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Sample records for prehospital triage scores

  1. The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents.

    Science.gov (United States)

    Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Garijo Gonzalo, Gracia; Martinez Monzon, Carlos; Pelaez Corres, Nieves; Rodriguez Soler, Alberto; Turegano Fuentes, Fernando

    2016-04-29

    This text describes the process of development of the new Spanish Prehospital Advanced Triage Method (META) and explain its main features and contribution to prehospital triage systems in mass casualty incidents. The triage META is based in the Advanced Trauma Life Support (ATLS) protocols, patient's anatomical injuries and mechanism of injury. It is a triage method with four stages including early identification of patients with severe trauma that would benefit from a rapid evacuation to a surgical facility and introduces a new patient flow by-passing the advanced medical post to improve evacuation. The stages of triage META are: I) Stabilization triage that classifies patients according to severity to set priorities for initial emergency treatment; II) Identifying patients requiring urgent surgical treatment, this is done at the same time than stage I and creates a new flow of patients with high priority for evacuation; III) Implementation of Advanced Trauma Life Support protocols to patients previously classified according to stablished priority; and IV) Evacuation triage, stablishing evacuation priorities in case of lacks of appropriate transport resources. The triage META is to be applied only by prehospital providers with advanced knowledge and training in advanced trauma life support care and has been designed to be implemented as prehospital procedure in mass casualty incidents (MCI).

  2. Hospital and Pre-Hospital Triage Systems in Disaster and Normal Conditions; a Review Article

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    Saeed Safari

    2015-02-01

    Full Text Available Triage is a priority classification system based on the severity of problem to do the best therapeutic proceedings for patients in the less time. A triage system should be performed in a way which can make a decision with high accuracy and in the least time for each patient. Simplicity and reliability of the performance are the most important features of a standard triage system. An appropriate triage causes to increase the quality of health care services and patients’ satisfaction rate, decrease the waiting time as well as mortality rate, and increase the yield and efficiency of emergency wards along with reducing the related expenses. Considering to the above statements, in the present study the history of triage formation was evaluated and categorizing of all triage systems regarding prehospital and hospital as well as triage in normal and critical conditions were assessed, too.

  3. Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

    DEFF Research Database (Denmark)

    Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten

    2014-01-01

    Objective: European ST-segment elevation myocardial infarction (STEMI) guidelines recommend prehospital diagnosis to facilitate early reperfusion in patients with STEMI, and they provide recommendations regarding optimal system delay (time from first medical contact (FMC) to the primary...... percutaneous coronary intervention (PPCI)). There are limited data on achievable system delays in an optimal STEMI system of care using prehospital diagnosis to triage patients with STEMI directly to percutaneous coronary intervention (PCI) centres. We examined the proportion of tentative prehospital STEMI...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported

  4. Implementation of a pre-hospital decision rule in general practice. Triage of patients with suspected myocardial infarction

    NARCIS (Netherlands)

    E.W.M. Grijseels (Els); J.W. Deckers (Jaap); A.W. Hoes (Arno); H. Boersma (Eric); J.A.M. Hartman; E. van der Does (Emiel); M.L. Simoons (Maarten)

    1996-01-01

    textabstractOBJECTIVE: To improve pre-hospital triage of patients with suspected acute cardiac disease. DESIGN: Prospective study. SUBJECTS. Patients with symptoms suggestive of acute cardiac pathology, who were seen by a general practitioner, for whom acute admission into hospital was requested, an

  5. The Eldicus prospective, observational study of triage decision making in European intensive care units : Part I-European Intensive Care Admission Triage Scores

    NARCIS (Netherlands)

    Sprung, Charles L.; Baras, Mario; Iapichino, Gaetano; Kesecioglu, Jozef; Lippert, Anne; Hargreaves, Chris; Pezzi, Angelo; Pirracchio, Romain; Edbrooke, David L.; Pesenti, Antonio; Bakker, Jan; Gurman, Gabriel; Cohen, Simon L.; Wiis, Joergen; Payen, Didier; Artigas, Antonio

    2012-01-01

    Objective: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage decisio

  6. Prehospital score for acute disease: a community-based observational study in Japan

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    Fujiwara Hidekazu

    2007-10-01

    Full Text Available Abstract Background Ambulance usage in Japan has increased consistently because it is free under the national health insurance system. The introduction of refusal for ambulance transfer is being debated nationally. The purpose of the present study was to investigate the relationship between prehospital data and hospitalization outcome for acute disease patients, and to develop a simple prehospital evaluation tool using prehospital data for Japan's emergency medical service system. Methods The subjects were 9,160 consecutive acute disease patients aged ≥ 15 years who were transferred to hospital by Kishiwada City Fire Department ambulance between July 2004 and March 2006. The relationship between prehospital data (age, systolic blood pressure, pulse rate, respiration rate, level of consciousness, SpO2 level and ability to walk and outcome (hospitalization or non-hospitalization was analyzed using logistic regression models. The prehospital score component of each item of prehospital data was determined by beta coefficients. Eligible patients were scored retrospectively and the distribution of outcome was examined. For patients transported to the two main hospitals, outcome after hospitalization was also confirmed. Results A total of 8,330 (91% patients were retrospectively evaluated using a prehospital score with a maximum value of 14. The percentage of patients requiring hospitalization rose from 9% with score = 0 to 100% with score = 14. With a cut-off point score ≥ 2, the sensitivity, specificity, positive predictive value and negative predictive value were 97%, 16%, 39% and 89%, respectively. Among the 6,498 patients transported to the two main hospitals, there were no deaths at scores ≤ 1 and the proportion of non-hospitalization was over 90%. The proportion of deaths increased rapidly at scores ≥ 11. Conclusion The prehospital score could be a useful tool for deciding the refusal of ambulance transfer in Japan's emergency medical

  7. Prehospital severity scoring at major rock concert events.

    Science.gov (United States)

    Erickson, T B; Koenigsberg, M; Bunney, E B; Schurgin, B; Levy, P; Willens, J; Tanner, L

    1997-01-01

    in stratifying the acuity level of this patient population. This severity score may serve as a potential triage mechanism for future mass gatherings such as rock concerts.

  8. Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

    Science.gov (United States)

    Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

    2016-01-01

    We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria.

  9. Implementation of a prehospital triage system for patients with chest pain and logistics for primary percutaneous coronary intervention in the region of Amsterdam, the Netherlands.

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    Adams, Rob; Appelman, Yolande; Bronzwaer, Jean G; Slagboom, Ton; Amoroso, Giovanni; van Exter, Pieternel; Tijssen, G P Jan; de Winter, Robbert J

    2010-10-01

    We aimed to describe the logistics of a prehospital triage system for patients with acute chest pain in the region of Amsterdam, The Netherlands. Ambulance electrocardiograms (ECGs) were evaluated immediately in 1 of the percutaneous coronary intervention (PCI)-capable centers. Patients accepted for primary PCI (PPCI) were directly transferred to the catheterization laboratory. Two thousand three hundred fifty ECGs of 2,192 patients were transmitted to the region's intervention centers. Median duration of chest complaints before ambulance dispatch was 67 minutes; ambulance crews recorded the first ECG within 7 minutes after arrival. Actual transmission of the ECG took an additional (median) 10 minutes. Seven hundred eleven patients (32.4%) were transported to the catheter laboratory and were treated with PPCI. Time between first prehospital ECG and start of PPCI procedure was 66 minutes. The PPCI procedure started 36 minutes after ambulance arrival at the hospital. In conclusion, the results of this study compare favorably to other reported performances of prehospital triage systems of PPCI for ST-segment elevated myocardial infarction and demonstrate that the European Society of Cardiology and American Heart Association guidelines for treatment of patients with ST-segment elevated myocardial infarction can be met.

  10. Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

    NARCIS (Netherlands)

    Groot, N.; Oijen, M.G. van; Kessels, K.; Hemmink, M.; Weusten, B.; Timmer, R.; Hazen, W.; Lelyveld, N. van; Vermeijden, J.R.; Curvers, W.; Baak, L.; Verburg, R.; Bosman, J.; Wijkerslooth, L. de; Rooij, J van; Venneman, N.; Pennings, M.C.P.; Hee, K. van; Scheffer, R.; Eijk, R. van; Meiland, R.; Siersema, P.; Bredenoord, A.

    2014-01-01

    INTRODUCTION: Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added

  11. Nurse-administered early warning score system can be used for emergency department triage

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke;

    2011-01-01

    Studies have shown that early warning score systems can identify in-patients at high risk of catastrophic deterioration and this may possibly be used for an emergency department (ED) triage. Bispebjerg Hospital has introduced a multidisciplinary team (MT) in the ED activated by the Bispebjerg Early...

  12. Sonographic Scoring for Operating Room Triage in Trauma

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    Raghavendran, Krishnan MD

    2010-05-01

    Full Text Available Objective: The focused assessment with sonography for trauma (FAST exam is a routine diagnostic adjunct in the initial assessment of blunt trauma victims but lacks the ability to reliably predict which patients require laparotomy. Physiologic data play a major role in decision making regarding the need for emergent laparotomy versus further diagnostic testing or observation. The need for laparotomy often influences the decision to transfer the patient to a trauma center. We set out to derive a simple scoring system using both ultrasound findings and immediately available physiologic data that would predict which patients require laparotomy.Methods: We conducted a prospective observational study of victims of blunt trauma who presented to a Level 1 Trauma Center. We collected FAST findings, physiologic data, and lab values. A previously-developed ultrasound scoring system was applied to the FAST findings. Patients were followed to determine if they underwent laparotomy. We used logistic regression analysis to determine which variables correlated with laparotomy and developed a new scoring system.Results: We enrolled a convenience sample of 1,393 patients. A simple scoring system (range 0-6 was developed that included both FAST findings and vital signs (heart rate and blood pressure. Patients with a score of 0 or 1 had a less than 1% chance of requiring laparotomy.Conclusion: The combination of FAST findings with vital signs in our scoring system predicted which victims of blunt trauma did not undergo laparotomy. Applying this to trauma patients who present to non-trauma centers could help prevent unnecessary patient transfers. This derivation set must be validated prior to use in patient care. [West J Emerg Med. 2010; 11(2:138-143.

  13. Physiological-Social Scores in Predicting Outcomes of Prehospital Internal Patients

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    Abbasali Ebrahimian

    2014-01-01

    Full Text Available The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708–0.767. Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients’ wards in EMS situations.

  14. Physiological-social scores in predicting outcomes of prehospital internal patients.

    Science.gov (United States)

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708-0.767). Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients' wards in EMS situations.

  15. 院前病情评估表对急诊患者分诊的指导意义%Guiding Significance of Pre-hospital Condition Assessment for Emergency Triage

    Institute of Scientific and Technical Information of China (English)

    胡登科; 刘利生; 刘晓海; 朱勇

    2014-01-01

    Objective To discuss the values and guiding significance of pre-hospital condition assessment for emer-gency triage. Methods A total of 1 810 patients who visited Department of Emergency,the Fourth People's Hospital of Li-anyungang from August 2012 to January 2014 were enrolled in this study. The experienced nurses observed and scored the pa-tients' age,temperature,heart rate respiration frequency,blood pressure,blood oxygen saturation,state of consciousness, and divided the patients,according to score standards,into mild,moderate,severe,critical conditions,and followed physi-cians' disposals for the patients. Results The emergency physicians( doctor group) and triage nurses( nurse group) evalua-ted the 1 810 patients' condition. There was no significant difference in condition evaluation between 2 groups(P>0. 05). In 21 patients who were assessed as severe condition by nurse group,18 were assessed as severe,3 as moderate by doctor group;in 10 patients who were assessed as critical condition by nurse group,9 assessed as critical,1 as severe by doctor group. Conclu-sion Pre-hospital condition assessment which can score emergency patients' condition and help triage,is of a certain role in i-dentifying potential critical patients and has them treated first. It is an emergency triage method worthy of generalization.%目的:探讨院前病情评估表对急诊患者分诊的价值与指导意义。方法选取2012年8月—2014年1月于连云港市第四人民医院急诊科就诊的患者共1810例,由有经验的分诊护师按照院前病情评估表对患者进行年龄、体温、心率、呼吸、血压、血糖、血氧饱和度、意识状态的评估并评分,按评分标准将患者病情分为轻、中、重、危(护师组);同时追踪急诊医师对患者的评估结果(医师组)。结果医师组和护师组对急诊患者病情的评估比较,差异无统计学意义( P>0.05)。其中被护师组评估为重的21例中18

  16. Assessing Field Triage Decisions and the International Classification Injury Severity Score (ICISS) at Predicting Outcomes of Trauma Patients.

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    Allen, Casey J; Baldor, Daniel J; Schulman, Carl I; Pizano, Louis R; Livingstone, Alan S; Namias, Nicholas

    2017-06-01

    Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed. ICISS was calculated from the product of the survival risk ratios for a patient's three worst injuries. Outcomes were compared between patients with ICISS <0.85 either triaged to the ED or its separate, neighboring, free-standing TC at a large urban hospital. A total of 32,191 (83%) patients were triaged to the ED by EMS and 6,827 (17%) were triaged to the TC. Of these, 2544 had an ICISS <0.85, with 2145 (84%) being triaged to the TC and 399 (16%) to the ED. In these patients, those taken to the TC more often required admission, and those taken to the ED had better outcomes. When the confounders influencing triage to an ED or a TC are eliminated, those triaged by EMS to the ED rather than the TC had better overall outcomes. EMS providers better identified patients at risk for mortality than did the retrospective application of ICISS. ICISS <0.85 does not identify the absolute need for TC as EMS providers were able to appropriately triage a large portion of this population to the ED.

  17. The implementation of the South African Triage Score (SATS in an urban teaching hospital, Ghana

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    Sarah Rominski

    2014-06-01

    Conclusion: Under-triage is a concern to patient care and safety, and while the under-triage rate of 5.7% in this sample falls within the 5–10% range considered unavoidable by the American College of Surgeons Committee on Trauma, concentrated efforts to regularly train triage nurses to ensure no patients are under-triaged have been undertaken. Overall though, SATS has been implemented successfully in the EC at KATH by triage nurses.

  18. Severe hemiparesis as a prehospital tool to triage stroke severity: a pilot study to assess diagnostic accuracy and treatment times.

    Science.gov (United States)

    Gupta, Rishi; Manuel, Marissa; Owada, Kumiko; Dhungana, Samish; Busby, Leslie; Glenn, Brenda A; Brown, Debbie; Zimmermann, Susan A; Horn, Christopher; Rochestie, Dustin; Hormes, Joseph T; Johnson, Andrew K; Khaldi, Ahmad

    2016-08-01

    With the publication of the recent trials showing the tremendous benefits of mechanical thrombectomy, opportunities exist to refine prehospital processes to identify patients with larger stroke syndromes. We retrospectively reviewed consecutive patients who were brought via scene flight from rural parts of the region to our institution, from December 1, 2014 to June 5, 2015, with severe hemiparesis or hemiplegia. We assessed the accuracy of the diagnosis of stroke and the number of patients requiring endovascular therapy. Moreover, we reviewed the times along the pathway of patients who were treated with endovascular therapy. 45 patients were brought via helicopter from the field to our institution. 27 (60%) patients were diagnosed with an ischemic stroke. Of these, 12 (26.7%) were treated with mechanical thrombectomy and 6 (13.3%) with intravenous tissue plasminogen activator alone. An additional three patients required embolization procedures for either a dural arteriovenous fistula or cerebral aneurysm. Thus a total of 15 (33%) patients received an endovascular procedure and 21/45 (46.7%) received an acute treatment. For patients treated with thrombectomy, the median time from first medical contact to groin puncture was 101 min, with 8 of the 12 patients (66.7%) being discharged to home. We have presented a pilot study showing that severe hemiparesis or hemiplegia may be a reasonable prehospital tool in recognizing patients requiring endovascular treatment. Patients being identified earlier may be treated faster and potentially improve outcomes. Further prospective controlled studies are required to assess the impact on outcomes and cost effectiveness using this methodology. 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/

  19. Assessing the need for hospital admission by the Cape Triage discriminator presentations and the simple clinical score.

    LENUS (Irish Health Repository)

    Emmanuel, Andrew

    2010-11-01

    There is uncertainty about how to assess unselected acutely ill medical patients at the time of their admission to hospital. This study examined the use of the Simple Clinical Score (SCS) and the medically relevant Cape Triage discriminator clinical presentations to determine the need for admission to an acute medical unit.

  20. Implementation of a triage score system in an emergency room in Timergara, Pakistan

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    Dalwai, M. K.; Trelles, M.; Jemmy, J-P.; Maikéré, J.; Twomey, M.; Wakeel, M.; Iqbal, M.; Zachariah, R.

    2013-01-01

    Following implementation of the South African Triage Scale (SATS) system in the emergency department (ED) at the District Headquarter Hospital in Timergara, Pakistan, we 1) describe the implementation process, and 2) report on how accurately emergency staff used the system. Of the 370 triage forms evaluated, 320 (86%) were completed without errors, resulting in the correct triage priority being assigned. Fifty completed forms displayed errors, but only 16 (4%) resulted in an incorrect triage priority being assigned. This experience shows that the SATS can be implemented successfully and used accurately by nurses in an ED in Pakistan. PMID:26392995

  1. Effect of pre-hospital advanced airway management for out-of-hospital cardiac arrest caused by respiratory disease: a propensity score-matched study.

    Science.gov (United States)

    Ohashi-Fukuda, N; Fukuda, T; Yahagi, N

    2017-05-01

    Optimal pre-hospital care for out-of-hospital cardiac arrest (OHCA) caused by respiratory disease may differ from that for OHCA associated with other aetiologies, especially with respect to respiratory management. We aimed to investigate whether pre-hospital advanced airway management (AAM) was associated with favourable outcomes after OHCA caused by intrinsic respiratory disease. This nationwide, population-based, propensity score-matched study of adult patients in Japan with OHCA due to respiratory disease from 1 January 2005 to 31 December 2012 compared patients with and without pre-hospital AAM. The primary outcome was neurologically favourable survival at one month after the OHCA. Of 49,534 eligible patients, 20,458 received pre-hospital AAM and 29,076 did not. In a propensity score-matched cohort (18,483 versus 18,483 patients), the odds of neurologically favourable survival were significantly lower for patients receiving pre-hospital AAM (0.6% versus 1.5%; odds ratio [OR] 0.42 [95% confidence interval {CI} 0.34 to 0.52]). The results from multivariable logistic regression analysis also showed that pre-hospital AAM was significantly associated with a decreased chance of neurologically favourable survival (adjusted OR 0.43 [95% CI 0.35 to 0.52]). Similar findings were observed for one-month survival and pre-hospital return of spontaneous circulation. In subgroup analyses, pre-hospital AAM was associated with poor neurological outcomes, regardless of the type of airway device used (laryngeal mask airway, adjusted OR 0.35 [95% CI 0.19 to 0.57]; oesophageal obturator airway, adjusted OR 0.44 [95% CI 0.35 to 0.55]; and endotracheal tube, adjusted OR 0.47 [95% CI 0.30 to 0.69]). In conclusion, pre-hospital AAM was associated with poor neurological outcome among patients with OHCA caused by intrinsic respiratory disease.

  2. Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico.

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    Eduardo Rodriguez-Noriega

    Full Text Available BACKGROUND: Pandemic influenza A (H1N1 virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI was implemented at Hospital Civil de Guadalajara, Mexico. METHODS: A medical history, laboratory and radiology results were collected on emergency room (ER patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1 patients versus test-negative patients were compared by Pearson's Chi(2, Fisher's Exact, and Wilcoxon rank-sum tests. RESULTS: Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15, and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11, and 1324 untreated (median ILI-score = 5. Fourteen (1% untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score = 19. Of 371 patients tested by RT-PCR, 104 (28% had pandemic influenza and 42 (11% had seasonal influenza A detected. Twenty (91% of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38% of 61 imaged hospital test-negative patients (p<0.001. One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died. CONCLUSIONS: The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services.

  3. Interlaboratory variation in scoring dicentric chromosomes in a case of partial-body x-ray exposure: implications for biodosimetry networking and cytogenetic "triage mode" scoring.

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    Ainsbury, E A; Livingston, G K; Abbott, M G; Moquet, J E; Hone, P A; Jenkins, M S; Christensen, D M; Lloyd, D C; Rothkamm, K

    2009-12-01

    The international radiation biodosimetry community has recently been engaged in activities focused on establishing cooperative networks for biodosimetric triage for radiation emergency scenarios involving mass casualties. To this end, there have been several recent publications in the literature regarding the potential for shared scoring in such an accident or incident. We present details from a medical irradiation case where two independently validated laboratories found very different yields of dicentric chromosome aberrations. The potential reasons for this disparity are discussed, and the actual reason is identified as being the partial-body nature of the radiation exposure combined with differing criteria for metaphase selection. In the context of the recent networking activity, this report is intended to highlight the fact that shared scoring may produce inconsistencies and that further validation of the scoring protocols and experimental techniques may be required before the networks are prepared to deal satisfactorily with a radiological or nuclear emergency. Also, the findings presented here clearly demonstrate the limitations of the dicentric assay for estimating radiation doses after partial-body exposures and bring into question the usefulness of rapid "triage mode" scoring in such exposure scenarios.

  4. Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic—Mexico

    Science.gov (United States)

    Rodriguez-Noriega, Eduardo; Gonzalez-Diaz, Esteban; Morfin-Otero, Rayo; Gomez-Abundis, Gerardo F.; Briseño-Ramirez, Jaime; Perez-Gomez, Hector Raul; Lopez-Gatell, Hugo; Alpuche-Aranda, Celia M.; Ramírez, Ernesto; López, Irma; Iguala, Miguel; Chapela, Ietza Bojórquez; Zavala, Ethel Palacios; Hernández, Mauricio; Stuart, Tammy L.; Villarino, Margarita Elsa; Widdowson, Marc-Alain; Waterman, Steve; Uyeki, Timothy; Azziz-Baumgartner, Eduardo

    2010-01-01

    Background Pandemic influenza A (H1N1) virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI) was implemented at Hospital Civil de Guadalajara, Mexico. Methods A medical history, laboratory and radiology results were collected on emergency room (ER) patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1) patients versus test-negative patients were compared by Pearson's Χ2, Fisher's Exact, and Wilcoxon rank-sum tests. Results Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15), and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11), and 1324 untreated (median ILI-score = 5). Fourteen (1%) untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score  = 19). Of 371 patients tested by RT-PCR, 104 (28%) had pandemic influenza and 42 (11%) had seasonal influenza A detected. Twenty (91%) of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38%) of 61 imaged hospital test-negative patients (p<0.001). One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died. Conclusions The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services. PMID:20498718

  5. Dose estimation using dicentric chromosome assay and cytokinesis block micronucleus assay: comparison between manual and automated scoring in triage mode.

    Science.gov (United States)

    De Amicis, Andrea; De Sanctis, Stefania; Di Cristofaro, Sara; Franchini, Valeria; Regalbuto, Elisa; Mammana, Giacomo; Lista, Florigio

    2014-06-01

    In cases of an accidental overexposure to ionizing radiation, it is essential to estimate the individual absorbed dose of a potentially radiation-exposed person. For this purpose, biological dosimetry can be performed to confirm, complement or even replace physical dosimetry when this proves to be unavailable. The most validated biodosimetry techniques for dose estimation are the dicentric chromosome assay, the "gold standard" for individual dose assessment, and cytokinesis-block micronucleus assay. However, both assays are time consuming and require skilled scorers. In case of large-scale accidents, different strategies have been developed to increase the throughput of cytogenetic service laboratories. These are the decrease of cell numbers to be scored for triage dosimetry; the automation of procedures including the scoring of, for example, aberrant chromosomes and micronuclei; and the establishment of laboratory networks in order to enable mutual assistance if necessary. In this study, the authors compared the accuracy of triage mode biodosimetry by dicentric chromosome analysis and the cytokinesis block micronucleus assay performing both the manual and the automated scoring mode. For dose estimation using dicentric chromosome assay of 10 blind samples irradiated up to 6.4 Gy of x-rays, a number of metaphase spreads were analyzed ranging from 20 up to 50 cells for the manual and from 20 up to 500 cells for the automatic scoring mode. For dose estimation based on the cytokinesis block micronucleus assay, the micronucleus frequency in both 100 and 200 binucleated cells was determined by manual and automatic scoring. The results of both assays and scoring modes were compared and analyzed considering the sensitivity, specificity, and accuracy of dose estimation with regard to the discrimination power of clinically relevant binary categories of exposure doses.

  6. Discrepancy Between Clinician and Research Assistant in TIMI Score Calculation (TRIAGED CPU

    Directory of Open Access Journals (Sweden)

    Taylor, Brian T.

    2014-11-01

    Full Text Available Introduction: Several studies have attempted to demonstrate that the Thrombolysis in Myocardial Infarction (TIMI risk score has the ability to risk stratify emergency department (ED patients with potential acute coronary syndromes (ACS. Most of the studies we reviewed relied on trained research investigators to determine TIMI risk scores rather than ED providers functioning in their normal work capacity. We assessed whether TIMI risk scores obtained by ED providers in the setting of a busy ED differed from those obtained by trained research investigators. Methods: This was an ED-based prospective observational cohort study comparing TIMI scores obtained by 49 ED providers admitting patients to an ED chest pain unit (CPU to scores generated by a team of trained research investigators. We examined provider type, patient gender, and TIMI elements for their effects on TIMI risk score discrepancy. Results: Of the 501 adult patients enrolled in the study, 29.3% of TIMI risk scores determined by ED providers and trained research investigators were generated using identical TIMI risk score variables. In our low-risk population the majority of TIMI risk score differences were small; however, 12% of TIMI risk scores differed by two or more points. Conclusion: TIMI risk scores determined by ED providers in the setting of a busy ED frequently differ from scores generated by trained research investigators who complete them while not under the same pressure of an ED provider. [West J Emerg Med. 2015;16(1:24–33.

  7. Discrepancy between clinician and research assistant in TIMI score calculation (TRIAGED CPU).

    Science.gov (United States)

    Taylor, Brian T; Mancini, Michelino

    2015-01-01

    Several studies have attempted to demonstrate that the Thrombolysis in Myocardial Infarction (TIMI) risk score has the ability to risk stratify emergency department (ED) patients with potential acute coronary syndromes (ACS). Most of the studies we reviewed relied on trained research investigators to determine TIMI risk scores rather than ED providers functioning in their normal work capacity. We assessed whether TIMI risk scores obtained by ED providers in the setting of a busy ED differed from those obtained by trained research investigators. This was an ED-based prospective observational cohort study comparing TIMI scores obtained by 49 ED providers admitting patients to an ED chest pain unit (CPU) to scores generated by a team of trained research investigators. We examined provider type, patient gender, and TIMI elements for their effects on TIMI risk score discrepancy. Of the 501 adult patients enrolled in the study, 29.3% of TIMI risk scores determined by ED providers and trained research investigators were generated using identical TIMI risk score variables. In our low-risk population the majority of TIMI risk score differences were small; however, 12% of TIMI risk scores differed by two or more points. TIMI risk scores determined by ED providers in the setting of a busy ED frequently differ from scores generated by trained research investigators who complete them while not under the same pressure of an ED provider.

  8. Nurse-administered early warning score system can be used for emergency department triage

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke

    2011-01-01

    Warning Score (BEWS). The BEWS is calculated on the basis of respiratory frequency, pulse, systolic blood pressure, temperature and level of consciousness. The aim of this study is to evaluate the ability of the BEWS to identify critically ill patients in the ED and to examine the feasibility of using...

  9. Web-based scoring of the dicentric assay, a collaborative biodosimetric scoring strategy for population triage in large scale radiation accidents.

    Science.gov (United States)

    Romm, H; Ainsbury, E; Bajinskis, A; Barnard, S; Barquinero, J F; Barrios, L; Beinke, C; Puig-Casanovas, R; Deperas-Kaminska, M; Gregoire, E; Oestreicher, U; Lindholm, C; Moquet, J; Rothkamm, K; Sommer, S; Thierens, H; Vral, A; Vandersickel, V; Wojcik, A

    2014-05-01

    In the case of a large scale radiation accident high throughput methods of biological dosimetry for population triage are needed to identify individuals requiring clinical treatment. The dicentric assay performed in web-based scoring mode may be a very suitable technique. Within the MULTIBIODOSE EU FP7 project a network is being established of 8 laboratories with expertise in dose estimations based on the dicentric assay. Here, the manual dicentric assay was tested in a web-based scoring mode. More than 23,000 high resolution images of metaphase spreads (only first mitosis) were captured by four laboratories and established as image galleries on the internet (cloud). The galleries included images of a complete dose effect curve (0-5.0 Gy) and three types of irradiation scenarios simulating acute whole body, partial body and protracted exposure. The blood samples had been irradiated in vitro with gamma rays at the University of Ghent, Belgium. Two laboratories provided image galleries from Fluorescence plus Giemsa stained slides (3 h colcemid) and the image galleries from the other two laboratories contained images from Giemsa stained preparations (24 h colcemid). Each of the 8 participating laboratories analysed 3 dose points of the dose effect curve (scoring 100 cells for each point) and 3 unknown dose points (50 cells) for each of the 3 simulated irradiation scenarios. At first all analyses were performed in a QuickScan Mode without scoring individual chromosomes, followed by conventional scoring (only complete cells, 46 centromeres). The calibration curves obtained using these two scoring methods were very similar, with no significant difference in the linear-quadratic curve coefficients. Analysis of variance showed a significant effect of dose on the yield of dicentrics, but no significant effect of the laboratories, different methods of slide preparation or different incubation times used for colcemid. The results obtained to date within the MULTIBIODOSE

  10. Algorithm for the automatic computation of the modified Anderson-Wilkins acuteness score of ischemia from the pre-hospital ECG in ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Sejersten, Maria; Schoos, Mikkel Malby

    2017-01-01

    BACKGROUND: The acuteness score (based on the modified Anderson-Wilkins score) estimates the acuteness of ischemia based on ST-segment, Q-wave and T-wave measurements obtained from the electrocardiogram (ECG) in patients with ST Elevation Myocardial Infarction (STEMI). The score (range 1 (least...... the acuteness score. METHODS: We scored 50 pre-hospital ECGs from STEMI patients, manually and by the automated algorithm. We assessed the reliability test between the manual and automated algorithm by interclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS: The ICC was 0.84 (95% CI 0.......72-0.91), PECGs, all within the upper (1.46) and lower (-1.12) limits...

  11. Triage in military settings.

    Science.gov (United States)

    Falzone, E; Pasquier, P; Hoffmann, C; Barbier, O; Boutonnet, M; Salvadori, A; Jarrassier, A; Renner, J; Malgras, B; Mérat, S

    2017-02-01

    Triage, a medical term derived from the French word "trier", is the practical process of sorting casualties to rationally allocate limited resources. In combat settings with limited medical resources and long transportation times, triage is challenging since the objectives are to avoid overcrowding medical treatment facilities while saving a maximum of soldiers and to get as many of them back into action as possible. The new face of modern warfare, asymmetric and non-conventional, has led to the integrative evolution of triage into the theatre of operations. This article defines different triage scores and algorithms currently implemented in military settings. The discrepancies associated with these military triage systems are highlighted. The assessment of combat casualty severity requires several scores and each nation adopts different systems for triage on the battlefield with the same aim of quickly identifying those combat casualties requiring lifesaving and damage control resuscitation procedures. Other areas of interest for triage in military settings are discussed, including predicting the need for massive transfusion, haemodynamic parameters and ultrasound exploration.

  12. A propensity score analysis of prehospital factors and directness of transport of major trauma patients to a level I trauma center.

    Science.gov (United States)

    Garwe, Tabitha; Cowan, Linda D; Neas, Barbara R; Sacra, John C; Albrecht, Roxie M; Rich, Katy M

    2011-01-01

    Indications for direct transport may be strongly related to risk of future health outcomes, and these indications may not be adequately controlled by considering only in-hospital variables. This study was designed to identify prehospital factors associated with directness of transport. The study included 2,062 patients treated at a Level I trauma center between January 1, 2006, and December 31, 2007. The outcome of interest was directness of transport to a Level I trauma center. A propensity score analysis was used to identify demographic, clinical, distance, and other injury scene-related variables associated with the probability of direct transport. A total of 1,459 patients were directly transported to the Level I trauma center and 603 were transferred from lower level facilities. Patients were more likely to be transported directly if they had lower Glasgow Comma Scale scores, had penetrating injuries, were involved in traffic-related injuries, were closer to a Level IV or I trauma center, and if an advanced life support emergency medical service agency transported them from the scene. Patients were more likely to initially stop if they required advanced airway management, met at least one anatomic criterion, were further away from a Level I trauma center, or closer to an intermediate facility. Confounding due to unadjusted prehospital factors may be present in studies evaluating the impact of directness of transport on short-term mortality outcomes. Propensity score analysis of treatment indications provides an additional and efficient method to reduce this bias.

  13. [Emergency Triage. An Overview].

    Science.gov (United States)

    Christ, Michael; Bingisser, Roland; Nickel, Christian Hans

    2016-03-01

    In emergency departments, patients present with different severities of diseases and traumatic injuries. However, patients with severe and life-threatening conditions compete for the same resources such as personal and structure. As a general rule, each patient should receive immediate diagnostic and treatment, independent of his or her severity of disease or traumatic injury. However, an unexpected number of patients presenting to the emergency department at the same time may exceed available resources. Thus, waiting times will occur and management of patients may be impeded. As a consequence, patients with diseases or traumatic injuries with a need for time-critical management, have to be detected at the time of presentation. After categorization, patients have to be prioritized and guided to the correct place of treatment ("triage"). Starting in Australia and the United States, nurse-driven triage systems have been introduced in the emergency departments. Aim of triage is to correctly identify at increased risk of death and guide them to rapid and correct treatment. In Germany, two five-level triage systems have been introduced: Manchester Triage System (MTS) and Emergency Severity Index (ESI). We give an overview of these risk assessment tools and discuss pros and cons. In addition, new options such as "team triage" and a combination with "Early Warning Scores" are reported. In summary, nurse-driven triage is an instrument to improve patient safety in emergency medicine. A structured and systematic triage of patients using validated triage assessment tools are recommended from national and international societies of emergency medicine. Therefore, nurse-driven triage is also a must in Germany.

  14. The Eldicus prospective, observational study of triage decision making in European intensive care units: Part I-European Intensive Care Admission Triage Scores (EICATS)

    DEFF Research Database (Denmark)

    Sprung, Charles L; Baras, Mario; Iapichino, Gaetano

    2012-01-01

    care unit admission. INTERVENTIONS:: Admission or rejection to an intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Clinical, laboratory, and physiological variables and data from severity scores were collected. Separate scores for accepted and rejected patients with 28-day mortality end point were...... built. Values for variables were grouped into categories determined by the locally weighted least squares graphical method applied to the logit of the mortality and by univariate logistic regressions for reducing candidates for the score. Multivariate logistic regression was used to construct the final...... score. Cutoff values for 99.5% specificity were determined. Of 6796 patients, 5602 were admitted and 1194 rejected. The initial refusal score included age, diagnosis, systolic blood pressure, pulse, respirations, creatinine, bilirubin, PaO2, bicarbonate, albumin, use of vasopressors, Glasgow Coma Scale...

  15. Triage Drift:

    DEFF Research Database (Denmark)

    Bjørn, Pernille; Rødje, Kjetil

    2008-01-01

    . The paper provides in-depth empirical observations describing the situated work practices of triage work, and the complex collaborative nature of the triage process. We identify and conceptualize triage work practices as comprising patient trajectories, triage nurse activities, coordinative artefacts......This paper presents a workplace study of triage work practices within an emergency department (ED). We examine the practices, procedures, and organization in which ED staff uses tools and technologies when coordinating the essential activity of assessing and sorting patients arriving at the ED...... and exception handling; we also articulate how these four features of triage practices constitute and connect workflows, organize and re-organize time and space during the triage process. Finally we conceptualize these connections as an assessing and sorting mechanism in collaborative work. We argue...

  16. Emergency Physician Awareness of Prehospital Procedures and Medications

    Directory of Open Access Journals (Sweden)

    Rachel Waldron

    2014-07-01

    Full Text Available Introduction: Maintaining patient safety during transition from prehospital to emergency department (ED care depends on effective handoff communication between providers. We sought to determine emergency physicians’ (EP knowledge of the care provided by paramedics in terms of both procedures and medications, and whether the use of a verbal report improved physician accuracy. Methods: We conducted a 2-phase observational survey of a convenience sample of EPs in an urban, academic ED. In this large ED paramedics have no direct contact with physicians for non-critical patients, giving their report instead to the triage nurse. In Phase 1, paramedics gave verbal report to the triage nurse only. In Phase 2, a research assistant (RA stationed in triage listened to this report and then repeated it back verbatim to the EPs caring for the patient. The RA then queried the EPs 90 minutes later regarding their patients’ prehospital procedures and medications. We compared the accuracy of these 2 reporting methods. Results: There were 163 surveys completed in Phase 1 and 116 in Phase 2. The oral report had no effect on EP awareness that the patient had been brought in by ambulance (86% in Phase 1 and 85% in Phase 2. The oral report did improve EP awareness of prehospital procedures, from 16% in Phase 1 to 45% in Phase 2, OR=4.28 (2.5-7.5. EPs were able to correctly identify all oral medications in 18% of Phase 1 cases and 47% of Phase 2 cases, and all IV medications in 42% of Phase 1 cases and 50% of Phase 2 cases. The verbal report led to a mild improvement in physician awareness of oral medications given, OR=4.0 (1.09-14.5, and no improvement in physician awareness of IV medications given, OR=1.33 (0.15-11.35. Using a composite score of procedures plus oral plus IV medications, physicians had all three categories correct in 15% of Phase 1 and 39% of Phase 2 cases (p<0.0001. Conclusion: EPs in our ED were unaware of many prehospital procedures and

  17. 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.

  18. Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Sejersten, M.; Sillesen, M.; Hansen, Peter Riis;

    2008-01-01

    Prehospital electrocardiogram (ECG) transmission to hospitals was shown to reduce time to treatment in patients with acute myocardial infarction. However, new technologies allow transmission directly to a mobile unit so an attending physician can respond irrespective of presence within or outside...

  19. Ambulance smartphone tool for field triage of ruptured aortic aneurysms (FILTR): study protocol for a prospective observational validation of diagnostic accuracy.

    Science.gov (United States)

    Lewis, Thomas L; Fothergill, Rachael T; Karthikesalingam, Alan

    2016-10-24

    Rupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible that more rapid access to definitive intervention might be a key aspect of improving mortality for rAAA. Diagnosis is not always straightforward with up to 42% of rAAA initially misdiagnosed, introducing potentially harmful delay. There is a need for an effective clinical decision support tool for accurate prehospital diagnosis and triage to enable transfer to an appropriate centre. Prospective multicentre observational study assessing the diagnostic accuracy of a prehospital smartphone triage tool for detection of rAAA. The study will be conducted across London in conjunction with London Ambulance Service (LAS). A logistic score predicting the risk of rAAA by assessing ten key parameters was developed and retrospectively validated through logistic regression analysis of ambulance records and Hospital Episode Statistics data for 2200 patients from 2005 to 2010. The triage tool is integrated into a secure mobile app for major smartphone platforms. Key parameters collected from the app will be retrospectively matched with final hospital discharge diagnosis for each patient encounter. The primary outcome is to assess the sensitivity, specificity and positive predictive value of the rAAA triage tool logistic score in prospective use as a mob app for prehospital ambulance clinicians. Data collection started in November 2014 and the study will recruit a minimum of 1150 non-consecutive patients over a time period of 2 years. Full ethical approval has been gained for this study. The results of this study will be disseminated in peer-reviewed publications, and international/national presentations. CPMS 16459; pre-results. 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. Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia

    DEFF Research Database (Denmark)

    Fakhri, Yama; Schoos, Mikkel Malby; Sejersten-Ripa, Maria;

    2017-01-01

    BACKGROUND: Elevated levels of N-terminal pro brain natriuretic peptide (NT-proBNP) are associated with adverse cardiovascular outcome after ST elevation myocardial infarction (STEMI). We hypothesized that decreasing acuteness-score (based on the electrocardiographic score by Anderson-Wilkins acu...

  1. The prehospital management of traumatic brain injury.

    Science.gov (United States)

    Goldberg, Scott A; Rojanasarntikul, Dhanadol; Jagoda, Andrew

    2015-01-01

    Traumatic brain injury (TBI) is an important cause of death and disability, particularly in younger populations. The prehospital evaluation and management of TBI is a vital link between insult and definitive care and can have dramatic implications for subsequent morbidity. Following a TBI the brain is at high risk for further ischemic injury, with prehospital interventions targeted at reducing this secondary injury while optimizing cerebral physiology. In the following chapter we discuss the prehospital assessment and management of the brain-injured patient. The initial evaluation and physical examination are discussed with a focus on interpretation of specific physical examination findings and interpretation of vital signs. We evaluate patient management strategies including indications for advanced airway management, oxygenation, ventilation, and fluid resuscitation, as well as prehospital strategies for the management of suspected or impending cerebral herniation including hyperventilation and brain-directed hyperosmolar therapy. Transport decisions including the role of triage models and trauma centers are discussed. Finally, future directions in the prehospital management of traumatic brain injury are explored. © 2015 Elsevier B.V. All rights reserved.

  2. Diabetes patient at risk score - a novel system for triaging appropriate referrals of inpatients with diabetes to the diabetes team.

    Science.gov (United States)

    Rajendran, Rajesh; Round, Rachael-Marie; Kerry, Christopher; Barker, Sarah; Rayman, Gerry

    2015-06-01

    The acceptability, uptake and effectiveness of a new referral tool - the diabetes patient at risk (DPAR) score - were evaluated and the timeliness of review of referred inpatients by the diabetes team was measured. For this, a snapshot survey of ward healthcare professionals (HCPs) and a review of all DPAR referrals to the diabetes team between 1 September 2013 and 31 January 2014 were undertaken. All referrals in November 2013 were audited for timeliness of review. 77% of HCPs agreed/strongly agreed that the tool improved access to the diabetes team. 76% of referrals were from nurses. 80% of who should have been referred were referred; the remaining had already been reviewed by the diabetes team and therefore did not require referral. Only 11% of referrals were inappropriate. All DPAR referrals were reviewed within the stipulated time period in November 2013. Overall, the DPAR system was well accepted, successfully identified appropriate referrals and facilitated referrals in a timely manner to the diabetes team.

  3. 改良早期预警评分在急诊分诊管理中的应用价值%Application Value of Modified Early Warning Score in the Management of Emergency Triage

    Institute of Scientific and Technical Information of China (English)

    宋桂林; 胡赛; 黄艳

    2015-01-01

    【目的】研究改良早期预警评分(MEWS)在急诊分诊管理中的应用价值。【方法】随机选取2013年5月至2014年4月本院急诊患者560例随机分为对照组和观察组,每组各280例。对照组患者按常规的急诊分诊预检法,观察组患者采用M EWS系统,按评分结果分级处置,比较两种分诊方法在急诊患者分诊中的准确率以及两组患者满意度。【结果】观察组分诊准确率为95.0%(266/280),患者满意度为94.6%(265/280),两者均明显高于对照组的90.7%(254/280)和88.9%(249/280),且两组相比较差异有显著性(χ2=3.88和6.06,P均<0.05)。【结论】MEWS可以提高急诊分诊的准确性,患者更为满意,值得推广。%[Objective] To explore the application value of modified early warning score (MEWS) in the management of emergency triage .[Methods] At our emergency department from May 2013 to April 2014 ,a total of 560 patients were divided into control ( n = 280) and observation ( n = 280) groups .The control group was triaged conventionally while the observation group applied MEWS .And the patients received treat‐ment of different levels according to the scores .The triage accuracy of two groups and satisfaction rate for two systems were compared .[Results] The rates of accurate triage rate and satisfaction in observation group (95 . 0% ,94 .6% ) was significantly higher than that of control group (90 .7% ,88 .9% )(χ2 =3 .88 ,6 .06 ,either P<0 .05) .[Conclusion] MEWS evaluation allows a more accurate triage of patients .And it is worthy of wider popularization in emergency department .

  4. Prehospital care in Hong Kong.

    Science.gov (United States)

    Lo, C B; Lai, K K; Mak, K P

    2000-09-01

    A quick and efficient prehospital emergency response depends on immediate ambulance dispatch, patient assessment, triage, and transport to hospital. During 1999, the Ambulance Command of the Hong Kong Fire Services Department responded to 484,923 calls, which corresponds to 1329 calls each day. Cooperation between the Fire Services Department and the Hospital Authority exists at the levels of professional training of emergency medical personnel, quality assurance, and a coordinated disaster response. In response to the incident at the Hong Kong International Airport in the summer of 1999, when an aircraft overturned during landing, the pre-set quota system was implemented to send patients to designated accident and emergency departments. Furthermore, the 'first crew at the scene' model has been adopted, whereby the command is established and triage process started by the first ambulance crew members to reach the scene. The development of emergency protocols should be accompanied by good field-to-hospital and interhospital communication, the upgrading of decision-making skills, a good monitoring and auditing structure, and commitment to training and skills maintenance.

  5. 改良早期预警评分在急诊分诊系统中的应用%Application of Modified Early Warning Score in the Emergency Triage System

    Institute of Scientific and Technical Information of China (English)

    陈建萍; 洪凌; 毕东军; 杨伟英; 孙美萍; 施欢欢

    2014-01-01

    Objective To explore the value of applying modified early warning score (MEWS) in the emergency triage management. Methods A total of 65,147 patients admitted from March to December, 2011 in our emergency department were taken as the control group while 68,092 ones from March to December 2012 as the observation group. The control group was triaged with conventional methods while the observation group with MEWS was referred to relevant regions to receive treatment of different levels according to the scores. The triage accuracy of the two groups and satisfaction rate of doctor and nurse in emergency department for the two systems were compared. Results The accurate triage rate in the observation group was significantly higher than that of the control group (P<0.01). The satisfaction rates of doctor and nurses for the emergency triage administration with and without MEWS were 86.7% and 94.6%respectively (χ2=18.61, P<0.05). Conclusion MEWS evaluation which can help nurses to triage patients to the right units more accurately is worthy of popularizing in emergency department as an effective tool of triage.%#目的探讨改良早期预警评分(MEWS)在急诊分诊管理中的应用价值。方法选取2011年3月至12月急诊患者65147例为对照组,2012年3至12月急诊患者68092例为观察组。对照组患者按常规的急诊分诊流程处理,观察组患者采用MEWS系统,根据评分结果进行分区分级处置,比较两种分诊流程在急诊患者病情评估中的准确率,比较医生、护士对两种分诊管理模式的满意度。结果观察组分诊准确率高于对照组(P<0.01);医生、护士对实施MEWS系统前后的急诊患者分诊管理满意度分别为86.7%和94.6%(χ2=18.61,P<0.05)。结论 MEWS便于急诊护士更准确地将患者分诊至相应就诊区域,可作为急诊合理分诊患者的有效工具,值得推广。

  6. Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines

    Directory of Open Access Journals (Sweden)

    Rehn Marius

    2009-01-01

    Full Text Available Abstract Background Field triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived access to trauma team resuscitation (undertriage, yet high specificity to avoid resource over-utilization (overtriage. Previous informal trauma team activation (TTA at Ulleval University Hospital (UUH caused imprecise triage. We have analyzed triage precision after introduction of TTA guidelines. Methods Retrospective analysis of 7 years (2001–07 of prospectively collected trauma registry data for all patients with TTA or severe injury, defined as at least one of the following: Injury Severity Score (ISS > 15, proximal penetrating injury, admitted ICU > 2 days, transferred intubated to another hospital within 2 days, dead from trauma within 30 days. Interhospital transfers to UUH and patients admitted by non-healthcare personnel were excluded. Overtriage is the fraction of TTA where patients are not severely injured (1-positive predictive value; undertriage is the fraction of severely injured admitted without TTA (1-sensitivity. Results Of the 4 659 patients included in the study, 2 221 (48% were severely injured. TTA occurred 4 440 times, only 2 002 of which for severely injured (overtriage 55%. Overall undertriage was 10%. Mechanism of injury was TTA criterion in 1 508 cases (34%, of which only 392 were severely injured (overtriage 74%. Paramedic-manned prehospital services provided 66% overtriage and 17% undertriage, anaesthetist-manned services 35% overtriage and 2% undertriage. Falls, high age and admittance by paramedics were significantly associated with undertriage. A Triage-Revised Trauma Score (RTS Patients subject to undertriage had an ISS-adjusted Odds Ratio for 30-day mortality of 2.34 (95% CI 1.6–3.4, p Conclusion Triage precision had not improved after TTA guideline introduction. Anaesthetists perform precise trauma triage, whereas paramedics have potential for improvement. Skewed

  7. The Copenhagen Triage Algorithm

    DEFF Research Database (Denmark)

    Hasselbalch, Rasmus Bo; Plesner, Louis Lind; Pries-Heje, Mia

    2016-01-01

    is non-inferior to an existing triage model in a prospective randomized trial. METHODS: The Copenhagen Triage Algorithm (CTA) study is a prospective two-center, cluster-randomized, cross-over, non-inferiority trial comparing CTA to the Danish Emergency Process Triage (DEPT). We include patients ≥16 years...

  8. Berlin prehospital or usual delivery of acute stroke care - Study protocol.

    Science.gov (United States)

    Ebinger, Martin; Harmel, Peter; Nolte, Christian H; Grittner, Ulrike; Siegerink, Bob; Audebert, Heinrich J

    2017-08-01

    Rationale Prehospital stroke care in specialized ambulances increases thrombolysis rates, reduces alarm-to-treatment times, and improves the prehospital triage. Preliminary analyses suggest cost-effectiveness. However, scientific proof of better functional outcome compared to usual care is still lacking. Aim To prove better functional outcomes after deployment of the Stroke Emergency Mobile compared to regular ambulances. Sample size estimates A sample size of 686 patients will be required in each arm (Stroke Emergency Mobile group vs. regular care) to detect a difference regarding the primary outcome with 80% power at a two-sided significance level of 0.05. Methods and design This is a pragmatic, prospective study with blinded outcome assessment. Primary outcome will be functional status as defined by modified Rankin Scale score three months after the incident event. We will include cerebral ischemia patients within a predefined catchment area in Berlin, Germany. The study population consists of patients who might be candidates for acute recanalizing treatments, with onset-to-alarm time ≤4 h, symptoms not resolved at time of ambulance arrival, and able to walk without assistance prior to the qualifying incident. About 45% of Stroke Emergency Mobile dispatches are expected to be handled by regular ambulances, since Stroke Emergency Mobile will be already in operation creating the control group. Primary outcome Functional outcome after three months measured by the modified Rankin Scale over the entire range. Discussion The results will inform decision makers on the effectiveness of Stroke Emergency Mobile.

  9. Current Status of Applications of Scoring Tool in Pre-hospital Care and Its Prospect in China%我国院前急救中评分工具的应用现状与展望

    Institute of Scientific and Technical Information of China (English)

    唐维骏

    2011-01-01

    This paper reviews the application status and clinical evaluation of several scoring tools applying to prehospital first - aid and the difficulties and challenges we are currently facing in China. The future research direction is how to improve the sensitivity and specificity of scoring tools and how to use them to score disease severity and disability, etc. except death , thus to make the scoring system more perfect.%本文综述了适用于院前急救中的几种评分工具在国内的应用现状和临床评价,及目前面临的困境与挑战.认为今后的研究方向是如何提高评分工具的灵敏度和特异度,并对死亡之外的疾病严重程度和伤残等进行评分,使评分系统更加完善.

  10. Emergency Centre Organization and Automated Triage System

    CERN Document Server

    Golding, Dan; Marwala, Tshilidzi

    2008-01-01

    The excessive rate of patients arriving at accident and emergency centres is a major problem facing South African hospitals. Patients are prioritized for medical care through a triage process. Manual systems allow for inconsistency and error. This paper proposes a novel system to automate accident and emergency centre triage and uses this triage score along with an artificial intelligence estimate of patient-doctor time to optimize the queue order. A fuzzy inference system is employed to triage patients and a similar system estimates the time but adapts continuously through fuzzy Q-learning. The optimal queue order is found using a novel procedure based on genetic algorithms. These components are integrated in a simple graphical user interface. Live tests could not be performed but simulations reveal that the average waiting time can be reduced by 48 minutes and priority is given to urgent patients

  11. [Competence of triage nurses in hospital emergency departments].

    Science.gov (United States)

    Martínez-Segura, Estrella; Lleixà-Fortuño, Mar; Salvadó-Usach, Teresa; Solà-Miravete, Elena; Adell-Lleixà, Mireia; Chanovas-Borrás, Manel R; March-Pallarés, Gemma; Mora-López, Gerard

    2017-06-01

    To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training.

  12. An advance triage system.

    Science.gov (United States)

    Cheung, W W H; Heeney, L; Pound, J L

    2002-01-01

    This paper describes the redesign of the triage process in an Emergency Department with the purpose of improving the patient flow and thus increasing patient satisfaction through the reduction of the overall length of stay. The process, Advance Triage, allows the triage nurse to initiate diagnostic protocols for frequently occurring medical problems based on physician-approved algorithms. With staff and physician involvement and medical specialist approval, nine Advance Triage algorithms were developed-abdominal pain, eye trauma, chest pain, gynaecological symptoms, substance abuse, orthopaedic trauma, minor trauma, paediatric fever and paediatric emergent. A comprehensive educational program was provided to the triage nurses and Advance Triage was initiated. A process was established at one year to evaluate the effectiveness of the Advance Triage System. The average length of stay was found to be 46 min less for all patients who were advance triaged with the greatest time-saving of 76 min for patients in the 'Urgent' category. The most significant saving was realized in the patient's length of stay (LOS) after the Emergency Physician assessed them because diagnostic results, available during the initial patient assessment, allowed treatment decisions to be made at that time. Advance Triage utilizes patient waiting time efficiently and increases the nurses' and physicians' job satisfaction.

  13. Clinical use of the combined Sclarovsky Birnbaum Severity and Anderson Wilkins Acuteness scores from the pre-hospital ECG in ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Schoos, Mikkel M; Clemmensen, Peter

    2014-01-01

    This review summarizes the electrocardiographic changes during an evolving ST segment elevation myocardial infarction and discusses associated electrocardiographic scores and the potential use of these indices in clinical practice, in particular the ECG scores developed by Anderson and Wilkins...

  14. Prehospital transported patients

    DEFF Research Database (Denmark)

    Bech, Camilla Louise Nørgaard; Brabrand, M.; Lassen, Annmarie Touborg

    2015-01-01

    Introduction The survival of patients transported by ambulance to the emergency department (ED) depends on clinical conditions, patient-related factors and organisational prehospital set up. Data and information concerning patients in the prehospital system could form a valuable resource for asse......Introduction The survival of patients transported by ambulance to the emergency department (ED) depends on clinical conditions, patient-related factors and organisational prehospital set up. Data and information concerning patients in the prehospital system could form a valuable resource......-time ambulance transport to the ED at Odense University Hospital in the period 1 April 2012 to 30 September 2013. Ambulance personnel recorded vital signs and other clinical findings on a structured form on paper during the ambulance transport. Each contact was linked to information from population...

  15. Application of modified early warning score in triage of emergency patients with syncope%改良早期预警评分在急诊晕厥患者分诊中的应用及评价

    Institute of Scientific and Technical Information of China (English)

    周仲瑶; 晓妮; 林碎钗

    2014-01-01

    Objective To evaluate the application of modified early warning score(MEWS) in triage of emergency patients with syncope. Methods Three hundred and forty five emergency patients with syncope were divided into emergency group (MEWS score>4) and non- emergency group (MEWS score ≤4) . The urgent events were observed within 24h of emergency visit. Results Urgent events occurred in 20 cases (5.9%), including 6 cases of death, 4 cases of recurrent syncope, 6 cases of respiratory and circulatory arrest and 6 cases of ICU admission. The mortality and the incidence of total urgent events in emer-gency group were significantly higher than those in non- emergency group. MEWS score predicted urgent events with a sensi-tivity of 65.0%, specificity of 60.4%, positive predictive value of 9.4%and negative predictive value of 96.5%. Conclusion Mod-ified early warning score contributes to triage of patients with syncope to some extent and further research and development of specialized triage methods for syncope patients is needed.%目的:探讨改良早期预警评分(MEWS)在急诊晕厥患者分诊中的应用及准确性。方法以345例符合条件的急诊晕厥患者为研究对象,根据MEWS评分情况将患者分为紧急组(MEWS评分>4分)和非紧急组(MEWS评分≤4分),观察就诊24h内所发生的紧急事件。结果共有20例患者(5.9%)出现紧急事件,包括死亡6例,再次晕厥4例,呼吸循环骤停6例,入住ICU 6例。紧急组病死率(3.6%)和紧急事件总发生率(9.4%)明显高于非紧急组(0.5%、3.5%),差异有统计学意义(P>0.05)。MEWS评分预测紧急事件的灵敏度为65.0%,特异度为60.4%,阳性预测值为9.4%,阴性预测值为96.5%。结论改良早期预警评分在一定程度上有助于晕厥患者的分诊,但其准确度并不高,需要进一步研究和建立专门针对晕厥患者的分诊方法。

  16. The trauma report nurse: a trauma triage process improvement project.

    Science.gov (United States)

    Jelinek, Lisa; Fahje, Carol; Immermann, Carol; Elsbernd, Terri

    2014-09-01

    Accurate trauma triage is imperative to facilitate appropriate resource mobilization for severely injured trauma patients. A critical window of opportunity exists to prevent secondary injury or death. Timely assessment with a multidisciplinary trauma team is essential to facilitate rapid diagnosis and treatment. However, consistent and accurate trauma triage proved daunting at our institution, resulting in instances of undertriage. A process improvement strategy aimed at improving trauma triage accuracy was implemented. An innovative role, the trauma report nurse (TRN), was created and became the trauma nurse expert. The TRN was responsible for assigning a trauma triage level to all incoming adult and pediatric trauma patients. In parallel, improvements were made to the prehospital report format, increasing standardization and clarifying hand-off verbiage. Undertriage rates dropped from 14% to 4.8%. Qualitative data demonstrated acceptance and support of the TRN role among physicians, nurses and nursing and ancillary staff. Designating trauma triage to an ED registered nurse proved to reduce undertriage rates. By providing staff education, infrastructure improvements, and leadership support, the role continues to thrive, resulting in improved care for severely injured trauma patients. Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  17. [Building a quality evaluation system for the nursing triage process].

    Science.gov (United States)

    Gadda, Giorgio; Destrebecq, Anne; Bollini, Giovanna; Terzoni, Stefano

    2009-01-01

    In literature there are no studies regarding the quality evaluation of the whole triage process; however, since it is necessary to evaluate what really happens everyday in the Emergency Rooms, as well as verifying the daily level of throughput, there is a strong need for an appropriate tool. Measuring the quality of triage means improving the caring process. This article presents a new measurement grid, aimed at realizing a Quality Evaluation of Nursing Care. Currently, the most widespread systems used for the QENC are the Australian Triage Scale, the Canadian triage and Acuity Scale and the Italian Group of Triage Scale. The global/biphasic triage system was used in our study because it seems the most accurate, according to literature. There are several indicators that evaluate many aspects of the triage process; every single indicator has a score. The sum of the scores defines the quality level of the nursing triage process. Our paper discusses the application of this score in a major Milan hospital, based upon a preliminary study.

  18. A Novel Prehospital Electrocardiogram Score Predicts Myocardial Salvage in Patients with ST-Segment Elevation Myocardial Infarction Evaluated by Cardiac Magnetic Resonance

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Lønborg, Jacob; Vejlstrup, Niels

    2013-01-01

    We hypothesized that prehopsital ECG scores can identify ST-segment elevation myocardial infarction (STEMI) patients in whom time delay is particularly important for myocardial salvage.......We hypothesized that prehopsital ECG scores can identify ST-segment elevation myocardial infarction (STEMI) patients in whom time delay is particularly important for myocardial salvage....

