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A patient's current or previous experience of trauma may have an impact on their health and affect their ability to engage in health care. Every year, millions of patients who have experienced physically or emotionally traumatic experiences present to emergency departments (ED) for care. Often, the experience of being in the ED itself can exacerbate patient distress and invoke physiological dysregulation. The physiological reactions that lead to fight, flight, or freeze responses can make providing care to these patients complex and can even lead to harmful encounters for providers. There is a need to improve the care provided to the vast number of patients in the ED and create a safer environment for patients and healthcare workers. One solution to this complex challenge is understanding and integrating trauma-informed care (TIC) into emergency services. The federal Substance Abuse and Mental Health Service Administration's (SAMHSA) six guiding principles of TIC offer a universal precaution framework that ensures quality care for all patients, providers, and staff in EDs. While there is growing evidence that TIC quantitatively and qualitatively improves ED care, there is a lack of practical, emergency medicine-specific guidance on how to best operationalize TIC. In this article, using a case example, we outline how emergency medicine providers can integrate TIC into their practice. [ABSTRACT FROM AUTHOR]

Child safety seat use reduces the risk of fatal injury by 71% for infants and 54% for toddlers, yet more than one-third of child passengers killed in traffic crashes in the US are unrestrained. Nearly half (47%) of crash injuries occur within 5 miles of the injured person's home. Mapping the location of motor vehicle crashes resulting in serious or fatal injury to unrestrained child passengers may pinpoint high-risk neighborhoods. Illinois Department of Transportation data were used to map crashes that resulted in a fatal or incapacitating injury to a child passenger (age 0 to 8) in Cook County, IL from 2011 to 2015. Maptitude® Geographic Information System (GIS) software was used to identify hot spots of unrestrained child passenger injury on the South Side and West Side of Chicago. Of 174 zip codes in Cook County, 3 zip codes on the South Side of Chicago (60620, 60621; 60628) accounted for 11% of the total unrestrained fatalities and incapacitating injuries among children. Results of this study reveal the feasibility of detecting geographic disparities in child passenger safety at the zip code and neighborhood level and indicate the potential for more targeted allocation of resources. [ABSTRACT FROM AUTHOR]

Background: Previous studies on the effect of zolpidem or zopiclone use on the risk of road traffic crashes (RTCs) have shown mixed results.Objective: Our objective was to determine the association between zolpidem or zopiclone use (as separate drugs or combined) and the occurrence of injurious RTCs among older adult drivers.Methods: This was a population-based matched case-control and case-crossover study based on secondary data linked together from Swedish national registers. Cases were drivers aged 50-80 years involved in a vehicle crash resulting in injuries between January 2006 and December 2009 for the case-control study (n = 27,096) and from February 2006 to December 2009 for the case-crossover study (n = 26,586). For the first design, four controls were matched to each case by sex, age, and residential area, and exposure was categorized into new, occasional, and frequent use of zolpidem only, zopiclone only, and combined zolpidem and zopiclone. For the case-crossover study, newly dispensed zolpidem or zopiclone users were assessed during the 28 days prior to the crash and compared with an equally long control period using a 12-week washout period. Matched adjusted odds ratios (OR) were computed using conditional logistic regression.Results: Increased ORs for all users were observed. In the case-control study, the highest odds were seen among newly initiated zolpidem-only users involved in single-vehicle crashes (adjusted OR 2.27; 95% confidence interval [CI] 1.21-4.24), followed by frequent combined zolpidem and zopiclone users [adjusted OR 2.20; CI 1.21-4.00]. In the case-crossover, newly initiated treatment with zolpidem or zopiclone showed an increased risk that was highest in the 2 weeks after the start of the treatment (OR 2.66; 95% CI 1.04-6.81).Conclusions: These results provide more compelling evidence for the role of zolpidem or zopiclone in the occurrence of RTCs among older adults, not only in frequent users, but also at the beginning of treatment. [ABSTRACT FROM AUTHOR]

Introduction: For over a century, the occurrence of dissociative symptoms in connection to traumatic exposure has been acknowledged in the scientific literature. Recently, the importance of dissociation has also been recognized in the long-term traumatic response within the DSM-5 nomenclature. Several studies have confirmed the existence of the dissociative posttraumatic stress disorder (PTSD) subtype. However, there is a lack of studies investigating latent profiles of PTSD solely in victims with PTSD.Purpose and Method: This study investigates the possible presence of PTSD subtypes using latent class analysis (LCA) across two distinct trauma samples meeting caseness for DSM-5 PTSD based on self-reports (N = 787). Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in a dissociative compared with a non-dissociative PTSD class.Results: The results of LCA revealed a two-class solution with two highly symptomatic classes: a dissociative class and a non-dissociative class across both samples. Increased emotion-focused coping increased the probability of individuals being grouped into the dissociative class across both samples. Social support reduced the probability of individuals being grouped into the dissociative class but only in the victims of motor vehicle accidents (MVAs) suffering from whiplash.Conclusions: The results are discussed in light of their clinical implications and suggest that the dissociative subtype can be identified in victims of incest and victims of MVA suffering from whiplash meeting caseness for DSM-5 PTSD. [ABSTRACT FROM AUTHOR]

Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and contribute significantly to the overall road traffic injuries. The aims of this work were to study the attitudes and practices of the motorcyclists regarding training and safety measures, and to determine some underlying factors of motorcycle crashes. This cross sectional hospital based study was conducted on all injured conscious motorcyclists who were admitted to the emergency department at Benha University Hospital, Benha City, Qalubia governorate, Egypt from December 2012 up to December 2013. The data were collected using a standard interview questionnaire which included four main sections; personal data, data about the rider's experience and training, safety issues and data about the crash the motorcyclist involved in. The questionnaire was completed by 246 motorcyclists. Of these, 67.5 % did not have a motor cycle license and friends/family were the source of training for 56.9 % of them. There were highly significant associations between the source of training and age, education, occupation and marital status ( P < 0.001 for all). Correctly positioning the motorcycle according to road conditions, making one visible to other road users and the proper maintenance of the motorcycle were the most commonly reported safety measures. Inattentive mode, suffering stress on the day of the accident, not paying attention to distances or to the regulations, not being familiar with the road of the accident and not using the protection system were some of the underlying factors of motorcycle accidents. [ABSTRACT FROM AUTHOR]

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2-4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent's report. Parent-child agreement for ASD was poor (Cohen's kappa = -.04), but fair for PTSD (Cohen's kappa = .21). Agreement ranged widely for other emotional disorders (Cohen's kappa = -.07-.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma. [ABSTRACT FROM AUTHOR]

The aim of the two studies presented here was to produce and refine a measure of victim empathy for the assessment of child molesters. In the first study, 61 nonfamilial child molesters completed the Child Molester Empathy Measure (CMEM), a questionnaire designed specifically for this study. The measure assessed empathy in three contexts: (a) toward a child who was in a motor vehicle accident and was disfigured, (b) toward a child who had been sexually molested by an unknown assailant over a period of time, and (c) toward the offender's own victim(s). Results indicated that the measure was both internally reliable and produced stable responses over time. The results also revealed a relative deficit in empathy toward the offender's own victim(s). The goal of the second study was to replicate the data obtained in the first study and compare child molesters' responses with the responses of a group of nonoffenders. Twenty-nine child molesters and 36 community males (nonoffenders) completed the questionnaire. This study also confirmed the internal reliability and test-retest reliability of the CMEM. The discriminant validity of the measure was supported by the child molesters' demonstrated relative deficiency in empathy toward an unknown offender's victim of sexual abuse. However, the child molesters displayed equal empathy toward the accident victim relative to nonoffenders. Additionally, the child molesters displayed significantly less empathy toward their own victims than toward the general sexual abuse victim. The results are discussed in terms of their theoretical and practical implications. [ABSTRACT FROM AUTHOR]

Abstract Questionnaire information about possible psychological changes in the months following their accident was obtained for 45 school age children who had attended an Accident and Emergency Department because of their involvement in road traffic accidents. Central nervous system involvement was rare in this group. Short-term psychological consequences were common, but even after 4-7 months 33% were considered by their parents to still have a moderate reaction and a further 11% were considered to be severely affected. The children had high levels of posttraumatic stress symptoms, particularly avoidance in over 50%. Travel anxiety was described in 39%, 23% were depressed and 14% highly anxious-features which were considered by parents to have appeared following the accident, often with increasing disturbance over time. Other apparent repercussions were nightmares and other sleep difficulties in 17%, accident related fears, irritability, anger and emotionally regressed behaviour. As head injury was very uncommon in this series, such psychological consequences were attributable to non-neurological factors. Parents had become more protective of their children and placed greater restrictions on their travel, causing conflict. Younger children, those who had not fully recovered from their accident injuries, and children who also had a parent involved in the same accident, were most at risk. Greater awareness of these psychological consequences of road traffic accidents is required on the part of parents and professionals. Prospective studies are also needed to delineate more precisely those at greatest risk and to assess the effectiveness of treatment approaches. [ABSTRACT FROM AUTHOR]