Unique Challenges for WHO Emergency Medical Teams in Ukraine: Field Assessment & Global Recommendations.

The purpose of WHO Emergency Medical Teams is to Minor wording edit recommendations: 'to provide timely, high-quality health services.' (removed 'of') 'in the immediate aftermath of disasters and during disease outbreaks and other emergencies, including conflict and insecurity.'improve the timeliness and quality of health services by national and international Emergency Medical Teams in the immediate aftermath of a disaster, outbreak, and other emergencies, including war and conflicts. 'The war in Ukraine has presented all healthcare providers with many unique challenges'. What is meant by this? All Ukrainian HCPs, all HCP operating in Ukraine? Can you be more specific regarding what you are trying to say.The war in Ukraine has presented all healthcare providers with many unique challenges. This assessment addresses would edit to: 'the importance and the complexities of' the importance of and the complexities of the global spread of the Emergency Medical Team system challenges to meet a wide variety of crises including war, those that are unique to this very complex crisis in Ukraine, and the essential role of educational initiatives, not only in professional development but also in teamwork and cultural integration.

Enhancing disaster response of emergency medical teams through "TEAMS 3.0" training package-Does the multidisciplinary intervention make a difference?

Background: In the aftermath of disasters, Emergency Medical Teams (EMTs) are dispatched to help local rescue efforts. Although EMTs are recognized to be a critical component of the global health workforce, concerns have emerged over their functioning and effectiveness. For example, lack of cooperation and coordination between different EMTs has been a longstanding issue, resulting in fragmented disaster management. Methods: To enhance the provision of EMT's field teamwork, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established, and later further updated with novel scenarios and exercises (i.e., adapting EMT operations to a sudden disaster; becoming a modular team; reflecting on ethical dilemmas) in the complementary "TEAMS 3.0" project where a more comprehensive training package was developed. The aim of this study was to assess the effectiveness and quality of the TEAMS 3.0 training package in four training programs in Portugal, Germany, Norway, and Turkey. Participants completed a set of questionnaires designed to assess self-efficacy, teamwork, and quality of training. Results: The results from all the trainings suggest an improvement for both teams' self-efficacy and teamwork. The mean score among all the participants (N = 100) for both the self-efficacy scale and teamwork scale was 3.217 (±0.223) prior to training and 3.484 (±0.217) following the training, and 2.512 (±1.313) prior to training and 3.281 (±0.864), respectfully, with statistically significant differences according to Wilcoxon paired samples test (p < 0.05). The quality of training is regarded as high and deemed as an appropriate tool package for addressing the objectives of the project and the perceived needs of EMT disaster deployment. Conclusion: Thus far, the TEAMS 3.0 project has demonstrated to be effective in promoting EMT teamwork capacities.

Public conformism with health regulation is crumbling as COVID-19 becomes a chronic threat: Repeated Cross-sectional Studies.

BACKGROUND: The purpose of this study is to analyze the long terms trends in public attitudes toward the COVID-19 pandemic and compliance with self-quarantine regulations. METHODS: Repeated cross-sectional studies looking into data collected from nationally representative samples (N = 2568) of the adult population in Israel at five points in time representing the five morbidity waves of the COVID-19 pandemic. This study examined public trust in Israeli health regulations, levels of public panic, feelings of personal worry, and compliance with health regulations, specifically self-quarantine. RESULTS: Public trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value of nearly 75% measured in March 2020. While reported worry is steadily reducing, the perception of public panic is increasing. In earlier rounds, public compliance with self-quarantine was reported close to 100%; however, it has dropped to 38% by January 2022 when compensation is not assumed. Regression analysis suggests that trust is a major predictor of compliance with health regulations. CONCLUSIONS: The "fifth wave" of the COVID-19 pandemic brought about an all-time low in public trust in health regulations. The Israeli public, normally a highly compliant one, is showing signs of crumbling conformity.

Rethinking the Current "Stage-and-Wait" Paradigm.

