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PubMed2001

AAEM, CORD, and SAEM reach a landmark position: consensus recommendations to the Federation of State Medical Boards (FSMB) for revisions to the FSMB May 1998 policy statement on physician licensure. American Academy of Emergency Medicine. Council of Emergency Medicine Residency Directors. Society for Academic Medicine.

As a result of months of meetings and deliberations coordinated with the Medical Board of California and chaperoned by the California Chapter of the American Academy of Emergency Medicine (CAL/AAEM), the Society for Academic Medicine (SAEM), the Council of Emergency Medicine Residency Directors (CORD), and the American Academy of Emergency Medicine (AAEM) recently reached a landmark agreement on recommendations to the Federation of State Medical Boards (FSMB) pertaining to controversial May 1998 FSMB recommendations regarding physician licensure. Endorsed unanimously by the boards of all three emergency medicine (EM) organizations, the recommendations of this consensus have been forwarded to the FSMB and await its official response. The recommendations will also be forwarded to remaining EM organizations and to the medical community for comment and to enlist their support.

California↗
PubMed1999

A unified emergency care system for the early management of emergencies in medicine.

Emergency medicine is increasingly compartmentalised. The Unified Emergency Care System (UECS) requires the user to consider every option for emergency care for each patient, in a logical manner that transcends these artificial compartments and recognises the relative priority of concomitant medical, surgical, environmental and toxicological problems. The system is presented as a series of icons, allowing considerations to be made at a glance. Drop shadows refer the user to detailed management protocols for specific conditions. The system follows the logical sequence of quick history, quick look, primary survey with resuscitation and secondary survey. Established management principles of airway-breathing-circulation-disability (ABCD) are incorporated. The complexity of the management algorithms increases from first aider through medic, paramedic, and primary care physician to emergency physician. The stepwise care facilitates seamless immediate medical care between providers, teamwork, and the development of a structured series of training programmes.

Adolescent↗
PubMedDate not supplied

Emerging and re-emerging viral infections in Europe.

Emerging viral infections are becoming a serious problem in Europe in the recent years. This is particularly true for severe acute respiratory syndrome (SARS), West Nile virus (WNV) disease, Toscana virus (TOSV) disease, and potentially for avian influenza virus (H5N1). In contrast, emergence or re-emergence of severe viral infections, including tick borne encephalitis virus, and viral haemorrhagic fever caused by Hantavirus and dengue virus have been frequently reported in several European countries. Laboratory diagnosis of these viral infections based on viral isolation or detection by immune electron microscopy, immunoassay and polymerase chain reaction (PCR) has dramatically improved in the recent years, and SARS represents a good example of a diagnostic approach to emerging viral infections. Finally, old and new promising agents are in the pipeline of pharmaceutical companies to treat emerging viral infections. However only prevention based on large epidemiological studies, and research and development of new vaccines may be able to control and eventually eradicate these deadly viral infections.

Animals↗
PubMed1980

"Emergency room" and "mobile response" models of emergency psychiatric services.

The present study surveyed federally-funded emergency psychiatric programs in 33 California community mental health centers (CMHCs). Four aspects of service organization were examined: (1) the availability of various response styles (telephone service, walk-in service, follow-up home visits, mobile initial response); (2) the types of staff providing the service; (3) the location of the programs, and (4) the organizational setting of the CMHCs (consortium or single agency centers). From these characteristics of service organization two contrasting types of emergency psychiatric programs were derived--the "emergency room" and "mobile response" models. The relationship between these two models of service delivery and catchment area demographic characteristics was examined and no remarkable trends emerged. The implications of developing a typology of emergency psychiatric programs are discussed with respect to a scheme for evaluating the relative effectiveness of services and for planning future programs.

Community Mental Health Services↗
PubMed1995

The symptom of headache in emergency departments. The experience of a neurology emergency department.

