Sample records for accident and emergency medicine

  1. Accident knowledge and emergency management

    Rasmussen, B.; Groenberg, C.D.


    The report contains an overall frame for transformation of knowledge and experience from risk analysis to emergency education. An accident model has been developed to describe the emergency situation. A key concept of this model is uncontrolled flow of energy (UFOE), essential elements are the state, location and movement of the energy (and mass). A UFOE can be considered as the driving force of an accident, e.g., an explosion, a fire, a release of heavy gases. As long as the energy is confined, i.e. the location and movement of the energy are under control, the situation is safe, but loss of confinement will create a hazardous situation that may develop into an accident. A domain model has been developed for representing accident and emergency scenarios occurring in society. The domain model uses three main categories: status, context and objectives. A domain is a group of activities with allied goals and elements and ten specific domains have been investigated: process plant, storage, nuclear power plant, energy distribution, marine transport of goods, marine transport of people, aviation, transport by road, transport by rail and natural disasters. Totally 25 accident cases were consulted and information was extracted for filling into the schematic representations with two to four cases pr. specific domain. (au) 41 tabs., 8 ills.; 79 refs.

  2. Fatal traffic accidents and forensic medicine

    Kazuhiko Kibayashi


    Full Text Available In the event of a traffic accident fatality, the death is reported as an “unusual death,” an inquest is conducted, and, if necessary, a forensic autopsy is performed to prove any causal relationship between the accident and the death, identify the vehicle at fault, and determine the cause of the accident. A forensic autopsy of a traffic accident fatality needs to both determine the cause of death and identify the mechanism of injury, an analytical task that requires observation of three major traffic accident factors: the body, the vehicles involved, and the scene of the accident. Also crucial to determining the cause of death is the process of looking into whether the people involved in the accident had any diseases that might affect their driving performance or were under the influence of alcohol or drugs. In order to reduce the number of people killed in traffic accidents, it will be important to promote joint research uniting forensic medicine, clinical medicine, automotive engineering, and road engineering, take measures to limit the impact of inebriated pedestrians and pedestrians suffering from dementia, and ensure proper screening of alcohol and illegal drug consumption in drivers.

  3. Socioeconomic deprivation and accident and emergency attendances

    Scantlebury, Rachel; Rowlands, Gillian; Durbaba, Stevo;


    BACKGROUND: Demand for England's accident and emergency (A&E) services is increasing and is particularly concentrated in areas of high deprivation. The extent to which primary care services, relative to population characteristics, can impact on A&E is not fully understood. AIM: To conduct...... a detailed analysis to identify population and primary care characteristics associated with A&E attendance rates, particularly those that may be amenable to change by primary care services. DESIGN AND SETTING: This study used a cross-sectional population-based design. The setting was general practices.......1, B = 547.3 [95% CI = 418.6 to 676.0]). The final model explained 34.4% of the variation in A&E attendance rates, mostly due to factors that could not be modified by primary care services. CONCLUSION: Demographic characteristics were the strongest predictors of A&E attendance rates. Primary care...

  4. Guidelines for accident prevention and emergency preparedness

    Fthenakis, V.M.; Morris, S.C.; Moskowitz, P.D.


    This report reviews recent developments in the guidelines on chemical accident prevention, risk assessment, and management of chemical emergencies, principally in the United States and Europe, and discusses aspects of their application to developing countries. Such guidelines are either in the form of laws or regulations promulgated by governments, or of recommendations from international, professional, or non governmental organizations. In many cases, these guidelines specify lists of materials of concern and methods for evaluating safe usage of these materials and recommend areas of responsibility for different organizations; procedures to be included in planning, evaluation, and response; and appropriate levels of training for different classes of workers. Guidelines frequently address the right of communities to be informed of potential hazards and address ways for them to participate in planning and decision making.

  5. Medical Journalism and Emergency Medicine

    Saeed Safari


    Full Text Available Nowadays, many researches in the field of medicine are conducting all around the world and medical journalism is a way to share the results. In fact, dissemination of the related manuscripts can prevent the repetitive research or may even lead to conducting a better survey. Therefore high quality medical journals are considered as up-to-date resources for further investigations. Medical journals are propagating their papers in various media including television programs, newspapers, internet websites and different social media. So they can influence the government policy makers, health-care professionals and even public. Moreover, most researchers hear about medical discoveries for the first time through medical journals and their related social media. So as well a high quality journal can help to improve medical science, a journal of poor quality can be damaging and distorting. Indeed, popular journals have the power of inventing a “communication storm” to draw attention to a certain topic. Thus they have to respect the accepted international principles to prevent spreading inaccurate and misleading data. This paper aims to review the previous and current situation of medical journalism by focus on field of emergency medicine.

  6. Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey.

    Tye, C C; Ross, F.; Kerry, S. M.


    OBJECTIVE: To establish the current and predicted distribution of formal emergency nurse practitioner services in major accident and emergency departments in the United Kingdom; to determine organisational variations in service provision, with specific reference to funding, role configuration, training, and scope of clinical activity. METHODS: Postal survey of senior nurses of all major accident and emergency departments in the United Kingdom (n = 293) in May/June 1996. RESULTS: There were 27...

  7. Bioethics and Emergency Medicine: problems and perspectives

    Maurizio Mori


    Full Text Available Before examining the specific problems of emergency medicine, the article identifies the cardinal points for orientation in bioethics, in the conviction that the knowledge of the basic aspects of the subject allow the reader to make more conscious and suitable choices. The questions of moral relativism and the consequences of the biomedical revolution are addressed in detail in order to support the argument for a new ethical base for healthcare in general and for emergency medicine.

  8. Redundancy in the accident and emergency department.

    Durcan, T


    Whilst this article was being written, the Government announced that the pay of nurses will be based on productivity. The Trade Unions have announced that they have made a claim to the independent pay review body for a payment of 10% as a pay award, but the RCN indicated that up to 50,000 nursing jobs have been lost between 1992 and 1993. This gives an indication that the future is not so bright for nurses. Under this cloud of uncertainty nurses may deduce that there is a clear message that their job is no longer a job for life. Market forces, contracts, targets and flexibility are the jargon of today's care. Nursing is under threat and attack.

  9. Accident Emergency Response And Routing Software (AERARS using Genetic Algorithm

    Naveen Ramachandran,


    Full Text Available AERARS is a response and routing software for accident emergency requirement. A method has been proposed in this project for using a genetic algorithm to find the shortest route between a source and adestination. It make use of genetic algorithms ability to search the opt solution from the population helping to solve spatially addressed problem. The numbers of accident spots are plotted in ArcGISenvironment and ten major accident spots are identified. The software package is designed with closest facility estimation and shortest route generation along with other basic software facilities in Visual Basic environment. Genetic algorithm provided a great optimality to the solutions. The closest facility tool helps to estimate the nearest hospital, ambulance, police station and fire station. The shortest route estimation tool generates shortest path between a locations to the hospital or ambulance spot. The various risk zonesare assessed and more safety measures can be taken to reduce the frequency of accident. The software efficiency can be further increased by incorporating GPS and satellite technology.

  10. The Consumer Quality Index in an accident and emergency department : Internal consistency, validity and discriminative capacity

    Bos, Nanne; Sturms, Leontien M.; Stellato, Rebecca K.; Schrijvers, Augustinus J P; van Stel, Henk F.


    Background: Patients' experiences are an indicator of health-care performance in the accident and emergency department (A&E). The Consumer Quality Index for the Accident and Emergency department (CQI A&E), a questionnaire to assess the quality of care as experienced by patients, was investigated. Th

  11. Human factors and safety in emergency medicine

    Schaefer, H. G.; Helmreich, R. L.; Scheidegger, D.


    A model based on an input process and outcome conceptualisation is suggested to address safety-relevant factors in emergency medicine. As shown in other dynamic and demanding environments, human factors play a decisive role in attaining high quality service. Attitudes held by health-care providers, organisational shells and work-cultural parameters determine communication, conflict resolution and workload distribution within and between teams. These factors should be taken into account to improve outcomes such as operational integrity, job satisfaction and morale.

  12. Recruitment and Retention of Patients into Emergency Medicine Clinical Trials

    Cofield,Stacey; Conwit, Robin; Barsan, William; Quinn, James


    The emergency medicine and pre-hospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in Emergency Medicine Clinical Trials (EMCT), and provides strategies from emergency medicine and non-emergency medicine trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment...

  13. Recruitment and Retention of Patients into Emergency Medicine Clinical Trials

    Cofield, Stacey; Conwit, Robin; Barsan, William; Quinn, James


    The emergency medicine and pre-hospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in Emergency Medicine Clinical Trials (EMCT), and provides strategies from emergency medicine and non-emergency medicine trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment and retention issues with specific strategies will help researchers deal with these issues in their funding applications and in turn develop the necessary infrastructure to participate in emergency medicine clinical trials. PMID:21040112

  14. Emerging infectious diseases and travel medicine.

    Ostroff, S M; Kozarsky, P


    International movement of individuals, populations, and products is one of the major factors associated with the emergence and reemergence of infectious diseases as the pace of global travel and commerce increases rapidly. Travel can be associated with disease emergence because (1) the disease arises in an area of heavy tourism, (2) tourists may be at heightened risk because of their activities, or (3) because they can act as vectors to transport the agent to new areas. Examples of recently recognized diseases with relationship to travel include HIV, Legionnaire's disease, cyclosporiasis, Vibrio cholerae O139 Bengal, hantavirus, and variant Creutzfeldt-Jacob disease. Reemerging diseases include dengue fever, malaria, cholera, schistosomiasis, leptospirosis, and viral hemorrhagic fevers. In addition, tuberculosis, drug-resistant shigellosis, and cholera have been major concerns in refugee and migrant populations. Because of the unique role of travel in emerging infections, efforts are underway to address this factor by agencies such as the CDC, WHO, the International Society of Travel Medicine, and the travel industry.

  15. Community emergency response to nuclear power plant accidents: A selected and partially annotated bibliography

    Youngen, G.


    The role of responding to emergencies at nuclear power plants is often considered the responsibility of the personnel onsite. This is true for most, if not all, of the incidents that may happen during the course of the plant`s operating lifetime. There is however, the possibility of a major accident occurring at anytime. Major nuclear accidents at Chernobyl and Three Mile Island have taught their respective countries and communities a significant lesson in local emergency preparedness and response. Through these accidents, the rest of the world can also learn a great deal about planning, preparing and responding to the emergencies unique to nuclear power. This bibliography contains books, journal articles, conference papers and government reports on emergency response to nuclear power plant accidents. It does not contain citations for ``onsite`` response or planning, nor does it cover the areas of radiation releases from transportation accidents. The compiler has attempted to bring together a sampling of the world`s collective written experience on dealing with nuclear reactor accidents on the sate, local and community levels. Since the accidents at Three Mile Island and Chernobyl, that written experience has grown enormously.

  16. Blog and Podcast Watch: Pediatric Emergency Medicine

    Zaver, Fareen; Hansen, Michael; Leibner, Evan; Little, Andrew; Lin, Michelle


    Introduction By critically appraising open access, educational blogs and podcasts in emergency medicine (EM) using an objective scoring instrument, this installment of the ALiEM (Academic Life in Emergency Medicine) Blog and Podcast Watch series curated and scored relevant posts in the specific areas of pediatric EM. Methods The Approved Instructional Resources – Professional (AIR-Pro) series is a continuously building curriculum covering a new subject area every two months. For each area, six EM chief residents identify 3–5 advanced clinical questions. Using to search blogs and podcasts, relevant posts are scored by eight reviewers from the AIR-Pro Board, which is comprised of EM faculty and chief residents at various institutions. The scoring instrument contains five measurement outcomes based on 7-point Likert scales: recency, accuracy, educational utility, evidence based, and references. The AIR-Pro label is awarded to posts with a score of ≥26 (out of 35) points. An “Honorable Mention” label is awarded if Board members collectively felt that the posts were valuable and the scores were > 20. Results We included a total of 41 blog posts and podcasts. Key educational pearls from the 10 high quality AIR-Pro posts and four Honorable Mentions are summarized. Conclusion The WestJEM ALiEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. Until more objective quality indicators are developed for learners and educators, this series provides an expert-based, crowdsourced approach towards critically appraising educational social media content for EM clinicians. PMID:27625713

  17. Blog and Podcast Watch: Pediatric Emergency Medicine

    Fareen Zaver


    Full Text Available Introduction: By critically appraising open access, educational blogs and podcasts in emergency medicine (EM using an objective scoring instrument, this installment of the ALiEM (Academic Life in Emergency Medicine Blog and Podcast Watch series curated and scored relevant posts in the specific areas of pediatric EM.    Methods: The Approved Instructional Resources – Professional (AIR-Pro series is a continuously building curriculum covering a new subject area every two months. For each area, six EM chief residents identify 3-5 advanced clinical questions. Using to search blogs and podcasts, relevant posts are scored by eight reviewers from the AIR-Pro Board, which is comprised of EM faculty and chief residents at various institutions. The scoring instrument contains five measurement outcomes based on 7-point Likert scales: recency, accuracy, educational utility, evidence based, and references. The AIR-Pro label is awarded to posts with a score of ≥26 (out of 35 points. An “Honorable Mention” label is awarded if Board members collectively felt that the posts were valuable and the scores were > 20. Results: We included a total of 41 blog posts and podcasts. Key educational pearls from the 10 high quality AIR-Pro posts and four Honorable Mentions are summarized. Conclusion: The WestJEM ALiEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. Until more objective quality indicators are developed for learners and educators, this series provides an expert-based, crowdsourced approach towards critically appraising educational social media content for EM clinicians.

  18. [The Sino-French emergency and disaster medicine training center].

    Pourriat, Jean-Louis; Dahan, Benjamin; Lapandry, Claude


    French (AP-HP) and Chinese (Beijing Health Office) hospitals, with support from the French company Total, collaborated in order to improve Chinese doctors' knowledge of emergency and disaster medicine prior to the Beijing Olympic Games. A Sino-French emergency and disaster medicine training center was subsequently opened in Beijing in 2008, with the aim of providing high-level continuous medical training for Chinese specialists in emergency medicine. Teaching in the management of critical situations was based on the use of a latest-generation simulator (Sim 3G; Laerdal). This collaboration has had both pedagogical and diplomatic benefits.

  19. The Sheffield experiment: the effects of centralising accident and emergency services in a large urban setting

    Simpson, A.; Wardrope, J; Burke, D


    Objectives—To assess the effects of centralisation of accident and emergency (A&E) services in a large urban setting. The end points were the quality of patient care judged by time to see a doctor or nurse practitioner, time to admission and the cost of the A&E service as a whole.

  20. Dermatobia hominis in the accident and emergency department: "I've got you under my skin".

    MacNamara, A; Durham, S


    An unusual form of larval infestation from South America is presented which, in view of increasing tourism to South america's tropical areas, may present to any accident and emergency department. Infestation with Dermatobia hominis is reviewed in terms of clinical recognition and life cycle. Techniques of removal are described.

  1. Dermatobia hominis in the accident and emergency department: "I've got you under my skin".

    MacNamara, A; Durham, S


    An unusual form of larval infestation from South America is presented which, in view of increasing tourism to South america's tropical areas, may present to any accident and emergency department. Infestation with Dermatobia hominis is reviewed in terms of clinical recognition and life cycle. Techniques of removal are described.

  2. [Emergency care for traffic accidents in Bavaria: current process analysis depending on hospital and emergency service structures].

    Lackner, C K; Bielmeier, S; Burghofer, K


    A change is emerging in the hospital landscape due to health political measures, which in consequence also influences the prehospital medical care in emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data from Bavarian emergency medical services. In 2006 there were 14,261 traffic accidents in Bavaria where an emergency doctor attended the scene. The patients were primarily cared for by land-based rescue services and air rescue services were only used in 19.1% of the cases. Of the patients involved in a traffic accident 47.6% were transported to a primary health care hospital. A prehospital interval of more than 60 min occurred in 20% of the missions. Of the patients 96.2% were transported to tertiary or maximum care hospital by air rescue services but emergency facilities were, however restricted to daylight hours. There was a further limitation due to the routine duty hours in hospitals as only 36.7% of accidents occurred during this time intervall. An increase of admission post trauma in maximum care clinics occurred from 2002 until 2006 while simultaneously the prehospital period was extended. In order to assure sufficient trauma care for seriously injured persons a continuous 24 h availability of emergency trauma facilities is necessary. For this purpose it is necessary to establish regional trauma networks between receiving hospitals as well as air rescue services at night time. Furthermore, a cost-efficient compensation of the structural, personnel and logistic expenses for the treatment of the severely injured has to be assured.

  3. Characteristics of motorcyclists involved in road traffic accidents attended at public urgent and emergency services.

    Mascarenhas, Márcio Dênis Medeiros; Souto, Rayone Moreira Costa Veloso; Malta, Deborah Carvalho; Silva, Marta Maria Alves da; Lima, Cheila Marina de; Montenegro, Marli de Mesquita Silva


    Injuries resulting from motorcycle road traffic accidents are an important public health issue in Brazil. This study aimed to describe the characteristics of motorcyclists involved in traffic accidents attended in public urgent and emergency services in the state capitals and the Federal District. This is a cross-sectional study based on data from the Violence and Accident Surveillance System (VIVA Survey) in 2014. Data were analyzed according to sociodemographic, event and attendance characteristics. Proportional differences between genders were analyzed by chi-square test (Rao-Scott) with 5% significance level. Motorcyclist-related attendances (n = 9,673) reported a prevalence of men (gender ratio = 3.2), young people aged 20-39 years (65.7%), black / brown (73.6%), paid work (76.4%). Helmet use was reported by 79.1% of the victims, 13.3% had consumed alcohol in the six hours prior to the accident, 41.4% of the events were related to the victim's work. Accidents were more frequent on weekends, in the morning and late afternoon. These characteristics can support the development of public accident prevention policies and health promotion.

  4. Sustainable working practices and minimizing burnout in emergency medicine.

    Hassan, Tajek B


    Sustainable and satisfying working practices in emergency medicine are vital to produce career longevity and prevent premature 'burnout'. A range of strategies is required to ensure success for the individual and the system in which he/she works.

  5. Radiological accidents balance in medicine; Bilan des accidents radiologiques en medecine

    Nenot, J.C.


    This work deals with the radiological accidents in medicine. In medicine, the radiation accidents on medical personnel and patients can be the result of over dosage and bad focusing of radiotherapy sealed sources. Sometimes, the accidents, if they are unknown during a time enough for the source to be spread and to expose a lot of persons (in the case of source dismantling for instance) can take considerable dimensions. Others accidents can come from bad handling of linear accelerators and from radionuclide kinetics in some therapies. Some examples of accidents are given. (O.L.). 11 refs.

  6. Emergency Responses and Health Consequences after the Fukushima Accident; Evacuation and Relocation.

    Hasegawa, A; Ohira, T; Maeda, M; Yasumura, S; Tanigawa, K


    The Fukushima accident was a compounding disaster following the strong earthquake and huge tsunami. The direct health effects of radiation were relatively well controlled considering the severity of the accident, not only among emergency workers but also residents. Other serious health issues include deaths during evacuation, collapse of the radiation emergency medical system, increased mortality among displaced elderly people and public healthcare issues in Fukushima residents. The Fukushima mental health and lifestyle survey disclosed that the Fukushima accident caused severe psychological distress in the residents from evacuation zones. In addition to psychiatric and mental health problems, there are lifestyle-related problems such as an increase proportion of those overweight, an increased prevalence of hypertension, diabetes mellitus and dyslipidaemia and changes in health-related behaviours among evacuees; all of which may lead to an increased cardiovascular disease risk in the future. The effects of a major nuclear accident on societies are diverse and enduring. The countermeasures should include disaster management, long-term general public health services, mental and psychological care, behavioural and societal support, in addition to efforts to mitigate the health effects attributable to radiation.

  7. Characteristics of female victims of assault attending a Scottish accident and emergency department.

    Wright, J; Kariya, A


    OBJECTIVE: To compare the characteristics of female victims of assault with those of male victims and to see if there is a difference between female victims of domestic assault and females assaulted by strangers or acquaintances. DESIGN: A two month prospective study (June and July 1995) of all assault victims attending a Scottish accident and emergency (A&E) department. SETTING: A large district general A&E department (the Royal Alexandra Hospital in Paisley) seeing 60,000 new patients per y...

  8. Report of an audit of nurse triage in an accident and emergency department.

    Wong, T W; Tseng, G; Lee, L. W.


    The nurse triage process in an accident and emergency (A&E) department was audited as part of the nursing quality assurance programme. It was found that in most cases documentation was adequate and guidelines had been adhered to. Triage decisions were accurate in most cases using the discharge diagnosis as a bench-mark. Waiting time improvements were also seen. Triage audit was a useful tool in the continuous quality improvement effort.

  9. Rescuing the drowned: cardiopulmonary resuscitation and the origins of emergency medicine in the eighteenth century.

    Marinozzi, Silvia; Bertazzoni, Giuliano; Gazzaniga, Valentina


    The concept of a medical emergency, i.e., a time when immediate action is required to stabilize and restore the vital functions, is absent in the tradition of ancient medicine, which seeks to cure the sick. The theoretical and conceptual development of a prompt medical assistance definitely owes much to the refinement of instruments and surgical techniques that were develop in the early modern age, allowing the extension of therapeutic action to "healthy" individuals who are suddenly life-threatened due to an accident or to some external events that affect their vital functions. But it is especially in the eighteenth century that the epistemic basis of medical emergency is structured, when the Enlightenment gave rise to the ethical and political imperative of public assistance that required the planning of first aid at multiple levels, and medicine developed the concept of life-saving treatment. In particular, eighteenth century medicine, studying systems to assure immediate relief to the victims of accidents-especially to the drowned-allowed the development of specific and methodological systems of resuscitation and emergency treatment.

  10. Influences on tetanus immunization in accident and emergency.

    Montague, A; Glucksman, E


    We studied the casualty records of 479 patients with open skin injury arriving over 2 single weeks, 3 months apart, to assess adequacy of adherence to protocols for active immunization against tetanus. 234 patients were treated correctly. In 114 cases immunization was insufficient or tetanus was not mentioned at all; in 29 cases immunization was excessive and 102 records were ambiguous and no conclusion could be drawn. There was no evidence in junior doctors' management indicating learning ov...

  11. Key articles and guidelines for the emergency medicine pharmacist.

    Thomas, Michael C; Acquisto, Nicole M; Patanwala, Asad E; Weant, Kyle A; Baker, Stephanie N


    Abstract Compilations of articles important to the pharmacist practicing in the emergency department have not been published. Consistent with other specialty areas of practice, a collection of important literature is valuable for both the new and experienced clinician. A diverse breadth of medical problems are represented that were felt to be the most pertinent issues facing the emergency medicine pharmacist; however, it is not intended to be a complete representation of available literature.

  12. Human factors and error prevention in emergency medicine.

    Bleetman, Anthony; Sanusi, Seliat; Dale, Trevor; Brace, Samantha


    Emergency departments are one of the highest risk areas in health care. Emergency physicians have to assemble and manage unrehearsed multidisciplinary teams with little notice and manage critically ill patients. With greater emphasis on management and leadership skills, there is an increasing awareness of the importance of human factors in making changes to improve patient safety. Non-clinical skills are required to achieve this in an information-poor environment and to minimise the risk of errors. Training in these non-clinical skills is a mandatory component in other high-risk industries, such as aviation and, needs to be part of an emergency physician's skill set. Therefore, there remains an educational gap that we need to fill before an emergency physician is equipped to function as a team leader and manager. This review will examine the lessons from aviation and how these are applicable to emergency medicine. Solutions to averting errors are discussed and the need for formal human factors training in emergency medicine.

  13. Differences between family and emergency medicine training before sports medicine fellowship.

    Christensen, Mark; Christensen, Heidi K


    Residency training clearly impacts physicians' approach toward fellowship in Primary Care Sports Medicine. Although the Accreditation Council for Graduate Medical Education sets strict standards for all programs, family medicine and emergency medicine training differ a great deal in general and provide physicians from both backgrounds varied perspectives and skill sets. The family physician acquires a substantial amount of experience in continuity of care and integration of health care into a patient's everyday life. On the other hand, the emergency physician receives exceptional training in the management of acutely ill and injured patients and leadership of a large health care team. Furthermore, while the emergency physician may be skilled in procedures such as fracture reduction and diagnostic ultrasound, the family physician is proficient in developing patient rapport and compliance with a treatment plan. Although physicians from different backgrounds may start with many differences, fellowship training is essential in bridging those gaps.

  14. Technology and work within emergency medicine

    Kristensen, Margit

    human life on the most basic, physical level - and they are mobile and carry out nomadic work (using the definitions of mobility and nomadicity, as described in Bogdan (2006). However spaces and places in which they work, the degree of mobility and nomadicity, they ‘practice', and the artefacts...... and technologies, they make use of, are most often of very diverse character.Below I describe the characteristics for the mobile and nomadic work for the two different work situations of an anaesthesiologist - in-hospital and pre-hospital - and in these descriptions I include description of which technologies...

  15. Capabilities for Clinical Management of Radiation Injuries of the Nikiforov Russian Center of Emergency and Radiation Medicine (EMERCOM of Russia).

    Aleksanin, S


    This article presents an overview of the capabilities for clinical management of radiation injuries available at the Nikiforov Russian Center of Emergency and Radiation Medicine (NRCERM) of the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters (EMERCOM). NRCERM is a federal state budgetary institution and the Russian Federation's head organization for providing medical assistance for persons overexposed to ionizing radiation, responders to radiation emergencies and people evacuated from radiation contaminated areas. As the WHO Collaborating Center for Treatment and Rehabilitation of Accident Recovery Workers of Nuclear and Other Disasters and a member of the WHO Radiation Emergency Medical Preparedness and Assistance Network (REMPAN), NRCERM is prepared to provide assistance and technical support in case of a radiation accident. For this purpose, NRCERM hospitals are equipped with technologically advanced facilities and possess well-trained specialist staff.

  16. Chikungunya virus: emerging targets and new opportunities for medicinal chemistry.

    Rashad, Adel A; Mahalingam, Suresh; Keller, Paul A


    Chikungunya virus is an emerging arbovirus that is widespread in tropical regions and is spreading quickly to temperate climates with recent epidemics in Africa and Asia and documented outbreaks in Europe and the Americas. It is having an increasingly major impact on humankind, with potentially life-threatening and debilitating arthritis. There is no treatment available, and only in the past 24 months have lead compounds for development as potential therapeutics been reported. This Perspective discusses the chikungunya virus as a significant, new emerging topic for medicinal chemistry, highlighting the key viral target proteins and their molecular functions that can be used in drug design, as well as the most important ongoing developments for anti-chikungunya virus research. It represents a complete picture of the current medicinal chemistry of chikungunya, supporting the development of chemotherapeutics through drug discovery and design targeting this virus.

  17. Assessing interpersonal and communication skills in emergency medicine.

    Chan, Teresa M; Wallner, Clare; Swoboda, Thomas K; Leone, Katrina A; Kessler, Chad


    Interpersonal and communication skills (ICS) are a key component of several competency-based schemata and key competency in the set of six Accreditation Council for Graduate Medical Education (ACGME) core competencies. With the shift toward a competency-based educational framework, the importance of robust learner assessment becomes paramount. The journal Academic Emergency Medicine (AEM) hosted a consensus conference to discuss education research in emergency medicine (EM). This article summarizes the initial preparatory research that was conducted to brief consensus conference attendees and reports the results of the consensus conference breakout session as it pertains to ICS assessment of learners. The goals of this consensus conference session were to twofold: 1) to determine the state of assessment of observable learner performance and 2) to determine a research agenda within the ICS field for medical educators. The working group identified six key recommendations for medical educators and researchers.

  18. Emergency medicine in Dubai, UAE

    Partridge, Robert; Abbo, Michael; Virk, Alamjit


    Dubai has rapidly risen to prominence in the Persian Gulf region as a center of global commerce and tourism and as a cultural crossroad between East and West. The health-care infrastructure has undergone rapid development. Collaborations with academic medical centers now exist to advance clinical care, teaching and research. Emergency medicine has also advanced and is undergoing dynamic change. Dubai may soon emerge as a regional leader in emergency medicine training and practice.

  19. Emergency medicine in Dubai, UAE.

    Partridge, Robert; Abbo, Michael; Virk, Alamjit


    Dubai has rapidly risen to prominence in the Persian Gulf region as a center of global commerce and tourism and as a cultural crossroad between East and West. The health-care infrastructure has undergone rapid development. Collaborations with academic medical centers now exist to advance clinical care, teaching and research. Emergency medicine has also advanced and is undergoing dynamic change. Dubai may soon emerge as a regional leader in emergency medicine training and practice.

  20. Diagnostic ultrasound use in physiotherapy, emergency medicine, and anaesthesiology

    McKiernan, Sharmaine [School of Health Sciences, University of Newcastle, Callagham, NSW 2308 (Australia)], E-mail:; Chiarelli, Pauline; Warren-Forward, Helen [School of Health Sciences, University of Newcastle, Callagham, NSW 2308 (Australia)


    Background: Diagnostic ultrasound is traditionally and extensively used within the radiology department. However in recent years its use has expanded outside this traditional area into health professions such as physiotherapy, emergency medicine and anaesthesiology. Purpose: The radiology community needs to be aware of the expansion of use of diagnostic ultrasound. This article starts this exploration in the health professions mentioned, however it is acknowledged that diagnostic ultrasound use goes beyond what is covered in this article. As diagnostic ultrasound is a user dependant modality and the outcome of an examination is largely influenced by the skill and experience of the operator, the radiology community should take a guiding role in its use, training and protocol development for health professionals. Method: This article explores the literature on the use of diagnostic ultrasound within physiotherapy, emergency medicine and anaesthesiology. Literature was searched for on the databases Medline, Cinahl and Embase. Results: Diagnostic ultrasound is being used in health professions such as physiotherapy, where it is being used to provide biofeedback to patients on contraction of abdominal and pelvic floor muscles; emergency medicine, for the investigation of free fluid within the abdomen of a trauma patient and anaesthesiology, for the placement of catheters and nerve blocks. Conclusion: As members of the radiology community are considered experts in the field, they need to take the lead to guide and mentor the other health professionals who are now using the modality. To be able to achieve this they must have an understanding of what these professions are using the modality for.

  1. [Teaching in emergency medicine].

    Ayuso, Fernando; Nogué, R; Coll Vinent, Begoña; Fernández Esáin, Begoña; Miró, O


    The appropriate care of patients in emergency services can reach a level of complexity as to make a sound training necessary, which should be based on a medical specialty, as happens in the majority of the countries in our context. In Spain at present there is no regulated and homogeneous training in urgency and emergency medicine (UEM), either during the period of undergraduate training (in the form of a universally compulsory subject in the faculties of medicine) or during the postgraduate period (in the form of a medical specialty). In this respect, the definitive approval of the specialty in UEM is currently pending within the framework of a reform of the residence program that will evolve towards a core training program of specialties. Until thus occurs, the reality in Spain is that professionals who work in this care setting possess a heterogeneous training. As a result of this vacuum and the training needs of these professionals, a wide range of specific training proposals has been developed over the years in order to optimise the skills and abilities of the professionals who provide initial emergency care to the patient. A new generation of courses has been set underway using the new didactic methodologies of training, into which didactic tools of e-learning and robotic simulation have been incorporated.

  2. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents

    Shi, Shenggang [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China); College of Chemistry, Baotou Teachers’ College, Baotou 014030 (China); Cao, Jingcan; Feng, Li; Liang, Wenyan [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China); Zhang, Liqiu, E-mail: [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China)


    Highlights: • Different chemical pollution accidents were simplified using the event tree analysis. • Emergency disposal technique plan repository of chemicals accidents was constructed. • The technique evaluation index system of chemicals accidents disposal was developed. • A combination of group decision and analytical hierarchy process (AHP) was employed. • Group decision introducing similarity and diversity factor was used for data analysis. - Abstract: The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012.

  3. Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?

    Ulahannan, T; Hardern, R D; Hamer, D W


    Avoidable deaths from asthma continue, even in hospital. Since the management of acute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge. An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors' levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.

  4. Elderly patients attended in emergency health services in Brazil: a study for victims of falls and traffic accidents.

    de Freitas, Mariana Gonçalves; Bonolo, Palmira de Fátima; de Moraes, Edgar Nunes; Machado, Carla Jorge


    The article aims to describe the profile of elderly victims of falls and traffic accidents from the data of the Surveillance Survey of Violence and Accidents (VIVA). The VIVA Survey was conducted in the emergency health-services of the Unified Health System in the capitals of Brazil in 2011. The sample of elderly by type of accident was subjected to the two-step cluster procedure. Of the 2463 elderly persons in question, 79.8% suffered falls and 20.2% were the victims of traffic accidents. The 1812 elderly who fell were grouped together into 4 clusters: Cluster 1, in which all had disabilities; Cluster 2, all were non-white and falls took place in the home; Cluster 3, younger and active seniors; and Cluster 4, with a higher proportion of seniors 80 years old or above who were white. Among cases of traffic accidents, 446 seniors were grouped into two clusters: Cluster 1 of younger elderly, drivers or passengers; Cluster 2, with higher age seniors, mostly pedestrians. The main victims of falls were women with low schooling and unemployed; traffic accident victims were mostly younger and male. Complications were similar in victims of falls and traffic accidents. Clusters allow adoption of targeted measures of care, prevention and health promotion.

  5. Clinical benefits of early cold therapy in accident and emergency following ankle sprain.

    Sloan, J P; Hain, R; Pownall, R


    One hundred and forty-three patients presenting with ankle sprains within 24 h of injury were entered into a double blind study. Treatment consisted of a standardized regime of high dose non-steroidal anti-inflammatory medication and an elastic support for all patients, who were then randomly allocated to two groups. One group received immediate cold therapy, the other received simulated therapy. Assessments made at 7 days showed a trend in favour of the group receiving cold therapy, although this did not reach significance. It is concluded that cold therapy together with compression may have a beneficial effect but that a single application in the accident and emergency department is not justified when a background therapy of non-steroidal anti-inflammatory medication is given.

  6. Designing of an emergency call system for traffic accidents

    Ziya Ekşi


    Full Text Available In our country, many people have been seriously injured or died in traffic accidents. Fatal accidents often occur because of not complying with traffic rules or carelessness. Except these driver mistakes, heavy injuries can result in deaths because of emergency aid teams failing to arrive to accident scene in time. In this study, an accident emergency call system is designed to help injured people's treatment as soon as possible by notifying emercengy team automatically in accidents. The designed system sends messages, including information such as vehicle location, exploding airbag number, vehicle model, age and registration plate, to emergency aid team using GPS module at the moment of crashed vehicle's airbag explosion.

  7. Making the journey safe: recognising and responding to severe sepsis in accident and emergency

    Pinnington, Sarah; Atterton, Brigid; Ingleby, Sarah


    Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality. The project intended to make the pathway for those presenting with sepsis safe and consistent, where sepsis is recognised and treated in a timely manner according to best practice. The aim of the project was to understand the what the barriers where to providing safe effective care for the patient presenting with severe sepsis in A&E. Using the Safer Clinical Systems (SCS) tools developed byte Health Foundation and Warwick University, the project team identified the hazards and associated risks in the septic patient pathway. The level of analysis employed enabled the project team to identify the major risks, themes, and factors of influence within this pathway. The analysis identified twenty nine possible interventions, of which six were chosen following option appraisal. Further interventions were recommended to the accident and emergency as part of a business case and further changes in process. Audits identified all severely septic patients presenting to A&E in October 2014 (n=67) and post intervention in September 2015 (n=93). Compared analysis demonstrated an increase in compliance with the implementation of the sepsis six care bundle from 7% to 41%, a reduction in LoS by 1.9 days and a decrease in 30 day mortality by 50%. Additional audit reviewed the management of 10 septic patients per week for the duration of the project to assess the real time impact of the selected interventions.

  8. Brief interventions for hazardous and harmful alcohol consumption in accident and emergency departments

    Marcin eWojnar


    Full Text Available The prevalence of alcohol abuse among patients treated in accident and emergency departments (A&E is considered substantial. This paper is a narrative review of studies investigating the effectiveness of brief interventions (BI for hazardous and harmful alcohol consumption in A&E. A&E departments in hospitals (and other health care infrastructures are commonly the place where serious consequences of alcohol drinking are seen and need to be tackled, supporting the suggested theoretical usefulness of delivering brief interventions in this environment. Available research shows that brief interventions (BI may be considered a valuable technique for dealing with alcohol-related problems. However, it is suggested that the usefulness of BI may depend significantly on the target population to be dealt with. BI have proved to be beneficial for male individuals and those patients who do not abuse other psychoactive substances. In contrast, evidence indicates that brief interventions in A&E settings are not effective at all when dealing with men admitted as a consequence of a violence-related event. In addition, some studies were unable to confirm the effectiveness of BI in female population, in emergency setting. Studies investigating the association between drinking patterns and the effectiveness of brief interventions also present inconsistent results. Most studies assessing the effectiveness of BI in A&E settings only adopted a short perspective (looking at the impact up to a maximum of twelve months after the BI was delivered. When assessing the effects of BI, both the amount of alcohol consumed as well as expected reductions in alcohol consequences, such as injuries, can be taken into account. Evidence on the implementation of brief intervention in emergency departments remains inconclusive as to whether there are clear benefits. A variety of outcome measures and assessing procedures were used in the different studies, which have investigated this

  9. Development and application of a random walk model of atmospheric diffusion in the emergency response of nuclear accidents

    CHI Bing; LI Hong; FANG Dong


    Plume concentration prediction is one of the main contents of radioactive consequence assessment for early emergency response to nuclear accidents. Random characteristics of atmospheric diffusion itself was described, a random walk model of atmospheric diffusion (Random Walk) was introduced and compared with the Lagrangian puff model (RIMPUFF) in the nuclear emergency decision support system (RODOS) developed by the European Community for verification. The results show the concentrations calculated by the two models are quite close except that the plume area calculated by Random Walk is a little smaller than that by RIMPUFF. The random walk model for atmospheric diffusion can simulate the atmospheric diffusion in case of nuclear accidents, and provide more actual information for early emergency and consequence assessment as one of the atmospheric diffusion module of the nuclear emergency decision support system.

  10. How do patients come to the Accident and Emergency Department of RIPAS Hospital?

    Po Thaw DA


    Full Text Available Introduction: The mode and speed of transportation to the Accident and Emergency Department (AED of hospitals is very important for critically ill patients. This study looked at the mode of transportation to the AED at the Raja Isteri Pengiran Anak Saleha (RIPAS Hospital. Materials and Methods: Three different time periods: Period A from 15th May to 31st May 2004, (17 days, n=2,170 without prioritising, Period B from 1st January 2004 to 31st July 2006 (31 months, n=235 dead on arrival and resuscitation cases, and Period C from 20th to 26th November 2006 (7 days, all Priority Cases 1 to 3 were reviewed. Data on mode of transportation and triage categories were extracted from the ambulance response sheets. Results: During Period A, the main mode of transportation to the AED was private vehicles (90.7% followed by ambulance (7.9%, and other transportation (1.4%. During study Period B, the main mode of transportation was also private transports (50.2% followed closely by ambulance (48.5% and other transportation (1.3%. During Period C, Priority 1 cases (life-threatening conditions, n=7, most were transported with private transport (71.4% followed by ambulance (28.6%; Priority 2 (n=232 cases, majority were transported with private transport (89.2%, followed by ambulance (10.3%, and one case used police transportation; and in Priority 3 cases (non-life threatening conditions, n=1,010, almost all were transported with private transport (98.7%, followed by police (0.9% and ambulance (0.4% respectively. Conclusion: Utilisation of designated emergency transportation is low especially for the moderate to seriously ill (Priority 1 and 2 patients when compared to other well developed countries. More needs to be done to improve the usage of emergency transportations especially for the seriously ill cases.

  11. Work shifts in Emergency Medicine

    Roberto Recupero


    Full Text Available Emergency Medicine is known as a high stress specialty. The adverse effect of constantly rotating shifts is the single most important reason given for premature attrition from the field. In this work problems tied with night shift work will be taken into account and some solutions to reduce the impact of night work on the emergency physicians will be proposed.

  12. Review article: burnout in emergency medicine physicians.

    Arora, Manit; Asha, Stephen; Chinnappa, Jason; Diwan, Ashish D


    Training and the practice of emergency medicine are stressful endeavours, placing emergency medicine physicians at risk of burnout. Burnout syndrome is associated with negative outcomes for patients, institutions and the physician. The aim of this review is to summarise the available literature on burnout among emergency medicine physicians and provide recommendations for future work in this field. A search of MEDLINE (1946-present) (search terms: 'Burnout, Professional' AND 'Emergency Medicine' AND 'Physicians'; 'Stress, Psychological' AND 'Emergency Medicine' AND 'Physicians') and EMBASE (1988-present) (search terms: 'Burnout' AND 'Emergency Medicine' AND 'Physicians'; 'Mental Stress' AND 'Emergency Medicine' AND 'Physicians') was performed. The authors focused on articles that assessed burnout among emergency medicine physicians. Most studies used the Maslach Burnout Inventory to quantify burnout, allowing for cross-study (and cross-country) comparisons. Emergency medicine has burnout levels in excess of 60% compared with physicians in general (38%). Despite this, most emergency medicine physicians (>60%) are satisfied with their jobs. Both work-related (hours of work, years of practice, professional development activities, non-clinical duties etc.) and non-work-related factors (age, sex, lifestyle factors etc.) are associated with burnout. Despite the heavy burnout rates among emergency medicine physicians, little work has been performed in this field. Factors responsible for burnout among various emergency medicine populations should be determined, and appropriate interventions designed to reduce burnout.

  13. Education Scholarship and its Impact on Emergency Medicine Education

    Jonathan Sherbino


    Full Text Available Emergency medicine (EM education is becoming increasingly challenging as a result of changes to North American medical education and the growing complexity of EM practice. Education scholarship (ES provides a process to develop solutions to these challenges. ES includes both research and innovation. ES is informed by theory, principles and best practices, is peer reviewed, and is disseminated and archived for others to use. Digital technologies have improved the discovery of work that informs ES, broadened the scope and timing of peer review, and provided new platforms for the dissemination and archiving of innovations. This editorial reviews key steps in raising an education innovation to the level of scholarship. It also discusses important areas for EM education scholars to address, which include the following: the delivery of competency-based medical education programs, the impact of social media on learning, and the redesign of continuing professional development.

  14. Functional Somatic Syndromes: Emerging Biomedical Models and Traditional Chinese Medicine

    Steven Tan


    Full Text Available The so-called functional somatic syndromes comprise a group of disorders that are primarily symptom-based, multisystemic in presentation and probably involve alterations in mind-brain-body interactions. The emerging neurobiological models of allostasis/allostatic load and of the emotional motor system show striking similarities with concepts used by Traditional Chinese Medicine (TCM to understand the functional somatic disorders and their underlying pathogenesis. These models incorporate a macroscopic perspective, accounting for the toll of acute and chronic traumas, physical and emotional stressors and the complex interactions between the mind, brain and body. The convergence of these biomedical models with the ancient paradigm of TCM may provide a new insight into scientifically verifiable diagnostic and therapeutic approaches for these common disorders.

  15. International Federation for Emergency Medicine model curriculum for emergency medicine specialists

    Cherri Hobgood


    Full Text Available To meet a critical and growing need for emergency physicians and emergency medicine resources worldwide, physicians must be trained to deliver time-sensitive interventions and lifesaving emergency care. Currently, there is no globally recognized, standard curriculum that defines the basic minimum standards for specialist trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for training of specialists in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed to provide a framework for educational programs in emergency medicine. The focus is on the basic minimum emergency medicine educational content that any emergency medicine physician specialist should be prepared to deliver on completion of a training program. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance physician education in basic emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to expand emergency medicine within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught. This variability will reflect the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership with regard to the training of emergency medicine specialists.

  16. Potential and limitations of e-learning in emergency medicine.

    Roe, David; Carley, Simon; Sherratt, Cathy


    This paper describes the potential benefits, pitfalls and barriers to adopting e-learning in emergency medicine. While the benefits relating to access, engagement and quality assurance are clear, caution is urged in embracing e-learning for e-learning's sake. It is argued that, if educational strategies are to change, this must be to the benefit of learners and not just for the convenience of access or record keeping. A variety of e-learning approaches are available, but those that promote group discussion or provide feedback from an educator are more likely to lead to successful learning than stand-alone feedback-free modules. A blended approach to learning is advocated where e-learning opportunities form an important but limited part of the overall educational experience. Shop floor and workshop-based teaching should be enhanced with e-learning, not replaced by it.

  17. [Domestic violence in the accident and emergency department: don't forget the children].

    Hoytema van Konijnenburg, Eva M M; van der Lee, Johanna H; Brilleslijper-Kater, Sonja N; van Leerdam, Frank J M; Teeuw, Arianne H


    In 2013, the Dutch Government mandated a new policy stating that all healthcare professionals caring for adults in difficult psychosocial situations should always investigate the safety of any children involved. We describe two cases of such 'child checks' in the accident and emergency department (A&E). Patient A, a 10-year-old girl, was referred to the outpatient paediatric department (OPD) after her mother had attended the A&E as a victim of domestic violence (DV). The child had witnessed DV on multiple occasions. The family were referred to voluntary social and psychiatric healthcare. Patient B, a 46 year-old woman, attended the A&E with serious injuries, and said she had tripped over. The A&E physician suspected that the injuries were caused by DV, and the mother and her 9-year-old daughter were referred to the OPD. However, the mother refused to attend, and the family was reported to the Youth Care Office. Because parents' psychosocial problems, such as DV, can seriously affect children, their safety should always be investigated by performing a 'child check'.

  18. Emergency monitoring strategy and radiation measurements document of the NKS project emergency management and radiation monitoring in nuclear and radiological accidents (EMARAD)

    Lahtinen, J. [Radiation and Nuclear Safety Authority (STUK) (Finland)


    This report is one of the deliverables of the NKS Project Emergency management and radiation monitoring in nuclear and radiological accidents (EMARAD) (20022005). The project and the overall results are briefly described in the NKS publication 'Emergency Management and Radiation Monitoring in Nuclear and Radiological Accidents. Summary Report on the NKS Project EMARAD' (NKS-137, April 2006). In a nuclear or radiological emergency, all radiation measurements must be performed efficiently and the results interpreted correctly in order to provide the decision-makers with adequate data needed in analysing the situation and carrying out countermeasures. Managing measurements in different situations in a proper way requires the existence of pre-prepared emergency monitoring strategies. Preparing a comprehensive yet versatile strategy is not an easy task to perform because there are lots of different factors that have to be taken into account. The primary objective of this study was to discuss the general problematics concerning emergency monitoring strategies and to describe a few important features of an efficient emergency monitoring system as well as factors affecting measurement activities in practise. Some information concerning the current situation in the Nordic countries has also been included. (au)

  19. Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes toward Homeless Persons

    Morrison, Ann; Roman, Brenda; Borges, Nicole


    Objective: The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden…

  20. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents.

    Shi, Shenggang; Cao, Jingcan; Feng, Li; Liang, Wenyan; Zhang, Liqiu


    The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012.

  1. A local perspective to asthma management in the accident and emergency department in Malta

    Caroline Gouder


    Full Text Available Aim: This study was performed to assess the management of adult patients presenting to the Mater Dei Hospital Accident and Emergency (A&E department with acute asthma. Subjects and Methods: Asthmatic patients age 14 or older who presented to A&E department between January and October 2010 with asthma exacerbations were included. Data were collected from the clinical notes and analyzed. Results: A total of 244 patients (67.2% females were included, 126 (51.6% were admitted, 97 (39.8% discharged and 21 (8.6% discharged themselves against medical advice. There was a decline in the presentations between January and July, followed by an upward trend until October (P = 0.42. Pulse oximetry was performed in 207 patients (84.8%, arterial blood gases in 133 (54.5%, peak expiratory flow rate in 106 (43.4% and chest radiography in 206 (84.4% patients. The respiratory rate was documented in 151 (61.8%, heart rate in 204 (83.6% and ability to complete sentences in 123 (50.4% patients. One hundred and ninety six patients (80.3% were given nebulized bronchodilators, 103 (42.2% intravenous corticosteroids, 7 (2.87% oral corticosteroids, 109 (44.7% oxygen, 28 (11.5% antibiotics and 9 (3.69% magnesium. Systemic corticosteroids and antibiotics were more commonly prescribed to patients admitted (P < 0.001. Conclusion: Management of acute asthma in Malta requires optimization in order to compare with international guidelines.

  2. Criticality accident in uranium fuel processing plant. Emergency medical care and dose estimation for the severely overexposed patients

    Akashi, Makoto; Ishigure, Nobuhito [National Inst. of Radiological Sciences, Chiba (Japan)


    A criticality accident occurred in JCO, a plant for nuclear fuel production in 1999 and three workers were exposed to extremely high-level radiation (neutron and {gamma}-ray). This report describes outlines of the clinical courses and the medical cares for the patients of this accident and the emergent medical system for radiation accident in Japan. One (A) of the three workers of JCO had vomiting and diarrhea within several minutes after the accident and another one (B) had also vomiting within one hour after. Based on these evidences, the exposure dose of A and B were estimated to be more than 8 and 4 GyEq, respectively. Generally, acute radiation syndrome (ARS) is assigned into three phases; prodromal phase, critical or manifestation phase and recovery phase or death. In the prodromal phase, anorexia, nausea, vomiting and diarrhea often develop, whereas the second phase is asymptotic. In the third phase, various syndromes including infection, hemorrhage, dehydration shock and neurotic syndromes are apt to occur. It is known that radiation exposure at 1 Gy or more might induce such acute radiation syndromes. Based on the clinical findings of Chernobyl accident, it has been thought that exposure at 0.5 Gy or more causes a lowering of lymphocyte level and a decrease in immunological activities within 48 hours. Lymphocyte count is available as an indicator for the evaluation of exposure dose in early phase, but not in later phase The three workers of JCO underwent chemical analysis of blood components, chromosomal analysis and analysis of blood {sup 24}Na immediately after the arrival at National Institute of Radiological Sciences via National Mito Hospital specified as the third and the second facility for the emergency medical care system in Japan, respectively. (M.N.)

  3. Emergency Management and Radiation Moni-toring in Nuclear and Radiological Accidents. Summary Report on the NKS Project EMARAD

    Lahtinen, J. [Radiation and Nuclear Safety Authority (STUK) (Finland)


    In order to manage various nuclear or radiological emergencies the authorities must have pre-prepared plans. The purpose of the NKS project EMARAD (Emergency Management and Radiation Monitoring in Nuclear and Radiological Accidents) was to produce and gather various data and information that could be useful in drawing up emergency plans and radiation monitoring strategies. One of the specific objectives of the project was to establish a www site that would contain various radiation-threat and radiation-monitoring related data and documents and that could be accessed by all Nordic countries. Other important objectives were discussing various factors affecting measurements in an emergency, efficient use of communication technology and disseminating relevant information on such topics as urban dispersion and illicit use of radiation. The web server is hosted by the Radiation and Nuclear Safety Authority (STUK) of Finland. The data stored include pre-calculated consequence data for nuclear power plant accidents as well as documents and presentations describing e.g. general features of monitoring strategies, the testing of the British urban dispersion model UDM and the scenarios and aspects related to malicious use of radiation sources and radioactive material. As regards the last item mentioned, a special workshop dealing with the subject was arranged in Sweden in 2005 within the framework of the project. (au)

  4. Emergency medicine in the United Arab Emirates

    Fares, Saleh; Irfan, Furqan B; Corder, Robert F; Al Marzouqi, Μuneer Abdulla; Al Zaabi, Ahmad Hasan; Idrees, Marwa Mubarak; Abbo, Michael


    It has been a decade since emergency medicine was recognized as a specialty in the United Arab Emirates (UAE). In this short time, emergency medicine has established itself and developed rapidly in the UAE. Large, well-equipped emergency departments (EDs) are usually located in government hospitals, some of which function as regional trauma centers. Most of the larger EDs are staffed with medically or surgically trained physicians, with board-certified emergency medicine physicians serving as...

  5. Workplace violence in emergency medicine

    A. Chatterjee*


    Conclusion: Violence against ED health care workers is a real problem with significant implications to the victims, patients, and departments/institutions. ED WPV needs to be addressed urgently by stakeholders through continued research on effective interventions specific to Emergency Medicine. Coordination, cooperation, and active commitment to the development of such interventions are critical.

  6. Pre-hospital emergency medicine.

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E


    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.

  7. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States

    Sonja E. Raaum


    Full Text Available Purpose: Smartphone technology offers a multitude of applications (apps that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100% were calculated to assess the frequency of their use of general features (email, text and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%. The average score for using general features, 14.4/20 (72.2% was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001. The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1% than year 1–2 residents, 14.1/20 (70.5%, P=0.035, and for internal medicine residents, 14.9/20 (74.6% in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001. The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5% than for year 1–2 residents, 13.7/44 (31.1%; P=0.044. Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.

  8. Emerging nanotechnology approaches in tissue engineering and regenerative medicine

    Kim ES


    Full Text Available Eung-Sam Kim,1,2 Eun Hyun Ahn,3,4 Tal Dvir,5,6 Deok-Ho Kim1,4,71Department of Bioengineering, University of Washington, Seattle, WA, USA; 2Department of Biological Sciences, Chonnam National University, Gwangju, Korea; 3Department of Pathology, 4Institute of Stem Cell and Regenerative Medicine, School of Medicine, University of Washington, Seattle, WA, USA; 5Department of Molecular Microbiology and Biotechnology, 6Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel; 7Center for Cardiovascular Biology, University of Washington, Seattle, WA, USAThe history of human kind suggests that there has been a correlation between global population growth and major events in science and technology over the last three centuries. Sharp increases in the world’s population have been triggered by the industrial revolution and scientific and technological breakthroughs including: the advent of the railways, discovery of penicillin and deoxyribonucleic acid (DNA, and the invention of the computer.1 Since the 20th century, interdisciplinary areas in the physical and biological sciences have accelerated the progress of biomedical applications. The recent integration of emerging nanotechnology into biology and biomedicine has resulted in a range of innovative nanoengineering efforts for the repair and regeneration of tissues and organs.2 Thus, it is expected that nanoengineering approaches to biomedical applications can contribute to addressing the present issue of personal and global health care and its economic burden for more than 7 billion people.Why are we paying attention to nanoengineering for biomedical applications? The size of most biomolecules ranges from 0.2 nm to 200 nm (Figure 1. Research has focused on control of the interaction and localization of biomolecules even at the single-molecule level using ever-evolving nanotechnology.3 The evidence indicates that cells can respond to nanoscale changes in the dynamic

  9. Emergency medicine in pediatric dentistry: preparation and management.

    Malamed, Stanley F


    Medical emergencies can and do occur in the practice of dentistry. Although most emergencies take place in adults, serious problems can also develop in younger patients. The contemporary dentist must be prepared to manage expeditiously and effectively those few problems that do arise. Basic life support (as necessary) is all that is required to manage many emergency situations, with the addition of specific drug therapy in some others. Preparation of the office and staff includes basic life support (annually), pediatric advanced life support, development of an emergency team, consideration for emergency medical services, and the availability of emergency drugs and equipment with the ability to use these items effectively. As with the adult patient, effective management of pain (local anesthesia) and anxiety (behavioral management, conscious sedation) will minimize the development of medical emergencies.

