BACKGROUND: Physicians can expect to confront a variety of psychiatric emergencies during their careers. However, medical schools are not required to teach emergency psychiatry and little is known about the content of existing instruction. PURPOSES: We conducted this survey to better understand the emergency psychiatry experiences provided to 3rd-year medical ...

Successful outcome following cardiac arrest have been reported in the range of 13-59%. It is well established that the time from the onset of a ventricular arrhythmia to successful defibrillation predicts outcome. Recent out of hospital arrest protocols minimizing time to defibrillation have reported significant improvement in outcomes. The Bethesda ...

The last 350 years since the publication of the first medical monograph on rickets (old English term wrickken) (Glisson et al., 1651) have seen spectacular advances in our understanding of mineral-homeostasis. Seminal and exciting discoveries have revealed the roles of PTH, vitamin D, and calcitonin in regulating calcium and phosphate, ...

STUDY OBJECTIVE: Dispatcher-assisted telephone cardiopulmonary resuscitation (CPR) instruction can increase the proportion of sudden cardiac arrest victims who receive bystander CPR and has been associated with improved survival. Most sudden cardiac arrest victims, however, do not receive bystander CPR. The study objective was to examine factors that may impede implementation ...

OBJECTIVE: To expose pharmacy educators and practitioners to concepts of medical geography and medical surveillance. Severe acute respiratory syndrome (SARS) is used as a case example because it is an emerging infection and a prime example of the type of disease that pharmacists may encounter in daily practice (e.g., easily ...

BACKGROUND: The relatively simple technique of administering a femoral nerve block is known to be quick, safe and effective in providing prolonged analgesia to children with femoral shaft fracture. Although medical literature supports its use in the emergency setting, no studies have been conducted on how this is undertaken in ...

There are 20 SOS Alarm emergency dispatch centres in Sweden, and from these centres approximately one million ambulances are dispatched each year. The aim of the study was to explore factors and circumstances that contributed to misjudgements or filed complaints in emergency medical dispatching filed at the Patient Advisory Committees ...

Complaints against Emergency Medical Services (EMS) agencies represent a concerning and potentially time-consuming problem for all involved in the delivery of prehospital emergency medical care. The objective of this study was to identify the source of complaints against an EMS system to help focus quality and performance improvement and customer ...

OBJECTIVE: It has been estimated that between 11% and 61% of ambulance transports to emergency departments are not medically necessary. This study's objective was to analyze paramedic ability to determine the medical necessity of ambulance transport to the emergency department. METHODS: Paramedics prospectively assessed adult patients transported to an emergency ...

As efforts are made to make Emergency Medicine and the Journal of Emergency Medicine more international, the different systems of medical education and practice trends in other countries should be considered when making suggestions. This article is a personal perspective of a surgeon who has been involved in emergency care ...

Accurate prehospital diagnosis and early initiation of emergency medical treatment for pediatric patients found to have supraventricular tachycardia is a reasonable task to accomplish and one that does not have to be anxiety-provoking. The most important point to remember is that the standard approach to resuscitation and stabilization for pediatric ...

This updated guidance from the Advisory Committee on Malaria Prevention for UK Travellers provides the essential information for healthcare workers who advise travellers. The many personal, visit and location-specific factors that need to be taken into account are discussed. Tables include the available antimalarials for prophylaxis and for standby treatment, ...

OBJECTIVE: Many children enter the emergency medical system through primary care offices, yet these offices may not be adequately prepared to stabilize severely ill children. We conducted this study to evaluate the effectiveness of an office-based educational program designed to improve the preparation of primary care practices for pediatric emergencies. ...

This paper develops the concept of epistemological alignment as a means of understanding how the medical emergency entered into biomedical classification. The working hypothesis is that the medical emergency could not develop as a paradigm from which knowledge could proliferate until a series of related concepts has been elucidates, and ...

OBJECTIVES: To evaluate the pattern of emergency adult medical admissions during the winter period and the usefulness of sales of over-the-counter cough/cold remedies as a predictor of these. METHODS: The databases of a single NHS trust acute unit and pharmacy outlets in its catchment area were analyzed retrospectively, comparing numbers ...

The use of chemical warfare agents intentionally has become a great concern in the arena of the cold war. On the other hand, there has always been a threat on civilian population due to their mass destruction effects, including psychological damage and a great deal of discussion how to respond ...

OBJECTIVES: To prospectively determine if on-site physicians at a mass gathering reduced the number of ambulance transports to local medical facilities. The authors also wished to determine the level of care provider (emergency medical technician, EMT-P, registered nurse, or medical doctor) required to treat and disposition each patient. METHODS: This ...

