WorldWideScience

Sample records for accident and emergency medicine

  1. Correlates of work-related stress among consultants and senior registrars in accident and emergency medicine.

    OpenAIRE

    Heyworth, J; Whitley, T W; Allison, E J; Revicki, D. A.

    1993-01-01

    A mail survey was conducted of consultants and senior registrars practising accident and emergency (A&E) medicine in the United Kingdom. The 201 respondents (72%) comprised 154 consultants (70.6%) and 47 senior registrars (77%), who provided demographic information and completed inventories measuring stress, depression, task and role clarity, work group functioning and overall satisfaction with work. The respondents did not report particularly high levels of stress or depression and generally...

  2. Correlates of work-related stress among consultants and senior registrars in accident and emergency medicine.

    Science.gov (United States)

    Heyworth, J; Whitley, T W; Allison, E J; Revicki, D A

    1993-01-01

    A mail survey was conducted of consultants and senior registrars practising accident and emergency (A&E) medicine in the United Kingdom. The 201 respondents (72%) comprised 154 consultants (70.6%) and 47 senior registrars (77%), who provided demographic information and completed inventories measuring stress, depression, task and role clarity, work group functioning and overall satisfaction with work. The respondents did not report particularly high levels of stress or depression and generally evaluated aspects of their work environments favourably. Higher levels of stress were reported by consultants and respondents from district general hospitals. Levels of stress were similar to those reported by other groups of health care providers. Respondents generally considered tasks and roles to be clearly defined, work groups to be supportive, efficient units and work satisfying. There was no statistically significant correlation on the affective scales for the number of patient attendances, on call commitment or staffing numbers. Senior staff with more than 10 years experience in the specialty reported more satisfaction with work and work group functioning, and perceived their tasks and roles to be significantly clearer. Consultants over 45 evaluated their work groups favourably and were more likely to view them as cohesive, smoothly functioning units than senior registrars. The results probably reflect the ad hoc coping strategies adopted by a group of doctors, who have already demonstrated appropriate personality characteristics by completing a long training programme, with no realistic alternative late career opportunities. To prevent mid or late career attrition, however, A&E doctors should receive formal training in stress recognition and avoidance. Accessible counselling without stigma should be easily available. Senior A&E doctors have a role in detecting and managing stress amongst other staff in the department. PMID:8110315

  3. Accident knowledge and emergency management

    Energy Technology Data Exchange (ETDEWEB)

    Rasmussen, B.; Groenberg, C.D.

    1997-03-01

    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.

  4. Fatal traffic accidents and forensic medicine

    Directory of Open Access Journals (Sweden)

    Kazuhiko Kibayashi

    2014-07-01

    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.

  5. Socioeconomic deprivation and accident and emergency attendances

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

  6. Guidelines for accident prevention and emergency preparedness

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-05-01

    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.

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

    OpenAIRE

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

    1998-01-01

    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...

  8. Medical Journalism and Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Saeed Safari

    2015-07-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Naveen Ramachandran,

    2011-07-01

    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. Redundancy in the accident and emergency department.

    Science.gov (United States)

    Durcan, T

    1994-04-01

    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.

  11. Human factors and simulation in emergency medicine.

    Science.gov (United States)

    Hayden, Emily M; Wong, Ambrose H; Ackerman, Jeremy; Sande, Margaret K; Lei, Charles; Kobayashi, Leo; Cassara, Michael; Cooper, Dylan D; Perry, Kimberly; Lewandowski, William E; Scerbo, Mark W

    2017-09-19

    This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida on May 16, 2017 focused on the use of human factors and simulation in the field of emergency medicine. The human factors discipline is often underutilized within emergency medicine but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of human factors, its benefits in medicine, how simulation can be a catalyst for human factors work in emergency medicine, and how emergency medicine can collaborate with human factors professionals to affect change. Implementing human factors in emergency medicine through healthcare simulation will require a demonstration of clinical and safety outcomes, advocacy to stakeholders and administrators, and establishment of structured collaborations between human factors professionals and emergency medicine, such as in this breakout group. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  12. Bioethics and Emergency Medicine: problems and perspectives

    Directory of Open Access Journals (Sweden)

    Maurizio Mori

    2005-10-01

    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.

  13. Emergency Management of Maritime Accidents in the Yangtze River: Problems, Practice and Prospects

    Directory of Open Access Journals (Sweden)

    Xin Ping Yan

    2017-03-01

    Full Text Available Maritime accidents have received considerable attentions due to the enormous property damage, casualties and serious environmental pollution. This paper first makes statistical analysis of the different types of maritime accidents in the period of 2012 to 2014 in the Yangtze River. Second, the problems of emergency management of maritime accidents are also proposed from the analysis of the major accident “Eastern Star”.. Afterwards, four practice cases, including decision support for maritime accidents, emergency resource allocation, emergency simulation system and effectiveness of emergency management, are introduced to present the insights gained from these practices. Last, in order to address these problems, this paper proposes that an artificial societies, Computational experiments, and Parallel execution (ACP approach should be introduced to establish an improved management system for maritime accidents in the future, and an ACP based maritime accident emergency management framework is proposed.

  14. Communication in Hong Kong Accident and Emergency Departments

    Directory of Open Access Journals (Sweden)

    Eloise Chandler

    2015-03-01

    Full Text Available In this article, we report findings from the first qualitatively driven study of patient–clinician communication in Hong Kong Accident and Emergency Departments (AEDs. In light of the Hong Kong Hospital Authority’s policy emphasis on patient-centered care and communication in the public hospitals it oversees, we analyze clinicians’ perceptions of the role and relevance of patient-centered communication strategies in emergency care. Although aware of the importance of effective communication in emergency care, participants discussed how this was frequently jeopardized by chronic understaffing, patient loads, and time pressures. This was raised in relation to the absence of spoken interdisciplinary handovers, the tendency to downgrade interpersonal communication with patients, and the decline in staff attendance at communication training courses. Participants’ frequent descriptions of patient-centered communication as dispensable from, and time-burdensome in, AEDs highlight a discrepancy between the stated Hong Kong Hospital Authority policy of patient-centered care and the reality of contemporary Hong Kong emergency practice.

  15. Designing the accident and emergency system: lessons from manufacturing.

    Science.gov (United States)

    Walley, P

    2003-03-01

    To review the literature on manufacturing process design and demonstrate applicability in health care. Literature review and application of theory using two years activity data from two healthcare communities and extensive observation of activities over a six week period by seven researchers. It was possible to identify patient flows that could be used to design treatment processes around the needs of the patient. Some queues are built into existing treatment processes and can be removed by better process design. Capacity imbalance, not capacity shortage, causes some unnecessary waiting in accident and emergency departments. Clinicians would find that modern manufacturing theories produce more acceptable designs of systems. In particular, good quality is seen as a necessary pre-requisite of fast, efficient services.

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

    NARCIS (Netherlands)

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

    2015-01-01

    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

  17. Human factors and safety in emergency medicine

    Science.gov (United States)

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

    1994-01-01

    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.

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

    OpenAIRE

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

    2010-01-01

    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...

  19. Avoidable attendance at accident and emergency by the elderly in Hong Kong.

    OpenAIRE

    Lau, E M; Woo, J; Chan, J. T.

    1997-01-01

    Twenty per cent of Accident and Emergency department attendance by the elderly in a regional hospital in Hong Kong were deemed 'avoidable' by the attending doctors. The 'avoidable' attendants were younger and physically more independent than the appropriate attendants, and more of them were illiterate. Half of them attended the Accident and Emergency department for somatic complaints. Strategies to reduce these 'avoidable' attendances should be formulated.

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

    Energy Technology Data Exchange (ETDEWEB)

    Youngen, G.

    1988-10-01

    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.

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

    Science.gov (United States)

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

    2010-01-01

    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

  2. Bibliography for nuclear criticality accident experience, alarm systems, and emergency management

    Energy Technology Data Exchange (ETDEWEB)

    Putman, V.L.

    1995-09-01

    The characteristics, detection, and emergency management of nuclear criticality accidents outside reactors has been an important component of criticality safety for as long as the need for this specialized safety discipline has been recognized. The general interest and importance of such topics receives special emphasis because of the potentially lethal, albeit highly localized, effects of criticality accidents and because of heightened public and regulatory concerns for any undesirable event in nuclear and radiological fields. This bibliography lists references which are potentially applicable to or interesting for criticality alarm, detection, and warning systems; criticality accident emergency management; and their associated programs. The lists are annotated to assist bibliography users in identifying applicable: industry and regulatory guidance and requirements, with historical development information and comments; criticality accident characteristics, consequences, experiences, and responses; hazard-, risk-, or safety-analysis criteria; CAS design and qualification criteria; CAS calibration, maintenance, repair, and testing criteria; experiences of CAS designers and maintainers; criticality accident emergency management (planning, preparedness, response, and recovery) requirements and guidance; criticality accident emergency management experience, plans, and techniques; methods and tools for analysis; and additional bibliographies.

  3. Emerging infectious diseases and travel medicine.

    Science.gov (United States)

    Ostroff, S M; Kozarsky, P

    1998-03-01

    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.

  4. Blog and Podcast Watch: Pediatric Emergency Medicine.

    Science.gov (United States)

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

    2016-09-01

    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. 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 FOAMsearch.net 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. 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. 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.

  5. Blog and Podcast Watch: Pediatric Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Fareen Zaver

    2016-09-01

    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 FOAMsearch.net 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.

  6. Blog and Podcast Watch: Pediatric Emergency Medicine

    Science.gov (United States)

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

    2016-01-01

    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 FOAMsearch.net 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

  7. Uncertainty analysis of accident notification time and emergency medical service response time in work zone traffic accidents.

    Science.gov (United States)

    Meng, Qiang; Weng, Jinxian

    2013-01-01

    Taking into account the uncertainty caused by exogenous factors, the accident notification time (ANT) and emergency medical service (EMS) response time were modeled as 2 random variables following the lognormal distribution. Their mean values and standard deviations were respectively formulated as the functions of environmental variables including crash time, road type, weekend, holiday, light condition, weather, and work zone type. Work zone traffic accident data from the Fatality Analysis Report System between 2002 and 2009 were utilized to determine the distributions of the ANT and the EMS arrival time in the United States. A mixed logistic regression model, taking into account the uncertainty associated with the ANT and the EMS response time, was developed to estimate the risk of death. The results showed that the uncertainty of the ANT was primarily influenced by crash time and road type, whereas the uncertainty of EMS response time is greatly affected by road type, weather, and light conditions. In addition, work zone accidents occurring during a holiday and in poor light conditions were found to be statistically associated with a longer mean ANT and longer EMS response time. The results also show that shortening the ANT was a more effective approach in reducing the risk of death than the EMS response time in work zones. To shorten the ANT and the EMS response time, work zone activities are suggested to be undertaken during non-holidays, during the daytime, and in good weather and light conditions.

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

    OpenAIRE

    MacNamara, A; Durham, S

    1997-01-01

    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.

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

    Science.gov (United States)

    MacNamara, A; Durham, S

    1997-05-01

    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.

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

    OpenAIRE

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

    2001-01-01

    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.

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

    Science.gov (United States)

    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

    2016-12-01

    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.

  12. Preventing post traumatic stress disorder in accident and emergency nursing. A review of the literature.

    Science.gov (United States)

    Cudmore, J

    1996-01-01

    Nurses working in Accident and Emergency may be susceptible to post-traumatic stress disorder (Rentoul and Ravenscroft 1993, Scott and Stradling 1994). The literature suggests that defusing immediately following a resuscitation may help to reduce abnormal stress reactions (Mitchell, 1988; Wright, 1992, 1993). Critical incident stress debriefing is recommended following critical incidents to help prevent emergency personnel developing post-traumatic stress disorder (Jimmerson, 1988; Mitchell, 1983, 1988; Parkinson, 1995).

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

    Energy Technology Data Exchange (ETDEWEB)

    Nenot, J.C.

    1995-12-31

    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.

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

    Science.gov (United States)

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

    2010-03-01

    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.

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

    Science.gov (United States)

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

    2016-04-01

    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.

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

    Science.gov (United States)

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

    2012-01-01

    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.

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

    Science.gov (United States)

    Hassan, Tajek B

    2014-11-01

    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.

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

    OpenAIRE

    Wright, J; Kariya, A

    1997-01-01

    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...

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

    OpenAIRE

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

    1994-01-01

    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.

  20. Influences on tetanus immunization in accident and emergency.

    OpenAIRE

    Montague, A; Glucksman, E

    1990-01-01

    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...

  1. [Cooperation between emergency and forensic medicine - retrospective evaluation of pre-hospital emergency measures].

    Science.gov (United States)

    Buschmann, Claas T; Kleber, Christian; Tsokos, Michael; Püschel, Klaus; Hess, Thorsten; Kerner, Thoralf; Stuhr, Markus

    2015-06-01

    Emergency medical research is subject to special conditions. Emergency patients e.g. are generally considered to be non-capable of giving consent. This results in sparse emergency medical data when compared to clinical observation studies under controlled conditions. After emergency medical treatment, deceased patients are not rarely subject to forensic investigation. The cooperation between emergency and forensic medicine has not only emergency medical training potential in individual cases, but also scientific innovation potential especially with respect to the retrospective evaluation of pre-hospital emergency measures. Such partnerships (like in Berlin at the Charité - Universitätsmedizin Berlin between the Institute of Legal Medicine and the Center for Musculoskeletal Surgery or in Hamburg between the Institute for Legal Medicine at the University Hospital and the Municipal Fire Brigade with the Emergency Medical Service) are yet exceptional in Germany. © Georg Thieme Verlag Stuttgart · New York.

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

    DEFF Research Database (Denmark)

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

    1998-01-01

    ). 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...... significantly elevated concentrations of adrenaline and glucagon were found in diabetic patients admitted with severe hypoglycaemia to an Accident and Emergency Department....

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

    Science.gov (United States)

    Marinozzi, Silvia; Bertazzoni, Giuliano; Gazzaniga, Valentina

    2011-08-01

    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.

  4. Assessing interpersonal and communication skills in emergency medicine.

    Science.gov (United States)

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

    2012-12-01

    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. © 2012 by the Society for Academic Emergency Medicine.

  5. Towards emergency management of natural disasters and critical accidents: the Greek experience.

    Science.gov (United States)

    Nivolianitou, Zoe; Synodinou, Barbara

    2011-10-01

    This paper presents the findings of a prototype study which sought to identify factors that contribute to effective emergency management in Greece and other European states regarding both natural disasters and critical accidents. The parameters for proper action and successful intervention in operational and logistical are identified based on the document analysis and interviews with emergency responders. The interviews are conducted between state-owned and voluntary organizations. They were asked to rate in terms of their importance for effective emergency response efforts. This paper offers useful information of the organization and management of emergency response in Greece, as well as provides interesting responders' opinions data concerning important priorities in the emergency management area. Despite the fact that the data come from the Greek experience, the conclusions may be applied for a broader use in the emergency planning of disasters. The whole study has been undertaken within the European Pre-Emergencies (PreEm) project. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2011-12-01

    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.

  7. WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan

    National Research Council Canada - National Science Library

    Atif, Muhammad; Azeem, Muhammad; Sarwar, Muhammad Rehan; Shahid, Samia; Javaid, Sidra; Ikram, Huria; Baig, Uzma; Scahill, Shane

    2016-01-01

    A descriptive, retrospective and cross sectional study was conducted to assess the prescribing practices and antibiotic use patterns in the Accident and Emergency department of the Bahawal Victoria...

  8. Human factors and error prevention in emergency medicine.

    Science.gov (United States)

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

    2012-05-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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: zhangliqiu@163.com [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China)

    2014-07-15

    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.

  10. Technology and work within emergency medicine

    DEFF Research Database (Denmark)

    Kristensen, Margit

    From medical research it has been recognized that physicians doing medical work in the pre-hospital area can make a difference for the acutely ill people, meaning higher survival (Høyer, Schønemann). In the light of this it has during the last years - in the biggest cities in Denmark - been...... implemented that anaesthesiologists[1], employed at level 1 hospitals, can sometimes be on duty outside the hospital; some shifts they work in hospital, other shifts they perform in the pre-hospital field. No matter where they work - if they are in or out of hospital - their tasks are the same - they support...... 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...

  11. Emergency Medicine and the Underage Athlete

    OpenAIRE

    Martin, David E.

    1994-01-01

    Most high school and some collegiate athletes are legal minors. In civil matters, the law treats minors (usually individuals under the age of 18 years) uniquely. Limitations exist on a minor's ability to enter into contracts, make determinations regarding medical care, and bear responsibility for personal actions. Medical professionals are often unclear on matters relating to the provision of medical care to minors. The purpose of this discourse is to present selected legal issues in the cont...

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

    Science.gov (United States)

    Aleksanin, S

    2016-09-01

    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.

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

    Science.gov (United States)

    Christensen, Mark; Christensen, Heidi K

    2015-01-01

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

    Science.gov (United States)

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

    1996-03-01

    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.

  15. Sudden water pollution accidents and reservoir emergency operations: impact analysis at Danjiangkou Reservoir.

    Science.gov (United States)

    Zheng, Hezhen; Lei, Xiaohui; Shang, Yizi; Duan, Yang; Kong, Lingzhong; Jiang, Yunzhong; Wang, Hao

    2017-05-03

    Danjiangkou Reservoir is the source reservoir of the Middle Route of the South-to-North Water Diversion Project (MRP). Any sudden water pollution accident in the reservoir would threaten the water supply of the MRP. We established a 3-D hydrodynamic and water quality model for the Danjiangkou Reservoir, and proposed scientific suggestions on the prevention and emergency management for sudden water pollution accidents based on simulated results. Simulations were performed on 20 hypothetical pollutant discharge locations and 3 assumed amounts, in order to model the effect of pollutant spreading under different reservoir operation types. The results showed that both the location and mass of pollution affected water quality; however, different reservoir operation types had little effect. Five joint regulation scenarios, which altered the hydrodynamic processes of water conveyance for the Danjiangkou and Taocha dams, were considered for controlling pollution dispersion. The results showed that the spread of a pollutant could be effectively controlled through the joint regulation of the two dams and that the collaborative operation of the Danjiangkou and Taocha dams is critical for ensuring the security of water quality along the MRP.

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

    Science.gov (United States)

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

    2014-02-27

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

    Directory of Open Access Journals (Sweden)

    Mariana Gonçalves de Freitas

    2015-03-01

    Full Text Available 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.

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

    Science.gov (United States)

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

    2015-03-01

    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.

  19. American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2016-2017).

    Science.gov (United States)

    Marco, Catherine A; Nelson, Lewis S; Baren, Jill M; Beeson, Michael S; Carius, Michael L; Chudnofsky, Carl R; Gausche-Hill, Marianne; Goyal, Deepi G; Keim, Samuel M; Kowalenko, Terry; Muelleman, Robert L; Joldersma, Kevin B

    2017-05-01

    The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2017 annual report on the status of US emergency medicine training programs. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  20. Emergency medicine in Dubai, UAE.

    Science.gov (United States)

    Partridge, Robert; Abbo, Michael; Virk, Alamjit

    2009-08-18

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    McKiernan, Sharmaine [School of Health Sciences, University of Newcastle, Callagham, NSW 2308 (Australia)], E-mail: sharmaine.mckiernan@newcastle.edu.au; Chiarelli, Pauline; Warren-Forward, Helen [School of Health Sciences, University of Newcastle, Callagham, NSW 2308 (Australia)

    2010-05-15

    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.

  2. [Teaching in emergency medicine].

    Science.gov (United States)

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

    2010-01-01

    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.

  3. Screening for Type 2 diabetes in the accident and emergency department.

    Science.gov (United States)

    George, P M; Valabhji, J; Dawood, M; Henry, J A

    2005-12-01

    To assess the proportion of patients, aged 40 years and over, attending an inner city accident and emergency department that have Type 2 diabetes, and the proportion previously undiagnosed, and to assess whether the identification of undiagnosed Type 2 diabetes is feasible in this setting. Five hundred unselected people participated. All completed a demographic questionnaire regarding risk factors for diabetes. In those without known diabetes, random capillary blood glucose (CBG) was measured. If this was greater than 7.0 mmol/l, patients were asked to return for two fasting blood glucose tests. Diagnosis of diabetes was based on World Health Organization criteria. Of the 500 participating subjects, 73 were already known to have Type 2 diabetes. Of the remaining 427 subjects, 36 had CBG>7.0 mmol/l. All 36 returned for fasting blood tests: 13 fulfilled the diagnostic criteria for Type 2 diabetes, eight for impaired fasting glucose (IFG), and 15 had normal fasting glucose values. The prevalence of Type 2 diabetes was therefore 17.2%, including 2.6% with a new diagnosis, and 14.6% with pre-existing disease; 1.6% were found to have IFG. Body mass index was greater in those with Type 2 diabetes (previously and newly diagnosed) [27.1 (5.15) (mean+/-standard deviation)] vs. 25.8 (4.70) kg/m2; unpaired t-test P=0.0213), and those with Type 2 diabetes were more likely to be of black and minority ethnic origin (57 vs. 28%; chi2 P<0.001) and to have a first-degree family history of diabetes (45 vs. 23%; chi2 P<0.001). It can be estimated from this survey that, annually, this case-finding methodology could identify 539 (95% CI 249-828) people aged 40 years and over attending our accident and emergency department with previously undiagnosed Type 2 diabetes.

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

    Science.gov (United States)

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

    1989-03-01

    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.

