Accident Services Research Articles

Need for research collaboration between cardiologists and emergency service doctors

Time is a key factor when tackling acute coronary diseases and syndromes. The current organization of health services means that the first minutes of care are not carried out in cardiology rooms and do not depend on cardiologists. Instead they take place in the pre-hospital setting of emergency medical services (EMS) and in hospital accident and emergency services (A&E) and in the first phase this attention is provided by emergency doctors. Therefore, to obtain the best possible result for the patient it is necessary that there should be extensive two-way collaboration between cardiologists and emergency service doctors. This article analyzes these needs and tries to identify areas of improvement in two of the most frequent acute coronary processes: acute coronary syndrome and acute cardiac insufficiency.

Caring for small wounds in the school setting

School nurses can manage most minor cuts, scrapes and punctures. However, the amount of bleeding is a poor guide to severity. Because an everyday injury occasionally hides serious damage, such as internal bleeding, nurses should take even minor cuts and scrapes seriously. In addition to acute wound care, knowing when to refer to accident and emergency services and practice nurses, as well as advising parents and older children are essential elements of management.

Charging overseas visitors could have an impact on children

The government has plans to charge overseas visitors and migrants for using NHS accident and emergency services. Dorothy Lepkowska looks at the impact this could have on children and young people.

Characterization of Computerized Tomographic findings In Traumatic head Injured PatientsIn Jos, North Central,Nigeria

Background:Head traumais a major health problem which is becoming increasingly a burden on the already stressed accident and emergency services of hospitals in Nigeria especially in the Northcentral part of Nigeria due to heightened insurgent activities. It is associated with significant long term morbidity and mortality. The aim of the study was to characterize and establish patternof computed tomographic features in patients with head trauma in Jos metropolis. Methods: We prospectively evaluated CT findings in 110 patients between the ages of one and eighty years who were sent to the Radiology department of JUTH for CTbrain with history of head trauma. Results: There were 81 males and 29 females with a mean age of 33.4years (SD26.5).Cerebral contusion, fractures, and Intracranial haemorrhage, were the commonest CT features in subjects and accounted for 21.8% , 19.3%and13.7.8%,for cerebral contusion, fractures and intracranial haemorrhage respectively. The age ranges of 21 to 40 years were mostly affected accounting for 45.4% of cases with 37.3% male subjects. 16.4% of the subjects were children under the age of ten. Conclusions: this study has clearly demonstratedthat cerebral contusion,intracranial haemorrhage and fracture are the commonest computed tomographic features seen in this region among head injured patients and these involve men mostly in their reproductive and sexually active ages.

Rehabilitation Services for the Injured

Based on a Dissertation read before the Royal Medical Society on Friday, 23rd October, 1964Not until the start of the 20th century did the organisation of rehabilitation services on a comprehensive scale develop. In this, Britain played a leading role largely due to the influence and leadership of one great man—Sir Robert Jones. Robert Jones was selected in the 1890’s to organise the first unified accident service in Great Britain, which was set up to deal with the injuries sustained by the large body of men employed in the construction of Manchester Ship Canal. The social conscience of the time did not include rehabilitation per se in the accident service, but the experience gained there by the young surgeon bore fruit in the First World War when as a famous orthopaedic surgeon, he was given the task of organising special military hospitals with full rehabilitation facilities.

Alcohol ‘Pre-loading’: A Review of the Literature

To review the international literature concerning pre-loading (PL); this is drinking before going out to pubs and bars. A literature review conducted in May 2013 using the EBSCO database entering the following search terms 'pre-loading', 'front-loading', 'pre-partying' and 'pre-drinking'. Thereafter, the reference lists were checked for further relevant articles. The review consisted of 40 articles of which 11 were excluded because PL was not the primary unit of analysis or they did not fulfil a quality assurance criterion. Despite being an internationally widespread development to date, most of the research on this has been from the USA and UK. The majority of US studies have been concerned with PL in a college and high school setting, while the research in the UK has mainly concentrated on the correlation/relationship between PL and what takes place when drinkers enter pubs and bars later in the evening. A consistent finding was that PL is associated with greater alcohol consumption, intoxication and alcohol-related risks. The price of alcohol and achieving intoxication were the main motivations for PL. However, other reasons included a chance to meet members of the opposite sex or own friends in surroundings that encouraged interaction rather than intoxication. PL should be regarded as part of a wider drinking culture and understood within the context of what individuals require from a night out or staying in when drinking. There is little evidence to suggest that PL is a risk factor for admissions to accident and emergency services.

