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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

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.
Fuente Ministerio de Interior de España

jueves, 25 de octubre de 2018

The State of Pediatric Transport. Free E-Book by EMS World and Quantum

The State of Pediatric Transport. Free E-Book  by EMS World and Quantum 

Pediatric transport has historically been a subset of EMS without much regulation, oversight or guidance. Currently, there is no federal standard to test the crashworthiness of restraints on cots, and no national crash standard available specific to stretchers or ambulances that can be used by manufacturers of ambulance restraints or child passenger safety seats.

In 2009, the National Highway Traffic Safety Administration (NHTSA) convened an expert interdisciplinary panel to develop guidelines based upon current pilot testing, manufacturers’ recommendations and existing standards.

This special supplement produced in partnership between EMS World and Quantum outlines the findings of the panel, current recommendations and other evidence-based guidelines specific to the prehospital transport of children. 

martes, 23 de octubre de 2018

Congreso del Comité Iberoamericano de Medicina Táctica y Operacional 5 al 8 de Diciembre del 2018 Academia Metropolitana de Seguridad Publica Leon, Guanajuato. MEXICO

5 al 8 de Diciembre del 2018
Academia Metropolitana de Seguridad Publica

Leon, Guanajuato. MEXICO

Ester presente en el Congreso IBEROAMERICANO de Medicina Tactica el Chair de la Seccion Tactica Colegio Americano de Medicos de Emergencias 

Dr. A. Alejandro Baez, MD FACEP 
ACEP Tactical Emergency Medicine Section ACEP-TEMS

lunes, 15 de octubre de 2018

Confirmed by PRAC that hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients. 11/10/2013

hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients. 11/10/2013

PRAC confirms that hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients

HES will be available in restricted patient populations
The EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) has completed its review of HES solutions following an assessment of new information and commitments from companies for additional studies and risk minimisation activities. The Committee confirmed that HES solutions must no longer be used to treat patients with sepsis (bacterial infection in the blood) or burn injuries or critically ill patients, because of an increased risk of kidney injury and mortality. HES solutions may, however, continue to be used in patients to treat hypovolaemia (low blood volume) caused by acute blood loss, provided that appropriate measures are taken to reduce potential risks and that additional studies are carried out.
The review of HES solutions was initially triggered by the German medicines agency, the Federal Institute for Drugs and Medical Devices (BfArM), following studies showing an increased risk of mortality in patients with sepsis and an increased risk of kidney injury requiring dialysis in critically ill patients following treatment with HES solutions.
The PRAC had initially concluded on 13 June 2013 that HES solutions should be suspended in all patient populations. Since then, the PRAC has analysed and considered new evidence that was not available at the time of the initial recommendation, including new studies. The Committee has also looked at new proposals for additional risk minimisation measures, including restrictions on use and a commitment from the companies to conduct additional studies.
The PRAC, on the basis of all data available to date, considered whether a group of patients could be identified for whom HES treatment remains beneficial. The Committee concluded that there was clear evidence for an increased risk of kidney injury and mortality in critically ill and septic patients, and that therefore HES should no longer be used in these patients. However the PRAC agreed that HES could continue to be used in patients with hypovolaemia caused by acute blood loss where treatment with alternative infusions solutions known as ‘crystalloids’ alone are not considered to be sufficient. The PRAC acknowledged the need for measures to minimise potential risks in these patients and recommended that HES solutions should not be used for more than 24 hours and that patients’ kidney function should be monitored for at least 90 days. In addition, the PRAC requested that further studies be carried out on the use of these medicines in elective surgery and trauma patients.
The PRAC recommendation will now be sent to the Coordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh), for consideration at its meeting on 21-23 October 2013.

