Real Emergency Research Articles

Epidemiological profiles of otorhinolaryngological disorders in adults admitted to the emergency room of a tertiary university hospital.

The incidence of otorhinolaryngological emergencies has been steadily increasing. With the increasing number of patients admitted to the emergency room, numerous challenges in healthcare have become more prevalent. This study aimed to evaluate the epidemiological profile of otorhinolaryngological disorders in adults admitted to the emergency department of a tertiary university hospital. A total of 7028 adult patients with otorhinolaryngological disorders admitted to the emergency department of a tertiary hospital from January 1 to December 31, 2016, were enrolled in the study. Each patient underwent a comprehensive clinical evaluation by the physicians of the emergency department and was consulted by an otorhinolaryngologist. Age, sex, time of visits, and cost of each patient due to healthcare insurance were recorded. In total, 3098 patients were male (36.6 ± 16.4 years; 44.1%) and 3930 were female (35.4 ± 16.2 years; 55.9%). The most common otorhinolaryngological disorders were pharyngitis (n = 2713; 38.6%), followed by tonsillitis (n = 1302; 18.5%) and rhinitis (n = 1161; 16.5%). These three infectious diagnoses constituted 73.6% of all otorhinolaryngological disorders. The highest number of medical visits due to otorhinolaryngological disorders was in January, whereas the lowest number of visits was in July. When we excluded the three infection-based diagnoses, otorhinolaryngological disorders were stable at approximately 150 patients per month. The main reason for the increase in the number of visits per month due to otorhinolaryngological disorders appeared to be a result of these three infection-based diagnoses. More than 80% of otorhinolaryngological disorders in adults admitted to the emergency department were not truly emergencies requiring attendance at a tertiary hospital emergency room. New policies should be instituted to reduce the workload of the emergency services and to allow more effort to be spent on real emergencies.

Optimization of Data Collection during Public Health Emergencies—Experience with APACHE II Score

Background Capturing accurate clinical data in real time is a challenge during public health emergencies. The United States Critical Illness and Injury Trials Group-Program for Emergency Preparedness is committed to improving these preparedness efforts. Objectives We aimed to create an electronic Acute Physiology and Chronic Health Evaluation (APACHE) II data collection instrument that (1) leverages Research Electronic Data Capture (REDCap) automated calculations and logic, (2) may be shared across sites, (3) overcomes limitations in existing APACHE II instruments in the REDCap library, and (4) suggests changes to be made to data collection instruments during emergencies. Methods The APACHE II instrument was implemented using REDCap. Data fields were divided into four sections: age, Acute Physiology, Glasgow Coma Scale, and chronic health status. Usability testing was followed by two preliminary evaluations: a comparison to existing APACHE II instruments and a simulated emergency exercise. Results The final instrument consisted of 34 data fields. It produced an accurate APACHE II score and was faster to complete than two previous implementations (average of 97.5 seconds vs. 323.5 and 183.5 seconds). During the simulated emergency exercise, the instrument was used at 10 sites to create 34 patient records; median time to complete the instrument was 150.5 seconds. Conclusion This project demonstrated feasibility of improving the accuracy and efficiency of a data collection instrument. Future efforts should focus on expanding these methods to develop other scoring tools for use during emergencies and additional testing to ensure it is ready for use during a real emergency.

Epidemiology of Pediatric Medical Emergencies at the Kindu Reference General Hospital (HGRK): State of Affairs and Perspectives

