Real-time Emergency Department Research Articles

Emergency Department Visits for Pedestrians Injured in Motor Vehicle Traffic Crashes - United States, January 2021-December 2023.

Traffic-related pedestrian deaths in the United States reached a 40-year high in 2021. Each year, pedestrians also suffer nonfatal traffic-related injuries requiring medical treatment. Near real-time emergency department visit data from CDC's National Syndromic Surveillance Program during January 2021-December 2023 indicated that among approximately 301 million visits identified, 137,325 involved a pedestrian injury (overall visit proportion=45.62 per 100,000 visits). The proportions of visits for pedestrian injury were 1.53-2.47 times as high among six racial and ethnic minority groups as that among non-Hispanic White persons. Compared with persons aged ≥65 years, proportions among those aged 15-24 and 25-34 years were 2.83 and 2.61 times as high, respectively. The visit proportion was 1.93 times as high among males as among females, and 1.21 times as high during September-November as during June-August. Timely pedestrian injury data can help collaborating federal, state, and local partners rapidly monitor trends, identify disparities, and implement strategies supporting the Safe System approach, a framework for preventing traffic injuries among all road users.

COVID–19 driven decline in emergency visits: Has it continued, is it permanent, and what does it mean for emergency physicians?

IntroductionHospital-based emergency departments have been a sustained source of overall hospital utilization in the United States. In 2019, an estimated 150 million hospital-based emergency department (ED) visits occurred in the United States, up from 90 million in 1993, 108 million in 2000 and 137 million in 2015. This study analyzes hospital ED visit registration data pre and post to the COVID-19 pandemic describe the impact of on hospital ED utilization and to assess long-term implications of COVID and other factors on the utilization of hospital-based emergency services. MethodsWe analyze real-time hospital ED visit registration data from a large sample of US hospitals to document changes in ED visits from January 2020 through March 2022 relative to 2019 (pre-COVID baseline) to describe the impact of the COVID-19 pandemic on EDs and assess long-term implications. ResultsOur data show an initial steep reduction in ED visits during the first half of 2020 (compared to 2019 levels) with rebounding occurring in 2021, but never reaching pre-pandemic levels. Overall, ED visit volumes across the study states declined in each year since 2019: 2020 declined by −18%, 2021 by −10% and the first quarter of 2022 is −12% below 2019 levels. ConclusionsThere is a wide range of potential long-term implications of the observed reduction in the demand for hospital-based emergency services not only for emergency physicians, but for hospitals, health plans and consumers.

Real-time prediction of patient disposition and the impact of reporter confidence on mid-level triage accuracies: an observational study in Israel

AimThe emergency department (ED) is the first port-of-call for most patients receiving hospital care and as such acts as a gatekeeper to the wards, directing patient flow through the hospital....

Utilizing Syndromic Surveillance for Hurricane Irma-Related CO Poisonings in Florida

Utilizing Syndromic Surveillance for Hurricane Irma-Related CO Poisonings in Florida

Increased Seizure Activity in Florida Associated with Hurricane Irma, September 2017

ObjectiveUsing Florida’s syndromic surveillance data, to describe the increase in seizure activity in the days after Hurricane Irma made landfall in 2017IntroductionOn September 10, 2017, Irma made landfall in the Florida Keys as a Category 4 hurricane and subsequently tracked up the west side of the state. Due to the size of the storm, it impacted nearly all of Florida. The Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL), the state’s syndromic surveillance system, captures 98% of the emergency department (ED) visits statewide and has historically served a vital function in providing near real-time ED data that are used to track post-disaster morbidity and mortality. After previous hurricanes and tropical storms, increases in carbon monoxide poisonings, animal bites, and injuries have been documented. During post-Irma surveillance, an additional increase in seizure-related ED visits was observed.MethodsTwice-daily Hurricane Irma surveillance reports were produced from Sept 10-22, 2017. In addition to specialized queries specific to storm surveillance, analysis was conducted using ESSENCE-FL’s syndrome and subsyndrome categories. The subsyndrome category of Seizure captures ED visits which list the words seizure or convulsion in the patient chief complaint. Daily number of seizure visits were compared against a 28-day baseline using an exponentially weighted moving average algorithm. Additionally, daily seizure visits as a percentage of total ED visits were calculated and plotted.ResultsOn September 11, 12, and 13, ED visits for seizures were increased above the expected levels. On these dates respectively, 336 visits (270 expected, p < 0.01), 349 visits (278 expected, p < 0.01), and 306 visits (267 expected, p < 0.01) seizure visits occurred statewide. September 10 showed the largest increase in seizure visits as a percent of all visits.ConclusionsRoutine post-storm surveillance was able to identify an increase in seizure visits at EDs in Florida. This hurricane-related increase, while not detected using our syndromic surveillance system during previous storms, supports findings of increased emergency medical service calls for convulsions and seizures after Hurricanes Katrina and Rita (both in 2005) found by other researchers (Davis et al., 2013). Due to the size, strength, and projected path of Hurricane Irma, stress (a known seizure trigger) is a possible biological explanation for the increase that was observed. A greater understanding of storm-related public health threats allows the Florida Department of Health to better plan for these events and communicate this information to the public and our partners. Post-storm analysis was complicated by large changes in overall ED volumes during and immediately following the hurricane, and further exploration of the association found in this study is encouraged.ReferencesDavis JS, Allan BJ, Pearlman AM, Carvajal DP, Schulman CI., Optimal emergency personnel allocation after a natural disaster, Am J Disaster Med. 2012 Winter;7(1):31-6.

