with ExDS often results in a call to police resulting in an arrest for disorderly conduct. The suspect's inability to comply with police commands during the arrest frequently results in a struggle and the use of physical or chemical control measures, including the use of conductive energy weapons (CEWs).

Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature.

Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion.

Development of a National Consensus for Tactical Emergency Medical Support (TEMS) Training Programs--Operators and Medical Providers.

Introduction: Tactical teams are at high risk of sustaining injuries. Caring for these casualties in the field involves unique requirements beyond what is provided by traditional civilian emergency medical services (EMS) systems. Despite this need, the training objectives and competencies are not uniformly agreed to or taught.

Clinical encounters in tactical medicine: a mission-specific analysis of the Maryland State Police experience.

Introduction: The Maryland State Police (MSP) Tactical Medical Unit (TMU) provides tactical emergency medical support (TEMS) through the deployment of specially trained state trooper tactical paramedics. The MSP TMU maintains an operational database of all mission related medical activity. This information constitutes a robust dataset derived from real world operational medicine experiences.

Rice-based electrolyte drinks more effective than water in replacing sweat losses during hot weather training and operations.

Heat-related injury presents significant threats to the health and operational effectiveness of Soldiers and military operations. In 2012, active component, U.S.

Semi-open percutaneous tracheostomy in burn patients.

Introduction: We describe a semi-open approach to percutaneous tracheostomy as an effective and potentially safer alternative to open tracheostomy or percutaneous techniques in burn patients.

Methods: We identified patients who underwent the modified technique from 2005 to 2007. Our method used a 2-3 cm incision and limited dissection to the pretracheal fascia.

Recovery room delirium predicts postoperative delirium after hip-fracture repair.

Unlabelled: In this study, we sought to determine the incidence of recovery room delirium in elderly patients having hip-fracture repair under general anesthesia and to discover whether recovery room delirium is associated with continuing postoperative delirium. In this prospective study, patients undergoing hip-fracture repair were anesthetized using a standardized protocol. In addition, postoperative pain management was standardized in both the postoperative anesthesia care unit and in the hospital ward.