Cuidado de heridos en el combate táctico / Care of wounded in tactical combat

Introducción: las fuerzas armadas norteamericanas han estado desarrollando un sistema de tratamiento y evacuación médico expedicionario que permite disminuir el número de fallecidos hasta valores muy bajos. Uno de los factores que ha facilitado este resultado es el protocolo de tratamiento de las bajas sanitarias en combates tácticos conocido en inglés como Tactical Combat Casualty Care. Objetivo: brindar información actualizada sobre el origen y conceptos de este. Métodos: se revisó la literatura internacional utilizando combinaciones de palabras claves relacionadas con este tema mediante buscadores (Pubmed, Clinicalkey, Hinari, Ebsco), desde enero del 2001 hasta noviembre del 2016. Desarrollo: en el año 1984 el Coronel Ronald Bellamy del ejército de los EE.UU. en su artículo denominado Causas de muertes en el combate terrestre convencional. Implicaciones en las investigaciones sobre las bajas sanitarias, desafió a la comunidad militar para que enfrentara estas realidades, revisó las causas de muerte en escenarios combativos analizando los datos históricos sobre heridas recogidos por diferentes investigadores que se basaron en la efectividad de las diferentes municiones durante la guerra de Vietnam. Definió que durante las operaciones combativas terrestres convencionales, la mayoría de las muertes resultan por heridas catastróficas. Conclusiones: este protocolo surgió por la necesidad de disminuir las muertes prevenibles en los escenarios combativos y bajo consideraciones tácticas. Debido a su gran repercusión en el tratamiento del lesionado en los escenarios combativos se ha convertido en el documento rector de los servicios médicos de la mayoría de los ejércitos del mundo(AU)

Introduction: The United States Armed Forces have been developing an expeditionary medical treatment and evacuation system that allows to reduce the number of deaths to very low. One of the factors that has facilitated this result is the Tactical Combat Casualty Care protocol. Objective: To provide updated information on the origin and concepts of this. Methods: The international literature was reviewed using combinations of keywords related to this topic through search engines (Pubmed, Clinicalkey, Hinari, Ebsco), from January 2001 to November 2016. Body: In 1984 Colonel Ronald Bellamy of the Army of the USA in his article entitled Causes of deaths in conventional terrestrial combat. Implications of Health Disposal Investigations, challenged the military community to address these realities, reviewed causes of death in combat scenarios by analyzing historical data on injuries collected by different researchers who relied on the effectiveness of different ammunition during the Viet Nam war. He stated that during conventional ground fighting operations, most of the deaths result from catastrophic injuries. Conclusions: This protocol arose because of the need to reduce preventable deaths in combat scenarios and under tactical considerations. Due to its great impact in the treatment of the injured in the combative scenarios has become the guiding document of the medical services of the majority of the armies of the world(AU)

Profile of community death events among urban poor residents: community-based mortality survey and case study in Ancol Village, North Jakarta, Indonesia / 国際保健医療

<B>Background</B><BR>Mortality statistics are key inputs for evidence based health policy at national level. However mortality statistics alone does not provide necessary information for further identification of improvement opportunities which could be manageable in local health systems in the place where vital registration system is not established.<BR>This study intends to disclose the profile of death events among the urban poor, with aim to identify improvement opportunities from the view of quality management of local health system.<BR><B>Methods</B><BR>Eleven communities in Ancol, Jakarta, were selected for the survey, and the information of death events were collected from community leaders of rukun warga (RW), village office, health centers, hospitals, and public cemeteries. The families or co-habitants of the deceased cases under 55 years old were interviewed.<BR><B>Results</B><BR>Two hundred and twenty four of death events were identified. The number reported in the demography statistics was 114 in 24 months during the same period, while 67 cases less than 55 years old were investigated by interview regarding history prior to death. . Thirty-eight percent died at healthcare facilities while 59% died at home. Private services were consulted as frequently as public services. Case studies based on history review revealed “improvement opportunities” in local health systems, and some of those critically contributed to eventual deaths which would be prevented by improvement in quality management of local health systems.<BR><B>Conclusion</B><BR>Community death events were good tracer for assessment of actual performance of local health systems as well as for identifying improvement opportunities.