  10. The consumer quality index (CQ-index in an accident and emergency department: development and first evaluation

    Bos Nanne


    Full Text Available Abstract Background Assessment of patients’ views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients’ experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E. Methods Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire. Results Survey data of 304 (47% patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: ‘Attitude of the healthcare professionals’, ‘Environment and impression of the A&E’ and ‘Respect for and explanation to the patient’. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: ‘Attitude of the healthcare professionals’, ‘Information and explanation’, ‘Environment of the A&E’,’Leaving the A&E’ and ‘General information and rapidity of care’. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients’ health care expectations. In general, the highest improvement scores concerned patient information. Conclusions The Consumer Quality index for the accident and emergency department measures patients’ experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify

  11. [Rotator cuff diseases in occupational medicine between occupational diseases and accidents: medical-legal considerations].

    Spigno, F; Galli, R; Casali, C; Lagattolla, N; De Lucchi, M


    The authors have gone through the complaints concerning all the cases of shoulder accidents at work filed by the Genoa office of the Italian Workers' National compensation Agency (INAIL) during the two years' period 2006-2007, reviewing in particular those somehow affecting rotator components. The aim of this paper is to assess the real role played by the occupational trauma in the rotator cuff tear. The data gathered so far have shown, on the one hand, a high prevalence of pre-existing inflammatory and degenerative diseases and, on the other, a rather modest influence of the trauma which, for this reason, has usually borne, as an immediate medico-legal consequence, the rejection of a cause-effect relationship between the accident and the rotator cuff lesion, without taking into any account whether the worker was likely to be affected by an occupational disease (ex table Ministerial Decree n. 81 April 9th 2008- item 78). In such cases a systematic and in-depth investigation of the occupational case history is suggested, in order to highlight the possible pre-existence of a former biomechanical overload of the upper limbs, so as to allow the physician to detect a pathology often misdiagnosed.

  12. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.

    Carpenter, Christopher R; Bromley, Marilyn; Caterino, Jeffrey M; Chun, Audrey; Gerson, Lowell W; Greenspan, Jason; Hwang, Ula; John, David P; Lyons, William L; Platts-Mills, Timothy F; Mortensen, Betty; Ragsdale, Luna; Rosenberg, Mark; Wilber, Scott


    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.

  13. Skills and educational needs of accident and emergency nurses in Ghana: An initial needs analysis

    Sarah Rominski


    Discussion: Current nurse knowledge and function as well as areas to focus on for future specialty training in emergency nursing have been identified by this needs assessment. The emergency department nurses shared an overwhelming interest in increasing their skill level, learning new methods of patient care and implementing new technologies into their clinical practice.

  14. Development of emergency medicine in Rwanda

    Antoine Bahati Kabeza


    The Rwandan government, partnering with international organizations, has launched a campaign to improve human resources for health, and as a part of that effort the creation of training programs in emergency medicine is now underway. The Rwandan Human Resources for Health program can serve as a guide to the development of similar programs within other African countries. The emergency medicine component of this program includes two tracks: a 2-year postgraduate diploma course, followed by a 3-year Masters of Medicine in Emergency Medicine. The program is slated to graduate its first cohort of trained Emergency Physicians in 2017.

  15. Emerging nanotechnology approaches in tissue engineering and regenerative medicine

    Kim ES; Ahn EH; Dvir T; Kim DH


    Eung-Sam Kim,1,2 Eun Hyun Ahn,3,4 Tal Dvir,5,6 Deok-Ho Kim1,4,71Department of Bioengineering, University of Washington, Seattle, WA, USA; 2Department of Biological Sciences, Chonnam National University, Gwangju, Korea; 3Department of Pathology, 4Institute of Stem Cell and Regenerative Medicine, School of Medicine, University of Washington, Seattle, WA, USA; 5Department of Molecular Microbiology and Biotechnology, 6Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israe...

  16. Emergency medicine in Vietnam.

    Richards, J R


    The Socialist Republic of Vietnam is one of the poorest countries in the world. Recent economic developments, as the country attempts to start a market economy, have had a profound impact on its health care system. This report describes the state of prehospital and emergency medical care in Vietnam and possibilities for the future.

  17. The emergence and potential impact of medicine 2.0 in the healthcare industry.

    Stump, Terra; Zilch, Sarah; Coustasse, Alberto


    Medicine 2.0 has emerged within healthcare information technology to enable more defined relationships among providers and patients. Physicians, hospitals, and patients are using Medicine 2.0 through social networking to maintain their foothold in the evolution of medical technologies. The authors' purpose was to determine potential improvements that Medicine 2.0 has on communication and collaboration of healthcare information. Research has shown that Medicine 2.0 has integrated into the healthcare industry and is enabling an increase in communication in healthcare matters. The provider-patient relationship is improving through the use of Medicine 2.0 and has positively impacted society so far.

  18. Association between temperature and emergency room visits for cardiorespiratory diseases, metabolic syndrome-related diseases, and accidents in metropolitan Taipei.

    Yu-Chun Wang

    Full Text Available This study evaluated risks of the emergency room visits (ERV for cerebrovascular diseases, heart diseases, ischemic heart disease, hypertensive diseases, chronic renal failure (CRF, diabetes mellitus (DM, asthma, chronic airway obstruction not elsewhere classified (CAO, and accidents associated with the ambient temperature from 2000 to 2009 in metropolitan Taipei.The distributed lag non-linear model was used to estimate the cumulative relative risk (RR and confidence interval (CI of cause-specific ERV associated with daily temperature from lag 0 to lag 3 after controlling for potential confounders.This study identified that temperatures related to the lowest risk of ERV was 26 °C for cerebrovascular diseases, 18 °C for CRF, DM, and accidents, and 30 °C for hypertensive diseases, asthma, and CAO. These temperatures were used as the reference temperatures to measure RR for the corresponding diseases. A low temperature (14°C increased the ERV risk for cerebrovascular diseases, hypertensive diseases, and asthma, with respective cumulative 4-day RRs of 1.56 (95% CI: 1.23, 1.97, 1.78 (95% CI: 1.37, 2.34, and 2.93 (95% CI: 1.26, 6.79. The effects were greater on, or after, lag one. At 32°C, the cumulative 4-day RR for ERV was significant for CRF (RR = 2.36; 95% CI: 1.33, 4.19 and accidents (RR = 1.23; 95% CI: 1.14, 1.33 and the highest RR was seen on lag 0 for CRF (RR = 1.69; 95% CI: 1.01, 3.58, DM (RR = 1.69; 95% CI: 1.09, 2.61, and accidents (RR = 1.19; 95% CI: 1.11, 1.27.Higher temperatures are associated with the increased ERV risks for CRF, DM, and accidents and lower temperatures with the increased ERV risks for cerebrovascular diseases, hypertensive diseases, and asthma in the subtropical metropolitan.

  19. Personal experience in pediatric emergency medicine training in Canada and China

    LIN Gang-xi; LUO Yi-ming; Adam CHENG; YANG Shu-yu; WANG Jian-she; Ran-D Goldman


    Currently,pediatric emergency medicine (PEM) as practiced in many developed countries is different from ours in China.Chinese pediatric emergency medicine is just children's internal medicine and does not include general surgery,ear-nose-throat,etc.If children have an emergency condition that require specialized treatments they need to go to different departments.However in Canada,the pediatric emergency physicians will first treat the patients whatever the condition,then,if it is a complicated sub specialty problem,they will consult the specialist or let the patient see the specialist later.In addition,resuscitation is done in the pediatric intensive care unit (PICU) in China,but it is done in the emergency room in Canada.This article compares the differences in the pediatric emergency systems in Canada and China and also introduces the international standard system of pediatric triage.

  20. Towards integration of general practitioner posts and accident and emergency departments: a case study of two integrated emergency posts in the Netherlands

    Kamphuis Helen CM


    Full Text Available Abstract Background Accident and emergency (A&E departments and general practitioner (GP posts are often used inappropriately, leading to overcrowding. In the Netherlands, increasingly more integrated emergency posts (IEPs are being created, integrating the care provided by GP posts and A&E departments, in order to improve the provision of the emergency care. Methods This explorative study compares the efficiency and patient and employee satisfaction in IEPs with those in two GP posts and two A&E departments. To this end, information was retrieved from hospital and GP patient records for the first quarter of the year before and of the year after the creation of IEPs. Patients and employees were sent a questionnaire to measure their satisfaction. Lastly, groups of hospital doctors, GPs, GP assistants, and nurses were interviewed. Results After the creation of IEPs, there was a shift of more than fifteen percent from secondary care to primary care for emergency consultations and waiting/consultation times were shortened by more than ten percent. Compared with the control settings, patients were more satisfied about telephone contact with an IEP, but professionals working at the IEP were less satisfied with several aspects of their work. Conclusion IEPs could be a promising innovation to organize emergency care more efficiently; however, it might take time to convince professionals of the possible advantages. Studies involving more IEPs and longer follow-up times are needed to determine whether such integration should be stimulated.

  1. Advance directives, preemptive suicide and emergency medicine decision making.

    Heinrich, Richard L; Morgan, Marshall T; Rottman, Steven J


    As the United States population ages, there is a growing group of aging, elderly, individuals who may consider "preemptive suicide"(Prado, 1998). Healthy aging patients who preemptively attempt to end their life by suicide and who have clearly expressed a desire not to have life -sustaining treatment present a clinical and public policy challenge. We describe the clinical, ethical, and medical-legal decision making issues that were raised in such a case that presented to an academic emergency department. We also review and evaluate a decision making process that emergency physicians confront when faced with such a challenging and unusual situation .

  2. Emergency medicine: Concepts and clinical practice. Second edition. Volume 2

    Rosen, P.


    This book contains over 50 selections. Some of the titles are: Radiation Injuries; Hydrocarbons; Pain control: anesthesia and analgesia; Techniques of endotracheal intubation and muscle relaxation; Neck injuries; Vascular and cardiac injuries; Foreign bodies; Dental emergencies; Knee and lower leg; and Orthopedic injuries.

  3. Helicopter emergency medical services accident rates in different international air rescue systems

    J Hinkelbein


    Full Text Available J Hinkelbein1,2, M Schwalbe2, H V Genzwuerker2,31Department for Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Germany; 2Working Group “Emergency Medicine and Air Rescue”, German Society of Aviation and Space Medicine (DGRLM eV; 3Clinic of Anesthesiology and Intensive Care Medicine, Neckar-Odenwald-Kliniken gGmbH, Hospitals Buchen and Mosbach, Buchen, GermanyAim: Each year approximately two to four helicopter emergency medical services (HEMS crashes occur in Germany. The aim of the present study was to compare crash rates and fatal crash rates in Germany to rates in other countries.Materials and methods: A MEDLINE search from 1970 to 2009 was performed using combinations of the keywords “HEMS”, “rescue helicopter”, “accident”, “accident rate”, “crash”, and “crash rate”. The search was supplemented by additional published data. Data were compared on the basis of 10,000 missions and 100,000 helicopter flying hours. These data were allocated to specific time frames for analyis.Results: Eleven relevant studies were identified. Five studies (three from Germany, one from the US, one from Australia analyzing HEMS accidents on the basis of 10,000 missions were identified. Crash rates per 10,000 missions ranged between 0.4 and 3.05 and fatal crash rates between 0.04 and 2.12. In addition, nine studies (six from the US, two from Germany, one from Australia used 100,000 flying hours as a denominator. Here, crash rates ranged between 1.7 and 13.4 and fatal crash rates between 0.91 and 4.7.Conclusions: Data and accident rates were inhomogeneous and differed significantly. Data analysis was impeded by publication of mean data, use of different time frames, and differences in HEMS systems.Keywords: fatal accident rate, rescue helicopter, fatal crash rate, helicopter emergency medical system, accident analysis

  4. State of emergency medicine in Rwanda 2015: an innovative trainee and trainer model.

    Mbanjumucyo, Gabin; DeVos, Elizabeth; Pulfrey, Simon; Epino, Henry M


    The 1994 Rwandan war and genocide left more than 1 million people dead; millions displaced; and the country's economic, social, and health infrastructure destroyed. Despite remaining one of the poorest countries in the world, Rwanda has made remarkable gains in health, social, and economic development over the last 20 years, but modern emergency care has been slow to progress. Rwanda has recently established the Human Resources for Health program to rapidly build capacity in multiple sectors of its healthcare delivery system, including emergency medicine. This project involves multiple medical and surgical residencies, nursing programs, allied health professional trainings, and hospital administrative support. A real strength of the program is that trainers work with international faculty at Rwanda's referral hospital, but also as emergency medicine specialty trainers when returning to their respective district hospitals. Rwanda's first emergency medicine trainees are playing a unique and important role in the implementation of emergency care systems and education in the country's district hospitals. While there has been early vital progress in building emergency medicine's foundations in Rwanda, there remains much work to be done. This will be accomplished with careful planning and strong commitment from the country's healthcare and emergency medicine leaders.

  5. Use of a virtual learning environment for training in maxillofacial emergencies: impact on the knowledge and attitudes of staff in accident and emergency departments.

    Elledge, Ross; McAleer, Sean; Thakar, Meera; Begum, Fathema; Singhota, Sanjeet; Grew, Nicholas


    Many graduates will take up junior roles in accident and emergency (A&E) departments to which a large proportion of patients present with facial injuries caused by interpersonal violence. However, it is widely recognised that undergraduates and postgraduates have few opportunities for training in oral and maxillofacial surgery. We aimed to assess the impact of a specifically designed maxillofacial emergencies virtual learning environment (VLE) on the knowledge and confidence of junior doctors in two A&E departments. They were given free access to the VLE for one month, and were asked to complete multiple choice questions and to rate their confidence to deal with 10 common situations on visual analogue scales (VAS) at baseline and one month after training. A total of 29 doctors agreed to pilot the website, 21 (72%) completed both sets of questions, and 18 (62%) completed both VAS assessments. The mean (SD) multiple choice score improved from 10 (2.52) to 13 (3.56) out of a maximum of 20 (p=0.004) and the mean (SD) VAS improved from 29.2 (19.2) mm to 45.7 (16.6) mm out of a maximum of 100 mm (p=0.007). This was a small pilot study with limited numbers, but it showed improvements in the knowledge of maxillofacial emergencies and in confidence, although the latter remained low. Further work is needed to examine how these brief educational interventions affect the attitudes of frontline staff to maxillofacial emergencies.

  6. Qualitative Research on Emergency Medicine Physicians

    Paltved, Charlotte; Musaeus, Peter


    with qualitative research. Methods: Electronic databases of English peer-reviewed articles were searched from 1971 to 2012 using Medline through PubMed and PsychINFO. This search was supplemented with hand-searches of Academic Emergency Medicine and Emergency Medicine Journal from 1999 to 2012 and cross references......Aim: This study aims to systematically review the qualitative research studying Emergency Medicine (EM) physicians in Emergency Departments (ED). Background: Qualitative research aims to study complex social phenomena. EM is a highly complex medical and social environment that can be investigated...... were reviewed. The key words used were emergency medicine, qualitative, ethnography, observation, interview, video, anthropology, simulation, and simulation-based. Results: 820 papers were identified and 46 studies were included in this review. This literature review found that the reviewed qualitative...

  7. Counterregulatory hormones in insulin-treated diabetic patients admitted to an accident and emergency department with hypoglycaemia

    Hvidberg, A; Christensen, N J; Hilsted, Jannik


    The aim of the study was (1) to describe hormone responses in insulin-induced hypoglycaemia and (2) to investigate if a combined treatment with intravenous glucose and intramuscular glucagon (group A) would improve glucose recovery as compared to treatment with intravenous glucose alone (group B......). Eighteen adult patients with insulin-treated diabetes mellitus admitted to the Accident and Emergency Department with hypoglycaemia (plasma glucose 1.23 +/- 0.15 mmol l(-1) on admission) were randomized to one of the above treatments and plasma glucose and counterregulatory hormones were measured before...... and 30-120 min after treatment. Pre-treatment counterregulatory hormone concentrations were significantly lower than hormone concentrations during induced hypoglycaemia in healthy control subjects but significantly higher than healthy fasting concentrations for plasma adrenaline (p = 0.020), glucagon (p...

  8. An analysis of the effectiveness of emergency locator transmitters to reduce response time and locate wreckage in U.S. general aviation accidents

    Jesudoss, Ajit

    Emergency Locator Transmitters (ELT) help search crews to locate aircraft in distress and to rescue survivors. This study analyzed ELT data from U.S. General Aviation accidents during the period 2006 to 2010. This study examined the effectiveness of ELTs in terms of ELT Success Rate (ESR) and False Negative Rate (FNR) based on ELT-Aided. This study found a significant difference between ELT-Operated and ELT-Aided. The ESR was found to be 38.58% whereas the FNR was found to be 61.42 %. The Missing Data Ratio (MDR), where accident reports had no ELT information, was found to be above 95%. Recommendations were made to include ELT information in all accident reports and to stress the importance of including response time in the accident report. Also the significant differences between ELT-Operated and ELT-Aided were explained.

  9. Zika virus and the never-ending story of emerging pathogens and transfusion medicine.

    Marano, Giuseppe; Pupella, Simonetta; Vaglio, Stefania; Liumbruno, Giancarlo M; Grazzini, Giuliano


    In the last few years, the transfusion medicine community has been paying special attention to emerging vector-borne diseases transmitted by arboviruses. Zika virus is the latest of these pathogens and is responsible for major outbreaks in Africa, Asia and, more recently, in previously infection-naïve territories of the Pacific area. Many issues regarding this emerging pathogen remain unclear and require further investigation. National health authorities have adopted different prevention strategies. The aim of this review article is to discuss the currently available, though limited, information and the potential impact of this virus on transfusion medicine.

  10. A comparison of the quality of care in accident and emergency departments in England and the Netherlands as experienced by patients

    Bos, Nanne; Seccombe, Ian J.; Sturms, Leontien M.; Stellato, Rebecca; Schrijvers, Augustinus J P; van Stel, Henk F.


    Background: Measuring patients' experiences to determine health-care performance and quality of care from their perspective can provide valuable evidence for international improvements in the quality of care. We compare patients' experiences in Accident & Emergency departments (A&E) in England and t

  11. Occupational Emergency Medicine - Introduction


    4302. Respondents should be aware that notwithstanding any other provision of law , no person shall be subject to a penalty for failing to comply with...Under Title III, companie covered under the Hazard Communication Standard are r qulred to make their chemica l inventor ies known to emergency response...anagement howe ver. misp)"l’ed . OCClIj1illi.ll1illllleliicilll’ h olli - ia lly, ~ llb ~l)(’ciJ lty of I’rcvellliV l- Illedi cine, which dut’~ ind "d

  12. Planning the content of a brief educational course in maxillofacial emergencies for staff in accident and emergency departments: a modified Delphi study.

    Elledge, Ross O C; McAleer, Sean


    It is well known that staff in accident and emergency (A&E) departments lack the knowledge and confidence needed to deal with maxillofacial emergencies, and that it is related to limited education at undergraduate and postgraduate levels. We therefore aimed to design a syllabus for a short course to educate staff about the most common emergencies. To find out which learning outcomes should be included and to reach a consensus, we did a 3-stage modified Delphi study of the opinions of members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). Of a possible 890 members, 188 responded (21%) in the second round and 105 in the third (12%). Eighteen (37%) of the 49 proposed learning outcomes were rated very important and all of them were retained in the syllabus after the third round. Thirty (61%) items were retained with a consensus of 51% or above in the final round. The Delphi technique is a useful addition to the armamentarium of those involved in education, and has been used effectively in syllabus design. We achieved good consensus on the items to be included and the syllabus will be piloted locally.

  13. Zika virus and the never-ending story of emerging pathogens and Transfusion Medicine

    Marano, Giuseppe; Pupella, Simonetta; Vaglio, Stefania; Liumbruno, Giancarlo M.; Grazzini, Giuliano


    In the last few years, the transfusion medicine community has been paying special attention to emerging vector-borne diseases transmitted by arboviruses. Zika virus is the latest of these pathogens and is responsible for major outbreaks in Africa, Asia and, more recently, in previously infection-naïve territories of the Pacific area. Many issues regarding this emerging pathogen remain unclear and require further investigation. National health authorities have adopted different prevention stra...

  14. Knowledge, Skills and Experience Managing Tracheostomy Emergencies: A Survey of Critical Care Medicine trainees

    Nizam, AA


    Since the development of percutaneous tracheostomy, the number of tracheostomy patients on hospital wards has increased. Problems associated with adequate tracheostomy care on the wards are well documented, particularly the management of tracheostomy-related emergencies. A survey was conducted among non-consultant hospital doctors (NCHDs) starting their Critical Care Medicine training rotation in a university affiliated teaching hospital to determine their basic knowledge and skills in dealing with tracheostomy emergencies. Trainees who had received specific tracheostomy training or who had previous experience of dealing with tracheostomy emergencies were more confident in dealing with such emergencies compared to trainees without such training or experience. Only a minority of trainees were aware of local hospital guidelines regarding tracheostomy care. Our results highlight the importance of increased awareness of tracheostomy emergencies and the importance of specific training for Anaesthesia and Critical Care Medicine trainees.

  15. The Role of Family and Emergency Medicine in Undergraduate Medical Education

    Sawchuk, Victor N.


    Clinical clerks electing emergency and family medicine rotations during the 1977 and 1978 academic years at the University of Calgary Faculty of Medicine evaluated their clerkships on the opportunities provided to learn new useful medical knowledge, learn new clinical skills and practice them. All rotations were perceived as providing excellent opportunities to learn medical knowledge. However, nearly 20% of students felt that four of the teaching hospital ward based specialty and subspecialt...

  16. Education scholarship in emergency medicine part 1: innovating and improving teaching and learning.

    Sherbino, Jonathan; Van Melle, Elaine; Bandiera, Glen; McEwen, Jill; Leblanc, Constance; Bhanji, Farhan; Frank, Jason R; Regehr, Glenn; Snell, Linda


    As emergency medicine (EM) education evolves, a more advanced understanding of education scholarship is required. This article is the first in a series of three articles that reports the recommendations of the 2013 education scholarship consensus conference of the Academic Section of the Canadian Association of Emergency Physicians. Adopting the Canadian Association for Medical Education's definition, education scholarship (including both research and innovation) is defined. A rationale for why education scholarship should be a priority for EM is discussed.

  17. Short-term associations between outdoor air pollution and visits to accident and emergency departments in London for respiratory complaints

    Atkinson, R.W.; Anderson, H.R.; Strachan, D.P.; Bland, J.M.; Bremner, S.A. [St. George`s Hospital Medical School, Dept. of Public Health Sciences, London (United Kingdom); Ponce de Leon, A. [IME/UERJ Rua Sao Francisco Xavier, Dept. de Estatistica, Maracana Rio de Janeiro (Brazil)


    Many epidemiological studies have shown positive short-term associations between health and current levels of outdoor air pollution. The aim of this study was to investigate the association between air pollution and the number of visits to accident and emergency (A and E) departments in London for respiratory complaints. A and E visits include the less severe cases of acute respiratory disease and are unrestricted by bed availability. Daily counts of visits to 12 London A and E departments for asthma, other respiratory complaints, and both combined for a number of age groups were constructed from manual registers of visits for the period 1992-1994. A poison regression allowing for seasonal patterns meteorological conditions and influenza epidemics was used to assess the associations between the number of visits and six pollutants: nitrogen dioxide, ozone, sulphur dioxide, carbon monoxide, and particles measured as black smoke (BS) and particles with a median aerodynamic diameter of <10 {mu}m (PM10). After making an allowance for the multiplicity of tests, there remained strong associations between visits for all respiratory complaints and increases in SO{sub 2}: a 2.8% (95% confidence interval (CI) 0.7-4.9) increase in the number of visits for a 18 {mu}g{sup .}m{sup -3} increase (10th-90th percentile range) and a 3.0% (95% Cl 0.8-5.2) increase for a 31 {mu}g{sup .}m{sup -3} increase in PM10. There were also significant associations between visits for asthma and SO{sub 2}, NO{sub 2} and PM10. No significant associations between O{sub 3} and any of the respiratory complaints investigated were found. Because of the strong correlation between pollutants, it was difficult to identify a single pollutant responsible for the associations found in the analyses. This study suggests that the levels of air pollution currently experienced in London are linked to short-term increases in the number of people visiting accident and emergency departments with respiratory complaints

  18. Short-term associations between outdoor air pollution and visits to accident and emergency departments in London for respiratory complaints

    Atkinson, R.W.; Anderson, H.R.; Strachan, D.P.; Bland, J.M.; Bremner, S.A. [St. George' s Hospital Medical School, Dept. of Public Health Sciences, London (United Kingdom); Ponce de Loen, A. [IME/UERJ Rua Sao Francisco Xavier, Dept. de Estatistica, Maracana Rio de Janeiro , RJ (Brazil)


    Many epidemiological studies have shown positive short-term associations between health and current levels of outdoor air pollution. The aim of this study was to investigate the association between air pollution and the number of visits to accident and emergency (A and E) departments in London for respiratory complaints. A and E visits include the less severe cases of acute respiratory disease and are unrestricted by bed availability. Daily counts of visits to 12 London A and E departments for asthma, other respiratory complaints, and both combined for a number of age groups were constructed from manual registers of visits for the period 1992-1994. A Poisson regression allowing for seasonal patterns, meteorological conditions and influenza epidemics was used to assess the associations between the number of visits and six pollutants: nitrogen dioxide, ozone, sulphur dioxide, carbon monoxide, and particles measured as black smoke (BS) and particles with a median aerodynamic diameter of <10 {mu}m (PM10). After making an allowance for the multiplicity of tests, there remained strong associations between visits for all respiratory complaints and increases in SO{sub 2}: a 2.8% (95% confidence interval (CI) 0.7-4.9) increase in the number of visits for a 18 {mu}g{sup .}m{sup -3} increase (10th-90th percentile range) and a 3.0% (95% CI 0.8-5.2) increase for a 31 {mu}g{sup .}m{sup -3} increase in PM10. There were also significant associations between visits for asthma and SO{sub 2}, NO{sub 2} and PM10. No significant associations between O{sub 3} and any of the respiratory complaints investigated were found. Because of the strong correlation between pollutants, it was difficult to identify a single pollutant responsible for the associations found in the analyses. This study suggests that the levels of air pollution currently experineced in London are linked to short-term increases in the number of people visiting accident and emergency departments with respiratory

  19. Emergency Medicine for medical students world wide!

    Perinpam, Larshan; Thi Huynh, Anh-Nhi


    A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) -

  20. Useulness of B Natriuretic Peptides and Procalcitonin in Emergency Medicine

    P. Ray


    Full Text Available Congestive heart failure (CHF is the main cause of acute dyspnea in patients presented to an emergency department (ED, and it is associated with high morbidity and mortality. B-type natriuretic peptide (BNP is a polypeptide, released by ventricular myocytes directly proportional to wall tension, for lowering renin-angiotensin-aldosterone activation. For diagnosing CHF, both BNP and the biologically inactive NT-proBNP have similar accuracy. Threshold values are higher in elderly population, and in patients with renal dysfunction. They might have also a prognostic value. Studies demonstrated that the use of BNP or NT-proBNP in dyspneic patients early in the ED reduced the time to discharge, total treatment cost. BNP and NT-proBNP should be available in every ED 24 hours a day, because literature strongly suggests the beneficial impact of an early appropriate diagnosis and treatment in dyspneic patients. Etiologic diagnosis of febrile patients who present to an ED is complex and sometimes difficult. However, new evidence showed that there are interventions (including early appropriate antibiotics, which could reduce mortality rate in patients with sepsis. For diagnosing sepsis, procalcitonin (PCT is more accurate than C-reactive protein. Thus, because of its excellent specificity and positive predictive value, an elevated PCT concentration (higher than 0.5 ng/mL indicates ongoing and potentially severe systemic infection, which needs early antibiotics (e.g. meningitis. In lower respiratory tract infections, CAP or COPD exacerbation, PCT guidance reduced total antibiotic exposure and/or antibiotic treatment duration.

  1. How to start and operate a National Emergency Medicine specialty organisation

    Elizabeth L. DeVos


    Full Text Available As a service for the International Federation for Emergency Medicine, a task force of the Specialty Implementation Committee wrote this manuscript of guidelines for developing a National Emergency Medicine (EM specialty organisation. This manuscript offers structural and procedural considerations for creating or developing an EM specialty organisation in a country or region that currently does not have one. It was written in response to requests for aid in developing a country’s specialty of EM. International EM leaders with experience in the development of national organisations have reviewed these guidelines.

  2. What is regenerative medicine? Emergence of applied stem cell and developmental biology.

    Mironov, V; Visconti, R P; Markwald, R R


    Regenerative medicine is an emerging, but still poorly defined, field of biomedicine. The ongoing 'regenerative medicine revolution' is based on a series of new exciting breakthrough discoveries in the field of stem cell biology and developmental biology. The main problem of regenerative medicine is not so much stem cell differentiation, isolation and lineage diversity, although these are very important issues, but rather stem cell mobilisation, recruitment and integration into functional tissues. The key issue in enhancing tissue and organ regeneration is how to mobilise circulating stem and progenitor cells and how to provide an appropriate environment ('niche') for their tissue and organo-specific recruitment, 'homing' and complete functional integration. We need to know more about basic tissue biology, tissue regeneration and the cellular and molecular mechanisms of tissue turnover (both cellular and extracellular components) at different periods of human life and in different diseases. Systematic in silico, in vitro and in vivo research is a foundation for further progress in regenerative medicine. Regenerative medicine is a rapidly advancing field that opens new and exciting opportunities for completely revolutionary therapeutic modalities and technologies. Regenerative medicine is, at its essence, an emergence of applied stem cell and developmental biology.

  3. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

    Stoneking LR


    Full Text Available LR Stoneking,1 AL Waterbrook,1 J Garst Orozco,2 D Johnston,1 A Bellafiore,1 C Davies,3 T Nuño,1 J Fatás-Cabeza,4 O Beita,5 V Ng,1 KH Grall,6 W Adamas-Rappaport7 1Department of Emergency Medicine, University of Arizona, Tucson, AZ, 2Department of Emergency Medicine, Sinai Health System, Chicago, IL, 3Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, 4Department of Spanish and Portuguese, University of Arizona, Tucson, AZ, 5Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 6Department of Emergency Medicine, Regions Hospital, St Paul, MN, 7Department of Surgery, University of Arizona, Tucson, AZ, USA Background: After emergency department (ED discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.Objectives: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.Methods: Our ED has two Emergency Medicine Residency Programs, University Campus (UC and South Campus (SC. SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.Results: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study

  4. Partnerships to provide care and medicine for chronic diseases: a model for emerging markets.

    Goroff, Michael; Reich, Michael R


    The challenge of expanding access to treatment and medicine for chronic diseases in emerging markets is both a public health imperative and a commercial opportunity. Cross-sector partnerships-involving a pharmaceutical manufacturer; a local health care provider; and other private, public, and nonprofit entities-could address this challenge. Such partnerships would provide integrated, comprehensive care and medicines for a specific chronic disease, with medicines directly supplied to the partnership at preferential prices by the manufacturer. The model discussed here requires additional specification, using real numbers and specific contexts, to assess its feasibility. Still, we believe that this model has the potential for public health and private business to cooperate in addressing the rising problem of chronic diseases in emerging markets.

  5. Emergency medicine: beyond the basics.

    Malamed, S F


    Medical emergencies can arise in the dental office. Preparedness for these emergencies is predicated on an ability to rapidly recognize a problem and to effectively institute prompt and proper management. In all emergency situations, management is based on implementation of basic life support, as needed. The author describes the appropriate management of two common emergency situations: allergy and chest pain.

  6. Risk analysis of emergent water pollution accidents based on a Bayesian Network.

    Tang, Caihong; Yi, Yujun; Yang, Zhifeng; Sun, Jie


    To guarantee the security of water quality in water transfer channels, especially in open channels, analysis of potential emergent pollution sources in the water transfer process is critical. It is also indispensable for forewarnings and protection from emergent pollution accidents. Bridges above open channels with large amounts of truck traffic are the main locations where emergent accidents could occur. A Bayesian Network model, which consists of six root nodes and three middle layer nodes, was developed in this paper, and was employed to identify the possibility of potential pollution risk. Dianbei Bridge is reviewed as a typical bridge on an open channel of the Middle Route of the South to North Water Transfer Project where emergent traffic accidents could occur. Risk of water pollutions caused by leakage of pollutants into water is focused in this study. The risk for potential traffic accidents at the Dianbei Bridge implies a risk for water pollution in the canal. Based on survey data, statistical analysis, and domain specialist knowledge, a Bayesian Network model was established. The human factor of emergent accidents has been considered in this model. Additionally, this model has been employed to describe the probability of accidents and the risk level. The sensitive reasons for pollution accidents have been deduced. The case has also been simulated that sensitive factors are in a state of most likely to lead to accidents.

  7. Emergency/disaster medical support in the restoration project for the Fukushima nuclear power plant accident.

    Morimura, Naoto; Asari, Yasushi; Yamaguchi, Yoshihiro; Asanuma, Kazunari; Tase, Choichiro; Sakamoto, Tetsuya; Aruga, Tohru


    The Fukushima Daiichi Nuclear Power Plant (1F) suffered a series of radiation accidents after the Great East Japan Earthquake on 11 March 2011. In a situation where halting or delaying restoration work was thought to translate directly into a very serious risk for the entire country, it was of the utmost importance to strengthen the emergency and disaster medical system in addition to radiation emergency medical care for staff at the frontlines working in an environment that posed a risk of radiation exposure and a large-scale secondary disaster. The Japanese Association for Acute Medicine (JAAM) launched the 'Emergency Task Force on the Fukushima Nuclear Power Plant Accident' and sent physicians to the local response headquarters. Thirty-four physicians were dispatched as disaster medical advisors, response guidelines in the event of multitudinous injury victims were created and revised and, along with execution of drills, coordination and advice was given on transport of patients. Forty-nine physicians acted as directing physicians, taking on the tasks of triage, initial treatment and decontamination. A total of 261 patients were attended to by the dispatched physicians. None of the eight patients with external contamination developed acute radiation syndrome. In an environment where the collaboration between organisations in the framework of a vertically bound government and multiple agencies and institutions was certainly not seamless, the participation of the JAAM as the medical academic organisation in the local system presented the opportunity to laterally integrate the physicians affiliated with the respective organisations from the perspective of specialisation.

  8. Some Ethical Issues in Prehospital Emergency Medicine.

    Erbay, Hasan


    Prehospital emergency medical care has many challenges including unpredictable patient profiles, emergency conditions, and administration of care in a non-medical area. Many conflicts occur in a prehospital setting that require ethical decisions to be made. An overview of the some of ethical issues in prehospital emergency care settings is given in this article. Ethical aspects of prehospital emergency medicine are classified into four groups: the process before medical interventions, including justice, stigmatization, dangerous situations, and safe driving; the treatment process, including triage, refusal of treatment or transport, and informed consent; the end of life and care, including life-sustaining treatments, prehospital cardiopulmonary resuscitation (CPR), withholding or withdrawal of CPR, and family presence during resuscitation; and some ambulance perception issues, including ambulance misuse, care of minors, and telling of bad news. Prehospital emergency medicine is quite different from emergency medicine in hospitals, and all patients and situations are unique. Consequently, there are no quick formulas for the right action and emotion. It is important to recognize the ethical conflicts that occur in prehospital emergency medicine and then act to provide the appropriate care that is of optimal value.


    V. K. Ivanov


    Full Text Available Morbidity and mortality among emergency workers of the Chernobyl accident for the follow- up period of 199Morbidity and mortality among the emergency workers of the Chernobyl accident for the follow-up period of 1992-2008 is analyzed in the article. The cohort consists of 47141 emergency workers of 1986-1987. Radiation risks for cancer morbidity (ERR/Gy is 0.76; 95% CI: 0.19; 1.42, p-value=0008 and cancer mortality (ERR/Gy is 0.95; 95% CI: 0.19; 1.89, p-value=0.01 are statistically significant. Radiation risk for vascular diseases is assessed as well.

  10. Generational influences in academic emergency medicine: structure, function, and culture (Part II).

    Mohr, Nicholas M; Smith-Coggins, Rebecca; Larrabee, Hollynn; Dyne, Pamela L; Promes, Susan B


    Strategies for approaching generational issues that affect teaching and learning, mentoring, and technology in emergency medicine (EM) have been reported. Tactics to address generational influences involving the structure and function of the academic emergency department (ED), organizational culture, and EM schedule have not been published. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic EM. Understanding generational characteristics and mitigating strategies can address some common issues encountered in academic EM. By understanding the differences and strengths of each of the cohorts in academic EM departments and considering simple mitigating strategies, faculty leaders can maximize their cooperative effectiveness and face the challenges of a new millennium.

  11. Microgrants - a method of facilitating research in emergency medicine

    Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars


    ABSTRACT: Microgrants is a novel concept where small grants are used to facilitate research. The concept might have a place in developing emergency medicine research, especially in countries where emergency medicine in not established or in new areas of research. Two examples of the beneficial...... effects of microgrants in emergency medicine research are described. Emergency medicine interest groups and foundations should consider setting up microgrant schemes....

  12. Microfinance as a method of facilitating research in emergency medicine.

    Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars


    Microgrants are a novel concept where small grants are used to facilitate research. The concept might have a place in developing emergency medicine research, especially in countries where emergency medicine is not established or in new areas of research. Two examples of the beneficial effects of microgrants in emergency medicine research are described. Emergency medicine interest groups and foundations should consider setting up microgrant schemes.

  13. 风险识别和事故应急处理方法%Risk Identification and Accident Emergency Response Measures



    This paper introduces the general engineering construction proj ects of hazards identification and risk anal-ysis methods,expounds the emergency response measures after the accident and accident treatment procedures and methods,reiterates about risk analysis in proj ect construction safety management and the points of accident treatment, combining with the characteristics of the engineering construction proj ect.%该文介绍了一般工程建设项目中的危险源的识别和相关风险分析方法,阐述了事故发生后的应急响应举措和事故处理程序与方法,结合工程建设项目施工的特点,重申了项目施工安全管理中关于风险分析和事故处理的要点。


    G. G. Onischenko


    Full Text Available The article presents preliminary assessment of the accident scale, level of its radiation effect on the population and response of national authorities of various countries for the population radiation protection provisions. High levels of the environmental radioactive contamination demanded the application of complex measures for the radiation protection of the population from adjacent territories of Japan. Radionuclides from the region of damaged NPP can get to the other countries by means of the long-distant air and sea water mass transfer. Specific activity of cesium radionuclides in the sea biota can reach the level recommended by the Codex Alimentarius Commission as the safe level for the international trade or exceed it. Significant radioactive contamination of the territories of other countries resulting from the «Fukushima-I» NPP accident did not occur. Many world countries applied measures of the Japanese food products import control on the base of the radiation monitoring data. These prohibitions are consequently remitted following the radiation situation improvement.

  15. Tensions and Opportunities in Convergence: Shifting Concepts of Disease in Emerging Molecular Medicine.

    Boenink, Marianne


    The convergence of biomedical sciences with nanotechnology as well as ICT has created a new wave of biomedical technologies, resulting in visions of a 'molecular medicine'. Since novel technologies tend to shift concepts of disease and health, this paper investigates how the emerging field of molecular medicine may shift the meaning of 'disease' as well as the boundary between health and disease. It gives a brief overview of the development towards and the often very speculative visions of molecular medicine. Subsequently three views of disease often used in the philosophy of medicine are briefly discussed: the ontological or neo-ontological, the physiological and the normative/holistic concepts of disease. Against this background two tendencies in the field of molecular medicine are highlighted: (1) the use of a cascade model of disease and (2) the notion of disease as a deviation from an individual pattern of functioning. It becomes clear that molecular medicine pulls conceptualizations of disease and health in several, partly opposed directions. However, the resulting tensions may also offer opportunities to steer the future of medicine in more desirable directions.

  16. Bedside ultrasound in pediatric emergency medicine.

    Levy, Jason A; Noble, Vicki E


    Bedside emergency ultrasound has been used by emergency physicians for >20 years for a variety of conditions. In adult centers, emergency ultrasound is routinely used in the management of victims of blunt abdominal trauma, in patients with abdominal aortic aneurysm and biliary disease, and in women with first-trimester pregnancy complications. Although its use has grown dramatically in the last decade in adult emergency departments, only recently has this tool been embraced by pediatric emergency physicians. As the modality advances and becomes more available, it will be important for primary care pediatricians to understand its uses and limitations and to ensure that pediatric emergency physicians have access to the proper training, equipment, and experience. This article is meant to review the current literature relating to emergency ultrasound in pediatric emergency medicine, as well as to describe potential pediatric applications.

  17. Generational influences in academic emergency medicine: teaching and learning, mentoring, and technology (part I).

    Mohr, Nicholas M; Moreno-Walton, Lisa; Mills, Angela M; Brunett, Patrick H; Promes, Susan B


    For the first time in history, four generations are working together-traditionalists, baby boomers, generation Xers (Gen Xers), and millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another.

  18. Emergency response to a highway accident in Springfield, Massachusetts, on December 16, 1991


    On December 16, 1991, a truck carrying unirradiated (fresh) nuclear fuel was involved in an accident on US Interstate 91, in Springfield, Massachusetts. This report describes the emergency response measures undertaken by local, State, Federal, and private parties. The report also discusses lessons learned'' from the response to the accident and suggests areas where improvements might be made.

  19. Emergency response to a highway accident in Springfield, Massachusetts, on December 16, 1991


    On December 16, 1991, a truck carrying unirradiated (fresh) nuclear fuel was involved in an accident on US Interstate 91, in Springfield, Massachusetts. This report describes the emergency response measures undertaken by local, State, Federal, and private parties. The report also discusses ``lessons learned`` from the response to the accident and suggests areas where improvements might be made.

  20. Hypoglycaemic complications with diabetes mellitus management: the predominant adverse drug reaction presenting to the Accident and Emergency Department of The University Hospital of the West Indies.

    Gossell-Williams, M; Williams-Johnson, J; Francis, L


    Evaluation of adverse drug reactions (ADRs) is important to the assessment of risk factors in an aim to ensure maximum benefits of drug therapy. This study was done to assess the types of ADRs presenting to the Accident and Emergency department (A&E) of the University Hospital of the West Indies. Admissions to the A&E associated with drugs were followed on a weekly basis for 19 weeks from October 2007 to February 2008 using the patient logbook. Medical records of patients with suspected ADRs were collected and evaluated by an Emergency Medicine Consultant of A & E to confirm the occurrence of ADRs and the suspected drug. Of the 8170 admissions to A&E, 48 (0.6%) were related to ADRs, with most occurring in females and the mean age (+/- standard error) was 58.9 (+/- 3.4) years. Drug induced hypoglycaemia accounted for 28 (56.3%) cases of ADRs and included mainly patients on insulin, with or without a sulphonylurea therapy. Most of these diabetic patients also had co-morbidities and were on multi-drug therapy (18). Allergic reactions accounted for 10 (21%) of the ADR outcomes. Other drugs accounting for ADRs included cardiovascular drugs (10.4%), analgesic/anti-inflammatory medications (8.3%), drugs acting on the central nervous system (8.3%) and anti-infectives (8.3%). It is concluded that drug-induced hypoglycaemia is the major ADR presenting to the A&E of the University Hospital of the West Indies; it is a preventable ADR and therefore further investigation should evaluate possible factors attributed to the occurrences.

  1. Accident investigation and analysis

    Kampen, J. van; Drupsteen, L.


    Many organisations and companies take extensive proactive measures to identify, evaluate and reduce occupational risks. However, despite these efforts things still go wrong and unintended events occur. After a major incident or accident, conducting an accident investigation is generally the next ste

  2. [Diagnosis and treatment of diving accidents. New German guidelines for diving accidents 2014-2017].

    Jüttner, B; Wölfel, C; Liedtke, H; Meyne, K; Werr, H; Bräuer, T; Kemmerer, M; Schmeißer, G; Piepho, T; Müller, O; Schöppenthau, H


    In 2015 the German Society for Diving and Hyperbaric Medicine (GTÜM) and the Swiss Underwater and Hyperbaric Medical Society (SUHMS) published the updated guidelines on diving accidents 2014-2017. These multidisciplinary guidelines were developed within a structured consensus process by members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Sports Divers Association (VDST), the Naval Medical Institute (SchiffMedInst), the Social Accident Insurance Institution for the Building Trade (BG BAU), the Association of Hyperbaric Treatment Centers (VDD) and the Society of Occupational and Environmental Medicine (DGAUM). This consensus-based guidelines project (development grade S2k) with a representative group of developers was conducted by the Association of Scientific Medical Societies in Germany. It provides information and instructions according to up to date evidence to all divers and other lay persons for first aid recommendations to physician first responders and emergency physicians as well as paramedics and all physicians at therapeutic hyperbaric chambers for the diagnostics and treatment of diving accidents. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose and the following key action statements: on-site 100% oxygen first aid treatment, still patient positioning and fluid administration are recommended. Hyperbaric oxygen (HBO) recompression remains unchanged the established treatment in severe cases with no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa. For quality management purposes there is a need in the future for a nationwide register of hyperbaric therapy.

  3. Influence of radiation accident on human being health and its medical emergency%核事件对人类健康的影响及医学应急



    核电站已成为解决能源问题的重要途径之一,但核事件的发生则会给人类带来深重灾难,如何针对核事件的危害而采取有效预防和应急,已成为全球发展面临的重要公共卫生问题.本文将从世界重大核事件的回顾、核事件对人类健康的影响,以及核事件的医学应急和公众防护方面进行综述.%Nuclear power plant is one of the important way to solve the energy problem, but nuclear accident could bring the extremely serious disaster onto the human being. It has been the key for taking the effective actions promptly to meet the hazards resulted from nuclear accident. In order to prevent the accident and protect the human being health, we would sum up the messages as follows, review of serious nuclear accidents in the world, analysis on influence of radiation accident on human being health and its medical emergency.

  4. Communication and industrial accidents

    As, Sicco van


    This paper deals with the influence of organizational communication on safety. Accidents are actually caused by individual mistakes. However the underlying causes of accidents are often organizational. As a link between these two levels - the organizational failures and mistakes - I suggest the conc

  5. How Much are Emergency Medicine Specialists’ Decisions Reliable in the Diagnosis and Treatment of Pediatric Fractures?

    Mohsen Mardani-Kivi


    Full Text Available Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared. Results: In total, there were 108 patients (54 patients in each group with a mean age of 8.1+3.3 years. Identical diagnosis in 48 cases (88.9% of distal radius and 36 cases (66.7% of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8% received identical treatment. Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education.

  6. Education scholarship in emergency medicine part 2: supporting and developing scholars.

    Bandiera, Glen; Leblanc, Constance; Regehr, Glenn; Snell, Linda; Frank, Jason R; Sherbino, Jonathan


    Emergency medicine (EM) is defined, in part, by clinical excellence across an immense breadth of content and the provision of exemplary bedside teaching to a wide variety of learners. The specialty is also well-suited to a number of emerging areas of education scholarship, particularly in relation to team-based learning, clinical reasoning, acute care response, and simulation-based teaching. The success of EM education scholarship will be predicated on systematic, collective attention to providing the infrastructure for this to occur. Specifically, as a new generation of emergency physicians prepares for education careers, academic organizations need to develop means not only to identify potential scholars but also to mentor, support, and encourage their careers. This paper summarizes the supporting literature and presents related recommendations from a 2013 consensus conference on EM education scholarship led by the Academic Section of the Canadian Association of Emergency Physicians.

  7. Pattern of Sexual Offences Attended at Accident and Emergency Department of HUSM from Year 2000 to 2003: A Retrospective Study.

    Islam, Mohammed Nasimul; See, Khoo Lay; Ting, Lai Chin; Khan, Jesmine


    This paper investigates the pattern of sexual offence cases attended at the One Stop Crisis Center (OSCC) of the Accident and Emergency Department, Hospital Universiti Sains Malaysia (HUSM), Kelantan. A total of 439 reported sexual offence cases were examined over a period of 4 years from 2000 to 2003. Sexual offence constituted by male partner or boyfriend in 18.9%, by relatives in 27.3% and by "others" in 53.8% of cases. Only 0.7% of victims did not attempt to lodge a police report. There is a significant relationship between occupation and the risk of experiencing sexual violence. Students were mostly targeted by the perpetrator throughout the study period. Among the offences, rape cases were the highest in number, among those who attended at the OSCC, HUSM with a total of 72.7%; followed by 27.3% of incest; 26.4% of child sexual abuse; 4.8% of sodomy and lastly 1.6% of gerontophilia cases. Only 70% of the specimens obtained from sexual offences victims were sent for laboratory analysis. The result remained negative in 82.4% specimens and thus the laboratory analysis result is merely functioning as a supportive evidence for sexual offence cases attended at OSCC. The studies showed that most of the sexual assault perpetrators were known to the victims. The place of crime was also known to the perpetrators. Health sectors of various levels should be working in conjunction to promote a societal changes to improve more of the women's right and thus to reduce the violence crime.

  8. Advanced training in pediatric emergency medicine in the United States, Canada, United Kingdom, and Australia : An international comparison and resources guide

    Babl, FE; Weiner, DL; Bhanji, F; Davies, F; Berry, K; Barnett, P


    Pediatric emergency medicine is an important subspecialty of pediatrics and emergency medicine. It is a well-established subspecialty in some countries and less well developed or evolving in others. We set out to develop a resource guide and document the current status of pediatric emergency medicin

  9. Emergency Medicine Clerkship Directors: Current Workforce

    David A. Wald


    Full Text Available Introduction: The emergency medicine clerkship director serves an important role in the education of medical students. The authors sought to update the demographic and academic profile of the emergency medicine clerkship director. Methods: We developed and implemented a comprehensive questionnaire, and used it to survey all emergency medicine clerkship directors at United States allopathic medical schools accredited by the Liaison Committee on Medical Education. We analyzed and interpreted data using descriptive statistics. Results: One hundred seven of 133 (80.4% emergency medicine clerkship directors completed the survey. Clerkship Director’s mean age was 39.7 years (SD-7.2, they were more commonly male 68.2%, of Caucasian racial backgrounds and at the instructor or assistant professor (71.3% level. The mean number of years of experience as clerkship director was 5.5 (SD-4.5. The mean amount of protected time for clerkship administration reported by respondents was 7.3 hours weekly (SD-5.1, with the majority (53.8% reporting 6 or more hours of protected time per week. However, 32.7% of emergency medicine clerkship directors reported not having any protected time for clerkship administration. Most clerkship directors (91.6% held additional teaching responsibilities beyond their clerkship and many were involved in educational research (49.5%. The majority (79.8%, reported being somewhat or very satisfied with their job as clerkship director. Conclusion: Most clerkship directors were junior faculty at the instructor or assistant professor rank and were involved with a variety of educational endeavors beyond the clerkship. [West J Emerg Med. 2014;15(4:398–403.

  10. Pain prevalence and pain relief in trauma patients in the Accident & Emergency department.

    Berben, S.A.; Meijs, T.H.; Dongen, R.T.M. van; Vugt, A.B. van; Vloet, L.C.M.; Mintjes-de Groot, J.J.; Achterberg, T. van


    BACKGROUND: Acute pain in the A&E department (ED) has been described as a problem, however insight into the problem for trauma patients is lacking. OBJECTIVE: This study describes the prevalence of pain, the pain intensity and the effect of conventional pain treatment in trauma patients in the ED. M

  11. Differences between attendance in emergency care of male and female victims of traffic accidents in Porto alegre, Rio Grande do Sul state, Brazil

    Raquel Forgiarini Saldanha


    Full Text Available Driving under the influence of alcohol/ drugs (DUI is a well-established risk factor for traffic accidents, and men and women have different consumption patterns. The scope of this paper is to analyze differences in alcohol and drug consumption, as well as on behavior associated with traffic accidents among men and women. A cross-sectional study was conducted with 609 sequential traffic accident victims attended in emergency care from Porto Alegre. Subjects gave a structured interview, were breathalyzed and had a saliva test for alcohol/drug screening. Results showed that women were mainly passengers or pedestrians (p < 0.001. There was no significant difference in positive blood alcohol concentration. However, men reported more binge drinking and THC use, while women had more benzodiazepine in their saliva (p<0.05. This is the first Brazilian study to compare alcohol and drug use among men and women who were the victims of traffic accidents. Results point to differences in the pattern of substance abuse, as well on risk behavior. Data may be useful for specific prevention strategies that take gender differences into consideration.

  12. Acidentes e violências entre mulheres atendidas em Serviços de Emergência Sentinela - Brasil, 2009 Accidents and violence among women attended in Sentinel Emergency Services - Brazil, 2009

    Celeste de Souza Rodrigues


    Full Text Available As causas externas afetam de maneira desigual as populações humanas. O presente artigo tem como objetivo analisar os atendimentos de emergência em mulheres vítimas de acidentes e violências. Foram analisados dados do inquérito de Vigilância de Violências e Acidentes em 74 Unidades de Emergência de 23 capitais e no Distrito Federal em 2009. Analisaram-se 6.965 atendimentos de mulheres adultas comparando-se as faixas de 20-39 e 40-59 anos, em relação a ocorrência de acidentes e violências. Os acidentes foram mais frequentes em mulheres jovens (20 a 39 anos, de cor negra e com escolaridade maior que 9 anos de estudo. A ocorrência de violência também foi predominante em mulheres jovens e negras, porém com menor escolaridade. Entre os acidentes predominaram as quedas (38,6%, seguidas de acidentes de transporte. As violências foram mais frequentes no domicílio (p Accidents from external causes affect the human population in different ways. This article seeks to analyze emergency care for women who are victims of accidents and violence. Data from the Surveillance System for Violence and Accidents were analyzed. This study was carried out in 74 emergency units of 23 state capitals and the Federal District in 2009 and included 6,965 women aged from 20-59 years. The age groups of 20-39 and 40-59 years were compared for the occurrence of accidents and violence. Accidents were more frequent among young black women (20-39 years with more than nine years of schooling. The occurrence of violence was also prevalent in young black women but with less schooling. Falls were the most frequent accidents (38.6%, followed by traffic accidents. The occurrence of violence was more frequent in the home (p <0.000 and the mention of alcohol abuse among victims of violence was predominant. The most frequent type of violence was aggression (84.6%, in which the aggressor was male (79.1% and identified as an intimate partner (44.1%. It is increasingly

  13. Disposition of Patients Before and After Establishment of Emergency Medicine Specialists

    Payman Asadi


    Full Text Available Introduction: Emergency department (ED as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time. To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran.  Methods: In this cross-sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005-2012 were evaluated. Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of discharging under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20. Results: Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001. The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have increased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively(p=0.001. Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.0001. The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005-2008 to 637.7±30.8 through 2009-2012 (p=0.002. Also, during 2005-2008 the

  14. Setting up and functioning of an Emergency Medicine Department: Lessons learned from a preliminary study

    K Asish


    Full Text Available Background and Aims: Tertiary care teaching hospitals remain referral centres for victims of trauma and mass casualty. Often specialists from various disciplines manage these crowded casualty areas. These age old casualty areas are being replaced, throughout the country by Emergency Medicine Departments (EMDs, presumed to be better planned to confront a crisis. We aimed to gather basic data contributive in setting up of an EMD at a tertiary care teaching hospital from the lessons learned from functioning existent systems. Methods: This is primarily a questionnaire-based descriptive study at tertiary care referral centres across the country, which was purposively selected.The study models included one from a hospital without designated EMD and the other four from hospitals with established EMDs. Direct observation and focus group meetings with experienced informants at these hospitals contributed to the data. In the absence of a validated hospital preparedness assessment scale, comparison was done with regard to quantitative, qualitative and corroborative parameters using descriptive analysis. Results: The EMDs at best practice models were headed by specialist in Emergency Medicine assisted by organised staff, had protocols for managing mass casualty incident (MCI, separate trauma teams, ergonomic use of infrastructure and public education programmes. In this regard, these hospitals seemed well organised to manage MCIs and disasters. Conclusion: The observation may provide a preliminary data useful in setting up an EMD. In the absence of published Indian literature, this may facilitate further research in this direction. Anaesthesiologists, presently an approved Faculty in Emergency Medicine training can provide creative input with regard to its initial organisation and functioning, thus widening our horizons in a country where there is a severe dearth of trained emergency physicians.