INTRODUCTION: The experience of terrorist incidents involving a secondary explosive device that targeted rescue forces led to changes in the safety protocols of these forces in most countries of the world. These protocols are the foundation of the current "Stage-and-Wait" paradigm that prohibits the entry of Emergency Medical Services (EMS) from entering the scene and treating casualties until it is deemed safe. These guidelines were established absent of an evidence-base detailing the risk to responders and the potential consequences to the injured on-scene. The lack of clarity is compounded by the fact that different situations, as well as operational considerations, such as the length of time until bomb squad arrival at the scene versus time of massive bleeding injuries, for example, impact outcomes must be taken into account. OBJECTIVE: This study sought to shed light on this matter while employing an evidence-based approach exploring the investigations of the frequency of secondary explosion threats in terrorist attacks over the last 20 years and discussing some of the ethical challenges and ramifications ensuing. While this study does not propose an outright change to current guidelines, in light of the evidence gathered, an open review and discussion based on the findings may be beneficial. METHODS: The Global Terrorism Database (GTD) was used as the data source of bombing incidents world-wide. RESULTS: The results revealed that approximately 70 per-1,000 bombing incidents involved secondary explosions across regions and countries within the study period. CONCLUSION: This study emphasizes the need to rethink the current "Stage-and-Wait" paradigm by recommending brainstorming conferences comprised of multi-sectoral experts aimed at deliberating the matter. World-wide experts in emergency medicine, bioethics, and disaster management should cautiously consider all aspects of bomb-related incidents. These brainstorming deliberations should consider the calculated risk of secondary explosions that account for approximately 70 per-1,000 bombing incidents. This study highlights the need to re-examine the current versus new paradigm to achieve a better balance between the need to ensure EMS safety while also providing the necessary and immediate care to improve casualty survival. This ethical dilemma of postponing urgent care needs to be confronted.

Do first responders and populations perceive risks similarly? A comparative study of seven countries.

Introduction: Risk perception illustrates the subjective evaluation of individuals concerning the characteristics, severity, and capacity to cope with potential hazards. Risk perception influences attitudes and actions individuals take to protect themselves from future threats. Risk perceptions might change among different stakeholder groups such as society and first responders. Identifying risk perceptions of stakeholders is essential to establish effective protective measures. Method: This study investigated the commonalities and diversities in risk perception among first responders and the public, within and between seven European and beyond countries. A self-administered questionnaire was used to gather data from both first responders and civilians. They were asked to assess their risk perception level for five categories of risks (Extreme weather-related events, nature-related events, social disruptions, critical services dependencies, and pandemics). Results: Using Univariate Analysis of Variance showed disparity concerning both the levels of risk perception between the public and first responders, as well as their relative ranking. For example, concerning extreme weather-related and nature-related events, risk perception levels of the first responders is higher than that of the population in six out of the seven studied countries. In contrast, the population's risk perception is higher compared to the first responders in six out of the seven countries, concerning critical infrastructure dependencies and pandemics. Discussion: The relative gaps between the first responders versus the population, within each country, vary considerably. Norway for example presents significant differences between the two internal populations concerning all risks (except for extreme weather), while in Sweden, no significant gaps were identified, concerning all five risks.

Combat Injury Profile in Urban Warfare.

