First aid on field management in youth football.

INTRODUCTION: Sufficient first aid equipment is essential to treat injuries on football fields. Deficits in first aid on field are still present in youth football. METHODS: Injury pattern in youth football over one season and first aid equipment in youth football were analyzed, retrospectively. PRICE and ABC procedure served as basic principles in emergency management to assess the need for first aid equipment on field. Considering financial limits and adapted on youth football injuries, sufficient first aid equipment for youth football was configured. RESULTS: 84% of 73 participating youth football teams had their own first aid kit, but the majority of them were insufficiently equipped. Team coaches were in 60% of all youth teams responsible for using first aid equipment. The injury evaluation presented 922 injuries to 1,778 youth players over one season. Frequently presented types of injury were contusions and sprains of the lower extremity. Based on the analyzed injury data in youth football, first aid equipment with 90 € is sufficient for 100% of all occurred youth football injuries. CONCLUSION: Current first aid equipment in youth football is insufficient. Scientific-based first aid equipment with 90 € is adequate to serve all injuries. Football coaches need education in first aid management.

A strategy to implement and support pre-hospital emergency medical systems in developing, resource-constrained areas of South Africa.

Resource-constrained countries are in extreme need of pre-hospital emergency care systems. However, current popular strategies to provide pre-hospital emergency care are inappropriate for and beyond the means of a resource-constrained country, and so new ones are needed-ones that can both function in an under-developed area's particular context and be done with the area's limited resources. In this study, we used a two-location pilot and consensus approach to develop a strategy to implement and support pre-hospital emergency care in one such developing, resource-constrained area: the Western Cape province of South Africa. Local community members are trained to be emergency first aid responders who can provide immediate, on-scene care until a Transporter can take the patient to the hospital. Management of the system is done through local Community Based Organizations, which can adapt the model to their communities as needed to ensure local appropriateness and feasibility. Within a community, the system is implemented in a graduated manner based on available resources, and is designed to not rely on the whole system being implemented first to provide partial function. The University of Cape Town's Division of Emergency Medicine and the Western Cape's provincial METRO EMS intend to follow this model, along with sharing it with other South African provinces.

Use of the non-pneumatic anti-shock garment (NASG) for life-threatening obstetric hemorrhage: a cost-effectiveness analysis in Egypt and Nigeria.

OBJECTIVE: To assess the cost-effectiveness of a non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage in tertiary hospitals in Egypt and Nigeria. METHODS: We combined published data from pre-intervention/NASG-intervention clinical trials with costs from study sites. For each country, we used observed proportions of initial shock level (mild: mean arterial pressure [MAP] >60 mmHg; severe: MAP ≤60 mmHg) to define a standard population of 1,000 women presenting in shock. We examined three intervention scenarios: no women in shock receive the NASG, only women in severe shock receive the NASG, and all women in shock receive the NASG. Clinical data included frequencies of adverse health outcomes (mortality, severe morbidity, severe anemia), and interventions to manage bleeding (uterotonics, blood transfusions, hysterectomies). Costs (in 2010 international dollars) included the NASG, training, and clinical interventions. We compared costs and disability-adjusted life years (DALYs) across the intervention scenarios. RESULTS: For 1000 women presenting in shock, providing the NASG to those in severe shock results in decreased mortality and morbidity, which averts 357 DALYs in Egypt and 2,063 DALYs in Nigeria. Differences in use of interventions result in net savings of $9,489 in Egypt (primarily due to reduced transfusions) and net costs of $6,460 in Nigeria, with a cost per DALY averted of $3.13. Results of providing the NASG for women in mild shock has smaller and uncertain effects due to few clinical events in this data set. CONCLUSION: Using the NASG for women in severe shock resulted in markedly improved health outcomes (2-2.9 DALYs averted per woman, primarily due to reduced mortality), with net savings or extremely low cost per DALY averted. This suggests that in resource-limited settings, the NASG is a very cost-effective intervention for women in severe hypovolemic shock. The effects of the NASG for mild shock are less certain.

The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need.

