Emergency Medical Treatment Research Articles

Android-based framework for condition assessment of existing RC hospital buildings

Rapid visual screening (RVS) is a practically viable tool implemented all over the world to rank structures based on their seismic vulnerability. Seismic assessment of hospital buildings is essential in seismic-prone regions to ensure their structural integrity and readiness to provide emergency care and medical treatment after significant seismic events. Therefore, in the current study, an approach is developed that is similar to the proven methodologies reported in the literature, for the seismic evaluation of structural and non-structural elements of hospital buildings in a metropolitan city like Karachi. Karachi is located in the southwest of Pakistan and is vulnerable to earthquake and tsunami hazards. To this end, an android-based RVS system has been developed for large-scale seismic risk mapping of hospital buildings. The proposed system acquires the physical status of the building features in real time and identifies the building performance obtained from the calculated seismic risk index. Moreover, three case study hospital buildings were employed and analysed through the proposed RVS system. Results illustrate the performance of case study hospital buildings at organisational, structural and non-structural levels based on seismic risk indices.

A Programmable Handheld Extrusion-Based Bioprinting Platform for In Situ Skin Wounds Dressing: Balance Mobility and Customizability.

Bioprinting technology plays a crucial role for constructing tissue substitutes. However, the mismatched scaffold shapes and the poor treatment timeliness limit its clinical translational application. In situ printing technology that prints bioregenerants directly inside patient's body can meet the needs of specific tissue repair. This study develops a smartphone controlled handheld bioprinter for in situ skin wounds dressing. The mini bioprinter can be handheld and placed on any printing surface to create strips, complex patterns, and 3D structures, and can be equipped with microchannel needles to expand functionality. The size of the strips as well as the printing path can be programmed and controlled by the smartphone to ensure the precision of the printed product quality. Furthermore, the device not only allows for smooth switching between different bioinks for printing heterogeneous structure, but also allows for fast and uniform coverage of large wound surfaces. When dealing with complex wounds in vitro & vivo, the printer can effectively fill and precisely close wounds, promoting wound healing. The programmable handheld bioprinter can balance mobility and customizability in the management of skin wounds and is expected to realize its potential for emergency medical treatment in condition-constrained scenarios, such as battlefields or disaster areas.

Ketamine use in a large global sample: Characteristics, patterns of use and emergency medical treatment.

Ketamine's popularity has surged globally in the past decade, especially among young men. Emergency department visits due to its toxicity remain relatively rare, often linked to co-occurring use of other substances. Using data from the Global Drug Survey (GDS) 2018, this study explored the correlates associated with lifetime and past-year ketamine use, and estimated the socio-demographic characteristics, usage patterns and experiences of respondents seeking emergency medical treatment (EMT) after ketamine use. Secondary analysis of GDS 2018, an online cross-sectional survey on drug use patterns conducted between November 2017 and January 2018. The survey received 130,761 valid responses, with 5.93% reporting lifetime ketamine use, of which 57.70% used ketamine within the past year. Predominantly, respondents were from Germany, England and Denmark. Within the past year, 8.55% met the criteria for ketamine dependence. Respondents who used ketamine in their lifetime tended to be young (mean (x̄) = 27.37 years), men, heterosexual and of white ethnicity. Younger age (x̄ = 24.84 years), gay sexual orientation, student status, past-year use of other drugs and no lifetime mental health diagnosis were associated with past-year ketamine use. Among 4477 respondents reporting past-year ketamine use, 120 adverse events were reported, with less than 0.10% prompting EMT seeking. The study reveals frequent ketamine use but low harm occurrence, underscoring the complex interplay between ketamine use, substance use and dependence, and related factors. This underscores the need to reassess EMT priorities, implement tailored harm reduction strategies and incorporate comprehensive screening for addressing ketamine and substance dependence challenges.

Emergent endovascular treatment versus medical treatment for acute large vessel occlusions with nondisabling symptoms.