INTRODUCTION: Combat ground maneuvers consist of various platforms and have several environmental characteristics, influenced by the terrain, the operational mission, and the force's capabilities. This study assesses data on injuries sustained during urban warfare, aiming to evaluate the relationship between injury characteristics, maneuver platform, and personal protective gear on the battlefield. MATERIALS AND METHODS: IDF soldiers injured infantry soldiers from the "Cast Lead" and the "Protective Edge" operations in the Gaza Strip (2008-2009 and 2014, respectively) were divided into four groups according to the maneuver platform and the environment: mounted infantry (armored and unarmored vehicle) and dismounted infantry (urban and open area). The primary outcome was the severity of the injury, and the secondary outcome was the injured body part. RESULTS: Overall, 588 casualties were included in the final analysis, of whom 507 were dismounted infantry soldiers (265 in open terrain and 242 in urban area) and 81 were mounted infantry soldiers (20 in unarmored and 61 were injured in armored vehicles). The Injury Severity Score was similar in all subgroups. Open terrain subgroups were found to have fewer head injuries and higher levels of lower extremity injuries, similar to the unarmored vehicle group. More facial injuries were documented in the urban area group. CONCLUSIONS: The Injury Severity Score was not influenced by environmental protection. Although we found differences in the injured body parts, further studies on the exact mechanism of injury are needed to elucidate further the relationship and differences between the various platforms used and injuries seen in urban warfare, aiming for tailor-made protection.

Applying the Haddon Matrix to Frontline Care Preparedness and Response in Asymmetric Warfare.

INTRODUCTION: Asymmetric warfare and the reaction to its threats have implications in the way far-forward medical assistance is provided in such settings. Investments in far-forward emergency resuscitation and stabilization can contribute to saving lives and increase the resilience of health systems. Thus, it is proposed to extend the use of the Haddon Matrix to determine a set of strategies to better understand and prioritize activities to prepare for and set-up frontline care in the form of Trauma Stabilization Points (TSPs). METHODS: An expert consensus methodology was used to achieve the research aim. A small subject matter experts' group was convened to create and validate the content of the Haddon Matrix. RESULTS: The result of the expert group consultations presented an overview of TSP Preparedness and Operational Readiness activities within a Haddon Matrix framework. Main strategies to be adopted within the cycle from pre- to post-event had been identified and presented considering the identified opportunities in the context of the possibility of implementation. Of particular importance was the revision of a curriculum that fits the civilian medical system and facilitates its adaptation to the context and available resources. CONCLUSION: The new framework to enhance frontline care preparedness and response using the Haddon Matrix facilitated the identification of a set of strategies to support frontline health care workers in a more efficient manner. Since the existing approach and tools are insufficient for modern warfare, additional research is needed.

Lockdown Efficacy in Controlling the Spread of COVID-19 May Be Waning Due to Decline in Public Compliance, Especially among Unvaccinated Individuals: A Cross-Sectional Study in Israel.

Public compliance is paramount for the success of public health measures and decision making, such as lockdowns, in controlling the spread of diseases. The aim of this population-based cross-sectional study was to investigate the level of reported compliance with home isolation among the adult Israeli population (n = 940) during the first three national lockdowns, compliance with a potential fourth national lockdown if enacted, risk perception of COVID-19, vaccination uptake status, perceived effectiveness of the vaccine, and compliance with additional protective health behaviors (e.g., mask wearing and social distancing). Following widespread compliance with initial lockdowns (90.7% reported "high" or "very high" compliance), as few as 60.1% of participants indicated that they would comply with a fourth lockdown if the government decides to enact it. Non-vaccinated individuals reported the lowest levels of compliance with previous lockdowns, compared to participants who received one or two vaccines and participants vaccinated with three doses. Adjusted for gender and age, the results suggest that fearing being infected with COVID-19, perceiving the vaccine to be effective, and reporting being compliant with other health behaviors-such as mask wearing and maintaining social distance from others-are predictors of lockdown compliance. Considering the effect of pandemic lockdown fatigue, there is little support for additional lockdowns among the Israeli public, unless dramatic changes occur in the characteristics of the COVID-19 pandemic. Compliance with lockdowns is reduced among individuals who are at higher risk of contracting COVID-19, therefore rendering this non-pharmaceutical intervention even less effective in reducing the spread of the disease.

Injuries From Explosions: More Differences Than Similarities Between Various Types.

