Emergency Care Providers Research Articles

Emergency care providers' perspectives of acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A qualitative study

IntroductionA growing body of evidence suggests that pain knowledge and management are poor, perhaps more so in the prehospital setting. The daily challenges that emergency care providers face in dealing with prehospital pain remain unclear. This study aimed to gain a deeper understanding of acute prehospital pain assessment and management in the Western Cape, South Africa. MethodsA series of focus group discussions, using a constructivist paradigm and qualitative content analysis were conducted. ResultsThe key themes emerging from six focus groups (total 25 emergency care providers) related to the difficulties of assessing pain in this setting, factors affecting clinical reasoning in this (hostile) setting, the realities of prehospital pain care for non-advanced life support practitioners, along with emergency departments’ lack of understanding and appreciation of the prehospital environment, and participants’ suggestions to improve pain practice. ConclusionSeveral barriers and enablers, some novel, to pain assessment and management in the South African prehospital setting were identified. Our findings provide valuable insight and understanding of the challenges related to pain care prehospital providers face, in other similar prehospital settings, but also to the global body of knowledge on prehospital barriers and enablers of pain assessment and management.

Outcomes of a Climate Change Workshop at the 2020 African Conference on Emergency Medicine.

A changing climate will have demonstrable effects on health and healthcare systems, with specific and disproportionate effects on communities in Africa. Emergency care systems and providers have an opportunity to be at the forefront of efforts to combat the worst health effects from climate change. The 2020 African Conference on Emergency Medicine, under the auspices of the African Federation for Emergency Medicine, convened its first ever workshop on the topic of climate change and human health. Structured as a full day virtual course, the didactic sections were available for both live and asynchronous learning with more than 100 participants enrolled in the course. The workshop introduced the topic of the health effects of climate as they relate to emergency care in Africa and provided a forum to discuss ideas regarding the way forward. Lectures and focused discussions addressed three broad themes related to: health impacts, health care delivery, and advocacy. To our knowledge, this is the first workshop for health professionals to cover topics specific to emergency care, climate change, and health in Africa. The results of this workshop will help to guide future efforts aimed at advancing emergency care approaches in Africa with regard to medical education, research, and policy.African relevance•Climate-related extreme weather events are adversely affecting health and health care delivery in African countries.•African organisations, cities, and nations have taken positive steps to adapt and build climate resilience.•There are opportunities for emergency care professionals and scholars to continue to expand, and lead, climate and health education, research, and policy initiatives on the continent.

Healthcare Service In The "Dentistry" Profle To The Population Of Moscow Under Restrictive Measures Of Covid-19

In the beginning of the COVID-19 pandemic in March 2020, by the decree of the Mayor of Moscow, the provision of dental services to the population was temporarily suspended, with the exception of diseases and conditions requiring emergency or urgent dental care. A Headquarters was established to coordinate the provision of emergency and urgent dental care for COVID-19 patients and for those who was in isolation during lockdown. The Moscow Healthcare Department has been organized an activity of mobile medical and nursing teams (MNT) to provide emergency medical care in the "dentistry" profle. All MNTs were equipped with portable dental equipment. The MNTs has been working for free within the framework of compulsory medical insurance. For the period from March 26 to June 16 – 2020, medical care was provided to 1501 patients, of which 294 with a confrmed diagnosis of COVID-19, including 57 children. The measures taken were of a temporary nature and were aimed at preserving the health of Moscow residents and preventing the further spread of the new coronavirus infection COVID-19 in Moscow.

Changes in Prescribing by Provider Type Following a State Prescription Opioid Restriction Law.

