Emergency Medical Procedures Research Articles

Sepsis in Home Health Care: Screening, Education, and Rapid Triage.

A majority of sepsis cases originate in the home and community. Home health clinicians play an important role in the early identification and timely treatment of sepsis. A home health care provider sought to prevent hospital readmissions due to sepsis by implementing a sepsis-screening protocol and quality improvement initiative. The provider conducted a retrospective chart review of 33 264 sepsis screens of 7242 patients. A sepsis-screening protocol, clinician and patient/caregiver sepsis education, physician and emergency department communication, and emergency medical services collaboration procedure were implemented. A majority (69.2%) of positive sepsis screens resulted in patients receiving early medical intervention and avoiding hospitalization. Having a formal sepsis-screening program in place prompts home health clinicians to communicate the patient's symptoms to their primary care provider, which can positively impact hospital readmission rates and associated medical costs.

Discussions on the emergency medical procedure of children's hospitals against COVID-19 epidemic

December 2019 witnessed the outbreak of COVID-19 in Wuhan, Hubei province of China, which has soon spread nationwide and across national borders, posting a menacing pandemic threat. Children are themselves highly susceptible infectious diseases in normal times not to mention an epidemic period. Coupled with the high incidence of seasonal influenza, it is imperative to strengthen epidemiological screening of children, along with effective isolation, treatment, prevention and control measures. In view of specifics of the hospital, the authors proposed to further improve the medical emergency procedure, strictly enforcing screening and isolation regulations, and standardizing medical procedure. They also proposed scientific layout and use of the infection wards. These measures are designed to control the epidemic and protect the safety of medical staff.

The influence of emergency medical procedures and event circumstances on the acute effectiveness of resuscitation in out-of-hospital sudden cardiac arrest in adults

The influence of emergency medical procedures and event circumstances on the acute effectiveness of resuscitation in out-of-hospital sudden cardiac arrest in adults

An analysis of the relationship between the applied medical rescue actions and the return of spontaneous circulation in adults with out-of-hospital sudden cardiac arrest.

Sudden cardiac arrest (SCA) is a significant medical and social issue, the main cause of death in Europe and the United States.The aim of the research was to evaluate the effectiveness of emergency medical procedures applied by emergency medical teams in prehospital care in the context of return of spontaneous circulation (ROSC).The case–control study was based on the medical documentation of the Rescue Service in Katowice (responsible for monitoring 2.7 million inhabitants of the region) referring to 2016. The research involved exclusively adults (ie, individuals older than 18 years) with out-of-hospital cardiac arrest (OHCA). After considering the above inclusion criteria, there were 1603 dispatch order forms (0.64% of all dispatch orders) involved in further research.On the basis of the emergency medical procedure forms, the actions of emergency medical teams were verified as medical procedures (endotracheal intubation, the use of suction pumps, defibrillation, the use of alternatives providing airway patency and ROSC was determined.The analysis covered 1603 cases of OHCA. SCA turned out more frequent in men than in women (P = .000). Most often, SCA occurred in domestic conditions during the day and was witnessed by a third person. In 59.9% of the cases, actions were taken by witnesses, which increased the probability of ROSC. Patients were usually intubated (51.4%). Respirators were used less frequently (20.2%). Ventricular fibrillation (VF) was reported only in 22.0% of the cases. The ROSC rate was higher in the group of patients with diagnosed VF than in those with nonshockable rhythms (VF, 55.43% vs asystole, 24.05%; P = .000).Successful resuscitation depends on the quality of emergency medical procedures performed at the place of incident. The highest probability of ROSC is related with defibrillation (in the cases of VF or ventricular tachycardia with no pulse), intubation, the application of a respirator, and performing mechanical ventilation, as well as with a shorter time from dispatch to arrival.

Evaluation of musculoskeletal disorders risk of 119 emergency medical technicians during emergency medical services procedures in firefighter combat challenge

Evaluation of musculoskeletal disorders risk of 119 emergency medical technicians during emergency medical services procedures in firefighter combat challenge

Glosa do postanowienia Sądu Najwyższego z dnia 28 kwietnia 2016 r. (I KZP 24/15)

The author agrees with the thesis of the verdict according to which, “the legal protection that is due to a public official granted to a physician in Art. 44 of the Act of 5 December 1996 on the Professions of a Physician and a Dentist Physician and in Art. 5 of the Act of 8 September 2006 on National Medical Emergency Service does not cover situations other than providing short-term assistance (i.e. providing first aid and performing emergency medical procedures) or medical assistance where any delay would result in exposing to danger of loss of life, grievous bodily harm or health disorder, and in other urgent cases”.

