Emergency medical dispatch recognition, clinical intervention and outcome of patients in traumatic cardiac arrest from major trauma : an observational study

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate. SETTING: Helicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people. PARTICIPANTS: Patients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust's geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected. OUTCOME MEASURES: Patient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates. RESULTS: 112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the 'not in TCA cohort', 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-of-spontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital. CONCLUSION: A significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival.Peer reviewedFinal Published versio

Scholars Forum: A New Model For Scholarly Communication

Scholarly journals have flourished for over 300 years because they successfully address a broad range of authors' needs: to communicate findings to colleagues, to establish precedence of their work, to gain validation through peer review, to establish their reputation, to know the final version of their work is secure, and to know their work will be accessible by future scholars. Eventually, the development of comprehensive paper and then electronic indexes allowed past work to be readily identified and cited. Just as postal service made it possible to share scholarly work regularly and among a broad readership, the Internet now provides a distribution channel with the power to reduce publication time and to expand traditional print formats by supporting multi-media options and threaded discourse. Despite widespread acceptance of the web by the academic and research community, the incorporation of advanced network technology into a new paradigm for scholarly communication by the publishers of print journals has not materialized. Nor have journal publishers used the lower cost of distribution on the web to make online versions of journals available at lower prices than print versions. It is becoming increasingly clear to the scholarly community that we must envision and develop for ourselves a new, affordable model for disseminating and preserving results, that synthesizes digital technology and the ongoing needs of scholars. In March 1997, with support from the Engineering Information Foundation, Caltech sponsored a Conference on Scholarly Communication to open a dialogue around key issues and to consider the feasibility of alternative undertakings. A general consensus emerged recognizing that the certification of scholarly articles through peer review could be "decoupled" from the rest of the publishing process, and that the peer review process is already supported by the universities whose faculty serve as editors, members of editorial boards, and referees. In the meantime, pressure to enact regressive copyright legislation has added another important element. The ease with which electronic files may be copied and forwarded has encouraged publishers and other owners of copyrighted material to seek means for denying access to anything they own in digital form to all but active subscribers or licensees. Furthermore, should publishers retain the only version of a publication in a digital form, there is a significant risk that this material may eventually be lost through culling little-used or unprofitable back-files, through not investing in conversion expense as technology evolves, through changes in ownership, or through catastrophic physical events. Such a scenario presents an intolerable threat to the future of scholarship

An investigation of extensional tectonics of southern California

Geologic mapping and interpretation of Landsat TM imagery has filled in a significant gap in the geologic database for southwestern Arizona and southeastern California. The new data acquired, along with interpretation of existing data, forms the basis for a proposed reconstruction of late Tertiary faults in these regions. This reconstruction integrates available geological and geophysical data to define the eastern limit of deformation related to the San Andreas fault, and has significant implications for other recently proposed reconstructions of Tertiary deformation in the region. This progress in interpreting deformation during the last 10 Ma in the region forms a foundation for developing and testing models of older deformation in this region, including the initiation of San Andreas fault system, and the interaction of Early Miocene extension in the Basin and Range with the evolving San Andreas system

Neutron--Antineutron Oscillations at the Surface of Nuclei

We discuss some aspects of possible neutron--antineutron oscillations in nuclei. The phenomenon occurs mostly at the surface of nuclei, and hence {\sl i)} is not very sensitive to medium corrections and {\sl ii)} makes use of the antinucleon-nucleus interaction in a region probed by experiments at CERN.Comment: Contr. Oak Ridge Workshop on Workshop on Baryon Instability, Latex, 4 pages, comments to [email protected]

Comparison of hydrogen and methane as coolants in regeneratively cooled panels

Comparison of hydrogen and methane as coolants in regeneratively cooled panel

Hilbert's "Verunglueckter Beweis," the first epsilon theorem, and consistency proofs

In the 1920s, Ackermann and von Neumann, in pursuit of Hilbert's Programme, were working on consistency proofs for arithmetical systems. One proposed method of giving such proofs is Hilbert's epsilon-substitution method. There was, however, a second approach which was not reflected in the publications of the Hilbert school in the 1920s, and which is a direct precursor of Hilbert's first epsilon theorem and a certain 'general consistency result' due to Bernays. An analysis of the form of this so-called 'failed proof' sheds further light on an interpretation of Hilbert's Programme as an instrumentalist enterprise with the aim of showing that whenever a `real' proposition can be proved by 'ideal' means, it can also be proved by 'real', finitary means.Comment: 18 pages, final versio