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Biomedical subjects

T J Hodgetts

Publications and source records attributed to T J Hodgetts.

At least 19 recordsLinked to original sources
PubMed2003

Impact of deployment of personnel with chronic conditions to forward areas.

AIM: To identify reasons for inappropriate deployment of soldiers with chronic conditions to an operational environment. SETTING: Two British Army field hospitals in Kuwait, 08 February to 17 March 2003, during the period of troop concentration prior to war-fighting (Operation Telic). POPULATION: All British military personnel on land during the concentration phase, rising to an estimated 28,000 troops. METHODS: Real-time electronic record maintained of all cases presenting to 22 and 33 Field Hospitals judged to be inappropriately deployed. RESULTS: 50 sequential cases were analysed. 34% were downgraded prior to deployment. Of those who were P2 FE, 85% were judged to have required protection from deployment by down-grading. 20% of all cases had a history of chronic asthma, and of the asthmatics 60% (6/10) were not downgraded. 18% of all cases were deployed while waiting for secondary care investigation or review that should have ensured protection from deployment. No patient had an existing "FT" (forward temperate) or "LT" (lines of communication temperate) grading: but in four cases it was predictable that the patient's underlying condition would be adversely affected by deployment to a desert environment. In 5 cases it was identified that the inappropriate deployment could be attributed to clinical management within the civilian sector, with a consequent failure to institute the necessary downgrading process. CONCLUSIONS: Review of the medical grading process is needed to protect those soldiers who are awaiting outpatient opinion or definitive diagnosis from investigation, and to provide an employability grading that matches a soldier's fitness for operational role.

Chronic Disease↗
PubMed2002

Should ward nurses be using automatic external defibrillators as first responders to improve the outcome from cardiac arrest? A systematic review of the primary research.

INTRODUCTION: The outcome from in-hospital cardiac arrest has improved little since the implementation of cardiopulmonary resuscitation 40 years ago. Early defibrillation improves survival following ventricular fibrillation and pulseless ventricular tachycardia. The emergence of automatic external defibrillators and advisory defibrillators has been heralded as the answer to defibrillation delays in-hospital. AIM: To locate and evaluate the evidence supporting automatic external defibrillator use in-hospital on general wards. METHOD: A systematic review of indexed and grey literature to identify primary research. RESULTS: Fifteen in-hospital automatic external defibrillator studies were located, five met the inclusion criteria. CONCLUSIONS: There is limited primary research evaluating automatic external defibrillators in-hospital. Manual defibrillators remain the most commonly used device for in-hospital defibrillation. Automated external defibrillators offer an alternative to manual defibrillation providing they have a screen and manual override capability, and the technology for pacing is close to hand. For in-hospital automatic external defibrillator programmes to be effective a change in nursing philosophy must occur, and defibrillation must become an expected rather than an extended nursing role.

Cardiopulmonary Resuscitation↗
PubMed1999

Battlefield First Aid: a simple, systematic approach for every soldier.

First aid training for the trained soldier has been modified to incorporate the best available current clinical evidence and clinical experience. This annual training requirement will be achieved in one day and is introduced as Individual Training Directive (Army) 3 (ITD(A) 3) on 1 April 1999. With the exception of a short introductory video, the course is entirely taught and assessed on practical models. ITD(A) 3 teaches a systematic approach to every incident and to each injured soldier. This is presented in a robust, waterproof pocket aide memoire of Battlefield First Aid Drills, which is an individual issue item. The soldier must start with the MASTER DRILL to control the incident, and will then follow the INJURED SOLDIER DRILL to identify and treat life-threatening injuries. The best available clinical experience has resulted in the replacement of the three-sided dressing with the Asherman Chest Seal for open pneumothorax, and the introduction of a simple physiology based triage system. The best available clinical evidence has led to the removal of basic life support in the context of a soldier with no vital signs on the battlefield. It is retained as an 'add on' package for peace and peace-keeping environments.

Cardiopulmonary Resuscitation↗
PubMed1999

A unified emergency care system for the early management of emergencies in medicine.

Emergency medicine is increasingly compartmentalised. The Unified Emergency Care System (UECS) requires the user to consider every option for emergency care for each patient, in a logical manner that transcends these artificial compartments and recognises the relative priority of concomitant medical, surgical, environmental and toxicological problems. The system is presented as a series of icons, allowing considerations to be made at a glance. Drop shadows refer the user to detailed management protocols for specific conditions. The system follows the logical sequence of quick history, quick look, primary survey with resuscitation and secondary survey. Established management principles of airway-breathing-circulation-disability (ABCD) are incorporated. The complexity of the management algorithms increases from first aider through medic, paramedic, and primary care physician to emergency physician. The stepwise care facilitates seamless immediate medical care between providers, teamwork, and the development of a structured series of training programmes.

