The document summarizes the medical response to the November 2015 terrorist attacks in Paris from the perspective of emergency physicians, trauma surgeons, and anesthesiologists. It describes how the Assistance Publique-Hôpitaux de Paris (APHP) crisis unit coordinated the response across 40 hospitals. The "White Plan" was activated, mobilizing all hospitals and staff. Over 256 wounded people were safely transferred to hospitals. Pre-hospital teams provided triage and damage control to stabilize victims. Over 35 surgical teams operated on the most serious injuries that night. Despite the unprecedented number of wounded, available hospital services were not saturated due to effective coordination and emergency preparedness.
Emergency Preparation In Outdoor EducationIan Boyle
This presentation was a collaboration between the NSW Ambulance and Police Resue service and Ian Boyle in an attempt to highlight the steps outdoor educators need to follow in the event of an emergency
Background: The frequency and intensity of both natural and man-made disasters have increased substantially over the past few decades. Consequences include great suffering, massive mortality, enormous economic losses, environmental damage and lasting psychological disorders of the survivors. For this reason, community members and government agencies have high expectations regarding the quality of medical care provided during a disaster response. Disaster medicine covers all aspects of disaster response including: disaster management systems, triage, epidemiology and infectious diseases prevention and psychological management.
Objective: This study aims to asses familiarity of students of the University of Medicine/ Faculty of Technical Medical sciences with disaster medicine concepts, evaluate training needs and define the preferred teaching method. It is a cross-sectional study of 100 students selected at random. A self administered structured questionnaire was distributed to the students containing questions regarding triage categories, first aid steps, trauma treatment, biological and chemical weapons, procedures to follow in specific disasters and preferred learning method.
Emergency Preparation In Outdoor EducationIan Boyle
This presentation was a collaboration between the NSW Ambulance and Police Resue service and Ian Boyle in an attempt to highlight the steps outdoor educators need to follow in the event of an emergency
Background: The frequency and intensity of both natural and man-made disasters have increased substantially over the past few decades. Consequences include great suffering, massive mortality, enormous economic losses, environmental damage and lasting psychological disorders of the survivors. For this reason, community members and government agencies have high expectations regarding the quality of medical care provided during a disaster response. Disaster medicine covers all aspects of disaster response including: disaster management systems, triage, epidemiology and infectious diseases prevention and psychological management.
Objective: This study aims to asses familiarity of students of the University of Medicine/ Faculty of Technical Medical sciences with disaster medicine concepts, evaluate training needs and define the preferred teaching method. It is a cross-sectional study of 100 students selected at random. A self administered structured questionnaire was distributed to the students containing questions regarding triage categories, first aid steps, trauma treatment, biological and chemical weapons, procedures to follow in specific disasters and preferred learning method.
Prolégomènes du President Med Gal Henri Julien : Dans le climat bien particulier de cet été 2016 qui a débuté par un mois de juillet marqué par deux attentats particulièrement odieux, nous vous adressons la Lettre de la SFMC n° 89.
Elle fait une part aux derniers événements sur lesquels elle propose un point d'information, sachant que les données sont en constante évolution : la secrétaire d’État aux victimes, Mme Juliette Médéal a annoncé un bilan alourdi de l'attentat de Nice : 428 personnes blessées, 47 toujours à l'hôpital dont 9 ayant un pronostic vital engagé.
Nos pensées vont aux malheureuses victimes et à leurs familles, aux sauveteurs et soignants qui se sont engagés avec volonté et beaucoup de professionnalisme à leur secours.
N'omettons pas de remercier le Med Gl Noto pour la rédaction de cette 89ème Lettre.
American Journal of Emergency Medicine: Stroke and first responders strategyEmergency Live
Background
Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
Methods
This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after phone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU), if symptom onset was over 6 hours ago; they were transported to an emergency department. Confirmation of stroke diagnosis, the rate of thrombolysis, and the time intervals between the call and hospital arrival and imaging were assessed. Comparison used Fisher's exact test.
Results
Of the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 with ischemic stroke), 69 received thrombolytic therapy, and the mean stroke-thrombolysis interval was 150 minutes. Over 64 patients admitted to ED, 36 patients suffered a stroke (ischaemic: 24). None were thrombolysed. Globally, 36% of ischaemic strokes were thrombolysed (27% of all strokes diagnosed). The mean interval call-hospital was 65 min (ED vs NVU: p=0.61). The interval call-imaging was 202 min [IQR: 105.5-254.5] for ED and 92 min [IQR: 77 116] for NVU (p<0.001).
Conclusions
The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients suffering from stroke in an urban environment, and may improve the access to thrombolysis.
The management of pediatric polytrauma -a simple reviewEmergency Live
This Clinical review, published by Libertas Academica, is an interesting commentary about the management of pediatric polytrauma.
This research was realized by
H. Mevius, M. van Dijk, A. Numanogluand A.B. van As between the MC-Sophia Childen's Hospital, Rotterdam, and the Red Cross War memorial Children's Hospital in Cape Town, South Africa.