Although the symptom of headache is a frequent cause of Emergency Department examinations, it is often considered to be of little clinical relevance in comparison with other emergencies and is usually treated only symptomatically. But how frequently does a simple headache mask a severe cerebral pathology? To answer this question, we studied a consecutive series of patients examined at the Neurology Emergency Department of Turin's Ospedale Molinette over a period of three months; the patients were then followed-up for more than two years in order to confirm the diagnoses. Of 215 cases of "acute" headache, 121 (56%) were essential and 94 (44%) symptomatic; of the latter, 18 (8.3%) were the only clinical manifestation of a severe cerebral pathology (10 hemorrhages, 2 ischemias, 6 tumours). In diagnosing these 18 cases, 72 EEG, 57 CT and 4 rachicentesis examinations were carried out and their diagnostic efficacy is here analysed. Our data show the importance of a careful evaluation of the symptom of headache in Emergency Departments and the need to send any doubtful cases to a facility specialised in coping with such emergencies.

Adult↗
PubMed1995

[The efficiency of emergency therapy in patients with head-brain, multiple injury. Quality assurance in emergency medicine].

For cardio-pulmonary resuscitation there are standardized treatment concepts, but there have been few prospective investigations examining the efficacy of prehospital advanced trauma life support and its effect on the outcome in patients with severe head injury and multiple trauma treated within the German emergency system. The results of this study underline the importance of intensive prehospital treatment and highlight some problems that should be taken into account in future in the training of emergency physicians. METHODS. A total of 179 patients with cerebral trauma were investigated. Data obtained included demographic and logistic data of the patients and the emergency physicians, diagnoses and treatment at the scene of the accident and state of the patient on admission in each case. Having divided the patients into three groups by severity of the trauma, we distinguished between sufficient and insufficient treatment and assessed infusion therapy, ventilatory support, positioning and immobilization, and analgesic and sedative therapy. For statistical analysis of the data we used chi 2-test and Fisher's exact test. P < 0.05 was considered significant. RESULTS. There were 102 patients who had sustained a cerebral trauma without other life-threatening lesions (score 1), 40 with multiple trauma (score 2) and 37 with multiple trauma (score 3). On average 2.4 IV lines were established and the patients received 1186 +/- 765 cc of crystalloid in addition to 801 +/- 411 cc of colloid fluids. In all groups, patients who received adequate infusion therapy had a better outcome; even in the group with score 1 significantly fewer had a fatal outcome. In all, 167 (93%) patients had endotracheal tubes placed, and in 150 cases (84%) ventilatory therapy was considered sufficient. The proportion of score 1 patients with sufficient ventilatory support who had a fatal outcome was significantly lower than that in the group with insufficient treatment. In patients with multiple trauma we could not separate the benefits of sufficient respiratory therapy and infusion therapy. In only 54% of the cases a vacuum mattress was used and in only 41% the patients were positioned with the upper part of the body elevated by 30 degrees. These were 28 patients (16%) who received neither analgesics nor sedatives. Regardless of the quality of prehospital treatment of isolated head injury, a Glasgow Coma Scale (GCS) score lower than 5 involved a very high mortality and all patients with a GCS score of 9 or more survived. In the group with GCS scores between 5 and 8, however, significantly more of the patients who received adequate treatment survived (82.5% vs 40%). CONCLUSIONS. The present study confirms that sufficient advanced trauma life support can improve the outcome of trauma victims with cerebral trauma. Adequate infusion and respiratory therapy reduce the mortality among such patients significantly. In patients with multiple trauma a clear positive effect of generous infusion therapy also is evident. The clearest effect of sufficient prehospital treatment is seen in patients with isolated cerebral trauma and a GCS score between 5 and 8. These results demonstrate the importance of advanced trauma life support and show emphatically that the so-called scoop-and-run strategy should be abandoned when resources are available for extended preclinical emergency treatment. On the other hand, we detected some problem areas in the prehospital treatment of trauma victims, such as positioning, immobilization and drug therapy with analgesics and sedatives. These findings allow us to pinpoint specific points that should be stressed in the training of emergency physicians and paramedics.

Adult↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents in off-service rotations: dental emergencies.

Patients presenting for emergency care with complaints of dental origin are common. Rarely are dental topics systematically addressed during training rotations. In this second article in a continuing series on objectives for emergency medicine resident training, dental emergency objectives will be presented. Instructions for use of the references and objectives are provided. Cognitive and evaluative objectives are organized for mastery. A list of resources including references and audio visual materials are outlined. The objectives and reference materials presented provide a structure for the systematic study of dental emergencies in emergency medicine resident training.

Education, Dental↗
PubMed2006

Percutaneous transtracheal emergency ventilation during respiratory arrest: comparison of the oxygen flow modulator with a hand-triggered emergency jet injector in an animal model.

