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The administration of blood products to battlefield casualties in the prehospital arena has contributed significantly to the survival of critically injured patients in Afghanistan over the past 5 years. Given as part of an established military "chain of survival," blood product administration has represented a step-change improvement in capability for both UK and US tactical aeromedical evacuation (TACEVAC) platforms. The authors explore current concepts, analyzing and exploring themes associated with early use of blood products (fresh frozen plasma [FFP] and red blood cells [RBCs]), and they compare and evaluate a US/UK study analyzing the differences and recommending future strategy. The subject matter expert (SME) consensus guidelines developed for use by the US Army Air Ambulance units commonly known as call sign "DUSTOFF." These TACEVAC assets in Afghanistan were validated in this retrospective study. Using statistical analysis, the authors were able to ascertain that the current DUSTOFF SME-derived guidelines offer a sensitivity of 63.04% and a specificity of 89.07%. By adjusting the indicators to include a single above-ankle amputation with a systolic blood pressure (SBP) less than 90 mmHg and pulse greater than 120/min, the sensitivity could be increased to 67.39% while maintaining the specificity at 89.07%. In our data set, a single amputation above the ankle, in combination with an SBP of less than 100 mmHg and a pulse of greater than 120/min, increased the sensitivity to 76% but with a slight drop in specificity to 86%. Further study of military prehospital casualty data is under way to identify additional physiological parameters that will allow simple scoring tools in the remote setting to guide the administration of prehospital blood products., (2014.)

Introduction: Medical care provided by medical specialists is one of the scarcest resources in the public system. It is costly and difficult to access for the general population. Availability and accessibility of specialized care is related to economic, social and cultural aspects that vary among geographical areas. An aggravating factor for this situation is patients’ failure to appear on the date of their appointment, which is defined as the nonattendance of patients to medical specialist appointments without notice., Objectives: To measure and analyze the phenomenon of nonattendance of patients to medical appointments with specialists in the public healthcare system of Chile and its relationship with environmental and socioeconomic regional indicators., Methods: Ecological design study, using medical care records in the public system and environmental and socioeconomic regional indicators potentially related to the absence of patients, between the years 2005-2010. Poisson regression models with random components were used for assessing associations., Results: There is 16.5% of nonattendance of patients, with a range between regions from 8.8 to 20.2%. Nonattendance is higher in the specialties of dermatology, geriatrics and nutrition (20.0%), in children (3.1% more than in adults), in areas with highest indigenous population (RR=1.3), in areas with low diversity of specialties (RR=1.1) and in the months of February, July, November and December (RR>1.1)., Conclusions: In Chile, socioeconomic factors and the management of healthcare resources have greater influence on the nonattendance of patients to medical specialists’ appointments than environmental factors; therefore, this phenomenon may be avoidable.

As the only burn center in the Department of Defense, the U.S. Army Institute of Surgical Research is the primary location for care of service members with burn injuries. The combat operations in Iraq and Afghanistan during the past decade have caused an increase in burn patients. As a result of this increased need, advancements in care were developed. The speed and precision of transporting patients from the battlefield to the burn center has improved over previous conflicts. Technological advancements to support treating complications of burn wound healing were leveraged and are now integrated into daily practice. Clinical decision support systems were developed and deployed at the burn center as well as to combat support hospitals in combat zones. Technology advancements in rehabilitation have allowed more service members to return to active duty or live productive civilian lives. All of these advancements were developed in a patient-centered, interdisciplinary environment where the nurses are integrated throughout the research process and clinical practice with the end goal of healing combat burns in mind.

Background: Revision total hip arthroplasty in cases with severe acetabular bone loss is challenging. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been the treatment of choice. The current paper describes an impaction grafting into a mesh for uncontained defects in revision total hip arthroplasty., Description of Technique: After restoring containment with a mesh fixed with small fragment screws, defects were restored using impaction grafting combined with a cemented all-polyethylene cup., Patients and Methods: Fourteen consecutive acetabular impaction graftings were performed by two surgeons. All patients had a type 3B defect according to the Paprosky classification., Results: No re-revisions or radiographic failure was detected in the early follow-up period., Conclusion: Impaction grafting into a mesh is an interesting treatment option to restore bone in combined cavitary and segmental defects.

Background: suicide attempt with aluminum phosphide fumigant has high mortality conditions. The aim was to investigate the frequency of aluminum phosphide consumption in suicide attempt., Methods: a retrospective case series study at the Hospital General de Tejupilco during the period 2009-2011 was done. Thirty-two patients had attempted suicide; we included 18 whose suicide attempt was with aluminum phosphide. The risk of rescue according Weisman's scale was measured., Results: from 18 suicidal patients, 83 % were women (n = 15); the average age was 17.7 ± 4.4 years; 89 % (n = 16) were = 23 years old; and 89 % (n = 16) had depression. The motive for the suicide attempt was being abandoned by a partner in 56 % (10). Mortality rate was 78 % (n = 14) and death ocurred in 4 ± 2 hours., Conclusions: aluminum phosphide is the most commonly used toxic substance in rural areas for suicide attempts. Among suicides, the most common cause among women was abandonment by her partner and was also related to depression and emotional security to dying.

The Combat Ready Clamp (CRoC™) was designed to control hemorrhage from the groin region, on the battlefield. The purpose of this experiment was to determine whether CRoC™ user performance varied by the surface the casualty laid on (flat-hard, flat-soft, and curved-soft) and how quickly the device could be applied. The commercial manikin selected to assess user performance was designed to train soldiers in CRoC™ use. The manikin simulated severe hemorrhage from an inguinal wound, controllable by correct use of the CRoC™. Each individual (n = 6) performed 3 iterations on each of the 3 surfaces (54 iterations total). The CRoC™ achieved hemorrhage control 100% of the time (54/54). Patient surface affected time to stop bleeding. The flat-soft surface (padded, 55 ± 9.7 seconds) was significantly different from the curved-soft surface (litter, 65 ± 16.5 seconds) and had the lowest overall total time (p = 0.007); time for the hard-flat surface was 58 ± 9.5 seconds. Users were trained to use the Combat Ready Clamp effectively, and the surface the casualty was lying on made some difference to user performance. All six persons trained had success in all nine of their iterations of CRoC™ use- a 100% rate. These findings indicate that training was effective and that training of other users is plausible, feasible, and practical within the scope of the present evidence.