Accidental hypothermia remains an important contributory factor to the mortality of trauma patients in both civilian and military environments. As a component of the ‘lethal triad’ it poses a significant problem in patients at risk of hemorrhage from traumatic injuries. Systems used to mitigate hypothermia in the prehospital environment must strike a balance between weight: size ratio and optimal performance.

This study compared three hypothermia mitigation systems; two leading products and the novel Xtract™SR Heatsaver, over a three-day trial period. Seven subjects were placed in a closed system, held at around 0°C, to promote the onset of mild hypothermia. Individuals with a tympanic temperature recording of < or = 35°C were placed into one of the three systems. Recordings of aural temperature and a numerical perceived comfort score were made every 15-20 minutes to assess rate of rewarming and subject’s perceptions of the process. An additional study was carried out by an experienced consultant in military and civilian emergency medicine, on day three of the trial, to determine the ease of clinical assessment of individuals placed inside the Xtract™SR Heatsaver prototype.

On all three days, subjects placed in the Xtract™SR Heatsaver recovered from their hypothermic state faster than those placed in the other systems. Clinical assessment could easily be performed on a patient placed in the Xtract™SR Heatsaver system.

Results demonstrate that the new Xtract™SR Heatsaver system is superior with regards to reducing heat loss, increasing patient comfort and allowing for clinical assessment. The study also highlights the importance of the use of adjuncts such as heat cell blankets and insulation matts alongside hypothermia mitigation systems deployed in the prehospital environment. Furthermore, data gathered provides scope for future research into nuances surrounding the effects and onset of hypothermia.

Despite strong evidence recommending supportive care as the mainstay of management for most infants with bronchiolitis, prior studies show that patients still receive low-value care (e.g., respiratory viral testing, salbutamol, chest radiography). Our objective was to decrease low-value care by delivering individual physician reports, in addition to group-facilitated feedback sessions to pediatric emergency physicians.

Our cohort included 3,883 patients ≤ 12 months old who presented to pediatric emergency departments in Calgary, Alberta, with a diagnosis of bronchiolitis from April 1, 2013, to April 30, 2018. Using administrative data, we captured baseline characteristics and therapeutic interventions. Consenting pediatric emergency physicians received two audit and feedback reports, which included their individual data and peer comparators. A multidisciplinary group-facilitated feedback session presented data and identified barriers and enablers of reducing low-value care. The primary outcome was the proportion of patients who received any low-value intervention and was analysed using statistical process control charts.

Seventy-eight percent of emergency physicians consented to receive their audit and feedback reports. Patient characteristics were similar in the baseline and intervention period. Following the baseline physician reports and the group feedback session, low-value care decreased from 42.6% to 27.1% (absolute difference: −15.5%; 95% CI: −19.8% to −11.2%) and 78.9% to 64.4% (absolute difference: −14.5%; 95% CI: −21.9% to −7.2%) in patients who were not admitted and admitted, respectively. Balancing measures, such as intensive care unit admission and emergency department revisit, were unchanged.

The combination of audit and feedback and a group-facilitated feedback session reduced low-value care for patients with bronchiolitis.

The decision to declare a major incident (MI) is not one to be taken lightly, but a delay in doing so may have dire consequences. The aim of this study was to ascertain what factors make specialists from a variety of pro-fessional backgrounds in the United Kingdom determine from an initial visu-al assessment of a scene that a MI should be declared.

Participants were presented with three different scenarios, which were presented pictorially. Their responses were noted.

One hundred seventy-eight professionals took part in this study. For Scenario 1 (a road traffic incident), 101 (57%) declared a MI. For a coach rollover in Scenario 2, a MI was declared by 82 (46%) people, and a MI was declared by 156 (87%) for a rail crash in Scenario 3.

Forty-six participants had attended a MI previously.The results for declar-ing a MI in this group were: (1) Scenario 1, 25 (54%); (2) Scenario 2, 25 (54%); and (3) Scenario 3, 44 (96%). Of this group, 44 had previously had training before experiencing the MI. Those who had >10 years of service in emergency services were more likely to declare a MI in Scenario 2 and 3.

The main problem with the existing system is the interpreta-tion and subjective nature of the word “major”. Specialists incorporate many individual factors into using the word. Future research should focus on the development of a system tied to more objective analysis.