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PubMed1992

Academic emergency medicine: a national profile with and without emergency medicine residency programs.

STUDY OBJECTIVE: Formal data are lacking regarding emergency departments in academic medical centers, particularly those without an emergency medicine residency program. The Education Committee of the Society for Academic Emergency Medicine conducted a survey to define a national profile of academic emergency medicine. DESIGN: Prospective survey with telephone follow-up. SETTING: Academic medical centers. PARTICIPANTS: One hundred twenty-three academic medical centers as defined by the Association of American Medical Colleges. RESULTS: Results were obtained from 94 (78%) institutions: 27 (29%) had an emergency medicine residency program and 67 (71%) had no emergency medicine residency program. Significant differences were found between those with and without emergency medicine residency programs regarding 24-hour attending coverage (96% versus 73%), mean weekly clinical faculty hours (26 versus 33), the number of emergency medicine board-certified faculty, faculty recruitment difficulties (25% versus 75%), and the presence of a curriculum for housestaff (96% versus 38%). No significant differences were noted regarding the presence of a curriculum for medical students (78% versus 64%). Of the 67 institutions with no emergency medicine residency programs, 42% were actively planning a program, and 42% would consider future development of a program. CONCLUSION: This article provides the first comprehensive profile of emergency medicine in the Association of American Medical Colleges academic medical centers. Programs with emergency medicine residency programs provided more 24-hour attending coverage, had more emergency medicine board-certified faculty, and reported less difficulty recruiting additional faculty than institutions with no emergency medicine residency program. Both need to expand their undergraduate educational activities. Many institutions with no emergency medicine residency program are attempting to develop emergency medicine residency programs.

Academic Medical Centers↗
PubMed2005

Emergency ventilation of the tracheostomy patient, part II: a story of tracheotomy history and emergency airway management--advocating education for emergency resuscitation.

Over a period of 5000 years, dramatic changes have occurred in airway management, tracheotomy procedure terminology, indications, techniques, instruments, settings where procedures are performed, tube design and patient outcomes. Specialized knowledge and skills necessary to safely care for tracheostomy patients and to provide effective respiratory resuscitation are reviewed. The purpose of this paper is to document the history of the tracheotomy as a backdrop for understanding patient management. Recommendations for staff education regarding emergency ventilation of the tracheostomy patient are presented.

Equipment Design↗
PubMed2002

[Invasive emergency techniques (INTECH). A training concept in emergency medicine].

BACKGROUND: Introducing a chest tube is a routine emergency procedure in trauma victims. Emergency coniotomy or establishing an intraosseous access, however, are not often necessary, but in individual cases these techniques can be decisive for patient survival. The aim of this study was to present and evaluate a model for teaching these techniques, since the majority of emergency physicians do not have adequate experience in this area. METHODS: In November 2001 our institution organized the first workshop on "Invasive emergency techniques (INTECH): chest tube, emergency coniotomy, and intraosseous access" in collaboration with the Institute of Anatomy II of the University of Heidelberg. After presenting basic anatomy and also particular features of the relevant regions of the body, the techniques of introducing a thoracic drainage, performing a coniotomy, and establishing an intraosseous access were presented. Video demonstrations as well as practical exercises on corpses followed the theoretical part of the course. At the end of each lesson, the participants were asked anonymously why they took part in the workshop and about their previous experience with these emergency techniques in written form and also asked to assess the didactic concept of the workshop (scale 1=very good up to 6=very poor). RESULTS: Of the 86 participants, 66 completed the questionnaire (77%) and 40 of the participants had been working as emergency physicians for 6.5+/-6.3 years (range 0.5-22) with approx. 13+/-8 (range 4-30) interventions per month. The most common reason for participating was lack of practice (52%): prior to the workshop, 98% of the emergency physicians had never performed a coniotomy, 85% had never established an intraosseous access, and 28% had never introduced a chest tube in an emergency setting. The theoretical parts of the course received the following scores: "Basic anatomy" 2.3+/-0.8, "coniotomy" 1.7+/-0.7, "intraosseous access" 1.5+/-0.5, and "thoracic drainage " 1.7+/-0.7. In the practical part they were given the scores: "coniotomy" 1.9+/-0.7, and "intraosseous access" and "thoracic drainage" both 1.6+/-0.8. Finally, the "positioning demonstrations" were given scores of 1.7+/-0.8 and the practical exercises as a whole 1.4+/-0.7. CONCLUSIONS: These results show that even emergency physicians with many years of practice have too little knowledge about thoracic drainage, even though it is required in the management of trauma victims. Over 80% of the emergency physicians have no experience with certain other emergency measures recommended as lifesaving in individual cases. Despite the criticism that the participants of the workshop were a selected study group, these numbers seem to reflect reality: Institutions with emergency medicine departments have reported considerable and serious deficiencies in providing emergency care to patients with polytrauma. These gaps could be closed by implementing practice-oriented workshops in collaboration with anatomical institutes. As these institutes use fixated corpses for training purposes, the differences in working with living patients would have to be made clear. In spite of this minor restriction, practical exercises could counteract the deficits in the care of emergency patients and should therefore be integrated into a future educational concept on a long-term basis.