  5. Affective temperament and executive functions in emergency medicine professionals.

    Science.gov (United States)

    Jaracz, Marcin; Paciorek, Przemysław; Buciński, Adam; Borkowska, Alina

    2014-10-01

    Recent studies indicate that choice of profession is related to differences in affective temperament, which is probably due to various predispositions needed to efficiently perform particular professions. The aim of the present study was to assess affective temperament and executive functions in a sample of emergency medicine professionals. 75 emergency medicine professionals were enrolled in the study. Affective temperament was assessed by means of TEMPS-A. Executive functions were assessed by means of Trail Making Test and Stroop Color Word Interference Test. Subjects showed significantly higher rates of hyperthymic, compared to depressive, cyclothymic, irritable and anxious temperaments. The principal component analysis revealed that hyperthymic temperament contributes to a different factor, than the remaining ones. Higher rates of depressive, cyclothymic, irritable and anxious temperaments were related to poorer performance in Trail Making Test, whereas hyperthymic temperament had the opposite effect. Due to the size of the sample, results of the present study may have lacked power to show all the relationships between tested variables. Hyperthymic temperament promotes efficient performance of complex tasks under time pressure. Depressive, cyclothymic, irritable and anxious temperaments have the opposite effect. This makes hyperthymic temperament a desirable trait in emergency medicine professionals, performing complex medical tasks under extreme conditions. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Designing of an emergency call system for traffic accidents

    Directory of Open Access Journals (Sweden)

    Ziya Ekşi

    2013-06-01

    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. Emergency medicine and its development in Ethiopia with emphasis on the role of Addis Ababa University, School of Medicine, Emergency Medicine Department.

    Science.gov (United States)

    Azazh, Aklilu; Teklu, Sisay; Woldetsadi, Assefu; Seyoum, Nebyou; Geremew, Haimanot; Busse, Heidi; Tefera, Girma; Wubben, Ryan; Rankin, Pete; Tupesis, Janis P; Maskalyk, James; Landes, Megan; Mehari, Enawgaw; Derbew, Milliard

    2014-07-01

    Globally Emergency Medicine (EM) is young discipline and even in developed countries it is about five decades old. In Ethiopia formal pre-hospital care or hospital based Emergency department (ED) development is a recent phenomenon and this article describes development of Emergency Medicine care in Ethiopia before, around and after Ethiopia millennium. Documents related to emergency medicine development and implementation from different government and nongovernmental data sources are used as a resource for this article. Emergency Medicine task force (EMTF) has been established in Addis Ababa University (AAU) school of Medicine (SOM) in June 2006 and the taskforce has closely worked with Federal Ministry of Health (FMOH) and Addis Ababa city council Health Bureau (AACCHB). In addition to the main actors many partners have contributed significantly to this initiative. Some of the developments were establishment of emergency departments in Tikur Anbessa Specialized Hospital (TASH) and the restructuring of EM service by FMOH. Emergency care has been considered as a crucial service in hospitals' service along with outpatient and inpatient services. Furthermore, Pre-hospital care initiatives have been commenced in Addis Ababa and expanded to the regions with a arrangement of one or two ambulances to small districts having 100,000 population. There have also been key achievement in human resource development, notably the establishment of EM residency and MSC in EM and critical care nursing. Prehospital care givers training programs in order to produce emergency medicine technicians (EMT) have been started in various regional health professionals training centers. Furthermore, EM module has been included in the current undergraduate medical education. The Ethiopian society of emergency professionals (ESEP) has been established with members from different categories of emergency medicine professionals. In all these developments the emergency medicine training center in the

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

    Science.gov (United States)

    Pinnington, Sarah; Atterton, Brigid; Ingleby, Sarah

    2016-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Marcin eWojnar

    2014-11-01

    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

  10. Current and emerging applications of 3D printing in medicine.

    Science.gov (United States)

    Liaw, Chya-Yan; Guvendiren, Murat

    2017-06-07

    Three-dimensional (3D) printing enables the production of anatomically matched and patient-specific devices and constructs with high tunability and complexity. It also allows on-demand fabrication with high productivity in a cost-effective manner. As a result, 3D printing has become a leading manufacturing technique in healthcare and medicine for a wide range of applications including dentistry, tissue engineering and regenerative medicine, engineered tissue models, medical devices, anatomical models and drug formulation. Today, 3D printing is widely adopted by the healthcare industry and academia. It provides commercially available medical products and a platform for emerging research areas including tissue and organ printing. In this review, our goal is to discuss the current and emerging applications of 3D printing in medicine. A brief summary on additive manufacturing technologies and available printable materials is also given. The technological and regulatory barriers that are slowing down the full implementation of 3D printing in the medical field are also discussed.

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

    Institute of Scientific and Technical Information of China (English)

    CHI Bing; LI Hong; FANG Dong

    2007-01-01

    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.

  12. A case-control study estimating accident risk for alcohol, medicines and illegal drugs.

    Directory of Open Access Journals (Sweden)

    Kim Paula Colette Kuypers

    Full Text Available BACKGROUND: The aim of the present study was to assess the risk of having a traffic accident after using alcohol, single drugs, or a combination, and to determine the concentrations at which this risk is significantly increased. METHODS: A population-based case-control study was carried out, collecting whole blood samples of both cases and controls, in which a number of drugs were detected. The risk of having an accident when under the influence of drugs was estimated using logistic regression adjusting for gender, age and time period of accident (cases/sampling (controls. The main outcome measures were odds ratio (OR for accident risk associated with single and multiple drug use. In total, 337 cases (negative: 176; positive: 161 and 2726 controls (negative: 2425; positive: 301 were included in the study. RESULTS: Main findings were that 1 alcohol in general (all the concentrations together caused an elevated crash risk; 2 cannabis in general also caused an increase in accident risk; at a cut-off of 2 ng/mL THC the risk of having an accident was four times the risk associated with the lowest THC concentrations; 3 when ranking the adjusted OR from lowest to highest risk, alcohol alone or in combination with other drugs was related to a very elevated crash risk, with the highest risk for stimulants combined with sedatives. CONCLUSION: The study demonstrated a concentration-dependent crash risk for THC positive drivers. Alcohol and alcohol-drug combinations are by far the most prevalent substances in drivers and subsequently pose the largest risk in traffic, both in terms of risk and scope.

  13. Best educational practices in pediatric emergency medicine during emergency medicine residency training: guiding principles and expert recommendations.

    Science.gov (United States)

    Cloutier, Robert L; Walthall, Jennifer D H; Mull, Colette C; Nypaver, Michele M; Baren, Jill M

    2010-10-01

    The state of pediatric emergency medicine (PEM) education within emergency medicine (EM) residency programs is reviewed and discussed in the context of shifting practice environments and new demands for a greater focus on the availability and quality of PEM services. The rapid growth of PEM within pediatrics has altered the EM practice landscape with regard to PEM. The authors evaluate the composition, quantity, and quality of PEM training in EM residency programs, with close attention paid to the challenges facing programs. A set of best practices is presented as a framework for discussion of future PEM training that would increase the yield and relevance of knowledge and experiences within the constraints of 3- and 4-year residencies. Innovative educational modalities are discussed, as well as the role of simulation and pediatric-specific patient safety education. Finally, barriers to PEM fellowship training among EM residency graduates are discussed in light of the shortage of practitioners from this training pathway and in recognition of the ongoing importance of the EM voice in PEM. © 2010 by the Society for Academic Emergency Medicine.

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

    Directory of Open Access Journals (Sweden)

    Po Thaw DA

    2012-06-01

    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.

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

    Science.gov (United States)

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

    2014-01-01

    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'.

  16. Work shifts in Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Roberto Recupero

    2007-06-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-04-15

    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)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-04-15

    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. Overcrowding of accident & emergency units: is it a growing concern ...

    African Journals Online (AJOL)

    Background: The inability of the Nigeria's Accident and Emergency .... tertiary care to the then Midwestern Region (now Edo .... Table 3: Common causes of poor outcome of patients' management in AEDs ... bulance diversion, (4) threat to disaster preparedness, and (5) eroding reliability of the emergency care system.

  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.

    Science.gov (United States)

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

    2014-07-15

    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. Education Scholarship and its Impact on Emergency Medicine Education

    Directory of Open Access Journals (Sweden)

    Jonathan Sherbino

    2015-11-01

    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.

  2. Review article: burnout in emergency medicine physicians.

    Science.gov (United States)

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

    2013-12-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Steven Tan

    2004-01-01

    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.

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

    Science.gov (United States)

    Roe, David; Carley, Simon; Sherratt, Cathy

    2010-02-01

    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.

  5. Current Workforce Characteristics and Burnout in Pediatric Emergency Medicine.

    Science.gov (United States)

    Gorelick, Marc H; Schremmer, Robert; Ruch-Ross, Holly; Radabaugh, Carrie; Selbst, Steven

    2016-01-01

    Changes in health care delivery and graduate medical education have important consequences for the workforce in pediatric emergency medicine (PEM). This study compared career preparation and potential attrition of the PEM workforce with the prior assessment from 1998. An e-mail survey was sent to members of the American Academy of Pediatrics (AAP) Section on EM and to non-AAP members board certified in PEM. Information on demographics, practice characteristics and professional activities, career preparation, future plans, and burnout (using two validated screening questions) was analyzed using standard descriptive statistics. Of 2,120 surveys mailed, 895 responses were received (40.8% response). Over half (53.7%) of respondents were female, compared with 44% in 1998. The majority (62.9%) practiced in the emergency department (ED) of a free-standing children's hospital. The distribution of professional activities was similar to that reported in 1998, with the majority of time (60%) spent in direct patient care. Half indicated involvement in research, and almost half had dedicated time for other activities, including emergency medical services (7.3%), disaster (6.9%), child abuse (5.0%), transport (3.6%), toxicology (2.3% of respondents), and other (13.6%); additionally, 21.3% had dedicated time for quality/safety. Respondents were highly satisfied (95.6%) with fellowship preparation for clinical care, but less satisfied with preparation for research (49.2%) and administration (38.7%). However, satisfaction with nonclinical training was higher for those within 10 years of medical school graduation. Forty-six percent plan to change clinical activity in the next 5 years, including reducing hours, changing shifts, or retiring. Overall, 11.9% of all respondents, including 20.1% of women and 2.6% of men (p preparation for professional activities in PEM is improving, gaps remain in training in nonclinical skills. Symptoms of burnout are prevalent, and there is likely to

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-08-01

    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.)

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

    Directory of Open Access Journals (Sweden)

    Caroline Gouder

    2013-01-01

    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.

  8. Infections in traumatic wounds sutured at a Norwegian Accident and Emergency Department.

    Science.gov (United States)

    Brudvik, Christina; Tariq, Hina; Bernardshaw, Soosaipillai V; Steen, Knut

    2015-05-05

    Different countries have different wound treatment traditions. We have studied the incidence and different factors related to infections in wound injuries sutured at a Norwegian A&E department. In this prospective study, clinical data were collected on 102 patients with traumatic wound injuries treated with sutures at Bergen Accident and Emergency Department between 30 February 2011 and 30 June 2011. Any wound infections in 97 of these patients at the time of suture removal were assessed and classified according to severity on a scale of grade 0 to grade 4. There were no serious infections, but mild clinical wound infections occurred in 15% of patients: 11% grade 1 and 4% grade 2 infections. Patients less than 65 years old had often cut themselves with knives (n = 33, 37%), and on their hands (n = 60, 67%), Men were most frequently injured at work (n = 38, 54%) and women most often at home (n = 18, 56%). No statistically significant correlation was found between the incidence of wound infections and the length of the wound, the time elapsed before suturing, the wound's location on the body, contamination or underlying chronic diseases. Two of the three self-inflictors in our study had clinical wound infections. Half of the bacteriological samples from ten of 15 wounds with clinical infection had plentiful growth of Staphylococcus aureus. One patient received oral antibiotic treatment for wound infection, and two had local antibiotic treatment. Mild clinical infections were found in almost one of six wounds sutured at a Norwegian A&E department. More studies are necessary to provide basic data to enable targeted improvements in wound treatment in the primary healthcare service.

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

    Directory of Open Access Journals (Sweden)

    Cherri Hobgood

    2011-06-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-04-15

    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)

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

    Science.gov (United States)

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

    2010-01-01

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

    Science.gov (United States)

    Morrison, Ann; Roman, Brenda; Borges, Nicole

    2012-01-01

    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…

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

    Science.gov (United States)

    Morrison, Ann; Roman, Brenda; Borges, Nicole

    2012-01-01

    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…

  14. The accident and emergency department as a single portal of entry for the reassessment of all trauma patients transferred to specialist units.

    OpenAIRE

    O'Connor, P. M.; Steele, J A; Dearden, C H; Rocke, L G; Fisher, R. B.

    1996-01-01

    127 patients who were transferred to a regional referral centre for specialist treatment within 48 h of serious injury were reassessed on arrival in the receiving accident and emergency department by a trauma team. 80 transferred patients (63%) required intervention in the accident and emergency department to complete assessment or resuscitation. In view of the well recognised difficulties in managing patients with multiple trauma and the possibility that initially occult injuries may become ...

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

    Directory of Open Access Journals (Sweden)

    Bos Nanne

    2012-08-01

    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

  16. Workplace violence in emergency medicine

    Directory of Open Access Journals (Sweden)

    A. Chatterjee*

    2013-12-01

    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.

  17. Pre-hospital emergency medicine.

    Science.gov (United States)

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

    2015-12-19

    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.

  18. Emergency medicine in the United Arab Emirates

    OpenAIRE

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

    2014-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Sonja E. Raaum

    2015-10-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Sarah Rominski

    2011-09-01

    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.

  1. Emerging nanotechnology approaches in tissue engineering and regenerative medicine

    Directory of Open Access Journals (Sweden)

    Kim ES

    2014-05-01

    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

  2. Football emergency medicine

    African Journals Online (AJOL)

    With the planning and preparation for effective and efficient medical service provision ... Medical management limitations and adaptations .... so that emergency medical management may be .... sudden cardiac death in high school and college.

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

    Science.gov (United States)

    Malamed, Stanley F

    2003-10-01

    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.

  4. Investigation and management of patients with pleuritic chest pain presenting to the accident and emergency department.

    OpenAIRE

    Jones, K.; Raghuram, A

    1999-01-01

    The assessment of a patient with pleuritic chest pain calls for a high degree of clinical acumen and a high degree of suspicion that the diagnosis might be pulmonary embolism. This area is one of the most difficult in A&E medicine (and indeed chest medicine). One error is to "think the best" when considering the diagnosis in such patients but experience soon teaches to "think PE" and diagnose less serious conditions only when pulmonary embolism has been excluded. A key consideration is the pr...

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

    Directory of Open Access Journals (Sweden)

    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.

  6. [Informed consent in emergency medicine].

    Science.gov (United States)

    Ersoy, Nermin; Ozcan Senses, Müesser; Aydin Er, Rahime

    2010-01-01

    Informed consent is a prerequisite for the ethical and legal validity of the emergency intervention in emergency medicine, since it protects the fiduciary relationship between the physician and patient; the principle of honesty that grounds this relationship; the principle of autonomy that necessitates right of self-determination; and the principle of respect for persons. Informed consent in emergency medicine, which is supposed to include the nature, benefits and risks of emergency medical intervention, differentiates with respect to definite groups of patients: (1) conscious patients, (2) unconscious patients, and (3) children and mature minors. In addition, informed consent differentiates between medical, psychological and even social circumstances of the patients, referred to as valid consent, expressed-explicit consent, blanket consent, presumed consent, tacit consent, proxy consent, and parental consent. There are a few exceptions in which emergency medical intervention is administered without informed consent. In addition to the exceptions of life-saving interventions, when a patient can not decide for herself/himself, intervention of the physician in the best interest of the patient or children is based on the "therapeutic privilege" of the physician. As an ethically defensible right, since therapeutic privilege may open a door to hard paternalistic approaches, in those situations, emergency physicians should be cautious not to violate a patient's autonomy.

  7. Exploring Scholarship and the Emergency Medicine Educator: A Workforce Study

    Directory of Open Access Journals (Sweden)

    Jordan, Jaime

    2017-01-01

    Full Text Available Recent literature calls for initiatives to improve the quality of education studies and support faculty in approaching educational problems in a scholarly manner. Understanding the emergency medicine (EM educator workforce is a crucial precursor to developing policies to support educators and promote education scholarship in EM. This study aims to illuminate the current workforce model for the academic EM educator. Program leadership at EM training programs completed an online survey consisting of multiple choice, completion, and free-response type items. We calculated and reported descriptive statistics. 112 programs participated. Mean number of core faculty/program: 16.02 ± 7.83 [14.53-17.5]. Mean number of faculty full-time equivalents (FTEs/program dedicated to education is 6.92 ± 4.92 [5.87- 7.98], including (mean FTE: Vice chair for education (0.25; director of medical education (0.13; education fellowship director (0.2; residency program director (0.83; associate residency director (0.94; assistant residency director (1.1; medical student clerkship director (0.8; assistant/associate clerkship director (0.28; simulation fellowship director (0.11; simulation director (0.42; director of faculty development (0.13. Mean number of FTEs/program for education administrative support is 2.34 ± 1.1 [2.13-2.61]. Determination of clinical hours varied; 38.75% of programs had personnel with education research expertise. Education faculty represent about 43% of the core faculty workforce. Many programs do not have the full spectrum of education leadership roles and educational faculty divide their time among multiple important academic roles. Clinical requirements vary. Many departments lack personnel with expertise in education research. This information may inform interventions to promote education scholarship.

  8. Emerging nanotechnology approaches in tissue engineering and regenerative medicine

    OpenAIRE

    Kim ES; Ahn EH; Dvir T; Kim DH

    2014-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Kamphuis Helen CM

    2008-11-01

    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.

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

    Science.gov (United States)

    Kool, Rudolf B; Homberg, Daniel J; Kamphuis, Helen C M

    2008-11-04

    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. 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. 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. 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.

  11. How alternative payment models in emergency medicine can benefit physicians, payers, and patients.

    Science.gov (United States)

    Harish, Nir J; Miller, Harold D; Pines, Jesse M; Zane, Richard D; Wiler, Jennifer L

    2017-06-01

    While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Emergency medicine in Vietnam.

    Science.gov (United States)

    Richards, J R

    1997-04-01

    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.

  13. Development of emergency medicine in Rwanda

    Directory of Open Access Journals (Sweden)

    Antoine Bahati Kabeza

    2013-09-01

    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.

  14. Law Enforcement and Emergency Medicine: An Ethical Analysis.

    Science.gov (United States)

    Baker, Eileen F; Moskop, John C; Geiderman, Joel M; Iserson, Kenneth V; Marco, Catherine A; Derse, Arthur R

    2016-11-01

    Emergency physicians frequently interact with law enforcement officers and patients in their custody. As always, the emergency physician's primary professional responsibility is to promote patient welfare, and his or her first duty is to the patient. Emergency physicians should treat criminals, suspects, and prisoners with the same respect and attention they afford other patients while ensuring the safety of staff, visitors, and other patients. Respect for patient privacy and protection of confidentiality are of paramount importance to the patient-physician relationship. Simultaneously, emergency physicians should attempt to accommodate law enforcement personnel in a professional manner, enlisting their aid when necessary. Often this relates to the emergency physician's socially imposed duties, governed by state laws, to report infectious diseases, suspicion of abuse or neglect, and threats of harm. It is the emergency physician's duty to maintain patient confidentiality while complying with Health Insurance Portability and Accountability Act regulations and state law. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    J Hinkelbein

    2010-04-01

    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

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

    Science.gov (United States)

    Stump, Terra; Zilch, Sarah; Coustasse, Alberto

    2012-01-01

    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.

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

    Science.gov (United States)

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

    2016-02-01

    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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

    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.

  19. Development of emergency medicine as academic and distinct clinical discipline in Bosnia & Herzegovina.

    Science.gov (United States)

    Salihefendic, Nizama; Zildzic, Muharem; Masic, Izet; Hadziahmetovic, Zoran; Vasic, Dusko

    2011-01-01

    Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam. Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries. Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina. There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through

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

    Science.gov (United States)

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

    2011-01-01

    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 .

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

    Energy Technology Data Exchange (ETDEWEB)

    Rosen, P.

    1988-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Carlos Gorios

    2014-08-01

    Full Text Available ObjectiveTo 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.MethodsThis 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.ResultsAmong 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.ConclusionTransport 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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2015-01-01

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

    NARCIS (Netherlands)

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

    2016-01-01

    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

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

    Science.gov (United States)

    Elledge, Ross O C; McAleer, Sean

    2015-02-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

    1999-02-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

    1999-07-01

    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

  9. Just allocation and team loyalty: a new virtue ethic for emergency medicine

    Science.gov (United States)

    Girod, J; Beckman, A

    2005-01-01

    When traditional virtue ethics is applied to clinical medicine, it often claims as its goal the good of the individual patient, and focuses on the dyadic relationship between one physician and one patient. An alternative model of virtue ethics, more appropriate to the practice of emergency medicine, will be outlined by this paper. This alternative model is based on the assumption that the appropriate goal of the practice of emergency medicine is a team approach to the medical wellbeing of individual patients, constrained by the wellbeing of the patient population served by a particular emergency department. By defining boundaries and using the key virtues of justice and team loyalty, this model fits emergency practice well and gives care givers the conceptual clarity to apply this model to various conflicts both within the department and with those outside the department. PMID:16199595

  10. Perceived Quality of Life With Spinal Cord Injury: A Comparison Between Emergency Medicine and Physical Medicine and Rehabilitation Physicians.