The management of pediatric medical emergencies is a focus of WHO’s strategy to reduce child and adolescent morbidity and mortality worldwide. It requires the synergy of several inputs including infrastructure, equipment and a sufficiently trained staff. The aim of our study was to present the epidemiological aspects of pediatric medical emergencies at Kindu General Reference Hospital in order to facilitate the projection of the actions to be carried out. To do this, we undertook a cross-sectional, descriptive and retrospective study by collecting the data in the pediatric ward of Kindu General Reference Hospital from January 1st to December 31st, 2017 with age, sex, month of admission, emergency sign, diagnostic hypothesis, treatment, length of stay and discharge modality as study’s variables in children with an emergency sign (difficulty breathing, convulsion, coma, shock and severe dehydration). After processing data on Excel 2010 and SPSS 23 software, the analysis by descriptive statistical measures shows that the frequency of signs of medical emergency in children is 21.4% among which 52.3% are male, over 70% of children with emergency signs are under the age of five with an average age of 2.1 years, the high frequency of signs of urgency was observed in June, the decreasing order of frequency of various emergency signs is severe dehydration (58.9%), seizures (24.1%), difficulty breathing (10.3%), coma (5.6%) and the state of shock (1.2%); Malaria (48.1%), diarrhea (28.3%) and meningitis (19.2%) were common causes of the signs of emergencies, symptomatic treatment for the different signs of urgency was applied in 88.6% of cases, the duration of hospitalization of children with an emergency sign is less than 4 days in 50% of cases with an average of 4 ± 3 days and mortality among children with a sign emergency in our study is 17.3%. These results highlight the existence of life-threatening medical emergencies in the child in our work environment and require the establishment of a real pediatric emergency unit within the HGRK.

A Rare Case Managed with Misdiagnosis in Third Trimester of Pregnancy: Ovarian Torsion

Ovarian torsion (OT) is one of the real gynecological emergencies. Up to one-fifth of OT cases develop during pregnancy. Although it is seen especially in the first trimester, it can also develop in the third trimester. OT in the third trimester of pregnancy is a rare condition that can lead to midline laparotomy and birth of a preterm baby with caesarean section (CS). It is associated with nonspecific symptoms such as lower abdominal pain, nausea and vomiting in pregnancies and is often misdiagnosed as appendicitis or preterm labor. A case of acute abdomen resulting from OT at the right ovary, in the third trimester of pregnancy described. The importance of prompt action in the case of OT is emphasized to achive success in their management for both mother and fetus. We aimed to emphasize the importance of evaluating the adnexa when performing obstetric ultrasonography, together with the diagnosis and management of OT in pregnancy.

Spatial-Temporal Correlation Prediction Modeling of Origin-Destination Passenger Flow Under Urban Rail Transit Emergency Conditions

Establishing a passenger flow prediction mechanism is necessary for quickly evacuating many passengers in an emergency, which can improve the service quality of urban rail transit (URT). To effectively forecast origin-destination (OD) passenger flows in URT under emergency conditions, 35-day automatic fare collection (AFC) data are used for a statistical analysis of the time, location and passenger flow aspects. The influence range of the OD passenger flow during an emergency is determined by analyzing the degree of passenger flow fluctuation. Considering the time period of an emergency occurrence and its continuous influence, this paper also studies the influence of an emergency occurring at a station, a section between two stations or a section across several stations. A spatial-temporal correlation prediction model of OD passenger flow based on nonlinear regression is constructed by introducing the concept of passenger flow spatial-temporal influencing parameters. According to the characteristics of URT lines, a passenger flow prediction algorithm is proposed to predict the OD passenger flow for different line categories for an emergency. A real typical emergency involving the Beijing urban rail transit (BURT) system in 2017 is analyzed to verify the effectiveness of the proposed model. The results show that this model can effectively predict OD passenger flow in a URT system during an emergency, which provides basic support for the evacuation of passengers.

Lehetőségek vészkijáratok nyithatóságának biztosítására

The usability of the emergency exits in buildings is a basic condition for the safe escape of persons staying in the building. In addition to the basic functions (open and closed) of the doors and windows, an easy and quick opening in an emergency situation is vital. Moreover, there is a need that emergency exits should only be used in case of real emergencies. The authors present and analyse the options that ensure safe use in case of emergencies.

Reuse of the existing

Design the contemporary city and architecture means, first of all, dealing with the existing, a huge amount of abandoned space, of uninhabited factories, of crumbling artefacts, of an entire territory which asks to be taken care of. After years of urban sprawl with soil consumption, it is necessary to rethink the way of planning in the existing contexts of the contemporary city and its environmental sustainability. The immediacy of new constructions is often preferred to the recycling of existing ones that work in the long term and return value to the places and their historical stratifications. This is why today the reuse of the existing represents the real emergency to face with a process of regeneration of cities and their territories, where the architectural project, with the contribution of other disciplines - such as archaeology and restoration, geography and landscape design - represents the only instrument able to offer an answer to the current problems of urban structures. Reuse is actually a necessity as well as an emergency; reuse is the ontological condition of architecture because every building has always recycled materials and spaces to reshape the new and we need to analyse past examples of reuse in order to create a methodology for the design reuse of existing structures. This paper aims to contribute to the definition of a teaching methodology of reuse through design and proposes an approach that interprets those characters of the different architectural forms of the existing modernist buildings.