H. Mevius1, M. van Dijk2–4, A. Numanoglu2,3 and A.B. van As2,3
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
ABSTRACT: Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. The primary goal of this review is to provide a comprehensive overview on current knowledge in the management of pediatric polytrauma patients (PPPs). A database review was conducted based on a search in the Embase, Medline OVID-SP, Web of Science, Cochrane central, and Pubmed databases. Only studies with “paediatric population” and “polytrauma” as criteria were included. A total of 3310 citations were retrieved. Of these, 3271 were excluded after screening, based on title and abstract. The full texts of 39 articles were assessed; further selection left 25 articles to be included in this review. The most crucial point in the
management of PPPs is preparedness of the staff and an emergency room furnished with age-appropriate drugs and equipment combined with a systemic
approach.
KEY WORDS: pediatric population, polytrauma, multiple injuries, current management, review
Introduction
Polytrauma is a medical term that describes the condition of a patient subjected to multiple traumatic injuries and can be a life-threatening condition. These (life threatening) injuries typically affect two or more body regions and present a challenge for diagnosis and treatment.1,2 However, there is no consensus yet about the term polytrauma in both literature and practice.3
Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. Despite its preventability, trauma remains the most common cause of death and disability in children.2 In fact, all over the world, more than 700,000 children under the age of 15 years die each year due to accidental injury.4 Leading causes of polytrauma are road traffic crashes, falls from heights, and
latest knowledge practical points short presentation
It will serve as guideline for Covid-19 corona virus
it will help in preparing ICU as well as policy making
institutions should device their own strategy
Transfusion and Postoperative Outcome in Pediatric Abdominal Surgeryasclepiuspdfs
Background: Intraoperative and post-operative morbimortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one independent factor among others. This study was undertaken to investigate whether transfusion was an independent factor of morbimortality in pediatric abdominal surgical patients. Objectives: The objective of the study is to identify morbimortality risk factors in intraoperatively transfused and not transfused pediatric abdominal surgical patients. Design: This was a retrospective observational descriptive pediatric cohort study. Setting: Monocentric pediatric tertiary center, Necker–Enfants Malades University Hospital, Paris, from January 1, 2014, to May 17, 2017. Patients: 193 patients with a median age of 27.5 months (1.0–100.5) were included in the study. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in abdominal surgery patients. Exclusion criterion was transfusion in the post-operative period until discharge from hospital and non-abdominal surgical patients.
First Health Cluster Bulletin, which corresponds to the organizations that are providing a coordinated health collaboration in the epidemic, about the health situation and needs intervention.
emergency medicine introduction.pdf
Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians, often called ER doctors, specialize in providing care for unscheduled and undifferentiated patients of all ages. They are trained to assess and treat a wide range of medical conditions, from minor injuries to life-threatening illnesses.
Emergency medicine is a challenging and rewarding field that requires quick thinking, and compassion. Emergency physicians play a vital role in providing life-saving care to patients in need
Prolégomènes du President Med Gal Henri Julien : Dans le climat bien particulier de cet été 2016 qui a débuté par un mois de juillet marqué par deux attentats particulièrement odieux, nous vous adressons la Lettre de la SFMC n° 89.
Elle fait une part aux derniers événements sur lesquels elle propose un point d'information, sachant que les données sont en constante évolution : la secrétaire d’État aux victimes, Mme Juliette Médéal a annoncé un bilan alourdi de l'attentat de Nice : 428 personnes blessées, 47 toujours à l'hôpital dont 9 ayant un pronostic vital engagé.
Nos pensées vont aux malheureuses victimes et à leurs familles, aux sauveteurs et soignants qui se sont engagés avec volonté et beaucoup de professionnalisme à leur secours.
N'omettons pas de remercier le Med Gl Noto pour la rédaction de cette 89ème Lettre.
American Journal of Emergency Medicine: Stroke and first responders strategyEmergency Live
Background
Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
Methods
This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after phone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU), if symptom onset was over 6 hours ago; they were transported to an emergency department. Confirmation of stroke diagnosis, the rate of thrombolysis, and the time intervals between the call and hospital arrival and imaging were assessed. Comparison used Fisher's exact test.
Results
Of the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 with ischemic stroke), 69 received thrombolytic therapy, and the mean stroke-thrombolysis interval was 150 minutes. Over 64 patients admitted to ED, 36 patients suffered a stroke (ischaemic: 24). None were thrombolysed. Globally, 36% of ischaemic strokes were thrombolysed (27% of all strokes diagnosed). The mean interval call-hospital was 65 min (ED vs NVU: p=0.61). The interval call-imaging was 202 min [IQR: 105.5-254.5] for ED and 92 min [IQR: 77 116] for NVU (p<0.001).
Conclusions
The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients suffering from stroke in an urban environment, and may improve the access to thrombolysis.
The management of pediatric polytrauma -a simple reviewEmergency Live
This Clinical review, published by Libertas Academica, is an interesting commentary about the management of pediatric polytrauma.
This research was realized by
H. Mevius, M. van Dijk, A. Numanogluand A.B. van As between the MC-Sophia Childen's Hospital, Rotterdam, and the Red Cross War memorial Children's Hospital in Cape Town, South Africa.
