Emergency Medical Resources Research Articles

Analysis by data mining in the emergency medicine triage database at a Taiwanese regional hospital

“Emergency medicine” is the front line of medical service a hospital provides; also it is the department people seek medical care from immediately after an emergency happens. The statistics by the Department of Health, Executive Yuan, indicate that over years, the number of people at the emergency department has been increasing. The US has introduced and practiced the triage system in the emergency medicine in 1960, whereby to aid the emergency department in allocating the patients, to give them appropriate medical care by the fast decision of the nurses and doctors in case of the patients’ seriousness through their judgment. This study takes on the knowledge contained in the massive data of unknown characteristics in the triage database at a Taiwanese regional hospital, using the cluster analysis and the rough set theory as tools for data mining to extract, with the analysis software ROSE2 (Rough Sets Data Explorer) and through rule induction technique, the imprecise, uncertain and vague information of rules from the massive database, and builds the model that is capable of simplifying massive data while maintaining the accuracy in classifying rules. After analyzing and evaluating the knowledge obtained from relevant mining in the hospitals past medical data for the consumption of emergency medical resources, this thesis proposes suggestions as reference for the hospitals in subsequent elevation of medical quality and decrease in operative costs.

Surgery under Extreme Conditions in the Aftermath of the 2010 Haiti Earthquake: The Importance of Regional Anesthesia

The 12 January 2010 earthquake that struck Port-au-Prince, Haiti caused >200,000 deaths, thousands of injuries requiring immediate surgical interventions, and 1.5 million internally displaced survivors. The earthquake destroyed or disabled most medical facilities in the city, seriously hampering the ability to deliver immediate life- and limb-saving surgical care. A Project Medishare/University of Miami Miller School of Medicine trauma team deployed to Haiti from Miami within 24 hours of the earthquake. The team began work at a pre-existing tent facility in the United Nations (UN) compound based at the airport, where they encountered 225 critically injured patients. However, non-sterile conditions, no means to administer oxygen, the lack of surgical equipment and supplies, and no anesthetics precluded the immediate delivery of general anesthesia. Despite these limitations, resuscitative care was administered, and during the first 72 hours following the event, some amputations were performed with local anesthesia. Because of these austere conditions, an anesthesiologist, experienced and equipped to administer regional block anesthesia, was dispatched three days later to perform anesthesia for limb amputations, debridements, and wound care using single shot block anesthesia until a better equipped tent facility was established. After four weeks, the relief effort evolved into a 250-bed, multi-specialty trauma/intensive care center staffed with >200 medical, nursing, and administrative staff. Within that timeframe, the facility and its staff completed 1,000 surgeries, including spine and pediatric neurological procedures, without major complications. This experience suggests that when local emergency medical resources are completely destroyed or seriously disabled, a surgical team staffed and equipped to provide regional nerve block anesthesia and acute pain management can be dispatched rapidly to serve as a bridge to more advanced field surgical and intensive care, which takes longer to deploy and set up.

An analysis on 486 casesof pediatric pre-hospitalization rescue in Kunming

：Objective To study thecharacteristics of the pediatric pre-hospitalization rescue in kun-ming. Methods Theinformation of spectrum of disease,locus in quo,peak incidence and peak of visiting timewere retrospectively analyzed. Results There were 486 patients with pre-hospi-talizationrescue in Kunming in the year 2008. The ratio of male to female was 1.47:1. The patientsaged from 13 months to 3 years accounted for 39.30% in all the pre-hospitalization rescuecases. The major causes of disease in children with pre-hospi talization rescue werefebrile convulsion (30.45% ) .disease of digestive system (14.19% ),disease of respiratory system (13. 37% ) , afebrile convulsion (11.93% ) , and fever (10. 08% ). The majorrescue sites were from family (37. 86% ) .small town health center (21. 81% ) .publicplaces (7. 61% ). The first visiting peak was May and June,and the second was October.During the daytime,the occurrence of the pre-hospitalization rescue cases peaked at13:00,19:00 and 23:00. The peak incidence of febrile convulsion was in winter,and therespiratory and alimentary system diseases were common in summer and autumn. ConclusionThe professional instruction of pediatric emergency care personnel should focus on febrileconvulsion,digestive and respiratory system diseases. At the same time, the popularity offamily emergency is indispensable. The characteristic of pre-hospitalization rescue is animportant guidance to arrange emergency medical resources rationally.

