Usability of Mobile Computing in Emergency Response Systems – Lessons Learned and Future Directions

This paper reports the effects on a community hospital's emergency room utilization that were brought about by the development of a primary care group practice. The practice, which has replaced the hospital's traditionally structured outpatient clinics, employs full-time, salaried physicians and provides evening office hours and 24-hour coverage. The primary care group appears to have effected a substantial reduction in pediatric emergency room use. To a lesser extent, utilization by former clinic users among the adult atients was also reduced. These reductions, however, created only modest impact in the context of the hospital's total emergency room use, owed in part to the relatively small size of the patient population who formerly had depended upon the hospital for primary care.

There is a shortage of nurses in America. This article provides an applied example of the value of ethnographic/qualitative research in an urban hospital's emergency room to identify factors associated with nurse turnover and low morale. A narrative that identifies some of the underlying problems in a hospital's emergency room is provided. The authors challenge public administration research methods courses to broaden their focus and incorporate more qualitiative methods.

Attempted suicide attention at an emergency room: A hospital-based descriptive approach

:Car accidents and traffic accidents incidents represents one of the greatest challenges to a community’s emergency response system. Rescuers, field medical personnel, and regional emergency departments and hospitals must often provide care to large numbers of casualties in a setting of limited resources, inadequate communication, misinformation, damaged infrastructure, and great personal risk. Emergency care providers and incident managers attempt to procure and coordinate resources and personnel, often with inaccurate data regarding the true nature of the incident, needs, and ongoing response. New technologies in communications, the Internet, computer miniaturization, and advanced ‘‘smart devices’’ have the potential to vastly improve the emergency medical response to such car accident disasters. In particular, next generation wireless Internet and repositioning technologies may have the greatest impact on improving communications, information management, and overall disaster response and emergency medical care. One consistent challenge for disaster response is communication and information management. Effective response requires a moment-to-moment ‘‘situational analysis’’ and real-time information to assess needs and available resources that can change suddenly and unexpectedly. A critical ‘‘sequential interdependence’’ exists: accurate information from the field about the incident, casualties, medical needs, triage, and treatment impacts the utilization and preparedness of community resources such as ambulances, EDs, hospitals, and intensive care units. Similarly, information on available and accessible hospital, ED, and ambulance resources alters the management and disposition of victims at the scene. The major problem at emergency room (ER) is access to specialist when they are elsewhere in the hospital. The nurse pages the doctor about the emergency. The specialists do not respond because they are busy with other patients in other place or something else. Radio Frequency Identification [RFID] can help us to track doctors, nurses or patients to render better health services to cure patients. This study reviewed the literature on the information technology applications in prehospital emergency center and emergency room in hospital. The literature search was conducted with the help of library, data bank, and also searches engines available at Google, and conference proceedings. Keywords:Health Information Technology, Emergency center, Emergency room

Objective: Deliberate self-harm (DHS) is a deviant behavior that has been not completely emphasized in health-related studies in Iran. The current study was conducted to explore the prevalence and reasons associated with the incidence of DSH in patients referring to the emergency room of Baradaran-e Rezaee Hospital in Damghan, Iran.Methods:Fifty-four clients with the mean age of 29.4 (±10.3) years participated in this cross-sectional study in 2010. Firstly, demographics and details of substance use were collected based on items elicited from the Addiction Severity Index (ASI) and a researcher-made questionnaire. Then details of comorbidity and factors associated with the current DHS were collected by a semi-structured interview. Data were analyzed by performing descriptive methods of statistics. Results:Deliberate self-poisoning with using toxic substances such as lead, and poison (44.8%) followed by drug intoxication such as opiate and methamphetamine (35.2%) and body and vessel cutting (20%) were the most prevalent types of DSH. Furthermore, results revealed that comorbidities such as physical illness (38.9%) and psychiatric disorders including depression (31.5%), psychotic symptoms (15%), bipolar disorder (5.6%), stress (5.6%), and anxiety (1.9%) were commonly prevalent. The most frequently reported factors associated with DSH were desires for self-punishing (42%), self-medication for emotional sufferings (33%), experiencing euphoric feelings (24%), and stress (20%), respectively.Conclusion:DSH is one of the critical health and treatment priorities, which are prevalent in emergency rooms of hospitals in Iran. Clients with comorbid diagnosis of DSH, especially drug use warrant specific attention in emergency rooms.

