Trauma on farms in the Republic of Ireland

Background: Farming is the most dangerous occupation in high-income countries worldwide. However, there is a lack of descriptive literature in this area. Injuries on farms are increasing, at a time when the cohort of trauma patients generally has become older and more medically complex. Farmers continue to work late in life when other industry workers would be retired. This study describes major trauma occurring on farms in the Republic of Ireland, the demographics of patients and treatments they received.Methods: Data was gathered from the National Office of Clinical Audit Major Trauma Audit (MTA) 2014 to 2016. Patients were included and excluded based on Trauma Audit and Research Network(TARN) inclusion criteria.Results: There were 430 patients included in this study. The median age was 54.5 years (range 1-93). There were 6.3%(n=27) paediatric patients, and 27%(n=116) over 65-year olds. Patients had predominantly low Charlson Comorbidity Index scores (median 0). Patients >65 years had more comorbidities (pConclusions: A substantial proportion of trauma on Irish farms involves older men who have co-morbidities and complexity of medical need. Farm trauma occurs in rural and remote locations with longer journey times to trauma centres and trauma units-this has implications for trauma care education and mode of EMS transport. Older patients who suffer trauma on farms require longer hospital stays and may not return to independent living.</div

What clinical crew competencies and qualifications are required for helicopter emergency medical services - A review of the literature

Background: Patients served by Helicopter Emergency Medical Services (HEMS) tend to be acutely injured or unwell and in need of stabilisation followed by rapid and safe transport. It is therefore hypothesised that a particular clinical crew composition is required to provide appropriate HEMS patient care. A literature review was performed to test this hypothesis.Methods: MEDLINE, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were systematically searched from 1 January 2009 to 30 August 2019 to identify peer-reviewed articles of relevance. All HEMS studies that mentioned ‘staffing’, ‘configuration’, ‘competencies’ or ‘qualifications’ in the title or abstract were selected for full-text review.Results: Four hundred one studies were identified. Thirty-eight studies, including one systematic review and onerandomised controlled trial, were included. All remaining studies were of an observational design. The vast majority of studies described clinical crews that were primarily doctor-staffed. Descriptions of non-doctor staff competencies were limited, with the exception of one paramedic-staffed model.Conclusions: HEMS clinical crews tended to have a wider range of competencies and experience than ground-basedcrews, and most studies suggested a patient outcome benefit to HEMS provision. The conclusions that can be drawn are limited due to study quality and the possibility that the literature reviewed was weighted towards particular crewing models (i.e. primarily doctor-staffed) and countries. There is a need for trial-based studies that directly compare patient outcomes between different HEMS crews with different competencies and qualifications.</div

Paediatric major trauma in the setting of the Irish trauma network

Background: The construction of a new tertiary children's hospital and reconfiguration of its two satellite centres will become the Irish epicentre for all paediatric care including paediatric trauma. Ireland is also currently establishing a national trauma network although further planning of how to manage paediatric trauma in the context of this system is required. This research defines the unknown epidemiology of paediatric major trauma in Ireland to assist strategic planning of a future paediatric major trauma network.Methods: Data from 1068 paediatric trauma cases was extracted from a longitudinal series of annual cross-sectional studies collected by the Trauma Audit and Research Network (TARN). All paediatric patients between the ages of 0-16 suffering AIS ≥2 injuries in Ireland between 2014-2018 were included. Demographics, injury patterns, hospital care processes and outcomes were analysed.Results: Children were most commonly injured at home (45.1%) or in public places/roads (40.1%). The most frequent mechanisms of trauma were falls Conclusion: Paediatric Trauma represents a significant childhood burden of mortality and morbidity in Ireland. There are currently several sub-optimal elements of paediatric trauma service delivery that will benefit from the establishment of a trauma network. This research will help guide prevention strategy, policy-making and workforce planning during the establishment of an Irish paediatric trauma network and will act as a benchmark for future comparison studies after the network is implemented.</div

Additional file 1: of Apples to apples: can differences in out-of-hospital cardiac arrest incidence and outcomes between Sweden and Ireland be explained by core Utstein variables?

Table S1. Comparison of Irish and Swedish OHCA resuscitation registries, Table S2. Missing data items, Table S3. Logistic regression analysis for the outcome survival in the Utstein subgroup using original data (adult, bystander-witnessed, initial rhythm, shockable, presumed medical aetiology). (PDF 95ย�kb

Cycling related major trauma in Ireland.

Introduction: Cycling as a means of transport or recreational activity is increasing in popularity in Ireland. However, increasing numbers of cyclists may lead to an increased number of bicycle collisions and fatalities. The Road Safety Authority is the statutory body for road safety in Ireland but uses police data alone to collate cycling collision statistics. This may lead to an underestimation of cycling injuries in Ireland. Using hospital statistics may provide a greater understanding of cycling trauma in Ireland.Objective: The present study examines cycling related trauma in Ireland using the Major Trauma Audit (MTA) data collected via the Trauma and Research Network (TARN) from hospitals in Ireland for the period 2014 to 2016. The database was interrogated for demographics, mechanism of injury, injury characteristics and patient outcomes.Results: There were 410 cycling collisions recorded in the TARN database which represented 4.4% of trauma captured by TARN for the study period. Of this cohort 79% were male compared with 58% in the overall (TARN) trauma cohort (p Conclusion: The TARN data presented in this paper builds a more complete overview of the burden of cycling collisions in Ireland. Particular points of focus are that serious cycling injuries occur in a predominantly male population, and that only around 30% of cases are recorded as involving a motor vehicle, with the majority having an unknown mechanism of injury. There was an association between helmets and head injuries in this study, but there are likely other contributing factors such as mechanism of injury, velocity or cycling infrastructure. Using hospital data such as the MTA provides valuable information on the injuries sustained by cyclists, but more prospective studies to capture injury mechanism and contributing factors are needed.</div

Prehospital characteristics that identify major trauma patients: a hybrid systematic review protocol [version 1; peer review: awaiting peer review]

Background: International evidence has consistently demonstrated significant improvements both in the trauma care process and outcomes for patients through re-configuring care services from that which is fragmented to integrated trauma networks. A backbone of any trauma network is a trauma triage tool. This is necessary to support paramedic staff in identifying major trauma patients based on prehospital characteristics. However, there is no consensus on an optimal triage tool and with that, no consensus on the minimum criteria for prehospital identification of major trauma.  Objective: Examine the prehospital characteristics applied in the international literature to identify major trauma patients.  Methods: To ensure the systematic review is both as comprehensive and complete as possible, we will apply a hybrid overview of reviews approach in accordance with best practice guidelines. Searches will be conducted in Pubmed (Ovid MEDLINE), Embase, Cochrane Library of Systematic Reviews and Cochrane Central Register of Clinical Trials. We will search for papers that analyse prehospital characteristics applied in trauma triage tools that identify major trauma patients. These papers will be all systematic reviews in the area, not limited by year of publication, supplemented with an updated search of original papers from November 2019. Duplication screening of all articles will be conducted by two reviewers and a third reviewer to arbitrate disputes. Data will be extracted using a pre-defined data extraction form, and quality appraised by the Newcastle Ottawa Quality Assessment form.  Conclusions: An exhaustive search for both systematic reviews and original papers will identify the range of tools developed in the international literature and, importantly, the prehospital characteristics that have been applied to identify major trauma patients. The findings of this review will inform the development of a national clinical prediction rule for triage of major trauma patients.</p

Prehospital characteristics that identify major trauma patients: a hybrid systematic review protocol [version 2; peer review: 1 approved, 1 approved with reservations]

Background: International evidence has demonstrated significant improvements both in the trauma care process and outcomes for patients through re-configuring care services from that which is fragmented to integrated trauma networks. A backbone of any trauma network is a trauma triage tool. This is necessary to support paramedic staff in identifying major trauma patients based on prehospital characteristics. However, there is no consensus on an optimal triage tool and with that, no consensus on the minimum criteria for prehospital identification of major trauma. Objective: Examine the prehospital characteristics applied in the international literature to identify major trauma patients. Methods: To ensure the systematic review is both as comprehensive and complete as possible, we will apply a hybrid overview of reviews approach in accordance with best practice guidelines. Searches will be conducted in Pubmed (Ovid MEDLINE), Embase, Cochrane Library of Systematic Reviews and Cochrane Central Register of Clinical Trials. We will search for papers that analyse prehospital characteristics applied in trauma triage tools that identify major trauma patients. These papers will be all systematic reviews in the area, not limited by year of publication, supplemented with an updated search of original papers from November 2019. Duplication screening of all articles will be conducted by two reviewers and a third reviewer to arbitrate disputes. Data will be extracted using a pre-defined data extraction form, and quality appraised by the Newcastle Ottawa Quality Assessment form. Conclusions: An exhaustive search for both systematic reviews and original papers will identify the range of tools developed in the international literature and, importantly, the prehospital characteristics that have been applied to identify major trauma patients. The findings of this review will inform the development of a national clinical prediction rule for triage of major trauma patients.</div

Major Trauma Audit national report 2019 and 2020

The Major Trauma Audit (MTA) is a clinically led audit established by the National Office of Clinical Audit (NOCA) in 2013. This audit focuses on the care of the more severely injured trauma patients in Ireland’s healthcare system. The methodological approach for the MTA is provided by the Trauma Audit and Research Network (TARN), based in the University of Manchester, United Kingdom (UK). In 2016, the MTA became the first national clinical audit endorsed by the National Clinical Effectiveness Committee (NCEC) and mandated by the Minister for Health. </p

Major Trauma Audit paediatric report 2014-2019

This report provides the first comprehensive analysis of paediatric major trauma in the Irish population. This is timely, given the opportunities for improving care for traumatically injured children throughout Ireland presented by the new children’s hospital, as this will be the single paediatric major trauma centre for the State. The report highlights that paediatric major trauma is of low frequency, at 5% of the overall trauma caseload for the 26 participating Irish hospitals. This represents a challenge in ensuring that healthcare institutions have the required expertise, preparedness and practice for presentations and procedures that happen relatively infrequently. The report also highlights the volume of major trauma patients attending model 3 and level 4 hospitals outside of Dublin and the need for on-site expertise and rapid transport services to get critically injured children to the right place at the right time. The MTA will continue to inform the reconfiguration of the Irish trauma system so that it is continuously modifying and improving, driven by the data and outcomes of MTA reports, in order to ensure equity of access to efficient and high-quality care for the children and adults of Ireland. A key finding from this report has been the many preventable mechanisms of injury leading to major trauma in children. Disseminating injury prevention messages to key groups and programmes will be a key focus for the audit. Moving forward, the MTA will work to support hospital MTA governance committees to use the data to identify areas of variation and develop QIPs to improve care

Additional file 2: of The Penicillin for the Emergency Department Outpatient treatment of CELLulitis (PEDOCELL) trial: update to the study protocol and detailed statistical analysis plan (SAP)

Health-related quality of life (HRQoL) questionnaires. The HRQoL questionnaires to be used in the PEDOCELL trial are to be found in Additional File 2. The EQ-5D-5L, the SF-12 and the Extremity Soft Tissue Infection (ESTI) score will be used to measure HRQoL outcomes in patients enrolled to the PEDOCELL trial at each follow-up visit. (DOCX 86 kb