BACKGROUND: As many as 90% of all trauma-related deaths occur in developing nations, and this is expected to get worse with modernisation. The current method of creating an emergency care system by modelling after that of a Western nation is too resource-heavy for most developing countries to handle. A cheaper, more community-based model is needed to establish new emergency care systems and to support them to full maturity. METHODS: A needs assessment was undertaken in Manenberg, a township in Cape Town with high violence and injury rates. Community leaders and successfully established local services were consulted for the design of a first responder care delivery model. The resultant community-based emergency first aid responder (EFAR) system was implemented, and EFARs were tracked over time to determine skill retention and usage. RESULTS: The EFAR system model and training curriculum. Basic EFARs are spread throughout the community with the option of becoming stationed advanced EFARs. All EFARs are overseen by a local organisation and a professional body, and are integrated with the local ambulance response if one exists. On competency examinations, all EFARs tested averaged 28.2% before training, 77.8% after training, 71.3% 4 months after training and 71.0% 6 months after training. EFARs reported using virtually every skill taught them, and further review showed that they had done so adequately. CONCLUSION: The EFAR system is a low-cost, versatile model that can be used in a developing region both to lay the foundation for an emergency care system or support a new one to maturity.

First things first: effectiveness and scalability of a basic prehospital trauma care program for lay first-responders in Kampala, Uganda.

BACKGROUND: We previously showed that in the absence of a formal emergency system, lay people face a heavy burden of injuries in Kampala, Uganda, and we demonstrated the feasibility of a basic prehospital trauma course for lay people. This study tests the effectiveness of this course and estimates the costs and cost-effectiveness of scaling up this training. METHODS AND FINDINGS: For six months, we prospectively followed 307 trainees (police, taxi drivers, and community leaders) who completed a one-day basic prehospital trauma care program in 2008. Cross-sectional surveys and fund of knowledge tests were used to measure their frequency of skill and supply use, reasons for not providing aid, perceived utility of the course and kit, confidence in using skills, and knowledge of first-aid. We then estimated the cost-effectiveness of scaling up the program. At six months, 188 (62%) of the trainees were followed up. Their knowledge retention remained high or increased. The mean correct score on a basic fund of knowledge test was 92%, up from 86% after initial training (n = 146 pairs, p = 0.0016). 97% of participants had used at least one skill from the course: most commonly haemorrhage control, recovery position and lifting/moving and 96% had used at least one first-aid item. Lack of knowledge was less of a barrier and trainees were significantly more confident in providing first-aid. Based on cost estimates from the World Health Organization, local injury data, and modelling from previous studies, the projected cost of scaling up this program was $0.12 per capita or $25-75 per life year saved. Key limitations of the study include small sample size, possible reporter bias, preliminary local validation of study instruments, and an indirect estimate of mortality reduction. CONCLUSIONS: Lay first-responders effectively retained knowledge on prehospital trauma care and confidently used their first-aid skills and supplies for at least six months. The costs of scaling up this intervention to cover Kampala are very modest. This may be a cost-effective first step toward developing formal emergency services in Uganda other resource-constrained settings. Further research is needed in this critical area of trauma care in low-income countries.

Methodological design for economic evaluation in Public Access Defibrillation (PAD) trial.

OBJECTIVE: Our objective is to describe the rationale and methods for the economic analysis of the PAD trial. The objective of this analysis is to assess whether automated external defibrillators (AEDs) use by lay responders is good value for money. METHODS: Design. This economic evaluation is being conducted concurrently with a randomized trial of (a) control--training to recognize arrest, access 911, and administer cardiopulmonary resuscitation (CPR) while awaiting arrival of emergency medical services providers versus (b) intervention--training to recognize arrest, access 911, administer CPR, and use an AED while awaiting emergency medical services providers. Lay responders in either group were trained to deliver the study intervention. Population. Participating sites identified distinct units with a population of at least 250 people aged > or = 50 years. Outcome. The primary economic outcome is the incremental cost-effectiveness ratio of intervention versus control. RESULTS: Nine hundred ninety-three units including 1260 public and residential locations were randomized. There were 30 survivors in the intervention group and 15 in the control group (P = .03). Sampling will identify program and health care costs. A societal perspective will be adopted. Incremental cost effectiveness will be estimated by using bootstrapping and decision analytic modeling. CONCLUSION: The study will demonstrate whether defibrillation by lay responders improves outcomes at reasonable cost. If so, then the thousands of lives will be improved annually. If not, then limited resources can be invested in other interventions. Our methods also provide a framework for economic evaluations of other interventions for acute cardiovascular events.

