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PubMed1992

Geriatric emergency medicine: a survey of practicing emergency physicians.

STUDY OBJECTIVES: To evaluate the current status of clinical, educational, social, ethical, and resource issues related to the care of the elderly among practitioners of emergency medicine. DESIGN: A mailed survey instrument. SETTING: None. TYPE OF PARTICIPANTS: Practicing emergency physicians randomly drawn from the membership list of the American College of Emergency Physicians. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 971 surveys were mailed, with 433 usable surveys among the 485 (50%) respondents. The surveyed emergency physicians anticipated a major impact on emergency department patient flow and bed availability in the hospital and ICU as the population ages. For each of seven clinical presentations (abdominal pain, altered mental status, chest pain, dizziness/vertigo, fever without a source, headache, multisystem trauma), 45% or more of the emergency physicians have more difficulty in the management of older compared with younger patients. Most respondents reported that each of these presentations required more time and resources for older patients. The majority believed research, the availability of continuing medical education, and time spent during residency training regarding geriatric emergency medicine was inadequate. CONCLUSION: Practicing emergency physicians are uncomfortable with elderly patients, and this may reflect the inadequacies of training, research, and continuing education in geriatric emergency medicine.

Aged↗

PubMed1999

[Prehospital emergencies (emergencies and acute cases) in childhood].

OBJECTIVE: To determine incidence and management of prehospital emergencies in children. METHODS: Between November 15, 1994 and March 14, 1995 in the City of Mainz (200,000 inhabitants) children with the diagnosis of a prehospital emergency were identified. RESULTS: 390 children were discovered, 62% in the age group 0-3 years. 85% of the emergency conditions occurred at home. In 71% the medical practitioner providing prehospital care was a paediatrician, in 14% an emergency physician. 48% of the children were transported to the Children's Hospital by the parents. 32 different types of emergency were diagnosed, 8 types more than 10 times. A retrospective analysis of 386 emergencies demonstrated an acute life-threatening situation in 12%. Lacking a final diagnosis in 19%, first and final diagnosis were identical in 64% of all children evaluated. CONCLUSIONS: In Germany acute life-threatening emergencies are rare. Paediatricians are mainly involved also in the care of children with emergency conditions. Most pediatricians and nonpaediatricians are familiar with the relevant prehospital emergency conditions in the young children mainly concerned.

Acute Disease↗

PubMed2003

Attitudes of emergency department patients and visitors regarding emergency exception from informed consent in resuscitation research, community consultation, and public notification.

OBJECTIVE: To assess public views on emergency exception to informed consent in resuscitation research, public awareness of such studies, and effective methods of community consultation and public notification. METHODS: A face-to-face survey was conducted in two academic Level I trauma center emergency departments (EDs) in Oregon and Minnesota from June through August 2001. RESULTS: Five hundred thirty people completed the survey, with an 82% response rate. The mean age of the respondents was 41 years (range 18-95) with a standard deviation of 14.5; 46% were female and 64% white. Most (88%) believed that research subjects should be informed prior to being enrolled, while 49% believed enrolling patients without prior consent in an emergency situation would be acceptable and 70% (369) would not object to be entered into such a study without providing prospective informed consent. Informing and consulting the community as a substitute for patient consent in emergency research was thought to be reasonable by 45% of the respondents. Most respondents would prefer to be informed about a study using emergency exception from informed consent by radio and television media (42%). Two hundred fifty-eight respondents (49%) stated they would attend a community meeting; the less educated were more likely to attend than those with college degrees (OR = 0.53; 95% CI = 0.33 to 0.85, p = 0.008). However, only 5% knew of ongoing studies in their community using emergency exception from informed consent. CONCLUSIONS: Most respondents disagreed with foregoing prospective informed consent for research participation even in emergency situations; however, many would be willing to participate in studies using emergency exception from informed consent. Most respondents would not attend community meetings, and would prefer to rely upon the media for information. Very few were aware of emergency exception from informed consent studies in their community. This suggests that current methods of community notification may not be effective.

Adolescent↗

PubMed1998