Emergency Medical Treatment Research Articles

Do clinical pharmacy activities have an impact on the rehospitalisation rate of elderly patients admitted to a MUPA unit for a fall?

to evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalisation rates of elderly people admitted following a fall to the emergency medical treatment for the elderly unit (médecine d'urgence de la personne âgée [MUPA]) in a teaching hospital. this was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the MUPA unit following a fall, who had at least two chronic diseases, and who were being treated with two or more medications were included between 1 February 2018 and 30 June 2018 and were followed for 90 days. The main outcomes were the unplanned rehospitalisation rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 h. The estimated cost-saving was also assessed. 252 patients were included. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction in the rate of unplanned rehospitalisations at 90 days (OR = 0.45 (0.26-0.79) P = 0.005). These results were also consistent at 30 days (P = 0.035) and 72 h (P = 0.041). We found a cost-saving of €37770 related to 21 avoided rehospitalisations. our results strongly emphasise the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalisations of elderly patients admitted following a fall.

Factors Affecting Delayed Hospital Arrival of Patients with Acute Myocardial Infarction in Kinmen.

This study explores factors related to delayed emergency medical treatment for acute myocardial infarction patients on Kinmen Island. A cross-sectional study was performed in the only hospital in Kinmen Island. The study group consisted of 116 patients diagnosed with acute myocardial infarction (AMI, ICD-10 codes: I21.9) from November 2015 to May 2019. The binary logistic regression analyses were performed for the inferential statistical analysis. The mean age of the study group was 63.0 ± 14.5 years, 39.7% of the patients arrived at the emergency medicine longer than 6 h after the onset of symptoms. The related factors for delayed arrival the hospital emergency medicine department were female sex, age over 65 years, less than nine years’ education, and Killip Class, but only Killip Class reached the significant difference of statistics (OR = 3.616, 95% C.I. = 1.574 to 8.310, p = 0.002), and patients with delayed arrival times (>6 h) were found to have a higher percentage of Killip Class ≥ II. Therefore, it is essential to remind the physicians to proceed with risk stratification for acute coronary syndrome patients. In addition, health authorities should provide effective programs to increase awareness of the symptoms and timely treatment of acute myocardial infraction to the general public, especially the elderly.

Knowledge level on the management of pediatric burn patients among physicians working in the emergency department.

Prognosis of burned child is heavily influenced by how they are treated in the first 24 h. This study aimed to assess the degree of knowledge of emergency department physicians about the pediatric burn patients. The study included 229 physicians (80 emergency medicine specialists, 84 pediatricians, and 65 general practitioners). The questions were organized into six categories, each based on the Turkish Ministry of Health's Burn Treatment Algorithm, American Burn Association criteria, and current literature: 1 - Etiology and Degree of Burn, 2 - Emergency Medical Intervention, 3 - Calculation of Burn Area and Fluid-electrolyte Treatment, 4 - Indications for Hospitalization in Burn Treatment Units, 5 - Judicial and Medical Liability, and 6 - Training Sufficiency and Demand for Burn Injury Training. Questionnaire form was sent to the participants through the WhatsApp application. The outcomes were rated as 75-100% good, 50%-75% moderate, and <50% poor. The overall knowledge level of physicians about pediatric burns was moderate, with a score of 57.65±10.13 (emergency medicine specialists: 60.11, pediatricians: 57.56, and general practitioners: 54.75). Emergency medical intervention scores (35.02±22.43) and burn treatment units and hospitalization indications scores (38.6±18.96) were both low. Despite having a statistically significant higher medical intervention score than the pediatricians and general practitioners, the knowledge level of the emergency medicine specialists was poor. As result, physicians practicing in the emergency department have a poor knowledge level about pediatric burns. Hence, pediatric burn education should be provided to all emergency department physicians.