    Science.gov (United States)

    Cushman, Daniel M; Thomas, Katrina; Mukherjee, Debjani; Johnson, Reid; Spill, Gayle

    2015-09-01

    To explore the attitudes of health care providers who treat patients with spinal cord injury (SCI) and examine whether Emergency Medicine (EM) and Physical Medicine and Rehabilitation (PM&R) physicians differ in their judgments about quality of life (QOL) after SCI. Questionnaire survey of PM&R and EM physicians. Board-certified PM&R and EM physicians listed in the American Academy of Physical Medicine & Rehabilitation and the American College of Emergency Physicians and/or faculty from academic PM&R and EM departments in the United States and Canada. Evaluating various aspects of perceived QOL if the physician hypothetically sustained an SCI, including impact on leisure activities, social relationships, happiness, meaningful work, satisfying sexual relationships, and overall QOL. A total of 91 EM physicians and 89 PM&R physicians completed the surveys. PM&R physicians were more likely to agree that they would have a better QOL compared with EM physicians, regardless of the level of injury or aspect of life (P Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-03-01

    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.

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

    OpenAIRE

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

    2016-01-01

    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...

  13. Publication rate of abstracts presented at the emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012.

    Science.gov (United States)

    Kalkan, Asim; Kose, Ozkan; Bilir, Ozlem; Ersunan, Gokhan; Ozel, Deniz; Guler, Ferhat

    2015-09-01

    The purpose of this study was to assess the publication rate of the abstracts presented at the 6th Mediterranean Emergency Medicine Congress, 2011 and the 7th European Congress on Emergency Medicine, 2012. All abstracts, both posters and oral presentations, from the international emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012 were identified. To establish whether these abstracts were subsequently published in peer-reviewed medical journals, the names of all the authors and the title of the abstracts were searched for in the databases of Clinical Key/Elsevier, EBSCO Discovery Service, MD Consult, Science Direct, Scopus, EMBASE, Medscape, Google Scholar and local ULAKBIM. The year of publication, consistency of author names and titles, the type of study, the journals in which papers were published and countries from which reports were submitted were all recorded. A total of 1721 abstracts were examined; 626 from 2011 (307 oral presentations and 319 posters) and 1095 from 2012 (154 oral presentations and 941 posters). Of all abstracts in 2011, 172 (27.5%) and of all abstracts in 2012, 265 (24.2%) were subsequently published as full-text reports in peer-reviewed journals. Of the 172 papers published in 2011, 152 (88.4%) were accepted by Science Citation Index (SCI) and/or SCI Expanded (SCI-E) journals and 155 (58.5%) of 265 papers were accepted by SCI and/or SCI-E journals in 2012 (p=0.0001). The publication rate of abstracts submitted to international emergency medicine congresses held by EUSEM over those 2 years was low compared with that of abstracts presented in other emergency medicine congresses. Presenters should be encouraged to send their studies to peer-reviewed journals. During the selection process by the scientific panel, constructive critics should be notified to the presenters instead of simply accepting or rejecting the studies that submitted to the congress, which may increase the

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

    LENUS (Irish Health Repository)

    Nizam, AA

    2016-10-01

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

    Science.gov (United States)

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

    2014-05-01

    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.

  16. Emergency response and nuclear risk governance. Nuclear safety at nuclear power plant accidents; Notfallschutz und Risk Governance. Zur nuklearen Sicherheit bei Kernkraftwerksunfaellen

    Energy Technology Data Exchange (ETDEWEB)

    Kuhlen, Johannes

    2014-07-01

    The present study entitled ''Emergency Response and Nuclear Risk Governance: nuclear safety at nuclear power plant accidents'' deals with issues of the protection of the population and the environment against hazardous radiation (the hazards of nuclear energy) and the harmful effects of radioactivity during nuclear power plant accidents. The aim of this study is to contribute to both the identification and remediation of shortcomings and deficits in the management of severe nuclear accidents like those that occurred at Chernobyl in 1986 and at Fukushima in 2011 as well as to the improvement and harmonization of plans and measures taken on an international level in nuclear emergency management. This thesis is divided into a theoretical part and an empirical part. The theoretical part focuses on embedding the subject in a specifically global governance concept, which includes, as far as Nuclear Risk Governance is concerned, the global governance of nuclear risks. Due to their characteristic features the following governance concepts can be assigned to these risks: Nuclear Safety Governance is related to safety, Nuclear Security Governance to security and NonProliferation Governance to safeguards. The subject of investigation of the present study is as a special case of the Nuclear Safety Governance, the Nuclear Emergency governance, which refers to off-site emergency response. The global impact of nuclear accidents and the concepts of security, safety culture and residual risk are contemplated in this context. The findings (accident sequences, their consequences and implications) from the analyses of two reactor accidents prior to Fukushima (Three Mile Iceland in 1979, Chernobyl in 1986) are examined from a historical analytical perspective and the state of the Nuclear Emergency governance and international cooperation aimed at improving nuclear safety after Chernobyl is portrayed by discussing, among other topics, examples of &apos

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

    Science.gov (United States)

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

    2016-01-01

    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.

  18. Accident investigation and analysis

    NARCIS (Netherlands)

    Kampen, J. van; Drupsteen, L.

    2013-01-01

    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

  19. Emergency Medicine for medical students world wide!

    DEFF Research Database (Denmark)

    Perinpam, Larshan; Thi Huynh, Anh-Nhi

    2015-01-01

    A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - http://blogs.bmj.com/emj/2015/04/17/emergency-medicine-for-medical-students-world-wide/......A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - http://blogs.bmj.com/emj/2015/04/17/emergency-medicine-for-medical-students-world-wide/...

  20. ACCIDENT AT «FUKUSHIMA-I» NPP: FIRST RESULTS OF EMERGENCY RESPONSE. REPORT 1: GENERAL INFORMATION ABOUT THE ACCIDENT AND RADIATION SITUATION

    Directory of Open Access Journals (Sweden)

    G. G. Onischenko

    2011-01-01

    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.

  1. MORBIDITY AND MORTALITY AMONG EMERGENCY WORKERS OF THE CHERNOBYL ACCIDENT: ASSESSMENT OF RADIATION RISKS FOR THE FOLLOW-UP PERIOD OF 1992-2008

    Directory of Open Access Journals (Sweden)

    V. K. Ivanov

    2011-01-01

    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.

  2. Attitude of interns towards implementation and contribution of undergraduate Emergency Medicine training: Experience of an Ethiopian Medical School

    Directory of Open Access Journals (Sweden)

    Temesgen Beyene

    2017-09-01

    Conclusion: An Emergency Medicine rotation during the final year of medical school provides opportunities to learn about undifferentiated medical emergencies and it should be included for other medical schools in the country. Participants suggest that leadership aspects of Emergency Medicine need more emphasis as the curriculum is further developed in the future.

  3. Communication and industrial accidents

    NARCIS (Netherlands)

    As, Sicco van

    2001-01-01

    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

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

    Institute of Scientific and Technical Information of China (English)

    郭祥义

    2016-01-01

    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。

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

    Directory of Open Access Journals (Sweden)

    P. Ray

    2008-01-01

    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.

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

    Science.gov (United States)

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

    2013-12-01

    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.

  7. Using queuing theory to analyse the government's 4-H completion time target in accident and emergency departments.

    Science.gov (United States)

    Mayhew, L; Smith, D

    2008-03-01

    This paper uses a queuing model to evaluate completion times in Accident and Emergency (A&E) departments in the light of the Government target of completing and discharging 98% of patients inside 4 h. It illustrates how flows though an A&E can be accurately represented as a queuing process, how outputs can be used to visualise and interpret the 4-h Government target in a simple way and how the model can be used to assess the practical achievability of A&E targets in the future. The paper finds that A&E targets have resulted in significant improvements in completion times and thus deal with a major source of complaint by users of the National Health Service in the U.K. It suggests that whilst some of this improvement is attributable to better management, some is also due to the way some patients in A&E are designated and therefore counted through the system. It finds for example that the current target would not have been possible without some form of patient re-designation or re-labelling taking place. Further it finds that the current target is so demanding that the integrity of reported performance is open to question. Related incentives and demand management issues resulting from the target are also briefly discussed.

  8. 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.

    Science.gov (United States)

    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

    2014-07-01

    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. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

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

    Directory of Open Access Journals (Sweden)

    Elizabeth L. DeVos

    2014-12-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    1992-06-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    1992-06-01

    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.

  12. Design of a High Power Robotic Manipulator for Emergency Response to the Nuclear Accidents

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jongwon; Bae, Yeong-Geol; Kim, Myoung Ho; Choi, Young Soo [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2016-10-15

    An accident in a nuclear facility causes a great social cost. To prevent an unexpected nuclear accident from spreading to the catastrophic disaster, emergency response action in early stage is required. However, high radiation environment has been proved as a challenging obstacle for human workers to access to the accident site and take an action in previous accident cases. Therefore, emergency response robotic technology to be used in a nuclear accident site instead of human workers are actively conducted in domestically and internationally. Robots in an accident situation are required to carry out a variety of tasks depend on the types and patterns of accidents. An emergency response usually includes removing of debris, make an access road to a certain place and handling valves. These tasks normally involve high payload handling. A small sized high power robotic manipulator can be an appropriate candidate to deal with a wide spectrum of tasks in an emergency situation. In this paper, we discuss about the design of a high power robotic manipulator, which is capable of handling high payloads for an initial response action to the nuclear facility accident. In this paper, we presented a small sized high power robotic manipulator design. Actuator types of manipulator was selected and mechanical structure was discussed. In the future, the servo valve and hydraulic pump systems will be determined. Furthermore, control algorithms and test bed experiments will be also conducted.

  13. 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

    Institute of Scientific and Technical Information of China (English)

    苏虹

    2011-01-01

    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.

  14. International Federation for Emergency Medicine Model curriculum for medical student education in emergency medicine

    Directory of Open Access Journals (Sweden)

    Cherri Hobgood

    2011-09-01

    The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is designed, not to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership.

  15. Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy.

    Science.gov (United States)

    Venkatesh, Arjun K; Savage, Dan; Sandefur, Benjamin; Bernard, Kenneth R; Rothenberg, Craig; Schuur, Jeremiah D

    2017-01-01

    Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence. Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies. A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent. Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality

  16. 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.

    Science.gov (United States)

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

    2010-10-01

    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.

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

    Science.gov (United States)

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

    2004-06-01

    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.

  18. Emergency medicine: beyond the basics.

    Science.gov (United States)

    Malamed, S F

    1997-07-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Stoneking LR

    2016-08-01

    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

  20. Qualitative Research on Emergency Medicine Physicians

    DEFF Research Database (Denmark)

    Paltved, Charlotte; Musaeus, Peter

    2012-01-01

    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...... 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...... and training, communication, professional roles, and organizational factors, and into 12 sub-themes. Conclusion: The strength of qualitative research is its ability to grasp and operationalize complex relations within EM. Although qualitative research methodologies have gained in rigour in recent years and few...

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

    Science.gov (United States)

    Goroff, Michael; Reich, Michael R

    2010-12-01

    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.

  2. Critical Emergency Medicine Procedural Skills: A Comparative Study of Methods for Teaching and Assessment.

    Science.gov (United States)

    Chapman, Dane M.; And Others

    Three critical procedural skills in emergency medicine were evaluated using three assessment modalities--written, computer, and animal model. The effects of computer practice and previous procedure experience on skill competence were also examined in an experimental sequential assessment design. Subjects were six medical students, six residents,…

  3. Some Ethical Issues in Prehospital Emergency Medicine.

    Science.gov (United States)

    Erbay, Hasan

    2014-12-01

    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.

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

    Science.gov (United States)

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

    2011-02-01

    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.

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

    Science.gov (United States)

    Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars

    2010-04-22

    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.

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

    DEFF Research Database (Denmark)

    Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars

    2010-01-01

    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....

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

    Science.gov (United States)

    Boenink, Marianne

    2009-12-01

    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.

  8. Bedside ultrasound in pediatric emergency medicine.

    Science.gov (United States)

    Levy, Jason A; Noble, Vicki E

    2008-05-01

    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.

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

    Science.gov (United States)

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

    2006-01-01

    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.

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

    Science.gov (United States)

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

    2011-02-01

    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.

  11. Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I)

    Science.gov (United States)

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

    2010-01-01

    For the first time in history, four generations are working together – Traditionalists, Baby Boomers, Generation 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 (SAEM) 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. PMID:21314779

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

    Directory of Open Access Journals (Sweden)

    Raquel Forgiarini Saldanha

    2014-09-01

    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.

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

    NARCIS (Netherlands)

    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

    2008-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Mohsen Mardani-Kivi

    2016-01-01

    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.

  15. 36th International Symposium on Intensive Care and Emergency Medicine

    OpenAIRE

    Bateman, R. M.; Sharpe, M. D.; Jagger, J. E.; Ellis, C. G.; Sol?-Viol?n, J; L?pez-Rodr?guez, M.; Herrera-Ramos, E.; Ru?z-Hern?ndez, J.; Border?as, L; Horcajada, J.; Gonz?lez-Quevedo, N.; Rajas, O; Briones, M.; Rodr?guez de Castro, F.; Rodr?guez Gallego, C.

    2016-01-01

    Table of contents P001 - Sepsis impairs the capillary response within hypoxic capillaries and decreases erythrocyte oxygen-dependent ATP efflux R. M. Bateman, M. D. Sharpe, J. E. Jagger, C. G. Ellis P002 - Lower serum immunoglobulin G2 level does not predispose to severe flu. J. Sol?-Viol?n, M. L?pez-Rodr?guez, E. Herrera-Ramos, J. Ru?z-Hern?ndez, L. Border?as, J. Horcajada, N. Gonz?lez-Quevedo, O. Rajas, M. Briones, F. Rodr?guez de Castro, C. Rodr?guez Gallego P003 - Brain protective effects...

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

    Science.gov (United States)

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

    2014-05-01

    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.

  17. 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

    Directory of Open Access Journals (Sweden)

    Celeste de Souza Rodrigues

    2012-09-01

    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

  18. Injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: a prospective hospital based study.

    Science.gov (United States)

    Seid, Mohammed; Azazh, Aklilu; Enquselassie, Fikre; Yisma, Engida

    2015-05-20

    Road traffic injuries are the eighth leading cause of death globally, and the leading cause of death for young people. More than a million people die each year on the world's roads, and the risk of dying as a result of a road traffic injury is highest in Africa. A prospective hospital based study was undertaken to assess injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. A structured pre-tested questionnaire was used to gather the required data. The collected data were analyzed using SPSS version 20.0. Hierarchical multiple regression analysis was used to identify predictors of fatalities among the road traffic crash victims. A total of 230 road traffic accident victims were studied. The majority of the study subjects were men 165 (71.7%) and the male/female ratio was 2.6:1. The victims' ages ranged from 14 to 80 years with the mean and standard deviations of 32.15 and ± 14.38 years respectively. Daily laborers (95 (41.3%)) and students (28 (12.2%)) were the majority of road traffic accident victims. Head (50.4%) and musculoskeletal (extremities) (47.0%) were the most common body region injured. Fractures (78.0%) and open wounds (56.5%) were the most common type of injuries sustained. The overall length of hospital stay (LOS) ranged from 1 day to 61 days with mean (± standard deviation) of 7.12 ± 10.5 days and the mortality rate was 7.4%. Hierarchical multiple regression analysis showed that age of the victims (ß = 0.16, p traffic accident is a major public health problem. Urgent road traffic accident preventive measures and prompt treatment of the victims are warranted in order to reduce morbidity and mortality among the victims.

  19. Critical thinking, curiosity and parsimony in (emergency) medicine: 'Doing nothing' as a quality measure?

    Science.gov (United States)

    Keijzers, Gerben

    2017-06-01

    Current medical decision-making is influenced by many factors, such as competing interests, distractions, as well as fear of missing an important diagnosis. This can result in ordering tests or providing treatments that can be harmful. Unnecessary tests are more likely to lead to false positive diagnosis or incidental findings that are of uncertain clinical relevance. Estimates indicate that almost one-third of all health spending is wasteful. The 'Choosing Wisely' campaign has identified many of these wasteful tests and treatments. This perspective proposes some suggestions to focus on our critical thinking, embrace shared decision-making and stay curious about the patient we are treating. Most importantly, 'doing nothing' could be a quality indicator for EDs, and ACEM supported audits and research to develop benchmarks for certain tests and procedures in the ED are important to achieve a cultural change. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  20. Survey of emergency medicine resident debt status and financial planning preparedness.

    Science.gov (United States)

    Glaspy, Jeffrey N; Ma, O John; Steele, Mark T; Hall, Jacqueline

    2005-01-01

    Most resident physicians accrue significant financial debt throughout their medical and graduate medical education. The objective of this study was to analyze emergency medicine resident debt status, financial planning actions, and educational experiences for financial planning and debt management. A 22-item questionnaire was sent to all 123 Accreditation Council on Graduate Medical Education-accredited emergency medicine residency programs in July 2001. Two follow-up mailings were made to increase the response rate. The survey addressed four areas of resident debt and financial planning: 1) accrued debt, 2) moonlighting activity, 3) financial planning/debt management education, and 4) financial planning actions. Descriptive statistics were used to analyze the data. Survey responses were obtained from 67.4% (1,707/2,532) of emergency medicine residents in 89 of 123 (72.4%) residency programs. Nearly one half (768/1,707) of respondents have accrued more than 100,000 dollars of debt. Fifty-eight percent (990/1,707) of all residents reported that moonlighting would be necessary to meet their financial needs, and more than 33% (640/1,707) presently moonlight to supplement their income. Nearly one half (832/1,707) of residents actively invested money, of which online trading was the most common method (23.3%). Most residents reported that they received no debt management education during residency (82.1%) or medical school (63.7%). Furthermore, 79.1% (1,351/1,707) of residents reported that they received no financial planning lectures during residency, although 84.2% (1,438/1,707) reported that debt management and financial planning education should be available during residency. Most emergency medicine residency programs do not provide their residents with financial planning education. Most residents have accrued significant debt and believe that more financial planning and debt management education is needed during residency.

  1. Emergency Medicine Clerkship Directors: Current Workforce

    Directory of Open Access Journals (Sweden)

    David A. Wald

    2014-07-01

    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.

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

    NARCIS (Netherlands)

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

    2005-01-01

    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

  3. Work Accidents and Professional Diseases

    Directory of Open Access Journals (Sweden)

    Doru Hauptmann

    2009-10-01

    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.

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

    OpenAIRE

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

    2010-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Payman Asadi

    2014-09-01

    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

  6. Medical Emergency Triage and Treatment System (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine.

    Science.gov (United States)

    Widgren, Bengt R; Jourak, Majid

    2011-06-01

    In many Emergency Department (ED) triage scoring systems, vital signs are not included as an assessment parameter. To evaluate the validity of a new protocol for Emergency Medicine in a large cohort of patients referred to in-hospital care. From January 1 to June 30, 2006, 22,934 patients were admitted to the ED at Sahlgrenska University Hospital. Of those, 8695 were referred to in-hospital care and included in the study. A new five-level triage tool, combining vital signs, symptoms, and signs in the triage decision, was used. A small control of the inter-rater disagreement was also performed in 132 parallel, single-blinded observations. Fifty percent of the patients were admitted by ambulance and the other 50% by walk-in. Hospital stay was significantly (p ambulance (9.3 ± 14 days) as compared with walk-in patients (6.2 ± 10 days). In-hospital mortality incidence was higher (8.1%) in patients admitted by ambulance, as compared with walk-in patients (2.4%). Hospital stay and in-hospital mortality increased with higher level of priority. In the highest priority groups, 32-53% of the patients were downgraded to a lower priority level after primary treatment. In the present study, the METTS protocol was shown to be a reliable triage method and a sensitive tool for secondary re-evaluation of the patient in the ED. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    K Asish

    2016-01-01

    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.

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

    Science.gov (United States)

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

    2015-01-01

    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.

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

    Science.gov (United States)

    Jones, Russell; Avies-Jones, Alison

    2007-10-01

    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.

  10. 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

    Institute of Scientific and Technical Information of China (English)

    孙高穹; 刘剑俊

    2016-01-01

    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。

  11. Simulation training based on observation with minimal participation improves paediatric emergency medicine knowledge, skills and confidence.

    Science.gov (United States)

    Bloch, Scott A; Bloch, Amy J

    2015-03-01

    Simulation is becoming standard during emergency medicine (EM) training. To determine if observation-based simulation with minimal participation improves knowledge, skill performance and confidence, we created and evaluated 12 paediatric emergency medicine (PEM) simulations focusing on the educational value of observation. Thirty-one EM residents participated in 1-2 simulations each and observed multiple others. Scores obtained on a knowledge test presimulation and postsimulation, clinical skills assessed for changes in performance over the course of the study, and confidence questionnaires given presimulation and postsimulation were analysed. Participants' feedback regarding the observation model was also evaluated. Average scores obtained on the knowledge test improved significantly presimulation to postsimulation (36.3% vs 51.4%), and remained consistent postsimulation to 4 months after simulation training (51.4% vs 48.8%). Gain scores for participants who observed >80% of the simulations were significantly higher than for those who observedobserved was stressful but beneficial, as clinical emergencies are stressful as well. Using observation with minimal participation as the foundation of simulation training may lead to improvement in observer knowledge, skills and confidence. Observation-based simulation training may also save time and resources, allowing a broader coverage of clinical scenarios than programmes requiring active participation by all learners. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

    Directory of Open Access Journals (Sweden)

    Edward J. Calabrese

    2016-12-01

    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.

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

    Science.gov (United States)

    Calabrese, Edward J.

    2016-01-01

    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

  14. FOAMSearch.net: A custom search engine for emergency medicine and critical care.

    Science.gov (United States)

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

    2015-08-01

    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.

