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Ambulance triage

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https://www.readbyqxmd.com/read/29450938/hot-off-the-press-sgem-197-cannulation-in-the-ed
#1
Sahaana Rangarajan, Justin Morgenstern, William K Milne, Corey Heitz
This is a prospective before-after study comparing peripheral intravenous cannulation (PIVC) placement and usage rates following a 10 week long multimodal intervention provided to medical and nursing staff working in a tertiary emergency department (ED). The intervention focused on improving appropriate use of PIVCs in an emergency setting by emphasizing to clinicians that a PIVC should only be placed if it was believed there was more than an 80% chance that it would be used. Patients were eligible for the study if they presented to the ED and were >18 years of age...
February 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29450701/burden-characteristics-and-process-of-care-among-the-pediatric-and-adult-trauma-patients-in-botswana-s-main-hospitals
#2
Michael B Mwandri, Timothy C Hardcastle
BACKGROUND: Botswana is notable among countries with high rates of Road Traffic Collisions (RTC); like many other lower-middle-income countries (LMICs), it lacks trauma systems. The World Health Organization recommends 'Essential Trauma Care' in countries with no formal trauma systems. The proportion of injuries in Emergency Departments and the care process were investigated to gain an overview for enabling the design of a relevant LMICs trauma system. METHOD: Blunt and penetrating trauma patients were included from three major hospitals, examining the proportion of injuries, patient characteristics, the care process and comparing these between pediatrics and adults...
February 15, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29440876/research-of-an-emergency-medical-system-for-mass-casualty-incidents-in-shanghai-china-a-system-dynamics-model
#3
Wenya Yu, Yipeng Lv, Chaoqun Hu, Xu Liu, Haiping Chen, Chen Xue, Lulu Zhang
Objectives: Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. Methods: This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program...
2018: Patient Preference and Adherence
https://www.readbyqxmd.com/read/29433441/ambulance-use-is-not-associated-with-patient-acuity-after-road-traffic-collisions-a-cross-sectional-study-from-addis-ababa-ethiopia
#4
Yonas Abebe, Tolesa Dida, Engida Yisma, David M Silvestri
BACKGROUND: Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined. METHODS: This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months...
February 13, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29386096/cost-analysis-of-an-integrated-aged-care-program-for-residential-aged-care-facilities
#5
Rod Ling, Andrew Searles, Jacqueline Hewitt, Robyn Considine, Catherine Turner, Susan Thomas, Kelly Thomas, Keith Drinkwater, Isabel Higgins, Karen Best, Jane Conway, Carolyn Hullick
Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents.Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District...
February 1, 2018: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/29345508/response-by-twin-italian-hub-hospitals-in-a-double-seismic-event-a-retrospective-observational-investigation
#6
Alberto Barbieri, Gabriele Melegari, Valentina Lob, Lorenzo Mazzali, Luca D'Amelio, Andrea Giovannoni, Enrico Giuliani
INTRODUCTION: The objectives of this study were to compare prevalence rates of different pathologies, ambulance system and emergency department management times, and patient survival and hazard ratios for codes 2 and 3 in two hub hospitals in Modena in the 36-month period across the stages of two major earthquakes in short sequence in Northern Italy in 2012. METHODS: Clinical records pertaining to the emergency care of patients were analyzed and only those assigned status codes 2 and 3 by ambulance professionals were included (if the assessment was confirmed by emergency department triage)...
January 18, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29321074/patient-and-case-characteristics-associated-with-no-paramedic-treatment-for-low-acuity-cases-referred-for-emergency-ambulance-dispatch-following-a-secondary-telephone-triage-a-retrospective-cohort-study
#7
Kathryn Eastwood, Amee Morgans, Johannes Stoelwinder, Karen Smith
BACKGROUND: Predicting case types that are unlikely to be treated by paramedics can aid in managing demand for emergency ambulances by identifying cases suitable for alternative management pathways. The aim of this study was to identify the patient characteristics and triage outcomes associated with 'no paramedic treatment' for cases referred for emergency ambulance dispatch following secondary telephone triage. METHODS: A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch following secondary telephone triage between September 2009 and June 2012...