Modelling optimal location for pre-hospital helicopter emergency medical services

BackgroundIncreasing the range and scope of early activation/auto launch helicopter emergency medical services (HEMS) may alleviate unnecessary injury mortality that disproportionately affects rural populations. To date, attempts to develop a quantitative framework for the optimal location of HEMS facilities have been absent.MethodsOur analysis used five years of critical care data from tertiary health care facilities, spatial data on origin of transport and accurate road travel time catchments for tertiary centres. A location optimization model was developed to identify where the expansion of HEMS would cover the greatest population among those currently underserved. The protocol was developed using geographic information systems (GIS) to measure populations, distances and accessibility to services.ResultsOur model determined Royal Inland Hospital (RIH) was the optimal site for an expanded HEMS – based on denominator population, distance to services and historical usage patterns.ConclusionGIS based protocols for location of emergency medical resources can provide supportive evidence for allocation decisions – especially when resources are limited. In this study, we were able to demonstrate conclusively that a logical choice exists for location of additional HEMS. This protocol could be extended to location analysis for other emergency and health services.

Life or death. The social impact of paramedics and first responders in landmine-infested villages in northern Iraq

Landmines are indiscriminate weapons that mainly injure poor populations in the developing world. Pre-hospital treatment by village-based paramedics and first responders has reduced mortality, but little is known about the social impact of paramedic and first responder training in villages. The aim of this study was to understand how villagers in socially deprived, mine-infested villages experience the establishment of paramedic and first responder chains of survival. The study used focus-group interviews conducted in four villages in northern Iraq, to explore villagers' perceptions of the impact of paramedic and first responder training. The material was analyzed using grounded theory, with the main category identified entitled 'life or death', with three subcategories: 'living on the edge', 'demanding equal rights', and 'adapting to new needs'. The paramedics were perceived by the villagers as having a large impact on the social life of the village, first as an emergency medical resource, and also as a prerequisite for the villages' continued existence. The system represented one of the few services offered by outside society to villages that lacked health care, schools, electricity, roads, and clean water. Despite an improved economic situation in the larger society, conditions in the villages had deteriorated. Although originally intended as an emergency care system for land mine victims, the system was adapted to include the role of a general medical resource in the villages. This adaptation was perceived as useful by the villagers, and necessary for their continued trust in the system. A prerequisite for this adaptation was that the program coordinator was a villager himself, and that the program deviated from its originally fixed time period. This flexibility depended on very close cooperation between expatriate and local program managers. Our findings indicate that the paramedic system made a wider impact than just the provision of emergency health care. The program earned trust through a strong local anchor, and by adapting to the needs of the population served.

Hospital-Based Event Medical Support for the Baltimore Marathon, 2002−2005

Objectives. We present a four-year, cross-sectional epidemiologic description of injuries andillnesses among Baltimore Marathon participants andthe evaluation, treatment, anddisposition of those conditions by an on-site event medical team led by physicians andstaff from an urban, academic emergency department. Methods.We analyzed data from injuries encountered during the marathon. Subjects presenting to a medical aid station along the course route or at the finish line were defined as “injured or ill” andwere prospectively divided into two groups: 1) a brief-encounter group and2) an extended-encounter group. Data collected included gender, presenting complaint(s), assessment, treatment(s), anddisposition. Results.Three percent (N = 1,144) of approximately 33,700 total participants over four years presented to medical aid stations during the Baltimore Marathon between 2002 and2005. Most participants (66%) did not require a full clinical evaluation. Common complaints encountered were dehydration (32%), musculoskeletal injuries (25%), andcutaneous wounds (20%). Transport to the hospital was required for 4% of all injured participants, and61% returned to the race. Conclusions.Most injuries/illnesses encountered at the Baltimore Marathon in 2002–2005 were minor, although some were serious enough to require transport to a hospital. The year with the highest average race-day temperature had the highest observed injury rates andthe highest number of hospital transports. These results help to improve understanding of the types, severity, anddistribution of injuries commonly sustained by marathon participants andmay guide decisions regarding the appropriate distribution of emergency medical resources at such events.

Suburban sprawl: Where does emergency medicine fit on the map?

The built environments of the American suburbs stretch out from cities resembling “the end of a Scrabble game,” but these spacious suburban dreamscapes create havoc for emergency care. In some sense, the scattered environs and the high-speed arteries that connect them created the specialty of emergency medicine and laid the groundwork for emergency medical services. The landmark 1966 National Academy of Science’s report Accidental Death and Disability: The Neglected Disease of Modern Society was largely in response to automobile accidents and the then-nonexistent emergency care system. The notion was reinforced in 2006’s Institute of Medicine report titled The Future of Emergency Care in the United States Health Care System, which criticized the stillfragmented nature of trauma care.

