Emergency Facilities Research Articles

Differences in clinical variables of cervical cancer in women with schizophrenia

IntroductionSchizophrenia is associated with a reduced life expectancy, not only because of suicide, but also medical causes such as cancer. Standardized mortality for cancer is higher in patients with schizophrenia, specially for lung, breast and colorectal locations (Ni et al, 2019). Other less frequent tumor locations have not been deeply studied.Thir mortality gap could be related to a delayed diagnosis due to several reasons, such as lower inclusion in screening programs (Solmi et al, 2019). Since cervical cancer has a very efficient screening technique, women with schizophrenia and cervical cancer could have a worse prognosis because of a delayed diagnosis. However, there is a lack of research in this tumor location.ObjectivesTo analyze clinical differences in women with cervical cancer with and without a diagnosis of schizophrenia.MethodsWe carried out a retrospective cohort analysis with adult patients from the cancer registry of Hospital del Mar diagnosed between 1997 and 2021. The information was crossed with the Minimum Basic Data Set (MBDS) to identify those cancer patients with a diagnosis of schizophrenia using International Classification of Diseases (ICD) 9 codes 295*. The sociodemographic variables were age and sex. The clinical oncological variables included tumor location, place of first conultation, stage, first treatment intention, vital status and place of decease. We used t-student for continuous data and Chi-squared test for categorical variables. We performed a post-hoc analysis using Bonferroni correction for multiple comparisons to identify specifically which categories were significantly different between groups.ResultsWe identified 13 women with schizophrenia and cervical cancer, and 1354 women with cervical cancer without schizophrenia. The proportion of this location was higher in the schizophrenia group (8% of all cancers vs. 4.4%; p=0.03). The proportion of diagnoses through screening programm was significantly lower (7.7% vs 14.6%; p=0.04). There was a trend of fewer diagnoses in situ in patients with schizophrenia (30.8% vs 55.6%) and less radical intention as first treatment option (15.4% vs 3.5%) but without statistical significance in both cases. There was a higher proportion of deceased patients in the group with schizophrenia (46.2% vs 15% p=0.002), and also a higher proportion of deaths outside hospital facilities (30.8% vs 6.6%; p=0.003).Image:ConclusionsWomen with schizophrenia receive less diagnoses of cervical cancer through screening programs and more in emergency facilities, which could lead to more advanced stages and fewer indication of radical treatments. This ultimately leads to a higher proportion of deaths, and more frequently outside of hospital facilities.Our data supports the idea that the increased mortality for cancer is related to a delayed diagnosis. Women with schizophrenia need special care to ensure their inclusion in early detection programs for cancer.Disclosure of InterestNone Declared

A Critical Review of Accident and Emergency Facilities Functionality: A Case Study of Uganda’s National Referral Hospital

A Critical Review of Accident and Emergency Facilities Functionality: A Case Study of Uganda’s National Referral Hospital

Road Accessibility during Natural Hazards Based on Volunteered Geographic Information Data and Network Analysis

Natural hazards can present a significant risk to road infrastructure. This infrastructure is a fundamental component of the transportation infrastructure, with significant importance. During emergencies, society heavily relies on the functionality of the road infrastructure to facilitate evacuation and access to emergency facilities. This study introduces a versatile, multi-scale framework designed to analyze accessibility within road networks during natural hazard scenarios. The first module of the framework focuses on assessing the influence of natural hazards on road infrastructure to identify damaged or blocked road segments and intersections. It relies on near real-time information, often provided by citizen science through Volunteered Geographic Information (VGI) data and Natural Language Processing (NLP) of VGI texts. The second module conducts network analysis based on freely available Open Street Map (OSM) data, differentiating between intact and degraded road networks. Four accessibility measures are employed: betweenness centrality, closeness centrality, a free-flow assumption index, and a novel alternative routing assumption measure considering congestion scenarios. The study showcases its framework through an exemplary application in California, the United States, considering different hazard scenarios, where degraded roads and connected roads impacted by the hazard can be identified. The road extraction methodology allows the extraction of 75% to 100% of the impacted roads mentioned in VGI text messages for the respective case studies. In addition to the directly extracted impacted roads, constructing the degraded network also involves finding road segments that overlap with hazard impact zones, as these are at risk of being impacted. Conducting the network analysis with the four different measures on the intact and degraded network, changes in network accessibility due to the impacts of hazards can be identified. The results show that using each measure is justified, as each measure could demonstrate the accessibility change. However, their combination and comparison provide valuable insights. In conclusion, this study successfully addresses the challenges of developing a generic, complete framework from impact extraction to network analysis independently of the scale and characteristics of road network types.

