OBJECTIVE: To examine current patterns of deployment and use of emergency ambulance crews in Nottinghamshire, with particular reference to crew status (technician or paramedic), case mix, interventions performed, and operational times. METHODS: A retrospective survey of routinely collected computerised ambulance service despatch data, and patient treatment forms for 242 randomly selected emergency callouts in Nottinghamshire, during September 1994. Data were collected on patient demography, broad diagnostic group, crew status and operational times, and paramedic interventions performed. RESULTS: 170 of 242 callouts (70%) involved a paramedic crew; extended skills were used on 31 of these occasions (18%), predominantly for medical emergencies. Paramedic crews recorded significantly longer on-scene times (median time: 14.0 v 11.5 min, P = 0.04). An examination of the difference between paramedics who performed interventions and those who did not revealed that "intervening" paramedics recorded significantly longer onscene times (median time: 23 v 12 min, P < 0.001), turnaround times (median time: 28 v 18 min, P < 0.001), and total out-of-service times (median time 73 v 51 min, P < 0.001). CONCLUSIONS: The additional time taken by paramedics at the scene of an emergency incident relates to their performance of an intervention, rather than time spent assessing the patient to decide whether stabilisation or immediate evacuation would be most appropriate. Paramedic interventions were most often performed for medical emergencies. The performance of paramedic interventions also extended turnaround times and total out-of-service times.

Allied Health Personnel↗

PubMed1995

Results of extensor tendon repair performed by junior accident and emergency staff.

The results of 46 extensor tendon repairs performed by junior accident and emergency doctors were assessed, with a minimum follow up of 6 months. Based on Miller's assessment, 80 per cent of the proximal injuries achieved excellent or good results. Only 18 per cent of distal injuries achieved excellent or good results. Neither grip or fingertip pinch strength were significantly reduced. Sixty-seven per cent of patients complained of no residual pain and only 7 per cent complained of the injured digit getting in the way.

Adolescent↗

PubMed1991

Self-poisoning patients discharged from accident and emergency: risk factors and outcome.

In a prospective audit of 1,096 consecutive attendances by deliberate self-poisoning patients at an accident and emergency department (A&E), such patients were discharged directly from A&E on 31% of occasions. Outcome and risk were compared for patients admitted to hospital and discharged directly from A&E. In the following year repetition of self-poisoning occurred in the same proportions of patients admitted to hospital and discharged from A&E (12%, relative risk 1.02). Suicide during the following three years occurred in 1.3% of patients admitted and 1.1% of those discharged (relative risk 1.2). Patients admitted to hospital from A&E were those likely to be at greater risk: they were older, reported more physical ill-health, expressed a threat or left a note more often, and had more frequently experienced psychiatric inpatient care. Thus, nearly one-third of deliberate self-poisoning attenders were discharged from A&E; outcomes were similar despite higher risk among admitted patients, suggesting that brief admission has some benefit.

Adolescent↗

PubMed1979

[Analysis of hippocampal sensory EP-changes in dependence on activation level].

Photically evoked potentials were recorded from the visual cortex (VC) as well as CA 1/2- and CA 4/Fascia dentata-region of the dorsal hippocampus in alert resting rabbits. Analysing the whole time-course of the individual hippocampal EP attention was focused on components corresponding in time to the late negative complex of the cortical EP. Enhancement of such components was seen following habituation to repeated flashes. These changes occurred concerning components in the CA 4/FD-record with shorter latency. The duration and peak latency, however, was longer in CA 4/FD than in the other records. During stimulation of the medial septal nucleus a diminution of late EP-components was seen in the visual cortex and less pronounced in the hippocampus. The time-course of the changes was almost the same in VC and CA 4/FD, whereas in CA 1/2 later components were affected. RF-stimulation caused very similar changes, while those in hippocampal EP's were extended up to later components. Whereas the time range of changes in the hippocampal EP's to all influences under investigation was almost the same, in the VC by RF-stimulation in contrast to habituation components with shorter latencies were affected. In this way it is supposed that for the VC different processes are affected by the three influences, while this could not be established for the hippocampus.

Animals↗

PubMed1978

[Comparison of evoked potential changes from lateral geniculate body and visual cortex by stimulation of the medial septal nucleus and mesencephalic reticular formation in rabbits].

Evoked potentials to flash from visual cortex (VC) and corpus geniculatum laterale (Cgl) were observed in alert resting rabbits. The direction and volume of changes in the late negative complex (sn-) of the EP were investigated during repetition of light flashes only (habituation), during stimulation of septum and reticular stimulation (RFmes). Habituation showed an increase of amplitudes during the sn-complex, which was started first in Cgl, had its maximum earlier and lasted longer in the Cgl than in the visual cortex. Septal stimulation in the majority of experiments caused diminution of these EP-components almost synchronously in the VC and Cgl. Reticular stimulation gave rise to diminution of amplitudes during the sn-complex, which started first in the VC, where it had its maximum earlier and lasted longer than in the Cgl too. Our results show that all three influences under investigation caused typical but different changes of processes underlying EP of the visual cortex and lateral geniculate body.

Animals↗

PubMedDate not supplied

Paediatric nursing: computer detection of child abuse.

A computerised system which enables the detection of children who regularly attend an accident and emergency department with seemingly trivial injuries is described. The system is linked to the Nottinghamshire Children at Risk register and alerts staff to the possibility of non-accidental injury. Concern about safeguarding the confidentiality of data stored on the computer has been allayed by strict observation of the rules governing accessibility to medical information. Despite experiencing some problems with the system, operators believe it gives them the opportunity to intervene in suspected child abuse cases at an early stage.

Child↗