A prospective study was carried out of the health effects and sustainability of a low-cost trauma training program for non-graduate village healthcare workers. From 1996 to 1999, a core group of 44 ...health workers from mine-infested rural communities in Cambodia and Northern Iraq were trained and equipped to deliver low-cost life support to trauma victims. They in turn trained a network of 2800 layman village first responders. Training was done in makeshift camps at village level ('Village Universities'). A total of 813 patients were managed by the rural rescue system from 1997 to 1999. The mortality rate for trauma victims decreased from 22.6% in 1997 to 13.7% in 1999 (95% CI for difference 1.8% to 16.0%). Management by village first responders had a significant impact on in-field response times and trauma mortality. The rescue system replicated itself during the study period as an indicator of sustainability. The study showed that after trauma care training at rural makeshift training centers, non-graduate health workers can build efficient and sustainable rural rescue systems.
An open letter for the people in Gaza Manduca, Paola; Chalmers, Iain; Summerfield, Derek ...
The Lancet,
08/2014, Letnik:
384, Številka:
9941
Journal Article
Recenzirano
Odprti dostop
According to Gaza Ministry of Health and UN Office for the Coordination of Humanitarian Affairs (OCHA),1 as of July 21, 149 of the 558 killed in Gaza and 1100 of the 3504 wounded are children. There ...are now fears for the main hospital Al Shifa.
Health Care Workers and War in the Middle East Chaudhry, Zoobia W; Berger, Zackary D
JAMA : the journal of the American Medical Association,
01/2024, Letnik:
331, Številka:
1
Journal Article
Health Care Workers and War in the Middle East Alser, Osaid; Gilbert, Mads; Loubani, Tarek
JAMA : the journal of the American Medical Association,
01/2024, Letnik:
331, Številka:
1
Journal Article
The extension of academic censorship on Palestine to the medical world is, despite its pervasiveness, relatively unknown. In the latest iteration, a letter highlighting the Gaza Strip's vulnerability ...to the Covid‐19 pandemic was removed from The Lancet's website after a swift pressure campaign. While the immediate effects were minimal — despite its short shelf‐life, the piece is among the top 5% most discussed research publications1 — the chilling effect of such campaigns on writers and editors is profound and enduring. This commentary outlines the struggle to make space for discussion and academic inquiry into the health impacts of the ongoing suffering inflicted on the Palestinian people.As Palestinians marked Land Day on March 30,2 The Lancet, one of the world's oldest and most prestigious medical journals, silently removed from its website a commentary that was published three days prior.3 At just over 400 words, “Structural violence in the era of a new pandemic: the case of the Gaza Strip,” draws on the deep historical and political forces that have rendered the Palestinian people in the Gaza Strip particularly susceptible to an impending Covid‐19 outbreak. Mirroring numerous warnings that continue to be published elsewhere, including a statement by 20 Palestinian, Israeli, and international health and human rights organizations,4 our commentary highlights the impact of pandemics on “populations burdened by poverty, military occupation, discrimination, and institutionalised oppression.” Its critical tone is consistent with other Lancet commentaries targeting various national and global responses to Covid‐19.
Teamwork is important for patient care and outcome in emergencies. In rural areas, efficient communication between rural hospitals and regional trauma centers optimise decisions and treatment of ...trauma patients. Little is known on potentials and effects of virtual team to team cooperation between rural and regional trauma teams.
We adapted a video conferencing (VC) system to the work process between multidisciplinary teams responsible for trauma as well as medical emergencies between one rural and one regional (university) hospital. We studied how the teams cooperated during simulated critical scenarios, and compared VC with standard telephone communication. We used qualitative observations and interviews to evaluate results.
The team members found VC to be a useful tool during emergencies and for building "virtual emergency teams" across distant hospitals. Visual communication combined with visual patient information is superior to information gained during ordinary telephone calls, but VC may also cause interruptions in the local teamwork.
VC can improve clinical cooperation and decision processes in virtual teams during critical patient care. Such team interaction requires thoughtful organisation, training, and new rules for communication.
