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Ambulance triage

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https://www.readbyqxmd.com/read/28077253/a-survey-of-patients-with-bed-bugs-in-the-emergency-department
#1
Johnathan M Sheele, Stephanie Gaines, Nicholas Maurer, Katirina Coppolino, Jennifer S Li, Amy Pound, Jeffrey H Luk, Ed Mandac
Bed bugs are one of the most important human ectoparasites in the United States, and a growing problem in the emergency department. We evaluated 40 emergency department (ED) patients found with a bed bug. The data show that ED patients with bed bugs are statistically more likely to be male, older, more likely to be admitted to the hospital, have higher triage emergency severity index (ESI) scores, and arrive by ambulance than the general ED patient population (p<0.05). On average bed bugs were found 108min after a patient arrived to the ED, after 35% of subjects had already received a blood draw, and after 23% had already received a radiology study; putting other ED patients and staff at risk for acquiring the infestation...
January 3, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28065200/testing-the-start-triage-protocol-can-it-improve-the-ability-of-nonmedical-personnel-to-better-triage-patients-during-disasters-and-mass-casualties-incidents
#2
Stefano Badiali, Aimone Giugni, Lucia Marcis
OBJECTIVE: START (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether "last-minute" START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients. METHODS: In this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group)...
January 9, 2017: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/28041758/emergency-medical-services-ems-versus-non-ems-transport-among-injured-children-in-the-united-states
#3
Michelle M Corrado, Junxin Shi, Krista K Wheeler, Jin Peng, Brian Kenney, Sarah Johnson, Huiyun Xiang
OBJECTIVES: This study aimed to assess the proportions of injured children transported to trauma centers by different transportation modes and evaluate the effect of transportation mode on inter-facility transfer rates using the US national trauma registry. METHODS: We analyzed data from the 2007-2012 National Trauma Data Bank (NTDB) to study trends of EMS versus non-EMS transport. Multivariable logistic regression was used to evaluate the association between transport mode and inter-facility transfer...
November 30, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28017330/mortality-following-helicopter-versus-ground-transport-of-injured-children
#4
Stephanie F Polites, Martin D Zielinski, Aodhnait S Fahy, Amy E Wagie, Christopher R Moir, Donald H Jenkins, Scott P Zietlow, Elizabeth B Habermann
INTRODUCTION: Injured children may be transported to trauma centers by helicopter air ambulance (HAA); however, a benefit in outcomes to this expensive resource has not been consistently shown in the literature and there is concern that HAA is over-utilized. A study that adequately controls for selection biases in transport mode is needed to determine which injured children benefit from HAA. The purpose of this study was to determine if HAA impacts mortality differently in minimally and severely injured children and if there are predictors of over-triage of HAA in children that can be identified...
December 19, 2016: Injury
https://www.readbyqxmd.com/read/28011758/ambulance-telephone-triage-using-nhs-pathways-to-identify-adult-cardiac-arrest
#5
Charles D Deakin, Simon England, Debbie Diffey
BACKGROUND: UK ambulance services are called to 30 000 cardiac arrests (CAs) annually where resuscitation is attempted. Correct identification by the ambulance service trebles survival by facilitating bystander-cardiopulmonary resuscitation (CPR) and immediate ambulance dispatch. Identification of CA by telephone is challenging and involves algorithms to identify key features. 'NHS Pathways' is now used for triage by six of 12 UK ambulance services, covering a population of 20 million...
December 23, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27925145/the-oldest-old-in-the-emergency-department-impact-of-renal-function
#6
T Brünnler, M Drey, G Dirrigl, C Weingart, F Rockmann, C Sieber, U Hoffmann
OBJECTIVES: The ageing population implicates an increasing numbers of older adults attending Emergency Departments (ED). We assessed the effect of estimated glomerular filtration rate as a predictor of clinical outcomes in oldest-old patients ≥ 85 years attending the ED in an university teaching hospital. DESIGN: Within three years, 81831 patient contacts were made in our ED. 7799 (9.5%) were older than 85 years, in whom we analyzed the impact of renal function on various outcome parameters...
2016: Journal of Nutrition, Health & Aging
https://www.readbyqxmd.com/read/27917744/a-determination-of-emergency-department-pre-triage-times-in-patients-not-arriving-by-ambulance-compared-to-widely-used-guideline-recommendations
#7
Martin Betz, James Stempien, Sachin Trevidi, Rhonda Bryce
OBJECTIVES: Emergency department (ED) lengths of stay are measured from the time of patient registration or triage. The time that patients wait in line prior to registration and triage has not been well described. We sought to characterize pre-triage wait times and compare them to recommended physician response times, as per the Canadian Triage and Acuity Scale (CTAS). METHODS: This observational study documented the time that consenting patients entered the ED and the time that they were formally registered and triaged...
December 5, 2016: CJEM
https://www.readbyqxmd.com/read/27913657/cost-benefit-analysis-of-telehealth-in-pre-hospital-care
#8
James R Langabeer, Tiffany Champagne-Langabeer, Diaa Alqusairi, Junghyun Kim, Adria Jackson, David Persse, Michael Gonzalez
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...