Hospital-based healthcare provider (nurse and physician) integration into an emergency medical services–managed mass-gathering event

Introduction This report describes not only the implementation of a coordinated emergency medical services–hospital–based healthcare team but also investigates the integration of nurse-physician teams at a mass gathering medical care event. Methods A review of resource utilization, patient encounters, and local ED census was performed during this period at a college football stadium. Results During this 4-year period, 1681 patients presented for medical care during 26 events with a total attendance of 1 544 244 (1.09 patients per thousand attendees [PT]). The majority of patient contacts were for minor complaints (1451, 87.6%), whereas 205 (12.4%) received full evaluations (focused history and physical examination most often with pulse oximetric and electrocardiographic monitoring). A total of 109 patients were transported (4.19 PT), representing 6.48% of all patients. Patient census for the event medical deployment increased from 0.44 PT in 2001 to 1.75 PT in 2004. The number and percent of patients transported also increased between 2001 (0.02 PT, 4.48%) and 2004 (0.12 PT, 6.67%). However, 118 (57.6%) patients who received full evaluations were able to be discharged by a physician, avoiding transport. Chief complaints and management of patients receiving full evaluations were consistent across this period, with altered mental status (52.7%) and chest pain (12.7%) as the most common complaints. Average ED census during this period was found to be significantly higher on event days (176.2) than nonevent days (161.2) ( t = 8.04, P < .001), although this produced only a minor impact on the emergent care system. Conclusion This study describes one potential deployment plan for a mass gathering medical event and suggests that the incorporation of physicians into a mass gathering setting may be associated with an absolute increase in patient census and transports, while decreasing the percent of patients transported. The impact on local emergency medical services and ED resources, although not specifically investigated in this study, was likely minimal.

Impact of the San Diego Serial Inebriate Program on Use of Emergency Medical Resources

We determine the impact of a treatment strategy called the San Diego Serial Inebriate Program on the use of emergency medical services (EMS) and emergency department (ED) and inpatient services by individuals repeatedly arrested for public intoxication. This was a retrospective review of health care utilization records (EMS, ED, and inpatient) of 529 individuals from 2000 to 2003. Judges offered individuals a 6-month outpatient treatment program in lieu of custody (Serial Inebriate Program). Demographics and health care utilization are reported overall and by treatment acceptance. From 2000 to 2003, 308 of 529 (58%) individuals were transported by EMS 2,335 times; 409 of 529 (77%) individuals amassed 3,318 ED visits, and 217 of 529 (41%) individuals required 652 admissions, resulting in 3,361 inpatient days. Health care charges totaled $17.7 million (EMS, $1.3 million; ED, $2.5 million; and inpatient, $13.9 million). Treatment was offered to 268 individuals, and 156 (58%) accepted. Use of EMS, ED, and inpatient services declined by 50% for clients who chose treatment, resulting in an estimated decrease in total monthly average charges of $5,662 (EMS), $12,006 (ED), and $55,684 (inpatient). There was no change in use of services for individuals who refused treatment. There was a significant increasing trend in acceptance among individuals with longer jail sentences (<0.001). Treatment acceptance was 20% among those with sentences of 0 to 30 days and reached 63% for those with sentences longer than 150 days. Operational costs and alternate care at clinics and nonparticipating hospitals were not analyzed. This community-supported treatment strategy reduced the use of EMS, ED, and inpatient resources by individuals repeatedly intoxicated in public.

Comparison of Termination-of-Resuscitation Guidelines for Basic Life Support: Defibrillator Providers in Out-of-Hospital Cardiac Arrest