Lessons Learned from an Extreme Heat Event using ACES for Situational Awareness, Ontario, Canada

ObjectiveTo describe the lessons learned for public health decision-makers from an analysis of Acute Care Enhanced Surveillance (ACES) data for the heatwaves experienced in Ontario, Canada in the summer of 2018.IntroductionThe Acute Care Enhanced Surveillance (ACES) system provides syndromic surveillance for Ontario’s acute care hospitals. ACES receives over 99% of acute care records for emergency department (ED) visits; mean daily volume is 17,500 visits. ACES uses a maximum entropy classifier and generates more than 80 standard syndromes, fifteen of which are actively monitored for aberrational activity and are considered of higher public health relevance, including RESP (respiratory infection, non-croup), ILI (influenza-like illness), TOX (toxicological, chemical/drug exposure), AST (asthma), OPI (opioid exposure), CELL (cellulitis), GASTRO (gastroenteritis), ENVIRO (environmental, heat/cold exposure), MH (mental health), EOH (alcohol intoxication), DERM (rash), and SEP (bacteremia, sepsis).Syndromic surveillance provides a salient source of public health surveillance during extreme heat events; monitoring real-time ED visits can inform local public health authorities of health impacts, provide situation awareness to initiate and/or inform public health response, and help decision-makers allocate resources according to geographic (or demographic) vulnerability. While the use of syndromic surveillance has been well-characterized to monitor infectious disease outbreaks, its use to monitor the heat-health impacts is relatively novel for ACES users, specifically local public health authorities. This report describes the the data collected during an extended extreme heat event in Ontario, Canada, to highlight the value of syndromic surveillance during extreme heat events and make recommendations regarding incorporating ACES data into routine workflows.MethodsTemperature data were retrieved from Environment Canada historical databases for mid-June to mid-July 2018. Aggregate counts per day for total ED visits and and for individual syndromes were retrieved from ACES databases. Descriptive statistics were used to analyze all datasets.ResultsAn extreme heat event occurred in the southern region of Ontario in early summer, 2018. Environment Canada issues heat warnings for regions throughout Canada according to region-specific criteria; for southern Ontario, heat warnings are issued when 2 or more consecutive days of daytime maximum temperatures are expected to reach 31°C or when 2 or more consecutive days of humidex values are expected to reach 40. Extended heat warnings are issued when the event lasts beyond 2 days. An extended heat event occurred June 29 to July 5, 2018. Although the region is large, temperature data from Environment Canada’s climate monitoring station at Toronto’s Pearson Airport are shown (Figure 1) as an example of the temperatures observed for this time period in the region.ConclusionsLessons learned from an analysis of ACES data during an extreme heat event:1. The ENVIRO syndrome provides real-time monitoring of the health impacts during a heat event and may provide proxy for estimating the indirect effects of heat (e.g., impacts on chronic conditions). Public health authorities can monitor local health impacts during an extreme heat event.2. Patients seeking help at the ED do not appear to be skewed in acuity, sex nor age. This does not necessarily reflect the population that experiences the greatest impact from extreme heat, but rather those that are seeking help at the ED for the direct effects of heat. That said, an increase in ENVIRO counts does not indicate whether the increase is due to greater exposure to the heat (or sun), engaging in vigorous outdoor activity during the event (recreational or occupational), or lack of access to air conditioning.3. ED visits for ENVIRO can be geolocated to determine areas experiencing greater health impacts. This may allow allocation of resources to specifically address vulnerabilities. ACES has built-in mapping capabilities that allows a geovisualization of the home addresses for patients. Furthermore, aggregate counts for relevant syndromes are available for registered users on the Public Health Information Management System (PHIMS), a web-accessible GIS tool for situational awareness that gives public health decision-makers access to real time health impacts in concert with demographics, weather, and other emergency management information.

