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Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.

ABSTRACT: OBJECTIVE:To determine if using a parachute prevents death or major traumatic injury when jumping from an aircraft. DESIGN:Randomized controlled trial. SETTING:Private or commercial aircraft between September 2017 and August 2018. PARTICIPANTS:92 aircraft passengers aged 18 and over were screened for participation. 23 agreed to be enrolled and were randomized. INTERVENTION:Jumping from an aircraft (airplane or helicopter) with a parachute versus an empty backpack (unblinded). MAIN OUTCOME MEASURES:Composite of death or major traumatic injury (defined by an Injury Severity Score over 15) upon impact with the ground measured immediately after landing. RESULTS:Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001). CONCLUSIONS:Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.

SUBMITTER: Yeh RW

PROVIDER: S-EPMC6298200 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.

Yeh Robert W RW Valsdottir Linda R LR Yeh Michael W MW Shen Changyu C Kramer Daniel B DB Strom Jordan B JB Secemsky Eric A EA Healy Joanne L JL Domeier Robert M RM Kazi Dhruv S DS Nallamothu Brahmajee K BK

BMJ (Clinical research ed.) 20181213

<h4>Objective</h4>To determine if using a parachute prevents death or major traumatic injury when jumping from an aircraft.<h4>Design</h4>Randomized controlled trial.<h4>Setting</h4>Private or commercial aircraft between September 2017 and August 2018.<h4>Participants</h4>92 aircraft passengers aged 18 and over were screened for participation. 23 agreed to be enrolled and were randomized.<h4>Intervention</h4>Jumping from an aircraft (airplane or helicopter) with a parachute versus an empty backp ...[more]

PMID: 30545967

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Project description:BackgroundAcute pain frequently transitions to chronic pain after major lower extremity trauma (ET). Several modifiable psychological risk and protective factors have been found to contribute to, or prevent, chronic pain development. Some empirical evidence has shown that interventions, including cognitive and behavioral strategies that promote pain self-management, could prevent chronic pain. However, the efficacy of such interventions has never been demonstrated in ET patients. We have designed a self-management intervention to prevent acute to chronic pain transition after major lower extremity trauma (iPACT-E-Trauma).ObjectiveThis pilot randomized controlled trial (RCT) aims to evaluate the feasibility and research methods of the intervention, as well as the potential effects of iPACT-E-Trauma, on pain intensity and pain interference with daily activities.MethodsA 2-arm single-blind pilot RCT will be conducted. Participants will receive the iPACT-E-Trauma intervention (experimental group) or an educational pamphlet (control group) combined with usual care. Data will be collected at baseline, during iPACT-E-Trauma delivery, as well as at 3 and 6 months post-injury. Primary outcomes are pain intensity and pain interference with daily living activities at 6 months post-injury. Secondary outcomes are pain self-efficacy, pain acceptance, pain catastrophizing, pain-related fear, anxiety and depression symptoms, health care service utilization, and return to work.ResultsFifty-three patients were recruited at the time of manuscript preparation. Comprehensive data analyses will be initiated in July 2017. Study results are expected to be available in 2018.ConclusionsChronic pain is an important problem after major lower ET. However, no preventive intervention has yet been successfully proven in these patients. This study will focus on developing a feasible intervention to prevent acute to chronic pain transition in the context of ET. Findings will allow for the refinement of iPACT-E-Trauma and methodological parameters in prevision of a full-scale multi-site RCT.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 91987302; http://www.controlled-trials.com/ISRCTN91987302 (Archived by WebCite at http://www.webcitation.org/6rR8G2vMs).

Project description:BackgroundMajor abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection.MethodsThis was a single-centre, parallel group, randomized, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline. The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with haemodynamic data. Blood samples and data were collected before surgery (T0), and at 1-3 h (T1) and 24 h (T2) post-surgery.ResultsSyndecan-1 concentration increased significantly post-surgery (P < 0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups.ConclusionsLidocaine failed to have any effect on endothelial function. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated.Trial registration« ISRCTN Registry » identifier: ISRCTN63417725. Date: 15/06/2020. Retrospectively registered.