Chest Tubes↗
PubMed1993

Impact of emergency medicine residency program on rotators' emergency medicine education.

STUDY OBJECTIVE: To assess the perceived impact of emergency medicine residency programs on other program directors' perceptions of emergency medicine as a distinct service and educational entity. DESIGN: Self-administered questionnaire. TYPE OF PARTICIPANTS: Residency directors in medicine, surgery, pediatrics, and obstetrics and gynecology at sites containing emergency medicine residency programs. RESULTS: Two hundred twenty-four of 372 questionnaires (60.1%) were returned completed, with equal distributions among all specialties. Respondents stated that the presence of the emergency medicine training program has positively influenced their attitude toward emergency medicine as a specialty (61% agree, 26% neutral), improved their residents' training in emergency medicine (47% agree, 31% neutral), and improved emergency care at their institution (65% agree, 26% neutral). Fifty-seven percent think emergency physicians should teach emergency medicine (27% were neutral). There were statistically significant associations between age of the emergency medicine program and perceived improvement in rotating residents' education and institutional delivery of emergency care. CONCLUSION: Residency directors in other specialties have a generally positive view of emergency medicine as a specialty and as an important component of their residents' education. The presence of an emergency medicine training program appears to have positively influenced their attitudes, improved their residents' education, and improved emergency care. Older programs have positively influenced attitudes to a greater degree than have newer programs.

Attitude of Health Personnel↗
PubMed2003

Emergency prophylaxis following needle-stick injuries and sexual exposures: results from a survey comparing New York Emergency Department practitioners with their national colleagues.

BACKGROUND: Emergency prophylaxis following needle-stick and sexual exposures includes HIV post-exposure prophylaxis, hepatitis B prophylaxis and emergency contraception. The Centers for Disease Control and Prevention endorse HIV post-exposure and hepatitis B prophylaxis for health care workers, and hepatitis B prophylaxis and emergency contraception after sexual assault. The New York State Department of Health advocates HIV post-exposure prophylaxis after sexual assault. This study compares emergency department practitioners in New York State (NYS) with those from other states in their willingness to offer emergency prophylaxis after needle-stick and sexual exposures, and their self-reported history of prescribing and using HIV post-exposure prophylaxis. METHODS: The authors surveyed emergency department practitioners from across the US at the American College of Emergency Physicians 2000 Scientific Assembly. The questionnaire included clinical scenarios describing different patients who present to the emergency department within one hour of a needle-stick injury, sexual assault or consensual sexual encounter, and had questions on the practitioners self-reported prescribing and usage of HIV post-exposure prophylaxis. For each scenario the practitioners were asked to indicate if they would offer emergency prophylaxis to different patients at varied HIV risk levels. The data were processed through SPSS 10.0. RESULTS: Of the 600 respondents, 100 were from NYS. In the clinical scenarios, NYS practitioners were more likely than other US practitioners to offer HIV post-exposure prophylaxis for exposures to unknown and low HIV risk sources (p<0.05) and to offer hepatitis B prophylaxis in most of the sexual exposure scenarios (p<0.01). All practitioners offered HIV post-exposure and hepatitis B prophylaxis less often after consensual sexual encounters than after sexual assault and needle-stick injuries. In most cases, NYS practitioners were more willing to offer emergency contraception after sexual assault and consensual sexual encounters than were other practitioners (p<0.05). In terms of self-reported prescribing of HIV post-exposure prophylaxis, NYS practitioners had prescribed HIV post-exposure prophylaxis after sexual assault (p<0.001) and non-health-care-worker needle-stick injuries (p<0.05) much more often than did other practitioners. CONCLUSIONS: Compared to their national colleagues, NYS emergency department practitioners were generally more willing to offer all forms of emergency prophylaxis after sexual assault. They also reported having had more experience than other practitioners in prescribing HIV post-exposure prophylaxis. Although most practitioners were clearly willing to offer HIV post-exposure prophylaxis for nonoccupational exposures, NYS practitioners were less willing to offer emergency prophylaxis following consensual sex than after sexual assault. These findings suggest that the NYS guidelines for HIV post-exposure prophylaxis after sexual assault may have influenced emergency practitioners willingness to offer and prescribe prophylaxis.

Emergency Service, Hospital↗
PubMed2006

[The position of the emergency physician in the emergency medical service].

The participation of emergency physicians guarantees the quality of a modern emergency medical service (EMS). Within the scope of cost savings in health-care system, it is questioned whether emergency medical services in the future can be managed without emergency physicians. Deficits of structure and qualitaty of the emergency physician service are raised objections. Recent studies have shown that preclinical care carried out by an emergency physician assure better results. An ongoing improvement in the quality of care should be achieved by the introduction of the new professional training for physicians "emergency medicine". In a direct comparison of two emergency medical services, one with emergency physicians, one only with paramedics it could be demonstrated that the integration of emergency physicians will increase the rate of patients, whose vital status could be improved by more than 20 %. The rate of patients discharged from hospital after cardiopulmonal resuscitation is 3 fold higher than in a rescue service without emergency physicians. However this improvement of quality of care by physicians is linked to higher financial charges. Another aspect supporting the obligatory employment of emergency physicians in Germany is the jurisdiction guaranteeing the right of the patient to receive advanced medical treatment only by (emergency) physicians.

Allied Health Personnel↗
PubMed2006

Pediatric mental health emergencies in the emergency medical services system.

Emergency departments are vital in the management of pediatric patients with mental health emergencies. Pediatric mental health emergencies are an increasing part of emergency medical practice because emergency departments have become the safety net for a fragmented mental health infrastructure that is experiencing critical shortages in services in all sectors. Emergency departments must safely, humanely, and in a culturally and developmentally appropriate manner manage pediatric patients with undiagnosed and known mental illnesses, including those with mental retardation, autistic spectrum disorders, and attention-deficit/hyperactivity disorder and those experiencing a behavioral crisis. Emergency departments also manage patients with suicidal ideation, depression, escalating aggression, substance abuse, posttraumatic stress disorder, and maltreatment and those exposed to violence and unexpected deaths. Emergency departments must address not only the physical but also the mental health needs of patients during and after mass-casualty incidents and disasters. The American Academy of Pediatrics and the American College of Emergency Physicians support advocacy for increased mental health resources, including improved pediatric mental health tools for the emergency department, increased mental health insurance coverage, and adequate reimbursement at all levels; acknowledgment of the importance of the child's medical home; and promotion of education and research for mental health emergencies.

Child↗
PubMed1999

Prevalence of emergency events in British dental practice and emergency management skills of British dentists.

Medical emergencies in dental practice are generally perceived as being rare but when an emergency does occur it can be life-threatening. The ability of the dentist to initiate primary management is the key to minimising morbidity and mortality. Accurate data on the prevalence of emergency events, required so that dentists can adequately prepare to deal with emergency situations, is sparse and obsolete. This study aimed to determine the current prevalence of medical emergencies and the perceived emergency management skills of dentists. A questionnaire, distributed to 887 dentists working in general dental practice across five counties of Northern England, produced a response rate of 34%. The most frequently reported emergency was vasovagal syncope (1.9 cases, per dentist per year), followed by hypoglycaemia (0.17), angina (0.17), epileptic fit (0.13), choking (0.09), asthma (0.06), hypertensive crisis (0.023) and anaphylaxis (0.013). Myocardial infarction and cardiac arrest were extremely rare with an incidence of 0.003 and 0.002 cases per dentist per year, respectively. The total prevalence of all emergency events (excluding syncope) was 0.7 cases per dentist per year. Only 20.8% of dentists felt competent to diagnose the cause of a collapse in the dental surgery. However the majority believed that they would be able to undertake initial treatment of most common emergencies. Despite this more than 50% felt unable to manage a myocardial infarction or anaphylaxis, and 49.7% did not know how to insert an oral airway or undertake an intravenous injection. Future postgraduate training in emergency care for dentists needs to be more accurately targeted to the known prevalence of emergencies and deficiencies in dentists' emergency skills.

Adult↗