J Trauma
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The potential need for rapid medical intervention and access to a trauma center after major injury is crucial to the safety and success of SWAT team operations. This manuscript describes the genesis and development of a unique model for which advanced medical care is rendered by trained health care professionals within a regional trauma system in the support of a SWAT team. The model was developed jointly by the Newark, New Jersey, Division of the Federal Bureau of Investigation and The New Jersey Trauma Center-University Hospital, an academic, urban Level I trauma center. ⋯ Since inception, the medical team has provided medical support for 33 tactical missions and 99 training days. Ten patients were treated: 7 agents (syncope, fractured foot, blunt head/neck trauma, lacerations), 2 bystanders (chest pain, asthma), and 1 suspect (chest pain). The advantages of the Newark model in contrast to other programs of tactical medical support, are the operational activities of the team and the cost of the program was outlined.
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Comparative Study
Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation.
Regional trauma systems were proposed 2 decades ago to reduce injury mortality rates. Because of the difficulties in evaluating their effectiveness and the methodologic limitations of previously published studies, the relative benefits of establishing an organized system of trauma care remains controversial. ⋯ These data demonstrate that a state trauma system is associated with a reduction in the risk of death caused by injury. The effect is most evident on analysis of MVC deaths.
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The technique of percutaneous catheterization of the subclavian vein by the infraclavicular approach is dependent on the location of the subclavian vein in relation to the clavicle. The purpose of this study was to analyze the anatomic relationship between these two structures and how it is influenced by changes in shoulder positioning. ⋯ Infraclavicular subclavian venipuncture should be performed with shoulders in a neutral position and also in slight retraction. An appreciation of the anatomic relationship between the clavicle and the subclavian vein is the key to successful execution of this technique.
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The liver plays a critical regulatory role in the acute inflammatory response to injury, although the mechanisms of this regulation are not well understood. transforming growth factor-beta1 (TGF-beta1) is induced after burn injury and may contribute to an inhibitory or fatal effect on hepatocytes. We investigated the association over time between plasma concentration of TGF-beta1, expression of TGF-beta1 m-RNA in liver tissue, and histologic analysis of liver apoptosis after burn injury. ⋯ The levels of induced TGF-beta1 and TGF-beta1 m-RNA after L burn injury are higher and peak earlier than after M burn injury. Elevated TGF-beta1 may be associated with cell death in hepatocytes. The TGF-beta1 rise may be associated with hepatocyte injury and systemic response to massive burn.