Intervenção de enfermagem para prevenção de queda da pessoa idosa com transtorno mental / Nursing intervention to prevent fall of the elderly person with mental disorder / Intervención enfermera para evitar que los ancianos caigan con transtorina mental

Objetivo: aplicar intervenções de enfermagem sobre prevenção de quedas a pessoas idosas com transtornos mentais. Material e Método: Trata-se de uma pesquisa- cuidado, para subsidiar a aplicação das intervenções de enfermagem foi utilizado componentes do Modelo Teórico de Promoção da Saúde, desenvolvido por Nola J. Pender. A primeira etapa do estudo foi desenvolvida em um Centro de Atenção Psicossocial e a segunda etapa no domicilio dos idosos. A coleta de dados foi realizada entre os meses de agosto a novembro de 2022, com idosos de idade igual ou superior a 60 anos, que estivessem sendo acompanhados no serviço. A amostra foi composta por 15 idosos. Para a coleta de dados, foi utilizado um formulário estruturado com variáveis sociodemográficas, investigação de saúde e doença e características do domicílio e um instrumento utilizado para avaliar o risco de quedas em idosos. A análise descritiva dos dados, ocorreu por meio do cálculo de frequências absolutas e relativas. Os aspectos éticos da resolução 466/12 foram respeitados em todas as fases do estudo. Resultados: Predominaram mulheres (80,00%), casadas (53,33%), com uma média de idade de 70,52 anos, de cor branca (53,33%) e analfabetos (55,33%). No que se refere às condições de saúde e doença, foi possível observar que o tipo de transtorno mental que mais predominou foi a depressão (60,00%) e a ansiedade (33,33%). Grande parte dos participantes do estudo (73,33%) relataram que já caíram ao menos 6 vezes, em um tempo médio de 1 ano. Ressalta-se que (93,33%) dos idosos não receberam orientações sobre prevenção de quedas no domicilio. Todos os idosos apresentaram alto risco de quedas. As intervenções de enfermagem foram realizadas aos idosos com transtornos mentais com alto risco para quedas. Considerações Finais: A maioria dos idosos tiveram quedas dentro do domicilio, a ocorrência de quedas nesse espaço está relacionada a insegurança do ambiente. Diante disso, a realização da intervenção foi de grande importância para a prevenção a quedas com enfoque na saúde do idoso direcionados aos gestores, profissionais e comunidade.

Objective: To apply nursing interventions on prevention of falls to elderly people with mental disorders. Material and Method: It is a research-care, to subsidise the application of nursing interventions was used components of the Theoretical Model of Health Promotion, developed by Nola J. Pender. The first stage of the study was developed at a Psychosocial Care Centre and the second stage in the home of the elderly. Data collection has been conducted between August and November 2022, with elderly people aged 60 and over, who were being accompanied in the service. The sample consisted of 15 elderly people. For the data collection, a structured form was used with sociodemographic variables, health and disease research and characteristics of the household, and an instrument used to assess the risk of falls in the elderly. Descriptive analysis of the data, occurred by calculating absolute and relative frequencies. The ethical aspects of resolution 466/12 were respected at all stages of the study. Results: Women predominated (80.00%), married (53.33%), with an average age of 70.52 years, white (53.33%) and illiterate (55.33%). With regard to health and illness conditions, it was observed that the type of mental disorder that predominated most was depression (60.00%) and anxiety (33.33%). A large number of the study's participants (73.33%) reported that they have already fallen at least 6 times, in an average time of 1 year. It should be noted that (93.33%) of the elderly did not receive guidelines on the prevention of falls in the home. All older adults were at high risk of falls. Nursing interventions were performed for elderly with mental disorders at high risk for falls. Final Considerations: Most of the elderly have had falls within the home, the occurrence of falls in this space is related to environmental insecurity. In view of this, the implementation of the intervention was of great importance for the prevention of falls with a focus on the health of the elderly directed towards managers, professionals and community.

