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Biomedical subjects

G C Hamilton

Publications and source records attributed to G C Hamilton.

At least 19 recordsLinked to original sources

Objectives to direct the training of emergency medicine residents on off-service rotations: electrocardiology.

This is a continuing series of objectives to direct resident training in emergency medicine. Electrocardiography may not receive individual attention in many training programs. However, the importance, omnipresence, and medicolegal potential of electrocardiography in the practice of emergency medicine suggests its individual attention. Contents and specific learning objectives are presented to provide guidelines for resident mastery, following the format presented by preceding subjects.

Arrhythmias, Cardiac

Autonomous departments of emergency medicine in contemporary academic medical centers.

There are currently 20 autonomous departments of emergency medicine in United States medical schools. EDs seeking autonomous status should institute a faculty development program to channel faculty energy into worthwhile research projects; establish protected time for clinical faculty to increase research productivity; develop expertise to compete for extramural funding; initiate an intramural research program so that faculty can learn the basics of grantsmanship; teach health care issues in ambulatory medicine; become involved in interdisciplinary teaching programs and curriculum development; maintain the present faculty commitment to 24-hour attending coverage; and develop university-based programs that originate from the ED. Program directors should establish liaisons with the medical school dean to acquaint him with the advantages of an autonomous department of emergency medicine; attempt to assess other relationships within the medical school to determine support for emergency medicine and to uncover and address opposition to autonomous departmental status; attempt to serve on medical school committees to meet other faculty, solve problems with them and develop trusting relationships; and develop broad-based support for autonomous departmental status both within and outside of the university. By devising and following a deliberate approach to attaining departmental status, emergency medicine will be assured of continued growth in the important decade ahead.

Academic Medical Centers

Influence of emergency medical services systems and prehospital defibrillation on survival of sudden cardiac death victims.

This article reviews the influence of emergency medical systems and prehospital defibrillation on survival of sudden cardiac death. The historical perspective and epidemiologic considerations of prehospital sudden cardiac death are highlighted. Factors predictive of successful resuscitation and impact of community activity on sudden death are discussed. Influences of emergency medical services on outcome of prehospital cardiac arrest are reviewed, with emphasis on the role of dispatchers, emergency medical technicians, and paramedics. The recent emergence of prehospital automatic defibrillation by emergency medical technicians, first responders, and lay persons is discussed in depth, as it has great potential to positively influence outcome of prehospital sudden cardiac death.

Death, Sudden

Content listings for consistency of policies and procedures in an academic department.

Communicating expectations is central to effective management. In a large academic department spread over several sites, written guidelines are often necessary to limit misinterpretation of these expectations. Three "operation manuals" for residents, faculty, and support staff were developed to supply these guidelines. They have evolved into an effective means of communicating departmental policy and standards for performance. The table of contents are provided as a guide for those developing new academic departments.

Communication

Hemoglobin/hematocrit and other erythrocyte parameters.

The authors review erythrocyte physiology, blood collection, and laboratory methodology for enumerating blood cells. The clinical interpretation of abnormal erythrocyte parameters is discussed, and the emergency department approach to anemia and polycythemia is detailed.

Anemia

Platelet count.

An estimate of the platelet count is usually given as part of the complete blood count (CBC). It should not be neglected when reviewing CBC results as it is a fair screening test and satisfactory for most purposes in the emergency department. It is a quantitative study, and the functional status of the platelet must always be considered in interpretation of clinical significance. Patients presenting with abnormal bleeding histories, particularly women with mucosal origin bleeding, should have an evaluation of platelet quantity by an accurate method and functional quality by a bleeding time. Though rarely used, the emergency physician should be familiar with the indication and mechanics of platelet transfusions. The laboratory charge for the platelet count is $17.00 to 18.00, whether it is automated or hand counted.

Adult

A course in anatomy for emergency medicine residents.

The understanding of human anatomy is a critical component of the practice of medicine. A specialty with the breadth of emergency medicine is best approached with a sound basis in anatomy and pathophysiology which leads to a better understanding and differential diagnosis of the disease process. It was the authors' opinion that a specialty with the surgical emphasis found in emergency medicine should have a correlating emphasis in the anatomical sciences. Subsequent testing of PGY-II residents demonstrated a fair to poor understanding of anatomy when gauged by a standard freshman anatomy examination tailored to clinical circumstances. This paper reports on a 3-year experience in giving a 1-week 40-hour anatomy course which included didactic presentations by the anatomy and surgery departments. The impact of this course on clinical practice, problems in its preparation, and outcome of a shared experience with residents from general surgery are discussed. The course is felt to be a successful addition to the training of emergency medicine specialists.

Anatomy

The Cincinnati DC-9 experience: lessons in aircraft and airport safety.

Twenty-three passengers died on June 2, 1983, when a McDonnell Douglas DC-9 experienced an inflight rear lavatory fire near Cincinnati, OH. Evidence of toxic fume inhalation was developed by investigators, demonstrating lethal levels of carbon monoxide and cyanide in the victims' blood. An analysis of the inflight progression of fire and smoke, and the subsequent extension of this following the emergency landing at Greater Cincinnati Airport has been accomplished. This data is augmented by other data from previous accidents of this type. Data from interviews with survivors was collected, including inflight experiences, emergency escape processes and airport disaster management during the emergency. Several practical means of respiratory protection both inflight and during emergency evacuation are documented. Onboard preventive measures in regard to this type of emergency have been identified. Emergency evacuation and modern airport disaster management techniques are codified and described. This recent accident provides information for future adoption by the responsible authorities so that inflight and postflight fires do not continue to cause significant numbers of fatalities. Modified lightweight passenger breathing apparatus, upgraded flight attendant and aircrew portable breathing apparatus, floor level guidance to exits, less flammable and toxic interior materials, improved passenger evacuation information, tailored airport emergency response procedures, and upgraded toilet smoke detector equipment are examples.

Accidents, Aviation

A library to assist in the development of academic faculty in emergency medicine.

Faculty development is a training process that strives continually to improve the creativity, productivity, and longevity of individuals committed to the practice of academic medicine. Information pertinent to faculty development is contained in textbooks scattered throughout the medical literature. From a more than 80-volume personal library, a list of 15 recommended texts in 11 major topics is given. The cost of this library is +333.50. This library was designed to assist emergency physicians in obtaining useful sources of information as part of their continuing education as academic faculty.

Education, Medical, Continuing

Objectives to direct the training of emergency medicine residents on off-service rotations.

Up to 50% of the 36 months of resident training in emergency medicine may be on off-service rotations. The experience on these rotations can lack educational content and opportunity pertinent to emergency medicine. The resident rarely has readily available and structured guidance to optimize training in terms of the anticipated needs of the specialty. In response to this problem, the authors have written curricula containing subject content listings, objectives, and supplied references for 16 off-service rotations. A plan for implementing the materials and an example from the obstetrics-gynecology rotation is given. After 12 months' experience, the authors have subjective responses from residents and off-service program directors that support the value of this information. Positive reports include: Residents having a better understanding of faculty expectations, improved "consistency of experience," residents appreciating the added attention, improved performance, and expanded reading efforts. One expressed concern is "too much to read." The project continues to evolve.

Curriculum