Medical Radiation Safety Process in Case of Changing Medical Condition of Patients Who Received Radionuclide Therapy or Radioactive Substances: Emergency Medical Procedures

Medical Radiation Safety Process in Case of Changing Medical Condition of Patients Who Received Radionuclide Therapy or Radioactive Substances: Emergency Medical Procedures

Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment?

IntroductionNon-adherence to disease-modifying antirheumatic drugs (DMARDs) is suspected to relate to health care costs. In this study we investigated this relation in the first year of treatment.MethodsIn a multi-center cohort study with a one year follow up, non-adherence was continuously measured using electronic monitored medication jars. Non-adherence was defined as the number of days with a negative difference between expected and observed opening of the container. Cost measurement focused on hospital costs in the first year: consultations, emergency room visits, hospitalization, medical procedures, imaging modalities, medication costs, and laboratory tests. Cost volumes were registered from patient medical files. We applied multivariate regression analyses for the association between non-adherence and costs, and other variables (age, sex, center, baseline disease activity, diagnosis, socioeconomic status, anxiety and depression) and costs.ResultsOf the 275 invited patients, 206 were willing to participate. 74.2% had rheumatoid arthritis, 20.9% had psoriatic arthritis and 4.9% undifferentiated arthritis. 23.7% of the patients were more than 20% non-adherent over the follow-up period. Mean costs are € 2117.25 (SD € 3020.32). Non-adherence was positively related to costs in addition to baseline anxiety.ConclusionNon-adherence is associated with health care costs in the first year of treatment for arthritis. This suggests that improving adherence is not only associated with better outcome, but also with savings.

When Cardiopulmonary Resuscitation Becomes Harmful

Cardiopulmonary resuscitation is a standard emergency medical procedure. Since its inception in the late 1960s, CPR has been performed on patients unless they or their proxies refuse it. However, like all medical inter­ventions, CPR has its benefits, risks, and consequences. Although the expected benefits of the procedure often outweigh its potential harm, CPR is not always clinically appropriate, especially for the dying, who have a very small statistical chance of surviving the intervention. Just as antibiotics are not prescribed for viruses and surgeries and treatments are withheld when clinically inappropri­ate, CPR should not be offered as a clinical treatment when it has a very low probability of success and is thought to be futile. Health care providers have an ethical and moral responsibility to withhold clinically inappropriate CPR, even when patients or their proxies request the procedure.

Medical Radiation Safety Process in Case of Changing Medical Condition of Patients Who Received Radionuclide Therapy or Radioactive Substances: Emergency Medical Procedures

Medical Radiation Safety Process in Case of Changing Medical Condition of Patients Who Received Radionuclide Therapy or Radioactive Substances: Emergency Medical Procedures

Assessment of level of knowledge on cardio-Pulmonary resuscitation among nurses

Cardiac arrest is fatal if prompt and immediate treatment is not given and is considered as a medical emergency. It is documented that sudden cardiac arrest can be managed by a timely performed cardio pulmonary resuscitation (CPR). The CPR guidelines are revised periodically by American Heart Association (AHA) and the latest revision was made in the year 2010. Nurses are expected to update their knowledge on CPR as per AHA’s revision to ensure quality patient care. This study aimed to assess the knowledge on revised cardio-pulmonary resuscitation guidelines among nurses. A descriptive cross sectional study design was adopted for the present study. The data were collected from 100 nurses after explaining the purpose of the study and obtained informed consent from them. Self-developed questionnaires which consist of 30 questionnaires were used to collect the data. The results showed that 54% of nurses had moderately adequate knowledge and 46% of them had inadequate knowledge on cardio-pulmonary resuscitation. The present study revealed that the nurses lack adequate knowledge on CPR. Since, nurses spent most of their time in direct patient care; they are the ones who are readily available to manage emergency situations. Hence, she should be knowledgeable and skillful enough in performing emergency medical procedures. Assessing the level of knowledge among nurses help the nurse educators to organize the in-service education and CNE programme which help to improve their knowledge to keep pace with the health care demand.

Beyond Traditional Biosafety

Beyond Traditional Biosafety

Assessing Physician-Parent Communication During Emergency Medical Procedures in Children

Effective physician-patient communication is critical to the clinical decision-making process. We studied parental recall of information provided during an informed consent discussion process before performance of emergency medical procedures in a pediatric emergency department of an inner-city hospital with a large bilingual population. Fifty-five parent/child dyads undergoing emergency medical procedures were surveyed prospectively in English/Spanish postprocedure for recall of informed consent information. Exact logistic regression was used to predict the ability to name a risk, benefit, and alternative to the procedure based on a parent's language, education, and acculturation. Among English-speaking parents, there tended to be higher proportions that could name a risk, benefit, or alternative. Our regression models showed overall that the parents with more than a high school education tended to have nearly 5 times higher odds of being able to name a risk. A gap in communication may exist between physicians and patients (or parents of patients) during the consent-taking process, and this gap may be impacted by socio-demographic factors such as language and education level.

