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6 años con el Sello HONcode

6 años con el Sello HONcode
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Nota Importante

Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD


martes, 5 de junio de 2018

Stop the Bleed could provide ‘herd immunity’ against exsanguination: Interview with Dr. Lenworth Jacobs 0 BY ROBERT FOJUT ON MAY 30, 2018

Stop the Bleed could provide ‘herd immunity’ against exsanguination: Interview with Dr. Lenworth Jacobs  0 BY ROBERT FOJUT ON MAY 30, 2018
    Dr. Lenworth Jacobs
Recent mass casualty incidents in the U.S. have changed the way we think about traumatic injury. Trauma leaders now know that the key to survival for many victims is immediate bleeding control provided by first responders or private citizens.
According to Lenworth Jacobs, MD, MPH, FACS, chairman of the Hartford Consensus and leader of the ACS Stop the Bleed Program, more than half a million people have received hemorrhage control training in the last two years. And while the percentage of Americans who know how to use a tourniquet is still small, there is good reason to believe their training provides a protective effect at the population level against the risk of bleeding out.
Dr. Jacobs will discuss the Stop the Bleed program during his keynote address at this year’s Creighton Trauma Symposium in Omaha, Nebraska. Recently, he spoke with Trauma System News about Stop the Bleed’s origins, goals and accomplishments.

Q. Could you explain the origin of Stop the Bleed?

Jacobs: This all started about five years ago after the Sandy Hook incident. At Hartford Hospital, which is a Level I trauma center, we were put on alert to respond to that incident — but then about half an hour later we were shut down. We thought that was because there was no problem needing us. But it turned out there was a gigantic problem which didn’t need us. And that was just overwhelming, primarily because the victims were six-year-olds. The senselessness of that was just overwhelming.
Very shortly after that, I was at a meeting of the Board of Regents of the American College of Surgeons. We agreed we needed to do something about this, so the college commissioned a committee to look at increasing survival after these incidents. And this became the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events.

Q. What was your key finding?

Jacobs: It immediately became clear that these kinds of events are multidisciplinary events. The first thing is that law enforcement goes in, and their mission is to secure the scene and preserve the evidence of the crime. Fire/rescue then goes in, and their mission is to put out fires and rescue people. And then the third to go in is emergency medical services, and their mission is to render emergency medical aid.
So it is very sequential, and the three groups usually have completely different governance systems, different communication systems and different “rules of engagement” and operation. That works just fine if you have a law enforcement event or a fire event or an emergency event. But it doesn’t work very well when all three of those things are happening simultaneously.

Q. So what’s the solution?

Jacobs: Since these active shooter and intentional mass casualty events are multidisciplinary events, that means they cannot be solved by one group. It’s a three-legged school.
The first leg of the stool is law enforcement. We actually took a page from the military and the Tactical Combat Casualty Care group. The Navy SEALs, for example, use a buddy system. If a soldier goes down, the person right beside him stops what he’s doing for the minute and first addresses the bleeding before calling in the medics. So we were able to get law enforcement to modify their mission to include hemorrhage control. Previously, if you were bleeding it really wasn’t the mission of law enforcement to stop your bleeding. But if you want to make bleeding control a part of their mission, (1) you have to train them to help stop the bleeding and (2) you have to equip them to stop the bleeding.
The second leg of the stool is EMS. They don’t have protective equipment, they’re not trained to go into hostile areas, etc. So their mission was typified at Columbine, where EMS providers were held back for 40 minutes and injured people died. You want to bring emergency medical services closer to the scene and employ them earlier on in the event. So the second leg was to bring EMS closer to the scene — not into the hot zone or the danger zone — but into the warm zone, which is not totally secure but you can begin treatment there. EMS can then later move the patient into the cold zone, where you can do triage and more defensive treatment.
The third leg is probably the most important. If a shooting goes down, where is it? It’s in a certain building, but where in the building? Second floor, third floor? Right, left? You don’t really know and it’s not safe. So that means the response is delayed. It can be five or ten minutes, which if you’re bleeding from a big enough vessel can be very deleterious to you. So if you want to have the maximum chance of survival, the person who’s going to take care of you is the person right beside you. And that person is most likely not a medical person, that is just a regular citizen.
So then our mission has to include informing and then educating and then empowering the public to be an immediate responder in this area. That is the third leg of this stool, and it is equivalent to if you see someone drop down from a heart attack, society says it’s okay for you to do CPR. And it’s not only okay, it’s a good thing for you to do. Similarly, if the person beside you is bleeding to death, we want you to be empowered and educated to do your best to stop that bleeding.