New review of hydroxyethyl-starch-containing solutions for infusion started. 12/07/2013
The European Medicines Agency (EMA) has started a new review of hydroxyethyl-starch (HES)-containing solutions for infusion, following the suspension of the use of these medicines in the United Kingdom (UK) on 27 June 2013.
The EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) had recommended in June 2013 that these medicines be suspended in the European Union (EU), following an assessment of available data which concluded that their benefits do not outweigh the risks of kidney injury and mortality. However, the process to implement the PRAC’s recommendation across the EU has not yet begun since a number of marketing-authorisation holders have exercised their legal right to request a re-examination of the recommendation.
In the meantime, some Member States have taken action to suspend or limit the marketing or use of these medicines in their territories. In accordance with EU legislation, this type of action currently requires that a review procedure be carried out. Consequently, the UK has requested the PRAC to start this review procedure, which will run in parallel with the re-examination of the PRAC’s June 2013 recommendation.
The Agency invites all stakeholders (e.g. healthcare professionals, patients’ organisations, the general public) to submit data relevant to this procedure. Full details are available under the 'data submission' tab.
HES-containing solutions are volume expanders used to replace lost blood volume in hypovolaemia (low blood volume caused by dehydration or blood loss) and hypovolaemic shock (a steep fall in blood pressure caused by drop in blood volume). They are used in critically ill patients including patients with sepsis (bacterial infection of the blood), or burn or trauma injuries, or patients who are undergoing surgery. HES-containing solutions are given by infusion (drip) into a vein.
Infusion solutions containing HES belong to the class of colloids. There are two main types of volume expanders: crystalloids and colloids. Colloids contain large molecules such as starch, whereas crystalloids such as saline solutions contain smaller molecules. In the EU, HES-containing solutions for infusion have been approved via national procedures.
This review of HES solutions for infusion has been initiated at the request of the UK medicines agency, the Medicines and Healthcare Products Regulatory Agency (MHRA), under Article 107i of Directive 2001/83/EC, also known as the urgent Union procedure.
The review is being carried out by the Pharmacovigilance Risk Assessment Committee (PRAC), the committee responsible for the evaluation of safety issues for human medicines, which will make a set of recommendations. As these medicines are all authorised nationally, the PRAC recommendation will be forwarded to the Coordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh), which will adopt a final position. The CMDh is a regulatory body that represents the EU Member States, responsible for ensuring harmonised safety standards for medicines authorised via national procedures across the EU.
In June 2013, the PRAC adopted recommendations on HES solutions under Article 31 of Directive 2001/83/EC. A number of marketing-authorisation holders have requested a re-examination of these recommendations.

domingo, 14 de octubre de 2018

WHO recommendations: non-clinical interventions to reduce unnecessary caesarean sections free PDF by WHO

WHO recommendations: non-clinical interventions to reduce unnecessary caesarean sections free PDF by WHO

This new guideline on non-clinical interventions to reduce unnecessary caesarean sections incorporates the views, fears and beliefs of both women and health professionals about caesarean sections. It also considers the complex dynamics and limitations of health systems and organizations and relationships between women, health professionals and organization of health care services.

Related articles in scientific journals

Related publications

sábado, 13 de octubre de 2018

Abominal Aortic Tourniquet AAT™

Abominal Aortic Tourniquet AAT™

The Abdominal Aortic Tourniquet - AAT™Hemorrhage Stops Here™

The Abdominal Aortic Tourniquet is the first device to provide stable and complete occlusion of flow of blood to the lower extremities. It has 510(k) approval from the FDA for difficult to control inguinal hemorrhage. It is applied to the mid-abdomen, tightened and inflated and may remain on for up to an hour safely.

Available Mid-April 2012

Abdominal Aortic Tourniquet – AAT™

The project is focused at the number one priority identified by the Institute of Surgical Research for care on the battlefield: how to address uncompressible hemorrhage that is not treatable by a tourniquet in the leg, groin and inguinal region. This encompasses a significant capability gap related to preventable deaths. The solution to this problem must be stable, easy to apply and completely stop the loss of blood. The AAT™ is capable of this, and animal and human studies have demonstrated its safety and efficacy.

The AAT™ provides a rapid application of pneumatic compression to the aorta at the abdominal-pelvic junction to occlude blood flow in the inguinal arteries. The specific claim of the device is to occlude arterial flow through the inguinal region. The target of the compression is the aortic bifurcation, which has historically been identified in relation to the umbilicus or the superior margin of the iliac crests. Difficult bleeds in the inguinal region continue to be a significant source of morbidity and mortality on the battlefield. Providing solutions for treating these wounds have direct life saving results. Wounds to the pelvis and inguinal region are now preventable causes of death.

The AAT™ is a circumferential device that greatly increases the stability of the compression. The pneumatic wedge shaped bladder provides focused pressure to squeeze the blood vessels passing through the lower abdomen and preventing flow. The research referenced below demonstrates the safety of up to one hour of application and its effectiveness in non-invasively cross-clamping the aorta or fully stopping all blood flow to the pelvis and lower extremities. In essence the AAT™ acts as a valve to figuratively ‘turn the faucet off’ and prevent the further flow of blood out of wounds below its application site.

Blood is the vital component to surviving blunt or penetrating trauma in the golden hour. It allows oxygen to be carried to the heart, brain and kidneys. Every drop of blood lost impacts survival. Why let any of it spill to the ground when we can prevent its loss?


