[Thermal injuries in the OEAMTC air rescue service. Epidemiological characteristics of burns/scalds in children and adults]. / Thermische Verletzungen in der ÖAMTC-Luftrettung. Einsatzcharakteristika bei Verbrennungen/Verbrühungen von Kindern und Erwachsenen.

BACKGROUND: Few data exist on the epidemiological characteristics of thermal injuries in prehospital emergency care, especially in the context of air rescue. Therefore, this study aimed to analyze the epidemiology of pediatric and adult thermal injuries in the helicopter emergency medical service (HEMS) run by the Austrian Automobile Motorcycle Touring Club (OEAMTC) air rescue service from an almost nationwide sample. METHODS: All OEAMTC-HEMS rescue missions flown for thermal injuries in 2009 were retrospectively reviewed. Primary (n=88) and secondary missions (n=17) were collated and all primary missions were analyzed in detail. RESULTS: In total 71 out of 16,100 (0.4 %) primary HEMS rescue missions were for patients suffering from burns or scalds (children n=27, adults n=44). The proportion of major burns (burns covering >20 % of the total body surface area) was 40.7 % in children and 54.5 % in adults, 44 (62 %) burn/scald injuries were related to the head/neck, 37 (52.1 %) to the upper limbs and 10 (14.1 %) to the anogenital region. More than half of the victims (63.4%) suffered potentially life-threatening injury. CONCLUSIONS: In HEMS thermal injuries are infrequent but mostly life-threatening. Differences in epidemiological characteristics of pediatric and adult burns/scalds may have important operational, training and public health implications.

The real expansion rate of meshers and micrografts: things we should keep in mind.

Skin graft expansion techniques (mesh and micrograft) are widely used, but there is ample evidence that skin graft meshers do not provide their claimed expansion rates. Although this finding might not be new for the majority of surgeons, less is known about surgeons' actual knowledge of expansion rates. The aim of this study was to evaluate the true expansion rates of commonly used expansion techniques with regard to claimed, achieved, and polled results. In the first part of the study, 54 surgeons were polled during an annual burns meeting regarding the most commonly used expansion techniques and expansion ratios; in the second step the true (achievable) expansion rates of the most widely used meshers and micrografts were analysed; and in third step, a poll involving 40 surgeons was conducted to estimate the true expansion rates of the most frequently used skin expansion techniques. The skin meshers (1:1.5 / 1:3) did not achieve their claimed values: (1:1.5) 84.7% of the claimed expansion (mean ± SD: 1:1.27 ± 0.15) and (1:3) 53.1% of the 1:3 (1:1.59 ± 0.15) mesher. The use of the micrografting technique resulted in 99.8% of the 1:3 (1:2.99 ± 0.09), 93.6% of the 1:4 (1:3.74 ± 0.12) and 93.8% of the 1:6 (1:5.63 ± 0.12) claimed expansion rates, respectively. In general the surgeons overestimated the achievable expansion rates. In general the achieved expansion rate was lower than the estimated and claimed expansion rates. The micrografting technique provided reliable and valid expansion rates compared to the skin meshers. We recommend using the micrograft technique when large expansion ratios are required, for example in severe extensive burns.

