The origins of casualty evacuation and echelons of care: lessons learned from the American Civil War.

The American Civil War produced many victims of battle who challenged the medical community. Not long after the war started the medical community was forced to make rapid, significant changes in how soldiers were evacuated, how they were cared for both immediately and long-term, and how the spread of fatal infectious diseases was controlled. This was the era in which nurses proved their importance and became a permanent segment of trauma care.

Endotracheal reintubation: a closer look at a preventable condition.

We designed a prospective study of endotracheal intubations and reintubations in our inner city Level 1 Trauma Center, to determine the frequency and causes of reintubation and evaluate the impact of an educational intervention aimed at minimizing unplanned extubations (UEs). After an initial 3-month phase, efforts were instituted to educate healthcare providers to the causes of reintubation noted. An identical 3-month period was then studied to evaluate the efficacy of the interventions. There were 862 patients, all adults, in the initial phase of the study, with 40 reintubation events in 22 patients; of the 808 in the second phase, there were 16 reintubations in 13 patients. The reintubation rate decreased from 4.4% to 1.9% (p = 0.005). Reintubations after UEs decreased from 14% to 5.2% (rate ratio, 0.374; 95% confidence interval = 0.141, 0.990). Multiple reintubation events decreased from 45% to 18.8% (p = 0.07). Increased provider education and protocol changes were associated with lower reintubation rates.