基于美军二战海战减员数据的校正

目的：通过对二战减员数据的校正，为下一步建立海战减员预计模型提供数据支持．方法：选取美军在二战太平洋海战中的减员数据作为研究的基本资料，通过专家咨询法(Delph method)对其进行校正，所有结果都对其进行了t检验．结果：水面舰艇遭受炸弹、舰炮及航空火炮、短程导弹、鱼雷和水雷的攻击时减员将减少，遭受中程导弹攻击时减员将会增加．结论：该校正结果可作为研究未来海战卫生减员预计的基本依据之一．     

海勤人员战伤救护知识培训现状调查

目的 了解海勤人员战伤救护知识培训现状,为进一步系统有效地开展培训提供依据.方法 根据海勤人员的工作环境、战备训练及现代海战伤救治特点和规律自行设计问卷,对潜艇艇员、潜水员共计217人进行调杳.结果 特殊伤现场救护和心理应激渊适培训在潜艇艇员和潜水员之间差异有统计学意义(P<0.05).特殊武器伤现场救护培训内容中的生物武器伤和化学武器伤救护知识的培训,在潜艇艇员和潜水员之间差异无统计学意义(P>0.05);对核武器伤和新概念武器伤救护知识的培训,在潜艇艇员和潜水员之间差异有统计学意义(P<0.05).结论 战伤救护知识的培洲已在海勤部队开展,自救瓦救6项技术培训较好,新概念武器伤和特殊伤救护知识的培训开展较差.心理应激调适知识培训欠缺.     

新型高级创伤外科机动救治力量及其培训体系的建立

未来远海环境下的舰艇编队作战将成为我海军主要作战形式。远海作战战场广阔、攻防形势转换快、所致伤情伤势复杂,易在任意时间、任意战场地点瞬间产生批量伤员,救治难度极大。本文系统介绍了一种针对远海舰艇编队作战的新型高级创伤外科机动救治队伍及其专属模块化、标准化、轻量化的手术复苏装备系统,并阐述其培训体系构想,以备卫勤研究者、参与者借鉴参考。     

REBOA by a non-surgeon as an adjunct during MASCAL

Use of Resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of non-compressible hemorrhage is a re-emerging technology that historically is employed by surgeons. We present a case in which REBOA was successfully placed by an emergency physician in a critical mass casualty patient awaiting transfer to the operating table. This case is an example in which emergency physicians, in collaboration with the surgeon, can utilize REBOA to temporize non-compressible hemorrhage when a surgeon is not immediately available.     

Injuries caused by fragmenting rifle ammunition

IntroductionAlthough penetrating injuries are encountered on a regular basis in high volume trauma centres, most civilian trauma teams will be unfamiliar with the treatment of patients with injuries caused by fragmenting ammunition. The terrorist attacks in Norway on July 22, 2011 included a shooting spree causing 69 deaths and 60 injured. One of the weapons used was a semi-automatic rifle, calibre 5.56 mm, with soft tip, short stop ammunition. The aim of the present study was to describe the characteristic injury patterns and lessons learned from the treatment of multiple patients admitted at the regional trauma centre with injuries from this type of ammunition.MethodsWe undertook an observational study of patients admitted at Oslo University Hospital, Ulleval after the shooting spree at Utoya on July 22, 2011. Data on demographics, injuries, injury severity, surgical procedures and outcome were collected prospectively.ResultsOf the 21 patients admitted after the shooting incident, 18 were identified with injuries caused by fragmenting ammunition and included in the study. Median age was 17 years (IQR 16, 19), median ISS 21 (IQR 12, 30) and 12 patients were female. They had been hit by a total of 38 projectiles, of which 32 were fragmenting bullets. Of the seven patients who sustained injuries to the head, neck and face, one patient required a craniotomy and one patient had a non-survivable head injury. Of the 11 patients with torso injuries, six of the eight patients with chest injuries had intra-thoracic injuries that could be treated with chest tubes only. One patient had cardiac tamponade, requiring thoracotomy. Six patients underwent laparotomy, four of them more than one. Of the 10 patients with extremity injuries, two had nerve injuries and six patients had fractures. Five amputations were performed within the first nine days.A total of 101 operations were required within the first four weeks. The majority of these were repeated soft tissue debridements due to progressive necrosis.ConclusionKnowledge about the specific challenges created by the progressive soft tissue necrosis caused by fragmenting ammunition should lead to planned, repeated debridements to reduce total tissue loss and complications.     

Disaster Training in 24 Hours: Evaluation of a Novel Medical Student Curriculum in Disaster Medicine

Background

Over a decade ago, the Association of American Medical Colleges called for incorporation of disaster medicine training into the education of medical students in the United States. Despite this recommendation, similar suggestions by other professional organizations, and significant interest from medical students and educators, few medical schools explicitly include robust disaster training in their curricula.