British journal of anaesthesia
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Preparedness for mass casualty events is essential at local, national, and global levels. Much more needs to be done by all stakeholders to avoid unnecessary morbidity and mortality despite the challenges that COVID-19 continues to present. In this editorial, we highlight the challenges and solutions for mass casualty incident preparations.
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Editorial Comment
Meta-analyses of clinical trials: are we getting lemonade from lemons?
Meta-analyses guide planning of clinical trials and clinical care, but are subject to all the methodologic problems and potential biases present in the underlying trials. Furthermore, publication bias often contributes to overestimated benefit in meta-analyses of small trials, which are often 'corrected' by subsequent large trials. Meta-analyses are no substitute for large robust trials.
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We outline the history, implementation and clinical impact of the formation of an Airway Lead Network. Although recommendations to improve patient safety in airway management are published and revised regularly, uniform implementation of such guidelines are applied sporadically throughout the hospital and prehospital settings. ⋯ Locally, the Airway Lead may chair a multi-disciplinary airway committee within their organisation; an Airway Lead Network enables Airway Leads to share common problems and solutions to promote optimal airway management on a national level. Support from governing bodies is an essential part of this structure.
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Mass casualty events occur on a regular although unpredictable basis within the contexts of both Mèdecins Sans Frontières (MSF) and the International Committee of the Red Cross (ICRC) activities. The frequency of both natural disasters and other mass casualty incidents is increasing with urbanisation and industrialisation, compounded by climate change and conflict. Both organisations have recognised that the historical training focus on full-scale mass casualty simulations has not always been followed through to the resolution of action points and dissemination of learning. ⋯ This led MSF and ICRC to develop a multimodal approach to assist development of mass casualty plans and preparedness. Capitalising on our presence in these contexts we are incorporating our experience of quality improvement and change management to complement simulation to 'stress and test' systems. We examine the challenges and share our efforts to improve training of staff in field projects across both MSF and ICRC and discussing future innovations.
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The delivery of medical care to the severely injured during major incidents and mass casualty events has been a recurring challenge for decades across the world. From events in resource-poor developing countries, through richly funded military conflicts, to the most equipped of developed nations, the provision of rapid medical care to the severely injured during major incidents and mass casualty events has been a priority for healthcare providers. This is often under the most difficult of circumstances.1,2 Whilst mass casualty events are a persistent global challenge, it is clear in developed countries that patients and their families demand and expect a high standard of care from their rescuers, that this care should be delivered rapidly, and this should be of the highest quality possible.3 Whilst there is respect afforded to those who 'run towards danger' during a high-threat situation, first responders are subjected to a high degree of scrutiny for their actions, even when the circumstances they are presented with are considered to be extraordinary.4 Likewise, even for those who are catastrophically injured beyond salvage, society expects the response to be dignified, calculated, and thorough.3.