The oxygen flow modulator is a device for percutaneous transtracheal emergency ventilation. Simulating a respiratory arrest situation, we studied the effects of this device in comparison with a hand-triggered emergency jet injector during pulmonary resuscitation. Nine pigs were anesthetized and mechanically ventilated. After surgical exposure, an emergency transtracheal airway catheter was inserted into the trachea. Ventilation was stopped until SpO2 was below 70%. Each animal was subsequently randomly ventilated via the transtracheal airway catheter with either the hand-triggered emergency jet injector or the oxygen flow modulator. After 10 minutes, respiratory and hemodynamic parameters were recorded. Ventilation was stopped again until SpO2 reached 70%, and the animal was ventilated with the second device. With both devices, pulmonary resuscitation was successful. Whereas PaO2 differed not significantly between the two devices, PaCO2 was lower during percutaneous transtracheal ventilation with the hand-triggered emergency jet injector.

Animals↗
PubMed2005

Emergency organ transplantation in Spain: liver emergency and outcomes.

The 2 main indications for emergency liver transplantation are severe acute hepatic insufficiency and emergency retransplantation. In Spain, since the creation of the National Transplant Organisation (NTO), known as "the Spanish model," there have been high rates of donation, with a mean of 33.9 donors per million inhabitants in 2003 and 34.6 donors per million inhabitants in 2004. According to data provided by the NTO, there were 169 liver emergencies in the 2-year period 2003-2004. The time on the waiting list in an emergency situation was limited; 82.8% of cases were resolved in less than 48 hours. During this 2-year period, there were 2077 liver transplantations, including 128 emergence patients, which accounted for 6.1% of transplantations.

Adult↗
PubMed1993

Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: monitoring emergency medical services system performance in sudden cardiac arrest.

STUDY OBJECTIVE: To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest. STUDY DESIGN: A 22-month case series, collected prospectively, of out-of-hospital cardiac arrests. Times of collapse, dispatch, scene arrival, CPR, and initial defibrillation were determined from dispatch records, recordings of arrest events, interviews with bystanders, and hospital records. SETTING: Southwestern city (population, 400,000; area, 390 km2) with a two-tiered basic life support-advanced life support emergency medical services system. Emergency medical technician-firefighters without electrical defibrillation capability comprised the first response tier; firefighter-paramedics were the second tier. PATIENTS: One hundred eighteen cases of witnessed, out-of-hospital cardiac arrest in adults with initial ventricular fibrillation. MAIN OUTCOME MEASURES: Survival was defined as a patient who was discharged alive from the hospital. RESULTS: Eighteen of 118 patients (15%) survived. Survivors did not differ significantly from nonsurvivors in age, sex, or basic life support or advanced life support response intervals. Survivors had significantly (P < .05) shorter intervals from collapse to CPR (1.7 versus 5.2 minutes) and to defibrillation (7.4 versus 9.5 minutes). CONCLUSION: Collapse-to-intervention intervals, not emergency vehicle response intervals, should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death.

Aged↗
PubMed1977

Emergency nurse practitioner: an answer to an emergency care crisis in rural hospitals.

During the last three years, a nine-month training program at the University of Virginia was designed and implemented to prepare the nurse to assume an expanded role in the emergency department. The course provides the student with sufficient knowledge and skill to diagnose and treat patients in the emergency department setting while under the supervision of a physician. Graduates of the program are certified by the State of Virginia as "emergency nurse practitioners". Qualified candidates who had identified a physician preceptor or were from an area with embryonic emergency medical systems were given priority in the selection process. The training program was divided into three-month modules which dealt first with teaching interview techniques and physical assessment skills, then clinical experiences in rural and urban emergency departments, and finally a preceptorship in the community hospital where the nurses work with the physician preceptors.

Curriculum↗
PubMed2002

Population biology of emerging and re-emerging pathogens.

Emerging and re-emerging pathogens present a huge challenge to human and veterinary medicine. Emergence is most commonly associated with ecological change, and specific risk factors are related to the type of pathogen, route of transmission and host range. The biological determinants of host range remain poorly understood but most pathogens can infect multiple hosts, and three-quarters of emerging human pathogens are zoonotic. Surveillance is a key defence against emerging pathogens but will often need to be integrated across human, domestic animal and wildlife populations.