Many states have implemented opioid days' supply restriction policies, leading to reductions in opioid prescribing. Although research within certain provider types exist, no study has evaluated a restriction policy by various provider types. To evaluate changes in opioid utilization following a days' supply restriction policy stratified by provider type: surgery, emergency medicine, primary care, specialty care, and dentistry. Interrupted time series (ITS) PARTICIPANTS: Opioid prescription claims of patients in a private health plan serving a large Florida employer from 1/1/2015 to 3/31/2019. Provider types were determined using the Healthcare Provider Taxonomy Code associated with the national provider identifier (NPI). Florida's opioid restriction policy implemented on July 1, 2018. Changes in mean morphine milligram equivalent (MMEs), mean days' supply, and mean number of units dispensed per opioid prescription before and after policy implementation. There were 10,583 opioid initial prescriptions dispensed. Treating providers were classified as surgery (16.4%; n = 1732), emergency care (14.3%; n = 1516), primary care (21.2%; n = 2241), specialty care (11.4%; n = 1207), and dentistry providers (23.7%; n = 2511). Significant reductions in mean days' supply were observed across most provider types ranging from 14% reduction for dentistry providers to 41% reduction for specialty care providers. Significant changes were observed for emergency care and specialty care providers with a 30% (p = 0.001)and 29% (p < 0.001) reduction in mean MME, respectively, and a 27% (p = 0.040) reduction in mean number of units dispensed in emergency care providers, after implementation. Pre-implementation trends in opioid prescribing varied by provider type impacting the effects of the opioid days' supply restriction policy. Pre-policy opioid prescribing varied by provider type with a differential impact on mean MMEs, mean days' supply, and mean number of units dispensed per prescription following implementation.

Medical Legal Implications When Providing Emergency Care on a Commercial Flight.

INTRODUCTION: U.S. airlines often request a healthcare professional to volunteer to assist an ill passenger. Litigation from a Good Samaritans care of an in-flight medical emergency (IME) is considered improbable. The 1998 Aviation Medical Assistance Act (AMAA) encourages health care professionals to volunteer with indemnity for standard and good medical care. It does not offer legal or financial assistance. Our review explored the legal support malpractice companies and U.S. airlines provide if litigation is initiated for IME care. Malpractice insurance policies can differ on IME coverage. We found most private practice physicians policies include IME. Medical institutions may have policies restricting their physicians coverage to the institutions location. Those without malpractice coverage will need to retain and pay for a legal defense to demonstrate no gross negligence and no willful misconduct. The physicians, airline crews, and on-ground IME documentation support should be retained by the Good Samaritan especially for a pediatric or adolescent ill passenger. U.S. airlines consider a Good Samaritan medical volunteer as a passenger and do not extend legal assistance. This contrasts with some foreign airlines that do provide liability protection. Knowledge of the malpractice policy IME coverage is essential prior to traveling by air. After completing care for an ill passenger, physicians should generate their medical documentation and request the IME documentation generated by the airline and on-ground medical expert. We also believe U.S. airlines should assume responsibility to provide legal assistance to a Good Samaritan physician in the event of IME litigation.de Caprariis PJ, Di Maio A. Medical legal implications when providing emergency care on a commercial flight. Aerosp Med Hum Perform. 2021; 92(7):588592.

After the Match

After the Match

The principles of providing emergency care for patients with pancreatic necrosis

At the present stage, the treatment of patients with pancreatic necrosis is one of the most urgent surgical tasks. Pancreatic necrosis is a destructive lesion of the pancreas, often leading to the development of multiple organ failure. The pathogenesis is based on a violation of the mechanism of counteraction to proteolytic enzymes produced by the pancreas. Pancreatic necrosis is a formidable complication of pancreatitis, with mortality ranging from 30 to 70 %. Today, in terms of the frequency of occurrence in surgical practice, this pathology ranks second after acute appendicitis. The leading role in the prevention of the development of pancreatic necrosis and the prevention of mortality is taken by early detection, timely hospitalization and the fastest possible start of therapeutic measures. A special place in the treatment of pancreatic necrosis is occupied by measures aimed at rehydration, optimization of hemodynamic parameters, the prescription of vasoactive drugs and prophylactic antibiotics in order to prevent the development of infectious complications.

Preventing avoidable hospital admissions after emergency care in humanitarian settings: a cross-sectional review of Médecins Sans Frontières emergency departments

ObjectivesThe aim of this study was to describe the types of emergency departments (EDs), and the acuity, types and disposition of conditions managed at Médecins Sans Frontières (MSF)-supported EDs in...

Identification of Elder Abuse through Out-of-Hospital Emergency Care Providers.