  19. Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

    Science.gov (United States)

    2014-05-15

    The impact of prehospital endotracheal intubation on outcome in moderate to severe traumatic brain injury. J. Trauma 58, 933–939. 6. Magazzini, S...tracheal intubation after traumatic injury.4 In addition, the GCS is often relied upon in prehospital research to help control for degree of TBI (for...GCS, hypotension, and higher mortality has been quantified in classic prehospital severity scores, such as the trauma score,14 the prehospital index

  20. Prehospital Emergency Ultrasound: A Review of Current Clinical Applications, Challenges, and Future Implications

    Directory of Open Access Journals (Sweden)

    Mazen J. El Sayed

    2013-01-01

    Full Text Available Imaging modalities in the prehospital setting are helpful in the evaluation and management of time-sensitive emergency conditions. Ultrasound is the main modality that has been applied by emergency medical services (EMS providers in the field. This paper examines the clinical applications of ultrasound in the prehospital setting. Specific focus is on applications that provide essential information to guide triage and management of critical patients. Challenges of this modality are also described in terms of cost impact on EMS agencies, provider training, and skill maintenance in addition to challenges related to the technical aspect of ultrasound.

  1. The use of an In House Scoring System Scale versus Glasgow Coma Scale in non-traumatic altered states of consciousness patients: can it be used for triaging patients in Southeast Asian developing countries?

    Science.gov (United States)

    Maheswaran, M; Adnan, W A W; Ahmad, R; Ab Rahman, N H N; Naing, N N; Abdullah, J

    2007-11-01

    Non-traumatic Altered States of Consciousness (ASC) are a non-specific consequence of various etiologies, and are normally monitored by Glasgow Coma Scale (GCS). The GCS gives varriable results among untrained emergency medicine personel in developing countries where English is not the first language. An In House Scoring System (IHSS) scale was made by the first author for the purpose of triaging so as to quickly asses patients when seen by medical personel. This IHSS scale was compared to the GCS to determine it's specificity and sensitivity in the accident and emergency department (ED) of Hospital University Sains Malaysia (HUSM). All patients with non-traumatic ASC were selected by purposive sampling according to pre-determined criteria. Patients were evaluated by the two systems, IHSS and GCS, by emergency physicians who were on call. Patient demographics, clinical features, investigations, treatment given and outcomes were collected and followed for a period of 14 days. A total of 221 patients with non-traumatic ASC were studied, 54.3% were males. The mean age of the patients was 56 years old. The mean overall GCS score on presentation to the ED was 10.3. The mean duration of ASC was 11.6 hours. One hundred thirty patients (58.8%) experienced ASC secondary to general or focal cerebral disorders. The mortality rate was 40.3% 2 weeks after the ED visit. Fifty-four point three percent of the patients were awake and considered to have good outcomes while 45.7% of the patients had poor outcomes (comatose or dead) 2 weeks after the ED visit. The mean overall GCS score, verbal and motor subscores as well as the IHSS had significantly decreased (worsened) after treatment in the ED. A poor IHSS scale, hypertension, current smoking, abnormal pupillary reflexes and acidosis were associated with a worse 2-week outcome. The mean age and WBC count was lower and the mean overall GCS score and eye, verbal and motor subscores were higher as well as those having a lower IHSS

  2. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    Directory of Open Access Journals (Sweden)

    Lockey David

    2011-10-01

    Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

  3. 主动脉夹层风险评分表在早期分诊中应用的效果评价%Preliminary assessment on Risk Score Scale for aortic dissection in early triage stage

    Institute of Scientific and Technical Information of China (English)

    赵亚锋; 李敏玲; 李会玲; 李宁; 刘小敏

    2015-01-01

    目的 初步评价主动脉夹层风险评分表在早期分诊中应用的有效性.方法 分诊护士根据预先制订的分诊用主动脉夹层风险评分表,对201 1年至2013年就诊的主诉为急性胸背痛251例患者进行分诊.经过影像学确诊患者95例(列为确诊组),其中评分≥5分的87例,≥6分的80例.排除主动脉夹层患者156例作为对照组.比较2组患者的一般情况、主动脉夹层危险因素分布、危险因素评分结果、评分方法的灵敏度与特异度.并对评分结果≥5分及≥6分的分诊误诊率、漏诊率、特异度、灵敏度、OR值进行了比较.结果 2组患者在撕裂样剧烈胸背痛、脉搏短绌或双上肢收缩压差≥20 mmHg(1 mmHg=0.133 kPa)或双下肢收缩压差≥10 mmHg这些危险因素的分布上比较,差异有统计学意义x2值分别为62.6,94.2和20.2.评分≥5分时分诊的灵敏度与特异度最高.评分≥5分时分诊为急性主动脉夹层具有较高的灵敏度,较低的漏诊率及很高的OR值.结论 评分≥5分可以作为急性主动脉夹层早期分诊的可靠依据.%Objective We aimed to assess effectiveness of Risk Score Scale (RSS) for aortic Dissection (AD) in early triage stage.Methods A total of 251 patients with acute chest or back pain complaints were allocated by triage nurses according to the pre-established RSS from 2011 to 2013.87 cases were assessed to have 5 points or more,and 80 cases were assessed to have 6 points or more from 95 patients diagnosed as aortic dissection (the diagnosed group) by CT angiography and magnetic resonance imaging while excluded 156 cases of control after discharge (control group).The general conditions,distribution of aortic dissection risk factors,aortic dissection risk score,sensitivity and specificity of RSS between two groups were compared.The misdiagnosis rate,missed diagnosis rate,RSS triage sensitivity and specificity and OR value were compared between RSS ≥5 points and RSS ≥6 points

  4. Cardiac risk factors and risk scores vs cardiac computed tomography angiography: a prospective cohort study for triage of ED patients with acute chest pain.

    Science.gov (United States)

    Halpern, Ethan J; Deutsch, Jacob P; Hannaway, Maria M; Estepa, Adrian T; Kenia, Anand S; Neuburger, Kenneth J; Levin, David C

    2013-10-01

    The objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome. Informed consent was obtained from consecutive ED patients who presented with chest pain and were evaluated with coronary computed tomography angiography (cCTA). Cardiac risk factors, clinical presentation, electrocardiogram, and laboratory studies were recorded; the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were tabulated. Coronary computed tomography angiography findings were rated on a 6-level plaque burden scale and classified for significant CAD (stenosis ≥50%). Adverse cardiovascular outcomes were recorded at 30 days. Among 250 patients evaluated by cCTA, 143 (57%) had no CAD, 64 (26%) demonstrated minimal plaque (70% stenosis). Six patients developed adverse cardiovascular outcomes. Among traditional cardiac risk factors, only age (older) and sex (male) were significant independent predictors of CAD. Correlation with CAD was poor for the TIMI (r = 0.12) and GRACE (r = 0.09-0.23) scores. The TIMI and GRACE scores were not useful to predict adverse outcomes. Coronary computed tomography angiography identified severe CAD in all subjects with adverse outcomes. Among ED patients who present with chest pain judged to be at low to intermediate risk for acute coronary syndrome, traditional risk factors are not useful to stratify risk for CAD and adverse outcomes. Coronary computed tomography angiography is an excellent predictor of CAD and outcome. © 2013.

  5. Is obstetric triage necessary?

    Directory of Open Access Journals (Sweden)

    Seetha Panicker

    2014-02-01

    Conclusions: Obstetric triage would improve efficiency of care and reduce waiting time. The suggestions for improvement were also discussed. There should be clear guidelines and protocols for the initial assessment and action for each level of severity. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 44-47

  6. Triage as Urban Policy.

    Science.gov (United States)

    Marcuse, Peter; And Others

    1982-01-01

    Triage policy is the exclusion of severely declining urban areas from services and programs on the grounds that the intensity of their needs cannot be met and the provision of services is therefore inefficient. Community groups must insist that severity of need, human benefits, and community protection be the priorities for allocation of funds.…

  7. Does prehospital time affect survival of major trauma patients where there is no prehospital care?

    Directory of Open Access Journals (Sweden)

    S B Dharap

    2017-01-01

    Full Text Available Background: Survival after major trauma is considered to be time dependent. Efficient prehospital care with rapid transport is the norm in developed countries, which is not available in many lower middle and low-income countries. The aim of this study was to assess the effect of prehospital time and primary treatment given on survival of major trauma patients in a setting without prehospital care. Materials and Methods: This prospective observational study was carried out in a university hospital in Mumbai, from January to December 2014. The hospital has a trauma service but no organized prehospital care or defined interhospital transfer protocols. All patients with life- and/or limb-threatening injuries were included in the study. Injury time and arrival time were noted and the interval was defined as “prehospital time” for the directly arriving patients and as “time to tertiary care” for those transferred. Primary outcome measure was in-hospital death (or discharge. Results: Of 1181 patients, 352 were admitted directly from the trauma scene and 829 were transferred from other hospitals. In-hospital mortality was associated with age, mechanism and mode of injury, shock, Glasgow Coma Score <9, Injury Severity Score ≥16, need for intubation, and ventilatory support on arrival; but neither with prehospital time nor with time to tertiary care. Transferred patients had a significantly higher mortality (odds ratio = 1.869, 95% confidence interval = 1.233–2.561, P = 0.005 despite fewer patients with severe injury. Two hundred and ninety-four (35% of these needed airway intervention while 108 (13% needed chest tube insertion on arrival to the trauma unit suggesting inadequate care at primary facility. Conclusion: Mortality is not associated with prehospital time but with transfers from primary care; probably due to deficient care. To improve survival after major trauma, enhancement of resources for resuscitation and capacity building of on

  8. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis.

    Science.gov (United States)

    Henriksen, Hanne H; Rahbar, Elaheh; Baer, Lisa A; Holcomb, John B; Cotton, Bryan A; Steinmetz, Jacob; Ostrowski, Sisse R; Stensballe, Jakob; Johansson, Pär I; Wade, Charles E

    2016-12-09

    The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. 75 patients received pre-hospital plasma and/or RBCs (PH group; nearly half received both RBCs and plasma) whereas 182 patients only received in-hospital blood products (RBCs, Plasma and Platelets) within 6 hours of admission (IH group). PH patients had lower Glasgow coma scale (GCS) scores, more penetrating injuries, lower systolic blood pressures, lower hemoglobin levels, lower platelet counts and greater acidosis upon ED admission than the IH group (all p plasma, more pre-hospital plasma transfusion was tendency towards improved rTEG variables. When adjusting for pre-hospital RBC, pre-hospital plasma was associated with significantly higher rTEG MA (p = 0.012) at hospital admission. After adjusting for pre-hospital RBCs, pre-hospital plasma transfusion was independently associated with increased rTEG MA, as well as arrival indices of shock and hemodynamic instability. Besides more severe injury and worse clinical presentation, the group that received pre-hospital transfusion had early and late mortality similar to patients not transfused pre-hospital. These data suggest that early administration of plasma can provide significant hemostatic and potential

  9. A concept for major incident triage: full-scaled simulation feasibility study

    Directory of Open Access Journals (Sweden)

    Rehn Marius

    2010-08-01

    Full Text Available Abstract Background Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS. The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents. Methods The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1 through "Worked excellent" (7. Results Among the 93 (85% participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32 without TAS-triage vs. 10 minutes (range 5-21 with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2 before the course vs. mean 5,8 (95% CI 5,6-6,0 after the course, p Conclusions Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and

  10. Acidentes de trânsito: caracterização das vitimas segundo o "Revised Trauma Score" medido no período pré-hospitalar Accidentes de transito: caracterización de las víctimas según el "Revised Trauma Score" medido en el periodo pre-hospitalario Motor vehicle crash: victims' characterization throughout prehospital "Revised Trauma Score"

    Directory of Open Access Journals (Sweden)

    Marisa Amaro Malvestio

    2002-12-01

    Full Text Available O estudo descreve idade, sexo, aspectos do mecanismo e procedimentos realizados em. 643 acidentados de trânsito atendidos nas Marginais Tietê e Pinheiros, considerando os valores do Revised Trauma Score (RTS do período pré-hospitalar. As vítimas com RTS=12 somaram 90,8%, com RTS=11, 4,0% e RTSEste estudio tiene como obje tivo describer, considerando el Revised Trauma Score (RTS obtenido en el periodo pré hospitalario, edad, sexo, aspectos del mecanismo e procedimientos realizados en 643 víctimas de accidente de tránsito. Las víctimas con RTS=12 sumaron 90,8%, con RTS=11, 4,0% y RTSThis report describes age, gender, trauma mechanics aspects and procedures from 643 motor vehicle crashes, MVC, victims in Tietê and Pinheiros expressways, by considering the prehospital Revised Trauma Score (RTS. The RTS=12 victims' were 90,8%, with RTS=11 added 4,0% and in group with RTS<10, 5,2%. Among the RTS<10 victims, the pedestrians stand out (36,4%, the frontal impacts (24,2% and the projected (36,4% or trapped victims (15,1%, and those that received advanced life support procedures.The motorcyclists and the male victims with 21 with 30 years of age were predominant. This study is expected to contribute to a better assistance to MVC victims.

  11. Relationships between Triage Knowledge, Training, Working Experiences and Triage Skills among Emergency Nurses in East Java, Indonesia

    Directory of Open Access Journals (Sweden)

    Mukhamad Fathoni

    2013-01-01

    Full Text Available Background: Since there are increased numbers of clients with traumatic injuries and non-traumatic cases in the emergency department in Indonesia, triage skill is an essential competency required for the emergency nurses.Purposes: This study aimed to examine the level of perceived triage skills and the relationship between knowledge, training, working experience and perceived triage skills among emergency nurses.Method: Two hundred and sixty six emergency room (ER nurses working in two secondary and two tertiary public hospitals in East Java Province, Indonesia, were recruited by purposive sampling. Data were collected using a set of questionnaires which included the Demographic Data including training and working experiences, Triage Knowledge Questionnaire (TKQ and Triage Skill Questionnaire (TSQ. The contents of questionnaires were validated by three experts and tested for reliability. The correlation coefficient for the TKQ was 0.99 and Cronbach’s alpha coefficient of the TSQ was 0.93. The collected data were analyzed using descriptive statistics including Pearson’s product-moment correlation to examine the relationship.Result: The results showed that the majority of subjects were female (71.4% with aged of 22 – 40 years (79.3%, educated to diploma level (94.4%. All subjects had attended Basic Life Support (BLS and Advanced Life Support (ACLS, and about half of them had greater than 5 years working experiences in ED. Overall perceived triage skill was at a moderate level with the mean score of 75.12 (SD = 11.23. There were significantly positive correlations between triage skill and working experience (r = .27, p < .01, training experience (r = .37, p < .01, and triage knowledge (r = .38, p < .01.Conclusion: The findings provide a better understanding of triage skills among ER nurses and suggest that the continuing education and training courses related to triage and advanced management of medical emergencies for ER nurses are required

  12. Objective triage in the disaster setting: will children and expecting mothers be treated like others?

    Science.gov (United States)

    Kouliev, Timur

    2016-01-01

    The study of disaster triage is made difficult by the complex emotional response of potentially lifesaving intervention that a triage officer must make basing decisions on a succinct and efficient algorithm. A survey of triage professionals in international settings was designed to identify possible emotionally led bias that affects objective decision making in identifying victims most likely to benefit from immediate life support intervention. This survey suggests a lack of correlation between triage priority and predictable clinical outcomes as predicted by the Revised Trauma Score tool. Among the subjects, it was observed that a pediatric victim is uniformly overtriaged when compared to less injured victims. PMID:27822127

  13. 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.

  14. Objective triage in the disaster setting: will children and expecting mothers be treated like others?

    Directory of Open Access Journals (Sweden)

    Kouliev T

    2016-10-01

    Full Text Available Timur Kouliev Beijing United Family Hospital, Beijing, People's Republic of China Abstract: The study of disaster triage is made difficult by the complex emotional response of potentially lifesaving intervention that a triage officer must make basing decisions on a succinct and efficient algorithm. A survey of triage professionals in international settings was designed to identify possible emotionally led bias that affects objective decision making in identifying victims most likely to benefit from immediate life support intervention. This survey suggests a lack of correlation between triage priority and predictable clinical outcomes as predicted by the Revised Trauma Score tool. Among the subjects, it was observed that a pediatric victim is uniformly overtriaged when compared to less injured victims. Keywords: triage, disaster triage, emotional bias, pediatric trauma, obstetric trauma, People's Republic of China

  15. The fate of triaged and rejected manuscripts

    Science.gov (United States)

    Zoccali, Carmine; Amodeo, Daniela; Argiles, Angel; Arici, Mustafa; D'arrigo, Graziella; Evenepoel, Pieter; Fliser, Danilo; Fox, Jonathan; Gesualdo, Loreto; Jadoul, Michel; Ketteler, Markus; Malyszko, Jolanta; Massy, Ziad; Mayer, Gert; Ortiz, Alberto; Sever, Mehmet; Vanholder, Raymond; Vinck, Caroline; Wanner, Christopher; Więcek, Andrzej

    2015-01-01

    In 2011, Nephrology Dialysis and Transplantation (NDT) established a more restrictive selection process for manuscripts submitted to the journal, reducing the acceptance rate from 25% (2008–2009) to currently about 12–15%. To achieve this goal, we decided to score the priority of manuscripts submitted to NDT and to reject more papers at triage than in the past. This new scoring system allows a rapid decision for the authors without external review. However, the risk of such a restrictive policy may be that the journal might fail to capture important studies that are eventually published in higher-ranked journals. To look into this problem, we analysed random samples of papers (∼10%) rejected by NDT in 2012. Of the papers rejected at triage and those rejected after regular peer review, 59 and 61%, respectively, were accepted in other journals. A detailed analysis of these papers showed that only 4 out of 104 and 7 out of 93 of the triaged and rejected papers, respectively, were published in journals with an impact factor higher than that of NDT. Furthermore, for all these papers, independent assessors confirmed the evaluation made by the original reviewers. The number of citations of these papers was similar to that typically obtained by publications in the corresponding journals. Even though the analyses seem reassuring, previous observations made by leading journals warn that the risk of ‘big misses’, resulting from selective editorial policies, remains a real possibility. We will therefore continue to maintain a high degree of alertness and will periodically track the history of manuscripts rejected by NDT, particularly papers that are rejected at triage by our journal. PMID:26597920

  16. The role of cytogenetics in early triage of radiation casualties

    Energy Technology Data Exchange (ETDEWEB)

    Lloyd, D.C. E-mail: david.lloyd@nrpb.org.uk; Edwards, A.A.; Moquet, J.E.; Guerrero-Carbajal, Y.C

    2000-05-15

    Preliminary dose estimates by chromosomal analysis can be made rapidly in order to supplement early triage of radiation casualties based on clinical signs. An in vitro simulation of an accident with many casualties receiving whole or partial body exposure in the range 0-8 Gy is described. Faced with an urgent need for rapid results, confirmation of clinical triage can generally be obtained from scoring 20 metaphases per subject. Scoring should be increased to 50 cells where there is disagreement with the initial assessments or evidence of significantly inhomogeneous exposure.

  17. Low compliance with a validated system for emergency department triage

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke;

    2011-01-01

    Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have...... a "primary criterion" or a BEWS ≥ 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital....

  18. Low compliance with a validated system for emergency department triage

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke;

    2011-01-01

    Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have...... a "primary criterion" or a BEWS = 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital....

  19. Application of the modified early waming scoring to the assessment of conditions of elderly patients in prehospital first aid%改良早期预警评分在院前急救老年患者病情评估中的应用

    Institute of Scientific and Technical Information of China (English)

    林伟茹

    2013-01-01

    目的:探讨改良早期预警评分(MEWS)在院前急救老年患者病情评估中的应用效果.方法:对我院2011年院前急救的281例60岁以上老年患者的病历资料进行回顾性调查,分析MEWS与患者去向和预后的相关性及临床应用意义.结果:MEWS0~3分者病死率为4.15%,4~8分者病死率为8.82%,>9分者病死率为100.00%.MEWS以死亡为预测指标的ROC曲线下面积为0.902,表示MEWS对院前急救老年患者死亡风险的预测有较高的准确性.结论:MEWS分值越高者死亡风险越大,MEWS适用于对院前急救老年患者快速评估病情,以便采取相应治疗和护理措施.%Objective:To investigate the effect of the modified early warning scoring (MEWS) in the assessment of conditions of elderly patients in prehospital first aid.Methods:The medical records of 281 elderly patients (over 60 years old) who received prehospital first aid in 2011 were retrospectively studied and the correlation between MEWS and the patients'prognosis and the significance of its clinical application was analyzed.Results:The fatality rate was 4.15% when MEWS was 0 to 3 points,the fatality rate was 8.82% when MEWS was 4 to 8 points and the fatality rate was 100% when MEWS was more than 9 points.The area under ROC curve taken as the prediction index of death was 0.902,indicating that the prediction of MEWS in mortality risk of elderly patients with prehospital first aid was accurate.Conclusion:The higher the value of MEWS is,the greater the risk of death is.MEWS is suitable for the rapid assessment of conditions of elderly patients with prehospital first aid,so the corresponding treatment and nursing measures can be taken in time.

  20. Technology for trauma: testing the validity of a smartphone app for pre-hospital clinicians.

    Science.gov (United States)

    Freshwater, Eleanor S; Crouch, Robert

    2015-01-01

    With the introduction of regional trauma networks in England, ambulance clinicians have been required to make triage decisions relating to severity of injury, and appropriate destination for the patient, which may require 'bypassing' the nearest Emergency Department. A 'Trauma Unit Bypass Tool' is utilised in this process. The Major Trauma Triage tool smartphone application (App) is a digital representation of a tool, available for clinicians to use on their smartphone. Prior to disseminating the application, validity and performance against the existing paper-based tool was explored. A case-based study using clinical scenarios was conducted. Scenarios, with appropriate triage decisions, were agreed by an expert panel. Ambulance clinicians were assigned to either the paper-based tool or smartphone app group and asked to make a triage decision using the available information. The positive predictive value (PPV) of each tool was calculated. The PPV of the paper tool was 0.76 and 0.86 for the smartphone app. User comments were mainly positive for both tools with no negative comments relating to the smartphone app. The smartphone app version of the Trauma Unit Bypass Tool performs at least as well as the paper version and can be utilised safely by pre-hospital clinicians in supporting triage decisions relating to potential major trauma. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Does the Norwegian emergency medical dispatch classification as non-urgent predict no need for pre-hospital medical treatment? An observational study.

    Science.gov (United States)

    Grusd, Eystein; Kramer-Johansen, Jo

    2016-05-06

    The number of ambulance call-outs in Norway is increasing owing to societal changes and increased demand from the public. Together with improved but more expensive education of ambulance staff, this leads to increased costs and staffing shortages. We wanted to study whether the current dispatch triage tools could reliably identify patients who only required transport, and not pre-hospital medical care. This could allow selection of such patients for designated transport units, freeing up highly trained ambulance staff to attend patients in greater need. A cross-sectional observational study was used, drawing on all electronic and paper records in our ambulance service from four random days in 2012. The patients were classified into acuity groups, based on Emergency Medical Dispatch codes, and pre-hospital interventions were extracted from the Patient Report Forms. Of the 1489 ambulance call-outs included in this study, 82 PRFs (5 %) were missing. A highly significant association was found between acuity group and recorded pre-hospital intervention (p ≤ 0.001). We found no correlation between gender, distance to hospital, age and pre-hospital interventions. Ambulances staffed by paramedics performed more interventions (234/917, 26 %) than those with emergency medical technicians (42/282, 15 %). The strongest predictor for needing pre-hospital interventions was found to be the emergency medical dispatch acuity descriptor. This study has demonstrated that the Norwegian dispatch system is able to correctly identify patients who do not need pre-hospital interventions. Patients with a low acuity code had a very low level of pre-hospital interventions. Evaluation of adherence to protocol in the Emergency Medical Dispatch is not possible due to the inherent need for medical experience in the triage process. This study validates the Norwegian dispatch tool (Norwegian index) as a predictor of patients who do not need pre-hospital interventions.

  2. Prehospital Intubation is Associated with Favorable Outcomes and Lower Mortality in ProTECT III.

    Science.gov (United States)

    Denninghoff, Kurt R; Nuño, Tomas; Pauls, Qi; Yeatts, Sharon D; Silbergleit, Robert; Palesch, Yuko Y; Merck, Lisa H; Manley, Geoff T; Wright, David W

    2017-01-01

    Traumatic brain injury (TBI) causes more than 2.5 million emergency department visits, hospitalizations, or deaths annually. Prehospital endotracheal intubation has been associated with poor outcomes in patients with TBI in several retrospective observational studies. We evaluated the relationship between prehospital intubation, functional outcomes, and mortality using high quality data on clinical practice collected prospectively during a randomized multicenter clinical trial. ProTECT III was a multicenter randomized, double-blind, placebo-controlled trial of early administration of progesterone in 882 patients with acute moderate to severe nonpenetrating TBI. Patients were excluded if they had an index GCS of 3 and nonreactive pupils, those with withdrawal of life support on arrival, and if they had documented prolonged hypotension and/or hypoxia. Prehospital intubation was performed as per local clinical protocol in each participating EMS system. Models for favorable outcome and mortality included prehospital intubation, method of transport, index GCS, age, race, and ethnicity as independent variables. Significance was set at α = 0.05. Favorable outcome was defined by a stratified dichotomy of the GOS-E scores in which the definition of favorable outcome depended on the severity of the initial injury. Favorable outcome was more frequent in the 349 subjects with prehospital intubation (57.3%) than in the other 533 patients (46.0%, p = 0.003). Mortality was also lower in the prehospital intubation group (13.8% v. 19.5%, p = 0.03). Logistic regression analysis of prehospital intubation and mortality, adjusted for index GCS, showed that odds of dying for those with prehospital intubation were 47% lower than for those that were not intubated (OR = 0.53, 95% CI = 0.36-0.78). 279 patients with prehospital intubation were transported by air. Modeling transport method and mortality, adjusted for index GCS, showed increased odds of dying in those transported by ground

  3. Field Triage Decision Scheme: The National Trauma Triage Protocol

    Centers for Disease Control (CDC) Podcasts

    2009-01-22

    In this podcast, Dr. Richard C. Hunt, Director of CDC's Division of Injury Response, provides an overview on the development process and scientific basis for the revised field triage guidelines published in the MMWR Recommendations and Report: Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage.  Created: 1/22/2009 by National Center for Injury Prevention and Control (NCIPC), Division of Injury Response (DIR).   Date Released: 1/22/2009.

  4. Knowledge of triage in the senior medical students in Shiraz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    HOSSEIN MAHMOODIAN

    2016-07-01

    Full Text Available Introduction: Triage is a response to the problem of overcrowding in Emergency Departments (EDs and accuracy of decisions made by the triage unit affects the ultimate outcome of EDs. This study was conducted to evaluate the knowledge of triage among last year medical students in Shiraz University of Medical Sciences. Methods: This is a cross-sectional analytical study whose subjects were all the senior students of medicine (62 in the last year of medicine from January to June 2013 who attended emergency medicine course in the screen room of 2 University Hospitals. This questionnaire was designed in 3 sections including personal data, 15 questions on knowledge of triage and 10 case scenarios for triage decision making and completed by the students. Statistical analysis was performed in SPSS statistical software (version 14 using independent sample t-test, one way ANOVA, and Pearson correlation coefficient (p≤0.001. Results: The total mean score of the participants was 10.6±1.5, ranging from 7 to 13. 58(93.5% students had poor triage knowledge. In the scenario’s section, the percentage of correct triage by students was 49.2% and those of over and under triage were 28.1% and 22.7%, respectively. There was a significant relationship between the triage accuracy and level of triage (ESI 4 (p≤0.001. Conclusion: The level of knowledge of triage in the last year medical students was poor, although most of them had passed a course in the screen room. It is recommended that medical students’ educational courses should include sections on the knowledge of triage in emergency rooms.

  5. Portable ultrasound in disaster triage: a focused review.

    Science.gov (United States)

    Wydo, S M; Seamon, M J; Melanson, S W; Thomas, P; Bahner, D P; Stawicki, S P

    2016-04-01

    Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessment of life-threatening trauma or hemodynamic conditions, to elective procedures such as image-guided peripheral nerve blocks. Sonographers have utilized ultrasound techniques in the pre-hospital setting, emergency departments, operating rooms, intensive care units, outpatient clinics, as well as during mass casualty and disaster management. Currently available ultrasound devices are more affordable, portable, and feature user-friendly interfaces, making them well suited for use in the demanding situation of a mass casualty incident (MCI) or disaster triage. We have reviewed the existing literature regarding the application of sonology in MCI and disaster scenarios, focusing on the most promising and practical ultrasound-based paradigms applicable in these settings.

  6. Dyspnea is a dangerous symptom in the pre-hospital setting

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Kirkegaard, Hans; Christensen, Erika Frischknecht

    ABSTRACT: Background Electrocardiogram (ECG) based telemedicine is a cornerstone in pre-hospital triage of patients with suspected ST-elevation myocardial infarction (STEMI). An ECG transmitted from the ambulance is reviewed by a cardiologist on-call in case of ongoing or recent chest pain......, resuscitation from cardiac arrest, acute dyspnea of unknown origin and other suspicion of STEMI. We hypothesize that unresolved dyspnea is an independent predictor of mortality in this prehospital setting and that the mortality is higher in patients with acute dyspnea of unknown origin than in patients......,204 (70%) of the patients, acute dyspnea of unknown origin in 1,461 (8 %), resuscitated from cardiac arrest in 163 (1%) and other suspicion of STEMI in 3,533 (20%). When adjusting for age, sex, systolic blood pressure and Charlson Comorbidity Index (p

  7. Multicenter observational prehospital resuscitation on helicopter study.

    Science.gov (United States)

    Holcomb, John B; Swartz, Michael D; DeSantis, Stacia M; Greene, Thomas J; Fox, Erin E; Stein, Deborah M; Bulger, Eileen M; Kerby, Jeffrey D; Goodman, Michael; Schreiber, Martin A; Zielinski, Martin D; O'Keeffe, Terence; Inaba, Kenji; Tomasek, Jeffrey S; Podbielski, Jeanette M; Appana, Savitri N; Yi, Misung; Wade, Charles E

    2017-07-01

    Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHT were compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. Twenty-five thousand one hundred eighteen trauma patients were admitted, 2,341 (9%) were transported by helicopter, of which 1,058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1,058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHT was not significantly associated with mortality

  8. Nurses' and doctors' perceptions regarding the implementation of a triage system in an emergency unit in South Africa

    Directory of Open Access Journals (Sweden)

    Valerie J. Ehlers

    2009-04-01

    Full Text Available Triage assessment of patients on arrival at an emergency unit is an essential function in quality emergency care provision, and is a cost-effective and time saving venture. This study investigated nurses’ and doctors’ perceptions about the implementation of the Cape Triage Score in one emergency unit. The challenges encountered prior to the implementation of the Cape Triage Score and the roles and core competencies of the triage nurse were addressed as well as the strengths and weaknesses of the Cape Triage Score. In this descriptive, quantitative and exploratory study, 15 nurses and doctors completed questionnaires. The challenges decreased and the sorting of patients improved after the implementation of the Cape Triage Score. Other strengths of this system included that the triage nurse prioritised patients, as opposed to the receptionist or the administrative staff; and nurses could undertake preliminary investigations without waiting for doctors’ orders to do so. The weaknesses of the implemented Cape Triage Score included that it was not fully functional 100% of the time, and that it was difficult to maintain during peak admission periods due to a shortage of nurses. The recommendations included that management should be convinced of the system’s benefits; nurses should perform the triage function on a rotation basis; more nurses should be available during peak periods; and that the administrative and reception staff should also be orientated about the triage system.

    Opsomming

    Triage assessering van pasiënte met hulle aankoms by ‘n ongeluk/noodeenheid is ‘n noodsaaklike funksie van noodsorgvoorsiening, en is ‘n koste-effektiewe en tydbesparende onderneming. Hierdie studie het die persepsies van dokters en verpleegkundiges ondersoek betreffende die implementering van die Cape Triage Score in een noodeenheid. Die uitdagings wat ervaar is voor die implementering van die Cape Triage Score, die rolle en

  9. Termination of prehospital resuscitative efforts

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Schaffalitzky de Muckadell, Caroline; Binderup, Lars Grassmé

    2017-01-01

    BACKGROUND: Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts...... need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical....... The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. RESULTS: In total, 1275 patients were either declared dead at the scene...

  10. Prehospital Volume Therapy as an Independent Risk Factor after Trauma

    Science.gov (United States)

    Heuer, Matthias; Lefering, Rolf; Touma, Alexander; Schoeneberg, Carsten; Keitel, Judith; Lendemans, Sven

    2015-01-01

    Background. Prehospital volume therapy remains widely used after trauma, while evidence regarding its disadvantages is growing. The primary objective of this study was to investigate the volume administered in a prehospital setting as an independent risk factor for mortality. Material and Methods. Patients who met the following criteria were analyzed retrospectively: Injury Severity Score = 16, primary admission (between 2002 and 2010), and age = 16 years. The following data had to be available: volume administered (including packed red cells), blood pressure, Glasgow Coma Scale, therapeutic measures, and laboratory results. Following a univariate analysis, independent risk factors for mortality after trauma were investigated using a multivariate regression analysis. Results. A collective of 7,641 patients met the inclusion criteria, showing that increasing volumes administered in a prehospital setting were an independent risk factor for mortality (odds ratio: 1.34). This tendency was even more pronounced in patients without severe traumatic brain injury (TBI) (odds ratio: 2.71), while the opposite tendency was observed in patients with TBI. Conclusions. Prehospital volume therapy in patients without severe TBI represents an independent risk factor for mortality. In such cases, respiratory and circulatory conditions should be stabilized during permissive hypotension, and patient transfer should not be delayed. PMID:25949995

  11. Prehospital Volume Therapy as an Independent Risk Factor after Trauma

    Directory of Open Access Journals (Sweden)

    Bjoern Hussmann

    2015-01-01

    Full Text Available Background. Prehospital volume therapy remains widely used after trauma, while evidence regarding its disadvantages is growing. The primary objective of this study was to investigate the volume administered in a prehospital setting as an independent risk factor for mortality. Material and Methods. Patients who met the following criteria were analyzed retrospectively: Injury Severity Score = 16, primary admission (between 2002 and 2010, and age = 16 years. The following data had to be available: volume administered (including packed red cells, blood pressure, Glasgow Coma Scale, therapeutic measures, and laboratory results. Following a univariate analysis, independent risk factors for mortality after trauma were investigated using a multivariate regression analysis. Results. A collective of 7,641 patients met the inclusion criteria, showing that increasing volumes administered in a prehospital setting were an independent risk factor for mortality (odds ratio: 1.34. This tendency was even more pronounced in patients without severe traumatic brain injury (TBI (odds ratio: 2.71, while the opposite tendency was observed in patients with TBI. Conclusions. Prehospital volume therapy in patients without severe TBI represents an independent risk factor for mortality. In such cases, respiratory and circulatory conditions should be stabilized during permissive hypotension, and patient transfer should not be delayed.

  12. The overall concordance of triage level between emergency medical technicians, triage nurses and instructor

    Directory of Open Access Journals (Sweden)

    Sabzevari S

    2015-08-01

    Full Text Available Background and Objective : Triage is essential for classification of patients in order to providing the best treatment and their transport to medical centers. The concordance of triage level between emergency medical technicians and triage nurses increases the accuracy and reduce of delivery time of patients, however the results of some studies demonstrated the poor triage of patients. This study was conducted aimed to determine the overall concordance of triage level between emergency medical technicians, triage nurses and instructor. Materials and Method: In this descriptive study, one instructor, 5 triage nurses and 30 emergency medical technicians participated through census in Iranshahr in 2014. Data collection tools were the demographic information form and “Emergency Severity Index" triage form. 78 patients were triaged separately by emergency medical technicians, triage nurses and instructor (as criteria. The overall concordance was assessed by kappa coefficient using SPSS 16. Results: The Kappa coefficient about the overall concordance of triage between emergency medical technicians and triage nurses was 0.20, between emergency medical technicians and instructor was 0.10 and between triage nurse and instructor was 0.19 Conclusion: According to the results, the overall concordance in triage level between triage nurse, emergency medical technicians and instructor was poor. Therefore, triage training courses and implementation of common triage is suggested for increase the agreement rate and reduce the time of patient transfer.

  13. Is mechanism of injury alone in the prehospital setting a predictor of major trauma – a review of the literature

    Directory of Open Access Journals (Sweden)

    Boyle Malcolm J

    2007-11-01

    Full Text Available Abstract Background The literature identifying mechanism of injury came to prominence in the mid to late 1980s. The current Victorian prehospital triage guidelines do not necessarily reflect the conditions within the Victorian population as the triage guidelines are based on studies undertaken and validated in the U.S.A. The objective of this study was to identify the mechanism of injury alone literature and the predictability of the mechanism criteria. Methods A search of the prehospital related electronic databases was undertaken utilising the Ovid and EMASE systems available through the Monash University library. The Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, and EMBASE databases were searched from their beginning until the end of June 2006. Selected non-electronic listed prehospital journals were hand searched. References from articles gathered were reviewed. Results The electronic database search located 203 articles for review. Three additional articles were identified from the reference lists. Of these articles 17 were considered relevant. After reviewing the articles only five provided sufficient information about mechanism of injury alone and its triage capability. None of the articles identified mechanism of injury criteria as a good predictor of major trauma. Conclusion This study identified only five articles on the predictability of the mechanism of injury criteria alone. All studies stated that the mechanism of injury criteria alone are not good predictors of major trauma or the need for trauma team activation. This study was the precursor of a Victorian prehospital study to determine the predictability of the mechanism of injury alone criteria for trauma patients in the Australian context.

  14. Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills.

    Science.gov (United States)

    Luigi Ingrassia, Pier; Ragazzoni, Luca; Carenzo, Luca; Colombo, Davide; Ripoll Gallardo, Alba; Della Corte, Francesco

    2015-04-01

    This study tested the hypothesis that virtual reality simulation is equivalent to live simulation for testing naive medical students' abilities to perform mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm in a simulated disaster scenario and to detect the improvement in these skills after a teaching session. Fifty-six students in their last year of medical school were randomized into two groups (A and B). The same scenario, a car accident, was developed identically on the two simulation methodologies: virtual reality and live simulation. On day 1, group A was exposed to the live scenario and group B was exposed to the virtual reality scenario, aiming to triage 10 victims. On day 2, all students attended a 2-h lecture on mass casualty triage, specifically the START triage method. On day 3, groups A and B were crossed over. The groups' abilities to perform mass casualty triage in terms of triage accuracy, intervention correctness, and speed in the scenarios were assessed. Triage and lifesaving treatment scores were assessed equally by virtual reality and live simulation on day 1 and on day 3. Both simulation methodologies detected an improvement in triage accuracy and treatment correctness from day 1 to day 3 (PVirtual reality simulation proved to be a valuable tool, equivalent to live simulation, to test medical students' abilities to perform mass casualty triage and to detect improvement in such skills.

  15. Effect of an organizational change in a prehospital trauma care protocol and trauma transport directive in a large urban city: a before and after study.

    Science.gov (United States)

    Rubenson Wahlin, Rebecka; Ponzer, Sari; Skrifvars, Markus B; Lossius, Hans Morten; Castrén, Maaret

    2016-03-09

    Trauma systems and regionalized trauma care have been shown to improve outcome in severely injured trauma patients. The aim of this study was to evaluate the implementation of a prehospital trauma care protocol and transport directive, and to determine its effects on the number of primary admissions and secondary trauma transfers in a large Scandinavian city. We performed a retrospective observational study based on local trauma registries and hospital and ambulance records in Stockholm County; patients > 15 years of age with an Injury Severity Score (ISS) > 15 transported to any emergency care hospitals in the Stockholm area were included for the years 2006 and 2008. We also included secondary transferred patients to the regional trauma center during 2006, 2008, and 2013. A total of 693 primarily admitted trauma patients were included for the years 2006 and 2008. For the years 2006, 2008 and 2013, we included 114 secondarily transported trauma patients. The number of primary patient transports to the trauma center increased during the years by 20.2%, (p organizational change. Patients primarily admitted to the trauma center after the change had more severe injuries than patients transported to other emergency hospitals in the area even if 20 % of patients were not admitted primarily to a trauma center. This does not imply that the transport directives or the criteria were not followed but rather reveals the difficulties and uncertainties of field triage. With the introduction of a prehospital trauma transport directive in a large urban city, an increase in patients transported to the regional trauma center and a decrease in secondary transfers were detected, but a considerable number of severely injured patients were still transported to local hospitals.

  16. Analysis of Prehospital Documentation of Injury-Related Pain Assessment and Analgesic Administration on the Contemporary Battlefield.

    Science.gov (United States)

    Gerhardt, Robert T; Reeves, Patrick T; Kotwal, Russ S; Mabry, Robert L; Robinson, John B; Butler, Frank

    2016-01-01

    In addition to life-saving interventions, the assessment of pain and subsequent administration of analgesia are primary benchmarks for quality emergency medical services care which should be documented and analyzed. Analyze US combat casualty data from the Department of Defense Trauma Registry (DoDTR) with a primary focus on prehospital pain assessment, analgesic administration and documentation. Retrospective cohort study of battlefield prehospital and hospital casualty data were abstracted by DoDTR from available records from 1 September 2007 through 30 June 2011. Data included demographics; injury mechanism; prehospital and initial combat hospital pain assessment documented by standard 0-to-10 numeric rating scale; analgesics administered; and survival outcome. Records were available for 8,913 casualties (median ISS of 5 [IQR 2 to 10]; 98.7% survived). Prehospital analgesic administration was documented for 1,313 cases (15%). Prehospital pain assessment was recorded for 581 cases (7%; median pain score 6 [IQR 3 to 8]), hospital pain assessment was recorded for 5,007 cases (56%; median pain score5 [CI95% 3 to 8]), and 409 cases (5%) had both prehospital and hospital pain assessments that could be paired. In this paired group, 49.1% (201/409) had alleviation of pain evidenced by a decrease in pain score (median 4,, IQR 2 to 5); 23.5% (96/409) had worsening of pain evidenced by an increase in pain score (median 3, CI95 2.8 to 3.7, IQR 1 to 5); 27.4% (112/409) had no change; and the overall difference was an average decrease in pain score of 1.1 (median 0, IQR 0 to 3, p prehospital and hospital pain assessment documentation and prehospital analgesic documentation. Our study demonstrates that prehospital pain assessment, management, and documentation remain primary targets for performance improvement on the battlefield. Results of paired prehospital to hospital pain scores and time-series analysis demonstrate both feasibility and benefit of prehospital analgesics

  17. Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency?

    NARCIS (Netherlands)

    Giesen, P.H.J.; Ferwerda, R.; Tijssen, R.; Mokkink, H.G.A.; Drijver, R.; Bosch, W.J.H.M. van den; Grol, R.P.T.M.

    2007-01-01

    BACKGROUND: In recent years, there has been a growth in the use of triage nurses to decrease general practitioner (GP) workloads and increase the efficiency of telephone triage. The actual safety of decisions made by triage nurses has not yet been assessed. OBJECTIVES: To investigate whether triage

  18. [Use the Netherlands Triage Standard for children].

    Science.gov (United States)

    Drijver, C R Roeland

    2015-01-01

    Studies have shown that the reliability and validity of the Netherlands Triage Standard (NTS) is comparable to the Manchester Triage System. The NTS has good sensitivity and specificity in the emergency room. The Dutch Society of Emergency and Accident Nurses, the Dutch College of General Practitioners and Ambulancezorg Nederland use the NTS as the guideline for both physical and telephone triage in ambulance care, primary care and hospital care with the competence of the triage nurse in a pivotal role.

  19. Is paediatric trauma severity overestimated at triage?

    DEFF Research Database (Denmark)

    DO, H Q; Hesselfeldt, R; Steinmetz, J

    2014-01-01

    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational...... follow-up study that involves one level I TC and seven local hospitals. We included paediatric (trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC. RESULTS: We included 1934...... trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P 

  20. [Results of a national survey about the use of sedation scales in emergency prehospital medicine].

    Science.gov (United States)

    Belpomme, V; Devaud, M-L; Pariente, D; Ricard-Hibon, A; Mantz, J

    2009-04-01

    The primary goal of sedation in emergency prehospital care is to guarantee the security of the mechanically ventilated patients by optimising their adaptation to the respirator. If the French prehospital guidelines are well codified, their applicability in routine clinical practice seem to be rather empirical. The aim of this national survey was to evaluate the use of the clinical sedation scales by the prehospital physicians. This prospective and clinical practice survey was begun in January 2005. An anonymous questionnaire was sent to the physicians working in the 377 Mobile Intensive Care Unit of the 105 French Emergency Medical Service System. The total response rate from physicians was 28% (n=497). Only 29% of the physicians (n=145) declared to use a sedation scale for a mechanically ventilated patient. The Ramsay score was used in 97% of the cases (n=141).The principal reasons given by the physicians for not using the sedation scales were their ignorance in 57% of the cases (n=200) and the systematic choice of a deep sedation in 42% of the cases (n=147). For 18% of them (n=62), the use of sedation scores was considered too complicated. The final results show that the utilisation ratio of the sedation scores is very low in emergency prehospital medicine and suggest that an effort toward improving the use of sedation in prehospital emergency medicine is necessary.

  1. Job Burnout Status among Pre-Hospital Emergency Technicians

    Directory of Open Access Journals (Sweden)

    Zohre Moradi

    2015-02-01

    Full Text Available Introduction: Since pre-hospital emergency staff, who play a vital role in saving peoples’ lives, work under a lot of pressure, determining the rate and dangers of their job burnout is very important. Therefore, this study was carried out to determine the job burnout rate of the pre-hospital emergency staff in Isfahan, Iran. Methods: In this cross-sectional study, all of the pre-hospital emergency staff in all emergency operation centers in Isfahan were included. Using the standard Maslach burnout inventory questionnaire, the job burnout rate of emergency technicians was measured. The studied aspects were frequency and intensity of emotional exhaustion, depersonalization and personal accomplishment feeling, which were then divided into 3 levels (low, average and high according to the intensity and frequency of these feelings. Results: In the end, 68 technicians were involved in this study (Mean age 26.97±7.7; 42.6% single. Regarding intensity, their mean emotional exhaustion score was 25.59±20.39, depersonalization score was 10.57±7.83 and personal accomplishment feeling was 34.6±8.46. Moreover, the mean emotional exhaustion frequency was 21.21±11.95 (low level, depersonalization frequency was 8.94±5.43 (low level and personal accomplishment feeling frequency was 26.82±5.72 (high level. Conclusion: The data obtained in this study shows that the pre-hospital emergency technicians in Isfahan show average levels of emotional exhaustion and depersonalization intensity and frequency and feel highly unaccomplished.

  2. Triage in mass casualty situations

    African Journals Online (AJOL)

    More often than not major incidents and disasters result in a mass casualty situation, which places ... As part of the FIFA 2010 preparation, the National Department of Health ... Over-triage of children in this way is acceptable because children ...

  3. Advances in prehospital airway management.

    Science.gov (United States)

    Jacobs, Pe; Grabinsky, A

    2014-01-01

    Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.

  4. 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.

  5. Diagnosis and outcome in a prehospital cohort of patients with bundle branch block and suspected acute myocardial infarction

    Science.gov (United States)

    Stengaard, Carsten; Sørensen, Christina Ankjær; Thygesen, Kristian; Bøtker, Hans Erik; Thuesen, Leif; Terkelsen, Christian Juhl

    2013-01-01

    Background: Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly. Methods: ECG, final diagnosis, and mortality were assessed in a prehospital cohort of 4905 consecutive patients with suspected acute myocardial infarction (AMI). Bundle branch block (BBB) was defined as QRS duration ≥120 ms caused by delayed intraventricular conduction. Mortality and angiography data were obtained from the Central Office of Civil Registration and the Western Denmark Heart Registry. Definite diagnosis of AMI and the onset of BBB were determined by expert consensus. Patients were divided into four groups: with or without AMI and with or without BBB. Mortality was evaluated by Kaplan–Meier plots and compared using log-rank statistics. Results: AMI was diagnosed in 954 patients, of whom 118 had BBB. In 3951 patients without AMI, 436 had BBB. Patients with BBBMI were less often revascularized than patients with AMI without BBB (24 vs. 54%, p<0.001). BBBMI was categorized as new onset in 43 patients of whom two were triaged for acute angioplasty. One-year mortality was 47.2, 17.5, 20.8, and 8.6% (log-rank <0.001) in patients with BBBMI, patients with AMI without BBB, patients with BBB without AMI, and patients without AMI or BBB, respectively. Conclusions: Patients with BBBMI have a high mortality. Less than 25% undergo revascularization and only very few patients with new-onset BBBMI are transferred for urgent revascularization. Focus on improving triage and prehospital identification of high-risk patients with BBB and chest pain could improve outcome. PMID:24222828

  6. The development of intelligent, triage-based, mass-gathering emergency medical service PDA support systems.

    Science.gov (United States)

    Chang, Polun; Hsu, Yueh-Shuang; Tzeng, Yuann-Meei; Sang, Yiing-Yiing; Hou, I-Ching; Kao, Wei-Fong

    2004-09-01

    The support systems for the Emergency Medical Services (EMS) at mass gatherings, such as the local marathon or large international baseball games, are underdeveloped. The purposes of this study were to extend well-developed, triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-hospital emergency medical services and onsite evaluation forms for the mass gatherings, and to evaluate users ' perceived ease of use and usefulness of the systems in terms of Davis ' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. Twenty-three nurses and six physicians in the medical center, who had served at mass gatherings, were invited to examine the new systems and answer the TAM questionnaire. The PDA systems were composed of 450 information items within 42 screens in 6 categories. The results supported the potential for using triage-based PDA systems at mass gatherings. Overall, most of the subjects agreed that the systems were easy to use and useful for mass gatherings, and they were willing to accept the systems.

  7. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

    Directory of Open Access Journals (Sweden)

    Castrén Maaret

    2011-05-01

    Full Text Available Abstract Background Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. Methods The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. Results The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. Conclusions The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

  8. Nurses' accuracy and self-perceived ability using the Emergency Severity Index triage tool: a cross-sectional study in four Swiss hospitals.

    Science.gov (United States)

    Jordi, Karin; Grossmann, Florian; Gaddis, Gary M; Cignacco, Eva; Denhaerynck, Kris; Schwendimann, René; Nickel, Christian H

    2015-08-28

    The Emergency Severity Index (ESI) is an English language emergency department patient triage tool. After translation, it has been adapted for use to triage patients in growing numbers of emergency departments in non-English-speaking countries. Few reports of the proficiency of triage nurses to score an ESI exist. We sought to determine accuracy, inter-rater reliability, and subjective confidence of triage nurses at four hospitals to determine an ESI from standardized ESI scenarios. Triage nurses assigned an ESI score to each of 30 standard ESI (ESI Implementation Handbook Version 4) translated teaching case scenarios. Accuracy and Inter-rater reliability (Krippendorff's alpha) of the ESI scoring was measured. Nurses' subjective confidence applying the ESI algorithm was obtained by a Likert scale. Sixty-nine nurses from four EDs participated in the study. They scored 59.6 % of the case scenarios correctly. Inter-rater reliability was 0.78 (Krippendorff's alpha). Most (54/69, 78 %) felt confident in their ability to apply the ESI. Low accuracy of ESI score assignment was observed when nurses scored an ESI for 30 standard written case scenarios, translated into nurses' native language, despite a good inter-rater reliability and high nurse confidence in their ability to apply the ESI. Although feasible, using standard written case scenarios to determine ESI triage scoring effectiveness may not be the optimum means to rate nurses' triage skills.

  9. Outcome following physician supervised prehospital resuscitation

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Krüger, Andreas J; Zwisler, Stine T

    2015-01-01

    patient were manually established in each case in a combined audit of the prehospital database, the discharge summary of the MECU and the medical records from the hospital. Outcome parameters were final outcome, the aetiology of the life-threatening condition and the level of competences necessary...... to their own home. CONCLUSIONS: The present study demonstrates that anaesthesiologist administrated prehospital therapy increases the level of treatment modalities leading to an increased survival in relation to a prehospital system consisting of emergency medical technicians and paramedics alone and thus...

  10. Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: an observational study.

    Science.gov (United States)

    Rognås, Leif; Hansen, Troels M; Kirkegaard, Hans; Tønnesen, Else

    2014-12-01

    Guidelines recommend that patients with brain trauma with a Glasgow Coma Scale (GCS) score of less than 9 should have an airway established. Hypoxia, hypotension and hypertension as well as hypoventilation and hyperventilation may worsen outcome in these patients. The objectives were to investigate guideline adherence, reasons for nonadherence and the incidences of complications related to prehospital advanced airway management in patients with traumatic brain injury. We prospectively collected data from eight anaesthesiologist-staffed prehospital critical care teams in the Central Denmark Region according to the Utstein-style template. Among 1081 consecutive prehospital advanced airway management patients, we identified 54 with a traumatic brain injury and an initial GCS score of less than 9. Guideline adherence in terms of airway management was 92.6%. The reasons for nonadherence were the patient's condition, anticipated difficult airway management and short distance to the emergency department. Following rapid sequence intubation (RSI), 11.4% developed oxygen saturation below 90%, 9.1% had a first post-RSI systolic blood pressure below 90 mmHg and 48.9% had a first post-RSI systolic blood pressure below 120 mmHg. The incidence of hypertension following prehospital RSI was 4.5%. The incidence of postendotracheal intubation hyperventilation was as high as 71.1%. The guideline adherence was high. The incidences of post-RSI hypoxia and systolic blood pressure below 90 compare with the results reported from other physician-staffed prehospital services. The incidence of systolic blood pressure below 120 as well as that of hyperventilation following prehospital endotracheal intubation in patients with traumatic brain injury call for a change in our current practice.

  11. Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

    Directory of Open Access Journals (Sweden)

    Matute-Cruz Petra

    2009-04-01

    Full Text Available Abstract Background Mortality from invasive meningococcal disease (IMD has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848 diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72% of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93. Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

  12. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions.

    Science.gov (United States)

    Burkle, Frederick M

    2002-05-01

    and compassionate management and triage system and an in-depth and accurate health information system that appropriately addresses every level of threat or consequence. In a PICE stage I to III BT event resources will be compromised. Triage and management will be one process requiring multiple levels of cooperation, coordination, and decision-making. An immediate challenge to existing emergency medical services systems (EMSS) is the recognition that locally there will be a shift of emphasis and decision-making from prehospital first responders to community public health authorities. The author suggests that a working relationship, in most areas, between EMSS and the public health system is lacking. As priorities shift in a BT event to hospitals and public health care systems, they need to: 1. Improve their capabilities and capacities in surveillance, discovery, and in the consequences of different triage and management decisions and interventions in a BT environment, starting at the local level. 2. Develop triage and management systems (with clear lines of authority) based on public health and epidemiologic requirements, capability, and capacity (triage teams, categories, tags, rapid response, established operational priorities, resource-driven responsible management process), and link local level surveillance systems with those at the national or regional level. 3. Use a triage and management system that reflects the population (cohort) at risk, such as the epidemiologic based SEIRV triage framework. 4. Develop an organizational capacity that uses lateral decision-making skills, pre-hospital outpatient centers for triage-specific treatments, health information systems, and resource-driven hospital level pre-designated protocols appropriate for a surge of unprecedented proportions. Such standards of care, it is recommended, should be set at the local to federal levels and spelled out in existing incident-management system protocols.

  13. Emergency department triage: an ethical analysis

    Directory of Open Access Journals (Sweden)

    Gastmans Chris

    2011-10-01

    Full Text Available Abstract Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.

  14. Accountability Pressure, Academic Standards, and Educational Triage

    Science.gov (United States)

    Lauen, Douglas Lee; Gaddis, S. Michael

    2012-01-01

    This study aims to determine whether educational accountability promotes educational triage. This study exploits a natural experiment in North Carolina in which standards increased first in math in 2006 and second in reading in 2008 to determine whether an increase in educational standards caused an increase in educational triage at the expense of…

  15. Nursing Software for Emergency Triage (NSET).

    Science.gov (United States)

    Mandirola Brieux, H F; Guillen, S; La Rosa, F; Moreno, C; Benitez, S

    2015-01-01

    Determining the priority of attention in an Emergency Room (ER) has always been a difficult issue. Priority is determined with a simple triage system as people arrive at the hospital. It is important to establish how long they can wait for treatment. In order to obtain the best assessment of patients' conditions, we built a Nursing Software for Emergency Triage (NSET). The objective of this work was to assess the efficacy of the NSET versus the triage process without any software (TWS). Results showed that the NSET we built was a substantial help. With this software, we decreased significantly:1) the length of the triage system process, 2) the waiting time of patients in the waiting room, 3) the number of complaints and 4) the number of patients who walk away. In conclusion, the NSET improves and helps to define more accurately a patient's risk. NSET helps in the emergency department triage.

  16. Prehospital identification of stroke - room for improvement

    DEFF Research Database (Denmark)

    Fischer, C.E.; Barnung, S.; Nielsen, S.L.;

    2008-01-01

    INTRODUCTION: Rapid recognition of stroke is important because it allows early brain imaging and management such as thrombolytic therapy. We evaluated the identification of the diagnosis acute cerebrovascular incident in a physician-based prehospital emergency medical system. METHODS: From...... cerebrovascular incident in the prehospital setting with room and need for improvement in order to allow appropriate and expeditious referral for thrombolytic therapy Udgivelsesdato: 2008/8...

  17. Incidence of difficult airway situations during prehospital airway management by emergency physicians--a retrospective analysis of 692 consecutive patients.

    Science.gov (United States)

    Thoeni, Nils; Piegeler, Tobias; Brueesch, Martin; Sulser, Simon; Haas, Thorsten; Mueller, Stefan M; Seifert, Burkhardt; Spahn, Donat R; Ruetzler, Kurt

    2015-05-01

    In the prehospital setting, advanced airway management is challenging as it is frequently affected by facial trauma, pharyngeal obstruction or limited access to the patient and/or the patient's airway. Therefore, incidence of prehospital difficult airway management is likely to be higher compared to the in-hospital setting and success rates of advanced airway management range between 80 and 99%. 3961 patients treated by an emergency physician in Zurich, Switzerland were included in this retrospective analysis in order to determine the incidence of a difficult airway along with potential circumstantial risk factors like gender, necessity of CPR, NACA score, GCS, use and type of muscle relaxant and use of hypnotic drugs. 692 patients underwent advanced prehospital airway management. Seven patients were excluded due to incomplete or incongruent documentation, resulting in 685 patients included in the statistical analysis. Difficult intubation was recorded in 22 patients, representing an incidence of a difficult airway of 3.2%. Of these 22 patients, 15 patients were intubated successfully, whereas seven patients (1%) had to be ventilated with a bag valve mask during the whole procedure. In this physician-led service one out of five prehospital patients requires airway management. Incidence of advanced prehospital difficult airway management is 3.2% and eventual success rate is 99%, if performed by trained emergency physicians. A total of 1% of all prehospital intubation attempts failed and alternative airway device was necessary. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Triage in medical practices: an unacceptable model?

    Science.gov (United States)

    Bell, Nora K

    1981-12-01

    Two basic presuppositions of triage are challenged: the utilitarian notion that it is morally preferable to save the greater number, and the extension of the salvageability concept as a model for macroallocation of scarce medical resources. The 'more is better' principle lacks the status of a universal moral obligation and leads to an impersonal view of the valuing of life. In the allocation of scarce resources, triage is suspect since life-saving decisions involve medical, social, economic, and political criteria. Triage thus perpetuates existing injustices.

  19. Triage-hoitajatoiminta Kymenlaakson keskussairaalan ensiapupoliklinikalla

    OpenAIRE

    Pakasto, Teemu

    2013-01-01

    Opinnäytetyön tarkoituksena on selvittää sairaanhoitajien kokemuksia triage-hoitajuudesta ja sitä, miten triage-hoitajatoimintaa voitaisiin jatkossa kehittää Kymenlaakson keskussairaalan ensiapupoliklinikalla. Tavoitteena on, että opinnäytetyötä voidaan hyödyntää Kymenlaakson keskussairaalan ensiapupoliklinikan triage-hoitajatoiminnan kehittämisessä. Opinnäytetyö on kvalitatiivinen eli laadullinen tutkimus, jonka tiedonhankintamenetelmänä käytettiin kyselylomaketta, joka sisälsi sekä avoi...

