Presence of a pre-hospital enhanced care team reduces on scene time and improves triage compliance for stab trauma

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: A reduction in pre-hospital scene time for patients with penetrating trauma is associated with reduced mortality, when combined with appropriate hospital triage. This study investigated the relationship between presence of pre-hospital enhanced care teams (ECT) (Critical Care Paramedics (CCPS) or Helicopter Emergency Medical Service (HEMS)), on the scene time and triage compliance, of penetrating trauma patients in a UK ambulance service. The primary outcome was whether scene time reduces when an ECT is present. A secondary outcome was whether the presence of an ECT improved compliance with the trust's Major Trauma Decision Tree (MTDT). Methods: All suspected penetrating trauma incidents involving a patient's torso were identified from the Trust's computer-aided dispatch (CAD) system between 31st March 2017 and 1st April 2018. Only patients who sustained central penetrating trauma were included. Any incidents involving firearms were excluded due to the prolonged times that can be involved when waiting for specialist police units. Data relevant to scene time for each eligible incident were retrieved, along with the presence or absence of an ECT. The results were analysed to identify trends in the scene times and compliance with the MTDT. Results: One hundred seventy-one patients met the inclusion criteria, with 165 having complete data. The presence of an ECT improved the median on-scene time in central stabbing by 38% (29m50s vs. 19m0s, p = 0.03). The compliance with the trust's MTDT increased dramatically when an ECT is present (81% vs. 37%, odds ratio 7.59, 95% CI, 3.70-15.37, p < 0.0001). Conclusions: The presence of an ECT at a central stabbing incident significantly improved the scene time and triage compliance with a MTDT. Ambulance services should consider routine activation of ECTs to such incidents, with subsequent service evaluation to monitor patient outcomes. Ambulance services should continue to strive to reduce scene times in the context of central penetrating trauma.Peer reviewe

Promoting sex and gender inclusivity in the classroom: A re-evaluation of discipline norms.

Creating curricula that are inclusive of sex and gender diverse students starts with redefining the classroom environment and how course materials are discussed. Such inclusive environments help increase diversity and representation in STEM. However, traditional approaches to teaching and the use of gendered language can reinforce unsupported notions regarding sex and gender. These notions persist throughout STEM and only serve to alienate our sex and gender diverse students and impact their safety. Thus, we have been exploring how best to approach the topics of sex and gender. Our context is in Biology, as our courses can explore the complexity of biological sex, why it is different from gender, and thus why transgender and non-binary individuals are part of natural variation instead of outliers. However, gendered language and misconceptions can appear in any discipline, in the terminology, metaphors, and examples given in class. In addition, all disciplines must consider how best to foster inclusivity among their students. In this presentation, we invite participants to share experiences and concerns regarding inclusivity in their classes, discuss case studies, and brainstorm with each other on how best to incorporate sex and gender awareness in their disciplines. Participants will come away with an appreciation for why sex and gender inclusivity is important, a framework for applying sex and gender inclusivity to their own curricula, a desire to learn more, and resources to help them on their journey

Drain Design – Circa 1975

Andy McBride will describe how Drainage Act projects were undertaken when he started his drainage practice in the mid 1970’s. Topics include drainage area determination using onsite inspection; aerial photography and topographic mapping; site surveying; project design parameters and methods; preparation of drawings; preparation of reports, including assessments and allowances; construction methods and supervision; and a description of his first appearance in front of the Drainage Tribunal

Drain Design – Circa 1975

Andy McBride will describe how Drainage Act projects were undertaken when he started his drainage practice in the mid 1970’s. Topics include drainage area determination using onsite inspection; aerial photography and topographic mapping; site surveying; project design parameters and methods; preparation of drawings; preparation of reports, including assessments and allowances; construction methods and supervision; and a description of his first appearance in front of the Drainage Tribunal

Narrowing opportunities for adults in Ontario secondary schools

A survey of five school boards, this study shows that the net result of the several changes made to education policy by the Ontario Ministry of Education has been a seriously eroded system of education for adults characterized by an overall reduction in educational opportunities and an increase in the variability of programs from Board to Board. The population demonstrated to be most negatively affected by these changes is that group of adults who do not have an OSSD and are economically disadvantaged; additionally, within this population exists groups of students who are even more disadvantaged. These groups: people with disabilities, visible minorities, women, and students who are taking English as a Second Language (ESL), continue to be disproportionately represented in the population of adults who are enrolled in the publicly-funded secondary school system. The new system of adult education increases the burden on these disadvantaged groups making it even more unlikely that they will be able to benefit from the philosophy of life-long learning espoused by the current government of Ontario, and particularly the Ministry of Education. Even in the first year of the new system, the effects of the changes in grants were seen in the dramatic decrease in the number of adults enrolled in secondary school programsNational Research Network on New Approaches to Lifelong Learning (NALL) founded by the Social Sciences and Humanities Research Council of Canada (SSHRC) Grant No. 818-96-103

Comparing the costs of alternative models of end-of-life care

This study explores the financial consequences of decreased acute care utilization and expanded community-based care for patients at the end of life in England. A Markov model based on cost and utilization data was used to estimate the costs of care for cancer and organ failure in the last year of life and to simulate reduced acute care utilization. We estimated at 1.8 pound billion the cost to the taxpayer of care for the 127,000 patients dying from cancer in 2006. The equivalent cost for the 30,000 people dying from organ failure was 553 pound million. Resources of 16 pound to 171 pound million could be released for cancer. People generally prefer to die outside hospital. Our results suggest that reducing reliance on acute care could release resources and better meet peoples' preferences. Better data on the cost-effectiveness of interventions are required. Similar models would be useful to decision-makers evaluating changes in service provision