Knowledge Map Analysis of Basic Medical and Health Service Research Based on Web of Science

At present, the contradiction between people's growing demand for basic public health services and the unbalanced and insufficient development of basic public health services is becoming increasingly acute. Analyzing the research status and the latest progress in this field is of great significance to improve the level of basic medical public health services in various countries. This paper takes 5610 related studies of web of science from 2007 to 2020 as the research object, and uses CiteSpace, SPSS and other software to conduct co word analysis, literature cluster analysis and factor analysis. The results and conclusions are as follows: (1) There are great differences in the research and development level of basic medical public health services in the world, and the development efficiency is low. The country with the highest level of theory and technology development is the United States, followed by Canada and China; (2) In chronological order: the results of the frontier analysis of basic medical and health services in different periods have a strong inheritance relationship. The core evolution path is: Research on basic medical service level and medical quality in grass-roots communities → research on advanced life support theory and technology research on higher-level and higher-quality intelligent medical services; (3) The research on basic medical and health services has attracted a high degree of attention, mainly including cardiopulmonary resuscitation, medical services, emergency medical treatment and medical education.

Deep Reinforcement Learning Model for Blood Bank Vehicle Routing Multi-Objective Optimization

The overall healthcare system has been prioritized within development top lists worldwide. Since many national populations are aging, combined with the availability of sophisticated medical treatments, healthcare expenditures are rapidly growing. Blood banks are a major component of any healthcare system, which store and provide the blood products needed for organ transplants, emergency medical treatments, and routine surgeries. Timely delivery of blood products is vital, especially in emergency settings. Hence, blood delivery process parameters such as safety and speed have received attention in the literature, as well as other parameters such as delivery cost. In this paper, delivery time and cost are modeled mathematically and marked as objective functions requiring simultaneous optimization. A solution is proposed based on Deep Reinforcement Learning (DRL) to address the formulated delivery functions as Multi-objective Optimization Problems (MOPs). The basic concept of the solution is to decompose the MOP into a scalar optimization sub-problems set, where each one of these sub-problems is modeled as a separate Neural Network (NN). The overall model parameters for each sub-problem are optimized based on a neighborhood parameter transfer and DRL training algorithm. The optimization step for the sub-problems is undertaken collaboratively to optimize the overall model. Pareto-optimal solutions can be directly obtained using the trained NN. Specifically, the multi-objective blood bank delivery problem is addressed in this research. One major technical advantage of this approach is that once the trained model is available, it can be scaled without the need for model retraining. The scoring can be obtained directly using a straightforward computation of the NN layers in a limited time. The proposed technique provides a set of technical strength points such as the ability to generalize and solve rapidly compared to other multi-objective optimization methods. The model was trained and tested on 5 major hospitals in Saudi Arabia’s Riyadh region, and the simulation results indicated that time and cost decreased by 35% and 30%, respectively. In particular, the proposed model outperformed other state-of-the-art MOP solutions such as Genetic Algorithms and Simulated Annealing.

Adverse experiences resulting in emergency medical treatment seeking following the use of magic mushrooms

Adverse experiences resulting in emergency medical treatment seeking following the use of magic mushrooms

Adverse experiences resulting in emergency medical treatment seeking following the use of lysergic acid diethylamide

Adverse experiences resulting in emergency medical treatment seeking following the use of lysergic acid diethylamide

Mental health of Japanese firefighters administering emergency medical treatments during COVID-19

This is the first study investigating the determinants of mental health among Japanese firefighters with the COVID-19 outbreak. Firefighters who respond to emergency calls and administer emergency medical treatment face numerous serious threats to their mental health because of the spread of COVID-19. These threats range from significant infection risks to changes in daily operations. We conducted an online questionnaire survey with Japanese firefighters (n = 2,748, valid responses = 2,204) who also served as ambulance workers during the second COVID-19 wave in August 2020. The questionnaires inquired about personal and occupational demographics, occupational stress resulting from COVID-19, social support, germ aversion using a subscale of the Perceived Vulnerability to Disease (PVD) scale, and the General Health Questionnaire (GHQ-12). The results indicated that the burdens of infection prevention, anxiety about infection and furloughs, interpersonal conflicts related to COVID-19, reduced social support, and germ aversion were associated with deterioration of mental health. Measures for maintaining the mental health of firefighters are discussed based on these results.

