Recent discussions
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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. The CoSTR review process generates the published scientific information and derives a treatment recommendation based on the GRADE analysis of this evidence. In this PICOST the evidence was equivocal. As can be seen in the Justification and Evidence to Decision Framework Highlights, the Task Force debated the possibility of raising the level of recommendation to a more definitive conclusion but decided that there was insufficient evidence to support either the intervention or the comparator. -
Виктория Антонова
Many thanks for this review. In some countries, such as Sweden, there are legal restrictions on administration of drugs by non-professional individuals, a recommendations such as ”administration of aspirin as first aid treatment” instead of ”by first aid providers” would help our guidelines writing, how does ILCOR see such rephrasing? -
Виктория Антонова
The Task Force acknowledges your comment and thanks you for your support. -
Виктория Антонова
The Task Force thanks you for your comment. As highlighted in the review, the critical time window remains unknown, but within the review we used a cutoff of 2 hours from onset of pain. Regarding the description of traumatic and non-traumatic, we agree that such description would be helpful to include in educational material. The Consensus on Science and Treatment Recommendation (CoSTR) provides a detailed review of the science and a treatment recommendation based on this science. The next stage in the process is for interested national and international bodies to use the CoSTR to develop detailed clinical guidelines and educational materials for wider dissemination. -
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.