In the past 10–15 years, thousands of civilians in Gaza have experienced conflict-related traumatic injuries. How injuries affect survivors’ risks of negative long-term health effects and serious ...illness is unclear. We report follow-up findings in a group of patients with traumatic amputations.
Eligible patients had traumatically amputated limbs and showed signs and symptoms of possible serious illness on standardised clinical examination. The patients were all receiving rehabilitation treatment at the Artificial Limbs and Polio Centre, Gaza, which is the main provider of rehabilitation and protheses. All patients had suffered from at least one amputation during Israeli military incursions between 2006 and 2016. All were offered referral to the Al-Shifa Hospital, Gaza, for further diagnostic clinical, radiological, and laboratory tests. Each patient was examined by CT of the abdomen (or ultrasonography if CT could not be performed) and chest and MRI of the amputation stump or stumps. Laboratory analyses included ESR, complete blood count, kidney and liver function tests, serum glucose, creatine kinase, lactate dehydrogenase, and hepatitis B and hepatitis C virus infections.
Of 254 traumatically amputated patients assessed, 105 had signs and symptoms of possible serious illness, among whom 94 accepted referrals. 88 (93%) of 94 were men and the median age was 31.5 years, mean age 34 years (SD 9·6). Of 90 patients who had imaging, 19 (21%) patients had fatty liver infiltration, three (<1%) had lung nodules, and ten had lung atelectasis. Shrapnel was found in the chest of 12 patients (13%), the abdomen of five patients (6%), the scrotum of one patient (<1%), in the amputation stumps of 26 patients (29%), and the non-amputated limbs of eight patients (1%). Three (<1%) of 90 patients had liver lesions. 32 (34%) of 94 patients had elevated ESR, 19 (20%) had elevated liver enzyme concentrations, and 12 (13%) were anaemic. Two patients tested positive for hepatitis C virus and three were positive for hepatitis B virus (one with fatty liver changes). Two of the 19 patients with fatty liver infiltration were diagnosed as having type 2 diabetes. A limitation of this study is that, owing to conflict-related supply-chain issues in Gaza, we were unable to collect complete data in four (5%) of patients.
As well as residual shrapnel in more than half of patients, a notable proportion of patients had fatty liver infiltration, for which we have no clear hypothesis. We recommend close medical follow-up for trauma patients in injured by explosives.
The Norwegian street-artist AFK provided €1,500 to this project, which was used to cover patients’ transportation costs.
During four separate Israeli military attacks on Gaza (2006, 2009, 2012, and 2014), about 4000 Palestinians were killed and more than 17 000 injured (412 killed and 1264 injured in 2006; 1383 killed ...and more than 5300 injured in 2009; 130 killed and 1399 injured in 2012; and 2251 killed and 11 231 injured in 2014). An unknown number of people had traumatic amputations of one or more extremities. Use of unmanned Israeli drones for surveillance and armed attacks on Gaza was evident, but exact figures on numbers of drone strikes on Gaza are not available. The aim of this study was to explore the medical consequences of strikes on Gaza with different weapons, including drones.
We studied a cohort of civilians in the Gaza Strip who had one of more traumatic limb amputation during the Israeli military attacks between 2006 and 2016. The study was done at The Artificial Limb and Polio Center (ALPC) in the Gaza Strip where most patients are treated and trained after amputation. We used standardised forms and validated instruments to record date and mechanism of injury, self-assessed health, socioeconomic status, anatomical location and length of amputation, comorbidity, and the results of a detailed clinical examination.
The studied cohort consisted of 254 Paletinian civilians (234 92% men, 20 8% women, and 43 17% children aged 18 years and younger) with traumatic amputations caused by different weapons. 216 (85%) people had amputations proximal to wrist or ankle, 131 (52%) patients had more than one major amputation or an amputation above the knee, or both, and 136 (54%) people were injured in attacks with Israeli drones, including eight (40%) of the women. The most severe amputations were caused by drone attacks (p=0·0001). Extremity injuries after drone attacks led to immediate amputation more often than with other weapons (p=0·014). Patients injured during cease-fire periods were younger than patients injured during periods of declared Israeli military operations (p=0·0001).