  20. Benefit of a Tiered-Trauma Activation System for Triaging Dead-on-Arrival Patients

    Directory of Open Access Journals (Sweden)

    Omar K. Danner

    2012-08-01

    Full Text Available Introduction: Although national guidelines have been published for the management of critically injured traumatic cardiopulmonary arrest (TCPA patients, many hospital systems have not implemented in-hospital triage guidelines. The objective of this study was to determine if hospital resources could be preserved by implementation of an in-hospital tiered triage system for patients in TCPA with prolonged resuscitation who would likely be declared dead on arrival (DOA.Method: We conducted a retrospective analysis of 4,618 severely injured patients, admitted to our Level I trauma center from December 2000 to December 2008 for evaluation. All of the identified patients had sustained life-threatening penetrating and blunt injuries with pre-hospital TCPA. Patients who received cardiopulmonary resuscitation (CPR for 10 minutes were assessed for survival rate, neurologic outcome, and charge-for-activation (COA for our hospital trauma system.Results: We evaluated 4,618 charts, which consisted of patients seen by the MSM trauma service from December 2001 through December 2008. We identified 140 patients with severe, life-threatening traumatic injuries,who sustained pre-hospitalTCPArequiring prolongedCPRin the field andwere brought to the emergency department (ED.Group I was comprised of 108 patients sustaining TCPA (53 blunt, 55penetrating, who died after receiving, 45 minutes of ACLS after arrival. Group II, which consisted of 32 patients (25 blunt, 7 penetrating, had resuscitative efforts in the EDlasting.45 minutes, but all ultimately died prior to discharge. Estimated hospital charge-for-activation for Group I was approximately $540,000, based on standard charges of $5000 per full-scale trauma system activation (TSA.Conclusion: Full-scale trauma system activation for patients sustaining greater than 10 minutes of prehospital TCPA in the field is futile and economically depleting. [West J Emerg Med. 2012;13(3:225–229.

  1. Improving Emergency Department Triage Classification with Computerized Clinical Decision Support at a Pediatric Hospital

    Science.gov (United States)

    Kunisch, Joseph Martin

    2012-01-01

    Background: The Emergency Severity Index (ESI) is an emergency department (ED) triage classification system based on estimated patient-specific resource utilization. Rules for a computerized clinical decision support (CDS) system based on a patient's chief complaint were developed and tested using a stochastic model for predicting ESI scores.…

  2. Estimation of the severity of breathlessness in the emergency department: a dyspnea score.

    Science.gov (United States)

    Gondos, Tibor; Szabó, Viktor; Sárkány, Ágnes; Sárkány, Adrienn; Halász, Gábor

    2017-04-26

    Dyspnea is a frequent complaint in emergency departments (ED). It has a significant amount of subjective and affective components, therefore the dyspnea scores, based on the patients' rating, can be ambiguous. Our purpose was to develop and validate a simple scoring system to evaluate the severity of dyspnea in emergency care, based on objectively measured parameters. We performed a double center, prospective, observational study including 350 patients who were admitted in EDs with dyspnea. We evaluated the patients' subjective feeling about dyspnea and applied our Dyspnea Severity Score (DSS), rating the dyspnea in 7 Dimensions from 0 to 3 points. The DSS was validated using the deterioration of pH, base-excess and lactate levels in the blood gas samples (Objective Classification Scale (OCS) 9 points and 13 points groups). All of the Dimensions correlated closely with the OCS values and with the subjective feeling of the dyspnea. Using multiple linear regression analysis we were able to decrease the numbers of Dimensions from seven to four without causing a significant change in the determination coefficient in any OCS groups. This reduced DSS values (exercise tolerance, cooperation, cyanosis, SpO2 value) showed high sensitivity and specificity to predict the values of OCS groups (the ranges: AUC 0.77-0.99, sensitivity 65-100%, specificity 64-99%). There was a close correlation between the subjective dyspnea scores and the OCS point values (p < 0.001), though the scatter was very large. A new DSS was validated which score is suitable to compare the severity of dyspnea among different patients and different illnesses. The simplified version of the score (its value ≥7 points without correction factors) can be useful at the triage or in pre-hospital care.

  3. Reducing uncertainty in triaging mental health presentations: examining triage decision-making.

    Science.gov (United States)

    Brown, Anne-Marie; Clarke, Diana E

    2014-01-01

    Little is known about how emergency department (ED) nurses make decisions and even less is known about triage nurses' decision-making. There is compelling motivation to better understand the processes by which triage nurses make decisions, particularly with complex patient populations such as those with frequently emotive mental health and illness issues. While accuracy and reliability of triage decisions generally have been improved through the introduction of standardised triage scales and instruments, other factors such as lack of knowledge or confidence related to mental health issues, past experiences that may elicit transference and countertransference, judgments about individuals based on their behavioural presentations may impact on decisions made at triage. In this paper, we review the current research regarding the effectiveness of triage tools particularly with mental health presentations, present a theoretical framework that may guide research in understanding how triage nurses approach decision-making, and apply that framework to thinking about research in mental health-related triage. Developing a better understanding of how triage nurses make decisions, particularly in situations where issues related to mental health and illness may raise the levels of uncertainty, is crucial to ensure that they have the skills and tools they need to provide the most effective, sensitive, and compassionate care possible.

  4. Prehospital Cricothyrotomy Kits Used in Combat.

    Science.gov (United States)

    Schauer, Steven G; April, Michael D; Cunningham, Cord W; Long, Adrianna N; Carter, Robert

    2017-01-01

    Surgical cricothyrotomy remains the only definitive airway management modality for the tactical setting recommended by Tactical Combat Casualty Care guidelines. Some units have fielded commercial cricothyrotomy kits to assist Combat Medics with surgical cricothyrotomy. To our knowledge, no previous publications report data on the use of these kits in combat settings. This series reports the the use of two kits in four patients in the prehospital combat setting. Using the Department of Defense Trauma Registry and the Prehospital Trauma Registry, we identified four cases of patients who underwent prehospital cricothyrotomy with the use of commercial kits. In the first two cases, a Medic successfully used a North American Rescue CricKit (NARCK) to obtain a surgical airway in a Servicemember with multiple amputations from an improvised explosive device explosion. In case 3, the Medic unsuccessfully used an H&H Medical kit to attempt placement of a surgical airway in a Servicemember shot in the head by small arms fire. A second attempt to place a surgical airway using a NARCK was successful. In case 4, a Soldier sustained a gunshot wound to the chest. A Medic described fluid in the airway precluding bag-valve-mask ventilation; the Medic attempted to place a surgical airway with the H&H kit without success. Four cases of prehospital surgical airway cannulation on the battlefield demonstrated three successful uses of prehospital cricothyrotomy kits. Further research should focus on determining which kits may be most useful in the combat setting. 2017.

  5. Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care.

    Science.gov (United States)

    Norouzpour, Amir; Khoshdel, Ali Reza; Modaghegh, Mohammad-Hadi; Kazemzadeh, Gholam-Hossein

    2013-09-01

    Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality. To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers. This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome. There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis. GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.

  6. [Triage in acute medical admission units.

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Folkestad, Lars; Hallas, Peter

    2010-01-01

    . At 87% of the MAUs, a doctor was contacted by the admitting physician, while the contact was the responsibility of a nurse in 13% of MAUs. None of the contacted MAUs used a validated triage tool and 95% answered that they triaged on the basis of individual clinical assessment of patients. However, 22......INTRODUCTION: Many emergency departments use validated triage tools. It is currently undocumented if such a practice is common in Danish medical admission units (MAU). The current study was conducted in order to clarify this. MATERIAL AND METHODS: Questionnaire survey with data collected from......% answered that selected groups of patients were routinely assessed by a senior physician. CONCLUSION: None of the Danish MAUs uses a validated triage tool to prioritize acutely admitted medical patients. Udgivelsesdato: 2010-May-31...

  7. Interrater reliability of the Australasian Triage Scale for mental health patients.

    Science.gov (United States)

    Creaton, Anne; Liew, Don; Knott, Jonathan; Wright, Melissa

    2008-12-01

    To evaluate interrater reliability of the Australasian Triage Scale (ATS) for mental health patients in ED. In a prospective descriptive study, triage nurses were shown video vignettes of simulated scenarios of mental health presentations. Trieurs (raters) were asked to allocate an ATS category (rating) to each case. The primary outcome was the degree of interrater reliability for each simulated case. Also assessed were differences between raters or settings, grouped by level of ED activity, state of origin, hospital type and familiarity with appropriate guidelines. Chi-squared analysis was used for independent categorical variables; the Friedman test was used to compare the triage scores between busy and quiet ED scenarios. Ordinal data results were compared using opartchi. All 90 eligible participants were enrolled. The highest interrater concordance was 65.6% whereas the lowest interrater concordance was 53.3%. Significant association occurred between the distribution of triage ratings, ED activity level and the state of origin. A busy ED resulted in the assignment of a more urgent ATS category and decrease in concordance. There is a need to develop and implement a validated, standardized national triage tool for mental health patients. The ATS per se is insufficient to ensure acceptable interrater reliability, particularly during busy periods in the ED, and between states. Given the influence the ATS has on key outcomes, it is imperative for this tool to be robust.

  8. A new scoring system for the triage of cardiac tamponade.

    Science.gov (United States)

    Imazio, Massimo; Adler, Yehuda; Ristić, Arsen D; Charron, Philippe

    2015-03-01

    Prompt recognition of cardiac tamponade is critical since the underlying hemodynamic disorder can lead to death if not resolved by percutaneous or surgical drainage of the pericardium. Nevertheless, the management of cardiac tamponade can be challenging because of the lack of the validated criteria for the risk stratification that should guide clinicians in the decision-making process. The Working Group on Myocardial and Pericardial Diseases issued this position statement in order to reply to specific questions: Which patients need immediate drainage of the pericardial effusion?; Is echocardiography sufficient for guidance of pericardiocentesis or should patient be taken to the cardiac catheterization laboratory?; Who should be transferred to specialized/tertiary institution or surgical service?; What type of medical support is necessary during transportation? Current European guidelines published in 2004 do not cover these issues and no additional guidelines are available from major medical and cardiology societies.

  9. Inter-rater Reliability of Triages Performed by the Electronic Triage System

    Directory of Open Access Journals (Sweden)

    Faramarz Pourasghar

    2015-10-01

    Full Text Available Objective: To examine the inter-rater reliability of triages performed by the Electronic Triage System (ETS which has recently developed and used in hospital emergency department (ED. Methods: This cross-sectional study was conducted prospectively and studied 408 visitors of Tabriz Imam Reza hospital’s ED. The variables of interest were age, sex, nurse-assigned triage category, physician-assigned triage category, disease type (trauma, non-trauma, and the referred room within the ED. Cohen’s un-weighted kappa, linear weighted kappa, and quadratic weighted kappa were used to describe the reliability. Results: Un-weighted kappa observed to be 0.186 (95% CI: 0.123-0.249. Linear weighted kappa observed as 0.317 (95% CI: 0.251-0.384 and quadratic weighted kappa as 0.462 (95% CI: 0.336-0.589. In general, low agreement was seen between the triage nurses and ED physicians. For trauma patients and for those who were referred to the cardiopulmonary resuscitation room (CPR, all three types of kappa were higher than other visitors of the ED. Conclusion: Inter-rater reliability of the triages performed by the ETS observed as ranging from poor to moderate. Implementing interventions that would create a common language between nurses and physicians about the triage of the ED visitors seems necessary. The more agreement on the triage of trauma and CPR patients might be due to their condition and the more attention to them.

  10. A descriptive analysis of injury triage, surge of medical demand, and resource use in an university hospital after 8.12 Tianjin Port Explosion, China

    Institute of Scientific and Technical Information of China (English)

    Guo-Qiang Li; Shi-Ke Hou; Xin Yu; Xiang-Tao Meng; Liang-Liang Liu; Peng-Bo Yan; Meng-Na Tian

    2015-01-01

    Objective: The 8.12 Tianjin Port Explosion in 2015 caused heavy casualties.Pingjin Hospital, an affiliated college hospital in Tianjin, China participated in the rescue activities.This study aims to analyze the emergency medical response to this event and share experience with trauma physicians to optimize the use of medical resource and reduce mortality of critical patients.Methods: As a trauma centre at the accident city, our hospital treated 298 patients.We retrospectively analyzed the data of emergency medical response, including injury triage, injury type, ICU patient flow, and medical resource use.Results: There were totally 165 deaths, 8 missing, and 797 non-fatal injuries in this explosion.Our hospital treated 298 casualties in two surges of medical demand.The first one appeared at 1 h after explosion when 147 wounded were received and the second one at 4 h when 31 seriously injured patients were received, among whom 29 were transferred from Tianjin Emergency Center which was responsible for the scene injury triage.After reexamination and triage, only 11 cases were defined as critical ill patients.The over-triage rate reached as high as 62.07%.Seventeen patients underwent surgery and 17 patients were admitted to the intensive care unit.Conclusions: The present pre-hospital system is incomplete and may induce two surges of medical demand.The first one has a much larger number of casualties than predicted but the injury level is mild;while the second one has less wounded but almost all of them are critical patients.The over-triage rate is high.The hospital emergency response can be improved by an effective re-triage and implementation of a hospital-wide damage control.

  11. Model uniform core criteria for mass casualty triage.

    Science.gov (United States)

    2011-06-01

    There is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident.

  12. Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

    Directory of Open Access Journals (Sweden)

    Christine M. Van Dillen

    2016-01-01

    Full Text Available Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel. Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42; P<0.001. Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55 for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77. Conclusion. Simulation training improved prehospital care providers’ confidence level in performing two life-saving procedures.

  13. Prehospital care of head injured patients

    Directory of Open Access Journals (Sweden)

    Dash Hari

    2008-01-01

    Full Text Available Resuscitation of head injured patients at the accident site is paramount in minimizing morbidity and mortality. This can be achieved through prehospital care which is nonexistent in our country. This review is a step forward, so that we can formulate guidelines in this regard.

  14. Mental health triage nursing: an Australian perspective.

    Science.gov (United States)

    Sands, N

    2004-04-01

    This paper presents the findings of a doctoral research project that involved a state-wide investigation into mental health triage nursing in Victoria, Australia. Mental health triage is a specialized domain of nursing practice that has emerged within the context of wider mental health reform in the State. The overall aim of the study was to produce a comprehensive definition and description of psychiatric triage nursing in Victoria. Methodological triangulation was used in the design of the study to enable the use of both survey (n = 139) and semi-structured interview (n = 21) data collection methods. Mental health triage nursing was found to be a complex, stressful role that involves high levels of responsibility, clinical decision making, and multiple role functions, many of which overlap into areas of practice previously the exclusive domain of medicine, such as assessment, diagnosis, and referral. The paper raises discussion on contemporary professional issues of concern to mental health triage nursing, and concludes with recommendations for the future development of the discipline.

  15. [Emergency department triage: independent nursing intervention?].

    Science.gov (United States)

    Corujo Fontes, Sergio José

    2014-03-01

    The branch hospital triage aimed at, as well as exercised by nurses, has evolved to meet their needs to organize and make visible the nurses' duties. However, it is still not properly considered as independent nursing intervention. Evidencing practice triage nurse in hospital as experienced by their protagonists disclosed the possible causes of this paradoxical competence. In a sample of 41 nurses, of the 52 possible with previous experience in hospital triage in the Emergency Department of the Hospital General Dr. José Molina Orosa in Lanzarote, the nurses themselves carried out an opinion survey that group together statements about different aspects of the triaje nurse. In its results, 65.8% of those polled thought the triaje nursing training to be deficient and even though nearly half 48.7%, was considered competent to decide the level of emergency, 46.3% disagreed to take this task part of their duty. It is conclusive that the training received in hospital triage, regulated and sustained, is deficient, that is the main reason why professionals have their doubts to take on an activity they are not familiar with. Triage systems do not record the entire outcome of the nursing work and nursing methodology does not seem to be quite indicative for this task.

  16. What is dignity in prehospital emergency care?

    Science.gov (United States)

    Abelsson, Anna; Lindwall, Lillemor

    2017-05-01

    Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation. To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care. The study had a qualitative approach. Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis. Ethical considerations: The study followed the ethical principles in accordance with the Declaration of Helsinki. The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient. It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human. Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.

  17. A National Survey of Emergency Department Triage in Sweden

    Science.gov (United States)

    Göransson, Katarina; Ehrenberg, Anna; Ehnfors, Margareta

    2003-01-01

    The aim of this study was to identify the organisation of and knowledge about triage work in Swedish emergency departments (ED) as a first step to understanding what is necessary for decision support in ED triage systems in Sweden. A national survey using telephone interviews for data collection was used. Results showed great variety in how work regarding ED triage is organised and performed. The variety occurs in several areas including education, personnel performing triage, facilities available and scales used. PMID:14728356

  18. Visitation by physicians did not improve triage in trauma patients

    DEFF Research Database (Denmark)

    Holm Burén, Lars Andreas; Daugaard, Morten; Larsen, Jens Rolighed

    2013-01-01

    Introduction: A formalized trauma response team is designed to optimize the quality and progress of patient care for severely injured patients in order to reduce mortality and morbidity. The goal of this study was to determine over- and undertriage and to evaluate if a physicianmanned pre......-hospital response (MD-EMS) would reduce overtriage. Overtriage was defined as the process of overestimating the level of injury sustained by an individual. Material and methods: This was a retrospective study. All patients admitted with trauma team activation (TTA) (n = 1,468) during a four-year period (2007......-2011) were included. Undertriage was estimated by assessing the fraction of major trauma patients (New Injury Severity Score (NISS) > 15) admitted to Viborg Regional Hospital in the project period without TTA. RESULTS : For each year, overtriage was 88.3% (2007), 89.9% (2008), 92.8% (2009) and 88.2% (2010...

  19. Visitation by physicians did not improve triage in trauma patients

    DEFF Research Database (Denmark)

    Holm Burén, Lars Andreas; Daugaard, Morten; Larsen, Jens Rolighed

    2013-01-01

    Introduction: A formalized trauma response team is designed to optimize the quality and progress of patient care for severely injured patients in order to reduce mortality and morbidity. The goal of this study was to determine over- and undertriage and to evaluate if a physicianmanned pre......-hospital response (MD-EMS) would reduce overtriage. Overtriage was defined as the process of overestimating the level of injury sustained by an individual. Material and methods: This was a retrospective study. All patients admitted with trauma team activation (TTA) (n = 1,468) during a four-year period (2007......-2011) were included. Undertriage was estimated by assessing the fraction of major trauma patients (New Injury Severity Score (NISS) > 15) admitted to Viborg Regional Hospital in the project period without TTA. RESULTS : For each year, overtriage was 88.3% (2007), 89.9% (2008), 92.8% (2009) and 88.2% (2010...

  20. Abnormal vital signs are strong predictors for Intensive Care Unit admission and in-hospital mortality in adults triaged in the Emergency Department - A prospective cohort study

    DEFF Research Database (Denmark)

    Barfod, Charlotte; Laurtizen, Marlene Mp; Danker, Jakob K

    2012-01-01

    with the highest in-hospital mortality were 'dyspnoea' (11.5 %) and 'altered level of consciousness' (10.6 %). More than half of the patients had a Tcomplaint more urgent than Tvitals, the opposite was true in just 6 % of the patients. CONCLUSION: The HAPT system is valid in terms of predicting in......, scored and categorized at admission, that are most strongly associated with the outcome measures. METHODS: The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category...

  1. [Triage--and the management of mass casualty incidents].

    Science.gov (United States)

    Peters, Sigurd

    2010-01-01

    Triage ("sorting") will only be necessary in the setting of mass casualties and lack of sufficient paramedical and medical specialists as well as equipment. Triage means that the victims will be divided into four categories denoting urgency of treatment and chance of survival. The most experienced medical doctor or officer is responsible for the triage. Copyright (c) 2010. Published by Elsevier GmbH.

  2. The Manchester Triage System in paediatric emergency care

    NARCIS (Netherlands)

    M. van Veen (Mirjam)

    2010-01-01

    textabstractIn the first part of the thesis performance of the Manchester Triage System in paediatric emergency care was evaluated. In chapter 1 we reviewed the literature to evaluate realibility and validity of triage systems in paediatric emergency care. The Manchester Triage System was used to tr

  3. 院前急救时的检伤分类——定量分析方法及程序%Pre-hospital First Aid Triage: Quantitative Analysis Methods and Procedures

    Institute of Scientific and Technical Information of China (English)

    冯庚

    2012-01-01

    Objective This article introduces several common methods of triage assessments, including triage checklist, pre -hospital index, CRAMS score, trauma score and simple wound score, START triage method and improved CESIRA classification.%本文介绍了几种常用的检伤分类的评估方法的应用及程序,包括对照指标、院前指数、CRAMS评分法、创伤计分法及简易创伤计分法、START检伤分类法及改良CESIRA分类法.

  4. Triage: Napoleon to the present day.

    Science.gov (United States)

    Blagg, C R

    2004-01-01

    Triage, the sorting of patients according to the severity of their injuries and the need for urgent surgery was a concept developed by Dr. Larrey, a military surgeon in Napoleon's army. The evolution of the concept in military medicine from that time to the present is described. Triage in civilian practice first became a serious issue with the development of dialysis for chronic renal failure in the 1960s and the problem of the allocation of this scarce and very expensive treatment. With new developments in organ transplantation and technology it continues to be an issue today.

  5. Remote triage support algorithm based on fuzzy logic.

    Science.gov (United States)

    Achkoski, Jugoslav; Koceski, S; Bogatinov, D; Temelkovski, B; Stevanovski, G; Kocev, I

    2017-06-01

    This paper presents a remote triage support algorithm as a part of a complex military telemedicine system which provides continuous monitoring of soldiers' vital sign data gathered on-site using unobtrusive set of sensors. The proposed fuzzy logic-based algorithm takes physiological data and classifies the casualties according to their health risk level, calculated following the Modified Early Warning Score (MEWS) methodology. To verify the algorithm, eight different evaluation scenarios using random vital sign data have been created. In each scenario, the hypothetical condition of the victims was assessed in parallel both by the system as well as by 50 doctors with significant experience in the field. The results showed that there is high (0.928) average correlation of the classification results. This suggests that the proposed algorithm can be used for automated remote triage in real life-saving situations even before the medical team arrives at the spot, and shorten the response times. Moreover, an additional study has been conducted in order to increase the computational efficiency of the algorithm, without compromising the quality of the classification results. 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/.

  6. Breast clinic triage tool: telephone assessment of new referrals.

    Science.gov (United States)

    Cusack, Leila; Brennan, Meagan; Weissenberg, Leisha; Moore, Katrina

    2012-04-01

    Efficient systems to triage increasing numbers of new referrals to breast clinics are needed, to optimise the management of patients with cancer and benign disease. A tool was developed to triage the urgency of referrals and allocate the most appropriate clinician consultation (surgeon or breast physician (BP)). 259 consecutive new referrals were triaged using the tool. 100% new cancers and 256 (98.8%) referrals overall were triaged to both appropriate category of urgency and the appropriate clinician. This triage tool provides a simple method for assessing new referrals to a breast clinic and can be easily delivered by trained administrative staff by telephone.

  7. The Danish quality database for prehospital emergency medical services

    DEFF Research Database (Denmark)

    Frischknecht Christensen, Erika; Berlac, Peter Anthony; Nielsen, Henrik;

    2016-01-01

    AIM OF DATABASE: The aim of the Danish quality database for prehospital emergency medical services (QEMS) is to assess, monitor, and improve the quality of prehospital emergency medical service care in the entire prehospital patient pathway. The aim of this review is to describe the design......: Descriptive data included age, region, and Danish Index for Emergency Care including urgency level. CONCLUSION: QEMS is a new database under establishment and is expected to provide the basis for quality improvement in the prehospital setting and in the entire patient care pathway, for example, by providing...

  8. Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

    Directory of Open Access Journals (Sweden)

    Mamta Swaroop

    2013-01-01

    Full Text Available Background: Achieving definitive care within the "Golden Hour" by minimizing response times is a consistent goal of regional trauma systems . This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries. Materials and Methods: A retrospective cohort study was performed using a statewide trauma registry for the years 1999-2003 . Total pre-hospital times were measured for urban victims of penetrating thoracic trauma. Crude and adjusted mortality rates were compared by pre-hospital time using STATA statistical software. Results: During the study period, 908 patients presented to the hospital after penetrating thoracic trauma, with 79% surviving . Patients with higher injury severity scores (ISS were transported more quickly. Injury severity scores (ISS ≥16 and emergency department (ED hypotension (systolic blood pressure, SBP <90 strongly predicted mortality (P < 0.05 for each . In a logistic regression model including age, race, and ISS, longer transport times for hypotensive patients were associated with higher mortality rates (all P values <0.05. This was seen most significantly when comparing patient transport times 0-15 min and 46-60 min (P < 0.001. Conclusion: In victims of penetrating thoracic trauma, more severely injured patients arrive at urban trauma centers sooner . Mortality is strongly predicted by injury severity, although shorter pre-hospital times are associated with improved survival . These results suggest that careful planning to optimize transport time-encompassing hospital capacity and existing resources, traffic patterns, and trauma incident densities may be beneficial in areas with a high burden of penetrating trauma.

  9. Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury.

    Science.gov (United States)

    Hernandez, Matthew C; Thiels, Cornelius A; Aho, Johnathon M; Habermann, Elizabeth B; Zielinski, Martin D; Stubbs, James A; Jenkins, Donald H; Zietlow, Scott P

    2017-09-01

    Trauma-related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBIs). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improves neurologic function after TBI; however, data in humans are lacking. We retrospectively identified all patients with multiple injuries age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single Level I trauma center from January 2002 to December 2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBCs) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow-up. Of 76 patients meeting inclusion criteria, 53% (n = 40) received prehospital pRBCs and 47% (n = 36) received thawed plasma. Age, gender, injury severity or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p > 0.05). Patients who received thawed plasma had an improved neurologic outcome compared to those receiving pRBCs (median GOSE 7 [7-8] vs. 5.5 [3-7], p plasma had improved functionality compared to pRBCs (median DRS 2 [1-3.5] vs. 9 [3-13], p plasma compared to pRBCs by both median GOSE (8 [7-8] vs. 6 [6-7], p plasma is associated with improved neurologic and functional outcomes at discharge and during follow-up compared to pRBCs alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. Therapeutic, level V.

  10. Accountability Incentives: Do Schools Practice Educational Triage?

    Science.gov (United States)

    Springer, Matthew G.

    2008-01-01

    Increasingly frequent journalistic accounts report that schools are responding to No Child Left Behind (NCLB) by engaging in what has come to be known as "educational triage." Although these accounts rely almost entirely on anecdotal evidence, the prospect is of real concern. The NCLB accountability system divides schools into those in…

  11. [Prehospital care in extremity major vascular injuries].

    Science.gov (United States)

    Samokhvallov, I M; Reva, V A; Pronchenko, A A; Seleznev, A B

    2011-09-01

    The problem of temporary hemorrhage control is one of the most important issues of modern war surgery and surgery of trauma. It is a review of literature devoted to prehospital care in extremity major vascular injuries, embraced up-to-date domestic materials as well as the modern foreign papers in this area. The most important historical landmarks of temporary hemorrhage control system are considered. We paid special attention to the most usable methods and means of hemorrhage control which are utilized at the modern time: pressure bandages, tourniquets, local haemostatic agents. The comprehensive analysis of the contamporary haemostatic means concerning U.S. Army has done. The experience of foreign colleagues in development of prehospital care for the injured, creation and progress of new haemostatic methods, application of temporary hemorrhage control system is analyzed.

  12. Prehospital ACLS--does it work?

    Science.gov (United States)

    Maheshwari, Alok; Mehrotra, Avanti; Gupta, Anoop K; Thakur, Ranjan K

    2002-11-01

    Cardiac disease is the most common cause of death in the United States, and sudden cardiac arrest frequently claims the lives of men and women during their most productive years. It is believed that much better survival rates can be achieved for victims of cardiac arrest through optimizing the "chain of survival" as described by the American Heart Association. The relative and incremental benefit of full prehospital ACLS over basic life support and defibrillation is unproven, however. This is an important issue in this era of cost containment. Some of the ongoing studies including the OPALS study may clarify the cost effectiveness and relative efficacy of rapid defibrillation and full ACLS programs for victims of prehospital cardiac arrest [6].

  13. Prehospital care and new models of regionalization.

    Science.gov (United States)

    Cone, David C; Brooke Lerner, E; Band, Roger A; Renjilian, Chris; Bobrow, Bentley J; Crawford Mechem, C; Carter, Alix J E; Kupas, Douglas F; Spaite, Daniel W

    2010-12-01

    This article summarizes the discussions of the emergency medical services (EMS) breakout session at the June 2010 Academic Emergency Medicine consensus conference "Beyond Regionalization: Integrated Networks of Emergency Care." The group focused on prehospital issues such as the identification of patients by EMS personnel, protocol-driven destination selection, bypassing closer nondesignated centers to transport patients directly to more distant designated specialty centers, and the modes of transport to be used as they relate to the regionalization of emergency care. It is our hope that the proposed research agenda will be advanced in a way that begins to rigorously approach the unanswered research questions and that these answers, in turn, will lead to an evidence-based, cohesive, comprehensive, and more uniform set of guidelines that govern the delivery and practice of prehospital emergency care.

  14. Trauma patient outcome after the Prehospital Trauma Life Support program.

    Science.gov (United States)

    Ali, J; Adam, R U; Gana, T J; Williams, J I

    1997-06-01

    We have previously demonstrated a significant improvement in trauma patient outcome after the Advanced Trauma Life Support (ATLS) program in Trinidad and Tobago. In January of 1992, a Prehospital Trauma Life Support (PHTLS) program was also instituted. This study assessed trauma patient outcome after the PHTLS program. Morbidity (length of stay and degree of disability), mortality, injury severity score, mechanism of injury, age, and sex among all adult trauma patients transported by ambulance to the major trauma hospital were assessed between July of 1990 to December of 1991 (pre-PHTLS, n = 332) and January of 1994 to June of 1995 (post-PHTLS, n = 350). Age, sex distribution, percentage blunt injury, and injury severity score were similar for both groups. Mortality pre-PHTLS (15.7%) was greater than post-PHTLS (10.6%). Length of stay and disability were statistically significantly decreased post-PHTLS. Age, injury severity score, and mechanism of injury were positively correlated with mortality in both periods. The previously reported post-ATLS mortality was similar to the pre-PHTLS mortality. Post-PHTLS mortality and morbidity were significantly decreased, suggesting a positive impact of the PHTLS program on trauma patient outcome.

  15. Ethical conflicts in the prehospital setting.

    Science.gov (United States)

    Adams, J G; Arnold, R; Siminoff, L; Wolfson, A B

    1992-10-01

    To assess the range of ethical conflicts that confront prehospital care providers. Convenience sample, from October 1989 to January 1990. An urban advanced life support emergency medical service that transports approximately 3,000 patients per month. Six hundred seven paramedic responses were analyzed by a single observer. An ethical conflict was identified when the paramedic faced a dilemma about what "ought to be done" and the paramedic's values conflicted or potentially conflicted with the patient's. Cases with potential ethical consequence were brought to experts in medical ethics and epidemiology for further analysis and classification. Ethical conflicts arose in 14.4% of paramedic responses (88 of 607 cases). Twenty-seven percent of the conflicts involved issues of informed consent, such as refusal of treatment or transport, conflicts of hospital destination, treatment of minors, and consent for research. Difficulties regarding the duty of the paramedics, usually under threatening circumstances, accounted for 19% of the dilemmas encountered. Requests for limitation of resuscitation accounted for 14%. Other circumstances that presented ethical conflicts involved questions of patient competence (17%), resource allocation (10%), confidentiality (8%), truth telling (3%), and training (1%). The data demonstrate a range of ethical conflicts in the prehospital setting and point to areas in which policy needs to be developed. The data also can be used in a prehospital ethics curriculum for paramedics and physicians. Because case sampling was not strictly random, absolute conclusions should not be drawn regarding the frequency of the dilemmas.

  16. Risk Analysis for Environmental Health Triage

    Energy Technology Data Exchange (ETDEWEB)

    Bogen, K T

    2005-11-18

    The Homeland Security Act mandates development of a national, risk-based system to support planning for, response to and recovery from emergency situations involving large-scale toxic exposures. To prepare for and manage consequences effectively, planners and responders need not only to identify zones of potentially elevated individual risk, but also to predict expected casualties. Emergency response support systems now define ''consequences'' by mapping areas in which toxic chemical concentrations do or may exceed Acute Exposure Guideline Levels (AEGLs) or similar guidelines. However, because AEGLs do not estimate expected risks, current unqualified claims that such maps support consequence management are misleading. Intentionally protective, AEGLs incorporate various safety/uncertainty factors depending on scope and quality of chemical-specific toxicity data. Some of these factors are irrelevant, and others need to be modified, whenever resource constraints or exposure-scenario complexities require responders to make critical trade-off (triage) decisions in order to minimize expected casualties. AEGL-exceedance zones cannot consistently be aggregated, compared, or used to calculate expected casualties, and so may seriously misguide emergency response triage decisions. Methods and tools well established and readily available to support environmental health protection are not yet developed for chemically related environmental health triage. Effective triage decisions involving chemical risks require a new assessment approach that focuses on best estimates of likely casualties, rather than on upper plausible bounds of individual risk. If risk-based consequence management is to become a reality, federal agencies tasked with supporting emergency response must actively coordinate to foster new methods that can support effective environmental health triage.

  17. Cost-benefit analysis of telehealth in pre-hospital care.

    Science.gov (United States)

    Langabeer, James R; Champagne-Langabeer, Tiffany; Alqusairi, Diaa; Kim, Junghyun; Jackson, Adria; Persse, David; Gonzalez, Michael

    2017-09-01

    Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.

  18. Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale.

    Science.gov (United States)

    Dhiliwal, Sunil; Salins, Naveen; Deodhar, Jayitha; Rao, Raghavendra; Muckaden, Mary Ann

    2016-01-01

    Home-based palliative care is an essential model of palliative care that aims to provide continuity of care at patient's own home in an effective and timely manner. This study was a pilot test of triage coding system in home-based palliative care using Edmonton Symptom Assessment System (ESAS) scale. Objective of the study was to evaluate if the triage coding system in home-based palliative care: (a) Facilitated timely intervention, (b) improved symptom control, and (c) avoided hospital deaths. Homecare services were coded as high (Group 1 - ESAS scores ≥7), medium (Group 2 - ESAS scores 4-6), and low (Group 3 - ESAS scores 0-3) priority based on ESAS scores. In high priority group, patients received home visit in 0-3 working days; medium priority group, patients received home visit in 0-10 working days; and low priority group, patients received home visit in 0-15 working days. The triage duration of home visit was arbitrarily decided based on the previous retrospective audit and consensus of the experts involved in prioritization and triaging in home care. "High priority" patients were visited in 2.63 ± 0.75 days; "medium priority" patients were visited in 7.00 ± 1.5 days, and "low priority" patients were visited in 10.54 ± 2.7 days. High and medium priority groups had a statistically significant improvement in most of the ESAS symptoms following palliative home care intervention. Intergroup comparison showed that improvement in symptoms was the highest in high priority group compared to medium and low priority group. There was an 8.5% increase in home and hospice deaths following the introduction of triage coding system. There was a significant decrease in deaths in the hospital in Group 1 (6.3%) (χ (2) = 27.3, P testing triaging coding system in home-based palliative care showed, triage coding system: (a) Facilitated early palliative home care intervention, (b) improved symptom control, (c) decreased hospital deaths, predominantly in high priority group

  19. Prehospital chest tube thoracostomy: effective treatment or additional trauma?

    NARCIS (Netherlands)

    Spanjersberg, W.; Bergs, B.; Krijen, P.; Schipper, I.; Ringburg, A.; Steyerberg, E.W.; Edwards, M.J.R.; Schipper, I.B.; Vugt, A.B. van

    2005-01-01

    BACKGROUND: The use of prehospital chest tube thoracostomy (TT) remains controversial because of presumed increased complication risks. This study analyzed infectious complication rates for physician-performed prehospital and emergency department (ED) TT. METHODS: Over a 40-month period, all consecu

  20. Prehospital chest tube thoracostomy: effective treatment or additional trauma?

    NARCIS (Netherlands)

    Spanjersberg, W.; Bergs, B.; Krijen, P.; Schipper, I.; Ringburg, A.; Steyerberg, E.W.; Edwards, M.J.R.; Schipper, I.B.; Vugt, A.B. van

    2005-01-01

    BACKGROUND: The use of prehospital chest tube thoracostomy (TT) remains controversial because of presumed increased complication risks. This study analyzed infectious complication rates for physician-performed prehospital and emergency department (ED) TT. METHODS: Over a 40-month period, all consecu

  1. Development and validation of the Pre-hospital Stroke Symptoms Coping Test.

    Directory of Open Access Journals (Sweden)

    Qiuli Zhao

    Full Text Available BACKGROUND AND PURPOSE: Measures of specific knowledge of coping with pre-hospital stroke symptoms can help educate high-risk patients and family caregivers. This study aimed to develop and validate the Pre-hospital Stroke Symptoms Coping Test (PSSCT. MATERIALS AND METHODS: Reliability and validity were analyzed using multiple data sources. The Delphi expert consultation method was applied to assess the test's surface validity and content validity index. The final edition of the 19-item PSSCT contained 3 sections assessing coping with typical symptoms and symptoms associated with vomiting and twitching. Its psychometric properties were investigated in a community sample of 300 high-risk patients and family members. RESULTS: The PSSCT was readily accepted by participants. It demonstrated adequate surface validity and content validity, and good internal consistency (KR20 = 0.822 and test-retest reliability (0.769, with difficulty (P and degree of differentiation (D ranges of 0.28-0.83 and 0.15-0.66, respectively. It was also able to distinguish between individuals who had/had not experienced a stroke. Experienced individuals scored significantly higher overall and on coping with typical symptoms and twitching (P<0.01. CONCLUSIONS: The PSSCT can practically and directly assess critical knowledge regarding coping with pre-hospital stroke symptoms and has good reliability and validity.

  2. A citywide prehospital protocol increases access to stroke thrombolysis in Toronto.

    Science.gov (United States)

    Gladstone, David J; Rodan, Lance H; Sahlas, Demetrios J; Lee, Liesly; Murray, Brian J; Ween, Jon E; Perry, James R; Chenkin, Jordan; Morrison, Laurie J; Beck, Shann; Black, Sandra E

    2009-12-01

    Intravenous tissue plasminogen activator for ischemic stroke is approved for eligible patients who can be treated within a 3-hour window, but treatment rates remain disappointingly low, often protocol was implemented by the provincial government to transport acute stroke patients directly to one of 3 regional stroke centers, bypassing local hospitals. This comprised a paramedic screening tool, ambulance destination decision rule, and formal memorandum of understanding of system stakeholders. This report describes the initial impact of the activation protocol at our regional stroke center. We compared consecutive patients with stroke arriving to our stroke center during the first 4 months of this new triage protocol (February 14 to June 14, 2005) versus the same 4-month period in 2004. The protocol resulted in an immediate doubling in the number of patients with acute stroke arriving to our regional stroke center within 2.5 hours of symptom onset. We observed a 4-fold increase in patients who were eligible for and treated with tissue plasminogen activator. The tissue plasminogen activator treatment rate for ischemic stroke patients increased from 9.5% to 23.4% (P=0.01), and one in 2 patients with ischemic stroke arriving within 2.5 hours received thrombolysis during this period (one in 5 of patients with ischemic stroke overall). The median onset-to-needle time for tissue plasminogen activator-treated patients was significantly reduced. Many implementation challenges were identified and addressed. This prehospital triage was immediately successful in improving tissue plasminogen activator access for patients with ischemic stroke, enabling our center to achieve one of the highest tissue plasminogen activator treatment rates in North America and underscoring the need for coordinated systems of acute stroke care. Sustainability of such an initiative will be dependent on interdisciplinary teamwork, ongoing paramedic training, adequate hospital staffing, bed availability

  3. A systematic review of stroke recognition instruments in hospital and prehospital settings.

    Science.gov (United States)

    Rudd, Matthew; Buck, Deborah; Ford, Gary A; Price, Christopher I

    2016-11-01

    We undertook a systematic review of all published stroke identification instruments to describe their performance characteristics when used prospectively in any clinical setting. A search strategy was applied to Medline and Embase for material published prior to 10 August 2015. Two authors independently screened titles, and abstracts as necessary. Data including clinical setting, reported sensitivity, specificity, positive predictive value, negative predictive value were extracted independently by two reviewers. 5622 references were screened by title and or abstract. 18 papers and 3 conference abstracts were included after full text review. 7 instruments were identified; Face Arm Speech Test (FAST), Recognition of Stroke in the Emergency Room (ROSIER), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Scale (MASS), Ontario Prehospital Stroke Screening tool (OPSS), Medic Prehospital Assessment for Code Stroke (MedPACS) and Cincinnati Prehospital Stroke Scale (CPSS). Cohorts varied between 50 and 1225 individuals, with 17.5% to 92% subsequently receiving a stroke diagnosis. Sensitivity and specificity for the same instrument varied across clinical settings. Studies varied in terms of quality, scoring 13-31/36 points using modified Standards for the Reporting of Diagnostic accuracy studies checklist. There was considerable variation in the detail reported about patient demographics, characteristics of false-negative patients and service context. Prevalence of instrument detectable stroke varied between cohorts and over time. CPSS and the similar FAST test generally report the highest level of sensitivity, with more complex instruments such as LAPSS reporting higher specificity at the cost of lower detection rates. Available data do not allow a strong recommendation to be made about the superiority of a stroke recognition instrument. Choice of instrument depends on intended purpose, and the consequences of a false-negative or false

  4. Effect of educational television commercial on pre-hospital delay in patients with ischemic stroke.

    Science.gov (United States)

    Nishijima, Haruo; Kon, Tomoya; Ueno, Tatsuya; Haga, Rie; Yamazaki, Keishi; Yagihashi, Kei; Funamizu, Yukihisa; Arai, Akira; Suzuki, Chieko; Nunomura, Jin-ichi; Baba, Masayuki; Tomiyama, Masahiko

    2016-01-01

    Administering intravenous recombinant tissue plasminogen activator (r-tPA) within 4.5 h or endovascular procedures within 8 h of ischemic stroke onset may reduce the risk of disability. The effectiveness of media campaigns to raise stroke awareness and shorten pre-hospital delay is unclear. We studied 1144 consecutive ischemic stroke patients at Aomori Prefectural Central Hospital, Japan, between March 2010 and February 2014. From March 2012, the government sponsored an educational campaign based on a television commercial to improve knowledge of stroke symptoms and encourage ambulance calls for facial palsy, arm palsy, or speech disturbance. For the 544 and 600 patients admitted before and during the intervention, respectively, we recorded the National Institutes of Health Stroke Scale score, stroke type, the time when patients or bystanders recognized stroke symptoms, and hospital arrival time. Pre-hospital delay, as the time interval from awareness of stroke to hospital arrival, was categorized as 0-3, 3-6, and 6+ h. The mean pre-hospital delay was shorter (12.0 vs 13.5 h; P = 0.0067), the proportion of patients arriving within 3 h was larger (55.7 vs 46.5 %; P = 0.0021), and the proportion arriving after 6 h was smaller (32.7 vs 39.5 %; P = 0.0162) in the intervention group than in the pre-intervention group. There was no significant difference in the proportion of patients treated with r-tPA (6 and 7.5 % of the intervention and pre-intervention groups, respectively). A television-based public education campaign potentially reduced pre-hospital delay for ischemic stroke patients, but the r-tPA treatment rate was unchanged.

  5. Mass Casualty Triage Performance Assessment Tool

    Science.gov (United States)

    2015-02-01

    tactical tasks for which Soldiers are supposed to be trained to complete and the lack of more precise measurement tools, one key gap identified for...between the wound and the heart) and elevate the wound above the level of the heart to slow the flow of blood to the wound. • Apply a clean...TERMS Assessment, Triage, Performance measurement , Feedback, Tasks-Collective, Brigade Combat Teams, Task analysis

  6. The effectiveness of the South African Triage Toll use in Mahalapye District Hospital – Emergency Department, Botswana

    Directory of Open Access Journals (Sweden)

    Stephane T. Tshitenge

    2016-03-01

    Full Text Available Background: The study aimed to determine the proportion of each priority level of patients, time of performance in each priority level, and the reliability of the South African Triage Scale (SATS tool at the Mahalapye District Hospital - Emergency Department (MDH-ED, a setting where the majority of the nurses were not formally trained on the use of the SATS.Methods: This was a cross-sectional study using case records in MDH-ED from 1 January 2014 to 31 December 2014. A panel of experts from the Mahalapye site of the Family Medicine Department, University of Botswana, reviewed and scored each selected case record that was compared with the scores previously attributed to the nurse triage.Results: From the 315 case records, both the nurse triage and the panel of expert triage assigned the majority of cases in the routine category (green, 146 (46% and 125 (40%, respectively, or in the urgent category (yellow, they assigned 140 (44% and 111 (35% cases, respectively.Overall, there was an adequate agreement between the nurse triage and the panel of expert triage (k = 0.4, 95% confidence interval: 0.3–0.5, although the level of agreement was satisfactory.Conclusion: Findings of the study reported that the profile of the priority-level categories in MDH-ED was made in the majority of routine and urgent patients, only the routine and the emergency patients were seen within the targeted time and they had a satisfactory level of reliability (between 0.4 and 0.6.

  7. Identifying the core competencies of mental health telephone triage.

    Science.gov (United States)

    Sands, Natisha; Elsom, Stephen; Gerdtz, Marie; Henderson, Kathryn; Keppich-Arnold, Sandra; Droste, Nicolas; Prematunga, Roshani K; Wereta, Zewdu W

    2013-11-01

    The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage. Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice. An observational design was employed to address the research aims. Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011. The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation. The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to

  8. The utility of the prehospital electrocardiogram.

    Science.gov (United States)

    Davis, Matthew T; Dukelow, Adam; McLeod, Shelley; Rodriguez, Severo; Lewell, Michael

    2011-11-01

    The 12-lead electrocardiogram (ECG) can capture valuable information in the prehospital setting. By the time patients are assessed by an emergency department (ED) physician, their symptoms and any ECG changes may have resolved. We sought to determine whether the prehospital electrocardiogram (pECG) could influence ED management and how often the pECG was available to and reviewed by the ED physician. A retrospective medical record review was conducted on a random sample of patients ≥ 18 years who had a prehospital 12-lead ECG and were transported to one of two tertiary care centres. Data were recorded onto a standardized data extraction tool. Three investigators independently compared the pECG to the first ECG obtained in the ED after patient arrival at the hospital. Any abnormalities not present on the ED ECG were adjudicated to ascertain whether they had the potential to change ED management. Of 115 ambulance runs selected, 47 had no pECG attached to the ambulance call record (ACR) and another 5 were excluded (one ST elevation myocardial infarction, one cardiac arrest, three ACR missing). Of the 63 pECGs reviewed, 16 (25%) showed changes not apparent on the initial ED ECG (κ  =  0.83; 95% CI 0.74-0.93), of which 12 had differences that might influence ED management (κ  =  0.76; 95% CI 0.72-0.82). Only one hospital record contained a copy of the pECG, despite the current protocol that paramedics print two copies of the pECG on arrival in the ED (one copy for the ACR and one to be handed to the medical personnel). None of 110 ED charts documented that the pECG was reviewed by the ED physician. The pECG has the potential to influence ED management. Improvement in paramedic and physician documentation and a formal pECG handover process appear necessary.

  9. Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage algorithmic approach.

    Science.gov (United States)

    Bogle, Lee B; Boyd, Jeff J; McLaughlin, Kyle A

    2010-03-01

    As winter backcountry activity increases, so does exposure to avalanche danger. A complicated situation arises when multiple victims are caught in an avalanche and where medical and other rescue demands overwhelm resources in the field. These mass casualty incidents carry a high risk of morbidity and mortality, and there is no recommended approach to patient care specific to this setting other than basic first aid principles. The literature is limited with regard to triaging systems applicable to avalanche incidents. In conjunction with the development of an electronic avalanche rescue training module by the Canadian Avalanche Association, we have designed the Avalanche Survival Optimizing Rescue Triage algorithm to address the triaging of multiple avalanche victims to optimize survival and disposition decisions.

  10. Safety and Efficacy of Prehospital Diltiazem

    Directory of Open Access Journals (Sweden)

    Jeffrey H Luk

    2013-05-01

    Full Text Available Introduction: Very few studies exist on the use of diltiazem in the prehospital setting. Some practitioners believe this medication is prone to causing hypotension in this setting. Our goals were to determine whether the prehospital administration of diltiazem induced hypotension and to evaluate the efficacy of the drug.Methods: Our two-tiered system is located in a suburban region of New Jersey with advanced life support (ALS care provided by fly-car units. The ALS units do not transport patients, and all of them are hospital based. The ALS providers are employed by the hospital system. In New Jersey, all ALS care requires online medical control, including the administration of diltiazem. We retrospectively reviewed patient care records for those who were believed to be in rapid atrial fibrillation and were given diltiazem in a suburban emergeny medical services system over a 22-month period. We examined the differences between heart rate (HR and blood pressure (BP on the initial evaluation and on arrival to the emergency department (ED. A hypotensive response was defined as a final systolic BP (SBP less than 90 mmHg and a drop in SBP of at least 10 mmHg. Diltiazem was considered effective if the ED HR was ,100 beats per minute (bpm or if it decreased [1]20%.Results: During the study period, 26,979 patients were transported. Of these patients, 2,488 had a documented rhythm of atrial fibrillation or atrial flutter. Of the 320 patients who received diltiazem, 42 patient encounters were excluded for incomplete data, yielding 278 patients for analysis. The average initial SBP was 139 mmHg and the average diastolic BP was 84 mmHg. The average diltiazem dosage was 16.7 mg. Two patients became hypotensive. The average initial HR was 154 bpm. On arrival to the ED, 33% of the patients had an HR , 100 bpm and 69% had a drop in HR [1] 20%. The overall efficacy of prehospital diltiazem was 73%.Conclusion: In the prehospital setting, diltiazem is associated

  11. The German Version of the Manchester Triage System and its quality criteria--first assessment of validity and reliability.

    Directory of Open Access Journals (Sweden)

    Ingo Gräff

    Full Text Available BACKGROUND: The German Version of the Manchester Triage System (MTS has found widespread use in EDs across German-speaking Europe. Studies about the quality criteria validity and reliability of the MTS currently only exist for the English-language version. Most importantly, the content of the German version differs from the English version with respect to presentation diagrams and change indicators, which have a significant impact on the category assigned. This investigation offers a preliminary assessment in terms of validity and inter-rater reliability of the German MTS. METHODS: Construct validity of assigned MTS level was assessed based on comparisons to hospitalization (general / intensive care, mortality, ED and hospital length of stay, level of prehospital care and number of invasive diagnostics. A sample of 45,469 patients was used. Inter-rater agreement between an expert and triage nurses (reliability was calculated separately for a subset group of 167 emergency patients. RESULTS: For general hospital admission the area under the curve (AUC of the receiver operating characteristic was 0.749; for admission to ICU it was 0.871. An examination of MTS-level and number of deceased patients showed that the higher the priority derived from MTS, the higher the number of deaths (p<0.0001 / χ² Test. There was a substantial difference in the 30-day survival among the 5 MTS categories (p<0.0001 / log-rank test.The AUC for the predict 30-day mortality was 0.613. Categories orange and red had the highest numbers of heart catheter and endoscopy. Category red and orange were mostly accompanied by an emergency physician, whereas categories blue and green were walk-in patients. Inter-rater agreement between expert triage nurses was almost perfect (κ = 0.954. CONCLUSION: The German version of the MTS is a reliable and valid instrument for a first assessment of emergency patients in the emergency department.

  12. Effect of basic prehospital trauma life support program on cognitive and trauma management skills.

    Science.gov (United States)

    Ali, J; Adam, R; Josa, D; Pierre, I; Bedsaysie, H; West, U; Winn, J; Ali, E; Haynes, B

    1998-12-01

    We tested the effectiveness of a basic prehospital trauma life support (PHTLS) program by assessing cognitive performance and trauma management skills among prehospital trauma personnel. Fourteen subjects who completed a standard PHTLS course (group I) were compared to a matched group not completing a PHTLS program (group II). Cognitive performance was assessed on 50-item multiple choice examinations, and trauma skills management was assessed with four simulated trauma patients. Pre-PHTLS multiple choice questionnaire scores were similar (45.8 +/- 9.4% vs. 48.8 +/- 8.9% for groups I and II, respectively), but the post-PHTLS scores were higher in group I (80.4 +/- 5.9%) than in group II (52.6 +/- 4.9%). Pre-PHTLS simulated trauma patient performance scores (standardized to a maximum total of 20 for each station) were similar at all four stations for both groups, ranging from 7.9 to 10.4. The post-PHTLS scores were statistically significantly higher at all four stations for group I (range 16.0-19.0) compared to those for group II (range 8.0-11.1). The overall mean pre-PHTLS score for all four stations was 8.3 +/- 2.1 for group I and 8.8 +/- 2.0 (NS) for group II; the group I post-PHTLS mean score for the four stations was 17.1 +/- 2.7 (p PHTLS Adherence to Priority scores on a scale of 1 to 7 were similar (1.1 +/- 0.9 for group I and 1.2 +/- 1.0 for group II). Post-PHTLS group I Priority scores increased to 5.9 +/- 1.1. Group II (1.1 +/- 1.0) did not improve their post-PHTLS scores. The pre-PHTLS Organized Approach scores in the simulated trauma patients on a scale of 1 to 5 were 2.1 +/- 1.0 for group I and 1.9 +/- 1.2 for group II (NS) compared to 4.2 +/- 0.9 (p PHTLS. This study demonstrates improved cognitive and trauma management skills performance among prehospital paramedical personnel who complete the basic PHTLS program.

  13. Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments.

    Science.gov (United States)

    Vigil, Jacob M; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S; Strenth, Chance; Parshall, Mark; Cichowski, Sara B

    2016-04-01

    Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment.The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses.A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, nurses and patients, African-American, Hispanic, and mixed-ethnicity patients reported higher average PI scores but lower HRs and RRs than NHW patients. NHW patients received higher priority ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans).This study provides evidence for systemic differences in how patients' vital signs are applied for determining ESI scores for different ethnic groups. Additional prospective research will be needed to determine how this specific person-level mechanism affects healthcare quality and

  14. Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report.

    Science.gov (United States)

    Manzon, Cyril; Barrot, Loïc; Besch, Guillaume; Barbot, Olivier; Desmettre, Thibaut; Capellier, Gilles; Piton, Gaël

    2015-01-01

    The triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED. This was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded. One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and 28-day mortality was 16%. Capillary lactate at ED presentation was significantly higher among 28-day non-survivors than among survivors (5.7 mmol.L(-1) [3.2 to 7.4] vs 2.9 mmol.L(-1) [1.9 to 5.2], p = 0.003). A score based on mottling and capillary lactate concentration >3.6 mmol.L(-1) was significantly associated with 28-day mortality (area under curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC global model 0.87). A high capillary lactate concentration measured by the triage nurse among patients presenting to the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.

  15. Customer care. Patient satisfaction in the prehospital setting.

    Science.gov (United States)

    Doering, G T

    1998-09-01

    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew

  16. Effects of Triage Education on Knowledge, Practice and Qualitative Index of Emergency Room Staff: A Quasi-Interventional Study

    Directory of Open Access Journals (Sweden)

    Najaf Zare

    2013-04-01

    Full Text Available Objective: To determine the effects of triage education based on emergency severity index (ESI on promoting the knowledge and performance of nurses and qualitative indices of emergency department.Methods: This study was a quasi-interventional study being performed in Vali Asr Hospital of Fasa University of Medical Sciences during 2012. For this purpose, 50 members of staff including nurses and technicians of emergency medicine in the Emergency department with the inclusion criteria for participation were selected. Data collection instruments included a questionnaire consisting of two parts, (personal characteristics, and knowledge and the performance assessment checklist was prepared. Content validity was used to determine the validity. The test-retest method and quder-Richardson 20 were applied to determine the reliability of the questionnaire. Interobserver reliability and the correlation between the two observers and imaging modalities were measured to determine the reliability of the performance checklist. The questionnaires and checklist were completed by the participants before, 2 days and 6 weeks after completion of the training. Workshop in two 9-hour sessions was provided which consisted of lectures, questions and answers.Results: The triage scores were 10.7±3.1, 17.8± 1.6 and 16.1±2.3 before, 2 days and 6 weeks after training, respectively. Triage performance score increased from 48.9 ± 9.9 before training to 59.8 ± 7.6, two days after training and to 59.7 ± 8.1 six weeks later (p=0.001. In addition to triage training of the nurses the emergency department qualitative indices were impressively upgraded. Other results showed that there was no significant correlation between individual characteristics and personal knowledge of triage score 6-week after training (r=0.018, p=0.126. However, significant positive correlation was found between nursing work experience, work experience in emergency ward and type of employment and

  17. The development and feasibility of a remote damage control resuscitation prehospital plasma transfusion protocol for warfarin reversal for patients with traumatic brain injury.

    Science.gov (United States)

    Zielinski, Martin D; Smoot, Dustin L; Stubbs, James R; Jenkins, Donald H; Park, Myung S; Zietlow, Scott P

    2013-01-01

    The rapid reversal of warfarin in the setting of traumatic brain injury (TBI) has been associated with improved outcomes. Until now, remote reversal of hypocoagulable states has not been possible in the prehospital environment. This manuscript describes the development and analysis of a prehospital plasma transfusion protocol to reverse warfarin at the earliest possible moment after TBI. A retrospective review of all TBI patients receiving plasma transfusion(s) in the prehospital environment for warfarin reversal between February 2009 and September 2010 was conducted. Thawed plasma was carried on every air ambulance flight centered at the main campus. A total of 2836 flights carried over 2500 units of thawed plasma throughout the study period. During this time, 16 patients received prehospital plasma resuscitation, five of who were on warfarin with a concurrent TBI. The median Injury Severity Score was 17 (8.5-27.5) with a median Glasgow Coma Score of 13 (8-15) and a mortality rate of 40%. A median of 2 (1.5-2.0) units of thawed plasma and 0 (0-0) units of RBCs were transfused en route. The pretransfusion point-of-care international normalized ratio improved from 3.1 (2.3-4.0) to 1.9 (1.3-3.6) upon trauma center admission (serum sample). One hundred percent of the transported, but unused, thawed plasma underwent subsequent transfusion prior to expiration. Remote prehospital plasma transfusions effectively reverse anticoagulation secondary to warfarin administration in TBI patients. It is feasible to transfuse thawed plasma in the prehospital setting via remote damage control techniques without increasing waste. Prospective studies are needed to determine if this practice can improve outcomes in this population. © 2013 American Association of Blood Banks.

  18. Trauma-informed care for children in the ambulance: international survey among pre-hospital providers.

    Science.gov (United States)

    Alisic, Eva; Tyler, Mark P; Giummarra, Melita J; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A; Kassam-Adams, Nancy

    2017-01-01

    Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers' knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one-off group

  19. Trauma-informed care for children in the ambulance: international survey among pre-hospital providers

    Science.gov (United States)

    Alisic, Eva; Tyler, Mark P.; Giummarra, Melita J.; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A.; Kassam-Adams, Nancy

    2017-01-01

    ABSTRACT Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers’ knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one

  20. Effect of the prehospital trauma life support program (PHTLS) on prehospital trauma care.

    Science.gov (United States)

    Ali, J; Adam, R U; Gana, T J; Bedaysie, H; Williams, J I

    1997-05-01

    Improvement in trauma patient outcome has been demonstrated after the implementation of the Prehospital Trauma Life Support (PHTLS) program in Trinidad and Tobago. This study was aimed at identifying prehospital care factors that may explain this improvement. All patients transferred by ambulance to the major trauma referral hospital had assessment of airway control, oxygen use, cervical (C)-spine control, and hemorrhage control, as well as splinting of extremities during pre-PHTLS (July of 1990 to December of 1991; n = 332) and post-PHTLS periods (January of 1994 to June of 1995; n = 350). Pre-PHTLS data were compared with post-PHTLS data by chi 2 analysis with a p value PHTLS period for airway control (10 vs. 99.7%), C-spine control (2.1 vs. 89.4%), splinting of extremities (22 vs. 60.6%), hemorrhage control (16 vs. 96.9%), and oxygen use (6.6 vs. 89.5%) when no specific problem was identified. When a specific problem was identified in these areas, the post-PHTLS percentage also increased for airway control (16.2 vs. 100%), C-spine control (25 vs. 100%), splinting of extremities (33.9 vs. 100%), hemorrhage control (18 vs. 100%), and oxygen use (43.2 vs. 98.9%). Prehospital trauma care has changed after the introduction of the PHTLS program as indicated by more frequent airway control, use of oxygen, control of cervical (C)-spine and hemorrhage, as well as splinting of fractures. This finding was evident not only as a routine but particularly when a specific related problem was identified. This change in prehospital care could be responsible for the improved trauma patient outcome after PHTLS.