Simulation, Epistemic Opacity, and \u2018Envirotechnical Ignorance\u2019 in Nuclear Crisis

The Fukushima nuclear accident from 2011 provided an occasion for the public display of radiation maps (or dose projections) generated using decision-support systems for nuclear emergency management. Such systems rely on computer models for simulating the atmospheric dispersion of radioactive materials and estimating potential doses in the event of a radioactive release from a nuclear reactor. In Germany, as in Japan, such systems are part of the national emergency response apparatus and, in case of accidents, they can be used by emergency task forces for planning radioprotection countermeasures. In this context, the paper addresses the epistemology of dose projections by critically analyzing some of the sources of epistemic opacity and non-knowledge (or ignorance) affecting them, and the different methods and practices used by German radioprotection experts to improve their trustworthiness and reliability. It will be argued that dose projections are part of an entire radioprotection regime or assemblage built around the belief that the effects of nuclear accidents can be effectively mitigated thanks to the simulation technologies underlying different protocols and practices of nuclear preparedness. And, as the Fukushima experience showed, some of these expectations will not be met in real emergencies due to the inherent uncertainties entailed by the use of dose projections when planning protective countermeasures.

An Operational Marine Oil Spill Forecasting Tool for the Management of Emergencies in the Italian Seas

Oil extraction platforms are potential sources of oil spills. For this reason, an oil spill forecasting system was set up to support the management of emergencies from the oil fields in the Italian seas. The system provides ready-to-use products to the relevant response agencies and optimizes the anti-pollution resources by assessing hazards and risks related to this issue. The forecasting system covers seven working oil platforms in the Sicily Channel and middle/low Adriatic Sea. It is composed of a numerical chain involving nested ocean models from regional to coastal spatial scales and an oil spill model. The system provides two online services, one automatic and a second dedicated to possible real emergencies or exercises on risk preparedness and responding. The automatic service produces daily short-term simulations of hypothetical oil spill dispersion, transport, and weathering processes from each extraction platform. Products, i.e., risk maps, animations, and a properly called bulletin, are available on a dedicated web-portal. The hazard estimations are computed by performing geo-statistical analysis on the daily forecasts database. The second service is activated in near-real-time producing oil spill simulations for the following 48 h.

Towards pedestrian room evacuation with a spatial game

During the process of a real emergency evacuation, interactions among evacuees may vary with different positions, which are affected by many objective factors such as the density of crowds, the distance to the exit and so on. To better reproduce real crowd behavior in the process of an evacuation, we propose a spatial game to model the pedestrian room evacuation in a discrete lattice. In the game, each agent interacts with its immediate neighbors and chooses one of three possible modes of strategy that leads to patient, normal or impatient behavior. The payoffs of the game change with the evacuation conditions and each agent plays against its nearest neighbors for the expected evacuation time. The model shows how evacuation conditions affect behavioral evolution in an emergency evacuation.

Improving short-term information spreading efficiency in scale-free networks by specifying top large-degree vertices as the initial spreaders.

The positive function of initially influential vertices could be exploited to improve spreading efficiency for short-term spreading in scale-free networks. However, the selection of initial spreaders depends on the specific scenes. The selection of initial spreaders needs to offer low complexity and low power consumption for short-term spreading. In this paper, we propose a selection strategy for efficiently spreading information by specifying a set of top large-degree vertices as the initially informed vertices. The essential idea behind the proposed selection strategy is to exploit the significant diffusion of the top large-degree vertices at the beginning of spreading. To evaluate the positive impact of initially influential vertices, we first build an information spreading model in the Barabási–Albert (BA) scale-free network; next, we design 54 comparative Monte Carlo experiments based on a benchmark strategy and the proposed selection strategy in different BA scale-free network structures. Experimental results indicate that (i) the proposed selection strategy can significantly improve spreading efficiency in the short-term spreading and (ii) both network size and number of hubs have a strong impact on spreading efficiency, while the number of initially informed vertices has a weak impact. The proposed selection strategy can be employed in short-term spreading, such as sending warnings or crisis information spreading or information spreading in emergency training or realistic emergency scenes.

