Medical Emergency Care Research Articles

A study of knowledge, attitude and practice of hospital consultants, resident doctors and private practitioners with regard to pre-hospital and emergency care in Lucknow

Burden of death and disability resulting from lack of emergency medical system (EMS) and emergency care is very high in low and middle income countries (LMIC). To study the knowledge, attitudes and practices of pre-hospital care and emergency services among health care providers of Lucknow Cross-sectional survey, 200 residents, 104 hospital consultants and 108 private practitioners A close ended, self administered questionnaire based on 5-point Likert scale with 30 items of knowledge, attitude and practice of pre-hospital and emergency care Median scores of knowledge (26/50), attitude (41/50) and practices (27/50) showed less than adequate knowledge and practices. However, a positive attitude was seen in all the 3 group of respondents i.e. resident doctors, hospital consultants and private practitioners. Lucknow is the capital city of Indian largest state - Uttar Pradesh with over 100 years of established medical education. The results of the study in this town are applicable to most developed cities in India. Lack of adequate knowledge and practices in emergency medical system (EMS) at Lucknow represent a dismal situation and require continuing medical education in this area.

The epidemiology of traumatic brain injuries (TBI) – a literature review

A search of the literature showed limited reported research on the epidemiology of TBI in South Africa. This prompted a search of literature on the epidemiology of TBI in the rest of the world. Traumatic brain injury (TBI) is a leading cause of death and disability in most western countries. Motor vehicle accidents (MVA) are the main cause of TBI, followed by gunshot wounds (GSW) and falls. In South Africa, road accident fatalities are 27,3 per 100 000 of the population. The causes of death and disability vary with age, race and gender groups. Improved medical emergency care has resulted in a decrease in the mortality rate following TBI, but has increased the morbidity rate. The increase in the number of people living with neurological impairments is a significant economic burden when taking into account hospitalization, rehabilitation, medication and the loss of working hours. The emotional burden is unknown. The purpose of this paper is to place in perspective, the epidemiology of TBI, by looking at the published literature in the rest of the world. In the developing world it is projected that the burden of disease resulting from interpersonal violence will nearly double by 2020 unless preventive action is taken. Many more people survive acts of interpersonal violence than die from them.

Emergency medical service systems in Japan: Past, present, and future

Emergency medical services are provided by the fire defence headquarters of the local government in Japan. There is a one-tiered EMS system. Ambulances are staffed by three crew members trained in rescue, stabilisation, transport, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class One, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergency Life Saving Technician, ELST). ELSTs are trained in all aspects of BLS and some ALS procedures relevant to pre-hospital emergency care. Further development of an effective medical control system is imperative as the activities of ambulance crews become more sophisticated. A marked recent increase in the volume of emergency calls is another issue of concern. Currently, private services for transportation of non-acute or minor injury/illness have been introduced in some areas, and dispatch protocols to triage 119 calls are being developed.

Impact of specialist care on clinical outcomes for medical emergencies

General hospitals have commonly involved a wide range of medical specialists in the care of unselected medical emergency admissions. In 1999, the Royal Liverpool University Hospital, a 915-bed hospital with a busy emergency service, changed its system of care for medical emergencies to allow early placement of admitted patients under the care of the most appropriate specialist team, with interim care provided by specialist acute physicians on an acute medicine unit - a system we have termed 'specialty triage'. Here we describe a retrospective study in which all 133,509 emergency medical admissions from February 1995 to January 2003 were analysed by time-series analysis with correction for the underlying downward trend from 1995 to 2003. This showed that the implementation of specialty triage in May 1999 was associated with a subsequent additional reduction in the mortality of the under-65 age group by 0.64% (95% CI 0.11 to 1.17%; P=0.021) from the 2.4% mortality rate prior to specialty triage, equivalent to approximately 51 fewer deaths per year. No significant effect was seen for those over 65 or all age groups together when corrected for the underlying trend. Length of stay and readmission rates showed a consistent downward trend that was not significantly affected by specialty triage. The data suggest that appropriate specialist management improves outcomes for medical emergencies, particularly amongst younger patients.