H. Mevius1, M. van Dijk2–4, A. Numanoglu2,3 and A.B. van As2,3
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
ABSTRACT: Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. The primary goal of this review is to provide a comprehensive overview on current knowledge in the management of pediatric polytrauma patients (PPPs). A database review was conducted based on a search in the Embase, Medline OVID-SP, Web of Science, Cochrane central, and Pubmed databases. Only studies with “paediatric population” and “polytrauma” as criteria were included. A total of 3310 citations were retrieved. Of these, 3271 were excluded after screening, based on title and abstract. The full texts of 39 articles were assessed; further selection left 25 articles to be included in this review. The most crucial point in the
management of PPPs is preparedness of the staff and an emergency room furnished with age-appropriate drugs and equipment combined with a systemic
approach.
KEY WORDS: pediatric population, polytrauma, multiple injuries, current management, review
Introduction
Polytrauma is a medical term that describes the condition of a patient subjected to multiple traumatic injuries and can be a life-threatening condition. These (life threatening) injuries typically affect two or more body regions and present a challenge for diagnosis and treatment.1,2 However, there is no consensus yet about the term polytrauma in both literature and practice.3
Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. Despite its preventability, trauma remains the most common cause of death and disability in children.2 In fact, all over the world, more than 700,000 children under the age of 15 years die each year due to accidental injury.4 Leading causes of polytrauma are road traffic crashes, falls from heights, and
latest knowledge practical points short presentation
It will serve as guideline for Covid-19 corona virus
it will help in preparing ICU as well as policy making
institutions should device their own strategy
Transfusion and Postoperative Outcome in Pediatric Abdominal Surgeryasclepiuspdfs
Background: Intraoperative and post-operative morbimortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one independent factor among others. This study was undertaken to investigate whether transfusion was an independent factor of morbimortality in pediatric abdominal surgical patients. Objectives: The objective of the study is to identify morbimortality risk factors in intraoperatively transfused and not transfused pediatric abdominal surgical patients. Design: This was a retrospective observational descriptive pediatric cohort study. Setting: Monocentric pediatric tertiary center, Necker–Enfants Malades University Hospital, Paris, from January 1, 2014, to May 17, 2017. Patients: 193 patients with a median age of 27.5 months (1.0–100.5) were included in the study. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in abdominal surgery patients. Exclusion criterion was transfusion in the post-operative period until discharge from hospital and non-abdominal surgical patients.
First Health Cluster Bulletin, which corresponds to the organizations that are providing a coordinated health collaboration in the epidemic, about the health situation and needs intervention.
emergency medicine introduction.pdf
Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians, often called ER doctors, specialize in providing care for unscheduled and undifferentiated patients of all ages. They are trained to assess and treat a wide range of medical conditions, from minor injuries to life-threatening illnesses.
Emergency medicine is a challenging and rewarding field that requires quick thinking, and compassion. Emergency physicians play a vital role in providing life-saving care to patients in need
ABCs in EIDs: Preparing for Emerging Infectious DiseasesArthur Dessi Roman
With the imminent threat of emerging infectious diseases in our midst, Dr. Arthur Dessi Roman provides a step by step guide on how institutions can prepare for these EIDs.
Cette formation expérientielle délivrée parle MTC du CHU de Rouen est dédiée à la coordination des décideurs et responsables d’entreprises, d’établissements, d’agences, d’administrations — publiques ou privés — des domaines industriels, sécurité, secours et sanitaire en situation de crise/catastrophe
L’AVOCAT ET L’APPUI AUX VICTIMES ET LES ASSOCIATIONS DE VICTIMESJan-Cedric Hansen
Le droit de la catastrophe est toujours très difficile à esquisser en si peu de temps, tant il est large. Pour en comprendre les contours, il est essentiel de s’accorder sur ce qu’est une catastrophe que l’on pourrait caractériser par les effets dommageables d'un phénomène brutal, durable ou intense. Mais surtout, et cette distinction sera fondamentale, il convient de distinguer la catastrophe d'origine naturelle de celle d’origine humaine.
Ce texte propose un tour d'horizon des aspects juridiques de la crise/catastrophe
The COVID-19 GloHSA Risk Assessment report that has been just released. It intends to point key facts and questions to help policy decision makers in their daily duties regarding the COVID-19 outbreak strategic steering.
Formation iCrisis au pilotage stratégique des crises/catastrophesJan-Cedric Hansen
La formation expérientielle iCrisis, dispensée par le MTC du CHU de Rouen, en partenariat avec StratAdviser et l'Université de Rouen, est dédiée à la coordination des décideurs et responsables d’entreprises, d’établissements, d’agences, d’administrations — publiques ou privés — des domaines industriels, sécurité, secours et sanitaire en situation de crise/catastrophe.
Formation iCrisis au pilotage stratégique des crises/catastrophesJan-Cedric Hansen
La formation expérientielle iCrisis, dispensée par le MTC du CHU de Rouen, en partenariat avec StratAdviser et l'Université de Rouen, est dédiée à la coordination des décideurs et responsables d’entreprises, d’établissements, d’agences, d’administrations — publiques ou privés — des domaines industriels, sécurité, secours et sanitaire en situation de crise/catastrophe.
Présentation du programme de formation expérientielle iCrisis dédié aux dirigeants d'entreprises publiques ou privées pour améliorer leur capacité à réaliser un pilotage stratégique de crise
EN: The French Society for Disaster Medicine (SFMC), the International Commission on Disaster Medicine (CIMC-CDM) and Université Senghor joint their efforts and resources to host and develop a common framework and lexicon related to Disaster Medicine translated into multiple languages and applicable to myriad cultures.