Elder abuse, neglect, and exploitation are under-detected and under-reported. The purpose of this qualitative study was to describe out-ofhospital emergency care providers' experiences of identifying elder abuse. Individual theme interviews were conducted with nine prehospital emergency care providers and three community paramedics in spring 2019. The transcribed data were analyzed using inductive content analysis. Although the short duration of care contacts made the identification of elder abuse challenging, the emergency care providers detected indicators of physical, psychological and social abuse, unethical action, material exploitation, and self-neglect/self-abuse. The professionals based their observations on patient and family interviews, on clues in the home environment, on caregiving quality combined with the patient's medical history, and on physical signs, which were the easiest to identify. The identification of elder abuse may be improved by multiprofessional collaboration, by increased attention given to risk groups and common indicators of abuse, and by adoption or creation of screening tools to assist detection and reporting. Training on the detection of elder abuse should be included in nursing and social work curricula and in the continuing professional development of emergency care providers.

An online emergency medical management information system using mobile computing

Purpose The purpose of this paper is to investigate the way technology affects the provision of prehospital emergency care, upgrading the quality of services offered and significantly reducing the risk of premature termination of the patients. Design/methodology/approach The paper presents the development of the eEKAB, a pilot emergency medical information system that simulates the main services offered by the Greek National Instant Aid Centre (EKAB). The eEKAB was developed on an agile system methodology. From a technical perspective, the features and the technology were mainly chosen to provide reliable and user-friendly interfaces that will attract many users. eEKAB is based on three important pillars for offering health care to the patients: the “On-time Incident Reporting”, the “On-time Arrival at the Incident” and “Transfer to the Health Center”. According to the literature review, the emergency medical services (EMS) systems that combine all the features are very few. Findings It reduces the total time of the EMS procedures and it allows for an easier management of EMS, by providing a better allocation of human resources and a better geographical distribution of ambulances. The evaluation displayed that it is a very helpful application for the ambulance drivers as it reduces the ambulance response time to arrive in the patient's location and contributes significantly to the general performance of the prehospital medical care system. Also, the survey verified the importance of implementing eEKAB on a larger scale beyond the pilot usage. It is worth mentioning that the younger ambulance drivers had a more positive view for the purpose of the application. Research limitations/implications The paper clearly identifies implications for further research. Regarding interoperability, the mobile app cooperates with the Operational Center of EKAB, while further collaboration could be achieved with other operational ambulance handling center, mainly, of the private sector. The system can evolve to include better communications among the EKAB departments. Particularly, the ambulance crew as well as the doctors should be informed with more incident features such as the emergency signal so that they know whether to open the siren, the patient's name, etc. The authors are currently working on implementing some features to provide effective medical health services to the patient in the ambulance. Practical implications eEKAB will have very significant implications in case of its enforcement, such as the reduction of the total time of EMS procedures with a corresponding reduction of the operating costs of an accident management system and an ambulance fleet handling system while in parallel informing in time the doctors/clinics. It will provide better distribution of ambulances as well as of total human resources. It will greatly assist ambulance drivers, while reducing ambulance response time to reach the patient's location. In other words, the authors will have a better performance of the whole prehospital care system. Social implications Providing emergency care before the hospital is of great importance for upgrading the quality of health services provided at the accident site, thus significantly reducing the risk of premature death of patients. This in itself has a significant social implication. Originality/value The paper demonstrates a solid understanding in the field of the EMS systems and the corresponding medical services offered. It proposes the development of an effective, feasible and innovative EMS information system that will improve the existing emergency health care system in Greece (EKAB). An in depth literature review and presentation of the adopted new technologies and the respective architecture take place. An evaluation and statistical validation were conducted for proving the high applicability of eEKAB in case of real-life running.