Objetivo: aplicar intervenciones de enfermería en la prevención de caídas a personas mayores con trastornos mentales. Material y método: Se trata de una investigación cuidadosa, para subsidiar la aplicación de las intervenciones de enfermería, se utilizaron componentes del Modelo Teórico para la Promoción de la Salud, desarrollado por Nola J. Pender. La primera etapa del estudio se desarrolló en un Centro de Atención Psicosocial y la segunda etapa en los hogares de ancianos. La colección de datos tiene entre agosto y noviembre de 2022, se llevaron a cabo con personas mayores de 60 años que estaban acompañadas en el servicio. La muestra consistió en 15 ancianos. Para la recolección de datos se utilizó una forma estructurada con variables sociodemográficas, investigación de la salud y las enfermedades y características del hogar, así como un instrumento utilizado para evaluar el riesgo de caída en los ancianos. El análisis descriptivo de los datos se realizó mediante el cálculo de frecuencias absolutas y relativas. En todas las etapas del estudio se respetaron los aspectos éticos de la resolución 466/12. Resultados: mujeres predominantes (80,00%), casadas (53,33%), con una edad media de 70,52 años, blancas (53,33%) y analfabetas (55,33%). En cuanto a la salud y las enfermedades, se observó que el tipo de trastorno mental más prevalente fue depresión (60,00%) y ansiedad (33,33%). Un gran número de participantes en el estudio (73,33%) informó que ya habían caído al menos seis veces en un período medio de un año. Cabe señalar que (93,33%) de las personas de edad avanzada no recibieron directrices sobre la prevención de las caídas desde el hogar. Todos los ancianos mostraron un alto riesgo de caída. Las intervenciones de enfermería se realizaron en ancianos con trastornos mentales con alto riesgo de caída. Consideraciones finales: La mayoría de las personas de edad se habían refugiado en el hogar, la aparición de caídas en este espacio está relacionada con la inseguridad del medio ambiente. A la luz de ello, la aplicación de la intervención fue de gran importancia para la prevención de caídas, centrándose en la salud de las personas de edad, dirigida a los directivos, los profesionales y la comunidad. PALABRAS CLAVE: Salud Mental; Enfermería; Ancianos; Crash.

Analysis of length of hospital stay of road crash patients in the Philippine General Hospital’s Integrated Surgical Information Systemfrom 2008–2017

Introduction@#Mobility in the Philippines has increasingly become a major issue especially with the growing economy of the country. Collisions on the road cannot be entirely avoided; thus, we focus our efforts to reducing road crashes that result in death and serious injuries. To do this, we analyzed road crash patients brought to the Philippine General Hospital (PGH). @*Objective@#The study aimed to quantify how crash factors affect length of hospital stay (LOS) of patients brought to PGH, as well as to look for associations between the LOS and demographic and clinical variables. @*Methods@#This is a retrospective study using database of patients admitted in PGH from 2008 to 2017. The study focused on LOS, which was used as the dependent variable for Poisson regression and Kruskal-Wallis H tests. The determinants considered in the study are socio-demographic variables such as age, sex, civil status, victim type, vehicle type, patient classification, and region of incidence, as well as clinical variables such as consult type, outcome of the patient, body parts injured, Glasgow coma score (GCS), among others. @*Results@#We analyzed data of 4979 road crash patients from the PGH database. We found that civil status, age, patient classification, vehicle type, and province were associated with LOS. For the clinical variables, consult type, primary service, outcome of patient, body injuries, GCS and systolic blood pressure were found significant. Poisson regression suggests longer hospital stay for patients with injuries sustained in the head and neck (RR = 1.102, p < 0.001), face (RR = 1.218, p < 0.001), and extremity (RR = 1.673, p < 0.001). @*Conclusion@#Results show that injury sustained in certain parts of the body such as head and neck, face, and extremity significantly affect LOS. Results also show that subgroups within demographic variables affect LOS. There is a need to address the ever-increasing number of road crash patients and implications to length of hospitalization.

Epidemiologic profile of vehicular accident patients in the largest hospital in the Philippines covering ten years

Introduction@#Globally, the number of people who die from road crashes continues to rise, reaching a high of 1.35 million in 2016. Due to this continued increase in fatalities and injuries within the road transport system, especially in low- and middle-income countries, 2011 to 2020 was declared by the United Nations General Assembly in 2010 as the Decade of Action for Road Safety. @*Objectives@#This study looked into the epidemiology of road crashes and injuries in Metro Manila over ten years, from 2008-2017, from data gathered at the Department of Surgery of the Philippine General Hospital (PGH). @*Method@#A retrospective review of patients’ clinical records was conducted to describe the epidemiology of road crash cases in the Trauma Division, Department of Surgery of the PGH. Clinical records of the road crash patients admitted to the division over the ten years, January 1, 2008, to December 31, 2017, were extracted from the Integrated Surgical Information System (ISIS). @*Results@#A total of 422 patients were admitted to the PGH Department of Surgery and recorded in the ISIS database, from 2008 to 2017, who suffered from road crashes in Metro Manila. Most of these patients (80.8%) were male. The mean age of patients was 32.4 years. The highest number of admissions (27.5%) and road crash deaths (6.9%) were in 2016; the highest number was from the city of Manila (26.7%), and most happened at nighttime (61.8%) between 6:00 PM and 5:59 AM. Throughout the years, motorcycle (52.8%) was the vehicle type involved. Among patients with helmet use information, 65.4% were not wearing helmets, 91.2% had a history of alcohol intake. The majority incurred multiple injuries (82.7%), with the external region (53.8%) as the most common. Patients who sustained injuries to their head and neck region were five times more likely to die and six times more likely to have an unchanged patient outcome than those who did not have these injuries. Patients who had a GCS of 8 and below or those who had severe brain injuries were eight times more likely to die and six times more likely to have an unchanged patient outcome. @*Conclusion@#This study looked into the epidemiology of road crash cases admitted to the Surgery Department of the PGH. Road crash injuries and deaths remain a growing concern among the citizens of Metro Manila. It is hoped that the results of this study will provide policymakers with an objective and data-driven perspective on road crashes.

