Recent discussions
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Виктория Антонова
I support giving early Aspirin in Non-traumatic chest pain -
Виктория Антонова
Thank you for this review, which is important given the popular continued use of the RICE acronym in first aid education. Despite a move in some education contexts to incorporate the limited evidence available by replacing 'compression' with 'comfortable support', it is clear that this is only retained for its perceived educative value. However this review again questions the clinical value of the retention of this element and its impact on immediate care and ongoing recovery. It is questionable whether retention for in order to give a sense of purpose to the care giver is a justifiable reason to retain it. We know that leaving the decision as to whether to apply or not apply a bandage should not be left to the discretion of the lay provider, so from a first aid perspective, ideally the advice needs to be definitive. Finally, we welcome your acknowledgement in the gaps section that the limitations of the review in the context of the adult and the lower limb injury focus of the studies should be considered in the context of any future first aid guidance. -
Виктория Антонова
Thank you for this interesting, helpful and detailed review. From an education perspective we would welcome clarity for the lay responder on 'early' provision, and also, as per the final bullet point from the Task Force, strongly support the suggestion that education on this topic includes a description regarding the categorisation of traumatic and non traumatic chest pain. -
Виктория Антонова
Thank you for your comment. The Task Force did consider the resource implications and our discussions were included in the Evidence to Decision (EtD) table submitted and published with this CoSTR. In the EtD under Resource Implications the Task Force said: Research Evidence We did not identify any heat stroke / exertional hyperthermia studies that specifically addressed the costs of specific interventions. The development of plans for the treatment of individuals with heat stroke (exertional or nonexertional (classic) is likely to have potentially substantial savings for health systems, especially during extreme heat events (heat waves). There is evidence of a significant economic burden associated with heat related illnesses (Schmeltz 2016 894). Case reports indicate that whole-body water immersion techniques can be facilitated with improvised and cheap materials (Luhring 2016 946; Hospkawa 2017 347). Additional Considerations Water is cheap but not always readily available. Natural bodies of water (e.g., pond, lake, river, sea, ocean) in temperate zones may be used if cooler than 26°C (78.8 °F) and if safe to use. Natural body water temperatures in tropical zones may not be appropriate based on the time of year. Tropical sea temperatures, for example, can peak in the ranges of 26-28C between February and August. Task Force members report cost of suitable vessels to establish whole-body water immersion ranges from $100- $500 USD. Improvised methods can be established for less than $50 USD. Commercial cold packs cost between $1-$3 USD depending on quantity. Multiple ice packs need to be used per person thereby increasing costs. Cooling vests range in price from $150-$350 USD. There are minimal costs associated with passive cooling – however there are costs associated with cooling utilizing air conditioning. There were also further comments from the Task Force on Cost Effectiveness and Equity which were included in the Evidence to Decision table. -
Виктория Антонова
Thank you for the time you have taken to read and comment on our draft CoSTR on First Aid Cooling Techniques for Heat Stroke and Exertional Hyperthermia. The CoSTR did not research the ability of a First Aid Responder to be able to differentiate between exertional and non-exertional /classical heat stroke. The practical aspects of implementing this treatment recommendation would be detailed in the national or international guidelines and should include good practice points as you have suggested. -
Виктория Антонова
Thank you for the time you have taken to read and comment on our draft CoSTR on compression wrap for closed extremity joint injuries. ILCOR has a very specific format for the text presentation of its CoSTR documents which is formally reviewed by the ILCOR Scientific Advisory Committee before any manuscript is e-published as a draft for comment or as a final CoSTR document. It may be of interest that publication language becomes less formalised as and when the CoSTR is converted from a treatment recommendation to a national or international guideline. -
Виктория Антонова
Thanks for this clear recommendation due to limited and low evidence. A not mentionned article [van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. J Athl Train. 2012;47(4):435–443.] conclude also: "Based on our review, evidence from RCTs to support the use of compression in the treatment of acute ankle sprains is limited. No information can be provided about the best way, amount, and duration of compression or the position in which the compression treatment is given (recumbent or elevated)." -
Ali Ramadan
Thank you for the amazing studies in first aid field. I hope you respond on my email. ( About reviewer mentey ) ..... About the study I think it will be more readable if edit the writing, following tips of effective writing ex Original text " For the critical outcome free from walking pain after 4 days and 8 days (measured as having pain during walking, yes or no), we have identified very-low-certainty evidence from 1 non-randomized trial (Linde 1984 177) enrolling 100 adult patients with ankle sprains, not showing benefit from the use of a compression bandage, when compared with not using a compression bandage (RR, 1.25; 95%CI, 0.78–2.11, P=0.33 and RR, 1.39; 95%CI, 0.98–1.95, P=0.06, respectively). Edited text " Linde 1984 , (Non-RCT, n=100 ankle sprain) shows No benefit from the use of a compression bandage, compared with not using the compression bandage. - very-low-certainty evidence - ## I think it can be more easier and readable . -
Виктория Антонова
We welcome the range of interventions explored for this topic and useful analysis. We agree that there are significant gaps in research, and given the practical limitations of immersion, indicators of the most effective of the other options, including combinations, will indeed be useful and important going forward. A further concern is the possibility of different treatment pathways for exertion and non-exertion/classic heat stroke hyperthermia. For lay responder educational purposes, does the Task Force consider it necessary for the lay responder to differentiate or can the same treatment recommendations be applied (perhaps as good practice points) as for exertional hyperthermia? -
Виктория Антонова
1. The recommendation to immerse adults with exertional heat exhaustion or stroke in ice slush carries considerable resource implications and will generally only be available in large "fun run" type events 2. I would suggest in the knowledge gaps that research on the effect of the rate of cooling on the recovery from heat exhaustion or stroke is needed as well