OBJECTIVE: To determine the compensation, benefit package, and level of satisfaction with the benefits of nationally registered emergency medical technicians (NREMTs) in 2001. METHODS: The Longitudinal EMT Attribute Demographic Study (LEADS) Project included an 18-question snapshot survey on compensation with the 2001 core survey. This survey was sent to 4,835 ...

During the last decade, Japan has experienced the largest burden of chemical terrorism-related events in the world, including the: (1) 1994 Matsumoto sarin attack; (2) 1995 Tokyo subway sarin attack; (3) 1998 Wakayama arsenic incident; (4) 1998 Niigata sodium-azide incident; and (5) 1998 Nagano cyanide incident. Two other intentional cyanide ...

The Emergency Medical Video Multiplexing Transport System (EMTS) is designed to support prehospital care by delivering high quality patient's live video streams in an ambulance to emergency doctors in a remote hospital on the basis of satellite communications. The feature is that EMTS divides a patient's live video scene into ...

BACKGROUND: Adults frequently seek medical services in children's hospital emergency departments (CHEDs), and are required to be admitted to CHEDs under the provisions of the Emergency Medical Transfer and Active Labor Act (EMTALA), which requires medical evaluation and stabilization of every patient who presents to an emergency department. In recent ...

AIM: To ascertain the level of acceptance of the PRIME (Primary Response In Medical Emergencies) scheme by rural general practitioners (GPs) in New Zealand. METHODS: A nationwide, anonymous, postal/email questionnaire was sent to 536 rural/semi-rural GPs, inquiring as to their involvement in and opinions of emergency care, and the acceptability ...

OBJECTIVE: Childhood ingestion of medications remains a substantial problem. Medication available over the counter (OTC) is widely used and has significant toxicity. The present study aims to investigate the nature and extent of unintentional ingestion of OTC medication in children < 5 years old in Victoria, Australia, during the period ...

Autointoxications are among the most common medical emergencies. Patterns of toxicosyndromes show regional variation, and they change over time. Intoxications are usually multiple. Although autointoxication is often self-limiting and a fatal outcome is unusual, suicide attempts may kill. Toxicity screening, emergency room first aid, decision rules for admission to the ...

Use of methohexital as an agent for moderate procedural sedation in the Emergency Department (ED) recently has increased. As a barbiturate, potential complications include respiratory and myocardial depression. We conducted a retrospective review of medical records and procedural flow charts for all use of methohexital in our ED during a ...

STUDY OBJECTIVE: Stress is an emergent occupational problem in modern societies. Among workers, medical practitioners are particularly exposed. However, data objectifying stress levels during work time are scarce. The aim of this study was to establish diurnal salivary cortisol levels in a highly stressful work environment, the medical dispatch center ...

Ketamine has been known to the medical world for over 30 years, yet is not widely used to its full potential. It is often considered to be a 'third world' drug only. In light of a recent increase in interest in its use in the developed world, this review is ...

The Republic of China on the island of Taiwan has experienced at least 20 terrorist events since 1979, including 13 aircraft hijackings and five bombings. Factors responsible for the relatively small burden of terrorism on Taiwan in the past include tight military control over political dissent until 1987, a warming ...

Over the past two decades, terrorism has exacted an enormous toll on the Republic of Turkey, a secular democracy with a 99.8% Muslim population. From 1984 to 2000, an estimated 30,000 to 35,000 Turkish citizens were killed by a nearly continuous stream of terrorism-related events. During this period, the Partiya ...

Rings, intravenous lines, and other objects on the injured upper extremities of trauma patients are frequently overlooked by radiology and emergency department (ED) personnel. This can impair proper radiologic evaluation of the injured extremity as well as negatively affect the quality of the patient's treatment. A 1-week sample of radiographs ...

Pediatric patients frequently seek medical treatment in the emergency department (ED) unaccompanied by a legal guardian. Current state and federal laws and medical ethics recommendations support the ED treatment of minors with an identified emergency medical condition, regardless of consent issues. Financial reimbursement should not limit the minor patient's access ...

The objective of this study was to assess the effectiveness of bag-valve-mask ventilation performed by emergency medical technicians with prehospital clinical responsibilities and to compare this with anaesthetists working clinically in tertiary referral teaching hospitals. Participants were asked to perform bag-valve-mask ventilation for three minutes on a Resusi Anne manniquin ...