Les techniques pour l'extension des greffes cutanées (en filet ou microgreffes) sont largement utilisées, mais il est amplement prouvé que les greffes cutanées en filet ne correspondent aux taux d'expansion réclamés. Il est bien possible que cette constatation ne constitue pas rien de nouveau pour les chirurgiens, mais nous savons encore moins des connaissances réelles des chirurgiens pour ce qui concerne cette matière. Le but de cette étude était d'évaluer l'exact taux d'expansion des techniques d'expansion couramment utilisées à l'égard des résultats revendiqués, réalisés et soumis à sondage. Dans la première partie de l'étude, 54 chirurgiens ont été interrogés lors d'une réunion annuelle des brûlologues sur les techniques d'expansion les plus utilisées et les rapports d'expansion. Dans la deuxième étape, les taux effectifs d'extension (possibles) des greffes en filet et les microgreffes les plus utilisés ont été analysés. Dans la troisième étape, un sondage auprès de 40 chirurgiens a été réalisé pour évaluer les taux effectifs des techniques d'expansion cutanée les plus utilisées. Les greffes en filet évaluées (1 : 1,5 / 1:3) en effet n'atteignaient pas les valeurs revendiquées: 1:1,5 = 84,7% de l'expansion revendiquée (moyenne ± écart-type = 1:1.27 ± 0,15) et 1:3 = 53,1% du mesher 1:3 (1:1.59 ± 0,15). L'utilisation de la technique de la microgreffe a produit des taux revendiqués d'expansion de 99,8% dans le cas de 1:3 (1:2,99 ± 0,09), de 93,6% dans le cas de 1:4 (1:3,74 ± 0,12) et de 93,8% dans le cas de 1:6 (1:5.63 ± 0,12). En général, les chirurgiens ont surestimé les taux d'expansion réalisables. Ainsi, toutes choses considérées, le taux d'expansion effectivement réalisé était inférieur aux divers taux d'expansion estimés et revendiqués. Les microgreffes montraient des taux d'expansion fiables et valides par rapport aux greffes en filet. Les Auteurs recommandent l'utilisation de la technique de la microgreffe quand il faut obtenir un rapport d'expansion élevé, par exemple dans le cas de brûlures graves de grande extension.

The epidemiology of amputation injuries in the Austrian helicopter emergency medical service: a retrospective, nationwide cohort study.

PURPOSE: Data on the epidemiological characteristics of traumatic amputations in prehospital emergency care, especially in the context of air rescue, are scarce. Therefore, we aimed to describe the epidemiology of total and subtotal amputation injuries encountered by the OEAMTC helicopter emergency medical service (HEMS) in Austria, based on an almost nationwide sample. METHODS: We retrospectively reviewed all HEMS rescue missions flown for amputation injuries in 2009. Only primary missions were analyzed. RESULTS: In total, 149 out of 16,100 (0.9 %) primary HEMS rescue missions were for patients suffering from amputation injuries. Among these, HEMS physicians diagnosed 63.3 % (n = 94) total and 36.9 % (n = 55) subtotal amputations, with both groups showing a predominance of male victims (male:female ratios were 8:1 and 6:1, respectively).The highest rate occurred among adults between 45 and 64 years of age (35.6 %, n = 53). The most common causes were working with a circular saw (28.9 %, n = 43) and processing wood (16.8 %, n = 25). The majority of the cases included digital amputation injuries (77.2 %, n = 115) that were mainly related to the index finger (36.2 %, n = 54). One hundred forty patients (94.0 %) showed a total GCS of more than 12. Amputations were most prevalent in rural areas (84.6 %, n = 126) and between Thursday and Saturday (55.0 %, n = 82). The replantation rate after primary air transport was low (28 %). CONCLUSIONS: In the HEMS, amputation injuries are infrequent and mostly not life-threatening. However, HEMS crews need to maintain their focus on providing sufficient and fast primary care while facilitating rapid transport to a specialized hospital. The knowledge of the epidemiological characteristics of amputation injuries encountered in the HEMS gained in this study may be useful for educational and operational purposes.

Evaluation of the online-presence (homepage) of burn units/burn centers in Germany, Austria and Switzerland.

PURPOSE: A successful online presence is an important key factor in the competition among hospitals today. However, little is known about the internet presence and the quality of websites of burn units on the World Wide Web. The aim was to assess the online presence of hospitals provided by specialized burn units in German speaking countries with a focus on the rate and the performance of actively run websites. METHODS: A multicenter, observational, cross-sectional study was performed over a period of 1.5 month (October-December 2010). Forty-four burn units were assessed by using a previously generated criteria list. The list included 36 criteria with following topics: "research and teaching"; "patient care"; "clinical emphases", "general information"; "information brokerage". RESULTS: Overall, the websites examined offered a good overview about their different online services with many multimedia-based elements included. All websites consisted of hyperlinks, general multimedia-based elements and information on means of communication with the hospital, respectively. In contrast, the quality of specific information for burn patients was relatively poor. With regard to the need of elderly people, the usability and the layout, the different websites offer a lot of options for future improvements. CONCLUSION: Burn centers in Germany, Austria and Switzerland already consider the World Wide Web as an important tool for self-promotion and communication. The potential of burn center websites to function as a knowledge base for first aid as well as preventive measurements should be considered and realized in future web site designs.