Termination of resuscitation in the field for out-of-hospital cardiac arrest can reduce unnecessary transport to hospital and associated road hazards and increase availability of emergency medical services (EMS) and emergency department resources for other patients. We compare the performance of 3 termination-of-resuscitation guidelines for basic life support-defibrillator (BLS) providers when applied to cardiac arrest patients in the Ontario Prehospital Advanced Life Support study. This prospective cohort study involved all out-of-hospital cardiac arrest patients attended by BLS defibrillator providers in 21 Ontario urban or suburban communities. The data analyses were conducted secondarily on these prospectively collected data. Three termination-of-resuscitation guidelines (referred to as Marsden, Petrie, and Verbeek rules) were applied and contingency tables calculated to show the relationship between the rule and actual survival. From 1988 to 2003, 13,684 cardiac arrest patients were attended by BLS defibrillator providers. Six hundred thirty-six (4.7%) patients survived to hospital discharge. For the 3 termination-of-resuscitation rules, sensitivity was 99.8% (95% confidence interval [CI] 99.5% to 100.0%) (Petrie rules), 99.5% (95% CI 99.0% to 100.0%) (Verbeek rules), and 99.8% (95% CI 99.5% to 100.0%) (Marsden rules). Specificity was 9.9% (95% CI 9.4% to 10.4%) (Petrie rules), 52.9% (95% CI 52.1% to 53.8%) (Verbeek rules), and 19.4 % (95% CI 18.8% to 20.1%) (Marsden rules). Negative predictive value was 99.9% (95% CI 99.8% to 100.0%) (Petrie rules), 100.0% (95% CI 99.9% to 100.0%) (Verbeek rules), and 100.0% (95% CI 99.9% to 100.0%) (Marsden rules). These rules would have resulted in field termination of resuscitation in 9.4% (Petrie rules), 50.5% (Verbeek rules), and 18.5 % (Marsden rules) of cases. Termination of resuscitation was recommended for 1 patient (Petrie rules), 3 patients (Verbeek rules), and 1 patient (Marsden rules), who survived. We found all 3 termination-of-resuscitation rules to have high sensitivity and negative predictive value. However, the specificity and transport rates varied greatly. The results of this study will be useful for EMS providers considering adoption of termination of resuscitation in BLS defibrillator systems for out-of-hospital cardiac arrest.

Public health issues in disasters

This article outlines a number of important areas in which public health can contribute to making overall disaster management more effective. This article discusses health effects of some of the more important sudden impact natural disasters and potential future threats (e.g., intentional or deliberately released biologic agents) and outlines the requirements for effective emergency medical and public health response to these events. All natural disasters are unique in that each affected region of the world has different social, economic, and health backgrounds. Some similarities exist, however, among the health effects of different natural disasters, which if recognized, can ensure that health and emergency medical relief and limited resources are well managed.

Development of a Web-based Emergency Medical Information Service Program for Health Promotion

BACKGROUND: Demand for emergency medical information is high according to the health information use, utilization and demand survey for on the Internet. In spite of high demand for emergency information service, emergency information service on-line and off-line are very limited. Therefore, it is necessary to develop a website providing emergency medical information and emergency medical resources information by linking emergency medicine where timely information is required with the Internet technology for health promotion of the public. OBJECTIVE: This study is conducted to develop and evaluate a Web site to provide information on emergency medicine and resources for health promotion. METHODS: To identify and specify users' requirements for the emergency medicine related information, online survey was performed for 209 Internet users who visited the Healthguide. Based on this survey results, we developed content for emergency medical information service: cause, risk factors, prevention, treatment, facilities, laws and rules, policy and statistics of emergency medicine. To evaluate the web site developed in this study, twenty health and nursing informatics experts were recruited and asked to rate using an evaluation tool. RESULTS: This content was integrated into the healthy life (http://healthguide.kihasa.re.kr/health_life/emergency/pages/index.html), which is a service component of the Healthguide. This approach was expected to increase accessibility and usability of implemented services. The rating score of the website was fairly high with mean 3.9(SD 0.6) out of 5.0. According to each evaluation criteria, purpose of the site, easiness of use, relevancy, and reliability were scored 4.1-4.2 and authority and accuracy 3.8-3.9 and currency 3.5-3.7. This evaluation results will be fed back to the Healthguide for operation, maintenance, and upgrade in the future.

Oropharyngeal Hymenoptera Stings: A Special Concern for Airway Obstruction

Hymenoptera stings are common and cause 40 to 50 deaths each year. Hymenoptera venom contains a variety of toxic and allergenic substances that can produce many types of both local and systemic reactions. Of these, anaphylaxis is the most feared and the most common cause of sting-related deaths. Oropharyngeal stings, although rare, have the added potential to produce life-threatening airway obstruction via localized swelling. This threat is of particular concern to military personnel who operate in environments where stings are more likely to occur and where emergency medical resources are limited or lacking. This risk can be minimized if such victims are treated early and aggressively, even though they may initially present with minimal symptoms.

