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The impact of the Covid 19 lockdown of Western countries has had extensive coverage, but for other countries, like Myanmar, little information has been shared in the Western media. Yet the impact on everyday activities there has been just as great, including closure of workplaces and universities, the wearing of masks, and restrictions on travellers from outside Myanmar. When a planned programme of face-to-face legal research teaching in May 2020 could not be offered, another means had to be found to deliver a course which had been successfully introduced the previous year. In this article Ruth Bird outlines how the course went ahead even though she was in lockdown in Melbourne, while her colleagues and participants were locked down in Yangon.

Injured patients are at risk of developing acute kidney injury (AKI), which is associated with increased morbidity and mortality. The aim of this study is to describe the incidence, timing, and severity of AKI in a large trauma population, identify risk factors for AKI, and report mortality outcomes. A prospective observational study of injured adults, who met local criteria for trauma team activation, and were admitted to a UK Major Trauma Centre. AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression and Cox proportional hazard modelling was used to analyse parameters associated with AKI and mortality. Of the 1410 patients enrolled in the study, 178 (12.6%) developed AKI. Age; injury severity score (ISS); admission systolic blood pressure, lactate and serum creatinine; units of Packed Red Blood Cells transfused in first 24 hours and administration of nephrotoxic therapy were identified as independent risk factors for the development of AKI. Patients that developed AKI had significantly higher mortality than those with normal renal function (47/178 [26.4%] versus 128/1232 [10.4%]; OR 3.09 [2.12 to 4.53]; p<0.0001). After adjusting for other clinical prognostic factors, AKI was an independent risk factor for mortality. AKI is a frequent complication following trauma and is associated with prolonged hospital length of stay and increased mortality. Future research is needed to improve our ability to rapidly identify those at risk of AKI, and develop resuscitation strategies that preserve renal function in trauma patients.

In this article Ruth Bird examines the issues around moving, or relocating, a library. Drawing on her experiences of moving, relocating and renovating, and in the context of current work that is happening at the Bodleian Law Library (BLL), she compares the issues in relation to both law firm libraries and academic libraries. The article examines space management and collection management issues, planning, allocating roles and how the burden of moves can be shared in a collaborative way. Ruth also looks at the ‘people’ issues and the implications for collections.

Legal education in each of the jurisdictions varies in the requirements of its lawyers. In this paper, Ruth Bird, addresses the requirements in each country to study law; the specific requirement for foreign law graduates to study law, and which bodies regulate legal education. The answers to these questions are presented in a series of charts to provide a degree of clarity for the reader.

ObjectivesHospitals have the responsibility of creating, testing and maintaining major incident (MI) plans. Plans emphasise readiness for acceptance of casualties, though often they neglect discharge planning and care for existing inpatients to make room for the sudden influx.After collaboration and design of a discharge policy for a paediatric MI, we aimed to establish the number of beds made available (primary outcome) to assess potential surge and patient flow. We hypothesised that prompt patient discharge would improve overall departmental flow. Flow is vital for sick patients awaiting admission, for those requiring theatre and also to keep the emergency department clear for ongoing admissions.Method and settingA simulated MI was declared at a London major trauma centre. Five paediatric priority 1 and 15 priority 2 and priority 3 patients were admitted. Using live bed boards, staff initiated discharge plans, and audits were conducted based on hospital bed occupancy and discharge capacity. The patients identified as dischargable were identified and folllowed up for 7 days.ResultsTwenty-nine ward beds were created (42% of the total capacity). Handwritten summaries just took 13.3% of the time that electronic summaries took for the same patients by the same doctor. In-hospital transfers allowed five critically injured children into paediatric intensive care unit (PICU), and creation of a satellite PICU allowed for an additional six more if needed.ConclusionWe increased level 3 capacity threefold and created 40% extra capacity for ward patients. A formalised plan helped with speed and efficiency of safe discharge during an MI. Carbon copy handwritten discharge letters allowed tracking and saved time. Robust follow-up procedures must be in place for any patients discharged.

IntroductionTrauma is the leading cause of death in children over 1 year of age in the UK. However, individual prehospital clinicians only encounter paediatric trauma patients rarely. This study describes the frequency and type of paediatric trauma experienced by a mature prehospital trauma service in an urban environment to inform prehospital services about the type of injuries likely to be attended, and the key interventions that might be required on scene.Study designRetrospective review of patients 16 years of age and under attended by a physician-led prehospital trauma service between January 2017 and June 2022. Patients were divided into subgroups of 0–4 years, 5–11 years and 12–16 years.Results782 paediatric patients were included, which comprised 8.3% of total patient workload. The median age was 15 years old (IQR 5–16 years) and the majority were male (n=597, 76.3%). The most common mechanism of injury for subgroups were falls from height (>2 m) in 0–4 year olds, road traffic collisions in 5–11 year olds and penetrating trauma in 12–16 year olds. 20.2% (n=158) of patients attended received critical care interventions. 9.8% (n=77) underwent prehospital emergency anaesthesia (PHEA) and 7.4% (n=58) received a blood transfusion.ConclusionPaediatric major trauma constitutes only a small minority of prehospital care workload. However, cases are attended regularly. Attending prehospital teams need to be trained to perform difficult resuscitations and perform high acuity, low frequency interventions. Educational and training strategies required to equip prehospital providers treating paediatrics may include checklists, algorithms, simulation training and mental health support.

Background: Trauma calls with substantial injuries are low volume; exposure per fellow is low. A pilot questionnaire demonstrated that fellows were unaware of colleagues' trauma workload. There was no standardized process for departmental case review. With COVID-19 precautions limiting face-to-face time with colleagues, we were concerned that learning may be affected. We aimed to improve education by identifying cases with high potential for shared learning or system improvement and instigating a triannual \"Coffee and Cases\" meeting. Methods: We devised a feedback form for trainees to fill in following each trauma team activation. These data were combined with trauma registry data to provide an overall perspective on the anesthesia workload for trauma and presented via Teams to the entire department. Infographics were used to illustrate cases and highlight important learning points. These were combined with up-to-date literature regarding pediatric trauma management. Trainees were reaudited following the talk. Results: During the pilot questionnaire, just 14.3% of fellows agreed with the statement: \"I am aware of the number of trauma calls, mechanisms of trauma and injuries sustained, presenting to Sick Kids in the previous month.\" In total, 71.4% disagreed and 14.3% strongly disagreed. Reaudit in November 2020 following the Coffee and Cases meeting online via Teams showed 100% agreement, with 71.4% strongly agreeing. Because of clinical commitments, it is often not possible for all relevant and interested staff members to attend such meetings, so a supplementary update PDF was provided via hospital email. Issues were identified regarding communication (team briefing), billing and prompt drug availability. These issues were addressed and reaudited. Conclusion: The questionnaire allowed us to collect real-time feedback on our trauma service and collate learning points from cases. This was integrated with up-to-date literature. Trauma patients may present critically unwell, yet the environment may be unfamiliar to rotating staff. Education is vital. Infographics helped us to illustrate cases, highlighting important learning points. These are 30 times more likely to be read than text so can successfully improve readership and learning of information.

Ruth Bird considers how the facilities and services at the Bodleian Law Library will evolve in the 21st Century given its status as a member library of the Copyright Deposit Scheme, which means that whilst other libraries are shrinking their paper collections, it is still expanding them.