January 10, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29284734/impact-of-prehospital-triage-scales-to-detect-large-vessel-occlusion-on-resource-utilization-and-time-to-treatment
#8
Ludwig Schlemm, Martin Ebinger, Christian H Nolte, Matthias Endres
BACKGROUND AND PURPOSE: Prehospital stroke severity scales may help to triage acute ischemic stroke patients with large vessel occlusion (LVO) for direct transportation to a comprehensive stroke center. The impact on resource use and time to reperfusion treatment for patients with and without LVO is unknown. METHODS: Based on empirical distributions of stroke symptom severity, prehospital delay times, and stroke symptom severity-dependent likelihood of LVO, we simulate prehospital incidents of stroke-like symptoms in abstract geographical environments to estimate the impact of prehospital triage strategies based on different cutoffs of the rapid arterial occlusion evaluation scale...
December 28, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29277493/emergency-department-visits-in-patients-with-low-acuity-conditions-factors-associated-with-resource-utilization
#9
Claire Pearson, Deborah S Kim, Valerie H Mika, S Imran Ayaz, Scott R Millis, Robert Dunne, Phillip D Levy
OBJECTIVES: To identify health beliefs of emergency department (ED) patients with low acuity conditions and how these affect ambulance (AMB) utilization. METHODS: We performed a prospective, observational study on a convenience sample of patients 18years or older, who presented to the ED of an urban, academic hospital with an Emergency Severity Index (ESI) triage level of 4 or 5. Demographics, treatment, and disposition data were obtained along with self-administered surveys...
December 13, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29262428/bringing-emergency-neurology-to-ambulances-mobile-stroke-unit
#10
Ritvij Bowry, James C Grotta
Ischemic stroke results from blocked arteries in the brain, with earlier thrombolysis with intravenous tissue plasminogen activator (tPA) and/or mechanical thrombectomy resulting in improved clinical outcomes. Mobile Stroke Unit (MSU) can speed up the treatment with tPA and facilitate faster triage for patients to hospitals for mechanical thrombectomy. The first registry-based MSU study in Germany demonstrated faster treatment times with tPA using a MSU, a higher proportion of patients being treated within the first "golden hour," and a suggestion of improved 3-month clinical outcomes...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29225903/early-clinical-outcomes-as-a-function-of-use-of-newer-oral-p2y12-inhibitors-versus-clopidogrel-in-the-euromax-trial
#11
Kurt Huber, Gregory Ducrocq, Christian W Hamm, Arnoud van 't Hof, Frédéric Lapostolle, Pierre Coste, Giovanni Gordini, Jacob Steinmetz, Freek W A Verheugt, Jennifer Adgey, Lutz Nibbe, Vojko Kaniĉ, Peter Clemmensen, Uwe Zeymer, Debra Bernstein, Jayne Prats, Efthymios N Deliargyris, Ph Gabriel Steg
Objective: To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI). Methods: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator's discretion...
2017: Open Heart
https://www.readbyqxmd.com/read/29170328/31%C3%A2-the-quality-improvement-qip-improving-multidisciplinary-staff-engagement-with-quality-improvement-in-the-rvh-emergency-department
#12
Olly Bannon, Emma Greenwood
: In recent years the RVH Emergency Department (ED) had been under intense pressure and public scrutiny. This led to a demoralised workforce who had become disengaged with quality improvement (QI). QI projects had become an exercise in data collection with little focus on improving care for patients.Two consultants undertook training in QI and then decided to develop a QI project aiming to empower staff and embed QI as daily practice. An ED QI steering group of interested multidisciplinary members was formed and devised an improvement plan to increase staff engagement with QI...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170314/17%C3%A2-exploring-ambulance-conveyances-to-the-emergency-department-a-descriptive-analysis-of-non-urgent-transports
#13
Jamie Miles, Colin O'Keeffe, Richard Jacques, Tony Stone, Suzanne Mason
OBJECTIVES: An NHS England report highlighted key issues in how patients were initially navigating access to healthcare. This has manifested in increased pressure on ambulance services and emergency departments (EDs) to provide high quality, safe and efficient services to manage this demand. This study aims to identify non-urgent conveyances by ambulance services to the ED that would be suitable for care at scene or an alternative response. DESIGN: A retrospective analysis of emergency department data linked to initial pre-hospital call data (either '111' or '999') in 2014 in Yorkshire and Humber...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170313/16%C3%A2-investigating-the-effects-of-under-triage-by-existing-major-incident-triage-tools