Q. Which brings us to the mission of Stop the Bleed…

Jacobs: So that next mission was to develop an educational program which could allow a layperson to become competent in stopping bleeding in a very short period of time.
We only teach three things — how to use your hands, how to use a hemostatic dressing and how to use a tourniquet. And that teaching process takes between half an hour and an hour. We give you an educational overview and then teach you how to use the equipment, and then you demonstrate it back to us and you’re good to go.
So that is the third leg of the stool, to create immediate responders in the lay public to stop bleeding — not just from an explosion or gunshot, but from any cause, because it is far more common for someone to be cut with a chainsaw, cut with a kitchen knife, fall on a stake, have a very bad motorcycle accident, etc. Those kinds of injuries are much more common than shootings or explosive events.

Q. Does bleeding control training “stick” months or years later?

Jacobs: That’s a good question. There is a very good study out in JAMA Surgery by a group at Brigham and Women’s Hospital in Boston. They found that three to nine months after people go through a Bleeding Control Basic (B-Con) course, there is about a 55% retention rate for tourniquet use.
So, yes, there is some loss of the skill set, no question about it. But you know, we have this thing called “herd immunity.” So say I teach ten people how to perform bleeding control. Even if half of them forget how to do it or don’t do it very well, the other half will retain the skill and probably be able to help the ones who have forgot. Will they be perfect? I don’t think so. But they will be effective, and all we’re really trying to do is keep the blood inside the body until you get to a trauma center. That’s all.
So you don’t really have to do anything definitive. You just have to keep the blood inside the body. Just stop the bleeding. You don’t have to fix it, just stop it.

Q. Do people seem willing to do this?

Jacobs: There is definitely a willingness on the part of the public to be helpful. We know that. We did a survey and it showed that 92% of people said they were willing to help somebody who was bleeding. So there’s a tremendous wellspring of altruism in the public as evidenced by all these events. Whether it’s Boston or Las Vegas or Orlando or wherever, people want to be helpful. We just need to train them and inform them and empower them so if they try to be helpful, they can go ahead and be helpful.

Q. What is the takeaway for trauma professionals who hear you at the Creighton symposium?

Jacobs: We want the group that’s coming to the Creighton Trauma Symposium to understand this message, to recognize that Stop the Bleed is an important thing and a public good. And then we want them to learn how to perform bleeding control and become teachers for the general public. If they learn how to do it and then go back to their home communities and become trainers of the trainers, then the message escalates exponentially.

Q. Ideally, everyone would learn how to control bleeding. What is the progress so far?

Jacobs: There are more than 300 million people in the country, so it’s a daunting task. But in the last year to year and a half, we have trained 20,000 instructors in all 50 states and 68 countries. We have also provided basic bleeding control training to 300,000 or 400,000 law enforcement officers, the entire FBI and probably well over 200,000 citizens, and that is an underestimate. So it’s a start. As you like to say, it’s a grain of sand on the beach, but it’s an important grain of sand.

MANUAL DE ATENCIÓN AL PARTO EN EL ÁMBITO EXTRAHOSPITALARIO. Ministerio de Sanidad, Servicios Sociales e Igualdad. España

¿Qué es el parto velado "Parto Empelicado" o nacer con bolsa intacta? by

Balística de las heridas: introducción para los profesionales de la salud, del derecho, de las ciencias forenses, de las fuerzas armadas y de las fuerzas encargadas de hacer cumplir la ley
Guía para el manejo médico-quirúrgico de heridos en situación de conflicto armado by CICR


Manual Suturas, Ligaduras, Nudos y Drenajes. Hospital Donostia, Pais Vasco. España