Effects of Real-time EMS Direction on Optimizing EMS Turnaround and Load-balancing Between Neighboring Hospital Campuses

Background: Implemented in September 2017, the “nurse navigator program” identified the preferred emergency department (ED) destination within a single healthcare system using real-time assessment of hospital and ED capacity and crowding metrics. Objective: The primary objective of the navigator program was to improve load-balancing between two closely situated emergency departments, both of which feed into the same inpatient facilities of a single healthcare system. A registered nurse in the hospital command center made real-time recommendations to emergency medical services (EMS) providers via radio, identifying the preferred destination for each transported patient based on such factors as chief complaint, ED volume, and waiting room census. The destination decision was made via the utilization of various real-time measures of health system capacity in conjunction with existing protocols dictating campus-specific clinical service availability. The objective of this study was to evaluate the efficacy of this real-time ambulance destination direction program as reflected in changes to emergency medical services (EMS) turnaround time and the incidence of intercampus transports. Methods: A before-and-after time series was performed to determine if program implementation resulted in a change in EMS turnaround time or incidence of intercampus transfers. Results: Implementation of the nurse navigator program was associated with a statistically significant decrease in EMS turnaround times for all levels of dispatch and transport at both hospital campuses. Intercampus transfers also showed significant improvement following implementation of the intervention, although this effect lagged behind implementation by several months. Conclusion: A proactive approach to EMS destination control using a nurse navigator with access to real-time hospital and ED capacity metrics appears to be an effective method of decreasing EMS turnaround time.

Public Health Impact of Syndromic Surveillance Data—A Literature Survey

Public Health Impact of Syndromic Surveillance Data—A Literature Survey

Tracking suspected heroin overdoses in CDC's National Syndromic Surveillance Program

ObjectiveThis paper analyzes emergency department syndromic data in the Centers for Disease Control and Prevention’s (CDC) National Syndromic Surveillance Program’s (NSSP) BioSense Platform to understand trends in suspected heroin overdose.IntroductionOverdose deaths involving opioids (i.e., opioid pain relievers and illicit opioids such as heroin) accounted for at least 63% (N = 33,091) of overdose deaths in 2015. Overdose deaths related to illicit opioids, heroin and illicitly-manufactured fentanyl, have rapidly increased since 2010. For instance, heroin overdose deaths quadrupled from 3,036 in 2010 to 12,989 in 2015. Unfortunately, timely response to emerging trends is inhibited by time lags for national data on both overdose mortality via vital statistics (8-12 months) and morbidity via hospital discharge data (over 2 years). Emergency department (ED) syndromic data can be leveraged to respond more quickly to emerging drug overdose trends as well as identify drug overdose outbreaks. CDC’s NSSP BioSense Platform collects near real-time ED data on approximately two-thirds of ED visits in the US. NSSP’s data analysis and visualization tool, Electronic Surveillance System for the Notification of Community-based Epidemics (ESSENCE), allows for tailored syndrome queries and can monitor ED visits related to heroin overdose at the local, state, regional, and national levels quicker than hospital discharge data.MethodsWe analyzed ED syndromic data using ESSENCE to detect monthly and annual trends in suspected unintentional or undetermined heroin overdose by sex and region for those 11 years and older. An ED visit was categorized as a suspected heroin overdose if it met several criteria, including heroin overdose ICD-9-CM and ICD-10-CM codes (i.e., 965.01 and E850.0; T40.1X1A, T40.1X4A) and chief complaint text associated with a heroin overdose (e.g., “heroin overdose”). Using computer code developed specifically for ESSENCE based on our case definition, we queried data from 9 of the 10 HHS regions from July 2016-July 2017. One region was excluded due to large changes in data submitted during the time period. We conducted trend analyses using the proportion of suspected heroin overdoses by total ED visits for a given month with all sexes and regions combined and then stratified by sex and region. To determine significant linear changes in monthly and annual trends, we used the National Cancer Institute’s Joinpoint Regression Program.ResultsFrom July 2016-July 2017, over 72 million total ED visits were captured from all sites and jurisdictions submitting data to NSSP. After applying our case definition to these records, 53,786 visits were from a suspected heroin overdose, which accounted for approximately 7.5 heroin overdose visits per 10,000 total ED visits during that timeframe. The rate of suspected heroin overdose visits to total ED visits was highest in June 2017 (8.7 per 10,000) and lowest in August 2016 (6.6 per 10,000 visits). Males accounted for a larger rates of visits over all months (range = 10.7 to 14.2 per 10,000 visits) than females (range = 3.8 to 4.7 per 10,000 visits). Overall, compared to July 2016, suspected heroin overdose ED visits from July 2017 were significantly higher for all sexes and US regions combined (β = .010, p = .036). Significant increases were also demonstrated over time for males (β = .009, p = .044) and the Northeast (β = .012, p = .025). No other significant increases or decreases were detected by demographics or on a monthly basis.ConclusionsEmergency department visits related to heroin overdose increased significantly from July 2016 to July 2017, with significant increases in the Northeast and among males. Urgent public health action is needed reduce heroin overdoses including increasing the availability of naloxone (an antidote for opioid overdose), linking people at high risk for heroin overdose to medication-assisted treatment, and reducing misuse of opioids by implementing safer opioid prescribing practices. Despite these findings, there are several limitations of these data: not all states sharing data have full participation thus limiting the representativeness of the data; not all ED visits are shared with NSSP; and our case definition may under-identify (e.g., visits missing discharge diagnosis codes and lacking specificity in chief complaint text) or over-identify (e.g., reliance on hospital staff impression and not drug test results) heroin overdose visits. Nonetheless, ED syndromic surveillance data can provide timely insight into emerging regional and national heroin overdose trends.ReferencesWarner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief 2011(81):1-8.Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016;65(5051):1445-1452.Spencer MRA, F. Timeliness of Death Certificate Data for Mortality Surveillance and Provisional Estimates. National Center for Health Statistics 2017.Richards CL, Iademarco MF, Atkinson D, Pinner RW, Yoon P, Mac Kenzie WR, et al. Advances in Public Health Surveillance and Information Dissemination at the Centers for Disease Control and Prevention. Public Health Rep 2017;132(4):403-410.

Retrospective observational study of emergency department syndromic surveillance data during air pollution episodes across London and Paris in 2014

IntroductionPoor air quality (AQ) is a global public health issue and AQ events can span across countries. Using emergency department (ED) syndromic surveillance from England and France, we describe changes...

Tweet Now, See You In the ED Later? Examining the Association Between Alcohol-related Tweets and Emergency Care Visits.

Alcohol use is a major and unpredictable driver of emergency department (ED) visits. Regional Twitter activity correlates ecologically with behavioral outcomes. No such correlation has been established in real time. The objective was to examine the correlation between real-time, alcohol-related tweets and alcohol-related ED visits. We developed and piloted a set of 11 keywords that identified tweets related to alcohol use. In-state tweets were identified using self-declared profile information or geographic coordinates. Using Datasift, a third-party vendor, a random sample of 1% of eligible tweets containing the keywords and originating in state were downloaded (including tweet date/time) over 3 discrete weeks in 3 different months. In the same time frame, we examined visits to an urban, high-volume, Level I trauma center that receives > 25% of the emergency care volume in the state. Alcohol-related ED visits were defined as visits with a chief complaint of alcohol use, positive blood alcohol, or alcohol-related ICD-9 code. Spearman's correlation coefficient was used to examine the hourly correlation between alcohol-related tweets, alcohol-related ED visits, and all ED visits. A total of 7,820 tweets (representing 782,000 in-state alcohol-related tweets during the 3 weeks) were identified. Concurrently, 404 ED visits met criteria for being alcohol-related versus 2939 non-alcohol-related ED visits. There was a statistically significant relationship between hourly alcohol-related tweet volume and number of alcohol-related ED visits (rs = 0.31, p < 0.00001), but not between hourly alcohol-related tweet volume and number of non-alcohol-related ED visits (rs = -0.07, p = 0.11). In a single state, a statistically significant relationship was observed between the hourly number of alcohol-related tweets and the hourly number of alcohol-related ED visits. Real-time Twitter monitoring may help predict alcohol-related surges in ED visits. Future studies should include larger numbers of EDs and natural language processing.

Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013-2014.

From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.

Use of a syndromic surveillance system to describe the trend in cycling-related presentations to emergency departments in Sydney.

To describe population-based trends in cycling-related presentations to EDs over the past decade. A retrospective cohort of road trauma patients (motor vehicle, motor cyclist, cyclist and pedestrian) presenting to EDs in the Sydney Greater Metropolitan Area between 2004 and 2013 was obtained using the Public Health Real-time Emergency Department Surveillance System. The outcomes of interest were the cycling-related ED presentation rate per 1000 population, as well as the proportion of cycling-related presentations that died in ED or were admitted to a critical care ward. Trends in ED presentation rates based on presentation counts and Sydney population data were plotted and described. There were 68,438 cycling-related presentations identified, representing 30% of all road trauma patients presenting to EDs in Sydney. There was a 91% increase in cycling-related presentations for the 35 to 64-year-old age group and a 123% increase in cycling-related presentations in the 65-year-old and over age group. All other age groups were associated with a stable or decrease in cycling-related ED presentation rates. The proportion of presentations requiring critical care ward admission or death in ED has decreased by 20%. Using an ED syndromic surveillance system, cycling-related ED presentation rates in Sydney Australia have increased in those aged 35 years and over the past 10 years, with a relative decrease in the proportion of deaths in ED or those requiring critical care admission.

Utility of a near real-time emergency department syndromic surveillance system to track injuries in New York City.

BackgroundThe New York City emergency department (ED) syndromic surveillance (SS) system provides near real-time data on the majority of ED visits. The utility of ED SS for injury surveillance has not been thoroughly evaluated. We created injury syndromes based on ED chief complaint information and evaluated their utility compared to administrative billing data.MethodsSix injury syndromes were developed: traffic-related injuries to pedal cyclists, pedestrians, and motor vehicle occupants; fall-related injuries; firearm-related injuries; and assault-related stabbings. Daily injury counts were compared for ED SS and the administrative billing data for years 2008–2010. We examined characteristics of injury trends and patterns between the two systems, calculating descriptive statistics for temporal patterns and Pearson correlation coefficients (r) for temporal trends. We also calculated proportions of demographic and geospatial patterns for both systems.ResultsAlthough daily volume of the injuries varied between the two systems, the temporal patterns were similar (all r values for daily volume exceeded 0.65). Comparisons of injuries by time of day, day of week, and quarter of year demonstrated high agreement between the two systems—the majority had an absolute percentage point difference of 2.0 or less. Distributions of injury by sex and age group also aligned well. Distribution of injury by neighborhood of residence showed mixed results—some neighborhood comparisons showed a high level of agreement between systems, while others were less successful.ConclusionsAs evidenced by the strong positive correlation coefficients and the small absolute percentage point differences in our comparisons, we conclude that ED SS captures temporal trends and patterns of injury-related ED visits effectively. The system could be used to identify changes in injury patterns, allowing for situational awareness during emergencies, timely response, and public messaging.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-015-0044-5) contains supplementary material, which is available to authorized users.

Examination of narratives from emergency department presentations to identify road trauma, crash and injury risk factors for different age groups.

Road trauma represents a high proportion of injury-related emergency department presentations. Narrative text recorded in the emergency department could provide useful information to monitor road trauma and to identify crash and injury risk factors by age group. To examine the Public Health Real-time Emergency Department Surveillance System (PHREDSS) to identify road users (i.e. motor vehicle drivers, motor vehicle passengers, motorcyclists, pedal cyclists and pedestrians), and crash (e.g. vehicle speed) and injury risk factors (e.g. non-restraint use) by age group. Narrative text from the PHREDSS in New South Wales, Australia, during 1 January 2006 to 31 December 2012 was reviewed. A keyword search of all emergency department presentations potentially identified 388,991 road trauma-related presentations and between 6,420 motorbike crashes to 138,889 motor vehicle accident emergency department presentations. Potential crash and injury risk factors were also identified. This exploratory study demonstrated the capability of information from PHREDSS to be used to support injury prevention efforts in road safety.

2090775 A Prospective Evaluation of Real-Time, Transverse Tracheal Ultrasound in the Evaluation of Emergent Intubation by Minimally Trained Practitioners

ObjectivesThe primary OBJECTIVES: is to determine if minimally trained Emergency Medicine resident physicians can confirm correct placement of endotracheal intubation using bedside ultrasound in real time. A secondary OBJECTIVES: will be to determine if level of training plays a role in the ability of a sonographer to determine endotracheal versus esophageal intubation.MethodsThis was a multi-center, prospective, cohort study designed to assess the diagnostic accuracy of real-time Emergency Department (ED) bedside ultrasound in confirming position of endotracheal intubation. Patients were prospectively enrolled through the Emergency Department at both sites. Any patient in the Emergency Department requiring emergent intubation was considered for study enrollment beginning December 2013. During the intubation attempt, the sonographer was positioned at the side of the patient with the ultrasound screen facing away from the intubator. A 6 second video clip was recorded for a later review by the ultrasound director at each institution. Both immediate interpretation by ultrasound resident and retrospective video review by ultrasound director was then compared to CO2 color change, direct visualization by intubator and post procedural chest x-ray for placement.ResultsTo date, 41 patients have been enrolled with a sensitivity of 96% and a specificity of 100%.ConclusionsWith our results thus far, point of care ultrasound in the hands of minimally trained Emergency Medicine residents has shown great promise in accurately identifying correct placement of endotracheal tube during Emergency Department intubations. ObjectivesThe primary OBJECTIVES: is to determine if minimally trained Emergency Medicine resident physicians can confirm correct placement of endotracheal intubation using bedside ultrasound in real time. A secondary OBJECTIVES: will be to determine if level of training plays a role in the ability of a sonographer to determine endotracheal versus esophageal intubation. The primary OBJECTIVES: is to determine if minimally trained Emergency Medicine resident physicians can confirm correct placement of endotracheal intubation using bedside ultrasound in real time. A secondary OBJECTIVES: will be to determine if level of training plays a role in the ability of a sonographer to determine endotracheal versus esophageal intubation. MethodsThis was a multi-center, prospective, cohort study designed to assess the diagnostic accuracy of real-time Emergency Department (ED) bedside ultrasound in confirming position of endotracheal intubation. Patients were prospectively enrolled through the Emergency Department at both sites. Any patient in the Emergency Department requiring emergent intubation was considered for study enrollment beginning December 2013. During the intubation attempt, the sonographer was positioned at the side of the patient with the ultrasound screen facing away from the intubator. A 6 second video clip was recorded for a later review by the ultrasound director at each institution. Both immediate interpretation by ultrasound resident and retrospective video review by ultrasound director was then compared to CO2 color change, direct visualization by intubator and post procedural chest x-ray for placement. This was a multi-center, prospective, cohort study designed to assess the diagnostic accuracy of real-time Emergency Department (ED) bedside ultrasound in confirming position of endotracheal intubation. Patients were prospectively enrolled through the Emergency Department at both sites. Any patient in the Emergency Department requiring emergent intubation was considered for study enrollment beginning December 2013. During the intubation attempt, the sonographer was positioned at the side of the patient with the ultrasound screen facing away from the intubator. A 6 second video clip was recorded for a later review by the ultrasound director at each institution. Both immediate interpretation by ultrasound resident and retrospective video review by ultrasound director was then compared to CO2 color change, direct visualization by intubator and post procedural chest x-ray for placement. ResultsTo date, 41 patients have been enrolled with a sensitivity of 96% and a specificity of 100%. To date, 41 patients have been enrolled with a sensitivity of 96% and a specificity of 100%. ConclusionsWith our results thus far, point of care ultrasound in the hands of minimally trained Emergency Medicine residents has shown great promise in accurately identifying correct placement of endotracheal tube during Emergency Department intubations. With our results thus far, point of care ultrasound in the hands of minimally trained Emergency Medicine residents has shown great promise in accurately identifying correct placement of endotracheal tube during Emergency Department intubations.

Development of Mental Health Classification Related to Severe Weather Events

Real-time emergency department (ED) data are currently received from 78 of 80 New Jersey acute care and satellite EDs by Health Monitoring Systems Inc. (HMS) EpiCenter system. After the 2012 Superstorm Sandy, NJDOH initiated a plan to develop severe weather surveillance using ED data to track both health and mental health outcomes during adverse weather conditions to alert the public about emerging health hazards. Data from 68 out of a total of 80 emergency departments with dates from October 28, 2012 to November 17, 2012 were used in this analysis. Validation results for classifications were reviewed and issues are addressed.

Fear of Discovery Among Latino Immigrants Presenting to the Emergency Department

Recent legislation mandating reporting of undocumented immigrants may instill fear of discovery when they access emergency department (ED) services. The objectives of this study were to: 1) characterize the knowledge and beliefs of undocumented Latino immigrants (UDLI) about health care workers' reporting (or nonreporting) of illegal immigrants in the ED, 2) determine whether UDLI fear discovery when presenting to the ED, and 3) determine the nature and sources of this fear. This was a cross-sectional study of UDLI and two comparison groups conducted in two California county EDs, from November 2009 to August 2010. The authors interviewed a convenience sample of adult UDLI, Latino legal residents (LLR), and non-Latino legal residents (NLLR) using a structured instrument in their native language. The main outcome was fear of discovery among UDLI and the sources of that fear. Of 1,224 patients approached, 1,007 (82.3%) were interviewed: 314 UDLI, 373 LLR, and 320 NLLR. The median age was 43 years (interquartile range [IQR] = 31 to 55 years), and 51% were male. UDLIs were less likely to speak English (14%, 95% confidence interval [CI] = 10% to 18%), have health insurance (39%, 95% CI 32% to 44%), or have a regular primary care provider (PCP; 39%, 95% CI = 34% to 45%), compared to LLR (English 56%, 95% CI = 51% to 61%; health insurance 50%, 95% CI = 45% to 55%; regular PCP 51%, 95% = CI 46% to 57%) and NLLR (English 95%, 95% CI = 92% to 97%; health insurance 49%, 95% CI = 43% to 54%; regular PCP 51%, 95% CI = 45% to 56%). Of the 16% of UDLI who stated that nurses and doctors treat undocumented immigrant patients differently than citizens, 41% (95% CI = 29% to 54%) reported less respect given to UDLI by staff. Thirty-two percent of UDLI had heard of Proposition 187, 13% believed hospital staff reported UDLI to immigration authorities, and 9% said they were asked about their citizenship status. Fear of coming to the hospital because of discovery was expressed by 12% (95% CI = 9% to 16%) of UDLI, with 42% (95% CI = 28% to 58%) citing discussions with friends/family, 32% (95% CI = 19% to 47%) citing media and 16% (95% CI = 7% to 30%) citing both as sources of this fear. One in eight of UDLI presenting to the ED express fear of discovery and consequent deportation. Belief that medical staff report UDLI and recent immigration are risk factors for this fear. Family, friends, and media are the primary sources of these concerns.

Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis

BackgroundFrom January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED) and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave.MethodsED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects.ResultsDuring the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03), all-cause ambulance calls increased by 14% (95% CI 1.11-1.16), and all-cause mortality increased by 13% (95% CI 1.06-1.22). Those aged 75 years and older had the highest excess rates of all outcomes.ConclusionsThe 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes.

Automated data extraction from general practice records in an Australian setting: Trends in influenza-like illness in sentinel general practices and emergency departments

BackgroundInfluenza intelligence in New South Wales (NSW), Australia is derived mainly from emergency department (ED) presentations and hospital and intensive care admissions, which represent only a portion of influenza-like illness (ILI) in the population. A substantial amount of the remaining data lies hidden in general practice (GP) records. Previous attempts in Australia to gather ILI data from GPs have given them extra work. We explored the possibility of applying automated data extraction from GP records in sentinel surveillance in an Australian setting.The two research questions asked in designing the study were: Can syndromic ILI data be extracted automatically from routine GP data? How do ILI trends in sentinel general practice compare with ILI trends in EDs?MethodsWe adapted a software program already capable of automated data extraction to identify records of patients with ILI in routine electronic GP records in two of the most commonly used commercial programs. This tool was applied in sentinel sites to gather retrospective data for May-October 2007-2009 and in real-time for the same interval in 2010. The data were compared with that provided by the Public Health Real-time Emergency Department Surveillance System (PHREDSS) and with ED data for the same periods.ResultsThe GP surveillance tool identified seasonal trends in ILI both retrospectively and in near real-time. The curve of seasonal ILI was more responsive and less volatile than that of PHREDSS on a local area level. The number of weekly ILI presentations ranged from 8 to 128 at GP sites and from 0 to 18 in EDs in non-pandemic years.ConclusionAutomated data extraction from routine GP records offers a means to gather data without introducing any additional work for the practitioner. Adding this method to current surveillance programs will enhance their ability to monitor ILI and to detect early warning signals of new ILI events.