#14
James Vassallo, Jason Smith
INTRODUCTION: Triage, the process of prioritising patients on the basis of clinical acuity, is a key principle in the effective management of a major incident. The overall effectiveness of the triage process is not only a balance between identifying those who need or don't need a life-saving intervention, but also those who are under or over-triaged as either incorrectly needing/not needing intervention. The primary aim of this study was to describe the implications of under-triage using existing major incident triage tools, including the 2013 National Ambulance Resilience Unit (NARU) Sieve...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29151402/difference-in-first-aid-activity-during-mass-casualty-training-based-on-having-taken-an-educational-course
#15
Youichi Yanagawa, Kazuhiko Omori, Kouhei Ishikawa, Ikuto Takeuchi, Kei Jitsuiki, Toshihiko Yoshizawa, Jun Sato, Hideyuki Matsumoto, Masaru Tsuchiya, Hiromichi Osaka
BACKGROUND: The Japanese Association for Disaster Medicine developed a mass casualty life support (MCLS) course to improve cooperation among medical practitioners during a disaster, which is essential for reducing the rates of preventable disaster death. We investigated whether there was difference in first aid activity among members of the ambulance service during mass casualty training based on having taken the MCLS course. METHODS: Mass casualty training was held at the fire department of Numazu City...
November 20, 2017: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#16
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
October 31, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29123897/a-review-of-the-history-of-the-origin-of-triage-from-a-disaster-medicine-perspective
#17
REVIEW
Hiroyuki Nakao, Isao Ukai, Joji Kotani
We usually associate triage with the Simple Triage and Rapid Treatment method, but much of its origin is still unknown. Therefore, French studies and the origin of triage shown in domestic and foreign published works have been investigated and its significance reaffirmed. The etymology of the word "triage" means "to break into three pieces." It was suggested by a literature review that the rise of Napoleon led to military tactical changes, and that the prototype of triage arose from the experience gained in the difficult campaign in Egypt and Syria...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29120878/investigating-the-effects-of-under-triage-by-existing-major-incident-triage-tools
#18
James M Vassallo, Jason E Smith, Lee A Wallis
OBJECTIVES: Triage is a key principle in the effective management of a major incident. Its effectiveness is a balance between identifying those in need of life-saving intervention, and those triaged incorrectly as either needing/not needing life-saving intervention. The primary aim of this study was to report mortality in those under-triaged by existing major incident triage tools. Secondary aims were to report the ability of triage tools at identifying serious injury by body region (defined as the Abbreviated Injury Scale≥3)...
November 8, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/29113021/trauma-case-review-a-quality-and-safety-feature-of-the-victorian-state-trauma-system
#19
Carolyn Pinto, Peter A Cameron, Belinda Gabbe, Susan McLellan, Tony Walker
The aim of the present study was to describe the trauma case review process and its role in a regionalised trauma system. Victoria has a population of 5.9 million people, accounting for 26% of Australia's population. Victoria has been serviced by an inclusive, organised trauma system since 2000 comprising 138 health services with trauma designations and three major trauma services. Pre- and interhospital guidelines prescribe the timely transport of patients to the appropriate level of trauma service. A review of the role and contribution of 10 years of operation of the trauma case review group (CRG) was undertaken to describe the aims, processes and governance surrounding the implementation of an individual case review for specified major trauma patients...
November 7, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29100549/low-sensitivity-of-qsofa-sirs-criteria-and-sepsis-definition-to-identify-infected-patients-at-risk-of-complication-in-the-prehospital-setting-and-at-the-emergency-department-triage
#20
Selin Tusgul, Pierre-Nicolas Carron, Bertrand Yersin, Thierry Calandra, Fabrice Dami
BACKGROUND: Sepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with suspected infection at risk of complication (intensive care unit (ICU) admission, in-hospital mortality). The aim of this study was to measure the sensitivity of the qSOFA score, SIRS criteria and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the emergency department (ED) triage...
November 3, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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