Individual Attributes and Environmental Conditions of Registered Nurses Working in Freestanding Emergency Departments in the United States: A Descriptive Exploratory Study

IntroductionFreestanding emergency departments (FSEDs) are emergency facilities not connected to inpatient services. The percentage of FSEDs of all EDs grew from 1% in 2001 to 12% in 2017, making FSEDs a substantial subset of US emergency care. The purpose of this study was to describe the individual attributes and environmental conditions of registered nurses working in FSEDs in the US. MethodsA quantitative descriptive exploratory design with cross-sectional survey methodology. ResultsA total of 364 emergency nurses responded to the survey. Most reported their FSED was open 24 hours/day (99.5%), with board-certified emergency physicians onsite (91.5%) and a mean of 3.6 RNs working per shift. Resources immediately available in more than 50% of FSEDs included laboratory and imaging services, and in fewer than 30% of FSEDs included behavioral health care, MRI, obstetric care, orthopedic care, neurologic care, and surgical consult care. Respiratory therapy was reported by 39.6% of respondents as being immediately available. A significant minority of respondents expressed concerns about adequacy of resources and training and the effect on patient care in both survey (30% of respondents) and open-ended questions (42.5% of respondents). DiscussionThe practice environment of emergency nurses in FSEDs was reported as having positive elements; however, a substantial subpopulation reported serious concerns. FSEDs adhere to some of the standards put forward by the American College of Emergency Physicians, with notable exceptions in the areas of staffing RNs, staffing ancillary staff, and availability of some resources.

A web-based decision support framework for optimizing road network accessibility and emergency facility allocation during flooding

Transportation systems can be significantly affected by flooding, leading to physical damage and hindering accessibility. Despite flooding being a frequent occurrence, there are limited accessible online tools available for supporting routing and emergency planning decisions during flooding. Existing tools are generally based on complicated models and are not easily accessible to non-expert users, highlighting the need for efficient communication and decision-making tools for analyzing flood impacts on transportation networks for various stakeholders, including the public, to minimize the adverse impacts on those groups. This paper presents a web application that uses graph network methods and the latest web technologies and standards to assist in describing flood events in terms of operational constraints and provide analytical methods to support mobility and mitigation decisions during these events. The framework is designed to be user-friendly, enabling non-expert users to access information about road status, shortest paths to critical amenities, location-allocation, and service coverage. The study area includes the following two communities in the State of Iowa, Cedar Rapids and Charles City, which were used to test the application's functionality and explore the outcomes. Our research demonstrates that flooding can significantly affect bridge operation, routing from locations to critical amenities, arbitrary point-to-point routing, planning for emergency facility placement, and service area accessibility. The introduced framework can solve complex flood-related analytical decision tasks and provide an understandable representation of transportation vulnerability, enhancing mitigation strategies. Therefore, this web application provides a valuable tool for stakeholders to make informed decisions on transportation networks during flood events.

A cooperative optimization model and enhanced algorithm for guided strategies in emergency mobile facilities

In the realm of emergency response, the swift and efficient deployment of mobile units is of paramount importance. This research introduces a strategy centered around the “proximity response” principle, aiming to strategically position emergency services nearer to areas of higher demand. This approach is designed to enhance response times while optimizing resource allocation. Through the integration of practical planning with user-friendly computational methodologies, this paper presents a novel framework for improving the allocation and reach of emergency facilities. This includes extending critical care to broader areas and minimizing operational costs. The simulations conducted demonstrate that this strategy markedly enhances crisis management effectiveness. The paper also includes a statistical analysis that provides substantial evidence of the practicality and efficiency of this approach in real-world emergency scenarios. This study contributes to the field by offering a new perspective on resource distribution and emergency response planning, potentially impacting the way these critical services are organized and deployed.

