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PubMedDate not supplied

Standardized emergency management system and response to a smallpox emergency.

The smallpox virus is a high-priority, Category-A agent that poses a global, terrorism security risk because it: (1) easily can be disseminated and transmitted from person to person; (2) results in high mortality rates and has the potential for a major public health impact; (3) might cause public panic and social disruption; and (4) requires special action for public health preparedness. In recognition of this risk, the Los Angeles County Department of Health Services (LAC-DHS) developed the Smallpox Preparedness, Response, and Recovery Plan for LAC to prepare for the possibility of an outbreak of smallpox. A unique feature of the LAC-DHS plan is its explicit use of the Standardized Emergency Management System (SEMS) framework for detailing the functions needed to respond to a smallpox emergency. The SEMS includes the Incident Command System (ICS) structure (management, operations, planning/intelligence, logistics, and finance/administration), the mutual-aid system, and the multi/interagency coordination required during a smallpox emergency. Management for incident command includes setting objectives and priorities, information (risk communications), safety, and liaison. Operations includes control and containment of a smallpox outbreak including ring vaccination, mass vaccination, adverse events monitoring and assessment, management of confirmed and suspected smallpox cases, contact tracing, active surveillance teams and enhanced hospital-based surveillance, and decontamination. Planning/intelligence functions include developing the incident action plan, epidemiological investigation and analysis of smallpox cases, and epidemiological assessment of the vaccination coverage status of populations at risk. Logistics functions include receiving, handling, inventorying, and distributing smallpox vaccine and vaccination clinic supplies; personnel; transportation; communications; and health care of personnel. Finally, finance/administration functions include monitoring costs related to the smallpox emergency, procurement, and administrative aspects that are not handled by other functional divisions of incident command systems. The plan was developed and is under frequent review by the LAC-DHS Smallpox Planning Working Group, and is reviewed periodically by the LAC Bioterrorism Advisory Committee, and draws upon the Smallpox Response Plan and Guidelines of the Centers for Disease Control and Prevention (CDC) and recommendations of the Advisory Committee on Immunization Practices (ACIP). The Smallpox Preparedness, Response, and Recovery Plan, with its SEMS framework and ICS structure, now is serving as a model for the development of LAC-DHS plans for responses to other terrorist or natural-outbreak responses.

Bioterrorism↗
PubMedDate not supplied

Is Q fever an emerging or re-emerging zoonosis?

Q fever is a zoonotic disease considered as emerging or re-emerging in many countries. It is caused by Coxiella burnetii, a bacterium developing spore-like forms that are highly resistant to the environment. The most common animal reservoirs are livestock and the main source of infection is by inhalation of contaminated aerosols. Although the culture process for Coxiella is laborious, advances on the knowledge of the life cycle of the bacterium have been made. New tools have been developed to (i) improve the diagnosis of Q fever in humans and animals, and especially animal shedders, (ii) perform epidemiological studies, and (iii) prevent the disease through the use of vaccines. This review summarizes the state of the knowledge on the bacteriology and clinical manifestations of Q fever as well as its diagnosis, epidemiology, treatment and prevention in order to understand what factors are responsible for its emergence or re-emergence.

Animals↗
PubMed1996

[The Ulm Emergency Training Course. 2: Realization and acceptance of the emergency medicine practicum].

The first part of this publication described the concept of the student course in emergency medicine at the University Hospital Ulm as part of a "vertical curriculum" of education in emergency medicine. METHODS. A training circuit (Fig. 1) was conceptualised using training manikins (i.e. BLS, intubation, megacode training, ATLS training), computer programmes (ECG-simulation) and other means of instruction to simulate twelve realistic situations. These practical skill sessions were linked with case presentation and lectures. Its topics were chosen depending on the prevalence, type and urgency. Separate guidelines for teachers and students were edited prior to the beginning of the course in 1994. RESULTS. Evaluation showed good acceptance by the students for most parts of the course except the ATLS skill station and CPR computer simulations (Table 5). The score of the national board examination (multiple-choice test) of the students from Ulm was nevertheless not better than the mean of all german examinees (72.1 to 71.7%). CONCLUSION. The concept of the course in emergency medicine is well accepted by our students. Results of the national examination were not improved, since the course aims at performance, skills and competence in emergency medicine and not at teaching factual knowledge that is measured by the MCQ examinations.

Attitude of Health Personnel↗
PubMedDate not supplied

Assessment of nationally registered emergency medical technician certification training in the United States: the LEADS Project. Longitudinal Emergency Medical Technician Attributes Demo-graphic Study.