  15. Helicopter emergency medical services accident rates in different international air rescue systems

    Hinkelbein, J; Schwalbe, M.; H V Genzwuerker


    J Hinkelbein1,2, M Schwalbe2, H V Genzwuerker2,31Department for Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Germany; 2Working Group “Emergency Medicine and Air Rescue”, German Society of Aviation and Space Medicine (DGRLM) eV; 3Clinic of Anesthesiology and Intensive Care Medicine, Neckar-Odenwald-Kliniken gGmbH, Hospitals Buchen and Mosbach, Buchen, GermanyAim: Each year approximately two to four helicopter emergency medical services (HEMS) cra...

  16. The Emergence of the Dose–Response Concept in Biology and Medicine

    Edward J. Calabrese


    Full Text Available A historical assessment of the origin of the dose–response in modern toxicology and its integration as a central concept in biology and medicine is presented. This article provides an overview of how the threshold, linear and biphasic (i.e., hormetic dose–response models emerged in the late 19th and early 20th centuries and competed for acceptance and dominance. Particular attention is directed to the hormetic model for which a general description and evaluation is provided, including its historical basis, and how it was marginalized by the medical and pharmacology communities in the early decades of the 20th century.

  17. The Emergence of the Dose–Response Concept in Biology and Medicine

    Calabrese, Edward J.


    A historical assessment of the origin of the dose–response in modern toxicology and its integration as a central concept in biology and medicine is presented. This article provides an overview of how the threshold, linear and biphasic (i.e., hormetic) dose–response models emerged in the late 19th and early 20th centuries and competed for acceptance and dominance. Particular attention is directed to the hormetic model for which a general description and evaluation is provided, including its historical basis, and how it was marginalized by the medical and pharmacology communities in the early decades of the 20th century. PMID:27929392

  18. A custom search engine for emergency medicine and critical care.

    Raine, Todd; Thoma, Brent; Chan, Teresa M; Lin, Michelle


    The number of online resources read by and pertinent to clinicians has increased dramatically. However, most healthcare professionals still use mainstream search engines as their primary port of entry to the resources on the Internet. These search engines use algorithms that do not make it easy to find clinician-oriented resources. FOAMSearch, a custom search engine (CSE), was developed to find relevant, high-quality online resources for emergency medicine and critical care (EMCC) clinicians. Using Google™ algorithms, it searches a vetted list of >300 blogs, podcasts, wikis, knowledge translation tools, clinical decision support tools and medical journals. Utilisation has increased progressively to >3000 users/month since its launch in 2011. Further study of the role of CSEs to find medical resources is needed, and it might be possible to develop similar CSEs for other areas of medicine.

  19. [Evolutionary medicine: an emergent basic science].

    Spotorno, Angel E


    Evolutionary Medicine is an emergent basic science that offers new and varied perspectives to the comprehension of human health. The application of classic evolutionary theories (descent with modification, and natural selection) to the human organism, to its pathogens, and their mutual co-evolution, provides new explanations about why we get sick, how we can prevent this, and how we can heal. Medicine has focused mainly on the proximate or immediate causes of diseases and the treatment of symptoms, and very little on its evolutionary or mediate causes. For instance, the present human genome and phenotypes are essentially paleolithic ones: they are not adapted to modern life style, thus favoring the so-called diseases of civilization (ie: ateroesclerosis, senescence, myopia, phobias, panic attacks, stress, reproductive cancers). With the evolutionary approach, post-modern medicine is detecting better the vulnerabilities, restrictions, biases, adaptations and maladaptations of human body, its actual diseases, and its preventions.

  20. An audit of the NICE self-harm guidelines at a local Accident and Emergency department in North Wales.

    Jones, Russell; Avies-Jones, Alison


    This paper reports the findings of a self-harm audit based on data collected at an A&E department in North Wales. The National Institute for Clinical Excellence (NICE) guidelines on the short term physical and psychological management of self-harm were published in 2004 and the audit was based on technical criteria recommended in the guideline booklet, including standards of psychosocial assessment, staff training and patient satisfaction information. The data in this study related to fifty consecutive self-harm attendances at the A&E department Ysbyty Glan Clwyd in the Spring of 2007. The hospital serves a mixed rural/urban population of approximately 250,000. Patient satisfaction questionnaires were made available to the group subsequently, whilst the staff training audit was distributed more widely to include emergency, medicine and mental health divisions of the Conwy & Denbighshire NHS Trust. The results demonstrated generally high standards of care on psychosocial assessment, though information relating to initial ambulance involvement in treatment was often unclear. The response to the staff-training questionnaire was an encouraging 44% and indicated wide variations between staff groups and areas of work. The patient satisfaction returns demonstrated favourable responses, with several comments added to expand on tick box replies. Service developments, as a result of the audit, include the proposal to provide mental health and self-harm training to all those staff likely to encounter the behaviour--not just to those who work in mental health. Patients, from the questionnaire, who express a willingness to become part of a mental health planning group are now provided details of the patient participation involvement (PPI) group, where their experiences can often inform service improvement. Meanwhile the case note audit has reinforced the need for a practical self-harm pathway which will ensure consistency.

  1. Soil sampling and analytical strategies for mapping fallout in nuclear emergencies based on the Fukushima Dai-ichi Nuclear Power Plant accident.

    Onda, Yuichi; Kato, Hiroaki; Hoshi, Masaharu; Takahashi, Yoshio; Nguyen, Minh-Long


    The Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident resulted in extensive radioactive contamination of the environment via deposited radionuclides such as radiocesium and (131)I. Evaluating the extent and level of environmental contamination is critical to protecting citizens in affected areas and to planning decontamination efforts. However, a standardized soil sampling protocol is needed in such emergencies to facilitate the collection of large, tractable samples for measuring gamma-emitting radionuclides. In this study, we developed an emergency soil sampling protocol based on preliminary sampling from the FDNPP accident-affected area. We also present the results of a preliminary experiment aimed to evaluate the influence of various procedures (e.g., mixing, number of samples) on measured radioactivity. Results show that sample mixing strongly affects measured radioactivity in soil samples. Furthermore, for homogenization, shaking the plastic sample container at least 150 times or disaggregating soil by hand-rolling in a disposable plastic bag is required. Finally, we determined that five soil samples within a 3 m × 3-m area are the minimum number required for reducing measurement uncertainty in the emergency soil sampling protocol proposed here.

  2. Queensland Emergency Medicine Research Foundation: special report.

    FitzGerald, Gerry; Codd, Catrina; Aitken, Peter; Sinnott, Michael


    Development of any new profession is dependent on the development of a special body of knowledge that is the domain of the profession. Key to this is research. Following sustained lobbying, the Queensland Government agreed to establish an emergency medicine research fund as part of an Enterprise Bargaining Agreement in 2006. That fund is managed by the Queensland Emergency Medicine Research Foundation. The present article describes the strategic approaches of the Foundation in its first 3 years, the application of research funds, and foreshadows an evaluative framework for determining the strategic value of this investment. The Foundation has developed a range of personnel and project support funding programmes, and competition for funding has increased. Ongoing evaluation will seek to determine the effectiveness of the current funding strategy on improving the effectiveness of research performance. It will also evaluate the clinical and organizational outcomes.

  3. 液氨储罐泄露后果模拟及应急处置%Consequences Simulation and Emergency Disposal of Liquid Ammonia Tank Leakage Accidents

    孙高穹; 刘剑俊


    Taking a liquid ammonia tank of a enterprise cold storage as an example,This paper identified the risk of ammonia storage possible poisoning and explosion accident,used the TNT equivalent method and overpressure criterion to simulate the accident consequences of the steam explosion caused by the leakage of a single tank,predicted the toxic gas leakage diffusion effect based on multi-puff model,Finally put forward prevention and emergency response measures of the liquid ammonia tank leak accident.%文章以某企业冷库配备的液氨储罐为实例,对液氨储存过程可能发生的中毒和爆炸事故进行风险识别,运用TNT当量法和超压准则模拟单个储罐泄露后引发蒸汽云爆炸的事故后果,同时运用多烟团模式预测有毒气体泄露扩散影响范围,最后提出液氨储罐泄露事故防范和应急处置措施。

  4. Work Accidents and Professional Diseases

    Doru Hauptmann


    Full Text Available The major accident is defined as “any event occurred, like an emission of dangerous materials or agents, which emerges from uncontrolled evolutions along the exploitation of any objective that leads to the immediate or delayed occurrence of serious dangers with impact over human health or over the environment, inside or outside the objective in which are involved one or more than one dangerous materials”.The dangerous phenomenon is a potential source of harms. In the ambit of industrial risks of accidental origins, this expression more frequently refers to physical phenomena like conflagrations, explosions, toxic gases dispersion, etc.Any accident scenario relates itself to the potential effects at the level of environmental “targets”. In the case of major accidents, we can distinguish the following categories of “targets”: human (employees of the objective, working or resident people in the nearby of the emplacement; the installation or equipments that may stay at the origin of the accidents (dangerous equipments; certain all-important equipments to ensure the safety level of the installation (critical security equipments: control rooms, civil fire brigade headquarters, etc; goods and structures situated in the installation’ environment (ground water, rivers, soil, flora, fauna.

  5. Nanotechnology in medicine emerging applications

    Koprowski, Gene


    This book will describe some of the most recent breakthroughs and promising developments in the search for improved diagnostics and therapies at the very small scales of living biological systems. While still very much a technology in the research and development stage, nanotechnology is already transforming today's medicine. This book, written by a general science author, provides a general overview of medical treatment potentials of nanotechnology in new, more effective drug delivery systems, in less invasive, ultra-small scale medical tools, and in new materials that can mimic or enhance na

  6. Electronic Whiteboards in Emergency Medicine

    Rasmussen, Rasmus


    As more and more Emergency Departments replace the manual dry-erase whiteboards used for coordination of patient care and communication among clinicians with IT-based electronic whiteboards a need to clarify the effects of implementing these systems arises. This paper seeks to answer this questio...

  7. Supervision and feedback for junior medical staff in Australian emergency departments: findings from the emergency medicine capacity assessment study

    Weiland Tracey J


    Full Text Available Abstract Background Clinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs and perceived feedback provided. Methods Semi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes. Results Thirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1% granted interviews including 100% (36/36 of ED Directors, and 96.2% (25/26 of eligible DEMTs, 24% (19/81 of advanced trainee/registrars, and 17% (15/90 of interns. Most participants (61% felt the ED was adequately supervised in general and (64.2% that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64% and junior staff (79% agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback. Conclusions Consultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.

  8. Evaluation of emergency medicine training programs in Egypt: Trainees’ perspective

    T. Montaser*


    Conclusions: Egyptian Emergency medicine trainees are not satisfied with their training and owing that to the unclear vision toward Emergency medicine as specialty from the policy makers and lack of professional staff responsible for education and evaluation. It is highly recommended that the training and mentoring go hand in hand and trainees should take part in the continuous evaluation process.

  9. Experience-based teaching of acute medicine for extra motivated medical students and young physicians – 4th Emergency Medicine Course and 6th AKUTNĚ.CZ Congress

    Petr Štourač


    Full Text Available Faculty of Medicine of the Masaryk University (MU, and especially its departments focusing on acute medicine, make an active effort to find and to support extra motivated students by organising courses and congresses with simulation-based learning sessions for them. 4th Emergency Medicine Course (EMC and 6th AKUTNĚ.CZ Congress were organised during 2014. EMC was held during a weekend in mid-April for 80 medical students. The congress was held on 22nd November 2014. A group of more than 700 enthusiastic professionals including physicians, nursing staff and medical students interested in acute medicine met again in Brno at the University Campus Bohunice. We also report the evaluation of effectiveness of different types of sessions, as well as its influence on practical skills and the fixation of memory footprint. The website AKUTNĚ.CZ ( is freely accessible, and anyone can find and watch all the videos and presentations there.

  10. Workplace violence in emergency medicine

    Chatterjee, A.


    Workplace violence (WPV) has increasingly become commonplace in the India, and particularly in the health care setting. Assaults are one of the leading causes of occupational injury-related deaths in health care setups. Among all health care settings, Emergency Departments (EDs) have been identified specifically as high-risk settings for WPV. Objective: This article reviews recent epidemiology and research on ED WPV and prevention; discusses practical actions and resources that ED provider...

  11. The Progress of Emergency Medicine in Taiwan, China, and Hong Kong: Perspective from Publications in Emergency Medicine Journals, 1992–2011

    Ching-Hsing Lee


    Full Text Available Study Objective. The progress of emergency medicine (EM in Taiwan, China, and Hong Kong was evaluated from the perspective of publications in EM journals. Methods. This was a retrospective study. All articles published from 1992 to 2011 in all journals in the EM category in the 2010 Journal Citation Reports (JCR were included. A computerized literature search was conducted using the SciVerse Scopus database. The slope (β of the linear regression was used to evaluate the trends in the numbers of articles as well as the ratios to the total number of EM journal articles. Results. The trends in the numbers of articles from Taiwan, China, and Hong Kong were 6.170, 1.908, and 2.835 and the trends in the ratios of their publication numbers to the total number of EM journal articles were 15.0 × 10−4, 4.60 × 10−4, and 6.80 × 10−4, respectively. All P-values were <0.01. The mean, median, and 75th percentiles of the number of citations in all EM journals were greater than those of these three areas. Conclusions. The publications from Taiwan, China, and Hong Kong have increased at a higher rate than those of the overall EM field in the past 20 years and indicated the rapid progress in these three areas.

  12. Approach to Reptile Emergency Medicine.

    Long, Simon Y


    This article summarizes the physiology and anatomy of reptiles, highlighting points relevant for emergency room veterinarians. Other systems, such as the endocrine and immune systems, have not been covered. The many other aspects of reptile species variation are too numerous to be covered. This article provides an overview but encourages clinicians to seek additional species-specific information to better medically diagnose and treat their reptile patients.

  13. Highway traffic safety accident prevention and emergency handling%高速公路突发交通安全事故预防和应急处置



    The highway has been rapidly developed,but also brought a lot of traffic congestion and traffic safety issues.In recent years,more and more highway emergencies,natural disasters,social problems,hazardous chemical spills can cause traffic congestion problems,and even traffic accidents.Therefore,this paper will analyze the severity of highway incidents and affecting highway traffic safety factors,and finally have a detailed study of highway burst traffic safety accident preven-tion and emergency response programs.%新时期,高速公路已经得到了快速发展,但是也带来很多交通拥挤和交通安全问题。近年来,高速公路突发事件越来越多,自然灾害、社会问题、危险化学物品泄漏等都会导致交通拥堵问题,甚至发生交通事故。对此,将分析高速公路突发事件的严重性以及影响高速公路交通安全的因素,最后详细探究高速公路突发交通安全事故预防和应急处置方案。

  14. Train accidents involving pedestrians, motor vehicles, and motorcycles.

    Goldberg, B A; Mootha, R K; Lindsey, R W


    In the United States, train-related accidents account for more than 18,000 injuries and 1,200 fatalities annually, yet there is a paucity of literature pertaining to this unique injury. We reviewed the medical records of 98 of 135 cases of train-related trauma treated at Ben Taub General Hospital, Baylor College of Medicine, Houston, Texas, from 1990 to 1995. There were 50 train-pedestrian accidents, 47 train-automobile accidents, and 1 train-motorcycle accident, with a mean patient age of 30.1 years (range, 2 to 66 years). Eighteen patients (18%) were pronounced dead on arrival or died shortly after admission. Of the other 80 patients, 27 (34%) were discharged from the emergency department after minor medical treatment, while 53 (66%) were hospitalized, of whom 10 (13%) later expired. The mean Injury Severity Score (ISS) was 11.9 (discharged, 1.8; hospitalized, 14.3; expired, 29.2). Forty-five patients (56%) sustained 57 extremity fractures, and 30 patients (38%) required 40 amputations. Mean Mangled Extremity Severity Score (MESS) for all injured extremities was 5.2 (amputation, 7.7; no amputation, 2.8). On average, the hospitalization cost per patient was greater than $18,698, while the reimbursement from the patients was $2,261, leaving the hospital with a net deficit of approximately 2 million dollars. Surprisingly, train accidents do not always result in serious injury. However, when serious injury is sustained, it is often of high morbidity (amputation) and mortality, which appears to correlate well with the initial MESS and ISS. Extrapolating our cost data to include all train-related accident injuries and deaths indicates that the direct costs to society may exceed 300 million dollars annually. Greater public awareness and preventive measures may reduce the tremendous human and financial costs of train-related accidents.

  15. The CORD Academy for scholarship in education in emergency medicine.

    Lamantia, Joseph; Kuhn, Gloria J; Searle, Nancy S


    In 2010 the Council of Emergency Medicine Residency Directors (CORD) established an Academy for Scholarship in Education in Emergency Medicine to define, promote, recognize, and reward excellence in education, education research, and education leadership in emergency medicine. In this article we describe the mission and aims of the Academy. Academies for medical educators are widespread in medical schools today and have produced many benefits both for faculty and for educational programs. Little effort, however, has been devoted to such a model in graduate medical education specialty societies. While CORD and other emergency medicine organizations have developed numerous initiatives to advance excellence in education, we believe that this effort will be accelerated if housed in the form of an Academy that emphasizes scholarship in teaching and other education activities. The CORD Academy for Scholarship in Education in Emergency Medicine is a new model for promoting excellence in education in graduate medical education specialty societies.

  16. Experience and lessons learned from emergency disposal of Fukushima nuclear power station accident%日本福岛核电站核事故应急处置的经验和教训

    徐卸古; 甄蓓; 杨晓明; 陈肖华


    After Fukushima nuclear accident , we visited the related medical aid agencies for nuclear accidents and con -ducted investigations in disaster-affected areas in Japan. This article summarizes the problems with emergency disposal of Fukushima nuclear accident while disclosing problems that should be solved during the emergency force construction for nu -clear accidents.%日本福岛核事故后,应日本同行的邀请,我们访问了日本核医学应急的相关单位,并到相关地区进行了考察.本文探讨了日本福岛核事故应急处置过程中存在的问题,提出了我国核应急力量建设过程中应注意的问题及相关对策.

  17. Focus on the emerging new fields of network physiology and network medicine

    Ivanov, Plamen Ch; Liu, Kang K. L.; Bartsch, Ronny P.


    Despite the vast progress and achievements in systems biology and integrative physiology in the last decades, there is still a significant gap in understanding the mechanisms through which (i) genomic, proteomic and metabolic factors and signaling pathways impact vertical processes across cells, tissues and organs leading to the expression of different disease phenotypes and influence the functional and clinical associations between diseases, and (ii) how diverse physiological systems and organs coordinate their functions over a broad range of space and time scales and horizontally integrate to generate distinct physiologic states at the organism level. Two emerging fields, network medicine and network physiology, aim to address these fundamental questions. Novel concepts and approaches derived from recent advances in network theory, coupled dynamical systems, statistical and computational physics show promise to provide new insights into the complexity of physiological structure and function in health and disease, bridging the genetic and sub-cellular level with inter-cellular interactions and communications among integrated organ systems and sub-systems. These advances form first building blocks in the methodological formalism and theoretical framework necessary to address fundamental problems and challenges in physiology and medicine. This ‘focus on’ issue contains 26 articles representing state-of-the-art contributions covering diverse systems from the sub-cellular to the organism level where physicists have key role in laying the foundations of these new fields.

  18. Nitrous oxide in emergency medicine.

    O'Sullivan, I; Benger, J


    Safe and predictable analgesia is required for the potentially painful or uncomfortable procedures often undertaken in an emergency department. The characteristics of an ideal analgesic agent are safety, predictability, non-invasive delivery, freedom from side effects, simplicity of use, and a rapid onset and offset. Newer approaches have threatened the widespread use of nitrous oxide, but despite its long history this simple gas still has much to offer. "I am sure the air in heaven must be this wonder-working gas of delight". Robert Southey, Poet (1774 to 1843)

  19. Potential role for psychological skills training in emergency medicine: Part 1 - Introduction and background.

    Lauria, Michael J; Rush, Stephen; Weingart, Scott D; Brooks, Jason; Gallo, Isabelle A


    Psychological skills training (PST) is the systematic acquisition and practice of different psychological techniques to improve cognitive and technical performance. This training consists of three phases: education, skills acquisition and practice. Some of the psychological skills developed in this training include relaxation techniques, focusing and concentration skills, positive 'self-suggestion' and visualisation exercises. Since the middle of the 20th century, PST has been successfully applied by athletes, performing artists, business executives, military personnel and other professionals in high-risk occupations. Research in these areas has demonstrated the breadth and depth of the training's effectiveness. Despite the benefits realised in other professions, medicine has only recently begun to explore certain elements of PST. The present paper reviews the history and evidence behind the concept of PST. In addition, it presents some aspects of PST that have already been incorporated into medical training as well as implications for developing more comprehensive programmes to improve delivery of emergency medical care.

  20. Do emergency medicine residents and faculty have similar learning styles when assessed with the Kolb learning style assessment tool?

    Fredette, Jenna; O'Brien, Corinne; Poole, Christy; Nomura, Jason


    Experiential learning theory and the Kolb Learning Style Inventory (Kolb LSI) have influenced educators worldwide for decades. Knowledge of learning styles can create efficient learning environments, increase information retention, and improve learner satisfaction. Learning styles have been examined in medicine previously, but not specifically with Emergency Medicine (EM) residents and attendings. Using the Kolb LSI, the learning styles of Emergency Medicine residents and attendings were assessed. The findings showed that the majority of EM residents and attendings shared the accommodating learning style. This result was different than prior studies that found the majority of medical professionals had a converging learning style and other studies that found attendings often have different learning styles than residents. The issue of learning styles among emergency medical residents and attendings is important because learning style knowledge may have an impact on how a residency program structures curriculum and how EM residents are successfully, efficiently, and creatively educated.

  1. Chernobyl accident and its consequences

    Gittus, J.H.


    The paper concerns the Chernobyl reactor accident, with emphasis on the design of the RBMK reactor and nuclear safety. A description is given of the Chernobyl nuclear power plant, including details of the RMBK reactor and safety systems. Comments on the design of the RBMK by UK experts prior to the accident are summarized, along with post-accident design changes to improve RBMK safety. Events of the Chernobyl accident are described, as well as design deficiencies highlighted by the accident. Differences between the USSR and UK approaches to nuclear safety are commented on. Finally source terms, release periods and environmental consequences are briefly discussed.

  2. Development and Implementation of an Emergency Medicine Podcast for Medical Students: EMIGcast

    Andrew Lichtenheld


    Full Text Available Podcasts, episodic digital audio recordings downloaded through web syndication or streamed online, have been shown to be an effective instructional method in undergraduate health professions education, and are increasingly used for self-directed learning.1-6 Emergency medicine (EM has embraced podcasting: over 80% of EM residents report listening to podcasts and a substantial number identify podcasts as the most valuable use of their educational time.4 Despite proven efficacy in undergraduate medical education and remarkable popularity with EM residents and attendings, there remain few EM podcasts targeted to medical students.5 Given that podcast effectiveness correlates with how well content matches the listener needs, a podcast specific to EM-bound medical students may optimally engage this target audience.

  3. On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature.

    Snooks, H A; Dale, J; Hartley-Sharpe, C; Halter, M


    With rising demand and recognition of the variety of cases attended by emergency ambulance crews, services have been considering alternative ways of providing non-urgent care. This paper describes and appraises the research literature concerning on-scene alternatives to conveyance to an emergency department, focusing on the: (1) profile and outcomes of patients attended but not conveyed by emergency crews; (2) triage ability of crews; (3) effectiveness and safety of protocols that allow crews to convey patients to alternative receiving units or to self care. The literature search was conducted through standard medical databases, supplemented with manual searches. Very few "live" studies were identified, and fewer still that included a control group. Findings indicated a complex area, with the introduction of protocols allowing crews to leave patients at scene carrying clinical risk. Robust research evidence concerning alternatives to current emergency care models is needed urgently to inform service and practice development.

  4. Dementia and Traffic Accidents

    Petersen, Jindong Ding; Siersma, Volkert; Nielsen, Connie Thurøe;


    BACKGROUND: As a consequence of a rapid growth of an ageing population, more people with dementia are expected on the roads. Little is known about whether these people are at increased risk of road traffic-related accidents. OBJECTIVE: Our study aims to investigate the risk of road traffic......-related accidents for people aged 65 years or older with a diagnosis of dementia in Denmark. METHODS: We will conduct a nationwide population-based cohort study consisting of Danish people aged 65 or older living in Denmark as of January 1, 2008. The cohort is followed for 7 years (2008-2014). Individual's personal...... data are available in Danish registers and can be linked using a unique personal identification number. A person is identified with dementia if the person meets at least one of the following criteria: (1) a diagnosis of the disease in the Danish National Patient Register or in the Danish Psychiatric...

  5. Screening and brief interventions for hazardous alcohol use in accident and emergency departments: a randomised controlled trial protocol

    Myles Judy


    Full Text Available Abstract Background There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption on the physical, psychological and social health of the population. There also exists a substantial evidence base for the efficacy of brief interventions aimed at reducing alcohol consumption across a range of healthcare settings. Primary research conducted in emergency departments has reinforced the current evidence regarding the potential effectiveness and cost-effectiveness. Within this body of evidence there is marked variation in the intensity of brief intervention delivered, from very minimal interventions to more intensive behavioural or lifestyle counselling approaches. Further the majority of primary research has been conducted in single centre and there is little evidence of the wider issues of generalisability and implementation of brief interventions across emergency departments. Methods/design The study design is a prospective pragmatic factorial cluster randomised controlled trial. Individual Emergency Departments (ED (n = 9 are randomised with equal probability to a combination of screening tool (M-SASQ vs FAST vs SIPS-PAT and an intervention (Minimal intervention vs Brief advice vs Brief lifestyle counselling. The primary hypothesis is that brief lifestyle counselling delivered by an Alcohol Health Worker (AHW is more effective than Brief Advice or a minimal intervention delivered by ED staff. Secondary hypotheses address whether short screening instruments are more acceptable and as efficient as longer screening instruments and the cost-effectiveness of screening and brief interventions in ED. Individual participants will be followed up at 6 and 12 months after consent. The primary outcome measure is performance using a gold-standard screening test (AUDIT. Secondary outcomes include; quantity and frequency of alcohol consumed, alcohol-related problems, motivation to change, health related quality of life and

  6. Chart Smart: A Need for Documentation and Billing Education Among Emergency Medicine Residents?

    Brian Dawson, MD


    Full Text Available Objective: The healthcare chart is becoming ever more complex, serving clinicians, patients, third party payers, regulators, and even medicolegal parties. The purpose of this study was to identify our emergency medicine (EM resident and attending physicians’ current knowledge and attitudes about billing and documentation practices. We hypothesized that resident and attending physicians would identify billing and documentation as an area in which residents need further education.Methods: We gave a 15-question Likert survey to resident and attending physicians regarding charting practices, knowledge of billing and documentation, and opinions regarding need for further education.Results: We achieved a 100% response rate, with 47% (16/34 of resident physicians disagreeing or strongly disagreeing that they have adequate training in billing and documentation, while 91% (31/34 of residents and 95% (21/22 of attending physicians identified this skill as important to a resident’s future practice. Eighty-two percent (28/34 of resident physicians and 100% of attending physicians recommended further education for residents.Conclusion: Residents in this academic EM department identified a need for further education in billing and documentation practices. [West J Emerg Med. 2010;11(2: 116-119.

  7. Bridging the gap between clinical research and knowledge translation in pediatric emergency medicine.

    Hartling, Lisa; Scott-Findlay, Shannon; Johnson, David; Osmond, Martin; Plint, Amy; Grimshaw, Jeremy; Klassen, Terry P


    In 2006, a multidisciplinary group of researchers from across Canada submitted a successful application to the Canadian Institutes for Health Research for a Canadian Institutes for Health Research Team in Pediatric Emergency Medicine. The conceptual foundation for the proposal was to bring together two areas deemed critical for optimizing health outcomes: clinical research and knowledge translation (KT). The framework for the proposed work is an iterative figure-eight model that provides logical steps for research and a seamless flow between the development and evaluation of therapeutic interventions (clinical research) and the implementation and uptake of those interventions that prove to be effective (KT). Under the team grant, we will conduct seven distinct projects relating to the two most common medical problems affecting children in the emergency department: respiratory illness and injury. The projects span the research continuum, with some projects targeting problems for which there is little evidence, while other projects involve problems with a strong evidence base but require further work in the KT realm. In this article, we describe the history of the research team, the research framework, the individual research projects, and the structure of the team, including coordination and administration. We also highlight some of the many advantages of bringing this research program together under the umbrella of a team grant, including opportunities for cross-fertilization of ideas, collaboration among multiple disciplines and centers, training of students and junior researchers, and advancing a methodological research agenda.

  8. The system of emergency cards for primary actions in accident at radioactive material transport in Russia

    Ananiev, V.V. [Div. of the Decommission of Nuclear and Radiation-Hazardous Object of the Federal Agency for Atomic Energy, Moscow (Russian Federation); Ermakov, S.V.; Ershov, V.N.; Stovbur, V.I. [FGUP ' ' Emergency Response Centre of Minatom of Russia' ' , St-Petersburg (Russian Federation); Shvedov, M.O. [Div. of Nuclear and Radiation Safety of the Federal Agency for Atomic Energy, Moscow (Russian Federation)


    In the paper are reviewed the current and new designed system of the emergency cards for consignments of radioactive materials in Russian Federation, within the framework of a uniform state system of warning and liquidation of consequences of extraordinary situations and functional subsystem of warning and liquidation of accident situations of Federal Agency for Atomic Energy.

  9. Creation and Assessment of a Bad News Delivery Simulation Curriculum for Pediatric Emergency Medicine Fellows.

    Chumpitazi, Corrie E; Rees, Chris A; Chumpitazi, Bruno P; Hsu, Deborah C; Doughty, Cara B; Lorin, Martin I


    Background  Bad news in the context of health care has been broadly defined as significant information that negatively alters people's perceptions of the present or future. Effectively delivering bad news (DBN) in the setting of the emergency department requires excellent communication skills. Evidence shows that bad news is frequently given inadequately. Studies show that trainees need to devote more time to developing this skill through formalized training. This program's objectives were to utilize trained standardized patients in a simulation setting to assist pediatric emergency medicine (PEM) fellows in the development of effective, sensitive, and compassionate communication with patients and family members when conveying bad news, and to recognize and respond to the patient/parent's reaction to such news. Methods PEM fellows participated in a novel curriculum utilizing simulated patients (SPs) acting as the patient's parent and immersive techniques in a realistic and supportive environment. A baseline survey was conducted to ascertain participant demographics and previous experience with simulation and DBN. Experienced, multi-disciplinary faculty participated in a training workshop with the SPs one week prior to course delivery. Three scenarios were developed for bad news delivery. Instructors watched via remote video feed while the fellows individually interacted with the SPs and then participated in a confidential debriefing. Fellows later joined for group debriefing. Fellow characteristics, experience, and self-perceived comfort pre/post-course were collected.   Results Baseline data demonstrated that 78% of fellows reported DBN two or more times per month. Ninety-three percent of fellows in this study were present during the delivery of news about the death of a child to a parent or family member in the six-month period preceding this course. Fellows' self-reported comfort level in DBN to a patient/family and dealing with patient and parent emotions

  10. Compassion Fatigue is Similar in Emergency Medicine Residents Compared to other Medical and Surgical Specialties

    M. Fernanda Bellolio


    Full Text Available Introduction: Compassion fatigue (CF is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM resident physicians, including an assessment of contributing factors. Methods: We distributed a validated electronic questionnaire consisting of the Professional Quality of Life Scale with subscales for the three components of CF (compassion satisfaction, burnout and secondary traumatic stress, with each category scored independently. We collected data pertaining to day- versus night-shift distribution, hourly workload and child dependents. We included residents in EM, neurology, orthopedics, family medicine, pediatrics, obstetrics, and general surgery. Results: We surveyed 255 residents, with a response rate of 75%. Of the 188 resident respondents, 18% worked a majority of their clinical shifts overnight, and 32% had child dependents. Burnout scores for residents who worked greater than 80 hours per week, or primarily worked overnight shifts, were higher than residents who worked less than 80 hours (mean score 25.0 vs 21.5; p=0.013, or did not work overnight (mean score 23.5 vs 21.3; p=0.022. EM residents had similar scores in all three components of CF when compared to other specialties. Secondary traumatic stress scores for residents who worked greater than 80 hours were higher than residents who worked less than 80 hours (mean score 22.2 vs 19.5; p=0.048, and those with child dependents had higher secondary traumatic stress than those without children (mean score 21.0 vs 19.1; p=0.012. Conclusion: CF scores in EM residents are similar to residents in other surgical and medical specialties. Residents working primarily

  11. [Switch from emergency medicine to disaster medicine].

    Morikawa, Kentaro; Shimizu, Keiki


    Disaster medical system in Japan has been changing after huge disaster attack. Disaster Medical Assistance Team (DMAT) was established on 1995 after the Hanshin-Awaji Great Earthquake and played important role in the Great Eastern Japan Earthquake on 2011. The action of DMAT is specialized within acute phase. Continual medical aid activity is required from acute phase to chronic phase. After DMAT evacuation, Japan Medical Association Team (JMAT), Japanese Red Cross Teams, Medical university teams and many other medical teams work sequentially in the disaster area. On the other hand, unbalance in the disaster area is occurred. Disaster medical coordinator accommodates that unbalance situation. Development of receive system for many medical assistance teams will be required.

  12. Transport accidents among children and adolescents at the emergency service of a teaching hospital in the southern zone of the city of São Paulo☆☆☆

    Gorios, Carlos; de Souza, Renata Maia; Gerolla, Viviane; Maso, Bruno; Rodrigues, Cintia Leci; Armond, Jane de Eston


    Objective to describe the victim profile and circumstances of transport accidents involving children and adolescents who were attended at a teaching hospital in the southern zone of the city of São Paulo. Methods this was an individual observational case series study among patients up to the age of 19 years who were attended at a hospital in the southern zone of the city of São Paulo, state of São Paulo, Brazil, due to traffic accidents. The files notifying suspected or confirmed cases of violence and accidents (SIVVA files) covering January to December 2012 were analyzed. Results among the 149 cases notified, 64.4% related to males and 35.6% to females. The transport accidents were predominantly among males, irrespective of age. The main injury diagnoses were superficial head trauma (24.8%) followed by multiple non-specified trauma (36.4%), in both sexes. Conclusion transport accidents among children and adolescents occurred more often among males. The main transport accidents among the children and adolescents attended as emergency cases were caused by motor vehicles and motorcycles. Among the accident victims, the largest proportion was attended because of being run over. PMID:26229833

  13. Pediatric training in emergency medicine residency programs.

    Ludwig, S; Fleisher, G; Henretig, F; Ruddy, R


    Endorsed emergency medicine (EM) residency programs were surveyed as to the nature and extent of training they provided in pediatric emergency care (PEC). In the surveys returned (82%) there were several important findings. The amount of time in PEC training was generally two months per year of training. This accounted for 16% of training time. However, the volume of pediatric patients was 25% of the overall patient population. There was wide variation in the sites of PEC training. Didactic sessions often did not cover even core topics. The training program directors were equally divided in their satisfaction with this aspect of their programs. Changes were recommended by 80% of the directors. Changes most often suggested were increasing pediatric patient exposure and obtaining PEC specialists as trainers.

  14. History and Guideline of Emergency Medicine Residency Discipline in Shahid Beheshti University of Medical Sciences, Iran; Review of 2014

    Majid Shojaee


    Full Text Available Introduction: Since many years ago several problems have been felt in emergency departments (ED of hospitals. In fact, none of physicians in the hospital have accepted the direct responsibility of patients’ management in the EDs and emergency wards of University centers have been managed by residents of various disciplines. Thus, the first line of therapy does not have guardian and several consultants with various specialists have been performed regarding patient’s management. The necessity of physician training was noticed for the first time in 1950 and after 24 years in 1974, the academic emergency medicine was established in United States of America (USA in response to people expectations for overnight accessibility to specialized and quality medical cares. It was performed with foundation of the first period of resident’s training in emergency medicine discipline at University of Cincinnati, Ohio. At beginning, specialists of different fields such as internal medicine, surgery, anesthesia, orthopedics, and neurosurgery initiated the training of emergency medicine residents together which could be responsible to most of referees. Finally, with formal accepting the specialty board in 1978, this field has been officially identified as the 23th discipline in USA. Today the EDs of most hospitals in European and American countries has been managing by emergency medicine specialists which leads to improve the quality of education and treatment, significantly. Also in Iran the request of establishing this major has been presented in the secretariat of the council for graduate medical education for the first time in 1996. This request was approved and principles of its initiating recognized officially by the ministry of health. But, considering to lack of an appropriate infrastructure, it postponed until 2000 that again this discipline was missioned for initiating to the council for graduate medical education by the minister and its outcome was

  15. Ethical issues in the response to Ebola virus disease in United States emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine.

    Venkat, Arvind; Asher, Shellie L; Wolf, Lisa; Geiderman, Joel M; Marco, Catherine A; McGreevy, Jolion; Derse, Arthur R; Otten, Edward J; Jesus, John E; Kreitzer, Natalie P; Escalante, Monica; Levine, Adam C


    The 2014 outbreak of Ebola virus disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments (EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians (EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD.

  16. Compassion Fatigue is Similar in Emergency Medicine Residents Compared to other Medical and Surgical Specialties

    Bellolio, M. Fernanda; Cabrera, Daniel; Sadosty, Annie T.; Hess, Erik P.; Campbell, Ronna L.; Lohse, Christine M.; Sunga, Karmen L.


    Introduction Compassion fatigue (CF) is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM) resident physicians, including an assessment of contributing factors. Methods We distributed a validated electronic questionnaire consisting of the Professional Quality of Life Scale with subscales for the three components of CF (compassion satisfaction, burnout and secondary traumatic stress), with each category scored independently. We collected data pertaining to day- versus night-shift distribution, hourly workload and child dependents. We included residents in EM, neurology, orthopedics, family medicine, pediatrics, obstetrics, and general surgery. Results We surveyed 255 residents, with a response rate of 75%. Of the 188 resident respondents, 18% worked a majority of their clinical shifts overnight, and 32% had child dependents. Burnout scores for residents who worked greater than 80 hours per week, or primarily worked overnight shifts, were higher than residents who worked less than 80 hours (mean score 25.0 vs 21.5; p=0.013), or did not work overnight (mean score 23.5 vs 21.3; p=0.022). EM residents had similar scores in all three components of CF when compared to other specialties. Secondary traumatic stress scores for residents who worked greater than 80 hours were higher than residents who worked less than 80 hours (mean score 22.2 vs 19.5; p=0.048), and those with child dependents had higher secondary traumatic stress than those without children (mean score 21.0 vs 19.1; p=0.012). Conclusion CF scores in EM residents are similar to residents in other surgical and medical specialties. Residents working primarily night shifts and

  17. The Fukushima Dai-ichi accident: additional lessons from a radiological emergency assistance mission.

    Becker, Steven M


    In response to the March 2011 earthquake-tsunami disaster and the Fukushima Dai-ichi nuclear accident, a special nongovernmental Radiological Emergency Assistance Mission flew to Japan from the United States. Invited by one of Japan's largest hospital and healthcare groups and facilitated by a New York-based international disaster relief organization, the mission included an emergency physician, a health physicist, and a disaster management specialist. During the 10 d mission, team members conducted fieldwork in areas affected by the earthquake, tsunami, and nuclear accident; went to cities and towns in the 20-30 km Emergency Evacuation Preparation Zone around the damaged nuclear plant; visited other communities affected by the nuclear accident; went to evacuation shelters; met with mayors and other local officials; met with central government officials; exchanged observations, experiences, and information with Japanese medical, emergency response, and disaster management colleagues; and provided radiological information and training to more than 1,100 Japanese hospital and healthcare personnel and first responders. The mission produced many insights with potential relevance for radiological/nuclear emergency preparedness and response. The first "lessons learned" were published in December 2011. Since that time, additional broad insights from the mission and mission followup have been identified. Five of these new lessons, which focus primarily on community impacts and responses and public communication issues, are presented and discussed in this article.

  18. The Social Media Index: Measuring the Impact of Emergency Medicine and Critical Care Websites

    Thoma, Brent


    Full Text Available Introduction: The number of educational resources created for emergency medicine and critical care (EMCC that incorporate social media has increased dramatically. With no way to assess their impact or quality, it is challenging for educators to receive scholarly credit and for learners to identify respected resources. The Social Media index (SMi was developed to help address this. Methods: We used data from social media platforms (Google PageRanks, Alexa Ranks, Facebook Likes, Twitter Followers, and Google+ Followers for EMCC blogs and podcasts to derive three normalized (ordinal, logarithmic, and raw formulas. The most statistically robust formula was assessed for 1 temporal stability using repeated measures and website age, and 2 correlation with impact by applying it to EMCC journals and measuring the correlation with known journal impact metrics. Results: The logarithmic version of the SMi containing four metrics was the most statistically robust. It correlated significantly with website age (Spearman r=0.372; p<0.001 and repeated measures through seven months (r=0.929; p<0.001. When applied to EMCC journals, it correlated significantly with all impact metrics except number of articles published. The strongest correlations were seen with the Immediacy Index (r=0.609; p<0.001 and Article Influence Score (r=0.608; p<0.001. Conclusion: The SMi’s temporal stability and correlation with journal impact factors suggests that it may be a stable indicator of impact for medical education websites. Further study is needed to determine whether impact correlates with quality and how learners and educators can best utilize this tool. [West J Emerg Med. 2015;16(2:242–249.

  19. Recommendations from the Society for Academic Emergency Medicine (SAEM) Taskforce on women in academic emergency medicine.

    Kuhn, Gloria J; Abbuhl, Stephanie B; Clem, Kathleen J


    The Society for Academic Emergency Medicine (SAEM) convened a taskforce to study issues pertaining to women in academic emergency medicine (EM). The charge to the Taskforce was to "Create a document for the SAEM Board of Directors that defines and describes the unique recruitment, retention, and advancement needs for women in academic emergency medicine." To this end, the Taskforce and authors reviewed the literature to highlight key data points in understanding this issue and made recommendations for individuals at four levels of leadership and accountability: leadership of national EM organizations, medical school deans, department chairs, and individual women faculty members. The broad range of individuals targeted for recommendations reflects the interdependent and shared responsibility required to address changes in the culture of academic EM. The following method was used to determine the recommendations: 1) Taskforce members discussed career barriers and potential solutions that could improve the recruitment, retention, and advancement of women in academic EM; 2) the authors reviewed recommendations in the literature by national consensus groups and experts in the field to validate the recommendations of Taskforce members and the authors; and 3) final recommendations were sent to all Taskforce members to obtain and incorporate additional comments and ensure a consensus. This article contains those recommendations and cites the relevant literature addressing this topic.

  20. Improving Knowledge and Process for International Emergency Medicine Fellowship Applicants: A Call for a Uniform Application

    Gabrielle A. Jacquet


    Full Text Available Background. There are currently 34 International Emergency Medicine (IEM fellowship programs. Applicants and programs are increasing in number and diversity. Without a standardized application, applicants have a difficulty approaching programs in an informed and an organized method; a streamlined application system is necessary. Objectives. To measure fellows’ knowledge of their programs’ curricula prior to starting fellowship and to determine what percent of fellows and program directors would support a universal application system. Methods. A focus group of program directors, recent, and current fellows convened to determine the most important features of an IEM fellowship application process. A survey was administered electronically to a convenience sample of 78 participants from 34 programs. Respondents included fellowship directors, fellows, and recent graduates. Results. Most fellows (70% did not know their program’s curriculum prior to starting fellowship. The majority of program directors and fellows support a uniform application service (81% and 67%, resp. and deadline (85% for both. A minority of program directors (35% and fellows (30% support a formal match. Conclusions. Program directors and fellows support a uniform application service and deadline, but not a formalized match. Forums for disseminating IEM fellowship information and for administering a uniform application service and deadline are currently in development to improve the process.

  1. Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine.

    Eitel, Dave R; Rudkin, Scott E; Malvehy, M Albert; Killeen, James P; Pines, Jesse M


    Emergency Department (ED) crowding is a common problem in the United States and around the world. Process reengineering methods can be used to understand factors that contribute to crowding and provide tools to help alleviate crowding by improving service quality and patient flow. In this article, we describe the ED as a service business and then discuss specific methods to improve the ED quality and flow. Methods discussed include demand management, critical pathways, process-mapping, Emergency Severity Index triage, bedside registration, Lean and Six Sigma management methods, statistical forecasting, queuing systems, discrete event simulation modeling and balanced scorecards. The purpose of this review is to serve as a background for emergency physicians and managers interested in applying process reengineering methods to improving ED flow, reducing waiting times, and maximizing patient satisfaction. Finally, we present a position statement on behalf of the American Academy of Emergency Medicine addressing these issues.

  2. Morbidity and Mortality Conference in Emergency Medicine Residencies and the Culture of Safety

    Aaronson, Emily L.; Wittels, Kathleen A.; Nadel, Eric S.; Schuur, Jeremiah D.


    Introduction Morbidity and mortality conferences (M+M) are a traditional part of residency training and mandated by the Accreditation Counsel of Graduate Medical Education. This study’s objective was to determine the goals, structure, and the prevalence of practices that foster strong safety cultures in the M+Ms of U.S. emergency medicine (EM) residency programs. Methods The authors conducted a national survey of U.S. EM residency program directors. The survey instrument evaluated five domains of M+M (Organization and Infrastructure; Case Finding; Case Selection; Presentation; and Follow up) based on the validated Agency for Healthcare Research & Quality Safety Culture survey. Results There was an 80% (151/188) response rate. The primary objectives of M+M were discussing adverse outcomes (53/151, 35%), identifying systems errors (47/151, 31%) and identifying cognitive errors (26/151, 17%). Fifty-six percent (84/151) of institutions have anonymous case submission, with 10% (15/151) maintaining complete anonymity during the presentation and 21% (31/151) maintaining partial anonymity. Forty-seven percent (71/151) of programs report a formal process to follow up on systems issues identified at M+M. Forty-four percent (67/151) of programs report regular debriefing with residents who have had their cases presented. Conclusion The structure and goals of M+Ms in EM residencies vary widely. Many programs lack features of M+M that promote a non-punitive response to error, such as anonymity. Other programs lack features that support strong safety cultures, such as following up on systems issues or reporting back to residents on improvements. Further research is warranted to determine if M+M structure is related to patient safety culture in residency programs. PMID:26594271

  3. Morbidity and Mortality Conference in Emergency Medicine Residencies and the Culture of Safety

    Emily L. Aaronson


    Full Text Available Introduction: Morbidity and mortality conferences (M+M are a traditional part of residency training and mandated by the Accreditation Counsel of Graduate Medical Education. This study’s objective was to determine the goals, structure, and the prevalence of practices that foster strong safety cultures in the M+Ms of U.S. emergency medicine (EM residency programs. Methods: The authors conducted a national survey of U.S. EM residency program directors. The survey instrument evaluated five domains of M+M (Organization and Infrastructure; Case Finding; Case Selection; Presentation; and Follow up based on the validated Agency for Healthcare Research & Quality Safety Culture survey. Results: There was an 80% (151/188 response rate. The primary objectives of M+M were discussing adverse outcomes (53/151, 35%, identifying systems errors (47/151, 31% and identifying cognitive errors (26/151, 17%. Fifty-six percent (84/151 of institutions have anonymous case submission, with 10% (15/151 maintaining complete anonymity during the presentation and 21% (31/151 maintaining partial anonymity. Forty-seven percent (71/151 of programs report a formal process to follow up on systems issues identified at M+M. Forty-four percent (67/151 of programs report regular debriefing with residents who have had their cases presented. Conclusion: The structure and goals of M+Ms in EM residencies vary widely. Many programs lack features of M+M that promote a non-punitive response to error, such as anonymity. Other programs lack features that support strong safety cultures, such as following up on systems issues or reporting back to residents on improvements. Further research is warranted to determine if M+M structure is related to patient safety culture in residency programs.

  4. [Chernobyl nuclear power plant accident and Tokaimura criticality accident].

    Takada, Jun


    It is clear from inspection of historical incidents that the scale of disasters in a nuclear power plant accident is quite low level overwhelmingly compared with a nuclear explosion in nuclear war. Two cities of Hiroshima and Nagasaki were destroyed by nuclear blast with about 20 kt TNT equivalent and then approximately 100,000 people have died respectively. On the other hand, the number of acute death is 30 in the Chernobyl nuclear reactor accident. In this chapter, we review health hazards and doses in two historical nuclear incidents of Chernobyl and Tokaimura criticality accident and then understand the feature of the radiation accident in peaceful utilization of nuclear power.

  5. Big data as a new approach in emergency medicine research

    Ho Ting Wong; QianYin; Ying Qi Guo; Kristen Murray; Dong Hau Zhou; Diana Slade


    Big data is a hot topic in the academic sector, and healthcare researchers are definitely not an exception. This article aims to provide a showcase in emergency medicine research to demonstrate the advantages of conducting such research using big data. Big data is a new and cost-effective research approach, and emergency medicine researchers could benefit from using this approach and by doing so producing high-quality research at a faster pace.

  6. Big data as a new approach in emergency medicine research

    Ho Ting Wong


    Full Text Available Big data is a hot topic in the academic sector, and healthcare researchers are definitely not an exception. This article aims to provide a showcase in emergency medicine research to demonstrate the advantages of conducting such research using big data. Big data is a new and cost-effective research approach, and emergency medicine researchers could benefit from using this approach and by doing so producing high-quality research at a faster pace.

  7. [Organisation of emergency medicine in France].

    Braun, Françis


    The French emergency medicine infrastructure (structures de médecine d'urgence) ensures patients care from the very location of the distress to the appropriate hospital department: medical care in the field, by hospital clinical teams (the services mobiles d'urgence et de réanimation [SMUR]), is a key characteristic of our medical emergency response system. Response to medical distress revolves around information about not only the location and characteristics of the medical need, but also the availability of adapted hospital services. Gathering and transmitting this information is the prerogative of the service d'aide médicale d'urgence (SAMU) and its telephone dispatch center (Centre 15). For patients coming directly to the hospital, the emergency room (ER), a former underfunded and neglected hospital service, has become a key point of access. The ER is now responsible, after providing immediate first line care, to guide the patient through the care system. As such they are equipped with short term hospitalization units designed to enable up to 24h patient observation before orientation. This ensemble, networked at the level of a health territory, ensures the quality, safety, and efficacy that the population is entitled to demand.

  8. 硫酸二甲酯泄漏事故消防应急救援与处置探究%Exploration of Fire Emergency Rescue and Disposal of Dimethylsulfate Leakage Accident



    Dimethylsulfate was one of the common dangerous chemicals , as a kind of important chemical raw material, which was mainly used as methylating agent in organic synthesis , widely used in pesticide , medicine, dyes and spices and other industrial production.In the process of production , storage , transportation and use the leaking was easy to cause combustion , explosion and poisoning accidents , and cause casualties and regional pollution.How to dispose of such accidents as soon as possible was introduced , and the study of emergency rescue technology was enhanced to minimize losses caused by disasters.At the same time , the corresponding safety measures were proposed.%硫酸二甲酯是常见的危险化学品之一,作为一种重要的化工原料,工业上主要用作甲基化剂,广泛应用于农药、医药、染料和香料等工业生产方面的有机合成,在生产、储存、运输、使用过程中发生泄漏事故,容易造成人员伤亡和区域性污染。本文介绍了如何尽快处置此类事故,加强应急救援技术的研究,最大限度减少灾害造成的损失,同时提出了相应的消防安全措施建议。

  9. Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine

    Gurley, Kiersten L.; Wolfe, Richard E.; Burstein, Jonathan L.; Edlow, Jonathan A.; Hill, Jason F.; Grossman, Shamai A.


    Introduction The value of using patient- and physician-identified quality assurance (QA) issues in emergency medicine remains poorly characterized as a marker for emergency department (ED) QA. The objective of this study was to determine whether evaluation of patient and physician concerns is useful for identifying medical errors resulting in either an adverse event or a near-miss event. Methods We conducted a retrospective, observational cohort study of consecutive patients presenting between January 2008 and December 2014 to an urban, tertiary care academic medical center ED with an electronic error reporting system that allows physicians to identify QA issues for review. In our system, both patient and physician concerns are reviewed by physician evaluators not involved with the patients’ care to determine if a QA issue exists. If a potential QA issue is present, it is referred to a 20-member QA committee of emergency physicians and nurses who make a final determination as to whether or not an error or adverse event occurred. Results We identified 570 concerns within a database of 383,419 ED presentations, of which 33 were patient-generated and 537 were physician-generated. Out of the 570 reports, a preventable adverse event was detected in 3.0% of cases (95% CI = [1.52–4.28]). Further analysis revealed that 9.1% (95% CI = [2–24]) of patient complaints correlated to preventable errors leading to an adverse event. In contrast, 2.6% (95% CI = [2–4]) of QA concerns reported by a physician alone were found to be due to preventable medical errors leading to an adverse event (p=0.069). Near-miss events (errors without adverse outcome) trended towards more accurate reporting by physicians, with medical error found in 12.1% of reported cases (95% CI = [10–15]) versus 9.1% of those reported by patients (95% CI = [2–24] p=0.079). Adverse events in general that were not deemed to be due to preventable medical error were found in 12.1% of patient complaints (95

  10. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013).

    Cadogan, Mike; Thoma, Brent; Chan, Teresa M; Lin, Michelle


    Disruptive technologies are revolutionising continuing professional development in emergency medicine and critical care (EMCC). Data on EMCC blogs and podcasts were gathered prospectively from 2002 through November 2013. During this time there was a rapid expansion of EMCC websites, from two blogs and one podcast in 2002 to 141 blogs and 42 podcasts in 2013. This paper illustrates the explosive growth of EMCC websites and provides a foundation that will anchor future research in this burgeoning field.

  11. Definition of Specific Functions and Procedural Skills Required by Cuban Specialists in Intensive Care and Emergency Medicine.

