The healthcare workers' clinical skill set requirements for a uniformed international response to the Ebola virus disease outbreak in West Africa: the Canadian perspective.

Since December 2013, the Zaire Ebola virus disease (EVD) epidemic has ravaged West Africa. In collaboration with the Public Health Agency of Canada, healthcare workers (HCWs) and support staff from the Royal Canadian Medical Services (RCMS) of the Canadian Armed Forces (CAF) were deployed to Kerry Town, Sierra Leone. A total of 79 RCMS personnel deployed over the course of the 6-month mission in collaboration with the British Armed Forces to support efforts in West Africa. The treatment centre was mandated to treat international and local HCWs exposed to the infection. The goal of the Ebola virus disease treatment unit (EVDTU) was to provide care to affected HCWs and a beacon to attract and engage foreign HCWs to work in one of the international non-governmental organisation Ebola treatment centres in Sierra Leone. We focus on the CAF experience at the Kerry Town Ebola treatment unit in Sierra Leone in particular on the various clinical skill sets demonstrated in physicians, nurses and medical technicians deployed to the EVDTU. We outline some of the staffing challenges that arose and suggest that the necessary clinical skills needed to effectively manage patients with EVD in an austere environment can be shared across a small and diverse team of healthcare providers.

Are IVC filters required in combat support hospitals?

BACKGROUND: Haemorrhagic shock from traumatic injuries is now often treated using a damage control resuscitation strategy that transfuses packed red blood cells, plasma and platelets in a 1:1:1 ratio, early use of activated recombinant factor VII and transfusion of fresh whole blood. These therapies are aimed at promoting thrombosis in injured vessels. Such patients are at high risk for thrombotic complications and thromboprophylaxis is necessary, but frequently impossible to use in the early phase of care. CASE PRESENTATION: We describe the case of an Afghan civilian worker who suffered a vertical shear pelvic fracture with massive bleeding in a pedestrian/truck collision that was treated with a damage control resuscitation strategy, and who later suffered a severe pulmonary embolus. The potential use of a temporary inferior vena cava [IVC] filters is discussed. RECOMMENDATIONS: Care providers and policy makers must recognize that the increased use of prothrombotic strategies of resuscitation will likely increase the incidence of thrombotic complications in the high risk population of severely injured patients in combat support hospitals. Monitoring the incidence of these complications and development of strategies for prevention and treatment are required to avoid undermining the positive outcomes of damage control resuscitation. These strategies could include supplying combat support hospitals with the equipment and training necessary for placement of temporary IVC filters under fluoroscopic guidance.

Influence of seat position on the static and dynamic forward and rear stability of occupied wheelchairs.

We tested the hypothesis that moving the seat of an occupied wheelchair forward would decrease the wheelchair's forward and increase its rear static and dynamic rotational stability, and that moving the seat backward would have the opposite effect. We studied 21 able-bodied subjects in a lightweight, manually propelled wheelchair with the occupied seat in the normal position, 5cm forward, and 5cm backward. Regression analysis revealed that, within the range studied, the relationship between seat position (chi, in cm) and the forward and rear static stability (SSf and SSr, in degrees) could be expressed by the linear equations SSf = 15.52 (0.06)-0.70 (0.01) chi (r2 = 0.98) and SSr = 24.55 (0.07) + 1.11 (0.02) chi (r2 = 0.99). These findings were consistent with the results of a computer model that we used to predict the nature and extent of the effect on static stability, except that the model showed that the relationship becomes nonlinear with seat-position changes greater than those we studied. The relationship between seat position and dynamic forward and rear stability (DSf and DSr, the threshold speed [in m/s] required to induce a transient tip) could be expressed by the equations DSf = 0.74 (0.01)-0.041 (0.002) chi (r2 = 0.91) and DSr = 0.63 (0.01) + 0.030 (0.002) chi (r2 = 0.91). The results support our hypothesis and indicate that seat position is a very significant determinant of wheelchair stability.