The aim of this study was to train and assess firefighters’ skill attainment in the use of tourniquets, and to assess their skill retention after 3 mo. The purpose is to show if firefighters can successfully apply a tourniquet after a short course based on the Norwegian national recommendation for civil prehospital tourniquet use.

This is a prospective experimental study. The study population were firefighters, and the inclusion criterion was any on-duty firefighter. The first phase consisted of baseline precourse testing (T1), a 45-min course, followed by immediate retesting (T2). The second phase consisted of retesting of skill retention after 3 mo (T3).

A total of 109 participants at T1, 105 at T2, and 62 participants at T3. The firefighters achieved a higher proportion of successful tourniquet applications at T2 (91.4%; 96 of 105) as well as T3 (87.1%; 54 of 62) compared with 50.5% at T1 (55 of 109) (P = 0.009). Mean application time was 59.6 s (55.1-64.2) in T1, 34.9 s (33.3-36.6) in T2 and 37.7 s (33.9-41.4) in T3.

A sample of firefighters can successfully apply a tourniquet after a 45-min course based on the 2019 Norwegian recommendation for civil prehospital tourniquet use. Skill retention after 3 mo was satisfactory for both successful application and application time.

Blast polytrauma is among the most serious mechanisms of injury confronted by medical providers. There are currently no specific studies or guidelines that define risk factors for mortality in the context of pediatric blast injuries or describe pediatric blast injury profiles.

The objectives of this study were to evaluate risk factors for pediatric mortality and to describe differences in injury profiles between explosions related to terrorism versus unrelated to terrorism within the pediatric population.

A PRISMA systematic review and meta-analysis was performed where articles published from the years 2000-2021 were extracted from PubMed. Mortality and injury profile data were extracted from articles that met inclusion criteria. A bivariant unadjusted odds ratio (OR) analysis was performed to establish protective and harmful factors associated with mortality and to describe the injury profiles of blasts related to terrorism. Statistical significance was established at P < .05.

Thirty-eight articles were included and described a total of 222,638 unique injuries. Factors associated with increased mortality included if the explosion was related to terrorism (OR = 32.73; 95% CI, 28.80-37.21; P < .05) and if the explosion involved high-grade explosives utilized in the Global War on Terror ([GWOT] OR = 1.28; 95% CI, 1.04-1.44; P < .05). Factors associated with decreased mortality included if the patient was resuscitated in a North Atlantic Treaty Organization (NATO)-affiliated combat trauma hospital (OR = 0.48; 95% CI, 0.37-0.62; P < .05); if the explosive was fireworks (OR = 3.20×10-5; 95% CI, 2.00×10-6-5.16×10-4; P < .05); and if the explosion occurred in the United States (OR = 2.40×10-5; 95% CI, 1.51×10-6-3.87×10-4; P < .05). On average, victims of explosions related to terrorism were 10.30 years old (SD = 2.73) with 68.96% (SD = 17.58%) of victims reported as male. Comparison of victims of explosions related to terrorism revealed a higher incidence of thoracoabdominal trauma (30.2% versus 8.6%), similar incidence of craniocerebral trauma (39.5% versus 43.1%), and lower incidence of extremity trauma (31.8% versus 48.3%) compared to victims of explosions unrelated to terrorism.

Explosions related to terrorism are associated with increased mortality and unique injury profiles compared to explosions unrelated to terrorism in the pediatric population. Such findings are important for optimizing disaster medical education of pediatric providers in preparation for and management of acute sequelae of blast injuries—terror-related and otherwise.

A systematic literature review (SLR) was performed to elucidate the current triage and treatment of an entrapped or mangled extremity in resource scarce environments (RSEs).

A lead researcher followed the search strategy following inclusion and exclusion criteria. A first reviewer (FR) was randomly assigned sources. One of the 2 lead researchers was the second reviewer (SR). Each determined the level of evidence (LOE) and quality of evidence (QE) from each source. Any differing opinions between the FR and SR were discussed between them, and if differing opinions remained, then a third reviewer (the other lead researcher) discussed the article until a consensus was reached. The final opinion of each article was entered for analysis.

Fifty-eight (58) articles were entered into the final study. There was 1 study determined to be LOE 1, 29 LOE 2, and 28 LOE 3, with 15 determined to achieve QE 1, 37 QE 2, and 6 QE 3.

This SLR showed that there is a lack of studies producing strong evidence to support the triage and treatment of the mangled extremity in RSE. Therefore, a Delphi process is suggested to adapt and modify current civilian and military triage and treatment guidelines to the RSE.

No study on hospital staff preparedness for managing blast injuries has been conducted in Libya. The internal conflict in Libya since 2011 and the difficulties faced by the hospitals has highlighted the need for such studies.

Physicians working in Tripoli (capital city Libya) hospitals are inadequately prepared for the management of blast injuries.

A survey was conducted in all 13 hospitals in Tripoli between June 2014 and May 2015 by using interviews based on a questionnaire consisting of 29 questions covering physicians’ education related to blast injury, hospital management of mass casualties, and aspects of hospital preparedness for such incidents.