Georgia Health Sciences University (formerly the Medical College of Georgia) has conducted research on the device using a swine model in 2009. Flow was undetectable in the femoral catheter during the tourniquet application. For hemodynamic variables, there were no significant differences in MAP or CVP measurements among animals. However, using one way repeated measures analysis of variance, there was a significant difference in MAP (P = 0.008) between 0 and 55 minutes for each subject. Serum potassium did not reach clinically significant numbers. However, serum lactate was significantly different between times 55 minutes (3.6 mmol/L +/- .95) and after tourniquet release 65 minutes 5.9 mmol/L +/- .87) (p <0.001). Gross and histological examination revealed no signs of significant ischemia or necrosis of the small and large intestine. These data were presented at the Advanced Technology Applications for Combat Casualty Care conference in August 2009 and the American College of Emergency Physicians Scientific Assembly in 2009.

Application of the device was studied on humans in 2011 again at the Georgia Health Sciences University and found to be safe and effective during the protocol. The Common Femoral Artery (CFA) was reduced to a no flow state by applying an average of 191 mm Hg. The device was associated with moderate discomfort that resolved completely with device removal. These data were presented at the Advanced Technology Applications for Combat Casualty Care conference in August 2011.

FDA Approval

Compression Works received FDA approval for the AAT™ on October 22, 2011.
AUGUSTA, Ga. – Two emergency medicine physicians with wartime experience have developed a weapon against one rapidly lethal war injury. Insurgents commonly aim just below a soldier’s body armor, where the trunk and legs join, to injure the body’s largest blood vessels, causing soldiers to bleed to death within minutes.
Dr. Richard Schwartz“There is no way to put a tourniquet around it, so soldiers are getting shot in this area and dying within several minutes,” said Dr. Richard Schwartz, Chairman of the Department of Emergency Medicine in the Medical College of Georgia at Georgia Health Sciences University. Police officers wearing chest protection as well as automobile accident victims can sustain similar injuries.
Efforts to externally compress the injury have been largely ineffective; the inch-round aorta runs parallel to the spine, so it can’t be approached from the back, and is several inches inside the abdomen even in a fit soldier.
Schwartz and Dr. John Croushorn, Chairman of the Department of Emergency Medicine at Trinity Medical Center in Birmingham, Ala., hope their inflatable wedge-shaped bladder will make a lifesaving difference.
Abdominal Aortic Tourniquet
Abominal Aortic Tourniquet AAT™
It’s called an abdominal aortic tourniquet and it’s placed around the body at the navel level, tightened then, much like a blood pressure cuff, inflated into the abdomen until it occludes the aorta and stops the bleeding. The goal is to restore the golden hour so soldiers survive long enough to get definitive care for their injury.
“By effectively cross-clamping the aorta with the abdominal aortic tourniquet, you are essentially turning the faucet off,” Croushorn said.  “You are stopping the loss of blood from the broken and damaged blood vessels. You are buying the patient an additional hour of survival time based on blood loss.”
It was known that the knee pressed into the mid-abdomen could slow bleeding and block blood flow to the legs. The idea for the device came from studies conducted at GHSU in 2006 that quantified pressure needed to occlude the abdominal aorta. Schwartz and Croushorn started talking about turning that concept into a lifesaving device at an American College of Emergency Physicians meeting.
They first put the device on pigs, inflated it to the point there was no blood flow from the aorta to the femoral arteries and left it that way for an hour. There saw no potentially deadly increase in potassium levels in the blood and the pigs’ leg and gut tissue remained healthy. Next they used it on healthy humans for a shorter duration to ensure that the aorta could be completed occluded.
Croushorn and Schwartz have premarket clearance for the abdominal aortic tourniquet from the Food and Drug Administration and have identified a manufacturer. They already have orders for the device from the U.S. military and will teach courses on how to use it to the military and law enforcement. Device development was funded by the U.S. Department of Defense.
The physicians still want to explore their device’s potential for also helping CPR recipients. The chest compression that is the hallmark of CPR actually pushes blood all the way out to the extremities when the focus is keeping vital organs alive.
“With this device, you could, in theory, double the blood flow to the kidneys, heart and brain,” Schwartz said. They also believe it will help concentrate drugs given during CPR where they are needed. “Now when a medic pushes a cardiac drug during cardiac arrest, the drug is circulated through the toes before it reaches steady state concentrations in the heart,” Croushorn said.
Schwartz was a member of the 5th Special Forces Group (Airborne) during Operation Desert Shield and Desert Storm. He works with the Federal and Georgia Bureaus of Investigation and helped develop courses that bridge the gap between military and civilian groups that may work together during major disasters.  Croushorn served as Command Surgeon, Task Force 185 Aviation in the U.S. Army in Iraq in 2004. He also works with the FBI.