The aim of this study is to analyze the effectiveness and safety of medical treatment (MT) versus endovascular treatment (EVT) in acute large vessel occlusion patients with mild nondisabling stroke symptoms. This study is a multicenter observational study in which data from patients at three stroke centers were prospectively obtained and retrospectively analyzed. Patients were included if they arrived for treatment within 6 h of stroke onset or last known well time and had a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤5. Primary outcome was modified Rankin Scale (mRS) score 0-2 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), discharge NIHSS score, 90-day all-cause mortality and length of stay. Clinical outcomes were compared through a multivariable logistic regression after adjusting for age, treatment type admission and discharge NIHSS score, admission Alberta Stroke Program Early CT (ASPECT) score and length of stay. Of the 82 patients included in the study, 42 were in the EVT group and 40 were in the MT group. The groups were similar in age (MT:66, EVT:64 age; p = .62), gender (MT:55%, EVT:54.8%; male) admission NIHSS score (MT:2, EVT:3 points; p = .26), ASPECT score (MT:10, EVT:9; p = .15). While discharge NIHSS score was found to be statistically significant between the groups (MT:1, EVT:2; p = .04). There was no difference between the two groups in terms of 90-day mRS scores (MT:1, EVT:1, p = .86) and mortality rates (MT:4, EVT:4; p = .94). In unadjusted analysis, sICH rates were similar between the MT and EVT groups (MT 5%, EVT 7.1%, p = .52). Neurological intensive care unit length of stay (MT:5 days, EVT:2 days p < .001), inpatient clinic length of stay (MT:3, EVT:2 days p = .041), and total length of stay (MT:9 days, EVT:4 days p < .001) were significantly longer in the MT group. Our multicenter study demonstrated that MT with blood pressure augmentation and anticoagulation at hyperacute stage is an alternative option for emergency large vessel occlusion patients with nondisabling mild stroke symptoms.

404 Emergency Medical Treatment and Labor Act (EMTALA) Citations Involving On-Call Obstetric and Gynecologic Responsibilities, 2011-2023

404 Emergency Medical Treatment and Labor Act (EMTALA) Citations Involving On-Call Obstetric and Gynecologic Responsibilities, 2011-2023

250 Civil Monetary Penalties Related to Violations of the Emergency Medical Treatment and Labor Act Involving Patients Arriving or Departing With Law Enforcement

250 Civil Monetary Penalties Related to Violations of the Emergency Medical Treatment and Labor Act Involving Patients Arriving or Departing With Law Enforcement

123 Civil Monetary Penalties Related to Violations of the Emergency Medical Treatment and Labor Act Involving Psychiatric Emergencies: A 5-Year Update

123 Civil Monetary Penalties Related to Violations of the Emergency Medical Treatment and Labor Act Involving Psychiatric Emergencies: A 5-Year Update

The Supreme Court and the Emergency Medical Treatment and Labor Act—A Dangerous Time for Us All

This Viewpoint explores recent US Supreme Court decisions and how they threaten the Emergency Medical Treatment and Labor Act and the health, safety, and rights of pregnant persons throughout the country.

ChatGPT's Role in Improving Education Among Patients Seeking Emergency Medical Treatment.

Providing appropriate patient education during a medical encounter remains an important area for improvement across healthcare settings. Personalized resources can offer an impactful way to improve patient understanding and satisfaction during or after a healthcare visit. ChatGPT is a novel chatbot-computer program designed to simulate conversation with humans- that has the potential to assist with care-related questions, clarify discharge instructions, help triage medical problem urgency, and could potentially be used to improve patient-clinician communication. However, due to its training methodology, ChatGPT has inherent limitations, including technical restrictions, risk of misinformation, lack of input standardization, and privacy concerns. Medicolegal liability also remains an open question for physicians interacting with this technology. Nonetheless, careful utilization of ChatGPT in clinical medicine has the potential to supplement patient education in important ways.

Civil Monetary Penalties for EMTALA Violations Involving Minors, 2002-2023.

The Emergency Medical Treatment and Labor Act (EMTALA) is intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (EDs). EMTALA requirements pertain to patients of all ages presenting to dedicated EDs regardless of whether facilities have dedicated pediatric specialty services. This study aims to describe EMTALA-related civil monetary penalty (CMP) settlements involving minors. Descriptions of all EMTALA-related CMPs occurring between 2002 and 2023 were obtained from the Office of the Inspector General web site and reviewed for involvement of minors (<18 years of age) using keywords in settlement summaries. Characteristics of settlements involving minors were described and compared with settlements not involving minors. Of 260 EMTALA-related CMPs, 38 (14.6%) involved minors. Most involved failure to provide a medical screening exam (MSE) (86.8%) and/or stabilizing treatment (52.6%). Seven (18.4%) involved pregnant minors. Eleven (28.9%) involved ED staff directing a patient (or guardian) to another facility, typically by private vehicle, and another involved 2 patients referred to on-campus outpatient clinics without an MSE. One in 7 CMPs related to EMTALA violations involved minors, and 1 in 5 of these minors was pregnant. One-third of CMPs involving minors included ED staff directing patients to proceed to another facility or on-campus clinic without MSE or stabilization. Findings suggest a need for providers to understand EMTALA-specific requirements for appropriate MSE, stabilization, and transfer, and for EDs at hospitals with limited pediatric services to implement policies for the evaluation of minors and protocols for transfer when indicated.

Fabrication and hemostasis evaluation of a carboxymethyl chitosan/sodium alginate/Resina Draconis composite sponge

Hemostasis is the first step of emergency medical treatment. It is particularly important to develop rapid-acting and efficacious hemostatic materials. Carboxymethyl chitosan (CMCS), sodium alginate (SA) and Resina Draconis (RD) were composited uniformly by polyelectrolyte blending. Their composite sponges (CMCS/SA/RD) were prepared by freeze-induced phase separation. CMCS/SA/RD sponges were characterized by Fourier transform infrared spectroscopy and scanning electron microscopy, and their blood absorption and hemolysis ratio were analyzed. The hemostatic effect of the composite sponges was evaluated by coagulation in vitro and in vivo. The composite sponges had a porous network structure. The water absorption ratio was >8000 %, and hemolysis ratio was <5 %. CMCS/SA/RD-II and CMCS/SA/RD-III composite sponges shortened the coagulation time in vitro by 11.33 s and 9.66 s, the hepatic hemostasis time by 13.8 % and 23.3 %, and the hemostasis time after mouse-tail amputation by 28.9 % and 23.9 %, respectively. A preliminary study on its coagulation mechanism showed that CMCS/SA/RD had significant effects on erythrocyte adsorption, platelet adhesion, and shortening of the activated partial thromboplastin time.

Lights, Sirens, and Load: Anticipatory emergency medical treatment planning causes cognitive load during emergency response driving among paramedicine students

Paramedics face various unconventional and secondary task demands while driving ambulances, leading to significant cognitive load, especially during lights-and-sirens responses. Previous research suggests that high cognitive load negatively affects driving performance, increasing the risk of accidents, particularly for inexperienced drivers. The current study investigated the impact of anticipatory treatment planning on cognitive load during emergency driving, as assessed through the use of a driving simulator. We recruited 28 non-paramedic participants to complete a simulated baseline drive with no task and a cognitive load manipulation using the 1-back task. We also recruited 18 paramedicine students who completed a drive while considering two cases they were travelling to: cardiac arrest and infant seizure, representing varying difficulty in required treatment. The results indicated that both cases imposed considerable cognitive load, as indicated by NASA Task Load Index responses, comparable to the 1-back task and significantly higher than driving with no load. These findings suggest that contemplating cases and treatment plans may impact the safety of novice paramedics driving ambulances for emergency response. Further research should explore the influence of experience and the presence of a second individual in the vehicle to generalise to broader emergency response driving contexts.

The use of analgesics in pediatric patients with body injuries in pre-hospital conditions.

Despite the positive dynamic changes in medicine and science, injuries continue to be the dominant cause of death among people under 45 years of age. Children's injuries are particularly dangerous as they can lead to hypovolemic shock, disability or even death. EMS uses opioid and non-opioid analgesics in order to provide relief to patients suffering from pain. The aim of this work is to analyze the types of pharmacological substances used in children in pre-hospital conditions. The research tools included medical documentation of the emergency medical services in Poland. The analysis included 68,441 medical emergency treatment forms from 2016-2017, from which 464 interventions for children after trauma were selected. The general patient profile, characteristics of the event site, type of injuries suffered, type of intervening EMS, pharmacotherapy being used, as well as vital signs (GCS, RTS, HR, NiBP) were subject to assessment. The χ2 independence tests were performed, considering the results as statistically significant for P<0.05. There were 354 instances of BEMS (Basic Emergency Medical Services - without a doctor) and 110 instances of SEMS (Specialist Emergency Medical Services - with a doctor) sent to the emergency site. The mean age was 10.8±4.84 years. Boys were subject to intervention more often than girls (N.=283 vs. N.=181). Analgesics were administered in case of 49 (10.56%) patients only. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the analgesics of choice, which were used in 25 patients (50%), while opioid analgesics were used in 10 patients (20.40%). Analgesia was mostly used in patients with lower limb (34.69%) and upper limb (30.61%) injuries. The lowest percentage of analgesic use was observed in patients with head and neck injuries (3.06%). There was a significant relationship demonstrated between the type of EMS and the use of analgesics (χ2=6.330; P=0.012). Analgesia with EMS in children with injuries is critically insufficient. NSAIDs are the most commonly administered drugs in pre-hospital conditions. Head and torso injuries reduce the percentage of drugs administered by EMS. The EMS teams with no doctors (BEMS) are significantly more likely to use anesthetics, compared to SEMS.

Tripping into the unknown: Exploring the experiences of first-time LSD users through global drug survey insights.

The recreational use of LSD, a synthetic psychedelic drug, has surged in recent years, coinciding with a renewed research focus on its potential psychotherapeutic properties. This study aims to describe the experiences and perceptions of individuals engaging in LSD use for the first time, derived from a large international sample. This study utilised 2018 Global Drug Survey data collected from 6 November 2017 to 10 January 2018. Participants who initiated LSD use in the preceding 12 months answered questions on their experiences, social settings, harm-reduction behaviours, and demographics. Descriptive statistics were employed, and characteristics of those seeking emergency medical treatment (EMT) and those not planning further LSD use were compared with other respondents. Among 3340 respondents who used LSD in the past year, their first-time experiences generally exceeded expectations, with 97.7% expressing excitement. Adverse and unwanted side effects were rarely reported, and only 17 individuals needed EMT. Feelings of fear were reported by most (64.1%), but only very mildly and not enough to put them off from wanting to use LSD again. Although the occurrence of unwanted side effects seems low and the LSD experience is generally pleasurable, vigilance amid the rising illicit use of LSD through harm-reduction education is still important in preventing possible risks.

Impact of drone-specific dispatch instructions on the safety and efficacy of drone-delivered emergency medical treatments: A randomized simulation pilot study

IntroductionMedical drones have potential for improving the response times to out-of-hospital emergencies. However, widespread adoption is hindered by unanswered questions surrounding medical dispatch and bystander safety. This study evaluated the impact of novel drone-specific dispatch instructions (DSDI) on bystanders’ ability to interact effectively with a medical drone and provide prompt, safe, and high-quality treatment in a simulated emergency scenario.11Drone-specific dispatch instructions. We hypothesized DSDI would improve bystanders’ performance and facilitate safer bystander-drone interactions. MethodsTwenty-four volunteers were randomized to receive either DSDI and standard Medical Priority Dispatch (MPD) instructions or MPD alone in a simulated out-of-hospital cardiac arrest (OHCA) or pediatric anaphylaxis.,22Medical priority dispatch3 Out-of-hospital cardiac arrest.3 Participants in the DSDI group received detailed instructions on locating and interacting with the drone and its enclosed medical kit. The simulations were video recorded. Participants completed a semi-structured interview and survey. ResultsThe addition of DSDI did not lead to statistically significant changes to the overall time to provide care in either the anaphylaxis or OHCA simulations. However, DSDI did have an impact on bystander safety. In the MPD only group, 50% (6/12) of participants ignored the audio and visual safety cues from the drone instead of waiting for it to be declared safe compared to no DSDI participants ignoring these safety cues. ConclusionsAll participants successfully provided patient care. However, this study indicates that DSDI may be useful to ensure bystander safety and should be incorporated in the continued development of emergency medical drones.

The Potential of Shell Extract as a Hemostasis and Wound Healing Agent: A Literature Review

Hemostasis is an emergency medical treatment to reduce pain and patient mortality, therefore research is being developed to find effective hemostasis. The utilization of natural materials for hemostasis and wound healing is rapidly expanding, including chitosan found in shell extracts. Chitosan is obtained from chitin found in the soft shells of marine animals such as squid, shrimp, and crabs, or from hard shells such as clams, crabs, and lobsters. Chitosan offers advantages such as good biodegradability, biocompatibility, and non-toxicity, and has been widely used in biomedical, chemical, food, and cosmetic industries. This literature review aims to investigate the potential of shell extracts, particularly the characteristics of chitosan, in wound healing across hemostasis, inflammation, proliferation, and remodeling stages. The study results indicate that extracts from shells containing chitosan exhibit varying characteristics in terms of molecular weight and degree of deacetylation. Chitosan with higher molecular weight and degree of deacetylation tends to yield better outcomes in hemostasis and wound healing. The material is effective in reducing antithrombin, enhancing blood clotting processes, and aiding clot formation. Increased molecular weight contributes to stimulating various cytokines, such as TNF-α, TGF-ß1, and FGF2, which play a key role in the wound healing process. Additionally, higher degree of deacetylation chitosan is effective in stimulating fibroblast proliferation. Chitosan also influences VEGF in inducing angiogenesis and enhancing neovascularization in bone healing. Chitosan from shell extracts with certain molecular weight characteristics and degree of deacetylation has the potential to be the material of choice for accelerating hemostasis and wound healing.