  1. No Child Overlooked: Mental Health Triage in the Schools

    Science.gov (United States)

    Wilson, F. Robert; Tang, Mei; Schiller, Kelly; Sebera, Kerry

    2009-01-01

    Mental health problems among children in schools are on the increase. To exercise due diligence in their responsibility to monitor and promote mental health among our nation's children, school counselors may learn from triage systems employed in hospitals, clinics, and mental health centers. The School Counselor's Triage Model provides school…

  2. Walk-In Triage Systems in University Counseling Centers

    Science.gov (United States)

    Shaffer, Katharine S.; Love, Michael M.; Chapman, Kelsey M.; Horn, Angela J.; Haak, Patricia P.; Shen, Claire Y. W.

    2017-01-01

    To meet the complex mental health needs of students, some university counseling centers (UCCs) have implemented walk-in triage intake systems, which have not yet been empirically investigated. This study compared client and clinician differences (N = 5564) between a traditional scheduled intake system (Year 1) and a walk-in triage system (Year 2)…

  3. Reliability and validity of triage systems in paediatric emergency care

    NARCIS (Netherlands)

    M. van Veen (Mirjam); H.A. Moll (Henriëtte)

    2009-01-01

    textabstractBackground. Triage in paediatric emergency care is an important tool to prioritize seriously ill children. Triage can also be used to identify patients who do not need urgent care and who can safely wait. The aim of this review was to provide an overview of the literature on reliability

  4. Technology Staff Development: Triage Using Three Mastery Levels.

    Science.gov (United States)

    Guffey, J. Stephen; Rampp, Lary C.; Bradley, Mary Jane

    The technology triage is a workable paradigm for straightforward school-site/school-district implementation of technology resources. Development of a triage system of participant involvement and in-service staff development can help address the tendency to ineffectively allocate funds within the total picture of the school commitment to…

  5. Improvements of Paediatric Triage at the Emergency Department

    NARCIS (Netherlands)

    N. Seiger (Nienke)

    2014-01-01

    markdownabstract__Abstract__ The practice of triage, originated from the French word “trier” which means to sort, was conceived around 1792 by Baron Dominique-Jean Larrey, Surgeon in Chief to Napoleon’s Imperial Gard. In these days, triage was used to identify soldiers whose injuries were readily t

  6. Mental health triage: towards a model for nursing practice.

    Science.gov (United States)

    Sands, N

    2007-05-01

    Mental health triage/duty services play a pivotal role in the current framework for mental health service delivery in Victoria and other states of Australia. Australia is not alone in its increasing reliance on mental health triage as a model of psychiatric service provision; at a global level, there appears to be an emerging trend to utilize mental health triage services staffed by nurses as a cost-effective means of providing mental health care to large populations. At present, nurses comprise the greater proportion of the mental health triage workforce in Victoria and, as such, are performing the majority of point-of-entry mental health assessment across the state. Although mental health triage/duty services have been operational for nearly a decade in some regional healthcare sectors of Victoria, there is little local or international research on the topic, and therefore a paucity of established theory to inform and guide mental health triage practice and professional development. The discussion in this paper draws on the findings and recommendations of PhD research into mental health triage nursing in Victoria, to raise discussion on the need to develop theoretical models to inform and guide nursing practice. The paper concludes by presenting a provisional model for mental health triage nursing practice.

  7. Reliability and validity of emergency department triage systems

    NARCIS (Netherlands)

    van der Wulp, I.

    2010-01-01

    Reliability and validity of triage systems is important because this can affect patient safety. In this thesis, these aspects of two emergency department (ED) triage systems were studied as well as methodological aspects in these types of studies. The consistency, reproducibility, and criterion vali

  8. Assessment of hospital-based adult triage at emergency receiving ...

    African Journals Online (AJOL)

    Methodology: This was a descriptive cross-sectional study. ... support were the major barriers to improvement/development of formal triage in ... surveyed had established and functional triage systems in ..... attendants, spectators and media teams and this situation .... hospitals for their co-operations during data collection.

  9. Triage and mortality in 2875 consecutive trauma patients

    DEFF Research Database (Denmark)

    Meisler, Rikke; Thomsen, A B; Abildstrøm, H

    2010-01-01

    Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage.......Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage....

  10. Impact of the ABCDE triage on the number of patient visits to the emergency department

    Directory of Open Access Journals (Sweden)

    Menezes Ricardo

    2010-06-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care specialists are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to tertiary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for those patients who need it the most. Methods A face-to-face triage system based on the letters A (patient directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse. If the patient was not considered to be in need of immediate care (i.e. A-D he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrmäki in Vantaa, Jorvi and Puolarmetsä in Espoo. To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public

  11. Accuracy of the field triage protocol in selecting severely injured patients after high energy trauma.

    Science.gov (United States)

    van Laarhoven, J J E M; Lansink, K W W; van Heijl, M; Lichtveld, R A; Leenen, L P H

    2014-05-01

    For optimal treatment of trauma patients it is of great importance to identify patients who are at risk for severe injuries. The Dutch field triage protocol for trauma patients, the LPA (National Protocol of Ambulance Services), is designed to get the right patient, in the right time, to the right hospital. Purpose of this study was to determine diagnostic accuracy and compliance of this triage protocol. Triage criteria were categorised into physiological condition (P), mechanism of trauma (M) and injury type (I). A retrospective analysis of prospectively collected data of all high-energy trauma patients from 2008 to 2011 in the region Central Netherlands is performed. Diagnostic parameters (sensitivity, specificity, negative predictive value, positive predictive value) of the field triage protocol for selecting severely injured patients were calculated including rates of under- and overtriage. Undertriage was defined as the proportion of severely injured patients (Injury Severity Score (ISS)≥16) who were transported to a level two or three trauma care centre. Overtriage was defined as the proportion of non-severely injured patients (ISSprotocol was 89.1% (95% confidence interval (CI) 84.4-92.6) and 60.5% (95% CI 57.9-63.1), respectively. The overall rate of undertriage was 10.9% (95%CI 7.4-15.7) and the overall rate of overtriage was 39.5% (95%CI 36.9-42.1). These rates were 16.5% and 37.7%, respectively for patients with M+I-P-. Compliance to the triage protocol for patients with M+I-P- was 78.7%. Furthermore, compliance in patients with either a positive I+ or positive P+ was 91.2%. The overall rate of undertriage (10.8%) was mainly influenced by a high rate of undertriage in the group of patients with only a positive mechanism criterion, therefore showing low diagnostic accuracy in selecting severely injured patients. As a consequence these patients with severe injury are undetected using the current triage protocol. As it has been shown that severely injured

  12. Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

    Directory of Open Access Journals (Sweden)

    Matej Strnad

    2015-01-01

    Full Text Available This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients’ charts. Prehospital vital signs, Injury Severity Score (ISS, initial Glasgow Coma Scale (GCS, Revised Trauma Score (RTS, arterial blood gases, and lactate were compared in two study groups: survivors (n=40 and nonsurvivors (n=30. There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006, with lower initial GCS (P<0.001 and higher ISS (P<0.001, along with higher lactate (P<0.001 and larger base deficit (BD; P=0.006, whereas RTS (P=0.001 was lower in nonsurvivors. For predicting mortality, area under the curve (AUC was calculated: for lactate 0.82 (P<0.001, for ISS 0.82 (P<0.001, and for BD 0.69 (P=0.006. Lactate level of 3.4 mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037, GCS (P=0.033, and age (P=0.002 were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001. Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.

  13. The role of pre-hospital blood gas analysis in trauma resuscitation

    Directory of Open Access Journals (Sweden)

    Katila Ari

    2010-04-01

    Full Text Available Abstract Background To assess, whether arterial blood gas measurements during trauma patient's pre-hospital shock resuscitation yield useful information on haemodynamic response to fluid resuscitation by comparing haemodynamic and blood gas variables in patients undergoing two different fluid resuscitation regimens. Methods In a prospective randomised study of 37 trauma patients at risk for severe hypovolaemia, arterial blood gas values were analyzed at the accident site and on admission to hospital. Patients were randomised to receive either conventional fluid therapy or 300 ml of hypertonic saline. The groups were compared for demographic, injury severity, physiological and outcome variables. Results 37 patients were included. Mean (SD Revised Trauma Score (RTS was 7.3427 (0.98 and Injury Severity Score (ISS 15.1 (11.7. Seventeen (46% patients received hypertonic fluid resuscitation and 20 (54% received conventional fluid therapy, with no significant differences between the groups concerning demographic data or outcome. Base excess (BE values decreased significantly more within the hypertonic saline (HS group compared to the conventional fluid therapy group (mean BE difference -2.1 mmol/l vs. -0.5 mmol/l, p = 0.003. The pH values on admission were significantly lower within the HS group (mean 7.31 vs. 7.40, p = 0.000. Haemoglobin levels were in both groups lower on admission compared with accident site. Lactate levels on admission did not differ significantly between the groups. Conclusion Pre-hospital use of small-volume resuscitation led to significantly greater decrease of BE and pH values. A portable blood gas analyzer was found to be a useful tool in pre-hospital monitoring for trauma resuscitation.

  14. Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury.

    Science.gov (United States)

    Sun, Hai; Samra, Navdeep S; Kalakoti, Piyush; Sharma, Kanika; Patra, Devi Prasad; Dossani, Rimal H; Thakur, Jai Deep; Disbrow, Elizabeth A; Phan, Kevin; Veeranki, Sreenivas P; Pabaney, Aqueel; Notarianni, Christina; Owings, John T; Nanda, Anil

    2017-08-01

    Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented. Copyright © 2017. Published by Elsevier Inc.

  15. Prevalence of Prehospital Hypoxemia and Oxygen Use in Trauma Patients

    Science.gov (United States)

    2013-10-01

    prehospital endotracheal intubation . Hypoxemia occurred in 86 (38.4%), paramedics suspected traumatic brain injury in 22 (9.8%), and 20 (8.9%) were...admitted; 36.2% sustained a penetrating injury. None underwent prehospital endotracheal intubation . Hypoxemia occurred in 86 (38.4%), paramedics...36.2% sustained a penetrating injury. No subject underwent endotracheal intubation in the pre hospital setting; 7 (3.1%) underwent intubation in the

  16. Prehospital Use of Plasma for Traumatic Hemorrhage - PUPTH-IIA

    Science.gov (United States)

    2016-08-01

    and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command...the Prehospital Use of Plasma in Traumatic Hemorrhage (PUPTH) trial. This trial was a multi- departmental , multi-agency, randomised clinical trial...to re-organise and manage a large multi-agency, multi- departmental clinical trial, Prehospital Use of Plasma in Traumatic Hemorrhage (PUPTH) trial

  17. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Barfod Charlotte

    2012-04-01

    Full Text Available Abstract Background Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT system and the outcome measures; Admission to Intensive Care Unit (ICU and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures. Methods The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures. Results The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2, respiratory rate (RR, systolic blood pressure (BP and Glasgow Coma Score (GCS. Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5% and 'altered level of consciousness' (10.6%. More than half of the patients had a Tcomplaint more urgent than Tvitals

  18. Pediatric triage and allocation of critical care resources during disaster: Northwest provider opinion.

    Science.gov (United States)

    Johnson, Erin Margaret; Diekema, Douglas S; Lewis-Newby, Mithya; King, Mary A

    2014-10-01

    Following Hurricane Katrina and the 2009 H1N1 epidemic, pediatric critical care clinicians recognized the urgent need for a standardized pediatric triage/allocation system. This study collected regional provider opinion on issues of care allocation and pediatric triage in a disaster/pandemic setting. This study was a cross-sectional survey of United States (US) health care providers and public health workers who demonstrated interest in critical care and/or disaster care medicine by attending a Northwest regional pediatric critical care symposium on disaster preparation, held in 2012 at Seattle Children's Hospital in Seattle, Washington (USA). The survey employed an electronic audience response system and included demographic, ethical, and logistical questions. Differences in opinions between respondents grouped by professions and work locations were evaluated using a chi-square test. One hundred and twelve (97%) of 116 total attendees responded to at least one question; however, four of these responders failed to answer every question. Sixty-two (55%) responders were nurses, 29 (26%) physicians, and 21 (19%) other occupations. Fifty-five (51%) responders worked in pediatric hospitals vs 53 (49%) in other locations. Sixty-three (58%) of 108 successful responses prioritized children predicted to have a good neuro-cognitive outcome. Seventy-one (68%) agreed that no pediatric age group should be prioritized. Twenty-two (43%) of providers working in non-pediatric hospital locations preferred a triage system based on an objective score alone vs 14 (26%) of those in pediatric hospitals (P = .038).

  19. Prehospital Care of Burn Patients and Trajectories on Survival.

    Science.gov (United States)

    Kallinen, Outi; Koljonen, Virve; Tukiainen, Erkki; Randell, Tarja; Kirves, Hetti

    2016-01-01

    We sought to identify factors associated with the prognosis and survival of burn patients by analyzing data related to the prehospital treatment of burn patients transferred directly to the burn unit from the accident site. We also aimed to assess the role of prehospital physicians and paramedics providing care to major burn patients. This study included adult burn patients with severe burns treated between 2006 and 2010. Prehospital patient records and clinical data collected during treatment were analyzed, and the Injury Severity Scale (ISS) was calculated. Patients were grouped into two cohorts based on the presence or absence of a physician during the prehospital phase. Data were analyzed with reference to survival by multivariable regression model. Specific inclusion criteria resulted in a sample of 67 patients. The groups were comparable with regard to age, gender, and injury etiology. Patients treated by prehospital physicians (group 1, n = 49) were more severely injured than patients treated by paramedics (group 2, n = 18) in terms of total burn surface area (%TBSA) (32% vs. 17%, p = 0.033), ISS (25 vs. 8, p prehospital prognostic factors affecting patient outcomes. Based on the results from this study, our current EMS system is capable of identifying seriously injured burn patients who may benefit from physician attendance at the injury scene.

  20. Prehospital Care of Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    TVSP Murthy

    2008-01-01

    Full Text Available Traumatic brain injury (TBI occurs when a sudden trauma causes brain damage. Depending on the severity, outcome can be anything from complete recovery to permanent disability or death. Emergency medical services play a dominant role in provision of primary care at the site of injury. Since little can be done to reverse the initial brain damage due to trauma, attempts to prevent further brain damage and stabilize the patient before he can be brought to a specialized trauma care centre play a pivotal role in the final outcome. Recognition and early treatment of hypoten-sion, hypoxemia, and hypoglycemia, objective neurological assessment based on GCS and pupils, and safe transport to an optimal care centre are the key elements of prehospital care of a TBI patient.

  1. The prehospital management of avalanche victims.

    Science.gov (United States)

    Kornhall, Daniel K; Martens-Nielsen, Julie

    2016-12-01

    Avalanche accidents are frequently lethal events with an overall mortality of 23%. Mortality increases dramatically to 50% in instances of complete burial. With modern day dense networks of ambulance services and rescue helicopters, health workers often become involved during the early stages of avalanche rescue. Historically, some of the most devastating avalanche accidents have involved military personnel. Armed forces are frequently deployed to mountain regions in order to train for mountain warfare or as part of ongoing conflicts. Furthermore, military units are frequently called to assist civilian organised rescue in avalanche rescue operations. It is therefore important that clinicians associated with units operating in mountain regions have an understanding of, the medical management of avalanche victims, and of the preceding rescue phase. The ensuing review of the available literature aims to describe the pathophysiology particular to avalanche victims and to outline a structured approach to the search, rescue and prehospital medical management.

  2. Pre-hospital care--current concepts.

    Science.gov (United States)

    Boyington, T; Williams, D

    1995-01-01

    After a brief outline of past developments in the training of ambulance personnel, this paper traces the adoption in the UK of Pre-Hospital Trauma Life Support (PHTLS) courses from the US. The 1991 World Student Games in Sheffield, UK led to liaison between training staff from South Yorkshire Metropolitan Ambulance and Paramedic Service (SYMAPS) and from Western New York Medical Training Institute. As a result, the trauma care policy of SYMAPS was altered from aiming to stabilise the patient at the scene of the accident to emphasising rapid and thorough assessment, packaging and transport. This is a resume of the scope of the PHTLS provider course. The course concentrates on the principles of PHTLS for the multisystems trauma victim.

  3. Multilocation teleradiology system for emergency triage consultation

    Science.gov (United States)

    Herron, John M.; Yonas, Howard

    1996-05-01

    A remote consultation system is available at the University of Pittsburgh Medical Center (UPMC) which links four outlying hospitals in Western Pennsylvania and Eastern Ohio. This system has the potential to improve short and long term clinical outcomes and to reduce overall medical care cost by establishing improved emergency triage capability. An EMED, Inc. teleradiology system permits rapid, high-quality transfer of digitized film and CT images from the remote sites to the tertiary care center (UPMC). The images are sent over dial-on- demand ISDN and SW56 lines from the remote hospitals to a central server where they are transmitted to a dual 2K monitor workstation in the Emergency Department, thirteen Eastman Kodak PDS workstations within UPMC, and to three physician homes. Transmission to a workstation at each of the physician homes over ISDN lines enables `after hours' consultation. The radiographic images along with voice and fax communications provide a technique where physicians in outlying hospitals will be able to consult with specialists at any time. A study is in progress to evaluate the effectiveness of this system in terms of perception of utility and its potential to improve emergency triage capability, as well as selection of the appropriate transportation mode (helicopter versus ambulance).

  4. Nurses' evaluation of a new formalized triage system in the emergency department - a qualitative study

    DEFF Research Database (Denmark)

    Johansen, Mette Brehm; Forberg, Jakob Lundager

    2011-01-01

    Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED.......Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED....

  5. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers

    Directory of Open Access Journals (Sweden)

    Marx Jean-Sebastian

    2009-01-01

    Full Text Available Abstract Background While ultrasound (US has continued to expedite diagnosis and therapy for critical care physicians inside the hospital system, the technology has been slow to diffuse into the pre-hospital system. Given the diagnostic benefits of thoracic ultrasound (TUS, we sought to evaluate image recognition skills for two important TUS applications; the identification of B-lines (used in the US diagnosis of pulmonary edema and the identification of lung sliding and comet tails (used in the US diagnosis of pneumothorax. In particular we evaluated the impact of a focused training module in a pre-hospital system that utilizes physicians as pre-hospital providers. Methods 27 Paris Service D'Aide Médicale Urgente (SAMU physicians at the Hôpital Necker with varying levels of US experience were given two twenty-five image recognition pre-tests; the first test had examples of both normal and pneumothorax lung US and the second had examples of both normal and pulmonary edema lung US. All 27 physicians then underwent the same didactic training modules. A post-test was administered upon completing the training module and results were recorded. Results Pre and post-test scores were compared for both the pneumothorax and the pulmonary edema modules. For the pneumothorax module, mean test scores increased from 10.3 +/- 4.1 before the training to 20.1 +/- 3.5 after (p Conclusion This brief training module resulted in significant improvement of image recognition skills for physicians both with and without previous ultrasound experience. Given that rapid diagnosis of these conditions in the pre-hospital system can change therapy, especially in systems where physicians can integrate this information into treatment decisions, the further diffusion of this technology would seem to be beneficial and deserves further study.

  6. Prehospital antiplatelet use and functional status on admission of patients with non-haemorrhagic moyamoya disease: a nationwide retrospective cohort study (J-ASPECT study)

    Science.gov (United States)

    Onozuka, Daisuke; Hagihara, Akihito; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Suzuki, Akifumi; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru; Nishimura, Ataru; Kurogi, Ryota; Sayama, Tetsuro; Iihara, Koji

    2016-01-01

    Objectives To elucidate the association between antiplatelet use in patients with non-haemorrhagic moyamoya disease before hospital admission and good functional status on admission in Japan. Design Retrospective, multicentre, non-randomised, observational study. Setting Nationwide registry data in Japan. Participants A total of 1925 patients with non-haemorrhagic moyamoya disease admitted between 1 April 2012 and 31 March 2014 in Japan. Main outcome measure We performed propensity score-matched analysis to examine the association between prehospital antiplatelet use and no significant disability on hospital admission, as defined by a modified Rankin Scale score of 0 or 1. Results Propensity-matched patients who received prehospital antiplatelet drugs were associated with a good outcome on hospital admission (OR adjusted for all covariates, 3.82; 95% CI 1.22 to 11.99) compared with those who did not receive antiplatelet drugs prior to hospital admission. Conclusions Prehospital antiplatelet use was significantly associated with good functional status on hospital admission among patients with non-haemorrhagic moyamoya disease in Japan. Our results suggest that prehospital antiplatelet use should be considered when evaluating outcomes of patients with non-haemorrhagic moyamoya disease. PMID:27008684

  7. Pre-hospital endotracheal intubation and positive pressure ventilation is associated with hypotension and decreased survival in hypovolemic trauma patients: an analysis of the National Trauma Data Bank.

    Science.gov (United States)

    Shafi, Shahid; Gentilello, Larry

    2005-11-01

    Studies of pre-hospital endotracheal intubation (ETI) from single EMS systems have shown contradictory results, which may represent local differences in paramedic training and experience. An alternative hypothesis is that positive pressure ventilation increases mortality because positive pressure ventilation causes hypotension in severely injured hypovolemic patients. A national sample (National Trauma Data Bank, 1994-2002) was used to minimize effects of local paramedic training and experience. All patients with pre-hospital GCS 16 (most likely to be hypovolemic) were included. Patients intubated in the field (pre-hospital group, n = 871) and in the emergency department (ED group, n = 6581) were compared. To determine whether pre-hospital ETI was an independent predictor of hypotension and mortality, logistic regression was used to control for potential confounders, including age, ISS, body region injured, AIS scores, pre-hospital IV fluids, and other variables. Physiologic variables were not used, as they may be influenced by ETI and positive pressure ventilation, and were therefore considered outcomes, rather than predictors. Groups were comparable in age, gender, anatomic distribution of injuries, likelihood of at least one severe injury (AIS >3) and other variables, except for head injury (ED 83%, pre-hospital 71%, p intubated in the field were more likely to be hypotensive upon arrival in the ED (SBP predictor of hypotension upon arrival in ED (OR 1.7, 95% CI 1.46 -2.09, p endotracheal intubation in trauma patients is associated with hypotension and decreased survival. This may be mediated by the effect of positive pressure ventilation during hypovolemic states.

  8. Gravidade do trauma avaliada na fase pré-hospitalar Trauma severity assessment in prehospital setting

    Directory of Open Access Journals (Sweden)

    I.Y. Whitaker

    1998-06-01

    Full Text Available A avaliação da gravidade do trauma e a instituição de manobras para manutenção básica da vida, no local do evento, podem representar a oportunidade de sobrevida para as vítimas de trauma até a sua chegada ao hospital. OBJETIVO: Estudar vítimas de causas externas avaliadas por um índice fisiológico denominado Trauma Score modificado (TSm aplicado durante o atendimento pré-hospitalar. MATERIAL E MÉTODO: Analisaram-se, retrospectivamente, 1.414 vítimas de causas externas atendidas pelo Sistema de Atendimento Móvel às Urgências (SAMU-RESGATE-SP no município de São Paulo, no ano de 1991. Os dados foram obtidos da ficha de atendimento pré-hospitalar e laudo de necropsia. RESULTADOS: O atendimento pré-hospitalar em 81,31% ocorreu até 40 minutos, dos quais 83,96% das vítimas não-fatais obtiveram escores TSm 12 e 11, e 53,96% das vítimas fatais obtiveram escores 0, 1 e 2. Superfície externa (30,25% e região da cabeça/pescoço (20,98% foram as mais acometidas. Das vítimas fatais, 63,63% com Injury Severity Score (ISS > ou = 16 morreram nas primeiras 24 horas. No cotejamento dos escores TSm e ISS, verificou-se que vítimas fatais com escore TSm entre 0 e 11 foram confirmadas como com ISS crítico (ISS > ou = 16. CONCLUSÃO: Constataram-se fortes indícios de que vítimas fatais com escores TSm baixos relacionaram-se com escores ISS altos.The trauma severity assessment and basic life support maneuvers in prehospital setting can represent to the trauma victim the opportunity of survival until his/her can get assistance in the hospital. PURPOSE: To study external cause victims assessed in the prehospital phase by the physiologic index named Trauma Score modificado (TSm. METHODS: Retrospective analyses were made of 1414 victims attended by Sistema de Atendimento Móvel às Urgências (SAMU-RESGATE-SP in the Municipality of São Paulo during 1991. Data were gathered from prehospital data recording sheets and necropsy records

  9. An exploration of clinical decision making in mental health triage.

    Science.gov (United States)

    Sands, Natisha

    2009-08-01

    Mental health (MH) triage is a specialist area of clinical nursing practice that involves complex decision making. The discussion in this article draws on the findings of a Ph.D. study that involved a statewide investigation of the scope of MH triage nursing practice in Victoria, Australia. Although the original Ph.D. study investigated a number of core practices in MH triage, the focus of the discussion in this article is specifically on the findings related to clinical decision making in MH triage, which have not previously been published. The study employed an exploratory descriptive research design that used mixed data collection methods including a survey questionnaire (n = 139) and semistructured interviews (n = 21). The study findings related to decision making revealed a lack of empirically tested evidence-based decision-making frameworks currently in use to support MH triage nursing practice. MH triage clinicians in Australia rely heavily on clinical experience to underpin decision making and have little of knowledge of theoretical models for practice, such as methodologies for rating urgency. A key recommendation arising from the study is the need to develop evidence-based decision-making frameworks such as clinical guidelines to inform and support MH triage clinical decision making.

  10. Methylphenidate intoxications in children and adults: exposure circumstances and evidence-based dose threshold for pre-hospital triage

    NARCIS (Netherlands)

    Hondebrink, Laura; Rietjens, Saskia J; Hunault, Claudine C; Pereira, Rob R; Kelleci, Nuriye; Yasar, Gulhan; Ghebreslasie, Ariam; Lo-A-Foe, Cindy; De Vries, Irma; Meulenbelt, Jan

    2015-01-01

    CONTEXT: Methylphenidate intoxications mostly have a relatively mild course, although serious complications can occur. OBJECTIVE: We aimed to characterize methylphenidate exposures and reassess our current dose threshold for hospital referral (2 mg/kg). METHODS: In a prospective follow-up study, we

  11. Methylphenidate intoxications in children and adults : Exposure circumstances and evidence-based dose threshold for pre-hospital triage

    NARCIS (Netherlands)

    Hondebrink, Laura; Rietjens, Saskia J.; Hunault, Claudine C.; Pereira, Rob R.; Kelleci, Nuriye; Yasar, Gulhan; Ghebreslasie, Ariam; Lo-A-Foe, Cindy; De Vries, Irma; Meulenbelt, Jan

    2015-01-01

    Context. Methylphenidate intoxications mostly have a relatively mild course, although serious complications can occur. Objective. We aimed to characterize methylphenidate exposures and reassess our current dose threshold for hospital referral (2 mg/kg). Methods. In a prospective follow-up study, we

  12. Evidence for a Higher Risk of Hypovolemia-Induced Hemodynamic Instability in Females: Implications for Decision Support During Prehospital Triage

    Science.gov (United States)

    2015-03-01

    would exempt them as participants. Body mass index ( BMI ) was calculated as the ratio of mass to height. Subjects were instrumented for standard lead II...purpose of this study was to predict TTP based on demographic characteristics (sex, age, height, and body mass index ) and physiological variables (heart... body negative pressure (LBNP) simulates hemorrhage, and tolerance to LBNP (time to presyncope [TTP]) is indicative of tolerance to blood loss. The

  13. Triage at the Emergency Department: association between triage levels and patient outcome

    Directory of Open Access Journals (Sweden)

    Juliana Barros Becker

    2015-10-01

    Full Text Available AbstractOBJECTIVEIdentify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP.METHODSRetrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05.RESULTSMen with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001.CONCLUSIONThe high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

  14. Canadian Triage and Acuity Scale: testing the mental health categories

    Directory of Open Access Journals (Sweden)

    Brown AM

    2015-11-01

    Full Text Available Anne-Marie Brown,1 Diana E Clarke,1 Julia Spence2 1College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; 2St Michael's Hospital, Faculty of Medicine, University of Toronto, Toronto, ON, Canada Purpose: The study tested the inter-rater reliability and accuracy of triage nurses' assignment of urgency ratings for mental health patient scenarios based on the 2008 Canadian Triage and Acuity Scale (CTAS guidelines, using a standardized triage tool. The influence of triage experience, educational preparation, and comfort level with mental health presentations on the accuracy of urgency ratings was also explored. Methods: Study participants assigned urgency ratings to 20 mental health patient scenarios in randomized order using the CTAS. The scenarios were developed using actual triage notes and were reviewed by an expert panel of emergency and mental health clinicians for face and content validity. Results: The overall Fleiss' kappa, the measure of inter-rater reliability for this sample of triage nurses (n=18, was 0.312, representing only fair albeit statistically significant (P<0.0001 agreement. Kendall's coefficient of concordance for the sample was calculated to be 0.680 (P<0.0001, which signifies moderate agreement. Although the sample reported high levels of education, comfort with mental health presentations, and experience, accuracy in urgency ratings measured by the percentage of correct responses ranged from 0.05% to 94% (mean: 54%. Greater accuracy in urgency ratings was recorded for triage nurses who used second-order modifiers and avoided the use of override. Conclusion: Specific focus on the use of second-order modifiers in orientation and ongoing education of triage nurses may improve the reliability and validity of the CTAS when used to assign urgency ratings to mental health presentations. Keywords: CTAS, mental health triage, inter-rater reliability 

  15. Pre-hospital care in burn injury

    Directory of Open Access Journals (Sweden)

    Shrivastava Prabhat

    2010-10-01

    Full Text Available The care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans

  16. Triage nurse's assessment of a child with a fever.

    Science.gov (United States)

    Knight, Angela

    2015-05-01

    Fever in children is a common presentation to the emergency department and in most instances has no adverse consequences. The role of the triage nurse is to have thorough knowledge of up to date practices in caring for the child with fever, and to accurately assess and manage the child. Using evidence based practice to apply appropriate triage categories, effective care including accurate and informed education of parents. Every nurse working on triage should maintain current knowledge and have continuous education concerning the child with fever and the unwell child to promote best patient outcomes and maintain best practice standards.

  17. Creation of a virtual triage exercise: an interprofessional communication strategy.

    Science.gov (United States)

    Farra, Sharon; Nicely, Stephanie; Hodgson, Eric

    2014-10-01

    Virtual reality simulation as a teaching method is gaining increased acceptance and presence in institutions of higher learning. This study presents an innovative strategy using the interdisciplinary development of a nonimmersive virtual reality simulation to facilitate interprofessional communication. The purpose of this pilot project was to describe nursing students' attitudes related to interprofessional communication following the collaborative development of a disaster triage virtual reality simulation. Collaboration between and among professionals is integral in enhancing patient outcomes. In addition, ineffective communication is linked to detrimental patient outcomes, especially during times of high stress. Poor communication has been identified as the root cause of the majority of negative sentinel events occurring in hospitals. The simulation-development teaching model proved useful in fostering interprofessional communication and mastering course content. Mean scores on the KidSIM Attitudes Towards Teamwork in Training Undergoing Designed Educational Simulation survey demonstrated that nursing students, after simulation experience,had agreement to strong agreement inall areas surveyed including interprofessional education, communication, roles and responsibilities of team members, and situational awareness. The findings indicate that students value interprofessional teamwork and the opportunity to work with other disciplines.

  18. Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults.

    Science.gov (United States)

    Ichwan, Brian; Darbha, Subrahmanyam; Shah, Manish N; Thompson, Laura; Evans, David C; Boulger, Creagh T; Caterino, Jeffrey M

    2015-01-01

    We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. We studied a retrospective cohort of injured patients aged 16 years or older in the 2006 to 2011 Ohio Trauma Registry. Patients aged 70 years or older were considered geriatric. We identified whether each patient met the geriatric and the adult triage criteria. The outcome measure was need for trauma center care, defined by surrogate markers: Injury Severity Score greater than 15, operating room in fewer than 48 hours, any ICU stay, and inhospital mortality. We calculated sensitivity and specificity of both triage criteria for both age groups. We included 101,577 patients; 33,379 (33%) were geriatric. Overall, 57% of patients met adult criteria and 68% met geriatric criteria. Using Injury Severity Score, for older adults geriatric criteria were more sensitive for need for trauma center care (93%; 95% confidence interval [CI] 92% to 93%) than adult criteria (61%; 95% CI 60% to 62%). Geriatric criteria decreased specificity in older adults from 61% (95% CI 61% to 62%) to 49% (95% CI 48% to 49%). Geriatric criteria in older adults (93% sensitivity, 49% specificity) performed similarly to the adult criteria in younger adults (sensitivity 87% and specificity 44%). Similar patterns were observed for other outcomes. Standard adult EMS triage guidelines provide poor sensitivity in older adults. Ohio's geriatric trauma triage guidelines significantly improve sensitivity in identifying Injury Severity Score and other surrogate markers of the need for trauma center care, with modest decreases in specificity for older adults. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  19. Alert Triage v 0.1 beta

    Energy Technology Data Exchange (ETDEWEB)

    2016-01-06

    In the cyber security operations of a typical organization, data from multiple sources are monitored, and when certain conditions in the data are met, an alert is generated in an alert management system. Analysts inspect these alerts to decide if any deserve promotion to an event requiring further scrutiny. This triage process is manual, time-consuming, and detracts from the in-depth investigation of events. We have created a software system that uses supervised machine learning to automatically prioritize these alerts. In particular we utilize active learning to make efficient use of the pool of unlabeled alerts, thereby improving the performance of our ranking models over passive learning. We have demonstrated the effectiveness of our system on a large, real-world dataset of cyber security alerts.

  20. Computer Forensics Field Triage Process Model

    Directory of Open Access Journals (Sweden)

    Marcus K. Rogers

    2006-06-01

    Full Text Available With the proliferation of digital based evidence, the need for the timely identification, analysis and interpretation of digital evidence is becoming more crucial. In many investigations critical information is required while at the scene or within a short period of time - measured in hours as opposed to days. The traditional cyber forensics approach of seizing a system(s/media, transporting it to the lab, making a forensic image(s, and then searching the entire system for potential evidence, is no longer appropriate in some circumstances. In cases such as child abductions, pedophiles, missing or exploited persons, time is of the essence. In these types of cases, investigators dealing with the suspect or crime scene need investigative leads quickly; in some cases it is the difference between life and death for the victim(s. The Cyber Forensic Field Triage Process Model (CFFTPM proposes an onsite or field approach for providing the identification, analysis and interpretation of digital evidence in a short time frame, without the requirement of having to take the system(s/media back to the lab for an in-depth examination or acquiring a complete forensic image(s. The proposed model adheres to commonly held forensic principles, and does not negate the ability that once the initial field triage is concluded, the system(s/storage media be transported back to a lab environment for a more thorough examination and analysis. The CFFTPM has been successfully used in various real world cases, and its investigative importance and pragmatic approach has been amply demonstrated. Furthermore, the derived evidence from these cases has not been challenged in the court proceedings where it has been introduced. The current article describes the CFFTPM in detail, discusses the model’s forensic soundness, investigative support capabilities and practical considerations.

  1. A clinical algorithm for triaging patients with significant lymphadenopathy in primary health care settings in Sudan

    Directory of Open Access Journals (Sweden)

    Eltahir A.G. Khalil

    2013-01-01

    Full Text Available Background: Tuberculosis is a major health problem in developing countries. The distinction between tuberculous lymphadenitis, non-specific lymphadenitis and malignant lymph node enlargement has to be made at primary health care levels using easy, simple and cheap methods.Objective: To develop a reliable clinical algorithm for primary care settings to triage cases ofnon-specific, tuberculous and malignant lymphadenopathies.Methods: Calculation of the odd ratios (OR of the chosen predictor variables was carried out using logistic regression. The numerical score values of the predictor variables were weighed against their respective OR. The performance of the score was evaluated by the ROC (ReceiverOperator Characteristic curve.Results: Four predictor variables; Mantoux reading, erythrocytes sedimentation rate (ESR,nocturnal fever and discharging sinuses correlated significantly with TB diagnosis and were included in the reduced model to establish score A. For score B, the reduced model included Mantoux reading, ESR, lymph-node size and lymph-node number as predictor variables for malignant lymph nodes. Score A ranged 0 to 12 and a cut-off point of 6 gave a best sensitivity and specificity of 91% and 90% respectively, whilst score B ranged -3 to 8 and a cut-off point of3 gave a best sensitivity and specificity of 83% and 76% respectively. The calculated area underthe ROC curve was 0.964 (95% CI, 0.949 – 0.980 and -0.856 (95% CI, 0.787 ‑ 0.925 for scores Aand B respectively, indicating good performance.Conclusion: The developed algorithm can efficiently triage cases with tuberculous andmalignant lymphadenopathies for treatment or referral to specialised centres for furtherwork-up.

  2. Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine.

    Science.gov (United States)

    Olives, Travis D; Nystrom, Paul C; Cole, Jon B; Dodd, Kenneth W; Ho, Jeffrey D

    2016-12-01

    Profound agitation in the prehospital setting confers substantial risk to patients and providers. Optimal chemical sedation in this setting remains unclear. The goal of this study was to describe intubation rates among profoundly agitated patients treated with prehospital ketamine and to characterize clinically significant outcomes of a prehospital ketamine protocol. This was a retrospective cohort study of all patients who received prehospital ketamine, per a predefined protocol, for control of profound agitation and who subsequently were transported to an urban Level 1 trauma center from May 1, 2010 through August 31, 2013. Identified records were reviewed for basic ambulance run information, subject characteristics, ketamine dosing, and rate of intubation. Emergency Medical Services (EMS) ambulance run data were matched to hospital-based electronic medical records. Clinically significant outcomes are characterized, including unadjusted and adjusted rates of intubation. Overall, ketamine was administered 227 times in the prehospital setting with 135 cases meeting study criteria of use of ketamine for treatment of agitation. Endotracheal intubation was undertaken for 63% (85/135) of patients, including attempted prehospital intubation in four cases. Male gender and late night arrival were associated with intubation in univariate analyses (χ2=12.02; P=.001 and χ2=5.34; P=.021, respectively). Neither ketamine dose, co-administration of additional sedating medications, nor evidence of ethanol (ETOH) or sympathomimetic ingestion was associated with intubation. The association between intubation and both male gender and late night emergency department (ED) arrival persisted in multivariate analysis. Neither higher dose (>5mg/kg) ketamine nor co-administration of midazolam or haloperidol was associated with intubation in logistic regression modeling of the 120 subjects with weights recorded. Two deaths were observed. Post-hoc analysis of intubation rates suggested a

  3. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

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    V. V. Omel'yanovskiy

    2011-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  4. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

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    V. V. Omel'yanovskiy

    2016-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  5. How Triage Nurses Use Discretion: a Literature Review

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    Lars Emil Fagernes Johannessen

    2016-02-01

    Full Text Available Discretion is quintessential for professional work. This review aims to understand how nurses use discretion when they perform urgency assessments in emergency departments with formalised triage systems—systems that are intended to reduce nurses’ use of discretion. Because little research has dealt explicitly with this topic, this review addresses the discretionary aspects of triage by reinterpreting qualitative studies of how triage nurses perform urgency assessments. The review shows (a how inexhaustive guidelines and a hectic work environment are factors that necessitate nurses’ use of discretion and (b how nurses reason within this discretionary space by relying on their experience and intuition, judging patients according to criteria such as appropriateness and believability, and creating urgency ratings together with their patients. The review also offers a synthesis of the findings’ discretionary aspects and suggests a new interactionist dimension of discretion.Keywords: Triage, discretion, emergency department, meta-ethnography, review, decision-making

  6. Prehospital thrombolysis in acute myocardial infarction: the Belgian eminase prehospital study (BEPS). BEPS Collaborative Group.

    Science.gov (United States)

    1991-09-01

    Interest in early thrombolysis has prompted a study on the feasibility and time course of prehospital thrombolysis in patients with acute myocardial infarction (AMI) in six centres in Belgium. Patients with clinically suspected AMI and with typical ECG changes presenting within 4 h after onset of pain were treated with 30 units of Anisoylated Plasminogen Streptokinase Activator Complex (APSAC, eminase) intravenously by a mobile intensive care unit (MICU). Sixty-two patients were included in the study and an AMI was confirmed in 60. The mean time (+/- 1 SD) from onset of pain to injection of APSAC was 95 +/- 47 min and the mean estimated time gain, calculated as the time difference between the arrival of the MICU at home and the arrival of the MICU at the emergency department, was 50 +/- 17 min. In the prehospital period four patients developed ventricular fibrillation and one cardiogenic shock. During hospital stay severe complications were observed in four patients. Two events were fatal, one diffuse haemorrhage and one septal rupture; two events were non fatal, one feasible and that an estimated time gain of 50 min can be obtained. Potential risks and benefits remain to be demonstrated in a large controlled clinical trial.

  7. Refraining from pre-hospital advanced airway management: a prospective observational study of critical decision making in an anaesthesiologist-staffed pre-hospital critical care service.

    Science.gov (United States)

    Rognås, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else

    2013-10-25

    We report prospectively recorded observational data from consecutive cases in which the attending pre-hospital critical care anaesthesiologist considered performing pre-hospital advanced airway management but decided to withhold such interventions. Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) registered data from February 1st 2011 to October 31st 2012. Included were patients of all ages for whom pre-hospital advanced airway management were considered but not performed. The main objectives were to investigate (1) the pre-hospital critical care anaesthesiologists' reasons for considering performing pre-hospital advanced airway management in this group of patients (2) the pre-hospital critical care anaesthesiologists' reasons for not performing pre-hospital advanced airway management (3) the methods used to treat these patients (4) the incidence of complications related to pre-hospital advanced airway management not being performed. We registered data from 1081 cases in which the pre-hospital critical care anaesthesiologists' considered performing pre-hospital advanced airway management. The anaesthesiologists decided to withhold pre-hospital advanced airway management in 32.1% of these cases (n = 347). In 75.1% of these cases (n = 257) pre-hospital advanced airway management were withheld because of the patient's condition and in 30.8% (n = 107) because of patient co-morbidity. The most frequently used alternative treatment was bag-mask ventilation, used in 82.7% of the cases (n = 287). Immediate complications related to the decision of not performing pre-hospital advanced airway management occurred in 0.6% of the cases (n = 2). We have illustrated the complexity of the critical decision-making associated with pre-hospital advanced airway management. This study is the first to identify the most common reasons why pre-hospital critical care

  8. Prehospital emergency medical services in Malaysia.

    Science.gov (United States)

    Hisamuddin, N A R Nik; Hamzah, M Shah; Holliman, C James

    2007-05-01

    Once a very slowly developing country in a Southeast Asia region, Malaysia has undergone considerable change over the last 20 years after the government changed its focus from agriculture to developing more industry and technology. The well-known "Vision 2020," introduced by the late Prime Minister, set a target for the nation to be a developed country in the Asia region by the year 2020. As the economy and standard of living have improved, the demand from the public for a better health care system, in particular, emergency medical services (EMS), has increased. Despite the effort by the government to improve the health care system in Malaysia, EMS within the country are currently limited, best described as being in the "developing" phase. The Ministry of Health, Ministry of Education, Civil Defense, and non-governmental organizations such as Red Crescent and St. John's Ambulance, provide the current ambulance services. At the present time, there are no uniform medical control or treatment protocols, communication systems, system management, training or education, or quality assurance policies. However, the recent development of and interest in an Emergency Medicine training program has gradually led to improved EMS and prehospital care.

  9. The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

    Science.gov (United States)

    Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

    2014-01-01

    In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised

  10. Management of pain in pre-hospital settings.

    Science.gov (United States)

    Parker, Michael; Rodgers, Antony

    2015-06-01

    Assessment and management of pain in pre-hospital care settings are important aspects of paramedic and clinical team roles. As emergency department waiting times and delays in paramedic-to-nurse handover increase, it becomes more and more vital that patients receive adequate pre-hospital pain relief. However, administration of analgesia can be inadequate and can result in patients experiencing oligoanalgesia, or under-treated pain. This article examines these issues along with the aetiology of trauma and the related socioeconomic background of traumatic injury. It reviews validated pain-assessment tools, outlines physiological responses to traumatic pain and discusses some of the misconceptions about the provision of effective analgesia in pre-hospital settings.

  11. Factors influencing prehospital delay for patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Shujuan CHENG; Lufen GUO; Juyuan LIU; Xiaoling ZHU; Hongbing YAN

    2007-01-01

    Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI).Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.

  12. "DETERMINANTS OF PREHOSPITAL DELAY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION"

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    M. Alidoosti

    2004-05-01

    Full Text Available Determination of pre-hospital delay time of patients with acute myocardial infarction and seeking ways of speeding up the time for reperfusion is an important factor to lower mortality in these patients. This is a cross-sectional study to determine pre-hospital delay time, its components, and related causes and conditions, obtained in 375 patients with prolonged chest pain referred to four hospitals of Tehran University of Medical Sciences. Means of transport to hospital, reasons of ambulance disuse, decision time by the patient and finally the entire time of pre-hospital delay were specified. Suspected factors related to delays of more than 2 and 6 h were scrutinized with chi-square test. Rate of ambulance utility (18.9% directly correlated with age of patients (P<0.05. Principal motives to disuse ambulance insuccession were unrememberance (33.7%, access to private vehicle (32.8% and supposition of sufficient speed of personal reference (18.9%. Pre-hospital delay time was 8.1 ± 9.1 h (mean ± SD in whole patients and 7.6 ± 9.1 h in those with acute myocardial infarction. Delays of more than 2 and 6 hoccurred in 67.5% and 33.6% of patients, respectively. Decision time constitute three fourth of whole pre-hospital delay and was correlated with female gender, older age, history of diabetes, lower level of literacy and nocturnal onset of symptoms. In conclusion, a significant number of patients with acute myocardial infarction have pre-hospital delay of more than 2 and even 6 h, when golden time for thrombolytic therapy has already been elapsed.

  13. Prehospital emergency care and injury prevention in Sudan

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    Khalid Elbashir

    2014-12-01

    Conclusion: Due to an absence of published literature in Sudan, much of the data have been recorded from paper records and empirical observations. Prehospital care and injury prevention in the Sudan is a recent initiative, but it is developing into a promising model with many opportunities for improvement. This momentum should be nurtured and requires a purposive, collective collaboration to draw a blueprint for a locally relevant, effective and efficient prehospital system in Sudan. It is hoped that this article will highlight and encourage further progress.

  14. Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage.

    Science.gov (United States)

    Sasser, Scott M; Hunt, Richard C; Sullivent, Ernest E; Wald, Marlena M; Mitchko, Jane; Jurkovich, Gregory J; Henry, Mark C; Salomone, Jeffrey P; Wang, Stewart C; Galli, Robert L; Cooper, Arthur; Brown, Lawrence H; Sattin, Richard W

    2009-01-23

    In the United States, injury is the leading cause of death for persons aged 1--44 years, and the approximately 800,000 emergency medical services (EMS) providers have a substantial impact on the care of injured persons and on public health. At an injury scene, EMS providers determine the severity of injury, initiate medical management, and identify the most appropriate facility to which to transport the patient through a process called "field triage." Although basic emergency services generally are consistent across hospital emergency departments (EDs), certain hospitals have additional expertise, resources, and equipment for treating severely injured patients. Such facilities, called "trauma centers," are classified from Level I (centers providing the highest level of trauma care) to Level IV (centers providing initial trauma care and transfer to a higher level of trauma care if necessary) depending on the scope of resources and services available. The risk for death of a severely injured person is 25% lower if the patient receives care at a Level I trauma center. However, not all patients require the services of a Level I trauma center; patients who are injured less severely might be served better by being transported to a closer ED capable of managing milder injuries. Transferring all injured patients to Level I trauma centers might overburden the centers, have a negative impact on patient outcomes, and decrease cost effectiveness. In 1986, the American College of Surgeons developed the Field Triage Decision Scheme (Decision Scheme), which serves as the basis for triage protocols for state and local EMS systems across the United States. The Decision Scheme is an algorithm that guides EMS providers through four decision steps (physiologic, anatomic, mechanism of injury, and special considerations) to determine the most appropriate destination facility within the local trauma care system. Since its initial publication in 1986, the Decision Scheme has been revised

  15. Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest.

    Science.gov (United States)

    Ohashi-Fukuda, Naoko; Fukuda, Tatsuma; Doi, Kent; Morimura, Naoto

    2017-05-01

    Respiratory care may be important in pediatric out-of-hospital cardiac arrest (OHCA) due to the asphyxial nature of the majority of events. However, evidence of the effect of prehospital advanced airway management (AAM) for pediatric OHCA is scarce. This was a nationwide population-based study of pediatric OHCA in Japan from 2011 to 2012 based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients aged between 1 and 17 years old. The primary outcome was one-month neurologically favorable survival defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1-2 (corresponding to a Pediatric CPC score of 1-3). A total of 2157 patients were included in the final cohort; 365 received AAM and 1792 received bag-valve-mask (BVM) ventilation only. Among the 2157 patients, 213 (9.9%) survived with favorable neurological outcomes (CPC of 1-2) one month after OHCA. There were no significant differences in neurologically favorable survival between the AAM and BVM groups after adjusting for potential confounders, although there was a tendency favoring BVM ventilation: propensity score matching, OR 0.74 (95%CI 0.35-1.59), and multivariable logistic regression modeling, ORadjusted 0.55 (95%CI 0.24-1.14). Subgroup analyses demonstrated that there were no subgroups in which AAM was associated with neurologically favorable survival, including the non-cardiac (primarily asphyxial) etiology group. In pediatric OHCA, prehospital AAM was not associated with an increased chance of neurologically favorable survival compared with BVM-only ventilation. However, careful consideration is required to interpret the findings, as there may be unmeasured residual confounders and selection bias. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Advance Directives and Communication Skills of Prehospital Physicians Involved in the Care of Cardiovascular Patients.

    Science.gov (United States)

    Gigon, Fabienne; Merlani, Paolo; Ricou, Bara

    2015-12-01

    Advance directives (AD) were developed to respect patient autonomy. However, very few patients have AD, even in cases when major cardiovascular surgery is to follow. To understand the reasons behind the low prevalence of AD and to help decision making when patients are incompetent, it is necessary to focus on the impact of prehospital practitioners, who may contribute to an increase in AD by discussing them with patients. The purpose of this study was to investigate self-rated communication skills and the attitudes of physicians potentially involved in the care of cardiovascular patients toward AD.Self-administered questionnaires were sent to general practitioners, cardiologists, internists, and intensivists, including the Quality of Communication Score, divided into a General Communication score (QOCgen 6 items) and an End-of-life Communication score (QOCeol 7 items), as well as questions regarding opinions and practices in terms of AD.One hundred sixty-four responses were received. QOCgen (mean (±SD)): 9.0/10 (1.0); QOCeol: 7.2/10 (1.7). General practitioners most frequently start discussions about AD (74/149 [47%]) and are more prone to designate their own specialty (30/49 [61%], P communication skills as good, whereas end-of-life communication was rated much lower. Only half of those surveyed speak about AD with cardiovascular patients. The majority would prefer that physicians of another specialty, most frequently general practitioners, initiate conversation about AD. In order to increase prehospital AD incidence, efforts must be centered on improving practitioners' communication skills regarding death, by providing trainings to allow physicians to feel more at ease when speaking about end-of-life issues.

  17. Comparison between two mobile pre-hospital care services for trauma patients

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    Gonsaga Ricardo

    2012-08-01

    Full Text Available Abstract Objectives Pre-hospital care (PH in Brazil is currently in the phase of implementation and expansion, and there are few studies on the impacts of this public health service. The purpose of this study is to assess the quality of care and severity of trauma among the population served, using trauma scores, attendance response times, and mortality rates. This work compares two pre-hospital systems: the Mobile Emergency Care Service, or SAMU 192, and the Fire Brigade Group, or CB. Method Descriptive study evaluating all patients transported by both systems in Catanduva, SP, admitted to a single hospital. Results 850 patients were included, most of whom were men (67.5%; the mean age was 38.5 ± 18.5 years. Regarding the use of PH systems, most patients were transported by SAMU (62.1%. The trauma mechanisms involved motorcycle accidents in 32.7% of cases, transferred predominantly by SAMU, followed by falls (25.8%. Regarding the response time, CB showed the lowest rates. In relation to patient outcome, only 15.5% required hospitalization. The average score on the Glasgow Coma Scale was 14.7 ± 1.3; average RTS was 7.7 ± 0.7; ISS 3.8 ± 5.9; and average TRISS 97.6 ± 9.3. The data analysis showed no statistical differences in mortality between the groups studied (SAMU - 1.5%; CB - 2.5%. The trauma scores showed a higher severity of trauma among the fatal victims. Conclusion Trauma victims are predominantly young and male; the trauma mechanism that accounted for the majority of PH cases was motorcycle accidents; CB responded more quickly than SAMU; and there was no statistical difference between the services of SAMU and CB in terms of severity of the trauma and mortality rates.

  18. Biological dosimetry by the triage dicentric chromosome assay: potential implications for treatment of acute radiation syndrome in radiological mass casualties.

    Science.gov (United States)

    Romm, Horst; Wilkins, Ruth C; Coleman, C Norman; Lillis-Hearne, Patricia K; Pellmar, Terry C; Livingston, Gordon K; Awa, Akio A; Jenkins, Mark S; Yoshida, Mitsuaki A; Oestreicher, Ursula; Prasanna, Pataje G S

    2011-03-01

    Biological dosimetry is an essential tool for estimating radiation dose. The dicentric chromosome assay (DCA) is currently the tool of choice. Because the assay is labor-intensive and time-consuming, strategies are needed to increase throughput for use in radiation mass casualty incidents. One such strategy is to truncate metaphase spread analysis for triage dose estimates by scoring 50 or fewer metaphases, compared to a routine analysis of 500 to 1000 metaphases, and to increase throughput using a large group of scorers in a biodosimetry network. Previously, the National Institutes for Allergies and Infectious Diseases (NIAID) and the Armed Forces Radiobiology Research Institute (AFRRI) sponsored a double-blinded interlaboratory comparison among five established international cytogenetic biodosimetry laboratories to determine the variability in calibration curves and in dose measurements in unknown, irradiated samples. In the present study, we further analyzed the published data from this previous study to investigate how the number of metaphase spreads influences dose prediction accuracy and how this information could be of value in the triage and management of people at risk for the acute radiation syndrome (ARS). Although, as expected, accuracy decreased with lower numbers of metaphase spreads analyzed, predicted doses by the laboratories were in good agreement and were judged to be adequate to guide diagnosis and treatment of ARS. These results demonstrate that for rapid triage, a network of cytogenetic biodosimetry laboratories can accurately assess doses even with a lower number of scored metaphases.

  19. Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study.

    Science.gov (United States)

    Tarpgaard, Mona; Hansen, Troels Martin; Rognås, Leif

    2015-08-27

    Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants). A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital advanced airway management in children. The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of airway management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation advanced airway management. Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but

  20. Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage

    Science.gov (United States)

    Orsini, Jose; Blaak, Christa; Yeh, Angela; Fonseca, Xavier; Helm, Tanya; Butala, Ashvin; Morante, Joaquin

    2014-01-01

    Background The demand for specialized medical services such as critical care often exceeds availability, thus rationing of intensive care unit (ICU) beds commonly leads to difficult triage decisions. Many factors can play a role in the decision to admit a patient to the ICU, including severity of illness and the need for specific treatments limited to these units. Although triage decisions would be based solely on patient and institutional level factors, it is likely that intensivists make different decisions when there are fewer ICU beds available. The objective of this study is to evaluate the characteristics of patients referred for ICU admission during times of limited beds availability. Methods A single center, prospective, observational study was conducted among consecutive patients in whom an evaluation for ICU admission was requested during times of ICU overcrowding, which comprised the months of April and May 2014. Results A total of 95 patients were evaluated for possible ICU admission during the study period. Their mean APACHE-II score was 16.8 (median 16, range 3 - 36). Sixty-four patients (67.4%) were accepted to ICU, 18 patients (18.9%) were triaged to SDU, and 13 patients (13.7%) were admitted to hospital wards. ICU had no beds available 24 times (39.3%) during the study period, and in 39 opportunities (63.9%) only one bed was available. Twenty-four patients (25.3%) were evaluated when there were no available beds, and eight of those patients (33%) were admitted to ICU. A total of 17 patients (17.9%) died in the hospital, and 15 (23.4%) expired in ICU. Conclusion ICU beds are a scarce resource for which demand periodically exceeds supply, raising concerns about mechanisms for resource allocation during times of limited beds availability. At our institution, triage decisions were not related to the number of available beds in ICU, age, or gender. A linear correlation was observed between severity of illness, expressed by APACHE-II scores, and the

  1. Battlefield triage life signs detection techniques

    Science.gov (United States)

    Boric-Lubecke, Olga; Lin, Jenshan; Park, Byung-Kwon; Li, Changzhi; Massagram, Wansuree; Lubecke, Victor M.; Host-Madsen, Anders

    2008-04-01

    Getting to wounded soldiers on the battlefield is a precarious task, and medics have a very high casualty rate. It is therefore a vital importance to prioritize which soldiers to attend to first. The first step is to detect life signs - if a soldier is dead or alive, and prioritize recovery of live soldiers. The second step is to obtain vital signs from live soldiers, and use this to prioritize which are in most urgent need of attention. Our team at Kai Sensors, University of Hawaii and University of Florida is developing Doppler radar heart sensing technology that provides the means to detect life signs, respiration and/or heart beat, at a distance, even for subjects lying motionless, e.g., unconscious subjects, wearing body armor, and hidden from direct view. Since this technology can deliver heart rate information with high accuracy, it may also enable the assessment of a subject's physiological and psychological state based on heart rate variability (HRV) analysis. Thus, the degree of a subject's injury may also be determined. The software and hardware developments and challenges for life signs detection and monitoring for battlefield triage will be discussed, including heart signal detection from all four sides of the human body, detection in the presence of body armor, and the feasibility of HRV parameter extraction.

  2. Pre-Hospital ECG E-Transmission for Patients with Suspected Myocardial Infarction in the Highlands of Scotland

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    Gordon F. Rushworth

    2014-02-01

    Full Text Available Patients with ST elevation myocardial infarction (STEMI require prompt treatment, best done by primary percutaneous coronary intervention (PPCI. However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients.