Epidemiological andEtiological Characteristics ofMyelopathies intheNeurology Department oftheUniversity Hospital Center ofCocody, Abidjan (Ivory Coast)

The term myelopathy defines a suffering of the spinal cord whatever the etiologies. They often represent real therapeutic emergencies and are burdened by serious functional sequelae. The aim of this work was to describe the epidemiological, clinical, and etiological aspects of all myelopathies. We have conducted a prospective and descriptive study from January1, 2015 to December31, 2016 at the Neurology department of the Cocody University Hospital in Abidjan. Seventy-one patients out of 1,006 were included, that is, a prevalence of 7.06%. The sex ratio was 1.7. The average age was 49years old. HIV was associated with myelopathy in 24.7% of cases. Medullary compression syndrome was predominant. Pott's disease was the etiology of compressive myelopathies (43.9%) followed by bone metastases (26.8%). Tuberculous myelitis was the most common etiology of non-compressive myelopathies (30%). Myelites of undetermined causes account for 50% of non-compressive myelopathies.

An Efficient Monitoring of Real Time Traffic Clearance for an Emergency Service Vehicle Using IOT

In this paper, a real time emergency vehicle tracking through architecture of instinctive emergency recognition system with high-intensity digital camera it is located in a national high way traffic signal. In a recent survey, there are thousands of people losing their lives due to the delay in the emergency services. Resent survey say that more than 4000 heart attack victims can be saved each year if the delay could be minimized and in the present scenario the number of deaths is in lakhs and this number can be effectively reduced by providing timely and accurate emergency service all the way through avoiding the unnecessary time delay near traffic jams during an emergency situation (Tagne et al. in IEEE Trans Intell Transp Syst 17(3):796–809, 2015). This method clarifies the modeling and working of different units of the emergency vehicle identification system such that optimized emergency vehicle tracking algorithm, with the traffic supervision unit. In this article confer the basic components and their function such that internet of things and their dissimilar layers of protocol, raspberry pi and its architecture, with interfacing sensors such as Siren sound detect (REES-52), the Wireless sensor (NRF905se). It is direct and the most efficient route that is asphalt construct to the central server checks for the location of the vehicle and change the traffic signal. When the emergency vehicle is approaching the traffic lights. The system generate in sequence regarding the traffic emergency situations such as ambulance and siren sound (Emergency Services Review: A comparative review of international ambulance service best practice. http://www.aace.org.uk. Accessed 28 July 2017, 2017). The processed information can be used to divert the live traffic as desirable to avoid the problems related to real time road traffic (Sundar et al. in Sens J IEEE 15(2):1109–1113, 2015).

Assessment of patients presented to the emergency department with dermatological complaints: Retrospective cohort study

Aim: Although dermatology is an area of expertise based largely on outpatient treatment, about 5-10% of emergency department patients are dermatological diseases. In this study, it was aimed to draw attention to management of dermatologic diseases which are frequently encountered in emergency services.Methods: Over 18 years old 96 patients who presented with a dermatologic problem to the emergency department of Kahramanmaras Sutcu Imam University Hospital between January and June 2018 were evaluated.Results: The mean age of the patients was 43.9 ± 17.1 years. When the gender distribution was examined, 39.6% (n=38) of the cases were male and 60.4% (n=58) were female. Pruritus and rash were the most common dermatological complaints and the most common diagnoses were urticaria (38.5%), urticaria-angioedema (13.5%), cellulitis (8.3%) and anaphylaxis (8.3%) in this study. The rate of cases without known dermatological disease was 77.1%. In 52 (54.2%) cases, there was a new drug use which may be associated with the current dermatosis, and antibiotics (22.9%) were the most frequently detected from these drugs.Conclusion: It was seen that most of the patients who admitted with a dermatological problem had no known dermatological disease, and some adult patients with chronic dermatosis might apply to emergency services. It has been determined that not all cases are real dermatologic emergencies and most of them are relieved and discharged by intervention made at the emergency department without need of examination. The presence of a new drug use in about half of the cases revealed that drugs are an important etiologic factor in emergency dermatological diseases.

