J Trauma
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Emergency Department crowding has long been described. Despite the daily challenges of managing emergency department volume and acuity; a surge response during a disaster entails even greater challenges including collaboration, intervention, and resourcefulness to effectively carry out pediatric disaster management. Understanding surge and how to respond with appropriate planning will lead to success. To achieve this, we sought to analyze models of surge; review regional and national data outlining surge challenges and factors that impact surge; and to outline potential solutions. ⋯ There are numerous shortcomings regionally and nationally affecting our ability to provide an effective and coordinated surge response. Planning, education, and training will lead to an effective pediatric disaster management response.
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The prehospital provider is met with unique challenges when responding to a call and finding a pediatric aged patient that requires evaluation, treatment, and transfer to a medical facility. Many mass causality incidents secondary to natural disaster, man-made disasters, or acts of terrorisms have exposed the vulnerabilities of prehospital emergency medical services personnel in the evaluation, treatment, and transport of the pediatric population. Many lessons learned from past events have been published with agendas to incorporate the needs of the transport of pediatric patients. This article will review the issues and recommendations of the prehospital personnel's role with expectations that pediatric aged victims are rendered optimal care.
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Pediatric and neonatal interfacility transport medicine is a relatively young but a rapidly evolving specialty. Transport teams are essential for the safe interfacility movement of critically ill patients. ⋯ The predicaments brought about by Hurricane Katrina that hindered the evacuation of pediatric and neonatal patients out of ravaged hospitals are also reviewed. From these experiences, recommendations to improve the efficiency and efficacy of interfacility transport of pediatric patients will be presented.
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Although the lethal triad of hypothermia, acidosis, and coagulopathy has been recognized for a decade, the underlying mechanisms related to the development of coagulopathy are not fully understood. Consequently, current strategy in treating trauma patients with coagulopathy is limited to "staying out of the trouble" instead of "getting out of trouble." A better understanding of the underlying mechanisms will facilitate the search for effective therapeutic approaches when this lethal triad cannot be avoided. ⋯ Hypothermia and acidosis impair thrombin generation and fibrinogen availability via different mechanisms. Current data indicate that pH correction alone cannot immediately correct acidosis-induced coagulation impairments. Future studies are warranted to test the effects of pH neutralization in conjunction with fibrinogen supplementation in normalizing acidosis-induced clotting complications.
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Pedestrian-related crashes cause an estimated 1.2 million deaths and 50 million injuries worldwide. There were 32,590 nonfatal injuries reported among children 0 to 14 years of age in the United States in 2006. ⋯ This article is a special communication and overview of selected literature regarding efforts to decrease the frequency of pediatric pedestrian trauma. WalkSafe an elementary school-based pedestrian injury prevention program will be discussed as an example of a program that has been able to demonstrate a decrease in injuries in children.