Background: Abdominal compartment syndrome (ACS) may lead to bacterial translocation and possibly be of importance for development of multiorgan failure. However, the underlying mechanisms have not ...

Background: This study evaluates the effects of early rapid control of multiple bowel perforations on cardiovascular and pulmonary function in high-energy traumatic shock compared with conventional small bowel resection anastomosis. Methods: Fifteen anesthetized pigs, 10 to 12 weeks old, were exposed to a reproducible high-energy trauma and were divided into two groups. In the first group, the resection anastomosis group (RA, n = 8), small-bowel injuries were treated with resection and anastomosis; in the second group, the multiple bowel ligation group (BL, n = 7), small-bowel injuries were treated by resection and ligation. Repeated measurement analysis of variance was used to study the within group change overtime, the between group difference, and the interaction between them. Mean outcome measures were intravascular pressures, cardiac output, vascular resistance, lactic acid, and blood gases. Results: The high-energy injuries caused traumatic shock in both groups with reduced cardiac output (p < 0.001) and lactic acidemia (p < 0.001). The BL group had a trend for higher cardiac output (p = 0.06). The rise in systemic and pulmonary vascular resistance was significantly reduced in the BL group compared with the RA group (p < 0.05). The BL group had a strong trend for higher oxygen extraction ratio (p = 0.06). There was a trend for less oxygen consumption in the BL group (p = 0.07). There was no difference in the lactic acidemia between the two groups. Conclusions: Early rapid control of multiple bowel perforations after high- energy trauma resulted in less impairment of cardiovascular function than conventional resection anastomosis of the bowel.

The objective of this study was to determine if a set of performance indicators could indicate what part of medical command and control needs to be improved in a training concept designed for medical officers at major incidents. A set of 11 different performance indicators previously proposed was used as a template when examining ambulance staff in medical command and control. The results were graded 0 to 2 where 0 = not acceptable, 1 = partially correct and 2 = correct. A total of 46 examinations comprising more than 200 students was included. Performing a correct second report (score 1.15), the ability to establish general guidelines for medical response (score 1.20), setting level of medical ambition (score 1.24) and informing media (score 1.33) had significantly lower scores than the other performance indicators. Performance indicators for medical management in a major incident can be used in a training setting for identifying areas that need improvement.

1 ABSTRACT: A new concept for education and training of prehopital medical staff in management and control on scene of accident has been developed at the Centre for Teaching and Research in Disaster Medicine in Linkoping, Sweden. The concept that is supported by the Swedish National Board of Health and Welfare is based on the same material as the national guidelines. Within 9 months there are more than 200 users trained and certifi ed in Sweden. Examination is standardised and uses measurable performance indicators as a tool for quality control.

Objective: The objective was to determine the outcome when applying a set of proposed performance indicators on previously published reports from major incidents. Methods: A set of 20 different performance indicators were proposed. These indicators were applied to 13 reports from major incidents issued by the KAMEDO organization. Results: The most frequently reported problems were command and control at the scene (11/13) followed by communication and command and control at the strategic level. In 25% of the published reports there was enough information available to apply the performance indicators, and in these the goal and/or objective was met in 67%. Conclusion: Performance indicators for the medical management of major incidents and disaster can to a limited extent be applicable to retrospective studies. Performance indicators might be a tool for evaluating the medical response if reports are made with a different template. Further studies are needed in order to validate which indicators to use.

Objective: The aim of this study was to examine, under field conditions, what impact additional insulation on a spine board would have on thermoregulation. Methods: The study was conducted outdoors, under field conditions in February in the north of Sweden. The subjects, all wearing standardized clothing, were immobilized on non‐insulated (n = 10) or insulated (n = 9) spine boards. Tympanic temperature as well as the subjects' estimated sensation of cold and their estimated level of shivering were measured at 5‐min intervals during the trial. Statistical analysis of the data gathered for the first 55 min was performed. Results: There were no differences between the two groups regarding reduction in body core temperature or cold discomfort. There was, however, a statistically significant increase in estimated shivering for the subjects placed on non-insulated spine boards. Conclusion: Additional insulation on a spine board by means of an insulation mat rendered a significantly reduced need for shivering in a cold environment. This is an effect that could be of great importance during protracted evacuations of injured, ill or otherwise compromised patients. In the light of these results we conclude that spine boards, as well as other materials used for prehospital transportation of patients in cold environments, should be well insulated. This is a measure that could be accomplished by such simple means as using an additional insulation mat.

Nonspecific vasodilatation during iontophoresis is an important confounding factor in experimental pharmacology. In this investigation, we studied the involvement of sensory nerves and histamine-related reactions in causing nonspecific vasodilatation in a model of anodal and cathodal iontophoresis of sodium chloride. Firstly, we applied a mixture of local anesthetic (EMLA) cream to confirm its suppressive effect on nonspecific vasodilatation and to measure its efficacy in three different dosages (duration: 1, 2, and 3 h). We then investigated the role of histamine in nonspecific vasodilatation by giving an oral antihistamine drug (cetirizine) to subjects who had and had not been given EMLA. We found substantial suppression of the nonspecific vasodilatation in all EMLA-treated groups (all dosages) compared with untreated controls (with suppression rates of 60-65%). Dosage had no significant effect. A further suppression of nonspecific vasodilatation was seen after oral cetirizine during anodal and cathodal iontophoresis in both EMLA-treated and untreated groups. The antihistamine effect was most pronounced during anodal iontophoresis. These results suggest a histaminergic increase in perfusion that may be independent of neurogenic mechanisms and depend on polarity (anode or cathode). Local nerve blocks (EMLA) together with cetirizine may therefore be used to reduce nonspecific vasodilatation in both anodal and cathodal iontophoresis.