  15. Night shifts in emergency medicine: the american board of emergency medicine longitudinal study of emergency physicians.

    Science.gov (United States)

    Smith-Coggins, Rebecca; Broderick, Kerryann B; Marco, Catherine A

    2014-09-01

    Night shift work is an integral component of the practice of emergency medicine (EM). Previous studies have demonstrated the challenges of night shift work to health and well being among health care providers. This study was undertaken to describe the self-reported experience of emergency physicians regarding night shift work with respect to quality of life and career satisfaction. The 2008 American Board of Emergency Medicine (ABEM) Longitudinal Study of Emergency Physicians (LSEP) was administered by mail to 1003 ABEM diplomates. Among 819 participants in the 2008 LSEP Physician Survey, most participants responded that night shift work negatively influenced job satisfaction with a moderate or major negative influence (58%; n = 467/800). Forty-three percent of participants indicated that night shifts had caused them to think about leaving EM (n = 344/809). Most participants responded that working night shifts has had mild negative effects (51%; n = 407/800) or major negative effects (9%; n = 68) on their health. Respondents were asked to describe how working night shifts has affected their health. Common themes included fatigue (36%), poor quality of sleep (35%), mood decrement/irritability (29%), and health maintenance challenges (19%). Among participants in the 2008 LSEP Retired Physician Survey, night shifts were a factor in the decision to retire for 56% of participants. Emergency physicians report negative impacts of night shift work, including fatigue, poor quality of sleep, mood decrement, irritability, and health challenges. Night shifts have a negative influence on job satisfaction and can be a factor in the decision to retire. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Admission of medical patients from the emergency department: An assessment of the attitudes, perspectives and practices of internal medicine and emergency medicine trainees.

    Science.gov (United States)

    Lawrence, Sean; Sullivan, Clair; Patel, Nadia; Spencer, Lyndall; Sinnott, Michael; Eley, Rob

    2016-08-01

    We sought to obtain a deeper understanding of the differing needs and expectations of inpatient and ED medical staff regarding the admission process for medical patients. Online questionnaire regarding their attitudes to and perceptions of various aspects of the admission process was used. The setting is a tertiary 640-bed adult hospital with over 60 000 ED presentations per year and an inpatient admission rate of 30%. A total of 42 out of 56 (75%) internal medical trainees (IMT) felt that the ED admission workup standard was lower or much lower than the inpatient standard; however, 10 of 16 (62.5%) ED trainees (EDT) thought it was similar (P = 0.009). Regarding why IMT order additional tests in the ED, the major reason supported by IMT was to 'identify or exclude urgent pathology' (53/56, 96.4%); however, this reason ranked only fifth for EDT (2/16, 12.5%) who ranked 'to ensure nothing was missed' (12/15, 80%) first. A total of 24 out of 56 (42.8%) IMT felt that if ED admissions were enacted without IMT review, inappropriate admissions to hospital would occur regularly although only one of 16 EDT (6.3%) agreed (P = 0.025). A total of 14 out of 16 (87.5%) EDT but only 16 of 56 (23.2%) IMT were comfortable with admissions occurring without inpatient review in the ED (P < 0.001). The top two perceived barriers to a smooth and timely admission process for IMT were patient instability (34/43, 79.1%) and inadequate ED workup (37/49, 75.5%); for EDT, they were excessive IMT workload (11/14, 78.6%) and referral close to the end of an IMT shift (7/11, 63.6%). Substantial barriers to more harmonious admission processes exist. A 'paradigm shift' where roles and responsibilities are clear might be required. Defusing tension across the ED-inpatient interface should improve efficiency and ensure that patient outcomes remain the focus. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

    Science.gov (United States)

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

    1998-04-01

    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.

  18. Chernobyl accident and its consequences

    Energy Technology Data Exchange (ETDEWEB)

    Gittus, J.H.

    1987-06-01

    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.

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

    Science.gov (United States)

    Stoneking, L R; Waterbrook, A L; Garst Orozco, J; Johnston, D; Bellafiore, A; Davies, C; Nuño, T; Fatás-Cabeza, J; Beita, O; Ng, V; Grall, K H; Adamas-Rappaport, W

    2016-01-01

    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. 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. 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. Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters - 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters - 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians and three (23%) encounters were with UC

  20. 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

    Institute of Scientific and Technical Information of China (English)

    彭佳

    2016-01-01

    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。

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

    Science.gov (United States)

    Spotorno, Angel E

    2005-02-01

    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.

  2. The Practice of Emergency Medicine in Fukuoka City Hospital, A Secondary Emergency Facility in Japan

    OpenAIRE

    Okuyama, Toshiro; Hirakawa, Katsuyuki; Kishikawa, Masanobu; Uchiyama, Hideaki; Kawanaka, Hirofumi; Korenaga, Daisuke; Takenaka, Kenji

    2012-01-01

    Objective : The transition of emergency departments and the current situation of emergency medicine (EM) in Fukuoka City Hospital (FCH) were reviewed. Methods : The data concerning emergency medicine, such as the transition of intra-hospital emergency systems, were obtained from annual reports published in our hospital. Additionally, the data regarding educational programs for emergency room staff, the number of patients taken to the emergency room by ambulances, the activities regarding the ...

  3. Medical Student Performance on the National Board of Medical Examiners Emergency Medicine Advanced Clinical Examination and the National Emergency Medicine M4 Exams

    OpenAIRE

    Hiller, Katherine; House, Joseph; Lawson, Luan; Poznanski, Stacey; Morrissey, Thomas K.

    2015-01-01

    Introduction: In April 2013, the National Board of Medical Examiners (NBME) released an Advanced Clinical Examination (ACE) in emergency medicine (EM). In addition to this new resource, CDEM (Clerkship Directors in EM) provides two online, high-quality, internally validated examinations. National usage statistics are available for all three examinations, however, it is currently unknown how students entering an EM residency perform as compared to the entire national cohort. This information m...

  4. 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

    Institute of Scientific and Technical Information of China (English)

    徐卸古; 甄蓓; 杨晓明; 陈肖华

    2012-01-01

    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.

  5. Electronic Whiteboards in Emergency Medicine

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus

    2012-01-01

    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...

  6. Medical procedures in the event of nuclear power plant accidents. Guidelines for: Medical consultants for emergency response commander; physicians in emergency care centres; physicians in outpatient and inpatient care

    Energy Technology Data Exchange (ETDEWEB)

    Genkel, Simone (ed.)

    2008-07-01

    The author of the contribution under consideration reports on medical procedures in the event of nuclear power plant accidents. This contribution consists of the following sections: protective measures, tasks of radiation protection physicians, emergency care centres. It has been pointed out that differentiation of the hospitals is acquired which accept radiation accident patients. However, only a small number of hospitals will be able to professionally treat patients with suspected gastrointestinal or pronounced (muco)cutaneous type of hospitals with haemotological-oncological departments. Thus they should be able to treat patients who have been exposed to radiation doses between 1 and 6 Gy without any difficulties. Even larger is the number of hospitals which can accept patients who were exposed to a radiation dose of less than 1 Gy, but suffer from other complicating diseases (injuries, general diseases).

  7. Queensland Emergency Medicine Research Foundation: special report.

    Science.gov (United States)

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

    2012-02-01

    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.

  8. Nanotechnology in medicine emerging applications

    CERN Document Server

    Koprowski, Gene

    2014-01-01

    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 natural materials like living tissue.

  9. Nanotechnology in medicine emerging applications

    CERN Document Server

    Koprowski, Gene

    2012-01-01

    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

  10. Setting the educational agenda and curriculum for error prevention in emergency medicine.

    Science.gov (United States)

    Croskerry, P; Wears, R L; Binder, L S

    2000-11-01

    Graduate and postgraduate medical education currently teaches safety in patient care by instilling a deep sense of personal responsibility in student practitioners. To increase safety, medical education will have to begin to introduce new concepts from the "safety sciences," without losing the advantages that the values of commitment and responsibility have gained. There are two related educational goals. First, we in emergency medicine (EM) must develop a group of safety-educated practitioners who can understand and implement safe practice innovations in their clinical settings, and will be instrumental in changing our professional culture. Second, EM must develop a group of teachers and researchers who can begin to deeply understand how safety is maintained in emergency care, develop solutions that will work in emergency department settings, and pass on those insights and innovations. The specifics of what should be taught are outlined briefly. Work is currently ongoing to identify more specifically the core content that should be included in educational programs on patient safety in emergency care. Finally, careful attention will have to be paid to the way in which these principles are taught. It seems unlikely that a series of readings and didactic lectures alone will be effective. The analysis of meaningful cases, perhaps supplemented by high-fidelity simulation, seems to hold promise for more successful education in patient safety.

  11. Newly approved antibiotics and antibiotics reserved for resistant infections: Implications for emergency medicine.

    Science.gov (United States)

    Mazer-Amirshahi, Maryann; Pourmand, Ali; May, Larissa

    2017-01-01

    Millions of patients are evaluated every year in the emergency department (ED) for bacterial infections. Emergency physicians often diagnose and prescribe initial antibiotic therapy for a variety of bacterial infections, ranging from simple urinary tract infections to severe sepsis. In life-threatening infections, inappropriate choice of initial antibiotic has been shown to increase morbidity and mortality. As such, initiation of appropriate antibiotic therapy on the part of the emergency physician is critical. Increasing rates of antibiotic resistance, drug allergies, and antibiotic shortages further complicates the choice of antibiotics. Patients may have a history of prior resistant infections or culture data indicating that common first-line antibiotics used in the ED may be ineffective. In recent years, there have been several new antibiotic approvals as well as renewed interest in second and third line antibiotics because of the aforementioned concerns. In addition, several newly approved antibiotics have the advantage of being administered once weekly or even as a single infusion, which has the potential to decrease hospitalizations and healthcare costs. This article reviews newly approved antibiotics and antibiotics used to treat resistant infections with a focus on implications for emergency medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. A review of existing and emerging digital technologies to combat the global trade in fake medicines.

    Science.gov (United States)

    Mackey, Tim K; Nayyar, Gaurvika

    2017-05-01

    The globalization of the pharmaceutical supply chain has introduced new challenges, chief among them, fighting the international criminal trade in fake medicines. As the manufacture, supply, and distribution of drugs becomes more complex, so does the need for innovative technology-based solutions to protect patients globally. Areas covered: We conducted a multidisciplinary review of the science/health, information technology, computer science, and general academic literature with the aim of identifying cutting-edge existing and emerging 'digital' solutions to combat fake medicines. Our review identified five distinct categories of technology including mobile, radio frequency identification, advanced computational methods, online verification, and blockchain technology. Expert opinion: Digital fake medicine solutions are unifying platforms that integrate different types of anti-counterfeiting technologies as complementary solutions, improve information sharing and data collection, and are designed to overcome existing barriers of adoption and implementation. Investment in this next generation technology is essential to ensure the future security and integrity of the global drug supply chain.

  13. Workplace violence in emergency medicine

    OpenAIRE

    Chatterjee, A.

    2013-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Weiland Tracey J

    2010-11-01

    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.

  15. Approach to Reptile Emergency Medicine.

    Science.gov (United States)

    Long, Simon Y

    2016-05-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Ching-Hsing Lee

    2014-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Petr Štourač

    2014-12-01

    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 (www.akutne.cz is freely accessible, and anyone can find and watch all the videos and presentations there.

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

    Directory of Open Access Journals (Sweden)

    T. Montaser*

    2013-12-01

    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.

  19. 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.

    Science.gov (United States)

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

    2004-03-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Myles Judy

    2009-07-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2004-07-01

    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.

  2. Nitrous oxide in emergency medicine.

    Science.gov (United States)

    O'Sullivan, I; Benger, J

    2003-05-01

    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)

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

    Science.gov (United States)

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

    2014-01-01

    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

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

    Science.gov (United States)

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

    2016-10-01

    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.

  5. Filovirus emergence and vaccine development: a perspective for health care practitioners in travel medicine.

    Science.gov (United States)

    Sarwar, Uzma N; Sitar, Sandra; Ledgerwood, Julie E

    2011-05-01

    Recent case reports of viral hemorrhagic fever in Europe and the United States have raised concerns about the possibility for increased importation of filoviruses to non-endemic areas. This emerging threat is concerning because of the increase in global air travel and the rise of tourism in central and eastern Africa and the greater dispersion of military troops to areas of infectious disease outbreaks. Marburg viruses (MARV) and Ebola viruses (EBOV) have been associated with outbreaks of severe hemorrhagic fever involving high mortality (25-90% case fatality rates). First recognized in 1967 and 1976 respectively, subtypes of MARV and EBOV are the only known viruses of the Filoviridae family, and are among the world's most virulent pathogens. This article focuses on information relevant for health care practitioners in travel medicine to include, the epidemiology and clinical features of filovirus infection and efforts toward development of a filovirus vaccine. Published by Elsevier Ltd.

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

    Science.gov (United States)

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

    2010-10-01

    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.

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

    Science.gov (United States)

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

    2016-10-01

    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.

  8. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis.

    Science.gov (United States)

    Ilgen, Jonathan S; Sherbino, Jonathan; Cook, David A

    2013-02-01

    Technology-enhanced simulation is used frequently in emergency medicine (EM) training programs. Evidence for its effectiveness, however, remains unclear. The objective of this study was to evaluate the effectiveness of technology-enhanced simulation for training in EM and identify instructional design features associated with improved outcomes by conducting a systematic review. The authors systematically searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Original research articles in any language were selected if they compared simulation to no intervention or another educational activity for the purposes of training EM health professionals (including student and practicing physicians, midlevel providers, nurses, and prehospital providers). Reviewers evaluated study quality and abstracted information on learners, instructional design (curricular integration, feedback, repetitive practice, mastery learning), and outcomes. From a collection of 10,903 articles, 85 eligible studies enrolling 6,099 EM learners were identified. Of these, 56 studies compared simulation to no intervention, 12 compared simulation with another form of instruction, and 19 compared two forms of simulation. Effect sizes were pooled using a random-effects model. Heterogeneity among these studies was large (I(2) ≥ 50%). Among studies comparing simulation to no intervention, pooled effect sizes were large (range = 1.13 to 1.48) for knowledge, time, and skills and small to moderate for behaviors with patients (0.62) and patient effects (0.43; all p 0.1). Qualitative comparisons of different simulation curricula are limited, although feedback, mastery learning, and higher fidelity were associated with improved learning outcomes. Technology-enhanced simulation for EM learners is associated with moderate or large favorable effects in comparison with no intervention and generally small and nonsignificant benefits in comparison

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

    Science.gov (United States)

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

    2015-04-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Andrew Lichtenheld

    2015-10-01

    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.

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

    Science.gov (United States)

    Takada, Jun

    2012-03-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Brian Dawson, MD

    2010-05-01

    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.

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

    Science.gov (United States)

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

    2007-11-01

    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.

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

    Science.gov (United States)

    Becker, Steven M

    2013-11-01

    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.

  15. Smartphones and Medical Apps in the Practice of Emergency Medicine in Iran

    Directory of Open Access Journals (Sweden)

    Amirhosein Jahanshir

    2017-01-01

    Full Text Available Introduction: Medical applications help physicians to make more rapid and evidence based decisions that may provide better patient care. This study aimed to determine the extent to which smart phones and medical applications are integrated in the emergency department daily practice.Method: In a cross sectional study, a modified standard questionnaire (Payne et al. consisting of demographic data and information regarding quality and quantity of smartphone and medical app utilization was sent to emergency-medicine residents and interns twice (two weeks apart, in January 2015. The questionnaire was put online using open access "Web-form Module" and the address of the web page was e-mailed along with a cover letter explaining the survey. Finally, responses were analyzed using descriptive statistics and SPSS 22 software.Results: 65 cases participated (response rate 86%. The mean age of interns and residents were 25.03 ± 1.13 and 30.27 ± 4.68 years, respectively (p < 0.001. There was no significant difference between interns and residents in owning a smartphone (p = 0.5. Android was more popular than IOS (67.7% against 25.8% and the most popular medical apps were Medscape and UpToDate, respectively. 38 (61.3% of the respondents were using their apps more than once a day and mostly for drug information. English (83.9%, Persian (12.9%, and other languages (3.2% were preferred languages for designing a medical software among the participants, respectively.Conclusion: The findings of present study showed that smartphones are very popular among Iranian interns and residents in emergency department and a substantial number of them own a smartphone and are using medical apps regularly in their clinical practice. 

  16. Annals of Emergency Medicine Journal Club. Global Emergency Medicine Journal Club: Social media responses to the November 2013 Annals of Emergency Medicine Journal Club.

    Science.gov (United States)

    Radecki, Ryan P; Rezaie, Salim R; Lin, Michelle

    2014-04-01

    The Annals November 2013 Journal Club issue marked one of the first collaborations with Academic Life in Emergency Medicine, a medical education blog, in an effort to promote a worldwide, transparent, online effort to perform critical appraisals of journal articles. The Global Emergency Medicine Journal Club was hosted on the blog for 1 week during November 18 to 24, 2013, with comments moderated on the blog and on Twitter. This summary article compiles the discussion and insights.

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

    Science.gov (United States)

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

    2016-05-01

    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

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

    Science.gov (United States)

    Morikawa, Kentaro; Shimizu, Keiki

    2016-02-01

    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.

  19. Bulgarian Emergency Response System (BERS) in case of nuclear accident with exposure doses estimation

    Energy Technology Data Exchange (ETDEWEB)

    Syrakov, D.; Prodanova, M.; Slavov, K.; Veleva, B.

    2015-07-01

    A PC-oriented Emergency Response System in case of nuclear accident (BERS) is developed and works operationally in the National Institute of Meteorology and Hydrology (NIMH). The creation and development of BERS was highly stimulated by the ETEX (European Tracer Experiment) project. BERS comprises two main parts - the operational and the accidental ones. The operational part, run automatically every 12 hours, prepares the input meteorological file used by both trajectory and dispersion models, runs the trajectory models, visualizes the results and uploads the maps of trajectories to a dedicated web-site. The accidental part is activated manually when a real radioactive releases occur or during emergency exercises. Its core is the Bulgarian dispersion models EMAP. Outputs are concentration, accumulated deposition and selected doses fields. In the paper, the BERS overall structure is described and examples of its products are presented. Key words: nuclear accident, emergency response, early warning system, air dispersion models, radioactive exposure dose. (Author)

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

    Directory of Open Access Journals (Sweden)

    M. Fernanda Bellolio

    2014-09-01

    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

  1. Learning from incidents and accidents

    NARCIS (Netherlands)

    Drupsteen, L.; Kampen, J. van

    2014-01-01

    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

  2. Learning from incidents and accidents

    NARCIS (Netherlands)

    Drupsteen, L.; Kampen, J. van

    2014-01-01

    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

  3. Fatal motorcycle accidents and alcohol

    DEFF Research Database (Denmark)

    Larsen, C F; Hardt-Madsen, M

    1987-01-01

    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...

  4. Pediatric training in emergency medicine residency programs.

    Science.gov (United States)

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

    1982-04-01

    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.

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

    Science.gov (United States)

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

    2011-11-01

    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.

  6. 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

    Institute of Scientific and Technical Information of China (English)

    曾笑

    2014-01-01

    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。

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

    Directory of Open Access Journals (Sweden)

    Majid Shojaee

    2014-09-01

    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

  8. 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.

    Science.gov (United States)

    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

    2015-05-01

    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.

  9. Free Open Access Medical Education resource knowledge and utilisation amongst Emergency Medicine trainees: A survey in four countries

    Directory of Open Access Journals (Sweden)

    Natalie Thurtle

    2016-03-01

    The Emergency Medicine trainees in both developed and low resource settings studied were aware that Free Open Access Medical Education resources exist, but trainees in lower income settings were generally less aware of specific resources. Lack of internet and device access was not a barrier to use in this group.

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

    Science.gov (United States)

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

    2014-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Thoma, Brent

    2015-03-01

    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.

  12. How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?

    Science.gov (United States)

    Smith, Robert J; Kilaru, Austin S; Perrone, Jeanmarie; Paciotti, Breah; Barg, Frances K; Gadsden, Sarah M; Meisel, Zachary F

    2015-06-01

    The prescription opioid epidemic is currently responsible for the greatest number of unintentional deaths in the United States. One potential strategy for decreasing this epidemic is implementation of state-based Prescription Drug Monitoring Programs (PDMPs), which are designed for providers to identify patients who "doctor shop" for prescriptions. Emergency medicine physicians are some of the most frequent PDMP users and opioid prescribers, but little is known about how they actually use PDMPs, for which patients, and for what reasons. We conducted and transcribed semistructured qualitative interviews with 61 physicians at a national academic conference in October 2012. Deidentified transcripts were entered into QSR NVivo 10.0, coded, and analyzed for themes using modified grounded theory. There is variation in pattern and frequency of PDMP access by emergency physicians. Providers rely on both structural characteristics of the PDMP, such as usability, and also their own clinical gestalt impression when deciding to use PDMPs for a given patient encounter. Providers use the information in PDMPs to alter clinical decisions and guide opioid prescribing patterns. Physicians describe alternative uses for the databases, such as improving their ability to facilitate discussions on addiction and provide patient education. PDMPs are used for multiple purposes, including identifying opioid misuse and enhancing provider-patient communication. Given variation in practice, standards may help direct indication and manner of physician use. Steps to minimize administrative barriers to PDMP access are warranted. Finally, alternative PDMP uses should be further studied to determine their appropriateness and potentially expand their role in clinical practice. Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    Gabrielle A. Jacquet

    2013-01-01

    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.

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

    Science.gov (United States)

    Anderson, M

    1997-06-01

    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.

