A follow-up study by personal interview (45) or written response (4) or next-of-kin (3) interview using a questionnaire, has been made at least 1 year from discharge of the 52 survivors (82%) of 65 lower limb amputees treated at the Royal South Sydney Hospital in the years 1988-1989. At follow-up prostheses were used by 94% of the people, 72% of the group using their prostheses all day. Independence in self-care was found to be more important to final discharge home than walking skills. The 93% return home rate was considered to be in part due to funding for home modifications provided by government sources. Car driving was a mobility aid for 25% of patients whereas public transport was used by only 9% of subjects. Some patients mentioned that the loss of pain and a feeling of well-being was a positive gain from their amputation surgery.
Changes in zinc (Zn) availability in muscle tissue that influence muscle performance in vitro have been observed. The effect of exercise of plasma Zn levels and urinary excretion of Zn was observed in sever untrained volunteers following brief intensive exercise and in seven trained volunteers after more prolonged road-running exercise. With brief exercise, plasma Zn decreased predominantly in the more loosely bound albumin fraction. Prolonged exercise resulted in a greater plasma Zn decrease of 30%. Urinary Zn excretion increased transiently with minimal effect on daily losses. However, weight loss by sweating was significant, and sweat Zn losses were greater than those in the urine. Exercise resulted in changes in Zn metabolism that may influence performance.
Combat casualties who die from their injuries do so primarily in the prehospital setting. Although most of these deaths result from injuries that are nonsurvivable, some are potentially survivable. Of injuries that are potentially survivable, most are from hemorrhage. Thus, military organizations should direct efforts toward prehospital care, particularly through early hemorrhage control and remote damage control resuscitation, to eliminate preventable death on the battlefield. A systems-based approach and priority of effort for institutionalizing such care was developed and maintained by medical personnel and command-directed by nonmedical combatant leaders within the 75th Ranger Regiment, U.S. Army Special Operations Command. The objective of this article is to describe the key components of this prehospital casualty response system, emphasize the importance of leadership, underscore the synergy achieved through collaboration between medical and nonmedical leaders, and provide an example to other organizations and communities striving to achieve success in trauma as measured through improved casualty survival.
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