At the Seventh World Conference of the International Civil Defence Organisation held in February 1974 in Venezuela, delegations from 61 countries participated. One of the main topics was 'Mass casualty care in disaster situations'. Three professors attending the meeting - Prof. J. A. Baumann (University of Geneva, Switzerland), Prof. R. Frey (University of Mainz, Germany) and Prof. E. Musso (Geneva Civil Defence Office, Switzerland) - decided to found an international society in the field of disaster medicine. The founding meeting of the International Society of Disaster Medicine (ISDM) was held in Geneva on 22 October 1975, with the participation of the three founding members and Dr Milan Bodi, Secretary General of the International Civil Defence Organisation. It was decided that the headquarters of the society would be located in Geneva.

i vad en hogre grad av realism i larandesituationen innebar. Resultaten fran studien tyder pa att det finns bade for- och nackdelar med att ge simulatorovningen en verklighetsnara inramning. Studien har utforts vid det medicinska simuleringscentrum, Clinical Skills Center, som ar under uppbyggnad inom ramen for Katastrofmedicinskt centrum vid Universitetssjukhuset i Linkoping. Studenter vid det kognitionsvetenskapliga programmet vid Linkopings universitet har drivit studien som ett fordjup

Objective. The ‘Swede information system’ was introduced in a county with approximately 450,000 inhabitants in April 2000. The implementation of this information system, intended to be operative in major incidents and disasters, has included the introduction of new technologies as well as new standard operating procedures for both ambulance crews and hospital staff. The objective of this study was to see how this information system with digitally mediated transmission was used as a daily routine during a 2‐month period, 1 year after its introduction. Methods. The Swede information system sends on‐line information from ambulances to emergency wards in the county. The technique used is a LAN (local area net) for communication within the site of the accident, Mobitex® from the ambulances to a data server and from this by Internet to the hospitals. During March and April 2001 all events when an ambulance was dispatched were recorded. All cases when the system was used to notify the receiving hospital were recorded as well as all cases when the ambulance crew alerted the hospital through the alert function. All technical problems and any period of time when the system was ‘out of use’ were noted. Results. During the period of the study, the system was successfully used to transfer data from the scene to hospital in a total of 3353 missions, including transport of a patient from the scene to an emergency department. Of these, in 150 transports the transferred data served as a base for immediate support on arrival at the hospital that was of critical importance for primary management in the hospital. In all, 2883 different kinds of medical data were transmitted. The local help‐desk was notified of problems with the system on 11 occasions; six of these were technical problems and the rest were user‐related. The IS Swede system was not operational during parts of 3 days (<5%) of the time. Conclusions. Despite the introduction of new equipment and new standard operating procedures, IS Swede was accepted within the organization to a degree which could be considered operational in major incidents. Technical problems with IS Swede caused only minor disturbances during the study period.

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To find out whether we could manage critical pulmonary haemorrhages in penetrating injuries, and to report our experience with blunt trauma of the lung. Retrospective study Teaching hospital, Sweden. 81 patients who presented with pulmonary injuries during the period January 1988-December 1997; 6 were penetrating and 75 blunt. There was only one patient with an isolated lung contusion. The remaining was divided into 2 groups: those with pulmonary contusion and thoracic lesions ( n = 32), and those with pulmonary contusion and extrathoracic lesions ( n = 42). Four patients in the penetrating group were shocked and required urgent operations; emergency room thoracotomy ( n = 1), urgent thoracotomy ( n = 2), and urgent thoracoabdominal exploration ( n = 1) were done successfully. We correlated grade of lung injury [American Association for the Surgery of Trauma-Abbreviated Injury Scale (AIS) ] with mortality. All patients with penetrating injuries survived without serious consequences. There were a mean (SD), of 6 (2) injuries/patient in those with extrathoracic injuries compared with 3 (1) injuries/patient in the group with thoracic lesions ( p < 0.001). The corresponding hospital mortality was 6/42 (19%) mainly as a result of the central nervous system lesions (4/6) compared with 0/32. The mean (SD) Injury Severity Score (ISS) was 9.3 (4.8) in patients with thoracic lesions compared with 24.1 (14.7) in patients with extrathoracic lesions ( p < 0.0001), and 14.9 (9.5) in all survivors compared with 49.9 (13.6) among those who died ( p < 0.0001). An excellent outcome can be achieved managing penetrating injuries of the lung by an aggressive approach and urgent surgical intervention even when emergency room thoracotomy is essential. Pulmonary contusion is considered to be a relatively benign lesion that does not add to the morbidity or mortality in patients with blunt chest trauma. These data may help to decrease the obsession with pulmonary contusion in patients with chest trauma, with or without extrathoracic lesions, and avoid many unnecessary computed tomograms of the chest. Copyright © 2000 Taylor and Francis Ltd.