  3. Application effect of new triage record list on acute chest pain%胸痛患者分诊记录单的应用效果

    Institute of Scientific and Technical Information of China (English)

    王国英; 赫晓慈; 朱静利; 王丽红; 高梦颖; 李彦平; 田素斋

    2015-01-01

    Objective To introduce triage standard for non-traumatic chest pain and SOAPIE triage method into triage work for acute chest pain patients, and to investigate its effect. Methods Based on triage standard for non-traumatic chest pain and SOAPIE triage method, a new triage record was established. And triage time, triage accuracy and patient satisfaction were compared with conventional methods. Results The triage time of the research group was (1. 94 ± 0. 30) minutes, which was significantly lower than (2. 27 ± 0. 35) minutes of the control group (t =6. 99,P <0. 05). The triage accuracy of the research group was 96. 0%, which was significantly higher than 82. 0% of the control group (χ2 =10. 01,P<0. 05). The score of patients′satisfaction was (98. 94 ± 1. 06), which was significantly higher than (89. 30 ± 5. 95) of the control group (t=15. 96,P <0. 01). Conclusions The new triage method can shorten the triage time, improve the triage accuracy and patients′satisfaction, which is worthy of promotion.%目的:将非创伤性胸痛的分诊标准和SOAPIE分诊方法引入急性胸痛的预检分诊工作,探讨其在急性胸痛预检分诊工作中的应用效果。方法依据SOAPIE分诊方法和非创伤性胸痛的分诊标准自行设计胸痛患者分诊记录单,比较采用常规分诊方法与该分诊方法的分诊时间、分诊准确率及患者满意度的差异。结果研究组分诊时间(1.94±0.30)min,低于对照组的(2.27±0.35)min,差异有统计学意义(t=6.99,P<0.05)。研究组分诊正确率为96.0%,高于对照组的82.0%,差异有统计学意义(χ2=10.01,P<0.05)。研究组患者满意度得分为(98.94±1.06)分,高于对照组的(89.30±5.95)分,差异有统计学意义(t=15.96,P<0.01)。结论新的分诊记录单缩短了分诊时间,提高了急性胸痛患者分诊的正确率和患者满意度,值得临床推广。

  4. Predicting prehospital care students' first-year academic performance.

    Science.gov (United States)

    Madigan, Veronica

    2006-01-01

    To answer two research questions: First, can previously identified factors relating to academic performance be used to predict first-year academic success for students undertaking a newly developed and vocationally oriented prehospital care course delivered in a rural setting? Second, can the study's findings be used to develop appropriate student selection criteria to assist in the admission of students into relevant tertiary studies or the prehospital care industry? A retrospective review of all first-year, on-campus prehospital care students enrolled in a vocational course at a rural Australian university from 1998 to 2001 was conducted. Six predictors of academic performance were examined, namely: University Admission Index (UAI), postsecondary educational qualifications, student entry type (traditional or mature-aged), previous health-related experience, gender, and background (rural or urban). Three dependent variables assessed academic performance: grade point average (GPA) of students who completed all required first-year subjects, GPA of students who completed at least one subject in the first year, and the student's ability to successfully complete the first year. UAI > 50, previous health-related experience, postsecondary educational qualifications, background, student entry type, and gender were all found to be significant predictors of first-year academic performance in selective cohorts. In addition, a combination of predictors produced higher GPAs than did any single predictor. Academic performance of first-year students in the prehospital care discipline can be predicted given the appropriate selection variables. Admission selection can be assisted with the generated Student Selection 001.

  5. Prehospital lung ultrasound for the diagnosis of cardiogenic pulmonary oedema

    DEFF Research Database (Denmark)

    Laursen, Christian B; Hänselmann, Anja; Posth, Stefan

    2016-01-01

    : The sensitivity of PLUS is high, making it a potential tool for ruling-out cardiogenic pulmonary. The observed specificity was lower than what has been described in previous studies. CONCLUSIONS: Performed, as part of a physician based prehospital emergency service, PLUS seems fast and highly feasible in patients...

  6. Prehospital endotracheal intubation; need for routine cuff pressure measurement?

    NARCIS (Netherlands)

    Peters, J.H.; Hoogerwerf, N.

    2013-01-01

    In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulner

  7. Prehospital thrombolysis for acute st-segment elevation myocardial infarction

    NARCIS (Netherlands)

    Lamfers, Evert Jan Pieter

    2003-01-01

    Early treatment of acute ST elevation myocardial infarction is associated with a good prognosis and a low incidence of complications. Prehospital administration of thrombolytic treatment is one of the ways of starting treatment early after onset of symptoms. Fifteen years of experience in prehospita

  8. Paramedic use of needle thoracostomy in the prehospital environment.

    Science.gov (United States)

    Warner, Keir J; Copass, Michael K; Bulger, Eileen M

    2008-01-01

    The use of prehospital needle thoracostomy (NT) is controversial as it is not without risk. Issues such as inappropriate patient selection, misplacement causing iatrogenic injury, treatment failures in obese patients, and delaying definitive tube thoracostomy in the emergency department contribute to this controversy. The purpose of this study is to evaluate a cohort of patients undergoing NT by paramedics for tension pneumothorax and review the indications for use, complications, and emergency department outcomes of NT. We conducted a retrospective review of patients undergoing NT in the prehospital setting and transported directly to a Level 1 trauma center over a one-year period. Patients were transported by a single ground transport agency staffed by paramedics. All paramedics were trained to follow uniform protocols for treatment procedures. Variables included indications for NT, patient demographics, prehospital vital signs, injury mechanism, chest X-ray, and Emergency Department outcomes. Paramedics responded to 20,330 advanced life support calls, and 39 (0.2%) patients had a NT placed for treatment of tension pneumothorax. Twenty-two (56.4%) patients were in circulatory arrest, with 12 suffering traumatic arrest and 10 patients in nontraumatic PEA arrest. The remaining 17 (43.6%) patients were treated for nonarrest causes. The use of NT appears to be a safe procedure when preformed by paramedics in an urban EMS system. Prehospital NT resulted in four cases of unexpected survival.

  9. Biological dosimetry by the triage dicentric chromosome assay - Further validation of international networking

    Energy Technology Data Exchange (ETDEWEB)

    Wilkins, Ruth C., E-mail: Ruth.Wilkins@hc-sc.gc.ca [Health Canada, Ottawa, ON K1A 0K9 (Canada); Romm, Horst; Oestreicher, Ursula [Bundesamt fur Strahlenschutz, 38226 Salzgitter (Germany); Marro, Leonora [Health Canada, Ottawa, ON K1A 0K9 (Canada); Yoshida, Mitsuaki A. [Biological Dosimetry Section, Dept. of Dose Assessment, Research Center for Radiation Emergency Medicine, NIRS, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555 (Japan); Department Radiation Biology, Institute of Radiation Emergency Medicine, Hirosaki University Graduate School of Health Sciences, 66-1 Hon-cho, Hirosaki, Aomori 036-8564 (Japan); Suto, Y. [Biological Dosimetry Section, Dept. of Dose Assessment, Research Center for Radiation Emergency Medicine, NIRS, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555 (Japan); Prasanna, Pataje G.S. [National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program, 6130 Executive Blvd., MSC 7440, Bethesda, MD 20892-7440 (United States)

    2011-09-15

    Biological dosimetry is an essential tool for estimating radiation doses received to personnel when physical dosimetry is not available or inadequate. The current preferred biodosimetry method is based on the measurement of radiation-specific dicentric chromosomes in exposed individuals' peripheral blood lymphocytes. However, this method is labor-, time- and expertise-demanding. Consequently, for mass casualty applications, strategies have been developed to increase its throughput. One such strategy is to develop validated cytogenetic biodosimetry laboratory networks, both national and international. In a previous study, the dicentric chromosome assay (DCA) was validated in our cytogenetic biodosimetry network involving five geographically dispersed laboratories. A complementary strategy to further enhance the throughput of the DCA among inter-laboratory networks is to use a triage DCA where dose assessments are made by truncating the labor-demanding and time-consuming metaphase spread analysis to 20 - 50 metaphase spreads instead of routine 500 - 1000 metaphase spread analysis. Our laboratory network also validated this triage DCA, however, these dose estimates were made using calibration curves generated in each laboratory from the blood samples irradiated in a single laboratory. In an emergency situation, dose estimates made using pre-existing calibration curves which may vary according to radiation type and dose rate and therefore influence the assessed dose. Here, we analyze the effect of using a pre-existing calibration curve on assessed dose among our network laboratories. The dose estimates were made by analyzing 1000 metaphase spreads as well as triage quality scoring and compared to actual physical doses applied to the samples for validation. The dose estimates in the laboratory partners were in good agreement with the applied physical doses and determined to be adequate for guidance in the treatment of acute radiation syndrome.

  10. Biological Dosimetry by the Triage Dicentric Chromosome Assay - Further validation of International Networking.

    Science.gov (United States)

    Wilkins, Ruth C; Romm, Horst; Oestreicher, Ursula; Marro, Leonora; Yoshida, Mitsuaki A; Suto, Y; Prasanna, Pataje G S

    2011-09-01

    Biological dosimetry is an essential tool for estimating radiation doses received to personnel when physical dosimetry is not available or inadequate. The current preferred biodosimetry method is based on the measurement of radiation-specific dicentric chromosomes in exposed individuals' peripheral blood lymphocytes. However, this method is labour-, time- and expertise-demanding. Consequently, for mass casualty applications, strategies have been developed to increase its throughput. One such strategy is to develop validated cytogenetic biodosimetry laboratory networks, both national and international. In a previous study, the dicentric chromosome assay (DCA) was validated in our cytogenetic biodosimetry network involving five geographically dispersed laboratories. A complementary strategy to further enhance the throughput of the DCA among inter-laboratory networks is to use a triage DCA where dose assessments are made by truncating the labour-demanding and time-consuming metaphase-spread analysis to 20 to 50 metaphase spreads instead of routine 500 to 1000 metaphase spread analysis. Our laboratory network also validated this triage DCA, however, these dose estimates were made using calibration curves generated in each laboratory from the blood samples irradiated in a single laboratory. In an emergency situation, dose estimates made using pre-existing calibration curves which may vary according to radiation type and dose rate and therefore influence the assessed dose. Here, we analyze the effect of using a pre-existing calibration curve on assessed dose among our network laboratories. The dose estimates were made by analyzing 1000 metaphase spreads as well as triage quality scoring and compared to actual physical doses applied to the samples for validation. The dose estimates in the laboratory partners were in good agreement with the applied physical doses and determined to be adequate for guidance in the treatment of acute radiation syndrome.

  11. Perspectives of Emergency Department Staff on Triage Practice

    Directory of Open Access Journals (Sweden)

    Özlem Bilir

    2017-04-01

    Full Text Available Objective: The aim of this study was to evaluate pre-training perspectives of the staff, who were scheduled to undertake triage in hospitals of Ministry of Health, working in collaboration with university hospitals on the triage system. Materials and Methods: This study included 33 workers who volunteered to participate. A questionnaire consisting of 19 questions on demographic characteristics and perspective on triage system was prepared. Results: Of the sample group, 75.8% were female and the average age was 28.94±6.11 years. All participants in the study considered that emergency department was overused by the society. When the percentage of patients who were admitted to the emergency department for causes complying with the emergency criteria was questioned, 54.5% stated that 10% or less of the admissions were actual emergency cases. Triage practice was suggested by 54.5% of the participants to reduce crowding in emergency departments. Conclusion: Triage practice which allows correct identification of patients who need the most urgent intervention in emergency departments is important in terms of both giving the right care to the right patients and quality of service provided by healthcare workers. Community-based education as well as training of workers on this subject is a necessity.

  12. Triage of HPV positive women in cervical cancer screening.

    Science.gov (United States)

    Wentzensen, Nicolas; Schiffman, Mark; Palmer, Timothy; Arbyn, Marc

    2016-03-01

    Despite HPV vaccines, screening will remain central for decades to control cervical cancer. Recently, HPV testing alone or with cytology was introduced as an alternative to cytology screening. However, most HPV infections are harmless and additional tests are required to identify women with progressing infections or precancer. With three options for primary screening, and without clear strategies for triage of screen-positive women, there is great confusion about the best approach. Also, increasing HPV vaccination coverage will lead to lower disease prevalence, and force new screening approaches. Currently recommended triage strategies for primary HPV screening include HPV genotyping for HPV16 and HPV18 and cytology. Other alternatives that are currently evaluated include p16/Ki-67 dual stain cytology, host methylation, and viral methylation testing. Clinical management of women with cervical cancer screening results is moving to use risk thresholds rather than individual test results. Specific risk thresholds have been defined for return to primary screening, repeat testing, referral to colposcopy, and immediate treatment. Choice of test algorithms is based on comparison of absolute risk estimates from triage tests with established clinical thresholds. Importantly, triage tests need to be evaluated together with the primary screening test and the downstream clinical management. An optimal integrated screening and triage strategy should reassure the vast majority of women that they are at very low risk of cervical cancer, send the women at highest risk to colposcopy at the right time, when disease can be colposcopically detected, and minimize the intermediate risk group that requires continued surveillance.

  13. Implementation of a Pediatric Emergency Triage System in Xiamen, China

    Science.gov (United States)

    Lin, Gang-Xi; Yang, Yin-Ling; Kudirka, Denise; Church, Colleen; Yong, Collin K K; Reilly, Fiona; Zeng, Qi-Yi

    2016-01-01

    Background: Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians. The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS), modeled after the Canadian Triage System and Acuity Scale. Methods: In this study, we compared CPETS outcomes in our PER relative to those of the prior two-level system. Patients who visited our PER before (January 2013–June 2013) and after (January 2014–June 2014) the CPETS was implemented served as the control and experimental group, respectively. Patient flow, triage rates, triage accuracy, wait times (overall and for severe patients), and patient/family satisfaction were compared between the two groups. Results: Relative to the performance of the former system experienced by the control group, the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER (Cox-Stuart test, t = 0, P rate (93.40% vs. 90.75%; χ2 = 801.546, P rates (94.23% vs. 92.21%; χ2 = 321.528, P < 0.001). Conclusions: Implementing the CPETS improved nurses’ abilities to triage severe patients and, thus, to deliver the urgent treatments more quickly. The system shunted nonurgent patients to outpatient care effectively, resulting in improved efficiency of PER health-care delivery. PMID:27748332

  14. Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care.

    Science.gov (United States)

    Ibrahim, Nasiru A; Ajani, Abdul Wahab O; Mustafa, Ibrahim A; Balogun, Rufai A; Oludara, Mobolaji A; Idowu, Olufemi E; Solagberu, Babatunde A

    2017-08-01

    Introduction Injuries are the third most important cause of overall deaths globally with one-quarter resulting from road traffic crashes. Majority of these deaths occur before arrival in the hospital and can be reduced with prompt and efficient prehospital care. The aim of this study was to highlight the burden of road traffic injury (RTI) in Lagos, Nigeria and assess the effectiveness of prehospital care, especially the role of Lagos State Ambulance Service (LASAMBUS) in providing initial care and transportation of the injured to the hospital. A three-year, retrospective review of road traffic injured patients seen at the Surgical Emergency Room (SER) of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, from January 1, 2012 to December 31, 2014 was conducted. Parameters extracted from the Institution Trauma Registry included bio-data, date and time of injury, date and time of arrival in SER, host status, type of vehicle involved, and region(s) injured. Information on how patients came to the hospital and outcome in SER also were recorded. Results were analyzed using Statistical Package for Social Sciences (SPSS; IBM Corporation; Armonk, New York USA) version 16. A total of 23,537 patients were seen during the study period. Among them, 16,024 (68.1%) had trauma. Road traffic crashes were responsible in 5,629 (35.0%) of trauma cases. Passengers constituted 42.0% of the injured, followed by pedestrians (34.0%). Four wheelers were the most frequent vehicle type involved (54.0%), followed by motor cycles (30.0%). Regions mainly affected were head and neck (40.0%) and lower limb (29.0%). Less than one-quarter (24.0%) presented to the emergency room within an hour, while one-third arrived between one and six hours following injury. Relatives brought 55.4%, followed by bystanders (21.4%). Only 2.3% had formal prehospital care and were brought to the hospital by LASAMBUS. They also had significantly shorter arrival time. One hundred and nine patients

  15. Strategies Used by Prehospital Providers to Overcome Language Barriers.

    Science.gov (United States)

    Tate, Ramsey C; Hodkinson, Peter W; Meehan-Coussee, Kelly; Cooperstein, Noah

    2016-01-01

    Language barriers are commonly encountered in the prehospital setting but there is a paucity of research on how prehospital providers address language discordance. We sought to identify the communication strategies, and the limitations of those strategies, used by emergency medical services (EMS) providers when confronted with language barriers in a variety of linguistic and cultural contexts. EMS providers were queried regarding communication strategies to overcome language barriers as part of an international, multi-site, sequential explanatory, qualitative-predominant, mixed methods study of prehospital language barriers. A survey of EMS telecommunicators was administered at dispatch centers in New Mexico (United States) and Western Cape (South Africa). Semi-structured qualitative interviews of EMS field providers were conducted at agencies who respond to calls from participating dispatch centers. Survey data included quantitative data on demographics and communication strategies used to overcome language barriers as well as qualitative free-text responses on the limitations of strategies. Interviews elicited narratives of encounters with language-discordant patients and the strategies used to communicate. Data from the surveys and interviews were integrated at the point of analysis. 125 telecommunicators (overall response rate of 84.5%) and a purposive sample of 27 field providers participated in the study. The characteristics of participants varied between countries and between agencies, consistent with variations in participating agencies' hiring and training practices. Telecommunicators identified 3rd-party telephonic interpreter services as the single most effective strategy when available, but also described time delays and frustration with interpreter communications that leads them to preferentially try other strategies. In the field, all providers reported using similar strategies, relying heavily on bystanders, multilingual coworkers, and non

  16. Prehospital care for multiple trauma patients in Germany

    Institute of Scientific and Technical Information of China (English)

    Marc Maegele

    2015-01-01

    For the German speaking countries,Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid.The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care.The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system.The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept.The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first").If no immediate treatment is necessary,a "Secondary Survey" follows with careful and structured body examination and detailed assessment of the trauma mechanism.Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme.Critical trauma patients should be referred without any delay ("work and go") to TR-DGU(R) certified trauma centers of the local trauma networks.Due to the difficult prehospital environment the number of quality studies in the field is low and,as consequence,the level of evidence for most recommendations is also low.Much information has been obtained from different care systems and the interchangeability of results is limited.The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung",the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

  17. The nursing triage process: a video review and a proposed audit tool.

    OpenAIRE

    J. C. Williams; Jones, N. L.; Richardson, F J; Jones, C.; Richmond, P W

    1996-01-01

    OBJECTIVE: To review the activity of the nurse triage process. SETTING: The triage room for adults attending the accident and emergency department of the Cardiff Royal Infirmary. METHODS: 226 triage processes were videotaped over 31 h during July 1994. Activities were subsequently analysed using a specially designed chart. RESULTS: Areas for improvement in staff communication skills and patient privacy were identified. CONCLUSIONS: The use of video in the triage room allows assessment of the ...

  18. Higher Education: A Time for Triage?

    Science.gov (United States)

    Lagowski, J. J.

    1995-10-01

    Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again be as it was before. Further, many believe that tinkering around the margins is no longer an adequate response to the new demands. Fundamental change is deemed necessary to meet the challenge of this melange of pressures. A number of commentators have observed that political and corporate America have responded to their challenges by instituting a fundamental restructuring of those institutions. The medical community is also in the midst of a similar basic restructuring of the health care delivery system in this country. Now its education's turn. People are questioning the historically expressed mission of higher education. They make the claim that we cost too much, spend carelessly, teach poorly, plan myopically, and when questioned, act defensively. Educational administrators, from department chairs up, are confronted with the task of simultaneously reforming and cutting back. They have no choice. They must establish politically sophisticated priority settings and effect a hard-nosed reallocation of resources in a social environment where competing public needs have equivalent--or stronger--emotional pulls. Triage in a medical context involves confronting an emergency in which the demand for attention far outstrips available assistance by establishing a sequence of care in which one key individual orchestrates the application of harsh priorities which have been designed to maximize the number of survivors. In recent years, the decisions that have been made in some centers of higher education bear a striking similarity. The literature

  19. Biopsychosocial predictors of short-term success among people with low back pain referred to a physiotherapy spinal triage service

    Directory of Open Access Journals (Sweden)

    Bath B

    2015-04-01

    Full Text Available Brenna Bath, Stacey Lovo Grona School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada Background: A spinal triage assessment service may impact a wide range of patient outcomes. Investigating potential predictors of success or improvement may reveal why some people improve and some do not, as well as help to begin to explain potential mechanisms for improvements. The objective of this study was to determine which factors were associated with improved short-term self-reported pain, function, general health status, and satisfaction in people undergoing a spinal triage assessment performed by physiotherapists. Methods: Participants with low back-related complaints were recruited from people referred to a spinal triage assessment program (N=115. Participants completed baseline questionnaires covering a range of sociodemographic, clinical, and psychological features. Self-reported measures of pain, function, quality of life, and satisfaction were completed at 4 weeks following the assessment. Determination of “success” was based on minimal important change scores of select outcome measures. Multivariate logistic regression was used to explore potential predictors of success for each outcome. Results: Despite the complex and chronic presentation of most participants, some reported improvements in outcomes at 4 weeks post assessment with the highest proportion of participants demonstrating improvement (according to the minimal important change scores in the Medical Outcomes Survey 36-item short-form version 2 physical component summary score (48.6% and the lowest proportion of participants having improvements in the Numeric Pain Rating Scale (11.5%. A variety of different sociodemographic, psychological, clinical, and other variables were associated with success or improvement in each respective outcome. Conclusion: There may be a potential mechanism of reassurance that occurs during the spinal triage

  20. The validity of the South African Triage Scale at a tertiary care centre, Kumasi, Ghana

    Directory of Open Access Journals (Sweden)

    S. Rominski*

    2013-12-01

    Conclusion: While under-triage is a concern to patient care and safety, the under-triage rate of 5.7% in this sample falls within the 5–10% range considered unavoidable by the American College of Surgeons Committee on Trauma. SATS has been implemented successfully in the AEC at KATH by triage nurses.

  1. Employees' views on home-based, after-hours telephone triage by Dutch GP cooperatives

    NARCIS (Netherlands)

    R. Backhaus (Ramona); N.J.A. van Exel (Job); A.A. de Bont (Antoinette)

    2013-01-01

    markdownabstract__Abstract__ __Background:__ Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hour

  2. Adherence to the guideline 'Triage in emergency departments': a survey of Dutch emergency departments

    NARCIS (Netherlands)

    Janssen, M.J.; Achterberg, T. van; Adriaansen, M.J.M.; Kampshoff, C.S.; Mintjes-de Groot, J.

    2011-01-01

    AIMS AND OBJECTIVES: The aim of this study was to evaluate the adherence to the 2004 guideline Triage in emergency departments three years after dissemination in Dutch emergency departments. BACKGROUND: In 2004, a Dutch guideline Triage in emergency departments was developed. Triage is the first ste

  3. Adherence to the guideline ‘Triage in emergency departments’ : A survey of Dutch emergency departments

    NARCIS (Netherlands)

    Janssen, M.A.P.; Achterberg, Theo van; Adriaansen, Marian; Mintjes, Joke; Kampshoff, C.S.

    2011-01-01

    The aim of this study was to evaluate the adherence to the 2004 guideline Triage in emergency departments three years after dissemination in Dutch emergency departments. In 2004, a Dutch guideline Triage in emergency departments was developed. Triage is the first step performed by nurses when a pati

  4. The value of the trauma mechanism in the triage of severely injured elderly

    NARCIS (Netherlands)

    Nijboer, J.M.M.; van der Sluis, C.K.; Dijkstra, P.U.; ten Duis, H.J.

    2009-01-01

    Background: The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable. Objective: To evaluate whether current trauma triage cri

  5. The value of the trauma mechanism in the triage of severely injured elderly

    NARCIS (Netherlands)

    Nijboer, J.M.M.; van der Sluis, C.K.; Dijkstra, P.U.; ten Duis, H.J.

    Background: The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable. Objective: To evaluate whether current trauma triage

  6. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers

    Science.gov (United States)

    Noble, Vicki E; Lamhaut, Lionel; Capp, Roberta; Bosson, Nichole; Liteplo, Andrew; Marx, Jean-Sebastian; Carli, Pierre

    2009-01-01

    Background While ultrasound (US) has continued to expedite diagnosis and therapy for critical care physicians inside the hospital system, the technology has been slow to diffuse into the pre-hospital system. Given the diagnostic benefits of thoracic ultrasound (TUS), we sought to evaluate image recognition skills for two important TUS applications; the identification of B-lines (used in the US diagnosis of pulmonary edema) and the identification of lung sliding and comet tails (used in the US diagnosis of pneumothorax). In particular we evaluated the impact of a focused training module in a pre-hospital system that utilizes physicians as pre-hospital providers. Methods 27 Paris Service D'Aide Médicale Urgente (SAMU) physicians at the Hôpital Necker with varying levels of US experience were given two twenty-five image recognition pre-tests; the first test had examples of both normal and pneumothorax lung US and the second had examples of both normal and pulmonary edema lung US. All 27 physicians then underwent the same didactic training modules. A post-test was administered upon completing the training module and results were recorded. Results Pre and post-test scores were compared for both the pneumothorax and the pulmonary edema modules. For the pneumothorax module, mean test scores increased from 10.3 +/- 4.1 before the training to 20.1 +/- 3.5 after (p < 0.0001), out of 25 possible points. The standard deviation decreased as well, indicating a collective improvement. For the pulmonary edema module, mean test scores increased from 14.1 +/- 5.2 before the training to 20.9 +/- 2.4 after (p < 0.0001), out of 25 possible points. The standard deviation decreased again by more than half, indicating a collective improvement. Conclusion This brief training module resulted in significant improvement of image recognition skills for physicians both with and without previous ultrasound experience. Given that rapid diagnosis of these conditions in the pre-hospital system

  7. One-day triage course for nurses, it is essential

    Directory of Open Access Journals (Sweden)

    Ramin Azhough

    2015-06-01

    Full Text Available Objective: Triage procedure is one of the most important aspects of emergency departments as it has an undeniable role on the management of patients. It includes 5 categories based on the Emergency Severity Index (ESI according to the condition of severity. For better decision making and management, it is important to have skillful and experienced nursing staff. In the current study, we aimed to investigate the effectiveness of a one-day workshop on participants in terms of their triage knowledge improvement. Methods: This is a pre- and post-test trial study. In this study all the nursing staff of Sina hospital participated. The workshop was conducted in a single day for 6 hours. During the one-day workshop, topics such as emergency triage and hospital triage were covered according to START and ESI. In order to evaluate triage knowledge, each participant completed a pre-test before the workshop, and a post-test after the workshop (15 questions. Data were analyzed with SPSS 15.0. Paired t test was applied for data analysis. Results: Fifty-five nurses with the mean age of 35.72 ± 7.35 participated in the workshop. The analysis of the data, using paired t test based on the pre-test and post-test results, did not show any significant differences (P > 0.05. Conclusion: This study suggests that a one-day workshop is not really effective and reliable for triage knowledge improvement. We propose longer planned workshops in order to train more skillful staff.

  8. Educational Triage in Open Distance Learning: Walking a Moral Tightrope

    Directory of Open Access Journals (Sweden)

    Paul Prinsloo

    2014-09-01

    Full Text Available Higher education, and more specifically, distance education, is in the midst of a rapidly changing environment. Higher education institutions increasingly rely on the harvesting and analyses of student data to inform key strategic decisions across a wide range of issues, including marketing, enrolment, curriculum development, the appointment of staff, and student assessment. In the light of persistent concerns regarding student success and retention in distance education contexts, the harvesting and analysis of student data in particular in the emerging field of learning analytics holds much promise. As such the notion of educational triage needs to be interrogated. Educational triage is defined as balancing between the futility or impact of the intervention juxtaposed with the number of students requiring care, the scope of care required, and the resources available for care/interventions. The central question posed by this article is “how do we make moral decisions when resources are (increasingly limited?” An attempt is made to address this by discussing the use of data to support decisions regarding student support and examining the concept of educational triage. Despite the increase in examples of institutions implementing a triage based approach to student support, there is a serious lack of supporting conceptual and theoretical development, and, more importantly, to consideration of the moral cost of triage in educational settings. This article provides a conceptual framework to realise the potential of educational triage to responsibly and ethically respond to legitimate concerns about the “revolving door” in distance and online learning and the sustainability of higher education, without compromising ‘openness.’ The conceptual framework does not attempt to provide a detailed map, but rather a compass consisting of principles to consider in using learning analytics to classify students according to their perceived risk of

  9. Triage Approaches Send Adverse Political Signals for Conservation

    Directory of Open Access Journals (Sweden)

    Ralf Christopher Buckley

    2016-04-01

    Full Text Available Conservation can be analysed as a political game between advocates and opponents, and games include signals. Triage approaches aim to trade off conservation gains and losses for different ecosystems, species, sites and subpopulations, in an attempt to reduce aggregate net losses. These approaches send a political signal that some local or global species extinctions are socially acceptable. This permits conservation opponents to argue that any species may become extinct where convenient to development interests. Endorsement of triage by any one conservation advocate undermines the efforts and strategies of other conservation advocates. This increases expected aggregate net conservation losses.

  10. [Triage and initial treatment of house fire victims].

    Science.gov (United States)

    Gremion, C; Wicky, R; Niquille, M

    2005-08-10

    Medical teams are often confronted to the numerous victims due to house fires. The time course of these disasters is difficult to predict and requires an excellent rescue organization as well as good cooperation with the fire brigades and appropriate matching and raising of means to the magnitude of the disaster. Victims usually present with three types of injuries: thermal, traumatic and toxic. In order to avoid an overflow of patients in surrounding hospitals, adequate triage and treatment are required on the field. Triage is best relized by history and physical examination and the main treatment remains maximal oxygen therapy. In case of severe monoxide intoxication, cyanide poisoning should be highly suspected.

  11. A Comparison of Alerting Strategies for Hemorrhage Identification During Prehospital Emergency Transport

    Science.gov (United States)

    2014-01-01

    cumulative sum method. In this report, we applied these strategies to continuously monitored prehospital vital-sign data from trauma patients during...optimized for one use case (e.g., long prehospital transport times) may not necessarily yield performance data that are optimized for another...clinical application (e.g., short prehospital transport times, intensive care units, etc.). I. INTRODUCTION Real-time alerting of life-threatening

  12. Study of Tranexamic Acid during Air Medical Prehospital Transport (STAAMP) Trial

    Science.gov (United States)

    2014-10-01

    during Air Medical Prehospital transport (STAAMP) trial PRINCIPAL INVESTIGATOR: Jason L. Sperry, MD, MPH CONTRACTING ORGANIZATION...Tranexamic acid during Air Medical Prehospital transport (STAAMP) trial 5b. GRANT NUMBER W81XWH-13-2-0080 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...and explained the purpose of this study to Pittsburgh local and surrounding area. 15. SUBJECT TERMS Prehospital ; Tranexamic acid 16

  13. Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

    Directory of Open Access Journals (Sweden)

    Kantonen Jarmo

    2012-01-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

  14. Pre-hospital treatment of acute poisonings in Oslo

    Directory of Open Access Journals (Sweden)

    Nore Anne K

    2008-11-01

    Full Text Available Abstract Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40% were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84% were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%, were frequently comatose (35%, had respiratory depression (37%, and many received naloxone (49%. The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%, fewer were comatose (10%, and they rarely had respiratory depression (4%. Among the hospitalized, pharmaceutical poisonings were most common (58%, 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often

  15. Triage en urgencias y emergencias hospitalarias: revisión de los principales sistemas de triage internacionales.

    OpenAIRE

    Estebaranz Santamaría, Cristina

    2014-01-01

    Trabajo fin de grado en Enfermería Introducción. El “triage” es un proceso de valoración que permite priorizar el nivel de urgencia de los pacientes. Para su aplicación, se utilizan los sistemas de triage estructurado, existiendo en la actualidad cinco modelos a nivel internacional. Objetivo. Analizar los sistemas de triage en el servicio de urgencias y emergencias hospitalarias, determinando las diferencias de sus últimas actualizaciones. Material y método. Revisión narrati...

  16. Hoitajien ennakkokäsityksiä triage-hoitajuudesta erään aluesairaalan ensiapupoliklinikalla

    OpenAIRE

    Forsström, Niina

    2010-01-01

    Opinnäytetyö käsittelee hoitajien ennakkokäsityksiä triage-hoitajuudesta erään aluesairaalan ensiapupoliklinikalla. Triage-hoitajuus on tarkoitus ottaa käyttöön kyseisellä päivystyspoliklinikalla vuoden 2010 aikana. Työ perustui tarpeeseen kartoittaa hoitajien ennakkokäsityksiä triagesta ja triage- hoitajuudesta ja olla apuna triage-hoitajille suunnatun koulutuksen suunnittelussa. Triage on se osa hoidon tarpeen arviota, joka tehdään potilaan päivystykseen vastaanottamisen yhteydessä. Arvi...

  17. Multivariate predictors of failed prehospital endotracheal intubation.

    Science.gov (United States)

    Wang, Henry E; Kupas, Douglas F; Paris, Paul M; Bates, Robyn R; Costantino, Joseph P; Yealy, Donald M

    2003-07-01

    Conventionally trained out-of-hospital rescuers (such as paramedics) often fail to accomplish endotracheal intubation (ETI) in patients requiring invasive airway management. Previous studies have identified univariate variables associated with failed out-of-hospital ETI but have not examined the interaction between the numerous factors impacting ETI success. This study sought to use multivariate logistic regression to identify a set of factors associated with failed adult out-of-hospital ETI. The authors obtained clinical and demographic data from the Prehospital Airway Collaborative Evaluation, a prospective, multicentered observational study involving advanced life support (ALS) emergency medical services (EMS) systems in the Commonwealth of Pennsylvania. Providers used standard forms to report details of attempted ETI, including system and patient demographics, methods used, difficulties encountered, and initial outcomes. The authors excluded data from sedation-facilitated and neuromuscular blockade-assisted intubations. The main outcome measure was ETI failure, defined as failure to successfully place an endotracheal tube on the last out-of-hospital laryngoscopy attempt. Logistic regression was performed to develop a multivariate model identifying factors associated with failed ETI. Data were used from 45 ALS systems on 663 adult ETIs attempted during the period June 1, 2001, to November 30, 2001. There were 89 cases of failed ETI (failure rate 13.4%). Of 61 factors potentially related to ETI failure, multivariate logistic regression revealed the following significant covariates associated with ETI failure (odds ratio; 95% confidence interval; likelihood ratio p-value): presence of clenched jaw/trismus (9.718; 95% CI = 4.594 to 20.558; p endotracheal tube through the vocal cords (7.653; 95% CI = 3.561 to 16.447; p < 0.0001); inability to visualize the vocal cords (7.638; 95% CI = 3.966 to 14.707; p < 0.0001); intact gag reflex (7.060; 95% CI = 3.552 to 14

  18. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study.

    Science.gov (United States)

    Rognås, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else

    2013-07-25

    We report data from the first Utstein-style study of physician-provided pre-hospital advanced airway management. Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) prospectively registered data according to the template for reporting data from pre-hospital advanced airway management. Data collection took place from February 1st 2011 to October 31st 2012. Included were patients of all ages on whom pre-hospital advanced airway management was performed. The objective was to estimate the incidences of failed and difficult pre-hospital endotracheal intubation, and complications related to pre-hospital advanced airway management. The overall incidence of successful pre-hospital endotracheal intubation among 636 intubation attempts was 99.7%, even though 22.4% of pre-hospital endotracheal intubations required more than one intubation attempt. The overall incidence of complications related to pre-hospital advanced airway management was 7.9%. Following rapid sequence intubation, the incidence of first pass success was 85.8%, the overall incidence of complications was 22.0%, the incidence of hypotension 7.3% and that of hypoxia 5.3%. Multiple endotracheal intubation attempts were associated with an increased overall incidence of complications. No airway management related deaths occurred. The overall incidence of successful pre-hospital endotracheal intubations compares to those found in other physician-staffed pre-hospital systems. The incidence of pre-hospital endotracheal intubations requiring more than one attempt is higher than suspected. The incidence of hypotension or hypoxia after pre-hospital rapid sequence intubation compares to those found in UK emergency departments. Pre-hospital advanced airway management including pre-hospital endotracheal intubation performed by experienced anaesthesiologists is associated with high success rates and relatively low

  19. The Effect of Education on the Knowledge and Practice of Emergency Department’s Nurses Regarding the Patients’ Triage

    Directory of Open Access Journals (Sweden)

    Mohammad Kalantarimeibidi

    2014-09-01

    Full Text Available Introduction: Emergency department as one of the most important wards of the hospital confronts with lots of referring patients. Timely service presentation in this ward depends on efficient and effective functions of its personnel. Thus, this study was aimed to evaluate the effect of education on the knowledge and practice of emergency department’s nurses in the patients’ triage field. Methods: In this cross-sectional study, the knowledge and practice of 50 nurses was evaluated before and after of 9 hours educational workshop regarding patients’ triage based on the emergency severity index (ESI. Persons who had at least six months work experience in the emergency department and did not participate in any triage workshop during the six years before starting the project were entered to the study. Data gathering was performed through preparing three questionnaires separately included demographic information as well as assessment of knowledge and practice. Evaluated demographic characteristics were age, gender, marital status, work history, academic degree, type of employment, work shift, and average of work shift weekly. To assess the knowledge and practice, two separate questionnaires were used that their reliability and validity were confirmed before. Data was analyzed using SPSS 16 and appropriate analytic tests. P<0.05 was considered as statistically significant. Results: The average knowledge scores of nurses reached from 7.5±2.1 to 14±1.6 (p= 0.001, r=0.49 after education. Also the average scores of participants increased from 31.8±9.9 to 69.7±8.1 (p= 0.001, r=0.87.  There was no significant relationship between characteristics of nurses and their knowledge scores in six weeks after education (p>0.05. While it was seen between the work history of nursing (p=0.038, working in emergency department (p=0.001, as well as type of employment (p=0.019 and average scores of practice within six weeks after education. No significant

  20. High-accuracy Decision of Call-triage by Using Bayesian Network

    Science.gov (United States)

    Yunoki, Shota; Hamagami, Tomoki; Oshige, Kenji; Kawakami, Chihiro; Suzuki, Noriyuki

    A new call-triage system, a key part of emergency support system with stochastic network model is examined. The call-triage is an operation allowing the efficient decision of service grade and dispatching of suitable rescue team service from phone call information. Nowadays, the call-triage is being trialed on a few cities and is achieving an effect. However, there is the issue that if under-triage in which the condition of sick person is estimated more lightly is eliminated, the efficiency is degraded (over-triage). In this report, in order to overcome the issue, the Bayesian network scheme is examined to the call-triage system. The experiments with real call-triage data set results show the Bayesian network achieves precision enhancement.

  1. Using Triage Figuratively to Describe Effective Teaching in Physical Education

    Science.gov (United States)

    Henkel, Steven A.

    2016-01-01

    This article presents critical outcomes for physical education in a "triage" framework by comparing the process of determining the severity of injuries at the scene of an accident to the process of prioritizing decisions in the classroom. The intent is to reduce all possible outcomes of effective teaching to six nonnegotiable outcomes…

  2. An Arm Mounted "Scratch and Sniff" Sample Triage Sensor

    Science.gov (United States)

    Darrach, M. R.; Kidd, R.; Shiraishi, L.

    2012-06-01

    A sample triage system based on the detection of volatiles released by mechanical abrasion is proposed. The instrument will be capable of detecting trace compounds found in Mars rock and soils. The instrument mass will be approximately 2.8 kg.

  3. Nurse telephone triage: good quality associated with appropriate decisions.

    NARCIS (Netherlands)

    Huibers, A.M.J.; Keizer, E.; Giesen, P.H.J.; Grol, R.P.T.M.; Wensing, M.J.P.

    2012-01-01

    Background Triage at out-of-hours GP cooperatives (GPCs) is aimed at determining medical urgency and guiding decisions. Both medical knowledge and communication skills are required for this complex task. Objective To explore the impact of quality of consultation and estimated urgency on the appropri

  4. Triage nurse requested x rays—are they worthwhile?

    OpenAIRE

    Lindley-Jones, M; Finlayson, B

    2000-01-01

    Objective—To study an established triage nurse x ray requesting system to determine whether sending defined groups of patients for radiography before assessment by doctors or emergency nurse practitioners (ENPs) resulted in shorter waiting times for patients without compromising quality of care.

  5. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2015-12-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  6. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2007-01-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  7. A dramatic drop in blood pressure following prehospital GTN administration.

    Science.gov (United States)

    Boyle, Malcolm J

    2007-03-01

    A male in his sixties with no history of cardiac chest pain awoke with chest pain following an afternoon sleep. The patient did not self medicate. The patient's observations were within normal limits, he was administered oxygen via a face mask and glyceryl trinitrate (GTN). Several minutes after the GTN the patient experienced a sudden drop in blood pressure and heart rate, this was rectified by atropine sulphate and a fluid challenge. There was no further deterioration in the patient's condition during transport to hospital. There are very few documented case like this in the prehospital scientific literature. The cause appears to be the Bezold-Jarish reflex, stimulation of the ventricular walls which in turn decreases sympathetic outflow from the vasomotor centre. Prehospital care providers who are managing any patient with a syncopal episode that fails to recover within a reasonable time frame should consider the Bezold-Jarisch reflex as the cause and manage the patient accordingly.

  8. [Prehospital teamwork life support service for traffic accident victims].

    Science.gov (United States)

    Pereira, Waleska Antunes da Porciúncula; Lima, Maria Alice Dias da Silva

    2009-06-01

    The objective of this study is to characterize prehospital teamwork service for traffic accident victims, identifying the actors' activities, the teamwork and the relations with actors from other areas. This is a qualitative study, in which data collection took place by observing the events that occurred at a public service in the city of Porto Alegre, in addition to interviews with each professional involved in the service. The results showed that prehospital care is founded on teamwork and that the understanding among professionals should go beyond the historical hierarchic relation existing in health organizations. There is a need to value the broad field of knowledge, which is associated with the core of care activities that meet most trauma victim needs.

  9. Advanced communication infrastructure for pre-hospital EMS care.

    Science.gov (United States)

    Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, Marcie

    2008-11-06

    The traditional communication infrastructure of the pre-hospital Emergency Medical System (EMS) is limited to voice communication using radio or cell phone technologies. With the emergence of 3rd Generation wireless networks (3G) and enhanced mobile devices capable of data communication (e.g., mobile tablets, PDAs with cell phones, or cell phones with PDA capabilities), the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication. However, video requires substantially more bandwidth which 4th Generation (4G) systems are promising. However, their availability is limited. We present an infrastructure that allows dynamic selection of the best data transport mode in the pre-hospital EMS environment.

  10. Implementation of a Pediatric Emergency Triage System in Xiamen, China

    Institute of Scientific and Technical Information of China (English)

    Gang-Xi Lin; Yin-Ling Yang; Denise Kudirka; Colleen Church; Collin K K Yong; Fiona Reilly; Qi-Yi Zeng

    2016-01-01

    Background:Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians.The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS),modeled after the Canadian Triage System and Acuity Scale.Methods:In this study,we compared CPETS outcomes in our PER relative to those of the prior two-level system.Patients who visited our PER before (January 2013-June 2013) and after (January 2014-June 2014) the CPETS was implemented served as the control and experimental group,respectively.Patient flow,triage rates,triage accuracy,wait times (overall and for severe patients),and patient/family satisfaction were compared between the two groups.Results:Relative to the performance of the former system experienced by the control group,the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER (Cox-Stuart test,t =0,P < 0.05),a higher triage rate (93.40% vs.90.75%;x2 =801.546,P < 0.001),better triage accuracy (96.32% vs.85.09%;x2 =710.904,P < 0.001),shorter overall wait times (37.30 ± 13.80 min vs.41.60 ± 15.40 min;t =11.27,P < 0.001),markedly shorter wait times for severe patients (2.07 [0.65,4.11] min vs.3.23 [1.90,4.36] min;z =-2.057,P =0.040),and higher family satisfaction rates (94.23% vs.92.21%;x2 =321.528,P < 0.001).Conclusions:Implementing the CPETS improved nurses' abilities to triage severe patients and,thus,to deliver the urgent treatments more quickly.The system shunted nonurgent patients to outpatient care effectively,resulting in improved efficiency of PER health-care delivery.

  11. Stroke awareness decreases prehospital delay after acute ischemic stroke in korea

    Directory of Open Access Journals (Sweden)

    Lee Su-Ho

    2011-01-01

    Full Text Available Abstract Background Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Methods A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay. Results Among the 500 patients (median 67 years, 62% men, the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313. Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381, knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633 and use of ambulance (OR 1.961, 95% CI 1.176-3.270 were significantly associated with early arrival. Conclusions In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.

  12. Prehospital use of furosemide for the treatment of heart failure.

    Science.gov (United States)

    Pan, Andy; Stiell, Ian G; Dionne, Richard; Maloney, Justin

    2015-01-01

    The diagnosis and management of acute decompensated heart failure (HF) in the prehospital setting can be challenging. The objectives of this study are to evaluate the appropriateness of furosemide use by Emergency Medical Services (EMS) and its association with adverse outcomes. This study was a multi-centre health records review of EMS patients who received prehospital furosemide or had an emergency department (ED) diagnosis of HF. We included acutely ill patients ≥50 years of age with shortness of breath transported by land EMS. Univariate and logistic regression analyses were performed to determine associations between furosemide use and serious adverse outcomes (acute renal failure, intubation, vasopressors or death). The study population consisted of 330 patients (N=58, furosemide given by EMS but no HF diagnosed in ED; N=110, furosemide given, HF diagnosed; N=162, no furosemide given, HF diagnosed). The median dose of intravenous furosemide was 80 mg (range 20-80 mg). Serious adverse outcomes occurred in 61 patients (19.0%, 23.6% and 14.8% of the three groups, respectively; p=0.18). The adjusted ORs for adverse events with furosemide use was 0.62 (95% CI 0.33 to 1.43) in patients with a diagnosis of HF and 1.14 (95% CI 0.58 to 2.23) in those without. More than a third of patients who received prehospital furosemide did not have an HF diagnosis, suggesting that the prehospital diagnosis of HF can be challenging. Serious adverse outcomes were identified in all patient groups and we found no statistically significant associations between furosemide use and adverse events. 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.

  13. Prehospital care for multiple trauma patients in Germany.

    Science.gov (United States)

    Maegele, Marc

    2015-01-01

    For the German speaking countries, Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first"). If no immediate treatment is necessary, a "Secondary Sur- vey" follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay ("work and go")toTR-DGU® certified trauma centers of the local trauma networks. Due to the difficult pre- hospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of rec- ommendations for early prehospital care for the severely injured based upon the 2011 updated multi- disciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung", the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

  14. Comparison of Three Prehospital Cervical Spine Protocols to Missed Injuries

    OpenAIRE

    Hong, Rick; Meenan, Molly; Prince, Erin; Murphy, Ronald; Tambussi, Caitlin; Rohrbach, Rick; Baumann, Brigitte M.

    2014-01-01

    Introduction: We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients wh...

  15. Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

    OpenAIRE

    Rick Hong; Molly Meenan; Erin Prince; Ronald Murphy; Caitlin Tambussi; Rick Rohrbach; Baumann, Brigitte M.

    2014-01-01

    Introduction: We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients wh...

  16. Pre-hospital treatment of convulsive status epilepticus in adults

    Directory of Open Access Journals (Sweden)

    Fei TIAN

    2015-11-01

    Full Text Available  Convulsive status epilepticus (CSE is the most serious seizure type in status epilepticus (SE, which may cause irreversible damage of brain and other vital organs without prompt and effective treatment, and result in a high mortality. Therefore, effective pre-hospital drug therapy can ensure the success of treatment for CSE. DOI: 10.3969/j.issn.1672-6731.2015.11.004

  17. Comparison of Three Prehospital Cervical Spine Protocols to Missed Injuries

    OpenAIRE

    Hong, Rick; Meenan, Molly; Prince, Erin; Murphy, Ronald; Tambussi, Caitlin; Rohrbach, Rick; Baumann, Brigitte M.

    2014-01-01

    Introduction: We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients wh...

  18. Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

    OpenAIRE

    Rick Hong; Molly Meenan; Erin Prince; Ronald Murphy; Caitlin Tambussi; Rick Rohrbach; Baumann, Brigitte M.

    2014-01-01

    Introduction: We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients wh...

  19. Man or machine? An experimental study of prehospital emergency amputation.

    Science.gov (United States)

    Leech, Caroline; Porter, Keith

    2016-09-01

    Prehospital emergency amputation is a rare procedure, which may be necessary to free a time-critical patient from entrapment. This study aimed to evaluate four techniques of cadaveric lower limb prehospital emergency amputation. A guillotine amputation of the distal femur was undertaken in fresh frozen self-donated cadavers. A prehospital doctor conducted a surgical amputation with Gigli saw or hacksaw for bone cuts and firefighters carried out the procedure using the reciprocating saw and Holmatro device. The primary outcome measures were time to full amputation and the number of attempts required. The secondary outcomes were observed quality of skin cut, soft tissue cut and CT assessment of the proximal bone. Observers also noted the potential risks to the rescuer or patient during the procedure. All techniques completed amputation within 91 s. The reciprocating saw was the quickest technique (22 s) but there was significant blood spattering and continuation of the cut to the surface under the leg. The Holmatro device took less than a minute. The quality of the proximal femur was acceptable with all methods, but 5 cm more proximal soft tissue damage was made by the Holmatro device. Emergency prehospital guillotine amputation of the distal femur can effectively be performed using scalpel and paramedic shears with bone cuts by the Gigli saw or fire service hacksaw. The reciprocating saw could be used to cut bone if no other equipment was available but carried some risks. The Holmatro cutting device is a viable option for a life-threatening entrapment where only firefighters can safely access the patient, but would not be a recommended primary technique for medical staff. 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. Apgar score

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003402.htm Apgar score To use the sharing features on this page, ... birth. Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952. How the Test is Performed The ...

  1. The South African triage scale (adult version) provides valid acuity ratings when used by doctors and enrolled nursing assistants

    OpenAIRE

    Michèle Twomey; Lee A. Wallis; Mary Lou Thompson; Myers, Jonathan E

    2012-01-01

    Objective: To estimate the validity of triage ratings by South African nurses and doctors with training and practical experience using the South African Triage Scale. Methods: Five emergency physicians and 10 enrolled nursing assistants, who had been trained in the use of the South African Triage Scale, were selected via convenience sampling to retrospectively triage adult emergency centre vignettes. Participants independently assigned triage ratings to 100 written vignettes unaware of the...

  2. Association of mechanical chest compression and prehospital thrombolysis.

    Science.gov (United States)

    Chenaitia, Hichem; Fournier, Marc; Brun, Jean Paul; Michelet, Pierre; Auffray, Jean Pierre

    2012-07-01

    Pulmonary embolism (PE) is a common cause of sudden death; the use of prehospital thrombolysis is currently a last-resort option and requires a prolonged cardiopulmonary resuscitation (CPR). Novel mechanical devices have recently been introduced that provides automatic mechanical chest compression (AMCC) according to the guidelines and continually without decrease efficiency throughout prolonged resuscitation. A 54 year-old woman with a history of breast cancer experienced sudden chest pain and severe dyspnea. A mobile intensive care unit was dispatched to her home. During physical examination, she suddenly collapsed with pulseless electrical activity as the initial rhythm. Prehospital thrombolysis during CPR combined with use of AMCC was performed based on a strongly suspected diagnosis of massive PE. After 75 minutes of effective CPR, return of spontaneous circulation was attained. After admission to an intensive care unit, computed tomographic scan confirmed bilateral PE. The patient was discharged 3 weeks after CPR in good neurologic condition. To our knowledge, this is the first case describing combined use of thrombolysis and AMCC in out-ofhospital cardiac arrest. However, for the time being, prehospital thrombolysis in CPR continues to be a measure that should only be performed on a case-by-case basis based on informed decision. Further studies are needed to evaluate the efficacy and safety of AMCC with thrombolysis and thus prolonged CPR.

  3. Organization of prehospital medical care for patients with cerebral stroke

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

    Full Text Available The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

  4. Prehospital administered fascia iliaca compartment block by emergency medical service nurses, a feasibility study

    Science.gov (United States)

    2014-01-01

    Introduction Patients with a proximal femur fracture are often difficult to evacuate from the accident scene. Prehospital pain management for this vulnerable group of patients may be challenging. Multiple co-morbidities, polypharmacy and increased age may limit the choice of suitable analgesics. The fascia iliaca compartment (FIC) block may be an alternative to intravenous analgesics. However this peripheral nerve block is mainly applied by physicians. In the Netherlands, prehospital emergency care is mostly provided by EMS-nurses. Therefore we examined whether well-trained EMS-nurses are able to successfully perform a FIC block in order to ensure timely and appropriate effective analgesia. The study was study was registered in the Netherlands Trial Register (NTR-nr 3824). Methods Ten EMS nurses were educated in the performance of a FIC-block. Indications, technique, side-effects and complications were discussed. Hereafter the trained EMS-nurses staffed ambulance teams were dispatched to patients with a suspicion for a proximal femur fracture. After confirmation of the diagnosis, the block was performed and 0.3 ml/kg lidocaine (10 mg/ml) with adrenaline 5 μg/ml was injected. The quality of pain relief, occurrence of complications and patient satisfaction were evaluated. Results In 108 patients a block was performed. One hundred patients could be included. Every EMS nurse performed at least 10 FIC blocks. The block was effective in 96 patients. The initial median (NRS)-pain score decreased after block performance to a score of 6 (after 10 minutes), 4 (after 20 minutes) and 3 (after 30 minutes). At arrival at the Emergency Department the median pain score was 3. Dynamic NRS-pain scores when transferring the patient from the accident scene to the ambulance stretcher, during transportation to the hospital and when transferring the patient to a hospital bed were, 4, 3 and 3.5 respectively. Patient satisfaction was very high. No complications were noted

  5. The effect of implementation of cardiac triage scale on time indices of triage in patients with chest pain

    Directory of Open Access Journals (Sweden)

    Fazel-Asgharpour Azam

    2016-06-01

    Full Text Available Background and Objective: Chest patient is the most common symptom in coronary artery disease, but its diagnosis is a complex issue and high mortality is attributed to this symptom. Therefore, the timely diagnosis and treatment is essential. The present study was conducted to determine the effect of implementation of cardiac triage scale on time indices in patients with chest pain. Materials and Method: In this clinical trial study with control group,  study population was the patients referred to emergency ward of Farabi hospital in Mashhad in 2014. 60 patients were selected purposefully and then were randomly allocated into intervention and control group. The patients in intervention group were triaged through using cardiac triage scale by researcher and in control group through emergency severity index and by nurse.  Data analysis was done through using descriptive statistics, Chi-square and Mann Whitney in SPSS 21. Results: The beginning of 6- hours hospitalization (p < 0.001, the time of the first visit by specialist (p<0.001 and the time of the first electrocardiogram (p < 0.001 in intervention group was shorter than the control group. Conclusion: The results of the study showed that the special triage of cardiac patients can decrease the time of assessment and caring of them. Thus, the using of this method is recommended for early care of cardiac patients.

  6. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment.

    Science.gov (United States)

    Amadi-Obi, Ahjoku; Gilligan, Peadar; Owens, Niall; O'Donnell, Cathal

    2014-01-01

    The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome.

  7. [Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure)].

    Science.gov (United States)

    Miró, Òscar; Llorens, Pere; Escalada, Xavier; Herrero, Pablo; Jacob, Javier; Gil, Víctor; Xipell, Carolina; Sánchez, Carolina; Aguiló, Sira; Martín-Sánchez, Francisco J

    2017-07-01

    To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased.

  8. A retrospective quality assessment of the 7119 call triage system in Tokyo - telephone triage for non-ambulance cases.

    Science.gov (United States)

    Sakurai, Atsushi; Morimura, Naoto; Takeda, Munekazu; Miura, Kunihisa; Kiyotake, Naoshi; Ishihara, Toru; Aruga, Tohru

    2014-07-01

    Summary We assessed the accuracy of telephone triage at the 7119 telephone consultation centre in Tokyo. We evaluated walk-in patients at primary care facilities in a clinic or hospital. Nurses asked all patients calling 7119 to join the study and gave them a specific identification number (ID no) at the end of the telephone consultation. The outcome of the consultation was defined as discharge to home (home), admittance to hospital (hospitalization), referral, or transfer to another hospital. After matching consultation records and patient data by ID no, emergency medical physicians reviewed the protocol for problems. During the study, consultation nurses issued an ID no in 17,141 cases, and hospitals and clinics sent back the data on 1205 patients. Among these patients, 1119 cases (93%) were home, 59 cases (5%) were hospitalization, 18 cases (2%) were referral and 9 cases (1%) were transfer. Of the 86 cases which had an outcome of hospitalization, referral or transfer, there were 56 cases with matched patient data. Among these 56 cases, review showed no significant problems with 37 cases. However, there were 11 cases with patient refusal to comply with the triage recommendation, 4 cases with 7119 staff education problems and 4 cases with problems with the protocol itself. We were able to evaluate the 7119 telephone triage system in Tokyo. The study identified three types of problems with the triage process: refusal of telephone triage recommendations, problems with staff education and problems with the protocol itself. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. Prehospital Air Medical Plasma (PAMPer) Trial

    Science.gov (United States)

    2015-07-01

    as one of the primary predictors of large volume transfusion requirements. The ABC scoring system consists of 4 non-weighted parameters and include...systems (pulmonary, renal, hepatic , and cardiac), which are evaluated daily throughout the patient’s intensive care unit stay and graded on a scale from 0...umol/L)  160 - 210 211 - 420 > 420 Hepatic Total Bilirubin (umol/L) < 34 34 – 68 69 - 137 > 137 Protocol

  10. Impacts of the introduction of a triage system in Japan: a time series study.

    Science.gov (United States)

    Hamamoto, Junko; Yamase, Hiroaki; Yamase, Yoshie

    2014-07-01

    The aim of the present study was to measure and compare the effectiveness of nursing triage before and after introduction of the Japanese Triage and Acuity Scale (JTAS), the Japanese version of the Canadian Triage and Acuity Scale (CTAS), during emergency treatment. Surveys of triage nurses and emergency physicians were conducted before and after JTAS introduction. Respondents were triage nurses (before 112 cases, after 94 cases), emergency physicians (before 50, after 41), and triaged patients (before 1057, after 1025) from seven separate emergency medical facilities. The results showed that nursing triage using the JTAS shortened "time from registration to triage" by 3.8min, "triage duration" by 1min, "time from registration to physician" by 11.2min, and "waiting time perceived by patients to see a physician" by 18.6min (ptriage nurses and emergency physicians decreased from 34.2% to 12.2% (ptriage decreased from 24.7% to 8.6% (ptriage decreased from 9.5% to 3.6% (ptriage nurses and emergency physicians increased significantly, from weighted κ=0.486 to weighted κ=0.820. These findings suggest that the introduction of the JTAS promoted more effective nursing triage and medical care.

  11. Momentary fitting in a fluid environment: A grounded theory of triage nurse decision making.

    Science.gov (United States)

    Reay, Gudrun; Rankin, James A; Then, Karen L

    2016-05-01

    Triage nurses control access to the Emergency Department (ED) and make decisions about patient acuity, patient priority, and placement of the patient in the ED. Understanding the processes and strategies that triage nurses use to make decisions is therefore vital for patient safety and the operation of the ED. The aim of the current study was to generate a substantive grounded theory (GT) of decision making by emergency triage Registered Nurses (RNs). Data collection consisted of seven observations of the triage environment at three tertiary care hospitals where RNs conducted triage and twelve interviews with triage RNs. The data were analyzed by constant comparison in accordance with the classical GT method. In the resultant theory, Momentary Fitting in a Fluid Environment, triage is conceptualized as a process consisting of four categories, determining acuity, anticipating needs, managing space, and creating space. The findings indicate that triage RNs continually strive to achieve fit, while simultaneously considering the individual patient and the ED as a whole entity. Triage RNs require appropriately designed triage environments and computer technology that enable them to secure real time knowledge of the ED to maintain situation awareness. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Holistic Evaluation Framework for Automated Bug Triage Systems: Integration of Developer Performance

    Directory of Open Access Journals (Sweden)

    Dr. V. Akila

    2016-04-01

    Full Text Available Bug Triage is an important aspect of Open Source Software Development. Automated Bug Triage system is essential to reduce the cost and effort incurred by manual Bug Triage. At present, the metrics that are available in the literature to evaluate the Automated Bug Triage System are only recommendation centric. These metrics address only the correctness and coverage of the Automated Bug Triage System. Thus, there is a need for user-centric evaluation of the Bug Triage System. The two types of metrics to evaluate the Automated Bug Triage System include Recommendation Metrics and User Metrics. There is a need to corroborate the results produced by the Recommendation Metrics with User Metrics. To this end, this paper furnishes a Holistic Evaluation Framework for Bug Triage System by integrating the developer performance into the evaluation framework. The Automated Bug Triage System is also to retrieve a set of developers for resolving a bug. Hence, this paper proposes Key Performance Indicators (KPI for appraising a developer’s effectiveness in contribution towards the resolution of the bug. By applying the KPIs on the retrieved set of developers, the Bug Triage System can be evaluated quantitatively.

  13. Effect of ultrasound training of physicians working in the prehospital setting

    DEFF Research Database (Denmark)

    Krogh, Charlotte Loumann; Steinmetz, Jacob; Rudolph, Søren Steemann

    2016-01-01

    BACKGROUND: Advances in technology have made ultrasound (US) devices smaller and portable, hence accessible for prehospital care providers. This study aims to evaluate the effect of a four-hour, hands-on US training course for physicians working in the prehospital setting. The primary outcome...

