AREAS OF APPLICATION OF UNMANNED AERIAL VEHICLES

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Defining adverse events during trauma resuscitation: a modified RAND Delphi study

BackgroundThe majority of preventable adverse event (AEs) in trauma care occur during the initial phase of resuscitation, often within the trauma bay. However, there is significant heterogeneity in reporting these AEs that limits performance comparisons between hospitals and trauma systems. The objective of this study was to create a taxonomy of AEs that occur during trauma resuscitation and a corresponding classification system to assign a degree of harm.MethodsThis study used a modified RAND Delphi methodology to establish a taxonomy of AEs in trauma and a degree of harm classification system. A systematic review informed the preliminary list of AEs. An interdisciplinary panel of 22 trauma experts rated these AEs through two rounds of online surveys and a final consensus meeting. Consensus was defined as 80% for each AE and the final checklist.ResultsThe Delphi panel consisted of 22 multidisciplinary trauma experts. A list of 57 evidence-informed AEs was revised and expanded during the modified Delphi process into a finalized list of 67 AEs. Each AE was classified based on degree of harm on a scale from I (no harm) to V (death).DiscussionThis study developed a taxonomy of 67 AEs that occur during the initial phases of a trauma resuscitation with a corresponding degree of harm classification. This taxonomy serves to support a standardized evaluation of trauma care between centers and regions.Level of evidenceLevel 5.

Management Issues with Infection Control during Trauma Resuscitation in the Era of COVID-19: South African Experience.

Background: This invited short report aims to document the management of trauma and nontrauma ICU patients in one quaternary facility in South Africa during the first two waves of the SARS CoV2 (Covid-19) pandemic in Kwa Zulu-Natal. Content: The setting of the trauma service and the changes made to ensure staff and patient safety are detailed. A brief overview of the clinical experience of caring for both trauma and non-trauma cases is provided along with the management of those cases who were found to be Covid-19 positive. The concerning aspect of increased antibiotic resistance development and the potential roles of antiseptic sanitisers is briefly discussed. Conclusion: Trauma care is essential during the infectious pandemic and there is a risk of increased antibiotic resistance. Doing the basics “right” can prevent staff contamination or adverse patient outcomes. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.72-76

The Process of Regional Trauma System Development in Shenzhen, China: An 8-Year Journey

Background: International experiences have shown that trauma system development significantly reduces preventable deaths and disabilities. During the 8-year study, the aim was to find solutions for trauma system development in Shenzhen, China, so as to reduce trauma mortality and morbidity. Methods: Introducing the ATLS® program to mainland China was started in 2013. A geospatial analysis of traumatic incidents was conducted in 2014. A regional trauma center was illustrated as an example to be used as a reference. The trauma audit meeting was introduced as an approach to continuous trauma quality improvement. The Shenzhen Trauma Surgery Committee was established to finalize the plan for designation of trauma care hospitals. The American College of Surgeons Trauma System Development Guidelines were translated into Chinese. Results: ATLS® provider course was held in Shenzhen and totally 205 doctors received training. A regional trauma center where adopted ATLS® principles as the standard for trauma resuscitation and early trauma care, with results showing significant improvements in trauma team organization, trauma resuscitation, definitive trauma care and a significant reduction in mortality among major trauma patients. The trauma audit meeting was introduced to 8 hospitals. A new trauma system plan for Shenzhen was set up and a consensus was reached on trauma center designation. The American College of Surgeons' “Resources for Optimal Care of the Injured Patient” was translated into Chinese and published in November 2020. Conclusion: The critical steps in establishing the framework for the Shenzhen trauma system included: geospatial analysis of traumatic incidents, trauma care training for providers, trauma center development, regional trauma center designation and development of trauma quality improvement programs. This practical approach can be replicated in other countries seeking to establish a trauma system. We are now working toward extension of this approach to other regions of mainland China.