¿Cómo aumentar la implicación del paciente de urgencias en su tratamiento?: eficacia de unos pósters informativos

To determine whether posters/leaflets increase doctors' information on the allergies and on the medication their patients are taking and patients' understanding of their treatment. First stage: multi-centre transversal descriptive study. Second stage: intervention with control and without randomisation. Primary care medical emergency services (MES). MES patients under prescribed drug treatment. Use of posters/leaflets. 1) Proportion of patients for whom the doctor was ignorant of allergies to drugs or of accompanying medication. 2) Proportion of prescriptions in which patients understood the dosage of the medication prescribed. ad hoc questionnaire to patients. chi2 test (category variables). In some cases, the Breslow-Day and Tarone tests were conducted. Total patients included, 1233; 1766 prescriptions analysed; 53.4% women. Mean age: 29+/-18 years old. 1) Doctor's understanding of accompanying medication: at the second stage, drop of 25.5% (95% CI, 33.5-17.5) for intervention group versus drop of 12.5% (95% CI, 19.8-5.2) for control group, in the number of patients for whom the doctor did not know the medication (P=.024). 2) Patient's understanding of dosage: at the second stage, increase of 16.8% (95% CI, 9.8-23.8) for intervention group, versus a decrease of 1% in control group, in the medicines whose dosage the patient was aware of (P<.001). The dissemination of posters/leaflets was effective in increasing patients' knowledge of their medication's dosage and doctors' understanding of questions affecting prescription.

Les maisons médicales de garde en France

The objective of this article is to take inventory of the different medical emergency care units in France as of June 30, 2003, and to describe their main characteristics. A telephone survey was conducted which posed questions based on a standard questionnaire to the Regional Unions of Liberal Doctors, the County Advisory Boards of the Medical Orders, and the directors and managers of the existing emergency care units. 97 medical safe houses were inventoried, 46 of which were operational and 51 which were in development. The Ile-de-France region is the region with the highest concentration of these units either operating or under construction. A large majority of the emergency care units were created since the year 2000, and half of them are located within health care centres and the other half into separate cells either close or distant from existing health care centres. More than half of them have no other staff aside from doctors, whilst the others comprise a spectrum of personnel including secretaries, nurses, and social assistants amongst others. More than half of the doctors are paid at the cost of each consultation and per treatment and do not have a technical platform at their disposal. Usually, these emergency care units are open all night during the week and on the weekends. One-third of them collaborate with the emergency centre and ambulance service (those who respond to calls to 15) and three-quarters of them are funded by the city's Assistance Fund for the Quality of Care. It would seem advantageous that a Charter for operation and management of these establishments be drafted and implemented in order standardise these types of structures and that their supervisors implement a national and regional follow-up mechanism for the establishments in order to better evaluate the evolution in terms of health care organisation, in particular with respect to raising the level and capacity of response.

Insufficient quality of research on prehospital medical emergency care--where are the major problems and solutions?

It is still unclear today whether a few minutes more or less spent in prehospital medical emergency care have a positive effect on a range of outcome variables. Modern emergency medical services (EMS) systems are expensive and have been introduced all over the industrialized world. Yet their effectiveness and efficiency are supported by scant scientific evidence. This is why research into EMS systems is urgently needed. There are significant differences between the approach to EMS research and traditional clinical research. New methodological approaches, such as system-orientated research and risk-adjustment measurements, must be further developed. The implementation of randomized controlled trials (RCTs) in the prehospital setting is often very difficult and not always possible or suitable. Valid alternatives to RCTs exist and should be further developed. Epidemiologists would be of assistance here. Agreement on clear definitions, standard data elements and validated severity scoring for trauma and non-trauma conditions, as well as their validation and routine use throughout the world are urgently needed. Clarifying many questions with regard to EMS systems cannot be left to chance. An internationally recognized research agenda with prioritisation and adaptation to regional requirements would be of great assistance here. Finally, reliable research in Switzerland into EMS enabling relevant decisions will hardly be possible without financial support from the Swiss National Fund and other institutions. Furthermore, it would be inappropriate to decrease the current standard of prehospital care we offer in the short term in order to save money as long as we have no reliable results that indicate that we should. This would also render impossible the very research into this sector that is urgently needed.

Insufficient quality of research on prehospital medical emergency care--where are the major problems and solutions?

It is still unclear today whether a few minutes more or less spent in prehospital medical emergency care have a positive effect on a range of outcome variables. Modern emergency medical services (EMS) systems are expensive and have been introduced all over the industrialized world. Yet their effectiveness and efficiency are supported by scant scientific evidence. This is why research into EMS systems is urgently needed. There are significant differences between the approach to EMS research and traditional clinical research. New methodological approaches, such as system-orientated research and risk-adjustment measurements, must be further developed. The implementation of randomized controlled trials (RCTs) in the prehospital setting is often very difficult and not always possible or suitable. Valid alternatives to RCTs exist and should be further developed. Epidemiologists would be of assistance here. Agreement on clear definitions, standard data elements and validated severity scoring for trauma and non-trauma conditions, as well as their validation and routine use throughout the world are urgently needed. Clarifying many questions with regard to EMS systems cannot be left to chance. An internationally recognized research agenda with prioritisation and adaptation to regional requirements would be of great assistance here. Finally, reliable research in Switzerland into EMS enabling relevant decisions will hardly be possible without financial support from the Swiss National Fund and other institutions. Furthermore, it would be inappropriate to decrease the current standard of prehospital care we offer in the short term in order to save money as long as we have no reliable results that indicate that we should. This would also render impossible the very research into this sector that is urgently needed.

Teaching consultants airway management skills.

Airway management skills are integral to the practice of anaesthesiology and also to the practice of emergency medicine and allied health professions such as respiratory care, emergency medical technology, and emergency and critical care nursing. The basic information to be taught is the same but the level of detail will vary depending on the audience. The learning process usually involves progression from didactic lessons to skills training on inanimate models to supervised clinical practice. Modalities that may be used for skills training include cadavers, recently dead patients, videotapes, mannequins, simulators and virtual reality trainers. To maintain knowledge and skills, review and possible retraining should be conducted on an approximately annual basis.

山口大学先進救急医療センターにおける血管疾患症例の検討

【目的】 当センター開設以来経験した, 血管疾患症例の現況について検討した.【対象と方法】 2000年1月1日から2003年12月31日の期間に当センターで経験した血管疾患113例を対象とした. 内訳は, 急性大動脈解離, 破裂性胸部・胸腹部大動脈瘤, 破裂性腹部大動脈瘤, 急性四肢動脈閉塞症およびその他として感染性胸部下行大動脈穿孔と深部静脈血栓症であった. 検討項目は, センター入室患者の内訳, 年次症例数の推移, 年齢, 性別, センター入室経路, 地域別内訳, 治療方法および転帰とした.【結果】 血管疾患は全センター入室症例の4.4%を占めた. 年次症例数は増加しており, 現在年間約30例の患者を受け入れている. センター入室経路は病院間搬送96例, 救急搬送17例で, 宇部市からの搬送が半数を占めた. 治療方法は, 手術65例, 保存的治療36例, 蘇生術12例であった. 各疾患別には, 急性大動脈解離 (Stanford type A) は手術28例, 保存的治療6例, 蘇生術6例, 急性大動脈解離 (Stanford type B) は手術4例, 保存的治療23例, 破裂性胸部・胸腹部大動脈瘤は手術5例, 保存的治療4例, 蘇生術3例, 破裂性腹部大動脈瘤は手術17例, 保存的治療3例, 蘇生術3例, 急性四肢動脈閉塞症とその他の2症例はいずれも手術が施行された. 転帰は, 生存93例, 死亡20例であった. 各疾患別には, 急性大動脈解離 (Stanford type A) は生存33例, 死亡7例, 急性大動脈解離 (Stanford type B) は生存24例, 死亡3例, 破裂性胸部・胸腹部大動脈瘤は生存9例, 死亡3例, 破裂性腹部大動脈瘤は生存17例, 死亡6例, 急性四肢動脈閉塞症は生存8例, 死亡1例, その他の2症例はいずれも生存した.【結語】 地域性により症例数は決して多いとはいえないが, 心臓血管外科医と救急医の連携により良好な治療成績が得られた.