  14. Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach

    Directory of Open Access Journals (Sweden)

    Nakstad Anders R

    2010-04-01

    Full Text Available Abstract Introduction Endotracheal intubation (ETI has been considered an essential part of pre-hospital advanced life support. Pre-hospital ETI, however, is a complex intervention also for airway specialist like anaesthesiologists working as pre-hospital emergency physicians. We therefore wanted to investigate the quality of pre-hospital airway management by anaesthesiologists in severely traumatised patients and identify possible areas for improvement. Method We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS. The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it. Results In the risk assessment, we assigned a high probability (29% for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers. Conclusion Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.

  15. Use of Morphine Sulphate by South African Paramedics for Prehospital Pain Management

    Directory of Open Access Journals (Sweden)

    Craig Vincent-Lambert

    2015-01-01

    Full Text Available BACKGROUND: Evidence in the literature highlights the fact that acute pain in the prehospital setting remains poorly managed. Morphine remains the most commonly used analgesic agent in the South African prehospital emergency care setting. Although guidelines and protocols relating to the dosage and administration of morphine exist, little data are available describing its use by South African paramedics.

  16. Prehospital intraosseus access with the bone injection gun by a helicopter-transported emergency medical team.

    NARCIS (Netherlands)

    Gerritse, B.M.; Scheffer, G.J.; Draaisma, J.M.T.

    2009-01-01

    BACKGROUND: To evaluate the use of the bone injection gun to obtain vascular access in the prehospital setting by an Helicopter-Transported Emergency Medical Team. METHODS: Prospective descriptive study to assess the frequency and success rate of the use of the bone injection gun in prehospital care

  17. Assessing the reliability and accuracy of nurse triage ratings when using the South African Triage Scale in the Emergency Department of District Headquarter Hospital of Timergara, Pakistan

    Directory of Open Access Journals (Sweden)

    M. Dalwai*

    2013-12-01

    Conclusion: The SATS has been shown to be a reliable triage scale for a developing country such as Pakistan. With accuracy being acceptable in the context of Timergara, we would suggest further validation studies looking at simple ways of validating the triage scale bearing in mind the challenges facing a developing country ED.

  18. An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Forberg Jakob L

    2012-02-01

    Full Text Available Abstract Background Pre-hospital electrocardiogram (ECG transmission to an expert for interpretation and triage reduces time to acute percutaneous coronary intervention (PCI in patients with ST elevation Myocardial Infarction (STEMI. In order to detect all STEMI patients, the ECG should be transmitted in all cases of suspected acute cardiac ischemia. The aim of this study was to examine the ability of an artificial neural network (ANN to safely reduce the number of ECGs transmitted by identifying patients without STEMI and patients not needing acute PCI. Methods Five hundred and sixty ambulance ECGs transmitted to the coronary care unit (CCU in routine care were prospectively collected. The ECG interpretation by the ANN was compared with the diagnosis (STEMI or not and the need for an acute PCI (or not as determined from the Swedish coronary angiography and angioplasty register. The CCU physician's real time ECG interpretation (STEMI or not and triage decision (acute PCI or not were registered for comparison. Results The ANN sensitivity, specificity, positive and negative predictive values for STEMI was 95%, 68%, 18% and 99%, respectively, and for a need of acute PCI it was 97%, 68%, 17% and 100%. The area under the ANN's receiver operating characteristics curve for STEMI detection was 0.93 (95% CI 0.89-0.96 and for predicting the need of acute PCI 0.94 (95% CI 0.90-0.97. If ECGs where the ANN did not identify a STEMI or a need of acute PCI were theoretically to be withheld from transmission, the number of ECGs sent to the CCU could have been reduced by 64% without missing any case with STEMI or a need of immediate PCI. Conclusions Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds.

  19. Comparison of emergency nurses association Emergency Severity Triage and Australian emergency mental health triage systems for the evaluation of psychiatric patients.

    Science.gov (United States)

    Downey, La Vonne A; Zun, Leslie S; Burke, Trena

    2014-01-01

    The use of a triage system in the emergency department allows for the ability to reliably assign patients for treatment within a short amount of time in order to prioritize and treat on the basis of patients injury and illness. A 5 point triage system has been shown to have the highest correlation with effective resource utilizations, lower time to be seen and treatment times, and admission or release outcomes for patients. The problem is, however, that these triage scales were developed on the basis of physical illness and not on the ever-increasing number of patients who present with mental illness. This article compares one physical and one specific mental illness-based triage system to measure the differences in times to be seen by a physician. It found that the specialized psychiatric triage system decreased wait times and allowed symptoms to be addressed sooner for patients presenting with psychiatric complaints.

  20. One-two-triage: validation and reliability of a novel triage system for low-resource settings

    Science.gov (United States)

    Khan, Ayesha; Mahadevan, S V; Dreyfuss, Andrea; Quinn, James; Woods, Joan; Somontha, Koy; Strehlow, Matthew

    2016-01-01

    Objectives To validate and assess reliability of a novel triage system, one-two-triage (OTT), that can be applied by inexperienced providers in low-resource settings. Methods This study was a two-phase prospective, comparative study conducted at three hospitals. Phase I assessed criterion validity of OTT on all patients arriving at an American university hospital by comparing agreement among three methods of triage: OTT, Emergency Severity Index (ESI) and physician-defined acuity (the gold standard). Agreement was reported in normalised and raw-weighted Cohen κ using two different scales for weighting, Expert-weighted and triage-weighted κ. Phase II tested reliability, reported in Fleiss κ, of OTT using standardised cases among three groups of providers at an urban and rural Cambodian hospital and the American university hospital. Results Normalised for prevalence of patients in each category, OTT and ESI performed similarly well for expert-weighted κ (OTT κ=0.58, 95% CI 0.52 to 0.65; ESI κ=0.47, 95% CI 0.40 to 0.53) and triage-weighted κ (κ=0.54, 95% CI 0.48 to 0.61; ESI κ=0.57, 95% CI 0.51 to 0.64). Without normalising, agreement with gold standard was less for both systems but performance of OTT and ESI remained similar, expert-weighted (OTT κ=0.57, 95% CI 0.52 to 0.62; ESI κ=0.6, 95% CI 0.58 to 0.66) and triage-weighted (OTT κ=0.31, 95% CI 0.25 to 0.38; ESI κ=0.41, 95% CI 0.35 to 0.4). In the reliability phase, all triagers showed fair inter-rater agreement, Fleiss κ (κ=0.308). Conclusions OTT can be reliably applied and performs as well as ESI compared with gold standard, but requires fewer resources and less experience. PMID:27466347

  1. Registered nurses integrate traditional Chinese medicine into the triage process.

    Science.gov (United States)

    Bertrand, Sharon W

    2012-02-01

    People in the United States often consult registered nurses (nurses) for advice when they want to explore alternatives to Western medicine, such as traditional Chinese medicine (TCM). Nurses find themselves confronting dilemmas when they are caught between these radically different worlds of medical cultures and thinking. Twenty Minnesota nurses were interviewed to learn how they integrate TCM into their triage process. Symbolic interactionism was the research framework used, and mixed coding methods facilitated data analysis. Several sociological theories explain the findings. The major finding is that nurses use a four-step triage process that begins from the Western medical perspective and includes consideration of TCM use. Nurses' recommendations are influenced by their situational roles and relationships, and by the cues they read from the person who is asking their advice. The results point to nurses being natural disseminators of TCM information and education in their resource role for others making health care decisions.

  2. Provider in triage: is this a place for nurse practitioners?

    Science.gov (United States)

    Bahena, Diana; Andreoni, Colleen

    2013-01-01

    The role of nurse practitioners (NPs) in emergency care continues to evolve. A new and exciting role is the provider-in-triage (PIT) role. This innovative role has been implemented in many emergency departments (EDs) across the country. It was developed primarily as a front-end strategy to improve throughput of patients receiving emergency care. The PIT process uses a provider, physician, NP, or physician assistant in the triage area. Patient satisfaction, quality measures, and financial improvements have been attributed to using a PIT. The emergency NP is an optimal choice for this role. Advanced emergency nursing knowledge, skills, and decision making confer the NP a cost-effective provider to improve throughput in the ED while providing quality emergency care.

  3. Nurses’ Evaluation of a New Formalized Triage System in the Emergency Department

    DEFF Research Database (Denmark)

    Brehm Johansen, Mette; Forberg, Jakob Lundager

    2011-01-01

    Introduction: Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED. Material and methods: Semi-structured qualitative interviews were conducted with 15 emergency nurses....... The interviews were preceded by observations of the work of the ED nurses in which focus was on the triage process. Results: Formalized triage was experienced to improve the overview of patients and resources at the ED, and the nurses described that they felt more assured when prioritizing between patients....... Communication and coordination were also improved by the triage system. But more time spent on documentation and re-evaluation may cause the nurses to feel professionally inadequate if adequate resources are not provided. Furthermore, the triage system has reduced the focus on the humanistic and psychosocial...

  4. Invariance of cognitive triage in the development of recall in adulthood.

    Science.gov (United States)

    Marche, Tammy A; Howe, Mark L; Lane, David G; Owre, Keith P; Briere, Jennifer L

    2009-07-01

    Past research has demonstrated that cognitive triage (weak-strong-weak recall pattern) is a robust effect that optimises children's recall. The aim of the current research was to determine whether adults' free recall also exhibits triage and whether cognitive triage is less marked with older than younger adults' recall. Younger and older adults memorized 16 unrelated words until all items were recalled perfectly. The triage pattern existed for both the younger and older adults' recall and there was evidence for age differences in triage. Our results are consistent with claims of greater verbatim forgetting and increased susceptibility to output interference with age in adulthood. Further research is needed to determine whether fuzzy-trace theory adequately explains the ageing of triage and what factors play a role in the development of this pattern of recall in adulthood.

  5. Apgar Scores

    Science.gov (United States)

    ... Stages Listen Español Text Size Email Print Share Apgar Scores Page Content Article Body As soon as your ... the syringe, but is blue; her one minute Apgar score would be 8—two points off because she ...

  6. Mass Casualty Incident Primary Triage Methods in China

    Institute of Scientific and Technical Information of China (English)

    Jin-Hong Chen; Jun Yang; Yu Yang; Jing-Chen Zheng

    2015-01-01

    Objective:To evaluate the technical characteristics and application of mass casualty incident (MCI) primary triage (PT) methods applied in China.Data Sources:Chinese literature was searched by Chinese Academic Journal Network Publishing Database (founded in June 2014).The English literature was searched by PubMed (MEDLINE) (1950 to June 2014).We also searched Official Websites of Chinese Central Government's (http://www.gov.cn/),National Health and Family Planning Commission of China (http://www.nhfpc.gov.cn/),and China Earthquake Information (http://www.csi.ac.cn/).Study Selection:We included studies associated with mass casualty events related to China,the PT applied in China,guidelines and standards,and application and development of the carding PT method in China.Results:From 3976 potentially relevant articles,22 met the inclusion criteria,20 Chinese,and 2 English.These articles included 13 case reports,3 retrospective analyses of MCI,two methods introductions,three national or sectoral criteria,and one simulated field testing and validation.There were a total of 19 kinds ofMCI PT methods that have been reported in China from 1950 to 2014.In addition,there were 15 kinds of PT methods reported in the literature from the instance of the application.Conclusions:The national and sectoral current triage criteria are developed mainly for earthquake relief.Classification is not clear.Vague criteria (especially between moderate and severe injuries) operability are not practical.There are no triage methods and research for children and special populations.There is no data and evidence supported triage method.We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real,practical,and efficient PT method.

  7. Triage systems: saturation in response to emergency rooms

    OpenAIRE

    Cubero Alpízar, Consuelo

    2014-01-01

    Background. Strategies for the attention of users in emergency rooms in hospitals have become indispensable for the proper functioning of these services, due to increase in the growing demand for service delivery. In this context, a research project whose objective was to analyze the effectiveness of care systems worldwide hospital emergency arises.Method. All that was reviewed evidence published over the past 15 years, including staff observation applies to the system types triage and waitin...

  8. Development of a Mass Casualty Triage Performance Assessment Tool

    Science.gov (United States)

    2015-02-01

    palm to tilt the head back. 3. Place the finger tips of the other hand under the bony part of the casualty’s lower jaw and lift, bringing the chin...his Soldiers were triaging correctly based on injuries observed in the casualties. Based on a thorough review of the current civilian and military...and medically sorted based on the urgency of the treatment needed, type and seriousness of injury , and likelihood of survival (Community Emergency

  9. Prediction of emergent heart failure death by semi-quantitative triage risk stratification.

    Directory of Open Access Journals (Sweden)

    Harriette G C Van Spall

    Full Text Available OBJECTIVES: Generic triage risk assessments are widely used in the emergency department (ED, but have not been validated for prediction of short-term risk among patients with acute heart failure (HF. Our objective was to evaluate the Canadian Triage Acuity Scale (CTAS for prediction of early death among HF patients. METHODS: We included patients presenting with HF to an ED in Ontario from Apr 2003 to Mar 2007. We used the National Ambulatory Care Reporting System and vital statistics databases to examine care and outcomes. RESULTS: Among 68,380 patients (76±12 years, 49.4% men, early mortality was stratified with death rates of 9.9%, 1.9%, 0.9%, and 0.5% at 1-day, and 17.2%, 5.9%, 3.8%, and 2.5% at 7-days, for CTAS 1, 2, 3, and 4-5, respectively. Compared to lower acuity (CTAS 4-5 patients, adjusted odds ratios (aOR for 1-day death were 1.32 (95%CI; 0.93-1.88; p = 0.12 for CTAS 3, 2.41 (95%CI; 1.71-3.40; p24 breaths/minute (aOR 1.96, 95%CI; 1.05-3.67; p = 0.034, and arrival by paramedic (aOR 3.52, 95%CI; 1.70-8.02; p = 0.001. While age/sex-adjusted CTAS score provided good discrimination for ED (c-statistic = 0.817 and 1-day (c-statistic = 0.724 death, mortality prediction was improved further after accounting for cardiac and non-cardiac co-morbidities (c-statistics 0.882 and 0.810, respectively; both p<0.001. CONCLUSIONS: A semi-quantitative triage acuity scale assigned at ED presentation and based largely on respiratory factors predicted emergent death among HF patients.

  10. The application of theory to triage decision-making.

    Science.gov (United States)

    Reay, Gudrun; Rankin, James A

    2013-04-01

    Theory in nursing is frequently thought of as being a mainly academic exercise with little relevance to the everyday practice of nursing. In nursing there is disagreement about what theory is and what it is not. Scientific theory is an abstract systematic explanation of how concepts are related to each other. Many nursing theories do not fit this description and should therefore, in the opinion of the authors, be thought of as models. Nursing knowledge has been described as the knowledge that is useful to nurses, whether it is derived from the discipline of nursing or other disciplines. Decision-making (DM) and triage nursing have been investigated by several nurse researchers, however, most have not clearly articulated a theoretical or conceptual framework. The recognition primed decision (RPD) model is based on research about DM under uncertain conditions such as time pressure, limited time available, high stakes, and changing cues. The context of emergency triage nursing DM is congruent with the RPD model. The authors propose that the RPD model can serve as a foundation for research that seeks to understand DM by triage nurses with the aim of yielding new knowledge that is useful for their practice.

  11. 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.

  12. Swedish emergency department triage and interventions for improved patient flows: a national update

    Directory of Open Access Journals (Sweden)

    Farrokhnia Nasim

    2011-12-01

    Full Text Available Abstract Background In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. Methods In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74 Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Results Nearly all (97% EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%. Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59% of the EDs have implemented or plan to implement nurse requested X-ray. Conclusions There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.

  13. Outpatient triage factors affecting accuracy and countermeasures%医院门诊分诊准确率的影响因素及对策探讨

    Institute of Scientific and Technical Information of China (English)

    张赟

    2011-01-01

    目的 分析并总结医院门诊分诊准确率的影响因素,在提高门诊分诊准确率与服务质量的前提下,增强医院门诊分诊导诊的服务效率,最终构建一个方便、快捷、有序、和谐的就诊环境.方法 回顾性分析淮安市第一人民医院自2009年12月-2010年11月期间的400 691人次的门诊分诊资料,对400 691人次中存在的总分诊失误的42 879人次的影响分诊准确率的相关因素进行统计分析.结果 本研究中共进行门诊分诊400 691人次,其中总分诊失误有42 879人次,本组对42 879次分诊失误的影响因素进行了归类与统计分析.结果表明患者与家属因素造成分诊失误率位于第一位,占31%(13292/42879),其次是疾病因素28%(11577/42879)和医护人员因素23%(10291/42879),最后是医院管理因素18%(7719/42879).结论 患者与家属因素、疾病因素、医护人员因素以及医院管理因素都会影响医院门诊分诊准确率,提高护理人员业务素质,加强对疾病因素的分析,完善医院管理,能够有效减少分诊失误率.%Objective To analyze and summarize the accuracy of outpatient triage of factors in improving patient triage accuracy and quality of service under the premise of enhancing outpatient clinic triage guide service efficiency, and ultimately build a convenient, fast and orderly, harmonious treatment environment. Methods A retrospective analysis of our hospital from December 2009 to November 2010 of 400,691 people during the out-patient triage data, the existence of 400,691 people in the total score of 42,879 people attending the impact of errors triage accuracy of the relevant factors Statistical Analysis. Results In this study, carried out triage 400,691 Chinese people, out of which there are 42,879 people attending mistakes, this group of 42 879 times triage mistakes of the factors affecting the classification and statistical analysis. The results show that patients and their families

  14. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring

    Directory of Open Access Journals (Sweden)

    Luis Rafael Moscote-Salazar

    2016-01-01

    Full Text Available Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.

  15. [Scandinavian guidelines for prehospital management of severe traumatic brain injury

    DEFF Research Database (Denmark)

    Sollid, S.; Sundstrom, T.; Kock-Jensen, C.

    2008-01-01

    Head trauma is the cause the death for many young persons. The number of fatalities can be reduced through systematic management. Prevention of secondary brain injury combined with the fastest possible transport to a neurosurgical unit, have been shown to effectively reduce mortality and morbidity....... Evidence-based guidelines already exist that focus on all steps in the process. In the present article members of the Scandinavian Neurotrauma Committee present recommendations on prehospital management of traumatic brain injury adapted to the infrastructure of the Nordic region Udgivelsesdato: 2008/6/26...

  16. [Scandinavian guidelines for prehospital management of severe traumatic brain injury

    DEFF Research Database (Denmark)

    Sollid, S.; Sundstrom, T.; Kock-Jensen, C.

    2008-01-01

    . Evidence-based guidelines already exist that focus on all steps in the process. In the present article members of the Scandinavian Neurotrauma Committee present recommendations on prehospital management of traumatic brain injury adapted to the infrastructure of the Nordic region Udgivelsesdato: 2008/6/26......Head trauma is the cause the death for many young persons. The number of fatalities can be reduced through systematic management. Prevention of secondary brain injury combined with the fastest possible transport to a neurosurgical unit, have been shown to effectively reduce mortality and morbidity...

  17. The introduction of the Manchester triage scale to an emergency department in the Republic of Ireland.

    LENUS (Irish Health Repository)

    Cronin, J G

    2012-02-03

    Triage is an integral part of the modern emergency department. The use of a recognised triage system has many advantages for the emergency department including reference to a recognised decision-making structure and support in the form of a professionally accepted and validated system. As part of a programme of internal change the Manchester triage system (MTS) was introduced to an emergency department in the Republic of Ireland. This article outlines the introduction of this method of triage and cites the domestic and international drivers of the change.

  18. Development and interrater reliability of the UK Mental Health Triage Scale.

    Science.gov (United States)

    Sands, Natisha; Elsom, Stephen; Colgate, Robert; Haylor, Helen; Prematunga, Roshani

    2016-08-01

    Mental health triage scales are clinical tools used at point of entry to specialist mental health service to provide a systematic way of categorizing the urgency of clinical presentations, and determining an appropriate service response and an optimal timeframe for intervention. The aim of the present study was to test the interrater reliability of a mental health triage scale developed for use in UK mental health triage and crisis services. An interrater reliability study was undertaken. Triage clinicians from England and Wales (n = 66) used the UK Mental Health Triage Scale (UK MHTS) to rate the urgency of 21 validated mental health triage scenarios derived from real occasions of triage. Interrater reliability was calculated using Kendall's coefficient of concordance (w) and intraclass correlation coefficient (ICC) statistics. The average ICC was 0.997 (95% confidence interval (CI): 0.996-0.999 (F (20, 1300) = 394.762, P < 0.001). The single measure ICC was 0.856 (95% CI: 0.776-0.926 (F (20, 1300) = 394.762, P < 0.001). The overall Kendall's w was 0.88 (P < 0.001). The UK MHTS shows substantial levels of interrater reliability. Reliable mental health triage scales employed within effective mental health triage systems offer possibilities for not only improved patient outcomes and experiences, but also for efficient use of finite specialist mental health services.

  19. Implementing The Automated Phases Of The Partially-Automated Digital Triage Process Model

    Directory of Open Access Journals (Sweden)

    Gary D Cantrell

    2012-12-01

    Full Text Available Digital triage is a pre-digital-forensic phase that sometimes takes place as a way of gathering quick intelligence. Although effort has been undertaken to model the digital forensics process, little has been done to date to model digital triage. This work discuses the further development of a model that does attempt to address digital triage the Partially-automated Crime Specific Digital Triage Process model. The model itself will be presented along with a description of how its automated functionality was implemented to facilitate model testing.

  20. Ambulatory oncology nurses making the right call: assessment and education in telephone triage practices.

    Science.gov (United States)

    Gleason, Karen; O'Neill, Eileen Brennan; Goldschmitt, Jennifer; Horigan, Jennifer; Moriarty, Linda

    2013-06-01

    Nurses in a hematology/oncology practice are responsible for the triage and management of phone calls from a diverse oncology population. An initiative was developed at the authors' institution to identify the educational needs of RNs while designing strategies to educate and improve telephone triage skills. The goal was to standardize triage practice and ultimately improve the effectiveness of telephone triage management. It was felt that these improvements could enhance the nurse-patient relationship, resulting in continuity of care to the patient, as well as reducing inappropriate appointments and hospitalizations, enhancing education, and lessening the risk of medical complications related to delays in care.

  1. Computerised triage in a prostate assessment clinic.

    Science.gov (United States)

    Rajkumar, G N; Small, D R; Conn, I G

    2004-01-01

    An MS Office package has been developed to score IPSS, take a patient history, compare flows with nomograms and decide on interim management. This is based on these scores, residual volume and laboratory results. A clearly formatted GP letter is produced. The patient uses a touch screen to answer questions on the IPSS and other medical history. These questions and responses are stored in Excel spread sheets. Clinic staff then enter results of flow studies, urinalysis, U&E and PSA. Excel Visual Basic creates a detailed printout for the notes and the MS Office mail merge facility creates a summary printout, which also serves as a letter to the GP. Excel allows embedding of formulae and program code to implement the rules for management. Based on these rules, the program either generates a request for an urgent appointment in the clinic or recommends the use of either an alpha blocker (if not contraindicated by medical history) or 5 alpha reductase inhibitors in the interim period before they are reviewed in clinic. A total of 139 patients have been seen and the computer decisions compared with those of a consultant urologist. Agreement was found in 106, disagreement in 33. However, 21 of the 33 involved computer oversensitivity to flow results. We do not anticipate difficulty improving this and are investigating using an artificial neural network. Of the other 12 patients, the urologist departed from the fixed rules for IPSS, creatinine, PSA and residual urine when only one variable was slightly abnormal. To conclude, this novel user-friendly system shows great potential in the management of prostate outpatients. Some tuning is needed, with particular respect to uroflow results.

  2. Risk profile of walk-in triage compared with an appointment-based phone-triage evening clinic.

    Science.gov (United States)

    Jongeling, S; Chen, M Y; Bush, M R; Bradshaw, C S; Fairley, C K

    2009-02-01

    The aim of this study is to compare risk factors in new clients attending the walk-in triage-based day clinic (WITS) to those attending a telephone-triage appointment-based evening clinic of a sexual health service. The method involves an audit of computerized medical records of new clients attending between July 2002 and December 2007. There were 37,833 new clients of which 37,223 (98.4%) attended WITS and 610 (1.6%) attended the evening clinic. WITS clients were significantly older (31% vs. 30%, P < 0.041), more likely to be male (58% vs. 43%, P < 0.001), sex workers (6% vs. 3%, P < 0.001), not employed (34% vs. 10%, P < 0.001), diagnosed with gonorrhoea (1.7% vs. 0.7%, P < 0.041), herpes (4% vs. 2%, P < 0.000), non-specific urethritis (6% vs. 2%, P < 0.000) and less likely asymptomatic (35.1% vs. 53.4%, P < 0.001). Men attending WITS had significantly more female partners in the 12 months (3.9 vs. 3.0, P < 0.001), but other risks were similar in both clinics. A telephone-triage appointment-based evening clinic is important for asymptomatic high-risk individuals.

  3. Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models

    Directory of Open Access Journals (Sweden)

    Burström Lena

    2012-08-01

    Full Text Available Abstract Background The management of emergency departments (EDs principally involves maintaining effective patient flow and care. Different triage models are used today to achieve these two goals. The aim of this study was to compare the performance of different triage models used in three Swedish EDs. Using efficiency and quality indicators, we compared the following triage models: physician-led team triage, nurse first/emergency physician second, and nurse first/junior physician second. Methods All data of patients arriving at the three EDs between 08:00- and 21:00 throughout 2008 were collected and merged into a database. The following efficiency indicators were measured: length of stay (LOS including time to physician, time from physician to discharge, and 4-hour turnover rate. The following quality indicators were measured: rate of patients left before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days. Results Data from 147,579 patients were analysed. The median length of stay was 158 minutes for physician-led team triage, compared with 243 and 197 minutes for nurse/emergency physician and nurse/junior physician triage, respectively (p  Conclusions Physician-led team triage seemed advantageous, both expressed as efficiency and quality indicators, compared with the two other models.

  4. Design of a Medical Triage Evidence-Based Clinical Management Protocol and Implementation of Medical Triage On-Line Training for Use by Mission of Mercy Volunteers.

    Science.gov (United States)

    Allen, Kimberly D; DiBartolo, Mary C; Welsh, Debra L; Brown, Voncelia

    2015-01-01

    Evidence-based protocols in safety net settings can help standardize care practices, increase organizational workflow, and enhance quality outcomes for those receiving services. The purpose of this quality improvement project is two-fold: to design an evidence-based medical triage clinical management protocol, and, to influence adherence to that protocol by safety net medical triage volunteers through an on-line volunteer orientation. Leadership skills were required to help translate evidence-based practice recommendations into useful tools to assist in directing practice. Project outcomes included successful multidisciplinary practice change, significantly improved volunteer knowledge surrounding medical triage protocol parameters, increased organizational workflow, and enhanced quality client outcomes.

  5. Wireless local area network in a prehospital environment

    Directory of Open Access Journals (Sweden)

    Grimes Gary J

    2004-08-01

    Full Text Available Abstract Background Wireless local area networks (WLANs are considered the next generation of clinical data network. They open the possibility for capturing clinical data in a prehospital setting (e.g., a patient's home using various devices, such as personal digital assistants, laptops, digital electrocardiogram (EKG machines, and even cellular phones, and transmitting the captured data to a physician or hospital. The transmission rate is crucial to the applicability of the technology in the prehospital setting. Methods We created two separate WLANs to simulate a virtual local are network environment such as in a patient's home or an emergency room (ER. The effects of different methods of data transmission, number of clients, and roaming among different access points on the file transfer rate were determined. Results The present results suggest that it is feasible to transfer small files such as patient demographics and EKG data from the patient's home to the ER at a reasonable speed. Encryption, user control, and access control were implemented and results discussed. Conclusions Implementing a WLAN in a centrally managed and multiple-layer-controlled access control server is the key to ensuring its security and accessibility. Future studies should focus on product capacity, speed, compatibility, interoperability, and security management.

  6. Does triage to critical care during a pandemic necessarily result in more survivors?

    Science.gov (United States)

    Utley, Martin; Pagel, Christina; Peters, Mark J; Petros, Andy; Lister, Paula

    2011-01-01

    The 2009 H1N1 pandemic reinforced the need for a planned response to increased demand for critical care. Triage protocols have been proposed incorporating the exclusion of specified subgroups of patients from critical care. There have been no studies that explore the theoretical underpinning of triage at referral, and it is not clear under what circumstances triage would confer the intended benefits. We sought to explore the mechanisms whereby triage could lead to fewer deaths across a critical care population in the context of a pandemic. We constructed a mathematical model based on queuing theory to compare the estimated short-term survival achieved by using a critical care service with and without triage at referral. Illustrative scenarios concerning a hypothetical critical care population were constructed to explore the roles of length of stay and critical care survival in determining the impact of triage and to identify "tipping points" of demand at which triage would result in more survivors. Not applicable as this was a data-free mathematical modeling exercise. We identified circumstances in which triage would be expected to result in more survivors and circumstances in which it would not. In some scenarios, excluding patient groups solely on the basis of anticipated length of stay could be effective due to a more efficient use of critical care bed days. The impact of triage is dependent on the level of demand and on the scale of achievable differences between included and excluded groups in terms of anticipated length of stay and critical care survival. It cannot be assumed that triage can or will result in fewer deaths. It should be remembered that there are considerations other than population-level short-term survival when determining the objectives of triage and its ethical implementation.

  7. Prehospital delay in acute coronary syndrome--an analysis of the components of delay

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian;

    2004-01-01

    more frequently atypical symptoms and increased prehospital delay caused by prolonged physician and transportation delay. Physician delay among women and men were 69 and 16 min, respectively. Patients with prior myocardial infarction had reduced prehospital delay, which was caused by shorter decision...... admitted with acute coronary syndrome is warranted. METHODS: A structured interview was conducted on 250 consecutive patients admitted alive with acute coronary syndrome. RESULTS: Median prehospital, decision, physician and transportation delays were 107, 74, 25 and 22 min, respectively. Women (n=77) had...... of acute coronary syndrome among women, and thereby contributes to unnecessary long delay to treatment. The patient's prior experience and interpretation has a significant influence on behaviour....

  8. [Prehospital stage of medical aid to patients with acute coronary syndrome and elevated ST segment].

    Science.gov (United States)

    Vertkin, A L; Morozov, S N; Fedorov, A I

    2013-01-01

    We studied effect of time on the outcome of acute coronary syndrome and elevated ST segment at the prehospital stage. Logistic regression analysis revealed two time-dependent predictors: "symptom-needle" time and total call service time. In patients undergoing prehospital thrombolysis, these indices (88 and 85 min respectively) reliably predicted the probability of fatal outcome. Their values of 71 and 77 min respectively predicted the risk of unfavourable outcome. The total call service time may serve as an indicator of the quality of work of an ambulance crew at the prehospital stage of management of acute coronary syndrome with elevated ST segment.

  9. A pilot study of quality of life in German prehospital emergency care physicians

    Directory of Open Access Journals (Sweden)

    Michael Sand

    2016-01-01

    Full Text Available Background: Quality of life in patients represents an important area of assessment. However, attention to health professionals should be equally important. The literature on the quality of life (QOL of emergency physicians is scarce. This pilot study investigated QOL in emergency physicians in Germany. Materials and Methods: We conducted a cross-sectional study from January to June in 2015. We approached the German Association of Emergency Medicine Physicians and two of the largest recruitment agencies for emergency physicians in Germany and invited their members to participate. We used the WHO Q-BREF to obtain QOL scores in four domains that included physical, mental, social, and environmental health. Results: The 478 German emergency physicians included in the study held board certifications in general medicine (n = 40; 8.4%, anesthesiology (n = 243; 50.8%, surgery (n = 63; 13.2%, internal medicine (n = 81; 17.0%, or others (n = 51; 10.7%. The women surveyed tended to report a better QOL but worse general health than the men. Regarding specific domains, women scored worse in physical health, particularly energy during everyday work (relative risk ratio [RRR]: 1.98 [1.21–3.24]. Both men and women scored worse in psychological health than general health, particularly young women. Women were also more likely to view their safety (RRR: 1.87 [1.07–3.28] and living place (RRR: 2.51 [1.10–5.73] as being poor than their male counterparts. Conclusion: QOL in German prehospital emergency care physicians is satisfactory for the included participants; however, there were some negative effects in the psychological health domain. This is particularly obvious in young female emergency physicians.

  10. The South African triage scale (adult version provides valid acuity ratings when used by doctors and enrolled nursing assistants

    Directory of Open Access Journals (Sweden)

    Michèle Twomey

    2012-03-01

    Conclusion: The results of this study fall within the accepted range of over-/under-triage and indicate that the South African Triage Scale is valid when used by emergency physicians and nurses to triage emergency centre vignettes under South African conditions. Further research into appropriate reference ranges for extent of over-/under-triage and over-/under-prediction within each acuity level is recommended.

  11. Anesthesia with topical lidocaine hydrochloride gauzes in acute traumatic wounds in triage, a pilot study.

    Science.gov (United States)

    Ridderikhof, Milan L; Leenders, Noukje; Goddijn, Helma; Schep, Niels W; Lirk, Philipp; Goslings, J Carel; Hollmann, Markus W

    2016-09-01

    Topical application of lidocaine in wounds has been studied in combination with vasoconstrictive additives, but the effect without these additives is unknown. The objective was to examine use of lidocaine-soaked gauzes without vasoconstrictive agents, in traumatic wounds in adult patients, applied in triage. A prospective pilot study was performed during 6 weeks in the Emergency Department of a level 1 trauma center. Wounds of consecutive adult patients were treated with a nursing protocol, consisting of lidocaine hydrochloride administration directly into the wound and leaving a lidocaine-soaked gauze, until wound treatment. Primary outcome was need for infiltration anesthesia. Secondary outcomes were Numerical Rating Scale (NRS) pain scores, adverse events and patient and physician satisfaction. Forty patients with a traumatic wound were included, 85% male with a wound on the arm. Thirty-seven patients needed a painful procedure as wound treatment. When suturing was necessary, 77% required additional infiltration anesthesia. Mean NRS pain scores decreased from 3.3 to 2.2 after application of the lidocaine gauze. No adverse events were recorded. Of the patients, 60% were satisfied with use of the lidocaine gauzes, compared to 40% of physicians. Lidocaine hydrochloride (2%) gauzes without vasoconstrictive additives cannot replace infiltration anesthesia in traumatic wounds. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Triage medfører hurtigere behandling af de mest syge

    DEFF Research Database (Denmark)

    Skriver, Claus; Lauritzen, Marlene Mauson Pankoke; Forberg, Jakob Lundager;

    2011-01-01

    Systematic process triage is a relatively unknown concept in Denmark. Currently there are no national recommendations regarding triage models for use in the emergency department (ED). Four medium-sized EDs from different regions across the country cooperated in a joint venture to develop a new...

  13. Triage of febrile children at a GP cooperative : determinants of a consultation

    NARCIS (Netherlands)

    Monteny, Miriam; Berger, Marjolein Y.; van der Wouden, Johannes C.; Broekman, Berth J.; Koes, Bart W.

    2008-01-01

    Background Most febrile children contacting a GP cooperative are seen by a GP, although the incidence of serious illness is low. The guidelines for triage might not be suitable in primary care. Aim To investigate the determinants related to the outcome of triage in febrile children. Design of study

  14. Calibrating Urgency: Triage Decision-Making in a Pediatric Emergency Department

    Science.gov (United States)

    Patel, Vimla L.; Gutnik, Lily A.; Karlin, Daniel R.; Pusic, Martin

    2008-01-01

    Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information.…

  15. [How to implement a unique triage system in the emergency departments of Latium, Italy].

    Science.gov (United States)

    De Luca, A; Francia, C; Gabriele, S; Guasticchi, G

    2008-01-01

    Triage is an efficient system that emergency departments (EDs) use to sort out presenting patients on the basis of the speed with which they need treatment. Because triage is not used consistently in the EDs of Latium, a region in central Italy, the regional Public Health Agency (PHA) planned and implemented a regional model of triage in all EDs. This manuscript describe the regional implementation strategy. The PHA activated the "Regional Triage Program--RTP" including: development and testing of a "triage section" in the computerized EDs clinical chart; production of an operational handbook for the RTP for triage health professionals (HPs); implementation of an continuum educational program on the "RTP" in all EDs of Latium. The computerized triage section was tested and implemented in all EDs in the region. The handbook for triage HPs was produced. The educational program, has been ongoing since 2008 in all regional EDs. Selected HPs, identified as "facilitators", were trained on how to implement the RTP. They will organize, in their own EDs, small groups of nurses to conduct on-site training of the RTP. The RTP was received with enthusiasm by most HPs, however its introduction into current practice could be hampered by organizational/structural problems and conflicts between nurses and doctors. Next actions of the regional program will be to overcome the possible above mentioned troubles.

  16. Characterization of trauma patients treated in a pre-hospital care service

    Directory of Open Access Journals (Sweden)

    Amanda de Ornelas Carvalho

    2004-09-01

    Full Text Available Objectives: To identify the characteristics of trauma patientstreated in a pre-hospital care service, to characterize the factorsrelated to the trauma event and quantify the severity of trauma,according to the Revised Trauma Score. Methods: This is adescriptive, exploratory, retrospective study carried out at thePre-Hospital Care Service of the Military Police - Rescue in thecity of São Paulo. Data comprised a randomized sample of 60nursing charts, distributed among the four advanced life supportunits in the city. Results: Of the occurrences dealt with, 65% arerelated to public streets, 20% are medical cases, 65% are maleindividuals, predominantly young adults. The predominantmechanisms of trauma are crash and run-over. Casa Verde wasthe care unit which obtained the highest Revised Trauma Scoreweighted mean. Conclusions: The results presented here are inconformity with the national statistics on trauma: young adults, ofworking age, involved in road accidents are most frequentlyaffected. Identifying this population is of utmost importance forthe development of preventive and educational measures.

  17. Score Correlation

    OpenAIRE

    Fabián, Z. (Zdeněk)

    2010-01-01

    In this paper, we study a distribution-dependent correlation coefficient based on the concept of scalar score. This new measure of association of continuous random variables is compared by means of simulation experiments with the Pearson, Kendall and Spearman correlation coefficients.

  18. SETTING UP TRIAGE SERVICES IN THE EMERGENCY DEPARTMENT: EXPERIENCE FROM A TERTIARY CARE INSTITUTE OF PAKISTAN. A JOURNEY TOWARD EXCELLENCE.

    Science.gov (United States)

    Khursheed, Munawar; Fayyaz, Jabeen; Jamil, Ahsan

    2015-01-01

    The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing the ED overcrowding. The history of triage at AKUH-ED dated back in 2000. In the beginning physicians and nurse both were assigned to triage desk where they use to sort out the patient according to presenting complaints. At that time the documentation was manual with locally developed triage priorities. With the expansion of ED in 2008, responsibility of triage was shifted to nursing services. Triage policy was established and implemented. Specific triage protocols were developed for guidance and uniformity of care. Manual recording system was replaced by computerized triage data entry software. Enabling the department to monitor patient quality care indicators like total number of patients triaged, triage category, lag time reports and left without being seen by physicians.

  19. Serological biomarkers in triage of FIT-positive subjects?

    DEFF Research Database (Denmark)

    Nielsen, Hans J; Christensen, Ib Jarle; Andersen, Berit

    2017-01-01

    that nucleosome blood tests may be one option for identifying some of these patients. Implementation of a triage test consisting of FIT, blood-based biomarkers and plus/minus colonoscopy is suggested to identify subjects with FIT levels between the initial and the increased cut-off level that must be offered...... with neoplastic lesions missed by increased cut-off levels appears to be much higher than expected. Therefore, tests that identify those patients missed by increased FIT cut-off levels must be developed. Preliminary results of determination of one of several biomarker entities currently under investigation show...

  20. Development of an obstetrics triage tool for clinical pharmacists.

    Science.gov (United States)

    Covvey, J R; Grant, J; Mullen, A B

    2015-06-25

    Obstetrics services are a high-throughput and high-risk environment poised for pharmacist involvement, but determining how to ideally allocate services is difficult. There is recent interest in the development of tools for service prioritization, but none are specifically targeted to obstetrics. Therefore, the aim of this study was (i) to conduct a practice audit surveying the demographics of patients attending obstetrics wards at a high-capacity maternity hospital; and (ii) to evaluate a triage tool developed to prioritize pharmacy services. A retrospective case review of women discharged after birth admissions was undertaken at a hospital in National Health Service (NHS) Scotland during June 2014. Demographic and admission data were collected, as well as pharmacist interventions and missed opportunities in patient care on post-natal wards. A pharmacy triage tool was developed and retrospectively applied to each case to ascertain a risk category that would trigger and target pharmacist review. Interventions/opportunities were classified as either clinical (medication related) or administrative (potential for error development). One hundred and seventy-five cases were reviewed with a median age of 29 years old. Eighty-six patients (49·1%) were retrospectively classified with elevated risk using the triage tool. A total of 117 charts (66·9%) were identified with missed opportunities for pharmacist intervention, which was significantly greater among patients classified as higher risk (75·6 vs. 58·4%, P = 0·017). Compared to low-risk patients, patients with a higher-risk classification had lower rates of administrative missed opportunities (55·4 vs. 80·8%, P = 0·015), but numerically higher rates of clinical (26·2 vs. 9·6%, p=NS) and mixed clinical/administrative (18·5 vs. 9·6%, p=NS) missed opportunities, although this failed to reach statistical significance. Evaluation of a triage tool for obstetric services demonstrated potential for prioritizing

  1. 固定专科护士分诊对分诊质量的影响%Impact of fixed specialist nurse triage on the quality of triage

    Institute of Scientific and Technical Information of China (English)

    李春联; 王志巧; 程晓桃; 黄丽清; 林小玲

    2013-01-01

    目的 探讨固定专科护士分诊对提高门诊分诊质量的影响.方法 将分诊护士分为固定专科护士组(A组)和门诊部轮转护士组(B组),每组分别对内科门诊就诊患者进行分诊5d,然后对2组分诊错误人数和医生平均每日超时数进行比较.结果 A组分诊3806人,分诊错误165人,B组分诊3812人,分诊错误308人;A组医生平均每日超时(5.24±0.37)h,B组医生平均每日超时(8.16±0.58)h,2组在分诊错误、医生平均每日超时数比较差异有统计学意义.结论 固定专科护士分诊能明显提高门诊分诊质量.%Objective To investigate the influence of fixed nurse specialists triage to improve the quality of patient triage.Methods Nurses were divided into the fixed nurse specialist triage group (group A) and the out-patient department rotation nursing group (group B),respectively,each group was responsible for triage of patients in clinic of medical department for five days.Then the number of two subdiagnosis error and the average daily working overtime for doctors were compared.Results A total of 3806 patients were in clinic triage in group A,165 patients had triage error.A total of 3812 patients were in clinic triage in group B,308 patients had triage error.The average daily working overtime of doctors in group A was(5.24 ± 0.37)hours,and(8.16 ± 0.58) hours in group B.The errors in triage and working overtime of doctors had significant differences between two groups.Conclusions Fixed specialist nurse triage can significantly improve the quality of patient triage in clinic.

  2. Inter-rater agreement of the triage system RETTS-HEV

    DEFF Research Database (Denmark)

    Larsen, Louise Pape; Kirkegaard, Hans; Nissen, Louise;

    2014-01-01

    Objective The purpose of this study was to evaluate the inter-rater agreement among nurses using the triage system RETTS-HEV (rapid emergency triage and treatment system – hospital unit west) in a Danish emergency department (ED). Background The use of triage systems in Denmark has been implemented...... presenting to the ED were assessed by both a duty and a study nurse using RETTS-HEV. Nurses did not receive training before the study. In all, 146 patients were enroled and a blinded, paired and simultaneous triage was conducted independently to evaluate inter-rater agreement using Fleiss j. Results A total...... recently together with structural changes in hospital organization. Testing and evaluation is therefore needed. The RETTS-HEV is a five-scale triage system being used in the ED of Herning, Denmark, since May 2010. The ED is semilarge, with 29 000 annual visits. Materials and methods Consecutive patients...

  3. pre-hospital management of febrile seizures in children seen at the ...

    African Journals Online (AJOL)

    appropriate health education to reduce the morbidity and mortality associated with ... parents/caregivers of children with febrile seizures and the maternal .... consequences of harmful traditional pre-hospital treatment of .... The natural history of.

  4. Pre-hospital management of mass casualty civilian shootings: a systematic literature review

    National Research Council Canada - National Science Library

    Turner, Conor D. A; Lockey, David J; Rehn, Marius

    2016-01-01

    .... This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice...

  5. The value of the pre-hospital learning environment as part of the emergency nursing programme

    Directory of Open Access Journals (Sweden)

    Sonett van Wyk

    2015-06-01

    Conclusion: The research findings support the value and continuation of utilising the pre-hospital clinical learning environment for placing post-basic emergency nursing students when enrolled in the emergency nursing programme.

  6. Prehospital Pediatric Care: Opportunities for Training, Treatment, and Research.

    Science.gov (United States)

    Drayna, Patrick C; Browne, Lorin R; Guse, Clare E; Brousseau, David C; Lerner, E Brooke

    2015-01-01

    Pediatric transports comprise approximately 10% of emergency medical services (EMS) requests for aid, but little is known about the clinical characteristics of pediatric EMS patients and the interventions they receive. Our objective was to describe the pediatric prehospital patient cohort in a large metropolitan EMS system. This retrospective analysis of all pediatric (age Pox), and respiratory effort. We defined abnormal vital signs using previously reported age-specific standards. We identified the working assessments most frequently associated with abnormal vital signs and the working assessments associated with the most commonly performed interventions. Data were analyzed using descriptive statistics. There were 9,956 pediatric transports, 8.7% of the total call volume. The most common working assessments were "other" (16.1%), respiratory distress (13.7%), seizure (12.4%), and blunt trauma (12.0%). Vital signs were documented at variable rates: RR (91.1%), GCS (82.9%), SBP (71.3%), pulse (69.4%), respiratory effort (49.7%), and Pox (33.5%). Of all transported patients, 61.5% had a documented abnormal initial vital sign. Patients with an abnormal vital sign had the same most common working assessments as those with normal vital signs. Glucometry (16.9%), medication delivery (13.6%), and IV placement (11.5%) were the most common interventions and were most often provided to patients with working assessments of seizure, asthma, trauma, altered consciousness, or "other." Cardiopulmonary resuscitation (0.4%), bag mask ventilation (0.4%), and advanced airway (0.4%) occurred rarely and were most often performed for cardiac arrest and trauma. Children made up a small part of EMS providers' clinical practice; those encountered most frequently had respiratory distress, seizures, trauma, or an undefined assessment (i.e., "other"). EMS providers frequently encounter children with physiologic evidence of acute illness, although vital sign documentation was incomplete

  7. Inter-Rater Agreement of Emergency Nurses and Physicians in Emergency Severity Index (ESI Triage

    Directory of Open Access Journals (Sweden)

    Mehrdad Esmailian

    2014-09-01

    Full Text Available Introduction: Triage is one of the most important systems in patients prioritizing at the time of arrival to hospital. Based on the severity of the injury and the need for treatment, this system manages patients in the least time which could lead to rotation of patients with high reliability and safety. Currently, the most accepted method for triage is emergency severity index (ESI system, considered as five-level triage method, too. This method were implemented in Al Zahra Hospital of Isfahan by trained nurses since March to May 2010. This study was aimed to evaluate the accuracy of emergency nursing triage using ESI. Methods: This prospective cross sectional study was carried out on 601 patients referred to Al-Zahra hospital of Isfahan through May 2010. The patients’ triage level were determined by physicians and nurses separately and the results compared. To define the level of agreement between two groups (inter-rater agreement, the kappa index was evaluated. To specify the association between the time interval of initial triage and patient final status, Chi-Square test was applied using SPSS 18 statistical software. Results: There was no significant difference between results of nurses and physicians triage (P<0/0001. The agreement level (kappa index between two groups was 94% (95% CI: 0.931-0.957. Of 601 patients, 44.1% ones were hospitalized at the emergency department, 52.6% discharged and 3.3% died. The average of time interval between nursing triage and physician visit was 9.55 minutes at the level one triage, 21.64 minutes at level two, 26.03 minutes at level three, 26.93 minutes at level four, and 11.70 minutes at level five. Conclusion: It seems that there is an acceptable inter-rater agreement between emergency nurses and physicians regarding patients’ triage in terms of ESI system.

  8. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Adeloye A. Adeniji

    2016-03-01

    Full Text Available Background: In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience.Aim: This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting: Gugulethu Community Health Centre, Cape Town.Methods: A purposive sample consisted of five women (one coded green, three orange, one yellow and four men (one coded green and three yellow. A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method.Results: All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue.Conclusion: Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened.Keywords: emergency care; primary care; triage; patient satisfaction

  9. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Adeloye A. Adeniji

    2016-03-01

    Full Text Available Background: In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience.Aim: This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting: Gugulethu Community Health Centre, Cape Town.Methods: A purposive sample consisted of five women (one coded green, three orange, one yellow and four men (one coded green and three yellow. A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method.Results: All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue.Conclusion: Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened.Keywords: emergency care; primary care; triage; patient satisfaction

  10. Novel wireless electroencephalography system with a minimal preparation time for use in emergencies and prehospital care

    OpenAIRE

    Jakab, Andrei; Kulkas, Antti; Salpavaara, Timo; Kauppinen, Pasi; Verho, Jarmo; Heikkilä, Hannu; Jäntti, Ville

    2014-01-01

    Background Although clinical applications such as emergency medicine and prehospital care could benefit from a fast-mounting electroencephalography (EEG) recording system, the lack of specifically designed equipment restricts the use of EEG in these environments. Methods This paper describes the design and testing of a six-channel emergency EEG (emEEG) system with a rapid preparation time intended for use in emergency medicine and prehospital care. The novel system comprises a quick-applicati...

  11. Personal protective equipment provision in prehospital care: a national survey.

    Science.gov (United States)

    Krzanicki, D A; Porter, K M

    2009-12-01

    Safety in prehospital practice is a paramount principle. Personal protective equipment (PPE) use is intrinsic to safe practice. There is varied guidance as to what constitutes effective PPE. No evidence is available of what current provision encompasses. A questionnaire-based study directed to all ambulance trusts, British Association for Immediate Care (BASICS) schemes and air ambulance operations in England, Scotland and Wales. Total response rate was in excess of 66%. A specific protocol for PPE use was issued by 81%, 89% and 38% of ambulance trusts, air ambulance and BASICS schemes, respectively. There was a wide variation in provision of PPE both within and between different groups of providers. Fewer than 55% of providers had an evaluation system in place for reviewing PPE use. Many reasons account for the differences in provision. There is a clear need for a standard to be set nationally in conjunction with locally implemented evaluation and re-accreditation processes.

  12. Influence of The Education and Training of Prehospital Medical Crews on Measures of Performance and Patient Outcomes

    OpenAIRE

    Blomberg, Hans

    2013-01-01

    Prehospital care has developed dramatically the last decades with the implementation of new devices and educational concepts. Clinical decisions and treatments have moved out from the hospitals to the prehospital setting. In Sweden this has been accompanied by an increase in the level of competence, i.e. by introducing nurses in the ambulances. With some exceptions the scientific support for these changes is poor. This thesis deals with such changes in three different subsets of prehospital c...

  13. Influence of The Education and Training of Prehospital Medical Crews on Measures of Performance and Patient Outcomes

    OpenAIRE

    Blomberg, Hans

    2013-01-01

    Prehospital care has developed dramatically the last decades with the implementation of new devices and educational concepts. Clinical decisions and treatments have moved out from the hospitals to the prehospital setting. In Sweden this has been accompanied by an increase in the level of competence, i.e. by introducing nurses in the ambulances. With some exceptions the scientific support for these changes is poor. This thesis deals with such changes in three different subsets of prehospital c...

  14. Accurate triage of lower gastrointestinal bleed (LGIB) - A cohort study.

    Science.gov (United States)

    Chong, Vincent; Hill, Andrew G; MacCormick, Andrew D

    2016-01-01

    Acute lower gastrointestinal bleeding (LGIB) is a common acute presenting complaint to hospital. Unlike upper gastrointestinal bleeding, the diagnostic and therapeutic approach is not well-standardised. Intensive monitoring and urgent interventions are essential for patients with severe LGIB. The aim of this study is to investigate factors that predict severe LGIB and develop a clinical predictor tool to accurately triage LGIB in the emergency department of a busy metropolitan teaching hospital. We retrospectively identified all adult patients who presented to Middlemore Hospital Emergency Department with LGIB over a one year period. We recorded demographic variables, Charlson Co-morbidities Index, use of anticoagulation, examination findings, vital signs on arrival, laboratory test results, treatment plans and further investigations results. We then identified a subgroup of patients who suffered severe LGIB. A total of 668 patients presented with an initial triage diagnosis of LGIB. 83 of these patients (20%) developed severe LGIB. Binary logistic regression analysis identified four independent risk factors for severe LGIB: use of aspirin, history of collapse, haemoglobin on presentation of less than 100 mg/dl and albumin of less than 38 g/l. We have developed a clinical prediction tool for severe LGIB in our population with a negative predictive value (NPV) of 88% and a positive predictive value (PPV) of 44% respectively. We aim to validate the clinical prediction tool in a further cohort to ensure stability of the multivariate model. Copyright © 2015. Published by Elsevier Ltd.

  15. Advanced airway management is necessary in prehospital trauma patients.

    Science.gov (United States)

    Lockey, D J; Healey, B; Crewdson, K; Chalk, G; Weaver, A E; Davies, G E

    2015-04-01

    Treatment of airway compromise in trauma patients is a priority. Basic airway management is provided by all emergency personnel, but the requirement for on-scene advanced airway management is controversial. We attempted to establish the demand for on-scene advanced airway interventions. Trauma patients managed with standard UK paramedic airway interventions were assessed to determine whether airway compromise had been effectively treated or whether more advanced airway management was required. A prospective observational study was conducted to identify trauma patients requiring prehospital advanced airway management attended by a doctor-paramedic team. The team assessed and documented airway compromise on arrival, interventions performed before and after their arrival, and their impact on airway compromise. Four hundred and seventy-two patients required advanced airway intervention and received 925 airway interventions by ground-based paramedics. Two hundred and sixty-nine patients (57%) still had airway compromise on arrival of the enhanced care team; no oxygen had been administered to 52 patients (11%). There were 45 attempted intubations by ground paramedics with a 64% success rate and 11% unrecognized oesophageal intubation rate. Doctor-paramedic teams delivering prehospital anaesthesia achieved definitive airway management for all patients. A significant proportion of severely injured trauma patients required advanced airway interventions to effectively treat airway compromise. Standard ambulance service interventions were only effective for a proportion of patients, but might not have always been applied appropriately. Complications of advanced airway management occurred in both provider groups, but failed intubation and unrecognized oesophageal intubation were a particular problem in the paramedic intubation group. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions

  16. [Prehospital analgesia by emergency physicians and paramedics : Comparison of effectiveness].

    Science.gov (United States)

    Schempf, B; Casu, S; Häske, D

    2017-05-01

    In some German emergency medical service districts, analgesia is performed by paramedics without support of emergency physicians on scene. With regard to safety and effectiveness, paramedics should not be overshadowed by emergency physicians. Is prehospital analgesia performed by paramedics under medical supervision or emergency physicians comparable regarding processes and effectiveness in the case of isolated limb injury? As a retrospective analysis of patients with isolated limb injury, analgesia performed by paramedics and by emergency physicians was analyzed. In addition to pain reduction, prescribed monitoring, and further airway maneuvers, vital parameters (Glasgow coma scale, systolic blood pressure, heartrate and respiratory rate, oxygen saturation) were recorded at the beginning and end of prehospital treatment. Pain was reduced from NRS 8 ± 1 to NRS 2 ± 1 in the paramedic group, and from NRS 8 ± 2 to NRS 2 ± 2 in the physician group, so the mean pain reduction was 6 ± 2 in the paramedic-group and 5 ± 2 in the physician group (p < 0.001). Adequate analgesia was found in 96.9% in the physician group and 91.7% in the paramedic group (p = 0.113). ECG monitoring and oxygen administration according to SOP was significantly more frequent in the paramedic group than in the physician group (p < 0.001). Respiratory frequency was significantly more frequent in the physician group than in the paramedic group (p < 0.001). The study shows, with a given indication, that German paramedics can independently perform safe and successful analgesia under medical supervision.

  17. Diagnostic Accuracy of Cincinnati Pre-Hospital Stroke Scale

    Directory of Open Access Journals (Sweden)

    Behzad Zohrevandi

    2015-07-01

    Full Text Available Introduction: Stroke is recognized as the third cause of mortality after cardiovascular and cancer diseases, so that lead to death of about 5 million people, annually. There are several scales to early prediction of at risk patients and decreasing the rate of mortality by transferring them to the stroke center. In the present study, the accuracy of Cincinnati pre-hospital stroke scale was assessed. Methods: This was a retrospective cross-sectional study done to assess accuracy of Cincinnati scale in prediction of stroke probability in patients referred to the emergency department of Poursina Hospital, Rasht, Iran, 2013 with neurologic symptoms. Three criteria of Cincinnati scale including facial droop, dysarthria, and upper extremity weakness as well as the final diagnosis of patients were gathered. Sensitivity, specificity, predictive values, and likelihood ratios of Cincinnati scale were calculated using SPSS version 20. Results: 448 patients were assessed. The agreement rate of Cincinnati scale and final diagnosis was 0.483 ± 0.055 (p<0.0001. The sensitivity of 93.19% (95% Cl: 90.11-95.54, specificity of 51.85% (95% Cl: 40.47-63.10, positive predictive value of 89.76% (95% Cl: 86.27-92.62, negative predictive value of 62.69% (95% Cl: 55.52-72.45, positive likelihood ratio of 1.94% (95% Cl: 1.54-2.43, and negative likelihood ratio of 0.13% (95% Cl: 0.09-0.20 were calculated. Conclusion: It seems that pre-hospital Cincinnati scale can be an appropriate screening tool in prediction of stroke in patients with acute neurologic syndromes.

  18. Mixed-methods approach for measuring the impact of video telehealth on outpatient clinic triage nurse workflow.

    Science.gov (United States)

    Cady, Rhonda G; Finkelstein, Stanley M

    2013-09-01

    Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing the efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed-methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage did, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests that the increased depth and breadth of data available during video triage alter the assessment that triage nurses provide physicians. This in turn could affect the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area.

  19. The mean prehospital machine; accurate prehospital non-invasive blood pressure measurement in the critically ill patient.

    Science.gov (United States)

    Muecke, Sandy; Bersten, Andrew; Plummer, John

    2010-06-01

    Non-invasive blood pressure recordings may be inaccurate in the critically ill patient and measurement difficulties are intensified in the prehospital setting. This may adversely impact upon outcomes for many critically ill patients, particularly those with traumatic brain injury and/or lengthy prehospital times. This study aimed to validate a non-invasive, oscillometric, ambulatory blood pressure measuring device, the Oscar 2, Model 222 (SunTech Medical, Morrisville, USA) during the ambulance transport of critically ill patients. We have previously shown that mean arterial blood pressures observed by Intensive Care Unit nurses from a patient monitor can be considered interchangeable with reference intra-arterial integrated mean pressures. In the current study, we compared non-invasive device mean pressures to intra-arterial pressures observed by retrieval nurses from the patient monitor, during the ambulance transportation of critically ill patients. Device performance was required to fulfil the Association for the Advancement of Medical Instrumentation (AAMI) protocol requirements. Additionally, linear mixed effects analyses and Bland-Altman comparisons were undertaken. For 157 measurements recorded from 23 patients, when the Oscar 2 did not indicate a measurement was associated with a fault, the device fulfilled the AAMI protocol requirements, with a mean error of -1.1 mmHg (standard deviation 7.8 mmHg), 95% confidence intervals (linear mixed effects analysis) -2.9, 0.8; P = 0.26. Bland-Altman plots indicated uniform agreement across a wide range of blood pressures. Sixteen percent of recordings were associated with a patient, environment, or device generated fault. When the Oscar 2 does not indicate a fault has occurred, clinicians may be confident the mean pressure, within acceptable limits, is accurate, even during ambulance motion, administration of high doses of vasopressors and mechanical ventilation. The Oscar 2 appears to be an accurate and rugged out

  20. Sepsis Alert - a triage model that reduces time to antibiotics and length of hospital stay.

    Science.gov (United States)

    Rosenqvist, Mari; Fagerstrand, Emma; Lanbeck, Peter; Melander, Olle; Åkesson, Per

    2017-07-01

    To study if a modified triage system at an Emergency Department (ED) combined with educational efforts resulted in reduced time to antibiotics and decreased length of hospital stay (LOS) for patients with severe infection. A retrospective, observational study comparing patients before and after the start of a new triage model at the ED of a University Hospital. After the implementation of the model, patients with fever and abnormal vital signs were triaged into a designated sepsis line (Sepsis Alert) for rapid evaluation by the attending physician supported by a infectious diseases (IDs) specialist. Also, all ED staff participated in a designated sepsis education before Sepsis Alert was introduced. Medical records were evaluated for patients during a 3-month period after the triage system was started in 2012, and also during the corresponding months in 2010 and 2014. A total of 1837 patients presented with abnormal vital signs. Of these, 221 patients presented with fever and thus at risk of having severe sepsis. Among patients triaged according to the new model, median time to antibiotics was 58.5 at startup and 24.5 minutes at follow-up two years later. This was significantly less than for patients treated before the new model, 190 minutes. Also, median LOS was significantly decreased after introduction of the new triage model, from nine to seven days. A triage model at the ED with special attention to severe sepsis patients, led to sustained improvements of time to antibiotic treatment and LOS.