OBJECTIVE: To compare injury patterns of different types of explosions. METHODS: A retrospective study of 4508 patients hospitalized due to explosions recorded in the Israel National Trauma Registry between January 1997 and December 2018. The events were divided into 4 groups: terror-related, war-related, civilian intentional explosions, and civilian unintentional explosions. The groups were compared in terms of injuries sustained, utilization of hospital resources, and clinical outcomes. RESULTS: Civilian intentional and terror-related explosions were found to be similar in most aspects except for factors directly influencing mortality and a larger volume of severely injured body regions among terror-victims. Comparisons between other groups produced some parallels, albeit less consistent. Civilian intentional explosions and civilian unintentional explosions were different from each other in most aspects. The latter group also differed from others by its high volume of life-threatening burns and a higher proportion of children casualties. CONCLUSIONS: While consistent similarities between explosion casualties exist, especially between victims of intentional civilian and terror-related explosions, the general rule is that clinical experience with a type of explosion cannot be directly transferred to other types.

Understanding Societal Resilience-Cross-Sectional Study in Eight Countries.

Civilian populations that are more prepared for emergencies are more resilient. Ample research has been carried out over the last three decades to identify the factors that contribute to public readiness to emergencies and disasters and enhance societal resilience. However, the analysis did not achieve an in-depth comprehension of the types of contributing factors, namely, contextual vs. target aspects. A cross-sectional study that explored attitudinal factors among civilian populations took place during the months of January-February 2021. Diverse representative samples (N ≥ 500 each) of adults from eight countries (Italy, Romania, Spain, France, Sweden, Norway, Israel, and Japan) were engaged. The primary outcomes of this study were individual and societal resilience as well as emergency preparedness. The results suggest that in most countries, levels of trust are relatively high for emergency services and health services, and relatively low for politicians. In the overall sample, the individual preparedness index, which delineates the compliance with general household adjustment recommendation for emergencies, averaged at 4.44 ± 2.05SD (out of 8). Some variability was observed between countries, with some countries (e.g., Spain, Norway, and Italy) reporting higher preparedness rates than others (e.g., Japan). In the overall sample, levels of individual resilience were mediocre. Multivariate analysis showed that the following variables are predictors of societal resilience: trust (ß = 0.59), social norms and communality (ß = 0.20), individual resilience (ß = 0.05), individual preparedness (ß = 0.04), risk awareness (ß = 0.04), and age (ß = 0.03). The results of this study show that there are commonalities and differences between societies across Europe and beyond concerning societal resilience at large, including preparedness, individual resilience, and risk perception. Despite socio-cultural driven differences, this study shows that societies share varied characteristics that may contribute toward a common model for assessing societal resilience and for explaining and predicting resilience and readiness.

Risk Perception of Natural and Human-Made Disasters-Cross Sectional Study in Eight Countries in Europe and Beyond.

Each year, emergency and disaster situations claim a heavy toll in human lives and economic loss. Civilian populations that are more aware and prepared for emergencies are more resilient. The aim of this study was to explore similarities and differences in risk perception of emergencies and disasters across different societies and its association with individual resilience. A cross sectional study that explored attitudinal factors, as expressed by diverse samples of target countries across Europe and beyond, took place during the months of January-February 2021. Diverse samples (N ≥ 500) of adults from 8 countries (Italy, Romania, Spain, France, Sweden, Norway, Israel, and Japan) were engaged in this study. This study used the Pictorial Representation of Illness and Self-Measure (iPRISM) tool to assess risk perception. The results suggest that for the overall sample (N = 4,013), pandemics were the risk of which participants showed the highest concern, followed by critical infrastructure fail, social disturbance, natural hazards, and extreme weather events. It was found that religiosity is associated with risk perception, with highly religious and non-religious reporting elevated risk perception (F = 5.735, df = 2, p = 0.003), however country-specific analysis revealed that this finding varies depending on local contexts. The analysis also revealed differences in risk perception depending on age and type of risk. The results of this study present that there are commonalities and differences between societies across Europe and beyond concerning societal resilience at large, including risk perception. The dependency of risk perception on local context suggests that a regional-based approach for disaster risk reduction may be called for to adapt and adjust to local socio-cultural characteristics of each population.