FR : La Société Française de Médecine de Catastrophe (SFMC), la Commission Internationale de Médecine de Catastrophe (CIMC-ICDM) et l’Université Senghor ont regroupés leurs efforts et leurs ressources pour héberger et développer un cadre commun et un lexique concernant la médecine de catastrophe traduit en plusieurs langues et applicable à toutes doctrines/cultures.
Programme Med Connect du 16 octobre 2018 à Evreux (27)Jan-Cedric Hansen
Premier congrès de médecine connecté organisé par le CH Eure-Seine, le département de l'EURE (27), le Collège Normand de Médecine d'Urgence, la ville d'Evreux et l'agglomération Seine-Normandie - soutenu par StratAdviser
AIRWAY FOREVER : JOURNÉE DU COLLÈGE D'URGENCE DE NORMANDIE
Le 16 novembre 2018
Centre des Congrès Caen - Caen - France
- Pathways optimisation de la réanimation cardio-respiratoire
- Surveillance VNI par les IDE
- Abords vasculaires difficiles veineux et artériels, M. Plumail
- Atelier aide à l’intubation
- Etre Infirmier Sapeur Pompier, Norbert Berginiat
- EtCO2 utilité/futilité en médecine d’urgence, Antoine Lefevre Scelles
- Etre infirmier réserviste du service de santé des Armées, Alexandre Bunn
- Optiflow en médecine d’urgence,
- ALR sous échographie, Dr Mathieu Violeau
- Hypnose en service d’urgence
- Abords vasculaires difficiles veineux et artériels, M. Plumail
- Démonstration (Groupement de Recherche et d’EXtraction) Norbert Berginiat
- Abord des voies aériennes intubation difficile ; cricothyrotomie
- Béaba de la VNI en médecine d’urgence, Guillaume Carteaux
- Pièges de la VNI, Luc-Marie Joly- Abords vasculaires : proche-IR, échographie comment s’en sortir, M. Plumail / LSO / M. Clarius
- Ethique et réanimation ou pas, Luc-Marie Joly, Jan-Cedric Hansen
- Intubation difficile imprévue - oxygénation d’apnée, Antoine Lefevre Scelles
all you need to know about iCrisis a seminar dedicated to the strategic steering of crisis and disasters thanks to an initiation to Cindynics, key facts about taking decisions in stressful situations and a simulation session to experience your own behavioral pitfalls.
This leaflet provides key informations regarding StratAdviser Ltd activity and services it can provides to its customers.
In short, StratAdviser Ltd provides sound strategic advices in three main domains which are Health/Pharma, Crisis
Preparation & Management and Military/Disaster
Medicine
Programme Med Connect 16 octobre 2018 à Evreux (27)Jan-Cedric Hansen
Premier congrès de médecine connecté organisé par le CH Eure-Seine, le département de l'EURE (27), le Collège Normand de Médecine d'Urgence, la ville d'Evreux et l'agglomération Seine-Normandie
Santé digitale et parcours de soin, une révolution inéluctable ?
Regards croisés entre industriels, académiques et acteurs de la santé.
un séminaire ESCP
Programme de la 5ème Journée du Marketing Santé (JIMS 5) sponsorisé par StratAdviser ltd partenaire depuis la première édition
Le Marketing Santé à l′ère digitale
Le terme «marketing santé ou health marketing» est utilisé pour signifier une approche systématisée des principes de la doctrine marketing dans le champ très large, très hétérogène et très complexe de la santé. Si de nombreux auteurs s’accordent pour célébrer son émergence comme un champ particulier d’investigation (Berry and Bendapudi, 2007 ; Lega, 2006 ; Stremersch, 2008), peu finalement en donnent une définition claire et surtout intégrative car il recouvre en fait des réalités diverses, évoquant par endroit le marketing des «life sciences» (Stremersch & Van Dyck, 2009 ; Manchanda et alii, 2005), le marketing social (Kotler & Zaltman, 1971; Hastings & Saren, 2003) ou encore le marketing des services de soins (Zaltman & Vertinsky, 1971 ; Berry & Bendapudi, 2007 ; Latham, 2004 ; Smith, 2011).
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Hirsch m the medical response to multisite terrorist attacks in paris lancet 2015 e pub
1. Viewpoint
www.thelancet.com Published online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6 1
The medical response to multisite terrorist attacks in Paris
Martin Hirsch, Pierre Carli, Rémy Nizard, Bruno Riou, Barouyr Baroudjian,Thierry Baubet,Vibol Chhor, Charlotte Chollet-Xemard,
Nicolas Dantchev, Nadia Fleury, Jean-Paul Fontaine,YouriYordanov, Maurice Raphael, Catherine Paugam Burtz, Antoine Lafont, on behalf of the
health professionals of Assistance Publique-Hôpitaux de Paris (APHP)
Introduction
Friday, Nov 13, 2015. It’s 2130 h when the Assistance
Publique-Hôpitaux de Paris (APHP) is alerted to the
explosions that have just occurred at the Stade de France,
a stadium in Saint-Denis just outside Paris. Within
20 min, there are shootings at four sites and three bloody
explosions in the capital. At 2140 h, a massacre takes
place and hundreds of people are held hostage for 3 h in
Bataclan concert hall (figure).