“SIMBurns”: A high-fidelity simulation program in emergency burn management developed through international collaboration

Acute management of a severely burned patient is an infrequent and stressful situation that requires medical knowledge as well as immediate coordinated action. Many adverse events in health care result from issues related to the application of ‘non-technical' skills such as communication, teamwork, leadership and decision making rather than lack of medical knowledge. Training in these skills is known as Crisis Resource Management (CRM) training.In order to create well-prepared burn teams, it is critical to teach CRM principles through high-fidelity simulation (HFS).While CRM teaches foundational non-technical skills, HFS incorporates lifelike, whole-body, fully-responsive mannequins in order to provide a realistic emergency situation.The aim of the study is to describe the development of a novel high-fidelity simulation course called “SIMBurns: High Fidelity Simulation Program for Emergency Burn Management” that uses CRM as its foundation and is focused on management of burn injuries. The course was designed by a panel of simulation and burns experts from Meyer Children’s Hospital in Italy and Birmingham Children’s Hospital in the U.K. Simulation Program experts were certified by Boston Children’s Hospital’s Simulation Program. In this paper, we describe the course’s design, development, structure, and participant’s assessment of the course. Since the creation of the SIMBurns course in 2013, 9 courses have been conducted and 101 participants have attended the course. The course was well-received and its “Overall Satisfaction” was rated at 4.8/5. The primary objective in the SIMBurns course – to teach teamwork and CRM skills to medical staff involved in emergency burn care – was also met at 4.8/5. Participants felt that the course developed their ability to interact with other team members, further improved their understanding of how to appropriately use resources, emphasized the importance of role clarity and developed their communication skills. Additional quantitative and qualitative analyses obtained from participants were also reviewed after each course. The SIMBurns course aims to contribute to the education of those in healthcare in order to improve patient safety and to continue advancing the education of our emergency burn care teams.

Gene expression-based biodosimetry for radiological incidents: assessment of dose and time after radiation exposure

Purpose: In order to ensure efficient use of medical resources following a radiological incident, there is an urgent need for high-throughput time-efficient biodosimetry tools. In the present study, we tested the applicability of a gene expression signature for the prediction of exposure dose as well as the time elapsed since irradiation.Materials and methods: We used whole blood samples from seven healthy volunteers as reference samples (X-ray doses: 0, 25, 50, 100, 500, 1000, and 2000 mGy; time points: 8, 12, 24, 36 and 48 h) and samples from seven other individuals as ‘blind samples’ (20 samples in total).Results: Gene expression values normalized to the reference gene without normalization to the unexposed controls were sufficient to predict doses with a correlation coefficient between the true and the predicted doses of 0.86. Importantly, we could also classify the samples according to the time since exposure with a correlation coefficient between the true and the predicted time point of 0.96. Because of the dynamic nature of radiation-induced gene expression, this feature will be of critical importance for adequate gene expression-based dose prediction in a real emergency situation. In addition, in this study we also compared different methodologies for RNA extraction available on the market and suggested the one most suitable for emergency situation which does not require on-spot availability of any specific reagents or equipment.Conclusions: Our results represent an important advancement in the application of gene expression for biodosimetry purposes.

Acoustic features in speech for emergency perception

Previous studies have reported that the acoustic features such as the speech rate, fundamental frequency (F0), amplitude, and voice gender are related to emergency perception in speech. However, the most critical factor influencing the emergency perception in speech remains unknown. In this study, we compared influences of three acoustic features (speech rate, F0, and spectral sequence (amplitude)) to determine the acoustic feature that has the most influence on emergency perception in speech. Prior to conducting our experiments, we selected five speech phrases with different level of perceived emergency among various speech phrase spoken by TV casters during real emergencies. We then created synthesized voices by replacing three acoustic features separately among the selected five voices. In experiment 1, we presented these synthesized voices to 10 participants and asked them to evaluate levels of the perceived emergency of each voice by the magnitude estimation method. The results from experiment 1 showed that F0 was most influential on emergency perception. In experiment 2, we examined influences of the three acoustic features on auditory impression related to the perceived emergency by the SD method. The results suggested that emotional effects of some words such as “tense” or/and “rush” were influenced by the fundamental frequency.Previous studies have reported that the acoustic features such as the speech rate, fundamental frequency (F0), amplitude, and voice gender are related to emergency perception in speech. However, the most critical factor influencing the emergency perception in speech remains unknown. In this study, we compared influences of three acoustic features (speech rate, F0, and spectral sequence (amplitude)) to determine the acoustic feature that has the most influence on emergency perception in speech. Prior to conducting our experiments, we selected five speech phrases with different level of perceived emergency among various speech phrase spoken by TV casters during real emergencies. We then created synthesized voices by replacing three acoustic features separately among the selected five voices. In experiment 1, we presented these synthesized voices to 10 participants and asked them to evaluate levels of the perceived emergency of each voice by the magnitude estimation method. The results from experiment 1 show...

Machine training to the distribution of tasks in the multi-agent robotic system in the elimination of emergency situations

An algorithm for machine learning of a transport type model is presented for the optimal distribution of tasks in a heterogeneous group of robots operating in an automatic mode without operator participation. It is assumed that the model is trained by an experienced operator in a landfill environment adequate to a real emergency situation in which robots are to perform operations. According to the configured model in a real setting, tasks can be distributed according to a supervisory or decentralized control scheme. Training can be carried out and in the process of the regular operation of robots. In this case, the use of the learning model allows you to split the configuration tuning circuits and the assignment of tasks, which enables the robots and the operator to function at their own natural pace.

Odontal and Protetic Reconstruction in Total Coronar Fractures

Beyond the acute character, two important aspects confer specificity to the dento-periodontal traumas: the age of the patients and the multidisciplinary attend of the therapeutic approach. The traumas, together with the dento-periodontal infections, are real pedodontic emergencies. Dento-periodontal traumas are lesions requiring careful examination to establish a correct diagnosis and a rapid establishment of appropriate treatment. They require a rapid diagnosis, an optimal therapeutic attitude, to resolve dento-periodontal structures and further harmonious development of the jaws. The coronary traumas that amputate the dental crown result from trauma that develop high intensity forces, with a point of application to the tooth cervical area, accompanied by other types of injuries. Radical status evaluation is performed paraclinically by imaging exploration methods. Information on root length, implantation, absence or presence of periapical diseases, endodontic treatment quality are fully provided by these methods.Clinically, the diameter of the roots of the teeth is evaluated. The analysis and synthesis of these data will allow the determination of the method of substitution and the planning of working methods. Material and Method: The study group comprises 39 children aged 6-16, most of them present for emergency treatment. Results and Discussion: The traumatic agent�s force exceeds the resistance and elasticity of tissues, causing discontinuities in the tissue structure, whether soft or rough. Conclusions: The provisional or final treatment of dento-periodontal traumas aims at restoring the morphological, functional and psychological integrity of the traumatized individual.

DeepUrbanMomentum: An Online Deep-Learning System for Short-Term Urban Mobility Prediction

Big human mobility data are being continuously generated through a variety of sources, some of which can be treated and used as streaming data for understanding and predicting urban dynamics. With such streaming mobility data, the online prediction of short-term human mobility at the city level can be of great significance for transportation scheduling, urban regulation, and emergency management. In particular, when big rare events or disasters happen, such as large earthquakes or severe traffic accidents, people change their behaviors from their routine activities. This means people's movements will almost be uncorrelated with their past movements. Therefore, in this study, we build an online system called DeepUrbanMomentum to conduct the next short-term mobility predictions by using (the limited steps of) currently observed human mobility data. A deep-learning architecture built with recurrent neural networks is designed to effectively model these highly complex sequential data for a huge urban area. Experimental results demonstrate the superior performance of our proposed model as compared to the existing approaches. Lastly, we apply our system to a real emergency scenario and demonstrate that our system is applicable in the real world.