Of 3,799 physicians working in Tripoli hospitals, 607 physicians were interviewed (16.0%). All but one of the physicians reported that there was no disaster response plan, none of them had read such a plan, 496 (81.7%) reported that hospitals were not prepared, and 471 (77.6%) that hospitals were not equipped for blast injuries. Though 414 (68.2%) reported that radiological equipment was available, 597 (98.3%) revealed that hospitals do not adopt training for blast injury. Only 39 (6.4%) had received professional training, though 183 (30.1%) were seeing blast injury patients at least once a week in their daily practice. Nevertheless, 185 (30.5%) had previous knowledge and experience in blast injuries management and 338 (55.70%) were aware of the major physical findings, but only 75 (12.4%) were following specific guidelines. According to approximately one-third of the physicians (192; 31%), staff and patient safety were not priorities for the hospital administration. Almost all (606; 99.9%) revealed that personal protective equipment for chemical and nuclear accidents was not available.

Preparedness for blast injuries in Tripoli hospitals is seriously deficient. Planning optimized blast and disaster management in Libya is essential.

OunAM, HadidaEM, StewartC. Assessment of the Knowledge of Blast Injuries Management among Physicians Working in Tripoli Hospitals (Libya). Prehosp Disaster Med. 2017;32(3):311–316.

Trauma patients in the extremes of age may require a specialized approach during a multiple-casualty incident (MCI).

The aim of this study was to examine the type of injuries encountered in children and elderly patients and the implications of these injuries for treatment and organization.

A review of medical record files of patients admitted in MCIs in one Level II trauma center was conducted. Patients were classified according to age: children (≤12 years), adults (between 12-65 years), and elders (≥65 years).

The files of 534 were screened: 31 (5.8%) children and 54 (10.1%) elderly patients. One-third of the elderly patients were either moderately or severely injured, compared to only 6.5% of the children and 11.1% of the adults (P<.001). Elderly patients required more blood transfusions (P=.0001), more computed tomography imaging (P=.0001), and underwent more surgery (P=.0004). Elders were hospitalized longer (P=.0003). There was no mortality among injured children, compared to nine (2.0%) of the adults and seven (13.0%) of the elderly patients (P<.0001). All the adult deaths occurred early and directly related to their injuries, whereas most of the deaths among the elderly patients (four out of seven) occurred late and were due to complications and multiple organ failure.

Injury at an older age confers an increased risk of complications and death in victims of MCIs.

AshkenaziI, EinavS, OlshaO, Turegano-FuentesF, KrauszMM, AlficiR. The Impact of Age upon Contingency Planning for Multiple-casualty Incidents Based on a Single Center’s Experience. Prehosp Disaster Med. 2016;31(5):492–497.

We investigated the accuracy of initial critical care triage in blast-injured versus non-blast-injured trauma patients, focusing on those inappropriately triaged to the intensive care unit (ICU) for brief (<16 h) stays.

We conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.

A total of 883 blast-injured and 112 185 non-blast-injured patients were categorized according to their need for ICU admission. Of these admissions, 5.7% in the blast setting and 8.4% in the non-blast setting were considered unnecessary. The sensitivity, specificity, and positive and negative likelihood ratios for the triage officers' decisions in assigning patients to the ICU were 95.5%, 98.8%, 77.2, and 0.05, respectively, in the blast setting, and 91.2%, 99.5%, 200.5, and 0.09, respectively, in the non-blast setting.

Triage officers do a better job sending to the ICU only those patients who require initial intensive care in the non-blast setting, though this is obscured by a much greater overall need for ICU-level care in the blast setting. Implementing triage protocols in the blast setting may help reduce the number of patients sent initially to the ICU for brief periods, thus increasing the availability of this resource. (Disaster Med Public Health Preparedness. 2014;0:1–7)

This report illustrates Croatia's experience with the terrorist attack in the city of Rijeka in October 1995. Also, the intention of this report is to outline how emergency services were functioning in this sudden-onset situation.

The medical documentation of 27 wounded citizens in the attack was analyzed and the appearance of bodily wounds, severity of wounds, and the mechanisms of injury are described. From the forensic medical report, the wounds and damages sustained by the terrorist also were analyzed. All findings were compared with similar cases from around the world.

In the 27 wounded citizens, three (11%) had head injuries, and injuries of the abdomen in only two cases (7%) were found. The most common injuries sustained involved one or more extremities: 16 (59%) persons had wounds of an upper or lower extremity or a combination of multiple wounds. The main cause of death of the terrorist was explosive wounds to the chest and abdomen with destruction of multiple inner organs (primarily kidneys, liver, abdomen, and lung). Furthermore, the terrorist had a fracture of the skull base and multiple injuries to the brain.

Comparing the findings with other data from the literature, the distribution in the percentages of wounded is almost the same as reported in many bomb attacks. In this case, the walls of the building protected many citizens, which is why so few were seriously injured. Forensic examination of the terrorist's body showed all of the characteristics of blast injuries.