Despite a growing call for use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for critically uncontrolled hemorrhagic shock, there is limited evidence of treatment efficacy. We compared the mortality between patients who received a REBOA with those who did not, adjusting for the likelihood of treatment and injury severity, to measure efficacy. We analyzed observational prospective data from the Japan Trauma Data Bank (2004-2011) to compare the mortality between adult patients who received a REBOA with those who did not. To adjust for potential treatment bias, we calculated the likelihood of REBOA treatment via a propensity score (PS) using available pretreatment variables (vital signs, age, sex, as well as anatomic and physiologic injury severity) and matched treated patients to up to five similar PS untreated patients. We compared survival to discharge between treated and untreated groups using conditional logistic regression and Cox proportional hazards regression. Of 45,153 patients who met inclusion, 452 patients (1.0%) received REBOA placement. These patients were seriously injured (median Injury Severity Score [ISS], 35) and had high mortality (76%). Patients who did not receive a REBOA had significantly lower injury severity (median ISS, 13; p < 0.0001) and lower mortality (16%). After matching REBOA patients with controls with similar PSs for treatment, the crude conditional odds ratio of survival by REBOA treatment was 0.30 (95% confidence interval, 0.23-0.40). REBOA treatment is associated with higher mortality compared with similarly ill trauma patients who did not receive a REBOA. The higher observed mortality among REBOA-treated patients may signal "last ditch" efforts for severity not otherwise identified in the trauma registry. Epidemiologic study, level III; therapeutic study, level IV.

ACADEMIC EMERGENCY MEDICINE 2012; 19: 608–612 © 2012 by the Society for Academic Emergency Medicine Objectives:  Teamwork and communication often play a role in adverse clinical events. Due to the multidisciplinary and time‐sensitive nature of trauma care, the effects of teamwork and communication can be especially pronounced in the treatment of the acutely injured patient. Our hypothesis was that an in situ trauma simulation (ISTS) program (simulating traumas in the trauma bay with all members of the trauma team) could be implemented in an emergency department (ED) and that this would improve teamwork and communication measured in the clinical setting.Methods:  This was an observational study of the effect of an ISTS program on teamwork and communication during trauma care. The authors observed a convenience sample of 39 trauma activations. Cases were selected by their presenting to the resuscitation bay of a Level I trauma center between 09:00 and 16:00, Monday through Thursday, during the study period. Teamwork and communication were measured using the previously validated Clinical Teamwork Scale (CTS). The observers were three Trauma Nursing Core Course certified RNs trained on the CTS by observing simulated and actual trauma cases and following each of these cases with a discussion of appropriate CTS scores with two certified Advanced Trauma Life Support instructors/emergency physicians. Cases observed for measurement were scored in four phases: 1) preintervention phase (baseline); 2) didactic‐only intervention, the phase following a lecture series on teamwork and communication in trauma care; 3) ISTS phase, real trauma cases scored during period when weekly ISTSs were performed; and 4) potential decay phase, observations following the discontinuation of the ISTSs. Multirater agreement was assessed with Krippendorf’s alpha coefficient; agreement was excellent (mean agreement = 0.92). Nonparametric procedures (Kruskal‐Wallis) were used to test the hypothesis that the scores observed during the various phases were different and to compare each individual phase to baseline scores.Results:  The ISTS program was implemented and achieved regular participation of all components of our trauma team. Data were collected on 39 cases. The scores for 11 of 14 measures improved from the baseline to the didactic phase, and the mean and median scores of all CTS component measures were greatest during the ISTS phase. When each phase was compared to baseline scores, using the baseline as a control, there were no significant differences seen during the didactic or the decay phases, but 12 of the 14 measures showed significant improvements from the baseline to the simulation phase. However, when the Kruskal‐Wallis test was used to test for differences across all phases, only overall communication showed a significant difference. During the potential decay phase, the scores for every measure returned to baseline phase values.Conclusions:  This study shows that an ISTS program can be implemented with participation from all members of a multidisciplinary trauma team in the ED of a Level I trauma center. While teamwork and communication in the clinical setting were improved during the ISTS program, this effect was not sustained after ISTS were stopped.

Criminologists tend to focus their attention on the dynamics of offending, paying limited theoretical and empirical attention to the well-established relation between offending and victimization. However, a number of criminological theories predict similarities in the correlates and etiology of victimization and offending, suggesting substantial overlap across offender and victim populations. Empirical research confirms this overlap across offender and victim populations, at least among those involved in non-lethal incidents. This research explores whether similarities between offender and victim populations extend to homicide, using criminal justice, health care, and U.S. Census data linked to homicide offenders and victims in Bernalillo County, New Mexico, between 1996 and 2001. Findings indicate substantial overlap in the social contexts and risk behaviors of homicide offenders and victims. However, results also side with more recent suggestions that although many victims overlap with offender populations, there is also a group of victims that appears to be distinguishable from offender groups. These findings have important implications for both theory and intervention.