GIS 네트워크 분석을 활용한 중구 화재 취약 지역 분석

Purpose: A fire in the city, classified as a social disaster, does huge damage to life and property. In Particular, the threat is being increased by the concentrated population density, the increase in the number of buildings and complex land use according to the deepening urbanization.Therefore, it is important to prevent a fire in advance by observing the golden time for fire suppression, rescue and first-aid activities. However, the issue of illegal parking is continues to be discussed as one of the factors that hinder the dispatch of fire trucks, and the increase in private vehicles in Seoul is expected to further increase the difficulty of accessing fire trucks in the future. Therefore, the purpose of this study is to grade vulnerable areas for fire through comprehensive judgment on the arrangement of emergency medical facilities and 119 safety centers and illegal parking. Method: Using fire outbreak data and Arc GIS Pro for Jung-gu, Seoul, comparison of fire fighting jurisdictions of the 119 Safety Center and areas that can be dispatched within golden time, emergency medical treatment After analyzing the correlation between the possible emergency transport distance to the facility within 5 minutes, public parking lot and illegal parking CCTV, and the occurrence of fire, the fire safety area and vulnerable area were derived through density analysis. Result: In the event of a fire in each administrative dong in Jung-gu, areas that are marginalized from initial suppression and evacuation measures were derived, and realistic and reasonable complementary measures according to the regionalization of administrative districts were suggested by proposing the relocation and expansion of fire fighting facilities and emergency medical facilities, and regional adjustment.

РОЛЬ ТА МІСЦЕ «DAMAGE CONTROL SURGERY» У ВІЙСЬКОВІЙ ЛІКУВАЛЬНО-ЕВАКУАЦІЙНІЙ ДОКТРИНІ ПІД ЧАС БОЙОВИХ ДІЙ В СУЧАСНІЙ ВІЙНІ.

Introduction: The severity of the combined injury, traumatic shock, blood loss and traumatic prolonged primary surgery are the cause of high mortality injured patients. In civilian medicine, damage control technology is widely used to treat patients with severe polytrauma, which has improved the survival of this group of patients. Objective: Analyze the effectiveness of using "damage control" technology in wounded with polytrauma at the second level of medical care during war conflict in Eastern Ukraine and organization of combat casualty care. Methods: Medical and statistical analysis of the effectiveness medical treatment for patients combat-ralated injuried and polytrauma performed on the basis of a mobile military hospital during 2015-2019 period. Results: In 660 patients with combat multiple and combined injuries and in 1027 - with severe military combined trauma, medical tratment was provide by "damage control" technology. The main task of the first stage of surgery intervention was to stop the bleeding and stabilize the patient condition. 130 patients with intra-abdominal bleeding underwent laparotomy, temporary stop of bleeding, blood sampling for autotransfusion and temporary closure of the abdominal cavity. For the purpose of temporary hemostasis in 15 patients abdominal tamponade was performed, in 26 - liver tamponade, in 24 - splenectomy, in 6 - nephrectomy and in 6 - put the clamps were applied to bleeding vessels. In 14% injured patients definitive stage of surgical procedures were performed at the second level of medical care on the background of abdominal compartment syndrome in 10, visceral edema in 14 and peritonitis in 40 patients. Conclusions: Providing emergency medical treatment, surgical procedures and intensive care at the second level of medical tretment using the technology of "damage control" and timely patients evacuation are the key to reducing mortality and complications of military surgical trauma

Analysis of Emergency Medical Treatment and Clinical Prognosis of Elderly Patients with Severe Heart Failure

Analysis of Emergency Medical Treatment and Clinical Prognosis of Elderly Patients with Severe Heart Failure

Blood Coagulation: A Potentially Lethal Manifestation in COVID-19 Patients

Blood clotting is a well-known phenomenon which is intended to provide protection in case of any external cellular/ tissue injury. However, this phenomenon in COVID-19 patients is leading to unusual thrombotic presentations. Since the emergence of novel coronavirus, World has come across various benign as well as lethal manifestations in COVID-19 patients and one such life-threatening manifestation which needs rigorous attention is the genesis of strange blood clots that can travel and get logged into several parts of the COVID-19 patients leading to various clinical presentations. COVID-19 infection is caused due to interaction of spike glycoproteins of coronavirus with ACE 2 receptors on the host cell surface. This interaction in the arteries, veins or capillaries could lead to injury in the vascular wall of blood vessels that can directly/Indirectly lead to coagulation and clotting cascades activation and subsequent formation of internal blood clots. However, it is undesirable to have the presence of these clots as they could lead to certain fatal complications that need emergency medical intervention or else, they may lead to the death of a patient. Due to the severity of this manifestation, early detection of these blood clots in covid-19 patients become very important intervention which could be done by observing certain specific signs and symptoms and/or with the help of various laboratory biomarkers like D-dimer, platelet count, erythrocyte sedimentation rate (ESR), ferritin, fibrinogen, etc. Once the early diagnosis is made, the patient can be treated appropriately with the help of anticoagulant therapy, which includes use of oral and parenteral anticoagulant drugs. This way the complications of blood coagulation like thrombo-embolism, could be prevented.