Clinical picture and risk factors of occurrence of pulmonary artery thromboembolism

Pulmonary artery thromboembolism (PATE) is a life-threatening condition in which the pulmonary artery or its branches are occluded by a detached thrombus (embolus). In this case, a thrombus can form both on the walls of blood vessels and directly in the right ventricle or atrium; in some cases, air or fat embolism may occur. The most common cause of pulmonary thromboembolism are thrombi that appear in the vessels of the lower extremities and migrate upward; a particular danger are floating thrombi, which attach to the vascular wall with one «leg» and can easily come off when coughing or exercising. Pulmonary embolism occurs in 1 case per 1000 patients, is observed mainly in adults and has a high mortality rate. There are no specific signs, characteristic of this particular pathology. Patients may have a sharp pain behind the sternum of a pleuritic nature, sudden shortness of breath, tachycardia, sometimes a cough with hemoptysis; precollaptoid state or even loss of consciousness may occur. Correct diagnosis is of utmost importance for the timely provision of emergency care. To make a diagnosis, pulse oximetry, chest radiography, CT angiography, and duplex or triplex angioscanning are used. In case of untimely provision of medical care, mortality in this condition can reach 50 %.

An Automated COVID-19 Exposure Surveillance System for EMS Clinicians

Emergency Medical Services clinicians serve on the front lines of responding to the COVID-19 pandemic. EMS clinicians are often face unknown and austere circumstances while providing emergency care in a myriad of settings. In an effort to protect EMS clinicians and inform EMS system clinical leaders, the State of Maryland has established an automated COVID-19 post-exposure surveillance system. The system provides encounter notifications to EMS system infection control officers through a linkage between the State’s prehospital patient care reporting system and the state-wide health information exchange (HIE).

Expert assessment of the suitability of treatment and diagnostic measures in providing emergency care to patients with acute coronary syndrome

It is known that it is possible to affect the extent of myocardial damage and, as a result, mortality only in the first hours of its development. Therapeutic tactics in ACS with elevation of the ST segment involves the restoration of coronary blood flow, the main method is the reperfusion of the coronary artery by systemic thrombolysis or PCI in a specialized hospital. The effectiveness of treatment is inversely related to the time spent.&#x0D; The aim of the study was to examine the opinion of specialists on the feasibility of implementing the items of the protocol of emergency medical care for patients with ACS at the place of call.&#x0D; Materials and methods. During the study the method of expert evaluations, which consisted of gathering information by interviewing experts and summarizing the individual opinions of experts into a general concept was used. The experts were 48 emergency physicians. The method of expert evaluation included the following stages: development of the questionnaire; survey of experts; summary of examination materials; calculation of statistical indicators; interpretation of the obtained results and formulation of conclusions.&#x0D; Results. In order to assess the actions of the emergency team, depending on the need to conduct them for diagnosis and emergency care for patients with ACS at the scene, we calculated the feasibility indexes for each item of the protocol. In the future, we divided the treatment and diagnostic measures for ACS with ST segment elevation according to the level of expediency at the scene into four groups (n): n1 – high level, n2 – sufficient level and n3 – low level and n4 – very low level. According to the results of the ranking, the scope of measures to be implemented by the head of the emergency team at the ACS with elevation of the ST segment on arrival on call, as well as measures that, according to interviewed experts, are not required at this stage and can be carried out during transportation of the patient to a specialized hospital.&#x0D; Conclusions. Based on the results of the calculation of feasibility indices and subsequent ranking of treatment and diagnostic measures for the relevant groups (n1, n2, n3, n4) from 37 items of the study, to assist patients with ACS with ST segment elevation at the scene, it is recommended to perform 16

Retour d’expérience de la mise en place d’une ligne de régulation psychiatrique au SAMU 62 dans le contexte Covid-19