[Topical issues of the primary medical and sanitary care]. / Aktual'nye problemy pervichnoi mediko-sanitarnoi pomoshchi.

Issues related with transforming the functioning of the country's health care on the basis of the model of general practitioner (GP) are discussed in the article. It is concluded that there is need in a full-scale preparatory activity comprising both the optimization of the internal structural-and-functional relations and the ensuring of the health care readiness as whole, i.e. evolving the activity of its elements in the direction of an integrally functioning system.

[Initial medical treatment by paramedics in combined first aid operations of paramedics and emergency physicians]. / Erstversorgung durch Rettungsassistenten und Rettungssanitäter bei kombinierten Einsätzen von RTW und NAW in einem stationären NAW-System.

OBJECTIVE: The present study was conducted to evaluate the quality of paramedic care and the feasibility and cost-effectiveness of sending a well-trained paramedic team to the sight of a medical emergency to initiate active medical treatment prior to the arrival of the mobile intensive care unit (MICU). METHODS: We examined 200 cases of medical treatment initiated by paramedics before arrival of the MICU team at the site of the medical emergency. Using a questionnaire, all emergency procedures performed by the paramedic team on scene were recorded and defined as "required", "carried out", and "accurately performed". The documented emergency procedures were divided into three categories: basic procedures (e. g. positioning, CRP, oxygen administration), additional procedures (e. g. placement of iv-lines, application of intravenous medication), and routine emergency diagnostic measures (e. g. monitoring of cardiopulmonary status). Further documented were the time of onset of emergency physician treatment, and the definitive transport vehicle used. To evaluate the time required for the measures performed, three different groups were identified according to the time gap between the arrival of the paramedic and the emergency physician teams (< 3 min, 3 - 5 min and > 5 min). RESULTS: In the 200 emergencies included in the study, 76 - 95 % of the required procedures were accurately performed prior to the arrival of the MICU team, at a success rate ranging from 87 to 100 %. CONCLUSIONS: In this study, a large number of emergency procedures could be performed by the paramedic team within a short period of time (in some cases < 3 min), and adequate effectiveness. Based on our results, the activation of paramedic-staffed first-tier ambulances with shorter response times is recommended in addition to the MICU system.

Burns treatment for children and adults: a study of initial burns first aid and hospital care.

AIM: To assess the adequacy of initial burns first aid treatment in the community and its subsequent impact on treatment outcome. METHODS: Four-month prospective study of consecutive burn patients presenting to Middlemore Hospital. Patients were interviewed to determine initial burns first aid treatment (BFAT) and assessed as "adequate" or "inadequate", then compared with subsequent treatment. Inpatient care was wound debridement with/without dressings (DO/DB) or split skin grafting (SSG). RESULTS: 40.5% of total 121 patients received adequate BFAT, 59.5% did not, p = <0.001. 50% Caucasians received adequate BFAT, compared with 25% Maori and 33% Pacific Island people, p = 0.084. 15.7% of adequate BFAT patients received DO/DB and 6.6% had SSG, compared with 23.4% and 19.3% respectively for inadequate BFAT, p = 0.03. Scald burns occurred most frequently, 4% adequate BFAT scald patients required SSG compared with 20% of inadequate BFAT scald patients, p = 0.003. Maori and Pacific Island people were over-represented as inpatients (collectively 34.8%) when compared to Caucasian (24.8%) or other ethnic groups, p = 0.25. 38% of all patients were children under 10 with inadequate BFAT tendency compared with adults, p = 0.067. Hospital stay decreased among adequate BFAT paediatric patients, p = 0.016. CONCLUSIONS: A public education strategy is required to improve BFAT, targeting at-risk communities. Following this, the study should be repeated to determine the effectiveness of the campaign and any resultant change in community behaviour.

Emergency medical equipment. Final rule.

This action responds to the Aviation Medical Assistance Act of 1998 by requiring that air carrier operators carry automated external defibrillators on large, passenger-carrying aircraft and augment currently required emergency medical kits. It affects those air carrier operations for which at least one flight attendant is required and includes provisions designed to provide the option of treatment of serious medical events during flight time.

Public access defibrillation: a shocking idea?