Strategy for Developing a Hospital Affiliated Ambulatory Care Medical Emergency Response Team

Health care facilities should reassess their resuscitation team response strategies in light of the shift in care from inpatient to outpatient facilities. This article discusses a strategy for assessing a health care facility's resuscitation needs globally, including a detailed analysis of the physical layout, population requiring coverage, personnel, and equipment. Resuscitation system design is reviewed, with particular emphasis on training, equipment, process variables, administration, cost, and quality improvement. Widespread training of nurse-first responders in the use of automated external defibrillators along with an in-hospital or community emergency medical services advanced life-support response is a cost-effective way of providing tiered coverage to remote outpatient facilities or satellite units.

Current and future applications of mobile and wireless networks

Wireless and mobile networks are being used in diverse areas such as travel, education, stock trading, military, package delivery, disaster recovery, and medical emergency care.

The training of pediatric residents in the care of acutely ill and injured children.

To describe the current educational experience of pediatric residents in pediatric emergency care, to identify areas of variability between residency programs, and to distinguish areas in need of further improvement. A 63-item survey mailed to all accredited pediatric residency training program directors in the United States and Puerto Rico. Pediatric residency programs and their directors. Primary training settings, required and elective rotations related to the care of the acutely ill and injured child, supervision of care, procedural and technical training, and didactic curriculum in pediatric emergency medicine (PEM). One hundred fifty-three (72%) of 213 residency programs responded. One hundred nine (71%) were based at general or university hospitals, the remaining 44 (29%) were based at freestanding children's hospitals. Residents most commonly saw patients in pediatric emergency departments (54%), followed by acute care clinics (21%), general emergency departments (21%), and urgent care clinics (5%). The mean number of weeks of PEM training required was 11, but varied widely from 0 to 36 weeks. Forty programs (27%) required their residents to spend 4 or fewer weeks rotating in an emergency department setting. The best predictor of the number of weeks spent in emergency medicine was residency program size, with small programs requiring fewer weeks (7 weeks for small [1-8 postgraduate year 1 residents] vs 13 for medium [9-17 postgraduate year 1 residents] vs 15 for large [> or =18 postgraduate year 1 residents]). Pediatric surgery (18%), orthopedic (8%), anesthesia (6%), and toxicology (4%) rotations were rarely required. Ninety-two percent of the programs had 24-hour on-site attending physician coverage of the emergency department. Supervising physicians varied widely in their training and included PEM attendings and fellows, general emergency medicine attendings, and general pediatric attendings. Small programs were less likely to have PEM coverage (57% at small vs 95% at large) and more likely to have general emergency medicine coverage (79% at small vs 29% at large). Reported opportunities to perform procedures were uniformly high and did not differ by program size or affiliated fellowship. Residency program directors were uniformly confident in their residents' training in medical resuscitation, critical care, emergency care, airway management, and minor trauma. Thirty-seven percent of all respondents were not confident in their residents' training in major trauma. Most programs reported that they had a didactic PEM curriculum (77%), although the number of hours devoted to the lectures varied substantially. Wide variability exists in the amount of time devoted to emergency medicine within pediatric residency training curricula and in the training background of attendings used to supervise patient care and resident education. Nevertheless, pediatric residency training programs directors feel confident in their residents training in most topics related to PEM. Residents' training in major trauma resuscitation was the most frequently cited deficiency.