COVID-19-related adaptations to the implementation and evaluation of a clinic-based intervention designed to improve opioid safety.

The United States faces an opioid crisis with an unprecedented and increasing death rate from opioid overdose. Successfully reducing the rates of opioid use disorder (OUD) and overdose will require the engagement of frontline clinicians to prescribe opioids more safely and to build their capacity to treat patients with OUD using evidence-based approaches. The COVID-19 pandemic has created significant challenges for patients, clinicians and health systems and has been associated with increasing risks of overdoses and deaths. Herein, we review a multidisciplinary project designed to implement and evaluate clinic-based interventions in Oregon, USA, to improve pain management, opioid prescribing and treatment of OUD. The intervention, called Improving PaIn aNd OPiOId MaNagemenT in Primary Care (PINPOINT), combines practice facilitation, academic detailing and education through the Oregon ECHO Network. Implementation of PINPOINT has occurred across the Oregon Rural Practice-based Research Network and has involved 49 clinic sites to date. To evaluate the impact of the intervention, the research team created the Provider Results of Opioid Management and Prescribing Training (PROMPT), a dataset that links information from the state prescription drug monitoring program, all-payer claims database, emergency medical services, vital records and substance use disorder treatment system. The PROMPT dataset will allow evaluation of the impact of the intervention at both the clinician and clinic levels. Due to the constraints of the COVID-19 pandemic, elements of both implementation and evaluation required significant adaptations to continue to meet the original project goals.

Ethical issues and obligations with undocumented immigrants relying on emergency departments for dialysis.

Undocumented immigrants with end‐stage renal disease in the United States are uniquely disadvantaged in their ability to access dialysis. This article examines the unique circumstances of the medical condition and healthcare system, including the relevant legal and regulatory influences that largely relegate undocumented immigrants to relying on emergency‐only dialysis through a hospital's Emergency Medical Treatment and Labor Act obligations. We explore the ethical implications of this current state, emphasizing the adverse effects on patients and staff alike. We also review necessary actions that range from the actions an individual emergency physician to changes needed in federal policy.

Medical liability and criminal law in emergency medicine

Medical liability is booming. Malpractice can entail both civil and criminal consequences. Besides financial and custodial penalties, at worst the license to practice medicine can be withdrawn. Physicians owe their patients atreatment according to current standards. Furthermore, physicians are obliged to fulfill their duty of care. Nevertheless, the patient's right of self-determination must not be violated. Especially in emergency situations, physicians have to focus on taking protective measures in order to avert further dangers to the health of patients. This article analyses common pitfalls in emergency medical treatment with respect to the legal aspects.

107 EMERGENCY DEPARTMENT IN THE HOME, WHO IS THE EDITH PATIENT?

Abstract Background The EDITH team has provided an alternative care pathway for older adults in need of emergency services. This vulnerable patient population receive emergency medical and occupational therapy treatment and intervention in their home environment. The typical patient profile is assumed to be ‘frail older adults’, but this needs to be more specifically defined within the clinical practice in EDITH. Methods A total of 230 electronic patient records were selected at random. Data was audited and analysed with regard to clinical descriptors for this patient population. Results Of the 230 patients treated, 26 were referred to hospital or rehabilitation facilities. This is a conveyance rate of 11% which is above the average rate of 7.2% for this service. The Rockwood Clinical Frailty Scale (CFS): 22% had a CFS of 5 (mildly frail), 37% had a CFS of 6 (moderately frail), 22% had a CFS of 7 (severely frail), 3% had a CFS of 8 (very severely frail). Living Status: 26% living alone, 48% living with family, 4% sheltered living accommodation and 22% in nursing homes. Formal Supports: 37% have no formal supports, 18% have &amp;lt;10 hours per week, 19% have between 11–21 hours, 4% have 24-hour care and 22% reside in nursing homes. Presenting complaint: 41% medically unwell, 23% fall, 14% functional decline, 9% pain, 5% infection, 5% orthopaedic and 2% confusion. Ages range from 61 years to 100 years with an average age of 82 years. Conclusion It is imperative to identify the type of patient that uses this service, in order to plan for future service needs and ensure their current clinical care needs are being met. Of note, a significant proportion of patients are living alone, have high CFS scores and have no formal supports in situ.