  1. A quantitative analysis of the benefits of pre-hospital infarct angioplasty triage on outcome in patients undergoing primary angioplasty for acute myocardial infarction

    NARCIS (Netherlands)

    van 't Hof, AWJ; van de Wetering, H; Ernst, N; Hollak, F; de Pooter, F; Suryapranata, H; Hoorntje, JCA; Gosselink, M; Zijlstra, F; de Boer, MJ; Dambrink, Jan Hendrik Everwijn

    2005-01-01

    Primary coronary angioplasty has been shown to be a very effective reperfusion modality in patients with acute myocardial infarction (MI). However, the time from diagnosis to therapy is often very long, often due to interhospital transfer of the patient. This study evaluates the effect of improving

  2. Adoption of the 2006 Field Triage Decision Scheme for Injured Patients

    Directory of Open Access Journals (Sweden)

    Sasser, Scott

    2011-07-01

    Full Text Available Background: When emergency medical services (EMS providers respond to the scene of an injury, they must decide where to transport the injured patients for further evaluation and treatment. This is done through a process known as “field triage”, whereby a patient’s injuries are matched to the most appropriate hospital. In 2005-2006 the National Expert Panel on Field Triage, convened by the Centers for Disease Control and Prevention and the National Highway Traffic Safety Administration, revised the 1999 American College of Surgeons Committee on Trauma Field Triage Decision Scheme. This revision, the 2006 Field Triage Decision Scheme, was published in 2006.Methods: State Public Health departments’ and EMS’ external websites were evaluated to ascertain the current status of implementation of the 2006 Field Triage Decision Scheme.Results: Information regarding field triage was located for 41 states. In nine states no information regarding field triage was available on their websites. Of the 41 states where information was located, seven were classified as “full adopters” of the 2006 Field Triage Decision Scheme; nine were considered “partial adopters”; 17 states were found to be using a full version or modification of the 1999 Field Triage Decision Scheme; and eight states were considered to be using a different protocol or scheme for field triage.Conclusion: Many states have adopted the 2006 Decision Scheme (full or partial. Further investigation is needed to determine the reasons why some states do not adopt the guidelines. [West J Emerg Med. 2011;12(3:275-283.

  3. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale.

    Science.gov (United States)

    Pérez de la Ossa, Natalia; Carrera, David; Gorchs, Montse; Querol, Marisol; Millán, Mònica; Gomis, Meritxell; Dorado, Laura; López-Cancio, Elena; Hernández-Pérez, María; Chicharro, Vicente; Escalada, Xavier; Jiménez, Xavier; Dávalos, Antoni

    2014-01-01

    We aimed to develop and validate a simple prehospital stroke scale to predict the presence of large vessel occlusion (LVO) in patients with acute stroke. The Rapid Arterial oCclusion Evaluation (RACE) scale was designed based on the National Institutes of Health Stroke Scale (NIHSS) items with a higher predictive value of LVO on a retrospective cohort of 654 patients with acute ischemic stroke: facial palsy (scored 0-2), arm motor function (0-2), leg motor function (0-2), gaze (0-1), and aphasia or agnosia (0-2). Thereafter, the RACE scale was validated prospectively in the field by trained medical emergency technicians in 357 consecutive patients transferred by Emergency Medical Services to our Comprehensive Stroke Center. Neurologists evaluated stroke severity at admission and LVO was diagnosed by transcranial duplex, computed tomography, or MR angiography. Receiver operating curve, sensitivity, specificity, and global accuracy of the RACE scale were analyzed to evaluate its predictive value for LVO. In the prospective cohort, the RACE scale showed a strong correlation with NIHSS (r=0.76; P<0.001). LVO was detected in 76 of 357 patients (21%). Receiver operating curves showed a similar capacity to predict LVO of the RACE scale compared with the NIHSS (area under the curve 0.82 and 0.85, respectively). A RACE scale≥5 had sensitivity 0.85, specificity 0.68, positive predictive value 0.42, and negative predictive value 0.94 for detecting LVO. The RACE scale is a simple tool that can accurately assess stroke severity and identify patients with acute stroke with large artery occlusion at prehospital setting by medical emergency technicians.

  4. Applying Lean: Implementation of a Rapid Triage and Treatment System

    Directory of Open Access Journals (Sweden)

    Murrell, Karen L

    2011-05-01

    Full Text Available Objective: Emergency department (ED crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS. Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT system affected ED metrics in our community hospital.Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system.Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.2-4.3; standard deviation [SD] = 3.9 than after (3.6 hours, 95% CI = 3.6-3.7; SD = 3.7. Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.5-63.0; SD = 58.9 prior to RTT and 41.9 minutes (95% CI = 41.5-42.4; SD = 30.9 after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.1-5.5 and 1.5% (95% CI = 0.6-1.8 after RTT initiation.Conclusion: Our experience shows that changes in ED processes using Lean thinking and available resources can improve efficiency. In this community hospital ED, use of an RTT system decreased patient wait times and LWBS rates. [West J Emerg Med. 2011;12(2:184-191.

  5. DEVELOPMENT OF IT TRIAGE SYSTEM (TRACY) TO SHARE REGIONAL DISASTER MEDICAL INFORMATION

    Science.gov (United States)

    Numada, Muneyoshi; Hada, Yasunori; Ohara, Miho; Meguro, Kimiro

    We developed an IT triage system for collecting disaster medical information in real time. FeliCa cards and card readers are used to obtain the number and cond ition of patients. The system is composed of two elements. First, the number of patie nts for each triage level and the accepted number of patients in each diagnosis and treatment department are obtained in real time, including response for changing triage level. Second, this information can be shared among hospitals, the administration, and residents in real time who are searching for their family. A disaster drill utiliz ing this system was held at the University of Yamanashi Hospital with 450 participants.

  6. Triage-hoitajan toiminan kehittäminen päivystyspoliklinikalla

    OpenAIRE

    Eronen, Jenni

    2012-01-01

    Tämän tutkimuksen tarkoituksena oli kuvata triage-hoitajien näkemyksiä triage-toiminnan toteutumista organisaatiossaan, sekä mahdollisista kehittämisehdotuksista. Tutkimus on tärkeä, koska sen avulla voidaan triage-toimintaa kehittää laadukkaammaksi. Tutkimus on otteeltaan kvalitatiivinen. Tutkimus aineisto kerättiin avoimella kyselylomakkeella, ja aineisto analysoitiin sisällönanalyysillä. Tutkimukseen osallistui 17 päivystyspoliklinikalla toimivaa sairaanhoitajaa, jotka työssään toteuttavat...

  7. Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department.

    Science.gov (United States)

    Weston, Victoria; Jain, Sushil K; Gottlieb, Michael; Aldeen, Amer; Gravenor, Stephanie; Schmidt, Michael J; Malik, Sanjeev

    2017-06-01

    Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined as differences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of left without being seen (LWBS), and proportion of "very good" overall patient satisfaction scores. Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss (ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time for resident TLPs was significantly lower (pfinancial profile.

  8. National Prehospital Evidence-Based Guidelines Strategy: A Summary for EMS Stakeholders.

    Science.gov (United States)

    Martin-Gill, Christian; Gaither, Joshua B; Bigham, Blair L; Myers, J Brent; Kupas, Douglas F; Spaite, Daniel W

    2016-01-01

    Multiple national organizations have recommended and supported a national investment to increase the scientific evidence available to guide patient care delivered by Emergency Medical Services (EMS) and incorporate that evidence directly into EMS systems. Ongoing efforts seek to develop, implement, and evaluate prehospital evidence-based guidelines (EBGs) using the National Model Process created by a multidisciplinary panel of experts convened by the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC). Yet, these and other EBG efforts have occurred in relative isolation, with limited direct collaboration between national projects, and have experienced challenges in implementation of individual guidelines. There is a need to develop sustainable relationships among stakeholders that facilitate a common vision that facilitates EBG efforts. Herein, we summarize a National Strategy on EBGs developed by the National Association of EMS Physicians (NAEMSP) with involvement of 57 stakeholder organizations, and with the financial support of the National Highway Traffic Safety Administration (NHTSA) and the EMS for Children program. The Strategy proposes seven action items that support collaborative efforts in advancing prehospital EBGs. The first proposed action is creation of a Prehospital Guidelines Consortium (PGC) representing national medical and EMS organizations that have an interest in prehospital EBGs and their benefits to patient outcomes. Other action items include promoting research that supports creation and evaluates the impact of EBGs, promoting the development of new EBGs through improved stakeholder collaboration, and improving education on evidence-based medicine for all prehospital providers. The Strategy intends to facilitate implementation of EBGs by improving guideline dissemination and incorporation into protocols, and seeks to establish standardized evaluation methods for prehospital EBGs. Finally, the Strategy

  9. Barriers professional competence and its relationship with job satisfaction of nurses' moral distress and pre-hospital emergency city of Bam and Jiroft in 1393

    Directory of Open Access Journals (Sweden)

    Mohammadjavad Rahimzadeh

    2016-05-01

    Full Text Available In order to "protect the health of people" Several organizations have been founded and given its role in saving lives when seconds play, is formed Medical Center Emergency Management Whose duty is satisfactory service in the shortest possible time. Because one of the pre-hospital emergency center nurses work centers and first deal with critical diseases carried by nurses, so they are faced with numerous obstacles which could impact on their job satisfaction has less moral distress. In this study, efficient professional barriers and its relation to moral distress and job satisfaction are studied prehospital emergency nurses. This study is a descriptive - correlation of prehospital emergency personnel Bam on 82 Jiroft who were selected by census was conducted. Data gathering questionnaire, including demographic characteristics, barriers to efficient professional, moral distress, job satisfaction after obtaining the appropriate reliability and validity were used. Analysis of the data in this study using SPSS version 18, using measures of central tendency and dispersion, t-test, Pearson correlation coefficient, ANOVA and regression analysis were used. According to the non-normal distribution efficiency and moral distress two variables obstacles relationship between these two variables with Spearman nonparametric Kruskal-Wallis test other variables and for other variables that were normally distributed parametric tests and ANOVA were used Pearson correlation coefficient. A total of 82 patients with mean age (31.54± 5.66 participated in th e study showed. Results are73.4% married, work experience, most people (% 91.5 were under 15 years old. Most people (52% with traffic and pedestrians as factors impeding efficient professional, fully agreed, the average score of moral distress (o.48 ± 2.13, the level of moral distress was most mid-level and job satisfaction 52. 4% of them were average. The results showed that between moral distress and job

  10. Triage in an adult emergency service: patient satisfaction

    Directory of Open Access Journals (Sweden)

    Pollyane Liliane Silva

    2016-06-01

    Full Text Available Abstract OBJECTIVE Assess the degree of patient satisfaction with triage in the adult emergency service of a public hospital. METHOD Exploratory, descriptive, cross-sectional study with a quantitative approach. Three hundred patients were interviewed and the data were analyzed using descriptive statistics based on sociodemographic variables and those related to patient satisfaction. RESULTS There was a predominance of women, with elementary education and a mean age of 41 years. Most of the interviewees reported being satisfied in regard to the following items: timely service, embracement, trust, environment (comfort, cleanliness and signage, humanization (courtesy, respect, and interest, timely referral/scheduling of appointments and care expectations. CONCLUSION There was a high level of patient satisfaction, evidenced by the strong association of user satisfaction with the items investigated.

  11. Triage (2009: la ética en tiempos de guerra

    Directory of Open Access Journals (Sweden)

    María Teresa ICART ISERN

    2016-09-01

    Full Text Available A través de la película Triage (2009 de Danis Tanovic, este trabajo repasa las características del triaje y sus implicaciones éticas en el contexto bélico donde dos fotorreporteros intentan documentar la crueldad de la guerra. Las características del singular triaje que realiza el Dr Talzani plantea la conveniencia de la eutanasia en situaciones extremas. También se analiza el trastorno por estrés post traumático que padecerá uno de los protagonistas como consecuencia del impacto que las experiencias vividas causan en quienes sobreviven al horror de la guerra

  12. The development and testing of the nurses' cardiac triage instrument.

    Science.gov (United States)

    Arslanian-Engoren, Cynthia; Hagerty, Bonnie M

    2013-01-01

    Rapid recognition and treatment of myocardial infarction (MI) reduces morbidity and mortality. Although emergency department (ED) nurses are often the first provider to evaluate individuals and are in a prime position to initiate MI guideline recommendations, no valid and reliable instrument was found to quantify their decision-making processes. The purpose of this study was to develop and test the psychometric properties of a new theoretically driven, empirically based instrument for measuring nurses' cardiac triage decisions. Using a descriptive research design, data were collected using a mailed survey. There were 158 ED nurses who completed a mailed questionnaire. Factor analysis revealed three factors (patient presentation, unbiased nurse reasoning process, and nurse action) with good internal consistency (Cronbach's alpha = .903, .809, .718) and sample adequacy (KMO = .758) of the 30-item instrument. The newly developed instrument has the potential to improve patient outcomes surrounding early MI identification and treatment.

  13. Pelvic and scrotal trauma: CT and triage of patients.

    Science.gov (United States)

    Ezra, Navid; Afari, Arash; Wong, Jimmie

    2009-07-01

    Traumatic dislocation of the testicles was first reported during crush injury but is now more commonly related to motor vehicle accidents. Approximately 55 cases had been reported by 2003. Virtually no papers discuss the role of CT in the rapid diagnosis of penoscrotal trauma, although most polytrauma or "pelvic trauma" patients are rapidly evaluated by CT in the emergency room setting. As more patients with pelvic trauma are triaged and evaluated using CT scanners with greater multidetector capability, more patients will be seen with testicular injury. It is important for the emergency physicians, radiologists, and traumatologists not to overlook unsuspected cases of penoscrotal injury which are typically initially evaluated by history, physical exam, and ultrasound. We describe a recent case of initial diagnosis of bilateral testicular dislocation from blunt trauma using modern multidetector CT imaging technique.

  14. Inter-laboratory comparison to validate the dicentric assay as a cytogenetic triage tool for medical management of radiation accidents

    Energy Technology Data Exchange (ETDEWEB)

    Beinke, Christina, E-mail: christinabeinke@bundeswehr.org [Bundeswehr Institute of Radiobiology Affiliated to the University of Ulm, Neuherbergstrasse 11, 80937 Munich (Germany); Oestreicher, Ursula [Federal Office for Radiation Protection, Neuherberg (Germany); Riecke, Armin [Department for Internal Medicine, Federal Armed Forces Hospital, Ulm (Germany); Kulka, Ulrike [Federal Office for Radiation Protection, Neuherberg (Germany); Meineke, Viktor [Bundeswehr Institute of Radiobiology Affiliated to the University of Ulm, Neuherbergstrasse 11, 80937 Munich (Germany); Romm, Horst [Federal Office for Radiation Protection, Neuherberg (Germany)

    2011-09-15

    Radiation accidents with exposure of human beings can assume huge dimensions concerning occurring health impairments and essential medical resources such as personnel, patient care management and appropriate medical facilities. Particularly in mass-casualty events, a rapid sorting and allocation of victims to treatment is needed and their classification in medical treatment groups has to be conducted as fast as possible. For triage purposes several approaches can be considered. Clinical signs and symptoms are extremely helpful in estimating radiation effects on an organ-based level, whereas the assessment of radiation effects based on cytogenetic biodosimetry tools is the alternative approach. For both systems there are pros and cons with respect to the usefulness for specific applications, such as individual cases versus mass-casualty screening or whole- versus partial-body exposures. Among the biodosimetry tools the dicentric chromosome assay (DCA) is considered as the 'gold standard' for biodosimetry after an acute radiation exposure. Recently, steady progress in standardization and harmonization of the DCA has occurred, in order to enable the validated performance of the DCA in the frame of cooperative response of biodosimetry networks during a large scale radiological scenario. Using the DCA in triage mode which allows the stratification of radiation exposed victims into broad 1.0 Gy categories only 20-50 metaphase cells per subject are scored instead of the 500-1000 scored for routine analysis. Our data show that there are significant differences between the dicentric yields after 1.0 Gy and 3.0 Gy {gamma}-ray ex vivo exposure of blood suggesting this assay as suitable for the distinction between high and low dosed exposed individuals. These preliminary findings indicate the usefulness of the DCA also for therapeutic decision making.

  15. Low-cost improvements in prehospital trauma care in a Latin American city.

    Science.gov (United States)

    Arreola-Risa, C; Mock, C N; Lojero-Wheatly, L; de la Cruz, O; Garcia, C; Canavati-Ayub, F; Jurkovich, G J

    2000-01-01

    Prehospital care is a critical component of efforts to lower trauma mortality. In less-developed countries, scarce resources dictate that any improvements in prehospital care must be low in cost. In one Latin American city, recent efforts to improve prehospital care have included an increase in the number of sites of ambulance dispatch from two to four and introduction of the Prehospital Trauma Life Support (PHTLS) course. The effect of increased dispatch sites was evaluated by comparing response times before and after completion of the change. The effect of PHTLS was evaluated by comparing prehospital treatment for the 3 months before initiation of the course (n = 361 trauma patients) and the 6 months after (n = 505). Response time decreased from a mean of 15.5 +/- 5.1 minutes, when there were two sites of dispatch, to 9.5 +/- 2.7 minutes, when there were four sites. Prehospital trauma care improved after initiation of the PHTLS course. For all trauma patients, use of cervical immobilization increased from 39 to 67%. For patients in respiratory distress, there were increases in the use of oropharyngeal airways (16-39%), in the use of suction (10-38%), and in the administration of oxygen (64-87%). For hypotensive patients, there was an increase in use of large-bore intravenous lines from 26 to 58%. The improved prehospital treatment did not increase the mean scene time (5.7 +/- 4.4 minutes before vs. 5.9 +/- 6.8 minutes after). The percent of patients transported who died in route decreased from 8.2% before the course to 4.7% after. These improvements required a minimal increase (16%) in the ambulance service budget. Increase in sites of dispatch and increased training in the form of the PHTLS course improved the process of pre-hospital care in this Latin American city and resulted in a decrease in prehospital deaths. These improvements were low cost and should be considered for use in other less developed countries.

  16. Scoring systems of severity in patients with multiple trauma.

    Science.gov (United States)

    Rapsang, Amy Grace; Shyam, Devajit Chowlek

    2015-04-01

    Trauma is a major cause of morbidity and mortality; hence severity scales are important adjuncts to trauma care in order to characterize the nature and extent of injury. Trauma scoring models can assist with triage and help in evaluation and prediction of prognosis in order to organise and improve trauma systems. Given the wide variety of scoring instruments available to assess the injured patient, it is imperative that the choice of the severity score accurately match the application. Even though trauma scores are not the key elements of trauma treatment, they are however, an essential part of improvement in triage decisions and in identifying patients with unexpected outcomes. This article provides the reader with a compendium of trauma severity scales along with their predicted death rate calculation, which can be adopted in order to improve decision making, trauma care, research and in comparative analyses in quality assessment. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Comparative Evaluation of Stroke Triage Algorithms for Emergency Medical Dispatchers (MeDS: Prospective Cohort Study Protocol

    Directory of Open Access Journals (Sweden)

    Bloom Evan

    2011-01-01

    Full Text Available Abstract Background Stroke is a major cause of death and leading cause of disability in the United States. To maximize a stroke patient's chances of receiving thrombolytic treatment for acute ischemic stroke, it is important to improve prehospital recognition of stroke. However, it is known from published reports that emergency medical dispatchers (EMDs using Card 28 of the Medical Priority Dispatch System protocols recognize stroke poorly. Therefore, to improve EMD's recognition of stroke, the National Association of Emergency Medical Dispatchers recently designed a new diagnostic stroke tool (Cincinnati Stroke Scale -CSS to be used with Card 28. The objective of this study is to determine whether the addition of CSS improves diagnostic accuracy of stroke triage. Methods/Design This prospective experimental study will be conducted during a one-year period in the 911 call center of Santa Clara County, CA. We will include callers aged ≥ 18 years with a chief complaint suggestive of stroke and second party callers (by-stander or family who are in close proximity to the patient and can administer the tool ≥ 18 years of age. Life threatening calls will be excluded from the study. Card 28 questions will be administered to subjects who meet study criteria. After completion of Card 28, CSS tool will be administered to all calls. EMDs will record their initial assessment of a cerebro-vascular accident (stroke after completion of Card 28 and their final assessment after completion of CSS. These assessments will be compared with the hospital discharge diagnosis (ICD-9 codes recorded in the Office of Statewide Health Planning and Development (OSHPD database after linking the EMD database and OSHPD database using probabilistic linkage. The primary analysis will compare the sensitivity of the two stroke protocols using logistic regression and generalizing estimating equations to account for clustering by EMDs. To detect a 15% difference in sensitivity

  18. PRE-HOSPITAL THROMBOLYSIS IN KRASNOYARSK: RESULTS OF A RETROSPECTIVE COMPARATIVE STUDY

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    S. A. Skripkin

    2011-01-01

    Full Text Available Aim. To compare the safety and efficacy of pre-hospital thrombolysis with tenecteplase and hospital thrombolysis with alteplase. Material and Methods. Pre-hospital thrombolytic therapy with tenecteplase (n=15 and hospital thrombolysis with alteplaza (n=60 in patients with acute coronary syndrome and acute ST-segment elevation myocardial infarction were analyzed in retrospective comparative study. Time characteristics of thrombolysis and its efficacy and safety were assessed. Results. The mean time from patients emergency medical service call to pre-hospital thrombolysis was 51.8±1.23 min, whereas to hospital thrombolysis 106.5±2.15 min (p<0.05. The effective hospital thrombolysis was observed in 68.3 and 83.3% of patients according to ECG (>50% resolution of ST-segment elevation and coronary angiography criteria, respectively. The effective pre-hospital thrombolysis was registered in 93.3% of patients as demonstrated with ECG and coronary angiography. Conclusion. Pre-hospital thrombolysis in patients with acute coronary syndrome was performed by 54.7 min earlier than hospital thrombolysis was. This can improve the patient prognosis.

  19. [Prehospital trauma care training course. Integration of emergency physician and rescue services].

    Science.gov (United States)

    Kopschina, C; Stangl, R

    2008-08-01

    With the emergence of a trauma network in the metropolitan area of Nuremberg, Germany, the question arose whether prehospital trauma management and emergency department management could be better integrated. A training scheme was designed for prehospital trauma care by the rescue services of the Workers' Samaritan Federation Germany (ASB), the Bavarian Red Cross, Maltese Ambulance, St. Johns Ambulance, representatives of the emergency physicians, and physicians of Rummelsberg Hospital. A detailed search of the international literature was done for all subjects regarding prehospital trauma management, and the American training systems (ITLS, PHTLS) were studied. The review was followed by a critical evaluation of the reality of on site-care, and the German and American systems were compared. A 2-day course with 6 sessions (accident place and kinetics, trauma investigation, pathologies, resuscitation, practical training, and evaluation) was developed, adapted from the Advanced Trauma Life Support (ATLS) algorithm. Special attention was given to the integration and position of the emergency physician in Germany, as well as to the defined authority of the rescue services. Conversion into practice was facilitated by teamwork. The course is free of charge to all rescue services and members of the concept group. With a qualified prehospital system that works smoothly with the ATLS concepts, improved prehospital care for trauma patients seems possible.

  20. [Prehospital emergency care in Mexico City: the opportunities of the healthcare system].

    Science.gov (United States)

    Pinet, Luis M

    2005-01-01

    Unintentional vehicle traffic injuries cause 1.2 million preventable deaths per year worldwide, mostly affecting the population in their productive years of life. In Mexico, unintentional vehicle traffic injuries are one of the main causes of death; in Mexico City they account for 8% of deaths. Prehospital systems are set up to provide hospital medical care to the population, by means of a complex network that includes transportation, communications, resources (material, financial and human), and public participation. These systems may be designed in a variety of ways, depending on availability, capacity and quality of resources, according to specific community needs, always abiding by laws and regulations. In Mexico, several institutions and organizations offer prehospital services without being overseen in terms of coordination, regulation and performance evaluation, despite the high rates of morbidity and mortality due to injuries and preventable conditions amenable to effective therapy during the prehospital period. Prehospital care may contribute to decrease the morbidity and mortality rates of injuries requiring prompt medical care. Emphasis is made on the importance of assessing the performance of prehospital care, as well as on identification of needs for future development.

  1. Prehospital management of evolving critical illness by the primary care provider.

    Science.gov (United States)

    Ellis, Kerri A; Hosseinnezhad, Alireza; Ullah, Ashfaq; Vinagre, Yuka-Marie; Baker, Stephen P; Lilly, Craig M

    2013-10-01

    The factors that limit primary care providers (PCPs) from intervening for adults with evolving, acute, severe illness are less understood than the increasing frequency of management by acute care providers. Rates of prehospital patient management by a PCP and of communication with acute care teams were measured in a multicenter, cross-sectional, descriptive study conducted in all four of the adult medical ICUs of the three hospitals in central Massachusetts that provide tertiary care. Rates were measured for 390 critical care encounters, using a validated instrument to abstract the medical record and conduct telephone interviews. PCPs implemented prehospital management for eight episodes of acute illness among 300 encounters. Infrequent prehospital management by PCPs was attributed to their lack of awareness of the patient's evolving acute illness. Only 21% of PCPs were aware of the acute illness before their patient was admitted to an ICU, and 33% were not aware that their patient was in an ICU. Rates of PCP involvement were not appreciably different among provider groups or by patient age, sex, insurance status, hospital, ICU, or ICU staffing model. We identified lack of PCP awareness of patients' acute illness and high rates of PCP referral to acute care providers as the most frequent barriers to prehospital management of evolving acute illness. These findings suggest that implementing processes that encourage early patient-PCP communication and increase rates of prehospital management of infections and acute exacerbations of chronic diseases could reduce use of acute care services.

  2. The cognitive processes underpinning clinical decision in triage assessment: a theoretical conundrum?

    Science.gov (United States)

    Noon, Amy J

    2014-01-01

    High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice.

  3. Factors influencing the implementation of the guideline triage in emergency departments: a qualitative study.

    NARCIS (Netherlands)

    Janssen, M.A.M.; Achterberg, T. van; Adriaansen, M.J.M.; Kampshoff, C.S.; Schalk, D.M.; Mintjes-de Groot, A.J.

    2012-01-01

    AIMS AND OBJECTIVES: The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline.

  4. Evaluation of the ACT intervention to improve nurses' cardiac triage decisions.

    Science.gov (United States)

    Arslanian-Engoren, Cynthia; Hagerty, Bonnie; Eagle, Kim A

    2010-10-01

    Emergency department (ED) nurses are in a key position to initiate life-saving recommendations for myocardial infarction, which include a physician-read electrocardiogram (ECG) within 10 min of ED arrival. Using a quasi-experimental, one-group pretest-posttest design, the authors evaluated the preliminary effectiveness of the Aid to Cardiac Triage (ACT) intervention to improve ED nurses' cardiac triage decisions. Charts of all women who received an ED ECG 3 months before ( n = 171) and after (n = 184) the intervention and who were at least 18 years of age were reviewed. A 1-hr educational session was conducted to improve nurses' (n = 23) cardiac triage decisions. Postintervention, the proportion of women receiving an ECG within 10 min of ED arrival improved, as did the odds of women receiving a timely ECG. Preliminary evaluation of the ACT intervention indicates its effectiveness at improving ED nurses' cardiac triage decisions and obtaining a 10-min physician-read ECG.

  5. 突发公共事件批量伤员院前急救的规范化组织与管理%Analysis on standardized organization and management of prehospital emergency care for the injured in sudden public event

    Institute of Scientific and Technical Information of China (English)

    岳俊伟; 张婵; 穆强; 完颜振杰; 赵琰; 邵惠玲

    2015-01-01

    目的 探讨规范化组织及管理在突发公共事件批量伤员院前急救中的应用,旨在提高院前救治成功率.方法 对2012-01-01至2014-12-31郑州市紧急医疗救援中心参与的3197起突发公共事件信息接报,合理调度,现场检伤分类、紧急救治,信息反馈,合理分流及快速转运等规范化救援的过程进行回顾性分析.结果 3197起11 591名伤病员经过院前规范化救治,11 312名伤病员成功转运至医院,279例死亡.结论 科学合理的制订预案、院前快速反应、规范化院前救援等措施,对突发公共事件的院前急救具有重要意义.%Objective To explore the effectiveness of the standard organization of the first aid for the injured in sudden public events, in order to improve the rate of successful treatment.Methods The emergency process of 3197 sudden public accidents from January 1, 2012 to December 31, 2014 including information dealing, dispatching, triage, emergency treatment, information feedback, considerable distribution and fast transport were reviewed and analyzed.Results 11 312 patients were transported to hospital successfully;279 patients were dead in totally 11 591 patients.Conclusions A scientific and reasonable plan formulation, rapid prehospital response and standardized prehospital rescue, were significant for prehospital emergency care in sudden public accidents.

  6. Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time

    NARCIS (Netherlands)

    Franschman, G.; Verburg, N.; Brens-Heldens, V.; Andriessen, T. M. J. C.; Van der Naalt, J.; Peerdeman, S. M.; Hoogerwerf, N.; Greuters, S.; Schober, P.; Vos, P. E.; Christiaans, H. M. T.; Boer, C.; Valk, J.P.

    2012-01-01

    Introduction: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch o

  7. Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time

    NARCIS (Netherlands)

    Franschman, G.; Verburg, N.; Brens-Heldens, V.; Andriessen, T.M.J.C.; Naalt, J. van der; Peerdeman, S.M.; Valk, J.P.M. van der; Hoogerwerf, N.; Greuters, S.; Schober, P.; Vos, P.E.; Christiaans, H.M.; Boer, C.

    2012-01-01

    INTRODUCTION: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch o

  8. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries : a retrospective observational study

    NARCIS (Netherlands)

    Oosterwold, J. T.; Sagel, D. C.; van Grunsven, P. M.; Holla, M.; de Man-van Ginkel, J.; Berben, S.

    Background Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital

  9. Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care

    Directory of Open Access Journals (Sweden)

    G.S. Youssef

    2017-09-01

    Conclusion: Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

  10. Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients

    Directory of Open Access Journals (Sweden)

    Madsen, Tracy E.

    2014-12-01

    Full Text Available Introduction: Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV tissue plasminogen activator (tPA. Emergency department (ED triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to determine whether gender disparities exist in the triage of acute stroke patients as defined by Emergency Severity Index (ESI levels and use of ED critical care beds. Methods: This was a retrospective, observational study of both ischemic and hemorrhagic stroke patients age ≥18 years presenting to a large, urban, academic ED within six hours of symptom onset between January 2010, and December 2012. Primary outcomes were triage to a non-critical ED bed and Emergency Severity Index (ESI level. Primary outcome data were extracted from electronic medical records by a blinded data manager; secondary outcome data and covariates were abstracted by trained research assistants. We performed bivariate and multivariate analyses. Logistic regression was performed using age, race, insurance status, mode of and time to arrival, National Institutes of Health Stroke Scale, and presence of atypical symptoms as covariates. Results: There were 537 patients included in this study. Women were older (75.6 vs. 69.5, p<0.001, and more women had a history of atrial fibrillation (39.8% vs. 25.3%, p<0.001. Compared to 9.5% of men, 10.3% of women were triaged to a non-critical care ED bed (p=0.77; 92.1% of women were triaged as ESI 1 or 2 vs. 93.6% of men (p=0.53. After adjustment, gender was not associated with triage location or ESI level, though atypical symptoms were associated with higher odds of being triaged to a non-critical care bed (aOR 1.98, 95%CI [1.03 – 3.81] and 3

  11. Stakeholder perspectives on triage in wildlife monitoring in a rapidly changing Arctic

    Directory of Open Access Journals (Sweden)

    Helen C Wheeler

    2016-11-01

    Full Text Available Monitoring activities provide a core contribution to wildlife conservation in the Arctic. Effective monitoring which allows changes in population status to be detected early, provides opportunities to mitigate pressures driving declines. Monitoring triage involves decisions about how and where to prioritise activities in species and ecosystem based monitoring. In particular, monitoring triage examines whether to divert resources away from species where there is high likelihood of extinction in the near-future in favour of species where monitoring activities may produce greater conservation benefits. As a place facing both rapid change with a high likelihood of population extinctions, and serious logistic and financial challenges for field data acquisition, the Arctic provides a good context in which to examine attitudes toward triage in monitoring.For effective decision-making to emerge from monitoring, multiple stakeholders must be involved in defining aims and priorities. We conducted semi-structured interviews with stakeholders in arctic wildlife monitoring (either contributing to observation and recording of wildlife, using information from wildlife observation and recording, or using wildlife as a resource to elicit their perspectives on triage in wildlife monitoring in the Arctic.The majority (56% of our 23 participants were predominantly in opposition to triage, 26% were in support of triage and 17% were undecided. Representatives of Indigenous organisations were more likely to be opposed to triage than scientists and those involved in decision-making showed greatest support for triage amongst the scientist participants. Responses to the concept of triage included that: 1 The species-focussed approach associated with triage did not match their more systems-based view (5 participants, 2 Important information is generated through monitoring threatened species which advances understanding of the drivers of change, responses and ecosystem

  12. Acute Alcohol Use and Injury Patterns in Young Adult Prehospital Patients.

    Science.gov (United States)

    Barton, David J; Tift, Frank W; Cournoyer, Lauren E; Vieth, Julie T; Hudson, Korin B

    2016-01-01

    The objective was to determine if acute alcohol consumption is associated with differences in injury pattern among young adult patients with traumatic injuries presenting to emergency medical services (EMS). A cross-sectional, retrospective review of prehospital patient care reports (PCRs) was conducted evaluating injured patients who presented to a collegiate EMS agency from January 1, 2011 to December 31, 2012. Included patients were age 18-24 y and sustained an injury within the previous 24 h. PCRs were reviewed independently by two abstractors to determine if the patient was documented to have acutely consumed alcohol proximate to his/her injury. Primary and secondary sites of regional body injury were recorded. Injury severity was recorded using the Revised Trauma Score (RTS). The association between primary injury site and acute alcohol use was assessed using a chi-square test. Multiple logistic regression was used to control for sex in predicting injury type. Of 440 injured patients, 135 (30.6%) had documented alcohol use prior to injury. Acute alcohol consumption altered the overall pattern of regional injury (p Alcohol users were more likely to present with injury secondary to assault, fall/trip, and unknown mechanism of injury (p alcohol group (p alcohol consumption predicted increased risk of head/neck injury 5.59-fold (p alcohol use in collegiate EMS patients appears to alter injury patterns in young adults and increases risk of head/neck injury. EMS providers in similar agencies should consider these trends when assessing and treating injured college-aged patients.

  13. Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients

    OpenAIRE

    Madsen, Tracy E.; Choo, Esther K.; Seigel, Todd A.; Palms, Danielle; Silver, Brian

    2015-01-01

    Introduction: Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV) tissue plasminogen activator (tPA). Emergency department (ED) triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to d...

  14. The Personalized Triage Service and Triage Skills in Dental Outpatient Clinic%口腔门诊人性化分诊服务与分诊技巧

    Institute of Scientific and Technical Information of China (English)

    赵丽萍; 朱琳虹

    2011-01-01

    门诊口腔科的分诊工作与其他科室相比,既有共性又有其特殊性.从人性化服务的角度出发,根据门诊口腔科的分诊特点,探讨人性化分诊服务与分诊技巧.主要有:候诊环境的人性化布局;分诊人员的人性化配备和服务,如挂号人员要有一定的口腔专业知识,分诊护士应提前到岗、做好分诊前的各项准备工作;要具备人性化分诊技巧,如诊前三分钟的医护交流、护患交流,诊后三分钟的随诊;逐步建立科学的预约管理体制.%The triage work in dental outpatient clinic, compared with other sub - sections, has some common points but also its unique features. From the perspective of people - oriented service, this paper explored the personalized triage service and triage skills according to the characteristics of outpatient dental clinic. Main contents include the user -friendly layout of the waiting environment, triage personnels equipment and personalized services( registering staff should be equipped with basic dental professional knowledge, and triage nurses should get ready for task in advance for better preparation) and personalized triage skills (such as the 3 - minute pre - therapy communication between dentists & nurses, and nurses & patients, and the 3 - minute post - therapy follow up) , and the stepwise establishment of the scientific appointments management system.

  15. Prehospital Dextrose Extravasation Causing Forearm Compartment Syndrome: A Case Report.

    Science.gov (United States)

    Chinn, Matthew; Colella, M Riccardo

    2017-01-01

    A 57-year-old woman was found at home by paramedics to be hypoglycemic with altered mental status. She had multiple attempts at IV access and eventually a 22G IV was established and D50 was infused into her right forearm. Extravasation of the dextrose was noted after approximately 12 g of the medication was infused. She was given a dose of glucagon intramuscularly and her mental status improved. Shortly after her arrival to the emergency department, she was noted to have findings of compartment syndrome of her forearm at the site of the dextrose extravasation. She was evaluated by plastic surgery and taken to the operating room for emergent fasciotomy. She recovered well from the operation. D50 is well known to cause phlebitis and local skin necrosis as a complication. This case illustrates the danger of compartment syndrome after D50 extravasation. It is the first documented case of prehospital dextrose extravasation leading to compartment syndrome. There may be safer alternatives to D50 administration and providers must be acutely aware to monitor for D50 infusion complications.

  16. [Pre-hospital observation as an alternative to emergency hospitalisation].

    Science.gov (United States)

    Jensvold, Morten; Seim, Arnfinn

    2014-09-30

    Pre-hospital observation beds in community care centres have for many years served as an alternative to hospitalisation in rural districts of Norway. The article presents the use of observation beds associated with the Fosen A&E centre. A retrospective review of records of patients who had contacted Fosen A&E centre during the period 21 August 2006-21 August 2009 was undertaken. Patient characteristics and clinical pathways were registered, including admissions to hospital or to an observation bed, as well as re-admissions. Ever since observation beds were first introduced, clear inclusion and exclusion criteria have been applied with regard to the allocation of patients to observation beds. Altogether 8027 patients had been in direct contact with an A&E doctor, and 2342 were admitted, of whom 77% to hospital and 23% to an observation bed. Of the 530 patients admitted to an observation bed, 55% were 70 years or older. Of these, 68% were discharged to their homes within 36 hours, 17% were transferred to hospital, and the remainder received further treatment in a local rehabilitation unit or nursing home. The rate of readmission to observation beds or hospital amounted to 4% among those who had been discharged after no more than three days, and 18% among those discharged after 3-28 days. A low number of readmissions may indicate that the use of observation beds is an alternative to hospitalisation.

  17. Evaluation of field triage decision scheme educational resources: audience research with emergency medical service personnel.

    Science.gov (United States)

    Sarmiento, Kelly; Eckstein, Daniel; Zambon, Allison

    2013-03-01

    In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons-Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The National Trauma Triage Protocol (Decision Scheme). In support of the Decision Scheme, CDC developed educational resources for emergency medical service (EMS) professionals, one of CDC's first efforts to develop and broadly disseminate educational information for the EMS community. CDC wanted to systematically collect information from the EMS community on what worked and what did not with respect to these educational materials and which materials were of most use. An evaluation was conducted to obtain feedback from EMS professionals about the Decision Scheme and use of Decision Scheme educational materials. The evaluation included a survey and a series of focus groups. Findings indicate that a segment of the Decision Scheme's intended audience is using the materials and learning from them, and they have had a positive influence on their triage practices. However, many of the individuals who participated in this research are not using the Decision Scheme and indicated that the materials have not affected their triage practices. Findings presented in this article can be used to inform development and distribution of additional Decision Scheme educational resources to ensure they reach a greater proportion of EMS professionals and to inform other education and dissemination efforts with the EMS community.

  18. The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study

    Directory of Open Access Journals (Sweden)

    Mohsen Ebrahimi

    2016-01-01

    Full Text Available Background. Triage nurses play a pivotal role in the emergency department. However some researchers have attempted to expand triage nurse’s role; remarkable discrepancies exist among scholarly communities. The aim was to develop a role description of triage nurse relying on the experts. Methods. A modified Delphi study consisting of 3 rounds was performed from March to October 2014. In the first round, an extensive review of the literature was conducted. Expert selection was conducted through a purposeful sample of 38 emergency medicine experts. Results. Response rates for the second and third rounds were 37% and 58%. Average age of panelists was (38.42±5.94 years. Thirty-nine out of 54 items reached to the final round. Prioritizing had the higher agreement rate and least agreement on triage related interventions. Conclusion. Triage nursing as a relatively new role for nurses needs significant development to be practiced. Comprehensive educational programs and developmental research are required to support diagnostic and therapeutic interventions in triage practice by nurses.

  19. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    Directory of Open Access Journals (Sweden)

    Yuwares Sittichanbuncha

    2015-01-01

    Full Text Available Background. To differentiate acute coronary syndrome (ACS from other causes in patients presenting with chest pain at the emergency department (ED is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0% were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval were 4.220 (1.445, 12.327, 3.333 (1.040, 10.684, and 12.539 (3.876, 40.567, respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  20. An online tool for nurse triage to evaluate risk for acute coronary syndrome at emergency department.

    Science.gov (United States)

    Sittichanbuncha, Yuwares; Sanpha-Asa, Patchaya; Thongkrau, Theerayut; Keeratikasikorn, Chaiyapon; Aekphachaisawat, Noppadol; Sawanyawisuth, Kittisak

    2015-01-01

    Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  1. Does Using a Standardised Mental Health Triage Assessment Alter Nurses Assessment of Vignettes of People Presenting with Deliberate Self-Harm

    Directory of Open Access Journals (Sweden)

    Richard Tanner

    2014-01-01

    Full Text Available Background. The Manchester Triage Scale is used in Irish emergency departments. This fails to provide guidance on triaging psychiatric presentations. A Mental Health Triage scale is recommended by the National Institute of Clinical Excellence. Aim. To examine the effectiveness of a Mental Health Triage scale in assessing patients presenting with self-harm. Method. Ten vignettes were created, detailing cases of deliberate self-harm. Nurses (n=49 were given five vignettes and asked to assign each vignette to a triage category, using The Manchester Triage Scale. Each nurse was subsequently asked to reevaluate the same vignettes using the Mental Health Triage Scale. Triage with each method was deemed safe or unsafe, using the benchmark triage categories assigned by a consultant in psychiatry and a consultant in emergency medicine departments. Results. 245 cases were triaged. There was a significant change in the categories assigned when the Mental Health Triage scale was in use, P<0.001. The triage categories assigned using the Mental Health Triage scale were significantly safer than under the Manchester Triage Scale (79% versus 60% safe, respectively, P<0.001.

  2. Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure

    DEFF Research Database (Denmark)

    Bakke, Skule A; Bøtker, Morten Thingemann; Riddervold, Ingunn S;

    2014-01-01

    Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are frequently used inhospital for treating respiratory failure, especially in treatment of acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease. Early initiation of treatment...... is important for success and introduction already in the prehospital setting may be beneficial. Our goal was to assess the evidence for an effect of prehospital CPAP or NIV as a supplement to standard medical treatment alone on the following outcome measures; mortality, hospital length of stay, intensive care...... examine prehospital CPAP. Of these, only one small, randomized controlled trial shows a reduced mortality rate and a reduced intubation rate with supplemental CPAP. The other three studies have neutral findings, but in two of these a trend toward lower intubation rate is found. The effect of supplemental...

  3. Does increased prehospital replacement volume lead to a poor clinical course and an increased mortality? A matched-pair analysis of 1896 patients of the Trauma Registry of the German Society for Trauma Surgery who were managed by an emergency doctor at the accident site.

    Science.gov (United States)

    Hussmann, Bjoern; Lefering, Rolf; Waydhas, Christian; Touma, Alexander; Kauther, Max D; Ruchholtz, Steffen; Lendemans, Sven

    2013-05-01

    Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is regarded as an important primary treatment option. Our study aimed to assess the influence of prehospital fluid replacement therapy on the post-traumatic course of severely injured patients in a retrospective analysis of matched pairs. The data of 51,425 patients of the Trauma Registry of the German Society for Trauma Surgery were analysed. The following patients were included: Injury Severity Score ≥ 16 points, primary admission, age ≥ 16 years, no isolated brain injury, transfusion of at least one unit of packed red blood cells (pRBC), systolic blood pressure ≥ 60 mmHg at the accident site. The patients were divided into two groups according to the following matched-pair criteria (low-volume: 0-1500 ml prehospital volume replaced; high-volume: ≥ 1501 ml prehospital volume): intubation at the accident site (yes/no), time from injury to hospital ± 10 min., means of rescue (emergency helicopter, MICU), Abbreviated Injury Scale (body regions), injury year, systolic blood pressure and age (years). All patients were managed by an emergency doctor at the accident site. A total of 948 patients in each group met the inclusion criteria. Increasing replacement volume was associated with an increased need for transfusion (pRBCs: low-volume: 7 units, high-volume: 8.3 units; ptrauma. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. EMS Adherence to a Pre-hospital Cervical Spine Clearance Protocol

    Directory of Open Access Journals (Sweden)

    Johnson, David

    2001-10-01

    Full Text Available Purpose: To determine the degree of adherence to a cervical spine (c-spine clearance protocol by pre-hospital Emergency Medical Services (EMS personnel by both self-assessment and receiving hospital assessment, to describe deviations from the protocol, and to determine if the rate of compliance by paramedic self-assessment differed from receiving hospital assessment. Methods: A retrospective sample of pre-hospital (consecutive series and receiving hospital (convenience sample assessments of the compliance with and appropriateness of c-spine immobilization. The c-spine clearance protocol was implemented for Orange County EMS just prior to the April-November 1999 data collection period. Results: We collected 396 pre-hospital and 162 receiving hospital data forms. From the pre-hospital data sheet. the percentage deviation from the protocol was 4.096 (16/396. Only one out of 16 cases that did not comply with the protocol was due to over immobilization (0.2%. The remaining 15 cases were under immobilized, according to protocol. Nine of the under immobilized cases (66% that should have been placed in c-spine precautions met physical assessment criteria in the protocol, while the other five cases met mechanism of injury criteria. The rate of deviations from protocol did not differ over time. The receiving hospital identified 8.0% (13/162; 6/16 over immobilized, 7/16 under immobilized of patients with deviations from the protocol; none was determined to have actual c-spine injury. Conclusion: The implementation of a pre-hospital c-spine clearance protocol in Orange County was associated with a moderate overall adherence rate (96% from the pre-hospital perspective, and 92% from the hospital perspective, p=.08 for the two evaluation methods. Most patients who deviated from protocol were under immobilized, but no c-spine injuries were missed. The rate of over immobilization was better than previously reported, implying a saving of resources.

  5. Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care

    Directory of Open Access Journals (Sweden)

    P. Brian Savino

    2015-12-01

    Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

  6. 急诊预检分诊的研究现状%Research status quo of previewing triage in emergency

    Institute of Scientific and Technical Information of China (English)

    陈兰

    2011-01-01

    综述国内外预检分诊的概况,分析了我国预检分诊存在的问题及原因,提出提高预检分诊质量的对策.%It summarized the overview of previewing triage in China and abroad .It analyzed existing problems and causes in previewing triage in China.And it put forward some countermeasures to enhance the quality of previewing triage.

  7. Strategically Leapfrogging Education in Prehospital Trauma Management: Four-Tiered Training Protocols

    OpenAIRE

    Abraham, Rohit; Vyas, Dinesh; Narayan, Mayur; Vyas, Arpita

    2015-01-01

    Trauma-related injury in fast developing countries are linked to 90% of international mortality rates, which can be greatly reduced by improvements in often non-existent or non-centralized emergency medical systems (EMS)—particularly in the pre-hospital care phase. Traditional trauma training protocols—such as Advanced Trauma Life Support (ATLS), International Trauma Life Support (ITLS), and Basic Life Support (BLS)—have failed to produce an effective pre-hospital ground force of medical firs...

  8. Effect of prehospital ultrasound on clinical outcomes of non-trauma patients

    DEFF Research Database (Denmark)

    Rudolph, Søren Steemann; Sørensen, Martin Kryspin; Svane, Christian

    2014-01-01

    studies for additional relevant studies. We then performed a risk of bias analysis and descriptive data analysis. RESULTS: We identified 1707 unique citations and included ten studies with a total of 1068 patients undergoing prehospital US examination. Included publications ranged from case series to non...... studies were of large heterogeneity and all showed a high risk of bias. We were thus unable to assess the effect of prehospital US on clinical outcomes. However, consistent reports suggested that US may improve patient management with respect to diagnosis, treatment, and hospital referral....

  9. The effectiveness of a military pre-hospital fluid infusion strategy.

    Science.gov (United States)

    O'Meara, M; Wood, P; Thurgood, A; Porter, K

    2007-09-01

    We performed a study to assess the effectiveness of a fluid infusion strategy currently used in the military pre-hospital environment using the patient's own body weight as an infusion device. Thirteen healthy volunteers were cannulated and 0.9% sodium chloride infused over a period of ten minutes. The volumes infused were measured and flow rates derived. A mean flow rate of 40 ml per minute was seen through an 18 g cannula. This strategy generates reasonable flow rates, but whether this is sufficient to the clinical aim of fluid resuscitation in pre-hospital settings is unknown.

  10. Triaging women with acute coronary syndrome: a review of the literature.

    Science.gov (United States)

    Kuhn, Lisa; Page, Karen; Davidson, Patricia M; Worrall-Carter, Linda

    2011-01-01

    This article analyzes the literature describing factors affecting nurses' triage of emergency department (ED) patients with potential acute coronary syndrome (ACS), with particular attention paid to gender-based differences. Acute coronary syndrome is one of the most time-critical conditions requiring ED nurse triage. This literature review will provide examination of how triage nurses prioritize patients with possible ACS, reflecting on challenges specifically associated with evaluating women for ACS in the ED. The article presents a description of the research findings that may help improve the timely revascularization of ACS in women. An electronic search of EBSCOhost CINAHL, Health Source Nursing Academic Edition, MEDLINE, Psychology and Behavioral Sciences Collection databases, online theses, the Cochrane Library, the Joanna Briggs Institute, and National Guideline Clearinghouse resources were used to identify all relevant scientific articles published between 1990 and 2010. Google and Google Scholar search engines were used to undertake a broader search of the World Wide Web to improve completeness of the search. This search technique was augmented by hand searching these articles' reference lists for publications missed during the primary search. : Review of the literature suggests factors such as patient age, sex, and symptoms at ED presentation affect the accuracy of nurses' triage of ACS, particularly for women. However, research examining delays due to ED triage is scant and has predominantly been undertaken by one researcher. Little research has examined triage of ACS specifically in women. The literature search revealed a small number of articles describing challenges associated with nurse triage of women with ACS. Although most of this published research is North American, the themes uncovered are well supported by broader international research on acute assessment and management of women's ACS. These include the following: gender-based differences in

  11. Serious gaming technology in major incident triage training: a pragmatic controlled trial.

    Science.gov (United States)

    Knight, James F; Carley, Simon; Tregunna, Bryan; Jarvis, Steve; Smithies, Richard; de Freitas, Sara; Dunwell, Ian; Mackway-Jones, Kevin

    2010-09-01

    By exploiting video games technology, serious games strive to deliver affordable, accessible and usable interactive virtual worlds, supporting applications in training, education, marketing and design. The aim of the present study was to evaluate the effectiveness of such a serious game in the teaching of major incident triage by comparing it with traditional training methods. Pragmatic controlled trial. During Major Incident Medical Management and Support Courses, 91 learners were randomly distributed into one of two training groups: 44 participants practiced triage sieve protocol using a card-sort exercise, whilst the remaining 47 participants used a serious game. Following the training sessions, each participant undertook an evaluation exercise, whereby they were required to triage eight casualties in a simulated live exercise. Performance was assessed in terms of tagging accuracy (assigning the correct triage tag to the casualty), step accuracy (following correct procedure) and time taken to triage all casualties. Additionally, the usability of both the card-sort exercise and video game were measured using a questionnaire. Tagging accuracy by participants who underwent the serious game training was significantly higher than those who undertook the card-sort exercise [Chi2=13.126, p=0.02]. Step accuracy was also higher in the serious game group but only for the numbers of participants that followed correct procedure when triaging all eight casualties [Chi2=5.45, p=0.0196]. There was no significant difference in time to triage all casualties (card-sort=435+/-74 s vs video game=456+/-62 s, p=0.155). Serious game technologies offer the potential to enhance learning and improve subsequent performance when compared to traditional educational methods. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  12. Education On Prehospital Pain Management: A Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Scott C. French

    2013-03-01

    Full Text Available Introduction: The most common reason patients seek medical attention is pain. However,there may be significant delays in initiating prehospital pain therapy. In a 2001 qualityimprovement (QI study, we demonstrated improvement in paramedic knowledge,perceptions, and management of pain. This follow-up study examines the impact of thisQI program, repeated educational intervention (EI, and effectiveness of a new painmanagement standard operating procedure.Methods: 176 paramedics from 10 urban and suburban fire departments and two privateambulance services participated in a 3-hour EI. A survey was performed prior to the EI andrepeated one month after the EI. We reviewed emergency medical services (EMS runs withpain complaints prior to the EI and one month after the EI. Follow-up results were comparedto our prior study. We performed data analysis using descriptive statistics and chi-square tests.Results: The authors reviewed 352 surveys and 438 EMS runs with pain complaints. Usingthe same survey questions, even before the EI, 2007 paramedics demonstrated significantimprovement in the knowledge (18.2%; 95% CI 8.9%, 27.9%, perceptions (9.2%; 95% CI6.5%, 11.9%, and management of pain (13.8%; 95% CI 11.3%, 16.2% compared to 2001.Following EI in 2007, there were no significant improvements in the baseline knowledge (0%;95% CI 5.3%, 5.3% but significant improvements in the perceptions of pain principles (6.4%;95% CI 3.9%, 9.0% and the management of pain (14.7%; 95% CI 11.4%, 18.0%.Conclusion: In this follow up study, paramedics’ baseline knowledge, perceptions, andmanagement of pain have all improved from 6 years ago. Following a repeat educationalintervention, paramedics further improved their field management of pain suggestingparamedics will still benefit from both initial and also ongoing continuing education on thetopic of pain management.

  13. Comparison of three prehospital cervical spine protocols for missed injuries.

    Science.gov (United States)

    Hong, Rick; Meenan, Molly; Prince, Erin; Murphy, Ronald; Tambussi, Caitlin; Rohrbach, Rick; Baumann, Brigitte M

    2014-07-01

    We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins' criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients who would require cervical immobilization per protocol and the number of missed cervical spine injuries, had each protocol been followed with 100% compliance. This was a cross-sectional study of patients ≥18 years transported by EMS post-traumatic mechanism to an inner city emergency department. Demographic and clinical/historical data obtained by physicians were recorded prior to radiologic imaging. Medical record review ascertained cervical spine injuries. Both physicians and EMS were blinded to the objective of the study. Of 498 participants, 58% were male and mean age was 48 years. The following participants would have required cervical spine immobilization based on the respective protocol: PHTLS, 95.4% (95% CI: 93.1-96.9%); Domeier, 68.7% (95% CI: 64.5-72.6%); Hankins, 81.5% (95% CI: 77.9-84.7%). There were 18 cervical spine injuries: 12 vertebral fractures, 2 subluxations/dislocations and 4 spinal cord injuries. Compliance with each of the 3 protocols would have led to appropriate cervical spine immobilization of all injured patients. In practice, 2 injuries were missed when the PHTLS criteria were mis-applied. Although physician-determined presence of cervical spine immobilization criteria cannot be generalized to the findings obtained by EMS personnel, our findings suggest that the mechanism-based PHTLS criteria may result in unnecessary cervical spine immobilization without apparent benefit to injured patients. PHTLS criteria may also be more difficult to implement due to the

  14. Prehospital Identification of Stroke Subtypes in Chinese Rural Areas

    Institute of Scientific and Technical Information of China (English)

    Hai-Qiang Jin; Jin-Chao Wang; Yong-An Sun; Pu Lyu; Wei Cui; Yuan-Yuan Liu; Zhi-Gang Zhen

    2016-01-01

    Background:Differentiating intracerebral hemorrhage (ICH) from cerebral infarction as early as possible is vital for the timely initiation of different treatments.This study developed an applicable model for the ambulance system to differentiate stroke subtypes.Methods:From 26,163 patients initially screened over 4 years,this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit,conscious or not,and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province.All the patients underwent cranial computed tomography (CT) or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria.Correlation with stroke subtype clinical features was calculated and Bayes' discriminant model was applied to discriminate stroke subtypes.Results:Among the 1989 patients,797,689,109,and 394 received diagnoses of cerebral infarction,ICH,subarachnoid hemorrhage,and other forms of nonstroke,respectively.A history of atrial fibrillation,vomiting,and diabetes mellitus were associated with cerebral infarction,while vomiting,systolic blood pressure ≥180 mmHg,and age <65 years were more typical of ICH.For noncomatose stroke patients,Bayes' discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients,corresponding agreement rates were 75.4% and 73.5%.Conclusions:The model herein presented,with multiple parameters,can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning,either in alert or comatose patients.This may facilitate prehospital management for patients with stroke.

  15. Determinants of Success and Failure in Prehospital Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    Lucas A. Myers

    2016-09-01

    Full Text Available Introduction: This study aimed to identify factors associated with successful endotracheal intubation (ETI by a multisite emergency medical services (EMS agency. Methods: We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth. We analyzed patient and EMS factors affecting ETI. Results: During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%. A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03. A small tube (≤7.0 inches was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches (OR, 4.25; p=0.01. After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001 and a nearly 40-fold (OR, 39.78; p<0.001 increased likelihood of successful intubation, respectively. Conclusion: Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used.

  16. Redeye: A Digital Library for Forensic Document Triage

    Energy Technology Data Exchange (ETDEWEB)

    Bogen, Paul Logasa [ORNL; McKenzie, Amber T [ORNL; Gillen, Rob [ORNL

    2013-01-01

    Forensic document analysis has become an important aspect of investigation of many different kinds of crimes from money laundering to fraud and from cybercrime to smuggling. The current workflow for analysts includes powerful tools, such as Palantir and Analyst s Notebook, for moving from evidence to actionable intelligence and tools for finding documents among the millions of files on a hard disk, such as FTK. However, the analysts often leave the process of sorting through collections of seized documents to filter out the noise from the actual evidence to a highly labor-intensive manual effort. This paper presents the Redeye Analysis Workbench, a tool to help analysts move from manual sorting of a collection of documents to performing intelligent document triage over a digital library. We will discuss the tools and techniques we build upon in addition to an in-depth discussion of our tool and how it addresses two major use cases we observed analysts performing. Finally, we also include a new layout algorithm for radial graphs that is used to visualize clusters of documents in our system.

  17. Data Triage of Astronomical Transients: A Machine Learning Approach

    Science.gov (United States)

    Rebbapragada, U.

