OBJECTIVE: To explore the feasibility of establishing a temporary trauma team led by trauma experts in primary hospitals for disaster medical rescue. METHODS: In the coal mine flooding accident in Xiaoyi City, Shanxi Province on December 15, 2021, according to the local emergency plan and the characteristics of the accident, the trauma experts trained the medical staff from the local primary hospital on advanced trauma life support (ATLS) and damage control surgery (DCS) in the short time interval between the occurrence of the mine disaster and the admission of medical staff to the disaster scene. A temporary trauma team composed of trauma experts, ATLS team, and DCS team was formed to provide early diagnosis and treatment for survivors before and in the hospital. RESULTS: The miners were found on the 36th hour of the disaster. All 22 miners were male, and 2 died underground. Another 20 people were rescued 39－43 hours after the disaster, with a median age of 48 years (34-57 years). All the survivors suffered from hypothermia, dehydration, maceration of feet and other injuries. There were 18 cases of acute inhalation tracheobronchitis, 14 cases of electrolyte acid-base disturbance, 6 cases of trunk contusion, 1 case of psoas major hematoma, and 1 case of lower extremity hematoma. Deep vein thrombosis was in 4 cases. The ATLS team focused on injury assessment, rewarming and rehydration within 50－60 minutes before admission, and completed auxiliary examinations within 2 hours after admission to clarify the diagnosis. The DCS team evaluated 6 patients with mechanical blunt trunk injury and excluded the indication of emergency surgery. The trauma experts conducted the whole process of supervision and quality control of disaster rescue. The positive rate of capillary refill test in the all survivors at the third hour of admission was significantly lower than that immediately after being rescued (75.0% vs. 15.0%, P=0.000 3), and they were discharged 4－7 days after admission. CONCLUSION Under the leadership of trauma experts and relying on the medical staff of primary hospitals, it is feasible to establish and train a temporary trauma team with ATLS and DCS functions to participate in the medical rescue of disasters, which is in line with the current national conditions of China.
Humans ; Adult ; Middle Aged ; Male ; Rescue Work/organization & administration* ; China ; Disasters ; Patient Care Team/organization & administration* ; Wounds and Injuries/therapy* ; Advanced Trauma Life Support Care/organization & administration* ; Disaster Planning/organization & administration* ; Emergency Medical Services/organization & administration*

PURPOSE: The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease. METHODS: This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients' demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. RESULTS: The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. CONCLUSION: This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.
Cardiopulmonary Resuscitation ; Decision Making ; Divorce ; Electronic Health Records ; Heart ; Humans ; Intubation ; Life Support Care ; Logistic Models ; Lung Diseases ; Renal Dialysis ; Retrospective Studies ; Terminal Care ; Tertiary Care Centers ; Ventilators, Mechanical

OBJECTIVE: Focused assessment with sonography for trauma (FAST) is used routinely for evaluating patients with major trauma. After a primary survey, the existence of hemoperitoneum or hemopericardium must be searched using FAST. Traditionally, hemopericardium can be assessed through the subcostal approach with the curved probe for the abdomen. On the other hand, satisfactory images (four chamber view) are difficult to obtain with this approach. METHODS: This was a prospective, single-center pilot study of an academic tertiary medical center. When FAST is performed on the patients, traditional FAST (subcostal approach with the curved probe) is generally conducted. During a FAST examination, the time consumed, numeric rating scale (NRS) for pain, and success rate of satisfactory images are recorded. After the traditional FAST was used, we used the curved probe like echo probe. The curved probe was positioned beside the left nipple with the probe marker opposite-sided (modified FAST) like the parasternal long-axis view of echocardiography. Finally, the existence of hemopericardium is confirmed using an echo probe. In this study, the consumed time, NRS, and success rate of satisfactory images were compared. RESULTS: The consumed time was shorter (57.4 vs. 71.2 seconds, P<0.001) and the pain score was lower (0.1 vs. 1.8, P<0.001) with the modified FAST compared to the traditional FAST. Satisfactory images were obtained in 23 cases (51%) with traditional FAST, whereas satisfactory images were obtained in 37 cases (82%) using modified FAST. CONCLUSION: Mvodified FAST is more accurate for the detection of hemopericardium than traditional FAST. The pain is less severe and the time consumed is shorter.
Abdomen ; Advanced Trauma Life Support Care ; Echocardiography ; Hand ; Hemoperitoneum ; Humans ; Nipples ; Pericardial Effusion ; Pilot Projects ; Prospective Studies ; Ultrasonography

OBJECTIVE: The outcome of traumatic cardiac arrests remains poor. Nevertheless, the prehospital treatments for traumatic arrests are insufficient in Korea. This study was conducted to compare the prehospital treatments in traumatic and non-traumatic out-of-hospital cardiac arrests (OHCA). METHODS: This was a retrospective, single-center study based on the prospectively collected database of an academic tertiary medical center. The study period was from 2009 to 2017. The following items were compared: age, sex, rates of bystander cardiopulmonary resuscitation (CPR), prehospital intubation, prehospital defibrillation, prehospital epinephrine administration, CPR duration, rates of return of spontaneous circulation, and the survival discharge. RESULTS: Among 786 arrest patients, there were 226 (28.7%) traumatic cardiac arrests and 560 (71.2%) non-traumatic cardiac arrests. The rate of bystander CPR was lower (3.1% vs. 17.5%, P<0.001) in traumatic OHCAs. The prehospital intubation, defibrillation, and epinephrine administration were lower in traumatic OHCAs. CONCLUSION: The prehospital treatments, including bystander CPR, prehospital intubation, and epinephrine administration, were performed less actively in traumatic OHCAs. On the other hand, these results were limited to a single hospital.
Advanced Trauma Life Support Care ; Cardiopulmonary Resuscitation ; Epinephrine ; First Aid ; Hand ; Heart Arrest ; Humans ; Intubation ; Korea ; Out-of-Hospital Cardiac Arrest ; Prospective Studies ; Retrospective Studies

