There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.

No abstract

IntroductionThe Phillips Report on traumatic brain injury (TBI) in Ireland found that injury was more frequent in men and that gender differences were present in childhood. This study determined when gender differences emerge and examined the effect of gender on the mechanism of injury, injury type and severity and outcome.MethodsA national prospective, observational study was conducted over a 2-year period. All patients under 17 years of age referred to a neurosurgical service following TBI were included. Data on patient demographics, events surrounding injury, injury type and severity, patient management and outcome were collected from ‘on-call’ logbooks and neurosurgical admissions records.Results342 patients were included. Falls were the leading cause of injury for both sexes. Boys’ injuries tended to involve greater energy transfer and involved more risk-prone behaviour resulting in a higher rate of other (non-brain) injury and a higher mortality rate. Intentional injury occurred only in boys. While injury severity was similar for boys and girls, significant gender differences in injury type were present; extradural haematomas were significantly higher in boys (p=0.014) and subdural haematomas were significantly higher in girls (p=0.011). Mortality was 1.8% for girls and 4.3% for boys.ConclusionsFalls were responsible for most TBI, the home is the most common place of injury and non-operable TBI was common. These findings relate to all children. Significant gender differences exist from infancy. Boys sustained injuries associated with a greater energy transfer, were less likely to use protective devices and more likely to be injured deliberately. This results in a different pattern of injury, higher levels of associated injury and a higher mortality rate.

Aim: Continuing professional development (CPD) will soon be mandatory for advanced paramedics (APs) registered with Ireland’s pre-hospital regulatory body. Effective and efficient CPD methodologies are needed. We determined what type of training methods might be used to reduce associated costs while maintaining effectiveness and benefit. Methods: In 2010, an ‘up-skill’ programme for APs was introduced in Ireland comprising: a) self-directed learning using a purpose-designed manual; b) workbooks based on the manual and clinical practice guidelines; c) small group practical sessions with discussion-based skill stations; and c) practical scenario-based assessment. Participants were invited to complete a web-based survey assessing a) short-term effectiveness, b) medium-term effectiveness, and c) user friendliness of the educational modalities. The preferred learning styles and respondents’ perceptions of outcome were determined. Results: Overall 49 % of participants responded. Of those eligible, 73 % believed that practical learning encouraged knowledge retention and skills in the immediate and medium-term, 82 % believed practical learning influenced patient care immediately, while 75 % stated that it influenced patient care six months later. All respondents agreed that practical learning was important, with 90 % stating that it was enjoyable. Overall, 80 % found the provided manual accessible, while >40 % believed that the manual alone did not provide all necessary information, 77 % had referenced it since completing the programme. Conclusion: APs enjoyed, and benefited from, the educational programme and the knowledge gained benefited patients in the short and medium-term. This study suggests that educators and training sponsors should consider the benefits of small group-based practical learning for APs.

Introduction. Opioid overdose is an ever-increasing problem globally. Recent studies have demonstrated that intranasal (IN) naloxone is a safe and effective alternative to traditional routes of naloxone administration for reversal of opioid overdose. Aims. This randomised controlled trial aimed to compare the time taken to deliver intranasal medication with that of intravenous (IV) medication by advanced paramedic trainees. Methods. 18 advanced paramedic trainees administered either an IN or IV medication to a mannequin model in a classroom-based setting. The time taken for medication delivery was compared. End-user satisfaction was assessed using a 5-point questionnaire regarding ease of use and safety for both routes. Results. The mean time taken for the IN and IV group was 87.1 seconds and 178.2 seconds respectively. The difference in mean time taken was 91.1 seconds (95% confidence interval 55.2 seconds to 126.9 seconds, P ≤ 0.0001). 89% of advanced paramedic trainees reported that the IN route was easier and safer to use than the IV route. Conclusion. This study demonstrates that, amongst advanced paramedic trainees, the IN route of medication administration is significantly faster, better accepted and perceived to be safer than using the IV route. Thus, IN medication administration could be considered more frequently when administering emergency medications in a pre-hospital setting.