The emergency medical services (service d’aide médicale
d’urgence, SAMU) are immediately mobilised and the
crisis cell at the APHP is opened. The APHP crisis unit
is able to coordinate 40 hospitals, the biggest entity in
Europe with a total of 100000 health professionals, a
capacity of 22000 beds, and 200 operating rooms. It is
very quickly confirmed that the attacks are multiple and
that the situation is highly scalable and progressing
dangerously. These facts led to a first decision: the
activation of the “White Plan” (by the APHP Director
General) at 2234 h—mobilising all hospitals, recalling
staff, and releasing beds to cope with a large influx of
wounded people. The concept of the White Plan was
developed 20 years ago, but this is the first time that the
plan has been activated. It is a big decision, and timing is
key: it would lose its effectiveness if taken too late. On the
night of Friday Nov 13 to Saturday Nov 14, the activation
of the White Plan had a critical effect. At no time during
the emergency was there a shortage of personnel. During
these hours, as the number of victims increased, with a
sharp increase after the assault was launched inside
the Bataclan, we were able to reassure the public and
government that our abilities matched the demand. And
when we felt that it might be necessary to deal with an
influx of severely injured people, two further “reservoir”
capacities were prepared: other hospitals in the area were
put on alert, together with some university hospitals,
more distant from Paris, but with the ability to mobilise
ten helicopters to organise the transport of the wounded.
These other two reservoirs have not been used, and we
believe that despite this unprecedented number of
wounded, the available services were far from being
saturated. While hospitals were receiving and directing
patients to specific institutions based on capacity and
specialty, a psychological support centre was set up.
35 psychiatrists, together with psychologists, nurses, and
volunteers were gathered in a central Paris hospital,
Hôtel Dieu. Most of them had played a similar role
during the attacks against Charlie Hebdo. Most of the
emergency workers and health professionals working on
the evening of Nov 13 had already been involved in
serious crises, were used to working together, and had
participated, especially in recent months, in exercises or
in updating emergency plans.
In this report, we present the prehospital and hospital
management of this unprecedented multisite attack in
Paris from the viewpoint of the emergency physician, the
trauma surgeon, and the anaesthesiologist. This is a
testimony on behalf of the health professionals involved
in the night of Nov 13.
The emergency physician’s perspective
Triage and prehospital care were the duty of SAMU. In
the minutes that followed the suicide bombing at the
Stade de France, the Paris SAMU unit regulatory crisis
team began to send out medical workers to the emergency
sites from all eight units of SAMU in the Paris region and
from the Paris fire brigade (Brigade de sapeurs-pompiers
de Paris), alongside rescue workers and police. The
regulatory crisis team was composed of 15 individuals to
answer the calls, and five physicians. Their mission was
to organise triage and dispatch mobile units (composed
of a physician, a nurse, and a driver) to the wounded and
to the most appropriate hospitals. As part of the White
Plan and ORSAN (organisation de la réponse du système de
santé en situations sanitaires exceptionnelles), 45 medical
teams from SAMU and the fire brigade were divided
between the sites (figure) and 15 were kept in reserve,
since we did not know how and when this nightmare
would end. This approach avoided early saturation of
services—often, in emergency situations, all the resources
are focused on the first crisis site, leaving a shortage for
Published Online
November 24, 2015
http://dx.doi.org/10.1016/
S0140-6736(15)01063-6
Assistance Publique-Hôpitaux
de Paris, Paris, France
(M Hirsch MsC); SAMU de Paris,
Hôpital Necker-Enfants
Malades, University
Paris-Descartes Paris, France
(Prof P Carli MD); Hôpital
Lariboisière, University
Paris-Diderot, Paris, France
(Prof R Nizard MD); Hôpital de
la Pitié Salpétrière, University
Pierre & Marie Curie, Paris,
France (Prof B Riou MD);
Hôpital Saint-Louis, Paris,
France (B Baroudjian MD,
J-P Fontaine MD); Hôpital
Avicenne, University Paris 13,
Paris, France
(Prof T Baubet MD); Hôpital
Européen Georges Pompidou,
Paris, France (V Chhor MD);
Hôpital Henri Mondor, Créteil,
France (C Chollet-Xemard);
Hôtel Dieu, Paris, France
(N Dantchev MD); Hôpital de la
Pitié Salpétrière, Paris, France
(N Fleury MsC); Hôpital
Saint-Antoine, Paris, France
(YYordanov MD), Hôpital
Bicêtre, Paris, France
(M Raphael MD); Hôpital
Beaujon, University
Paris-Diderot, Paris, France
Figure: Map of Paris attacks and prehospital emergency response
Bataclan
medical
teams
Stade de France
(Saint-Denis)
medical teams
La ComptoirVoltaire
medical teams
Casa Nostra
medical teams
3
4
8
9
15
6
Le Petit Cambodge,
Le Carillon
medical teams
La Belle Equipe
medical
teams
2. Viewpoint
2 www.thelancet.com Published online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6
(Prof C Paugam Burtz MD);
Hôpital Européen Georges
Pompidou, University
Paris-Descartes, Paris, France
(Prof A Lafont MD)
Correspondence to:
Prof Antoine Lafont, Cardiology
Department, Hôpital Europeen
Georges Pompidou, Paris, France
antoine.lafont@inserm.fr
For more on the APHP see
http://www.aphp.fr/
For more on the White Plan see
http://www.sante.gouv.fr/plan-
blanc-et-gestion-de-crise.html
For more on the ORSAN plan
see http://www.sante.gouv.fr/
le-dispositif-orsan
following crisis sites. 256 wounded people were safely
transferred to and treated in hospitals and the remaining
patients arrived at hospitals by their own means.