Animals↗
PubMed2000

Epileptological emergencies in accident and emergency: a survey at St James's university hospital, Leeds.

Many patients attending an Accident and Emergency (A&E) department with seizures never come into contact with a neurological service. This survey was designed to find out how many patients with epileptological emergencies come to A&E and how they are managed. Cases were identified using the computerized A&E database. The A&E records of all adult patients attending the casualty department at St James's University Hospital with emergencies related to epilepsy between 1 April and 30 September 1998 were reviewed retrospectively. Out of a total of 36 024 adults attending A&E, 190 were related to epileptological emergencies. A problem relating to a previously recognized seizure disorder was the commonest reason for attendance. Patient management was highly variable and often suboptimal. Descriptions of seizure semiology and examination findings were frequently deficient. Up to 37.5 mg of diazepam, in up to five boluses, was given. Twenty per cent of patients with a diagnosis of status epilepticus were discharged home after diazepam treatment. Neurologists only became involved in 24.2% of cases. Epileptological emergencies only make up a small proportion of cases seen in adult A&E departments. Treatment and referral guidelines should be agreed between A&E staff and neurologists. The communication between general, specialist and acute services needs to be improved.

Adult↗
PubMed1992

[Emergency Cesarean section--analysis of 143 emergency sections].

Since compromises must be accepted in emergency Caesarean sections in respect of preparation, anaesthesia and hygienic standards, 143 emergency caesarean sections out of a total number of 37,583 deliveries were analysed during 1981-1990 from four different obstetrical departments as well as risks, complications, maternal and foetal morbidity and mortality were studied. In connection with these operations, which are not influenced only by medical factors but also by logistics, two mothers died (1.4%). Perinatal mortality was 3.3% (unpurified perinatal mortality: 8.5%). Neither the influence of time, when the Caesarean section was performed, nor the place of operation (theatre or labor bed), nor the indication for the operation on foetal outcome and maternal morbidity were found. Maternal morbidity was mainly contributed to pre- and intraoperative bleeding. Intraoperatively 12.6% and postoperatively 10.5% of the patients had to be given heterologous blood conserves. In more than a third of the newborn, which had been delivered by emergency Caesarean section, because of a pathological cardiotocogram, the pH values showed no pathological findings. The benefit of an antibiotic prophylaxis in emergency Caesarean sections could be significantly demonstrated, showing the different rates of secondary healing complications. A particular problem exists in emergency Caesarean sections for the delivery of the second twin following spontaneous delivery of the first one (2.8%).

Adolescent↗
PubMed1998

Is there equity in emergency medical care? Waiting times and walk-outs in South Western Sydney hospital emergency departments.

This study explores the association between selected socioeconomic characteristics of emergency patients with waiting times in emergency departments and walk-outs (those who did not wait for treatment) in South Western Sydney Area Health Service hospital emergency departments. Bivariate and multivariate analyses indicated that waiting times to see a doctor and walk-out rates varied by age, sex, country of birth, insurance status, socioeconomic status, severity of patient illness and day of arrival. Patients who were female, from a non-English-speaking background, self-referred, uninsured and those from lower socioeconomic status showed significantly longer waiting times than others. Patients who left emergency departments without treatment showed higher waiting times from arrival to triage than other groups. This applied across socioeconomic categories. These findings indicate that prolonged waiting times for triage, which occur at the busiest periods, may be one of the main indicators for patients leaving emergency departments without treatment. The study also demonstrates variability in waiting times, which could possibly be partly addressed by more standardised triage policies, but may be influenced by other non-clinical factors, which require further investigation.

Adolescent↗
PubMed1998

Risk of admission within 4 weeks of discharge of elderly patients from the emergency department--the DEED study. Discharge of elderly from emergency department.