Pregnancy Complications After Dobbs: The Role of EMTALA.

In June 2023, the Supreme Court declared that there was no longer a right to abortion under the federal constitution. This decision has allowed states to promulgate different restrictions on abortion, many of which implicate the practice of emergency medicine. An abortion is defined as a "medical intervention provided to individuals who need to end the medical condition of pregnancy" and includes care such as termination of an ectopic pregnancy and induction of labor for previable preterm premature rupture of membranes-interventions that emergency physicians either perform or rely on the assistance of consultants to perform. State bans on abortion must be evaluated against duties under the Emergency Medical Treatment and Labor Act, a federal law that preempts state law. In this paper we examine the conflict between state and federal law as it applies to emergency abortion care and describe how emergency physicians can continue caring for patients.

Developing a multifunctional wearable system consisting of a helmet and clothing for two-wheeled vehicle users' safety assistance

Purpose This study aims to develop a safe, wearable clothing system that combines visibility-enhancing and emergency–accident-responding functions for two-wheeled vehicle (TWV) users' safety assistance.Design/methodology/approach First, the wearable system (WS) allowing users to control turn signals, brake lights and emergency flasher only with head movements was developed. Second, multiconnected systems were developed between WSs and a smartphone application (AS), providing accident occurrence recognition, driving photo capture–storage and emergency notification functions. Third, usability testing in each function was performed to assess the operability of the systems.Findings The intuitive interface, which uses head movement as gesture commands, was effectively operated for controlling turn signals, brake lights and emergency flasher when driving, despite differences in user physique and boarding structure among TWVs. In addition, using Bluetooth low energy and Wi-Fi protocols simultaneously can establish automatic accident recognition–notification and driving photo capture–storage–display functions by linking two WSs with one AS.Research limitations/implications This study presents a case using relatively accessible technologies within the fashion industry to improve users' safety and provide fundamental data for convergence education for smart fashion products, highlighting the significance of this study in this convergence era.Originality/value The WSs and the AS of a TWV user visually evoke the attention of other drivers and pedestrians, reducing the risk of accidents; social contribution regarding public safety will be possible by allowing the system to autonomously inform emergencies and receive emergency medical treatment quickly when the accident occurred.

Abortion Trigger Laws Compared With the Emergency Medical Treatment and Labor Act.

In 2022, the Supreme Court decision in Dobbs v Jackson Women's Health Organization reneged the Constitutional right to an abortion. Many states now enforce laws that ban abortions. There are significant conflicts between state abortion laws and federal regulations that mandate proper assessment, treatment, and stabilization of patients who present for emergency care. This conflict places physicians in an untenable position when treating patients who have a pregnancy that endangers their life. In states that deem abortion a felony, transfer of these patients can extricate the physician, who is in a difficult position. Currently, it is the only reasonable option for hospitals and physicians who are trapped between conflicting state laws and Emergency Medical Treatment and Labor Act rules and regulations.

Оказание скорой специализированной медицинской помощи и проведение медицинской эвакуации с использованием санитарной авиации в Республике Саха (Якутия) в условиях пандемии Covid-19

Summary. The aim of the study is to investigate the peculiarities of sanitary aviation work in the Republic of Sakha (Yakutia) during the COVID-19 pandemic. Materials and research methods. The subject of the study is the work of the Disaster Medicine Service of the Republic of Sakha (Yakutia); the object of the study is the volume and structure of sanitary tasks performed during the spread of the new coronavirus infection COVID-19. Research methods were analytical methods, methods of expert evaluation and mathematical analysis. Results of the study and their analysis. A comparative analysis of the main performance indicators of the Republican Center for Disaster Medicine of the Republic of Sakha (Yakutia) in 2020-2022 is presented. The results of the study indicate that during the spread of a new coronavirus infection COVID-19 the air ambulance service of the Republic worked with increased workload. Under the conditions of COVID-19 pandemic, emergency medical care and medical evacuation of not only patients with severe form of new coronavirus infection, but also of patients with other nosologic forms of diseases requiring emergency medical intervention were provided. The conclusion about the acute urgency of using sanitary aviation in vast sparsely populated areas of other regions is made.