Adolescent↗
PubMed1999

Emergency medical conference South Africa, October 1998--a report on proceedings and clinical visits.

The South Africans are keen to adopt the Major Incident Medical Management and Support course, developed in the UK. South Africa can provide an excellent training ground for military personnel in the triage, resuscitation and surgical management of the patient with penetrating trauma. Johannesburg General Hospital has a high quality training system under the direction of Dr Ken Boffard. The nearby Baragwaneth Hospital is the closest to military surgical practice one can probably get in a civilian setting. There is an unprecedented opportunity for clinical skills training, and a wealth of research opportunities.

Emergency Medicine↗
PubMed1999

A unified emergency care system from first aid to definitive care.

The Unified Emergency Care System (UECS) provides an integrated system of medical support from point of injury to the time a casualty is handed over to specialist care within hospital. It enables personnel at all skill levels to deliver life-saving support to casualties with a broad range of acute injuries and illness. The UECS facilitates standardised training with each level building upon the previous, yet it retains an inherent flexibility to adapt to specific operational and service requirements.

Delivery of Health Care, Integrated↗
PubMed1998

The early management of meningococcal disease.

Meningococcal disease is a fulminant infection with an overall mortality of 8%. Mortality is significantly increased with meningococcal septicaemia, particularly when there has been a delay in the diagnosis. The trend from 1985 to 1995 has been an increase in incidence of this disease, and the relative importance of meningococcal disease has also increased following a fall in the incidence of invasive Haemophilus influenzae disease with childhood immunisation. The management of such cases can be complex and time critical. Patients with meningococcal septicaemia often require aggressive resuscitation, including airway support, intravenous colloid, and parenteral antibiotics; hypoglycaemia is also commonly seen, and inotropes may be needed to support the circulation. We examine the treatment strategies in the early management of meningococcal disease and provide an algorithm for use by ambulance personnel, general practitioners, accident and emergency clinicians, and paediatricians. The objective of this algorithm is to ensure that an optimally resuscitated patient is delivered to the definitive care facility.

Adult↗
PubMed1995

Pre-hospital cardiac arrest: room for improvement.

OBJECTIVE: To audit the outcome from pre-hospital cardiac arrest managed by ambulance personnel, and to assess their proficiency by analysing the time to initiate basic and advanced cardiac life support, the compliance with national guidelines, and the overall success of resuscitation. DESIGN: A retrospective analysis of ambulance service report forms of pre-hospital cardiac arrests, where active resuscitation was attempted by ambulance personnel between October 1992 and May 1993. SETTING: The City of Salford. SUBJECTS: 100 consecutive patients who suffered cardiac arrest out-of-hospital and who were brought to the accident and emergency department of Hope Hospital alive, or with resuscitation still in progress. RESULTS: Only 4 of 100 patients were successfully resuscitated out of hospital, of whom 2 survived to leave hospital. Detailed analysis of pre-hospital performance was performed on 89 patients only, as 11 report forms were missing (no successful pre-hospital resuscitations in this 11). Ventricular fibrillation was the first recorded rhythm in 51.7%, but 85.7% were in asystole or electromechanical dissociation on arrival at hospital. No patient who was still in cardiac arrest on arrival at hospital was successfully resuscitated. 11 patients received 'bystander CPR'. The median time to basic life support was 6 min; the median call-to-response interval was 8 min; the median call-to-advanced cardiac life support interval was 21 min; the median on-scene time was 31 min (paramedics), or 15 min (technicians). The dose of drugs given by the intravenous route did not comply with the contemporary recommendations in 43.2%, and those doses given by the endotracheal route were inadequate in 37.9% of the cases. Endotracheal intubation was attempted in all paramedic resuscitations (91.4% success); intravenous access was attempted in 60.3% (91.7% success). CONCLUSIONS: The survival from pre-hospital cardiac arrest in this community is worse than the national average. There is no single explanation for this. Better community CPR training, greater efficiency at the scene through additional personnel, and stricter compliance with national ACLS guidelines, facilitated by extended refresher training, are all required if outcome is to be improved.

Adolescent↗
PubMed1993

The Burns Calculator: a simple proposed guide for fluid resuscitation.

Most burn casualties will receive their primary care in an emergency department. These departments are staffed by doctors with a varying degree of supervision, and their experience of the treatment of burns is often very modest. Evidently there is a need for a simple method to calculate the fluid requirements of these patients. The Burns Calculator is designed for use during the first eight hours post-injury and is based upon the Parkland resuscitation formula, using only Hartmann's solution BP. It is expected that the patient will have received expert aid by the end of this time. Values for children have been predetermined using body surface area nomograms. The calculator will assist the non-specialist to determine the correct amount of fluid needed to resuscitate a burned patient, and perhaps decrease morbidity and mortality associated with this injury.

Aging↗