    This talk presents real-time machine learning systems for triage of big data streams generated by photometric and image-differencing pipelines. Our first system is a transient event detection system in development for the Palomar Transient Factory (PTF), a fully-automated synoptic sky survey that has demonstrated real-time discovery of optical transient events. The system is tasked with discriminating between real astronomical objects and bogus objects, which are usually artifacts of the image differencing pipeline. We performed a machine learning forensics investigation on PTF’s initial system that led to training data improvements that decreased both false positive and negative rates. The second machine learning system is a real-time classification engine of transients and variables in development for the Australian Square Kilometre Array Pathfinder (ASKAP), an upcoming wide-field radio survey with unprecedented ability to investigate the radio transient sky. The goal of our system is to classify light curves into known classes with as few observations as possible in order to trigger follow-up on costlier assets. We discuss the violation of standard machine learning assumptions incurred by this task, and propose the use of ensemble and hierarchical machine learning classifiers that make predictions most robustly.

  18. PHTLS ® (Prehospital Trauma Life Support) provider courses in Germany – who takes part and what do participants think about prehospital trauma care training?

    OpenAIRE

    Frank, Christian B; Wölfl, Christoph G; Hogan, Aidan; Suda, Arnold J.; Gühring, Thorsten; Gliwitzky, Bernhard; Münzberg, Matthias

    2014-01-01

    Background The goal of this study was to examine PHTLS Provider courses in Germany and to proof the assumption that formation of physicians and paramedics in prehospital trauma care can be optimized. Methods PHTLS participants were asked to fill out standardized questionnaires during their course preparation and directly after the course. There were some open questions regarding their professional background and closed questions concerning PHTLS itself. Further questions were to be answered o...

  19. PHTLS ® (Prehospital Trauma Life Support) provider courses in Germany – who takes part and what do participants think about prehospital trauma care training?

    OpenAIRE

    Frank, Christian B; Christoph G Wölfl; Hogan, Aidan; Suda, Arnold J.; Gühring, Thorsten; Gliwitzky, Bernhard; Münzberg, Matthias

    2014-01-01

    Background The goal of this study was to examine PHTLS Provider courses in Germany and to proof the assumption that formation of physicians and paramedics in prehospital trauma care can be optimized. Methods PHTLS participants were asked to fill out standardized questionnaires during their course preparation and directly after the course. There were some open questions regarding their professional background and closed questions concerning PHTLS itself. Further questions were to be answered o...

  20. Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma

    Directory of Open Access Journals (Sweden)

    Jonathan J Morrison

    2012-01-01

    Full Text Available Background: An assessment of hemodynamic stability is central to surgical decision-making in the management of battlefield ballistic torso trauma (BBTT. Aims: To analyse the utility of admission physiological parameters in characterising hemodynamic stability. Settings and Design: A retrospective analysis of consecutive admissions, with BBTT, to forward surgical facility in Afghanistan. Materials and Methods: The cohorts′ admission physiology, need for operative intervention, and mortality data were collected retrospectively. The cohort was divided into patients requiring surgery for Life-Threatening Torso Hemorrhage (LTTH and those not requiring immediate surgery (non-LTTH. Statistical Analysis: Parameters were compared using two sample t tests, Mann-Whitney, Fisher′s exact, and Chi-square tests. Receiver operator characteristic curves were used to identify significant parameters and determine optimum cut-off values. Results: A total of 103 patients with isolated BBTT were identified: 44 in the LTTH group and 59 in the non-LTTH group. The mean New Injury Severity Score ± Standard Deviation (NISS±SD was 28±14 and 13±12, respectively. The heart rate, systolic blood pressure (SBP, pulse pressure, shock index (SI=heart rate/SBP and base excess were analysed. SI correlated best with the need for surgical torso hemorrhage control, P<0.05. An optimal cut-off of 0.9 was identified, producing a positive and negative predictive value of 81% and 82%, respectively. Conclusions: Shock index (SI is a useful parameter for helping military surgeons triage BBTT, identifying patients requiring operative torso hemorrhage control. SI performance requires a normal physiological response to hypovolemia, and thus should always be considered in clinical context.

  1. An economic analysis of a nurse-led telephone triage service.

    Science.gov (United States)

    Navratil-Strawn, Jessica L; Ozminkowski, Ronald J; Hartley, Stephen K

    2014-09-01

    Telephone nurse lines help callers to select the most appropriate site and level of care for acute conditions. We examined whether compliance with nurse recommendations was associated with lower average health care expenditure, and identified the employer characteristics associated with higher than average savings. Telephone calls to a nurse-led help line made by commercial health plan members who worked for large employers were identified. The callers' intention before calling and the nurse recommendation regarding site/level of care were recorded. Compliance was determined using medical claims during a 30-day post-call observation period and was based on adherence to nurse recommendations. A total of 132,509 calls during 2012 were identified for the study. Nurse recommendations were that 31% of the callers seek a higher level of care than mentioned at the start of the call, 25% use a lower level of care and 44% pursue their originally intended level of care. After regression-based adjustment, the average medical expenditures were compared between compliers and non-compliers. Overall, 57% of callers were compliant with nurse recommendations. The average expenditures were $328 lower among compliant callers. A logistic regression analysis identified employer characteristics positively associated with achieving higher than average savings. These were having a low employee-to-dependent ratio, a headquarters in the Western region of the US, a low prospective health risk score, and participation by the employer in a targeted communication campaign. Compliance with the triage recommendations resulted in lower average health care expenditures, and several characteristics were positively associated with achieving higher savings.

  2. Factors Associated With False-Positive Emergency Medical Services Triage for Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Yamamoto Swan, Pamela

    2009-11-01

    Full Text Available Background: In 2005, Orange County California Emergency Medical Services (EMS initiated a field 12-lead program to minimize time to emergency percutaneous coronary intervention (PCI for field-identified acute myocardial infarction (MI. As the program matured, “false-positive” (defined as no PCI or coronary artery occlusion upon PCI field MI activations have been identified as a problem for the program.Objectives: To identify potentially correctable factors associated with false-positive EMS triage to PCI centers.Methods: This was a retrospective, outcome study of EMS 12-lead cases from February 2006 to June 2007. The study system exclusively used cardiac monitor internal interpretation algorithms indicating an acute myocardial infarction as the basis for triage. Indicators and variables were defined prior to the study. Data, including outcome, was from the Orange County EMS database, which included copies of 12-lead ECGs used for field triage. Negative odds ratios (OR of less than 1.0 for positive PCI were the statistical measure of interest.Results: Five hundred forty-eight patients were triaged from the field for PCI. We excluded 19 cases from the study because of death prior to PCI, refusal of PCI, and co-morbid illness (sepsis, altered consciousness that precluded PCI. Three hundred ninety-three (74.3% patients had PCI with significant coronary lesions found. False-positive field triages were associated with underlying cardiac rhythm of sinus tachycardia [OR = 0.38 (95% CI 0.23, 0.62]; atrial fibrillation [OR = 0.43 (95% CI = 0.20, 0.94]; an ECG lead not recorded [OR = 0.39 (95% CI = 0.20, 0.76]; poor ECG baseline [OR = 0.59 (95% CI = 0.25, 1.37]; One of three brands of monitors used in the field [OR = 0.35 (95% CI = 0.21, 0.59]; and female gender [OR = 0.50 (95% CI = 0.34, 0.75]. Age was not associated with false-positive triage as determined by ordinal regression (p=1.00.Conclusion: For the urban-suburban EMS field 12-lead program

  3. Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

    Directory of Open Access Journals (Sweden)

    Jonsson Håkan

    2011-06-01

    Full Text Available Abstract Emergency department (ED triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity. Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability was limited for one triage scale and insufficient or

  4. The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa.

    Science.gov (United States)

    Goldstein, L N; Morrow, L M; Sallie, T A; Gathoo, K; Alli, K; Mothopeng, T M M; Samodien, F

    2017-02-27

    Triage in the emergency department (ED) is necessary to prioritise management according to the severity of a patient's condition.The South African Triage Scale (SATS) is a hospital-based triage tool that has been adopted by numerous EDs countrywide.Many factors can influence the outcome of a patient's triage result, and evaluation of performance is therefore pivotal. To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system. Triage forms from a tertiary hospital ED in Gauteng Province, South Africa, were collected over a 1-week period and reviewed retrospectively. A total of 1 091 triage forms were reviewed. Triage category allocations were correct 68.3% of the time. Of the incorrect category assignments, 44.4% of patients were promoted and 55.6% demoted. Patients in the green category were most commonly promoted (29.4%) and patients who should have been in orange were most commonly demoted (35.0%). Trauma patients were more likely to be incorrectly promoted and non-trauma patients to be incorrectly demoted. Mistakes were mainly due to discriminator errors (57.8%), followed by numerical miscalculations (21.5%). The leading omitted discriminators were 'abdominal pain', 'chest pain' and 'shortness of breath'. Mis-triaging using the SATS can be attributed to incorrect or lack of discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED.

  5. The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

    Directory of Open Access Journals (Sweden)

    L N Goldstein

    2017-03-01

    Full Text Available Background. Triage in the emergency department (ED is necessary to prioritise management according to the severity of a patient’s condition.The South African Triage Scale (SATS is a hospital-based triage tool that has been adopted by numerous EDs countrywide.Many factors can influence the outcome of a patient’s triage result, and evaluation of performance is therefore pivotal. Objectives. To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system. Methods. Triage forms from a tertiary hospital ED in Gauteng Province, South Africa, were collected over a 1-week period and reviewed retrospectively. Results. A total of 1 091 triage forms were reviewed. Triage category allocations were correct 68.3% of the time. Of the incorrect category assignments, 44.4% of patients were promoted and 55.6% demoted. Patients in the green category were most commonly promoted (29.4% and patients who should have been in orange were most commonly demoted (35.0%. Trauma patients were more likely to be incorrectly promoted and non-trauma patients to be incorrectly demoted. Mistakes were mainly due to discriminator errors (57.8%, followed by numerical miscalculations (21.5%. The leading omitted discriminators were ‘abdominal pain’, ‘chest pain’ and ‘shortness of breath’. Conclusions. Mis-triaging using the SATS can be attributed to incorrect or lack of discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED.

  6. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis

    DEFF Research Database (Denmark)

    Henriksen, Hanne Herborg; Rahbar, Elaheh; Baer, Lisa A

    2016-01-01

    BACKGROUND: The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. W...

  7. Is the current level of training in the use of equipment for prehospital radio communication sufficient?

    DEFF Research Database (Denmark)

    Holm, Jimmy Højberg

    2017-01-01

    BACKGROUND: Physicians working in prehospital care are expected to handle radio communication both within their own sector as well as with other divisions of the National Emergency Services. To date, no study has been conducted on the level of training received by physicians in the use of the equ......BACKGROUND: Physicians working in prehospital care are expected to handle radio communication both within their own sector as well as with other divisions of the National Emergency Services. To date, no study has been conducted on the level of training received by physicians in the use...... of the equipment provided or on the level of competency acquired by physicians. METHODS: In order to investigate the self-assessed skill level acquired in the use of the TETRA (TErrestrial Trunked RAdio) authority radio for communication in a prehospital setting, a cross-sectional study was conducted...... setting 38% of physicians reported having received no training in the use of the equipment, while 80% of physicians reported having received one1 hour of training or less. Among the majority of physicians their current level of training was sufficient for their everyday needs for prehospital communication...

  8. Effects of Crew Resource Management Training on Medical Errors in a Simulated Prehospital Setting

    Science.gov (United States)

    Carhart, Elliot D.

    2012-01-01

    This applied dissertation investigated the effect of crew resource management (CRM) training on medical errors in a simulated prehospital setting. Specific areas addressed by this program included situational awareness, decision making, task management, teamwork, and communication. This study is believed to be the first investigation of CRM…

  9. Measurement of lactate in a prehospital setting is related to outcome

    NARCIS (Netherlands)

    van Beest, Paul A.; Mulder, Peter Jan; Oetomo, Suparto Bambang; van den Broek, Bert; Kuiper, Michael A.; Spronk, Peter E.

    2009-01-01

    Objective We evaluated the relationship of lactate measured in a preclinical setting with outcome. Simultaneously, we evaluated the feasibility of implementing blood lactate measurement in a prehospital setting as part of a quality improvement project Methods Chart review of patients from whom serum

  10. Prehospital diagnosis in STEMI patients treated by primary PCI : the key to rapid reperfusion

    NARCIS (Netherlands)

    Vermeulen, R. P.; Jaarsma, T.; Hanenburg, F. G. A.; Nannenberg, J. W.; Jessurun, G. A. J.; Zijlstra, F.

    2008-01-01

    Background. Primary coronary intervention (PCI) for acute myocardial infarction should be performed as quickly as possible, with a door-to-balloon time of less then 90 minutes. However, in daily practice this cannot always be achieved. Prehospital diagnosis of ST-elevation myocardial infarction (STE

  11. Prehospital administration of P2Y12 inhibitors and early coronary reperfusion in primary PCI

    DEFF Research Database (Denmark)

    De Backer, Ole; Ratcovich, Hanna; Biasco, Luigi

    2015-01-01

    to prehospital loading with clopidogrel in a real-world ST-elevation myocardial infarction (STEMI) setting. Over a 70-month period, 3497 patients with on-going STEMI of less than 6 hours and without cardiac arrest or cardiogenic shock underwent primary percutaneous coronary intervention (PPCI) at our centre...

  12. Ischaemic Heart Disease: Accuracy of the Prehospital Diagnosis—A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Louise Houlberg Hansen

    2013-01-01

    Full Text Available Purpose. Correct prehospital diagnosis of ischaemic heart disease (IHD may accelerate and improve the treatment. We sought to evaluate the accuracy of prehospital diagnoses of ischemic heart diseases assigned by physicians. Methods. The Mobile Emergency Care Unit (MECU in Odense, Denmark, services a population of 260.000. All admissions in 2009 concerning patients diagnosed in the IHD category were assessed. Outcome and diagnosis of each patient were manually validated in accordance to the final diagnosis established following admission to hospital, using the discharge summary from the relevant department as reference. Results. 428 MECU runs with a prehospital diagnosis of IHD were registered. 422 of these were included in the study and 354 of those patients were suitable for this analysis. 73,4% of the patients hospitalized with a prehospital diagnosis of IHD were initially admitted to the relevant ward. Of these patients, 40,0% had their preliminary diagnosis of IHD confirmed. 14,1% of all patients admitted to the hospital were diagnosed with nonheart conditions. Preliminary diagnoses of STEMI had an accuracy of 87,5%. Conclusions. The preliminary IHD diagnoses assigned by the MECU physicians were acceptable. In case of STEMI patients the diagnostic accuracy was excellent. In this study there was an apparent overtriage.

  13. Nontraumatic Hypotension and Shock in the Emergency Department and the Prehospital setting, Prevalence, Etiology, and Mortality

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Bech, Camilla Nørgaard; Henriksen, Daniel Pilsgaard;

    2015-01-01

    studies in Epidemiology (STROBE-statement) to assess the quality. RESULTS: Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS) contacts, and the prevalence...

  14. Prehospital Unassisted Assessment of Stroke Severity Using Telemedicine A Feasibility Study

    NARCIS (Netherlands)

    Van Hooff, Robbert-Jan; Cambron, Melissa; Van Dyck, Rita; De Smedt, Ann; Moens, Maarten; Espinoza, Alexis Valenzuela; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; De Keyser, Jacques; Brouns, Raf

    2013-01-01

    Background and Purpose We evaluated the feasibility and the reliability of remote stroke severity quantification in the prehospital setting using the Unassisted TeleStroke Scale (UTSS) via a telestroke ambulance system and a fourth-generation mobile network. Methods The technical feasibility and the

  15. Issues and Solutions in Introducing Western Systems to the Prehospital Care System in Japan

    Directory of Open Access Journals (Sweden)

    Suzuki, Tetsuji

    2008-08-01

    Full Text Available Objective: This report aims to illustrate the history and current status of Japanese emergency medical services (EMS, including development of the specialty and characteristics adapted from the U.S. and European models. In addition, recommendations are made for improvement of the current systems.Methods: Government reports and academic papers were reviewed, along with the collective experiences of the authors. Literature searches were performed in PubMed (English and Ichushi (Japanese, using keywords such as emergency medicine and pre-hospital care. More recent and peer-reviewed articles were given priority in the selection process.Results: The pre-hospital care system in Japan has developed as a mixture of U.S. and European systems. Other countries undergoing economic and industrial development similar to Japan may benefit from emulating the Japanese EMS model.Discussion: Currently, the Japanese system is in transition, searching for the most suitable and efficient way of providing quality pre-hospital care.Conclusion: Japan has the potential to enhance its current pre-hospital care system, but this will require greater collaboration between physicians and paramedics, increased paramedic scope of medical practice, and greater Japanese societal recognition and support of paramedics.

  16. Response interval is important for survival until admission after prehospital cardiac arrest

    DEFF Research Database (Denmark)

    Do, Hien Quoc; Nielsen, Søren Loumann; Rasmussen, Lars Simon

    2010-01-01

    An increasing distance to the nearest hospital must be expected as a result of centralization of acute care at a small number of hospitals. This may have important consequences in emergency situations, such as prehospital or out-of-hospital cardiac arrest (OHCA) where the aim is to obtain return...

  17. Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces.

    Science.gov (United States)

    Acker, Peter; Newberry, Jennifer A; Hattaway, Leonard Bud F; Socheat, Phan; Raingsey, Prak P; Strehlow, Matthew C

    2016-06-27

    Despite significant improvements in health outcomes nationally, many Cambodians continue to experience morbidity and mortality due to inadequate access to quality emergency medical services. Over recent decades, the Cambodian healthcare system and civil infrastructure have advanced markedly and now possess many of the components required to establish a well functioning emergency medical system. These components include enhanced access to emergency transportation through large scale road development efforts, widspread availability of emergency communication channels via the spread of cellphone and internet technology, and increased access to health services for poor patients through the implementation of health financing schemes. However, the system still lacks a number of key elements, one of which is trained prehospital care providers. Working in partnership with local providers, our team created an innovative, Cambodia-specific prehospital care provider training course to help fill this gap. Participants received training on prehospital care skills and knowledge most applicable to the Cambodian healthcare system, which was divided into four modules: Basic Prehospital Care Skills and Adult Medical Emergencies, Traumatic Emergencies, Obstetric Emergencies, and Neonatal/Pediatric Emergencies. The course was implemented in nine of Cambodia's most populous provinces, concurrent with a number of overarching emergency medical service system improvement efforts. Overall, the course was administered to 1,083 Cambodian providers during a 27-month period, with 947 attending the entire course and passing the course completion exam.

  18. The accuracy of prehospital diagnosis of acute cerebrovascular accidents: an observational study

    Science.gov (United States)

    Gluszkiewicz, Marcin; Członkowska, Anna

    2015-01-01

    Introduction Time to treatment is the key factor in stroke care. Although the initial medical assessment is usually made by a non-neurologist or a paramedic, it should ensure correct identification of all acute cerebrovascular accidents (CVAs). Our aim was to evaluate the accuracy of the physician-made prehospital diagnosis of acute CVA in patients referred directly to the neurological emergency department (ED), and to identify conditions mimicking CVAs. Material and methods This observational study included consecutive patients referred to our neurological ED by emergency physicians with a suspicion of CVA (acute stroke, transient ischemic attack (TIA) or a syndrome-based diagnosis) during 12 months. Referrals were considered correct if the prehospital diagnosis of CVA proved to be stroke or TIA. Results The prehospital diagnosis of CVA was correct in 360 of 570 cases. Its positive predictive value ranged from 100% for the syndrome-based diagnosis, through 70% for stroke, to 34% for TIA. Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p CVA cases were referred with prehospital diagnoses other than CVA. Conclusions Emergency physicians appear to be sensitive in diagnosing CVAs but their overall accuracy does not seem high. They tend to overuse the diagnosis of TIA. Constant education and adoption of stroke screening scales may be beneficial for emergency care systems based both on physicians and on paramedics. PMID:26170845

  19. Ambulance or taxi? High acuity prehospital transports in the Ashanti region of Ghana

    Directory of Open Access Journals (Sweden)

    C. Nee-Kofi Mould-Millman

    2014-03-01

    Conclusion: Although a minority of patients were transported by ambulance, they represented the most acute patients arriving at the KATH EC. Given the limited availability of EMS resources and ambulances in Ashanti, selective ambulance use appears warranted and should inform prehospital care planning.

  20. Trauma in elderly people: access to the health system through pre-hospital care

    Directory of Open Access Journals (Sweden)

    Hilderjane Carla da Silva

    2016-01-01

    Full Text Available Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25% and in the age range between 60 and 69 years (38.25%, average age 74.19 years (standard deviation±10.25. Among the mechanisms, falls (56.75% and traffic accidents (31.25% stood out, showing a significant relation with the pre-hospital care services (p<0.001. Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8% were the most used, with trauma referral hospitals as the main destination (56.7%. Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims.

  1. Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services.

    Science.gov (United States)

    Karlsen, Anders M; Thomassen, Oyvind; Vikenes, Bjarne H; Brattebø, Guttorm

    2013-08-12

    Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services. In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air ambulance service, and the national search and rescue service. The survey explored available insulation materials, active warming devices, and the presence of protocols describing wrapping methods, temperature monitoring, and the use of warm i.v. fluids. Throughout the services, hospital duvets, cotton blankets and plastic "bubble-wrap" were the most common insulation materials. Active warming devices were to a small degree available in vehicle ambulances (14%) and the fixed wing ambulance service (44%) but were more common in the helicopter services (58-70%). Suitable thermometers for diagnosing hypothermia were lacking in the vehicle ambulance services (12%). Protocols describing how to insulate patients were present for 73% of vehicle ambulances and 70% of Search and Rescue helicopters. The minority of Helicopter Emergency Medical Services (42%) and Fixed Wing (22%) units was reported to have such protocols. The most common equipment types to treat and prevent hypothermia in Norwegian pre-hospital services are duvets, plastic "bubble wrap", and cotton blankets. Active external heating devices and suitable thermometers are not available in most vehicle ambulance units.

  2. Prehospital Unassisted Assessment of Stroke Severity Using Telemedicine A Feasibility Study

    NARCIS (Netherlands)

    Van Hooff, Robbert-Jan; Cambron, Melissa; Van Dyck, Rita; De Smedt, Ann; Moens, Maarten; Espinoza, Alexis Valenzuela; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; De Keyser, Jacques; Brouns, Raf

    2013-01-01

    Background and Purpose We evaluated the feasibility and the reliability of remote stroke severity quantification in the prehospital setting using the Unassisted TeleStroke Scale (UTSS) via a telestroke ambulance system and a fourth-generation mobile network. Methods The technical feasibility and the

  3. Prehospital Medical Documentation in the Joint Theater Trauma Registry: A Retrospective Study

    Science.gov (United States)

    2011-07-01

    Nesbitt , DSc, PA-C, Amelia M. Duran-Stanton, PhD, PA-C, and Robert T. Gerhardt, MD, MPH, FACEP Background: Prehospital care of combat casualties is a...5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Therien S. P., Nesbitt M. E., Duran-Stanton A. M., Gerhardt R. T., 5d. PROJECT NUMBER 5e. TASK NUMBER 5f

  4. Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

    Science.gov (United States)

    Moore, Bethany; Bone, Eric A

    2017-01-01

    The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions. Applying the concept of triage to business continuity provides those decision-makers navigating a rapidly evolving and unpredictable event with a path that protects the fundamental priorities of the organisation. A business triage methodology aids decision-makers in times of crisis by providing a simplified framework for decision-making based on objective, evidence-based criteria, which is universally accepted and understood. When disaster strikes, the survival of the organisation depends on critical decision-making and quick actions to stabilise the incident. This paper argues that organisations need to supplement BIA processes with a decision-making triage methodology that can be quickly applied during the chaos of an actual event.

  5. Examining triage patterns of inhalation injury and toxic epidermal necrolysis-Stevens Johnson syndrome.

    Science.gov (United States)

    Davis, James S; Pandya, Reeni K; Pizano, Louis R; Namias, Nicholas; Dearwater, Stephen; Schulman, Carl I

    2013-01-01

    The American Burn Association recommends that patients with toxic epidermal necrolysis-Stevens Johnson syndrome (TEN-SJS) or burn inhalation injuries would benefit from admission or transfer to a burn center (BC). This study examines to what extent those criteria are observed within a regional burn network. Hospital discharge data from 2000 to 2010 was obtained for all hospitals within the South Florida regional burn network. Patients with International Classification of Disease-9th revision discharge diagnoses for TEN-SJS or burn inhalation injury and their triage destination were compared using burn triage referral criteria to determine whether the patients were triaged differently from American Burn Association recommendations. Two hundred ninety-nine TEN-SJS and 131 inhalation injuries were admitted to all South Florida hospitals. Only 25 (8.4%) of TEN-SJS and 27 (21%) of inhalation injuries were admitted to the BC. BC patients had greater length of stay (TEN-SJS 22 vs 10 days; inhalation 13 vs 7) and were more likely to be funded by charity or be self-paid (TEN-SJS 24 vs 9.5%, P = .025; inhalation 44 vs 14%, P burn network. Unfamiliarity with triage criteria, patient insurance status, and overcoding may play a role. Further studies should fully characterize the problem and implement education or incentives to encourage more appropriate triage.

  6. Telephone survey of service-user experiences of a telephone-based mental health triage service.

    Science.gov (United States)

    Elsom, Stephen; Sands, Natisha; Roper, Cath; Hoppner, Cayte; Gerdtz, Marie

    2013-10-01

    The participation of service users in all aspects of mental health service delivery including policy development, service planning and evaluation is increasingly an expectation of contemporary mental health care. Although there are a growing number of publications reporting service-user perspectives in the evaluation of mental health services, little attention has been paid to the views of service users about mental health triage services. The purpose of the study reported here was to examine service-users' (consumers and informal carers) experiences of a telephone-based mental health triage service. Using a framework developed from the World Health Organisation's elements of responsiveness, we conducted structured telephone interviews with service users who had contacted a telephone-based mental health triage service in regional Victoria, Australia. The main findings of the study were that consumers experienced more difficulty than carers in accessing the service and that, although most participants were satisfied, only a minority reported being involved in decision-making. Further work is needed to improve accessibility of mental health triage services and to investigate barriers to consumer self-referral. Professional development and practice support systems should be established to support mental health triage nurses in the development of collaborative, consumer-focused care.

  7. A Semantic-Based Model for Triage Patients in Emergency Departments.

    Science.gov (United States)

    Wunsch, Guilherme; da Costa, Cristiano A; Righi, Rodrigo R

    2017-04-01

    Triage is a process performed in an emergency department that aims to sort patients according to their need for care. When performed speedily and correctly, this process can potentially increase the chances of survival for a patient with serious complications. This study aims to develop a computer model, called UbiTriagem, which supports the process of triage using the concepts of web semantics and ubiquitous computing focused on healthcare. For evaluating the proposal, we performed an analysis of scenario-driven triage based on previously determined ratings. In addition, we conducted a usability evaluation in emergency department with the developed prototype with two user groups: nurses and patients. The main scientific contribution is the automatic triage assessment based on the gathering of patient data on mobile devices, performed automatically through the use of a reasoning technique in an ontology. The results for all evaluations were very positive. The automatic triage assessment has been assertive in 93.3% of the cases and, after adjustments in the model, in 100% of the cases. Regarding user satisfaction, we obtained rates of 98.7% and 96% when considering perception of utility and ease of use, respectively.

  8. Patient cues that predict nurses' triage decisions for acute coronary syndromes.

    Science.gov (United States)

    Arslanian-Engoren, Cynthia

    2005-05-01

    The purpose of this study was to determine the patient cues that emergency department (ED) nurses use to triage male and female patients with complaints suggestive of acute coronary syndromes (ACSs) and to determine if cues used by ED nurses to make clinical inferences varied by patient sex or nurses' demographic characteristics. Using clinical vignette questionnaires with different patient characteristics, ED nurses' triage decisions were evaluated to determine the patient cues used to predict ACS. Men and women were equally likely to be given an ACS triage decision and this was not affected by nurses' demographic characteristics. However, nurses used different cues to triage men and women with complaints suggestive of ACS, although by receiver operating characteristic curves, the differences between sexes were small. In addition, female vignette patients were more likely than male vignette patients to be assigned a suspected cause of cholecystitis for their presentation in a small subset of 13 (11:2; odds ratio, 1.653; 95% confidence interval, 1.115-24.47; p=.036). This study provides insight into the complex phenomenon of triage decision making and warrants further exploration.

  9. Prehospital Lactate Measurement by Emergency Medical Services in Patients Meeting Sepsis Criteria

    Directory of Open Access Journals (Sweden)

    Lori L. Boland

    2016-09-01

    Full Text Available Introduction: We aimed to pilot test the delivery of sepsis education to emergency medical services (EMS providers and the feasibility of equipping them with temporal artery thermometers (TATs and handheld lactate meters to aid in the prehospital recognition of sepsis. Methods: This study used a convenience sample of prehospital patients meeting established criteria for sepsis. Paramedics received education on systemic inflammatory response syndrome (SIRS criteria, were trained in the use of TATs and hand-held lactate meters, and enrolled patients who had a recent history of infection, met ≥ 2 SIRS criteria, and were being transported to a participating hospital. Blood lactate was measured by paramedics in the prehospital setting and again in the emergency department (ED via usual care. Paramedics entered data using an online database accessible at the point of care. Results: Prehospital lactate values obtained by paramedics ranged from 0.8 to 9.8 mmol/L, and an elevated lactate (i.e. ≥ 4.0 was documented in 13 of 112 enrolled patients (12%. The unadjusted correlation of prehospital and ED lactate values was 0.57 (p< 0.001. The median interval between paramedic assessment of blood lactate and the electronic posting of the ED-measured lactate value in the hospital record was 111 minutes. Overall, 91 patients (81% were hospitalized after ED evaluation, 27 (24% were ultimately diagnosed with sepsis, and 3 (3% died during hospitalization. Subjects with elevated prehospital lactate were somewhat more likely to have been admitted to the intensive care unit (23% vs 15% and to have been diagnosed with sepsis (38% vs 22% than those with normal lactate levels, but these differences were not statistically significant. Conclusion: In this pilot, EMS use of a combination of objective SIRS criteria, subjective assessment of infection, and blood lactate measurements did not achieve a level of diagnostic accuracy for sepsis that would warrant hospital

  10. APPROACHES TO INCREASE THE AVAILABILITY AND EFFECTIVENESS OF PRE-HOSPITAL THROMBOLYSIS IN REAL CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    L. A. Ostroumova

    2012-01-01

    Full Text Available Aim. To identify the factors of the increasing the availability and effectiveness of pre-hospital thrombolytic therapy of patients with ST segment elevation acute coronary syndrome (STEACS. Material and methods. STEACS patients (n=70 were included in the study and stratified into two groups. Patients of the 1st group (n=30 received emergency medical assistance from the feldsher teams and patients of the 2nd group (n=40 — from the doctor teams. Expert estimation approach was used for the real practice assessment. Results. The hospital-matched diagnose rate was 97.5% in the doctor teams in comparison with 76.7% in feldsher teams (p<0.05. The efficiency of pre-hospital thrombolysis in 90 minutes after its beginning was 60.1% for the doctor teams versus 73.3% for the feldsher teams (p>0.05. The deviation from the standard operating procedure of the medical care for myocardial infarction patients was observed more often in the doctor teams in comparison with this in the feldsher teams. Time for the decision about pre-hospital thrombolysis start, the rate of unreasonable use or unreasonable refusal of thrombolysis did not differ significantly in feldsher and doctor teams. Conclusion. To increase the effectiveness of pre-hospital thrombolysis therapy it is necessary to follow strictly the standard of the medical care for patients with acute coronary syndrome. One of the main approaches to improve the availability of up to date medical care technologies in STEACS treatment is implementation of pre-hospital thrombolysis in practice of feldsher teams.

  11. Pre-hospital and initial management of head injury patients: An update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Most of the bad outcomes in patients with severe traumatic brain injury (TBI are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. Methods: A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013, which specifically discussed about the topic, was conducted. Results: Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. Conclusion: Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

  12. Prehospital management and fluid resuscitation in hypotensive trauma patients admitted to Karolinska University Hospital in Stockholm.

    Science.gov (United States)

    Talving, Peep; Pålstedt, Joakim; Riddez, Louis

    2005-01-01

    Few previous studies have been conducted on the prehospital management of hypotensive trauma patients in Stockholm County. The aim of this study was to describe the prehospital management of hypotensive trauma patients admitted to the largest trauma center in Sweden, and to assess whether prehospital trauma life support (PHTLS) guidelines have been implemented regarding prehospital time intervals and fluid therapy. In addition, the effects of the age, type of injury, injury severity, prehospital time interval, blood pressure, and fluid therapy on outcome were investigated. This is a retrospective, descriptive study on consecutive, hypotensive trauma patients (systolic blood pressure or = 15 years) recruited, the median age was 35.5 years (range: 27-55 years) and 77 patients (75%) had suffered blunt injury. The predominant trauma mechanisms were falls between levels (24%) and motor vehicle crashes (22%) with an ISS of 28.5 (range: 16-50). The on-scene time interval was 19 minutes (range: 12-24 minutes). Fluid therapy was initiated at the scene of injury in the majority of patients (73%) regardless of the type of injury (77 blunt [75%] / 25 penetrating [25%]) or injury severity (ISS: 0-20; 21-40; 41-75). Age (odds ratio (OR) = 1.04), male gender (OR = 3.2), ISS 21-40 (OR = 13.6), and ISS >40 (OR = 43.6) were the significant factors affecting outcome in the exact logistic regression analysis. The time interval at the scene of injury exceeded PHTLS guidelines. The vast majority of the hypotensive trauma patients were fluid-resuscitated on-scene regardless of the type, mechanism, or severity of injury. A predefined fluid resuscitation regimen is not employed in hypotensive trauma victims with different types of injuries. The outcome was worsened by male gender, progressive age, and ISS > 20 in the exact multiple regression analysis.

  13. Cost-effectiveness and benefit of alternatives to improve training for prehospital trauma care in Mexico.

    Science.gov (United States)

    Arreola-Risa, Carlos; Mock, Charles; Herrera-Escamilla, Alejandro J; Contreras, Ismael; Vargas, Jorge

    2004-01-01

    In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the cost-effectiveness of several approaches to improving training for personnel in three ambulance services in Mexico. In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US] dollar 150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of dollar 400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site. The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site. This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.

  14. Prehospital and en route cricothyrotomy performed in the combat setting: a prospective, multicenter, observational study.

    Science.gov (United States)

    Barnard, Ed B G; Ervin, Alicia T; Mabry, Robert L; Bebarta, Vikhyat S

    2014-01-01

    Airway compromise is the third most common cause of potentially preventable combat death. Surgical cricothyrotomy is an infrequently performed but lifesaving airway intervention. There are limited published data on prehospital cricothyrotomy in civilian or military settings. Our aim was to prospectively describe the survival rate and complications associated with cricothyrotomy performed in the military prehospital and en route setting. The Life-Saving Intervention (LSI) study is a prospective, institutional review board-approved, multicenter trial examining LSIs performed in the prehospital combat setting. We prospectively recorded LSIs performed on patients in theater who were transported to six combat hospitals. Trained site investigators evaluated patients on arrival and recorded demographics, vital signs, and LSIs performed. LSIs were predefined and include cricothyrotomies, chest tubes, intubations, tourniquets, and other procedures. From the large dataset, we analyzed patients who had a cricothyrotomy performed. Hospital outcomes were cross-referenced from the Department of Defense Trauma Registry. Descriptive statistics or Wilcoxon test (nonparametric) were used for data comparisons; statistical significance was set at pcombat medic (pre-evacuation), and 18 by an evacuation helicopter medic. Combat-hospital outcome data were available for 26 patients, 13 (50%) of whom survived to discharge. The cricothyrotomy patients had more LSIs than noncricothyrotomy patients (four versus two LSIs per patient; pcombat, procedural success was higher than previously reported. In addition, the majority of cricothyrotomies were performed by the evacuation helicopter medic rather than the prehospital combat medic. Prehospital military medics should receive training in decision making and be provided with adjuncts to facilitate this lifesaving procedure. 2014.

  15. Positive Coping: A Unique Characteristic to Pre-Hospital Emergency Personnel

    Science.gov (United States)

    Ebadi, Abbas; Froutan, Razieh

    2017-01-01

    Introduction It is important to gain a thorough understanding of positive coping methods adopted by medical emergency personnel to manage stressful situations associated with accidents and emergencies. Thus, the purpose of this study was to gain a better understanding of positive coping strategies used by emergency medical service providers. Methods This study was conducted using a qualitative content analysis method. The study participants included 28 pre-hospital emergency personnel selected from emergency medical service providers in bases located in different regions of the city of Mashhad, Iran, from April to November 2016. The purposive sampling method also was used in this study, which was continued until data saturation was reached. To collect the data, semistructured open interviews, observations, and field notes were used. Results Four categories and 10 subcategories were extracted from the data on the experiences of pre-hospital emergency personnel related to positive coping strategies. The four categories included work engagement, smart capability, positive feedback, and crisis pioneering. All the obtained categories had their own subcategories, which were determined based on their distinctly integrated properties. Conclusion The results of this study show that positive coping consists of several concepts used by medical emergency personnel, management of stressful situations, and ultimately quality of pre-hospital clinical services. Given the fact that efficient methods such as positive coping can prevent debilitating stress in an individual, pre-hospital emergency authorities should seek to build and strengthen “positive coping” characteristics in pre-hospital medical emergency personnel to deal with accidents, emergencies, and injuries through adopting regular and dynamic policies. PMID:28243409

  16. Parenteral midazolam is superior to diazepam for treatment of prehospital seizures.

    Science.gov (United States)

    Clemency, Brian M; Ott, Jamie A; Tanski, Christopher T; Bart, Joseph A; Lindstrom, Heather A

    2015-01-01

    Diazepam and midazolam are commonly used by paramedics to treat seizures. A period of drug scarcity was used as an opportunity to compare their effectiveness in treating prehospital seizures. A retrospective chart review of a single, large, commercial agency during a 29-month period was performed. The period included alternating shortages of both medications. Ambulances were stocked with either diazepam or midazolam based on availability of the drugs. Adult patients who received at least 1 parenteral dose of diazepam or midazolam for treatment of seizures were included. The regional prehospital protocol recommended 5 mg intravenous (IV) diazepam, 5 mg intramuscular (IM) diazepam, 5 mg IM midazolam, or 2.5 mg IV midazolam. Medication effectiveness was compared with respect to the primary end point: cessation of seizure without repeat seizure during the prehospital encounter. A total of 440 study subjects received 577 administrations of diazepam or midazolam and met the study criteria. The subjects were 52% male, with a mean age of 48 (range 18-94) years. A total of 237 subjects received 329 doses of diazepam, 64 (27%) were treated with first-dose IM. A total of 203 subjects received 248 doses of midazolam; 71 (35%) were treated with first-dose IM. Seizure stopped and did not recur in 49% of subjects after parenteral diazepam and 65% of subjects after parenteral midazolam (p = 0.002). Diazepam and midazolam exhibited similar first dose success for IV administration (58 vs. 62%; p = 0.294). Age, gender, seizure history, hypoglycemia, the presence of trauma, time to first administration, prehospital contact time, and frequency of IM administration were similar between groups. For parenteral administration, midazolam demonstrated superior first-dose seizure suppression. This study demonstrates how periods of drug scarcity can be utilized to study prehospital medication effectiveness.

  17. Conservation triage or injurious neglect in endangered species recovery.

    Science.gov (United States)

    Gerber, Leah R

    2016-03-29

    Listing endangered and threatened species under the US Endangered Species Act is presumed to offer a defense against extinction and a solution to achieve recovery of imperiled populations, but only if effective conservation action ensues after listing occurs. The amount of government funding available for species protection and recovery is one of the best predictors of successful recovery; however, government spending is both insufficient and highly disproportionate among groups of species, and there is significant discrepancy between proposed and actualized budgets across species. In light of an increasing list of imperiled species requiring evaluation and protection, an explicit approach to allocating recovery funds is urgently needed. Here I provide a formal decision-theoretic approach focusing on return on investment as an objective and a transparent mechanism to achieve the desired recovery goals. I found that less than 25% of the $1.21 billion/year needed for implementing recovery plans for 1,125 species is actually allocated to recovery. Spending in excess of the recommended recovery budget does not necessarily translate into better conservation outcomes. Rather, elimination of only the budget surplus for "costly yet futile" recovery plans can provide sufficient funding to erase funding deficits for more than 180 species. Triage by budget compression provides better funding for a larger sample of species, and a larger sample of adequately funded recovery plans should produce better outcomes even if by chance. Sharpening our focus on deliberate decision making offers the potential to achieve desired outcomes in avoiding extinction for Endangered Species Act-listed species.

  18. Novel Human Radiation Exposure Biomarker Panel Applicable for Population Triage

    Energy Technology Data Exchange (ETDEWEB)

    Bazan, Jose G. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Chang, Polly; Balog, Robert; D' Andrea, Annalisa; Shaler, Thomas; Lin, Hua; Lee, Shirley; Harrison, Travis [SRI International, Menlo Park, California (United States); Shura, Lei; Schoen, Lucy; Knox, Susan J. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Cooper, David E., E-mail: david.cooper@sri.com [SRI International, Menlo Park, California (United States)

    2014-11-01

    Purpose: To identify a panel of radiation-responsive plasma proteins that could be used in a point-of-care biologic dosimeter to detect clinically significant levels of ionizing radiation exposure. Methods and Materials: Patients undergoing preparation for hematopoietic cell transplantation using radiation therapy (RT) with either total lymphoid irradiation or fractionated total body irradiation were eligible. Plasma was examined from patients with potentially confounding conditions and from normal individuals. Each plasma sample was analyzed for a panel of 17 proteins before RT was begun and at several time points after RT exposure. Paired and unpaired t tests between the dose and control groups were performed. Conditional inference trees were constructed based on panels of proteins to compare the non-RT group with the RT group. Results: A total of 151 patients (62 RT, 41 infection, 48 trauma) were enrolled on the study, and the plasma from an additional 24 healthy control individuals was analyzed. In comparison with to control individuals, tenascin-C was upregulated and clusterin was downregulated in patients receiving RT. Salivary amylase was strongly radiation responsive, with upregulation in total body irradiation patients and slight downregulation in total lymphoid irradiation patients compared with control individuals. A panel consisting of these 3 proteins accurately distinguished between irradiated patients and healthy control individuals within 3 days after exposure: 97% accuracy, 0.5% false negative rate, 2% false positive rate. The accuracy was diminished when patients with trauma, infection, or both were included (accuracy, 74%-84%; false positive rate, 14%-33%, false negative rate: 8%-40%). Conclusions: A panel of 3 proteins accurately distinguishes unirradiated healthy donors from those exposed to RT (0.8-9.6 Gy) within 3 days of exposure. These findings have significant implications in terms of triaging individuals in the case of nuclear or other

  19. DNA methylation analysis in self-sampled brush material as a triage test in hrHPV-positive women

    NARCIS (Netherlands)

    Boers, A.; Bosgraaf, R. P.; van Leeuwen, R. W.; Schuuring, E.; Heideman, D. A. M.; Massuger, L. F. A. G.; Verhoef, V. M. J.; Bulten, J.; Melchers, W. J. G.; van der Zee, A. G. J.; Bekkers, R. L. M.; Wisman, G. B. A.

    2014-01-01

    Background: Primary high-risk human papillomavirus (hrHPV) testing in cervical cancer screening shows relatively low specificity, which makes triage testing necessary. In this study, DNA methylation analysis was compared with cytology for triage testing in hrHPV-positive women. Moreover, feasibility

  20. Successful five-item triage for the broad spectrum of mental disorders in pregnancy - A validation study

    NARCIS (Netherlands)

    C. Quispel (Chantal); T.A.J. Schneider (Tom); W.J.G. Hoogendijk (Witte); G.J. Bonsel (Gouke); M.P. Lambregtse-van den Berg (Mijke)

    2015-01-01

    textabstractBackground: Mental disorders are prevalent during pregnancy, affecting 10% of women worldwide. To improve triage of a broad spectrum of mental disorders, we investigated the decision impact validity of: 1) a short set of currently used psychiatric triage items, 2) this set with the

  1. Call-duration and triage decisions in out of hours cooperatives with and without the use of an expert system

    NARCIS (Netherlands)

    Ong, Rob S. G.; Post, Johan; van Rooij, Harry; de Haan, Jan

    2008-01-01

    Background: Cooperatives delivering out of hours care in the Netherlands are hesitant about the use of expert systems during triage. Apart from the extra costs, cooperatives are not sure that quality of triage is sufficiently enhanced by these systems and believe that call duration will be prolonged

  2. DNA methylation analysis in self-sampled brush material as a triage test in hrHPV-positive women

    NARCIS (Netherlands)

    Boers, A.; Bosgraaf, R.P.; Leeuwen, R.W. van; Schuuring, E.; Heideman, D.A.; Massuger, L.F.; Verhoef, V.M.; Bulten, J.; Melchers, W.J.; Zee, A.G. van der; Bekkers, R.L.; Wisman, G.B.

    2014-01-01

    BACKGROUND: Primary high-risk human papillomavirus (hrHPV) testing in cervical cancer screening shows relatively low specificity, which makes triage testing necessary. In this study, DNA methylation analysis was compared with cytology for triage testing in hrHPV-positive women. Moreover, feasibility

  3. DNA methylation analysis in self-sampled brush material as a triage test in hrHPV-positive women

    NARCIS (Netherlands)

    Boers, A.; Bosgraaf, R. P.; van Leeuwen, R. W.; Schuuring, E.; Heideman, D. A. M.; Massuger, L. F. A. G.; Verhoef, V. M. J.; Bulten, J.; Melchers, W. J. G.; van der Zee, A. G. J.; Bekkers, R. L. M.; Wisman, G. B. A.

    2014-01-01

    Background: Primary high-risk human papillomavirus (hrHPV) testing in cervical cancer screening shows relatively low specificity, which makes triage testing necessary. In this study, DNA methylation analysis was compared with cytology for triage testing in hrHPV-positive women. Moreover, feasibility

  4. Successful five-item triage for the broad spectrum of mental disorders in pregnancy - A validation study

    NARCIS (Netherlands)

    C. Quispel (Chantal); T.A.J. Schneider (Tom); W.J.G. Hoogendijk (Witte); G.J. Bonsel (Gouke); M.P. Lambregtse-van den Berg (Mijke)

    2015-01-01

    textabstractBackground: Mental disorders are prevalent during pregnancy, affecting 10% of women worldwide. To improve triage of a broad spectrum of mental disorders, we investigated the decision impact validity of: 1) a short set of currently used psychiatric triage items, 2) this set with the inclu

  5. Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

    Directory of Open Access Journals (Sweden)

    Rick Hong

    2014-07-01

    Full Text Available Introduction: We wanted to compare 3 existing emergency medical services (EMS immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based; the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria; and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness.To determine the proportion of patients who would require cervical immobilization per protocol and the number of missed cervical spine injuries, had each protocol been followed with 100% compliance. Methods: This was a cross-sectional study of patients ≥18 years transported by EMS post-traumatic mechanism to an inner city emergency department. Demographic and clinical/historical data obtained by physicians were recorded prior to radiologic imaging. Medical record review ascertained cervical spine injuries. Both physicians and EMS were blinded to the objective of the study. Results: Of 498 participants, 58% were male and mean age was 48 years. The following participants would have required cervical spine immobilization based on the respective protocol: PHTLS, 95.4% (95% CI: 93.1-96.9%; Domeier, 68.7% (95% CI: 64.5-72.6%; Hankins, 81.5% (95% CI: 77.9-84.7%. There were 18 cervical spine injuries: 12 vertebral fractures, 2 subluxations/dislocations and 4 spinal cord injuries. Compliance with each of the 3 protocols would have led to appropriate cervical spine immobilization of all injured patients. In practice, 2 injuries were missed when the PHTLS criteria were mis-applied. Conclusion: Although physician-determined presence of cervical spine immobilization criteria cannot be generalized to the findings obtained by EMS personnel, our findings suggest that the mechanism-based PHTLS criteria may result in unnecessary cervical spine immobilization without apparent benefit to injured patients. PHTLS

  6. Prehospital blood product transfusion by U.S. army MEDEVAC during combat operations in Afghanistan: a process improvement initiative.

    Science.gov (United States)

    Malsby, Robert F; Quesada, Jose; Powell-Dunford, Nicole; Kinoshita, Ren; Kurtz, John; Gehlen, William; Adams, Colleen; Martin, Dustin; Shackelford, Stacy

    2013-07-01

    U.S. Army flight medics performed a process improvement initiative of 15 blood product transfusions on select Category A (Urgent) helicopter evacuation casualties meeting approved clinical indications for transfusion. These transfusions were initiated from point of injury locations aboard MEDEVAC aircraft originating from one of two locations in southern Afghanistan. All flight medics executing the transfusions were qualified through a standardized and approved program of instruction, which included day and night skills validation, and a 90% or higher written examination score. There was no adverse reaction or out-of-standard blood product temperature despite hazardous conditions and elevated cabin temperatures. All casualties within a 10-minute flight time who met clinical indications were transfused. Utilization of a standard operating procedure with strict handling and administration parameters, a rigorous training and qualification program, an elaborate cold chain system, and redundant documentation of blood product units ensured that flight medic initiated transfusions were safe and effective. Research study is needed to refine the indications for prehospital blood transfusion and to determine the effect on outcomes in severely injured trauma patients. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  7. The Australasian Triage Scale Level 5 Criteria may Need to be Revised

    Directory of Open Access Journals (Sweden)

    Amir Mirhaghi

    2017-01-01

    Full Text Available Australasian Triage Scale (ATS is used to prioritize incoming patients in the emergency department (ED according to patient acuity. It`s a five-level triage scale endorsed by the Australasian College for Emergency Medicine (ACEM. The ATS categories are defined by physiological predictors (airway, breathing, circulation, and disability and maximum waiting time to treatment (1: immediate, 2: 10 minutes, 3: 30 minutes, 4: 60 minutes and 5: 120 minutes. Triage scales should be valid and reliable to ensure safe practice and promote clinical applicability in ED. Ebrahimi et al. reported that the pooled coefficient for ATS is fair: 0.390 (95% CI 0.307–0.466. 

  8. Misidentification of English Language Proficiency in Triage: Impact on Satisfaction and Door-to-Room Time.

    Science.gov (United States)

    Balakrishnan, Vamsi; Roper, Jamie; Cossey, Kori; Roman, Crystal; Jeanmonod, Rebecca

    2016-04-01

    We examined triage nurses' assessment of patients' language proficiency compared to patients' self-reported proficiency and the impact of language discordance on door-to-room time and patient satisfaction. This was a prospective study of emergency department walk-in patients. Patients completed a survey in which they identified their language proficiency. On a Likert scale, patients ranked how well they felt they were understood and how satisfied they were with the triage process. Nurses completed surveys identifying the patient's primary language and how well they felt they understood the patient. Door-to-room times were obtained from medical records. 163 patients were enrolled. 66% of patients identified themselves as having good English proficiency, while 34% of patients had limited English proficiency. Nurses misclassified 27% of self-identified Spanish-speaking patients as being English proficient. Spanish-speakers felt less satisfied with triage than English-speakers (p English-speakers.

  9. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.

    Science.gov (United States)

    Hasegawa, Kohei; Hiraide, Atsushi; Chang, Yuchiao; Brown, David F M

    2013-01-16

    It is unclear whether advanced airway management such as endotracheal intubation or use of supraglottic airway devices in the prehospital setting improves outcomes following out-of-hospital cardiac arrest (OHCA) compared with conventional bag-valve-mask ventilation. To test the hypothesis that prehospital advanced airway management is associated with favorable outcome after adult OHCA. Prospective, nationwide, population-based study (All-Japan Utstein Registry) involving 649,654 consecutive adult patients in Japan who had an OHCA and in whom resuscitation was attempted by emergency responders with subsequent transport to medical institutions from January 2005 through December 2010. Favorable neurological outcome 1 month after an OHCA, defined as cerebral performance category 1 or 2. Of the eligible 649,359 patients with OHCA, 367,837 (57%) underwent bag-valve-mask ventilation and 281,522 (43%) advanced airway management, including 41,972 (6%) with endotracheal intubation and 239,550 (37%) with use of supraglottic airways. In the full cohort, the advanced airway group incurred a lower rate of favorable neurological outcome compared with the bag-valve-mask group (1.1% vs 2.9%; odds ratio [OR], 0.38; 95% CI, 0.36-0.39). In multivariable logistic regression, advanced airway management had an OR for favorable neurological outcome of 0.38 (95% CI, 0.37-0.40) after adjusting for age, sex, etiology of arrest, first documented rhythm, witnessed status, type of bystander cardiopulmonary resuscitation, use of public access automated external defibrillator, epinephrine administration, and time intervals. Similarly, the odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.41; 95% CI, 0.37-0.45) and for supraglottic airways (adjusted OR, 0.38; 95% CI, 0.36-0.40). In a propensity score-matched cohort (357,228 patients), the adjusted odds of neurologically favorable survival were significantly lower both for

  10. Requesting wrist radiographs in emergency department triage: developing a training program and diagnostic algorithm.

    Science.gov (United States)

    Streppa, Joanna; Schneidman, Valerie; Biron, Alain D

    2014-01-01

    Crowding is extremely problematic in Canada, as the emergency department (ED) utilization is considerably higher than in any other country. Consequently, an increase has been noted in waiting times for patients who present with injuries of lesser acuity such as wrist injuries. Wrist fractures are the most common broken bone in patients younger than 65 years. Many nurses employed within EDs are requesting wrist radiographs for patients who present with wrist complaints as a norm within their working practice. Significant potential advantages can ensue if EDs adopt a triage nurse-requested radiographic protocol; patients can benefit from a significant time-saving of 36% in ED length of stay (M. Lindley-Jones & B. J Finlayson, 2000)— when nurses initiated radiographs in triage. In addition, the literature suggests that increased rates of patient and staff satisfaction may be achieved, without compromising quality of radiographic request or quality of service (W. Parris,S. McCarthy, A. M. Kelly, & S. Richardson, 1997). Studies have shown that nurses are capable of requesting appropriate radiographs on the basis of a preset protocol. As there are no standardized set of rules for assessing patients, presenting with suspected wrist fractures, a training program as well as a diagnostic algorithm was developed to prepare emergency nurses to appropriately request wrist radiographs. The triage nurse-specific training program includes the following topics: wrist anatomy and physiology, commonly occurring wrist injuries, mechanisms of injury, physical assessment techniques, and types of radiographic images required. The triage nurse algorithm includes the clinical decision-making process. Providing triage nurses with up-to-date evidence-based educational material not only allowed triage nurses to independently assess and request wrist radiographs for patients with potential wrist fractures but also strengthening the link between competent nursing care and better patient

  11. Open access phone triage for veterans with suspected malignant pleural mesothelioma.

    Science.gov (United States)

    Siegert, Charles Jeff; Fisichella, Piero Marco; Moseley, Jennifer M; Shoni, Melina; Lebenthal, Abraham

    2017-01-01

    Phone triaging patients with suspected malignant pleural mesothelioma (MPM) within the Veterans Healthcare Administration (VHA) system offers a model for rapid, expert guided evaluation for patients with rare and treatable diseases within a national integrated healthcare system. To assess feasibility of national open access telephone triage using evidence-based treatment recommendations for patients with MPM, measure timelines of the triage and referral process and record the impact on "intent to treat" for patients using our service. A retrospective study. The main outcome measures were: (1) ability to perform long distance phone triage, (2) to assess the speed of access to a mesothelioma surgical specialist for patients throughout the entire VHA, and (3) to determine if access to a specialist would alter the plan of care. Sixty veterans were screened by our phone triage program, 38 traveled an average of 997 miles to VA Boston Healthcare system. On average, 14 d elapsed from initial phone contact until the patient was physically evaluated in our general thoracic clinic in Boston. The treatment plan was altered for 71% of patients evaluated at VA Boston Healthcare system based on 2012 International Mesothelioma Interest Group guidelines. Our initial experience demonstrates that in-network centralized care for Veterans with MPM is feasible within the VHA. National open access phone triage improves access to expert surgical advice and can be delivered in a timely manner for Veterans using our service. Guideline-based treatment recommendations ("intent to treat") changed the therapeutic course for the majority of patients who used our service. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Observational study of admission and triage decisions for patients referred to a regional intensive care unit.

    Science.gov (United States)

    Howe, D C

    2011-07-01

    The objectives of this study were to identify factors associated with decisions concerning triage and admission to the intensive care unit and to describe the outcome of patients referred to intensive care unit for admission. The study was a single-centre, prospective, observational study. It was performed in the general intensive care unit of a tertiary regional hospital, over the period of February to June 2009. The patients were non-elective, acute medical in-patients. For 100 patients referred, only 36 were admitted to the intensive care unit. The remaining 64 were declined admission: nine were declined admission because they were assessed as too sick to benefit, 41 were declined admission because they were assessed as too well to benefit and 14 were deemed to potentially benefit from intensive care unit admission but were not admitted ('triage'). Patients most likely to receive triage decisions were medical in-patients who had expressed wishes about end-of-life care, who were functionally limited with co-morbid conditions affecting their performance status. Patients referred by Resident Medical Officers were also more likely to receive a triage decision. Age, gender Aboriginal and Torres Strait Islander status, diagnostic category and reason for referral did not impact on admission or triage decisions. Bed status in intensive care unit at the time of referral affected neither admission nor triage decisions. Hospital mortality in patients deemed too well to benefit from intensive care unit was 7.3%, suggesting that all patients referred for consideration of admission to intensive care unit should be classified as 'high risk'.

  13. 阳江市社区公众院前急救技能培训与巩固的调查%The investigation of prehospital first aid skills training and consolidation of yangjiang city's community public

    Institute of Scientific and Technical Information of China (English)

    茹光璇; 罗来喜; 宋明东; 苏月南; 余四权

    2010-01-01

    目的 探讨社区公众院前急救技能培训与巩固最佳间隔期.方法 在阳江市社区内开展公众院前急救技能培训并考核评分,与急诊科医务人员同期考核评分相比较.结果 考核评分社区四次分别为(57.172±6.299)分、(65.494±9.993)分、(73.520±10.000)分、(81.340±7.724)分,急诊科为(92.325±4.628)分、(93.763±3.998)分、(95.375±3.232)分、(96.625±2.345)分,比较差异有极显著性(P<0.01).培训前后知晓人数远高于培训前(P<0.01).结论 社区公院前急救技能培训与巩固间隔期最好半年至一年,且要想提高我国社区公众院前急救技能必须全民普及参与.%Objective To explore the best interval of the prehospital first aid skills training and consolidation of community public. Methods the examination score of the prehospital first aid skills training and consolidation of Yangjiang City's community public were compared with the same score of emergency department medical personnel in the same period Results. Between the examination score in the various stages were compared with, the difference had the remarkable statistics significance (P=0.000). Conclusion the best interval period of the prehospital first aid skills training and consolidation of community public was half-year to one year. All the people must participate in it to improvie our country pre-hospital first aid skills

  14. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

    DEFF Research Database (Denmark)

    Kruger, Andreas J; Lockey, David; Kurola, Jouni

    2011-01-01

    by the experts. Subsequent rounds reduced the number of core variables to 45. These constituted the final core data set. Emphasis was placed on the standardisation of reporting time variables, chief complaints and diagnostic and therapeutic procedures. CONCLUSIONS: Using a modified nominal group technique, we...... a higher quality of care to pre-hospital patients. There is no current data set collected to document the activity of physician pre-hospital activity which makes shared research efforts difficult. The aim of this study was to develop a core data set for routine documentation and reporting in physician......-staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...

  15. Assessment of a triage label system during a major incident exercise.

    Science.gov (United States)

    Barton, D; Bodiwala, G G

    1991-01-01

    The Metag triage label system was assessed during a major incident exercise at an international airport. The exercise simulated a crash of a plane carrying 40 passengers within the airport boundaries. A secondary incident also was staged involving an explosion resulting in a fire with three victims injured. The exercise involved the airport, fire, police, ambulance, and medical services of three counties--Leicestershire, Derbyshire, and Nottinghamshire. Use of the labels enabled evaluation of the triage process, early medical intervention for victims, and completion of the cards.

  16. Crisis and triage clinicians' attitudes toward working with people with personality disorder.

    Science.gov (United States)

    Purves, Deborah; Sands, Natisha

    2009-07-01

    This study aimed to investigate the attitud