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Patrick Melmer,1 Margo Carlin,2 Christine A Castater,2 Deepika Koganti,2 Stuart D Hurst,2 Brett M Tracy,2 April A Grant,2 Keneeshia Williams,2 Randi N Smith,2 Christopher J Dente,2 Jason D Sciarretta2 1Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC 29572, USA; 2Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA 30303, USACorrespondence: Jason D Sciarretta Tel +1 404 251-8914Fax +1 404 523-3931Email jason.d.sciarretta@emory.eduAbstract: Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a high-volume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.Keywords: mass casualty, multidisciplinary, mass shooting

Objectives: This study assessed whether Georgia Senate Bill 360, a statewide law passed in August, 2010, that prohibits text messaging while driving, resulted in a decrease in this behavior among emergency medicine (EM) and general surgery (GS) healthcare providers. Methods: SurveyMonkey was used to create a web-based survey containing up to 28 multiple choice and free-text questions about driving behaviors. EM and GS healthcare providers at a southeastern medical school and its affiliate county hospital received an email inviting them to complete this survey in February, 2011. All analyses were conducted in SPSS (version 19.0, Chicago, IL, 2010), using chi-squared tests and logistic regression models. The primary outcome of interest was a change in participant texting or emailing while driving after passage of the texting ban in Georgia.Results: Two hundred and twenty-six providers completed the entire survey (response rate 46.8%). Participants ranged in age from 23 to 71 years, with an average age of 38 (SD=10.2; median=35).Only three-quarters of providers (n=173, 76.6%) were aware of a texting ban in the state. Out of these, 60 providers (36.6%) reported never or rarely sending texts while driving (0 to 2 times per year), and 30 engaged in this behavior almost daily (18.9%). Almost two-thirds of this group reported no change in texting while driving following passage of the texting ban (n=110, 68%), while 53 respondents texted less (31.8%).Respondents younger than 40 were more than twice as likely to report no change in texting post-ban compared to older participants (OR=2.31, p=0.014). Providers who had been pulled over for speeding in the previous five years were about 2.5 times as likely to not change their texting while driving behavior following legislation passage compared to those without a history of police stops for speeding (OR=2.55, p=0.011). Each additional ticket received in the past 5 years for a moving violation lessened the odds of reporting a dec

Objectives: This study assessed whether Georgia Senate Bill 360, a statewide law passed in August, 2010, that prohibits text messaging while driving, resulted in a decrease in this behavior among emergency medicine (EM) and general surgery (GS) healthcare providers. Methods: SurveyMonkey was used to create a web-based survey containing up to 28 multiple choice and free-text questions about driving behaviors. EM and GS healthcare providers at a southeastern medical school and its affiliate county hospital received an email inviting them to complete this survey in February, 2011. All analyses were conducted in SPSS (version 19.0, Chicago, IL, 2010), using chi-squared tests and logistic regression models. The primary outcome of interest was a change in participant texting or emailing while driving after passage of the texting ban in Georgia.Results: Two hundred and twenty-six providers completed the entire survey (response rate 46.8%). Participants ranged in age from 23 to 71 years, with an average age of 38 (SD=10.2; median=35).Only three-quarters of providers (n=173, 76.6%) were aware of a texting ban in the state. Out of these, 60 providers (36.6%) reported never or rarely sending texts while driving (0 to 2 times per year), and 30 engaged in this behavior almost daily (18.9%). Almost two-thirds of this group reported no change in texting while driving following passage of the texting ban (n=110, 68%), while 53 respondents texted less (31.8%).Respondents younger than 40 were more than twice as likely to report no change in texting post-ban compared to older participants (OR=2.31, p=0.014). Providers who had been pulled over for speeding in the previous five years were about 2.5 times as likely to not change their texting while driving behavior following legislation passage compared to those without a history of police stops for speeding (OR=2.55, p=0.011). Each additional ticket received in the past 5 years for a moving violation lessened the odds of reporting a dec

Background: Up to 20% of all trauma patients admitted to an intensive care unit die from their injuries. End-of-life decision making is a variable process that involves prognosis, predicted functional outcomes, personal beliefs, institutional resources, societal norms, and clinician experience. The goal of this study was to better understand end-of-life processes after major injury by comparing clinician viewpoints from various countries and cultures. Methods: A clinician-based, 38-question international survey was used to characterize the impacts of medical, religious, social, and system factors on end-of-life care after trauma. Results: A total of 419 clinicians from the United States (49%), Canada (19%), South Africa (11%), Europe (9%), Asia (8%), and Australasia (4%) completed the survey. In America, the admitting surgeon guided most end-of-life decisions (51%), when compared with all other countries (0-27%). The practice structure of American respondents also varied from other regions. Formal medical futility laws are rarely available (14-38%). Ethical consultation services are often accessible (29-98%), but rarely used (0-29%), and typically unhelpful (<30%). End-of-life decision making for patients with traumatic brain injuries varied extensively across regions with regard to the impact of patient age, Glasgow Coma Scale score, and clinician philosophy. Similar differences were observed for spinal cord injuries (age and functional level). The availability and use of "donation after cardiac death" also varied substantially between countries. Conclusions: In this unique study, geographic differences in religion, practice composition, decision-maker viewpoint, and institutional resources resulted in significant variation in end-of-life care after injury. These disparities reflect competing concepts (patient autonomy, distributive justice, and religion).

Introduction: The supine antero-posterior (AP) chest radiograph (CXR) is an insensitive test for detecting post-traumatic pneumothoraces (PTXs). Computed tomography (CT) often identifies occult pneumothoraces (OPTXs) that were not diagnosed on CXR. The purpose of this study was to prospectively determine the incidence, and validate previously identified clinical predictors, of OPTXs after blunt trauma. Methods: All severe blunt injured patients (injury severity score (ISS) ≥ 12) presenting to a level 1 trauma centre over a 17-month period were prospectively evaluated. Thoracoabdominal CT scans and corresponding CXRs were reviewed at the time of admission. Patients with OPTXs were compared to those with overt PTXs regarding incidence and previously identified predictive risk factors (subcutaneous emphysema, rib fractures, female sex and pulmonary contusion). Results: CT imaging was performed concurrent to CXR in 405 blunt trauma patients (ISS ≥ 12) during the study period. PTXs were identified in 107 (26%) of the 405 patients. Eighty-one (76%) of these were occult when CXRs were interpreted by the trauma team. Concurrent chest trauma predictive of OPTXs was limited to subcutaneous emphysema (p = 0.003). Rib fractures, pulmonary contusions and female sex were not predictive. Conclusions: OPTXs were missed in up to 76% of all seriously injured patients when CXRs were interpreted by the trauma team. This is higher than previously reported in retrospective studies and is likely based on the difficult conditions in which the trauma team functions. Subcutaneous emphysema remains a strong clinical predictor for concurrent OPTXs.