    Véliz, Pedro L; Berra, Esperanza M; Jorna, Ana R


    INTRODUCTION Medical specialties' core curricula should take into account functions to be carried out, positions to be filled and populations to be served. The functions in the professional profile for specialty training of Cuban intensive care and emergency medicine specialists do not include all the activities that they actually perform in professional practice. OBJECTIVE Define the specific functions and procedural skills required of Cuban specialists in intensive care and emergency medicine. METHODS The study was conducted from April 2011 to September 2013. A three-stage methodological strategy was designed using qualitative techniques. By purposive maximum variation sampling, 82 professionals were selected. Documentary analysis and key informant criteria were used in the first stage. Two expert groups were formed in the second stage: one used various group techniques (focus group, oral and written brainstorming) and the second used a three-round Delphi method. In the final stage, a third group of experts was questioned in semistructured in-depth interviews, and a two-round Delphi method was employed to assess priorities. RESULTS Ultimately, 78 specific functions were defined: 47 (60.3%) patient care, 16 (20.5%) managerial, 6 (7.7%) teaching, and 9 (11.5%) research. Thirty-one procedural skills were identified. The specific functions and procedural skills defined relate to the profession's requirements in clinical care of the critically ill, management of patient services, teaching and research at the specialist's different occupational levels. CONCLUSIONS The specific functions and procedural skills required of intensive care and emergency medicine specialists were precisely identified by a scientific method. This product is key to improving the quality of teaching, research, administration and patient care in this specialty in Cuba. The specific functions and procedural skills identified are theoretical, practical, methodological and social contributions to

  12. Osteopathic Emergency Medicine Programs Infrequently Publish in High-Impact Emergency Medicine Journals

    Sean M. Baskin


    Full Text Available Introduction: Both the Accreditation Council for Graduate Medical Education (ACGME and the American Osteopathic Association (AOA require core faculty to engage in scholarly work, including publication in peer-reviewed journals. With the ACGME/AOA merger, we sought to evaluate the frequency of publication in high-impact peer-reviewed EM journals from authors affiliated with osteopathic emergency medicine (EM programs. Methods: We performed a retrospective literature review using the Journal Citation Report database and identified the top five journals in the category of ‘Emergency Medicine’ by their 2011 Impact Factor. We examined all publications from each journal for 2011. For each article we recorded article type, authors’ names, position of authorship (first, senior or other, the author’s degree and affiliated institution. We present the data in raw numbers and percentages.  Results: The 2011 EM journals with the highest impact factor were the following: Annals of Emergency Medicine, Resuscitation, Journal of Trauma, Injury, and Academic Emergency Medicine. Of the 9,298 authors published in these journals in 2011; 1,309 (15% claimed affiliation with U.S.-based EM programs, of which 16 (1% listed their affiliations with eight different osteopathic EM programs. The 16 authors claimed affiliation with 8 of 46 osteopathic EM programs (17%, while 1,301 authors claimed affiliation with 104 of 148 (70% U.S.-based allopathic programs.   Conclusion: Authors from osteopathic EM programs are under-represented in the top EM journals. With the pending ACGME/AOA merger, there is a significant opportunity for improvement in the rate of publication of osteopathic EM programs in top tier EM journals. [West J Emerg Med. 2014;15(7:-0.

  13. The Geneva Conferences and the emergence of the International Network for Person-centered Medicine.

    Mezzich, Juan E


    The yearly Geneva Conferences on Person-centered Medicine started in May 2008 as a collaborative effort of global medical and health organizations and committed clinicians and scholars to place the whole person at the centre of medicine and health care. They were informed by the traditions of great ancient civilizations and recent developments in clinical care and public health. The process of the Geneva Conferences led to the development of the International Network for Person-centered Medicine as a non-for-profit institution aimed at organizing future editions of the Geneva Conference and building person-centred medicine as a paradigmatic repriorizing of the medical and health fields in collaboration inter alia with the World Medical Association, the World Health Organization and the World Organization of Family Doctors.

  14. Integrating quantitative and qualitative methodologies for the assessment of health care systems: emergency medicine in post-conflict Serbia

    VanRooyen Michael J


    Full Text Available Abstract Background Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment – combining quantitative and qualitative methodologies – may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. Methods Integrated quantitative and qualitative methodologies – system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis – were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. Results Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. Conclusions By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings.

  15. Nanorobots: The Emerging tools in Medicinal

    Dron P. Modi


    Full Text Available Nowadays medical science is more and more improving with the blessings of new scientific discoveries. Nanotechnology is such a field which is changing vision of medical science. New automated procedures are being discovered with new aspects of self-guided nanorobots. Nanorobot is an excellent tool for future medicine. We can envision a day when you could inject billions of these nanorobots that would float around in your body. Nanorobots could carry and deliver drugs into defected cells. These nanorobots will be able to repair tissues, clean blood vessels and airways, transform our physiological capabilities, and even potentially counter act the aging process. Many scientists working on this bright field of nanorobots especially on Alzheimer disease and cancer treatments. The engineering of molecular products needs to be carried out by robotic devices, which have been termed Nano robots. Nano robotics, sometimes referred to as molecular robotics, is an emerging research area as evidenced by recent topics in the literature. A multifunctional platform based on nanorobots, with various types of nanomachines will surely fight against major diseases like cancer, HIV etc. In this review, we will summarize briefly about nanorobots and its tools, mechanism, approaches and main futuristic applications of the same which mainly useful for medicinal and to develop new formulations related to nanotechnology to cure the major diseases.

  16. Learning from incidents and accidents

    Drupsteen, L.; Kampen, J. van


    There are many different definitions for what constitutes an incident or an accident, however the focus is always on unintended and often unforeseen events that cause unintended consequences. This article is focused on the process of learning from incidents and accidents. The focus is on making sure

  17. New diploma in emergency medicine in France: the students' perspective.

    Dehours, Emilie; Vallé, Baptiste; Concina, François; Bounes, Vincent; Ducassé, Jean-Louis; Lauque, Dominique


    French emergency medicine (EM) has undergone rapid changes with the establishment of a diploma in emergency medicine (DES). We aimed to question medicine students on their knowledge of and apprehensions regarding this new DES. We conducted an email cross-sectional survey among second-cycle medical students before their choice of resident speciality. This included a demographic study and an evaluation of the willingness to choose emergency specialization. Two thousand and three fully completed questionnaires were analysed. Twenty-six per cent of the students (n=524) planned to choose emergency specialization and 54% of the students (n=1084) knew that emergency specialization would be proposed as a full speciality. Seventy-six per cent of students considered it tough to practice as an entire career. This study clearly shows that EM represents an attractive option for medical students. The establishment of DES represents a major step in the improvement of EM.

  18. [Violence and accidents among older and younger adults: evidence from the Surveillance System for Violence and Accidents (VIVA), Brazil].

    Luz, Tatiana Chama Borges; Malta, Deborah Carvalho; Sá, Naíza Nayla Bandeira de; Silva, Marta Maria Alves da; Lima-Costa, Maria Fernanda


    Data from the Brazilian Surveillance System for Violence and Accidents (VIVA) in 2009 were used to examine socio-demographic characteristics, outcomes, and types of accidents and violence treated at 74 sentinel emergency services in 23 Brazilian State capitals and the Federal District. The analysis included 25,201 individuals aged > 20 years (10.1% > 60 years); 89.3% were victims of accidents and 11.9% victims of violence. Hospitalization was the outcome in 11.1% of cases. Compared to the general population, there were more men and non-white individuals among victims of accidents, and especially among victims of violence. As compared to younger adults (20-59 years), accidents and violence against elderly victims showed less association with alcohol, a higher proportion of domestic incidents, more falls and pedestrian accidents, and aggression by family members. Policies for the prevention of accidents and violence should consider the characteristics of these events in the older population.

  19. Nurses' attitudes towards suicidal behaviour--a comparative study of community mental health nurses and nurses working in an accidents and emergency department.

    Anderson, M


    The purpose of this study was to explore and compare the attitudes towards suicidal behaviour of community mental health nurses (CMHNs) and registered nurses working in an accidents and emergency (A&E) department. The sample consisted of 80 nurses working in the same locality. An instrument was designed using statements from Domino's 'Suicide Opinion Questionnaire' (SOQ) and new statements based on a comprehensive survey of research in this area. The instrument contained four attitudinal categories consisting of; acceptability; morality and mental illness; professional role, work and care; and communication and attention. Results reveal that both groups of nurses held generally positive attitudes towards suicidal behaviour, contrasting with previous studies where more negative attitudes amongst nurses were found. A t-test showed no statistically significant differences between the two groups of nurses in any of the four attitudinal categories. Attitudes were significantly different in accordance with nurses' length of experience and age within both groups. Further research is needed in this area if nurses are to develop their role alongside other professionals working towards the objectives of suicide prevention policies.

  20. Personalized medicine and the role of health economics and outcomes research: issues, applications, emerging trends, and future research.

    O'Donnell, John C


    The decade since the completion of the sequencing of the human genome has witnessed significant advances in the incorporation of genomic information in diagnostic, treatment, and reimbursement practices. Indeed, as case in point, there are now several dozen commercially available genomic tests routinely applied across a wide range of disease states in predictive or prognostic applications. Moreover, many involved in the advancement of personalized medicine would view emerging approaches to stratify patients in meaningful ways beyond genomic information as a signal of the progress made. Yet despite these advances, there remains a general sense of dissatisfaction about the progress of personalized medicine in terms of its contribution to the drug development process, to the efficiency and effectiveness of health care delivery, and ultimately to the provision of the right treatment to the right patient at the right time. Academicians, payers, and manufacturers alike are struggling not only with how to embed the new insights that personalized medicine promises but also with the fundamental issues of application in early drug development, implications for health technology assessment, new demands on traditional health economic and outcomes research methods, and implications for reimbursement and access. In fact, seemingly prosaic issues such as the definition and composition of the term "personalized medicine" are still unresolved. Regardless of these issues, practitioners are increasingly compelled to find practical solutions to the challenges and opportunities presented by the evolving face of personalized medicine today. Accordingly, the articles comprising this Special Issue offer applied perspectives geared toward professionals and policymakers in the field grappling with developing, assessing, implementing, and reimbursing personalized medicine approaches. Starting with a framework with which to characterize personalized medicine, this Special Issue proceeds to

  1. A Model Longitudinal Observation Medicine Curriculum for an Emergency Medicine Residency.

    Wheatley, Matthew; Baugh, Christopher; Osborne, Anwar; Clark, Carol; Shayne, Philip; Ross, Michael


    The role of observation services for emergency department patients has increased in recent years. Driven by changing health care practices and evolving payer policies, many hospitals in the United States currently have or are developing an observation unit (OU) and emergency physicians are most often expected to manage patients in this setting. Yet, few residency programs dedicate a portion of their clinical curriculum to observation medicine. This knowledge set should be integrated into the core training curriculum of emergency physicians. Presented here is a model observation medicine longitudinal training curriculum, which can be integrated into an emergency medicine (EM) residency. It was developed by a consensus of content experts representing the observation medicine interest group and observation medicine section, respectively, from EM's two major specialty societies: the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP). The curriculum consists of didactic, clinical, and self-directed elements. It is longitudinal, with learning objectives for each year of training, focusing initially on the basic principles of observation medicine and appropriate observation patient selection; moving to the management of various observation appropriate conditions; and then incorporating further concepts of OU management, billing, and administration. This curriculum is flexible and designed to be used in both academic and community EM training programs within the United States. Additionally, scholarly opportunities, such as elective rotations and fellowship training, are explored.

  2. A one-time-only combination: Emergency medicine exports and the TRIPS agreement under Canada's access to medicines regime.

    Weber, Ashley; Mills, Lisa


    In 2008, a Canadian generic pharmaceutical firm, Apotex Inc. (Apotex), shipped 7 million doses of antiretroviral drugs to Rwanda for the treatment of HIV/AIDS. While this event may be seen as a positive outcome of international patent changes that facilitate the fulfillment of health as a human right, the fact that there has been only one shipment of medication in response to these changes highlights the difficulties with both the Canadian legislation and with the international decisions that it implements. The shipment was authorized under Canada's Access to Medicines Regime (CAMR), which implements the World Trade Organization (WTO) General Council Decision (the Decision), made in 2003, to permit someone other than the patent holder to manufacture a lower-cost version of a patented drug or medical device for export to developing countries that do not have the capacity to manufacture such products. The Decision requires that the developing country announce its intention to use this mechanism, to specify the expected quantity of drugs to be supplied, and to issue a compulsory license for the drugs. The requirement of notification in particular may render developing countries vulnerable to pressure from pharmaceutical firms. Neither the mechanism created by the Decision nor Canadian legislation implementing it have facilitated the export of generic medicines to developing countries. To date, the Canadian shipment is the only one to have occurred using the WTO mechanism.

  3. Selecting emergency medicine: rationales from perspective of Iranian residents.

    Shervin Farahmand


    Full Text Available Emergency medicine is a relatively new specialty in Iran. Therefore, the general public and the medical community do not have enough information on its duties, capabilities, its nature, and its work schedule or its degree of occupational difficulty compared to other specialties. Hence, an insight from the early group of residents who selected this specialty can help identify the strengths and weaknesses of this field in order to promote the scientific quality of this field, and attract medical students. It can also help to alleviate deficiencies and strengthen positive aspects of emergency medicine. The aim of this study was to identify the reasons behind choosing emergency medicine as a specialty. A qualitative study was conducted using semi-structured interviews. Maximum variation opportunistic sampling was done, and face-to-face interviews were held with 23 emergency medicine residents and fellows (4 faculty members and 19 residents. Data were analyzed through thematic analysis, and categories and themes were extracted. The main levels extracted were: 1 Individual priorities, 2 the nature of work and the field of study, and 3 professional future. The themes of each main level were extracted and encoded. This study showed that the majority of residents choose emergency medicine specialty to achieve a better social and professional status in one of the most challenging fields of medicine.

  4. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...


    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety Foundation AGENCY: Agency for Healthcare Research and... relinquishment from Emergency Medicine Patient Safety Foundation of its status as a Patient Safety...

  5. International Federation for Emergency Medicine point of care ultrasound curriculum.

    Atkinson, Paul; Bowra, Justin; Lambert, Mike; Lamprecht, Hein; Noble, Vicki; Jarman, Bob


    To meet a critical and growing need for a standardized approach to emergency point of care ultrasound (PoCUS) worldwide, emergency physicians must be trained to deliver and teach this skill in an accepted and reliable format. Currently, there is no globally recognized, standard PoCUS curriculum that defines the accepted applications, as well as standards for training and practice of PoCUS by specialists and trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM) convened a sub-committee of international experts in PoCUS to outline a curriculum for training of specialists in emergency PoCUS. This curriculum document represents the consensus of recommendations by this sub-committee. The curriculum is designed to provide a framework for PoCUS education in emergency medicine. The focus is on the processes required to select core and enhanced applications, as well as the key elements required for the delivery of PoCUS training from introduction through to continuing professional development and skill maintenance. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance PoCUS education in emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to develop PoCUS training programs within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational environment, resources and goals of educational programs.

  6. Emergency Medicine in Remote Regions.

    Renouf, Tia; Pollard, Megan


    Rural and remote places like Sable Island (Nova Scotia) or François (Newfoundland) pose a challenge in delivering both health care and appropriate education that today's learners need to practice in a rural setting. This education can be difficult to deliver to students far from academic centers. This is especially true for learners and practitioners at offshore locations like ships, oil installations, or in the air when patients are transported via fixed wing aircraft or helicopter. The following editorial provides a snapshot of the setting and the challenges faced while working as a physician on a ship, in remote regions.

  7. Emergency control system based on the analytical hierarchy process and coordinated development degree model for sudden water pollution accidents in the Middle Route of the South-to-North Water Transfer Project in China.

    Long, Yan; Xu, Guobin; Ma, Chao; Chen, Liang


    Water transfer projects are important for realizing reasonable allocation of water resources, but once a water pollution accident occurs during such a project, the water environment is exposed to enormous risks. Therefore, it is critical to determine an appropriate emergency control system (ECS) for sudden water pollution accidents that occur in water transfer projects. In this study, the analytical hierarchy process (AHP) integrated with the coordinated development degree model (CDDM) was used to develop the ECS. This ECS was developed into two parts, including the emergency risk assessment and the emergency control. Feasible emergency control targets and control technology were also proposed for different sudden water pollution accidents. A demonstrative project was conducted in the Fangshui to Puyang channel, which is part of the Beijing-Shijiazhuang Emergency Water Supply Project (BSP) in the Middle Route of the South-to-North Water Transfer Project (MR-SNWTP) in China. However, we could not use an actual toxic soluble pollutant to validate our ECS, so we performed the experiment with sucrose to test the ECS based on its concentration variation. The relative error of peak sucrose concentration was less than 20 %.

  8. Thorax, Trachea, and Lung Ultrasonography in Emergency and Critical Care Medicine: Assessment of an Objective Structured Training Concept

    Raoul Breitkreutz


    Full Text Available Background and Study objective. Focused lung ultrasound (LUS examinations are important tools in critical care medicine. There is evidence that LUS can be used for the detection of acute thoracic lesions. However, no validated training method is available. The goal of this study was to develop and assess an objective structured clinical examination (OSCE curriculum for focused thorax, trachea, and lung ultrasound in emergency and critical care medicine (THOLUUSE. Methods. 39 trainees underwent a one-day training course in a prospective educational study, including lectures in sonoanatomy and -pathology of the thorax, case presentations, and hands-on training. Trainees’ pre- and posttest performances were assessed by multiple choice questionnaires, visual perception tests by interpretation video clips, practical performance of LUS, and identification of specific ultrasound findings. Results. Trainees postcourse scores of correct MCQ answers increased from 56±4% to 82±2% (mean± SD; P<0.001; visual perception skills increased from 54±5% to 78±3% (P<0.001; practical ultrasound skills improved, and correct LUS was performed in 94%. Subgroup analysis revealed that learning success was independent from the trainees’ previous ultrasound experience. Conclusions. THOLUUSE significantly improves theoretical and practical skills for the diagnosis of acute thoracic lesions. We propose to implement THOLUUSE in emergency medicine training.

  9. Chernobyl accident and its consequences

    Gittus, J.H.; Bonell, P.G.; Hicks, D.


    The USSR power reactor programme is first described. The reasons for the accident at the Chernobyl-4 RBMK nuclear reactor on 26 April 1986, the sequence of events that took place, and the immediate and long-term consequences are considered. A description of the RBMK-type reactors is given and the design changes resulting from the experience of the accident are explained. The source terms describing the details of the radioactivity release associated with the accident and the environmental consequences are covered in the last two sections of the report. Throughout the text comments referring to the UK Nuclear Installations Inspectorate Safety assessment principles have been inserted. (U.K.).

  10. An innovative longitudinal curriculum to increase emergency medicine residents’ exposure to rarely encountered and technically challenging procedures

    Grall KH


    Full Text Available Kristi H Grall,1 Lisa R Stoneking,1 Lawrence A DeLuca,1 Anna L Waterbrook,1 T Gail Pritchard,2,3 Kurt R Denninghoff1 1Department of Emergency Medicine, The College of Medicine, The University of Arizona, 2Office Medical Student Education, 3Office of Graduate Medical Education, The College of Medicine, The University of Arizona, Tucson, AZ, USA Background: Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents’ procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation. Methods: We developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills. A departmental expert directed each session with collaboration from colleagues in related subspecialties. Sessions were developed based on Manthey and Fitch’s stages of procedural competency including 1 knowledge acquisition, 2 experience/technical skill development, and 3 competency evaluation. We then distributed a brief, 10-question, online survey to our residents in order to solicit feedback regarding their perceptions of increased knowledge and ability in uncommon and common emergency medical procedures, and their perception of the effectiveness of integrated cognitive training with hands-on instruction through high- and low-fidelity simulation. Results: Fifty percent of our residents (11/22 responded to our survey. Responses indicated the procedure series helped with understanding of both uncommon (65% strongly agreed [SA], 35% agreed [A] and common (55% SA, 45% A emergency medicine procedures and increased residents’ ability to perform uncommon (55% SA, 45% A and common (45% SA, 55% A emergency medical procedures. In addition, survey results

  11. Education and training for medicines development, regulation and clinical research in emerging countries.

    Sandor - Kerpel-Fronius


    Full Text Available The aim of this satellite workshop held at the 17th World Congress of Basic and Clinical Pharmacology (WCP2014 was to discuss the needs, optimal methods and practical approaches for extending education teaching of medicines development, regulation and clinical research to Low and Middle Income Countries (LMIC’s. It was generally agreed that, for efficiently treating the rapidly growing number of patients suffering from non-communicable diseases, modern drug therapy has to become available more widely and with a shorter time lag in these countries. To achieve this goal many additional experts working in medicines development, regulation and clinical research have to be trained in parallel. The competence-oriented educational programs designed within the framework of the European Innovative Medicine Initiative-PharmaTrain (IMI-PhT project were developed with the purpose to cover these interconnected fields. In addition, the programs can be easily adapted to the various local needs, primarily due to their modular architecture and well defined learning outcomes. Furthermore, the program is accompanied by stringent quality assurance standards which are essential for providing internationally accepted certificates. Effective cooperation between international and local experts and organizations, the involvement of the industry, health care centers and governments is essential for successful education. The initiative should also support the development of professional networks able to manage complex health care strategies. In addition it should help establish cooperation between neighboring countries for jointly managing clinical trials, as well as complex regulatory and ethical issues.

  12. Emergency Treatment and Prevention Measures of Chlorine Gas Accidents%氯气事故的处置措施与预防



    主要介绍氯气的制备发展史,及其物理、化学性质。通过实例说明氯气泄漏事故给人民的生命、财产造成极大的损失和对环境造成的严重污染和破坏。对氯气泄漏后的应急处置方法和泄漏预防措施进行简要概述。%Introduced the history of the development of the preparation of chlorine, the physical and chemical property of chlorine. Through several examples that the leakage accidents of chlorine gas threat people's life , brought a great loss of property and cause serious pollution and destruction to the environment. A brief overview was taken in this thesis that the disposal method and the leakage prevention measures of chlorine for the consequence of the chlorine leaking emergency.

  13. MDCT findings in sports and recreational accidents

    Bensch, Frank V; Koivikko, Mika P; Koskinen, Seppo K (Dept. of Radiology, Toeoeloe Hospital, Helsinki (Finland)), email:


    Background. Sports and recreational accidents involving critical areas of the body occur commonly in the general population. Reports on their demographics and recommendations for screening procedures are, however, few. Purpose. To assess injuries of the craniofacial area, spine, and torso resulting from sports and recreational accidents with multidetector computed tomography (MDCT) as primary imaging method in a Level I trauma center. Material and Methods. All emergency room CT requests over a time span of 105 months were reviewed retrospectively for trauma mechanism and injury. Patients were identified using an electronic picture archiving and communications system (PACS), and MDCT studies interpreted by two radiologists independently. Results. Of a total of 5898 patients, 492 patients (301 boys/men, 191 girls/women, age range 2-76 years, mean 33.5 years, median 29.5 years) with sports or recreational accidents emerged. A total of 102 traumatic findings were diagnosed, thereof 72 (71%) serious. The three most commonly encountered serious injuries were intracranial injury, fractures of facial bones, and vertebral injuries. The three most common injury mechanisms were bicycling, horseback riding, and team ball sports. Patients from recreational activities were on average significantly younger (29.2 years) than those from sports accidents (36.9 years; P < 0.001). Only age groups <21 years and 41-50 years differed in injury severity from the other age groups (P = 0.004 and P = 0.063, respectively). Of all trauma mechanisms, only bicycling had a significantly increased risk of injury (P < 0.001). Conclusion. Injuries in sports and recreational accidents presented with an overall incidence of 21%, of which 71% are serious. The most common mechanisms of injury were bicycling, horseback riding, and team ball sports. The largest incidence of serious injury involved bicycling. Because of the high probability of a serious injury and the high energies that are often involved

  14. A two-stage optimization model for emergency material reserve layout planning under uncertainty in response to environmental accidents.

    Liu, Jie; Guo, Liang; Jiang, Jiping; Jiang, Dexun; Liu, Rentao; Wang, Peng


    In the emergency management relevant to pollution accidents, efficiency emergency rescues can be deeply influenced by a reasonable assignment of the available emergency materials to the related risk sources. In this study, a two-stage optimization framework is developed for emergency material reserve layout planning under uncertainty to identify material warehouse locations and emergency material reserve schemes in pre-accident phase coping with potential environmental accidents. This framework is based on an integration of Hierarchical clustering analysis - improved center of gravity (HCA-ICG) model and material warehouse location - emergency material allocation (MWL-EMA) model. First, decision alternatives are generated using HCA-ICG to identify newly-built emergency material warehouses for risk sources which cannot be satisfied by existing ones with a time-effective manner. Second, emergency material reserve planning is obtained using MWL-EMA to make emergency materials be prepared in advance with a cost-effective manner. The optimization framework is then applied to emergency management system planning in Jiangsu province, China. The results demonstrate that the developed framework not only could facilitate material warehouse selection but also effectively provide emergency material for emergency operations in a quick response.

  15. Emergency Response System for Pollution Accidents in Chemical Industrial Parks, China.

    Duan, Weili; He, Bin


    In addition to property damage and loss of lives, environment pollution, such as water pollution and air pollution caused by accidents in chemical industrial parks (CIPs) is a significant issue in China. An emergency response system (ERS) was therefore planned to properly and proactively cope with safety incidents including fire and explosions occurring in the CIPs in this study. Using a scenario analysis, the stages of emergency response were divided into three levels, after introducing the domino effect, and fundamental requirements of ERS design were confirmed. The framework of ERS was composed mainly of a monitoring system, an emergency command center, an action system, and a supporting system. On this basis, six main emergency rescue steps containing alarm receipt, emergency evaluation, launched corresponding emergency plans, emergency rescue actions, emergency recovery, and result evaluation and feedback were determined. Finally, an example from the XiaoHu Chemical Industrial Park (XHCIP) was presented to check on the integrality, reliability, and maneuverability of the ERS, and the result of the first emergency drill with this ERS indicated that the developed ERS can reduce delays, improve usage efficiency of resources, and raise emergency rescue efficiency.

  16. Emergency Response System for Pollution Accidents in Chemical Industrial Parks, China

    Weili Duan


    Full Text Available In addition to property damage and loss of lives, environment pollution, such as water pollution and air pollution caused by accidents in chemical industrial parks (CIPs is a significant issue in China. An emergency response system (ERS was therefore planned to properly and proactively cope with safety incidents including fire and explosions occurring in the CIPs in this study. Using a scenario analysis, the stages of emergency response were divided into three levels, after introducing the domino effect, and fundamental requirements of ERS design were confirmed. The framework of ERS was composed mainly of a monitoring system, an emergency command center, an action system, and a supporting system. On this basis, six main emergency rescue steps containing alarm receipt, emergency evaluation, launched corresponding emergency plans, emergency rescue actions, emergency recovery, and result evaluation and feedback were determined. Finally, an example from the XiaoHu Chemical Industrial Park (XHCIP was presented to check on the integrality, reliability, and maneuverability of the ERS, and the result of the first emergency drill with this ERS indicated that the developed ERS can reduce delays, improve usage efficiency of resources, and raise emergency rescue efficiency.

  17. Internal medicine and emergency admissions: from a national hospital discharge records (SDO study to a regional analysis

    Filomena Pietrantonio


    Full Text Available In Italy, the number of internists has grown by 10% since 1990 reaching 11,435 units, they manage 39,000 beds in 1060 Internal Medicine (IM wards. The Internists are expected to ensure a cost-effective management of poly-pathological and complex patients. A collaborative study between the Federation of Associations of Hospital Doctors on Internal Medicine (FADOI and the Consortium for Applied Health Economics Research (C.R.E.A. Sanità based on data from hospital discharge records has been conducted starting from November 2014. In this article the preliminary results are shown with focus on emergency admissions characteristics to contribute to define the role of hospital IM. Evaluation is performed comparing emergency and planned admissions, IM impact on hospital admissions, availability of community-based healthcare services, diagnosis-related groups (DRGs weight in IM and regional differences in managing hospital admissions with focus on IM department. In 2013 IM wards discharged 1,073,526 patients (16.18% of the total discharged by hospitals with a total economic value of 3,426,279.88 € (average DRG 3882.80 €, from 3682.19 to 4083.42. The average length of stay (LOS in IM was 9.3 days. IM covers 27% of admissions from Emergency Room. Determinants significantly affecting the emergency admissions are old age and comorbidities of the patients that also have a role in increasing LOS. 55% of Italian hospital admissions are emergency admissions. Hospitalization rates in emergency are systematically higher than those in election and the greatest differences are in the regions with inefficiently organized regional network. The role of the hospital IM appears central in the offer of beds to the emergency room by accepting 27% of urgent admissions. The increasing impact of IM on hospital management will put the internists as authoritative stakeholders in health policy.

  18. Developing a curriculum framework for global health in family medicine: emerging principles, competencies, and educational approaches

    Wilson Briana


    Full Text Available Abstract Background Recognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs. Methods A working group comprised of global health educators from Ontario's six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes for Canadian Family Medicine training. Results The main outcome was an evidence-informed interactive framework to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontario's family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies. Conclusions The shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the

  19. Comparative analysis on emergency management for leakage explosion accidents of urban oil and gas pipeline%城市油气管道泄漏爆炸重大案例应急管理对比研究

    李晶晶; 朱渊; 陈国明; 李修峰


    The extraordinary serious accident of Dongying-Huangdao oil pipeline leakage explosion in Qingdao , Shandong, has aroused public concern nationwide about urban oil and gas pipeline safety .In recent years, acci-dents in urban oil and gas pipeline frequently occurred , which seriously indicate the major problems existed in se-curity management .Comparative analysis was carried out based on similar accident investigation , between sewer network explosion in Guadalajara Mexico and Dongying-Huangdao oil pipeline leakage explosion in Qingdao Shang-dong .According to the accident-causing theory , the developing trend of accident was explored and chain model was established .Combined the concept of emergency management , common issues were analyzed during the process from pre-warning and pre-control , emergency disposal , assessment and recovery .Control measures were proposed in each stage of emergency management , by learning from the lessons of accidents , in order to reduce the probabili-ty of accidents and enhance the capability of emergency manage .%青岛东黄输油管道泄漏爆炸特别重大事故,引起公众对城市油气管道安全的普遍关注。近年来,城市油气管道事故频繁发生,反映出我国在城市地下管道安全管理方面存在较大问题。基于国内外管道相似事故调研,选取墨西哥瓜达拉哈拉管道泄漏爆炸事故和青岛东黄输油管道泄漏爆炸事故进行对比分析。基于事故致因理论,探究事故发展模式,建立事故链模型。结合应急管理思想,从预警预控、应急处置、评估恢复角度分析事故应急管理过程的共性失误。最后,针对应急管理各阶段共性失误提出防范措施,对提高类似事故的应急管理能力具有一定的参考意义。

  20. Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?

    Dustin Smith, MD


    Full Text Available Introduction: Work interruptions during patient care have been correlated with error. Task-switching is identified by the Accreditation Council for Graduate Medical Education (ACGME as a core competency for emergency medicine (EM. Simulation has been suggested as a means of assessing EM core competencies. We assumed that senior EM residents had better task-switching abilities than junior EM residents. We hypothesized that this difference could be measured by observing the execution of patient care tasks in the simulation environment when a patient with a ST-elevation myocardial infarction (STEMI interrupted the ongoing management of a septic shock case. Methods: This was a multi-site, prospective, observational, cohort study. The study population consisted of a convenience sample of EM residents in their first three years of training. Each subject performed a standardized simulated encounter by evaluating and treating a patient in septic shock. At a predetermined point in every sepsis case, the subject was given a STEMI electrocardiogram (ECG for a separate chest pain patient in triage and required to verbalize an interpretation and action. We scored learner performance using a dichotomous checklist of critical actions covering sepsis care, ECG interpretation and triaging of the STEMI patient. Results: Ninety-one subjects participated (30 postgraduate year [PGY]1s, 32 PGY2s, and 29 PGY3s. Of those, 87 properly managed the patient with septic shock (90.0% PGY1s, 100% PGY2, 96.6% PGY 3s; p=0.22. Of the 87 who successfully managed the septic shock, 80 correctly identified STEMI on the simulated STEMI patient (86.7% PGY1s, 96.9% PGY2s, 93.1% PGY3s; p=0.35. Of the 80 who successfully managed the septic shock patient and correctly identified the STEMI, 79 provided appropriate interventions for the STEMI patient (73.3% PGY1s, 93.8% PGY2s, 93.8% PGY3s; p=0.07. Conclusion: When management of a septic shock patient was interrupted with a STEMI ECG in a

  1. Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents

    Daniel J. Kim


    Full Text Available Introduction: Starting in 2008, emergency ultrasound (EUS was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College emergency medicine (EM training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. Methods: This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5 EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Results: Survey response rate was 95% (37/39. EUS was part of the formal residency curriculum for 86% of respondents (32/37. Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37] was an ultrasound course, 73% (27/37 of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37] made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. Conclusion: EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs.

  2. Mentoring During Medical School and Match Outcome Among Emergency Medicine Residents

    Erin Dehon


    Full Text Available Introduction: Few studies have documented the value of mentoring for medical students, and research has been limited to more subjective (e.g., job satisfaction, perceived career preparation rather than objective outcomes. This study examined whether having a mentor is associated with match outcome (where a student matched based on their rank order list [ROL]. Methods: We sent a survey link to all emergency medicine (EM program coordinators to distribute to their residents. EM residents were surveyed about whether they had a mentor during medical school. Match outcome was assessed by asking residents where they matched on their ROL (e.g., first choice, fifth choice. They were also asked about rank in medical school, type of degree (MD vs. DO, and performance on standardized tests. Residents who indicated having a mentor completed the Mentorship Effectiveness Scale (MES, which evaluates behavioral characteristics of the mentor and yields a total score. We assessed correlations among these variables using Pearson’s correlation coefficient. Post-hoc analysis using independent sample t-test was conducted to compare differences in the MES score between those who matched to their first or second choice vs. third or higher choice. Results: Participants were a convenience sample of 297 EM residents. Of those, 199 (67% reported having a mentor during medical school. Contrary to our hypothesis, there was no significant correlation between having a mentor and match outcome (r=0.06, p=0.29. Match outcome was associated with class rank (r=0.13, p=0.03, satisfaction with match outcome (r= -0.37, p<0.001, and type of degree (r=0.12, p=0.04. Among those with mentors, a t-test revealed that the MES score was significantly higher among those who matched to their first or second choice (M=51.31, SD=10.13 compared to those who matched to their third or higher choice (M=43.59, SD=17.12, t(194=3.65, p<0.001, d=0.55. Conclusion: Simply having a mentor during medical

  3. Characterization of victims of aggression and transportation accidents treated at the Forensic Medicine and Dentistry Institute - Campina Grande, Paraíba, Brazil - 2010

    Sergio d'Avila


    Full Text Available The objective of this cross-sectional census study was to characterize agression and land-based transport accidents in a city in the Northeast of Brazil. Data was analyzed from live victims who were treated at a forensic service (N = 2.379. In the descriptive analysis, the majority of events were represented by aggression (71.6%; which occurred on weekdays (65%, with 35.1% at night. Trauma occurred to the whole body (63.6% and to soft tissue (74.2%. On the basis of multiple correspondence analysis, two dimensions were formed: the first dimension (internal reliability = 0.654 was formed by the cause of the event, the trauma and the age group and the second dimension (reliability = 0.514, by age group, occupation and civil status. Three groups with distinct profiles were formed for accidents and aggression: young women who suffered aggression, with trauma to the face and soft tissues during the evening and at weekends; adult men who suffered car accidents, in the morning and on work days; and retired elderly widowers, who were run over.

  4. Characterization of victims of aggression and transportation accidents treated at the Forensic Medicine and Dentistry Institute - Campina Grande, Paraíba, Brazil - 2010.

    d'Avila, Sergio; Campos, Ana Cristina; Cavalcante, Gigliana Maria Sobral; Silva, Carlos Jose de Paula; da Nóbrega, Lorena Marques; Ferreira, Efigenia Ferreira E


    The objective of this cross-sectional census study was to characterize agression and land-based transport accidents in a city in the Northeast of Brazil. Data was analyzed from live victims who were treated at a forensic service (N = 2.379). In the descriptive analysis, the majority of events were represented by aggression (71.6%); which occurred on weekdays (65%), with 35.1% at night. Trauma occurred to the whole body (63.6%) and to soft tissue (74.2%). On the basis of multiple correspondence analysis, two dimensions were formed: the first dimension (internal reliability = 0.654) was formed by the cause of the event, the trauma and the age group and the second dimension (reliability = 0.514), by age group, occupation and civil status. Three groups with distinct profiles were formed for accidents and aggression: young women who suffered aggression, with trauma to the face and soft tissues during the evening and at weekends; adult men who suffered car accidents, in the morning and on work days; and retired elderly widowers, who were run over.

  5. Gender differences in acute and chronic pain in the emergency department: results of the 2014 Academic Emergency Medicine consensus conference pain section.

    Musey, Paul I; Linnstaedt, Sarah D; Platts-Mills, Timothy F; Miner, James R; Bortsov, Andrey V; Safdar, Basmah; Bijur, Polly; Rosenau, Alex; Tsze, Daniel S; Chang, Andrew K; Dorai, Suprina; Engel, Kirsten G; Feldman, James A; Fusaro, Angela M; Lee, David C; Rosenberg, Mark; Keefe, Francis J; Peak, David A; Nam, Catherine S; Patel, Roma G; Fillingim, Roger B; McLean, Samuel A


    Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender

  6. Owning the cost of emergency medicine: beyond 2%.

    Lee, Michael H; Schuur, Jeremiah D; Zink, Brian J


    This article evaluates current evidence on the cost of emergency care. First, we reviewed data from national data sets and found that aggregate spending on emergency care is 5% to 6% of national health expenditures but could be as high as 10%. These figures are significantly higher than those previously published. Second, we reviewed the literature on economic models of the cost of emergency care and found that the results are inconclusive and incomplete. As an alternative, we discussed activity-based cost accounting and concluded that it is a promising research methodology for emergency medicine. We conclude by advocating for a strategy to demonstrate the value and strategic importance of emergency medicine rather than minimizing its role in national health care costs.

  7. Why and when to use CT in children: perspective of a pediatric emergency medicine physician

    Frush, Karen [Duke University School of Medicine, DUMC, Department of Pediatrics, Box 3701, Durham, NC (United States)


    The Emergency Department is a risk-laden environment for clinicians caring for children. A number of factors can increase the risk of medical errors and adverse events, including lack of standardized medication dosing because of size variation in the pediatric age range, unique physical and developmental characteristics of children that affect treatment strategies, and the inability of young or non-verbal children to provide a medical history or to clearly communicate pain and other symptoms. The Emergency Department (ED) setting is often hectic and chaotic, with lots of interruptions. Many EDs lack the pediatric-specific supplies deemed essential for managing pediatric emergencies, and long hours or overnight shifts, while necessary for maintaining 24-hour emergency services, can cause provider fatigue that can lead to increased medical errors. It is in this environment that ED physicians make decisions about the use of CT scans in children, often without evidence-based guidelines to help them weigh risks and benefits. Although recent efforts have raised the awareness of the risk of exposure to radiation, many pediatric providers and families lack adequate information to guide decisions about the use of CT. Pediatricians and emergency physicians need to collaborate with radiologists to maintain current knowledge of the risks and benefits of CT scans, to advocate for pediatric protocols and evidence-based guidelines, and to engage families in decisions regarding the evaluation and treatment of pediatric patients in the Emergency Department. (orig.)

  8. Back to basics: emergency medicine in dentistry.

    Malamed, S F


    It is important that all members of the dental office staff be trained to promptly recognize and efficiently manage emergency situations. This paper discusses how to prepare a dental office and staff for emergencies. It also describes several emergencies that may occur in dental offices and discusses methods of handling them.

  9. Development of a novel sports medicine rotation for emergency medicine residents

    Waterbrook AL


    Full Text Available Anna L Waterbrook,1 T Gail Pritchard,2 Allison D Lane,1 Lisa R Stoneking,1 Bryna Koch,2 Robert McAtee,1 Kristi H Grall,1 Alice A Min,1 Jessica Prior,1 Isaac Farrell,1 Holly G McNulty,1 Uwe Stolz1 1Department of Emergency Medicine, 2Office of Medical Student Education, The University of Arizona, Tucson, AZ, USA Abstract: Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC and University Campus (UC. The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the

  10. The clinical practice of emergency medicine in Mahajanga, Madagascar

    Vijay C. Kannan


    Conclusion: This is the first descriptive study of the clinical practice of emergency medicine in Mahajanga, Madagascar. It provides both the Malagasy and international medical communities with an objective analysis of the practice of emergency care in Madagascar from both diagnostic and therapeutic standpoints. Emergency care here focuses on the management of traumatic injury and infectious disease. The diagnostic imaging, pharmacologic and procedural therapeutic interventions reflect the burdens placed upon this institution by these diseases. We hope this study will provide guidance for the further development of Malagasy-specific emergency care systems.

  11. Improvements in emergency management in nuclear power plants after the Fukushima accident: ORE, CAE and CAGE; Mejoras en la gestion de emergencias en centrales nucleares tras el accidente de Fukushima: ORE, CAE y CAGE

    Gimenez Gonzalez, S.; Sanchez Lombardia, A.; Martin Calvarro, J. M.; Calvin Cuartero, M.


    After Fukushima accident European NPP safety was checked by means of homogenous stress test promoted by European council. At Spain CSN issued Technical instructions to confirm safety NPP margins were appropriate . As a result of this assessment licensees promoted improving NPP safety by strengthen ERO; a new Support Emergency center (CAE) and construction of a new alternative management centre (CAGE) at each site. European countries have been improving and reinforced NPP safety in a similar way to Spain. (Author)

  12. Improving outcomes for ill and injured children in emergency departments: protocol for a program in pediatric emergency medicine and knowledge translation science

    Shaw Nicola


    Full Text Available Abstract Approximately one-quarter of all Canadian children will seek emergency care in any given year, with the two most common medical problems affecting children in the emergency department (ED being acute respiratory illness and injury. Treatment for some medical conditions in the ED remains controversial due to a lack of strong supporting evidence. The purpose of this paper is to describe a multi-centre team grant in pediatric emergency medicine (PEM that has been recently funded by the Canadian Institutes of Health Research (CIHR. This program of research integrates clinical research (in the areas of acute respiratory illness and injury and knowledge translation (KT. This initiative includes seven distinct projects that address the objective to generate new evidence for clinical care and KT in the pediatric ED. Five of the seven research projects in this team grant make significant contributions to knowledge development in KT science, and these contributions are the focus of this paper. The research designs employed in this program include: cross-sectional surveys, randomized controlled trials (RCTs, quasi-experimental designs with interrupted time-series analysis and staggered implementation strategies, and qualitative designs. This team grant provides unique opportunities for making important KT methodological developments, with a particular focus on developing a better theoretical understanding of the causal mechanisms and effect modifiers of different KT interventions.

  13. Effectiveness of emergency medicine in longitudinal integrated clerkships

    Banh, Kenny; Ramirez, Rene; Thabit, Christina


    Objective: This study investigated third-year students’ experience with the emergency medicine (EM) component in integrated longitudinal programs. The study aimed to see if EM could be integrated into third-year integrated longitudinal programs while addressing accreditation standards and increasing interest in EM.Methods: The authors surveyed students who participated in an integrated longitudinal program at University of California San Francisco School of Medicine (UCSF) from 2010 to 2012. ...

  14. An Innovative Educational and Mentorship Program for Emergency Medicine Women Residents to Enhance Academic Development and Retention.

    Bhatia, Kriti; Takayesu, James Kimo; Arbelaez, Christian; Peak, David; Nadel, Eric S


    Given the discrepancy between men and women's equal rates of medical school matriculation and their rates of academic promotion and leadership role acquisition, the need to provide mentorship and education to women in academic medicine is becoming increasingly recognized. Numerous large-scale programs have been developed to provide support and resources for women's enrichment and retention in academic medicine. Analyses of contributory factors to the aforementioned discrepancy commonly cite insufficient mentoring and role modeling as well as challenges with organizational navigation. Since residency training has been shown to be a critical juncture for making the decision to pursue an academic career, there is a need for innovative and tailored educational and mentorship programs targeting residents. Acknowledging residents' competing demands, we designed a program to provide easily accessible mentorship and contact with role models for our trainees at the departmental and institutional levels. We believe that this is an important step towards encouraging women's pursuit of academic careers. Our model may be useful to other emergency medicine residencies looking to provide such opportunities for their women residents.

  15. Review article: Crisis resource management in emergency medicine.

    Carne, Belinda; Kennedy, Marcus; Gray, Tim


    Effective team management is a core element of expert practice in emergency medicine. Thus far, training in emergency medicine has focussed predominantly on proficiency in medical and technical skills, with emergency physicians acquiring these 'non-technical' skills in an ad hoc manner or by trial and error with varying levels of success. This paper describes a set of behaviours that, when practised in conjunction with medical and technical expertise, can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of an ED. Teaching and practice of these behaviours is now a core element of training and skills maintenance in other high-risk areas, such as aviation, and is becoming part of the routine training for anaesthetists. They address areas, such as communication, leadership, knowledge of environment, anticipation and planning, obtaining timely assistance, attention allocation and workload distribution. We outline the application of these behaviours in the speciality of emergency medicine, and suggest that the teaching and practice of crisis resource management principles should become part of the curriculum for training and credentialing of emergency medicine specialists.

  16. Emerging Glycolysis Targeting and Drug Discovery from Chinese Medicine in Cancer Therapy

    Zhiyu Wang


    Full Text Available Molecular-targeted therapy has been developed for cancer chemoprevention and treatment. Cancer cells have different metabolic properties from normal cells. Normal cells mostly rely upon the process of mitochondrial oxidative phosphorylation to produce energy whereas cancer cells have developed an altered metabolism that allows them to sustain higher proliferation rates. Cancer cells could predominantly produce energy by glycolysis even in the presence of oxygen. This alternative metabolic characteristic is known as the “Warburg Effect.” Although the exact mechanisms underlying the Warburg effect are unclear, recent progress indicates that glycolytic pathway of cancer cells could be a critical target for drug discovery. With a long history in cancer treatment, traditional Chinese medicine (TCM is recognized as a valuable source for seeking bioactive anticancer compounds. A great progress has been made to identify active compounds from herbal medicine targeting on glycolysis for cancer treatment. Herein, we provide an overall picture of the current understanding of the molecular targets in the cancer glycolytic pathway and reviewed active compounds from Chinese herbal medicine with the potentials to inhibit the metabolic targets for cancer treatment. Combination of TCM with conventional therapies will provide an attractive strategy for improving clinical outcome in cancer treatment.

  17. Road Accident Prevention with Instant Emergency Warning Message Dissemination in Vehicular Ad-Hoc Network.

    P Gokulakrishnan

    Full Text Available A Road Accident Prevention (RAP scheme based on Vehicular Backbone Network (VBN structure is proposed in this paper for Vehicular Ad-hoc Network (VANET. The RAP scheme attempts to prevent vehicles from highway road traffic accidents and thereby reduces death and injury rates. Once the possibility of an emergency situation (i.e. an accident is predicted in advance, instantly RAP initiates a highway road traffic accident prevention scheme. The RAP scheme constitutes the following activities: (i the Road Side Unit (RSU constructs a Prediction Report (PR based on the status of the vehicles and traffic in the highway roads, (ii the RSU generates an Emergency Warning Message (EWM based on an abnormal PR, (iii the RSU forms a VBN structure and (iv the RSU disseminates the EWM to the vehicles that holds the high Risk Factor (RF and travels in High Risk Zone (HRZ. These vehicles might reside either within the RSU's coverage area or outside RSU's coverage area (reached using VBN structure. The RAP scheme improves the performance of EWM dissemination in terms of increase in notification and decrease in end-to-end delay. The RAP scheme also reduces infrastructure cost (number of RSUs by formulating and deploying the VBN structure. The RAP scheme with VBN structure improves notification by 19 percent and end-to-end delay by 14.38 percent for a vehicle density of 160 vehicles. It is also proved from the simulation experiment that the performance of RAP scheme is promising in 4-lane highway roads.

  18. Tensions and Opportunities in Convergence: Shifting Concepts of Disease in Emerging Molecular Medicine

    Boenink, Marianne


    The convergence of biomedical sciences with nanotechnology as well as ICT has created a new wave of biomedical technologies, resulting in visions of a ‘molecular medicine’. Since novel technologies tend to shift concepts of disease and health, this paper investigates how the emerging field of molecu

  19. [Accidents with caterpillar Lonomia obliqua (Walker, 1855). An emerging problem].

    Sánchez, Matías N; Mignone Chagas, Mariana A; Casertano, Sergio A; Cavagnaro, Luis E; Peichoto, María E


    Lonomia obliqua (Walker, 1855) is a moth from the family Saturniidae, widely distributed in tropical rainforests of South America. In its larval stage (caterpillar) it is characterized by bristles that cover the animal's body. These structures are hard and branched spiny evaginations of the cuticle, underneath which a complex mixture of toxic molecules is stored. When spicules are brought into contact with the skin of people, toxins enter passively through the injury, causing not only local but also systemic poisoning (primarily hemorrhagic manifestations). When the whole animal is accidentally crushed, the insect's chitinous bristles are broken and the venomous secretions penetrate the human skin, reaching the blood circulation. Due to the numerous registered cases of erucism in Southern Brazil, the Butantan Institute has produced an antivenom able to neutralize the deleterious effects produced by contact with L. obliqua caterpillar bristles. In Argentina, these kinds of accidents are rare and restricted to the province of Misiones. Taking into account that to date there is no report in this country about clinical cases submitted to a specific treatment (antivenom), our aim is to communicate here six cases of Lonomia caterpillar-induced bleeding syndrome that were treated in the Hospital SAMIC of Puerto Iguazú (Misiones, Argentina) during 2014 with the antilonomic serum produced in Brazil. It is worthy to note that all patients evolved favorably within the first few hours, and for this reason, the use of this antivenom is recommended to treat the cases of Lonomia erucism in Argentina.

  20. Examining the relationship between critical-thinking skills and decision-making ability of emergency medicine students

    Mohammad Heidari


    Full Text Available Background and Aims: Critical-thinking ability would enable students to think creatively and make better decisions and makes them make a greater effort to concentrate on situations related to clinical matters and emergencies. This can bridge the gap between the clinical and theoretical training. Therefore, the aim of the present study is to examine the relationship between critical-thinking ability and decision-making skills of the students of Emergency Medicine. Materials and Methods: This descriptive and analytical research was conducted on all the students of medical emergency students (n = 86 in Shahrekord, Iran. The demographic information questionnaire, the California Critical Thinking Skills Test, and a decision-making researcher-made questionnaire were used to collect data. The data were analyzed by SPSS software version 16 using descriptive and analytical statistical tests and Pearson′s correlation coefficient. Results: The results of the present study indicate that the total mean score for the critical thinking was 8.32 ± 2.03 and for decision making 8.66 ± 1.89. There is a significant statistical relationship between the critical-thinking score and decision-making score (P < 0.05. Conclusions: Although critical-thinking skills and decision-making ability are essential for medical emergency professional competence, the results of this study show that these skills are poor among the students.

  1. Peptide B12: emerging trends at the interface of inorganic chemistry, chemical biology and medicine.

    Zelder, Felix; Zhou, Kai; Sonnay, Marjorie


    The sophisticated and efficient delivery of vitamin B(12) ("B(12)") into cells offers promise for B(12)-bioconjugates in medicinal diagnosis and therapy. It is therefore surprising that rather little attention is presently paid to an alternative strategy in drug design: the development of structurally perfect, but catalytically inactive semi-artificial B(12) surrogates. Vitamin B(12) cofactors catalyse important biological transformations and are indispensible for humans and most other forms of life. This strong metabolic dependency exhibits enormous medicinal opportunities. Inhibitors of B(12) dependent enzymes are potential suppressors of fast proliferating cancer cells. This perspective article focuses on the design and study of backbone modified B(12) derivatives, particularly on peptide B(12) derivatives. Peptide B(12) is a recently introduced class of biomimetic cobalamins bearing an artificial peptide backbone with adjustable coordination and redox-properties. Pioneering biological studies demonstrated reduced catalytic activity, combined with inhibitory potential that is encouraging for future efforts in turning natural cofactors into new anti-proliferative agents.

  2. Road characteristics and bicycle accidents.

    Nyberg, P; Björnstig, U; Bygren, L O


    In Umeå, Sweden, defects in the physical road surface contributed to nearly half of the single bicycle accidents. The total social cost of these injuries to people amount to at least SEK 20 million (SEK 60,000 or about USD 8,500 per accident), which corresponds to the estimated loss of "eight life equivalents a year". Improved winter maintenance seems to have the greatest injury prevention potential and would probably reduce the number of injuries considerably, whereas improved road quality and modification of kerbs would reduce the most severe injuries. A local traffic safety program should try to prevent road accidents instead of handling the consequences of them. In accordance with Parliament decisions on traffic we would like to see increased investment in measures favoring bicycle traffic, where cycling is seen as a solution, not as a problem.

  3. An eMERGE Clinical Center at Partners Personalized Medicine

    Jordan W. Smoller


    Full Text Available The integration of electronic medical records (EMRs and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians.

  4. Decision support system for emergency management of oil spill accidents in the Mediterranean Sea

    Liubartseva, Svitlana; Coppini, Giovanni; Pinardi, Nadia; De Dominicis, Michela; Lecci, Rita; Turrisi, Giuseppe; Cretì, Sergio; Martinelli, Sara; Agostini, Paola; Marra, Palmalisa; Palermo, Francesco


    This paper presents an innovative web-based decision support system to facilitate emergency management in the case of oil spill accidents, called WITOIL (Where Is The Oil). The system can be applied to create a forecast of oil spill events, evaluate uncertainty of the predictions, and calculate hazards based on historical meteo-oceanographic datasets. To compute the oil transport and transformation, WITOIL uses the MEDSLIK-II oil spill model forced by operational meteo-oceanographic services. Results of the modeling are visualized through Google Maps. A special application for Android is designed to provide mobile access for competent authorities, technical and scientific institutions, and citizens.

  5. State of emergency medicine in Rwanda 2015: an innovative trainee and trainer model

    Mbanjumucyo, Gabin; DeVos, Elizabeth; Pulfrey, Simon; Epino, Henry M.


    The 1994 Rwandan war and genocide left more than 1 million people dead; millions displaced; and the country’s economic, social, and health infrastructure destroyed. Despite remaining one of the poorest countries in the world, Rwanda has made remarkable gains in health, social, and economic development over the last 20 years, but modern emergency care has been slow to progress. Rwanda has recently established the Human Resources for Health program to rapidly build capacity in multiple sectors ...

  6. Preliminary elaboration on emergent properties of traditional Chinese medicine.

    Chai, Xing-yun


    Plant and animal derived secondary metabolites are the result of initiative and adaptability of natural evolution due to its adaptive stress responses. Based on countless attempts, rational thinking and thousands of years of clinical practice by ancient Chinese, the medicines were endowed with advantages for the treatment of diseases and keeping health balance through multiple components combination instead of single components, featured by a complex system with emergent properties. The emergence of traditional Chinese medicine is because of the integration of various components and its complex interactions. How to obtain the new multicomponent entities with the biological equivalent effect is an important and fundamental work for TCM-based new drug research and development. Currently, recognition of TCM emergence and development of related technical methods needs strengthened, and the understanding and research of TCM require a systematic integration of the holistic and reductive methods.