Is Diffuse Axonal Injury Different in Adults and Children? An Analysis of National Trauma Database.

BACKGROUND: Diffuse axonal injury (DAI) is typically associated with significant mechanisms of injury and the effects of acceleration-deceleration forces on brain tissues. The prognosis of DAI remains a matter of active investigation, but little is known about outcome differences between adult and pediatric populations with DAI. METHODS: We performed a retrospective cohort study involving blunt trauma patients with DAI between the years 1997 and 2018 from the Israeli National Trauma Registry. The patients were divided to pediatric (age <15 years) and adult (age >15 years) groups, with subsequent comparison of demographics and outcomes. RESULTS: Diffuse axonal injury was identified in 1983 patients, including 469 pediatric victims (23.6%) and 1514 adults (76.4%). Adults had higher Injury Severity Score (20.5% vs 13.2%, P = 0.0004), increased mortality (17.7% vs 13.4%, P < 0.0001), longer hospitalizations (58.4% vs 44.4%, P < 0.001), and higher rehabilitation need rates (56.4% vs 41.8%, P < 0.0001). Associated extracranial injuries were also more common in adults, particularly to the chest. CONCLUSIONS: Pediatric patients with DAI have improved outcomes and fewer associated injuries than adult counterparts.

Training Package for Emergency Medical Teams Deployed to Disaster Stricken Areas: Has 'TEAMS' Achieved its Goals?

In spite of their good intentions, Emergency Medical Teams (EMTs) were relatively disorganized for many years. To enhance the efficient provision of EMT's field team work, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established. The purpose of this study was to assess the effectiveness and quality of the TEAMS training package in 2 pilot training programs in Germany and Turkey. A total of 19 German and 29 Turkish participants completed the TEAMS training package. Participants were asked to complete a set of questionnaires designed to assess self-efficacy, team work, and quality of training. The results suggest an improvement for both teams' self-efficacy and team work. The self-efficacy scale improved from 3.912 (± 0.655 SD) prior to training to 4.580 (± 0.369 SD) after training (out of 5). Team work improved from 3.085 (± 0.591 SD) to 3.556 (± 0.339 SD) (out of 4). The overall mean score of the quality of the training scale was 4.443 (± 0.671 SD) (out of 5). In conclusion, The TEAMS Training Package for Emergency Medical Teams has been demonstrated to be effective in promoting EMT team work capacities, and it is considered by its users to be a useful and appropriate tool for addressing their perceived needs.

Pandemic Fatigue: The Effects Of The COVID-19 Crisis On Public Trust And Compliance With Regulations In Israel.

Social resilience and trust are two major components of the mitigation of the spread of contagious diseases. Although measures such as the imposition of national lockdowns and self-quarantines have been proven to be effective in reducing morbidity, their efficacy is dependent on public trust and compliance. The purpose of this study was to assess public attitudes toward the COVID-19 outbreak over the course of a year. A cohort study of the adult population in Israel was conducted during three waves of COVID-19 morbidity in that country, with February 2020 as the baseline, March 2020 for the first wave, August 2020 for the second, and January 2021 for the third. The results suggest that there is a relationship between risk perception and compliance with health regulations. Moreover, trust is a major component in public compliance. Fluctuations in risk perception and trust were found to affect compliance with regulations. The failure of decision makers to appropriately address the economic constraints imposed on the public during prolonged disasters, such as the COVID-19 outbreak, is likely to lead to a reduction in public trust in the government and to a decrease in societal resilience.

Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma: An analysis of a National Trauma Registry database.