Emergency medicine physicians develop device to stop lethal bleeding in soldiers

Estudio Conocimiento de la sociedad española en maniobras básicas de soporte vital y actitud ante las emergencias . by Fundación MAPFRE y SEMES,

Fundación MAPFRE y SEMES, presentan el estudio Conocimiento de la sociedad española en maniobras básicas de soporte vital y actitud ante las emergencias

Solo 4 de cada 10 españoles se siente capacitado para actuar ante una parada cardiaca inesperada y utilizar un desfibrilador
• Más de la mitad de población nunca ha recibido formación específica en primeros auxilios y maniobras de soporte vital.
• 8 de cada 10 ciudadanos cree que en España no se hace todo lo posible para recibir una formación adecuada en primeros auxilios.
• Entre 1.500 y 3.000 personas salvarían la vida cada año si la sociedad estuviera formada en reanimación cardiopulmonar.
• Tras una parada cardiaca, los primeros 10 minutos son fundamentales para sobrevivir con un buen estado neurológico.
En España se producen anualmente entre 15.000 y 20.000 paros cardiacos fuera del hospital. La tasa de supervivencia de este tipo de situaciones, que surgen de forma repentina, es baja, en torno a un 10%. Esta cifra podría incrementarse entre 2 y 4 veces si el nivel de sensibilización y formación en maniobras de reanimación, soporte vital y primeros auxilios fuera mayor.Pero los últimos datos no ayudan.  En la actualidad, sólo 4 de cada 10 adultos (39,2%) reconoce sentirse capacitado para responder ante este tipo de emergencias, un porcentaje similar al número de ciudadanos (41,3%) que en caso de necesidad admite no saber utilizar un desfibrilador automático y que desconoce (34,7%) que el número único de emergencias europeo es el 112.
Son algunas de las conclusiones del informe ‘Conocimiento de la sociedad española en maniobras básicas de soporte vital y actitud ante las emergencias’, que han presentado hoy Fundación MAPFRE y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) con el objetivo de analizar el nivel de conocimientos en maniobras de soporte vital de la población española y su actitud general ante las emergencias.
El estudio, fruto de 1.500 encuestas, pone de manifiesto otros datos de interés en relación a la atención inmediata que se ofrece a una persona antes de que pueda ser atendida por personal sanitario. Siete de cada 10 encuestados (75,6%) considera “insuficiente” o “muy insuficiente” la formación que poseen los españoles en relación a primeros auxilios, un dato relevante si se tiene en cuenta que casi 4 de cada 10 (38,5%) ha tenido que prestar alguna vez primeros auxilios a una persona que lo necesitaba. En este sentido, la situación a la que más se han tenido que enfrentar los ciudadanos es el desvanecimiento (63,5%), atragantamiento (43,8%), hemorragia abundante (35,6%) y parada cardiaca (18,4%).
Más formación y sensibilización
Esther Gorjón, directora del informe y responsable de Enfermería de SEMES, que ha participado en el acto, ha destacado que, a pesar de que el conocimiento sobre maniobras de soporte vital de la población española y su capacidad de responder ante una situación de emergencia ha aumentado en los últimos años, todavía estamos lejos de las cifras de otros países europeos.
Y ha hecho hincapié, "en la necesidad de la implementación de un Plan Nacional de formación y sensibilización en medidas de soporte vital, preferiblemente desde la edad escolar, y campañas de sensibilización públicas de formación y difusión". Todo ello, ha indicado, "contribuiría a incrementar notablemente el nivel de conocimientos, la capacidad de respuesta, y en consecuencia, la supervivencia ante la parada cardiaca”.
Antonio Guzmán, director de Promoción de la Salud de Fundación MAPFRE, también se ha referido a la importancia de la formación en primeros auxilios, clave para prevenir consecuencias fatales. “Es algo que demanda gran parte de la sociedad, que considera que en nuestro país no se hace todo lo posible para que los ciudadanos tengan una formación adecuada en primeros auxilios, algo que para muchos es sin duda una asignatura pendiente, a la que se debería poner solución en el aula, en concreto en las primeras etapas educativas”.
En esta línea, el director de Promoción de la Salud de Fundación MAPFRE ha hecho alusión los más de 200 talleres de RCP que junto con SEMES impartirán este año escolar en 60 centros educativos y escuelas deportivas. Gracias a esta actividad, cerca de 10.000 jóvenes, entre 12 y 16 años, aprenderán a identificar los síntomas de una parada cardiaca, avisar a los servicios de emergencia, iniciar las técnicas de reanimación si la persona esta inconsciente y no respira, utilizar un desfibrilador y actuar ante un atragantamiento.
Puedes ver el estudio aquÏ: