Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools.

Background: Major incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients-those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have limited evidence supporting their use.

Paediatric major incident triage: UK military tool offers best performance in predicting the need for time-critical major surgical and resuscitative intervention.

Background: Children are frequently injured during major incidents (MI), including terrorist attacks, conflict and natural disasters. Triage facilitates healthcare resource allocation in order to maximise overall survival. A critical function of MI triage tools is to identify patients needing time-critical major resuscitative and surgical intervention (Priority 1 (P1) status).

The BCD Triage Sieve outperforms all existing major incident triage tools: Comparative analysis using the UK national trauma registry population.

Background: Natural disasters, conflict, and terrorism are major global causes of death and disability. Central to the healthcare response is triage, vital to ensure the right care is provided to the right patient at the right time. The ideal triage tool has high sensitivity for the highest priority (P1) patients with acceptably low over-triage.

A Comparison of Improvised and Commercially Available Point-of-Wounding Tourniquets in Simulated Traumatic Amputation with Catastrophic Hemorrhage.

Introduction: Catastrophic hemorrhage is the leading cause of preventable trauma deaths in the military and civilian populations. The use of tourniquets by first responders (medical and nonmedically trained) is supported and has the potential to save lives if applied correctly.

Aims: We sought to examine the use of 5 tourniquets: 1 improvised and 4 commercially available tourniquets to investigate the time taken to stop simulated bleeding and to secure the device; evidence of rebleeding when the "blood pressure" was restored and to gain qualitative feedback on their application.

Conservation geopolitics.

We reviewed recent work concerning the impact of geopolitics on wildlife conservation (and vice versa) and identified future priorities in conservation geopolitics research. Geopolitics is understood as both an analytical focus on geopolitical practices (especially concerning the behavior) of countries with respect to territory and national security and a set of theories developed to explain and predict those behaviors. We developed a typology of core geopolitical practices of relevance to conservation: territorial practices of colonization and the management of migrations and borders, and security practices relating to military, economic, and environmental security.

The microbiome and its publics: A participatory approach for engaging publics with the microbiome and its implications for health and hygiene.

Our project to engage members of the public with metagenomics of microbiota in their households yielded interesting results about their perception of health and hygiene. These findings could direct health‐oriented research and help scientists to navigate the social contexts or microbiome research. [Image: see text]

Connectivity as a multiple: In, with and as "nature".

Connectivity is a central concept in contemporary geographies of nature, but the concept is often understood and utilised in plural ways. This is problematic because of the separation, rather than the confusion, of these different approaches. While the various understandings of connectivity are rarely considered as working together, the connections between them have significant implications.

Improving the role of global conservation treaties in addressing contemporary threats to lions.

Despite their iconic status, lion () populations continue to decline across the majority of their range. In the light of the recent decision (in October 2017) to add lions to the Appendices of the Convention on Migratory Species (CMS), this paper identifies the new and existing legal protections afforded to lions through five global treaties, and maps these protections against the most critical contemporary threats facing the species. It thus offers a new analysis of the CMS listing, and draws on existing legal reviews, to highlight the ways in which global treaties offer differing forms of protection for lions.

Evaluation of role 2 (R2) medical resources in the Afghanistan combat theater: Initial review of the joint trauma system R2 registry.

Background: A Role 2 registry (R2R) was developed in 2008 by the US Joint Trauma System (JTS). The purpose of this project was to undertake a preliminary review of the R2R to understand combat trauma epidemiology and related interventions at these facilities to guide training and optimal use of forward surgical capability in the future.

Methods: A retrospective review of available JTS R2R records; the registry is a convenience sample entered voluntarily by members of the R2 units.

Perceptions and culture of safety among helicopter emergency medical service personnel in the UK.

Background: The use of helicopter emergency medical services (HEMS) has increased significantly in the UK since 1987. To date there has been no research that addresses HEMS pilots and medical crews' own ideas on the risks that they view as inherent in their line of work and how to mitigate these risks. The aim of this survey is to describe and compare the attitudes and perceptions towards risk in HEMS operations of these staff.

A torso model comparison of temperature preservation devices for use in the prehospital environment.

Background: Hypothermia is an independent predictor of increased morbidity and mortality in patients with trauma. Several strategies and products have been developed to minimise patients' heat loss in the prehospital arena, but there is little evidence to inform the clinician concerning their effectiveness.

Methods: We used a human torso model consisting of two 5.

Survival to Discharge After Cardiac Arrest Attended by a Doctor-Paramedic Helicopter Emergency Medical Service: An Utstein-style Multiservice Review of 1085 Activations.

Background: The presentation of outcomes after cardiac arrest presented by emergency medical service and in-hospital teams in the Utstein style allows for comparative analysis of populations and systems. Essex and Herts Air Ambulance Trust (EHAAT) and the East Anglian Air Ambulance (EAAA) are doctor-plus-paramedic prehospital care teams that respond to a large number of medical cardiac arrests.

Objective: To report the outcomes of medical cardiac arrests according to the Utstein style.

A 26-year comparative review of United Kingdom helicopter emergency medical services crashes and serious incidents.

Background: The use of helicopter emergency medical services (HEMS) has increased substantially in the United Kingdom since 1987. There are currently no data on the rate of crashes and serious incidents related to HEMS in the United Kingdom. The aims of this article were to present data from a 26-year period since the start of HEMS operations in the United Kingdom and to compare them with published data from Germany, Australia, and the United States.

A roadmap for innovation.

Medicine has historically advanced during conflict, but military medical services have consistently regressed during peace. As over a decade of campaigning in Iraq and Afghanistan draws to a close, securing the legacy of hard won clinical lessons and retaining flexibility to adapt to new patterns of illness and injury during contingency is critical. Central to sustaining exceptional outcomes for future operations and to maintaining the current position of the Defence Medical Services as providers of clinical excellence is retaining the capability to innovate.

Tourniquet use in combat trauma: U.K. military experience.

Aim: To determine the prevalence of tourniquet use in combat trauma, the contribution to lives saved and the complications of their use in this environment.

Population: All casualties treated at U.K.

Is there one optimal medical treatment and evacuation chain for all situations: "scoop-and-run" or "stay-and-play".

In 2006, the Ministry of Defense of the Netherlands initiated a targeted agenda program for the World Congress on Disaster and Emergency Medicine in Amsterdam in 2007 (15WCDEM). The issue to be discussed was if there is one "golden" treatment and evacuation system that is applicable for different military and civilian situations. And, if there is not such a system, which parameters are important to construct the most optimal system for each different situation.