Three acute myocardial infarctions were treated. By the
middle of the night, more than 35 surgical teams had
operated on the most serious injuries (table).
Since the wounds were principally bullet related, the
strategy applied was prehospital damage control to
allow the fastest possible haemostatic surgery.1–4
This is
the civil application of war medicine. Indeed, four out of
five people shot in the head or the thorax will die.
Among those without lethal wounds, damage control
consists of maintaining the blood pressure at the lowest
level ensuring consciousness (mean arterial pressure
60 mm Hg) using tourniquets, vasoconstrictors,
antifibrinolytic agents (tranexamic acid), and prevention
of temperature lowering instead of fluid filling (the
demand for tourniquets was so high that the mobile
teams came back without their belts).
After initial treatment the wounded were transferred
by the Mobile Intensive Care Unit (MICU) teams to
trauma centres or nearest hospitals when appropriate.
Saint Louis Hospital is a few metres from two of the
shooting sites (Le Petit Cambodge and Le Carillon
restaurants, figure) and its physicians were able to take
care of the patients immediately. Some wounded people
were able to walk to the nearby Saint Antoine Hospital.
To avoid overwhelming the hospital emergency
department as ambulances arrived, triage also took place
at the hospital entrances.
Despite their brutality and appalling human toll
(129 dead on sites, and more than 300 injured) the attacks
were not a surprise. Since January, 2015, all state
departments had known that a multisite shooting could
happen, and although the police and intelligence services
had prevented several attacks, that possibility remained.
For 2 years, the prehospital teams of SAMU and the fire
brigade had been developing treatment protocols for
victims of gunfire wounds, and three field exercises have
mobilised doctors to practise prehospital damage control.
SAMU is characterised by the presence of physicians who
are able not only to stratify risk according to gathered
information and send the patient to the appropriate place,
but also to act during the prehospital period. In a cruel
irony, on the morning of the day of the attacks, SAMU and
the fire brigade participated in an exercise simulating the
organisation of emergency teams in the event of a multiple
shooting in Paris. In the evening, when the same doctors
were confronted with this situation in reality, some of
them believed it was another simulation exercise. At the
attack sites and in the hospital, the training received by the
emergency and medical workers was a key factor in the
success of treatment. Analysis of the experience of
bombings in many other countries—Israel, Spain,
England, and more recently in Boston, USA—as well as
lessons learned from Paris, during the Charlie Hebdo
attacks in January, were essential to improving the
management and application of damage control. It is
important to point out that the scientific publications that
issued from these horrible events have had a huge effect
on the improvement of medical strategies.5–7
But no
simulation had ever anticipated such a boost in the scale
of violence. During long periods of shooting, the streets
surrounding the attacks remained difficult and dangerous
for emergency intervention teams. Seriously injured
hostages in the hands of terrorists or obstructed by fire
could not be evacuated. Although emergency physicians
have been receiving training in disaster medicine for
more than 30 years, never before had such a number of
victims been reached and so many wounded been
operated on urgently. A new threshold has been crossed.
The approach of the anaesthesiologist
Pitié-Salpêtrière Hospital is one of the five civilian
level-one trauma centres in the APHP group involved in
the treatment of patients after terrorist attack. It is
located in the centre of Paris. The shock trauma room is
included inside a post-anaesthesia care unit of 19 beds.
The routine capacity of the emergency operating theatre
is two operating rooms, which can be extended to three
for multiple organ harvesting. After activation of the
White Plan, which includes a process to call back all
staff, but also because many physicians and nurses
spontaneously arrived rapidly in the hospital, we were
able to open ten operating rooms and treat injured
Absolute
emergencies
Relative
emergencies
Total
Ambroise Paré 1 6 7
Antoine Béclère 0 1 1
Avicenne 0 8 8
Beaujon 5 0 5
Bicêtre 1 6 7
Bichat 2 17 19
Cochin 0 7 7
HEGP 11 30 41
Henri Mondor 10 15 25
Hotel Dieu 0 31 31
JeanVerdier 0 2 2
Lariboisière 8 21 29
Pitié-Salpêtrière 28 25 53
Saint Antoine 6 39 45
Saint Louis 11 15 26
Tenon 0 10 10
Total 76 226 302
Absolute emergencies require immediate surgery or embolisation; relative
emergencies may need surgery and/or embolisation, but not immediately.
Numbers do not include psychological trauma and delayed admissions. Because
some patients were secondarily transferred from one hospital to another,
numbers do not add up. Data are from Assistance Publique-Hôpitaux de Paris
(APHP), Nov 20, 2015. HEPG=Hôpital Européen Georges Pompidou.