Project description:Objectives(1) To define blood product requirements in patients with trauma whose underlying injuries are consistent with major blood loss; (2) to use these data to estimate the annual number of patients in Scotland who sustain significant trauma and require substantial blood product replacement; and (3) to place these data in the context of recent findings concerning the efficacy of recombinant factor VIIa in patients with major trauma.MethodsA retrospective case note review study was conducted for patients who presented with trauma at each of four Scottish hospitals. The four sites were selected from the 26 hospitals that were the source of data for the Scottish Trauma Audit Group (STAG) database. Collected between 1991 and 2002, STAG encompasses approximately 53 000 patients. 129 patients whose trauma codes were likely to be linked to injuries associated with major blood loss were selected. Data on the use of blood products for each patient were collected and analysed for three periods: (1) time spent in the emergency department (ED); (2) time from leaving the ED to the end of the first 24 h; and (3) time from the end of the first 24 h to 7 days. Blood product use for each period and for the entire first week of care was described for all patients and for blunt and penetrating injury subgroups. Using national population data estimates, the incidence of major trauma requiring blood transfusion was calculated for Scotland.ResultsAmong the patients with trauma codes predicting significant blood loss, the proportion of patients requiring any blood transfusion within the first 7 days was 53.9%. 27.4% of patients received > or =8 units of red cell concentrate (RCC) within the first 24 h of hospitalisation. By direct extrapolation, we estimated that the annual number of Scotland's patients (aged >13 years) with a significant blood transfusion requirement secondary to traumatic injury was 67. Of these, 35 patients would require > or =8 units of RCC within the first 24 h.ConclusionIn summary, this study estimates that approximately 67 patients annually in Scotland, above the age of 13 years, require blood transfusion as a direct result of significant traumatic injury. Of these 67 patients, an estimated 35 patients (28 of whom had a blunt form of trauma) require > or =8 units of RCC during the first 24 h in hospital. On the basis of the current limited trial evidence, the potential benefit in using recombinant factor VIIa in such patients, in Scotland, is small-approximately seven patients per million population aged >13 years, per year.

Project description:BackgroundDespite the high rate of traumatic events in clients with substance use disorders, trauma exposure often remains undetected in a majority of treatment-seeking clients. Improving health professionals' knowledge and skills in the inquiry of traumatic events is therefore of utmost importance for appropriately addressing trauma-related treatment needs. However, professionals in substance use disorder treatment settings frequently report barriers to the inquiry about traumatic events, e.g., the fear of offending or harming the client. Such barriers should be addressed by trainings that aim to improve the systematic inquiry of traumatic events.MethodsUsing a cluster-randomized trial, we examined whether a one-day training in trauma inquiry ('Learning How to Ask') would reduce professionals' perceived barriers to trauma inquiry. One hundred forty-eight professionals working in outpatient substance use disorder treatment centers were randomized to an intervention (n = 72) or a control group (n = 76). The professionals in the intervention group received a one-day training plus a refresher session 3 months later, the professionals in the control group received no training. At baseline, and at 3-month and 6-month follow-up, professionals rated on a four-point Likert scale regarding how strongly they agreed with statements about six common barriers to trauma inquiry, namely 'Feeling uncomfortable when asking about traumatic events', 'Fear of offending the client', 'Fear of retraumatizing the client', 'Fear that client may terminate treatment', 'Unsure whether authorities have to be informed when perpetrator is known', and 'No trauma-specific treatment available in my local area'.ResultsThe trained group experienced significant greater decreases in five of the six perceived barriers to the inquiry of traumatic events from baseline to 6-month follow-up than the control group ('Feeling uncomfortable when asking about traumatic events': b = - 0.32, 95% CI [- 0.52, - 0.12]; 'Fear of offending the client': b = - 0.33, 95% CI [- 0.56, - 0.09]); 'Fear of retraumatizing the client': b = - 0.45, 95% CI [- 0.69, - 0.22]; 'Fear that client may terminate treatment': b = - 0.28, 95% CI [- 0.49, 0.07]; 'No trauma-specific treatment available in my local area': b = - 0.25, 95% CI [- 0.51, - 0.01]).ConclusionsOur findings provide first evidence that a one-day training in trauma inquiry is effective in reducing common barriers to trauma inquiry, which may in turn improve detection of traumatic events.

Dataset Information

Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.

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Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.

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