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Disaster medicine is a young discipline and there is a need for the development of methods for evaluation and research. This includes full-scale disaster exercises that are quite costly. Within each organization these exercises are seldom conducted. If there was a standardized concept on how to conduct as well as evaluate these exercises, this could lead to better knowledge and cost effectiveness. The aim of this study was to increase awareness of the possibility to develop and conduct full-scale exercises in different settings using performance indicators combined with indicators related to patient outcome serving as a basis for comparison and evaluation process.
Two full-scale exercises in different organizations were studied. Identical panorama with the same number and type of casualties was used. Sets of performance indicators combined with indicators for unfavorable patient outcome, according to the Emergo Train System®, were recorded as well as all transportation times and the patient distribution to selected hospitals. Qualified observers scored the results on predetermined locations; on the scene, hospital and strategic command and control.
The lowest scored performance indicators were “first report to dispatch”, “second report from scene” and “first patient evacuated”. Due to insufficient response and evacuation times of victims to the receiving hospitals the unfavourable patient outcome, regarding preventable deaths and preventable complications were 28% (n = 18) and 41% (n = 17), respectively.
Standardized full-scale exercises where the same type of results is recorded can be conducted. This combination of performance indicators and Emergo Train System® leads to probabilities of development and better command and control response. Future use of the same concept may demonstrate important results that will lead to new and better knowledge that can be applied during real incidents.
Plasma oxytocin was measured in 11 multiparous sows for 13 h after the start of parturition to confirm the existence of early milk ejections and determine whether they were associated with pulsatile oxytocin release. The relationship between oxytocin concentrations and duration of parturition was also analysed. Oxytocin was released in pulses during and after parturition and mean concentrations reached maximum 2 to 4 h after the first birth. Discrete milk ejections occurred during parturition but only 42% of these were associated with oxytocin peaks before 4 h post partum. After this more than 80% of milk ejections occurred with oxytocin peaks. Sow grunting increased during milk ejections and peak grunt rate increased after parturition. Oxytocin peaks without milk ejections did not lead to an increased rate of grunting. Sows with prolonged parturition had lower basal and peak oxytocin concentrations. During the first 4 h only half of the piglets were born during an oxytocin peak. Discrete milk ejections with oxytocin peaks can occur before parturition is completed. However, during the first 4 h post partum, basal oxytocin concentrations may be high enough for milk ejection to occur without further oxytocin secretion. Both milk ejection and oxytocin release are necessary for the sow to increase grunt rate. Low oxytocin concentration is associated with prolonged parturition.
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