PURPOSE: There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries, specifically for intra-abdominal injury (IAI). The impact of concomitant spinal cord injury (SCI) with the risk of associated IAI has not been well clarified. The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI. METHODS: A retrospective cohort study using the Israeli National Trauma Registry was conducted. Patients with thoracic, lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1, 1997 to December 31, 2018 were examined, comparing the incidence, severity and mortality of IAIs in patients with or without SCI. The collected variables included age, gender, mechanism of injury, incidence and severity of the concomitant IAIs and pelvic fractures, abbreviated injury scale, injury severity score, and mortality. Statistical analysis was performed using GraphPad InStat ® Version 3.10, with Chi-square test for independence and two sided Fisher's exact probability test. RESULTS: Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures. Combined thoracic and lumbar fractures were observed in 1272 patients (7.5%), isolated thoracic fractures in 4967 patients (29.4%) and isolated lumbar fractures in 10,639 patients (63.0%). The incidence of concomitant SCI was found in 4.95% (63/1272), 7.65% (380/4967) and 2.50% (266/10639) of these patients, respectively. The overall mortality was 2.5%, proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts (11.3% vs. 4.6%, p < 0.001). Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts (8.2% vs. 3.1%, p < 0.001). There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures; although isolated lumbar fractures patients with SCI were more likely to have renal (3.4% vs. 1.6%, p = 0.02) or bowel injuries (2.3% vs. 1.0%, p = 0.04) than the non-SCI counterparts. CONCLUSION: SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI. However, in a subset of isolated lumbar fractures, SCI patient is associated with increased risks for renal and bowel injury.

Early Trauma Predictors of Mobility in People with Spinal Cord Injury.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: This study aims to assess the potential value of very early trauma variables such as Abbreviated Injury Scale (AIS) and the Injury Severity Score for predicting independent ambulation following a traumatic spinal cord injury (TSCI). SUMMARY OF BACKGROUND DATA: Several models for prediction of ambulation early after TSCI have been published and validated. The vast majority rely on the initial examination of American Spinal Injury Association (ASIA) impairment scale and level of injury; however, in many locations and clinical situations this examination is not feasible early after the injury. METHODS: Patient characteristics, trauma data, and ASIA scores on admission to rehabilitation were collected for each of the 144 individuals in the study. Outcome measure was the indoor mobility item of the Spinal Cord Independence Measure taken upon discharge from rehabilitation. Univariate and multivariable models were created for each predictor, Odds ratios (ORs) were obtained by a multivariable logistic regression analysis, and area under the receiver operator curve was calculated for each model. RESULTS: We observed a significant correlation between the trauma variables and independent ambulation upon discharge from rehabilitation. Of the early variables, the AIS for the spine region showed the strongest correlation. CONCLUSION: These findings support using preliminary trauma variables for early prognostication of ambulation following a TSCI, allowing for tailored individual interventions.Level of Evidence: 3.

COVID-19 Changed the Injury Patterns of Hospitalized Patients.

INTRODUCTION: Injury patterns are closely related to changes in behavior. Pandemics and measures undertaken against them may cause changes in behavior; therefore, changes in injury patterns during the coronavirus disease 2019 (COVID-19) outbreak can be expected when compared to the parallel period in previous years. STUDY OBJECTIVE: The aim of this study was to compare injury-related hospitalization patterns during the overall national lockdown period with parallel periods of previous years. METHODS: A retrospective study was completed of all patients hospitalized from March 15 through April 30, for years 2016-2020. Data were obtained from 21 hospitals included in the national trauma registry during the study years. Clinical, demographic, and circumstantial parameters were compared amongst the years of the study. RESULTS: The overall volume of injured patients significantly decreased during the lockdown period of the COVID-19 outbreak, with the greatest decrease registered for road traffic collisions (RTCs). Patients' sex and ethnic compositions did not change, but a smaller proportion of children were hospitalized during the outbreak. Many more injuries were sustained at home during the outbreak, with proportions of injuries in all other localities significantly decreased. Injuries sustained during the COVID-19 outbreak were more severe, specifically due to an increase in severe injuries in RTCs and falls. The proportion of intensive care unit (ICU) hospitalizations did not change, however more surgeries were performed; patients stayed less days in hospital. CONCLUSIONS: The lockdown period of the COVID-19 outbreak led to a significant decrease in number of patients hospitalized due to trauma as compared to parallel periods of previous years. Nevertheless, trauma remains a major health care concern even during periods of high-impact disease outbreaks, in particular due to increased proportion of severe injuries and surgeries.

