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Traumatic vascular injury accounts for 4% of admissions to a British Trauma Centre. These patients are severely injured with high mortality and morbidity, and place a significant demand on hospital resources. Integration of vascular services with regional trauma systems will be an essential part of current efforts to improve trauma care in the UK.

Institution of a specialist trauma service and performance improvement programme was associated with significant improvements in outcomes that exceeded national variations.

INTRODUCTION Pleural drainage with chest tube insertion for thoracic trauma is a common and often life-saving technique. Although considered a simple procedure, complication rates have been reported to be 2-25%. We conducted a prospective cohort observational study of emergency pleural drainage procedures to validate the indications for pre-hospital thoracostomy and to identify complications from both pre-and in-hospital thoracostomies.PATIENTS AND METHODS Data were collected over a 7-month period on all patients receiving either pre-hospital thoracostomy or emergency department tube thoracostomy. Outcome measures were appropriate indications, errors in tube placement and subsequent complications.RESULTS Ninety-one chest tubes were placed into 52 patients. Sixty-five thoracostomies were performed in the field without chest tube placement. Twenty-six procedures were performed following emergency department identification of thoracic injury. Of the 65 pre-hospital thoracostomies, 40 (61%) were for appropriate indications of suspected tension pneumothorax or a low output state. The overall complication rate was 14% of which 9% were classified as major and three patients required surgical intervention. Twenty-eight (31%) chest tubes were poorly positioned and 15 (17%) of these required repositioning.CONCLUSIONS Pleural drainage techniques may be complicated and have the potential to cause life-threatening injury. Prehospital thoracostomies have the same potential risks as in-hospital procedures and attention must be paid to insertion techniques under difficult scene conditions. In-hospital chest tube placement complication rates remain uncomfortably high, and attention must be placed on training and assessment of staff in this basic procedure.

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Background The provision of online educational courses has soared since the creation of the World Wide Web, with most universities offering some degree of distance-based programs. The social constructivist pedagogy is widely accepted as the framework to provide education, but it largely relies on the face-to-face presence of students and faculty to foster a learning environment. The concern with online courses is that this physical interaction is removed, and therefore learning may be diminished. Objective The Community of Inquiry (CoI) is a framework designed to support the educational experience of such courses. This study aims to examine the characteristics of the CoI across the whole of an entirely online master’s course. Methods This research used a case study method, using a convergent parallel design to study the interactions described by the CoI model in an online master’s program. The MSc program studied is a postgraduate medical degree for doctors or allied health professionals. Different data sources were used to corroborate this dataset including content analysis of both asynchronous and synchronous discussion forums. Results This study found that a CoI can be created within the different learning activities of the course. The discussion forums integral to online courses are a rich source of interaction, with the ability to promote social interaction, teaching presence, and cognitive learning. Conclusions The results show that meaningful interaction between faculty and student can be achieved in online courses, which is important to ensure deep learning and reflection.

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