Técnicas de Suturas para Enfermería ASEPEYO y 7 tipos de suturas que tienen que conocer estudiantes de medicina

Manual Práctico de Cirugía Menor. Grupo de Cirugia Menor y Dermatologia. Societat Valenciana de Medicina Familiar i Comunitaria

Protocolo de Atencion para Cirugia. Ministerio de Salud Publica Rep. Dominicana. Marzo 2016
Manual de esterilización para centros de salud. Organización Panamericana de la Salud
Libre de Mantenimiento 
Vendemos en España y Rep. Dominicana
Hacemos entrega del Sistema Completo




Twitter: @DrtoleteMD

¿Por qué el Desfibrilador TELEFUNKEN?
El DESFIBRILADOR de Telefunken es un DESFIBRILADOR AUTOMÁTICO sumamente avanzado y muy fácil de manejar.
Fruto de más de 10 años de desarrollo, y avalado por TELEFUNKEN, fabricante con más de 80 años de historia en la fabricación de dispositivos electrónicos.
El desfibrilador TELEFUNKEN cuenta con las más exigentes certificaciones.
Realiza automáticamente autodiagnósticos diarios y mensuales.

Incluye bolsa y accesorios.
Dispone de electrodos de "ADULTO" y "PEDIÁTRICOS".
Tiene 6 años de garantía.
Componentes kit de emergencias
Máscarilla de respiración con conexión de oxígeno.
Tijeras para cortar la ropa
Guantes desechables.

¿ Qué es una Parada Cardíaca?
Cada año solo en paises como España mueren más de 25.000 personas por muerte súbita.
La mayoría en entornos extrahospitalarios, y casi el 80-90 % ocasionadas por un trastorno eléctrico del corazón llamado"FIBRILACIÓN VENTRICULAR"

El único tratamiento efectivo en estos casos es la "Desfibrilación precoz".
"Por cada minuto de retraso en realizar la desfibrilación, las posibilidades de supervivencia disminuyen en más de un 10%".

¿ Qué es un desfibrilador ?
El desfibrilador semiautomático (DESA) es un pequeño aparato que se conecta a la víctima que supuestamente ha sufrido una parada cardíaca por medio de parches (electrodos adhesivos).

¿ Cómo funciona ?

El DESA "Desfibrilador" analiza automáticamente el ritmo del corazón. Si identifica un ritmo de parada cardíaca tratable mediante la desfibrilación ( fibrilación ventricular), recomendará una descarga y deberá realizarse la misma pulsando un botón.

El desfibrilador va guiando al reanimador durante todo el proceso, por medio de mensajes de voz, realizando las órdenes paso a paso.

Únicamente si detecta este ritmo de parada desfibrilable (FV) y (Taquicardia Ventricular sin Pulso) permite la aplicación de la descarga. (Si por ejemplo nos encontrásemos ante una víctima inconsciente que únicamente ha sufrido un desmayo, el desfibrilador no permitiría nunca aplicar una descarga).

¿Quién puede usar un desfibrilador TELEFUNKEN?
No es necesario que el reanimador sea médico, Enfermero o Tecnico en Emergencias Sanitarias para poder utilizar el desfibrilador.

Cualquier persona (no médico) que haya superado un curso de formación específico impartido por un centro homologado y acreditado estará capacitado y legalmente autorizado para utilizar el DESFIBRILADOR (En nuestro caso la certificacion es de validez mundial por seguir los protolos internacionales del ILCOR International Liaison Committee on Resuscitation. y Una institucion de prestigio internacional que avale que se han seguido los procedimientos tanto de formacion, ademas de los lineamientos del fabricante como es el caso de