A mechanical chest compressor closed-loop controller with an effective trade-off between blood flow improvement and ribs fracture reduction.

Chest compression (CC) is a significant emergency medical procedure for maintaining circulation during cardiac arrest. Although CC produces the necessary blood flow for patients with heart arrest, improperly deep CC will contribute significantly to the risk of chest injury. In this paper, an optimal CC closed-loop controller for a mechanical chest compressor (OCC-MCC) was developed to provide an effective trade-off between the benefit of improved blood perfusion and the risk of ribs fracture. The trade-off performance of the OCC-MCC during real automatic mechanical CCs was evaluated by comparing the OCC-MCC and the traditional mechanical CC method (TMCM) with a human circulation hardware model based on hardware simulations. A benefit factor (BF), risk factor (RF) and benefit versus risk index (BRI) were introduced in this paper for the comprehensive evaluation of risk and benefit. The OCC-MCC was developed using the LabVIEW control platform and the mechanical chest compressor (MCC) controller. PID control is also employed by MCC for effective compression depth regulation. In addition, the physiological parameters model for MCC was built based on a digital signal processor for hardware simulations. A comparison between the OCC-MCC and TMCM was then performed based on the simulation test platform which is composed of the MCC, LabVIEW control platform, physiological parameters model for MCC and the manikin. Compared with the TMCM, the OCC-MCC obtained a better trade-off and a higher BRI in seven out of a total of nine cases. With a higher mean value of cardiac output (1.35L/min) and partial pressure of end-tidal CO2 (15.7mmHg), the OCC-MCC obtained a larger blood flow and higher BF than TMCM (5.19 vs. 3.41) in six out of a total of nine cases. Although it is relatively difficult to maintain a stable CC depth when the chest is stiff, the OCC-MCC is still superior to the TMCM for performing safe and effective CC during CPR. The OCC-MCC is superior to the TMCM in performing safe and effective CC during CPR and can be incorporated into the current version of mechanical CC devices for high quality CPR, in both in-hospital and out-of-hospital CPR settings.

Accion Venture Lab (Case Narrative)

innovations / volume 10, number 1-2 © 2015 Paul Breloff Paul Breloff is the founding Managing Director of the Accion Venture Lab. Accion Venture Lab, launched in 2012, is a seed-stage impact investment initiative that provides small amounts of capital (up to $500,000) and management support to jumpstart game-changing financial inclusion startups around the world, promoting better financial services to more people at the base of the pyramid (BOP). Lack of financial access is a massive global problem. At Accion we believe, and the research shows, that the right financial tools can make or break whether someone will be able to take advantage of an opportunity (e.g., invest at the right time to grow a business) or absorb a financial shock (e.g., pay for an emergency medical procedure without spiraling into debt). According to the World Bank’s Global Findex Database 2014, roughly two billion people around the world lack access to formal financial services. Our efforts address this widespread issue by helping to provide access to financial tools that help underserved customers—particularly low-income customers and small business owners—improve their lives. A reliable place to borrow and save, for example, can help a household manage uneven cash flow, smooth consumption, and build working capital; insurance can help mitigate risk and manage shocks; new types of payment services can help reduce transaction costs and keep money with families, rather than big money transfer organizations. Evidence also shows that financial inclusion is positively correlated with growth and employment at the macro level. Venture Lab is an in-house, strategic venture capital arm of Accion, a financial inclusion nonprofit organization headquartered in the United States, with offices in Colombia, Ghana, and India, and with 200 staff members around the globe. Although this strategic, in-house venture capital model is common among mainstream banks (e.g., Citi Ventures, American Express Ventures), it remains uncommon among nonprofits, which rarely have the resources to foot the bill for exploratory investment arms. Venture Lab’s purpose is to spur innovation in financial inclusion, specifically innovation led by the earliest and most unproven startups. We believe that market incumbents— the big banks, credit card companies, and remittance players—need a healthy dose of inspiration or perhaps fear from a new breed of entrepreneurs poised to shake up the status quo in global finance. Accion Venture Lab Paul Breloff

An innovative longitudinal curriculum to increase emergency medicine residents' exposure to rarely encountered and technically challenging procedures.

BackgroundProcedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents’ procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation.MethodsWe developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills. A departmental expert directed each session with collaboration from colleagues in related subspecialties. Sessions were developed based on Manthey and Fitch’s stages of procedural competency including 1) knowledge acquisition, 2) experience/technical skill development, and 3) competency evaluation. We then distributed a brief, 10-question, online survey to our residents in order to solicit feedback regarding their perceptions of increased knowledge and ability in uncommon and common emergency medical procedures, and their perception of the effectiveness of integrated cognitive training with hands-on instruction through high- and low-fidelity simulation.ResultsFifty percent of our residents (11/22) responded to our survey. Responses indicated the procedure series helped with understanding of both uncommon (65% strongly agreed [SA], 35% agreed [A]) and common (55% SA, 45% A) emergency medicine procedures and increased residents’ ability to perform uncommon (55% SA, 45% A) and common (45% SA, 55% A) emergency medical procedures. In addition, survey results indicated that the residents were able to reach their goal numbers.ConclusionBased on survey results, the procedure series improved our residents’ perceived understanding of and perceived ability to perform uncommon and more technically challenging procedures. Further, results suggest that the use of a cognitive curriculum model as developed by Manthey and Fitch is adaptable and could be modified to fit the needs of other medical specialties.

Comparison of Self-Efficacy and Its Improvement After Artificial Simulator or Live Animal Model Emergency Procedure Training

The objective of this study is to compare post-training self-efficacy between artificial simulators and live animal training for the performance of emergency medical procedures. Volunteer airmen of the 81st Medical Group, without prior medical procedure training, were randomly assigned to two experimental arms consisting of identical lectures and training of diagnostic peritoneal lavage, thoracostomy (chest tube), and cricothyroidotomy on either the TraumaMan (Simulab Corp., Seattle, Washington) artificial simulator or a live pig (Sus scrofa domestica) model. Volunteers were given a postlecture and postskills training assessment of self-efficacy. Twenty-seven volunteers that initially performed artificial simulator training subsequently underwent live animal training and provided assessments comparing both modalities. The results were first, postskills training self-efficacy scores were significantly higher than postlecture scores for either training mode and for all procedures (p < 0.0001). Second, post-training self-efficacy scores were not statistically different between live animal and artificial simulator training for diagnostic peritoneal lavage (p = 0.555), chest tube (p = 0.486), and cricothyroidotomy (p = 0.329). Finally, volunteers undergoing both training modalities indicated preference for live animal training (p < 0.0001). We conclude that artificial simulator and live animal training produce equivalent levels of self-efficacy after initial training, but there is a preference in using a live animal model to achieve those skills.

Ambulatory Telemedicine and Article 44 of the Emergency Life-Saving Technician's Act and Article 20 of the Medical Practitioner's Act

This paper shall discuss the legal bases for mobile telecommunications-based medical supervision in Japan and bulletin from the Ministry of Health, Labour and Welfare. According to Article 44 of the Emergency Life-Saving Technician’s Act, an emergency technician shall not perform certain emergency medical procedures unless specifically authorized to do so by a medical practitioner. Actual conditions make these requirements unwieldy to put into practice. When requested to provide medical control in response to a cell phone call inquiry from an ambulance, a medical practitioner (i.e., a licensed physician), has no choice but to allow the emergency technician to administer medical care, despite the lack of the information needed to grasp actual conditions within the ambulance. These circumstances expose medical practitioners (licensed physicians) to significant legal risks and societal ramifications.

Pre‐hospital critical care by anaesthesiologist‐staffed pre‐hospital services in Scandinavia: a prospective population‐based study

All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence and severity. This population-based, prospective study recorded activity in 16 anaesthesiologist-staffed pre-hospital services in Denmark, Finland, Norway and Sweden serving half of the Scandinavian population. We calculated population incidence of medical conditions, and the proportion of patients with severely deranged vital signs and/or receiving advanced therapy. Four thousand two hundred thirty-six alarm calls were recorded during 4 weeks. Two thousand two hundred fity-six alarms resulted in a patient encounter. The population incidence varied from 74.9 missions per 10,000 person-years (Denmark), followed by Finland with 14.6, Norway with 11, and Sweden with 5. Medical aetiology was most frequent (14.9 missions per 10,000 person-years, 95% CI: 14.2-15.8). Trauma was second (5.6 missions per 10,000 person-years, 95%CI: 5.12-6.09). Twenty-three per cent of patients had severely deranged vital functions, and advanced emergency medical procedures were performed in every four to twelve encounters (Denmark 8%, Sweden 15%, Norway 23%, and Finland 25%). The probability that the patient was physiologically deranged, received advanced medication, or procedure was 35%. Critical illness or injury occured at a rate of 25-30 per 10,000 person-years. The incidence of pre-hospital anaesthesiologist patient encounters in Scandinavia varies. Medical aetiology is most frequent. Almost one-quarter of patients presents with deranged vital functions requiring emergency measures. The Scandinavian pre-hospital population incidence of critical illness and injury is 25-30 per 10,000 person-years.

Perspective: Thorniest Issues In Healthcare

<i>Perspective:</i> Thorniest Issues In Healthcare