Table: Numbers of admissions of absolute emergencies and relative
emergencies inthe APHP hospitals withinthe first 24 h
3. Viewpoint
www.thelancet.com Published online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6 3
patients (mostly with penetrating trauma), absolute
emergencies (mostly admitted in the shock trauma
unit), and relative emergencies (all admitted in the
emergency department).
The number of admitted patients was far beyond what
we could imagine we would treat at the same time. The
resources available were never less than required, despite
the unprecedented number of patients admitted during a
very short period. Several factors may have contributed to
these favorable outcomes. First, the injured patients
arrived very quickly (in small groups of four or five)
because we had worked for several months with the
medical service of the French national police counter-
terrorism department (RAID), prehospital emergency
teams, and in-hospital trauma teams to be able to provide
a fast-track service for penetrating trauma, particularly
during a terrorist attack.8
Although penetrating traumas
usually represent only 16% of our severe trauma cases,9
injuries from firearms, including war arms, are no
longer rare events, and our anaesthesiologists and
surgeons have been trained to appropriately treat these
cases. Before the arrival of the first patients, the
postoperative care unit was rapidly emptied and the
surgical and medical care unit made several beds
available. This was important since, after emergency
surgery, patients could be directly admitted into the
units, enabling the shock trauma room to be free for
new patients, in accordance with the so-called one-way
progression concept (no return to the emergency or
shock trauma room). A rapid triage was organised at
the entrance of the emergency department, directing
absolute emergencies to the shock trauma unit and
relative emergencies to the emergency department, and
this second rapid triage was able to confirm the initial
triage done a few minutes previously by the prehospital
team. Each absolute emergency patient was cared for by
a dedicated trauma team (anaesthesiologist, surgeon,
fellow, and nurse), who decided whether or not to
perform CT scans, radiology, and to send the patient to a
prepared operating room where an operating team was
available (with appropriate senior and fellow surgeons,
anaesthesiologist and nurse anaesthetist, and operating
room nurse). Other post-anaesthesia care units were
reopened to receive patients once surgery was done.
A key element was the excellent cooperation of all
care-givers under the supervision of two trauma leaders
in the shock trauma unit and an operating room
allocation leader, who were not directly involved in the
care of the patients and who continuously communicated
between each other and regularly collated information
concerning the entire cohort of injured patients.
Furthermore, hospital management could immediately
provide logistic support. Another key element was
related to the dramatic characteristic of the event—each
participant wanted to do more than his or her best for
the victims. And they did it! Only 9 h after the event, we
were able to decrease the number of operating rooms to
six and send back home some of the more exhausted
staff. Within 24 h, all emergency surgeries (absolute and
relative emergencies) had been done and no victims
were still in the emergency department or the shock
trauma unit. The hospital was nearly ready to cope with
another attack that we all feared could occur.
The point of view of the trauma surgeon
If I had to summarise the “winning formula” in the recent
tragic hours that we lived, in an orthopaedic centre of
APHP, I would say that spontaneity and professionalism
were the key ingredients. When I arrived in Lariboisière
Hospital 2 h after the beginning of the events, I was
surprised to discover that at least six or seven of my
colleagues of different specialties were already there in
addition to the doctors on duty that night. The on-call
anaesthetists and intensive care doctors were helped by
three colleagues who joined them spontaneously. Extra
nursing staff also came to help. All these extra personnel
allowed us to open two operating rooms for orthopaedic
surgery, one for neurosurgery, one for ear, nose, and throat
surgery, and two for abdominal surgery. The first seriously
injured patients were operated on within half an hour of
admission. The triage of the later patients was done in two
locations: in the postoperative care unit next to the
operating rooms for the most seriously wounded patients,
who were brought directly by the mobile medical units,
and in the emergency department for the less critically
wounded patients. Triage was done by the most
experienced physician in each specialty. During the first
night, we operated continuously. On Saturday Nov 14, the
orthopaedic surgery team was helped spontaneously by
two other teams. The sequence of operations was
determined after the last patients were admitted, including
five patients who came from hospitals in which orthopaedic
surgery was not available. With the anaesthetists and the
nursing staff we operated continuously all day long. On
Sunday Nov 15, the usual services resumed.
On Monday Nov 16, when all the medical staff reviewed
what had been done during the weekend, the common
observation was that all but one of the patients were less
than 40 years old. All the patients we received had had a
high-energy ballistic trauma. All upper limb fractures
had been treated with external fixation because of the
open nature of the fractures and extensive bone loss.10
The two lower limb ballistic traumas were treated
with plates. Nerve damage was frequent, including
two patients with median nerve section, one with radial
nerve section, one with cubital nerve section, and one
with peroneal nerve section. Only one nerve was
repaired; for the others, gaps of several centimetres were
observed and secondary reconstruction will be needed.11
Vascular damage was not observed in our patients
because patients with suspected problems of this sort
were directed from the mobile medical unit to a hospital
where vascular surgery was available. Psychiatrists were
involved in treatment and had contact with all patients
4. Viewpoint
4 www.thelancet.com Published online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6
during this early period to assess for acute stress disorder
and begin the follow-up of potential post-traumatic
stress disorder.