  7. Development of a novel sports medicine rotation for emergency medicine residents

    Waterbrook, Anna L; Pritchard, T Gail; Lane, Allison D; Stoneking, Lisa R; Koch, Bryna; McAtee, Robert; Grall, Kristi H; Min, Alice A; Prior, Jessica; Farrell, Isaac; McNulty, Holly G; Stolz, Uwe


    Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students’ and residents’ musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their

  8. Development of a novel sports medicine rotation for emergency medicine residents.

    Waterbrook, Anna L; Pritchard, T Gail; Lane, Allison D; Stoneking, Lisa R; Koch, Bryna; McAtee, Robert; Grall, Kristi H; Min, Alice A; Prior, Jessica; Farrell, Isaac; McNulty, Holly G; Stolz, Uwe


    Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational

  9. Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

    Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B


    Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured

  10. Study on emergency mechanism for major process safety accidents in petroleum and petrochemical industry%石油石化重大工艺安全事故应急机制浅析

    李峰; 储胜利; 程宗华


    Three features of major process safety accidents in petroleum and petrochemical industry , such as strong-ly professional,high accident harm and liability to secondary disaster were summarized in the paper .Combining with the accidents characteristics and practical situation , five key emergency tactics for these accidents were presen -ted, including adequate risk identification , professional emergency organization, plentiful supply of emergency ma-terials, efficient joint-action mechanism of government & enterprise and right -hand guidance of public opinions .Fi-nally 5 work points of constructing perfect risk identification mechanism , training professional emergency team , es-tablishing complete emergency conservation system , building efficient joint-action mechanism and practical emer-gency tactics for social crisis were analyzed in detail .%石油石化生产关键工艺设备或流程蕴藏的风险能量巨大,一旦发生事故,后果往往极其严重。分析了石油石化重大工艺安全事故专业性强、事故规模大、易形成连锁反应和诱发环境污染事件等3个典型特征。通过事故应急经验分析,研究提出了石油石化重大工艺安全事故应急工作需要遵循的风险辨识充分到位、专业应急保障有力、应急资源保障充足、企地联动迅速高效、社会舆论引导得力等5方面的重点应急策略。设计了工艺安全事故风险辨识与评估、专业应急队伍建设与能力提升、应急资源联合储备、区域应急联动和公共危机公关等5项石油石化企业重大工艺安全事故应急重点工作机制内容和建设要点。石油石化企业需要不断建立和完善5项应急工作机制,才能为重大工艺安全事故应急工作提供可靠保障。

  11. Compilation and response key points of emergency plan for dangerous chemical poisoning accident attention and response points%危险化学品中毒事故应急预案编制与响应关注要点



    大工业的发展导致各类职业中毒事件的发生日益严重,除人员伤亡等影响外,也会对于社会公众安全带来影响.应急预案编制中强调应急准备的重要性和针对性.职业危害事故识别和分类分级处理以及对于社会公共安全影响的危机处理能力是应急工作中应该关注的重要内容.应急响应中强调第一目击者的处理能力的培养、现场的实时监测、事故报告与事态演变的持续预警、有效应急资源应对危机处理的能力.%The development of great industry lead to the occurrence of all kinds of occupational poisoning event, in addition to the increasingly serious casualties, the social public security will also be affected. Emergency plancom-pilation stressed in the the importance and relevance of emergency preparedness. Occupational hazard accidents I-dentification, classification and grading disposal, and the ability of handling crisis for public safety influence were the important content that should be focused on in emergency work. Emergency response stressed in the training of first witnesses processing ability that should be focused on in emergency work, on-site real-time monitoring, the accident report and the early warning of evolution, and the ability to effectively deal with crisis disposal of emergency resources.

  12. Assessment of Spatial Unevenness of Road Accidents Severity as Instrument of Preventive Protection from Emergency Situations in Road Complex

    Petrov, A.; Petrova, D.


    Emergency situations in road complex are road traffic accidents (RA) with severe consequences. These are incidents connected with the death and injury of large number of people. The most common reasons for this are the collision of three or more cars, the collision of buses with trains at railroad crossings, the fall of the buses in the mountain gorge, and other similar cases. Is it possible to predict such events? How to build a preventive protection against such emergencies? We have to understand that emergencies in a road complex are qualitative expression of the quantitative processes that characterize the general state of road safety in the region. In this regard, at the level of state monitoring of emergency situations it is important to understand in general - in which region the situation is more complicated and in which is more favorable. This knowledge helps to more efficiently reallocate resources intended to solve the problems of road safety provision. The consequence of this is improvement of the quality of preventive protection from the emergencies in the road complex. The article presents quantitative values of severity of accidents in the Russian Federation regions and the Pareto chart distribution of cumulates of the accident severity for the Russian Federation. On the basis of the complex assessment of the spatial non-uniformity of the accident severity results it offers two important recommendations, implementation of which will alleviate the issue of formation of emergency situations in the road of the Russian Federation on the basis of the complex assessment of the spatial nonuniformity of the accident severity results.

  13. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

    Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D


    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

  14. Emerging roles of hyaluronic acid bioscaffolds in tissue engineering and regenerative medicine.

    Hemshekhar, Mahadevappa; Thushara, Ram M; Chandranayaka, Siddaiah; Sherman, Larry S; Kemparaju, Kempaiah; Girish, Kesturu S


    Hyaluronic acid (HA), is a glycosaminoglycan comprised of repeating disaccharide units of N-acetyl-D-glucosamine and D-glucuronic acid. HA is synthesized by hyaluronan synthases and reaches sizes in excess of 2MDa. It plays numerous roles in normal tissues but also has been implicated in inflammatory processes, multiple drug resistance, angiogenesis, tumorigenesis, water homeostasis, and altered viscoelasticity of extracellular matrix. The physicochemical properties of HA including its solubility and the availability of reactive functional groups facilitate chemical modifications on HA, which makes it a biocompatible material for use in tissue regeneration. HA-based biomaterials and bioscaffolds do not trigger allergies or inflammation and are hydrophilic which make them popular as injectable dermal and soft tissue fillers. They are manufactured in different forms including hydrogels, tubes, sheets and meshes. Here, we review the pathophysiological and pharmacological properties and the clinical uses of native and modified HA. The review highlights the therapeutic applications of HA-based bioscaffolds in organ-specific tissue engineering and regenerative medicine.

  15. Viral metagenomics as an emerging and powerful tool in veterinary medicine.

    Blomström, Anne-Lie


    New diseases continue to emerge in both human and animal populations, and the importance of animals, as reservoirs for viruses that can cause zoonoses are evident. Thus, an increased knowledge of the viral flora in animals, both in healthy and diseased individuals, is important both for animal and human health. Viral metagenomics is a culture-independent approach that is used to investigate the complete viral genetic populations of a sample. This review describes and discusses the different possible steps of a viral metagenomic study utilizing sequence-independent amplification, high-throughput sequencing, and bioinformatics to identify viruses. With this technology, multiple viruses can be detected simultaneously and novel and highly divergent viruses can be discovered and genetically characterized for the first time. This review also briefly discusses the applications of viral metagenomics in veterinary science and lists some of the viruses discovered within this field.

  16. Barriers to learning from incidents and accidents

    Dechy, N.; Dien, Y.; Drupsteen, L.; Felicio, A.; Cunha, C.; Roed-Larsen, S.; Marsden, E.; Tulonen, T.; Stoop, J.; Strucic, M.; Vetere Arellano, A.L.; Vorm, J.K.J. van der; Benner, L.


    This document provides an overview of knowledge concerning barriers to learning from incidents and accidents. It focuses on learning from accident investigations, public inquiries and operational experience feedback, in industrial sectors that are exposed to major accident hazards. The document disc

  17. Problems and potentialities of e-Learning for regular undergraduate courses in emergency medicine

    William Rafaelo Schlinkert

    Full Text Available BACKGROUND: E-learning techniques are spreading at great speed in medicine, raising concerns about the impact of adopting them. Websites especially designed to host courses are becoming more common. There is a lack of evidence that these systems could enhance student knowledge acquisition. GOAL: To evaluate the impact of using dedicated-website tools over cognition of medical students exposed to a first-aid course. METHODS: Prospective study of 184 medical students exposed to a twenty-hour first-aid course. We generated a dedicated-website with several sections (lectures, additional reading material, video and multiple choice exercises. We constructed variables expressing the student's access to each section. The evaluation was composed of fifty multiple-choice tests, based on clinical problems. We used multiple linear regression to adjust for potential confounders. RESULTS: There was no association of website intensity of exposure and the outcome - beta-coeficient 0.27 (95%CI - 0.454 - 1.004. These findings were not altered after adjustment for potential confounders - 0.165 (95%CI -0.628 - 0.960. CONCLUSION: A dedicated website with passive and active capabilities for aiding in person learning had not shown association with a better outcome.

  18. Emerging New Physics with Major Implications for Energy Technology, Biology, and Medicine

    Mallove, Eugene F.


    In the past 15 years, reproducible experiments and prototype technological devices have emerged that may revolutionize much of physics and chemistry(despite the common perception that modern physics is on very solid ground and is nearing a "Theory of Everything"). This new physics has flourished despite very strong opposition by the entrenched foundational paradigms within physics and chemistry ( not to forget vested financial interests within academia). In fact, beginning with "cold fusion" (more generically low-energy nuclear reactions, LENR), one of the most important discoveries of the late 20th Century has been the irrefutable proof of the failure of the physics establishment to deal ethically and appropriately with potential and real paradigm shifts, when its "sacred writ" ( i.e. Its textbooks) -- are threatened with the need for massive revision.

  19. Ten Tips for Engaging the Millennial Learner and Moving an Emergency Medicine Residency Curriculum into the 21st Century

    Shannon L. Toohey


    Full Text Available Introduction: Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM residency program’s curriculum to accommodate the modern learner. Discussion: These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents. Conclusion: While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices.

  20. Approved Instructional Resources Series: A National Initiative to Identify Quality Emergency Medicine Blog and Podcast Content for Resident Education.

    Lin, Michelle; Joshi, Nikita; Grock, Andrew; Swaminathan, Anand; Morley, Eric J; Branzetti, Jeremy; Taira, Taku; Ankel, Felix; Yarris, Lalena M


    Background Emergency medicine (EM) residency programs can provide up to 20% of their planned didactic experiences asynchronously through the Individualized Interactive Instruction (III) initiative. Although blogs and podcasts provide potential material for III content, programs often struggle with identifying quality online content. Objective To develop and implement a process to curate quality EM content on blogs and podcasts for resident education and III credit. Methods We developed the Approved Instructional Resources (AIR) Series on the Academic Life in Emergency Medicine website. Monthly, an editorial board identifies, peer reviews, and writes assessment questions for high-quality blog/podcast content. Eight educators rate each post using a standardized scoring instrument. Posts scoring ≥ 30 of 35 points are awarded an AIR badge and featured in the series. Enrolled residents can complete an assessment quiz for III credit. After 12 months of implementation, we report on program feasibility, enrollment rate, web analytics, and resident satisfaction scores. Results As of June 2015, 65 EM residency programs are enrolled in the AIR Series, and 2140 AIR quizzes have been completed. A total of 96% (2064 of 2140) of participants agree or strongly agree that the activity would improve their clinical competency, 98% (2098 of 2140) plan to use the AIR Series for III credit, and 97% (2077 of 2140) plan to use it again in the future. Conclusions The AIR Series is a national asynchronous EM curriculum featuring quality blogs and podcasts. It uses a national expert panel and novel scoring instrument to peer review web-based educational resources.

  1. Microfinance as a method of facilitating research in emergency medicine

    Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars


    Microgrants are a novel concept where small grants are used to facilitate research. The concept might have a place in developing emergency medicine research, especially in countries where emergency medicine is not established or in new areas of research. Two examples of the beneficial effects of ...

  2. Toward a definition of teamwork in emergency medicine.

    Fernandez, Rosemarie; Kozlowski, Steve W J; Shapiro, Marc J; Salas, Eduardo


    The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well-defined, well-researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," a subset of the group expertise and group assessment breakout sections identified evidence-based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well-defined, well-described taxonomy that will help guide design, implementation, and assessment of simulation-based team training programs.

  3. Structure-based antivirals for emerging and neglected RNA viruses: an emerging field for medicinal chemistry in academia.

    Hilgenfeld, Rolf


    "Many [neglected viruses] predominantly hit developing countries in tropical and subtropical regions of the world (40% of the world's population are now at risk of contracting dengue fever), but developed countries are by no means immune to their impact."

  4. Drug use and the severity of a traffic accident

    Smink, BE; Ruiter, B; Lusthof, KJ; de Gier, JJ; Uges, DRA; Egberts, ACG


    Several studies have showed that driving under the influence of alcohol and/or certain illicit or medicinal drugs increases the risk of a (severe) crash. Data with respect to the question whether this also leads to a more severe accident are sparse. This study examines the relationship between the u

  5. Fatal motorcycle accidents and alcohol

    Larsen, C F; Hardt-Madsen, M


    A series of fatal motorcycle accidents from a 7-year period (1977-1983) has been analyzed. Of the fatalities 30 were operators of the motorcycle, 11 pillion passengers and 8 counterparts. Of 41 operators 37% were sober at the time of accident, 66% had measurable blood alcohol concentration (BAC......); 59% above 0.08%. In all cases where a pillion passenger was killed, the operator of the motorcycle had a BAC greater than 0.08%. Of the killed counterparts 2 were non-intoxicated, 2 had a BAC greater than 0.08%, and 4 were not tested. The results advocate that the law should restrict alcohol...... consumption by pillion passengers as well as by the motorcycle operator. Suggestions made to extend the data base needed for developing appropriate alcohol countermeasures by collecting sociodemographic data on drivers killed or seriously injured should be supported....

  6. Blurring the boundaries between public and private health care services as an alternative explanation for the emergence of black medicine: the Israeli case.

    Filc, Dani; Cohen, Nissim


    Black medicine represents the most problematic configuration of informal payments for health care. According to the accepted economic explanations, we would not expect to find black medicine in a system with a developed private service. Using Israel as a case study, we suggest an alternative yet a complimentary explanation for the emergence of black medicine in public health care systems - even though citizens do have the formal option to use private channels. We claim that when regulation is weak and political culture is based on 'do it yourself' strategies, which meant to solve immediate problems, blurring the boundaries between public and private health care services may only reduce public trust and in turn, contribute to the emergence of black medicine. We used a combined quantitative and qualitative methodology to support our claim. Statistical analysis of the results suggested that the only variable significantly associated with the use of black medicine was trust in the health care system. The higher the respondents' level of trust in the health care system, the lower the rate of the use of black medicine. Qualitatively, interviewee emphasized the relation between the blurred boundaries between public and private health care and the use of black medicine.

  7. Adult emergence inhibition and adulticidal activities of medicinal plant extracts againstAnopheles stephensiListon

    AbdulAbduzZahir; AbdulAbdulRahuman; AsokanBa=gavan; GandhiElango; Chinnaperumal Kamaraj


    Objective:To determine the adult emergence inhibition (EI) and adulticidal activities of hexane, chloroform, ethyl acetate, and acetone leaves extracts of Anisomeles malabarica (A. malabarica), Euphorbia hirta (E. hirta), Ocimum basilicum (O. basilicum), Ricinus communis (R. communis), Solanum trilobatum (S. trilobatum), Tridax procumbens (T. procumbens)and seeds ofGloriosa superba (G. superba) againstAnopheles stephensi (An. stephensi).Methods: The EI and adulticidal trials were carried out according to World Health Organization (WHO) procedures with slight modifications. The extracts were diluted in dimethyl sulphoxide in order to prepare a serial dilution of test dosages (15.625, 31.25, 62.5, 125, 250, 500 and1 000μg/mL). Five duplicate trials were carried out for every sample concentration, and for each trial a negative control was included and the mortality was determined after24 h of exposure.Results: The highestEI activity was found in ethyl acetate extracts ofA. malabarica, chloroform extracts ofO. basilicum, S.trilobatum, acetone of extract ofR. communis, T. procumbens, and seed extract ofG. superba withEI50 values143.12, 119.82, 157.87, 139.39, 111.19, and134.85 μg/mL, and the effective adulticidal activity was observed in chloroform, acetone extracts ofG. superba, T. procumbens, R. communis, S.trilobatum and ethyl acetate extract ofO. basilicum with LD50 values120.17, 108.77, 127.22, 163.11, 118.27, and93.02μg/mL, respectively. Chi-square value was significant atP<0.05 level.Conclusions: These results should encourage further efforts to investigate the compounds that might possess good EI and adulticidal properties when isolated in pure form.

  8. [Hanggliding accidents. Distribution of injuries and accident analysis].

    Ballmer, F T; Jakob, R P


    Paragliding--a relatively new sport to Switzerland--brought 23 patients with 48 injuries (38% lower limb and 29% spinal) within a period of 8 months to the Inselspital University hospital in Berne. The aim of the study in characterizing these injuries is to formulate some guidelines towards prevention. With over 90% of accidents occurring at either take off or landing, emphasis on better training for the beginner is proposed with strict guidelines for the more experienced pilot flying in unfavourable conditions.

  9. Evaluation of an accident management strategy of emergency water injection using fire engines in a typical pressurized water reactor

    Park, Soo Yong; Ahn, Kwang Il [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)


    Following the Fukushima accident, a special safety inspection was conducted in Korea. The inspection results show that Korean nuclear power plants have no imminent risk for expected maximum potential earthquake or coastal flooding. However long- and short-term safety improvements do need to be implemented. One of the measures to increase the mitigation capability during a prolonged station blackout (SBO) accident is installing injection flow paths to provide emergency cooling water of external sources using fire engines to the steam generators or reactor cooling systems. This paper illustrates an evaluation of the effectiveness of external cooling water injection strategies using fire trucks during a potential extended SBO accident in a 1,000 MWe pressurized water reactor. With regard to the effectiveness of external cooling water injection strategies using fire engines, the strategies are judged to be very feasible for a long-term SBO, but are not likely to be effective for a short-term SBO.

  10. Quality of Life in Emergency Medicine Specialists of Teaching Hospitals

    Afshin Amini


    Full Text Available Introduction: Quality of life (QOL of emergency medicine specialists can be effective in providing services to patients. The aim of the present study was evaluating the lifestyle of emergency medicine practitioners, understanding their problems, and addressing the solutions to enhance and improve their lifestyles, in teaching hospitals in Iran. Method: This descriptive cross-sectional study was conducted on emergency medicine physicians in 10 teaching hospitals of Iran in 2011. Emergency physicians with at least three years of experience who interested in the study, were enrolled in the project. All participants filled out the consent form and QOL questionnaires, then underwent physical examinations and some medical laboratory tests. Categorical variables were reported as percentages, while continuous variables expressed as means and standard deviations. p <0.05 was considered statistically significant. Results: Totally, 100 subjects participated in the study, of whom 48 were male. The mean and standard deviation of the physicians’ age were 38.7±5.1 years. 43% of physicians had an average QOL, while 37% good. 96% of studied physicians had a good condition regarding habitual history, while 93% of them had a poor condition in performing screening tests. Exercise program and personal health in individuals with normal BMI were correlated with higher levels of QOL. BMI was higher in 40-50 years old subjects than youngers. Hypertension was present in five cases (5%, hypercholesterolemia in six (6%, hypertriglyceridemia in six (6%, increased LDL in four (4%, low HDL in four (4%, and impaired FBS in 4 (4%. Conclusion: The findings showed that 63% of studied emergency physicians had an average level of QOL and other ones good. The majority of physicians had undesirable situation regarding the performance of screening tests.

  11. NPP accident scenario. Which emergency measures are planned in Switzerland?; Szenario KKW-Unfall. Welche Notfallschutzmassnahmen sind in der Schweiz geplant?

    Flury, Christoph [Bundesamt fuer Bevoelkerungsschutz (BABS), Bern (Switzerland). Eidgenoessisches Departement fuer Verteidigung Bevoelkerungsschutz und Sport (VBS)


    As a consequence of the reactor accident in Fukushima the Swiss government has ordered an extensive analysis of emergency planning in case of a NPP accident Switzerland. A special working group has analyzed the possible improvements of Swiss emergency planning based on the experiences in Japan. Under the special direction of the Bundesamt fuer Bevoelkerungsschutz (BABS) the agreed improvements were integrated into the emergency concept. The reference scenarios have been re-assessed and the zone concept adapted. The emergency measures include shelter-type rooms (basement or window-less rooms), the preventive distribution of iodine pills, measures concerning agriculture, aquatic systems, preventive evacuation, traffic regulations, and delayed evacuation.

  12. Radiation protection issues on preparedness and response for a severe nuclear accident: experiences of the Fukushima accident.

    Homma, T; Takahara, S; Kimura, M; Kinase, S


    Radiation protection issues on preparedness and response for a severe nuclear accident are discussed in this paper based on the experiences following the accident at Fukushima Daiichi nuclear power plant. The criteria for use in nuclear emergencies in the Japanese emergency preparedness guide were based on the recommendations of International Commission of Radiological Protection (ICRP) Publications 60 and 63. Although the decision-making process for implementing protective actions relied heavily on computer-based predictive models prior to the accident, urgent protective actions, such as evacuation and sheltering, were implemented effectively based on the plant conditions. As there were no recommendations and criteria for long-term protective actions in the emergency preparedness guide, the recommendations of ICRP Publications 103, 109, and 111 were taken into consideration in determining the temporary relocation of inhabitants of heavily contaminated areas. These recommendations were very useful in deciding the emergency protective actions to take in the early stages of the Fukushima accident. However, some suggestions have been made for improving emergency preparedness and response in the early stages of a severe nuclear accident.

  13. Coordination of Emergency Medical Services for a Major Road Traffic Accident on a Swiss Suburban Highway.

    Dami, Fabrice; Fuchs, Vincent; Péclard, Etienne; Potin, Mathieu; Vallotton, Laurent; Carron, Pierre-Nicolas


    On 9th April 2008 at 2:14 p.m., on the highway between Lausanne and Vevey in western Switzerland, there was a 72-car pileup including five trucks that caused one death and injured 26 others. The relatively light toll was attributed to reduced vehicular speeds on account of foggy weather, together with the quick actions and effectiveness of the first responders and the excellent collaboration between the various rescue groups (medical rescue services, fire and police departments). For the first time, we used an innovative on-site medical command and control system, based on a binomial team. Two hours after the accident, the last of the injured had been evacuated and first aid on the site had ended. This article describes how the Emergency Medical Services from the State of Vaud, Switzerland, handled the situation and how the binomial team is structured.

  14. Full-text publication of abstracts in emergency medicine in Denmark

    Ravn, Anne Katrine; Petersen, Dan Brun; Folkestad, Lars;


    presented at the Danish Emergency Medicine Conferences in 2009, 2010 and 2011. METHODS: Abstracts presented at the conferences were identified and authors contacted to obtain publication information. A further search was conducted using relevant databases. RESULTS: Publication rates for the 2009 and 2010....../or research courses provided by the Danish Society of Emergency Medicine....

  15. An Entry Point of the Emergency Response Robot for Management of Severe Accident of the Nuclear Power Plant

    Cho, Jaiwan; Jeong, Kyungmin [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)


    In this paper, from the view point of DID (defense-in depth), we discuss the entry point of the nuclear emergency response robot to cope with a nuclear disaster. A Japanese nuclear disaster preparedness robot system was developed, after the JCO criticality accident in 1999, to cope with INES (International Nuclear and Radiological Event Scale) Level 3 serious incidents. INES Level 3 means the loss of DID (defense-in-depth) functions. It also indicates that ESF (engineered safety features) and ECCS (emergency core cooling system) resources, which are used to prevent serious incidents from escalating to severe accidents (core melt-down), have been almost exhausted. In the unit 1 reactor accident of Fukushima Daiichi Nuclear Power Plant, escalation from INES Level 1 (Out of Limiting Condition for Operation) to INES Level 5 (serious core melting-down) took less than two hours. Major facts are briefly described here in based on data gathered immediately after the tsunami over Fukushima Daiichi Nuclear Power Plant. Ο 15:35 on March 11, 2nd tsunami arrived. - 15:37, SBO (station black out) Ο 15:42, Interprets as a SBO (INES Level 1) - Loss of DC power for Instrumentation (Unknown of reactor water level) Ο 16:36, Loss of ECCS function (INELS Level 5) (Entry into a BDBA status) The Moni ROBO-A robot of the Japan Nuclear Safety Technology Center (NUSTEC) was a nuclear disaster preparedness robot developed after the JCO criticality accident. It was the only robot that had been steadily maintained and was available at the time of the Fukushima Daiichi Nuclear Power Plant accident. However, it was not helpful in mitigating the accident because it is assumed to have arrived at J-Village after the accident had been escalated to INES Level 5 or higher. Based on the paper by S. Kawatsuma of JAEA and response data gathered immediately after the tsunami, it is estimated that the NUSTEC's Moni ROBO-A arrived at J-Village after the designed entry point for INES Level 3

  16. International law problems for realisation of the IAEA conventions on notification and assistance in the case of a nuclear accident

    Petrov, M.M.


    The Chernobyl accident underscored the need for an early warning system and international assistance plan in case of a nuclear accident. Shortly after Chernobyl, two conventions were adopted under the auspices of the IAEA. The convention on Early Notification of a Nuclear Accident, in force since 1986, establishes an early warning system for all nuclear accidents whose effects might cross national boundaries. Under the convention on Assistance in the Case of a Nuclear accident or radiological Emergency,in force since 1987, countries must facilitate prompt assistance in case of a nuclear accident or radiological emergency, to minimize it`s consequences. Issues with the conventions are described.

  17. A Comparative Analysis of Diagnostic Accuracy of Focused Assessment With Sonography for Trauma Performed by Emergency Medicine and Radiology Residents

    Zamani, Majid; Masoumi, Babak; Esmailian, Mehrdad; Habibi, Amin; Khazaei, Mehdi; Mohammadi Esfahani, Mohammad


    Background: Focused assessment with sonography in trauma (FAST) is a method for prompt detection of the abdominal free fluid in patients with abdominal trauma. Objectives: This study was conducted to compare the diagnostic accuracy of FAST performed by emergency medicine residents (EMR) and radiology residents (RRs) in detecting peritoneal free fluids. Patients and Methods: Patients triaged in the emergency department with blunt abdominal trauma, high energy trauma, and multiple traumas underwent a FAST examination by EMRs and RRs with the same techniques to obtain the standard views. Ultrasound findings for free fluid in peritoneal cavity for each patient (positive/negative) were compared with the results of computed tomography, operative exploration, or observation as the final outcome. Results: A total of 138 patients were included in the final analysis. Good diagnostic agreement was noted between the results of FAST scans performed by EMRs and RRs (κ = 0.701, P < 0.001), also between the results of EMRs-performed FAST and the final outcome (κ = 0.830, P < 0.0010), and finally between the results of RRs-performed FAST and final outcome (κ = 0.795, P < 0.001). No significant differences were noted between EMRs- and RRs-performed FASTs regarding sensitivity (84.6% vs 84.6%), specificity (98.4% vs 97.6%), positive predictive value (84.6% vs 84.6%), and negative predictive value (98.4% vs 98.4%). Conclusions: Trained EMRs like their fellow RRs have the ability to perform FAST scan with high diagnostic value in patients with blunt abdominal trauma. PMID:26756009

  18. Study on Emergency Disposal of Fire and Explosion Accident of Oil Depot and Gas Station%石油库站着火爆炸事故的应急处置研究



    由于油料特殊的物化性质,在库站储存、收发过程中极易造成火灾、爆炸事故,从而导致重大人员伤亡及财产损失。论文针对油罐火灾、罐(槽)车火灾、输油管线破裂火灾、加油站火灾及电器火灾五种事故形式,在深入分析其各自特点的基础上,提出了切实可行的应急处置方案,为石油库站火灾事故应急抢险方案制定、具体实施提供了重要参考。%Because of special physical and chemical property of oil, in the process of oil storage and transportation, fire and explosion accidents incidentally were led to cause severe casualty and loss. Focusing on the characteristic and dangerous degree of main types of oil accident, feasible emergency disposal measure was put forward. The work done laid the solid foundation on the operation of first aid repair of gasoline transportation and storage.

  19. Use of Free, Open Access Medical Education and Perceived Emergency Medicine Educational Needs Among Rural Physicians in Southwestern Ontario.

    Folkl, Alex; Chan, Teresa; Blau, Elaine


    Free, open access medical education (FOAM) has the potential to revolutionize continuing medical education, particularly for rural physicians who practice emergency medicine (EM) as part of a generalist practice. However, there has been little study of rural physicians' educational needs since the advent of FOAM. We asked how rural physicians in Southwestern Ontario obtained their continuing EM education. We asked them to assess their perceived level of comfort in different areas of EM. To understand how FOAM resources might serve the rural EM community, we compared their responses with urban emergency physicians. Responses were collected via survey and interview. There was no significant difference between groups in reported use of FOAM resources. However, there was a significant difference between rural and urban physicians' perceived level of EM knowledge, with urban physicians reporting a higher degree of confidence for most knowledge categories, particularly those related to critical care and rare procedures. This study provides the first description of EM knowledge and FOAM resource utilization among rural physicians in Southwestern Ontario. It also highlights an area of educational need -- that is, critical care and rare procedures. Future work should address whether rural physicians are using FOAM specifically to improve their critical care and procedural knowledge. As well, because of the generalist nature of rural practice, future work should clarify whether there is an opportunity cost to rural physicians' knowledge of other clinical domains if they chose to focus more time on continuing education in critical care EM.

  20. Implementation and evaluation of a novel research education rotation for Royal College of Physicians and Surgeons emergency medicine residents.

    Abu-Laban, Riyad B; Jarvis-Selinger, Sandra; Newton, Lana; Chung, Brian


    Royal College of Physicians and Surgeons (RCPS) emergency medicine (EM) residents must complete a scholarly project; however, significant variation exists in Canadian EM resident research education and facilitation. We developed and implemented a novel mandatory research education rotation for RCPS EM residents intended to increase knowledge, faculty/resident collaborations, and, ultimately, scholarly output. This 4-week rotation took place in the fall of 2011 and consisted of 37 faculty-led didactic, critical appraisal, and workshop seminars. Exposure to faculty research and resulting opportunities and the development of resident research projects were integrated into the rotation. Twelve participating residents completed daily evaluations and took part in an exit focus group analyzed using a constant comparative method. Knowledge acquisition was assessed with a pre/post comprehensive examination instrument evaluated by a paired t-test. Evaluations indicated generally high satisfaction throughout the rotation. Focus group analysis indicated that residents felt two important but competing goals existed: developing a research project and developing critical appraisal skills. The research knowledge of all participants improved significantly (mean/SD examination change +35.4%/+10.4%, range +20.0% to +53.6%, p < 0.001), and several new resident/faculty research collaborations arose from the rotation. A rotation of this nature is an efficient and effective means to increase research and critical appraisal knowledge and faculty/resident collaborations. As a result of our positive experience, the rotation will continue annually and has been expanded to include pediatric EM fellows. Longitudinal tracking of the participating trainee cohort will remain ongoing to assess the scholarly output impact of the rotation.

  1. Emergency medicine: an operations management view.

    Soremekun, Olan A; Terwiesch, Christian; Pines, Jesse M


    Operations management (OM) is the science of understanding and improving business processes. For the emergency department (ED), OM principles can be used to reduce and alleviate the effects of crowding. A fundamental principle of OM is the waiting time formula, which has clear implications in the ED given that waiting time is fundamental to patient-centered emergency care. The waiting time formula consists of the activity time (how long it takes to complete a process), the utilization rate (the proportion of time a particular resource such a staff is working), and two measures of variation: the variation in patient interarrival times and the variation in patient processing times. Understanding the waiting time formula is important because it presents the fundamental parameters that can be managed to reduce waiting times and length of stay. An additional useful OM principle that is applicable to the ED is the efficient frontier. The efficient frontier compares the performance of EDs with respect to two dimensions: responsiveness (i.e., 1/wait time) and utilization rates. Some EDs may be "on the frontier," maximizing their responsiveness at their given utilization rates. However, most EDs likely have opportunities to move toward the frontier. Increasing capacity is a movement along the frontier and to truly move toward the frontier (i.e., improving responsiveness at a fixed capacity), we articulate three possible options: eliminating waste, reducing variability, or increasing flexibility. When conceptualizing ED crowding interventions, these are the major strategies to consider.

  2. Discriminating Between Legitimate and Predatory Open Access Journals: Report from the International Federation for Emergency Medicine Research Committee

    Bhakti Hansoti


    Full Text Available Introduction: Open access (OA medical publishing is growing rapidly. While subscription-based publishing does not charge the author, OA does. This opens the door for “predatory” publishers who take authors’ money but provide no substantial peer review or indexing to truly disseminate research findings. Discriminating between predatory and legitimate OA publishers is difficult. Methods: We searched a number of library indexing databases that were available to us through the University of California, Irvine Libraries for journals in the field of emergency medicine (EM. Using criteria from Jeffrey Beall, University of Colorado librarian and an expert on predatory publishing, and the Research Committee of the International Federation for EM, we categorized EM journals as legitimate or likely predatory. Results: We identified 150 journal titles related to EM from all sources, 55 of which met our criteria for OA (37%, the rest subscription based. Of these 55, 25 (45% were likely to be predatory. We present lists of clearly legitimate OA journals, and, conversely, likely predatory ones. We present criteria a researcher can use to discriminate between the two. We present the indexing profiles of legitimate EM OA journals, to inform the researcher about degree of dissemination of research findings by journal. Conclusion: OA journals are proliferating rapidly. About half in EM are legitimate. The rest take substantial money from unsuspecting, usually junior, researchers and provide no value for true dissemination of findings. Researchers should be educated and aware of scam journals.

  3. Ready for Discharge? A Survey of Discharge Transition-of-Care Education and Evaluation in Emergency Medicine Residency Programs.

    Gallahue, Fiona E; Betz, Amy E; Druck, Jeffrey; Jones, Jonathan S; Burns, Boyd; Hern, Gene


    This study aimed to assess current education and practices of emergency medicine (EM) residents as perceived by EM program directors to determine if there are deficits in resident discharge handoff training. This survey study was guided by the Kern model for medical curriculum development. A six-member Council of EM Residency Directors (CORD) Transitions of Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to program residency directors via the CORD listserve and/or direct contact. There were 119 responses to the survey, which were collected using an online survey tool. Over 71% of the 167 American College of Graduate Medical Education (ACGME) accredited EM residency programs were represented. Of those responding, 42.9% of programs reported formal training regarding discharges during initial orientation and 5.9% reported structured curriculum outside of orientation. A majority (73.9%) of programs reported that EM residents were not routinely evaluated on their discharge proficiency. Despite the ACGME requirements requiring formal handoff curriculum and evaluation, many programs do not provide formal curriculum on the discharge transition of care or evaluate EM residents on their discharge proficiency.

  4. 对日本福岛核事故的应急响应及对中心应急准备工作的改进建议%The Emergency Response to Fukushima Nuclear Accident and Proposals of Improvement for the Emergency Preparedness of NSC

    杨玲; 岳会国; 林权益; 李冰; 郜建伟


    The paper described the emergency response activities to Fukushima nuclear severe accidents by Nuclear and Radiation Safety Center(NSC).According to this emergency response and the available situation of the emergency planning;emergency preparedness in NSC,some improvement suggestions are proposed.%本文简述了环境保护部核与辐射安全中心在日本福岛第一核电厂发生严重事故期间的应急响应活动,并根据此次的响应情况结合核与辐射安全中心的现状,提出了核与辐射安全中心在应急计划;应急准备工作方面需要改进的一些建议。

  5. Development and assessment of a pediatric emergency medicine simulation and skills rotation: meeting the demands of a large pediatric clerkship

    Elaine K. Fielder


    Full Text Available Objective: To implement a curriculum using simulation and skills training to augment a Pediatric Emergency Medicine (PEM rotation within a pediatric clerkship. Background: PEM faculty are often challenged with a high learner to teacher ratio in a chaotic clinical setting. This challenge was heightened when our pediatric clerkship's traditional 1-week PEM rotation (consisting of 4 students completing four 8-hour ED shifts/week expanded to 8 students every 2 weeks. We sought to meet this challenge by integrating simulation-based education into the rotation. Methods: Clerkship students from March to June 2012 completed our traditional rotation. Students between July and October 2012 completed the new PEM-SIM curriculum with 19 hours ED shifts/week and 16 hours/week of simulation/skills training. Pre/post-tests evaluated 1 medical management/procedural comfort (five-point Likert scale; and 2 PEM knowledge (15 multiple-choice questions. Results: One hundred and nine students completed the study (48 traditional, 61 PEM-SIM. Improvement in comfort was significantly higher for the PEM-SIM group than the traditional group for 6 of 8 (75% medical management items (p<0.05 and 3 of 7 (43% procedures, including fracture splinting, lumbar puncture, and abscess incision/drainage (p<0.05. PEM-SIM students had significantly more improvement in mean knowledge compared to the traditional group (p<0.001. Conclusions: We have successfully integrated 16 hours/week of faculty-facilitated simulation-based education into a PEM rotation within our clerkship. This curriculum is beneficial in clinical settings with high learner to teacher ratios and when patient care experiences alone are insufficient for all students to meet rotation objectives.

  6. Nuclide reduction module for the purpose the Information and Documentation Centre (IDC) for nuclear accidents emergency planning. Nuclide-reductie module t. b. v. het Informatie en Documentatiecentrum (IDC) voor kernongevallenbestrijding

    Blaauboer, R.O.


    Within the framework of a national program on emergency response planning and preparedness for a nuclear accident (PKOB) an Information and Documentation Centre (IDC) has been developed at RIVM. This IDC projects for instance the effective dose equivalent due to radionuclides that may be released during a nuclear accident. One of the tools in use is an air transport model. To direct the attention to the most significant radionuclides, as far as the dose to the population due to internal radiation after inhalation and external radiation is concerned, and to speed up calculations, a method was developed to sort the 54 most important radionuclides from a nuclear release according to their contribution to dose. This method has been turned into a spreadsheet model and is described in this report. Also an outline is given that was used for the implementation of the method within the IDC on a HP-9000/370 computer. Using the 'radionuclide reduction' method it can be shown that for source terms of different types of accidents a quite different set of radionuclides is of importance for the effective dose equivalent during or after the passage of a cloud of radioactive material. Another result is that on the short term (upto a few days) the set of seven radionuclides that contribute the most to the effective dose equivalent (during or after passage) is not significantly influenced by the transport time of the cloud of radioactive material to the location where the dose is delivered. 2 tabs., 4 appendices, 11 refs.

  7. Improvement of Severe Accident Analysis Computer Code and Development of Accident Management Guidance for Heavy Water Reactor

    Park, Soo Yong; Kim, Ko Ryu; Kim, Dong Ha; Kim, See Darl; Song, Yong Mann; Choi, Young; Jin, Young Ho


    The objective of the project is to develop a generic severe accident management guidance(SAMG) applicable to Korean PHWR and the objective of this 3 year continued phase is to construct a base of the generic SAMG. Another objective is to improve a domestic computer code, ISAAC (Integrated Severe Accident Analysis code for CANDU), which still has many deficiencies to be improved in order to apply for the SAMG development. The scope and contents performed in this Phase-2 are as follows: The characteristics of major design and operation for the domestic Wolsong NPP are analyzed from the severe accident aspects. On the basis, preliminary strategies for SAM of PHWR are selected. The information needed for SAM and the methods to get that information are analyzed. Both the individual strategies applicable for accident mitigation under PHWR severe accident conditions and the technical background for those strategies are developed. A new version of ISAAC 2.0 has been developed after analyzing and modifying the existing models of ISAAC 1.0. The general SAMG applicable for PHWRs confirms severe accident management techniques for emergencies, provides the base technique to develop the plant specific SAMG by utility company and finally contributes to the public safety enhancement as a NPP safety assuring step. The ISAAC code will be used inevitably for the PSA, living PSA, severe accident analysis, SAM program development and operator training in PHWR.

  8. Study on the radiological assessor's responsibility in radiological accident and emergency response%辐射事故应急情况下放射评估者的职责

    张建峰; 苏旭; 李文红; 拓飞


    目的:探讨放射评估者在辐射事故应急现场中承担的任务和职责.方法:根据国际原子能机构技术报告中提出的相关建议以及我国的具体情况,分析放射评估者在辐射事故应急中所担负的任务和职责.结果:明确放射评估者在不同辐射应急中的任务和职责.结论:通过对放射评估者的任务和职责讨论,以便在实际工作中更好地履行职责,从而减轻辐射事故对人体和环境造成的损害.%Objective:To discuss the radiological assessor's tasks and responsibility when the radiological emergency and accident occurred.Methods:According to the technical reports from International Atomic Energy Agency (IAEA) and specific circumstances in China,it analyzed the task and responsibility which radiological assessor should take.Results:It defined the tasks and responsibility of radiological assessor.Conclusion:Radiological assessor will carry out their task and responsibility well in practice to reduce the damage to personnel and environmental in radiological accident.

  9. An Epidemiological Study on the Incidence of Accidents Among under 5 Years of Age Referred to Emergency Hospital Units in Hamadan Province

    Salman Khazaei


    Full Text Available Background and objectives : Accidents and injuries are the leading causes of avoidable illness and death in most of the countries in the world. For health policymakers, it is essential to have knowledge about the occurrence of accidents. The aim of this study was to evaluate the incidence of accidents in children under 5 years of age referring to emergency departments in Hamadan province. Material and Methods: This is a retrospective study that all under 5 years of age patients referred to hospitals in Hamadan province were enrolled in the study during 2009 to 2014. Data were extracted from injury register software and by using descriptive and analytic statistics, data were analyzed with STATA software version 12 at the level of error less        than 5%. Results: A total of 7409 under 5 years of age patients were registered during this period. 70.4% were male and 38.97% of them were under 1 year old. Home accidents included 45.07% of the accidents. Car accidents (27.89%, hit (22.16% and fall (16.79% were the most occurred accidents in both sexes. Conclusion: Due to the high incidence of accidents at home and roads, necessary precautions should be taken in this regard

  10. How mobile robots have helped at Chernobyl and other accidents

    Meieran, H.B.


    The use of mobile robots at several recent accidents including Chernobyl is described. The robots assumed, with varying degrees of success, many of the tasks and missions that are normally conducted by the emergency response team. Lessons learned from the experiences, together with operational and performance problems are discussed. (U.K.).

  11. Two decades of radiological accidents direct causes, roots causes and consequences

    Rozental Jose de Julio


    Full Text Available Practically all Countries utilize radioisotopes in medicine, industry, agriculture and research. The extent to which ionizing radiation practices are employed varies considerably, depending largely upon social and economic conditions and the level of technical skills available in the country. An overview of the majority of practices and the associated hazards will be found in the Table IV to VII of this document. The practices in normal and abnormal operating conditions should follow the basic principles of radiation protection and the Safety of Radiation Sources, considering the IAEA Radiation Protection and the Safety of Radiation Sources, Safety Series 120 and the IAEA Recommendation of the Basic Safety Standards for Radiation Protection, Safety Series Nº 115. The Standards themselves underline the necessity to be able to predict the radiological consequences of emergency conditions and the investigations that should need to be done. This paper describes the major accidents that had happened in the last two decades, provides a methodology for analyses and gives a collection of lessons learned. This will help the Regulatory Authority to review the reasons of vulnerabilities, and to start a Radiation safety and Security Programme to introduce measurescapable to avoid the recurrence of similar events. Although a number of accidents with fatalities have caught the attention of the public in recent year, a safety record has accompanied the widespread use of radiation sources. However, the fact that accidents are uncommon should not give grounds for complacency. No radiological accident is acceptable. From a radiation safety and security of the sources standpoint, accident investigation is necessary to determine what happened, why, when, where and how it occurred and who was (were involved and responsible. The investigation conclusion is an important process toward alertness and feedback to avoid careless attitudes by improving the comprehension

  12. [The importance of teamwork in emergency medicine training].

    Vermeulen, B; Carron, P-N


    The study of dynamics in relation to performing in small groups has increased pedagogic knowledge about teamwork. The successful management of patients with life-threatening pathologies depends highly from a succession of teams with a specific mission as: the call centre 144, Paramedics, the ED, the Operating Theatre and the Intensive care. To enable each team to operate successfully, it is essential to coordinate their qualifications and synergism. This can be efficiently attained by simulating real situations and by following protocols dedicated to teamwork. Emergency Medicine, which is on the brink of acquiring its proper curriculum, must adopt this concept to integrate knowledge and know-how, and the art of being and doing. At this stage, the Emergency Physician will have the competence which will enable him to be a real "team leader".

  13. 深水钻井井喷事故情景构建及应急能力评估%Scenario design of blowout accidents in deepwater drilling and emergency capacity assessment

    殷志明; 张红生; 周建良; 李迅科


    Deepwater oil and gas development faces enormous risks and challenges. Especially when blowout out of control ac-cident occurs in the development process, the emergency rescue will be very dififcult. Scenario design approach for major accidents is used to build blowout scenarios in the drilling of a deepwater exploratory well in the South China Sea, covering the whole process from overlfow to blowout out of control, ifre and explosion of platform, platform overturn and sinking, underwater emergency well shut-in and relief well digging, spilled oil recycling and ecological restoration. The demands for engineering technology, equipment and staff for the emergency rescue are analyzed and evaluated and suggestions on the research of emergency rescue technology in the next stage in China are provided. The research results can be a reference for the independent building of emergency rescue engineering technique system in well control of deepwater drilling in China.%深水油气开发面临着巨大的风险和挑战,尤其是在油气开发过程中如果发生井喷失控事故,应急救援将十分困难。采用重大事故情景构建方法,建立南中国海某深水探井在钻井期间发生井喷失控事故情景,包括从溢流发生到井喷失控、平台发生火灾爆炸、平台倾覆沉没、水下应急封井及打救援井、溢油回收处理及生态恢复,并对应急救援必须的工程技术、设备、人员等需求进行分析和评估,对我国下一阶段开展应急救援技术研究提出建议。研究结果对我国自主建立深水钻井井控应急救援工程技术体系有一定参考意义。

  14. Effects of a Web-based Educational Module on Pediatric Emergency Medicine Physicians’ Knowledge, Attitudes, and Behaviors Regarding Youth Violence

    Tracy E. Madsen


    Full Text Available Introduction: Youth seen in the emergency department (ED with injuries from youth violence (YV have increased risk for future violent injury and death. Pediatric emergency medicine (PEM physicians rarely receive training in, or perform, YV screening and intervention. Our objective was to examine effects of a web-based educational module on PEM physicians’ knowledge, attitudes, and behaviors regarding YV screening and interventions in the ED. Methods: We invited all PEM fellows and attendings at an urban Level I pediatric trauma center to complete an interactive web-based education module (and 1-month booster with information on YV’s public health impact and how to screen, counsel and refer YV-involved patients. Consenting subjects completed electronic assessments of YV prevention knowledge and attitudes (using validated measures when possible before and after the initial module and after the booster. To measure behavior change, chart review identified use of YV-specific discharge instructions in visits by YV-injured PEM patients (age 12–17; identified by E codes 6 months before and after the intervention. We analyzed survey data were analyzed with Fisher’s exact for binary outcomes and Kruskal-Wallis for Likert responses. Proportion of patients given YV discharge instructions before and after the intervention was compared using chi-square. Results: Eighteen (67% of 27 PEM physicians participated; 1 was lost at post-module assessment and 5 at 1 month. Module completion time ranged from 15–30 minutes. At baseline, 50% of subjects could identify victims’ re-injury rate; 28% were aware of ED YV discharge instructions. After the initial module and at 1 month, there were significant increases in knowledge (p,0.001 and level of confidence speaking with patients about avoiding YV (p¼0.01, df¼2. Almost all (94% said the module would change future management. In pre-intervention visits, 1.6% of patients with YV injuries were discharged with

  15. In-Training Practice Patterns of Combined Emergency Medicine/Internal Medicine Residents, 2003-2007

    Todd A Templeman


    Full Text Available Introduction: This study seeks to evaluate the practice patterns of current combined emergency medicine/internal medicine (EM/IM residents during their training and compare them to the typical practice patterns of EM/IM graduates. We further seek to characterize how these current residents perceive the EM/IM physician’s niche. Methods: This is a multi-institution, cross-sectional, survey-based cohort study. Between June 2008 and July 2008, all 112 residents of the 11 EM/IM programs listed by the Accreditation Council for Graduate Medical Education were contacted and asked to complete a survey concerning plans for certification, fellowship, and practice setting. Results: The adjusted response rate was 71%. All respondents anticipated certifying in both specialties, with 47% intending to pursue fellowships. Most residents (97% allotted time to both EM and IM, with a median time of 70% and 30%, respectively. Concerning academic medicine, 81% indicated intent to practice academic medicine, and 96% planned to allocate at least 10% of their future time to a university/academic setting. In evaluating satisfaction, 94% were (1 satisfied with their residency choice, (2 believed that a combined residency will advance their career, and (3 would repeat a combined residency if given the opportunity. Conclusion: Current EM/IM residents were very content with their training and the overwhelming majority of residents plan to devote time to the practice of academic medicine. Relative to the practice patterns previously observed in EM/IM graduates, the current residents are more inclined toward pursuing fellowships and practicing both specialties. [West J Emerg Med. 2011;12(4:530–536.

  16. Training in emergency and severe accident (current situation and future after Fukushima); Formacion en emergencias y accidentes severos (situacion actual y futuro tras Fukushima)

    Caro, R. J.; Delgado, J. L.; Martinez Fanegas, R.; Gonzalez Anez, F.


    After Fukushima, training in emergency response has got a renewed meaning to cope, successfully with accidental scenarios that can occur in nuclear power plants. The authors in this paper review the fundamentals of training, considering from the training process to the main contents, including the main technological and methodological tools. The know-how acquired in training the NPPs staff and the development and in application of new methods and tools, allows analyzing the evolution expected in training to better contribute to the Nuclear Safety. (Author)

  17. Current and future directions in clinical fatigue management: An update for emergency medicine practitioners.

    Cheng, Yi Han; Roach, Gregory D; Petrilli, Renee Ma


    Physicians worldwide are working round the clock to meet the demands of healthcare systems, especially in acute medical settings such as EDs. Demanding shift work schedules cause fatigue and thus deterioration in mood and motor performance. This article explores the effects of sleep deprivation, focusing on cognition, executive decision-making and the implications for clinical care. Humans are capable of functioning and even adapting to sleep restriction; however, clinicians should be aware of pitfalls and absolute minimums for sleep. Fatigue management training shows promise in enhancing safety in aviation and might have a role in medical shift work. Strategic napping improves performance during night shift in the ED, but does not fully negate fatigue. Drugs offer limited benefit for performance under sleep-deprived conditions, and whenever possible, sleep and/or strategic napping takes precedence.

  18. [Cardiogenic pulmonary edema - truth and myths in the perspective of emergency medicine].

    Osterwalder, J J


    This critical analysis of the traditional pathophysiological approach to the diagnosis and treatment of cardiogenic pulmonary edema calls into question some long-established ideas and interventions that ought to be replaced by better evidence-based concepts.

  19. Salvia divinorum: from Mazatec medicinal and hallucinogenic plant to emerging recreational drug.

    Zawilska, Jolanta B; Wojcieszak, Jakub


    Salvia divinorum is a sage endemic to a small region of Mexico and has been traditionally used by the Mazatec Indians for divination and spiritual healing. Recently, it has gained increased popularity as a recreational drug, used by adolescents and young adults as an alternative to marijuana and LSD. Salvinorin A, the major active ingredient of the plant, is considered to be the most potent known hallucinogen of natural origin. This review surveys the current state of knowledge on the neurochemical, pharmacokinetic, and pharmacological properties of salvinorin A, the trends and motivation behind S. divinorum use, and the health problems among users of the plant's products. S. divinorum induces intense, but short-lived, psychedelic-like changes in mood and perception, with concomitant hallucinations and disorientation. Many websites have misinterpreted the limited existing research-based information on the side effects of salvia as evidence for its safety. However, data accumulated over the last few years indicate that potential health risks are associated with the use of S. divinorum, especially by teenagers, users of other substances of abuse, and individuals with underlying psychotic disturbances. Taken together, the data presented in this review point to the need for further basic and clinical studies to create a basis for the development of well-addressed prevention and treatment strategies.

  20. [Vertigo and dizziness. Diagnostic algorithm from the perspective of emergency medicine].

    Dodt, C; Zelihic, E


    Vertigo and dizziness are common symptoms in the acute care setting and have a wide diagnostic range. The most deleterious diagnosis is vertebrobasilar disease with brain infarction in the posterior fossa. Therefore, every patient with acute vestibular syndrome needs to be evaluated by a structured interview and a systematic physical examination for red flag symptoms which indicate vertebrobasilar infarction. Routinely, the physical examination should cover the head impulse (Halmagyi) test, test for nystagmus as well as the test of skew and in cases of benign paroxysmal positional vertigo, by the Dix-Hallpike maneuver. The suspicion of a central cause of vertigo is ideally confirmed by a magnetic resonance imaging (MRI) scan. Most patients with a peripheral cause of vertigo can be discharged under symptomatic therapy with the advice to consult an ear nose and throat physician while patients with a central cause of vertigo are admitted for further neurological treatment.

  1. Careers and Emerging Opportunities in Visual Communication in Medicine: Medical photography in Norway.

    Kjersem, Bård


    The community of medical photographers in Norway is relatively small. Except for one they are all employed with titles such as research technicians, department engineers, senior consultants and skilled workers. At the present there is no formal education in medical photography. The most common educational attainment for photographers is the Journeyman's certificate. Until recently, the requirement for employment for photographers at Norwegian hospitals was the Journeyman's Certificate. However, the Institutt for Klinisk Medisin at University in Oslo recently advertised a vacancy for a departmental Engineer to run its photographic and video services. The post required that the candidates possess either a Bachelor's degree in a relevant subject. This is the first vacancy in medical photography in nine years. The Norwegian health services have been reformed in the direction of New Public Management (NPM). To utilise the resources effectively, tasks that normally would be performed by one health profession are shifted to another with a different or lower education and training. There are reasons to believe that the shift of medical photography from professional photographers to other health personnel without specialist training or qualifications is an attempt to utilise resources more effectively. During the next two years a mixed methods research will be carried out to explore the current situation for medical photography in Norway.

  2. Time-Driven Activity-Based Costing in Emergency Medicine.

    Yun, Brian J; Prabhakar, Anand M; Warsh, Jonathan; Kaplan, Robert; Brennan, John; Dempsey, Kyle E; Raja, Ali S


    Value in emergency medicine is determined by both patient-important outcomes and the costs associated with achieving them. However, measuring true costs is challenging. Without an understanding of costs, emergency department (ED) leaders will be unable to determine which interventions might improve value for their patients. Although ongoing research may determine which outcomes are meaningful, an accurate costing system is also needed. This article reviews current costing mechanisms in the ED and their pitfalls. It then describes how time-driven activity-based costing may be superior to these current costing systems. Time-driven activity-based costing, in addition to being a more accurate costing system, can be used for process improvements in the ED.

  3. Investigation of epidemic characteristics and emergency nursing on patients suffered from traffic accidents%交通事故伤害患者流行病学特点及急救护理的调查研究

    唐灵芝; 陈由珠; 李云燕


    目的 了解交通伤患者的性别、年龄、受伤部位、车祸发生的时间等特征,为临床救护提供依据.方法 以2005年6月至2007年6月收治的2 955例交通事故伤害的急诊患者为研究对象,进行回顾性、描述性统计分析.结果 交通伤比例高的时间段为5~11月、双休日、每年3个长假,1 d内以11:00~13:00、16:00~19:00为多.交通伤患者男多于女,年龄以16~35岁的青年最多,伤害部位以头面部和四肢为主,需立即实施抢救措施者945例.结论 应加强节假日、双休日、中晚班急诊护理人员的配备,保证有足够的人力参与抢救;同时应加强护士急救意识、各种穿刺能力、抢救技能以及应急应变能力训练,进一步规范交通伤的救治.%Objective To understand the sex,age,injured portion,time of accident on patients suf-fered from traffic accidents in order to provide evidences for clinical emergency rescue.Methods For retrospective analysis and descriptive statistics,2955 patients who suffered from traffic accidents between Jun 2005 and Jun 2007 were as study objects.Results The periods with high traffic wounds were in May to September,weekends,three long holidays.Among a day,accidents happened more in 11Am to 13Pro,16Pm to 19Pm.Male patients were more than females.16 to 35 year old young people were at most.Injured portions were mainly in head,face and four limbs.945 patients needed emergency rescue immediately.Conclusion In order to have sufficient poople to take part in rescues,emergency nurses for holidays,weekends,mid and night duties should be prepared in-creasingly.Meanwhile,nurses'emergency consciousness,various kinds puncture techniques,rescuing and strin-gency skills should be strengthened.Remedy for traffic wounds should be further specified.

  4. Critical drug shortages: implications for emergency medicine.

    Mazer-Amirshahi, Maryann; Pourmand, Ali; Singer, Steven; Pines, Jesse M; van den Anker, John


    Prescription drug shortages have become increasingly common and more severe over the past decade. In addition, reported shortages are longer in duration and have had a greater effect on patient care. Some of the causes of current drug shortages are multifactorial, including the consolidation of drug manufacturers, quality problems at production plants that restrict the supply of drugs, and a lack of financial incentives for manufacturers to produce certain products, particularly generic medications. Generic injectable medications are most commonly affected by shortages because the production process is complex and costly for these drugs, and profit margins are often smaller than for branded medications. Many commonly used emergency department (ED) generic injectables have been affected by shortages, including multiple resuscitation and critical care drugs. Several reports have shown that shortages can potentially have major effects on the quality of medical care, including medication errors, treatment delays, adverse outcomes, and increased health care costs. Currently, no published data exist outside of case reports that directly link ED-based drug shortages to overall patient safety events; however, there are several examples in the ED where first-line therapies for life-saving medications have been in short supply, and alternatives have higher rates of adverse events, narrower therapeutic indexes, or both. Aside from increasing notification about shortages, the U.S. Food and Drug Administration has little power to coerce manufacturers to produce medications during a shortage. Therefore, ED providers must learn to mitigate the effects of shortages locally, through active communication with pharmacy staff to identify safe and effective alternatives for commonly used medications when possible. Particularly given the effect on critical care medications, therapeutic alternatives should be clearly communicated to all staff so that providers have easy access to this

  5. The Effectiveness of Emergency Response System’s Service Providers for Road Accidents in Johor Bahru, Malaysia

    Kazunori H.


    Full Text Available In Malaysia, there are three core services involved in emergency, namely the fire and rescue, police, and ambulance services. The aim of the service providers is to prevent the loss of life and damage by improving their response time. The Civil Defence Department and the 999 call centre also assist the main providers. This paper aims to provide an overview of emergency response system (ERS for road accidents in Johor Bahru. The objective is to find the effective services from ERS works. There are three sections of chronological events involved: the call centre receiving reports on accidents, at location of the accident and the time during which the victims are brought to the hospital. The paper studies the operation scheme of the ERS by describing the condition; to analyse the questionnaire using a set of questions on the ERS service; and to determine the effectiveness of the services provided. The provider’s services can be identified as a main factor in improving the ERS services provided in the study area.

  6. Emergency thoracic ultrasound and clinical risk management

    Interrigi MC


    Full Text Available Maria Concetta Interrigi,1 Francesca M Trovato,2,3 Daniela Catalano,3,4 Guglielmo M Trovato3,5 1Accident and Emergency Department, Ospedale Cannizzaro, Catania, 2Accident and Emergency Department, Ospedale Civile, Ragusa, 3Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania, 4Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania, 5Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy Purpose: Thoracic ultrasound (TUS has been proposed as an easy-option replacement for chest X-ray (CXR in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results: Three hundred and seventy emergency TUS scans (excluding trauma patients were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion; in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed

  7. Assessing Knowledge Base on Geriatric Competencies for Emergency Medicine Residents

    Teresita M. Hogan


    Full Text Available Introduction: Emergency care of older adults requires specialized knowledge of their unique physiology, atypical presentations, and care transitions. Older adults often require distinctive assessment, treatment and disposition. Emergency medicine (EM residents should develop expertise and efficiency in geriatric care. Older adults represent over 25% of most emergency department (ED volumes. Yet many EM residencies lack curricula or assessment tools for competent geriatric care. Fully educating residents in emergency geriatric care can demand large amounts of limited conference time. The Geriatric Emergency Medicine Competencies (GEMC are high-impact geriatric topics developed to help residencies efficiently and effectively meet this training demand. This study examines if a 2-hour didactic intervention can significantly improve resident knowledge in 7 key domains as identified by the GEMC across multiple programs. Methods: A validated 29-question didactic test was administered at six EM residencies before and after a GEMC-focused lecture delivered in summer and fall of 2009. We analyzed scores as individual questions and in defined topic domains using a paired student t test. Results: A total of 301 exams were administered; 86 to PGY1, 88 to PGY2, 86 to PGY3, and 41 to PGY4 residents. The testing of didactic knowledge before and after the GEMC educational intervention had high internal reliability (87.9%. The intervention significantly improved scores in all 7 GEMC domains (improvement 13.5% to 34.6%; p<0.001. For all questions, the improvement was 23% (37.8% pre, 60.8% post; P<0.001 Graded increase in geriatric knowledge occurred by PGY year with the greatest improvement post intervention seen at the PGY 3 level (PGY1 19.1% versus PGY3 27.1%. Conclusion: A brief GEMC intervention had a significant impact on EM resident knowledge of critical geriatric topics. Lectures based on the GEMC can be a high-yield tool to enhance resident knowledge of

  8. Coping behavior and risk and resilience stress factors in French regional emergency medicine unit workers: a cross-sectional survey

    AI, Lala; LM, Sturzu; JP, Picard; F, Druot; F, Grama; G, Bobirnac


    The Emergency Department (ED) has the highest workload in a hospital, offering care to patients in their most acute state of illness, as well as comforting their families and tending to stressful situations of the physical and psychological areal. Method. A cross-sectional survey of 366 Emergency Unit staff members including medical doctors, medical residents, medical nurses and ward aids, was undergone. Study participants came from four periphery hospitals in the Moselle Department of Easter...

  9. Accidents in Canada: mortality and hospitalization.

    Riley, R; Paddon, P


    For Canadians under 45, accidents are the leading cause of both death and hospitalization. For the Canadian population as a whole, accidents rank fourth as a cause of death, after cardiovascular disease (CVD), cancer and respiratory disease. This article analyzes accident mortality and hospitalization in Canada using age-specific rates, age-standardized mortality rates (ASMR), and potential years of life lost (PYLL). The six major causes of accidental death for men are motor vehicle traffic accidents (MVTA), falls, drowning, fires, suffocation and poisoning. For women, the order is slightly different: MVTA, falls, fires, suffocation, poisoning and drowning. From 1971 to 1986, age-standardized mortality rates (ASMR) for accidents decreased by 44% for men and 39% for women. The largest decrease occurred in the under 15 age group. Accidents accounted for 11.5% of total hospital days in 1985, and 8% of hospital discharges. Because young people have the highest rates of accidental death, potential years of life lost (PYLL) are almost as high for accidents as for cardiovascular disease, although CVD deaths outnumbered accidental deaths by almost five to one in 1985.

  10. Severe accident research and management in Nordic Countries - A status report

    Frid, W. [Swedish Nuclear Power Inspectorate, SKI (Sweden)] (ed.)


    The report describes the status of severe accident research and accident management development in Finland, Sweden, Norway and Denmark. The emphasis is on severe accident phenomena and issues of special importance for the severe accident management strategies implemented in Sweden and in Finland. The main objective of the research has been to verify the protection provided by the accident mitigation measures and to reduce the uncertainties in risk dominant accident phenomena. Another objective has been to support validation and improvements of accident management strategies and procedures as well as to contribute to the development of level 2 PSA, computerised operator aids for accident management and certain aspects of emergency preparedness. Severe accident research addresses both the in-vessel and the ex-vessel accident progression phenomena and issues. Even though there are differences between Sweden and Finland as to the scope and content of the research programs, the focus of the research in both countries is on in-vessel coolability, integrity of the reactor vessel lower head and core melt behaviour in the containment, in particular the issues of core debris coolability and steam explosions. Notwithstanding that our understanding of these issues has significantly improved, and that experimental data base has been largely expanded, there are still important uncertainties which motivate continued research. Other important areas are thermal-hydraulic phenomena during reflooding of an overheated partially degraded core, fission product chemistry, in particular formation of organic iodine, and hydrogen transport and combustion phenomena. The development of severe accident management has embraced, among other things, improvements of accident mitigating procedures and strategies, further work at IFE Halden on Computerised Accident Management Support (CAMS) system, as well as plant modifications, including new instrumentation. Recent efforts in Sweden in this area

  11. Road accidents and business cycles in Spain.

    Rodríguez-López, Jesús; Marrero, Gustavo A; González, Rosa Marina; Leal-Linares, Teresa


    This paper explores the causes behind the downturn in road accidents in Spain across the last decade. Possible causes are grouped into three categories: Institutional factors (a Penalty Point System, PPS, dating from 2006), technological factors (active safety and passive safety of vehicles), and macroeconomic factors (the Great recession starting in 2008, and an increase in fuel prices during the spring of 2008). The PPS has been blessed by incumbent authorities as responsible for the decline of road fatalities in Spain. Using cointegration techniques, the GDP growth rate, the fuel price, the PPS, and technological items embedded in motor vehicles appear to be statistically significantly related with accidents. Importantly, PPS is found to be significant in reducing fatal accidents. However, PPS is not significant for non-fatal accidents. In view of these results, we conclude that road accidents in Spain are very sensitive to the business cycle, and that the PPS influenced the severity (fatality) rather than the quantity of accidents in Spain. Importantly, technological items help explain a sizable fraction in accidents downturn, their effects dating back from the end of the nineties.

  12. Importance of risk communication during and after a nuclear accident.

    Perko, Tanja


    Past nuclear accidents highlight communication as one of the most important challenges in emergency management. In the early phase, communication increases awareness and understanding of protective actions and improves the population response. In the medium and long term, risk communication can facilitate the remediation process and the return to normal life. Mass media play a central role in risk communication. The recent nuclear accident in Japan, as expected, induced massive media coverage. Media were employed to communicate with the public during the contamination phase, and they will play the same important role in the clean-up and recovery phases. However, media also have to fulfill the economic aspects of publishing or broadcasting, with the "bad news is good news" slogan that is a well-known phenomenon in journalism. This article addresses the main communication challenges and suggests possible risk communication approaches to adopt in the case of a nuclear accident.

  13. Portfolios: possibilities for addressing emergency medicine resident competencies.

    O'Sullivan, Patricia; Greene, Constance


    Portfolios are an innovative approach to evaluate the competency of emergency medicine residents. Three key characteristics add to their attractiveness. First, portfolios draw from the resident's actual work. Second, they require self-reflection on the part of the resident. Third, they are inherently practice-based learning since residents must review and consider their practice in order to begin the portfolio. This paper illustrates five different applications of portfolios. First, portfolios are applied to evaluating specific competencies as part of the training of emergency physicians. While evaluating specific competencies, the portfolio captures aspects of the general competencies. Second, the article illustrates using portfolios as a way to address a specific residency review committee (RRC) requirement such as follow-ups. Third is a description of how portfolios can be used to evaluate resident conferences capturing the competency of practice-based learning and possibly other competencies such as medical knowledge and patient care. Fourth, the authors of the article designed a portfolio as a way to demonstrate clinical competence. Fifth, they elaborate as to how a continuous quality improvement project could be cast within the portfolio framework. They provide some guidance concerning issues to address when designing the portfolios. Portfolios are carefully structured and not haphazard collections of materials. Following criteria is important in maintaining the validity of the portfolio as well as contributing to reliability. The portfolios can enhance the relationship between faculty and residents since faculty will suggest cases, discuss anomalies, and interact with the residents around the portfolio. The authors believe that in general portfolios can cover many of the general competencies specified by the ACGME while still focusing on issues important to emergency medicine. The authors believe that portfolios provide an approach to evaluation commensurate

  14. Review of Severe Accident Phenomena in LWR and Related Severe Accident Analysis Codes

    Muhammad Hashim


    Full Text Available Firstly, importance of severe accident provision is highlighted in view of Fukushima Daiichi accident. Then, extensive review of the past researches on severe accident phenomena in LWR is presented within this study. Various complexes, physicochemical and radiological phenomena take place during various stages of the severe accidents of Light Water Reactor (LWR plants. The review deals with progression of the severe accidents phenomena by dividing into core degradation phenomena in reactor vessel and post core melt phenomena in the containment. The development of various computer codes to analyze these severe accidents phenomena is also summarized in the review. Lastly, the need of international activity is stressed to assemble various severe accidents related knowledge systematically from research organs and compile them on the open knowledge base via the internet to be available worldwide.

  15. Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar.

    Khudair, I F; Jassim, Z; Hanssens, Y; Alsaad, W A


    Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as "poisoning case" with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.

  16. Consideration of Command and Control Performance during Accident Management Process at the Nuclear Power Plant

    Ahmed, Nisrene M. [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of); Kim, Sok Chul [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)


    The accident at the Fukushima Daiichi nuclear power plants shifted the nuclear safety paradigm from risk management to on-site management capability during a severe accident. The kernel of on-site management capability during an accident at a nuclear power plant is situation awareness and agility of command and control. However, little consideration has been given to accident management. After the events of September 11, 2001 and the catastrophic Fukushima nuclear disaster, agility of command and control has emerged as a significant element for effective and efficient accident management, with many studies emphasizing accident management strategies, particularly man-machine interface, which is considered a key role in ensuring nuclear power plant safety during severe accident conditions. This paper proposes a conceptual model for evaluating command and control performance during the accident management process at a nuclear power plant. Communication and information processing while responding to an accident is one of the key issues needed to mitigate the accident. This model will give guidelines for accurate and fast communication response during accident conditions.

  17. The 2015 Academic College of Emergency Experts in India's INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India.

    Mahajan, Prashant; Batra, Prerna; Shah, Binita R; Saha, Abhijeet; Galwankar, Sagar; Aggrawal, Praveen; Hassoun, Ameer; Batra, Bipin; Bhoi, Sanjeev; Kalra, Om Prakash; Shah, Dheeraj


    The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally, organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine (MD) in Emergency Medicine (EM) as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3-year superspeciality course (in PEM) after completion of MD/Diplomate of National Board (DNB) Pediatrics or MD/DNB in EM. The National Board of Examinations (NBE) that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program - DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG-ACEE-India) gives its recommendations for starting 3-year DM/DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.

  18. The 2015 Academic College of Emergency Experts in Indias INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India.

    Mahajan, Prashant; Batra, Prerna; Shah, Binita R; Saha, Abhijeet; Galwankar, Sagar; Aggrawal, Praveen; Hassoun, Ameer; Batra, Bipin; Bhoi, Sanjeev; Kalra, Om Prakash; Shah, Dheeraj


    The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine in Emergency Medicine as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3 year superspeciality course after completion of MD Diplomate of National Board (DNB) Pediatrics or MD DNB in EM. The National Board of Examinations that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG ACEE India) gives its recommendations for starting 3 year DM DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.

  19. Advanced imaging approaches for regenerative medicine: Emerging technologies for monitoring stem cell fate in vitro and in vivo.

    Kupfer, Molly E; Ogle, Brenda M


    The future of regenerative medicine relies on our ability to control stem cell fate in order to produce functional tissues. Stem cells are the preferred cell source for tissue engineering endeavors and regenerative medicine therapies due to their high potency and capacity for expansion. However, their potency also makes them very difficult to control, as they are in a constant state of flux. Therefore, in order to advance research in regenerative medicine, it is necessary to be able to monitor cell state and phenotype both in vitro and in vivo. This review will detail the imaging technologies currently in use to monitor stem cell phenotype, migration, and differentiation. In addition to providing examples of the most recent work in this area, we will also discuss the future of imaging technologies for regenerative medicine, and how current imaging modalities might be utilized to image specific cell functionality in order to track stem cell fate. The research area of imaging stem cells is progressing toward identifying mature and differentiating cells not only by phenotypic markers, but also by visualizing cell function. Many of the cutting-edge modalities detailed in this review have the potential to be harnessed toward this goal.

  20. Correlation of the Emergency Medicine Resident In-service Examination with the American Osteopathic Board of Emergency Medicine Part I

    David Levy


    Full Text Available Introduction: Eligible residents during their fourth postgraduate year (PGY-4 of emergency medicine (EM residency training who seek specialty board certification in emergency medicine may take the American Osteopathic Board of Emergency Medicine (AOBEM Part 1 Board Certifying Examination (AOBEM Part 1. All residents enrolled in an osteopathic EM residency training program are required to take the EM Resident In-service Examination (RISE annually. Our aim was to correlate resident performance on the RISE with performance on the AOBEM Part 1. The study group consisted of osteopathic EM residents in their PGY-4 year of training who took both examinations during that same year. Methods: We examined data from 2009 to 2012 from the National Board of Osteopathic Medical Examiners (NBOME. The NBOME grades and performs statistical analyses on both the RISE and the AOBEM Part 1. We used the RISE exam scores, as reported by percentile rank, and compared them to both the score on the AOBEM Part 1 and the dichotomous outcome of passing or failing. A receiver operating characteristic (ROC curve was generated to depict the relationship. Results: We studied a total of 409 residents over the 4-year period. The RISE percentile score correlated strongly with the AOBEM Part 1 score for residents who took both exams in the same year (r¼0.61, 95% confidence interval [CI] 0.54 to 0.66. Pass percentage on the AOBEM Part 1 increased by resident percent decile on the RISE from 0% in the bottom decile to 100% in the top decile. ROC analysis also showed that the best cutoff for determining pass or fail on the AOBEM Part 1 was a 65th percentile score on the RISE. Conclusion: We have shown there is a strong correlation between a resident’s percentile score on the RISE during their PGY-4 year of residency training and first-time success on the AOBEM Part 1 taken during the same year. This information may be useful for osteopathic EM residents as an indicator as to how well

  1. Emergency department patient characteristics: Potential impact on emergency medicine residency programs in the Netherlands.

    Elshove-Bolk, J.; Mencl, F.; Rijswijck, B.T. van; Weiss, I.M.; Simons, M.P.; Vugt, A.B. van


    OBJECTIVES: We set out to study emergency department patient characteristics at a busy level-2 trauma center, to gain insight into the practise of emergency medicine, which is not yet recognized as a specialty in the Netherlands. METHODS: From May 27 to July 4 2001, the following data were recorded

  2. Simulation in Medical School Education: Review for Emergency Medicine

    Shahram Lotfipour


    Full Text Available Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM. The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.

  3. Household Animal and Human Medicine Use and Animal Husbandry Practices in Rural Bangladesh: Risk Factors for Emerging Zoonotic Disease and Antibiotic Resistance.

    Roess, A A; Winch, P J; Akhter, A; Afroz, D; Ali, N A; Shah, R; Begum, N; Seraji, H R; El Arifeen, S; Darmstadt, G L; Baqui, A H


    Animal antimicrobial use and husbandry practices increase risk of emerging zoonotic disease and antibiotic resistance. We surveyed 700 households to elicit information on human and animal medicine use and husbandry practices. Households that owned livestock (n = 265/459, 57.7%) reported using animal treatments 630 times during the previous 6 months; 57.6% obtained medicines, including antibiotics, from drug sellers. Government animal healthcare providers were rarely visited (9.7%), and respondents more often sought animal health care from pharmacies and village doctors (70.6% and 11.9%, respectively), citing the latter two as less costly and more successful based on past performance. Animal husbandry practices that could promote the transmission of microbes from animals to humans included the following: the proximity of chickens to humans (50.1% of households reported that the chickens slept in the bedroom); the shared use of natural bodies of water for human and animal bathing (78.3%); the use of livestock waste as fertilizer (60.9%); and gender roles that dictate that females are the primary caretakers of poultry and children (62.8%). In the absence of an effective animal healthcare system, villagers must depend on informal healthcare providers for treatment of their animals. Suboptimal use of antimicrobials coupled with unhygienic animal husbandry practices is an important risk factor for emerging zoonotic disease and resistant pathogens.

  4. Feasibility of Spanish-language acquisition for acute medical care providers: novel curriculum for emergency medicine residencies

    Grall KH; Panchal AR; Chuffe E; Stoneking LR


    Kristi H Grall,1 Ashish R Panchal,2 Eliud Chuffe,3 Lisa R Stoneking4 1Department of Emergency Medicine, Regions Hospital, Health Partners Institute, St Paul, MN, 2Department of Emergency Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, 3Department of Spanish and Portuguese, 4Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA Introduction: Language and cultural barriers are detriments to quality health care. In acute medical settings, these barriers a...

  5. 交通伤致颈椎挥鞭样损伤的急诊诊治%Emergency diagnosis and treatment of whiplash injury to cervical spinal cord caused by traffic accidents

    朱颉; 韩敦富; 吴晓翔; 罗自通; 皮斌; 彭吉才


    Objective To summarize the clinical features of whiplash injury to the cervical spine caused bv traffic accident for the emergency diagnosis and treatment. Methods Two hundred and sixty-three drives and passengers with whiplash injury caused by a road accident were reviewed.The clinical manifestations,imaging examinations,and early emergency treatments of the injury were analyzed. Results Among its many clinical manifestations,neck pain and tenderness was the common symptom,emerging within several hours after the injury.However,the clinical manifestations were delayed in about 1/3 cases.The positive results of X-ray films were much lower compared with CT and MRI.Followups for a mean of 7.2 months revealed 222 satisfactory conservative cases and 41 satisfactory operative cases. Conclusions The whiplash injury can be diagnosed and treated early according to the clinical manifestations and likely conditions in the traffic accident.The prognosis can be fine in most cases.Different imaging examinations,especially CT,can reduce misdiagnosis.%目的 总结交通伤致颈椎挥鞭样损伤的临床特点,为急诊诊治提供参考.方法 对2002年1月至2008年12月急诊收治的交通伤所致的263例颈椎挥鞭样损伤患者的临床表现、影像学检查结果和急诊早期处理方法进行回顾性分析总结.结果 该损伤临床表现呈多样性,以颈肩枕部疼痛不适和压痛最常见,多数患者伤后数小时内出现症状,但约1/3患者症状迟发;影像学检查中,X线片阳性结果最低,CT和MRI阳性结果高;222例保守治疗和41例手术治疗的患者,经平均7.2个月随访总体治疗效果满意.结论 根据交通事故中驾乘人员易出现颈椎挥鞭样损伤的创伤条件,结合临床表现可以对其进行早期诊断、及时治疗,多数预后较好,综合应用影像学检查町避免漏诊,CT检查可以作为诊断的重要手段.

  6. Multidimensional Attitudes of Emergency Medicine Residents Toward Older Adults

    Teresita M. Hogan


    Full Text Available Introduction: The demands of our rapidly expanding older population strain many emergency departments (EDs, and older patients experience disproportionately high adverse health outcomes. Trainee attitude is key in improving care for older adults. There is negligible knowledge of baseline emergency medicine (EM resident attitudes regarding elder patients. Awareness of baseline attitudes can serve to better structure training for improved care of older adults. The objective of the study is to identify baseline EM resident attitudes toward older adults using a validated attitude scale and multidimensional analysis. Methods: Six EM residencies participated in a voluntary anonymous survey delivered in summer and fall 2009. We used factor analysis using the principal components method and Varimax rotation, to analyze attitude interdependence, translating the 21 survey questions into 6 independent dimensions. We adapted this survey from a validated instrument by the addition of 7 EM-specific questions to measures attitudes relevant to emergency care of elders and the training of EM residents in the geriatric competencies. Scoring was performed on a 5-point Likert scale. We compared factor scores using student t and ANOVA. Results: 173 EM residents participated showing an overall positive attitude toward older adults, with a factor score of 3.79 (3.0 being a neutral score. Attitudes trended to more negative in successive post-graduate year (PGY levels. Conclusion: EM residents demonstrate an overall positive attitude towards the care of older adults. We noted a longitudinal hardening of attitude in social values, which are more negative in successive PGY-year levels. [West J Emerg Med. 2014;15(4:511–517.

  7. A Survey of Emergency Medicine Residents’ Use of Educational Podcasts

    Riddell, Jeff; Swaminathan, Anand; Lee, Monica; Mohamed, Abdiwahab; Rogers, Rob; Rezaie, Salim R.


    Introduction Emergency medicine (EM) educational podcasts have become increasingly popular. Residents spend a greater percentage of their time listening to podcasts than they do using other educational materials. Despite this popularity, research into podcasting in the EM context is sparse. We aimed to determine EM residents’ consumption habits, optimal podcast preferences, and motivation for listening to EM podcasts. Methods We created a survey and emailed it to EM residents at all levels of training at 12 residencies across the United States from September 2015 to June 2016. In addition to demographics, the 20-question voluntary survey asked questions exploring three domains: habits, attention, and motivation. We used descriptive statistics to analyze results. Results Of the 605 residents invited to participate, 356 (n= 60.3%) completed the survey. The vast majority listen to podcasts at least once a month (88.8%). Two podcasts were the most popular by a wide margin, with 77.8% and 62.1% regularly listening to Emergency Medicine: Reviews and Perspectives (EM:RAP) and the EMCrit Podcast, respectively; 84.6% reported the ideal length of a podcast was less than 30 minutes. Residents reported their motivation to listen to EM podcasts was to “Keep up with current literature” (88.5%) and “Learn EM core content” (70.2%). Of those responding, 72.2% said podcasts change their clinical practice either “somewhat” or “very much.” Conclusion The results of this survey study suggest most residents listen to podcasts at least once a month, prefer podcasts less than 30 minutes in length, have several motivations for choosing podcasts, and report that podcasts change their clinical practice. PMID:28210357

  8. Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of emergency medicine residents: a prospective descriptive study

    Golzari Samad EJ


    Full Text Available Abstract Background Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum. Methods A prospective descriptive study was conducted at Nikoukari Hospital, a teaching hospital located in Tabriz, Iran. In a skills lab, a total number of 18 emergency medicine residents (post graduate year 1 were given traditional intubation and bag-mask ventilation instructions in a 36 hour course combined with mannequin practice. Later the residents were given the opportunity of receiving training on airway management in an operating room for a period of one month which was considered as an additional training program added to their Anesthesiology Curriculum. Residents were asked to ventilate and intubate 18 patients (Mallampati class I and ASA class I and II in the operating room; both before and after completing this additional training program. Intubation achieved at first attempt within 20 seconds was considered successful. Successful bag-mask ventilation was defined as increase in ETCo2 to 20 mm Hg and back to baseline with a 3 L/min fresh gas-flow and the adjustable pressure limiting valve at 20 cm H2O. An attending anesthesiologist who was always present in the operating room during the induction of anesthesia confirmed the endotracheal intubation by direct laryngoscopy and capnography. Success rates were recorded and compared using McNemar, marginal homogeneity and paired t-Test tests in SPSS 15 software. Results Before the additional training program in the operating room, the participants had intubation and bag-mask ventilation success rates of 27.7% (CI 0.07-0.49 and 16.6% (CI 0-0.34 respectively. After the additional training program in the

  9. Truck Drivers' Experiences and Perspectives Regarding Factors Influencing Traffic Accidents: A Qualitative Study.

    Karimi Moonaghi, Hossein; Ranjbar, Hossein; Heydari, Abbas; Scurlock-Evans, Laura


    Traffic accidents are a major public health problem, leading to death and disability. Although pertinent studies have been conducted, little data are available in Iran. This study explored the experiences of truck drivers and their perspectives regarding factors contributing to traffic accidents. Eighteen truck drivers, purposively sampled, participated in semi-structured interviews. Data were analyzed using qualitative content analysis. A main theme, lack of ability to control stress, emerged as a factor influencing the incidence of traffic accidents. This main theme was found to have three subthemes: poor organization of the job, lack of workplace facilities and proper equipment, and unsupportive environment. Although several factors were found to contribute to traffic accidents, their effects were not independent, and all were considered significant. Identifying factors that contribute to traffic accidents requires a systematic and holistic approach. Findings could be used by the transportation industry and community health centers to prevent traffic accidents.

  10. Differences in the perception of characteristics of excellence of clinical tutors among residents and consultants at an emergency medicine residency program a qualitative research

    Muna Saleem Aljahany


    Full Text Available Introduction: Defining exactly what characterizes a clinical tutor as excellent and another less effective, is an important task in assessing the effectiveness of clinical training and guiding faculty development. Aim: We aimed to evaluate those characteristics and measure differences in their perception among accomplished and non-accomplished consultants and residents in the Emergency Department. We also compared perceptions between the different groups of participants. Methods: The characteristics measured were extracted from an extensive search of previously published studies summarized in a review article. A qualitative study was conducted, using a 20 item questionnaire piloted from the refined characteristics (good indicator of reliability; Cronbach′s Alpha = 0.86. The questionnaire was distributed among all consultants and residents in Saudi Board of Emergency Medicine. Results: No significant difference between consultants′ and residents′ perception was found. "Sincere" was an exception 87.8% versus 55.1%, P = 0.013. Consultants′ specifications did not seem to affect perception on overall scores and its component sub-scores. Conclusion: Since results showed no relation between accomplished and non-accomplished consultants in perceiving those qualities, we excluded the lack of knowledge of those characteristics as a cause of being accomplished or non-accomplished. We suggest a greater dedication from program developers towards creating more opportunities to involve more consultants in basic Emergency Medicine training.

  11. La investigación en medicina de urgencias y emergencias Research in urgent and emergency medicine

    Ò. Miró


    excellence, a fact that is also inherent in urgency and emergency medicine (UEM. Besides, the specific characteristics of the Spanish health CARE system and the organisation of hospital emergency CARE offer a probably unique scenario, offering unique opportunities for their scientific analysis and study. Although the indices of Spanish scientific production in UEM were traditionally below those registered for researchers of other medical specialities, as well for UEM researchers of other countries, there has been a dynamic of continuous growth since 1995: it is the highest with respect to the former and second amongst our European colleagues. Besides, there is a great deal of low level scientific activity (papers presented to conferences. To increase scientific production in UEM there is a need to solve some aspects that hinder this task, such as: the lack of a scientific culture, doubtless united to the lack of a recognised speciality; the limited training in research methodology; the lack of explicit recognition of scientific work; the limited scientific infrastructure; the practically 100% dedication to the work of care tasks; the scarce participation in national grants for research projects; and the absence in Spain of an indexed journal specialising in UEM. Besides, we believe that it is necessary to promote and interrelate the research groups of different hospitals and emergency medical systems, both locally and amongst the different autonomous communities, so that they work in a coordinated way and thus obtain the necessary critical mass that will enable the formation of a thematic network of cooperative research.

  12. Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?

    Tainter, Christopher R.; Gentges, Joshua A.; Thomas, Stephen H.; Burns, Boyd D.


    Introduction Diagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM) residents has not previously been studied. Methods A survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training. Results The survey completion rate was 100% (20/20 residents). We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs $57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training. Conclusion This pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation. PMID:28116030

  13. Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock

    McIntyre, Lauralyn; Rowe, Brian H; Walsh, Timothy S


    OBJECTIVES: Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid...... administered in early septic shock to inform the design of future septic shock fluid resuscitation trials. METHODS: Using a web-based survey tool, we invited critical care and emergency physicians in Canada, the UK, Scandinavia and Saudi Arabia to complete a self-administered electronic survey. RESULTS...... and Ringer's solutions were the preferred crystalloid fluids used 'often' or 'always' in 53.1% (n=556) and 60.5% (n=632) of instances, respectively. However, emergency physicians indicated that they would use normal saline 'often' or 'always' in 83.9% (n=376) of instances, while critical care physicians said...

  14. The Effect of Emergency Department Overcrowding on Efficiency of Emergency Medicine Residents’ Education

    Anita Sabzghabaei


    Full Text Available Introduction: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO on the training of emergency medicine residents (EMR is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. Methods: In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs.  The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. Results: 130 questionnaires were filled out during 61 shifts. 47 (77.05% shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008. The similar results were seen regarding the attend’s training ability in the acute care unit. Conclusion: It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs.

  15. The Chief Resident Role in Emergency Medicine Residency Programs

    Hafner, John W. Jr., MD, MPH


    Full Text Available Study Objectives: Although other specialties have examined the role of the chief resident (CR, the role and training of the emergency medicine (EM CR has largely been undefined.Methods: A survey was mailed to all EM CRs and their respective program directors (PD in 124 EM residency programs. The survey consisted of questions defining demographics, duties of the typical CR, and opinions regarding the level of support and training received. Multiple choice, Likert scale (1 strong agreement, 5 strong disagreement and short-answer responses were used. We analyzed associations between CR and PD responses using Chi-square, Student’s T and Mann-Whitney U tests.Results: Seventy-six percent of CRs and 65% of PDs responded and were similar except for age (31 vs. 42 years; p<0.001. CR respondents were most often male, in year 3 of training and held the position for 12 months. CRs and PDs agreed that the assigned level of responsibility is appropriate (2.63 vs. 2.73, p=0.15; but CRs underestimate their influence in the residency program (1.94 vs. 2.34, p=0.002 and the emergency department (2.61 vs. 3.03, p=0.002. The majority of CRs (70% and PDs (77% report participating in an extramural training program, and those CRs who participated in training felt more prepared for their job duties (2.26 vs. 2.73; p=0.03.Conclusion: EM CRs feel they have appropriate job responsibility but believe they are less influential in program and department administration than PD respondents. Extramural training programs for incoming CRs are widely used and felt to be helpful. [West J Emerg Med. 2010; 11(2:120-125.

  16. Evaluation of an evidence based quality improvement innovation for patients with musculoskeletal low back pain in an accident and emergency setting.

    Potier, Tara; Tims, Emily; Kilbride, Cherry; Rantell, Khadija


    We conducted a five stage pilot study which initially consisted of a review of 75 case notes of people attending an emergency department (ED) in an inner London Teaching Hospital with musculoskeletal (MSK) low back pain (LBP). This review highlighted inconsistencies in how they were assessed and managed across and within different staff groups. We found patient documentation was often incomplete and that a biomedical model approach to the management of these patients was common. As a result, four further stages in the project were conducted. Our primary aim was to evaluate the impact of implementing a locally developed quality improvement intervention for the assessment and treatment of MSK LBP in this ED. Secondary aims were to explore the user experience of the new pathway, measured by the patient experience questionnaire (PEQ), and any associated health economic costs of changes in practice. The quality improvement intervention consisted of an evidence based low back pain pathway (EBLBPP), a staff educational program, and a patient education booklet. We undertook a retrospective baseline audit of 100 clinical records of patients was undertaken prior to the instigation of the quality improvement intervention, and four months post implementation. The pre-defined variables of interest were: documentation of the case history, examination, classification of back pain (and if correct), prescribed management and if the documentation was compliant with medico-legal standards. All patients in the study were sent a PEQ to complete and return in a self-addressed envelope. Estimated health costs associated with each patient episode of care were calculated including re-attendance episodes for any people presenting with MSK LBP within a four week period. There was a significant improvement in all areas evaluated post implementation in all groups (simple, referred and simple, referred and serious spinal pathology combined). In particular; screening for red flags (22%) and

  17. Accidents - Chernobyl accident; Accidents - accident de Tchernobyl



    This file is devoted to the Chernobyl accident. It is divided in four parts. The first part concerns the accident itself and its technical management. The second part is relative to the radiation doses and the different contaminations. The third part reports the sanitary effects, the determinists ones and the stochastic ones. The fourth and last part relates the consequences for the other European countries with the case of France. Through the different parts a point is tackled with the measures taken after the accident by the other countries to manage an accident, the cooperation between the different countries and the groups of research and studies about the reactors safety, and also with the international medical cooperation, specially for the children, everything in relation with the Chernobyl accident. (N.C.)

  18. Virtual Alternative to the Oral Examination for Emergency Medicine Residents

    McGrath, Jillian


    Full Text Available Introduction: The oral examination is a traditional method for assessing the developing physician’s medical knowledge, clinical reasoning and interpersonal skills. The typical oral examination is a face-to-face encounter in which examiners quiz examinees on how they would confront a patient case. The advantage of the oral exam is that the examiner can adapt questions to the examinee’s response. The disadvantage is the potential for examiner bias and intimidation. Computer-based virtual simulation technology has been widely used in the gaming industry. We wondered whether virtual simulation could serve as a practical format for delivery of an oral examination. For this project, we compared the attitudes and performance of emergency medicine (EM residents who took our traditional oral exam to those who took the exam using virtual simulation. Methods: EM residents (n=35 were randomized to a traditional oral examination format (n=17 or a simulated virtual examination format (n=18 conducted within an immersive learning environment, Second Life (SL. Proctors scored residents using the American Board of Emergency Medicine oral examination assessment instruments, which included execution of critical actions and ratings on eight competency categories (1-8 scale. Study participants were also surveyed about their oral examination experience. Results: We observed no differences between virtual and traditional groups on critical action scores or scores on eight competency categories. However, we noted moderate effect sizes favoring the Second Life group on the clinical competence score. Examinees from both groups thought that their assessment was realistic, fair, objective, and efficient. Examinees from the virtual group reported a preference for the virtual format and felt that the format was less intimidating. Conclusion: The virtual simulated oral examination was shown to be a feasible alternative to the traditional oral examination format for

  19. Emergency Medicine: On the Frontlines of Medical Education Transformation

    Eric S. Holmboe


    Full Text Available Emergency medicine (EM has always been on the frontlines of healthcare in the United States. I experienced this reality first hand as a young general medical officer assigned to an emergency department (ED in a small naval hospital in the 1980s. For decades the ED has been the only site where patients could not be legally denied care. Despite increased insurance coverage for millions of Americans as a result of the Affordable Care Act, ED directors report an increase in patient volumes in a recent survey.1 EDs care for patients from across the socioeconomic spectrum suffering from a wide range of clinical conditions. As a result, the ED is still one of few components of the American healthcare system where social justice is enacted on a regular basis. Constant turbulence in the healthcare system, major changes in healthcare delivery, technological advances and shifting demographic trends necessitate that EM constantly adapt and evolve as a discipline in this complex environment.

  20. [Mild brain injuries in emergency medicine].

    Liimatainen, Suvi; Niskakangas, Tero; Ohman, Juha


    Diagnostics and correct classification of mild brain injuries is challenging. Problems caused by insufficient documentation at the acute phase become more obvious in situations in which legal insurance issues are to be considered. A small proportion of patients with mild brain injury suffer from prolonged symptoms. Medical recording and classification of the brain injury at the initial phase should therefore be carried out in a structured manner. The review deals with the diagnostic problems of mild brain injuries and presents a treatment protocol for adult patients at the acute phase, aiming at avoiding prolonged problems.

  1. Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock

    McIntyre, Lauralyn; Rowe, Brian H; Walsh, Timothy S;


    OBJECTIVES: Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid admin...

  2. Identification of Drivers in Traffic Accidents and Determination of Passenger Position in a Vehicle by Finger Marks

    Matej Trapečar


    Full Text Available The following paper aims to illustrate certain investigative activities in the forensic analysis and examination of the scene of traffic accidents. When a traffic accident occurs, the scene must be secured as soon as possible to enable professional and proper forensic investigation. Failure to secure the accident scene might result in losing or contaminating the traces, which makes it more difficult to prove or explain trace evidence in further procedure or even makes such evidence inadmissible. The topic is discussed from the viewpoint of crime scene examination, since analysing and investigating traffic accidents requires a great deal of expertise and attention of the investigators. Complex traffic accidents include feigned accidents, hit-and-run accidents as well as accidents in which the driver and passengers, dead or alive, need to be identified. In identifying the passengers, standard criminal investigation methods as well as police forensic and forensic medicine methods are followed. Such methods include confirming the identities with identity documents, other documents and vehicle ownership, fingerprints, biological traces, fibre traces, contact traces, traces of physical injuries on the driver and passengers, etc. According to the results obtained in fingerprint detection on human skin surfaces, this method can also be applied in confirming physical contact between the driver and the passengers in the accident, e.g. in the event of moving the victims and changing the scene of the accident.   Key words: traffic accidents, accident analysis, driver's identity, passengers' position, finger marks, human skin

  3. The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

    Pines, Jesse M


    Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.

  4. Education scholarship in emergency medicine part 3: a "how-to" guide.

    Bhanji, Farhan; Cheng, Adam; Frank, Jason R; Snell, Linda; Sherbino, Jonathan


    Successful emergency medicine (EM) education scholarship requires a systematic approach that includes searching the (grey) literature, mobilizing resources, adopting frameworks to focus the innovation, integrating a component of program evaluation, and disseminating the innovation via traditional and emerging avenues. This paper provides direction for EM teachers and educators looking to transform their education innovation into scholarship. Recommendations on producing EM education scholarship from the 2013 consensus conference of the Academic Section of the Canadian Association of Emergency Physicians are presented.

  5. Recommendations on pre-hospital & early hospital management of acute heart failure : a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine

    Mebazaa, Alexandre; Yilmaz, M. Birhan; Levy, Phillip; Ponikowski, Piotr; Peacock, W. Frank; Laribi, Said; Ristic, Arsen D.; Lambrinou, Ekaterini; Masip, Josep; Riley, Jillian P.; McDonagh, Theresa; Mueller, Christian; deFilippi, Christopher; Harjola, Veli-Pekka; Thiele, Holger; Piepoli, Massimo F.; Metra, Marco; Maggioni, Aldo; McMurray, John; Dickstein, Kenneth; Damman, Kevin; Seferovic, Petar M.; Ruschitzka, Frank; Leite-Moreira, Adelino F.; Bellou, Abdelouahab; Anker, Stefan D.; Filippatos, Gerasimos


    Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to

  6. Characteristics of frequent emergency department presenters to an Australian emergency medicine network

    Markham Donna


    Full Text Available Abstract Background To describe the characteristics of emergency department (ED patients defined as frequent presenters (FP presenting to an Australian emergency department network and compare these with a cohort of non-frequent presenters (NFP. Method A retrospective chart review utilising an electronic emergency medicine patient medical record database was performed on patients presenting to Southern Health EDs from March 2009 to March 2010. Non-frequent presenters were defined as patients presenting less than 5 times and frequent presenters as presenting 8 or more times in the study period. Characteristics of both groups were described and compared. Results During the 12-month study period there were 540 FP patients with 4549 admissions and 73,089 NFP patients with 100,943 admissions. FP patients were slightly older with a significant increase in frequency of patients between the ages of 70 to 79 years and they were more likely to be divorced or separated than NFP patients. Frequent presenters to the emergency department were more likely to utilise the ambulance service to arrive at the hospital, or in the custody of police than NFP patients. FPs were more likely to be admitted to hospital, more likely to have an admission to a mental health bed than NFP patients and more likely to self-discharge from the emergency department while waiting for care. Conclusions There are major implications for the utilisation of limited ED resources by frequent presenters. By further understanding the characteristics of FP we may be able to address the specific health care needs of this population in more efficient and cost effective ways. Further research analysing the effectiveness of targeted multidisciplinary interventions aiming to reduce the frequency of ED attendances may be warranted.


    A. N. Grebenyuk


    Full Text Available Experience of medical protection at radiation accidents is analyzed. It is shown, that medicines that have been in the arsenal of medical service during the liquidation of consequences of the Chernobyl nuclear power plant accident satisfied their predestination in a whole and were rather effective for radiation protection. The modern strategy of pharmacological maintenance based on use of means and methods, allowing to keeping a life, health and professional serviceability of people in conditions of amazing action of a complex of factors of radiation accidents, is submitted.

  8. Bundled automobile insurance coverage and accidents.

    Li, Chu-Shiu; Liu, Chwen-Chi; Peng, Sheng-Chang


    This paper investigates the characteristics of automobile accidents by taking into account two types of automobile insurance coverage: comprehensive vehicle physical damage insurance and voluntary third-party liability insurance. By using a unique data set in the Taiwanese automobile insurance market, we explore the bundled automobile insurance coverage and the occurrence of claims. It is shown that vehicle physical damage insurance is the major automobile coverage and affects the decision to purchase voluntary liability insurance coverage as a complement. Moreover, policyholders with high vehicle physical damage insurance coverage have a significantly higher probability of filing vehicle damage claims, and if they additionally purchase low voluntary liability insurance coverage, their accident claims probability is higher than those who purchase high voluntary liability insurance coverage. Our empirical results reveal that additional automobile insurance coverage information can capture more driver characteristics and driving behaviors to provide useful information for insurers' underwriting policies and to help analyze the occurrence of automobile accidents.


    B. B. Darizhapov


    Full Text Available The article describes the experience of the Administration of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being in Sakhalin Region in organizing prevention of conditions that endanger the public radiation safety related to the nuclear accident at the Fukushima nuclear power plant. The authors present results of the measurements of the radiation situation in the Sakhalin region and propose ways to improve organizational and sanitary-hygienic measures aimed on ensuring public protectiony in events of radiation accidents.

  10. Keynote address: Closing the research-to-practice gap in emergency medicine.

    Clancy, Carolyn M


    Emergency medicine in the United States is facing tremendous challenges due to recent public health emergencies, continuing threats of bioterrorism, and an increasing and unprecedented demand for emergency department services. These challenges include overcrowding; long waiting times; "boarding" of patients; ambulance diversion; a need for better, more reliable tools for triaging patients; and medical errors and other patient safety concerns. These challenges and concerns were brought to the forefront several years ago by the Institute of Medicine in several landmark reports that call for closing the research-to-practice gap in emergency medicine. The Agency for Healthcare Research and Quality is funding a number of projects that address many of the concerns raised in the reports, including the use of an advanced access appointment scheduling system to improve access to care; the use of an electronic medical record system to reduce waiting times and errors and improve patient and provider satisfaction; and the refinement of the Emergency Severity Index, a five-level triage scale to get patients to the right resources at the right time. The agency's Healthcare Cost and Utilization Project is gathering data that will allow researchers to examine a broad range of issues affecting the use, quality, and cost of emergency services. Although progress has been made over the past few years in closing the research-to-practice gap in emergency medicine, many challenges remain. The Agency for Healthcare Research and Quality has supported and will continue to support a broad portfolio of research to address the many challenges confronting emergency medicine, including ways to improve emergency care through the application of research findings.

  11. Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.

    Walsh, K


    BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.

  12. Reactor Safety Gap Evaluation of Accident Tolerant Components and Severe Accident Analysis

    Farmer, Mitchell T. [Argonne National Lab. (ANL), Argonne, IL (United States); Bunt, R. [Southern Nuclear, Atlanta, GA (United States); Corradini, M. [Univ. of Wisconsin, Madison, WI (United States); Ellison, Paul B. [GE Power and Water, Duluth, GA (United States); Francis, M. [Argonne National Lab. (ANL), Argonne, IL (United States); Gabor, John D. [Erin Engineering, Walnut Creek, CA (United States); Gauntt, R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Henry, C. [Fauske and Associates, Burr Ridge, IL (United States); Linthicum, R. [Exelon Corp., Chicago, IL (United States); Luangdilok, W. [Fauske and Associates, Burr Ridge, IL (United States); Lutz, R. [PWR Owners Group (PWROG); Paik, C. [Fauske and Associates, Burr Ridge, IL (United States); Plys, M. [Fauske and Associates, Burr Ridge, IL (United States); Rabiti, Cristian [Idaho National Lab. (INL), Idaho Falls, ID (United States); Rempe, J. [Rempe and Associates LLC, Idaho Falls, ID (United States); Robb, K. [Argonne National Lab. (ANL), Argonne, IL (United States); Wachowiak, R. [Electric Power Research Inst. (EPRI), Knovville, TN (United States)


    The overall objective of this study was to conduct a technology gap evaluation on accident tolerant components and severe accident analysis methodologies with the goal of identifying any data and/or knowledge gaps that may exist, given the current state of light water reactor (LWR) severe accident research, and additionally augmented by insights obtained from the Fukushima accident. The ultimate benefit of this activity is that the results can be used to refine the Department of Energy’s (DOE) Reactor Safety Technology (RST) research and development (R&D) program plan to address key knowledge gaps in severe accident phenomena and analyses that affect reactor safety and that are not currently being addressed by the industry or the Nuclear Regulatory Commission (NRC).

  13. Examination of offsite radiological emergency measures for nuclear reactor accidents involving core melt. [PWR

    Aldrich, D.C.; McGrath, P.E.; Rasmussen, N.C.


    Evacuation, sheltering followed by population relocation, and iodine prophylaxis are evaluated as offsite public protective measures in response to nuclear reactor accidents involving core-melt. Evaluations were conducted using a modified version of the Reactor Safety Study consequence model. Models representing each measure were developed and are discussed. Potential PWR core-melt radioactive material releases are separated into two categories, ''Melt-through'' and ''Atmospheric,'' based upon the mode of containment failure. Protective measures are examined and compared for each category in terms of projected doses to the whole body and thyroid. Measures for ''Atmospheric'' accidents are also examined in terms of their influence on the occurrence of public health effects.

  14. [Formalizing observation: The emergence of the modern patient record exemplified by Berlin and Paris medicine, 1725-1830].

    Hess, Volker


    The paper focuses on the material basis of the development of modern clinical documentation. With the examples of Berlin and Paris medicine, it analyzes the various ways of recording clinical data in the 18th century, from where they came, and how they were introduced into bedside observations. Particular interest is given to the interrelation between administrative techniques (registration, book-keeping etc.) and the practices of medical recording developed within the hospitals. Comparing Berlin and Paris makes it possible to work out the differences in writing cultures and to consider the local interdependencies. With this approach it can be demonstrated that the "patient record" was already established as a patient related recording system in the form of loose files in the early 19th century.

  15. Emergency Medicine Residency Boot Camp Curriculum: A Pilot Study

    Ataya, Ramsey


    Full Text Available Introduction: Establishing a boot camp curriculum is pertinent for emergency medicine (EM residents in order to develop proficiency in a large scope of procedures and leadership skills.  In this article, we describe our program’s EM boot camp curriculum as well as measure the confidence levels of resident physicians through a pre- and post-boot camp survey. Methods: We designed a one-month boot camp curriculum with the intention of improving the confidence, procedural performance, leadership, communication and resource management of EM interns. Our curriculum consisted of 12 hours of initial training and culminated in a two-day boot camp. The initial day consisted of clinical skill training and the second day included code drill scenarios followed by interprofessional debriefing.   Results: Twelve EM interns entered residency with an overall confidence score of 3.2 (1-5 scale across all surveyed skills. Interns reported the highest pre-survey confidence scores in suturing (4.3 and genitourinary exams (3.9. The lowest pre-survey confidence score was in thoracostomy (2.4. Following the capstone experience, overall confidence scores increased to 4.0. Confidence increased the most in defibrillation and thoracostomy. Additionally, all interns reported post-survey confidence scores of at least 3.0 in all skills, representing an internal anchor of “moderately confident/need guidance at times to perform procedure.” Conclusion: At the completion of the boot camp curriculum, EM interns had improvement in self-reported confidence across all surveyed skills and procedures. The described EM boot camp curriculum was effective, feasible and provided a foundation to our trainees during their first month of residency. [West J Emerg Med. 2015;16(2:356–361.

  16. Woodworking injuries: a comparative study of work-related and hobby-related accidents.

    Loisel, F; Bonin, S; Jeunet, L; Pauchot, J; Tropet, Y; Obert, L


    The primary objective of this study was to describe the injury characteristics and demographics of patients injured during woodworking activities, upon their arrival to the emergency department in a regional of France where this industry is prevalent. The secondary objective was to compare patient and injury characteristics for work-related and hobby-related accidents. A cohort of 87 patients who had suffered a woodworking accident over a two-year period was evaluated; 79 were available for follow-up. The context and circumstances of the accident, nature and location of the injuries and patient demographics were recorded. Hobby-related accidents accounted for two-thirds of the accidents (51/79). Most of the injured workers were either loggers (35%) or carpenters (46%). The hand was injured in 53 cases (67%). Work-related accidents resulted in significantly more serious consequences in terms of hospital stay, work stoppage, resumption of work or retraining than hobby-related accidents. For the workplace accidents, 86% occurred on new machines; more than 25% of the machines involved in accidents at home were over 15 years. Sixty-eight per cent of workers were wearing their safety gear, while only 31% of those injured during recreational woodworking wore the appropriate gear. Several elements of prevention should be improved: information about the need to maintain the equipment, protect the worker with suitable clothing, and learn which maneuvers are considered hazardous. Safety gear should be regularly inspected in the workplace.

  17. Pervasive Observation Medicine: The Application of RFID to Improve Patient Safety in Observation Unit of Hospital Emergency Department.

    Chen, Chang-I; Liu, Cheng-Yaw; Li, Yu-Chuan; Chao, Chia-Cheng; Liu, Chien-Tsai; Chen, Chieh-Feng; Kuan, Ching-Feng


    Over the past decade, observation medicine has become an important component of emergency medicine. There are several settings in which observation medicine has been useful and valuable.(1) RFID as the patient identification, not only generates the on-line laboratory data and radiology report via hand-held wireless PDA, this RFID system help physician stream-line patient admission to acute bed or ICU in the emergency department more effectively.

  18. Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan

    Kinoshita K


    Full Text Available Kensuke Kinoshita,1 Yusuke Tsugawa,2 Taro Shimizu,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Toshiaki Shiojiri,7 Yasuharu Tokuda8 1Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan; 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 3Tokyo Joto Hospital, Koto-ku, Tokyo, 4Good Medicine Japan, Miyagi, 5Department of General Internal Medicine, Kanto Rosai Hospital, Kawasaki, Kanagawa, 6Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, 7Department of General Internal Medicine, Asahi General Hospital, Asahi, Chiba, 8Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan Background: Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents. Methods: We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE. An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED duty on the residents' GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals' mean GM-ITE score. Results: A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater Up

  19. Emergencies and Emergent Selves

    Haynes, Felicity


    Marshall's (1999 ) article used Wittgenstein to argue that self functions as an explanation for a name rather than a referent. This brief response tries to rescue Marshall from an apparent reduction of self to material body without returning him to the mind/body dualism that he, with Wittgenstein and Dennett, seeks to avoid. It treats "I" as an…

  20. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine.

    Mebazaa, Alexandre; Yilmaz, M Birhan; Levy, Phillip; Ponikowski, Piotr; Peacock, W Frank; Laribi, Said; Ristic, Arsen D; Lambrinou, Ekaterini; Masip, Josep; Riley, Jillian P; McDonagh, Theresa; Mueller, Christian; deFilippi, Christopher; Harjola, Veli-Pekka; Thiele, Holger; Piepoli, Massimo F; Metra, Marco; Maggioni, Aldo; McMurray, John; Dickstein, Kenneth; Damman, Kevin; Seferovic, Petar M; Ruschitzka, Frank; Leite-Moreira, Adelino F; Bellou, Abdelouahab; Anker, Stefan D; Filippatos, Gerasimos


    Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to practicing physicians and nurses to manage acute heart failure in the pre-hospital and hospital setting. Criteria of hospitalization and of discharge are described. Gaps in knowledge and perspectives in the management of acute heart failure are also detailed. This consensus paper on acute heart failure might help enable contiguous practice.

  1. Developing technical expertise in emergency medicine--the role of simulation in procedural skill acquisition.

    Wang, Ernest E; Quinones, Joshua; Fitch, Michael T; Dooley-Hash, Suzanne; Griswold-Theodorson, Sharon; Medzon, Ron; Korley, Frederick; Laack, Torrey; Robinett, Adam; Clay, Lamont


    Developing technical expertise in medical procedures is an integral component of emergency medicine (EM) practice and training. This article is the work of an expert panel composed of members from the Society for Academic Emergency Medicine (SAEM) Interest Group, the SAEM Technology in Medical Education Committee, and opinions derived from the May 2008 Academic Emergency Medicine Consensus Conference, "The Science of Simulation in Healthcare." The writing group reviewed the simulation literature on procedures germane to EM training, virtual reality training, and instructional learning theory as it pertains to skill acquisition and procedural skills decay. The authors discuss the role of simulation in teaching technical expertise, identify training conditions that lead to effective learning, and provide recommendations for future foci of research.