The epidemic context of Covid-19 and the containment measures, put in place since 16 March 2020, has significantly increased the number of emergencies calls in call center (SAMU). In the department of Pas-de-Calais, one step of the crisis measures was setting up a psychiatric regulation line, which aims to manage calls with strong emotional valence (in connexion with containment, anxiety related to the epidemic context, or break in psychiatric cares for people suffering of mental disorders). This psychiatric hotline was provided from 20 March 2020 to 15 May 2020 by fifteen psychiatric careers (psychiatrists, psychologists and psychiatric nurses) from the network of the medical-psychological emergency unit (unit of the emergency call center which aims to manage people involved in psychotraumatic events). In total, 556 calls were answered, i.e. an average of 9,8 calls per day. The typology of calls was in a quarter of the cases anxiety related to the fear of being infected, in the second quarter, adjustment disorders related to containment, and for about half of the calls, psychiatrics symptoms whether it was preexisting and increased by the discontinuation of care, or context-induced. The benefits identified by this device were as follows: -the discharge of time-consuming calls for the medical dispatcher assistant, -the expertise of a mental health professional, knowing the mental health network, to make the decision more fluid. Last but not least, it is interesting to note that the presence of the psychiatric regulator in the regulation room allowed a transfer of calls and a reciprocal acculturation. In view of the relevance of the establishment of a psychiatric regulation line in the epidemic context of Covid-19, it seems interesting to consider the sustainability of this system, which is part of a global context of evolution of the provision of emergency care.

Successful treatment of severe calcium channel blocker poisoning: a clinical case

The article describes the successful experience of treating a female patient with severe poisoning by a mixture of drugs with a predominant cardiotoxic effect. The number of drugs taken was many times higher than the potentially lethal dose. Hemodynamics has been supported by vasopressors and inotropic drugs for a long time, antidotes, sorbents, detoxification agents were used. Due to inadequate spontaneous ventilation, the patient was on artificial lung ventilation for 24 days. After 26 days in the intensive care unit, she was transferred to the therapeutic department in a stable state and without neurological deficit. We believe that this material will be useful for intensive care physicians when providing emergency care to patients in such situations.

A Review of Ophthalmic Telemedicine for Emergency Department Settings

ABSTRACT Background: Patients presenting to emergency departments for ophthalmic emergencies benefit from prompt evaluation. However, Few emergency departments (EDs) have ophthalmologists on call, and eye care provided in EDs without ophthalmic services can be inaccurate. Methods: We review the current state of ophthalmic telemedical care in EDs and highlight important considerations when implementing telemedicine in this setting. Results: Telemedicine allows ophthalmologists to work with on-site emergency care providers to interview and examine patients remotely in EDs, enabling proper assessment of patient history, visual acuity, pupils, intraocular pressure, as well as the anterior and posterior segment. To date, patients’ perceptions of this new model of care have been largely positive. Discussion: The use of telemedical consultations for remote evaluation of patients with ophthalmic complaints stands to improve the quality of care provided to patients and extend the reach of remote ophthalmologists. The onset of the COVID-19 pandemic and the risk of in-person care further highlights the potential for telemedicine to augment existing models of emergency care.

A survey of Canadian emergency physicians' experiences and perspectives during the COVID-19 pandemic.

BackgroundThe objective of this study was to explore Canadian emergency physicians’ experiences, concerns, and perspectives during the first wave of the coronavirus disease (COVID-19) pandemic.MethodsThis cross-sectional survey of physician members of Pediatric Emergency Research Canada and the Canadian Association of Emergency Physicians explored: personal safety/responsibility to care; patient interactions; ethical issues in pandemic care; institutional dynamics and communication practices. Data analysis was descriptive: categorical data were summarised with frequency distributions, continuous data [100 mm visual analog scales (VAS)] were analysed using measures of central tendency. Short open-ended items were coded to identify frequencies of responses.ResultsFrom June 29 to July 29, 2020, 187 respondents (13% response rate) completed the survey: 39% were from Ontario and 20% from Quebec, trained in general (50%) or pediatric (37%) emergency medicine. Respondents reported a high moral obligation to care for patients (97/100, IQR: 85–100, on 100 mm VAS). Fear of contracting COVID-19 changed how 82% of respondents reported interacting with patients, while 97% reported PPE negatively impacted patient care. Despite reporting a high proportion of negative emotions (84%), respondents (59%) were not/slightly concerned about their mental health. Top concerns included a potential second wave, Canada’s financial situation, worldwide solidarity, and youth mental health. Facilitators to provide emergency care included: teamwork, leadership, clear communications strategies.ConclusionCanadian emergency physicians felt a strong sense of responsibility to care, while dealing with several ethical dilemmas. Clear communication strategies, measures to ensure safety, and appropriate emergency department setups facilitate pandemic care. Emergency physicians were not concerned about their own mental health, requiring further exploration.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-021-00129-4.