Evaluation of a transit first-aid station providing emergency care to former Yugoslavian war victims evacuated in Ancona, Italy.

A first-aid station was implemented in Falconara Marittima airport (Ancona, Italy). It provided medical emergency care to war victims evacuated from former Yugoslavia in transit for further treatment. A descriptive analysis of the displaced population arriving at the first-aid station was performed using three independent datasets for administrative information, of which one included medical information. The implemented resources were also evaluated. From August 1993 to March 1995, 2272 displaced persons were registered at the first-aid station, out of which 54.2% were accompanying family members. Among those needing medical intervention (45.8% of total), most frequent diagnoses were traumatisms and burns (59.8%), neoplasms (15.6%), and congenital malformations (13.2%). The medical care provided at the first-aid station was most often basic: a medical examination alone was performed on 77.0% of the patients, and a minor dressing on 17.3%. Median length of stay was 1 day. Patients were sent to 30 different countries and 8% were forwarded to the local regional hospital. Deployed logistical resources exceeded by far actual needs but a lack of psychological assistance was observed, mainly for children. The agencies involved did not coordinate data sharing and follow-up information. The medical assistance to the war victims was efficient regarding provided care and timeliness. Effectiveness of such a programme could be improved by a better coordination between partners, allowing more adequate logistics according to appropriate epidemiological information.

Risk Management in the Care of Medical Emergencies after Admission to Hospital

Risk Management in the Care of Medical Emergencies after Admission to Hospital

THE TRAINING OF PEDIATRIC RESIDENTS IN THE CARE OF ACUTELY ILL AND INJURED CHILDREN

Objectives To describe the current educational experience of pediatric residents in pediatric emergency care, to identify areas of variability between residency programs, and to distinguish areas in need of further improvement. Design A 63-item survey mailed to all accredited pediatric residency training program directors in the United States and Puerto Rico. Setting and Participants Pediatric residency programs and their directors. Main Outcome Measures Primary training settings, required and elective rotations related to the care of the acutely ill and injured child, supervision of care, procedural and technical training, and didactic curriculum in pediatric emergency medicine (PEM). Results One hundred fifty-three (72%) of 213 residency programs responded. One hundred nine (71%) were based at general or university hospitals, the remaining 44 (29%) were based at freestanding children's hospitals. Residents most commonly saw patients in pediatric emergency departments (54%), followed by acute care clinics (21%), general emergency departments (21%), and urgent care clinics (5%). The mean number of weeks of PEM training required was 11, but varied widely from 0 to 36 weeks. Forty programs (27%) required their residents to spend 4 or fewer weeks rotating in an emergency department setting. The best predictor of the number of weeks spent in emergency medicine was residency program size, with small programs requiring fewer weeks (7 weeks for small [1-8 postgraduate year 1 residents] vs 13 for medium [9-17 postgraduate year 1 residents] vs 15 for large [≥18 postgraduate year 1 residents]). Pediatric surgery (18%), orthopedic (8%), anesthesia (6%), and toxicology (4%) rotations were rarely required. Ninety-two percent of the programs had 24-hour on-site attending physician coverage of the emergency department. Supervising physicians varied widely in their training and included PEM attendings and fellows, general emergency medicine attendings, and general pediatric attendings. Small programs were less likely to have PEM coverage (57% at small vs 95% at large) and more likely to have general emergency medicine coverage (79% at small vs 29% at large). Reported opportunities to perform procedures were uniformly high and did not differ by program size or affiliated fellowship. Residency program directors were uniformly confident in their residents' training in medical resuscitation, critical care, emergency care, airway management, and minor trauma. Thirty-seven percent of all respondents were not confident in their residents' training in major trauma. Most programs reported that they had a didactic PEM curriculum (77%), although the number of hours devoted to the lectures varied substantially. Conclusions Wide variability exists in the amount of time devoted to emergency medicine within pediatric residency training curricula and in the training background of attendings used to supervise patient care and resident education. Nevertheless, pediatric residency training programs directors feel confident in their residents training in most topics related to PEM. Residents' training in major trauma resuscitation was the most frequently cited deficiency.

