British journal of anaesthesia
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Seasonal trends in patient outcomes are an under-researched area in perioperative care. This systematic review evaluates the published literature on seasonal variation in surgical outcomes worldwide. ⋯ PROSPERO CRD42019137214.
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The use of motor vehicles to initiate mass casualty incidents is increasing in frequency and such events are called intentional vehicular assaults. Perpetrators are inspired by a range of terrorist ideologies or have extremist views, criminal intent, or mental health issues. Assaults using a motor vehicle as the principal weapon of attack are easy to launch and require little to no forward planning. ⋯ With the increasing frequency of intentional vehicular assaults, anaesthesiologists in various settings may be involved in caring for victims and should be engaged in preparing for them. This narrative review examines the literature on vehicle assaults committed around the world and provides an overview of the unique injury patterns and considerations for the pre-hospital, perioperative, and critical care management of victims of these mass casualty events. The article discusses planning, education, and training in an attempt to reduce the mortality and morbidity of intentional vehicular assaults.
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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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Pre-hospital advanced airway management is a complex intervention composed of numerous steps, interactions, and variables that can be delivered to a high standard in the pre-hospital setting. Standard research methods have struggled to evaluate this complex intervention because of considerable heterogeneity in patients, providers, and techniques. In this study, we aimed to develop a set of quality indicators to evaluate pre-hospital advanced airway management. ⋯ We identified a set of quality indicators for pre-hospital advanced airway management that represent a practical tool to measure, report, analyse, and monitor quality and performance of this complex intervention.
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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.