Elizabeth A. Mann

The Combat Ready Clamp (CRoC™) was designed to control hemorrhage from the groin region, on the battlefield. The purpose of this experiment was to determine whether CRoC™ user performance varied by the surface the casualty laid on (flat-hard, flat-soft, and curved-soft) and how quickly the device could be applied. The commercial manikin selected to assess user performance was designed to train soldiers in CRoC™ use. The manikin simulated severe hemorrhage from an inguinal wound, controllable by correct use of the CRoC™. Each individual (n = 6) performed 3 iterations on each of the 3 surfaces (54 iterations total). The CRoC™ achieved hemorrhage control 100% of the time (54/54). Patient surface affected time to stop bleeding. The flat-soft surface (padded, 55 ± 9.7 seconds) was significantly different from the curved-soft surface (litter, 65 ± 16.5 seconds) and had the lowest overall total time (p = 0.007); time for the hard-flat surface was 58 ± 9.5 seconds. Users were trained to use the Combat Ready Clamp effectively, and the surface the casualty was lying on made some difference to user performance. All six persons trained had success in all nine of their iterations of CRoC™ use- a 100% rate. These findings indicate that training was effective and that training of other users is plausible, feasible, and practical within the scope of the present evidence.

Sepsis is a complicated syndrome that manifests within the complex adaptive system that is the human body. Complexity theory and the recently emerged applied complexity science illustrate these phenomena and the body's response in light of understanding these complex systems. Provision of careful observation by the nurse may recognize signs of moving into a nonadaptive or declining status, facilitating detection before complete sepsis or chaos. Systems or tools that aid the bedside nurse in prompt identification of sepsis and facilitate standardized evidence-based interventions are proving to be a valuable means in the care of the septic patient.

The purpose of this systematic review of the literature was to determine the association of sepsis with mortality in the severely injured adult patient by means of a comparative analysis of sepsis in burn and trauma injury with other critically ill populations. The MEDLINE (PubMed), Cochrane Library, and ProQuest databases were searched. The following keywords and MeSH headings were used: "sepsis," septicemia," "septic shock," "epidemiology," "burns," "thermal injury," "trauma," "wounds and injuries," "critical care," "intensive care," "outcomes," and "mortality." Included studies were clinical studies of adult burn, trauma, and critically ill patients that reported survival data for sepsis. Thirty-eight articles were reviewed (9 burn, 11 trauma, 18 general critical care). The age of burn (<45 years) and trauma (34-49 years) groups was lower than the general critical care (57-64 years) population. Sepsis prevalence varied with trauma-injured patients experiencing fewer episodes (2.4%-16.9%) contrasted with burn patients (8%-42.5%) and critical care patients (19%-38%). Survival differed with trauma patients experiencing a lower rate of mortality associated with sepsis (7%-36.9%) compared with the burn (28%-65%) and critical care (21%-53%) groups. This study is the first to compare sepsis outcomes in three distinct patient populations: burn, trauma, and general critical care. Trauma patients tend to have relatively low sepsis-associated mortality; burn patients and the older critical care population have higher prevalence of sepsis with worse outcomes. Great variability of criteria to identify septic patients among studies compromises population comparisons.

The purpose of this study was to determine baseline user satisfaction for 2 computer decision support systems (DSSs) with demonstrated improvement in patient outcome used in a burn intensive care unit. We conducted a survey of staff members of a 16-bed burn intensive care unit (n = 82) using a written, anonymous questionnaire to determine satisfaction for 2 DSSs: a commercial glycemic management system and software program to guide initial burn fluid resuscitation. Staff members are not yet convinced of a positive correlation between DSS technology and patient outcomes. We suggest user satisfaction may be generally improved for DSS with concentration in the areas of interface, information, and communication.

Automation and decision support systems are vital for improving critical patient care in the battlefield environment. However, advances in data management, sensor fusion, and decision support algorithms must be developed and incorporated into existing patient monitoring systems for this technology to improve battlefield patient care. This paper examines issues related to research and development of advanced monitoring and decision support systems for use both on the battlefield and in the civilian trauma environment.

The optimal method for glycemic control in the critically burned patient is unknown. The purpose of this randomized controlled study was to determine

Glycemic control with intensive insulin therapy (IIT) has received widespread adoption secondary to findings of improved clinical outcomes and survival in the burn population. Severe burn as a model for trauma is characterized by a hypermetabolic state, hyperglycemia, and insulin resistance. In this article, we review the findings of a burn center research facility in terms of understanding glucose management. The conferred benefits from IIT, our findings of poor outcomes associated with glycemic variability, advantages from preserved diurnal variation of glucose and insulin, and impacts of glucometer error and hematocrit correction factor are discussed. We conclude with direction for further study and the need for a reliable continuous glucose monitoring system. Such efforts will further the endeavor for achieving adequate glycemic control in order to assess the efficacy of target ranges and use of IIT.