Detonation of aerial bombs

Introduction. Even today aerial bombs and unexploded ordnance from World War II are still common. For deactivation many relevant factors must be noted by emergency medical service personnel. The aim of the present review is to summarize resulting problems and to assess organizational challenges for deactivation procedures of aerial bombs. Materials and methods. Detonations were analyzed only for Germany and Austria for the years 1990-2010. For the review an extensive Internet search on explosions and unexpected detonations was performed independently from deactivation procedures. Results. In the last years a total of 5 detonations during deactivation procedures were identified for Germany and Austria (in each case 0-4 killed and 0-6 injured persons). Additionally, 20 unexpected detonations independent from deactivation procedures (in each case 0-3 killed and 0-17 injured persons) were found. Discussion. During intended or performed deactivation of aerial bombs the emergency medical strategy, organizational assessment and coordination of the medical mission are the responsibility of the chief emergency physician. These missions are rare and therefore the personnel usually have very limited experience. The number of injured and killed persons may be considerable and represents a significant organizational challenge for the emergency physicians at the scene

Hypothermia after reanimation

The use of induced hypothermia is the only therapeutic method currently known to improve neurologic outcome and reduce mortality following cardiac arrest and return of spontaneous circulation. Therapeutic hypothermia can be implemented using various procedures. For the induction of preclinical therapeutic hypothermia in out-of-hospital cardiac arrest patients, surface cooling and infusion of + 4A degrees C ice-cold intravenous fluid have been successfully tested. The aim of the article is to provide an overview of the current standard of knowledge of preclinical therapeutic hypothermia and to provide practical guidance for the induction of therapeutic hypothermia

Specific aspects of anesthesiological management of laser surgery in otorhinolaryngology

Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. However, the specific risks for patients and personnel that are associated with this technique necessitate strict compliance with safety regulations and precautions. The safe anesthesiological and surgical management of such procedures requires explicit knowledge of the risks inherent to laser use, as well as close communication between surgeon and anesthesiologist throughout all operative and perioperative procedures. Although potentially fatal complications are rare, surgeon and anesthesiologist need to be aware of the dangers at all times and have exact knowledge of emergency measures. The use of suitable laser-resistant endotracheal tubes, total intravenous anesthesia and an optimized breathing gas mixture can contribute to minimize the occurrence of complications in otorhinolaryngology laser surgery

Specific aspects of anesthesiological management of laser surgery in otorhinolaryngology

Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. However, the specific risks for patients and personnel that are associated with this technique necessitate strict compliance with safety regulations and precautions. The safe anesthesiological and surgical management of such procedures requires explicit knowledge of the risks inherent to laser use, as well as close communication between surgeon and anesthesiologist throughout all operative and perioperative procedures. Although potentially fatal complications are rare, surgeon and anesthesiologist need to be aware of the dangers at all times and have exact knowledge of emergency measures. The use of suitable laser-resistant endotracheal tubes, total intravenous anesthesia and an optimized breathing gas mixture can contribute to minimize the occurrence of complications in otorhinolaryngology laser surgery

"Second victim" : "Critical incident stress management" in der klinischen Medizin

BACKGROUND Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. METHODS A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. RESULTS In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. CONCLUSIONS The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.Hintergrund Kritische Ereignisse in der Medizin können weitreichende Folgen für die Gesundheit des Patienten nach sich ziehen. Verursacht werden können kritische Ereignisse durch sowohl unsachgemäßes Verhalten im Sinne eines leichten Behandlungsfehlers als auch durch grobes Fehlverhalten, das aus objektiver ärztlicher Sicht unverständlich sowie unverantwortlich erscheint und als schwerer Behandlungsfehler gewertet wird. Ebenso kann eine Komplikation als unerwünschte und unerwartete Entwicklung einer Krankheit oder einer Behandlung dem Ereignis zugrunde liegen. Methoden Es wurden eine Internetrecherche zu den Stichworten „second victim“, „medical error“, „critical incident stress management“ (CISM) und „critical incident stress reporting system“ (CIRS) geführt sowie über Pubmed/Medline wissenschaftliche Studien zu denselben Themenbereichen gesichtet. Berichte und Beiträge von Fachgesellschaften und öffentlichen Institutionen, die Kriseninterventionsprogramme anbieten, wurden analysiert. Die vorhandenen Daten wurden nach Oberkriterien sortiert und dabei der Bezug zum Krankenhaus besonders berücksichtigt. Die Auswertung erfolgte deskriptiv. Ergebnisse In der Katastrophenmedizin und zivilen Luftfahrt ist „critical incident stress management“ (CISM) eine effektvolle Maßnahme, um eine rasche Erholung des Personals nach traumatisierenden Ereignissen zu gewährleisten und Normalisierung sowie Rückkehr an den Arbeitsplatz zu ermöglichen. Des Weiteren konnten verschiedene innerklinische Krisenpläne und Konzepte identifiziert werden. Schlussfolgerungen Mit der Implementierung von CISM und CISM-ähnlichen Programmen in den klinischen Alltag steht eine wirkungsvolle Methode in der Betreuung von medizinischem Personal nach kritischen Zwischenfällen zur Verfügung. Die Programme leisten einen wertvollen Beitrag zur Vermeidung zukünftiger Fehler sowie zur Mitarbeitersicherheit und -zufriedenheit