The value of the presence of social work in emergency rooms is supported by directly examining the hospitalization rates of patients seen by social workers. It utilizes a 3-year-long data set of social work self-reports on medical emergency room outcomes at a large, teaching hospital in the New York Metropolitan area with a sample size of 3370. The study findings suggest that social workers in this acute care hospital's emergency room often are referred the most complex cases. The data on this site indicate that the majority of social work dispositions were to home (54%) or a nursing facility (8.4%). Only 16% of the patients seen by social work were admitted to the hospital. These findings support the cost-effective nature of social work in the emergency room setting and the importance of finding alternatives to hospital admissions. The results of a logistic regression suggest that the criteria used by social workers to assess patients are based on sound psychosocial factors. Patients who were assessed as having “Environmental” (p = .00) or “Relationship” problems (p = .00) were much less likely to be admitted. Conversely, patients with “Care/ADL” problems (p = .00) and behavior problems (p = .00) had a heightened chance of being admitted. Being African American has less effect but was still relevant.

Another look at emergency room overcrowding: accessibility of the health services and quality of care.

The purpose of this study is to gain information about the social service needs and demographic characteristics of patients admitted to Providence Hospital's emergency room during the hours a social worker is not available. The emergency room staff requested the information in order to utilize it in planning emergency room services

Past studies have shown in many instances that elderly people are represented in the hospital emergency room in proportion to their distribution in the population. It is possible, though, that elderly patients in the emergency room are using different types of resources than individuals of a younger age. Samples of two hospital emergency room users were selected in 1981 and in 1986. Patients aged 25 years or older were included in the study. The dependent variable was the extent to which patients used resources available at the hospital emergency room only or at alternative emergency medical services in the community. The effect of age on the use of resources in the hospital emergency rooms was estimated separately for those who were transported to the emergency room by ambulance and for those who were not. Age had an effect on use of resources under both conditions, regardless of the patients' gender, time of the visits, availability of alternative sources of emergency care, and diagnostic categories. The role of the hospital emergency room is to address medical care needs of specific segments of the population in special circumstances. Elderly emergency room patients are indeed one of these specific segments with very special needs.

Penny Wise But Pound Foolish: How Permanent Supportive Housing Can Prevent a World of Hurt

OBJECTIVE: The aim of this study was to determine the injury pattern among trauma patients presenting at emergency room of the hospital, and highlight the outcome of such injuries. METHOD: It was a one-year prospective study between June 2001 to May, 2002. 2122 patients were seen at the emergency room, 652 (30.7%) were treated for traumatic injuries. The mean age was 34.6+ 13.6 (SD). The male to female ratio was 2.9:1. RESULTS: Road traffic accident was the commonest cause of injury occurring in 541 patients (83%). The predominant injury was laceration in 261 patients (39.6%), then fractures in 237 patients (36.3%). Among those with fractures, 203 (85.3%) were close and 34 (14.5%) were open with lower limb fractures predominating. Lacerations were sutured in 198 patients and the remanding 63 closed secondarily. Most fractures were managed with closed manipulative reduction and application of Plaster of Paris cast. 43 had internal fixation. 259 patients (39.7%) were discharged within 24 hours, 216 patients (33.2%) admitted to the wards for further investigations and treatment, 129 (19.8%) took their discharge against medical advice, 14 (2.1%) were referred to other centres and 34 died. The mortality rate was 5.2%. CONCLUSION: It was concluded that trauma related injuries affected the productive age group of our society. The establishment of organized trauma centre was recommended. Nig Jnl Orthopaedics & Trauma Vol.2(1) 2003: 11-17

During recent years the emergency room of the Grace-New Haven Hospital, where psychiatric consultation is freely available, has become an increasingly important diagnostic, treatment, and referral resource for persons with mental disorders and emotional problems. The fact that during each of the past three years more patients were referred for psychiatric consultation in the emergency room of the hospital than were seen in its psychiatric outpatient clinic points up the sheer magnitude of this patient population. Curious as to whether this phenomenon was restricted to this hospital, one of us (M.S.) conducted an informal survey of 25 large university and county hospitals throughout the country. The results of the survey showed the emergency psychiatric facilities of many to be in a state of rapid growth and change with a number of hospitals having only recently begun new programs to care for the increasingly large patient population receiving emergency psychiatric

n September 11, 2001, the United States experienced the worst terrorist attack in its history. As the nation sought to deal with this tragedy, it would face a second wave of terrorism—this time, in the form of a biological attack. The suspicion of anthrax in a patient by an astute infectious disease clinician along with capable clinical and public health laboratory staff in Florida would lead to the discovery that Bacillus anthracis spores had been intentionally distributed through the postal system, causing 22 cases of anthrax, including 5 deaths, and forever changing the realm of public health. In this issue of Emerging Infectious Diseases, numerous individuals involved in the public health aspect of the anthrax investigation document their experiences. Articles describe the epidemiologic and laboratory investigations, applied research findings, environmental assessment and remediation experiences, workplace safety issues, prophylaxis and clinical care information, international aspects, and collaborations between law enforcement and public health officials. The articles also highlight the widespread efforts made to identify the source of exposure and prevent illness among those exposed. While many of the individuals involved in this effort are acknowledged in these articles, many others are not, including the large numbers of medical, public health, law enforcement, and emergency response personnel throughout the country and the world who dealt with the numerous hoaxes perpetrated in the weeks following the attack. We recognize and thank them for their heroic efforts. This issue also provides an opportunity to review the valuable lessons we have learned from these experiences. Foremost among them is the knowledge that we cannot afford to be complacent. Throughout the Department of Health and Human Services (DHHS) as well as across other federal, state, and local agencies, we remain alert for the first evidence of a disease outbreak. Multiple systems are now in place, both in the United States and internationally, to detect initial cases. On the local level, clinicians and laboratorians play a key role in this process. Activities such as monitoring emergency room visits, pharmacy requests, calls to emergency response and poison control centers, and animal disease registries for unusual occurrences are also expanding. These lessons have also led us at the Centers for Disease Control and Prevention (CDC) to change the way we operate. Changes have been made within our programs, among our staff and partners, and in our coordination with other federal agencies. Many of these changes have been based on valuable input provided by public and private sector experts during numerous consultations. Terrorism response capacity is being integrated into existing infrastructures, further strengthening the foundation of public health. The anthrax cases highlighted the importance of the “golden triangle” of response between clinicians and clinical microbiologists, the health-care delivery system, and public health officials. Steps have been taken to strengthen these and other critical linkages, including those between professionals in the human, veterinary, and public health communities and between the public health, law enforcement, and emergency response systems. DHHS has made available through CDC more than $918 million for state and local health departments to enhance their terrorism preparedness programs. These funds are intended to strengthen capacity to respond to bioterrorism, other infectious disease emergencies, and other urgent public health threats. Existing programs that proved invaluable during the events of last fall, such as the Laboratory Response Network for Bioterrorism (LRN) and the National Pharmaceutical Stockpile (NPS), both described in this issue in the article by Perkins et al., have also been strengthened. During the anthrax attacks, laboratories within the LRN tested more than 125,000 clinical specimens and approximately 1 million environmental specimens. The number of these specialty laboratories participating in this network has now increased to more than 100, with at least one in each state, enabling widespread testing for microbes that might be used in a terrorist attack to cause illnesses such as anthrax, tularemia, plague, and botulism. New facilities have been opened, and improvements in others are in progress or planned for the near future. The NPS has also been O

With the increasing demands of the data transmission system of information, wireless data transmission systems has been widely studied and applied. Especially the limited and specified environment, take the underground mine environment for example, has a high demand of flexibility. The paper describes the wireless video image data transmission system which is formed on the basis of DSP and RF chips, and provides the general systematic design and functional design. Furthermore, on this basis of the previous study, the paper has also completed the hardware and software design of the modules which consist two parts: data capture and compression modules; wireless data transfer and communication module. Regarding the further improvement of the use of DSP embedded technology in exploring the real-time wireless data transmission and communication system as well as its application level, there is a certain reference.

As the accelerated development of the existing mobile communications and Internet integration, high-speed mobile access and Internet Protocol-based service become mature for different kinds of applications, which provide a great convenience for the remote wireless monitoring, mobile data transmission and so on. In this paper, an environmental monitoring data transmission system based on 3G networks is designed to transmit environmental data which is collected through sensors to server-side. The data transmission system is functioning with remote data transmission, and monitoring data reviewing at remote terminal any time. Scientific monitoring data can accurately, timely and comprehensively reflect of the various environmental parameters on-site detection status. The system components of environment monitoring platform based on virtual instrument is introduced firstly. Then, the network transmission system scheme based on Socket communication is proposed. Finally, the data transmission between LabVIEW application of monitoring terminal and PHP application of server-side through Socket interface is achieved. This system transmits well, and queries conveniently. It is safe and timely while being applied in environmental monitoring data transmission.