Weapons fired on the Gaza Strip from Israeli drones caused severe injuries in surviving Palestinian civilians. Drone-fired missiles resulted in major amputations in almost all victims who had limb losses. Substantially more severe injuries were inflicted by the drone-launched explosives than by other weapons used during the Gaza War. Traumatic amputations caused by drones were often immediately complete. One limitation of our study is that it does not elucidate injury patterns in victims with fatal injuries.
None.
During four separate Israeli military attacks on the Gaza Strip (in 2006, 2009, 2012, and 2014), about 4000 Palestinians were killed and more than 17 000 Palestinians were injured (412 killed and ...1264 injured in 2006; 1383 killed and more than 5300 injured in 2009; 130 killed and 1399 injured in 2012; and 2251 killed and 11 231 injured in 2014). An unknown number of people had traumatic amputation of one or more extremities. In addition to loss of body parts, loss of work and income further complicated patients' lives after trauma. In 2015, we reported preliminary data on the somatic consequences, showing that eight of ten amputees had unilateral or bilateral lower limb amputations, most often because of attacks by drone-carried weapons. A third of cases had amputations during ceasefire periods. A high number of debilitating extremity injuries were in the young civilian population, where needs of rehabilitation were difficult to meet because of limited local resources during the long-lasting siege of the Gaza Strip. Here we report long-term functional and psychosocial consequences of traumatic amputations in Gaza War casualties.
This cross-sectional study was done at The Artificial Limb and Polio Center, a local rehabilitation centre in Gaza City. We studied Palestinians living in the Gaza Strip who had sustained traumatic amputations during Israeli military attacks between 2006 and 2014. We explored the amputees' self-assessed health, socioeconomic status, anatomical location and level of amputation, comorbidity, and date and mechanism of injury. We used two validated and self-administered screening questionnaires (36-Item Short Form Survey and General Health Questionnaire 12 GHQ12) combined with a detailed clinical examination of each amputee. We used standardised records and questionnaires in Arabic. Data were analysed with SPSS. The study was approved by the Palestinian Ministry of Health in the Gaza Strip, Al-Shifa Hospital's board, and the director of the Artificial Limb and Polio Center in the Gaza Strip. All participants included in the study completed a written consent form.
We included 165 Palestinians in this study. Pain was reported by more patients who were unable to continue work because of the traumatic amputation than by patients who were unemployed for other reasons, even when adjusting for time passed since amputation (p=0·039). We found a correlation between reported pain and poverty (income <800 shekels per month; χ2=0·034) but no correlation between GHQ12 scores indicating psychological distress and the extent of the initial trauma. Use of prosthetics decreased GHQ12 scores, suggesting a lower level of psychological distress in users of artificial limbs.
Self-reported pain after loss of one or more limbs correlated with deteriorated occupational and financial life situation after the amputation. Use of prosthesis seemed to ease the psychological distress. Poverty and unemployment caused by amputations and disability might be a more important trauma than the physical amputation itself.
None.
Background
Bystander first aid and basic life support can likely improve victim survival in trauma. In contrast to bystander first aid and out‐of‐hospital cardiac arrest, little is known about the ...role of bystanders in trauma response. Our aim was to determine how frequently first aid is given to trauma victims by bystanders, the quality of this aid, the professional background of first‐aid providers, and whether previous first‐aid training affects aid quality.
Methods
We conducted a prospective 18‐month study in two mixed urban–rural Norwegian counties. The personnel on the first ambulance responding to trauma calls assessed and documented first aid performed by bystanders using a standard form.
Results
A total of 330 trauma calls were included, with bystanders present in 97% of cases. Securing an open airway was correctly performed for 76% of the 43 patients in need of this first‐aid measure. Bleeding control was provided correctly for 81% of 63 patients for whom this measure was indicated, and prevention of hypothermia for 62% of 204 patients. Among the first‐aid providers studied, 35% had some training in first aid. Bystanders with documented first‐aid training gave better first aid than those where first‐aid training status was unknown.
Conclusions
A majority of the trauma patients studied received correct pre‐hospital first aid, but still there is need for considerable improvement, particularly hypothermia prevention. Previous first‐aid training seems to improve the quality of first aid provided. The effect on patient survival needs to be investigated.
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