Professionalism was present at each level. While the
operating room is often described as a difficult place—
where the human factor is crucial—during this “stress
test” difficulties vanished, working together appeared
fluid and somehow harmonious. Trust and com-
munication between different specialties and jobs were
apparent. The common goal was so clear that no
stakeholder tried to impose an individual view. Solidarity
was observable inside the hospital but also between the
different APHP hospitals: when a specialist was not
available in one hospital the patient was transferred
easily to another hospital where the expertise was
available. The APHP network demonstrated its efficiency.
All operations were performed without any delay. The
sterile supply chain was augmented to allow a fluid
workflow, and administrative staff supported the
medical work, finding logistic solutions when necessary
(eg, patient registration, finding free beds, etc).
Timing might also have played a part in the success of
the response. This disaster occurred at the beginning of a
weekend and during the night. Some of the aspects might
have been more difficult if it had happened during a
working day, when the sterile stock is partly unavailable
and when doctors and staff are already busy. Unfortunately,
the current situation requires us to be prepared to face
even more difficult situations in the future.
Conclusion
This is the legacy of history that led to the creation of the
APHP hospital network as a single entity. Its huge size is
regularly questioned, both internally and externally, as an
obstacle to adaptation in a rapidly changing technological,
medical, and social context. The decision circuits are
complex, internal rivalries may develop, and changes are
slow to spread. We sensed, however, that the size of the
organisation could be an advantage in times of disaster.
This advantage has now been demonstrated. No lack of
coordination has been identified. No leakage or delay has
occurred. No limit was reached. Furthermore, we believe
that such a structure is not only an advantage in times of
crisis, but also on a normal day. A large hospital complex
is also able to produce powerful research, to process a
considerable amount of data, and to play a major part in
public health. What happened strengthens our belief that
size can be combined with speed and excellence.
In the aftermath of this terrible experience, it is too
early to report the details of the medical expense incurred
and the lessons that can be learned from this event. But
we already know that as terrorism becomes more lethal
and violent, nothing will prevent the medical community
from understanding, learning, and sharing knowledge to
become more effective in saving lives. However, we must
remain humble and expect deaths to occur among the
severely wounded patients in the upcoming days, despite
the fact that we observed only four deaths (1%) among
the 302 injuried patients, including two deaths on arrival
at hospital.
Contributors
All authors contributed equally to this report.
Declaration of interests
We declare no competing interests. We are all members of the Assistance
Publique-Hôpitaux de Paris (APHP), MH is Director General of APHP.
Acknowledgments
We thank our colleagues, more than a thousand health-care
professionals—including nurses, logistical and administrative staff,
medical doctors, and pharmacists—who were committed during this
major event to saving lives and supporting victims and their families,
and in some cases were personally endangered. We acknowledge the
teams of rescuers belonging to the fire brigade of Paris, the police forces,
and volunteers.
References
1 Duchesne JC, McSwain NE Jr, Cotton BA, et al. Damage control
resuscitation: the new face of damage control. J Trauma 2010;
69: 976–90.
2 Jenkins DH, Rappold JF, Badloe JF, et al. Trauma hemostasis and
oxygenation research position paper on remote damage control
resuscitation: definitions, current practice, and knowledge gaps.
Shock 2014; 41 (suppl 1): 3–12.
3 Tourtier JP, Palmier B, Tazarourte K, et al. The concept of damage
control: extending the paradigm in the prehospital setting.
Ann Fr Anesth Reanim 2013; 32: 520–26.
4 Gates JD, Arabian S, Biddinger P, et al. The initial response to the
Boston marathon bombing: lessons learned to prepare for the next
disaster. Ann Surg 2014; 260: 960–66.
5 Aylwin CJ, König TC, Brennan NW, et al. Reduction in critical
mortality in urban mass casualty incidents: analysis of triage, surge,
and resource use after the London bombings on July 7, 2005. Lancet
2006; 368: 2219–25.
6 Gutierrez de Ceballos JP, Turégano Fuentes F, Perez Diaz D,
Sanz Sanchez M, Martin Llorente C, Guerrero Sanz JE.
Casualties treated at the closest hospital in the Madrid, March 11,
terrorist bombings. Crit Care Med 2005; 33 (1 suppl): S107–12.
7 Mathieu L, Ouattara N, Poichotte A, et al. Temporary and definitive
external fixation of war injuries: use of a French dedicated fixator.
Int Orthop 2014; 38: 1569–76.
8 RAID (Research, Assistance, Intervention, Dissuasion) Medical
Service. Tactical emergency care during hostages’ crisis:
care principles and feedback. Ann Fr Med Urg 2015; 5: 166–75.
9 Régnier MA, Raux M, Le Manach Y, et al. Prognostic significance of
blood lactates and lactate clearance in trauma patients.
Anesthesiology 2012; 117: 1276–88.
10 Rochkind S, Strauss I, Shlitner Z, Alon M, Reider E, Graif M.
Clinical aspects of ballistic peripheral nerve injury: shrapnel versus
gunshot. Acta Neurochir 2014; 156: 1567–75.
11 Katz JD. Conflict and its resolution in the operating room.
J Clin Anesth 2007; 19: 152–58.