National study: Most elderly patients benefit from earlier hip fracture surgery despite co-morbidity.

OBJECTIVE: To estimate the potential influence of pre-operative patient condition on the benefit of earlier hip fracture surgery for elderly patients. BACKGROUND: Many studies emphasize the benefit of earlier hip fracture surgery for patient survival. However less is known regarding how this relationship is influenced by clinical factors which could serve as potential contra-indicators for earlier surgery. Rushed surgery of patients with contra-indications may even compromise their survival. METHODS: A retrospective study of patients aged 65 and above with an isolated hip fracture following trauma, based on data from 19 hospitals of the national trauma registry available for the years 2015-2016. Registry data was crossed with data on co-morbidities and medication intake from the biggest health insurance agency in the country, serving more than 50% of the country's population. Mediation analysis was performed on a wide list of co-morbidities, medications and clinical test results in order to establish the mediation of their relationship with inhospital mortality by earlier hip fracture surgery. Factors found significant in the mediation analysis were utilized to adjust a logistic regression for predicting inhospital mortality by function of waiting time to surgery and patient's sex and age. RESULTS: Anti-coagulant and anti-platelet intake; test results pointing to decreased kidney function and being diagnosed with diabetes or Ischemic Heart Disease were found to be significantly mediated in their influence on inhospital mortality by hip fracture surgery. Despite anti-platelet intake and kidney function having a significant impact on mortality in the multi-variate analysis, the positive effect of earlier hip surgery on survival remained unchanged after adjustment. CONCLUSIONS: Earlier hip fracture surgery was found to be beneficial for elderly patients even when their co-morbidities and medication intake are taken into account.

Maxillofacial trauma following road accidents-An 11-year multi-center study in Israel.

BACKGROUND/AIM: Road traffic collisions (RTC) are known to be one of the major causes of maxillofacial trauma (MFT). The road user factor is of crucial importance in the prevalence, severity, and treatment of maxillofacial injuries. The aims of the study were to determine the prevalence of maxillofacial trauma among road users, to illustrate injury patterns and to identify road users at high risk. METHODS: This historical prospective multi-center study was based on Israel's Trauma Registry between 2008-2018, which included 4829 hospitalized patients following RTC with MFT. Data were analyzed according to six road user types (vehicle driver, passenger, bicyclist, motorcyclist, pedestrian, and e-bike/scooter), maxillofacial injury location, and maxillofacial treatment. RESULTS: MFT, which accounted for 5% of the hospitalized RTC injuries, was not equally distributed among road users, as bicyclists and e-bike/scooters were more prone to maxillofacial trauma (7.2% and 10.1%, respectively) than vehicle drivers (3.2%). Children (age 0-14 years) comprised almost half of the cyclists, 25% of the pedestrians and 20% of the passengers. Some MFT patients experienced multiple injuries, with the majority involving jaw and facial bones and to a lesser extent the mouth, teeth, gingivae, and alveolar bone (mouth and dento-alveolar (DA) trauma). Approximately 30% of hospitalized road casualties with MFT underwent MF surgery, with the need for surgery lowest among pedestrians. CONCLUSION: Hospitalized road casualties had different types of MFT in terms of prevalence, location, severity, and treatment, depending on the road user type.

Motorcycle-related head and neck injuries: increased risk among ethnic minorities.

BACKGROUND: Ethnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC. METHODS: The National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling. RESULTS: Among 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12-1.65) and TBI (OR = 1.51,95%CI = 1.12-1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12-0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00-1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61-0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39-0.7). In-hospital mortality was not associated with ethnicity. CONCLUSIONS: Helmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance.