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Mass Casualty Incidents (MCIs) are rare but devastating events that require extensive planning in order to minimize morbidity and mortality. There are two broad categories limiting a hospital's response physical assets (e.g., critical care beds, operating rooms, food, communication devices) as well as operating procedures (e.g., MCI committees, regional coordination, provider training). The purpose of this study is to provide an examination of MCI preparedness according to these categories in Level 1 Trauma Centre across Canada.

This study surveyed all Level 1 Trauma Centres across Canada in order to assess the physical assets and operating procedures they had in place in the event of a hypothetical MCI on one of the busiest days of the year for trauma care.

Of the 28 Trauma Centres contacted, 13 completed surveys (46%). Most hospitals had sufficient food (9/13) water (9/13), fuel (7/13), and communication assets (8/13) for a hypothetical MCI. A median of 38 mechanical ventilators could be mobilized. No hospitals mandated physician training for MCIs, and 6/13 centres were certain that they had a Strategic Emergency Management Plan (SEMP). Only 6/13 hospitals had dedicated MCI committees, Overall, 4/13 hospitals had explicit plans developed with community hospitals.

This study demonstrated that physical assets are generally less limiting than operating procedures. Four key areas of potential improvement have been identified 1) provider training (especially physicians), 2) coordination with small hospitals, 3) mechanical ventilator availability, and 4) MCI committees with explicit Strategic Emergency Management Plans.

This study demonstrated that physical assets are generally less limiting than operating procedures. AZD2014 mw Four key areas of potential improvement have been identified 1) provider training (especially physicians), 2) coordination with small hospitals, 3) mechanical ventilator availability, and 4) MCI committees with explicit Strategic Emergency Management Plans.

To compare the clinical outcomes of external fixator+elastic stable intramedullary nail (EF+ESIN) vs. external fixator (EF) in the treatment for open tibial shaft fracture in overweight adolescents.

Patients of open tibial shaft fractures younger than 14 years old with body weight over 50Kg treated with EF+ESIN or EF at our institute from 2010 to 2018 were reviewed. Patients with Gustilo Type III open fractures, pathological fractures, previous fracture or instrumentation in the operative leg were excluded. Baseline information and clinical data were collected from the hospital database and during out-patient visits.

Forty-six patients, including 27 males and 19 females, were included in the EF group, whereas 35 patients, including 18 males and 17 females, were included in the EF+ESIN group (p=0.527). The incidence of superficial infection was higher in the EF group (26/46, 56.5%) than the EF+ESIN group (12/35, 34.3%), p<0.001. The frontal and sagittal angulation was higher in the EF group (p<0.001), but the degrees in both groups were within the acceptable range. The union time was longer in the EF group (68.0±12.7, d) than the EF+ESIN group (61.9±11.9), p<0.001. The retaining of EF (11.9±3.2, w) was longer in the EF group than the EF +ESIN group (5.7±1.2, w), p<0.001.

EF+ESIN is a safe and alternative choice for selected overweight adolescents with open tibial shaft fracture.

EF+ESIN is a safe and alternative choice for selected overweight adolescents with open tibial shaft fracture.

There is no universal agreement or supporting evidence for the content or format of a standardised guidance document for patients with blunt chest wall trauma. The aim of this study is to investigate current UK Emergency Medicine practice of the management of patients with blunt chest wall trauma, who do not require admission to hospital.

This was a cross-sectional survey study, with mixed quantitative / qualitative analysis methods. A convenience sample of all professions working in the Emergency Departments / Urgent Care Centres in the UK was used. A combination of closed and open-ended questions were included, covering demographics and current practice in the respondent's main place of work. Themes explored included management strategies for safe discharge home, risk prediction and variables considered relevant for inclusion in patient guidance.

A total of 113 clinicians responded from all UK trauma networks, including all devolved nations. A total of 20 different risk prediction tools / pathways werted in this study may be due in part to a lack of national consensus guidelines on how to manage this complex patient group. Further research is needed into whether structured national guidelines for the assessment and management of such patients could potentially lead to an overall improvement in outcomes. Such guidelines should be developed by not only expert clinicians and researchers, but also and more importantly by those service-users who have lived experience of blunt chest wall trauma.

The aim of this study was to compare the outcome in patients who did and did not undergo continuous compartment pressure monitoring (CCPM) following a tibial diaphyseal fracture.

We performed a retrospective cohort study of 287 patients with an acute tibial diaphyseal fractures who presented to three centres over a two-year period. Demographic data, diagnosis, management, wound closure, complications, and subsequent surgeries were recorded. The primary outcome measure was the rate of short-term complications. Secondary outcomes were time to fasciotomy and split-skin grafting rates.

Of the 287 patients in the study cohort, 171 patients underwent CCPM (monitored group; MG) and 116 did not (non-monitored group; NMG). There were 21 patients who developed ACS and underwent fasciotomy, with comparable rates in both groups (n=13 in the MG vs n=8 in NMG; p=0.82). There was no difference in the rate of complications between groups (all p>0.05). The mean time from admission to fasciotomy was 22.1hrs, with a mean time of 19.8hrs in the MG and 25.8hrs in the NMG (mean difference, 6hrs; p=0.301). One patient in the NMG required a below-knee amputation. There was a trend towards a reduced requirement for split-skin grafting post decompression in the MG (15% vs 50%; p=0.14).

This study found no difference in the short-term complication rates in those patients that underwent CCPM and those that did not following a fracture of the tibial diaphysis. CCPM does appear to be safe with no increase in the rate of fasciotomies performed. There was a trend towards a reduced time to fasciotomy and a reduced rate of split skin grafting for wound closure with CCPM.

Level III (Diagnostic Retrospective cohort study).

Level III (Diagnostic Retrospective cohort study).