Emergency medicine: past, present, and future challenges

Emergency medicine: past, present, and future challenges

Neurological outcomes of out-of-hospital cardiac arrest occurring in Tokyo train and subway stations

ObjectivesThe purpose of this study was to identify a relationship between the background environment, bystander and emergency medical services intervention, and favourable neurological outcomes (CPC1-2) one-month after out-of-hospital cardiac arrest (OHCA) occurred at Tokyo train and subway stations. MethodsThis retrospective observational study used OHCA data between 2014 and 2018 that occurred at train stations in Tokyo. The eligible 954 patients were analysed for correlation between background, time frame, and location. Multivariable logistic regression models were used to estimate factors associated with CPC1-2 in patients with cardiogenic OHCA. ResultsA total of 886 OHCA cases, cardiogenic (n=562) and non-cardiogenic (n=324), met the inclusion criteria. Of the cardiogenic cases, 71.9% occurred at the platform and on-a-train. One-month CPC1-2 was achieved in 32.0% of cardiogenic OHCAs, which included 47.3% during morning rush hour, 24.7% during daytime hours, 40.2% during evening rush hour, and 20.5% during night-time/early morning hours. CPC1-2 had significant correlation with morning rush hour (adjusted odds ratio [AOR],4.52; 95% confidence interval [CI], 1.09–18.78), evening rush hour (AOR, 6.85; 95% CI, 1.51–31.15), public access defibrillation (AOR, 5.19; 95% CI, 1.38–19.51), and ventricular fibrillation or pulseless ventricular tachycardia (AOR, 7.56; 95% CI, 1.35–42.43). ConclusionA total of 71.9% of cardiogenic OHCAs occurred at platforms and on trains. To improve neurological outcomes of OHCAs at stations, AED installations on train platforms are necessary. Additionally, using artificial intelligence-based platform monitoring for early detection of OHCAs and offering CPR training are required.

Organization of Emergency Medical Treatment Systems and Geographic Information Systems

Acil tıbbi destek tedavi kaynaklarına olan talep arzı aştığında acil servislerin kalabalıklaşmasına neden olmaktadır. Bu durum hem kırsal hem de kentsel izlenebilen bir durumdur ve büyük hastanelerin acil servislerin %90'ının tam kapasite veya kapasitesinin üstünde çalışmaktadır (1).&#x0D; Kalabalık ve kritik hastaları kabul eden acil servisler zaman zaman aşırı hasta yükü nedeniyle yoğunluklarını acil sağlık hizmetleri koordinatör merkezlere bildirerek hasta kabul etmemekte bu dönemde ambulans ile gerilen hasta başka merkezlere yönlendirilmektedir. Bu durum hastalar için zaman kaybına sağlık yönetimi için ise kaynak kaybına neden olmaktadır

Endovascular Repair of Thoracic Aorta Injury: 17 Years of Single-Center Experience.

BackgroundTraumatic thoracic aortic transection is one of the most severe complications of high-energy injuries, but patients rarely receive treatment, and it is fatal in the vast majority of cases. Due to the complexity of surgical revision for transection, endovascular repair with stent graft implantation is the preferred approach.Material/MethodsWe retrospectively analyzed the short-term and long-term treatment results for 31 patients (29 men, 2 women) treated at the Interventional Radiology Department, University Hospital Ostrava, for the isthmus part of a descending thoracic aorta injury between 2004 and 2020.ResultsThe median patient age was 48 years (interquartile range [IQR]: 28–63 years). The most common causes of injury were traffic accidents and falls or jumps, with the trauma location at the Ishimaru zones 2 to 4 of the aortic isthmus. Aortic stent grafts were successfully implanted in all patients; 13% of patients had complications and 10% died due to the trauma severity. The median procedure duration was 30 min (IQR: 25–43 min) and the median hospital stay was 29 days (IQR: 28–63 days).ConclusionsAortic stent graft implantation appears to be a safe and effective method for dealing with thoracic aorta injury, with a low complication rate and high patient survival. The endovascular approach is the method of choice for treating this severe disease, and a multidisciplinary approach for emergency medical treatment with a comprehensive trauma protocol is essential.