Determinants of prolonged length of stay among patients with road traffic injury at the Philippine General Hospital: A retrospective cohort study

Introduction@#Road traffic injuries are among the leading causes of preventable death, claiming around 7000 lives every year. Furthermore, road traffic can injure or disable thousands more every year in the Philippines. @*Objectives@#This study determined the hospital length-of-stay patterns and risk factors for a prolonged length of stay in a tertiary hospital after road traffic injury. @*Methods@#A retrospective cohort study was conducted to determine the determinants of the length of stay in the Philippine General Hospital (PGH) among road traffic injury victims for the year 2016. Length of stay was recorded according to the median. The other variables were cross-tabulated against the length of stay, and each of their crude odds ratios along with corresponding p-values were presented. Continuous variables were analyzed using Wilcoxon Mann-Whitney U-test. The predictor model for the determinants of prolonged length of stay in the hospital was built using forward selection. Likelihood-ratio test was used to compare the model with and without the exposure variable. @*Results@#A total of 427 road traffic injury victims were admitted to the Philippine General Hospital in 2016. The mean age of the patients was 31.55 years (±14.97) with a median age of 29 years. The majority of patients were males (82.4%) and single (60.8%). Most patients were riding a motorcycle during the time of the accident (64.2%) while 20% were pedestrians. The majority of the victims were intoxicated (74.3%) and were not using helmets (57.1%) at the time of the accident. Most of the victims received first aid (69.2%) and the mean time of admission was 3.03 (±13.31) days while the median time to admission was 12 hours. Receiving first aid (p<0.01), availed services (p<0.01), and married civil status (p=0.04) were found to be strongly associated with length of hospital stay. Without controlling for any confounders, pay patients (OR = 3.46, 95% CI: 1.3, -9.87), elective patients (OR = 7.88, 95% CI: 2.64, 31.61), and those in non-trauma wards (OR=2.07, 95% CI: 1.29, 3.36) had higher odds for longer hospitalization stay. On the other hand, those who did not receive first aid (OR = 0.55, CI:0.35, 0.85) had lower odds for prolonged hospitalization. Those who suffered face injury and did not suffer external injuries had a higher mean rank, suggesting a longer length of hospital stay. On the other hand, upon controlling variables found to be associated with previous studies, those with low Glasgow coma scale (GCS) scores were 2.77 times (95% CI: 1.13, 6.91) more likely to stay longer in the hospital. @*Conclusion@#The type of victim, mortality status, age, and sex were found to be important determinants of prolonged hospitalization. To lessen the number of fatalities and road trauma injuries, laws on road safety should be strictly and properly implemented. Shared responsibility of all road users is also important in improving the safe usage of roads.

Analysis of human error as a factor in road crash in Metro Manila (2005-2015)

