Computer-based simulative training system--a new approach to teaching pre-hospital trauma care

Objective:A computer-based STS(simulative training system) in providing pre-hospital trauma care at a disaster site was applied to teaching nursing students in the Second Military Medical University,China.This article reports on the teaching effectiveness of this system.Methods:Among 92 participants,46 were in the study group and 46 were in the 'control' group. Each student completed a multiple-choice quiz after completing 18 hours(six three-hour sessions) of the study module,and a score was recorded.The simulative training module was completed only by the study group;the 'control' group was assigned in-class discussions for the same amount of time covering the same content as the study group.The final course scores,which included both comprehensive and group task-based tests were compared between these two groups.The study used a descriptive and comparative approach for quantitative data analysis.Tests of independency between the multiple choice scores and the simulation scores were also performed.Finally,anonymous surveys were conducted.Results:The study group performed better than the 'control' group with a significantly higher average score for the group scenario task-based test score,and consequently the study group's final course score was significantly higher than the 'control' group.As per chi-square tests,no significant associations were found between the multiple choice scores and the simulated training scores.The final surveys showed students overwhelmingly agreed that STS training improved their knowledge and skills,their ability to recognize a potential critical event, and their initial response for trauma care at pre-hospital settings.The survey responses of the study group were noteworthy as they indicated that students recognized the importance of simulative training,appreciated the realism of the simulation,and were able to fight/adjust to the stressful feelings in order to focus on the task.Conclusion:Computer-based STS may be an effective teaching model to help students improve their capability in providing pre-hospital trauma care,and in their effectiveness in disaster response.

医务干部伞训伤调查

目的调查空降部队医务干部伞训伤的发生率,提出预防重点及措施。方法询问登记受伤史,检查伤情,填写伤员调查表。分析伞训受伤率,人均伤次,伞训伤的类型及伤病率,以及引起伞训伤的相关因素。结果伞训受伤率为88.46%,人均伤次为1.29。伞训伤发生率与年龄呈正相关,与性别无直接关系。伞训伤以骨关节损伤最多见(53.9%),其次为肌肉损伤(46.2%)、皮肤软组织损伤(28.9%)。各部位损伤中以颈项肌扭伤最常见(28.9%),其次为踝关节扭伤(21.2%)。骨折发生率为7.7%。致伤因素中以技术动作错误最常见,其次为缺乏保护措施,疲劳。结论此调查结果明显高于国内外空降兵训练伤调查结果,应重视预防并减少医务干部伞训伤。

Analysis of incidence of traumatic brain injury in blunt trauma patients with Glasgow Coma Scale of 12 or less

Purpose： Early diagnosis of traumatic brain injury （TBI） is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale （GCS） of 12 or less can predict the presence of TBl and the severity of associated injuries in blunt trauma patients. Methods： A retrospective cohort study including 303,435 blunt trauma patients who were transferred from the scene to hospital from 1998 to 2013. The data was obtained from the records of the National Trauma Registry maintained by Israel＇s National Center for Trauma and Emergency Medicine Research, in the Gertner Institute for Epidemiology and Health Policy Research. All blunt trauma patients with GCS 12 or less were included in this study. Data collected in the registry include age, gender, mechanism of injury, GCS, initial blood pressure, presence of TBI and incidence of associated injuries. Patients younger than 14 years old and trauma victims with GCS 13-15 were excluded from the study. Statistical analysis was performed by using Statistical Analysis Software Version 9.2. Statistical tests performed included Chi-square tests. A p-value less than 0.05 was considered statistically significant. Results： There were 303,435 blunt trauma patients, 8731 （2.9%） of them with GCS of 3-12 that including 6351 （72%） patients with GCS of 3-8 and 2380 （28%） patient with GCS of 9--12. In these 8731 patients with GCS of 3-12, 5372 （61.5%） patients had TBI. There were total 1404 unstable patients in all the blunt trauma patients with GCS of 3-12,1256 （89%） patients with GCS 3-8, 148 （11%） patients with GCS 9-12. In the 5095 stable blunt trauma patients with GCS 3-8, 32.4% of them had no TB1. The rate in the 2232 stable blunt trauma patients with GCS 9-12 was 50.1%. In the unstable patients with GCS 3-8, 60.5% of them had TBI, and in subgroup of patients with GCS 9-12, only 37.2% suffered from TBI. Conclusion： The utility of a GCS 12 and less is limited in prediction of brain injury in multiple trauma patients. Significant proportion of trauma victims with low GCS had no TBI and their impaired neurological status is related to severe extra-cranial injuries. The findings of this study showed that using of GCS in initial triage and decision making processes in blunt trauma patients needs to be re-evaluated.

Epidemiology of livestock-related injuries in a major trauma center in Kashan, Iran

Objective： Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital. Treatment of these patients is still a major problem in health care system. The aim of current study was to assess the epidemiology of livestock-related injuries in a major trauma center in Iran from 2006 to 2011. Methods： In a prospective study, patients with live- stock-related injuries who were consecutively admitted to the trauma center in Kashan, Iran between 2006 and 2011 were evaluated. The data collected included patient＇s demographics, place and nature of accident, damaged organ, educational level, transport and outcome. Data were expressed as mean±standard deviation. Results： A total of 129 patients were included in this study, accounting for 0.3% of all trauma admission （40 273 cases）. The mean age was （55.27±14.45） years. Men were affected four times more than women. Falling down from livestock is the main mechanism of trauma in all groups. Upper and lower extremities were most frequently injured （n=72）, followed by the head, neck and spine （n=33 for each）. There was one death resulting from livestock-related injury in this study. Conclusion： Despite the low incidence, livestock-related injuries can damage major organs of human body and therefore appropriate training program to increase the safety awareness in home and outdoor is very important.

Designing trauma registry system using a logical framework approach

While trauma registries provide the mechanisms to collect comprehensive, timely and accurate data related to the injuries and evaluate trauma care systems, they have not been established in most developing countries. On the other hand, in complex projects that have large aims, a logical framework approach （LFA） can help summarize and describe the multiple branches of the project systematically, and elucidate the main goals, extensive objectives, activities and expected outcomes. Therefore a LFA can be used to design and guide trauma registry project management, to integrate the cultural, clinical and capacity variations among countries; and to ensure early alignment of the project＇s design and evaluation.