Ethical triage in public health emergency facilities: distributive justice – a decision model

PurposeA new triage method, MBCE (Medical Bio Social Ethics), is presented with social justice, bio, and medical ethics for critical resource distribution during a pandemic. Ethical triage is a complex and challenging process that requires careful consideration of medical, social, cultural, and ethical factors to guide the decision-making process and ensure fair and transparent allocation of resources. When assigning priorities to patients, a clinician would evaluate each patient’s medical condition, age, comorbidities, and prognosis, as well as their cultural and social background and ethical factors.Design/methodology/approachA statistical analysis shows no interactions among the ethical triage factors. It implies the ethical components have no moderation effect; hence, each is independent. The result also points out that medical and bioethics may have an affinity for interactions. In such cases, there seem to be some ethical factors related to bio and medical ethics that are correlated. Therefore, the triage team should be careful in evaluating patient cases. The algorithm is explained with case histories of the selected patient. A group of triage nurses and general medical practitioners assists with the triage.FindingsThe MBCE triage algorithm aims to allocate scarce resources fairly and equitably. Another ethical principle in this triage algorithm is the principle of utility. In a pandemic, the principle of utility may require prioritizing patients with a higher likelihood of survival or requiring less medical care. The research presents a sensitivity analysis of a patient’s triage score to show the algorithm’s robustness. A weighted score of ethical factors combined with an assessment of triage factors combines multiple objectives to assign a fair triage score. These distinctive features of the algorithm are reasonably easy to implement and a new direction for the unbiased triage principle.Originality/valueThe idea is to make decisions about distributing and using scarce medical resources. Triage algorithms raise ethical issues, such as discrimination and justice, guiding medical ethics in treating patients with terminal diseases or comorbidity. One of the main ethical principles in triage algorithms is the principle of distributive justice.

Experience Sharing in Participating in the Environmental Safety Consultation Program—Tainan Hospital, Ministry of Health and Welfare

<p>本文分享財團法人醫院評鑑暨醫療品質策進會推動「環境安全諮詢計畫」，由兩位國內專家輔導委員及一位國外ACHSI輔導委員以緊急應變計畫、建築與設備、管理機制三大方面進入輔導過程，本文大致分享以國內醫療機構面臨機構建築設備老舊維護困難，在既有建築物空間規劃設計上，防災及疏散因應措施相較薄弱，如何以合宜的因應措施及編列合理改善預算，提升環境安全及災害應變能力，保障人員安全與健康，維持醫療正常營運及財產損害控管。</p> <p> </p><p>This manuscript shares the experience of participating in the “Environmental Safety Consultation Program” promoted by the Joint Commission of Taiwan. The program was guided by two domestic expert advisors and one international advisor from the Australian Council on Healthcare Standards International, focusing on three major aspects: emergency response plans, architecture and facilities, and management mechanisms. This manuscript broadly discusses how healthcare institutions in Taiwan, facing challenges with the maintenance of outdated buildings and facilities, and weak disaster prevention and evacuation measures due to existing architectural and spatial planning, can implement suitable response measures and allocate reasonable budgets for improvements. The goals are to enhance environmental safety and disaster response capabilities, ensure the safety and health of personnel, maintain normal medical operations, and manage property damage.</p> <p> </p>

IoT-based Collision Detection System

All around the world, a sizable percentage of traffic deaths take place every day. Two effective methods for reducing traffic fatalities include implementing systems that allow for real-time incident reporting can significantly reduce the time it takes for emergency services to be notified. Providing thorough training for emergency dispatchers, responders, and other personnel involved in the response process is crucial. The incidence of automobile accidents has increased as technology and auto manufacturing have advanced. Due to limited emergency facilities, the survival rate following an accident is quite low. Our strategy would help find an accident and identify it so that the rescue squad and the rider's emergency contact could be informed.

DESAIN PESANTREN MINHAJUSSALAM TINGKAT MTS DI KECAMATAN GUNUNG RAJA KABUPATEN TANAH LAUT

Flood is a natural disaster that can harm the environment, especially human settlements. The potential for flooding can be seen based on environmental characteristics, one of which is a swamp. Gunung Raja, Bati-Bati District, Kab. Tanah Laut is one of the residential areas that stands on swampland. Swampy land has high tide times and can potentially flood when it encounters high rainfall. Knowing the potential for flooding, we need a building that is responsive to tides. Buildings that have the potential for disaster response are educational facilities/schools, namely the Minhajussalam Islamic Boarding School. By creating a design using the Contextual Architecture method, it is hoped that this design can create a building that is responsive to sea tides and can become an emergency facility for the surrounding color in the event of a flood.

Prevalence and progression of pneumonia in immunocompetent adults with varicella

Pneumonia is the most common complication of varicella infections. Although previous studies have tended to focus mainly on immunocompromised patients, varicella pneumonia can also occur in healthy adults. Therefore, in this study, we aimed to assess the progression of varicella pneumonia in immunocompetent hosts. This retrospective study involved immunocompetent adult outpatients with varicella who attended the adult Fever Emergency facility of Peking University Third Hospital from April 1, 2020, to October 31, 2022. Varicella pneumonia was defined as a classic chickenpox-type rash in patients with infiltrates on chest computed tomography. The study included 186 patients, 57 of whom had a contact history of chickenpox exposure. Antiviral pneumonia therapy was administered to 175 patients by treating physicians. Computed tomography identified pneumonia in 132 patients, although no deaths from respiratory failure occurred. Seventy of the discharged patients were subsequently contacted, all of whom reported being well. Follow-up information, including computed tomography findings, was available for 37 patients with pneumonia, among whom 24 reported complete resolution whereas the remaining 13 developed persistent calcifications. Notably, we established that the true incidence of varicella pneumonia is higher than that previously reported, although the prognosis for immunocompetent hosts is generally good.

Assessing and Managing Medical Adhesive-Related Skin Injury in Patients with a Peripherally Inserted Central Catheter: A Case Series.

Medical adhesive-related skin injuries (MARSIs) are prevalent adverse effects associated with use of medical devices and increasingly recognized as potentially avoidable. Despite advances in preventive measures, MARSI events still occur, and individualized care must be designed to meet patient needs. This article describes three cases where skin injuries occurred because of application, removal, and ongoing use of a medical adhesive device; all three cases occurred underneath dressings used to secure and protect the skin adjacent to a peripherally inserted central catheter (PICC). The first case describes evaluation and management of a skin tear in an elderly female with multiple comorbid conditions, and Case 2 describes assessment and care of contact irritant dermatitis occurring under a PICC dressing. In both cases, specialist nurses with knowledge of MARSI assessed and managed the skin underneath the medical adhesive device in a manner that allowed maintenance of the PICC and continuation of therapy. In contrast, Case 3 describes a female with irritant contact dermatitis underneath a PICC dressing that was responding to care by the nurse specialists of a vascular access team. In this case, the patient presented to their facility's emergency department with severe itching. The vascular access team initially was not consulted, and the PICC line was removed, although inspection revealed dry skin without signs of infection. Medical adhesive-related skin injury is a clinically relevant and useful construct that identifies a variety of prevalent conditions associated with the use of medical adhesive device such as tapes and PICC dressings. These cases, in particular Cases 1 and 2, illustrate that the MARSI construct provides a framework for assessing and managing medical skin injuries with the possibility of preserving the PICC and the ongoing therapy these patients were receiving.

Multitasking Streetlight –A Novel System

In today's era vehicle accidents are one of the leading causes of death due to lack of attention and help in time, poor emergency facilities, people lose their life. Highways are very vulnerable to accidents and many times the accident victims are unattended. Several time the accidents do not come under notice due to low traffic or ignorant trespassers. The Street light discussed in the paper is an automated system which witness the street throughout day and night. In case of any accident the streetlight will be able to generate an alarm as well as it will alert the concern authority. It simply observes the stay time of a vehicle in a pre-decided patch of road. In case of any delay, the streetlight will warn the concern team about the same. If there is an issue, the location is sent to the rescue team with the help of GSM module. The authors are also trying to reduce power consumption whenever there is no vehicle movement on the road. The streetlight will glow with high intensity when there is a vehicle on road otherwise it will be dim.

Experiences of male irregular migrants during their migration process and reception in Spain: lessons learned from the COVID-19 pandemic.

The causes behind migration movements are complex. The COVID-19 pandemic highlighted how several countries failed to respond to the virus adequately, while simultaneously infringing on people's rights. Male irregular migrants fled their countries of origin and embarked on a perilous migration journey to Spain. The highly restrictive COVID-19 measures and border closures affected the mobility of male irregular migrants, whose reception in the host country posed a challenge. It led to the establishment of emergency facilities to accommodate male irregular migrants affected by COVID-19, which had repercussions on their mental health. The aim of this study was to describe and understand the experiences of male irregular migrants throughout their migration process and reception in Spain during the COVID-19 pandemic. Qualitative descriptive study. Sixteen male irregular migrants participated in this study. Data were collected between January and March 2023 through 16 one-on-one in-depth interviews. Thematic analysis was used to analyze the qualitative data using ATLAS.ti computer software. Three main themes emerged: (1) How the COVID-19 pandemic drove male irregular migrants to leave their countries of origin, (2) How COVID-19 lockdown policies affected the migration journey, and (3) Receiving male irregular migrants in a pandemic: a housing labyrinth marked by isolation and loneliness. The COVID-19 pandemic increased the social, employment and health inequalities experienced by male irregular migrants. Border closures exacerbated the migration journey and the social stigmatization of this group, who were seen as carriers of the virus in both transit and host countries. Strict control measures in emergency and reception facilities had a significant psychological impact on the male irregular migrants due to the social isolation they experienced. Health institutions should develop programs to guarantee the care needs of irregular migrants.

Pediatric Life Support in Prehospital Emergency Medicine: An Empirical Investigation in the Context of Taiwan's Critical Shortage of Pediatric Emergency Specialists.

This study aims to facilitate parental identification of designated emergency facilities for expeditious pediatric care within the framework of Taiwan's newly implemented "regional joint defense" approach to pediatric emergency services. The research seeks to elucidate the mechanisms by which this novel system can enhance timely access to appropriate emergency care for children, potentially improving health outcomes and resource utilization in acute pediatric situations. Factor analysis (FA) and triangular entropy matrix (TEM) analyzed the appearance, breathing and skin of pediatric assessment triangle (ABC of PAT), three types of prehospital pediatric emergence condition (PPEC), five levels of Taiwan's pediatric emergency triage (TPET), and applied the social learning theory (SLT) in educational doctrine, using experts' weighted questionnaires. Firstly, to address deficiencies in Taiwan's pediatric prehospital emergency medicine (PEM) system, integrating emergency medical knowledge (EMK) and pediatric life support (PLS) into medical education, staff training, and the national handbook for new parents is crucial. This equips parents to manage children's illnesses and prevent emergencies. Then, in life-threatening situations, immediate emergency room (ER) transport is vital for symptoms like whitish or purple lips, cold limbs, mottled skin, cold sweat, convulsions, dyspnea, chest dimples, weak consciousness, and oxygen saturation below 94%. Finally, for non-life-threatening emergencies, seek medical evaluation if symptoms include wheezing, chest tightness, chest pain, persistent high fever over 39 degrees with convulsions, chills, cold sweats, not eating or urinating for over 12 hours, or fever lasting more than 48 hours. Parents must remain calm and provide their baby with a sense of security while observing the development of physical symptoms. This approach enables them to effectively determine the most appropriate time to take their children to the emergency room, thereby avoiding life-threatening emergencies. Prompt and proper measures and treatments not only alleviate various discomforts caused by illness or medical emergencies but also reduce systemic distress, life-threatening situations, and unfortunate incidents before hospitalization.

Variations in the intended utilization of emergency care in case of gastrointestinal diseases

Frequent utilization of emergency care and overcrowded emergency departments (EDs) are highly relevant topics due to their harmful consequences for patients and staff. The present study examines variations of intended health care use in urgent and non-urgent cases among the general population. In a cross-sectional telephone survey, a sample of N = 1,204 adults residing in Hamburg, Germany, was randomly drawn. At the beginning of the survey, one of 24 different vignettes (case stories) describing symptoms of inflammatory gastrointestinal diseases were presented to the participants. The vignettes varied in sex (male/female), age (15, 49, 72 years), daytime (Tuesday morning, Tuesday evening), and urgency (low, high). Participants were asked in an open-ended question about their primal intended utilization if they or their children would be affected by such symptoms. Overall, about 14 % chose emergency facilities (ED, ambulance, emergency practice) despite presentation of non-urgent conditions (n = 602). Intended emergency care use varied considerably even if the degree of urgency was comparable. Adolescence, male sex, and symptoms occurring in the evening were associated with increased ED and ambulance use. Inappropriate utilization of ED and ambulance (analyses regarding utilization due to non-urgent problems) was more often observed among male respondents and those with a migration background (1st generation). Information campaigns focused on emergency care use and reorganisation of emergency care wards are possible interventions.

A new fuzzy approach of vehicle routing problem for disaster-stricken zones

Abstract Route planning problems are among the activities that have the highest impact in emergency logistical planning, goods transportation and facility location-distribution because of their effects on efficiency in resource management, service levels and client satisfaction. In the extreme conditions, such as disaster-stricken zones, the difficulty of vehicle movement between nearest different affected areas (demand points) on planning routes cause the imprecision of time of movement and the uncertainty of feasibility of movement. In this paper, the imprecision is presented by triangular fuzzy numbers and the uncertainty is presented by a possibility measure. A new two-stage, fuzzy bi-criterion optimization approach for the vehicle routing problem (VRP) is considered. On the first stage, the sample of so-called “promising” closed routes are selected based on a “constructive” approach. On the second stage, triangular fuzzy valued Choquet aggregation (TFCA) operator is constructed for the selected closed routes. The evaluation of constructed routes, levels of failure and possibility of vehicle movement on the roads are aggregated by the TFCA operator by the new criterion – minimization of infeasibility of movement. The new criterion together with the classic criterion – minimization of the total distance traveled – creates a bi-criteria fuzzy VRP. The constructed VRP is reduced to the bi-criteria fuzzy partitioning problem, and an 𝜀-constraint approach is developed for solving it. For numerical experiments, a parallel algorithm is created on the basis of D. Knuth’s algorithm of Dancing Links (DLX). An example is presented with the results of our approach for the VRP, where all Pareto-optimal solutions are found from the set of promising routes. The optimal solutions tend to avoid roads that are problematic because of extreme situations.

Analysis of deployable bridge

The rapid development of infrastructure leads to a wide variety of structural designs, and one of the upcoming techniques is deployable structure. A deployable structure is a structure that can change shape to significantly change size. Deployable structures have many potential applications ranging from emergency shelters and facilities, through relocatable, semi–permanent structures, to space station components. Their main advantages are their small volume during storage and transportation and their fast, easy erection procedure. The motivation behind doing this project is because of its adaptability to the environment and the easiest mode of construction. This project work is done using SOLIDWORKS Software, an application that can be used for structural analysis and designing of the pedestrian deployable bridge. The main aim of this project is to determine the strength of the deployable bridge and to reduce the loss of lives by providing safe transportation that is the designing of deployable evacuation bridge. The problems thus exist so far are that the structure is costly in parts and assembling, and friction in the joints determines the life of the structure.

Time frame guide for emergency model of care and patient satisfaction in emergency facilities

Time frame guide for emergency model of care and patient satisfaction in emergency facilities

Effectiveness of call system implementation for postpartum hemorrhage in a tertiary emergency medical center: a retrospective cohort study

BackgroundPostpartum hemorrhage is the leading cause of maternal death and severe maternal morbidity worldwide. Previous studies have reported the importance of multidisciplinary treatment approaches for postpartum hemorrhage; however, only a few studies have shown a clear improvement in maternal outcomes. Therefore, this study aimed to investigate the efficacy of a call system for postpartum hemorrhage in a tertiary emergency facility for rapid multidisciplinary treatment and its effect on maternal outcomes.MethodsThis single-center retrospective cohort study included patients transferred to our hospital due to postpartum hemorrhage between April 1, 2013, and March 31, 2019. The primary outcome was mortality, and the secondary outcomes were morbidity (duration of hospital stay, duration of intensive care unit stay, admission to the intensive care unit, respirator use, duration of ventilator support, acute kidney injury, transfusion-associated circulatory overload/transfusion-related acute lung injury, hysterectomy, composite adverse events, blood transfusion initiation time, blood transfusion volume, and treatment for postpartum hemorrhage). An in-hospital call system implementation commenced on April 1, 2016. The study outcomes were compared 3 years before and after implementing the call system.ResultsThe blood transfusion initiation time and duration of hospital stay were significantly shortened after implementing the call system for postpartum hemorrhage. No maternal deaths were observed after implementing the system.ConclusionsImplementing call systems specialized for postpartum hemorrhage in tertiary emergency facilities may improve maternal outcomes.