Psychiatric emergency services (PES) are evolving as freestanding, parallel components of emergency departments at many tertiary care medical centers in the U.S. While PES facilities provide an increasing percentage of first-line care for patients with psychiatric crises, the services they provide and their interactions with medical emergency services have not ...

Medical schools and specialty societies have struggled to define a core content for medical students and practitioners but, to date, have been stymied by both political considerations and the sheer burden of the innumerable decisions that must be made to define the essence of a medical specialty. Six professional organizations ...

The PAD Trial is a prospective, multicenter, randomized clinical study testing whether volunteer, non-medical responders can improve survival from out-of-hospital cardiac arrest (OOH-CA) by using automated external defibrillators (AEDs). These lay volunteers, who have no traditional responsibility to respond to a medical emergency as part of their primary job description, ...

The provision of radio medical advice by the National Health Service for British coastal waters has developed in an ad hoc fashion. In 1999, the closure of one of the two centres providing such advice led to unexpected problems. The demographic characteristics of the offshore population covered by each centre ...

During Saskatchewan's healthcare reform of the 1990s, the number of acute hospital beds in Saskatoon District Health was cut in half. The emergency room and outpatient facilities were not able to accommodate an increasing number of patients needing urgent assessments and medical procedures. In this article, we describe the development, ...

The National Emergency Medical Extranet (NEME) project was a collaborative multi-center effort to create a plan for a networked system to improve emergency clinical care through real-time information support, and simultaneously provide benefit through information support for public health initiatives. This article presents a review of the NEME project and ...

The outcome of patient care can be dramatically improved by bringing rapid rescue and medical care to the mountain rescue scene and by rapid transport to a medical facility. The use of a helicopter for these purposes is common. It is necessary when it has clear advantages for victims in ...

OBJECTIVE: To characterize the use of fire stations for walk-in health care and compare utilization patterns of fire stations in lower-income areas with those in higher-income areas. METHODS: The study was a retrospective review of emergency medical services (EMS) medical forms of patients who presented directly to a fire station ...

In many healthcare settings, medications are considered a less invasive alternative to the use of physical restraint for agitated patients experiencing a behavioral crisis, a practice that is often referred to as "chemical restraint." However, recent federal regulations appear to equate chemical and physical restraint and to characterize both as ...

In response to the technology and information explosion, practice-based learning and improvement is emerging within the medical field to deliver systematic practice-linked improvements. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance leadership principles long established in ...

OBJECTIVES: To describe the adequacy and characteristics of emergency medical services education as assessed by a population-based sample of emergency medical technician (EMT)-basics and EMT-paramedics from the National Registry of Emergency Medical Technicians. METHODS: Stratified random samples of EMT-basics and EMT-paramedics from the National Registry of Emergency Medical Technicians were ...

Hand lacerations less than 2 cm long without tendon, joint, fracture, or nerve complications and not involving the nail bed can be cleaned and dressed without suturing, with similar cosmetic results and time to resume normal activities. Moreover, managing these uncomplicated hand lacerations conservatively could result in better use of ...

Beginning over five decades ago, a pioneering series of studies was conducted that had a profound impact on the field of pharmacology. The impact of those studies was so forceful and sweeping that the discipline of pharmacology was modified in scope and practice by the emergence of a new discipline-behavioral ...

Use of rapid sequence induction for intubation was introduced to the prehospital environment in the hope of enhancing patient outcome by improving early definitive airway management. Varying success has been achieved in both air and ground transport emergency medical services systems, but concern persists about the potential to cause patients ...

The case of a 31-member family displaying mass hysteria in up to 10 members at one time is reported. The mass hysteria emerged in the context of the strong religious and cultural beliefs held by this closely knit family. The varied presentations included somatoform disorder, recurrent vomiting, conversion, dissociative and ...

BACKGROUND: Early defibrillation is the most important intervention influencing survival following sudden cardiac arrest (SCA). In order to improve public access to early defibrillation, in North America several experiences of out-of-hospital early defibrillation by non-medical volunteers have been successfully implemented and demonstrated to improve survival. METHODS: Since 1999, in Piacenza, ...

Epistaxis is one of the most common otorhinolaryngological emergencies. It is also one of the most common emergencies that places medical staff at risk of blood contamination. We report a simple yet extremely effective method in which a standard surgical facemask is worn by the patient, thereby reducing blood aerosol ...

As increases in criminal activity collide with more aggressive law enforcement postures, there is more contact between police officers and violent felons. Civilian law enforcement special operations teams routinely engage suspects in these violent, dynamic, and complex interdiction activities. Along with these activities comes the substantial and foreseeable risk of ...