Currently, survival from out-of-hospital cardiac arrest in the United Kingdom is poor. Ambulance response standards require that an ambulance reach 75 per cent of cardiac arrests within 8 min. But a short time to defibrillation from the onset of collapse is a key predictor of outcome from out-of-hospital cardiac arrest. The Department of Health has recently implemented a lay responder defibrillation programme, with the aim of shortening this time interval for victims in public places. This initiative utilizes automated external defibrillators (AEDs), which provide written and recorded voice prompts to minimize training requirements and errors in use. Lay responder AED programmes with very short response times have reported survival to discharge rates of up to 53 per cent for patients presenting in ventricular fibrillation (VF). This compares well with the results of a meta-analysis that reported a survival rate of only 6.4 per cent for traditional defibrillator-equipped ambulance systems. The annual incidence of out-of-hospital cardiac arrest in England is 123 per 100,000 population. Approximately half of these present in VF, and could benefit from an AED programme. But only 16 per cent of cardiac arrests occur in a public place. It has been calculated that there are approximately 5,000 instances of VF in public places each year in England. If half of these patients can be reached and administered a first shock within 4 min of their collapse, an additional 400 victims may survive each year. Given the current investment by the DoH of 2 million pounds, this suggests a cost per life saved of approximately 505 pounds over a 10 year period.

Life support and first aid in a mental health setting.

While there is much talk of holistic care in psychiatric care settings, emphasis on physical care is rare. Emergency aspects of care are always considered but their effectiveness is never certain until tested by real situations. With this in mind, and with some recent experiences to provide a focus, St Andrew's Hospital, Northampton, a national charity providing mental health services, implemented a review of life-support and first-aid provision. With financial and skills investment, the new systems and their associated maintenance and training are now in place.

First, do no harm: the role of defibrillators and advanced medical care in commercial aviation.

Primum non nocere-First, do no harm. How often have we as physicians and health care providers heard those words? We at American Airlines did not wish to put even one person in harm's way by not having care available to save a life in a remote commercial aviation environment. The decision was purely a business decision of the AMR corporation, who always keeps the welfare of the customer at the fore. It may not be the right choice for the entire commercial aviation industry under an FAA mandate. We know that we will save lives of persons traveling on American Airlines with this program. If the 'ripple' that we have started expands to affect the practices of other commercial air carriers in the domestic United States, American's reward will be a great one-to know that the lives of many people will be saved because one air carrier has taken the first step.

The use and cost of first aid in the food and drink manufacturing industry.

The Health & Safety (First Aid) Regulations 1981 require all companies to consider the provision of first-aid care at work. Information was obtained by postal questionnaires returned by 36 food and drink manufacturing companies on the provision and cost of the first-aid care they provide, as well as the types of treatment that their first aiders administer. Almost all of the companies complied with the legislation by providing trained first aiders and adequate treatment equipment and facilities. The average cost of first-aid provision was 16.00 pounds per worker per year. The majority (93%) of the first-aid treatment provided was of a minor nature. The study demonstrates that first aiders only infrequently use their specialist knowledge and skills for the management of serious or life-threatening medical emergencies. Based on the results of the study, and on the results of previous studies concerning the provision of first-aid care and the training requirements for first aiders, it is concluded that the present emphasis on the provision of minor treatment and the current first-aid training system have resulted in first aiders not being adequately trained to save life, the main objective of first-aid care. A case is made for first-aid training to be reduced in content, but undertaken more frequently, to ensure that first aiders can adequately manage an acute, life-threatening medical emergency.

[Medical kits in Army physicians' vehicles].

Physicians' medical kits (PMK) were distributed to 50 physicians, graduates of an advanced trauma life support course. The kits were always to be present in the physicians' designated vehicles, enabling them to provide advanced life support at the earliest possible stage (the "golden hour"). The kits have equipment for advanced airway intervention and management, chest trauma management (chest tube insertion, etc.) and fluid administration. To help assess the impact of the PMK and its cost effectiveness, questionnaires were sent to the physicians involved, of whom 35/50 responded. The questions included 2 subjects: the presence of the kit in the car and details of its use for injuries. The kit was present at all times in the cars of all except 1 of 31 physicians. 7 (22.5%) of them used the kit in 50 incidents which involved 74 injured persons. The injuries were caused by road accidents in 54 cases, in 17 by terrorist activity, and 3 cases involved heart attacks and cardiac resuscitation. Distribution of the PMK among army physicians appears to be valuable in the field, and before hospitalization.