A Review of "Prehospital Hypotension as a Valid Indicator of Trauma Team Activation" (2000).

Prehospital hypotension has been utilized for decades as a surrogate marker of injury severity. Several studies have discussed the correlation between injury and hypotension both in the field as well as in the emergency department. Increases have been noted in injury severity score and mortality. Resource utilization is higher in this patient population. This study revisits our original work from 2000 and reviews the current literature regarding hypotension and injury severity. We also examine the role of prehospital hypotension as an indicator of trauma team activation and resource allocation. This review serves as a part of a Literary Festschrift in honor of Dr J David Richardson's role as the Editor-in-Chief of The American Surgeon.

Los orígenes militares del triaje / Triage origins in the military

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Experiences of civilian nurses in triage during the Iran-Iraq War: An oral history.

PURPOSE: Nurses played a critical role in performing triage during the Iran-Iraq War. However, their experiences in triage have not been discussed. Therefore, the current study aimed to investigate the triage experiences of civilian nurses during the Iran-Iraq War. METHODS: Oral history method and in-depth interviews were used to collect data to gain the nurses' experiences in triage. RESULTS: Four themes were extracted from the data, which were the development of triage, challenging environment to perform triage, development of mobile triage teams, and challenges of triage chemical victims for nurses. CONCLUSION: Triage is an important skill for nurses to manage critical situations such as disasters and wars. Nurses have to be competent in performing triage. Involvement in critical situations helps the nurses learn and gain more experience on how to manage unexpected events.

[The evolution of the emergency medical services system - from ancient to modern times]. / Ewolucja systemu ratownictwa medycznego - od starozytnosci do czasów wspólczesnych.

The paper discusses the historical perspective - from ancient to modern times - on the evolution of military medicine and its support during the wars and battles as well as its impact on the development of civilian health care and emergency medical services. Indicated breakthroughs related to conducting military operations and pointed to the visionaries who have developed new paradigms of medical care, including programs designed to assess the health status of patients, treatment in the battlefield, medical transport, anesthesia, surgery and emergency procedures. Highlighted the important role of proper organization and urgent help to victims.

Contemporary Obstetric Triage.

IMPORTANCE: The role of obstetric triage in the care of pregnant women has expanded significantly. Factors driving this change include the Emergency Medical Treatment and Active Labor Act, improved methods of testing for fetal well-being, increasing litigation risk, and changes in resident duty hour guidelines. The contemporary obstetric triage facility must have processes in place to provide a medical screening examination that complies with regulatory statues while considering both the facility's maternal level of care and available resources. OBJECTIVE: This review examines the history of the development of obstetric triage, current considerations in a contemporary obstetric triage paradigm, and future areas for consideration. An example of a contemporary obstetric triage program at an academic medical center is presented. RESULT: A successful contemporary obstetric triage paradigm is one that addresses the questions of "sick or not sick" and "labor or no labor," for every obstetric patient that presents for care. Failure to do so risks poor patient outcome, poor patient satisfaction, adverse litigation outcome, regulatory scrutiny, and exclusion from federal payment programs. CONCLUSIONS: Understanding the role of contemporary obstetric triage in the current health care environment is important for both providers and health care leadership. TARGET AUDIENCE: This study is for obstetricians and gynecologists as well as family physicians. LEARNING OBJECTIVES: After completing this activity, the learner should be better able to understand the scope of a medical screening examination within the context of contemporary obstetric triage; understand how a facility's level of maternal care influences clinical decision making in a contemporary obstetric triage setting; and understand the considerations necessary for the systematic evaluation of the 2 basic contemporary obstetric questions, "sick or not sick?" and "labor or no labor?"

[War casualty triage during the First World War]. / Le triage des blessés pendant la Grande Guerre.

Along with the front hospitals (HOE), the action of sorting out the injured was one of the most important innovations of the Great War. Progressively, it was implemented and codified on each level of the evacuating chain, with variations due to the different phases of the conflict, such as in Verdun or in the Somme. From 1917 onwards, specific sorting centers, managed by experimented soldiers, were set up in the evacuating hospitals.

Effect of military conflicts on the formation of emergency medical services systems worldwide.

OBJECTIVES: This article briefly reviews the evolution of medical support during wars and conflicts from ancient to modern times and discusses the effect warfare has had on the development of civilian health care and emergency medical services (EMS). Medical breakthroughs and discoveries made of necessity during military conflicts have developed into new paradigms of medical care, including novel programs of triage and health assessment, emergency battlefield treatment and stabilization, anesthesia, and other surgical and emergency procedures. The critical role of organizations that provide proper emergency care to help the sick and injured both on the battlefield and in the civilian world is also highlighted.

[Treatment organization for patients with gunshot wounds of the maxillo-facial region evacuated during the military operations in the Far East (1938-1939) and the war with Finland (1939-1940)].

This article describes the path of the maxillo-facial surgery to becoming an independent part of the general surgery. We will look closely at the experience, gained y field surgeons during the events at Lake Hasan and Halkin-Gol river. The war with Finland, that enabled the surgeons to develop the system of specialized dental help for the gunshot wounds, to create standarts of specialized equipment, examples of splints, etc, which were widely used during the World War II.

Mass casualty response in the 2008 Mumbai terrorist attacks.

OBJECTIVES: The November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists. METHODS: A retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants. RESULTS: Among the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries). CONCLUSIONS: The use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar "Mumbai-style" attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.

Baron Dominique-Jean Larrey (1766-1842): founder of military surgery and trauma care.

Dominique-Jean Larrey was a distinguished surgeon in chief of Napoleon's army and a faithful servant of the Empire. His surgical skills and inventions, his absolute attachment and devotion to his profession, his humanitarian spirit and courage entitled him as one of history's greatest military surgeons.

Notes from a war diary--the filter system of sorting casualties from the battle of Cassino--Italy May 1944.

This is the second extract taken from the War Diaries of Brigadier JG Morgan CBE TD MD and is specifically taken from papers he used to prepare a talk for a Civil Defence Audience in the 1950's. Having introduced a system of filtering in Tripoli in 1943 when in command of 48th General Hospital, he was specifically appointed to oversee the medical arrangements for the Battle of Cassino and was awarded the CBE for his work which is outlined below. It has been prepared from the original documents and edited by his sons.

Dominique-Jean Larrey: the effects of therapeutic hypothermia and the first ambulance.

The fields of emergency medicine and resuscitation are indebted to the Baron Dominique-Jean Larrey (1766-1842) for significant advances in patient care. Larrey was a great surgeon who served in the French army during Napoleon's rule. He developed one of the first ambulance services, utilized positive pressure ventilation, and introduced hypothermia as a form of therapy. He dedicated his professional life to improving the care of wounded soldiers on the battlefield. Larrey coined the term "Triage" to allocate resources to those most in need of emergent care. Today, many of his techniques still prevail in modern medicine.

D-day on board a tank landing ship: meat, cheese and blood transfusion.

Tank Landing Ships were used as evacuation station hospitals during D-Day of World War Two. This historical vignette describes how difficulties were overcome in blood transfusion and trauma surgery aboard these ships. Their place in the evacuation chain is discussed in relation to previous experiences in military medicine.