TELEFUNKEN en Rep. Dominicana es parte de Emergency Educational Training Institute de Florida. Estados Unidos, siendo Centro de Entrenamiento Autorizado por la American Heart Association y American Safety and Health Institute (Por lo que podemos certificar ILCOR) Acreditacion con validez en todo el mundo y al mismo tiempo certificar el lugar en donde son colocados nuestros Desfibriladores como Centros Cardioprotegidos que cumplen con todos los estanderes tanto Europeos CE como de Estados Unidos y Canada
Dimensiones: 220 x 275 x 85mm
Peso: 2,6 Kg.
Clase de equipo: IIb
Temperatura: 0° C – + 50° C (sin electrodos)
Presión: 800 – 1060 hPa
Humedad: 0% – 95%
Máximo Grado de protección contra la humedad: IP 55
Máximo grado de protección contra golpes:IEC 601-1:1988+A1:1991+A2:1995
Tiempo en espera de las baterías: 3 años (Deben de ser cambiadas para garantizar un servicio optimo del aparato a los 3 años de uso)
Tiempo en espera de los electrodos: 3 años (Recomendamos sustitucion para mantener estandares internacionales de calidad)
Número de choques: >200
Capacidad de monitorización: > 20 horas (Significa que con una sola bateria tienes 20 horas de monitorizacion continua del paciente en caso de desastre, es optimo por el tiempo que podemos permanecer en monitorizacion del paciente posterior a la reanimacion)
Tiempo análisis ECG: < 10 segundos (En menos de 10 seg. TELEFUNKEN AED, ha hecho el diagnostico y estara listo para suministrar tratamiento de forma automatica)
Ciclo análisis + preparación del shock: < 15 segundos
Botón información: Informa sobre el tiempo de uso y el número de descargas administradas durante el evento con sólo pulsar un botón
Claras señales acústicas y visuales: guía por voz y mediante señales luminosas al reanimador durante todo el proceso de reanimación.
Metrónomo: que indica la frecuencia correcta para las compresiones torácicas. con las Guias 2015-2020, esto garantiza que al seguir el ritmo pautado de compresiones que nos indica el aparato de forma acustica y visual, podremos dar RCP de ALTA calidad con un aparato extremadamente moderno, pero economico.
Normas aplicadas: EN 60601-1:2006, EN 60601-1-4:1996, EN 60601-1:2007, EN 60601-2-4:2003
Sensibilidad y precisión:
Sensibilidad > 90%, tip. 98%,
Especificidad > 95%, tip. 96%,
Asistolia umbral < ±80μV
Protocolo de reanimación: ILCOR 2015-2020
Análisis ECG: Ritmos cardiacos tratables (VF, VT rápida), Ritmos cardiacos no tratables (asistolia, NSR, etc.)
Control de impedancia: Medición9 de la impedancia continua, detección de movimiento, detección de respiración
Control de los electrodos : Calidad del contacto
Identificación de ritmo normal de marcapasos
Lenguas: Holandés, inglés, alemán, francés, español, sueco, danés, noruega, italiano, ruso, chino
Comunicación-interfaz: USB 2.0 (El mas simple y economico del mercado)
Usuarios-interfaz: Operación de tres botones (botón de encendido/apagado , botón de choque/información.
Indicación LED: para el estado del proceso de reanimación. (Para ambientes ruidosos y en caso de personas con limitaciones acusticas)
Impulso-desfibrilación: Bifásico (Bajo Nivel de Energia, pero mayor calidad que causa menos daño al musculo cardiaco), tensión controlada
Energía de choque máxima: Energía Alta 300J (impedancia de paciente 75Ω), Energía Baja 200J
(impedancia de paciente 100Ω)

Medical Doctor for complex and high-risk missions
+34 671 45 40 59
Medicina Bona Locis Malis
EU Medical Doctor / Spain 05 21 04184
Advanced Prehospital Trauma Life Support /Tactical Combat Casualty Care TCCC Instructor and Faculty 
ACLS EP / PALS American Heart Association and European Resucitation Council Instructor and Faculty
Member SOMA Special Operational Medical Association ID Nº 17479 
Corresponding Member Dominican College of Surgeons Book 1  Page M H10
Member Spanish Society of Emergency Medicine SEMES
DMO Diving Medical Officer- USA
Air Medical Crew Instructor DOT- USA
Tactical Medical Specialist and Protective Medicine -USA
TECC Tactical Emergency Casualty Care Faculty and Medical Director by C-TECC

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