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

    Science.gov (United States)

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

    2008-08-01

    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.

  16. Do emergency medicine journals promote trial registration and adherence to reporting guidelines? A survey of "Instructions for Authors".

    Science.gov (United States)

    Sims, Matthew T; Henning, Nolan M; Wayant, C Cole; Vassar, Matt

    2016-11-24

    The aim of this study was to evaluate the current state of two publication practices, reporting guidelines requirements and clinical trial registration requirements, by analyzing the "Instructions for Authors" of emergency medicine journals. We performed a web-based data abstraction from the "Instructions for Authors" of the 27 Emergency Medicine journals catalogued in the Expanded Science Citation Index of the 2014 Journal Citation Reports and Google Scholar Metrics h5-index to identify whether each journal required, recommended, or made no mention of the following reporting guidelines: EQUATOR Network, ICMJE, ARRIVE, CARE, CONSORT, STARD, TRIPOD, CHEERS, MOOSE, STROBE, COREQ, SRQR, SQUIRE, PRISMA-P, SPIRIT, PRISMA, and QUOROM. We also extracted whether journals required or recommended trial registration. Authors were blinded to one another's ratings until completion of the data validation. Cross-tabulations and descriptive statistics were calculated using IBM SPSS 22. Of the 27 emergency medicine journals, 11 (11/27, 40.7%) did not mention a single guideline within their "Instructions for Authors," while the remaining 16 (16/27, 59.3%) mentioned one or more guidelines. The QUOROM statement and SRQR were not mentioned by any journals whereas the ICMJE guidelines (18/27, 66.7%) and CONSORT statement (15/27, 55.6%) were mentioned most often. Of the 27 emergency medicine journals, 15 (15/27, 55.6%) did not mention trial or review registration, while the remaining 12 (12/27, 44.4%) at least mentioned one of the two. Trial registration through ClinicalTrials.gov was mentioned by seven (7/27, 25.9%) journals while the WHO registry was mentioned by four (4/27, 14.8%). Twelve (12/27, 44.4%) journals mentioned trial registration through any registry platform. The aim of this study was to evaluate the current state of two publication practices, reporting guidelines requirements and clinical trial registration requirements, by analyzing the "Instructions for Authors" of

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

    Science.gov (United States)

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

    2010-01-01

    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.

  18. Relationship between category size and journals' impact factor: implications for emergency medicine journals and researchers.

    Science.gov (United States)

    Miró, Òscar; Brown, Anthony F T; Graham, Colin A; Ducharme, James; Martin-Sanchez, Francisco J; Cone, David C

    2015-10-01

    We assessed the relationship between the size of the 39 Journal Citation Reports (JCR) medical categories and impact factor (IF) of journals in these categories, and the implications that it might have for emergency medicine (EM) journals. Using the 2010 JCR database, we calculated the mean IF, 5-year IF (5y-IF), Eigenfactor (EF), and Article Influence (AI) scores including all journals for each category. We also calculated a 'weighted IF' for all journals by dividing each journal IF by the mean IF of its category. We ranked EM journals according to IF and 'weighted IF' into all the journals included in the 39 categories. We assessed the relationship between category size and bibliometric scores by linear regression. Category size varied from 252 journals (Pharmacology and Pharmacy) to 14 (Primary Healthcare), EM category occupying the 36th position (23 journals). The mean IF of EM category ranked in 34th position, 5-yIF in 32nd, EF in 34th, and AI in 34th position. Category size had a direct and significant association with mean IF, 5y-IF, and AI but not with mean EF. When the EM journals were ranked among all the journals according to their IF, only two (9%) were placed into the first quartile and raised up to eight (35%) when 'weighted IF' was considered. There is a negative relationship between JCR size category and IF achieved by the journals. This places EM journals at a clear disadvantage because they represent one of the smallest clinical medical research disciplines.

  19. Chernobyl accident and its consequences

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-01-01

    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.).

  20. Incidence and mortality of solid cancer among emergency workers of the Chernobyl accident: assessment of radiation risks for the follow-up period of 1992-2009

    Energy Technology Data Exchange (ETDEWEB)

    Kashcheev, V.V.; Chekin, S.Yu.; Maksioutov, M.A.; Tumanov, K.A.; Kochergina, E.V.; Kashcheeva, P.V.; Shchukina, N.V.; Ivanov, V.K. [Russian Ministry of Health, Federal State Institution, Medical Radiological Research Center, Obninsk, Kaluga Region (Russian Federation)

    2015-03-15

    This paper presents the results of a retrospective cohort study of cancer incidence and mortality among emergency workers of the Chernobyl accident, for the follow-up period 1992-2009. The cohort selected for analysis consists of 67,568 emergency workers who worked in the Chernobyl exclusion zone in 1986-1987. External radiation whole-body absorbed dose varied from 0.0001 gray (Gy) to 1.24 Gy, with a median of 0.102 Gy. Over the follow-up period 1992-2009, a total of 4,002 solid cancers of different sites were identified as the result of annual compulsory health examination, and a total of 2,442 deaths from all solid cancers in the study cohort were reported. Poisson regression was applied for the analysis of cancer incidence and mortality. The analysis of the standardized incidence ratio (SIR) has shown a statistically significant increase in cancer incidence in the cohort as compared with baseline cancer incidence among males of Russia. The average excess over the entire follow-up period is 18 % [SIR = 1.18, 95 % confidence interval (CI) 1.15; 1.22]. In contrast, however, no increase in the mortality from all cancers among the emergency workers as compared to the baseline mortality in Russian men was found. Values of excess relative risk of cancer incidence and mortality per 1 Gy (ERR Gy{sup -1}) are 0.47 (95 % CI 0.03; 0.96, p value = 0.034) and 0.58 (95 % CI 0.002; 1.25, p value = 0.049), respectively. These values are statistically significant. (orig.)

  1. Emerging framework of safety management after Fukushima accident

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joo Sang [TUV SUD KOCEN, Yongin (Korea, Republic of); Rawls, Scott [EXCEL, JP (United States)

    2012-10-15

    Since the Fukushima accident onset, concerned organizations and experts have tried to identify the causes and effects of the incident. Many have formulated new national regulatory measures to strengthen nuclear safety in an effort to protect the general public to the extent of probabilistic cases of the most severe or extreme accidents. The Japanese government is set to install a regulatory authority, comparable to the US NRC, which is completely independent from the promotion of nuclear energy. An official report of the National Diet (or Senate) of Japan in June of 2012 laments a lack of safety culture and insists the accident could have been prevented if due consideration and attention had been provided. Both France and other European countries have performed stress tests to their operating units, and have identified many areas for improvement including that of their regulatory framework. The US NRC also conducted special inspections of all operating reactors. In addition, the NRC established both near and long term specific goals, and issued a policy statement for streamlining patch worked regulatory framework. It is also applying the Risk informed Defense in Depth Design which includes the extended design basis requirements. The IAEA General Conference adopted a Nuclear Safety Action Plan in September 2011 and organized an International Expert Meeting in March 2012 in order to analyze all relevant technical aspects from the Japanese incident in order to prevent a reoccurrence. Korea is not an exception to this trend. She was swift to conduct a special inspection of operating reactors and is now implementing many scheduled measures. Numerous facts and insights are now available, not only those gained from the Japanese incident, but also those gleaned from experts worldwide concerning a wide array of information. Therefore, this is an opportunistic time to summarize the insights that have been identified with respect to nuclear safety management and to overview

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

    Directory of Open Access Journals (Sweden)

    Emily L. Aaronson

    2015-10-01

    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.

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

    Science.gov (United States)

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

    2015-01-01

    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

  4. [Emergency treatment of epilepsy with Yamamoto New Scalp Acupuncture (YNSA) and body acupuncture – acupuncture in emergency medicine: a case report].

    Science.gov (United States)

    Schockert, Thomas; Dittmar, Frank; Gleditsch, Jochen M

    2012-01-01

    Worldwide, acupuncture is used in conflict areas and increasingly also as a supportive measure in emergency medicine. In this case, the treatment of epilepsy, masseter cramp, unconsciousness and respiratory arrest by means of YNSA and body acupuncture with only 3 acupuncture needles is described. The 3 points used were YNSA basal ganglia point, Renzhong and Qiangu. After application of the needles, the epileptic fit stopped, the unconscious patient opened his mouth and started breathing spontaneously. In this case, acupuncture simplified the emergency procedure as a supportive treatment method and provided the patient with fast and safe relief.

  5. Emergency medicine: an operations management view.

    Science.gov (United States)

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

    2011-12-01

    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. © 2011 by the Society for Academic Emergency Medicine.

  6. Osteopathic emergency medicine programs infrequently publish in high-impact emergency medicine journals.

    Science.gov (United States)

    Baskin, Sean M; Lin, Christina; Carlson, Jestin N

    2014-11-01

    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. 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. 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. 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.

  7. [Organisation of emergency medicine in France].

    Science.gov (United States)

    Braun, Françis

    2015-01-01

    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. MDCT findings in sports and recreational accidents

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-12-15

    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

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

    Directory of Open Access Journals (Sweden)

    Kiersten L. Gurley

    2016-11-01

    Full Text Available 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

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

    Science.gov (United States)

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

    2016-01-01

    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

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Ho Ting Wong

    2015-08-01

    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.

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

    Science.gov (United States)

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

    2014-10-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Sean M. Baskin

    2014-11-01

    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.

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

    Science.gov (United States)

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

    2015-07-01

    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

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

    Science.gov (United States)

    Mezzich, Juan E

    2011-04-01

    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.

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

    Directory of Open Access Journals (Sweden)

    VanRooyen Michael J

    2005-02-01

    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.

  18. 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.

    Science.gov (United States)

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

    2016-06-01

    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 %.

  19. Nanorobots: The Emerging tools in Medicinal

    Directory of Open Access Journals (Sweden)

    Dron P. Modi

    2013-09-01

    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.

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

    Institute of Scientific and Technical Information of China (English)

    朱亚菲

    2012-01-01

    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.

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

    Science.gov (United States)

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

    2013-04-01

    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.

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

    Science.gov (United States)

    Weber, Ashley; Mills, Lisa

    2010-06-15

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

    Science.gov (United States)

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

    2015-03-01

    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

    Directory of Open Access Journals (Sweden)

    Sergio d'Avila

    2015-03-01

    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.

  5. CAEP 2016 Academic Symposium: How to have an impact as an emergency medicine educator and scholar.

    Science.gov (United States)

    Frank, Jason R; Cheung, Warren J; Sherbino, Jonathan; Primavesi, Robert; Woods, Robert A; Bandiera, Glen; LeBlanc, Constance

    2017-05-01

    In a time of major medical education transformation, emergency medicine (EM) needs to nurture education scholars who will influence EM education practice. However, the essential ingredients to ensure a career with impact in EM education are not clear. To describe how to prepare EM educators for a high-impact career. The Canadian Association of Emergency Physicians (CAEP) Academic Section commissioned an "Education Impact" working group (IWG) to guide the creation of consensus recommendations from the EM community. EM educators from across Canada were initially recruited from the networks of the IWG members, and additional educators were recruited via snowball sampling. "High impact educators" were nominated by this network. The high impact educators were then interviewed using a structured question guide. These interviews were transcribed and coded for themes using qualitative methods. The process continued until no new themes were identified. Proposed themes and recommendations were presented to the EM community at the CAEP 2016 Academic Symposium. Feedback was then incorporated into a final set of recommendations. Fifty-five (71%) of 77 of identified Canadian EM educators participated, and 170 names of high impact educators were submitted and ranked by frequency. The IWG achieved sufficiency of themes after nine interviews. Five recommendations were made: 1) EM educators can pursue a high impact career by leveraging either traditional or innovative career pathways; 2) EM educators starting their education careers should have multiple senior mentors; 3) Early-career EM educators should immerse themselves in their area of interest and cultivate a community of practice, not limited to EM; 4) Every academic EM department and EM teaching site should have access to an EM educator with protected time and recognition for their EM education scholarship; and 5) Educators at all stages should continuously compile an impact portfolio. We describe a unique set of

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

    Science.gov (United States)

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

    2016-06-05

    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.

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

    Science.gov (United States)

    O'Donnell, John C

    2013-01-01

    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

  8. Faculty Mentoring Practices in Academic Emergency Medicine.

    Science.gov (United States)

    Welch, Julie; Sawtelle, Stacy; Cheng, David; Perkins, Tony; Ownbey, Misha; MacNeill, Emily; Hockberger, Robert; Rusyniak, Daniel

    2017-03-01

    Mentoring is considered a fundamental component of career success and satisfaction in academic medicine. However, there is no national standard for faculty mentoring in academic emergency medicine (EM) and a paucity of literature on the subject. The objective was to conduct a descriptive study of faculty mentoring programs and practices in academic departments of EM. An electronic survey instrument was sent to 135 department chairs of EM in the United States. The survey queried faculty demographics, mentoring practices, structure, training, expectations, and outcome measures. Chi-square and Wilcoxon rank-sum tests were used to compare metrics of mentoring effectiveness (i.e., number of publications and National Institutes of Health [NIH] funding) across mentoring variables of interest. Thirty-nine of 135 departments completed the survey, with a heterogeneous mix of faculty classifications. While only 43.6% of departments had formal mentoring programs, many augmented faculty mentoring with project or skills-based mentoring (66.7%), peer mentoring (53.8%), and mentoring committees (18%). Although the majority of departments expected faculty to participate in mentoring relationships, only half offered some form of mentoring training. The mean number of faculty publications per department per year was 52.8, and 11 departments fell within the top 35 NIH-funded EM departments. There was an association between higher levels of perceived mentoring success and both higher NIH funding (p = 0.022) and higher departmental publications rates (p = 0.022). In addition, higher NIH funding was associated with mentoring relationships that were assigned (80%), self-identified (20%), or mixed (22%; p = 0.026). Our findings help to characterize the variability of faculty mentoring in EM, identify opportunities for improvement, and underscore the need to learn from other successful mentoring programs. This study can serve as a basis to share mentoring practices and stimulate

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

    Science.gov (United States)

    Duan, Weili; He, Bin

    2015-07-10

    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.

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

    Directory of Open Access Journals (Sweden)

    Weili Duan

    2015-07-01

    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.

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

    Science.gov (United States)

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

    2016-04-01

    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.

  12. 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

    Institute of Scientific and Technical Information of China (English)

    李晶晶; 朱渊; 陈国明; 李修峰

    2014-01-01

    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。

  13. Emerging trends in antibiotic resistance: Implications for emergency medicine.

    Science.gov (United States)

    Pourmand, Ali; Mazer-Amirshahi, Maryann; Jasani, Gregory; May, Larissa

    2017-08-01

    Many bacteria are demonstrating increasing levels of resistance to commonly used antibiotics. While this has implications for the healthcare system as a whole, many patients infected with these resistant organisms will initially present to the emergency department (ED). The purpose of this review is to provide a summary of current trends in infections caused by the most clinically relevant resistant organisms encountered in emergency medicine. Bacteria were selected based on the Centers for Disease Control and Prevention's National Action Plan for Combating Antibiotic Resistant Bacteria, and PubMed database. The following bacteria were included: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, Escherichia coli, carbapenem-resistant Enterobacteriaceae, Neisseria gonorrhoeae, and Pseudomonas aeruginosa. All have shown increasing rates of resistance to one or more of the antibiotics commonly used to treat them. Increasing rates of antibiotic resistance are associated with worse clinical outcomes and greater healthcare costs. Antibiotic resistance is increasing and poses significant a risk to both the patient and public health as a whole. Appropriate choice of initial antibiotic is important in improving clinical outcomes, which is often the role of the ED provider. On a broader level, the ED must also take part in institutional efforts such as Antibiotic Stewardship Programs, which have been shown to decrease costs and rates of infection with resistant organisms. Ultimately, a multifaceted approach will be required to curb the threat of antibiotic-resistant bacteria. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Shervin Farahmand

    2014-12-01

    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.

  15. The Cost and Burden of the Residency Match in Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Bush, Jeffrey S

    2017-01-01

    Full Text Available To obtain a residency match, medical students entering emergency medicine (EM must complete away rotations, submit a number of lengthy applications, and travel to multiple programs to interview. The expenses incurred acquiring this residency position are burdensome, but there is little specialty-specific data estimating it. We sought to quantify the actual cost spent by medical students applying to EM residency programs by surveying students as they attended a residency interview. Researchers created a 16-item survey, which asked about the time and monetary costs associated with the entire EM residency application process. Applicants chosen to interview for an EM residency position at our institution were invited to complete the survey during their interview day. In total, 66 out of a possible 81 residency applicants (an 81% response rate completed our survey. The “average applicant” who interviewed at our residency program for the 2015-16 cycle completed 1.6 away, or “audition,” rotations, each costing an average of $1,065 to complete. This “average applicant” applied to 42.8 programs, and then attended 13.7 interviews. The cost of interviewing at our program averaged $342 and in total, an average of $8,312 would be spent in the pursuit of an EM residency. Due to multiple factors, the costs of securing an EM residency spot can be expensive. By understanding the components that are driving this trend, we hope that the academic EM community can explore avenues to help curtail these costs.

  16. Emergency Medicine in Remote Regions.

    Science.gov (United States)

    Renouf, Tia; Pollard, Megan

    2016-09-09

    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.

  17. Student-selected component in the medical curriculum: investigations and psychiatric referral for paracetamol overdose in an accident and emergency department

    Directory of Open Access Journals (Sweden)

    Cowman JG

    2017-08-01

    Full Text Available James G Cowman, Manuel Bakheet Royal College of Surgeons in Ireland – Medical University of Bahrain, Manama, Bahrain Background: A student-selected component (SSC of the medical curriculum requires the student to be self-directed in locating and undertaking a placement in a clinical specialty of their choosing and completing a project. The clinical area for experience was an accident and emergency department, and our topic was a focused audit on the investigations and referral for paracetamol overdose. The purpose of this paper is twofold: to reflect on the education value to medical students of an SSC in a medical curriculum, and to highlight learning and understanding through completion of an audit.Materials and methods: An audit approach was applied. The aim of the project study was to investigate the level of compliance with best-practice guidelines for investigations and psychiatric referral in paracetamol overdose.Results: A total of 40 cases meeting the inclusion criteria were randomly selected. The sample had a mean age of 27 years, of whom 70.5% were female, and the ingested dose of paracetamol ranged from 0.864 to 80 g. Paracetamol abuse may present as intentional and unintentional overdose. In our study, 85% of cases were identified as intentional overdose and 76% had a history of psychiatric illness. Generally, medical management was compliant with guidelines, with some minor irregularities. The international normalized ratio was the most underperformed test.Conclusion: Our choice of topic, paracetamol overdose, contributed to our understanding of the breadth of factors to be considered in the emergency medical management of a patient. In this regard, we had the benefit of understanding how the diagnostic and therapeutic factors, when applied in accordance with best-practice guidelines, work very effectively. The SSC impacted positively on our cognitive, personal, and professional development. In facilitating the student with

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

    Science.gov (United States)

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

    2015-03-01

    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.

  19. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...

    Science.gov (United States)

    2011-11-17

    ... 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...

  20. Septic and non-septic olecranon bursitis in the accident and emergency department--an approach to management.

    Science.gov (United States)

    Stell, I M

    1996-01-01

    Olecranon bursitis is relatively common. One third of episodes are septic. Most of the remainder are non-septic, with occasional rheumatological causes. Trauma can cause both septic and non-septic olecranon bursitis. Clinical features are helpful in separating septic from non-septic olecranon bursitis, but there may be local erythema in both. Aspiration should be carried out in all cases, and if the presence of infection is still in doubt, microscopy, Gram staining, and culture of the aspirate will resolve the issue. Septic olecranon bursitis should be treated by aspiration, which may need to be repeated, and a long course of antibiotics. Some cases will need admission, and a few will need surgical treatment. Non-septic olecranon bursitis can be managed with aspiration alone. Non-steroidal anti-inflammatory drugs probably hasten symptomatic improvement. Intrabursal corticosteroids produce a rapid resolution but concern remains over their long term local effects. Recovery from septic olecranon bursitis can take months. PMID:8894865

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

    Science.gov (United States)

    Kerpel-Fronius, Sandor; Rosenkranz, Bernd; Allen, Elizabeth; Bass, Rolf; Mainard, Jacques D; Dodoo, Alex; Dubois, Dominique J; Hela, Mandisa; Kern, Steven; Massud, Joao; Silva, Honorio; Whitty, Jeremy

    2015-01-01

    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 and teaching of medicines development, regulation, and clinical research to Low and Middle Income Countries (LMICs). 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.

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

    Directory of Open Access Journals (Sweden)

    Raoul Breitkreutz

    2013-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Sandor - Kerpel-Fronius

    2015-04-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Grall KH

    2014-07-01

    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

  5. 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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-08-01

    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)

  6. A review of patients presenting to accident and emergency department with deliberate self-harm, KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Josephat O. Ani

    2017-01-01

    Full Text Available Background: The World Health Organization has described deliberate self-harm (DSH as a major global health challenge. Little is known about the profile of patients admitted following DSH at district and regional combo hospitals in KwaZulu-Natal, South Africa.Aim: The aim of this study was to assess the profiles of patients and reasons for admission following DSH.Setting: The study was conducted on data from a busy Accident and Emergency (A&E department in a combination district and regional hospital situated in Empangeni in northern KwaZulu-Natal.Method: This was a retrospective descriptive study. Data were collected from charts of all patients admitted to the A&E department from April 2012 to March 2013 following DSH. Variables assessed included age, gender, race, occupation, religion, education level, coexisting medical and mental health conditions, and reasons for DSH. Data were entered into SPSS and analysed descriptively.Results: A total of 262 charts were identified and 215 (82% were selected for inclusion. Most patients admitted following DSH were young, single African women with at least secondary-level education. Most (169/215;78% admissions were for parasuicide, with relational issues contributing in more than 50% of cases and circumstance challenges contributing in just under 30%.Conclusion: Although an underestimation, DSH is not an uncommon reason for patients to present in the A&E at this district and regional combo hospital. Findings from this study are consistent with those of other studies on DSH and highlight the need for a validated screening tool for the identification of patients at risk of DSH. There is a need to explore community-based intervention, which could address reasons for DSH and prevent future admissions.