OBJECTIVE: to identify risk factors for admission for patients aged 75 years and older after discharge from the emergency department (DEED: discharge of elderly from emergency department). DESIGN: Prospective evaluation of discharged elderly patients from the emergency department who were followed up after 4 weeks. SETTING: emergency department of a teaching hospital for 1 year. SUBJECTS: patients aged 75 and over discharged to their home or hostel. MAIN OUTCOME MEASURES: demographic data, indices of function and cognitive status and admission to hospital within 4 weeks. RESULTS: 468 patients aged 75 and over (mean age 81.7 years; range 75-98) were enrolled; 80 patients (17.1%) were admitted to hospital during the subsequent 4 weeks. Risk factors for admission included dependence in the following activities of daily living (relative risk; 95% confidence interval): bathing (2.41; 1.32-4.41); dressing (2.38; 1.22-4.63); stairs (1.60; 1.09-2.33); finance (1.66; 1.23-2.25); shopping (1.39; 1.12-1.73) and transport (1.61; 1.25-2.06), as well as use of a community nurse (1.88; 1.12-3.17). Logistic regression analysis found two variables to be significant in predicting admission or not: dependence in transport and use of a community nurse. CONCLUSIONS: older patients are at increased risk of readmission within 4 weeks of being sent home from the emergency department. It is possible to identify high-risk patients by a questionnaire. This allows targeting of these patients for more intensive follow-up in an attempt to ameliorate further deteriorations in their health.

Activities of Daily Living↗
PubMed2002

Who is responsible for pediatric triage decisions in Australian emergency departments: a description of the educational and experiential preparation of general and pediatric emergency nurses.

BACKGROUND: Pediatric presentations to the emergency department (ED) account for approximately one third of ED presentations. Triage is the process employed by the ED to prioritize presenting patients, including children, on the basis of clinical urgency. This role is undertaken by emergency nurses, and a range of recommendations are available regarding the level of experience and education required by the nurse responsible for pediatric triage decisions. However, little is known about the actual education and experience of nurses undertaking pediatric triage. OBJECTIVES: To describe the level of experiential and educational preparation of emergency nurses responsible for pediatric triage decisions in pediatric and adult and pediatric population EDs. METHODS: An anonymous survey of emergency nurses responsible for pediatric triage decisions in a number of specialist and mixed EDs was conducted. RESULTS: Education and experience varies widely among nurses responsible for pediatric triage decisions. Many nurses practicing pediatric triage do not meet recognized guidelines for the levels of education and experience required to undertake pediatric triage. Nurses practicing in mixed population EDs were less likely to meet the recommended educational requirements than pediatric emergency nurses and yet reported no difference in their level of confidence in undertaking pediatric triage. CONCLUSIONS: Educationalists and managers must make a commitment to pediatric triage preparation for nurses in EDs providing pediatric services. In particular, emphasis must be placed on providing pediatric continuing education for nurses practicing in mixed population EDs. However, it is also essential that the impact of education and experience on patient outcomes be investigated before an attempt is made to influence the preparation of nurses for triage.

Adult↗
PubMed1997

Comparison of types of research articles published in emergency medicine and non-emergency medicine journals.

INTRODUCTION: As the specialty of emergency medicine (EM) matures, its journals should be publishing research of a quality similar to that which appears in other premier journals. OBJECTIVE: To compare the types of original research published in 4 EM vs 3 non-EM journals. METHODS: Retrospective review of all 1995 articles published in Academic Emergency Medicine, American Journal of Emergency Medicine, Annals of Emergency Medicine, Journal of Emergency Medicine, Annals of Internal Medicine, JAMA, and New England Journal of Medicine. Research articles were classified as longitudinal vs cross-sectional, prospective vs retrospective, and interventional vs observational. Other characteristics noted were number of subjects, randomization, blinding, control, and power calculations. Journals were reviewed by 4 investigators who received specific training in research classification, adhering to previously reported criteria for retrospective reviews. Interobserver reliability was independently validated. RESULTS: The authors reviewed 3,524 articles, of which 874 (24.8%) were original research. Compared with research reported in non-EM journals, EM journals contained fewer longitudinal studies (40.5% vs 60.4%, p < 0.0001) and fewer prospective studies (70.8% vs 78.7%, p = 0.008). Fewer EM journals had studies that were blinded (13.7% vs 18.9%, p = 0.047) or controlled (36.3% vs 50.0%, p = 0.003). Studies reported in EM journals had fewer subjects (138 vs 300, p < 0.001). Research reports in EM journals were less likely to have been funded, even after adjustment for the differences in study designs (adjusted odds ratio 7.0, 95% CI 5.1-9.7). CONCLUSION: Significant differences in types of research published in EM and non-EN journals were identified.

Authorship↗