To collar or not to collar. Views of pre-hospital emergency care providers on immobilisation without cervical collars: a focus group study.

Background:Spinal cord injury (SCI) is a rare event, with high numbers of patients unnecessarily immobilised with no potential benefit based on limited evidence from the 1950s and 1960s. Contemporary opinion now challenges the notion that traditional immobilisation prevents movement and protects the spine. Current literature suggests that these methods which include semi-rigid collars can potentially cause more movement of the spine and harm the patient. The purpose of this study was to explore the views and perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar.Methods:Focus groups were used to allow individuals to discuss and comment on a new method of immobilisation which omits the semi-rigid collar and to capture the thoughts, feelings and experiences of participants. Thematic analysis of the coded transcriptions was used to identify emerging themes.Results:Three focus groups were conducted with 15 participants in each. Participants were all exposed to patients sustaining trauma within their professional roles. Six intertwined themes emerged from the analysis: communication, conflict, education/training, empowerment, risk and the patient. Woven between these themes are the complex interactions that bring together the inter-professional relationships with other emergency services and hospital staff, the patient, the public and pre-hospital care providers.Discussion:Existing immobilisation practices are being challenged, with clinicians empowered to tailor practice to meet specific patient needs. There is limited empirical evidence to support current immobilisation practices. Contemporary literature suggests current practices may potentially cause harm. New pragmatic immobilisation practices are gradually being adopted by some pre-hospital care providers.Conclusion:This study explored the perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar for potential SCI. The consensus of the participants supports a pragmatic approach to managing potential SCI that provides safe, high-quality patient-centred care.

Physicians’ experiences of providing emergency care to undocumented migrants arriving in Spain by small boats

IntroductionAccess to emergency care for undocumented migrants (UMs) is a public health problem. Spain receives thousands of UMs who arrive by sea. A multidisciplinary team of the Spanish Red Cross, made up of physicians, nurses, police, and cultural mediators, developed emergency care for UMs. AimThe aim of our study is to describe and understand the experiences of physicians in emergency care for UMs who arrive in Spain by small boats MethodsQualitative study, based on Gadamer’s phenomenology. Convenience and purposive sampling was carried out and included sixteen in-depth interviews with physicians, between June 2019 and March 2020 in Spain. ResultsThree main themes emerged: 1) Rediscovering humanistic medicine; 2) Leaving the personal and professional comfort zone; 3) Improving medical emergency care. ConclusionsTriage, pharmacological prescription, and the closure of the emergency care process are the key contributions of medical care. Cultural, language and security barriers make emergency care difficult.

Emergency centre handover from the perspective of prehospital emergency care providers in Johannesburg, South Africa

PurposeThe purpose of this paper is to describe handover in the emergency centre from the perspective of prehospital emergency care providers in Johannesburg, South Africa. Reference to emergency centre handover from the prehospital perspective will have particular relevance to all deliverers of emergency centre handover.Design/methodology/approachA purposive, cross-sectional design addressed the study aim by using a purpose-designed, validated, paper-based questionnaire to collect data relating to prehospital emergency care personnel's perspectives on emergency centre handover.FindingsThere were 175 completed questionnaires collected from South African prehospital personnel within the Johannesburg area. The response rate was 175/290 or 62%. Training on handover was described as poor. There was a general appreciation of mnemonics and how well they ensured that all relevant information was handed over. However, this was countered by poor familiarity of common mnemonics. Perception of the accuracy of their own and observed prehospital handovers was generally positive. Handover length was generally perceived to be appropriate. The qualification of emergency centre personnel was perceived to impact on how handovers were received.Research limitations/implicationsThe study was limited to one geographical area and did not include all potential participants in the study area. The self-reported data collection meant that there was a risk of self-report bias. These factors may have negatively affected the generalisability of the data.Originality/valueThis paper seeks to describe perceptions related to emergency centre handover from the perspective of prehospital emergency care personnel. In doing so, it is postulated that there is the potential to use these findings to improve certain aspects of emergency centre handover.