Background The majority of combat deaths occur in the prehospital setting. Efforts to increase survival including blood transfusions are made in the prehospital setting. The blood products available in the Role 1 setting include whole blood (WB), red blood cells (RBCs), fresh frozen plasma (FFP), and lyophilized (freeze-dried) plasma (FDP). Methods This is a secondary analysis of a previously published dataset within the Prehospital Trauma Registry (PHTR) from 2003 through May 2019. Deterministic linking was used when possible with the DoD Trauma Registry for outcome data. Descriptive statistics were used to analyze the data. Results We identified 1,357 patient encounters in the PHTR. Within that group, 28 patients received a prehospital blood product, with 41 total administrations: WB (18), RBCs (12), FFP (6), FDP (3), and blood not otherwise specified (2). Outcome data were available for 17 of the 28 patients. The median injury severity score was 20, with the thorax being the most frequent seriously injured body region. Most (94%) patients survived to discharge. The median ICU days was 11 (Interquartile Range [IQR] 3-19), and the median hospital days was 19 (IQR 8-29). The average volume (units) of RBCs was 6.0 (95% CI 1.9-10.1), WB 2.8 (95% CI 0.0-5.6), platelets 0.7 (95% CI 0.0-1.4), and FFP 5.0 (95% CI 1.2-8.8). Conclusions The use of prehospital blood products is uncommon in U.S. combat settings. Patients who received blood products sustained severe injuries but had a high survival rate. Given the infrequent but critical use and potentially increased need for adequate prolonged casualty care in future near-peer conflicts, optimizing logistical chain circulation is required.

This exploratory study examined the heart rates (HR) and skin temperatures (ST) of 18 preschool children while they viewed two clips of everyday children's television (TV) programming. The measurements were made in a day care setting, in a naturalistic environment designed to mimic the real world of children's TV viewing. The purpose of the study was to determine whether cardiovascular and autonomic arousal to TV programming might occur in some children. Since a large body of psychosocial literature addresses theaffects of TV violence on children, HR and ST were examined during exposure to scenes from Mr. Roger's Neighborhood and G.I. Joe cartoons. The Mr. Roger's clip was slow, rhythmic, prosocial, and nonviolent, while the G.I. Joe clip was fast-paced, staccato, colorful, and full of verbal and action violence. The study found a significant effect of exposure to the cartoon violence on HR, with HR increasing. ST decreased, but not significantly, and there was a significant effect of time on the ST, due possibly to habituation. This finding has relevance to nursing assessment, intervention, and education of parents and children, since TV viewing is a pervasive cultural phenomenon. The possibility of excessive or inappropriate autonomic and cardiovascular responsiveness in some children to TV must be considered.HIS study examines autonomically mediated variables in preschool children during exposure to an ecologi-

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Objective-To assess the quality of accident and emergency (A&E) medicine higher specialist training as perceived by current trainees and those who have recently completed training. Methods-Postal questionnaires to three groups of A&E specialists either currently in training or having recently completed training. Results-Levels of satisfaction were generally high. Previously identified deficiencies in management training remained and the implementation of guidelines regarding formative assessment and time for study and research was inconsistent. In many ways the proposals in Trainingfor the future' mirrored the course of action already taken by A&E for a shortened period of HST following general professional training.5 It is recognised that in order to maintain educational standards a more structured and intensive programme of HST is necessary. Against this background it seems appropriate to review the current state of HST in A&E.In this paper we assess the quality of training in A&E as perceived by recent and current trainees and discuss potential improvements to the current schemes. MethodsThree groups of trainees and former trainees were asked to complete questionnaires regarding aspects of their training.(1) Adequacy of recently completed training Postal questionnaires were sent to 42 consultants in A&E medicine who had been appointed from senior registrar posts within two years of the study. This study examined satisfaction with training in specific clinical, teaching and managerial skills at the end of training. Attitudes towards research as a component of HST was also assessed.(2) Current registrars-quality training?To assess the views of new entrants into HST, a list of registrars in A&E was compiled with the help of the Joint Committee on Higher Medical Training and the British Accident and Emergency Medicine Trainees Association (BAETA). A total of 110 questionnaires was sent out in early 1995. Respondents were asked to express their views on the quality of their training, including clinical skills and management. The allocation of protected study time and availability of study leave was also examined. (3) Training-supervision, assessment, and appraisal In order to assess the overall level of supervision to all trainees a questionnaire was circulated to registrars and senior registrars in A&E by regional representatives of BAETA. The relationships of the trainee with their trainer and educational supervisor and the occurrence of annual reviews of the trainee and appraisal of the training post were assessed.