CONGRESSIONAL OUTLOOK '93

Anew year. A new Administration. A new Congress. Congressional Democrats are elated at the prospect of having a President of their own party living at the other end of Pennsylvania Avenue—but after having acted as the opposition for the past 12 years they may have difficulty remembering how to cooperate with the White House. Although Congress' Democratic leaders—House Speaker Thomas S. Foley of Washington and Senate majority leader George J. Mitchell of Maine—have promised to do all they can to speed Clinton's legislative agenda through Congress, they also have agendas of their own. High on their agenda is legislation that would require employers to grant unpaid leave to workers taking care of new babies or family medical emergencies. Mitchell also gives top priority to the enactment of an authorization bill for the National Institutes of Health (NIH) that includes a provision lifting the ban on fetal-tissue research. Both are items that President Bush repeatedly ...

Medical planning and emergency care in radiation accidents

Emergency MedicineVolume 3, Issue s1 p. 136-148 Medical planning and emergency care in radiation accidents JOHN L HOLMES, JOHN L HOLMES Staff Specialist Emergency Medicine, Royal Brisbane Hospital, Hrisbane QLD 4029Search for more papers by this authorPAUL D MARK, PAUL D MARK Staff Specialist Emergency Medicine, Fremantle Hospital, Fremantle WA 6160Search for more papers by this author JOHN L HOLMES, JOHN L HOLMES Staff Specialist Emergency Medicine, Royal Brisbane Hospital, Hrisbane QLD 4029Search for more papers by this authorPAUL D MARK, PAUL D MARK Staff Specialist Emergency Medicine, Fremantle Hospital, Fremantle WA 6160Search for more papers by this author First published: September 1991 https://doi.org/10.1111/j.1442-2026.1991.tb00297.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume3, Issues1September 1991Pages 136-148 RelatedInformation

In-flight Medical Emergencies-Reply

In Reply. — Nicoll and Edge raise critical issues about in-flight medical emergencies. These issues have received attention in both medical 1-3 and lay publications ( Los Angeles Times , April 1, 1988, View Section, D, pp 1-2; and New York Times , Oct 9, 1988, Section XX, p 3). Actual death during air travel is extremely rare, approximately one death per 3.2 million passengers. 4 How often do severe emergencies, as described by Nicoll and Edge, occur? What can be done to assist extremely ill patients during flight? Who bears responsibility for the care of in-flight medical emergencies? Airline officials claim that in-flight emergencies and deaths seldom occur. If they do, emergency help can be obtained within 30 minutes by a priority landing. On long, overseas flights, physicians usually are available ( Los Angeles Times , April 1,1988, View Section, D, pp 1-2; and New York Times , Oct 9, 1988, Section XX, p 3).

Ambulance service and how we can improve it.

To the Editor.— On April 1, 1973, an evening news telecast showed the ambulance system in Russia. Russians have three different types of ambulances: (1) to manage cardiac emergencies; (2) to treat drug overdosage and poisoning; and (3) to take care of other medical and surgical emergencies. Most of their calls are entertained by qualified physicians and registered nurses. A properly equipped ambulance is sent to the site of the emergency with a physician and two nurses who start treatment immediately and then move the patient to the hospital. Each year in the United States, about 800,000 persons die from medical and surgical emergencies, including about 600,000 heart-attack deaths, 100,000 deaths from accidents, and 100,000 deaths from miscellaneous medical and surgical emergencies. I wish we could follow the Russian example and assign at least one physician and one allied medical person to ride ambulance. Care of acutely sick patients could