Introduction@#In the Philippines, data on road traffic injuries show that road injury is the 11th leading cause of premature deaths in the Philippines. The World Health Organization estimates that 1.24 million die globally due to road traffic crashes. @*Objectives@#This study aimed to show the trend of the road crash situation in Metro Manila, Philippines, over eleven years (2005–2015) and to analyze human error and other associated hazard factors for road crashes. @*Methods@#This study is a secondary analysis of an 11-year database culled from 2005–2015, for Metro Manila, Philippines. The variables included road crash classification, incidence over months and time of the day, road crash disaggregated by location, region, and city, and type of vehicle. Descriptive statistics were used to describe the incidence of a road crash, road crash fatalities, and risk factors associated with a road crash in Metro Manila. @*Results@#The incidence of road crashes in Metro Manila has increased from 65,111 in 2005 to 95,615 in 2015. Fatalities also increased from 348 to 536. The most predominant type of vehicle involved in road crashes were cars from 46% to 67%, followed by jeepneys, vans, and motorcycles. The most commonly reported human errors were speeding, inattentive and bad turning. The reported percentage of speeding from 2005–2010 ranged between 32% and 58%. In 2014, speeding (96%) was the most reported human error among the other reported errors; such as inattentiveness (range, 28 to 41%) and bad turning (0.6% and 33%). Fatigue and traffic violation made up 0.02% to 0.45% of the reported human factors of road crash-related hospitalization cases in Metro Manila for the period. Suspected alcohol use accounted for 0.04% to 4.57% of the human errors reported. For non-fatal and fatal crashes, the associated human errors were suspected alcohol use, inattentiveness, and speeding. The highest adjusted residual for both fatal and non-fatal (injurious) crashes was for inattentiveness. Human error was associated with years, suggesting that for some years, the number of crashes caused by human errors is significantly higher than expected. Alcohol-suspected crashes are significantly higher than expected for 2005 and 2011, with 2011 having the highest adjusted residual. Inattentiveness-caused crashes were significantly higher than expected for years 2005 to 2010, with 2007 having the highest adjusted residual. Bad turning was significantly higher from 2005 to 2007; while disobedience was significantly higher for 2005 to 2008. Speeding was significantly higher than expected from 2005 to 2010. @*Conclusion@#There is a need to address the public health concern posed by road crashes in Metro Manila, as well as to rectify the ergonomically related risk factors and human error components in a road crash.

Epidemiology of eyelid trauma among Filipino patients in a Tertiary Hospital

Objective@#This study aims to identify the epidemiological characteristics and co-morbidities of eyelid injuries among Filipino patients seen at the Emergency and Out-patient Clinics of a single, tertiary, government, urbanbased hospital from June 2014 to June 2015.@*Methods@#This is a retrospective, cross-sectional, descriptive single-center study. Medical records of 85 patients who consulted at the Emergency or Out-Patient Clinics of the Department of Ophthalmology and Visual Sciences of the Philippine General Hospital, Manila due to eyelid injuries that resulted to skin breaks with or without tissue loss or other ocular co-morbidities were reviewed. Information collected included: demographic data of the patient; the offending object; mechanism, place, date and time of injury; date and time of consult; possible risk factors and predisposing conditions such as alcohol intoxication and lack of use of protective gears. Complications associated with eyelid injuries were also noted. Descriptive statistics was used for analysis of patient demographics, epidemiologic characteristics of eyelid injuries and its associated complications.@*Results@#Of the 85 cases, 78% were males. Most of the patients were below 50 years of age with a range of 1-79 and a mean age of 25 years old. There is male preponderance across all age groups except in the pediatric group below 10 years of age. The right eye was involved in 58% of cases. The most common area affected was the right lower lid as seen in 36 cases. Most of the eyelid injuries were severe: 21 (25%) were margin-involving, 17 (20%) had canalicular transection and 34 (40%) had both. Other co-morbidities included some degree of tissue loss or avulsion (16%) and globe involvement (29%). Majority were accidental (36%). Public places (33%) and the home (33%) were the most common places of injury. Most of the injuries that happened at home were accidents (82%) while those that occurred in public places were mostly assault cases (71%). The most common offending objects that caused the eyelid injuries included metal (33%), pavement/cement (18%), and wood (16%). The most common mechanism of injury was blunt trauma (67%). There were 18 cases of vehicular crash, 89% of the patients were not wearing helmets. All work-related injuries reported absence of protective gear. Alcohol intoxication was reported in 30% of assault cases and 72% of vehicular crash. @*Conclusion@#Eyelid injuries continue to pose as a public health concern. Campaigns organized toward educating the public can stress on the importance of increased vigilance regarding safety especially in children and young adults. Use of protective gear and eyewear while driving or working in hazardous environments should also be emphasized. Monitoring of public places for any disturbance can prevent violent acts from escalating. The AntiDrunk and Drugged Driving Act of 2013 should also be strictly enforced.

Work-related Road Traffic Crash: Is Return to Work Rate After Rehabilitation Better With Outcome-focused Intervention?

Abstract@#Introduction: Work-related road traffic crashes (RTC) are a significant global public health challenge due to the seriousness of its consequences. Injured workers who have survived work-related RTC are advised to go for rehabilitation after they have been treated physically by healthcare providers. Reintegrate as soon as possible into the working community able avoid long periods of sick leave. Return to work (RTW) rate have been used extensively in many previous studies as an indicator of rehabilitation outcomes on the working capacity of injured workers. The objective of this study was to compare RTW rate after rehabilitation for injured workers who received physical rehabilitation only (control group) and physical rehabilitation plus outcome-focused intervention (intervention group). Methods: Eligible 200 workers who were involved in work-related RTC and agreed to participate in SOCSO RTW Program were identified and invited to be part of this study. Sociodemographic, employment and injury-related questions were distributed. Results: This study finding showed majority (79.5%) of the respondents were aged 25 years old or older, male (86.0%), married or divorced (63.5%), and attained secondary and below education level at secondary or below (66.0%). More than half of injured workers consisted of blue-collar workers (69%), had fracture injury (93.0%), and had injury to their lower limbs (48.5%). RTW rate was higher in the intervention group (received physical rehabilitation and outcome-focused intervention) compared to the control group (received physical rehabilitation only). Conclusion: RTW rate for work-related RTC was higher with outcome-focused intervention, in addition to physical rehabilitation.

Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia

@#Introduction: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. Conclusion: The guideline highlights select pre-hospital criteria’s and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.

Reconstruction of Vehicle-pedestrian Collision Road Traffic Accidents Based on PC-Crash Software / 法医学杂志

Objective To discuss the application value of vehicle-pedestrian collision road traffic accidents reconstruction based on PC-Crash software in forensic identification. Methods A case of vehicle-pedestrian collision was chosen based on a tachograph, then PC-Crash software was applied to construct a vehicle-pedestrian collision model, and reconstruct the vehicle-pedestrian collision road traffic accident. Finally, the process of vehicle-pedestrian collision was reproduced. Results In accident reconstruction, when the car speed was lower than 50km/h, the landing point of the pedestrian after collision was in the front of the car. When the car speed was higher than 50 km/h, after collision, the pedestrian flipped towards the car roof and landed behind the car. With the increase of vehicle speed, throwing distance of the pedestrian increased continuously. When the vehicle collision speed reached 60 km/h, the experimental results in this case were basically consistent with the actual situation of the case. Head acceleration of the pedestrian was at the maximum （1 655.70 m/s2） at 0.080 s. Chest acceleration of the pedestrian increased from 597.63 m/s2 to the peak 675.52 m/s2 at 0.055-0.060 s. Tibia acceleration of the pedestrian increased from 759.26 m/s2 to the first peak 1 367.06 m/s2, then reached the maximum speed （1 718.19 m/s2） at 1.225 s. Conclusion The process of vehicle-pedestrian collision road traffic accidents can be reconstructed based on PC-Crash software under a situation of limited conditions, and can further clarify the speed of the vehicle, the location and degree of human body injury as well as the mechanism of damage of the pedestrian in the accident. Therefore, PC-Crash software has a certain practical value in forensic identification of road traffic accidents.

Muscle activity during low-speed rear impact / 中华创伤杂志(英文版)

PURPOSE@#Whiplash associated disorders remain a major health problem in terms of impact on health care and on societal costs. Aetiology remains controversial including the old supposition that the cervical muscles do not play a significant role. This study examined the muscle activity from relevant muscles during rear-end impacts in an effort to gauge their influence on the aetiology of whiplash associated disorders.@*METHODS@#Volunteers were subjected to a sub-injury level of rear impact. Surface electromyography (EMG) was used to record cervical muscle activity before, during and after impact. Muscle response time and EMG signal amplitude were analysed. Head, pelvis, and T1 acceleration data were recorded.@*RESULTS@#The activities of the cervical muscles were found to be significant. The sternocleidomastoideus, trapezius and erector spinae were activated on average 59 ms, 73 ms and 84 ms after the impact stimulus, respectively, prior to peak head acceleration (113 ms).@*CONCLUSION@#The cervical muscles reacted prior to peak head acceleration, thus in time to influence whiplash biomechanics and possibly injury mechanisms. It is recommended therefore, that muscular influences be incorporated into the development of the new rear-impact crash test dummy in order to make the dummy as biofidelic as possible.

Crashes and Traffic Signal Violations Caused by Commercial Motorcycle Couriers

BACKGROUND: Motorcycles are one of the important members of commercial transportation because of the convenient use during congested traffic conditions and the ease of parking in narrow streets. This study investigates the characteristics of crashes and traffic signal violations caused by motorcycle couriers. METHODS: From the national compensation data, this study analyzed the traffic crashes caused by 671 motorcycle couriers. RESULTS: Among 671 injured couriers, 50.6% were aged less than 40 years, 49.2% run in a small business of < 5 employees, and 47.2% had work experience of < 6 months. Motorcycle crashes occurred mainly due to “rider overturned alone” (67.5%), in the daytime (73.5%), or on cloudy or clear days (77.2%). However, the violation rate caused by motorcycle couriers was high in couriers in a small business of < 5 employees (13.9%), with work experience of < 6 months (13.9%), on cloudy or clear days (12.4%), on an intersection (29.8%), in the type of “crash with a vehicle” (31.2%), or in a death accident (35.7%). CONCLUSION: The findings of this study can be used as a baseline in devising policies for preventing crashes of motorcycle couriers.

The Emergency Department Crash Cart: A systematic review and suggested contents / 世界急诊医学杂志（英文）

BACKGROUND: As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specificaly discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients. METHODS: The authors performed a systematic review of EDCC-specific literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council (ERC) guidelines for resuscitation, and the 2013 American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS) 9th edition. RESULTS: There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the final four articles specific to EDCC, and proposes a set of suggested contents for the EDCC. CONCLUSION: Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.

Research Progress of Traffic Accident Reconstruction Technology Based on PC-Crash Software / 法医学杂志

With the development of the computer simulation technology and the digital simulation technology, the traditional calculation method has been gradually replaced by the digital method to deal the road traffic accident scene and analyse the process. The PC-Crash software simulation system can reconstruct the traffic accidents within 32 vehicles, and the accuracy of reconstruction has been fully verified, which is widely used by the transport police department and the accreditation agency. In this paper, the research of road traffic accident reconstruction using PC-Crash software is reviewed, and the application of road traffic accident reconstruction technology based on PC-Crash software and some existing problems in forensic practice are discussed, which provides reference for the research and identification of road traffic accident simulation and reconstruction and theoretical basis for accident treatment.

Investigation on occupant injury severity in rear-end crashes involving trucks as the front vehicle in Beijing area, China / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Rear-end crashes attribute to a large portion of total crashes in China, which lead to many casualties and property damage, especially when involving commercial vehicles. This paper aims to investigate the critical factors for occupant injury severity in the specific rear-end crash type involving trucks as the front vehicle (FV).</p><p><b>METHODS</b>This paper investigated crashes occurred from 2011 to 2013 in Beijing area, China and selected 100 qualified cases i.e., rear-end crashes involving trucks as the FV. The crash data were supplemented with interviews from police officers and vehicle inspection. A binary logistic regression model was used to build the relationship between occupant injury severity and corresponding affecting factors. Moreover, a multinomial logistic model was used to predict the likelihood of fatal or severe injury or no injury in a rear-end crash.</p><p><b>RESULTS</b>The results provided insights on the characteristics of driver, vehicle and environment, and the corresponding influences on the likelihood of a rear-end crash. The binary logistic model showed that drivers' age, weight difference between vehicles, visibility condition and lane number of road significantly increased the likelihood for severe injury of rear-end crash. The multinomial logistic model and the average direct pseudo-elasticity of variables showed that night time, weekdays, drivers from other provinces and passenger vehicles as rear vehicles significantly increased the likelihood of rear drivers being fatal.</p><p><b>CONCLUSION</b>All the abovementioned significant factors should be improved, such as the conditions of lighting and the layout of lanes on roads. Two of the most common driver factors are drivers' age and drivers' original residence. Young drivers and outsiders have a higher injury severity. Therefore it is imperative to enhance the safety education and management on the young drivers who steer heavy duty truck from other cities to Beijing on weekdays.</p>

Current Status and Proposal of Drowsy Driving

Drowsy driving is a major cause of automobile crashes which can lead to more serious injuries than other causes of traffic accidents. Here, we review the accumulated scientific evidences and legal decisions of drowsy driving in various countries. Also, we highlight recent institutional strategies and developing technologies for prevention of drowsy driving. To prevent drowsy driving, raising public awareness as well as collaboration of professionals in various fields are requisites.

The Buffering analysis to identify common geographical factors within the vicinity of severe injury related to motor vehicle crash in Malaysia / 世界急诊医学杂志（英文）

@#BACKGROUND: The main objective was to identify common geographical buildup within the 100-meter buffer of severely injured based on injury severity score (ISS) among the motor vehicle crash (MVC) victims in Malaysia. METHODS: This was a prospective cohort study from July 2011 until June 2013 and involved all MVC patients attending emergency departments (ED) of two tertiary centers in a district in Malaysia. A set of digital maps was obtained from the Town Planning Unit of the district Municipal Office (local district map). Vector spaces were spanned over these maps using GIS software (ARCGIS 10.1 licensed to the study center), and data from the identified severe injured cases based on ISS of 16 or more were added. Buffer analysis was performed and included all events occurring within a 100-meter perimeter around a reference point. RESULTS: A total of 439 cases were recruited over the ten-month data collection period. Fifty two (11％) of the cases were categorized as severe cased based on ISS scoring of 16 and more. Further buffer analysis looking at the buildup areas within the vicinity of the severely injured locations showed that most of the severe injuries occurred at locations on municipal roads (15, 29％), straight roads (16, 30％) and within villages buildup (suburban) areas (18, 35％). CONCLUSION: This study has successfully achieved its objective in identifying common geographical factors and buildup areas within the vicinity of severely injured road traffic cases.

Componentes descriptivos y explicativos de la accidentalidad vial en Colombia: incidencia del factor humano / Descriptive and explanatory components of road accident rate in Colombia: Influence of the human factor / Componentes descritivos e explicativos da acidentalidade rodoviária na Colômbia: incidência do fator humano

Problema: Se analizó la incidencia del factor humano en la accidentalidad vial en el territorio colombiano, y se identificó evidencia empírica para la formulación de política pública del tránsito. Metodología: El diseño es descriptivo-correlacional. Instrumentos: cuestionario de comportamiento para conductores y motociclistas (D.B.Q.) y encuesta tipo Likert. Muestra no probabilística intencional: 16.322 personas (8.631 conductores de automotores, 5.133 motociclistas y 2.558 peatones, pasajeros y acompañantes). Resultados: a) conductores con nivel educativo superior inciden en menos accidentes; b) peatones con menor nivel educativo inciden en mayores conductas riesgosas; c) las mujeres tienen actitud positiva y perciben eficacia de campañas en prevencion; d) estilos de conducción iracundo, ansioso, riesgoso y de alta velocidad cometen más infracciones y accidentes; e) desobedecer señales de tránsito, la principal causa de accidentalidad; f) agresividad, hostilidad y estrés en el tránsito son factores que aumentan la probabilidad de accidente; g) campañas de prevención no están siendo captadas por la población más afectada. Conclusiones y recomendaciones: Los factores de accidentalidad vial guardan correspondencia con el Triángulo de Seguridad Vial establecido por la Organización de las Naciones Unidas –factor humano preponderante en la accidentalidad–. Lineamientos de política pública fundamentados en procesos educativos y corporativos tendientes a disminuir la accidentalidad por lo general no se concibe aplicada a la seguridad pública. Por ello, se presenta la inteligencia criminal como una disciplina que se ocupa de anticipar los riesgos criminales contra la seguridad pública. Esto permitiría disminuir la incertidumbre durante la toma de decisiones y calcular los daños contra la seguridad pública, que se pretende prevenir.

Problem: The influence of the human factor on accident rates in the Colombian territory was analyzed, and empirical evidence was identified for the formulation of public traffic policy. Methodology: The design is descriptive-correlational. Instruments: A behavior questionnaire (the D.B.Q.) for car drivers and motorcyclists, and a Likert-type survey. An intentional non-probabilistic sample: 16,322 individuals (8,631 vehicle drivers, 5,133 motorcyclists and 2,558 pedestrians, passengers, and accompanying persons). Results: a) drivers with a higher educational level have a lower impact on the accident rate; b) pedestrians with a lower educational level exhibit more risky behaviors: c) women have a poenfusitive attitude and perceive the effectiveness of prevention campaigns; d) angry, anxious, risky and high-speed driving result in more traffic offenses and accidents; e) disobeying traffic signs is the main cause of accidents; f) aggressiveness, hostility and stress are factors tending to increase the likelihood of traffic accidents; g) prevention campaigns are not being heard by the more affected population. Conclusions and recommendations: The accident rate factors correspond to the Road Safety Triangle established by the UNO –human factor prominent in accident levels–. Public policy guidelines based on educational and corporative processes leading to reduce the accident rate.

Problema: A incidência do fator humano na acidentalidade rodoviária no território colombiano foi analisada e a evidência empírica para a formulação da política pública do tráfego foi identificada. Metodologia: O projeto é descritivo-correlacional. Instrumentos: questionário do comportamento para os motoristas e os motoqueiros (D.B.Q.) e pesquisa tipo Likert. Amostra intencional não-probabilística: 16.322 pessoas (8.631 condutores de automotores, 5.133 motoqueiros e 2.558 pedestres, passageiros e companheiros). Resultados: a) os condutores com nível educativo superior incidem em menos acidentes; b) os pedestres com nível educativo menor incidem em maiores condutas de risco; c) as mulheres têm uma atitude positiva e percebem a eficácia das campanhas na prevenção; d) os estilos de dirigir enfurecido, ansioso, riscoso e da alta velocidade contribuem a cometer mais infrações e acidentes; e) para desobedecer sinalizações rodoviárias, a causa principal da acidentalidade; f) a agressividade, a hostilidade e o stress no tráfego são os fatores que aumentam a probabilidade do acidente; g) as campanhas da prevenção não são captadas pela população afetada. Conclusões e recomendações: Os fatores da acidentalidade rodoviária correspondem ao Triângulo da Segurança Rodoviária estabelecido pelas Nações Unidas – fator humano preponderante na acidentalidade–. Diretrizes da política pública baseadas em processos educativos e corporativos tendentes a diminuir a acidentalidade.

Attitudes towards child restrains and seat belts usage in the learned population of Karachi, Pakistan / 世界急诊医学杂志（英文）

BACKGROUND: Motor vehicles crashes (MVCs) are the leading cause of injury related morbidity and mortality in developed countries. Recent evidence proves that properly used child seat belts can dramatically reduce the risk of severe and life-threatening injury from MVCs. There are rarities of thought and inspiration regarding the use of child seat belts in our society and region, therefore we lack of data regarding factors and paucity of usage of child seat belts in motor vehicles. This study aimed to assess the knowledge and attitudes of child seat belt usage among the educated population in Karachi, Pakistan. METHODS: Altogether 304 employees were investigated. They were employees of Aga Khan University who were using their cars and having children younger than 10 years old. A cross sectional observational study was designed, and a 36-item questionnaire in English was used to collect data on participants' demographic details, designation, educational level, economic status, validity of driving license, number of children and cars, availability of adult seat belts and child seat belts along with their functionality, awareness, knowledge and attitude toward its use, and reason of not using these devices. SPSS version 20 for Windows was used to analyze the data and the Chi-square test was used. RESULTS: Totally 290 participants were recruited with a response rate of 72％ (212). Of 212 participants, 126 (59％) were male. 154 (72.6％) participants had valid driver licenses, and 154 (72.6％) had adult seat belts in their vehicles. Only 32 (15％) reported regular use of adult seat belts. Although 168 (79.2％) participants had some knowledge about child restrains (CRs), only 65 (22％) had CRs in their cars. Eighty-two (38.7％) participants got the knowledge about CRs and seat belts from media. Mothers were more concerned about the use of CRs than fathers. Only 14 (6.6％) parents were found to use both adult and child seat belts all the time. Of the 157 parents who did not us use CRs, 42 considered unnecessary, 35 lacked relevant knowledge. But 15 parents used CR against their children's wills. CONCLUSIONS: The pattern of CR usage among the employees at Aga Khan University, Karachi is dictated by the unavailability of CR, followed by ignorance, inconvenience, and non-acceptance by their children. The important issue of CR has consistently been ignored over the years and it has never gained enough popularity in Pakistan.

Research progress on foot and ankle injuries of occupants in frontal motor vehicle crashes / 医用生物力学

Road traffic injuries have become a major social issue. With the development of technology, legislation and safety consciousness, the fatal rate of brain and chest injuries has been declined. However, as to prevent foot and ankle injuries of occupants still no effectual protective devices have been developed. In this paper, research progress on foot and ankle injuries of occupants was reviewed, which found out that most of such injuries in the frontal motor vehicle crashes occurred more easily to the drivers, which was possibly due to the special loading on their lower extremity during braking. Although there still exists a continuing debate about taxonomy of the frontal motor vehicle crashes, researchers have approached unified understanding that foot and ankle injuries are usually caused in the real-world narrow object frontal crashes. Until now, studies on foot and ankle injury and its protective mechanisms in various types of crashes are rarely conducted. A combination of the in-vitro experiment and computational modeling would be an ideal method to solve this issue.

Accidentes de tránsito terrestre / Road traffic accidents

Los accidentes de tránsito terrestres en Costa Rica se han convertido en un serio problema de salud pública, que derivan ya sea en lesiones graves o bien en muertes de personas de todas las edades. Estos eventos incluyen el atropellamiento, las colisiones y choques, y producen cuadros lesionológicos muy diversos de acuerdo a la participación de las personas, el tipo de vehículo y la forma en la que se produce el traumatismo. Así mismo, se debe tener en cuenta la participación de factores coadyuvantes como el uso del casco y el cinturón de seguridad, o bien el consumo de alcohol y el uso del teléfono móvil. La valoración médico legal de las víctimas, vivas o muertas de accidentes de tránsito, está a cargo del Departamento de Medicina Legal del Organismo de Investigación Judicial, y se hace por solicitud de una Autoridad Judicial competente.

Traffic accidents in Costa Rica have become a major public health threat, since they produce severe injuries o even death of people of all ages. These events include car run over, collisions and car crashes, which derive in a huge variety of injuries, regarding the roll that people play in the accident, the vehicle involved and the manner in which trauma is held. Nevertheless, out coming factors such as the use of helmet, the buckling of seat belts, alcohol drinking and mobile phone use must be considered an assessed. The medical examination of victims, living or death in traffic accidents might be requested by Costa Rican Court of Law, and is the task of the Departamento de Medicina Legal of the Organismo de Investigación Judicial, which is the government office in charge of crime investigation.