To explore the correlation of quality of life with self-care efficacy and social support in patients with nasopharyngeal carcinoma after radiotherapy.
 Methods: A total of 179 patients with nasopharyngeal carcinoma at 3 months after radiotherapy were surveyed using self-designed general information questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30 V3.0), Chinese-version of Strategies Used by People to Promote Health (C-SUPPH), and Perceived Social Support Scale (PSSS).
 Results: The score of cognitive function was the highest, while the score of social function was the lowest. The score of related symptoms was 22.21±10.24, the overall score for quality of life was 52.46±17.96, the score of self-care efficacy was 62.14±14.50, and the score of social support was 56.03±7.63. Self-care efficacy of patients with nasopharyngeal cancer after radiotherapy was positively correlated with 5 functional areas of quality of life and overall quality of life, and negatively correlated with relevant symptoms (P<0.01). Social support was positively correlated with physical function, social function and overall quality of life (P<0.01), and negatively correlated with relevant symptoms (P<0.05). Multiple regression analysis showed that self-care efficacy could predict 5 functional areas of life quality, relevant symptoms, overall quality of life and social support predicted social function in quality of life.
 Conclusion: Self-care efficacy and social support for patients with nasopharyngeal cancer after radiotherapy can affect their quality of life. Nursing staff should pay attention to improving the self-care efficacy of patients, guide them to actively seek or obtain social support, and in turn to improve their quality of life.
Humans ; Nasopharyngeal Carcinoma ; radiotherapy ; Nasopharyngeal Neoplasms ; radiotherapy ; Quality of Life ; Self Care ; Social Support

PURPOSE: This study tried to understand discourses of life-sustaining treatments in general daily and healthcare newspapers. METHODS: A text-network analysis was conducted using the NetMiner program. Firstly, 572 articles from 11 daily newspapers and 258 articles from 8 healthcare newspapers were collected, which were published from August 2013 to October 2016. Secondly, keywords (semantic morphemes) were extracted from the articles and rearranged by removing stop-words, refining similar words, excluding non-relevant words, and defining meaningful phrases. Finally, co-occurrence matrices of the keywords with a frequency of 30 times or higher were developed and statistical measures—indices of degree and betweenness centrality, ego-networks, and clustering—were obtained. RESULTS: In the general daily and healthcare newspapers, the top eight core keywords were common: “patients,” “death,” “LST (life-sustaining treatments),” “hospice palliative care,” “hospitals,” “family,” “opinion,” and “withdrawal.” There were also common subtopics shared by the general daily and healthcare newspapers: withdrawal of LST, hospice palliative care, National Bioethics Review Committee, and self-determination and proxy decision of patients and family. Additionally, the general daily newspapers included diverse social interest or events like well-dying, euthanasia, and the death of farmer Baek Nam-ki, whereas the healthcare newspapers discussed problems of the relevant laws, and insufficient infrastructure and low reimbursement for hospice-palliative care. CONCLUSION: The discourse that withdrawal of futile LST should be allowed according to the patient's will was consistent in the newspapers. Given that newspaper articles influence knowledge and attitudes of the public, RNs are recommended to participate actively in public communication on LST.
Advisory Committees ; Bioethics ; Delivery of Health Care ; Euthanasia ; Farmers ; Hospice and Palliative Care Nursing ; Hospice Care ; Hospices ; Humans ; Jurisprudence ; Life Support Care ; Palliative Care ; Periodicals ; Proxy ; Semantics

Nearly 20 years after the Boramea Hospital case, the act on decisions on life-sustaining treatment for patients in hospice and palliative care or at the end of life has taken effect on February 4, 2018 as recommended by the National Bioethics Committee. However, during the legislation process, some parts of the bill that stakeholders and concerned parties did not see eye to eye were either revised or removed. Moreover, the hospice and palliative care part was added in the last minute before the enactment. As a result, the law includes parts that are not in line with the recommendations from the National Bioethics Committee, thereby causing various problems. Therefore, it is crucial to monitor how the decisions on life-sustaining treatments are made in the field and gather various opinions of concerned parties to identify and address problems in the early stage of the implementation of the law. Based on the data, the legislation must be amended to fulfill its purpose that is “to protect the dignity and value of human beings by assuring the best interests of the patients and by respecting their self-determination”.
Bioethics ; Decision Making ; Hospices ; Humans ; Jurisprudence ; Life Support Care ; Palliative Care

No abstract available.
Critical Illness ; Decision Making ; Humans ; Life Support Care ; Quality of Life ; Terminal Care ; Physician-Patient Relations ; Withholding Treatment

Trauma is a life-threatening "modern disease". The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS). Currently, the pre-hospital emergency medical services (EMS) has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT) with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training.
China ; Emergency Medical Services ; Humans ; Life Support Care ; Traumatology ; education ; Wounds and Injuries ; therapy

OBJECTIVE: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. METHODS: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. RESULTS: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36–6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03–0.81). CONCLUSION: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.
Advanced Cardiac Life Support* ; Cardiopulmonary Resuscitation ; Defibrillators ; Education ; Emergencies* ; Emergency Medicine* ; Hand ; Heart Arrest* ; Incidence ; Intensive Care Units ; Retrospective Studies ; Sodium Bicarbonate