OBJECTIVES: To describe the adequacy and characteristics of emergency medical services education as assessed by a population-based sample of emergency medical technician (EMT)-basics and EMT-paramedics from the National Registry of Emergency Medical Technicians. METHODS: Stratified random samples of EMT-basics and EMT-paramedics from the National Registry of Emergency Medical Technicians were mailed a 46-item demographic survey and a 16-question education survey in 1999. RESULTS: Overall, EMT-basics and EMT-paramedics reported that course cost and distance to the course were not barriers. The majority of EMT-basic and EMT-paramedic respondents rated their course instructors and course materials as excellent or very good. EMT-basic and EMT-paramedic respondents felt that they were very well prepared from their training in the areas of trauma assessment (63% and 72%), medical assessment (59% and 65%), cardiac arrest management (64% and 76%), and airway management (69% and 77%), respectively. However, EMT-basic and EMT-paramedic respondents were less likely to feel very well prepared regarding childbirth (29% and 44%) and pediatric patient management (36% and 38%). Overall, EMT-paramedics were more likely to report being very well prepared for clinical activities and tasks from their training compared with EMT-basics. CONCLUSIONS: These findings suggest that EMT-basics and EMT-paramedics were satisfied and felt well prepared by their certification courses. Opportunities to improve certification training exist, particularly related to childbirth and pediatric patient management.

Adolescent↗
PubMedDate not supplied

Disease and security: the effect of emerging and re-emerging diseases.

This article examines the role of emerging new and re-emerging diseases in the failure of the 'Health for All by 2000' concept. The gap between infection and control has widened instead of closing, which has definite military and security implications. It is argued that there is a direct link between disease and the social order, and that the traditional view of development first, followed by an increase in health status, must change. However, the political will and the necessary resources to combat emerging and re-emerging diseases are still lacking in many countries. Through the improper use of treatments and dosages, most notably antibiotics, new strains of previously eradicated diseases are appearing. Added to this are new patterns of relationships between man, his environment and the occurrence of disease leading to new diseases making their appearance. There is a direct relationship between war and disease, making disease something with political, military and security relevance. The aspect of intelligence which has the task of predicting the future, now has to take note of the occurrence of disease and its effects.

Communicable Diseases, Emerging↗
PubMed1990

A joint course in emergency radiology for residents in radiology and in emergency medicine.

A basic course in emergency radiology has been developed and taught jointly to first- and second-year radiology residents and emergency medicine residents at the Medical College of Georgia. The course, comprising thirty-five lectures, was presented in a 5-month block. Both written and practical examinations were administered at the end of the course, and the course was evaluated by the participating residents. There was little overlap in examination scores between emergency medicine and radiology residents, with radiology residents scoring higher than emergency medicine residents. There was a wider gap in scores between the two groups on the practical than on the written examination. All participants considered the course useful and the material presented to be immediately applicable.

Curriculum↗
PubMed1978

Categorization of hospital emergency capabilities: some empirical methods to evaluate appropriateness of emergency department utilization.

Despite the emphasis on appropriateness of emergency department utilization, there is currently no methodology for assessing appropriateness nor measures for a community to evaluate and improve effectiveness of its E.M.S. system in treating emergencies at the appropriate emergency room and nonemergencies at appropriate alternative settings. The writer feels that the one current strategy which is widely accepted, the A.M.A.'s concept of categorization, has substantial methodologic limitations. The present paper suggests a methodology and a set of measures to assess appropriateness of utilization and illustrates them with data from Buffalo, New York, on a chart review of 24,594 emergency department patient medical records and interviews with 888 patients and their attending physicians. The measures include: 1) distribution of ambulance and critically ill patients by A.M.A. category of hospital, 2) utilization, characterized as system under- or over-response or as appropriate utilization, and 3) physician judgments as to indicated alternative treatment sites, which are suggested as evaluative tools to hospital and communities for E.M.S. assessment, and to federal and state agencies as performance standards, for project selection for funding and monitoring for outcome evaluation.

Adolescent↗
PubMed1995

Fellowship training in pediatric emergency medicine for graduates of emergency medicine residencies.

Candidates for fellowship training in Pediatric Emergency Medicine may be residency-trained in pediatrics or emergency medicine. The fellows who are emergency medicine-trained have different needs than those with pediatric training. Training programs for these individuals should focus on normal and abnormal development, behavioral pediatrics, pediatric subspecialties, and resuscitation of newborns and children. In addition, training in anesthesia, pediatric intensive care, and transport medicine are also important components of the curriculum. All fellowships should include research methodology and protected time for research activities. Because of the variability in training, fellows with residency training in emergency medicine should receive a core curriculum with the remainder of the training time tailored to meet their specific training needs in pediatrics. This report offers a template for this training.

Curriculum↗
PubMed2004

Emergency mental health care for youth in Washington State: qualitative research addressing hospital emergency departments' identification and referral of youth facing mental health issues.

OBJECTIVES: The purpose of this formative research was to gain a better understanding of how Washington State hospital emergency departments (EDs) identify and refer children and adolescents with mental health concerns. Increased understanding of emergency mental healthcare for youth will lead to the development and implementation of strategies and policies that enhance the system of providing mental health services to children and adolescents. METHODS: We conducted structured group interviews, a form of qualitative research, with ED, social work, and mental health administrators and providers in 9 hospitals in Washington State. RESULTS: Interviews reflected a systemwide lack of emergency mental health services for youth, as well as a lack of coordination between the larger mental health system and hospital ED. In addition, we identified issues specific to the hospital/ED such as insufficient availability of social work and mental health staff, lack of mental and behavioral health screening tools, lack of knowledge of available mental health services, and lack of clarity about the ED's role in identification of mental health concerns. CONCLUSIONS: Specific interventions should be developed, implemented, and evaluated to increase coordination between the ED and the larger mental health system. This should include methods for increasing ED staff knowledge of available and accessible mental health services for youth, perhaps through an online system. In addition, the role of the ED in identifying youth facing mental health issues should be clarified, and a brief, nonintrusive screening tool for identifying emergency mental health concerns should be developed.

Adolescent↗
PubMed1996

Emergency physicians' attitudes toward the emergency nurse practitioner role: validation versus rejection.

A qualitative grounded theory approach was used in this study, which examined the attitudes of a group of emergency physicians toward collaborative practice with emergency nurse practitioners. Interviews were conducted with five physicians who were not currently working with nurse practitioners. Responses were coded, and a substantive theory model of dependent collaboration emerged. The physicians supported the emergency nurse practitioner role on the grounds that it be supervised in the traditional fashion by the physician. Concerns regarding education, trust, liability, and capability were identified. Deficits in knowledge regarding training and the role/function of nurse practitioners were also identified.

Adult↗
PubMed2006

Effects of armed conflict on access to emergency health care in Palestinian West Bank: systematic collection of data in emergency departments.

OBJECTIVE: To assess the impact of restrictions in access to hospital services imposed on the civilian population during the armed conflict in the Palestinian territories occupied by Israel. DESIGN: Consecutive registration of demographic and medical data, with information about transportation time, delay in access to hospital, and course of hospital contact. SETTING: Three hospital emergency departments in Bethlehem and Nablus, in the occupied Palestinian West Bank, during one week in each hospital. PARTICIPANTS: All patients seeking health care in the three hospitals during the study period. RESULTS: A total of 394 of the 2228 emergency department contacts reported being delayed at checkpoints or by detours on their way to the emergency department. Hospital admission was significantly more common for these patients: 32% (n = 125) compared with 13% (n = 205) among those who were not delayed. CONCLUSION: 18% of the emergency department contacts were delayed because of the occupation. The higher hospital admission rate in this group suggests that restrictions in access to hospital services influence the severity of the medical conditions presented.

Civil Disorders↗
PubMed1997

Administration of medicines by emergency nurse practitioners according to protocols in an accident and emergency department.

OBJECTIVE: To present the legal and professional issues related to nurse administration of drugs according to protocols, and describe the implementation and initial audit findings of such a scheme. SETTING: Accident and emergency (A&E) department of a district general hospital. METHODS: Analysis of legal and professional opinion. Protocols acceptable to the medical, nursing, and pharmacy professions were developed across a wide range of drugs appropriate for administration by accident and emergency nurse practitioners (ENPs). The first six months of the scheme were audited. Audit initially addressed general compliance with protocols and later the specific areas of tetanus immunisation and emergency contraception. RESULTS: ENPs assessed 2925 patients in six months (10.9% of all new patients); 455 patients (15.5% of the ENP patients) were given drugs according to protocols. There were no breaches of the protocols. Subsequent audit of tetanus immunisation showed 94-100% compliance with protocol standards and 71-100% compliance for emergency contraception. CONCLUSIONS: There are no legal or professional obstacles to the development of protocols for the administration of drugs to patients by nurses without reference to a doctor, providing the protocols meet all the requirements of the UKCC and have the support of consultant medical staff. Such a system must be subject to regular audit to promote a dynamic approach to protocols and training. The system safely enhanced the quality of care of patients treated by ENPs in A&E.

Clinical Protocols↗
PubMed2003

Emergency department overcrowding in the United States: an emerging threat to patient safety and public health.

Numerous reports have questioned the ability of United States emergency departments to handle the increasing demand for emergency services. Emergency department (ED) overcrowding is widespread in US cities and has reportedly reached crisis proportions. The purpose of this review is to describe how ED overcrowding threatens patient safety and public health, and to explore the complex causes and potential solutions for the overcrowding crisis. A review of the literature from 1990 to 2002 identified by a search of the Medline database was performed. Additional sources were selected from the references of the articles identified. There were four key findings. (1) The ED is a vital component of America's health care "safety net". (2) Overcrowding in ED treatment areas threatens public health by compromising patient safety and jeopardising the reliability of the entire US emergency care system. (3) Although the causes of ED overcrowding are complex, the main cause is inadequate inpatient capacity for a patient population with an increasing severity of illness. (4) Potential solutions for ED overcrowding will require multidisciplinary system-wide support.

Bed Occupancy↗
PubMed2004

Residency training in emergency psychiatry: a model curriculum developed by the education committee of the american association for emergency psychiatry.

OBJECTIVE: Describe training goals, objectives and requirements in emergency psychiatry to assist residency programs in developing comprehensive training programs to ensure psychiatric residents acquire the necessary skills and knowledge to competently assess and manage patients with psychiatric emergencies. METHODS: The American Association for Emergency Psychiatry (AAEP) Education Committee developed these guidelines using a consensus-building process. CONCLUSION: These guidelines address all aspects of training including objectives, recommended training sites, rotation length, clinical supervision, curriculum content and evaluation. The objectives emphasize acute assessment and intervention skills. The AAEP Education Committee hopes that by implementing these guidelines, training programs will enable residents to become competent and comfortable working in a psychiatric emergency service.

Clinical Competence↗
PubMed2006

Innovations: Emergency psychiatry: Relative accuracy of breath and serum alcohol readings in the psychiatric emergency service.

Management of changes in physiologic and mental status due to alcohol is a core skill utilized in the psychiatric emergency service. Blood alcohol concentrations are commonly approximated by measuring breath alcohol at triage. However, the blood-breath ratio is highly variable, and breath tests have produced lower readings than blood tests. The authors assessed the accuracy of breath alcohol readings at triage in a medical emergency department compared with subsequent serum alcohol levels taken in the psychiatric emergency service. The mean breath ethanol concentration was significantly lower than the mean corrected serum ethanol concentration (.15+/-.05 grams per 210 liters and .23+/-.05 grams per 100 milliliters, respectively). The relative accuracy of breath alcohol tests decreased with increasing serum alcohol. Although its low false-positive rate makes the breath test acceptable for legal purposes, the blood alcohol level is more appropriate for clinical use in emergency settings, because breath tests can underestimate the degree of toxicity.

Alcoholic Intoxication↗
PubMed1999

Emergency preparedness for children with special health care needs. Committee on Pediatric Emergency Medicine. American Academy of Pediatrics.

Children with special health care needs are those who have, or are at risk for, chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount not usually required by typically developing children. Formulation of an emergency care plan has been advocated by the Emergency Medical Services for Children (EMSC) program through its Children With Special Heath Care Needs Task Force. Essential components of a program of providing care plans include use of a standardized form, a method of identifying at-risk children, completion of a data set by the child's physicians and other health care professionals, education of families, other caregivers, and health care professionals in use of the emergency plan, regular updates of the information, 24-hour access to the information by authorized emergency health care professionals, and maintenance of patient confidentiality.

Child↗
PubMed1999

[Value of the laryngeal mask in emergency care--a survey of North German emergency physicians].

In clinical routine, the laryngeal mask airway (LMA) has proved an alternative to both endotracheal intubation and mask ventilation. In a survey among North German emergency physicians, aspects such as doctors' acquaintance with the LMA, the degree of ist distribution, its use and its potential benefits under non-hospital emergency conditions were evaluated. Seventeen per cent (n = 162) of physicians responded to the questionnaire, 75% of them (n = 122) anaesthetists. Although 73% (n = 119) were familiar with the use of the LMA from clinical experience, and again 73% would welcome having LMA use and application as part of the training of non-academic members of ambulance teams, only 24% (n = 37) of the responding doctors have an LMA on their emergency ambulances and merely twelve (7.4%) physicians reported actually using the LMA, one of them unsuccessfully. Sixty-three per cent considered the LMA the first-choice alternative in an unexpected "can't-ventilate-can't-intubate" situation. Use of the LMA should be extended in emergency medicine especially as its application is relatively easy to learn in clinical routine.

Attitude of Health Personnel↗
PubMed2000

Access to pediatric emergency medical care. American Academy of Pediatrics. Committee on Pediatric Emergency Medicine.

Hundreds of thousands of pediatric patients require some level of emergency care annually, and significant barriers limit access to appropriate services for large numbers of children. The American Academy of Pediatrics has a strong commitment to identify barriers to access to emergency care, work to surmount these obstacles, and encourage through education increased levels of emergency care available to all children. It is also crucial to involve and incorporate the child's medical home into emergency care, both during acute presentation when the medical home is identified and by assisting in locating a medical home for follow-up when none previously exists.

Academies and Institutes↗