Frequency of deployed emergency donor panel use prior to implementation of the low titre group O whole blood program.

INTRODUCTION: The US military has frequently used a 'walking blood bank', formally known as an 'emergency donor panel' (EDP) to obtain warm fresh whole blood (WFWB) which is then immediately transfused into the casualty. We describe the frequency of EDP activation by the US military. METHODS: We analysed data from 2007 to 2015 within the Department of Defense Trauma Registry for US, Coalition and US contractor casualties that received at least 1 unit of blood product within the first 24 hours and described the frequency of WFWB use. RESULTS: There were 3474 casualties that met inclusion, of which, 290 casualties (8%) required activation of the EDP. The highest proportion of EDP events was in 2014, whereas the highest number of EDP events was in 2011. Median injury severity scores were higher in the recipients, compared with non-EDP recipients (29 vs 20), as were proportions with serious injuries to the abdomen (43% vs 19%) and extremities (77% vs 65%). The median number of units of all blood products, except for packed red blood cells, was higher for WFWB recipients. Of the WFWB recipients, the median was 5 units (IQR 2-10) with a maximum documented 144 units. There were four documented cases of EDP recipients receiving >100 units of WFWB with only one surviving to hospital discharge. During the study period, there were a total of 3102 (3%) units of WFWB transfused among a total of 104 288 total units. CONCLUSIONS: We found nearly 1 in 11 casualties who received blood required activation of the EDP. Blood from the EDP accounted for 3% of all units transfused. These findings will enable future mission planning and medical training, especially for units with smaller, limited blood supplies. The lessons learned here can also enable mass casualty planning in civilian settings.

Significant attitude changes among residents associated with a pediatric nurse practitioner.

In the study reported here, significant changes in attitudes occurred over a three-year period among pediatric residents who had close association with a pediatric nurse practitioner (PNP) in their residency program. Residents entering the training program had an overall uncertain attitude toward PNPs but did respond favorably to the PNP's participation in the care of well children, patient education, and follow-up care. The greatest number of attitude changes toward the PNP took place after the first year of interaction between the residents and the PNP. After the first year, the residents favored the PNP's participation in the care of minor illnesses and stable chronic illnesses and in management of telephone calls from parents with concerns. Second-year residents also felt that the PNP was accepted by patients and physicians, that the PNP contributed to the reduction of health care costs, and that the PNP should have an expanded role. Upper-level residents continued to express favorable attitudes. The findings support the authors' hypothesis that favorable attitudes on the part of physicians toward PNPs can be cultivated during residency training by exposing residents to a PNP role model. In addition, the findings suggest that subsequent years of exposure will reinforce these favorable opinions if favorable opinions are established early in residency training.

Evaluation techniques in family practice residency training.

Evaluation is recognized as an essential component of an educational program, yet implementation of evaluation is difficult and few models exist. This article outlines an evaluation program implemented by one family practice residency.