The use of Suprathel(®) in deep dermal burns: first results of a prospective study.

INTRODUCTION: While autologous skin grafting has been the standard for coverage of full-thickness areas, several options for deep-partial-thickness defects exist. With regard to economising donor sites, we compared a copolymer based on DL-lactid acid (Suprathel(®)) as temporary wound dressing with autologous skin, and analysed time to healing and scar quality in matched areas of deep-partial-thickness burn. METHODS: We recruited 18 patients with a median age of 45 years (range: 25-83 years), for this prospective, non-blinded controlled non-inferiority study, suffering from deep-partial-thickness burns from November 2009 to July 2010. After early tangential excision, matched deep-partial-thickness areas were covered with 1:1.5 meshed autologous skin grafts and the copolymer for direct intra-individual comparison. Scars were evaluated by means of the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS) and suction cutometry (MPA 580, Courage and Khazaka Electronic GmbH, Cologne, Germany) on days 30 and 90, postoperatively. RESULTS: Fifteen days after surgery, complete wound closure was present in 44.4% (8/18) of all areas covered with copolymer and 88.9% (16/18) in the split-thickness skin graft (STSG) area (p=0.008). Evaluation of the total VSS, POSAS and cutometry satisfied the criterion of non-inferiority for Suprathel(®) on day 30. Ninety days after surgery, only the Observer Scar Scale showed that Suprathel is non-inferior to STSG, albeit the mean total VSS and Patient Scar Scale were better in Suprathel(®) areas. CONCLUSION: Suprathel(®) represents a solid, reliable epidermal skin substitute with longer healing times in comparison to skin grafts but comparable results concerning early scar formation. Suprathel(®) can serve as a tool in treatment portfolio for adult patients suffering from deep dermal burns. Especially in patients with extensive burns, Suprathel(®) can be used to cover the deep dermal burn wounds to save STSGs and its donor sites for the coverage of full-thickness burned areas.

A success story: A large urban district offers a working model for implementing multisensory teaching into the resource and regular classroom.

A large urban school district contracted with a private nonprofit educational foundation to train 126 special education resource teachers in the last three years in an Orton-Gillingham-based program. These teachers are currently teaching learning-disabled students in groups of 8-10 at the elementary level and 10-13 students at the secondary level. Learning-disabled students who qualify for Special Education, either in reading or spelling, or both, are receiving the instruction.The teachers took a Basic Introductory Class (90 hours of Advanced Academic Credit offered by the Texas Education Agency, or six hours of graduate credit at a local university) in order to teach the program in the resource setting. A two year Advanced Training included annual on-site observations, two half-day workshops each fall and spring, and a two-day advanced workshop in the second summer.First grade teachers, one selected from each of the 164 campuses, supervisors, and principals attended a 25-hour course on "Recognizing Dyslexia: Using Multisensory Teaching and Discovery Techniques." The first grade teachers and special education resource teachers collaborated to provide inservice training for their colleagues.Research, conducted by the district's Research Department, reveals statistically significant gains in reading and spelling ability for the learning-disabled resource students as measured by the Woodcock Reading Mastery Test-Revised, and the Test of Written Spelling.

Direct fluorination of carcinogenic polycylic aromatic hydrocarbons. 6-Fluorobenzo(a)pyrene.

Xenon difluoride reacts with benzo[a]pyrene(BaP) in dichloromethane solution in an open system to give 6-fluorobenzo[a]pyrene. This method constitutes a direct route to fluorine substituted carcinogenic polycyclic aromatic hydrocarbons.