IEEE 802.11p Based Vehicular Networking Operational Pilot Field Measurement

For vehicular networking purposes the main communication standard approach on global scale is the IEEE 802.11p. This protocol-based system, together with the 3G cellular network, was the main elements of our car communications test-bed network. The developed test-bed implements an intelligent heterogeneous traffic safety network between cars and infrastructure. It also offers the possibility to exploit vehicle based sensor and observation data in order to generate intelligent real-time services and a service platform for vehicles. The main goal was to improve traffic safety with accident and weather condition related accurate services, but also to offer a platform for true bi-directional Internet-like networking experience tailored cost-effectively to vehicular environments. This paper presents the field test results of a new standard system for car communication, IEEE 802.11p vehicular networking measurements in Northern Finland (with supporting simulations). The results achieved in developed heterogeneous networking system (with special services) pilot testing are presented also. Based on the experience gained from both field measurements and pilot deployment, we propose a system deployment strategy for simple scenarios with general system efficiency estimation. It is shown that the solution has clear potential for a comprehensive heterogeneous vehicular communication and safety network.

POLQUAL – measuring service quality in police traffic services

Purpose – The purpose of this paper is to build a customer quality assessment scale for use in the field of policing – POLQUAL. It adapts and applies a modified SERVQUAL approach to police traffic services in Portugal.Design/methodology/approach – Original data was collected by means of telephone interviews over a three‐month period. The proposed scale's reliability and validity are assessed.Findings – The study shows how it is possible to implement a SERVQUAL‐based approach in police traffic services. The adapted scale – POLQUAL – includes all five original dimensions plus another new dimension “promptitude”. The most negative gaps found are for the dimensions of reliability and tangibles. There was evidence that perceived quality of service decreases as the level of education of the driver increases. The paper did not find a difference between perceived quality of service provided between requested services and imposed services, respectively, represented by the accident service and radar service.Researc...

Academic emergency medicine in India and international collaboration

Pankaj Arora, Anita Bhavnani, Tamorish Kole and Chris Curry Department of Emergency Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Emergency Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, USA; Accident & Emergency Services, Max Healthcare, New Delhi, India; and Department of Emergency Medicine, The University of Western Australia, Crawley, Western Australia, Australia

Evaluation of a general practitioner-led urgent care centre in an urban setting: description of service model and plan of analysis

Estimates of patients attending with conditions deemed non-urgent or inappropriate for accident and emergency services vary widely, from 6 to 80%. Previous research suggests that general practitioners (GPs) working in emergency departments can reduce referral rates, diagnostic testing, the proportion of patients who become emergency hospital admissions, and inappropriate attendances. However, little of this previous research is recent and new models of care for GPs working in emergency departments have now been developed, which remain to be evaluated. In this paper, we describe an integrated urgent care model, which was commissioned by NHS Hammersmith and Fulham in 2009 to manage the rising number of urgent attendances at local hospitals and its associated evaluation. The evaluation will include examining the effect of the system on outcomes such as utilization of diagnostic tests and effect on unplanned hospital admissions. If the new model of care is shown to be both clinically effective and cost-effective, the model and the proposed plan of evaluation will also be helpful to other areas that are considering the introduction of similar models of GP-led urgent care.

Uncertainty Analysis of Accident Notification Time and Emergency Medical Service Response Time in Work Zone Traffic Accidents

Objective: Taking into account the uncertainty caused by exogenous factors, the accident notification time (ANT) and emergency medical service (EMS) response time were modeled as 2 random variables following the lognormal distribution. Method: Their mean values and standard deviations were respectively formulated as the functions of environmental variables including crash time, road type, weekend, holiday, light condition, weather, and work zone type. Work zone traffic accident data from the Fatality Analysis Report System between 2002 and 2009 were utilized to determine the distributions of the ANT and the EMS arrival time in the United States. A mixed logistic regression model, taking into account the uncertainty associated with the ANT and the EMS response time, was developed to estimate the risk of death. Results: The results showed that the uncertainty of the ANT was primarily influenced by crash time and road type, whereas the uncertainty of EMS response time is greatly affected by road type, weather, and light conditions. In addition, work zone accidents occurring during a holiday and in poor light conditions were found to be statistically associated with a longer mean ANT and longer EMS response time. The results also show that shortening the ANT was a more effective approach in reducing the risk of death than the EMS response time in work zones. Conclusions: To shorten the ANT and the EMS response time, work zone activities are suggested to be undertaken during non-holidays, during the daytime, and in good weather and light conditions.

Evaluation of pilot injury surveillance system in Sri Lanka

BackgroundThe Pilot Injury Surveillance System (ISS) had been implemented in seven hospitals in 2005 in Sri Lanka.PurposeTo evaluate the performance of pilot ISS.MethodsAn evaluation team comprised of multi stake holders...

Intimate partner violence: the silent burden in Sri Lankan women

IntroductionIntimate partner violence is one of the commonest forms of violence against women worldwide which continues to be a global burden. In Sri Lanka a proper legal framework has been...

Challenge to Long Term Care for the Elderly: Cold Weather Impacts Institutional Population More than Community-Dwelling Population

To examine whether cold weather affects the institutional population more than the community-dwelling population in terms of morbidity requiring hospital admission. Residence-based hospital discharge data were used to compile excess winter hospitalization (EWH) index for the older population (aged 65 years and above) living in institutions (residential care home for the elderly [RCHE] population) and the community-dwelling elderly population in Hong Kong. To separate the influence of influenza on the cold-related hospital admissions, episodes because of influenza were excluded from this study. In 2009, the EWH index for the RCHE population was 22.93% (95% CI: 20.80%-25.09%), which was much higher than that for the community-dwelling population (14.09%, 95% CI: 13.11%-15.08%). The EWH index was higher among RCHE population compared with community-dwelling population across different age groups and sex (paired t-test one-tailed P= .014). The institutional elderly population was more vulnerable to the risk of excess hospitalization in winter. There may be room for improvement in the living environment of institutions, in particular the ambient temperature and personal care, to reduce hospital admissions. Given the expanding institutional population, the limited hospital beds, and long waiting queue for accident and emergency services, prevention of cold-related hospitalization would help to reduce the medical care burden.

Accentuate the positive, eliminate the negative? The variable value dynamics of non-suicidal self-hurting

Medical accounts mostly frame non-suicidal self-hurting as an adverse event, the frequency of which has supposedly increased to a current ‘epidemic’ level, and which can be predicted probabilistically in terms of risk factors. This set of presuppositions gives rise to the common stigmatisation of those who present to Accident and Emergency services as a result of self-hurting. It is now being challenged in a small but growing body of social science literature which emphasises the diversity of self-hurting, and its range of socially situated meanings for those who self-hurt, family and health professionals. The present paper contributes to this research strand by discussing the accounts of their self-hurting given by a sample of 25 UK adults who had not been in contact with health or other services for this reason. The analysis focused on three value issues: the positive gains which motivated research participants to self-hurt; their own active efforts to mitigate associated risks; and the longer-term downsides which some respondents identified.

Informing the development of services supporting self-care for severe, long term mental health conditions: a mixed method study of community based mental health initiatives in England.

BackgroundSupporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems.MethodsA mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together.ResultsParticipants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health.ConclusionsService delivery components – e.g. peer support groups, personal planning – advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings.

Trauma care in South Africa: From humble beginnings to an afrocentric outreach

Trauma can be the result when humans interact with each other or the environment. In South Africa, trauma care has been associated inextricably with the development of surgery and nursing, as well as the development of the current pre-hospital care system (Brysiewicz and Bruce, 2008). Throughout both World Wars, as well as during the struggle for democracy, and particularly in a more formal manner from the early 1980s, trauma care has developed in South Africa, with the country leading the way in many areas (Clarke et al., 2005). South Africa actually preceded the USA by some years in the establishment of a trauma centre. In South Africa, the first trauma centre, called the Accident Service, was established in 1962 at the Johannesburg Hospital by Wilkinson, after his visit to Birmingham in 1960, and was supported by the Medical School of the University of Witwatersrand. Fol-

Prevalence of attention deficit hyperactivity disorder in children with unintentional injuries

Introduction: Attention deficit hyperactivity disorder (ADHD) is characterized by hyperactivity, inattention and impulsiveness. Risk-taking behaviour and accident proneness are well recognized in these children. Objectives: To estimate the prevalence of ADHD among children attending an Accident Service and to describe the injury profile. Method: Data was gathered from children with unintentional-injuries attending Accident Service on randomly selected days. SNAP IV, an 18-item standardized schedule validated for diagnosis of ADHD, was interviewer-administered to parents. Injury-related data was collected using a semi-structured questionnaire. Results: One hundred and fifty one children, aged 4 to 12 years (mean age 8.5 years), participated in the study. Prevalence of ADHD in this group was 18%. Children with and without ADHD did not differ in mean age and gender distribution. Children with ADHD were more likely to sustain injury needing hospitalization, report previous injury needing hospitalization and were perceived by mothers as injury prone, which were all statistically significant (p Conclusions: Prevalence of ADHD among children attending an Accident Service was 18%. Children with ADHD were more likely to sustain injury needing hospitalization (p Sri Lanka Journal of Child Health , 2012; 41 (1): 20-23 (Key Words: ADHD; unintentional-injuries; injury-proneness; children) DOI: http://dx.doi.org/10.4038/sljch.v41i1.4131

Hvilke fastleger deltar i legevakt?

Approximately half of all accident and emergency medical (A&E) services are provided by regular general practitioners (RGPs). We wished to find out which RGPs staff the A&E services. The material comprises billing cards from all A&E doctors in 2008, linked to information from Statistics Norway and the Regular GP database. We estimated the proportion of various RGPs who staff the A&E roster and how many patient contacts they had while on duty. The same variables describing the RGPs were used in a multivariate logistic regression analysis, in which the dependent variable was whether the RGPs were on the emergency service roster or not. Altogether 53% of the RGPs were on the emergency service roster, and accounted for 47% of all patient contacts. The RGPs were older than other emergency doctors (44 years as opposed to 34 years), and included a smaller proportion of women (33% as opposed to 44%). Immigrants accounted for 23% of the RGPs and 21% of the other emergency doctors. Women RGPs were on A&E duty less frequently than their male counterparts in all age groups, and they also had fewer patient contacts (206 and 374). The participation rate decreased in proportion to the doctors' age, increasing list length and increasing centrality. Immigrant RGPs with a short time of residence in Norway had the highest frequency of on-call duty (81%). The number of women RGPs is increasing, and it is therefore likely that the frequency of on-call duty among RGPs will decrease further. However, the immigrants are providing a significant contribution to maintaining the A&E scheme.

Investigation of the oral health needs for homeless people in specialist units in London, Cardiff, Glasgow and Birmingham

The aim was to assess the oral health needs of homeless people in dedicated homeless dental units in London, Cardiff and Glasgow and a homeless shelter in Birmingham in order to allow recommendations for service delivery to be made for this socially excluded group. Two questionnaires were designed, one to be completed by homeless people and the other by members of the dental team. A total of seventeen staff working in homeless dentistry completed questionnaires. Of these, nine were dentists, seven were nurses and one was a therapist. Twenty-seven homeless adults took part in interview. Of these, 22 were under active treatment at a homeless dental clinic and the remaining five were from the Birmingham homeless shelter who were not receiving dental care. This study found evidence that the oral health of homeless adults was poor, with a high level of dental need. The service use of homeless people is low, with low levels of registration and utilisation of accident and emergency services. In terms of the most suitable method of dental treatment, staff felt a dedicated homeless service was most appropriate, whereas there was almost an equal split of patients advocating the General Dental Service or the dedicated dental clinics.