  7. A review of patients presenting to accident and emergency department with deliberate self-harm, KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Ani, Josephat O; Ross, Andrew J; Campbell, Laura M

    2017-05-29

    The World Health Organization has described deliberate self-harm (DSH) as a major global health challenge. Little is known about the profile of patients admitted following DSH at district and regional combo hospitals in KwaZulu-Natal, South Africa. The aim of this study was to assess the profiles of patients and reasons for admission following DSH. The study was conducted on data from a busy Accident and Emergency (A&E) department in a combination district and regional hospital situated in Empangeni in northern KwaZulu-Natal. This was a retrospective descriptive study. Data were collected from charts of all patients admitted to the A&E department from April 2012 to March 2013 following DSH. Variables assessed included age, gender, race, occupation, religion, education level, coexisting medical and mental health conditions, and reasons for DSH. Data were entered into SPSS and analysed descriptively. A total of 262 charts were identified and 215 (82%) were selected for inclusion. Most patients admitted following DSH were young, single African women with at least secondary-level education. Most (169/215;78%) admissions were for parasuicide, with relational issues contributing in more than 50% of cases and circumstance challenges contributing in just under 30%. Although an underestimation, DSH is not an uncommon reason for patients to present in the A&E at this district and regional combo hospital. Findings from this study are consistent with those of other studies on DSH and highlight the need for a validated screening tool for the identification of patients at risk of DSH. There is a need to explore community-based intervention, which could address reasons for DSH and prevent future admissions.

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

    Directory of Open Access Journals (Sweden)

    Filomena Pietrantonio

    2016-02-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Wilson Briana

    2011-07-01

    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 http://globalhealth.ennovativesolution.com/ 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

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

    Science.gov (United States)

    2011-01-01

    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 http://globalhealth.ennovativesolution.com/ 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 framework. The process used to

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

    Science.gov (United States)

    Redwood-Campbell, Lynda; Pakes, Barry; Rouleau, Katherine; MacDonald, Colla J; Arya, Neil; Purkey, Eva; Schultz, Karen; Dhatt, Reena; Wilson, Briana; Hadi, Abdullahel; Pottie, Kevin

    2011-07-22

    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. 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. The main outcome was an evidence-informed interactive framework http://globalhealth.ennovativesolution.com/ 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. 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 framework. The process used to develop this framework can be applied

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

    Directory of Open Access Journals (Sweden)

    Dustin Smith, MD

    2016-03-01

    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

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

    Directory of Open Access Journals (Sweden)

    Erin Dehon

    2015-11-01

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Road characteristics and bicycle accidents.

    Science.gov (United States)

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

    1996-12-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Daniel J. Kim

    2014-05-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-15

    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.)

  18. Occupational burnout levels in emergency medicine--a nationwide study and analysis.

    Science.gov (United States)

    Popa, Florian; Raed, Arafat; Purcarea, Victor Lorin; Lală, Adrian; Bobirnac, George

    2010-01-01

    The specificity of the emergency medical act strongly manifests itself on account of a wide series of psycho-traumatizing factors augmented both by the vulnerable situation of the patient and the paroxysmal state of the act. Also, it has been recognized that the physical solicitation and distress levels are the highest among all medical specialties, this being a valuable marker for establishing the quality of the medical act. We have surveyed a total of 4725 emergency medical workers with the MBI-HSS instrument, receiving 4693 valid surveys (99.32% response rate). Professional categories included Emergency Department doctors (M-EMD), ambulance doctors (M-AMB), ED doctors with field work in emergency and resuscitation (including mobile intensive care units and airborne intensive care units) (D-SMU), medical nurses in Emergency Departments (N-EMD), medical nurses in the ambulance service (N-AMB), ED medical nurses with field activity in emergency and resuscitation (N-SMU), ambulance drivers (DRV) and paramedic (EMT). The n values for every category of subjects and percentage of system coverage (table 3) shows that we have covered an estimated total of 29.94% of the Romanian emergency medical field workers. MBI-HSS results show a moderate to high level of occupational stress for the surveyed subjects. The average values for the three parameters, corresponding to the entire Romanian emergency medical field were 1.41 for EE, 0.99 for DP and 4.47 for PA (95% CI). Average results stratified by professional category show higher EE average values (v) for the M-SMU (v=2.01, 95%CI) and M-EMD (v=2.21, 95% CI) groups corresponding to higher DP values for the same groups (vM-EMD=1.41 and vM-SMU=1.22, 95% CI). PA values for these groups are below average, corresponding to an increased risk factor for high degrees of burnout. Calculated PA values are 4.30 for the M-EMD group and 4.20 for the M-SMU group. Of all surveyed groups, our study shows a high risk of burnout consisting of

  19. Can emergency medicine research benefit from adaptive design clinical trials?

    Science.gov (United States)

    Flight, Laura; Julious, Steven A; Goodacre, Steve

    2017-04-01

    Adaptive design clinical trials use preplanned interim analyses to determine whether studies should be stopped or modified before recruitment is complete. Emergency medicine trials are well suited to these designs as many have a short time to primary outcome relative to the length of recruitment. We hypothesised that the majority of published emergency medicine trials have the potential to use a simple adaptive trial design. We reviewed clinical trials published in three emergency medicine journals between January 2003 and December 2013. We determined the proportion that used an adaptive design as well as the proportion that could have used a simple adaptive design based on the time to primary outcome and length of recruitment. Only 19 of 188 trials included in the review were considered to have used an adaptive trial design. A total of 154/165 trials that were fixed in design had the potential to use an adaptive design. Currently, there seems to be limited uptake in the use of adaptive trial designs in emergency medicine despite their potential benefits to save time and resources. Failing to take advantage of adaptive designs could be costly to patients and research. It is recommended that where practical and logistical considerations allow, adaptive designs should be used for all emergency medicine clinical trials. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

    Science.gov (United States)

    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

    2014-12-01

    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

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

    Science.gov (United States)

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

    2013-11-01

    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.

  2. Heterogeneity of Health Profiles of Older People Presenting to an Accident and Emergency Department With a Fall

    Directory of Open Access Journals (Sweden)

    Pui-Yee Yeung

    2009-09-01

    Conclusion: Older people presenting with falls at the A&E have multiple health problems and varying degrees of frailty. A homogeneous management pathway may not be appropriate, but rather, the approach should be in the context of management of the frailty syndrome, requiring an individualized approach and taking into account the heterogeneity of their health profile.

  3. Partnered medication review and charting between the pharmacist and medical officer in the Emergency Short Stay and General Medicine Unit.

    Science.gov (United States)

    Tong, Erica Y; Roman, Cristina P; Smit, De Villiers; Newnham, Harvey; Galbraith, Kirsten; Dooley, Michael J

    2015-08-01

    A partnered medication review and charting model involving a pharmacist and medical officer was implemented in the Emergency Short Stay Unit and General Medicine Unit of a major tertiary hospital. The aim of the study was to describe the safety and effectiveness of partnered medication charting in this setting. A partnered medication review and charting model was developed. Credentialed pharmacists charted pre-admission medications and venous thromboembolism prophylaxis in collaboration with the admitting medical officer. The pharmacist subsequently had a clinical discussion with the treating nurse regarding the medication management plan for the patient. A prospective audit was undertaken of all patients from the initiation of the service. A total of 549 patients had medications charted by a pharmacist from the 14th of November 2012 to the 30th of April 2013. A total of 4765 medications were charted by pharmacists with 7 identified errors, corresponding to an error rate of 1.47 per 1000 medications charted. Partnered medication review and charting by a pharmacist in the Emergency Short Stay and General Medicine unit is achievable, safe and effective. Benefits from the model extend beyond the pharmacist charting the medications, with clinical value added to the admission process through early collaboration with the medical officer. Further research is required to provide evidence to further support this collaborative model. Copyright © 2015. Published by Elsevier Ltd.

  4. Back to basics: emergency medicine in dentistry.

    Science.gov (United States)

    Malamed, S F

    1997-04-01

    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.

  5. Can the critically ill consent to participation in commercial television programmes? An Australian prehospital and emergency medicine perspective.

    Science.gov (United States)

    Mackenney, Jonathan N

    2015-08-01

    The fly-on-the-wall medical documentary is a popular television phenomenon. When patients can give appropriate consent to filming, the final product can be both educational for the public and rewarding for its subjects. However, in the dynamic world of emergency and prehospital medicine, consenting critically ill patients before filming is a significant challenge. The main barriers to gaining valid consent in the field and in the ED are limited time to inform the patient and the diminished capacity of the sick patient. Although there is an argument that involvement in a commercial film might be beneficial to several parties, including the patient, these benefits do not amount to therapeutic necessity if prior consent is not obtainable. Despite this, we still see acutely incapacitated patients featured in some television programmes. In these cases, the conventional process of consent might be being sidestepped in order to obtain permission for broadcast retrospectively. This alternative process fails to recognise that incapacitated patients require protection from an invasion of privacy that occurs when a crew is filming their resuscitations. This harm has already occurred by the time consent is sought. Ultimate responsibility for defending the patients' interests during their medical treatment rests with the medical practitioner. We argue that filming a patient without prior consent in both the prehospital and emergency environment is ethically unsound: it threatens trust in the healthcare relationship and might compromise the patient's dignity and privacy. Robust guidelines should be developed for all healthcare professionals who engage with commercial film crews. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

    Science.gov (United States)

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

    2015-01-01

    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.

  7. A Survey Assessment of Perceived Importance and Methods of Maintenance of Critical Procedural Skills in Pediatric Emergency Medicine.

    Science.gov (United States)

    Mittiga, Matthew R; FitzGerald, Michael R; Kerrey, Benjamin T

    2016-12-12

    The aim of this study was to delineate pediatric emergency medicine provider opinions regarding the importance of, and to ascertain existing processes by which practitioners maintain, the following critical procedural skills: oral endotracheal intubation, intraosseous line placement, pharmacologic and electrical cardioversion, tube thoracostomy, and defibrillation. A customized survey was administered to all members of the Listserv for the American Academy of Pediatrics Section on Emergency Medicine. Perceived importance of maintaining critical pediatric procedural skills was measured using a 5-point Likert-type scale. Secondary outcomes included presence and type of mandatory training, availability of on-site backup, and perceived barriers to maintenance of skills. Two hundred sixty-two members (25%) responded representing 106 different institutions, 70% of freestanding children's hospitals that received graduate medical education payments in 2014, and 68% of pediatric emergency medicine fellowship programs. More than 90% of respondents felt it was either very or extremely important to maintain competency for 5 of the 6 critical procedures, but no more than 49% of respondents felt that clinical care alone provided opportunity to maintain skills. The proportion of respondents indicating no mandatory training for each critical procedural skill was as follows: oral endotracheal intubation (23%), intraosseous line placement (30%), pharmacologic cardioversion (32%), electrical cardioversion (32%), tube thoracostomy (40%), and defibrillation (32%). Critical procedural skills are perceived by emergency providers who care for children as extremely important to maintain. Direct care of pediatric patients likely does not provide sufficient opportunity to maintain these skills. There are widespread deficiencies relating to mandatory maintenance of critical procedural skill training.

  8. Crime, accidents and social control

    NARCIS (Netherlands)

    Junger, Marianne; Terlouw, Gert-Jan; van der Heijden, Peter G.M.

    1995-01-01

    This paper addresses to questions. (1) Is there a demonstrable relation between accidents and crime, does this relation hold for each type of crime and each means of transport, and does it subsist after controlling for age and gender? (2) Can social control theory explain involvements in both

  9. The Development of Best Practice Recommendations to Support the Hiring, Recruitment, and Advancement of Women Physicians in Emergency Medicine.

    Science.gov (United States)

    Choo, Esther K; Kass, Dara; Westergaard, Mary; Watts, Susan H; Berwald, Nicole; Regan, Linda; Promes, Susan B; Clem, Kathleen J; Schneider, Sandra M; Kuhn, Gloria J; Abbuhl, Stephanie; Nobay, Flavia

    2016-11-01

    Women in medicine continue to experience disparities in earnings, promotion, and leadership roles. There are few guidelines in place defining organization-level factors that promote a supportive workplace environment beneficial to women in emergency medicine (EM). We assembled a working group with the goal of developing specific and feasible recommendations to support women's professional development in both community and academic EM settings. We formed a working group from the leadership of two EM women's organizations, the Academy of Women in Academic Emergency Medicine (AWAEM) and the American Association of Women Emergency Physicians (AAWEP). Through a literature search and discussion, working group members identified four domains where organizational policies and practices supportive of women were needed: 1) global approaches to supporting the recruitment, retention, and advancement of women in EM; 2) recruitment, hiring, and compensation of women emergency physicians; 3) supporting development and advancement of women in EM; and 4) physician health and wellness (in the context of pregnancy, childbirth, and maternity leave). Within each of these domains, the working group created an initial set of specific recommendations. The working group then recruited a stakeholder group of EM physician leaders across the country, selecting for diversity in practice setting, geographic location, age, race, and gender. Stakeholders were asked to score and provide feedback on each of the recommendations. Specific recommendations were retained by the working group if they achieved high rates of approval from the stakeholder group for importance and perceived feasibility. Those with >80% agreement on importance and >50% agreement on feasibility were retained. Finally, recommendations were posted in an open online forum (blog) and invited public commentary. An initial set of 29 potential recommendations was created by the working group. After stakeholder voting and feedback, 16

  10. Evolution of the Model of the Clinical Practice of Emergency Medicine: 1979 to Present.

    Science.gov (United States)

    Counselman, Francis L; Beeson, Michael S; Marco, Catherine A; Adsit, Susan K; Harvey, Anne L; Keehbauch, Julia N

    2017-02-01

    The Model of the Clinical Practice of Emergency Medicine (the EM Model) is a three-dimensional representation of the clinical practice of emergency medicine. It is a product of successful collaboration involving the American Board of Emergency Medicine (ABEM), the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), the Emergency Medicine Residents' Association (EMRA), the Council of Emergency Medicine Residency Directors (CORD), the Residency Review Committee for Emergency Medicine (RRC-EM), and the American Academy of Emergency Medicine (AAEM). In 2017, the most recent update and revision of the EM Model will be published. This document will represent the culmination of nearly 40 years of evolution, from a simple listing of presenting patient complaints, clinical symptoms, and disease states into a three-dimensional representation of the clinical practice of emergency medicine. These dimensions include conditions and components, physician tasks, and patient acuity. In addition, over the years, two other documents have been developed, the Knowledge, Skills, and Abilities (KSAs) and the Emergency Medicine Milestones. Both serve as related and complementary educational and assessment tools. This article will review the development of the EM Model from its inception in 1979 to today. © 2016 by the Society for Academic Emergency Medicine.

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

    Directory of Open Access Journals (Sweden)

    Waterbrook AL

    2016-04-01

    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

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

    Directory of Open Access Journals (Sweden)

    Vijay C. Kannan

    2016-03-01

    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.

  13. Society for Academic Emergency Medicine Statement on Plagiarism.

    Science.gov (United States)

    Asher, Shellie L; Iserson, Kenneth V; Merck, Lisa H

    2017-06-19

    The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine (SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications. © 2017 by the Society for Academic Emergency Medicine.

  14. Print Me an Organ? Ethical and Regulatory Issues Emerging from 3D Bioprinting in Medicine.

    Science.gov (United States)

    Gilbert, Frederic; O'Connell, Cathal D; Mladenovska, Tajanka; Dodds, Susan

    2017-02-09

    Recent developments of three-dimensional printing of biomaterials (3D bioprinting) in medicine have been portrayed as demonstrating the potential to transform some medical treatments, including providing new responses to organ damage or organ failure. However, beyond the hype and before 3D bioprinted organs are ready to be transplanted into humans, several important ethical concerns and regulatory questions need to be addressed. This article starts by raising general ethical concerns associated with the use of bioprinting in medicine, then it focuses on more particular ethical issues related to experimental testing on humans, and the lack of current international regulatory directives to guide these experiments. Accordingly, this article (1) considers whether there is a limit as to what should be bioprinted in medicine; (2) examines key risks of significant harm associated with testing 3D bioprinting for humans; (3) investigates the clinical trial paradigm used to test 3D bioprinting; (4) analyses ethical questions of irreversibility, loss of treatment opportunity and replicability; (5) explores the current lack of a specific framework for the regulation and testing of 3D bioprinting treatments.

  15. [Lightning strikes and lightning injuries in prehospital emergency medicine. Relevance, results, and practical implications].

    Science.gov (United States)

    Hinkelbein, J; Spelten, O; Wetsch, W A

    2013-01-01

    Up to 32.2% of patients in a burn center suffer from electrical injuries. Of these patients, 2-4% present with lightning injuries. In Germany, approximately 50 people per year are injured by a lightning strike and 3-7 fatally. Typically, people involved in outdoor activities are endangered and affected. A lightning strike usually produces significantly higher energy doses as compared to those in common electrical injuries. Therefore, injury patterns vary significantly. Especially in high voltage injuries and lightning injuries, internal injuries are of special importance. Mortality ranges between 10 and 30% after a lightning strike. Emergency medical treatment is similar to common electrical injuries. Patients with lightning injuries should be transported to a regional or supraregional trauma center. In 15% of all cases multiple people may be injured. Therefore, it is of outstanding importance to create emergency plans and evacuation plans in good time for mass gatherings endangered by possible lightning.

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

    Directory of Open Access Journals (Sweden)

    Shaw Nicola

    2009-09-01

    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.

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

    Science.gov (United States)

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

    2016-08-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Zhiyu Wang

    2012-01-01

    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.

  19. Effectiveness of emergency medicine in longitudinal integrated clerkships

    OpenAIRE

    Banh, Kenny; Ramirez, Rene; Thabit, Christina

    2014-01-01

    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. ...

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

    Science.gov (United States)

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

    2015-11-01

    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.

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

    Science.gov (United States)

    Carne, Belinda; Kennedy, Marcus; Gray, Tim

    2012-02-01

    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.

  2. Barriers to learning from incidents and accidents

    NARCIS (Netherlands)

    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.

    2015-01-01

    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

  3. Exclusion of Non-English Speakers in Published Emergency Medicine Research - A Comparison of 2004 and 2014.

    Science.gov (United States)

    Brodeur, Michael; Herrick, John; Guardioloa, Jose; Richman, Peter

    2017-06-01

    Non-English speakers (NES) as a proportion of the United States population have steadily increased in recent years. There remains substantial risk of excluding NES from research. To assess whether the percentage of emergency medicine (EM) studies that exclude Non-English speakers from participation has changed with time. In a structured fashion, the lead investigator analyzed all original research articles in Academic Emergency Medicine and Annals of Emergency Medicine retrospectively for 2004 and prospectively for 2014. An independent investigator conducted a blind review of a sample of articles to assess for interobserver agreement. Demographic data were analyzed using descriptive statistics. Chi-square, t-tests, and linear regression models were utilized; alpha set at 0.05. Cohen's kappa calculated to assess interrater reliability. We included a total of 236 original research articles. Overall, 11% excluded NES from research (10% AEM, 12% Annals). Cohen's kappa (nonweighted) was 0.73. Comparing all articles in 2004 vs. 2014, research excluded NES 6% vs. 16% of the time respectively (P=0.02). This was not statistically significant when comparing year to year for AEM (7.3% vs. 14.5%; P=0.12) and Annals (6.7% vs. 19%; P=0.06) separately. Factors affecting NES exclusion included type of study design (P<0.001), geographic area (P=0.009) and hospital type (P=0.035). Interestingly, 42% of articles failed to mention language as an exclusion or inclusion criteria. We found that the percentage of articles excluding NES from EM research increased between 2004 and 20014. Further, many investigators do not report whether NES are excluded/included in their studies.

  4. Intersection layout, traffic volumes and accidents.

    NARCIS (Netherlands)

    Poppe, F.

    1988-01-01

    This paper reports on the accident research carried out as a part of a large project started in 1983. For this accident research an inventory was made of a large number of intersections.Recorded were layout features, accident data and estimates of traffic volumes. Attention will be given to the

  5. 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

    Institute of Scientific and Technical Information of China (English)

    李峰; 储胜利; 程宗华

    2014-01-01

    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。

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

    NARCIS (Netherlands)

    Boenink, Marianne

    2009-01-01

    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

  7. Tensions and opportunities in convergence: Shifting concepts of disease in emerging molecular medicine.

    NARCIS (Netherlands)

    Boenink, Marianne

    2009-01-01

    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

  8. Identifying inaccuracies on emergency medicine residency applications

    Directory of Open Access Journals (Sweden)

    Evans Timothy

    2005-08-01

    Full Text Available Abstract Background Previous trials have showed a 10–30% rate of inaccuracies on applications to individual residency programs. No studies have attempted to corroborate this on a national level. Attempts by residency programs to diminish the frequency of inaccuracies on applications have not been reported. We seek to clarify the national incidence of inaccuracies on applications to emergency medicine residency programs. Methods This is a multi-center, single-blinded, randomized, cohort study of all applicants from LCME accredited schools to involved EM residency programs. Applications were randomly selected to investigate claims of AOA election, advanced degrees and publications. Errors were reported to applicants' deans and the NRMP. Results Nine residencies reviewed 493 applications (28.6% of all applicants who applied to any EM program. 56 applications (11.4%, 95%CI 8.6–14.2% contained at least one error. Excluding "benign" errors, 9.8% (95% CI 7.2–12.4%, contained at least one error. 41% (95% CI 35.0–47.0% of all publications contained an error. All AOA membership claims were verified, but 13.7% (95%CI 4.4–23.1% of claimed advanced degrees were inaccurate. Inter-rater reliability of evaluations was good. Investigators were reluctant to notify applicants' dean's offices and the NRMP. Conclusion This is the largest study to date of accuracy on application for residency and the first such multi-centered trial. High rates of incorrect data were found on applications. This data will serve as a baseline for future years of the project, with emphasis on reporting inaccuracies and warning applicants of the project's goals.

  9. Risk Assessment for Emergency Planning Related to Nuclear Weapons Accidents

    Science.gov (United States)

    1985-09-25

    agencies for handling emergencies (e.g., police , ambulance , medical, hospital, and fire-fighting organ zations should be specified). The facility...emerganey aczions, Including protective mesures . 1. Request for any needed on-site support by off-site organizations. a. Prognosis for worsening cr...decontamination. f. Providing ambulance servlce. S. Providing medical treatment services. 2. Each organization should establish a radiation protection program

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

    Science.gov (United States)

    Petrov, A.; Petrova, D.

    2016-08-01

    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.

  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

    Institute of Scientific and Technical Information of China (English)

    邢娟娟

    2011-01-01

    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. Exploring the value of technology to stimulate interprofessional discussion and education: a needs assessment of emergency medicine professionals.

    Science.gov (United States)

    Riley, Jennifer; McGowan, Melissa; Rozmovits, Linda

    2014-06-30

    The emergency department (ED) is an environment fraught with increasing patient volumes, competing priorities, fluctuating information, and ad hoc interprofessional clinical teams. Limited time is available to reflect on and discuss clinical experiences, policies, or research with others on the involved team. Online resources, such as webcasts and blogs, offer an accessible platform for emergency shift workers to engage in interprofessional discussion and education. Our objective was to explore the current opportunities for shared learning and discussion and to discover the potential of online resources to foster and facilitate interprofessional education within an academic tertiary emergency department community. A qualitative study using semistructured interviews was conducted to solicit participants' views of the current culture of IPE in the ED, the potential value of introducing new online resources and technology in support of IPE, and possible barriers to uptake. Participation was voluntary and participants provided verbal informed consent. Online resources discussed included webcasts, interactive discussion forums, websites, and dashboard with links to central repositories. Identified barriers to uptake of new online resources were an unwillingness to "work" off-shift, a dislike of static one-directional communication, concerns with confidentiality, and the suggestion that new resources would be used by only a select few. Owing to the sensitive dynamics of emergency medicine-and the preference among its professional staff to foster interprofessional discussion and education through personal engagement, in an unhurried, non-stressful environment-introducing and investing in online resources should be undertaken with caution.

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

    Directory of Open Access Journals (Sweden)

    Mohammad Heidari

    2016-01-01

    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.

  14. Bulgarian Emergency Response System (BERS) in case of nuclear accident with exposure doses’estimation

    Energy Technology Data Exchange (ETDEWEB)

    Syrakov, M.; Prodanova, M.; Slavov, K.; Veleva, B.

    2015-07-01

    A PC-oriented Emergency Response System in case of nuclear accident (BERS) is developed and works operationally in the National Institute of Meteorology and Hydrology (NIMH). The creation and development of BERS was highly stimulated by the ETEX (European Tracer Experiment) project. BERS comprises two main parts - the operational and the accidental ones. The operational part, run automatically every 12 hours, prepares the input meteorological file used by both trajectory and dispersion models, runs the trajectory models, visualizes the results and uploads the maps of trajectories to a dedicated web-site. The accidental part is activated manually when a real radioactive releases occur or during emergency exercises. Its core is the Bulgarian dispersion models EMAP. Outputs are concentration, accumulated deposition and selected doses fields. In the paper, the BERS overall structure is described and examples of its products are presented. (Author)

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

    Science.gov (United States)

    Zelder, Felix; Zhou, Kai; Sonnay, Marjorie

    2013-01-28

    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.

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

    Science.gov (United States)

    Heidari, Mohammad; Ebrahimi, Parvin

    2016-10-01

    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. 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. 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 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.

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

    OpenAIRE

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

    2015-01-01

    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 ...

  18. An eMERGE Clinical Center at Partners Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Jordan W. Smoller

    2016-01-01

    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.

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

    Science.gov (United States)

    Chai, Xing-yun

    2015-07-01

    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.

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

    Science.gov (United States)

    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

    2016-01-01

    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

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

    Science.gov (United States)

    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

    2016-01-01

    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

  2. Systematic Molecular Phenotyping: A Path Toward Precision Emergency Medicine?

    Science.gov (United States)

    Limkakeng, Alexander T; Monte, Andrew A; Kabrhel, Christopher; Puskarich, Michael; Heitsch, Laura; Tsalik, Ephraim L; Shapiro, Nathan I

    2016-10-01

    Precision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in analytical techniques have made it possible to characterize patients in a more comprehensive and sophisticated fashion at the molecular level, promising highly individualized diagnosis and treatment. Among these techniques are various systematic molecular phenotyping analyses (e.g., genomics, transcriptomics, proteomics, and metabolomics). Although a number of emergency physicians use such techniques in their research, widespread discussion of these approaches has been lacking in the emergency care literature and many emergency physicians may be unfamiliar with them. In this article, we briefly review the underpinnings of such studies, note how they already impact acute care, discuss areas in which they might soon be applied, and identify challenges in translation to the emergency department (ED). While such techniques hold much promise, it is unclear whether the obstacles to translating their findings to the ED will be overcome in the near future. Such obstacles include validation, cost, turnaround time, user interface, decision support, standardization, and adoption by end-users. © 2016 by the Society for Academic Emergency Medicine.

  3. The practice of emergency medicine in Fukuoka City Hospital, a secondary emergency facility in Japan.

    Science.gov (United States)

    Okuyama, Toshiro; Hirakawa, Katsuyuki; Kishikawa, Masanobu; Uchiyama, Hideaki; Kawanaka, Hirofumi; Korenaga, Daisuke; Takenaka, Kenji

    2012-12-01

    The transition of emergency departments and the current situation of emergency medicine (EM) in Fukuoka City Hospital (FCH) were reviewed. The data concerning emergency medicine, such as the transition of intra-hospital emergency systems, were obtained from annual reports published in our hospital. Additionally, the data regarding educational programs for emergency room staff, the number of patients taken to the emergency room by ambulances, the activities regarding the Fukuoka Medical Rally (FMR) and the disaster relief team (DRT) were also reviewed and analyzed. Departments of neurology, neurosurgery, emergency, and cardiology were opened sequentially, starting in 2003, with an establishment of facilities of an emergency room (ER), intensive care unit (ICU), stroke care unit (SCU), and coronary care unit (CCU). Regarding educational programs, lectures and demonstrations on basic and advanced life support techniques were given to all staff annually starting in 2004, and resident doctors completed rotations in the ER and the ICU for three months. FCH staff consistently obtained excellent results at the FMR. Ambulance crews attended lectures and received training on EM and intra-tracheal intubation. The numbers of patients taken by ambulance to FCH increased from 129 in 2002 to 2,316 in 2011. The DRT was dispatched to respond to disasters that occurred in Japan. As a secondary emergency hospital, FCH has developed a system to accept emergency patients. This project will contribute to the improvement of the EM system in the area.

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

    Science.gov (United States)

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

    2015-01-01

    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

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

    Science.gov (United States)

    Ballmer, F T; Jakob, R P

    1989-12-01

    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.

  6. Acidentes e violência na infância: evidências do inquérito sobre atendimentos de emergência por causas externas - Brasil, 2009 Accidents and violence in childhood: survey evidence of emergency care for external causes - Brazil, 2009

    Directory of Open Access Journals (Sweden)

    Deborah Carvalho Malta

    2012-09-01

    Full Text Available Compreender as características e a magnitude das causas externas (acidentes e violência em crianças de 0 a 9 anos de idade torna-se cada vez mais importante em Saúde Pública. O objetivo do presente artigo foi analisar os atendimentos de emergência por causas externas em crianças. Utilizaram-se dados do Sistema de Vigilância de Violências e Acidentes em Serviços Sentinelas de Urgência e Emergência (Inquérito VIVA, realizado em 74 serviços de urgência do Distrito Federal e 23 capitais no ano 2009. Analisaram-se dados de 7.123 crianças: 6.897 (96,7% vítimas de acidentes e 226 (3,3% de violência. Em comparação às vítimas de violência, os atendimentos por acidentes foram mais frequentes entre crianças de 2 a 5 anos, de pele branca e ocorridos no domicílio (p Understanding the characteristics and magnitude of accidents and violence due to external causes in children from 0 to 9 years of age is becoming ever more important in Public Health. The scope of this paper was to analyze emergency care for accidents due to external causes in children. The Sentinel Urgency and Emergency Services of the Violence and Accident Vigilance System (VIVA Survey, performed in 74 urgency services in the Federal District and 23 State capitals in 2009 was used. Data of 7,123 children were analyzed: 6,897 (96.7% victims of accidents and 226 (3.3% of violence. In comparison with victims of violence, the visits for accidents were more frequent among white children from 2 to 5 years old occurring in the home (p < 0.05. Among the accidents, falls and burns predominated in the 0 to 1group, while traffic accidents were most frequent in the 6 to 9-year-old age group (p < 0.001. With respect to violence, the visits for neglect and physical assault predominated, respectively, in extreme age groups, with someone in the family being the perpetrator (p < 0.001. Information on the occurrence of external causes in children may support health promotion policies

  7. The Patient Protection and Affordable Care Act's Effect on Emergency Medicine: A Synthesis of the Data.

    Science.gov (United States)

    Medford-Davis, Laura N; Eswaran, Vidya; Shah, Rohan M; Dark, Cedric

    2015-11-01

    This review synthesizes the existing literature to provide evidence-based predictions for the future of emergency care in the United States as a result of the Patient Protection and Affordable Care Act, with a focus on emergency department (ED) visit volume, acuity, and reimbursement. Patient behavior will likely be quite different for patients gaining Medicaid than for those gaining private insurance through the Marketplaces. Despite the threat of the individual mandate, not all uninsured patients will enroll, and those who choose to enroll will likely be a different population from those who remain uninsured. New Medicaid enrollees will be a sicker population and will likely increase their number of ED visits substantially. Their acuity will be higher at first but will then revert to the traditionally high number of low-acuity visits made by Medicaid patients. Most patients enrolling through the Marketplace are choosing high-deductible health plans, and they will initially avoid the ED because of high out-of-pocket costs but may present later and sicker after self-rationing their care. Most patients gaining health coverage through the Affordable Care Act will be shifting from uninsured to either Medicaid or private insurance, both of which reimburse more than self-pay, so ED collections should increase. Because of the differences between Medicaid and Marketplace plans, there will be a difference in ED volume, acuity, and financial outcomes, depending on states' current demographics, whether states expand Medicaid, and how aggressively states advertise new options for coverage in Medicaid or state health insurance Marketplaces. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  8. Authority structure and industrial accidents

    NARCIS (Netherlands)

    As, Sicco van

    2001-01-01

    This paper deals with the influence of organizational characteristics on safety. Accidents are actually caused by individual mistakes. However the underlying causes of accidents are often organizational. The general hypothesis is that the authority structure is a main cause of accident-proneness

  9. Drug use and the severity of a traffic accident

    NARCIS (Netherlands)

    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

  10. Drug use and the severity of a traffic accident

    NARCIS (Netherlands)

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

    2005-01-01

    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

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

    Science.gov (United States)

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

    2016-03-01

    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.

  12. Acidentes e violências: caracterização dos atendimentos no pronto-socorro de um hospital universitário Accidents and violence: characteristics of the medical cares in the emergency room's university hospital

    Directory of Open Access Journals (Sweden)

    José Luís Guedes dos Santos

    2008-09-01

    Full Text Available Este artigo, de caráter exploratório-descritivo, tem como objetivo caracterizar os atendimentos por acidentes e violências realizados no pronto-socorro de um hospital universitário localizado no interior do Rio Grande do Sul (RS. Os dados foram obtidos a partir dos registros de um sistema de vigilância, denominado "Observatório de Acidentes e Violência", existente nos serviços de urgência e emergência no RS, que atuam como sentinela desses agravos. Os resultados mostraram que os adultos jovens, com baixo nível de instrução e não-trabalhadores são as principais vítimas de acidentes e violências. Quanto ao tipo de ocorrência, destacaram-se os acidentes de trânsito e acidentes domésticos, gerando como agravos mais constantes ferimentos na cabeça e fraturas de fêmur. Com relação ao sexo, embora para alguns tipos de acidentes e violências a predominância tenha variado entre eles, o conjunto dos dados mostrou maior vulnerabilidade masculina, em especial nos casos de violência interpessoal. Nesse sentido, as consequências dos acidentes e violências para o sistema de saúde e para a sociedade apontam a necessidade de aprimoramento dos sistemas de informações de morbimortalidade por causas externas, visando subsidiar políticas públicas de prevenção e melhoria no atendimento às vítimas.This article, of an exploratory-descriptive character, aims to characterize the medical care provided in cases of accidents and violence in the emergency room of a university hospital, located in the interior of the state of Rio Grande do Sul (RS. The data were obtained from the registers of a monitoring system called "Observatório de Acidentes e Violência" (Observatory of Accidents and Violence, which exists in the urgency and emergency services in RS and acts as a sentry of these injuries. The results showed that young adults who are non-workers and have low schooling are the main victims of accidents and violence. The most frequent

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

    Science.gov (United States)

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

    2016-05-01

    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.

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

    Science.gov (United States)

    Blomström, Anne-Lie

    2011-09-01

    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.

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

    Science.gov (United States)

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

    2015-06-01

    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.

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

    Science.gov (United States)

    Mallove, Eugene F.

    2003-03-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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. Implementing peer review at an emergency medicine blog: bridging the gap between educators and clinical experts.

    Science.gov (United States)

    Thoma, Brent; Chan, Teresa; Desouza, Natalie; Lin, Michelle

    2015-03-01

    Emergency physicians are leaders in the ''free open-access meducation'' (FOAM) movement. The mandate of FOAM is to create open-access education and knowledge translation resources for trainees and practicing physicians (e.g., blogs, podcasts, and vodcasts). Critics of FOAM have suggested that because such resources can be easily published online without quality control mechanisms, unreviewed FOAM resources may be erroneous or biased. We present a new initiative to incorporate open, expert, peer review into an established academic medical blog. Experts provided either pre- or postpublication reviews that were visible to blog readers. This article outlines the details of this initiative and discusses the potentially transformative impact of this educational innovation.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-10-15

    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.

  20. Nanorobots: The Emerging tools in Medicinal

    OpenAIRE

    Dron P. Modi; Vishvadeep P. Patel; Patel, Ravi B.; Patel, Jay N; Bhavin V. Bhimani; Ragin R. Shah

    2013-01-01

    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. Thes...

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

    Science.gov (United States)

    Toohey, Shannon L; Wray, Alisa; Wiechmann, Warren; Lin, Michelle; Boysen-Osborn, Megan

    2016-05-01

    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. 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. 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.

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

    Directory of Open Access Journals (Sweden)

    Shannon L. Toohey

    2016-05-01

    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.

  3. Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department.

    Science.gov (United States)

    Borde, Johannes P; Kern, Winfried V; Hug, Martin; Steib-Bauert, Michaela; de With, Katja; Busch, Hans-Jörg; Kaier, Klaus

    2015-07-01

    intensified ABS programme using non-restrictive tools targeting third-generation cephalosporin and fluoroquinolone use in the setting of a large academic hospital emergency medicine department is feasible and effective. The intervention may serve as a model for other emergency medicine departments at hospitals with a similar structure and baseline situation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-07-01

    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.

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

    Science.gov (United States)

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

    2016-05-01

    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.

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

    Science.gov (United States)

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

    2009-06-01

    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.

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

    DEFF Research Database (Denmark)

    Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars

    2010-01-01

    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 ...

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

    Science.gov (United States)

    Hilgenfeld, Rolf

    2010-07-01

    "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."

  9. Relationship between childhood hyperactivity and accident proneness.

    Science.gov (United States)

    Gayton, W F; Bailey, C; Wagner, A; Hardesty, V A

    1986-10-01

    Previous research suggested that hyperactive children are especially susceptible to accidents. Two questions remain: is the relationship peculiar to hyperactivity in childhood or for behaviorally disturbed children in general and does the relationship hold for females as well as for males? To answer these questions 189 patients at a child psychiatric clinic were rated on a scale which included measures of hyperactivity and accident proneness. The hyperactive patients were more likely to be described as accident prone than nonhyperactive patients. The relationship between childhood hyperactivity and accident proneness is confirmed and is specific. The relationship holds for both boys and girls.

  10. Toward a definition of teamwork in emergency medicine.

    Science.gov (United States)

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

    2008-11-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Petrov, M.M.

    1993-12-31

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-05-15

    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

  13. Evaluation of Emergency Medicine Community Educational Program

    Directory of Open Access Journals (Sweden)

    Garcia, Estevan Adan

    2010-12-01

    Full Text Available Out-of-hospital emergencies occur frequently, and laypersons are often the first to respond to these events. As an outreach to our local communities, we developed “Basic Emergency Interventions Everyone Should Know,” a three-hour program addressing cardiopulmonary resuscitation and automated external defibrillator use, heart attack and stroke recognition and intervention, choking and bleeding interventions and infant and child safety. Each session lasted 45 minutes and was facilitated by volunteers from the emergency department staff. A self-administered 13-item questionnaire was completed by each participant before and after the program. A total of 183 participants completed the training and questionnaires. Average score pre-training was nine while the average score post-training was 12 out of a possible 13 (P< .0001. At the conclusion of the program 97% of participants felt the training was very valuable and 100% would recommend the program to other members of their community. [West J Emerg Med. 2010;11(5:416-418.

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

    OpenAIRE

    Shahram Lotfipour; T. Kent Denmark; Christopher Erik McCoy; Srinidhi Subraya Bhat; Elizabeth ter Haar; Bharath Chakravarthy

    2011-01-01

    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 documente...

  15. Scientific, legal, and ethical challenges of end-of-life organ procurement in emergency medicine.

    Science.gov (United States)

    Rady, Mohamed Y; Verheijde, Joseph L; McGregor, Joan L

    2010-09-01

    We review (1) scientific evidence questioning the validity of declaring death and procuring organs in heart-beating (i.e., neurological standard of death) and non-heart-beating (i.e., circulatory-respiratory standard of death) donation; (2) consequences of collaborative programs realigning hospital policies to maximize access of procurement coordinators to critically and terminally ill patients as potential donors on arrival in emergency departments; and (3) ethical and legal ramifications of current practices of organ procurement on patients and their families. Relevant publications in peer-reviewed journals and government websites. Scientific evidence undermines the biological criteria of death that underpin the definition of death in heart-beating (i.e., neurological standard) and non-heart-beating (i.e., circulatory-respiratory standard) donation. Philosophical reinterpretation of the neurological and circulatory-respiratory standards in the death statute, to avoid the appearance of organ procurement as an active life-ending intervention, lacks public and medical consensus. Collaborative programs bundle procurement coordinators together with hospital staff for a team-huddle and implement a quality improvement tool for a Rapid Assessment of Hospital Procurement Barriers in Donation. Procurement coordinators have access to critically ill patients during the course of medical treatment with no donation consent and with family or surrogates unaware of their roles. How these programs affect the medical care of these patients has not been studied. Policies enforcing end-of-life organ procurement can have unintended consequences: (1) erosion of care in the patient's best interests, (2) lack of transparency, and (3) ethical and legal ramifications of flawed standards of declaring death. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

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

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

    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.

  17. [A model system for emergency medicine for Mexico City].

    Science.gov (United States)

    Almanza-Cruz, S; Rea-Field, G

    1990-01-01

    Trauma and sudden illnesses already represent a capital problem of public health in our country. Since the social and financial costs that we must pay are very high, it is necessary to create an emergency medical system that categorizes both, the patients according to this aims and the available means in order to give them comprehensive and definitive care. This categorization implies quick and appropriate transportation from accidents to the ideal hospital facility and also the prehospital medical care at the scene and during transportation. The system should include two prehospital and two hospital levels, and the highest level being the keystone of the whole. Education and research are fundamental for the harmonic development of the system.

  18. Statistical modelling of the frequency and severity of road accidents

    DEFF Research Database (Denmark)

    Janstrup, Kira Hyldekær

    of the reasons for heterogeneity has been made, which in the end may lead to devising policy measures (Paper 1). 3) A connection between the occurrence probability of trauma type and crash, vehicle and person characteristics exists (Paper 2). 4) The attitudes that accident reporting is useless are found...... the literature about under-reporting and gives new and innovative knowledge which can contribute to new policy measures for improving the reporting rate. For that reason this thesis should be used as an important tool whenever addressing the under-reporting challenge....... management tool.Initially models were built by using existing traffic accident data collected by the police and emergency rooms in Denmark. The data registered by the police was collected on traffic accidents occurred on Danish roads in the period between 2002 and 2008. The emergency room data were collected...

  19. Intern underperformance is detected more frequently in emergency medicine rotations.

    Science.gov (United States)

    Aram, Narelle; Brazil, Victoria; Davin, Lorna; Greenslade, Jaimi

    2013-02-01

    To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. A retrospective review of intern assessment forms from a 2 year period (2009-2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as 'requiring substantial assistance' and/or 'requires further development' on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5-3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P Interns predominantly had difficulty with 'clinical judgment and decision-making skills', 'time management skills' and 'teamwork and colleagues' (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2-19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-03-15

    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.

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

    Science.gov (United States)

    Filc, Dani; Cohen, Nissim

    2015-07-01

    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.

  2. 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

    Institute of Scientific and Technical Information of China (English)

    陈蜀海

    2012-01-01

    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.

  3. Emergency Medicine Evaluation of Community-Acquired Pneumonia: History, Examination, Imaging and Laboratory Assessment, and Risk Scores.

    Science.gov (United States)

    Long, Brit; Long, Drew; Koyfman, Alex

    2017-09-20

    Pneumonia is a common infection, accounting for approximately one million hospitalizations in the United States annually. This potentially life-threatening disease is commonly diagnosed based on history, physical examination, and chest radiograph. To investigate emergency medicine evaluation of community-acquired pneumonia including history, physical examination, imaging, and the use of risk scores in patient assessment. Pneumonia is the number one cause of death from infectious disease. The condition is broken into several categories, the most common being community-acquired pneumonia. Diagnosis centers on history, physical examination, and chest radiograph. However, all are unreliable when used alone, and misdiagnosis occurs in up to one-third of patients. Chest radiograph has a sensitivity of 46-77%, and biomarkers including white blood cell count, procalcitonin, and C-reactive protein provide little benefit in diagnosis. Biomarkers may assist admitting teams, but require further study for use in the emergency department. Ultrasound has shown utility in correctly identifying pneumonia. Clinical gestalt demonstrates greater ability to diagnose pneumonia. Clinical scores including Pneumonia Severity Index (PSI); Confusion, blood Urea nitrogen, Respiratory rate, Blood pressure, age 65 score (CURB-65); and several others may be helpful for disposition, but should supplement, not replace, clinical judgment. Patient socioeconomic status must be considered in disposition decisions. The diagnosis of pneumonia requires clinical gestalt using a combination of history and physical examination. Chest radiograph may be negative, particularly in patients presenting early in disease course and elderly patients. Clinical scores can supplement clinical gestalt and assist in disposition when used appropriately. Published by Elsevier Inc.

  4. Comparing the Quality and Complications of Tube Thoracostomy by Emergency Medicine and Surgery Residents; a Cohort Study

    Science.gov (United States)

    Kashani, Parvin; Harati, Sepideh; Shirafkan, Ali; Amirbeigi, Alireza; Hatamabadi, Hamid Reza

    2017-01-01

    Introduction: Tube thoracostomy complications depend on the operator’s skill, patients’ general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs) and surgery residents (SRs). Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20. Results: 72 patients with the mean age of 37.1 ± 14.1 years were studied (86.1% male). 23 (63.8%) cases were complicated in SRs and 22 (61.1%) cases in EMRs group (total= 62.5%). Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99), drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50), and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25) were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814) for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867) for EMRs. Conclusion: The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60%) for both groups. PMID:28286840

  5. The Prevalence and Characteristics of Emergency Medicine Patient Use of New Media

    Science.gov (United States)

    2015-01-01

    Background Little is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit. Objective The objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health. Methods Face-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital. Results A total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, Pvs 16%, P.05) and personal health records (PiPhones compared to Android phones were similar (44% vs 45%, P<.05). Race and ethnicity played a significant role in texting and smartphone ownership, with Hispanics reporting the highest rates of 79% and 56%, respectively, followed by black non-Hispanics at 77% and 54%, respectively, and white non-Hispanics at 65% and 42%, respectively (P<.05). Conclusions There is a critical mass of ED patients who use new media. Older persons are less comfortable texting and using smartphone apps. Income status has a positive relationship with smartphone ownership and use of smartphone apps. Regardless of income, however, texting and ownership of smartphones was highest for Latinos and black non-Latinos. These findings have implications for expanding health care beyond the ED visit through the use of cell phones, smartphones, texting, the Internet, and health care apps to improve the health of

  6. Characteristics of evidence-based medicine training in Royal College of Physicians and Surgeons of Canada emergency medicine residencies - a national survey of program directors.

    Science.gov (United States)

    Bednarczyk, Joseph; Pauls, Merril; Fridfinnson, Jason; Weldon, Erin

    2014-03-21

    Recent surveys suggest few emergency medicine (EM) training programs have formal evidence-based medicine (EBM) or journal club curricula. Our primary objective was to describe the methods of EBM training in Royal College of Physicians and Surgeons of Canada (RCPSC) EM residencies. Secondary objectives were to explore attitudes regarding current educational practices including e-learning, investigate barriers to journal club and EBM education, and assess the desire for national collaboration. A 16-question survey containing binary, open-ended, and 5-pt Likert scale questions was distributed to the 14 RCPSC-EM program directors. Proportions of respondents (%), median, and IQR are reported. The response rate was 93% (13/14). Most programs (85%) had established EBM curricula. Curricula content was delivered most frequently via journal club, with 62% of programs having 10 or more sessions annually. Less than half of journal clubs (46%) were led consistently by EBM experts. Four programs did not use a critical appraisal tool in their sessions (31%). Additional teaching formats included didactic and small group sessions, self-directed e-learning, EBM workshops, and library tutorials. 54% of programs operated educational websites with EBM resources. Program directors attributed highest importance to two core goals in EBM training curricula: critical appraisal of medical literature, and application of literature to patient care (85% rating 5 - "most importance", respectively). Podcasts, blogs, and online journal clubs were valued for EBM teaching roles including creating exposure to literature (4, IQR 1.5) and linking literature to clinical practice experience (4, IQR 1.5) (1-no merit, 5-strong merit). Five of thirteen respondents rated lack of expert leadership and trained faculty educators as potential limitations to EBM education. The majority of respondents supported the creation of a national unified EBM educational resource (4, IQR 1) (1-no support, 5- strongly

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

    Directory of Open Access Journals (Sweden)

    Afshin Amini

    2014-08-01

    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.

  8. The Veterinary Public Health Service and the National Organization for Nuclear Emergency Planning and Response in the Netherlands: Development of a measurement strategy in case of nuclear accidents. De Veterinaire Hoofdinspectie en het NPK: Ontwikkeling van een meetstrategie

    Energy Technology Data Exchange (ETDEWEB)

    Lembrechts, J.F.M.M.; Pruppers, M.J.M.

    1993-12-01

    In this report the position of the Veterinary Public Health Service (VHI), which is part of the Ministry of Welfare, Health and Cultural Affairs, within the National Organisation for Nuclear Emergency Planning and Response (NPK), is evaluated. NPK is activated in case of nuclear accidents in order to describe and model the evolution of the environmental contamination, to advise on countermeasures and to supervise their application and effects. Within this organisation VHI has to organize or execute measurements on animals and veterinary products and to coordinate countermeasures pertaining to their field of work. The suggestion is made to integrate the tasks of VHI and those of the Inspectorate for Health Protection (IGB) and to attune the activities of VHI and those of the State Institute for Quality Control of Agricultural Products (RIKILIT). Advices are given on how to detail the tasks of VHI adequately in the context of NPK, amongst others by describing methods to collect and interpret data. It is suggested to firstly put into practice in vivo monitoring techniques for '3'I and [sup 134]Cs/[sup 137]Cs and to agree with other institutions on plans for sampling, sample preparation and measurements of milk. Finally a monitoring strategy for VHI is broadly outlined. It provides the framework for the definition of a detailed programme on sampling and measurement in case of a real accident. The monitoring strategy gives answers on the crucial question 'what has to be measured why and how by which person'. Since questions on where, when and how frequently measurements have to made should be tailored to the actual emergency situation, they are not dealt with in this report. 5 figs., 5 tabs., 66 refs.

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

    Energy Technology Data Exchange (ETDEWEB)

    Meieran, H.B.

    1988-04-01

    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.).

  10. 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

    Energy Technology Data Exchange (ETDEWEB)

    Blaauboer, R.O.

    1993-11-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Rozental Jose de Julio

    2002-01-01

    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. 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

    Institute of Scientific and Technical Information of China (English)

    杨玲; 岳会国; 林权益; 李冰; 郜建伟

    2011-01-01

    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。

  13. Characteristics of motorcyclists involved in accidents between motorcycles and automobiles

    Directory of Open Access Journals (Sweden)

    Amanda Lima de Oliveira

    2015-02-01

    Full Text Available Introduction: traffic accidents are one of the main causes of death and disability, with motorcyclists representing the great majority of both the victims and the perpetrators. Objective: this work studied the characteristics of motorcyclists injured in accidents involving motorcycles and automobiles. Method: this study sought to interview 100 motorcyclists who had been injured in collisions between motorcycles and automobiles, and who were undergoing emergency hospital treatment in the region of Belo Horizonte, Brazil. The questionnaires included demographic information (age, gender, skin color, education level, profession and questions about years of licensed driving practice, how often they would drive an automobile, how long they had had a motorcycle driver’s license, how often they would ride a motorcycle, the number of prior accidents involving a car, and the number of prior accidents not involving a car. Results: of the 100 consecutive accidents studied, 91 occurred with men and 9 with women, aged between 16 and 79 (m = 29 ± 11 years. Regarding their reason for using a motorcycle, 83% reported using it for transport, 7% for work, and 10% for leisure. Most of these accident victims had secondary or higher education (47%. Of the motorcyclists who held a car driver’s license, 68.3% drove the vehicle daily or weekly and held the license for more than one year. Sixty-seven percent of the accident victims used a motorcycle daily and had a motorcycle driver’s license for at least one year. Conclusion: among the motorcyclists injured, most were men aged 20 years or older, with complete secondary education, and experienced in driving both motorcycles and cars, indicating that recklessness while driving the motorcycle is the main cause of traffic accidents.

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

    Directory of Open Access Journals (Sweden)

    Salman Khazaei

    2016-09-01

    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

  15. 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

    Institute of Scientific and Technical Information of China (English)

    张建峰; 苏旭; 李文红; 拓飞

    2013-01-01

    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.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    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....

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

    Science.gov (United States)

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

    2016-06-01

    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. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-01-01

    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

  19. Appraisals and Cognitive Coping Styles Associated with Chronic Post-Traumatic Symptoms in Child Road Traffic Accident Survivors

    Science.gov (United States)

    Stallard, Paul; Smith, Elisabeth

    2007-01-01

    Background: Comparatively little is known about the cognitive appraisals and coping styles of child road traffic accident (RTA) survivors that are associated with chronic post-traumatic reactions. Methods: Seventy-five children and young people aged 7-18 who were involved in a road traffic accident and attended an accident and emergency department…

  20. 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

    Institute of Scientific and Technical Information of China (English)

    殷志明; 张红生; 周建良; 李迅科

    2015-01-01

    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。

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

    Science.gov (United States)

    Folkl, Alex; Chan, Teresa; Blau, Elaine

    2016-09-21

    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.

  2. Development of Public Training System for Emergency Exercise Using Virtual Reality Technology Based on Radioactive Release Accident

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Il; Park, Seong Jun; Lee, Dewhey; Song, Sub Lee; Park, Younwon [BEES Inc., Daejeon (Korea, Republic of)

    2016-10-15

    An exercise is normally conducted for a day or two days depending on the scale of the exercise. What we have experienced up to date there are several limitations in the radiological emergency exercises such as low public acceptance, poor enthusiasm in the exercise participation, not very attracting exercise scenarios, low efficiency in conducting an exercise, and so on. In order to overcome the limitations of the present exercising system, we would like to develop a radiological emergency exercise system using VR (virtual reality) technology based on a radioactive release accident. In this paper, we just introduce some basic development methods and event tree based scenario as a beginning stage. After the accident in Fukushima Daiichi NPP, the importance of emergency exercise especially for the public is far more emphasized around the world more and more. However, the human labor focused radiological emergency exercise up to now has many limitations. After developing this system properly and by using it, we could even expect to estimate the weak points of the emergency arrangements and strategy we have.

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

    Science.gov (United States)

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

    2013-07-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-07-01

    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)

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

    Directory of Open Access Journals (Sweden)

    Bhakti Hansoti

    2016-09-01

    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.

  6. 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

    Institute of Scientific and Technical Information of China (English)

    唐灵芝; 陈由珠; 李云燕

    2008-01-01

    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.

  7. Accidents in Canada: mortality and hospitalization.

    Science.gov (United States)

    Riley, R; Paddon, P

    1989-01-01

    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.

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

    Science.gov (United States)

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

    2015-11-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Elaine K. Fielder

    2015-11-01

    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.

  10. Balamuthia mandrillaris infection of the skin and central nervous system: an emerging disease of concern to many specialties in medicine.

    Science.gov (United States)

    Bravo, Francisco G; Alvarez, Patricia J; Gotuzzo, Eduardo

    2011-04-01

    Balamuthia mandrillaris infection of the skin and central nervous system has been increasingly reported in the last decade, making this entity a genuine emerging disease. The ability of the clinician in recognizing the skin lesion early in the course of the disease may lead to a successful therapeutic intervention in an otherwise fatal disease. In the past years, advances have been made regarding knowledge about the ubiquity of the ameba in the environment, its worldwide distribution (with higher prevalence in South America), the patients at risk (particularly those of Hispanic origin), the diagnostic methods (including those based on molecular biology) and the different therapeutic strategies that have resulted in survival of patients. A recent report dealing with organ transplant transmission of this infection has made it a subject of interest in transplant medicine. The present review will allow readers from different fields (clinician, dermatologist, neurologist, infectious disease and transplant specialist) to become familiar with the clinical aspect of the disease, including diagnosis and therapy.

  11. Road accidents and business cycles in Spain.

    Science.gov (United States)

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

    2016-11-01

    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. Overcrowding of accident & emergency units: is it a growing concern ...

    African Journals Online (AJOL)

    ed. Therefore, this study was intended to determine the prevalence, causes, and effects of overcrowding AEDs in Nigeria. Materials and .... logical, paediatric, psychiatric services, medical services and laboratory services. All these are tertiary ...

  13. Evaluating Emergency Medicine Faculty at End-of-Shift

    Directory of Open Access Journals (Sweden)

    Kovach, Regina A

    2010-12-01

    Full Text Available Introduction: Faculty often evaluate learners in the emergency department (ED at the end of each shift. In contrast, learners usually evaluate faculty only at the end of a rotation. In December 2007 [X] School of Medicine changed its evaluation process, requiring ED trainees to complete end-of-shift evaluations of faculty.Objective: Determine the feasibility and acceptance of end-of-shift evaluations for emergency medicine faculty.Methods: We conducted this one-year observational study at two hospitals with 120,000 combined annual ED visits. Trainees (residents and students anonymously completed seven-item shift evaluations and placed them in a locked box. Trainees and faculty completed a survey about the new process.Results: During the study, trainees were assigned 699 shifts, and 633 end-of-shift evaluations were collected for a completion rate of 91%. The median number of ratings per faculty was 31, and the median number of comments was 11 for each faculty. The survey was completed by 16/22 (73% faculty and 41/69 (59% trainees. A majority of faculty (86% and trainees (76% felt comfortable being evaluated at end-of-shift. No trainees felt it was a time burden.Conclusion: Evaluating faculty following an ED shift is feasible. End-of-shift faculty evaluations are accepted by trainees and faculty. [West J Emerg Med. 2010; 11(5:486-490.

  14. STUDY OF ROAD TRAFFIC ACCIDENTS WITH SPECIAL REFERENCE TO THE ACCIDENT VICTIMS ADMITTED IN GAUHATI MEDICAL COLLEGE AND HOSPITAL, ASSAM

    Directory of Open Access Journals (Sweden)

    Rocket Chandra

    2016-05-01

    Full Text Available BACKGROUND In the present scenario, road traffic accidents have become a major cause of human mortality and morbidity. Accidents are increasing at alarming rates in India. The objective of our study was to assess the socio-demographic profile of road traffic accident victims admitted in a tertiary care setting, and to assess the pattern of injuries. METHODOLOGY The present study is prospective and analytical hospital based study. RESULTS The present studies show that more than 70% of the victims are in the age group of below 45 years (n=3196 and with male preponderance. Out of 14364 accident patients visiting the emergency department of Gauhati Medical College and Hospital, 4953 patients were admitted. The majorities of the patients (n=2995 were admitted in surgery department and 1586 in orthopaedic department. CONCLUSIONS Several factors are responsible for causing road accidents such as drunk driving, lack of awareness of traffic rules, nonadherence to safety measures. To reduce morbidity and mortality following road accidents, comprehensive policy has to be adopted by the government

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Muhammad Hashim

    2013-04-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Kazunori H.

    2012-01-01

    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.

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

    Science.gov (United States)

    Perko, Tanja

    2011-07-01

    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.

  19. Causas externas em adolescentes: atendimentos em serviços sentinelas de urgência e emergência nas Capitais Brasileiras - 2009 Accidents by external causes in adolescents: care in sentinel urgency and emergency services in the Brazilian State Capitals - 2009

    Directory of Open Access Journals (Sweden)

    Deborah Carvalho Malta

    2012-09-01

    Full Text Available Os adolescentes estão em busca de novas referências e experiências, o que pode implicar atitudes de risco e exposição às causas externas - acidentes e violências. Estes eventos constituem um grave problema em Saúde Pública. O objetivo deste estudo foi analisar as ocorrências de causas externas em adolescentes de 10 a 19 anos atendidos em serviços sentinela de urgência e emergência no Brasil. Foram analisados dados do inquérito da Vigilância de Violências e Acidentes (Inquérito VIVA 2009 em 74 Unidades de Emergência em 23 capitais e no Distrito Federal. Os achados mostraram que 6.434 (89,8% adolescentes foram vítimas de acidentes e 730 (10,2 % de violências. As principais causas de acidentes foram as quedas, outros acidentes e o trânsito e entre as violências predominaram as agressões. Tanto para acidentes como para violências os adolescentes do sexo masculino e a raça/cor não branca foram predominantes; as ocorrências foram mais frequentes na via pública. A alta foi a evolução mais frequente, com maior ocorrência de internação hospitalar nas vítimas de violências entre 15 a 19 anos. Conhecer a realidade epidemiológica das causas externas entre os adolescentes representa uma importante ferramenta para as políticas de prevenção, promoção à saúde e da cultura de paz, visando à redução da morbimortalidade.Adolescents are seeking new references and experiences, which may involve attitudes of risk and exposure to accidents and violence from external causes. These events constitute a serious Public Health problem. The scope of this study was to analyze the occurrence of accidents by external causes in adolescents from 10 to 19 years of age attended at sentinel urgency and emergency services in Brazil. Data from the 2009 Surveillance System for Violence and Accidents (VIVA 2009 was analyzed in 74 emergency units in 23 state capitals and the Federal District. The findings revealed that 6,434 adolescents (89

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2015-10-15

    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.

  1. The Record-Setting Flood of 2014 in Kelantan: Challenges and Recommendations from an Emergency Medicine Perspective and Why the Medical Campus Stood Dry

    OpenAIRE

    Baharuddin, Kamarul Aryffin; ABDULL WAHAB, Shaik Farid; Nik Ab Rahman, Nik Hisamuddin; NIK MOHAMAD, Nik Arif; TUAN KAMAUZAMAN, Tuan Hairulnizam; Md Noh, Abu Yazid; ABDUL MAJOD, Mohd Roslani

    2015-01-01

    Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a ‘tsunami-like disaster’. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a prepa...

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

    Science.gov (United States)

    Osterwalder, J J

    2012-09-19

    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.

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

    Science.gov (United States)

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

    2014-12-01

    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.

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

    Science.gov (United States)

    Zawilska, Jolanta B; Wojcieszak, Jakub

    2013-09-01

    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.

  5. Coherent Raman scattering microscopy: an emerging platform for biology and medicine (Conference Presentation)

    Science.gov (United States)

    Xie, Sunney S.

    2016-03-01

    Stimulated Raman scattering (SRS) microscopy is a label-free and noninvasive imaging technique using vibration spectroscopy as the contrast mechanism. Recent advances have allowed significant improvements in sensitivity, selectivity, robustness, and cost reduction, opening a wide range of biomedical applications. In particular, it provides instant tissue examination without the need of previous histological staining, and is best suited for imaging small metabolite molecules. An overview will be given to a variety of biomedical applications of SRS microscopy.

  6. Vibrational spectroscopic imaging of living systems: An emerging platform for biology and medicine.

    Science.gov (United States)

    Cheng, Ji-Xin; Xie, X Sunney

    2015-11-27

    Vibrational spectroscopy has been extensively applied to the study of molecules in gas phase, in condensed phase, and at interfaces. The transition from spectroscopy to spectroscopic imaging of living systems, which allows the spectrum of biomolecules to act as natural contrast, is opening new opportunities to reveal cellular machinery and to enable molecule-based diagnosis. Such a transition, however, involves more than a simple combination of spectrometry and microscopy. We review recent efforts that have pushed the boundary of the vibrational spectroscopic imaging field in terms of spectral acquisition speed, detection sensitivity, spatial resolution, and imaging depth. We further highlight recent applications in functional analysis of single cells and in label-free detection of diseases. Copyright © 2015, American Association for the Advancement of Science.

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

    Science.gov (United States)

    Dodt, C; Zelihic, E

    2013-02-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Tracy E. Madsen

    2014-08-01

    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

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

    Science.gov (United States)

    Vermeulen, B; Carron, P-N

    2007-08-15

    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".

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

    Science.gov (United States)

    Kjersem, Bård

    2015-06-01

    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