The Public Health Consequences of Disasters

Although disasters have exacted a heavy toll of death and suffering, the future seems more frightening. Good disaster management must link data collection and analysis to the decision-making process. The overall objectives of disaster management from the viewpoint of public health are: 1) needs assessments; 2) matching available resources with defined needs; 3) prevention of further adverse health effects; 4) implementation of disease-control strategies; 5) evaluation of the effectiveness of the application of these strategies; and 6) improvement in contingency planning for future disasters. The effects of sudden-onset, natural disasters on humans are quantifiable. Knowledge of the epidemiology of deaths, injuries, and illnesses is essential to determine effective responses; provide public education; establish priorities, planning, and training. In addition, the temporal patterns for the medical care required must be established so that the needs in future disasters can be anticipated. This article discusses: 1) the nature of disasters due to sudden-onset, natural events; 2) the medical and health needs associated with such events and disasters; 3) practical issues of disaster responses; and 4) the advance organization and management of disasters. The discussion also includes: 1) discussions of past problems in disaster management including non-congruence between available supplies and the actual needs of the affected population; 2) information management; 3) needs assessments; 4) public health surveillance; and 5) linking information with decision-making. This discussion is followed by an analysis of what currently is known about the health-care needs during some specific types of sudden-onset, natural disasters: 1) floods; 2) tropical cyclones; 3) tornadoes; 4) volcanic eruptions; and 5) earthquakes. The article concludes with descriptions of some specific public-health problems associated with disasters including epidemics and disposition of corpses. All natural disasters are unique in that the regions affected have different social, economic, and health backgrounds. But, many similarities exist, and knowledge about these can ensure that the health and emergency medical relief and limited resources are well-managed.

Use of emergency departments by elderly patients: Projections from a multicenter data base

To assess the use of emergency medical care by the elderly in the United States, including emergency department visits, level of ED care required, ambulance services, and hospital admission rate. A multicenter computerized data base of 70 hospitals in 25 states. A retrospective review of elderly patients seeking ED care and comparison of elderly and nonelderly patients. The data were then used to estimate the use of emergency medical services nationally. Fifteen percent of the 1,193,743 ED visits were made by patients 65 years or older. Thirty-two percent of elderly patients seen in EDs were admitted to the hospital, compared with 7.5% of nonelderly patients. Seven percent of elderly patients were admitted to ICUs, compared with 1% of nonelderly patients. Thirty percent of elderly patients seeking emergency care used ambulance transports compared with 8% of nonelderly. It is estimated that 13,693,400 elderly patients were seen in EDs in 1990, with more than 4 million patients admitted to hospitals. Compared with the nonelderly, the elderly are 4.4 times more likely to use ambulance transport, 5.6 times more likely to be admitted to the hospital, 5.5 times more likely to be admitted to an intensive care bed, and 6.1 times more likely to be classified as a comprehensive ED level of service. In our sample, 36% of all patients arriving by ambulance to the ED, 43% of all ED admissions, and 48% of all intensive care admissions were geriatric patients. With the rapid growth of the size of the elderly population, it is important that we assess the emergency medical resources needed to care for the geriatric population.

Indices of Severity for Emergency Medical Evaluative Studies: Reliability, Validity, and Data Requirements

Indices of severity, that is, numerical ratings denoting the probability of mortality or morbidity resulting from a critical illness or injury, are important research, programmatic, and clinical tools. They are essential techniques for making screening decisions in the pre-hospital and emergency department arenas, describing the impact of environmental hazards, allocating and evaluating emergency medical resources, and assessing the effectiveness of emergency care. In view of these important roles, such indices should meet minimal standards of methodologic rigor. Three sets of methodologic requirements—reliability, validity, and data requirements—are suggested and used to evaluate the methodologic adequacy of 16 commonly used severity indices. In general, the indices were found to depend on clinically subjective judgments, lacked clear or objective definitions, and offered little evidence that they could be used reliably. While all correlated with mortality, few had a documented ability to predict morbidity. Most indices had not been validated prospectively and retrospectively, nor been tested in different settings. Thus, they may be substantially contaminated by the idiosyncratic patient mix in the facility and series used for scale development, and not generalizable as a severity measure to other populations. Only five of the 16 indices met even minimal methodologic criteria. It is likely, therefore, that the methodologic basis of most existing and commonly used indices of severity is insufficient to support the heavy burden of their current usage. It is concluded that a single severity index is neither desirable nor possible, and recommendations are made for future developmental work for multiple indices each predicting separate outcomes within different time slices with varying information needs and differential predictive capacities.