Appropriate pain management indicates the quality of casualty care in trauma. Gender bias in pain management focused so far on the patient. Studies regarding provider gender are scarce and have conflicting results, especially in the military and prehospital settings.

The purpose of this study is to investigate the effect of health care providers’ gender on pain management approaches among prehospital trauma casualties treated by the Israel Defense Forces (IDF) medical teams.

This retrospective cohort study included all trauma casualties treated by IDF senior providers from 2015-2020. Casualties with a pain score of zero, age under 18 years, or treated with endotracheal intubation were excluded. Groups were divided according to the senior provider’s gender: only females, males, or both female and male. A multivariate analysis was performed to assess the odds ratio of receiving an analgesic, depending on the presence of a female senior provider, adjusting for potential confounders. A subgroup analysis was performed for “delta-pain,” defined as the difference in pain score during treatment.

A total of 976 casualties were included, of whom 835 (85.6%) were male. Mean pain scores (SD) for the female only, male only, and both genders providers were 6.4 (SD = 2.9), 6.4 (SD = 3.0), and 6.9 (SD = 2.8), respectively (P = .257). There was no significant difference between females, males, or both female and male groups in analgesic treatment, overall and per specific agent. This remained true also in the multivariate model. Delta-pain difference between groups was also not significant. Less than two-thirds of casualties in this study were treated for pain among all study groups.

This study found no association between IDF Medical Corps providers’ gender and pain management in prehospital trauma patients. Further studies regarding disparities in acute pain treatment are advised.

In a mass-casualty incident (MCI) involving children, there is a need to apply accurate triage tools in order to help those who require important care, and at the same time, to avoid unnecessary use of resources. Thus, it is discussed which would be the best triage device to use in these situations. One of the most used is a modification of Simple Triage and Rapid Treatment, JumpSTART, whose performative quality this review focuses on.

This review sought to compare the performance parameters of JumpSTART with other triage algorithms used in pediatric disaster victims.

This systematic review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with the PROSPERO database of systematic reviews with the number CRD42021258415. The last update of the search in the databases was on August 12, 2021 and resulted in six documents to be analyzed. The inclusion criteria included the peer-reviewed academic papers in English, Portuguese, Spanish, and Italian languages, and the databases used were PubMed, Scopus, MEDLINE/Bireme (Virtual Library of Health), Web of Science, and CINAHL, which executes the query on the topic, keywords, or abstracts. Also to be included, documents that were available with full-text access through CAPES, Google, or Google Scholar. Books, non-academic research, and content in languages other than the presented ones were represented as exclusion criteria. The Joanna Briggs Institute (JBI) checklists were used to evaluate the methodological quality of the retrieved studies. The results were presented through narrative synthesis. This review was not funded.

Of the collected publications, five articles were used to carry out this review, with the addition of an extra article captured by citation tracking. The findings from the obtained results were that JumpSTART was the preferred tool and presented the fastest speed of use. Only one of the five studies that dealt with accuracy showed JumpSTART as the most accurate algorithm, while three of the other four showed its inferiority in most aspects. In one study, no significant difference was observed amongst the chosen protocols.

There is insufficient evidence to validate JumpSTART as a universal triage tool, given the disparities in the results obtained from the comparisons. No tool performed satisfactorily well, therefore there is an urgent need to create a reliable algorithm.

The management of out-of-hospital traumatic cardiac arrest (TCA) for professional rescuers entails Advanced Life Support (ALS) with specific actions to treat the potential reversible causes of the arrest: hypovolemia, hypoxemia, tension pneumothorax (TPx), and tamponade. The aim of this study was to assess the impact of specific rescue measures on short-term outcomes in the context of resuscitating patients with a TCA.

This retrospective study concerns all TCA patients treated in two emergency medical units, which are part of the Northern French Alps Emergency Network (RENAU), from January 2004 through December 2017. Utstein variables and specific rescue measures in TCA were compiled: fluid expansion, pelvic stabilization, tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at Day 30 with good neurological status (Cerebral Performance Category [CPC] score CPC 1 and CPC 2).

In total, 287 resuscitation attempts in TCA were included and 279 specific interventions were identified: 262 fluid expansions, 41 pelvic stabilizations, five tourniquets, and 175 bilateral thoracostomies (including 44 with TPx).

Among the standard resuscitation measures to treat the reversible causes of cardiac arrest, this study found that bilateral thoracostomy and tourniquet application on a limb hemorrhage improve survival in TCA. A larger sample for pelvic stabilization is needed.

Dogs left behind in the restricted area by the Great East Japan Earthquakes of 2011 (Fukushima Prefecture, Japan) were initially rescued at a temporary first response shelter under chaotic conditions: poor housing and husbandry was maintained by unfamiliar/untrained staff, and lack of exercise was associated with deterioration of the mental and physical health of the impounded dogs. The objectives of this study were to report characteristics, disposition, and health status of dogs rescued in the Fukushima Prefecture, and to perform a retrospective epidemiological evaluation of factors associated with disposition and disease incidence at shelters.

The problems addressed in this study were shelter-related health issues at the first response shelter and reasons for retained adoption at the secondary shelter that caused delayed closure of the shelter.

A retrospective cohort study was performed with all dogs that were rescued from the restricted area in the Fukushima Prefecture. Kaplan-Meier time-to-event analysis was performed to estimate the median days to outcomes. A chi-square test of homogeneity was used to determine whether ownership status was associated with breed. Cox proportional hazards regression models were used to assess the association between time-to-adoption with ownership status, age, sex, and breed, the association between time to onset of diarrhea with age and breed, and between duration of diarrheic symptoms with the number of antibiotics and the number of medications.

Five-hundred and twenty-nine dogs were admitted to the Ihno and Miharu shelters (Fukushima Prefecture), including 179 that had detailed medical records. Seventy-six percent of dogs were mixed breed. Twenty-six percent of dogs had verified ownership, and almost 16% of dogs were reclaimed by their owners. Sixty-six percent of dogs developed diarrhea, and 17 different antibiotics were used to treat it. Using three or more different antibiotics was associated with prolonged signs of diarrhea. Dogs with verified ownership took longer for adoption than those without verified ownership. Breed and sex were not significantly associated with time to adoption. Age was associated with prolonged time to adoption.

To improve the welfare of dogs in disasters, responsible owner education, a well-organized registered volunteer training program for care of animals at shelters, proper disease management protocols, and enrichment strategies to prevent stress and disease in shelter setting are essential.

TanakaA, Martinez-LopezB, KassP.Epidemiological Evaluation of Dogs Rescued in the Fukushima Prefecture Following the Great East Japan Earthquakes of 2011. Prehosp Disaster Med. 2018;33(5):478–583.