In this October issue

Abstract

The World Health Assembly (the decision-making arm of the World Health Organization) recently released this resolution, urging all countries to assess and develop their emergency care systems so as to improve care for the acutely ill and injured. Australian and New Zealand emergency care stakeholders have an important role to play. In an important editorial, we discuss the resolution in detail and what it means for the Indo-Pacific region and ACEM. [Correction added on 23 October 2019 after first online publication: the World Health Assembly Resolution number has been changed from 72.31 to 72.16.] Complaints about IT systems are common in ED. ED data are important for both primary (clinical) and secondary uses (remuneration, operational, strategic and research). Rapid turnover of patients and frequent task interruption means that emergency physicians can spend more time entering data than on patient care. We publish a paper that audits current data quality from ED systems in NSW. A linked editorial comments on the implications of these findings. Clinical research produces evidence regarding the efficacy or effectiveness of a diagnostic tool or treatment strategy, and this informs clinical decision-making. Clinicians, especially in the ED, are familiar with increasing service demands and limited resources and make daily decisions balancing risk and benefit, where providing care for one patient delays care for another. Health economics is the application of economic principles to the distribution of scarce resources for healthcare to improve patient outcomes. The latest paper in our popular Acute Geriatrics series reports on the challenge of diagnosing urinary tract infections in the elderly. Misdiagnosis is common. How valuable is dipstick testing? The AANZDEM/EURODEM study compared treatment and outcomes between patients treated for asthma in Europe and Southeast Asia/Australasia and compliance with international guidelines. A total of 584 patients were identified from a total of 112 EDs in both regions. Inhaled beta-agonists were given in 86% of cases, systemic corticosteroids in 66%, oxygen in 44% and antibiotics in 20%. Compliance with guideline-recommended therapy in both regions, particularly corticosteroid administration, is suboptimal. There is also overuse of antibiotics. Non-fatal injuries sustained from animal–vehicle collisions are a globally under-recognised road safety issue, with limited data on these crash types. An analysis of major trauma cases in Victoria between 2007 and 2016 demonstrated that 152 major trauma patients were admitted to Victorian trauma-receiving hospitals because of vehicle collisions with animals. In 2016, the World Health Organization introduced a Trauma Care checklist, which outlines steps to follow after the primary and secondary surveys and before the team leaves the patient. The checklist, whilst likely to be successful in reducing errors of omission related to hospital admission, is limited in its ability to reduce errors that occur in the initial 30 min of reception – when most of the life-saving decisions are made. An alternative option is discussed. Septic shock and severe bacterial infections benefit from antibiotics administered as soon as possible. Many hospitals have sepsis campaigns and sepsis pathways that focus on giving broad-spectrum antibiotics to patients with potential sepsis. Loosening of the definitions, clinically dichotomised cut-offs and pressure to treat might cause more harm than good. An author of a letter to the editor says that the evidence for early antibiotics is weaker than the strength of current recommendations. In the second article of our occasional series, an experienced clinician reflects on the ‘Scandinavian’ approach to barbiturate poisoning and its impact on the management of toxicological poisoning. Everything we do today is built on the pioneering work of those who came before us.