  2. A Needs Assessment for a Longitudinal Emergency Medicine Intern Curriculum

    Shappell, Eric; Ahn, James


    Introduction A key task of emergency medicine (EM) training programs is to develop a consistent knowledge of core content in recruits with heterogeneous training backgrounds. The traditional model for delivering core content is lecture-based weekly conference; however, a growing body of literature finds this format less effective and less appealing than alternatives. We sought to address this challenge by conducting a needs assessment for a longitudinal intern curriculum for millennial learners. Methods We surveyed all residents from the six EM programs in the greater Chicago area regarding the concept, format, and scope of a longitudinal intern curriculum. Results We received 153 responses from the 300 residents surveyed (51% response rate). The majority of respondents (80%; 82% of interns) agreed or strongly agreed that a dedicated intern curriculum would add value to residency education. The most positively rated teaching method was simulation sessions (91% positive responses), followed by dedicated weekly conference time (75% positive responses) and dedicated asynchronous resources (71% positive responses). Less than half of respondents (47%; 26% of interns) supported use of textbook readings in the curriculum. Conclusion There is strong learner interest in a longitudinal intern curriculum. This needs assessment can serve to inform the development of a universal intern curriculum targeting the millennial generation. PMID:28116005

  3. Speed Variance and Its Influence on Accidents.

    Garber, Nicholas J.; Gadirau, Ravi

    A study was conducted to investigate the traffic engineering factors that influence speed variance and to determine to what extent speed variance affects accident rates. Detailed analyses were carried out to relate speed variance with posted speed limit, design speeds, and other traffic variables. The major factor identified was the difference…

  4. Personalized Medicine and Pharmacogenomics

    ... medications. Pharmacogenomics is part of a field called personalized medicine — also called individualized or precision medicine — that ... may be part of routine medical care. References Personalized medicine. U.S. Food and Drug Administration. http://www. ...

  5. Leadership and the emergency department.

    LaSalle, Gar


    Emergency medicine, as the nation's health care system's safety net, is facing ever increasing demands on its resources and infrastructure. Classic and modern theories of leadership, which include broader based models that in corporate team responsibilities, should be studied by anyone wearing the mantle of leadership in emergency medicine, and the Realpolitik of the modern hospital must be accommodated if leadership efforts are to succeed.

  6. Violent deaths among composers (accidents, drownings and murders)

    Breitenfeld, Darko; Vodanović, Marijo; Akrap, Ankica; Juran, Dominik; Kranjčec, Darko; Vuksanović, Marina


    In this study, we described different accidents, drowning and murders as the main cause of death among 145 composers. We included accidents (48 composers), drowning (26 composers) and murders (71 composers) which were mainly fatal, and premature. Accidents are the third leading cause of deaths today. Murders were often during the wars and revolutions (World War I, II, French, Russian revolution). We mentioned all of the etiologies of these accidents, drowning and murders according to the c...

  7. From cradle to adolescence: the development of Research in European Pediatric Emergency Medicine.

    Mintegi, Santiago; Lyttle, Mark D; Maconochie, Ian K; Benito, Javier; Gervaix, Alain; Moll, Henriette; Shavit, Itai; Da Dalt, Liviana; Waisman, Yehezkel


    Pediatric emergency medicine (PEM) has been developing rapidly but heterogeneously in many European countries in recent years, and many national PEM societies have been founded to improve the quality of care of ill and injured children and adolescents. Key facets of any such improvement are the development, delivery and translation of high-quality research. Research in European Pediatric Emergency Medicine (REPEM) has developed a robust international structure involving clinicians, academics and national PEM research networks. This structure facilitates research collaboration within Europe and with PEM research networks from other continents. Multicentre research carried out in this way will bring about improvements in the quality of emergency care for children in European emergency departments, and result in a better quality of life for children and adolescents. This paper outlines the background and achievements of REPEM to date and describes the current structure and next steps.

  8. [With the introduction of Infection Control Committees in mid-sized private hospitals, cutting-edge accident prevention methods and solutions will be utilized to reduce the impact of needlestick accidents].

    Hatano, Yoshiji


    Exposure to medical equipment, such as needles and other sharp objects, can accidentally cause injury or transmit an infectious blood-borne disease. Because the risk of infection due to needlestick injury accidents is always a possibility it is important to inform medical staff of the best ways to reduce the possible risks and the appropriate measures to take when an accident occurs, in order to reduce the frequency or seriousness of an accident; however, it is extremely difficult to completely prevent accidents. Therefore, when needlestick accidents do occur, steps need to be taken to ease the psychological burden and reduce the severity of accidents. Contingency measures for needlestick and related injuries will be introduced in private and mid-sized hospital facilities. This will be accomplished by taking measure against exposure and emergent accidents. Introducing an Infection Committee will change administrative procedures.

  9. First international workshop on severe accidents and their consequences. [Chernobyl Accident


    An international workshop on past severe nuclear accidents and their consequences was held in Dagomys region of Sochi, USSR on October 30--November 3, 1989. The plan of this meeting was approved by the USSR Academy of Sciences and by the USSR State Committee of the Utilization of Atomic Energy. The meeting was held under the umbrella of the ANS-SNS agreement of cooperation. Topics covered include analysis of the Chernobyl accident, safety measures for RBMK type reactors and consequences of the Chernobyl accident including analysis of the ecological, genetic and psycho-social factors. Separate reports are processed separately for the data bases. (CBS)

  10. Application of the Bulgarian emergency response system in case of nuclear accident in environmental assessment study

    Syrakov, Dimiter; Veleva, Blagorodka; Georgievs, Emilia; Prodanova, Maria; Slavov, Kiril; Kolarova, Maria


    The development of the Bulgarian Emergency Response System (BERS) for short term forecast in case of accidental radioactive releases to the atmosphere has been started in the mid 1990's [1]. BERS comprises of two main parts - operational and accidental, for two regions 'Europe' and 'Northern Hemisphere'. The operational part runs automatically since 2001 using the 72 hours meteorological forecast from DWD Global model, resolution in space of 1.5o and in time - 12 hours. For specified Nuclear power plants (NPPs), 3 days trajectories are calculated and presented on NIMH's specialized Web-site ( The accidental part is applied when radioactive releases are reported or in case of emergency exercises. BERS is based on numerical weather forecast information and long-range dispersion model accounting for the transport, dispersion, and radioactive transformations of pollutants. The core of the accidental part of the system is the Eulerian 3D dispersion model EMAP calculating concentration and deposition fields [2]. The system is upgraded with a 'dose calculation module' for estimation of the prognostic dose fields of 31 important radioactive gaseous and aerosol pollutants. The prognostic doses significant for the early stage of a nuclear accident are calculated as follows: the effective doses from external irradiation (air submersion + ground shinning); effective dose from inhalation; summarized effective dose and absorbed thyroid dose [3]. The output is given as 12, 24, 36, 48, 60 and 72 hours prognostic dose fields according the updated meteorology. The BERS was upgraded to simulate the dispersion of nuclear materials from Fukushima NPP [4], and results were presented in NIMH web-site. In addition BERS took part in the respective ENSEMBLE exercises to model 131I and 137Cs in Fukushima source term. In case of governmental request for expertise BERS was applied for environmental impact assessment of hypothetical accidental transboundary

  11. A longitudinal study of well-being, confidence and competence in junior doctors and the impact of emergency medicine placements

    Mason, Suzanne; O'Keeffe, Colin; Carter, Angela; Stride, Chris


    Objectives To measure levels of, and change in junior doctor well-being, confidence and self-reported competence over their second postgraduate training year and the impact of emergency department (ED) placements on these outcomes. Design A longitudinal study using an online survey administered at four time points (2010–2011). Setting 28 Acute Hospital Trusts, drawn from nine participating Postgraduate Deaneries in England. Participants Junior doctors who had a placement in an ED as part of their second postgraduate training year. Main outcome measures Levels of anxiety, depression, motivation, job satisfaction, confidence and self-reported competence, collected at four time points spread over the period of the doctor's second training year (F2). Results 217 junior doctors were recruited to the study. Over the year there was a significant increase in their overall job satisfaction, confidence and self-reported competence. Junior doctors also reported significantly increased levels of motivation and anxiety, and significantly decreased levels of extrinsic job satisfaction when working in ED compared with other specialties. There were also significant increases in both junior doctor confidence and self-reported competence after their placement in ED relative to other specialties. Conclusions While elements of junior doctor well-being worsened in their ED placement compared with their time spent in other specialties, the increased levels of anxiety and reduced extrinsic job satisfaction were within the normal range for other healthcare workers. These deficits were also balanced by greater improvements in motivation, confidence in managing common acute clinical conditions and perceived competence in performing acute procedures compared with benefits offered by placements in other specialties. PMID:26338523

  12. Medical Emergency Rescue Mode of Nuclear and Radiation Accidents%核与辐射突发事件医学救援模式探讨

    郭洪德; 田伟; 冯威; 肖广哲; 宋莹; 王颖


    With the development of modem nuclear industry and nuclear technology,many countries have used nuclear power as a new energy source for their development.When human beings enjoy the convenience of using nuclear energy,they also provide leads for the accidental events of nuclear and radiation.Based on the analysis of China's current medical rescue mode of nuclear and radiation,the author put forward some suggestions and measures.%随着现代核工业的发展和核技术的普及,许多国家都将核电作为新能源进行建设发展.人类在享用核能源带来便利的同时,也为核与辐射突发事件的发生提供了引线.笔者通过对我国当前核与辐射医学救援模式的分析,对现在救援模式提出建议和措施.

  13. The relationship between benzodiazepine use and traffic accidents: A systematic literature review.

    Smink, Beitske E; Egberts, Antoine C G; Lusthof, Klaas J; Uges, Donald R A; de Gier, Johan J


    In many countries, benzodiazepines are the most commonly used and misused psychoactive medicinal drugs. Results of epidemiological studies investigating the association between benzodiazepine use and traffic accidents seem to be inconclusive or inconsistent at first sight. However, the outcome of epidemiological studies may be influenced by several methodological factors like study design, study population, exposure measurement, outcome definitions and possible confounders. Our objective was to conduct a systematic literature review of epidemiological studies that investigated the association between benzodiazepine use and traffic accidents, including related outcomes like culpability and injury or accident severity. We searched EMBASE, PubMed and Forensic Science Abstracts 3/0 (FORS) for references included in these databases at 1 June 2009 using the term 'benzodiazepines' in combination with 'driving performance' or 'accident risk' or 'traffic accident'. For inclusion in this review, the study design had to be comparative, include road users involved in accidents and provide specific data about benzodiazepines. Sixty-six studies were included in the review. The study populations varied from the general (driving) population, accident-involved road users with or without injury and persons admitted to a hospital to fatally injured accident-involved drivers. Exposure assessment was performed by using toxicological results, prescription data or questionnaires. The divergent study populations and comparison groups and the variety of methods used to express the outcome of interest hampered comparison between results. Evidence is growing that exposure to benzodiazepines is related to increased accident risk. The literature indicates that the greatest accident risk is associated with the use of long half-life benzodiazepines, increasing dosage and the first few weeks of use of benzodiazepines. Clear evidence of increased culpability associated with benzodiazepine use is

  14. A Survey of Graduating Emergency Medicine Residents’ Experience with Cricothyrotomy

    Makowski, Andrew L.


    Full Text Available Introduction: The Emergency Medicine (EM Residency Review Committee stipulates that residents perform 3 cricothyrotomies in training but does not distinguish between those done on patients or via other training methods. This study was designed to determine how many cricothyrotomies residents have performed on living patients, the breadth and prevalence of alternative methods of instruction, and residents’ degree of comfort with performing the procedure unassisted. Methods: We utilized a web-based tool to survey EM residents nearing graduation and gathered data regarding the number of cricothyrotomies performed on living and deceased patients, animals, and models/simulators. Residents indicating experience with the procedure were asked additional questions as to the indication, supervision, and outcome of their most recent cricothyrotomy. We also collected data regarding experience with rescue airway devices, observation of cricothyrotomy, and comfort (“0-10” scale with “10” representing complete confidence regarding the procedure. Results: Of 296 residents surveyed, 22.0% performed a cricothyrotomy on a living patient, and 51.6% had witnessed at least one performed. Those who completed a single cricothyrotomy reported a significantly greater level of confidence, 6.3 (95% confidence interval [CI] 5.7-7.0, than those who did none, 4.4 (95% CI 4.1-4.7, p<<0.001. Most respondents, 68.1%, had used the recently deceased to practice the technique, and those who had done so more than once reported higher confidence, 5.5 (95% 5.1-5.9, than those who had never done so, 4.1 (95% CI 3.7-4.5, p<<0.001. Residents who practiced cricothyrotomy on both simulators and the recently deceased expressed more confidence, 5.4 (95% CI 5.0-5.8, than those who used only simulators, 4.0 (95% CI 3.6-4.5, p<<0.001. Neither utilization of models, simulators, or animals, nor observance of others’ performance of the procedure independently affected reported

  15. Risk forecasting and evaluating model of Environmental pollution accident

    ZENG Wei-hua; CHENG Sheng-tong


    Environmental risk (ER) fact ore come from ER source and they are controlled by the primary control mechanism (PCM) of environmental risk, due to the self failures or the effects of external environment risk trigger mechanism, the PCM could not work regularly any more, then, the ER factore will release environmental space, and an ER field is formed up. The forming of ER field does not mean that any environmental pollution accident(EPA) will break out; only the ER receptore are exposed in the ER field and damaged seriously,the potential ER really turns into an actual EPA. Researching on the general laws of evolving from environmental risk to EPA, this paper bring forwards a relevant concept model of risk forecasting and evaluating of EPA. This model provides some scientific methods for risk evaluation, prevention and emergency response of EPA. This model not only enriches and develops the theory system of environment safety and emergency response, but also acts as an instruction for public safety, enterprise' s safety management and emergency response of the accident.

  16. Utilization of accident databases and fuzzy sets to estimate frequency of HazMat transport accidents.

    Qiao, Yuanhua; Keren, Nir; Mannan, M Sam


    Risk assessment and management of transportation of hazardous materials (HazMat) require the estimation of accident frequency. This paper presents a methodology to estimate hazardous materials transportation accident frequency by utilizing publicly available databases and expert knowledge. The estimation process addresses route-dependent and route-independent variables. Negative binomial regression is applied to an analysis of the Department of Public Safety (DPS) accident database to derive basic accident frequency as a function of route-dependent variables, while the effects of route-independent variables are modeled by fuzzy logic. The integrated methodology provides the basis for an overall transportation risk analysis, which can be used later to develop a decision support system.

  17. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims

    Gholipour, Changiz; Vahdati, Samad Shams; NOTASH, Mehdi; MIRI, Seyed Hassan; Ghafouri, Rouzbeh Rajaei


    SUMMARY Objectives Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a s...

  18. Bus accident severity and passenger injury: evidence from Denmark

    Prato, Carlo Giacomo; Kaplan, Sigal


    examining occurrence of injury to bus passengers. Results Bus accident severity is positively related to (i) the involvement of vulnerable road users, (ii) high speed limits, (iii) night hours, (iv) elderly drivers of the third party involved, and (v) bus drivers and other drivers crossing in yellow or red...... principle of sustainable transit and advance the vision “every accident is one too many”. Methods Bus accident data were retrieved from the national accident database for the period 2002–2011. A generalized ordered logit model allows analyzing bus accident severity and a logistic regression enables...

  19. The Relationship between Benzodiazepine Use and Traffic Accidents A Systematic Literature Review

    Smink, Beitske E.; Egberts, Antoine C. G.; Lusthof, Klaas J.; Uges, Donald R. A.; de Gier, Johan I.


    In many countries, benzodiazepines are the most commonly used and misused psychoactive medicinal drugs. Results of epidemiological studies investigating the association between benzodiazepine use and traffic accidents seem to be inconclusive or inconsistent at first sight. However, the outcome of ep

  20. Relationship among Translational Medicine, Evidence-Based Medicine and Precision Medicine

    HUANG Xin-en


    Translational medicine is a new concept in international medical ifeld. It integrates experimental research results and clinical guidance into the optimal implementation criteria for promoting the prediction, prevention and treatment of diseases. Based on people’s higher demand for medicine and health, appearance of translational medicine changes the mode of medical research. Evidence-based medicine (EBM) refers to cautious and accurate application of the current best research evidence and combination of the clinician’s professional skills and abundant clinical experience to consider the patients willing and value, consequently making the best diagnostic regimens for patients. Recently, some scholars have begun to question why the patients with the same diagnosis, course of disease and pathological condition have different efifcacies and prognosis after treatment with the same drug. So far, an accurate answer cannot be given based on the research data of EBM to implement translational medicine. The concept of precision medicine is accepted gradually with the development of disease management model. In this study, practice and enlightenment of translational medicine, effect of EBM on translational medicine, EBM limitations as well as emergence and development trend of precision medicine were all reviewed in order to investigate the relationship among translational medicine, EBM and precision medicine.

  1. Nuclear Accidents: Consequences for Human, Society and Energy Sector

    L. A. Bolshov


    Full Text Available The article examines radiation and hygienic regulations with regard to the elimination of consequences of the Chernobyl NPP accident in the context of relationships with other aspects, primarily socio-economic and political factors. This experience is reasonable to take into account when defining criteria in other regulatory fields, for example, in radioactive waste classification and remediation of areas. The article presents an analysis of joint features and peculiarities of nuclear accidents in the industry and energy sectors. It is noted that the scale of global consequences of the Chernobyl NPP accident is defined by the large-scale release of radioactivity into the environment, as well as an affiliation of the nuclear installation with the energy sector. Large-scale radiation accidents affect the most diverse spheres of human activities, what, in its turn, evokes the reverse reaction from the society and its institutions, including involvement of political means of settlement. If the latter is seeing for criteria that are scientifically justified and feasible, then the preconditions for minimizing socio-economic impacts are created. In other cases, political decisions, such as nuclear units’ shutdown and phasing out of nuclear energy, appear to be an economic price which society, as a whole and a single industry sector, pay to compensate the negative public response. The article describes fundamental changes in approaches to ensure nuclear and radiation safety that occurred after the Chernobyl NPP accident. Multiple and negative consequences of the Chernobyl accident for human and society are balanced to some extent by a higher level of operational safety, emergency preparedness, and life-cycle safety. The article indicates that harmonization and ensuring consistency of regulations that involve different aspects of nuclear and radiation safety are important to implement practical solutions to the nuclear legacy problems. The

  2. 张家港市突发危险化学品事故应急指挥与决策系统技术研究%Technology research on emergency command and decision-making system for sudden dangerous chemicals accidents in Zhangjiagang City

    王志刚; 邹玉华; 杨叶中; 孙震; 李娜; 蒋晓霞


    [Objective]To investigate the construction and operation situation of comprehensive emergency command and decision-making system for sudden dangerous chemicals accidents in Zhangjiagang City. [Methods]The data exchange platform, information databases and decision-making support database were established. The comprehensive emergency command and decision-making system for dangerous chemicals accidents were implemented by geographic information system (CIS) display. [ Results ] This software platform had achieved the functions of collection of basic data of the accident, the initial disposition of the accident, developments, on-site detection and early warning by CIS technique. On the basis of software platform, combined with appropriate hardware equipments, a complete set of emergency command and decision-making system was established. [Conclusion] The emergency command and decision-making system for treating the sudden dangerous chemicals accidents is established in Zhangjiagang city, which includes command and decision, prediction and warning, medical treatment, material reserves and other functions.%目的 探讨张家港市突发危险化学品事故综合应急指挥决策系统的建设及其运行情况.方法 建立数据交换平台、信息数据库和决策支持数据库,将多种综合信息集成,通过地理信息系统(GIS)展示实现危险化学品事故综合应急指挥、决策信息系统.结果 该软件平台利用GIS技术实现了事故的基本情况、事故初始处置、事态发展、现场检测预警等功能,在软件平台基础上搭配相应的硬件设备组成一套完整的应急指挥与决策系统.结论 张家港基本形成了融指挥决策、预测预警、医疗救治、物资储备等功能为一体的应对突发危险化学品事故应急救援指挥与决策系统.

  3. An Analysis of the Top-cited Articles in Emergency Medicine Education Literature

    Munzer, Brendan William; Love, Jeffrey; Shipman, Barbara; Byrne, Brendan; Cico, Stephen; Furlong, Bob; Khandalwal, Sorabh; Santen, Sally


    Introduction Dissemination of educational research is critical to improving medical education, promotion of faculty and, ultimately, patient care. The objective of this study was to identify the top 25 cited education articles in the emergency medicine (EM) literature and the top 25 cited EM education articles in all journals, as well as report on the characteristics of the articles. Methods Two searches were conducted ...

  4. An Assessment of an Oral Examination Format for Evaluating Clinical Competence in Emergency Medicine.

    Solomon, David J.; And Others


    In July 1989 the American Board of Emergency Medicine conducted a field test of the oral recertification examination process. Sixteen examiners and 25 examinees participated in the field test. The examination included 3 chart-stimulated recall and 3 simulated-patient encounter cases. (MLW)


    G. G. Onischenko


    Full Text Available Basic measures of the Rospotrebnadzor emergency response during the early stage of the «Fukushima-I» NPP radiation accident are being analyzed in the article. Radiation monitoring of the environmental objects of the territories of the Russian Federation Far East Federal District, radiation control of arriving from Japan vehicles, freights and passengers as well as imported from Japan food products were promptly organized. This allowed to get reliable evaluations of the levels of radioactive contamination at the Russian Federation territory and population exposure doses due to the «Fukushima-I» NPP accident, timely exclude the possibility of import to the Russian territory for the freights, vehicles, food products having contamination exceeding established in the Russian Federation standards.

  6. The emergence of trust in clinics of alternative medicine

    Pedersen, Inge Kryger; Hansen, Vibeke Holm; Grünenberg, Kristina


    qualitative studies and informing the empirical findings with a sociological concept of trust, this article provides new empirical insights on how trust emerges in Danish clinics of acupuncture, reflexology and homeopathy. The analysis demonstrates how trust is situational and emerges through both clients...

  7. Erwin H. Ackerknecht, social medicine, and the history of medicine.

    Rosenberg, Charles E


    Erwin H. Ackerknecht was an influential member of that small group of largely émigré historians of medicine who professionalized their field in the United States. Ackerknecht was influenced by both contemporary social science and an implicitly political vision of social medicine. It was a vision reinforced by his work in social anthropology in Paris in the 1930s, and it is a tradition that has its own intellectual pedigree, one that can be traced back to the era of Rudolf Virchow. It was no accident that Ackerknecht wrote on the social and ecological dimensions of disease, and that he was a vigorous advocate of a powerfully felt but, in retrospect, inconsistent relativism. His emphases on everyday medical practice and on siting ideas in their social and institutional context seem prescient, a forerunner of contemporary trends in social and cultural history.

  8. Impact of Learners on Emergency Medicine Attending Physician Productivity

    Rahul Bhat


    Full Text Available Introduction: Several prior studies have examined the impact of learners (medical students or residents on overall emergency department (ED flow as well as the impact of resident training level on the number of patients seen by residents per hour. No study to date has specifically examined the impact of learners on emergency medicine (EM attending physician productivity, with regards to patients per hour (PPH. We sought to evaluate whether learners increase, decrease, or have no effect on the productivity of EM attending physicians in a teaching program with one student or resident per attending.Methods: This was a retrospective database review of an urban, academic tertiary care center with 3 separate teams on the acute care side of the ED. Each team was staffed with one attending physician paired with either one resident, one medical student or with no learners. All shifts from July 1, 2008 to June 30, 2010 were reviewed using an electronic database. We predefined a shift as “Resident” if > 5 patients were seen by a resident, “Medical Student” if any patients were seen by a medical student, and “No Learners” if no patients were seen by a medical student or resident. Shifts were removed from analysis if more than one learner saw patients during the shift. We further stratified resident shifts by EM training level or off-service rotator. For each type of shift, the total number of patients seen by the attending physician was then divided by 8 hours (shift duration to arrive at number of patients per hour. Results: We analyzed a total of 7,360 shifts with 2,778 removed due to multiple learners on a team. For the 2,199 shifts with attending physicians with no learners, the average number of PPH was 1.87(95% confidence interval [CI] 1.86,1.89. For the 514 medical student shifts, the average PPH was 1.87(95% CI 1.84,1.90, p = 0.99 compared with attending with no learner. For the 1,935 resident shifts, the average PPH was 1.99(95% CI 1

  9. [Emergency medicine--medicine for an ageing society. A contribution to the context of emergency missions for elderly people].

    Prückner, S; Luiz, T; Steinbach-Nordmann, S; Nehmer, J; Danner, K; Madler, C


    Due to fundamental demographic as well as social changes, the emergency medical services (EMS) have to respond to an increasing number of geriatric emergencies. By means of some typical case histories the practical problems arising in preclinical emergency medical intervention and the central role of context factors like social isolation, reduced mental capabilities and the resulting need for help are demonstrated. It is discussed how emergency medical services (EMS) can contribute to the problems of an ageing society beyond the scope of a system which is dedicated only to the individual. One possibility is the epidemiological analysis of geriatric emergencies, the accompanying context factors and the development of an adequate infrastructure which is adapted to the needs of the elderly. The EU project EMERGE is an example of how emergency medical expertise is utilized in an interdisciplinary cooperation. An automatically working system based on ambient sensor technology is developed for early detection and prevention of emergency situations in the home environment. Supportive technology ("assisted living") should enable the elderly to live a safe and self-determined life as long as possible. Integration of this additional information into the processes of Emergency Medical Services (EMS) is the logistic prerequisite to establish a social medical assistance tailored to the needs of an ageing society.

  10. A bibliometric analysis of research productivity of emergency medicine researchers in South Korea

    Choi, Jiun; You, Je Sung; Joo, Young Seon; kong, Taeyoung; Ko, Dong Ryul; Chung, Sung Phil


    Objective During the past 20 years, over 1,400 doctors have been certified as emergency physicians in Korea. The number of scientific publications in the field of emergency medicine has also increased. This study aims to evaluate the research productivity of academic emergency physicians in South Korea. Methods Articles published from 1996 to 2015 by authors affiliated with Korean emergency departments were retrieved using Pubmed, Embase, and Web of Science. Research productivity was analyzed quantitatively to ascertain the number of articles for publication type and year. The performance of these articles was also analyzed qualitatively using impact factor, citation number, and Hirsch index. Bibliometric analysis was performed by researching Web of Science, Scopus, and Google Scholar. Results A total of 858 articles with 293 Korean authors as the first or corresponding authors were published across 191 journals. The number of publications increased continuously. The most common publication type was original article (n=618), the most commonly studied research topic was resuscitation medicine (n=110), and the average impact factor of the original articles was 2.158. The highest h-index was 17 and, using Web of Science, the maximum number of citations was found to be 85. Conclusion This study suggests that the research productivity of Korean authors in the emergency medicine field has progressed steadily during the last 10 years. However, qualitative indexes, such as the number of citations and h-index value, remain low. PMID:28168231

  11. Eye problems in mountain and remote areas: prevention and onsite treatment--official recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM.

    Ellerton, John A; Zuljan, Igor; Agazzi, Giancelso; Boyd, Jeffrey J


    Although eyes are not frequently injured in the mountains, they are exposed to many adverse factors from the environment. This article, intended for first responders, paramedics, physicians, and mountaineers, is the consensus opinion of the International Commission for Mountain Emergency Medicine (ICAR-MEDCOM). Its aim is to give practical advice on the management of eye problems in mountainous and remote areas. Snow blindness and minor injuries, such as conjunctival and corneal foreign bodies, could immobilize a person and put him or her at risk of other injuries. Blunt or penetrating trauma can result in the loss of sight in the eye; this may be preventable if the injury is managed properly. In almost all cases of severe eye trauma, protecting the eye and arranging an immediate evacuation are necessary. The most common eye problems, however, are due to ultraviolet light and high altitude. People wearing contact lenses and with previous history of eye diseases are more vulnerable. Any sight-threatening eye problem or unexplained visual loss at high altitude necessitates descent. Wearing appropriate eye protection, such as sunglasses with sidepieces and goggles with polarized or photochromic lenses, could prevent most of the common eye problems in mountaineering.

  12. Untying the gordian knot: what we do and don't know about gender-specific medicine-keynote address for the 2014 Academic Emergency Medicine Consensus Conference.

    Legato, Marianne


    Over the past two decades, a burgeoning interest in women's health, the direct consequence of the feminist movement, has inspired a worldwide interest in the differences between the normal function of men and women and their unique experiences of the same illnesses. The scope and significance of what we have discovered and continue to find has fundamentally changed the way we prevent, diagnose, and treat diseases. Important questions remain, however, and deserve specific investigation and analysis.

  13. Severe accident approach - final report. Evaluation of design measures for severe accident prevention and consequence mitigation.

    Tentner, A. M.; Parma, E.; Wei, T.; Wigeland, R.; Nuclear Engineering Division; SNL; INL


    An important goal of the US DOE reactor development program is to conceptualize advanced safety design features for a demonstration Sodium Fast Reactor (SFR). The treatment of severe accidents is one of the key safety issues in the design approach for advanced SFR systems. It is necessary to develop an in-depth understanding of the risk of severe accidents for the SFR so that appropriate risk management measures can be implemented early in the design process. This report presents the results of a review of the SFR features and phenomena that directly influence the sequence of events during a postulated severe accident. The report identifies the safety features used or proposed for various SFR designs in the US and worldwide for the prevention and/or mitigation of Core Disruptive Accidents (CDA). The report provides an overview of the current SFR safety approaches and the role of severe accidents. Mutual understanding of these design features and safety approaches is necessary for future collaborations between the US and its international partners as part of the GEN IV program. The report also reviews the basis for an integrated safety approach to severe accidents for the SFR that reflects the safety design knowledge gained in the US during the Advanced Liquid Metal Reactor (ALMR) and Integral Fast Reactor (IFR) programs. This approach relies on inherent reactor and plant safety performance characteristics to provide additional safety margins. The goal of this approach is to prevent development of severe accident conditions, even in the event of initiators with safety system failures previously recognized to lead directly to reactor damage.

  14. Characterization of motorcycle accident victims attended by the mobile emergency service (SAMU-192, Recife, Pernambuco State, Brazil - 10.4025/actascihealthsci.v34ispec.11524

    Betise Mery Alencar Sousa Macau Furtado


    Full Text Available This study described the epidemiological characteristics of victims of accidents involving motorcycles, attended by the Mobile Emergency Service (SAMU-192 in the city of Recife (PE in 2006. This is a descriptive cross-sectional study that analyzed a sample of 703 cases. The results showed that 81.8% were male, aged 20 to 29 years. It was noted that 406 of them were wearing a helmet at the time of the accident. The accidents occurred most frequently on Sundays (19.3% between 18:00 and 24:00 hours (0.28%. The extremities were the most affected body segment, with 341 occurrences. Regarding the severity of injuries, it was found that 37.6% were superficial or mild (scrapes, cuts and bruises. These results demonstrate the need for educational campaigns to encourage the use of personal protective equipment among motorcyclists. The best way to reduce the risks and damages from motorcycle accidents is through primary prevention. For this, are needed integrated intersectoral actions aimed at reducing the incidence and severity of injuries.  

  15. Study on Method of Coal Mine Gas Accident Emergency Decision Making%煤矿瓦斯事故应急决策方法研究

    李军涛; 郭德勇; 邸学勤


    In view of the situation of coal mine emergency decision-making comprehensively restricted by multi-objective,gas accidents emergency decision goals are divided into two parts.By analyzing emergency rescue body which including prevention,preparation,response,recovery four stages,the paper proproses the decision-making body of different types and levels,summarizes the different behaviors of decision-making in wartime and peacetime,enhances multi-stage concept of the emergency decision-making,and sets up structured and scientific gas accident emergency decision-making of coal mine.%针对煤矿事故应急决策受多目标综合限制的情况,将瓦斯事故应急决策目标简化分解为两大类,对预防、准备、响应、恢复4个阶段应急救援主体进行分析,提出了应急决策不同类别和级别时的决策主体,总结了战时和平时应急决策的不同行为,提升了应急决策的多阶段理念,并以此建立了结构化、科学化的煤矿瓦斯事故应急决策方法。

  16. Risk communication in the case of the Fukushima accident: Impact of communication and lessons to be learned.

    Perko, Tanja


    Risk communication about the Fukushima Daiichi nuclear power plant accident in 2011 was often not transparent, timely, clear, nor factually correct. However, lessons related to risk communication have been identified and some of them are already addressed in national and international communication programmes and strategies. The Fukushima accident may be seen as a practice scenario for risk communication with important lessons to be learned. As a result of risk communication failures during the accident, the world is now better prepared for communication related to nuclear emergencies than it was 5 years ago The present study discusses the impact of communication, as applied during the Fukushima accident, and the main lessons learned. It then identifies pathways for transparent, timely, clear and factually correct communication to be developed, practiced and applied in nuclear emergency communication before, during, and after nuclear accidents. Integr Environ Assess Manag 2016;12:683-686. © 2016 SETAC.

  17. Catastrophe medicine; Medecine de catastrophe

    Lebreton, A. [Service Technique de l`Energie Electrique et des Grands Barrages (STEEGB), (France)


    The `Catastrophe Medicine` congress which took place in Amiens (France) in December 5 to 7 1996 was devoted to the assessment and management of risks and hazards in natural and artificial systems. The methods of risk evaluation and prevision were discussed in the context of dams accidents with the analysis of experience feedbacks and lessons gained from the organisation of emergency plans. Three round table conferences were devoted to the importance of psychological aspects during such major crises. (J.S.)

  18. Cold and Cough Medicines

    ... What can you do for your cold or cough symptoms? Besides drinking lots of fluids and getting ... medicines. There are lots of different cold and cough medicines, and they do different things. Nasal decongestants - ...

  19. Medicine safety and children

    ... this page: // Medicine safety and children To use the sharing features ... especially careful if you have toddlers around. Keep Medicines out of Reach and Sight Safety tips: DO ...

  20. Explaining and predicting workplace accidents using data-mining techniques

    Rivas, T., E-mail: trivas@uvigo.e [Dpto. Ingenieria de los Recursos Naturales y Medio Ambiente, E.T.S.I. Minas, University of Vigo, Campus Lagoas, 36310 Vigo (Spain); Paz, M., E-mail: [Dpto. Ingenieria de los Recursos Naturales y Medio Ambiente, E.T.S.I. Minas, University of Vigo, Campus Lagoas, 36310 Vigo (Spain); Martin, J.E., E-mail: [CIPP International, S.L. Parque Tecnologico de Asturias, Parcela 43, Oficina 11, 33428 Llanera (Spain); Matias, J.M., E-mail: jmmatias@uvigo.e [Dpto. Estadistica e Investigacion Operativa, E.T.S.I. Minas, University of Vigo, Campus Lagoas, 36310 Vigo (Spain); Garcia, J.F., E-mail: [CIPP International, S.L. Parque Tecnologico de Asturias, Parcela 43, Oficina 11, 33428 Llanera (Spain); Taboada, J., E-mail: jtaboada@uvigo.e [Dpto. Ingenieria de los Recursos Naturales y Medio Ambiente, E.T.S.I. Minas, University of Vigo, Campus Lagoas, 36310 Vigo (Spain)


    Current research into workplace risk is mainly conducted using conventional descriptive statistics, which, however, fail to properly identify cause-effect relationships and are unable to construct models that could predict accidents. The authors of the present study modelled incidents and accidents in two companies in the mining and construction sectors in order to identify the most important causes of accidents and develop predictive models. Data-mining techniques (decision rules, Bayesian networks, support vector machines and classification trees) were used to model accident and incident data compiled from the mining and construction sectors and obtained in interviews conducted soon after an incident/accident occurred. The results were compared with those for a classical statistical techniques (logistic regression), revealing the superiority of decision rules, classification trees and Bayesian networks in predicting and identifying the factors underlying accidents/incidents.

  1. Insurance Exchange Marketplace: Implications for Emergency Medicine Practice

    David S. Rankey, MD, MPH


    Full Text Available The Patient Protection and Affordable Care Act of 2010 requires states to establish healthcareinsurance exchanges by 2014 to facilitate the purchase of qualified health plans. States are required toestablish exchanges for small businesses and individuals. A federally operated exchange will beestablished, and states failing to participate in any other exchanges will be mandated to join the federalexchange. Policymakers and health economists believe that exchanges will improve healthcare atlower cost by promoting competition among insurers and by reducing burdensome transaction costs.Consumers will no longer be isolated from monthly insurance premium costs. Exchanges will increasethe number of patients insured with more cost-conscious managed care and high-deductible plans.These insurance plan models have historically undervalued emergency medical services, while alsounderinsuring patients and limiting their healthcare system access to the emergency department. Thisparadoxically increases demand for emergency services while decreasing supply. The continualdevaluation of emergency medical services by insurance payers will result in inadequate distribution ofresources to emergency care, resulting in further emergency department closures, increases inemergency department crowding, and the demise of acute care services provided to families andcommunities.

  2. Investigation on legal problems encountered by emergency medicine physicians in Turkey.

    Afsin Emre Kayipmaz

    Full Text Available Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians' legal-administrative problems and reveal their level of understanding on forensic cases.An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. p<0.05 was considered statistically significant.294 physicians participated in the questionnaire. According to the questionnaire, 170 of the physicians were reported to the patient communication units due to medical malpractice. Mean number of compliant reports was 3.20±3.5. 29 of the physicians received administrative penalties. 42 of the physicians were judged in the court for medical malpractice. 1 physician was fined 5000 Turkish Liras as a result of these judgments.We found that the number of complaint reports is negatively correlated with duration of service in emergency medicine and age. There was a significant difference between number of complaint reports and career (p<0.05. The physicians' level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post-graduate education sessions and

  3. Emergency medicine physicians performed ultrasound for pediatric intussusceptions

    Yi-Jung Chang


    Full Text Available Background: Intussusception is the common acute abdomen in children with difficult clinical diagnosis. The routine ultrasound has recently been proposed as the initial diagnostic modality with high accuracy, but is not available for 24 h by gastroenterologists. We aimed to evaluate the validation of bedside ultrasound for intussusceptions performed by pediatric emergency physicians with ultrasound training during the night or holiday. Methods: A retrospective study was conducted in children with suspected intussusceptions when routine ultrasounds by gastroenterologists were not available over the period from July 2004 to July 2008. Patients were divided into two groups: those diagnosed by emergency physicians with ultrasound training and without training. The clinical characteristics and course for all patients were reviewed and compared for seeking the difference. Results: A total of 186 children were included. One hundred and thirteen (61% children were diagnosed by pediatric emergency physician with ultrasound training. The clinical symptoms were not statistically different between the two groups. The diagnostic sensitivity of the ultrasound training group was significantly higher (90% vs. 79%, p = 0.034. Children of the training group also had significantly shorter hospital stay duration at emergency departments before reduction (2.41 ± 2.01 vs. 4.58 ± 4.80 h, p = 0.002. Conclusion: Bedside ultrasound performed by pediatric emergency physicians with ultrasound training is a sensitive test for detecting intussusceptions. Knowledge and use of bedside ultrasound can aid the emergency physician in the diagnosis of pediatric intussusceptions with less delay in treatment.

  4. 立足灾害事故救援的急救医学课程构建与实践%Reform and practice of emergency medicine undergraduate course based on disasters medical rescue

    刘明华; 郭国宁; 向强; 文亮


    灾害事故频发,但医学救援相对落后,存在诸多缺陷,人才问题是阻挡灾害救援医学发展最大的瓶颈.急救医学本科教学应当承担起相应的责任,从医学生开始就要培养灾害事故的救灾技术和规范素质.灾害医学教育是急救医学教育的丰富和发展.我们结合近三年的灾害课程教学实践,分析了灾害医学教育的重要性和迫切性,并从理论课程构建和实践课程设计等方面对急救医学教学改革进行了探讨.%Disasters and incidents happen frequently, but medical rescue are relatively backward with many defects. The deficiency of special talents is the biggest bottle neck for the development of disaster medicine. Emergency medicine education should take the responsibility to cultivate disaster rescue skills and basic quality of medical undergraduate. Disaster medicine education shall quicken the development of emergency medicine further. Combined the recent three - year disaster medicine teaching practice, we analyzed the importance and urgency of disaster medicine education and explored the reform of emergency medicine education from both theory and practice curriculum design.

  5. Date fruits (Phoenix dactylifera Linn): an emerging medicinal food.

    Vayalil, Praveen K


    Date palm is one of the oldest trees cultivated by man. In the folk-lore, date fruits have been ascribed to have many medicinal properties when consumed either alone or in combination with other herbs. Although, fruit of the date palm served as the staple food for millions of people around the world for several centuries, studies on the health benefits are inadequate and hardly recognized as a healthy food by the health professionals and the public. In recent years, an explosion of interest in the numerous health benefits of dates had led to many in vitro and animal studies as well as the identification and quantification of various classes of phytochemicals. On the basis of available documentation in the literature on the nutritional and phytochemical composition, it is apparent that the date fruits are highly nutritious and may have several potential health benefits. Although dates are sugar-packed, many date varieties are low GI diet and refutes the dogma that dates are similar to candies and regular consumption would develop chronic diseases. More investigations in these areas would validate its beneficial effects, mechanisms of actions, and fully appreciate as a potential medicinal food for humans all around the world. Therefore, in this review we summarize the phytochemical composition, nutritional significance, and potential health benefits of date fruit consumption and discuss its great potential as a medicinal food for a number of diseases inflicting human beings.

  6. Analysis on relation between safety input and accidents

    YAO Qing-guo; ZHANG Xue-mu; LI Chun-hui


    The number of safety input directly determines the level of safety, and there exists dialectical and unified relations between safety input and accidents. Based on the field investigation and reliable data, this paper deeply studied the dialectical relationship between safety input and accidents, and acquired the conclusions. The security situation of the coal enterprises was related to the security input rate, being effected little by the security input scale, and build the relationship model between safety input and accidents on this basis, that is the accident model.

  7. Literature Between Medicine and Religion: Herder?s Aesthetics of Touch and the Emerging Field of Medical Humanities

    Mack, Michael


    Abstract This article uses a reading of Herder?s early essay Sculpture to locate Herder?s place within the complex genealogies of thought regarding the mind?body problem. It analyses how Herder discusses sculpture and touch by combining an idealist with a materialist position. Herder theorizes sculpture in order to close the gap between mind and body as well as that between art and life. According to Danto, this non-dualist approach shapes much of the contemporary art scene. mic...

  8. Rates of thoracic trauma and mortality due to accidents in Brazil

    Cury Francisco


    Full Text Available Aim: To report on the causes of trauma, indexes of trauma, and mortality related to thoracic trauma in one region of Brazil. Materials and Methods: This prospective study was performed at the Regional Trauma Center in Sγo Josι do Rio Preto over a 1-year period, from 1 st July 2004 to 30 th June 2005. We included all patients attending the center′s emergency room with thoracic trauma and an anatomic injury scale (AIS ≥ 2. We collected data using a protocol completed on arrival in hospital utilizing the AIS. We studied the types of accidents as well as the mortality and the AIS scores. Prevalence rates were calculated and the paired t-test and logistic regression were employed for the statistical analysis. Results:There were a total of 373 casualties with AIS ≥ 2 and there were 45 (12% deaths. The causes of thoracic trauma among the 373 casualties were as follows: 91 (24.4% car crashes, 75 (20.1% falls, 46 (12.3% motorbike accidents, 40 (10.7% stabbings, 22 (5.9% accidents involving pedestrians, 21 (5.6% bicycle accidents, 17 (4.6% shootings, and 54 (14.5% other types of accident. The severity of the injuries was classified according to the AIS: 224 (60% were grade 2, 101 (27% were grade 3, 27 (7.2% were grade 4, 18 (4.9% were grade 5, and 3 were (0.8% grade 6. With respect to thoracic trauma, pedestrians involved in accidents and victims of shootings had mortality rates that were significantly higher than that of those involved in other types of accidents. Conclusion: Road accidents are the main cause of thoracic injury, with accidents involving pedestrians and shootings being associated with a greater death rate.

  9. Cellular phones and traffic accidents: an epidemiological approach.

    Violanti, J M; Marshall, J R


    Using epidemiological case-control design and logistic regression techniques, this study examined the association of cellular phone use in motor vehicles and traffic accident risk. The amount of time per month spent talking on a cellular phone and 18 other driver inattention factors were examined. Data were obtained from: (1) a case group of 100 randomly selected drivers involved in accidents within the past 2 years, and (2) a control group of 100 randomly selected licensed drivers not involved in accidents within the past 10 years. Groups were matched on geographic residence. Approximately 13% (N = 7) of the accident and 9% (N = 7) of the non-accident group reported use of cellular phones while driving. Data was obtained from Department of Motor Vehicles accident reports and survey information from study subjects. We hypothesized that increased use of cellular phones while driving was associated with increased odds of a traffic accident. Results indicated that talking more than 50 minutes per month on cellular phones in a vehicle was associated with a 5.59-fold increased risk in a traffic accident. The combined use of cellular phones and motor and cognitive activities while driving were also associated with increased traffic accident risk. Readers should be cautioned that this study: (1) consists of a small sample, (2) reveals statistical associations and not causal relationships, and (3) does not conclude that talking on cellular phones while driving is inherently dangerous.

  10. Development of severe accident management and training support system

    Jeong, Kwang Sub; Kim, Ko Ryo; Jung, Won Dae; Ha, Jae Joo


    Recently, the overall severe accident management strategy is under development according to the logical flow of severe accident management guidelines in some foreign countries. In Korea, the basis of severe accident management strategy is established due to the development of Korean severe accident guideline. In the straining system, the professional information as well as the general information for severe accident should be provided to the related personnel and the function of prior simulation for plant behavior according to strategy execution should be required. Korean severe accident management guideline is chosen as the basis logic for development of support system for decision-support and training related with execution of severe accident strategy. The training simulator is developed for prior expectation of plant behavior and the severe accident computer code, MELCOR, is utilized as the engine, and it is possible to operate equipments necessary for execution of severe accident management guidelines. And also, the graphical interface is developed to provide the plant status and provide status change of major equipments dynamically.

  11. Experimental investigation of material chemical effects on emergency core cooling pump suction filter performance after loss of coolant accident

    Park, Jong Woon, E-mail: [Dongguk University, 707 Seokjang-Dong, Gyeongju, 780-714 (Korea, Republic of); Park, Byung Gi [Soonchunhyang University, Asan, Chungnam, 336-745 (Korea, Republic of); Kim, Chang Hyun [Korea Hydro and Nuclear Power Co., Ltd. 25-1, Jang-dong, Yuseong-gu, Daejeon, 305-343 (Korea, Republic of)


    Integral tests of head loss through an emergency core cooling filter screen are conducted, simulating reactor building environmental conditions for 30 days after a loss of coolant accident. A test rig with five individual loops each of whose chamber is established to test chemical product formation and measure the head loss through a sample filter. The screen area at each chamber and the amounts of reactor building materials are scaled down according to specific plant condition. A series of tests have been performed to investigate the effects of calcium-silicate, reactor building spray, existence of calcium-silicate with tri-sodium phosphate (TSP), and composition of materials. The results showed that head loss across the chemical bed with even a small amount of calcium-silicate insulation instantaneously increased as soon as TSP was added to the test solution. Also, the head loss across the filter screen is strongly affected by spray duration and the head loss increase is rapid at the early stage, because of high dissolution and precipitation of aluminum and zinc. After passivation of aluminum and zinc by corrosion, the head loss increase is much slowed down and is mainly induced by materials such as calcium, silicon, and magnesium leached from NUKON{sup TM} and concrete. Furthermore, it is newly found that the spay buffer agent, tri-sodium phosphate, to form protective coating on the aluminum surface and reduce aluminum leaching is not effective for a large amount of aluminum and a long spray.

  12. Decision Methods for Nuclear Accident Emergencies%核事故应急中的决策方法

    刘磊; 奚树人


    This paper presents the structure of a Decision Evaluation System for nuclear accident emergencies.With respect to decision problems in early phase after a nuclear accident,the attribute tree is proposed.The multiple attribute decision method for evaluation process is described in detail.An example is given.%介绍核事故应急决策评价系统的构成。针对核事故早期决策问题,建立评价时所考虑的属性树,描述评价过程中采用的多属性决策方法,最后给出计算的实例。

  13. Emerging and Disruptive Technologies


    Several emerging or disruptive technologies can be identified that might, at some point in the future, displace established laboratory medicine technologies and practices. These include increased automation in the form of robots, 3-D printing, technology convergence (e.g., plug-in glucose meters for smart phones), new point-of-care technologies (e.g., contact lenses with sensors, digital and wireless enabled pregnancy tests) and testing locations (e.g., Retail Health Clinics, new at-home testing formats), new types of specimens (e.g., cell free DNA), big biology/data (e.g., million genome projects), and new regulations (e.g., for laboratory developed tests). In addition, there are many emerging technologies (e.g., planar arrays, mass spectrometry) that might find even broader application in the future and therefore also disrupt current practice. One interesting source of disruptive technology may prove to be the Qualcomm Tricorder XPrize, currently in its final stages. PMID:27683538

  14. A retrospective quality assessment of pre-hospital emergency medical documentation in motor vehicle accidents in south-eastern Norway

    Staff Trine


    Full Text Available Abstract Background Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs. Methods Records from police, Emergency Medical Communication Centers (EMCC, ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS, respiratory rate (RR, and systolic blood pressure (SBP was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend. Results 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: p Conclusion EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research.

  15. EM Talk: communication skills training for emergency medicine patients with serious illness.

    Grudzen, Corita R; Emlet, Lillian L; Kuntz, Joanne; Shreves, Ashley; Zimny, Erin; Gang, Maureen; Schaulis, Monique; Schmidt, Scott; Isaacs, Eric; Arnold, Robert


    The emergency department visit for a patient with serious illness represents a sentinel event, signalling a change in the illness trajectory. By better understanding patient and family wishes, emergency physicians can reinforce advance care plans and ensure the hospital care provided matches the patient's values. Despite their importance in care at the end of life, emergency physicians have received little training on how to talk to seriously ill patients and their families about goals of care. To expand communication skills training to emergency medicine, we developed a programme to give emergency medicine physicians the ability to empathically deliver serious news and to talk about goals of care. We have built on lessons from prior studies to design an intervention employing the most effective pedagogical techniques, including the use of simulated patients/families, role-playing and small group learning with constructive feedback from master clinicians. Here, we describe our evidence-based communication skills training course EM Talk using simulation, reflective feedback and deliberate practice.

  16. 78 FR 48224 - Lac-Mégantic Railroad Accident Discussion and DOT Safety Recommendations


    .... 13-13] Lac-M[eacute]gantic Railroad Accident Discussion and DOT Safety Recommendations AGENCY... their destinations safely and without incident. In calendar year 2011, for example, out of the... might also travel. Human Factors Finally, Transport Canada's emergency directive and order...

  17. Developing a third-year emergency medicine medical student curriculum: a syllabus of content.

    Tews, Matthew C; Wyte, Collette Marie Ditz; Coltman, Marion; Grekin, Peter A; Hiller, Kathy; Oyama, Leslie C; Pandit, Kiran; Manthey, David E


    Emergency medicine (EM) educators have published several curricular guides designed for medical student rotations and experiences. These guides primarily provided brief overviews of opportunities to incorporate EM into all 4 years of the medical student curriculum, with one specific to the fourth year. However, there are no published guidelines specific to third-year medical students rotating in EM. Given the differences between third-year and fourth-year students in terms of clinical experience, knowledge, and skills, the Clerkship Directors in Emergency Medicine (CDEM) established the Third-year EM Medical Student Curriculum Work Group to create a third-year curriculum. The work group began this process by developing consensus-based recommendations for the content of a third-year medical student EM rotation, which are presented in this syllabus.

  18. A suggested core content for education scholarship fellowships in emergency medicine.

    Yarris, Lalena M; Coates, Wendy C; Lin, Michelle; Lind, Karen; Jordan, Jaime; Clarke, Sam; Guth, Todd A; Santen, Sally A; Hamstra, Stanley J


    A working group at the 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine (EM) convened to develop a curriculum for dedicated postgraduate fellowships in EM education scholarship. This fellowship is intended to create future education scholars, equipped with the skills to thrive in academic careers. This proceedings article reports on the consensus of a breakout session subgroup tasked with defining a common core content for education scholarship fellowships. The authors propose that the core content of an EM education scholarship fellowship can be categorized in four distinct areas: career development, theories of learning and teaching methods, education research methods, and educational program administration. This core content can be incorporated into curricula for education scholarship fellowships in EM or other fields and can also be adapted for use in general medical education fellowships.

  19. Implementation of a hypertext-based curriculum for emergency medicine on the World Wide Web.

    Savitt, D L; Steele, D W


    This project reports the publication of a variety of existing curricular resources for emergency medicine on the global Internet in a format that allows hypertext links between related material, timely updates, and end-user feedback. Curricular elements were converted to Hypertext Markup Language with extensive links between related content. The completed document contains instructions for curriculum development, specific curricula for subspecialty areas within a residency, reading lists for subspecialty curricula, banks of images, and board-type questions with answers. Users are provided with a mechanism to provide immediate feedback to section editors with suggestions for changes, including new references. Access to all or part of the document can be controlled via passwords, but is potentially available to anyone with an Internet connection and a World Wide Web browser. The document may by viewed on the World Wide Web at: curr.html.

  20. 50 CFR 401.17 - Safety and accident prevention.


    ... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Safety and accident prevention. 401.17 Section 401.17 Wildlife and Fisheries JOINT REGULATIONS (UNITED STATES FISH AND WILDLIFE SERVICE... FISHERIES CONSERVATION, DEVELOPMENT AND ENHANCEMENT § 401.17 Safety and accident prevention. In...

  1. An Analysis of the Top-cited Articles in Emergency Medicine Education Literature

    Munzer, Brendan W.; Love, Jeffery; Shipman, Barbara L.; Byrne, Brendan; Cico, Stephen J.; Furlong, Robert; Khandelwal, Sorabh; Sally A. Santen


    Introduction Dissemination of educational research is critical to improving medical education, promotion of faculty and ultimately patient care. The objective of this study was to identify the top 25 cited education articles in the emergency medicine (EM) literature and the top 25 cited EM education articles in all journals, as well as report on the characteristics of the articles. Methods Two searches were conducted in the Web of Science in June 2016 using a list of education-related search ...

  2. Defining a core curriculum for education scholarship fellowships in emergency medicine.

    Coates, Wendy C; Lin, Michelle; Clarke, Samuel; Jordan, Jaime; Guth, Todd; Santen, Sally A; Yarris, Lalena M


    A trained cadre of medical education scholars with a focus on methodologically sound research techniques is needed to ensure development of innovations that can be translated to educational practice, rigorous evaluation of instructional strategies, and progress toward improving patient care outcomes. Most established educational programs are aimed at existing faculty members and focus primarily on the development of teaching and leadership skills. At the 2012 Academic Emergency Medicine (AEM) consensus conference, "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success," a breakout session was convened to develop training recommendations for postgraduate fellowship programs in medical education scholarship that would enable residency graduates to join academic faculties armed with the skills needed to perform research in medical education. Additionally, these graduates would enjoy the benefits of established mentorships. A group of 23 medical education experts collaborated to address the following objectives: 1) construct a formal needs assessment for fellowship training in medical education scholarship in emergency medicine (EM), 2) compare and contrast current education scholarship programs in both EM and non-EM specialties, and 3) develop a set of core curriculum guidelines for specialized fellowship training in medical education scholarship in EM. Fellowship-trained faculty need to be proficient in learner instruction and assessment, organizational leadership, curriculum development, educational methodology, and conducting generalizable hypothesis-driven research to improve patient care.

  3. Aviation medicine and the Army.

    Vyrnwy-Jones, P; Thornton, R


    The purpose of this short series of articles is not to present the reader with a vast amount of technical data, soon to be forgotten, but to provide some items of general interest from the past, present, and future of Army aviation. Obviously there will be a concentration on medical matters, but the aim is to give the reader a feel for the rapid progress being made in helicopter design and the likely problems we may face in the future. The first article serves as an introduction to the series and three further articles will cover various aspects of the speciality. The second will be concerned with AAC helicopter accidents and will include accident investigation, crashworthiness and the contribution made by pilot error. The third article will cover major environmental problems of helicopters, particularly noise, vibration and thermal stress. The fourth article will examine ways in which microprocessors and modern technology will affect future helicopter and ancillary equipment development; for instance, a helicopter with no external windows has been suggested, 'The Iron Cockpit'. The fifth article will be concerned with the clinical aspects of Army Aviation medicine.

  4. Retrospective on the construction and practice of a state-level emergency medical rescue team.

    Lei, Zhang; Haitao, Guo; Xin, Wang; Yundou, Wang


    For the past few years, disasters like earthquakes, landslides, mudslides, tsunamis, and traffic accidents have occurred with an ever-growing frequency, coverage, and intensity greatly beyond the expectation of the public. In order to respond effectively to disasters and to reduce casualties and property damage, countries around the world have invested more efforts in the theoretical study of emergency medicine and the construction of emergency medical rescue forces. Consequently, emergency medical rescue teams of all scales and types have come into being and have played significant roles in disaster response work. As the only state-level emergency medical rescue force from the Chinese People's Armed Police Forces, the force described here has developed, through continuous learning and practice, a characteristic mode in terms of grouping methods, equipment system construction, and training.

  5. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

    J. Bousquet (Jean); P.W. Hellings (P.); I. Agache; A. Bedbrook (A.); C. Bachert (Claus); K.-C. Bergmann (Karl-Christian); Bewick, M.; C. Bindslev-Jensen; Bosnic-Anticevitch, S.; Bucca, C.; Caimmi, D.P.; P. Camargos; G. Canonica (Gwalter); T.B. Casale (Thomas); N.H. Chavannes (Nicolas); A.A. Cruz; De Carlo, G.; R. Dahl; P. Demoly; Devillier, P.; J. Fonseca; W.J. Fokkens (Wytske); Guldemond, N.A.; T. Haahtela; Illario, M.; P.M. Just; M. Keil (Mark); L. Klimek (Ludger); P. Kuna; D. Larenas-Linnemann (Désirée); M. Morais-Almeida; Mullol, J.; Murray, R.; R. Naclerio; R.E. O'hehir; N. Papadopoulos; R. Pawankar (Ruby); Potter, P.; D. Ryan (Dermot); Samolinski, B.; H.J. Schünemann (Holger); A. Sheikh (Aziz); F.E.R. Simons; Stellato, C.; A. Todo Bom; Tomazic, P.V.; A. Valiulis (Arunas); E. Valovirta (Erkka); Ventura, M.T.; M. Wickman (Magnus); Young, I.; A. Yorgancioglu; T. Zuberbier (Torsten); W. Aberer (W.); C.A. Akdis; C.A. Akdis; I. Annesi-Maesano; Ankri, J.; I.J. Ansotegui (I.); J.M. Antó (Josep M.); Arnavielhe, S.; Asarnoj, A.; Arshad, H.; Avolio, F.; I. Baiardini (Ilaria); Barbara, C.; Barbagallo, M.; E.D. Bateman (Eric); B. Beghe; E.H. Bel; K.S. Bennoor (K.); Benson, M.; Białoszewski, A.Z.; T. Bieber (Thomas); L. Bjermer (Leif); Blain, H.; F. Blasi (Francesco); A.L. Boner; M. Bonini (Matteo); S. Bonini (Sergio); Bosse, I.; J. Bouchard (Jacques); L.P. Boulet; Bourret, R.; J. Bousquet (Jean); F. Braido (Fulvio); A. Briggs (Andrew); C.E. Brightling (C.); J. Brozek; Buhl, R.; Bunu, C.; Burte, E.; A. Bush (Andrew); Caballero-Fonseca, F.; M. Calderon (Moises); Camuzat, T.; D. Cardona (Doris); Carreiro-Martins, P.; Carriazo, A.M.; K.H. Carlsen (Karin); W.W. Carr (Warner); Cepeda Sarabia, A.M.; Cesari, M.; L. Chatzi (Leda); Chiron, R.; Chivato, T.; Chkhartishvili, E.; A.G. Chuchalin; Chung, K.F.; G. Ciprandi (G.); De Sousa, J.C. (J. Correia); L. Cox (Linda); Crooks, G.; A. Custovic; S.E. Dahlen; U. Darsow (U.); Dedeu, T.; D. Deleanu (D.); J. Denburg; De Vries, G.; Didier, A.; Dinh-Xuan, A.T.; D. Dokic (D.); H. Douagui; Dray, G.; R. Dubakiene (R.); S.R. Durham (Stephen); G. Du Toit (George); Dykewicz, M.S.; Eklund, P.; Y. El-Gamal (Y.); Ellers, E.; R. Emuzyte; Farrell, J.; A. Fink-Wagner (A.); A. Fiocchi (Alessandro); M. Fletcher (M.); Forastiere, F.; M. Gaga (Mina); A. Gamkrelidze (Amiran); Gemicioǧlu, B.; J.E. Gereda (J.); Van Wick, R.G. (R. Gerth); S. González Diaz (S.); Grisle, I.; L. Grouse; Gutter, Z.; M.A. Guzmán (M.); B. Hellquist-Dahl (B.); J. Heinrich (Joachim); Horak, F.; J.O.B. Hourihane; Humbert, M.; Hyland, M.; Iaccarino, G.; Jares, E.J.; Jeandel, C.; S.L. Johnston; G.F. Joos (Guy); Jonquet, O.; Jung, K.S.; M. Jutel (M.); Kaidashev, I.; Khaitov, M.; O. Kalayci; A.F. Kalyoncu (A.); Kardas, P.; P.K. Keith; M. Kerkhof (Marjan); H.A.M. Kerstjens (Huib); N. Khaltaev; M. Kogevinas (Manolis); Kolek, V.; G.H. Koppelman (Gerard); M.L. Kowalski; Kuitunen, M.; C.A. Kull (Christian); V. Kvedariene (V.); B.N.M. Lambrecht (Bart); S. Lau (Susanne); Laune, D.; L.T. Le; A.P. Lieberman (Andrew); B. Lipworth; J. Li (J.); K.C. Lødrup Carlsen (K. C.); R. Louis (Renaud); Lupinek, C.; W. MacNee; Magar, Y.; Magnan, A.; B. Mahboub; Maier, D.; Majer, I.; Malva, J.; Manning, P.; De Manuel Keenoy, E.; G.D. Marshall; M.R. Masjedi (M.); Mathieu-Dupas, E.; Maurer, M.; S. Mavale-Manuel; E. Melén (Erik); Melo-Gomes, E.; E.O. Meltzer; Mercier, J.; J. Merk (Jeroen); Miculinic, N.; F. Mihaltan (F.); B. Milenkovic (Branislava); Millot-Keurinck, J.; Y. Mohammad; I. Momas (I.); R. Mösges; Muraro, A.; L. Namazova-Baranova (L.); R. Nadif (Rachel); Neffen, H.; Nekam, K.; A. Nieto (Antonio); B. Niggemann; Nogueira-Silva, L.; Nogues, M.; T.D. Nyembue (T.); K. Ohta; Y. Okamoto; Okubo, K.; Olive-Elias, M.; S. Ouedraogo; P. Paggiaro (Pierluigi); I. Pali-Schöll (I.); S. Palkonen; P. Panzner (P.); Papi, A.; Park, H.S.; G. Passalacqua (Giovanni); S.E. Pedersen (Soren E.); Pereira, A.M.; O. Pfaar (Oliver); Picard, R.; B. Pigearias (B.); I. Pin (Isabelle); Plavec, D.; Pohl, W.; T.A. Popov; Portejoie, F.; D.S. Postma (Dirkje); L.K. Poulsen; D. Price (David); K.F. Rabe (Klaus F.); Raciborski, F.; G. Roberts; Robalo-Cordeiro, C.; Rodenas, F.; L. Rodríguez-Mañas (Leocadio); Rolland, C.; M. Roman Rodriguez (M.); A. Romano; J. Rosado-Pinto; K. Rosario (Karyna); Rottem, M.; M. Sanchez-Borges; Sastre-Dominguez, J.; G.K. Scadding; Scichilone, N.; P. Schmid-Grendelmeier (Peter); Serrano, E.; M.D. Shields; V. Siroux (V.); J.C. Sisul (J.); Skrindo, I.; H.A. Smit (Henriëtte); D. Solé (D.); Sooronbaev, T.; O. Spranger; Stelmach, R.; P.J. Sterk (Peter); Strandberg, T.; J. Sunyer (Jordi); C. Thijs (Carel); M. Triggiani (M.); R. Valenta; A.L. Valero (A.); Van Eerd, M.; Van Ganse, E.; Van Hague, M.; O. Vandenplas (Olivier); Varona, L.L.; Vellas, B.; Vezzani, G.; Vazankari, T.; G. Viegi; Vontetsianos, T.; Wagenmann, M.; Walker, S.; D.Y. Wang (De Yun); U. Wahn (Ulrich); Werfel, T.; Whalley, B.; D. Williams; Williams, S.; Wilson, N.; J. Wright (Juliet); B.P. Yawn (Barbara); P.K. Yiallouros (P.); O.M. Yusuf (Osman); Zaidi, A.; H.J. Zar; M. Zernotti; Zhang, L.; Zhong, N.; M. Zidarn (M.)


    textabstractThe Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to de

  6. ARIA 2016 : Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

    Bousquet, J; Hellings, P W; Agache, I; Bedbrook, A; Bachert, C; Bergmann, K C; Bewick, M; Bindslev-Jensen, C; Bosnic-Anticevitch, S; Bucca, C; Caimmi, D P; Camargos, P A M; Canonica, G W; Casale, T; Chavannes, N H; Cruz, A A; De Carlo, G; Dahl, R; Demoly, P; Devillier, P; Fonseca, J; Fokkens, W J; Guldemond, N A; Haahtela, T; Illario, M; Just, J; Keil, T; Klimek, L; Kuna, P; Larenas-Linnemann, D; Morais-Almeida, M; Mullol, J; Murray, R; Naclerio, R; O'Hehir, R E; Papadopoulos, N G; Pawankar, R; Potter, P; Samolinski, B; Schunemann, H J; Sheikh, A; Simons, F E R; Stellato, C; Todo-Bom, A; Tomazic, P V; Valiulis, A; Valovirta, E; Ventura, M T; Wickman, M; Young, I; Yorgancioglu, A; Zuberbier, T; Aberer, W; Akdis, C A; Akdis, M; Annesi-Maesano, I; Ankri, J; Ansotegui, I J; Anto, J M; Arnavielhe, S; Asarnoj, A; Arshad, H; Avolio, F; Baiardini, I; Barbara, C; Barbagallo, M; Bateman, E D; Beghé, B; Bel, E H; Bennoor, K S; Benson, M; Białoszewski, A Z; Bieber, T; Bjermer, L; Blain, H; Blasi, F; Boner, A L; Bonini, M; Bonini, S; Bosse, I; Bouchard, J; Boulet, L P; Bourret, R; Bousquet, P J; Braido, F; Briggs, A H; Brightling, C E; Brozek, J; Buhl, R; Bunu, C; Burte, E; Bush, A; Caballero-Fonseca, F; Calderon, M A; Camuzat, T; Cardona, V; Carreiro-Martins, P; Carriazo, A M; Carlsen, K H; Carr, W; Cepeda Sarabia, A M; Cesari, M; Chatzi, L; Chiron, R; Chivato, T; Chkhartishvili, E; Chuchalin, A G; Chung, K F; Ciprandi, G; de Sousa, J Correia; Crooks, G; Custovic, A; Dahlen, S E; Darsow, U; Dedeu, T; Deleanu, D; Denburg, J A; Didier, A; Dinh-Xuan, A T; Dokic, D; Douagui, H; Dray, G; Dubakiene, R; Durham, S R; Du Toit, G; Dykewicz, M S; El-Gamal, Y; Ellers, E; Emuzyte, R; Farrell, J; Fink Wagner, A; Fiocchi, A; Fletcher, M; Forastiere, F; Gaga, M; Gamkrelidze, A; Gemicioğlu, B; Gereda, J E; van Wick, R Gerth; González Diaz, S; Grisle, I; Grouse, L; Gutter, Z; Guzmán, M A; Hellquist-Dahl, B; Horak, F; Hourihane, J O' B; Humbert, M; Hyland, M; Iaccarino, G; Jares, E J; Jeandel, C; Johnston, S L; Joos, G; Jonquet, O; Jung, K S; Jutel, M; Kaidashev, I; Khaitov, M; Kalayci, O; Kalyoncu, A F; Kardas, P; Keith, P K; Kerkhof, M; Kerstjens, H A M; Khaltaev, N; Kogevinas, M; Kolek, V; Koppelman, G H; Kowalski, M L; Kuitunen, M; Kull, I; Kvedariene, V; Lambrecht, B; Lau, S; Laune, D; Le, L T T; Lieberman, P; Lipworth, B; Lodrup Carlsen, K C; Louis, R; Lupinek, C; MacNee, W; Magar, Y; Magnan, A; Mahboub, B; Maier, D; Majer, I; Malva, J; Manning, P; De Manuel Keenoy, E; Marshall, G D; Masjedi, M R; Mathieu-Dupas, E; Mavale-Manuel, S; Melén, E; Melo-Gomes, E; Meltzer, E O; Mercier, J; Miculinic, N; Mihaltan, F; Milenkovic, B; Millot-Keurinck, J; Mohammad, Y; Momas, I; Mösges, R; Muraro, A; Namazova-Baranova, L; Nadif, R; Neffen, H; Nekam, K; Nieto, A; Niggemann, B; Nogueira-Silva, L; Nogues, M; Nyembue, T D; Ohta, K; Okamoto, Y; Okubo, K; Olive-Elias, M; Ouedraogo, S; Paggiaro, P; Pali-Schöll, I; Palkonen, S; Panzner, P; Papi, A; Park, H S; Passalacqua, G; Pedersen, S; Pereira, A M; Pfaar, O; Picard, R; Pigearias, B; Pin, I; Plavec, D; Pohl, W; Popov, T A; Portejoie, F; Poulsen, L K; Price, D; Rabe, K F; Raciborski, F; Robalo-Cordeiro, C; Rodenas, F; Rodriguez-Mañas, L; Rolland, C; Romano, A; Rosado-Pinto, J; Rosario, N; Rottem, M; Sanchez-Borges, M; Sastre-Dominguez, J; Scadding, G K; Scichilone, N; Schmid-Grendelmeier, P; Serrano, E; Shields, M; Siroux, V; Sisul, J C; Skrindo, I; Solé, D; Sooronbaev, T; Spranger, O; Stelmach, R; Sterk, P J; Strandberg, T; Sunyer, J; Triggiani, M; Valenta, R; Valero, A; van Eerd, M; van Ganse, E; van Hague, M; Vandenplas, O; Varona, L L; Vellas, B; Vezzani, G; Vazankari, T; Viegi, G; Vontetsianos, T; Wagenmann, M; Walker, S; Wahn, U; Werfel, T; Whalley, B; Wilson, N; Wright, J; Yawn, B P; Yiallouros, P K; Yusuf, O M; Zar, H J; Zernotti, M E; Zhong, N; Zidarn, M


    The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidel

  7. Should Osteopathic Students Applying to Allopathic Emergency Medicine Programs Take the USMLE Exam?

    Moshe Weizberg; Dara Kass; Abbas Hussains; Jennifer Cohen; Barry Hahn


    Introduction: Board scores are an important aspect of an emergency medicine (EM) residency application. Residency directors use these standardized tests to objectively evaluate an applicant’s potential and help decide whether to interview a candidate. While allopathic (MD) students take the United States Medical Licensing Examination (USMLE), osteopathic (DO) students take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX). It is difficult to compare these scores. Previous l...

  8. Procedural Skills Training During Emergency Medicine Residency: Are We Teaching the Right Things?

    Druck, Jeffrey; Morgan A Valley; Lowenstein, Steven R.


    Objectives: The Residency Review Committee training requirements for emergency medicine residents (EM) are defined by consensus panels, with specific topics abstracted from lists of patient complaints and diagnostic codes. The relevance of specific curricular topics to actual practice has not been studied. We compared residency graduates’ self-assessed preparation during training to importance in practice for a variety of EM procedural skills. Methods: We distributed a web-based surv...

  9. Fukushima Accident: Sequence of Events and Lessons Learned

    Morse, Edward C.


    The Fukushima Dai-Ichi nuclear power station suffered a devastating Richter 9.0 earthquake followed by a 14.0 m tsunami on 11 March 2011. The subsequent loss of power for emergency core cooling systems resulted in damage to the fuel in the cores of three reactors. The relief of pressure from the containment in these three reactors led to sufficient hydrogen gas release to cause explosions in the buildings housing the reactors. There was probably subsequent damage to a spent fuel pool of a fourth reactor caused by debris from one of these explosions. Resultant releases of fission product isotopes in air were significant and have been estimated to be in the 3 . 7 --> 6 . 3 ×1017 Bq range (~10 MCi) for 131I and 137Cs combined, or approximately one tenth that of the Chernobyl accident. A synopsis of the sequence of events leading up to this large release of radioactivity will be presented, along with likely scenarios for stabilization and site cleanup in the future. Some aspects of the isotope monitoring programs, both locally and at large, will also be discussed. An assessment of radiological health risk for the plant workers as well as the general public will also be presented. Finally, the impact of this accident on design and deployment of nuclear generating stations in the future will be discussed.

  10. Accurate dose assessment system for an exposed person utilising radiation transport calculation codes in emergency response to a radiological accident.

    Takahashi, F; Shigemori, Y; Seki, A


    A system has been developed to assess radiation dose distribution inside the body of exposed persons in a radiological accident by utilising radiation transport calculation codes-MCNP and MCNPX. The system consists mainly of two parts, pre-processor and post-processor of the radiation transport calculation. Programs for the pre-processor are used to set up a 'problem-dependent' input file, which defines the accident condition and dosimetric quantities to be estimated. The program developed for the post-processor part can effectively indicate dose information based upon the output file of the code. All of the programs in the dosimetry system can be executed with a generally used personal computer and accurately give the dose profile to an exposed person in a radiological accident without complicated procedures. An experiment using a physical phantom was carried out to verify the availability of the dosimetry system with the developed programs in a gamma ray irradiation field.

  11. Impacts of the 2011 Fukushima nuclear accident on emergency medical service times in Soma District, Japan: a retrospective observational study

    Morita, Tomohiro; Furutani, Tomoyuki; Nomura, Shuhei; Leppold, Claire; Takahara, Kazuhiro; Shimada, Yuki; Fujioka, Sho; Kami, Masahiro; Kato, Shigeaki; Oikawa, Tomoyoshi


    Objective To assess the influence of the 3.11 triple disaster (earthquake, tsunami and nuclear accident) on the emergency medical service (EMS) system in Fukushima. Methods Total EMS time (from EMS call to arrival at a hospital) was assessed in the EMS system of Soma district, located 10–40 km north of the nuclear plant, from 11 March to 31 December 2011. We defined the affected period as when total EMS time was significantly extended after the disasters compared with the historical control data from 1 January 2009 to 10 March 2011. To identify risk factors associated with the extension of total EMS time after the disasters, we investigated trends in 3 time segments of total EMS time; response time, defined as time from an EMS call to arrival at the location, on-scene time, defined as time from arrival at the location to departure, and transport time, defined as time from departure from the location to arrival at a hospital. Results For the affected period from week 0 to week 11, the median total EMS time was 36 (IQR 27–52) minutes, while that in the predisaster control period was 31 (IQR 24–40) min. The percentage of transports exceeding 60 min in total EMS time increased from 8.2% (584/7087) in the control period to 22.2% (151/679) in the affected period. Among the 3 time segments, there was the most change in transport time (standardised mean difference: 0.41 vs 0.13–0.17). Conclusions EMS transport was significantly delayed for ∼3 months, from week 1 to 11 after the 3.11 triple disaster. This delay may be attributed to malfunctioning emergency hospitals after the triple disaster. PMID:27683521

  12. A comparison of the hazard perception ability of accident-involved and accident-free motorcycle riders.

    Cheng, Andy S K; Ng, Terry C K; Lee, Hoe C


    Hazard perception is the ability to read the road and is closely related to involvement in traffic accidents. It consists of both cognitive and behavioral components. Within the cognitive component, visual attention is an important function of driving whereas driving behavior, which represents the behavioral component, can affect the hazard perception of the driver. Motorcycle riders are the most vulnerable types of road user. The primary purpose of this study was to deepen our understanding of the correlation of different subtypes of visual attention and driving violation behaviors and their effect on hazard perception between accident-free and accident-involved motorcycle riders. Sixty-three accident-free and 46 accident-involved motorcycle riders undertook four neuropsychological tests of attention (Digit Vigilance Test, Color Trails Test-1, Color Trails Test-2, and Symbol Digit Modalities Test), filled out the Chinese Motorcycle Rider Driving Violation (CMRDV) Questionnaire, and viewed a road-user-based hazard situation with an eye-tracking system to record the response latencies to potentially dangerous traffic situations. The results showed that both the divided and selective attention of accident-involved motorcycle riders were significantly inferior to those of accident-free motorcycle riders, and that accident-involved riders exhibited significantly higher driving violation behaviors and took longer to identify hazardous situations compared to their accident-free counterparts. However, the results of the regression analysis showed that aggressive driving violation CMRDV score significantly predicted hazard perception and accident involvement of motorcycle riders. Given that all participants were mature and experienced motorcycle riders, the most plausible explanation for the differences between them is their driving style (influenced by an undesirable driving attitude), rather than skill deficits per se. The present study points to the importance of

  13. Transport Accident Costs and the Value of Safety

    Koornstra, Matthijs; Evans, Andrew; Glansdorp, Cees;

    The publication descibes a study of costs of passenger transport accident by road, rail, air and sea. It is argued that "willingness to pay" theory should be preferred to "human capital" theory in valuations of life and limb. The total costs of passenger transport accidents in the EU is estimated...

  14. NASA's Accident Precursor Analysis Process and the International Space Station

    Groen, Frank; Lutomski, Michael


    This viewgraph presentation reviews the implementation of Accident Precursor Analysis (APA), as well as the evaluation of In-Flight Investigations (IFI) and Problem Reporting and Corrective Action (PRACA) data for the identification of unrecognized accident potentials on the International Space Station.

  15. A review of accidents and injuries to road transport drivers

    Copsey, N.; Drupsteen, L.; Kampen, J. van; Kuijt-Evers, L.; Schmitz-Felten, E.; Verjans, M.


    This review presents reports of work-related road transport accidents, near misses, and other effects relating to ill health that give details concerning the causes and effects of the accidents. The main focus of the report is on road transport activities that take place on the public highway; howev

  16. Fukushima Daiichi Accident and Its Radiological Impact on the Environment

    Bevelacqua, J. J.


    The Fukushima Daiichi nuclear accident is a topic of current media and public interest. It provides a means to motivate students to understand the fission process and the barriers that have been designed to prevent the release of fission products to the environment following a major nuclear power reactor accident. The Fukushima Daiichi accident…

  17. Conservation Medicine, Ecology of Diseases and Veterinary Medicine

    Rosa María Viviana Gómez Carrillo


    Full Text Available Conservation Medicine, Ecology of Diseases and Veterinary Medicine are intertwined in investigative processes and provide solutions to problems affecting both human and animal health. On this issue, it is known that infectious diseases affect the welfare of humans and animals; in this regard, it has been found that 75 %  of zoonotic diseases have origins in wild animals and 60 % of infectious diseases in humans are zoonotic. The foregoing puts at risk human populations because of emerging and reemerging diseases; also it affects livestock production by reducing the quality and quantity of products and manages to disrupt wildlife populations by decimating the species, which can sometimes reach extinction.

  18. Increasing Completion Rate of an M4 Emergency Medicine Student End-of-Shift Evaluation Using a Mobile Electronic Platform and Real-Time Completion

    Matthew C. Tews


    Full Text Available Introduction: Medical students on an emergency medicine rotation are traditionally evaluated at the end of each shift with paper-based forms, and data are often missing due to forms not being turned in or completed. Because students’ grades depend on these evaluations, change was needed to increase form rate of return. We analyzed a new electronic evaluation form and modified completion process to determine if it would increase the completion rate without altering how faculty scored student performance. Methods: During fall 2013, 29 faculty completed paper N=339 evaluations consisting of seven competencies for 33 students. In fall 2014, an electronic evaluation form with the same competencies was designed using an electronic platform and completed N=319 times by 27 faculty using 25 students’ electronic devices. Feedback checkboxes were added to facilitate collection of common comments. Data was analyzed with IBM® SPSS® 21.0 using multi-factor analysis of variance with the students’ global rating (GR as an outcome. Inter-item reliability was determined with Cronbach alpha. Results: There was a significantly higher completion rate (p=0.001 of 98% electronic vs. 69% paper forms, lower (p=0.001 missed GR rate (1% electronic. vs 12% paper, and higher mean scores (p=0.001 for the GR with the electronic (7.0±1.1 vs. paper (6.8±1.2 form. Feedback checkboxes were completed on every form. The inter-item reliability for electronic and paper forms was each alpha=0.95. Conclusion: The use of a new electronic form and modified completion process for evaluating students at the end of shift demonstrated a higher faculty completion rate, a lower missed data rate, a higher global rating and consistent collection of common feedback. The use of the electronic form and the process for obtaining the information made our end-of-shift evaluation process for students more reliable and provided more accurate, up-to-date information for student feedback and when

  19. Predicting Severity and Duration of Road Traffic Accident

    Fang Zong


    Full Text Available This paper presents a model system to predict severity and duration of traffic accidents by employing Ordered Probit model and Hazard model, respectively. The models are estimated using traffic accident data collected in Jilin province, China, in 2010. With the developed models, three severity indicators, namely, number of fatalities, number of injuries, and property damage, as well as accident duration, are predicted, and the important influences of related variables are identified. The results indicate that the goodness-of-fit of Ordered Probit model is higher than that of SVC model in severity modeling. In addition, accident severity is proven to be an important determinant of duration; that is, more fatalities and injuries in the accident lead to longer duration. Study results can be applied to predictions of accident severity and duration, which are two essential steps in accident management process. By recognizing those key influences, this study also provides suggestive results for government to take effective measures to reduce accident impacts and improve traffic safety.

  20. Summary of the JCO criticality accident in Tokai-mura and a dose assessment.

    Tanaka, S I


    A criticality accident occurred on September 30, 1999, in a conversion test facility at the JCO Tokai site. The accident was triggered by pouring an 18.8% enriched uranyl nitrate solution into a precipitation vessel beyond the critical mass. The accident continued for about 19 hours before the criticality could be stopped. during which time neutrons and gamma-rays were emitted continuously due to fission reactions. The total number of fission reactions was 2.5 x 10(18), which was estimated by an activity analysis of the fission products in the solution of the precipitation vessel. The accident gave serious radiation dose to 3 employees and fatal dose to 2 of them. Neutrons and gamma-rays emitted by the accident caused meaningful doses to the residents of the surrounding area of JCO. The dominant dose to the residents and JCO employees was brought by neutrons and gamma-rays from the precipitation vessel, while the contribution of radioactive plume was negligible. The individual dose was estimated for 234 resident, 169 JCO employees and 260 emergency personnel. The maximum doses were 21 mSv for the residents, 48mSv for the JCO employees, and 9.4mSv for the emergency personnel, respectively. No deterministic effect, however, has been observed, except for the 3 workers.

  1. Detection and analysis of accident black spots with even small accident figures.

    Oppe, S.


    Accident black spots are usually defined as road locations with high accident potentials. In order to detect such hazardous locations we have to know the probability of an accident for a traffic situation of some kind, or the mean number of accidents for some unit of time. In almost all procedures

  2. Zagreb and Tenerife: Airline Accidents Involving Linguistic Factors

    Cookson, Simon


    The International Civil Aviation Organization (ICAO) is currently implementing a program to improve the language proficiency of pilots and air traffic controllers worldwide. In justifying the program, ICAO has cited a number of airline accidents that were at least partly caused by language factors. Two accidents cited by ICAO are analysed in this…

  3. Occupational medicine and toxicology


    Abstract This editorial is to announce the Journal of Occupational Medicine and Toxicology, a new Open Access, peer-reviewed, online journal published by BioMed Central. Occupational medicine and toxicology belong to the most wide ranging disciplines of all medical specialties. The field is devoted to the diagnosis, prevention, management and scientific analysis of diseases from the fields of occupational and environmental medicine and toxicology. It also covers the promotion of occupational ...

  4. Study on Emergency Measures for Nuclear Accident of Missile Nuclear Weapon%导弹核武器核事故应急有关问题研究

    高桂清; 毕义明


    The major task, characteristics, organizing and commending, and resource manipulation of the emergency measures for nuclear accident of missile nuclear weapon are probed into. The measures may be considered as a complex system engineering involving system of organization, personnel, equipment, technique and scientific theory, so on. Relevant problems of emergency measures are deliberately studied referring the practical situations. The results could provide the theoretical guidance to emergency measures for nuclear accident of missile nuclear weapon.%对导弹核武器核事故应急的主要任务、特点、组织指挥以及力量运用等问题进行了探讨,导弹核武器核事故的应急问题是一项涉及体制、人员、装备、技术、科学理论等方面的复杂系统工程,笔者结合实际,有针对性的研究了事故应急有关的问题,可为导弹核武器核事故应急提供理论指导。

  5. [Initial medical management in radiological accidents and nuclear disaster].

    Tanigawa, Koichi


    Major radiological emergencies include criticality in nuclear power plants or terrorist attacks using dirty bombs or nuclear device detonation. Because irradiation itself does not cause any immediate death of the victims, and there is a minimum risk of secondary irradiation to medical personnel during decontamination procedures, lifesaving treatments should be prioritized. When a major radiological accident occurs, information is scarce and/or becomes intricate. We might face with significant difficulties in determining the exact culprits of the event, i.e., radiological or chemical or others. Therefore, it is strongly recommended for the national and local governments, related organizations and hospitals to develop comprehensive systems to cope with all hazards(chemical, biological, radiation, nuclear, and explosion) under the common incident command system.

  6. Chernobyl and Fukushima nuclear accidents: what has changed in the use of atmospheric dispersion modeling?

    Benamrane, Y; Wybo, J-L; Armand, P


    The threat of a major accidental or deliberate event that would lead to hazardous materials emission in the atmosphere is a great cause of concern to societies. This is due to the potential large scale of casualties and damages that could result from the release of explosive, flammable or toxic gases from industrial plants or transport accidents, radioactive material from nuclear power plants (NPPs), and chemical, biological, radiological or nuclear (CBRN) terrorist attacks. In order to respond efficiently to such events, emergency services and authorities resort to appropriate planning and organizational patterns. This paper focuses on the use of atmospheric dispersion modeling (ADM) as a support tool for emergency planning and response, to assess the propagation of the hazardous cloud and thereby, take adequate counter measures. This paper intends to illustrate the noticeable evolution in the operational use of ADM tools over 25 y and especially in emergency situations. This study is based on data available in scientific publications and exemplified using the two most severe nuclear accidents: Chernobyl (1986) and Fukushima (2011). It appears that during the Chernobyl accident, ADM were used few days after the beginning of the accident mainly in a diagnosis approach trying to reconstruct what happened, whereas 25 y later, ADM was also used during the first days and weeks of the Fukushima accident to anticipate the potentially threatened areas. We argue that the recent developments in ADM tools play an increasing role in emergencies and crises management, by supporting stakeholders in anticipating, monitoring and assessing post-event damages. However, despite technological evolutions, its prognostic and diagnostic use in emergency situations still arise many issues.

  7. Shipping container response to severe highway and railway accident conditions: Appendices

    Fischer, L.E.; Chou, C.K.; Gerhard, M.A.; Kimura, C.Y.; Martin, R.W.; Mensing, R.W.; Mount, M.E.; Witte, M.C.


    Volume 2 contains the following appendices: Severe accident data; truck accident data; railroad accident data; highway survey data and bridge column properties; structural analysis; thermal analysis; probability estimation techniques; and benchmarking for computer codes used in impact analysis. (LN)

  8. 急诊科药嘱相关隐患原因分析及对策%Analysis and countermeasures of emergency medicine related hidden dangers

    姜艳; 李素玲


    Objective To investigate the related problems and countermeasures of emergency medicine pre-scription. Methods The related problems of drug related orders in the second half of 2013 were analyzed,and the cau-ses of the trouble,measures to eliminate the drug hidden dangers were found. Results The hidden danger of drug order was related to doctors unfamiliar with interaction,usage and dosage of drugs,drug administration personnel lack of re-sponsibility. Conclusion Strengthening the verification link in nursing work,the training of medical staff rotation,drug administration responsibility,the training of clinical staff,can reduce the drug related risks,so as to reduce medication errors.%目的:探讨急诊科药嘱相关问题及对策。方法对2013年下半年用药医嘱中的隐患进行分析,发现造成药嘱隐患的原因,寻找消除药嘱隐患的对策。结果隐患药嘱与医生对药物作用、用法、剂量不熟悉,药局人员缺乏责任心有着直接的关系。结论加强护理工作中的核对环节,对轮转医生加强培训,加强药局工作人员的责任心,对临床医护人员加强相关培训,可以减少药嘱相关隐患,从而减少用药错误。

  9. Demographics, Management Strategies, and Problems in ST-Elevation Myocardial Infarction from the Standpoint of Emergency Medicine Specialists: A Survey-Based Study from Seven Geographical Regions of Turkey

    Kayipmaz, Afsin Emre; Karacaglar, Emir; Muderrisoglu, Haldun


    Background This study aimed to explore the ST segment elevation myocardial infarction (STEMI) management practices of emergency medicine specialists working in various healthcare institutions of seven different geographical regions of Turkey, and to examine the characteristics of STEMI presentation and patient admissions in these regions. Methods We included 225 emergency medicine specialists working in all geographical regions of Turkey. We e-mailed them a 20-item questionnaire comprising questions related to their STEMI management practices and characteristics of STEMI presentation and patient admissions. Results The regions were not significantly different with respect to primary percutaneous coronary intervention (PCI) resources (p = 0.286). Sixty six point two percent (66.2%) of emergency specialists stated that patients presented to emergency within 2 hours of symptom onset. Forty three point six percent (43.6%) of them contacted cardiology department within 10 minutes and 47.1% within 30 minutes. In addition, 68.3% of the participants improved themselves through various educational activities. The Southeastern Anatolian region had the longest time from symptom onset to emergency department admission and the least favorable hospital admission properties, not originating from physicians or 112 emergency healthcare services. Conclusion Seventy point seven percent (70.7%) of the emergency specialists working in all geographical regions of Turkey comply with the latest guidelines and current knowledge about STEMI care; they also try to improve themselves, and receive adequate support from 112 emergency healthcare services and cardiologists. While inter-regional gaps between the number of primary PCI capable centers and quality of STEMI care progressively narrow, there are still issues to address, such as delayed patient presentation after symptoms onset and difficulties in patient admission. PMID:27760229

  10. 基于事故发展与控制的隐患分级方法%Risk Classification Method for Accident Potential Based on Development and Control Measures of Accident

    赵东风; 申玉琪; 赵志强; 张佑明; 孟亦飞


    For the purpose of making the management of accident potential more scientific, the relationship between accident potential and accident was discussed and studied. The fundamental property of accident potential was brought forward that it can make the accident happen or develop. The mechanism whereby accident potential functions in the accident was revealed clearly, by predicting the impelling and inhibiting factors in the accident process. The accident potential was classified into two types (the first type of accident potential and the second type of accident potential) according to the different time they work. In the risk assessment, the problem of specific accident potential grading was resolved. By introducing the assessment indexes of accident potential exposure frequency, possibility of other factors, corrective actions, the initial value of the consequences of the accident, the correction factor of personnel protection, the correction factor of personnel exposure, the correction factor of emergency measures, the correction factor of property loss, an assessment index system was established. By calculating the risk of accident potential-causing accident, the real risk of accident potential was assessed.%为使隐患管理工作更加科学,对隐患与事故的关系进行研讨,提出隐患的根本属性是能够促使事故发生或发展.通过预估促使和控制(阻碍)事故发展的因素,来揭示隐患在事故过程中的作用机制.根据发生作用的时间将隐患分为第1类隐患和第2类隐患.在风险评估过程中,解决了具体隐患风险分级的问题,提出隐患暴露频率、其他条件的可能性、隐患纠正系数、事故后果初始分值、人员防护修正系数、人员暴露修正系数、应急处理与事故控制修正系数和财产损失修正系数等评价指标.通过隐患致因事故风险的计算,评估隐患的最终风险.


    G. G. Onischenko


    Full Text Available An article is devoted to the analysis of the radiation situation in the dynamics during the years since the accident at the Chernobyl nuclear power plant in 1986. Data on the scope of activities fulfilled for the assessment of the territories radioactive contamination levels and foodstuffs contamination levels, on the values of the exposure doses for the population living on the contaminated territories, on the medical and socio-psychological consequences of the Chernobyl accident is presented. Basic norms and principles, used during the protective measures development and introduction, are considered, their effectiveness is demonstrated. Mistakes emerged during protective measures implementation are analyzed, the prognosis of the population exposure dose values for the 70-year period since the accident and main directions of activities for the contaminated territories remediation and normal life conditions restoration for the population at these territories are presented.

  12. Causes and Severity of Fatal Injuries in Autopsies of Victims of Fatal Traffic Accidents

    F Panahi


    Full Text Available Introduction: In this retrospective study, we decided to determine the death causes and severity of injuries in traffic accidents according to reports of the forensic medical center of Yazd. Methods: A total of 251 fatalities due to traffic accidents that had undergone autopsy examinations at the Yazd forensic medicine center from2006 till 2008 were included in the study by census method. Data regarding gender, road user type, type of vehicle (car, motorcycle, autobus or minibus, consciousness level, and intensive care unit (ICU admission was gathered. For evaluation of injury severity, we used Injury Severity Score (ISS. Results: The population under study consisted of 202 men (80.5% and 49 women (19.5% with an average age of 34.1 years (range: 1-89 years. Motorcycle-pedestrian accidents were the most common type of injury (100, 39.8%. Head (220, 87.6% and face (169, 67.3% were the two most common sites of injuries. Mean (±SD of ISS was 23.2 (±10.4. According to autopsy records, the main cause of death was head trauma (146, 58.1%. Conclusion: Public awareness in terms of primary prevention of road accidents should be considered important. Also, regarding the high prevalence of brain injuries and complications associated with skull fractures, accessibility to neurosurgeons and availability of imaging devices have an important role in decreasing the mortality rate of traffic accidents.

  13. Lessons Learned from the Accident at the Fukushima Dai-ichi Nuclear Power Plant-More than Basic Knowledge: Education and its Effects Improve the Preparedness and Response to Radiation Emergency.

    Hachiya, Misao; Akashi, Makoto


    A huge earthquake struck the northeast coast of the main island of Japan on 11 March 2011 triggering an extremely large tsunami to hit the area. The earthquake and tsunami caused serious damage to the Fukushima nuclear power plants (NPPs) of Tokyo Electric Power Company (TEPCO), resulting in large amounts of radioactive materials being released into the environment. The major nuclides released were (131)I, (134)Cs and (137)Cs. The deposition of these radioactive materials on land resulted in a high ambient dose of radiation around the NPPs, especially within a 20-km radius. Dose assessments based on behavior survey and ambient dose rates revealed that external doses to most residents were lower than 5 mSv, with the maximum dose being 25 mSv. It was fortunate that no workers from the NPPs required treatment from the viewpoint of deterministic effects of radiation. However, a lack of exact knowledge of radiation and its effects prevented the system for medical care and transportation of contaminated personnel from functioning. After the accident, demands or requests for training courses have been increasing. We have learned from the response to this disaster that basic knowledge of radiation and its effects is extremely important for not only professionals such as health care providers but also for other professionals including teachers.

  14. 绿色通道在“7·23"温州动车事故早期急救中的作用%Role of fast passage for patients to enter emergency department in rescuing and triaging traumatic casualties from the bullet train accident occurred at Wenzhou station on 23 July 2011

    朱烈烈; 潘达; 吴钒; 闻浩; 陈大庆; 张春梅


    目的 探讨急诊绿色通道在特大交通事故伤员救治中的作用,为今后重大灾害救援积累经验.方法 回顾“7·23”温州动车事故伤员在温州市各医院急诊科的救治过程,并对不同伤情伤员在急诊科救治时停留的时间进行比较和分析.结果 事故后72 h内收治伤员136例,其中单一伤患者28例,在急诊科平均停留时间为27 min;多发伤患者108例,在急诊科平均停留时间为62 min,两者差异具有统计学意义(P<0.01).同时与本院前一年度的日常普通伤员救治时间进行回顾性对比发现,救治时间平均缩短达50 min,表明建立健全的急诊绿色通道制度,对加快应急状态下伤员救治有重要意义.结论 应根据实际情况,进一步完善绿色通道制度,使伤员在急诊科的停留时间不断缩短,从而保证伤员尽快得到专科救治,为抢救危重伤员赢得宝贵时间.%Objective To determine the effect of fast passage for patients' access to the emergency department of hospital on rescuing and triaging the traumatic casualties referred from the site of accident by collision between two bullet trains occurred at Wenzhou station on 23 July 2011 in order to accumulate experience of treating large number of traumatized casualties happened in a major accident or disaster.Methods A retrospective study was carried out to collect the data including the different courses of treatment for various types of injury in casualties and the length of stay of traumatized patients with different degrees of severity in the emergency department after casualties entered into the emergency department of hospital via fast passage.Results There were 136 traumatic casualties referred to hospital within 72 hours after the bullet train accident occurred at Wenzhou station.The average length of stay of patients with uncomplicated single injury in the hospital was 27min,and the average length of stay of 108 patients with multiple injuries in the

  15. Music and medicine

    Donatella Lippi


    Full Text Available Donatella Lippi1, Paolo Roberti di Sarsina2, John Patrick D’Elios11History of Medicine, Department of Anatomy, Histology, and Forensic Medicine, University of Florence, Florence, Italy; 2Health Local Unit, Department of Mental Health, Bologna, ItalyAbstract: Healing sounds have always been considered in the past an important aid in medical practice, and nowadays, medicine has confirmed the efficacy of music therapy in many diseases. The aim of this study is to assess the curative power of music, in the frame of the current clinical relationship.Keywords: history of medicine, medical humanities, healing music

  16. Herb-drug Interaction: An Emerging Issue of Integrative Medicine

    XU Hao; CHEN Ke-ji


    @@ With the increasing enhancement of people's awareness of self-care, the voice for humans to return to nature is growing louder and louder. Drugs with natural plants as raw materials are increasingly favored by people all over the world for their unique advantages in preventing and curing diseases,rehabilitation and health care, especially in Europe,the United States and many Asian countries.According to statistics, in the United States alone,there are currently more than 15 million people using herbal preparations in varying degrees, including Chinese herbal medicines, as either a therapy or an adjuvant therapy for various diseases at present,with the annual cost of approximately 30 billion U.S.dollars(1).

  17. [Results of a national survey about the use of sedation scales in emergency prehospital medicine].

    Belpomme, V; Devaud, M-L; Pariente, D; Ricard-Hibon, A; Mantz, J


    The primary goal of sedation in emergency prehospital care is to guarantee the security of the mechanically ventilated patients by optimising their adaptation to the respirator. If the French prehospital guidelines are well codified, their applicability in routine clinical practice seem to be rather empirical. The aim of this national survey was to evaluate the use of the clinical sedation scales by the prehospital physicians. This prospective and clinical practice survey was begun in January 2005. An anonymous questionnaire was sent to the physicians working in the 377 Mobile Intensive Care Unit of the 105 French Emergency Medical Service System. The total response rate from physicians was 28% (n=497). Only 29% of the physicians (n=145) declared to use a sedation scale for a mechanically ventilated patient. The Ramsay score was used in 97% of the cases (n=141).The principal reasons given by the physicians for not using the sedation scales were their ignorance in 57% of the cases (n=200) and the systematic choice of a deep sedation in 42% of the cases (n=147). For 18% of them (n=62), the use of sedation scores was considered too complicated. The final results show that the utilisation ratio of the sedation scores is very low in emergency prehospital medicine and suggest that an effort toward improving the use of sedation in prehospital emergency medicine is necessary.

  18. Head injury resulting from scooter accidents in Rome: Differences before and after implementing a universal helmet law

    G. La Torre (Giuseppe); E.F. van Beeck (Ed); G. Bertazzoni (Giuliano); W. Ricciardi


    textabstractObjectives: To estimate the incidence rates and related determinants of head injuries before and after the implementation of a new universal helmet law in Italy. Methods: The investigation took place in the Emergency Room of the Accident and Emergency Department, Teaching Hospital 'Umber

  19. [Interaction between medicines and medicinal plants].

    Tres, J C


    In recent years there has been a notable increase in the consumption of medicinal plants in Spanish society. This might be due to the fact that in some cases they have shown themselves to be efficient in treating certain pathologies and to the erroneous perception that these products are innocuous. Medicinal plants behave as authentic medicines since the chemical substances of which they are formed can have a biological activity in humans. For this reason, their joint administration with "conventional medicines" can produce variations in the magnitude of the effect. This type of interaction, just like those produced between two or more medicines, can produce pharmacokinetic mechanisms if they affect the processes of absorption, distribution, metabolism and excretion, or pharmacodynamic mechanisms if they affect the result of the pharmacological action. In the medical literature there are few articles and notifications of cases concerning the adverse effects and interactions that affect medicinal plants, which probably reflects an under-notification of these phenomena. If we add to this the lack of experimental data and controlled studies, perception of their prevalence is difficult or nearly impossible. This article sets out, in an order that will be explained later, the findings of an exhaustive review of the medical literature with the aim of making its existence known to the reader, without going into other considerations, such as the degree of evidence for example, which will be the subject of forthcoming articles.

  20. Road traffic accidents before and after seatbelt legislation--study in a district general hospital.

    Thomas, J


    Injuries among samples of car accident cases attending the Accident & Emergency (A & E) department of a District General Hospital (DGH) in the year before and after the introduction of seat belt legislation were classified applying the Abbreviated Injury Scale using information recorded in the patient case notes. Those who died or did not attend an A & E department were not included in the sampling frame. The number of those who escaped injury increased by 40% and those with mild and moderate injuries decreased by 35% after seatbelt legislation. There was a significant reduction in soft tissue injuries to the head. Only whiplash injuries to the neck showed a significant increase. PMID:2319551

  1. Executive summary. Consensus statement of the National AIDS Plan Secretariat, Spanish Society of Emergency Medicine and AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology on Emergency and HIV Infection.


    Emergency Services (ES) are the cornerstone of our health system and therefore it cannot remain indifferent to the HIV advances that have drastically changed the landscape of the disease, so, emergency specialist updating is not only necessary, it is also essential. The purpose of this paper is to support non-HIV specialist professionals in treating patients with urgent diseases resulting from HIV infection or related to it.

  2. Science, humanism, judgement, ethics: person-centered medicine as an emergent model of modern clinical practice.

    Miles, Andrew


    The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patient-centered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies--person-centered healthcare (PCH)--are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities

  3. Discussion on the Organization and Command of Emergency Rescue for Large-scale Disaster Accident of Fire Protection Brigades%消防部队大型灾害事故应急救援组织指挥问题探讨



    组织指挥是影响大型灾害事故应急救援效率的关键问题,从分析大型灾害事故应急救援对消防部队组织指挥的影响和要求入手,深入研究了大型灾害事故应急救援中消防部队组织指挥的实施过程,探讨了加强组织指挥应该注意的三个问题,为消防部队执行大型灾害事故应急救援任务的组织指挥问题提供了理论参考。%The organization and command are the key problems of the emergency rescue efficiency of the large-scale disaster accident. This paper analyzes the impact and requirements of the large-scale disaster emergency rescue on the organization and command of fire brigade, deeply studies the implementation process of the organization and command of the fire brigade in the emergency rescue of large-scale disaster, discusses three issues that should be paid attention to in strengthening organization and command and provides theoretical reference for the implementation of the organization and command of the emergency rescue mission of fire brigades.

  4. The evolution and current state of emergency care in Ghana

    Maxwell Osei-Ampofo


    Full Text Available Emergency Medicine as a specialty has only recently been introduced to Ghana. This article reviews the overall health and medical care systems as well as the evolution and the current state of emergency care in Ghana and the progress made in establishing Emergency Medicine (EM as a specialty along the Anglo-American model of emergency care. The article also describes the improvements implemented in emergency patient care, and emergency medicine management systems. Although there are challenges to overcome, much optimism remains about the future of this new specialty in Ghana and its ability to transform the face of emergency care.

  5. Bicycle accidents.

    Lind, M G; Wollin, S


    Information concerning 520 bicycle accidents and their victims was obtained from medical records and the victims' replies to questionnaires. The analyzed aspects included risk of injury, completeness of accident registrations by police and in hospitals, types of injuries and influence of the cyclists' age and sex, alcohol, fatigue, hunger, haste, physical disability, purpose of cycling, wearing of protective helmet and other clothing, type and quality of road surface, site of accident (road junctions, separate cycle paths, etc.) and turning manoeuvres.


    B. K. BANIK


    Full Text Available Roads, highways and streets are fundamental infrastructure facilities to provide the transportation for passenger travel and goods movement from one place to another in Sylhet, north–eastern division of Bangladesh with rapid growth of road vehicle, being comparatively developed economic tourist prone area faces severe road traffic accident. Such severe road accidents cause harsh safety hazards on the roads of Sylhet area. This research work presents an overview of the road traffic accident and degraded road safety situation in Sylhet zone which in particular, discusses the key road accident problem characteristics identifying the hazardous roads and spots, most responsible vehicles and related components, conditions of drivers and pedestrians, most victims of accident, effects of accident on society, safety priorities and options available in Sylhet. In this regard, a comprehensive questionnaire survey was conducted on the concerned groups of transportation and detailed accident data was collected from a popular local newspaper. Analysis of the study reveals that Dhaka- Sylhet highway is the most hazardous in road basis and Sylhet Sador thana is the most vulnerable in thana basis in Sylhet region.

  7. Foucault and modern medicine.

    Peerson, A


    Modernity as a concept or ideal, resulting from the age of Enlightenment and the French Revolution gave hope of a better future and new possibilities. To be modern means an 'enlightened' individual and society, welcoming change and development. In this paper, I will discuss Foucault's analysis (1973) of problematics in medicine in eighteenth century France. Three themes prominent in the text are: 'the birth of the clinic', 'the clinical gaze' and the power-knowledge relationship. Three problematics identified in modern medicine by Foucault and which are particularly relevant to twentieth century medicine are: (i) the extension of the clinical gaze from the individual body to the wider population; (ii) the increasing medical intervention and use of technology in fundamental life processes; and (iii) the relationship between society and medicine. I will argue that Foucault's analysis is fraught with ambiguities. It is useful, however, for establishing an explanation for medicine today and for presenting a particular interpretation of modernity.

  8. The impact of a pre-hospital medical response unit on patient care and emergency department attendances.

    Deasy, C


    A rapid response team was instigated in Cork to improve prehospital care and reduce unnecessary Emergency Department (ED) visits. This consisted of a Specialist Registrar (SpR) in Emergency Medicine and a Paramedic who attended all "999" calls in a designated rapid response vehicle on the allotted study days. Two hundred and sixty-three patients were seen on designated days between Jan 2004 and March 2006. Presentations seen included; road traffic accident (23%) collapse (12%), fall (10%) and seizure (8%). The majority of calls were to houses (36%). The most common medical intervention was intravenous cannulation (25%). Intravenous medications were administered in 21% of these patients--morphine sulphate was the most common drug given. It was possible to safely discharge 31% of patients on scene. In our experience skilled Emergency Medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance.

  9. Aspects Concerning The Rules And The Investigation Of Traffic Accidents As Work Accidents

    Tarnu, Lucian Ioan


    When Romania joined the European Union, it was imposed that the Romanian legislation in the field of the security and health at work be in line with the European one. The concept of health as it is defined by the International Body of Health, refers to a good physical, mental and social condition. The improvement of the activity of preventing the traffic accidents as work accidents must have as basis the correct and accurate evaluation of risks of getting injured. The goal of the activity of prevention and protection is to ensure the best working conditions, the prevention of accidents and occupational diseases and the adjustment to the scientific and technological progress. In the road transport sector, as in any other sector, it is very important to pay attention to working conditions to ensure a workforce motivated and well qualified. Some features make it a more difficult sector risk management than other sectors. However, if one takes into account how it works in practice this sector and the characteristics of drivers and how they work routinely, risks, dangers and threats can be managed efficiently and with great success.


    T. A. Marchenko


    Full Text Available The report contains information about measures undertaken by the Ministry of Civil Defense and Emergencies of the Russian Federation in the framework of implementation of the state policy in the field of radiation accidents remediation. Results of works realized in the framework of target programs on remediation of radiation accidents at Chernobyl NPP and Production Association MAYAK, and on problems caused by nuclear weapon tests at Seminalatinsk test site are presented.

  11. Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference.

    Marin, Jennifer R; Mills, Angela M


    The 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization" was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging use and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified before the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with the planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were a total of 164 individuals involved in the conference and spanned various specialties, including general emergency medicine, pediatric emergency medicine, radiology, surgery, medical physics, and the decision sciences.

  12. Unusually extensive head trauma in a hydraulic elevator accident: post-mortem MSCT findings, autopsy results and scene reconstruction.

    Jacobsen, Christina; Schön, Corinna A; Kneubuehl, Beat; Thali, Michael J; Aghayev, Emin


    Accidental or intentional falls from a height are a form of blunt trauma and occur frequently in forensic medicine. Reports describing elevator accidents as a small subcategory of falls from heights are rare in the medical literature and no report on injury patterns or scene reconstruction of such an accident was found. A case of an accident in a hydraulic elevator with a man falling 3m was examined using post-mortem multi-slice computed tomography (MSCT) and autopsy. The man suffered an unusually extensive trauma and died at the scene. Post-mortem MSCT examination showed a comminute fracture of the skull, the right femur and the first lumbar vertebra. Severe lacerations of the brain with epidural, subdural and subarachnoidal haemorrhages over both hemispheres were diagnosed. Autopsy confirmed these findings. To reconstruct the accident we used radiological and autopsy results as well as findings at the scene.

  13. Absence from work due to occupational and non-occupational accidents

    Jørgensen, Kirsten; Laursen, Bjarne


    Aims: The aim of the present study was to investigate absence from work in Denmark due to occupational and non-occupational accidents. Background: Since the beginning of the last decade, political focus has been placed on the population’s working capacity and the scope of absence due to illness....... Absence from work is estimated at between 3% and 6% of working hours in the EU and costs are estimated at approximately 2.5% of GNP. Methods: Victims of accidents treated at two emergency departments were interviewed regarding absence for the injured, the family and others. All answers were linked...... to the hospital information on the injury, so that it was possible to examine the relation between absence and injury type, and cause of the accident. Results: In total, 1,479 injured persons were interviewed. 36% of these reported absence from work by themselves or others. In mean, an injury caused 3.21 days...

  14. Emergency Preparedness


    The trends of RPC work in the area of preparedness for nuclear and radiological accidents are listed. RPC in cooperation with Swedish Government developed the project on preparation for iodine prophylaxis in case of accident at Ignalina NPP and arranged seminar on emergency preparedness issues in 2001.

  15. Societal and ethical aspects of the Fukushima accident.

    Oughton, Deborah


    The Fukushima Nuclear Power Station accident in Japan in 2011 was a poignant reminder that radioactive contamination of the environment has consequences that encompass far more than health risks from exposure to radiation. Both the accident and remediation measures have resulted in serious societal impacts and raise questions about the ethical aspects of risk management. This article presents a brief review of some of these issues and compares similarities and differences with the lessons learned from the 1986 Chernobyl Nuclear Power Plant accident in Ukraine. Integr Environ Assess Manag 2016;12:651-653. © 2016 SETAC.

  16. [Latin American social medicine: contributions and challenges].

    Iriart, Celia; Waitzkin, Howard; Breilh, Jaime; Estrada, Alfredo; Merhy, Emerson Elías


    This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine.