Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis

AbstractBackgroundMass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines.MethodsCases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR). These cases were identified as part of a research study evaluating Tactical Combat Casualty Care (TCCC) guidelines. Cases that were designated as or associated with denoted MASCAL events were included.DataFifty subjects were identified during the course of this project. Explosives were the most common cause of injuries. There was a wide range of vital signs. Tourniquet placement and pressure dressings were the most common interventions, followed by analgesia administration. Oral transmucosal fentanyl citrate (OTFC) was the most common parenteral analgesic drug administered. Most were evacuated as “routine.” Follow-up data were available for 36 of the subjects and 97% were discharged alive.ConclusionsThe most common prehospital interventions were tourniquet and pressure dressing hemorrhage control, along with pain medication administration. Larger data sets are needed to guide development of MASCAL in-theater clinical practice guidelines.SchauerSG, AprilMD, SimonE, MaddryJK, CarterR III, DelorenzoRA. Prehospital interventions during mass-casualty events in Afghanistan: a case analysis. Prehosp Disaster Med. 2017;32(4):465–468.

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Intuitive versus Algorithmic Triage

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18000626 ◽

2018 ◽

Vol 33 (4) ◽

pp. 355-361 ◽

Cited By ~ 4

Author(s):

Alexander Hart ◽

Elias Nammour ◽

Virginia Mangolds ◽

John Broach

Keyword(s):

Vital Signs ◽

Mass Casualty ◽

Publication Type ◽

Local Police ◽

Triage Category ◽

Government Leadership ◽

Cluster Randomized ◽

High Degree ◽

Adult Volunteers ◽

Very High

AbstractIntroductionThe most commonly used methods for triage in mass-casualty incidents (MCIs) rely upon providers to take exact counts of vital signs or other patient parameters. The acuity and volume of patients which can be present during an MCI makes this a time-consuming and potentially costly process.HypothesisThis study evaluates and compares the speed of the commonly used Simple Triage and Rapid Treatment (START) triage method with that of an “intuitive triage” method which relies instead upon the abilities of an experienced first responder to determine the triage category of each victim based upon their overall first-impression assessment. The research team hypothesized that intuitive triage would be faster, without loss of accuracy in assigning triage categories.MethodsLocal adult volunteers were recruited for a staged MCI simulation (active-shooter scenario) utilizing local police, Emergency Medical Services (EMS), public services, and government leadership. Using these same volunteers, a cluster randomized simulation was completed comparing START and intuitive triage. Outcomes consisted of the time and accuracy between the two methods.ResultsThe overall mean speed of the triage process was found to be significantly faster with intuitive triage (72.18 seconds) when compared to START (106.57 seconds). This effect was especially dramatic for Red (94.40 vs 138.83 seconds) and Yellow (55.99 vs 91.43 seconds) patients. There were 17 episodes of disagreement between intuitive triage and START, with no statistical difference in the incidence of over- and under-triage between the two groups in a head-to-head comparison.Conclusion:Significant time may be saved using the intuitive triage method. Comparing START and intuitive triage groups, there was a very high degree of agreement between triage categories. More prospective research is needed to validate these results.HartA, NammourE, MangoldsV, BroachJ. Intuitive versus algorithmic triagePrehosp Disaster Med.2018;33(4):355–361.

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Medication Administration in Critical Care Transport of Adult Patients with Hypoxemic Respiratory Failure

Prehospital and Disaster Medicine ◽

10.1017/s1049023x1500494x ◽

2015 ◽

Vol 30 (4) ◽

pp. 431-435 ◽

Cited By ~ 2

Author(s):

Susan R. Wilcox ◽

Mark S. Saia ◽

Heather Waden ◽

Susan J. McGahn ◽

Michael Frakes ◽

...

Keyword(s):

Critical Care ◽

Respiratory Failure ◽

Tertiary Care ◽

Medication Administration ◽

Adult Patients ◽

Publication Type ◽

Hypoxemic Respiratory Failure ◽

Homogeneous Population ◽

Wide Range ◽

Few Data

AbstractIntroductionCritical care transport (CCT) teams must manage a wide array of medications before and during transport. Appreciating the medications required for transport impacts formulary development as well as staff education and training.ProblemAs there are few data describing the patterns of medication administration, this study quantifies medication administrations and patterns in a series of adult CCTs.MethodsThis was a retrospective review of medication administration during CCTs of patients with severe hypoxemic respiratory failure from October 2009 through December 2012 from referring hospitals to three tertiary care hospitals.ResultsTwo hundred thirty-nine charts were identified for review. Medications were administered by the CCT team to 98.7% of these patients, with only three patients not receiving any medications from the team. Fifty-nine medications were administered in total with 996 instances of administration. Fifteen drugs were each administered to only one patient. The mean number of medications per patient was 4.2 (SD=1.8) with a mean of 1.9 (SD=1.1) drug infusions per patient.ConclusionsThese results demonstrate that, even within a relatively homogeneous population of patients transferred with hypoxemic respiratory failure, a wide range of medications were administered. The CCT teams frequently initiated, titrated, and discontinued continuous infusions, in addition to providing numerous doses of bolused medications.WilcoxSR, SaiaMS, WadenH, McGahnSJ, FrakesM, WedelSK, RichardsJB. Medication administration in critical care transport of adult patients with hypoxemic respiratory failure. Prehosp Disaster Med. 2015;30(4):1-5.

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Implications of Combat Casualty Care for Mass Casualty Events

JAMA ◽

10.1001/jama.2013.167481 ◽

2013 ◽

Vol 310 (5) ◽

pp. 475 ◽

Cited By ~ 38

Author(s):

Eric A. Elster ◽

Frank K. Butler ◽

Todd E. Rasmussen

Keyword(s):

Mass Casualty ◽

Combat Casualty ◽

Mass Casualty Events ◽

Combat Casualty Care

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The Impact of Terrorism on Children: A Two-Year Experience

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00002016 ◽

2004 ◽

Vol 19 (04) ◽

pp. 370-371 ◽

Cited By ~ 3

Author(s):

Julian M. Sandell ◽

I.K. Maconochie

Keyword(s):

Vital Signs ◽

Hospital Setting ◽

Young Person ◽

Mass Casualty ◽

Physiological Parameters ◽

Paediatric Trauma ◽

Mass Casualty Events ◽

Patterns Of Injury ◽

The Impact ◽

Real Challenge

Waismanet al1have once more highlighted the very real challenge of triaging children in mass-casualty events (MCE) in the pre-hospital setting. Difficulties encountered measuring vital signs and different patterns of injury, reflecting significant anatomical and physiological differences, necessitates a modified approach when applying traditional “adult” triage methods to paediatric trauma victims. When using physiological parameters to triage children, their faster respiratory rates and heart rates frequently result in younger children being triaged to a higher category than their injuries demand. These differences become less apparent during adolescence, as the young person matures into adulthood.

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Early Diagnosis and Intervention in Mass Casualty Events

PsycEXTRA Dataset ◽

10.1037/e517302011-140 ◽

2008 ◽

Author(s):

Ilan Kutz ◽

Rachel Dekel ◽

Shaul Schreiber ◽

Victor Resnick ◽

Ornah T. Dolberg ◽

...

Keyword(s):

Early Diagnosis ◽

Mass Casualty ◽

Mass Casualty Events

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mtDNAcombine: tools to combine sequences from multiple studies

BMC Bioinformatics ◽

10.1186/s12859-021-04048-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Eleanor F. Miller ◽

Andrea Manica

Keyword(s):

Sequence Data ◽

Data Extraction ◽

Bayesian Skyline Plot ◽

Model Organisms ◽

Data Sets ◽

Data Handling ◽

Online Database ◽

Genetic Studies ◽

Wide Range ◽

Existing Data

Abstract Background Today an unprecedented amount of genetic sequence data is stored in publicly available repositories. For decades now, mitochondrial DNA (mtDNA) has been the workhorse of genetic studies, and as a result, there is a large volume of mtDNA data available in these repositories for a wide range of species. Indeed, whilst whole genome sequencing is an exciting prospect for the future, for most non-model organisms’ classical markers such as mtDNA remain widely used. By compiling existing data from multiple original studies, it is possible to build powerful new datasets capable of exploring many questions in ecology, evolution and conservation biology. One key question that these data can help inform is what happened in a species’ demographic past. However, compiling data in this manner is not trivial, there are many complexities associated with data extraction, data quality and data handling. Results Here we present the mtDNAcombine package, a collection of tools developed to manage some of the major decisions associated with handling multi-study sequence data with a particular focus on preparing sequence data for Bayesian skyline plot demographic reconstructions. Conclusions There is now more genetic information available than ever before and large meta-data sets offer great opportunities to explore new and exciting avenues of research. However, compiling multi-study datasets still remains a technically challenging prospect. The mtDNAcombine package provides a pipeline to streamline the process of downloading, curating, and analysing sequence data, guiding the process of compiling data sets from the online database GenBank.

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MUREN: a robust and multi-reference approach of RNA-seq transcript normalization

BMC Bioinformatics ◽

10.1186/s12859-021-04288-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yance Feng ◽

Lei M. Li

Keyword(s):

Biological Significance ◽

Housekeeping Genes ◽

R Package ◽

Data Sets ◽

Statistical Regression ◽

Rna Seq ◽

Least Trimmed Squares ◽

Standard Data ◽

Wide Range ◽

Multiple References

Abstract Background Normalization of RNA-seq data aims at identifying biological expression differentiation between samples by removing the effects of unwanted confounding factors. Explicitly or implicitly, the justification of normalization requires a set of housekeeping genes. However, the existence of housekeeping genes common for a very large collection of samples, especially under a wide range of conditions, is questionable. Results We propose to carry out pairwise normalization with respect to multiple references, selected from representative samples. Then the pairwise intermediates are integrated based on a linear model that adjusts the reference effects. Motivated by the notion of housekeeping genes and their statistical counterparts, we adopt the robust least trimmed squares regression in pairwise normalization. The proposed method (MUREN) is compared with other existing tools on some standard data sets. The goodness of normalization emphasizes on preserving possible asymmetric differentiation, whose biological significance is exemplified by a single cell data of cell cycle. MUREN is implemented as an R package. The code under license GPL-3 is available on the github platform: github.com/hippo-yf/MUREN and on the conda platform: anaconda.org/hippo-yf/r-muren. Conclusions MUREN performs the RNA-seq normalization using a two-step statistical regression induced from a general principle. We propose that the densities of pairwise differentiations are used to evaluate the goodness of normalization. MUREN adjusts the mode of differentiation toward zero while preserving the skewness due to biological asymmetric differentiation. Moreover, by robustly integrating pre-normalized counts with respect to multiple references, MUREN is immune to individual outlier samples.

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Medical Challenges in Underground Warfare

Military Medicine ◽

10.1093/milmed/usaa447 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 839-844

Author(s):

Alex Sorkin ◽

Roy Nadler ◽

Adir Sommer ◽

Avishai M Tsur ◽

Jacob Chen ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Trauma Registry ◽

Smoke Inhalation ◽

Expert Committee ◽

Medical Support ◽

Response Planning ◽

Combat Casualty ◽

Combat Casualty Care

ABSTRACT Introduction Throughout history, underground systems have served military purposes in both offensive and defensive tactical settings. With the advance of underground mining, combat tactics, and weapon systems, providing medical support in the subterranean battlefield is a constantly growing challenge. This retrospective cohort study describes the Israeli Defense Force (IDF) Medical Corps experience with treating casualties from underground warfare, as recorded in the IDF Trauma Registry. Methods A retrospective cohort study of all casualties engaged in underground warfare, between the years 2004-2018. Medical data were extracted from the IDF Trauma Registry and tactical data were obtained from operational reports. An expert committee characterized the most prevalent challenges. Recommendations were based on a literature review and the lessons learned by the IDF experience. Results During the study period, 26 casualties were injured in the underground terrain. Of casualties, 12 (46%) due to blast injuries, 9 (35%) were due to smoke inhalation, and 5 (19%) due to crushing injuries. All were males, and the average age was 21.6 years. Ten (38%) were killed in action (died before reaching a medical facility). All 16 casualties reaching the hospital survived (Table I). The expert committee divided the most common challenges into three categories—tactical, environmental, and medical. An overview of medical response planning, common injuries, and designated combat casualty care are discussed below. As in all combat casualty care, the focus should be on safety, bleeding control, and rapid evacuation. Conclusion To plan and provide medical support, a thorough understanding of operational planning is essential. This manuscript presents the evolution of underground warfare, tactical and medical implications, environmental hazards, and common casualty care challenges.

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Nothing in Popular Culture Makes Sense except in the Light of Evolution

Review of General Psychology ◽

10.1037/a0027906 ◽

2012 ◽

Vol 16 (2) ◽

pp. 109-120 ◽

Cited By ~ 12

Author(s):

Gad Saad

Keyword(s):

Popular Culture ◽

Evolutionary Psychology ◽

Case Analysis ◽

Human Mind ◽

Cultural Form ◽

The Public ◽

Psychology Today ◽

Wide Range ◽

Current Article ◽

Song Lyrics

An evolutionary lens can inform the study of cultural forms in a myriad of ways. These can be construed as adaptations, as exaptations (evolutionary byproducts), as gene–culture interactions, as memes, or as fossils of the human mind. Products of popular culture (e.g., song lyrics, movie themes, romance novels) are to evolutionary cultural theorists what fossils and skeletal remains represent to paleontologists. Although human minds do not fossilize or skeletonize (the cranium does), the cultural products created by human minds do. By identifying universally recurring themes for a given cultural form (song lyrics and collective wisdoms in the current article), spanning a wide range of cultures and time periods, one is able to test key tenets of evolutionary psychology. In addition to using evolutionary psychology to understand the contents of popular culture, the discipline can itself be studied as a contributor to popular culture. Beginning with the sociobiology debates in the 1970s, evolutionary informed analyses of human behavior have engendered great fascination and animus among the public at large. Following a brief summary of studies that have explored the diffusion of the evolutionary behavioral sciences within specific communities (e.g., the British media), I offer a case analysis of the penetration of evolutionary psychology within the blogosphere, specifically the blog community hosted by Psychology Today.

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A Visual and VAE Based Hierarchical Indoor Localization Method

Sensors ◽

10.3390/s21103406 ◽

2021 ◽

Vol 21 (10) ◽

pp. 3406

Author(s):

Jie Jiang ◽

Yin Zou ◽

Lidong Chen ◽

Yujie Fang

Keyword(s):

Image Retrieval ◽

Indoor Localization ◽

Data Sets ◽

Indoor Environments ◽

Global Features ◽

Data Set ◽

Data Annotation ◽

Wide Range ◽

Annotation Costs ◽

Global And Local

Precise localization and pose estimation in indoor environments are commonly employed in a wide range of applications, including robotics, augmented reality, and navigation and positioning services. Such applications can be solved via visual-based localization using a pre-built 3D model. The increase in searching space associated with large scenes can be overcome by retrieving images in advance and subsequently estimating the pose. The majority of current deep learning-based image retrieval methods require labeled data, which increase data annotation costs and complicate the acquisition of data. In this paper, we propose an unsupervised hierarchical indoor localization framework that integrates an unsupervised network variational autoencoder (VAE) with a visual-based Structure-from-Motion (SfM) approach in order to extract global and local features. During the localization process, global features are applied for the image retrieval at the level of the scene map in order to obtain candidate images, and are subsequently used to estimate the pose from 2D-3D matches between query and candidate images. RGB images only are used as the input of the proposed localization system, which is both convenient and challenging. Experimental results reveal that the proposed method can localize images within 0.16 m and 4° in the 7-Scenes data sets and 32.8% within 5 m and 20° in the Baidu data set. Furthermore, our proposed method achieves a higher precision compared to advanced methods.

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