December 2, 2016: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/27912757/the-sydney-triage-to-admission-risk-tool-start-to-predict-emergency-department-disposition-a-derivation-and-internal-validation-study-using-retrospective-state-wide-data-from-new-south-wales-australia
#9
Michael M Dinh, Saartje Berendsen Russell, Kendall J Bein, Kris Rogers, David Muscatello, Richard Paoloni, Jon Hayman, Dane R Chalkley, Rebecca Ivers
BACKGROUND: Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making. METHODS: This was a retrospective analysis of State-wide Emergency Department data in New South Wales, Australia. Adult patients (age ≥ 16 years) were included if they presented to a Level five or six (tertiary level) Emergency Department in New South Wales, Australia between 2013 and 2014...
December 3, 2016: BMC Emergency Medicine
https://www.readbyqxmd.com/read/27903076/the-potential-of-optimizing-prehospital-triage-of-patients-with-suspected-acute-myocardial-infarction-using-high-sensitivity-cardiac-troponin-t-and-copeptin
#10
Carsten Stengaard, Jacob T Sørensen, Søren A Ladefoged, Jens F Lassen, Martin B Rasmussen, Claus Kjær Pedersen, Antoine Ayer, Hans Erik Bøtker, Christian J Terkelsen, Kristian Thygesen
PURPOSE: In patients with a suspected acute myocardial infarction (AMI), to evaluate the potential for early triage based on measurement of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin in blood samples collected in the prehospital phase. MATERIALS AND METHODS: In this retrospective study, we measured hs-cTnT and copeptin in blood samples collected in the ambulance form 962 patients with suspected AMI. The diagnostic accuracy was estimated by receiver-operating characteristic (ROC) curve area under the curve (AUC) for both biomarkers and a combined model...
December 12, 2016: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
https://www.readbyqxmd.com/read/27852453/current-use-and-outcomes-of-helicopter-transport-in-pediatric-trauma-a-review-of-18-291-transports
#11
Brian R Englum, Kristy L Rialon, Jina Kim, Mark L Shapiro, John E Scarborough, Henry E Rice, Obinna O Adibe, Elisabeth T Tracy
PURPOSE: The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries. METHODS: All blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS)≥9 were included...
October 27, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27833455/a-decision-support-system-dss-for-municipal-nurses-encountering-health-deterioration-among-older-people
#12
Annica Kihlgren, Fredrik Svensson, Conny Lövbrand, Mervyn Gifford, Annsofie Adolfsson
BACKGROUND: This study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver...
2016: BMC Nursing
https://www.readbyqxmd.com/read/27797986/ambulance-smartphone-tool-for-field-triage-of-ruptured-aortic-aneurysms-filtr-study-protocol-for-a-prospective-observational-validation-of-diagnostic-accuracy
#13
Thomas L Lewis, Rachael T Fothergill, Alan Karthikesalingam
INTRODUCTION: 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...
October 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27789567/variables-associated-with-administration-of-analgesia-nurse-initiated-analgesia-and-early-analgesia-in-the-emergency-department
#14
David McD Taylor, Jessie Chen, Munad Khan, Marina Lee, Mani Rajee, Michael Yeoh, Joanna R Richardson, Antony M Ugoni
OBJECTIVE: To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation). METHODS: We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Australia, during July and August, 2013. The ED has an established NIA programme. Patients were included if they were aged 18 years or more and presented with a painful complaint...
January 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/27786390/diagnosis-based-emergency-department-alcohol-harm-surveillance-what-can-it-tell-us-about-acute-alcohol-harms-at-the-population-level
#15
Genevieve Whitlam, Michael Dinh, Craig Rodgers, David J Muscatello, Rhydwyn McGuire, Therese Ryan, Sarah Thackway
INTRODUCTION AND AIMS: Acute harm from heavy drinking episodes is an increasing focus of public health policy, but capturing timely data on acute harms in the population is challenging. This study aimed to evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms. DESIGN AND METHODS: We selected a random sample of 1000 ED presentations assigned an ED diagnosis code for alcohol harms (the 'alcohol syndrome') in the New South Wales, Australia, automatic syndromic surveillance system...
November 2016: Drug and Alcohol Review
https://www.readbyqxmd.com/read/27752318/a-collaborative-improvement-project-by-an-nhs-emergency-department-and-scottish-ambulance-paramedics-to-improve-the-identification-and-delivery-of-sepsis-6
#16
Martin Carberry, John Harden
Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38)...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27747560/the-epidemiology-of-pre-hospital-potential-spinal-cord-injuries-in-victoria-australia-a-six-year-retrospective-cohort-study
#17
Ala'a O Oteir, Karen Smith, Johannes U Stoelwinder, Shelley Cox, James W Middleton, Paul A Jennings
BACKGROUND: Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI. METHODS: This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI...
December 2016: Injury Epidemiology
https://www.readbyqxmd.com/read/27732713/evaluation-of-rural-vs-urban-trauma-patients-served-by-9-1-1-emergency-medical-services
#18
Craig D Newgard, Rongwei Fu, Eileen Bulger, Jerris R Hedges, N Clay Mann, Dagan A Wright, David P Lehrfeld, Carol Shields, Gregory Hoskins, Craig Warden, Lynn Wittwer, Jennifer N B Cook, Michael Verkest, William Conway, Stephanie Somerville, Matthew Hansen
Importance: Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma. Objectives: To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS). Design, Setting, and Participants: This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization...
October 12, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27726972/emergency-nursing-workload-and-patient-dependency-in-the-ambulance-bay-a-prospective-study
#19
Wayne Varndell, Elizabeth Ryan, Alison Jeffers, Nadya Marquez-Hunt
AIM: The purpose of this prospective observational study was to characterise patients occupying the ambulance bay and to determine the ensuing nursing workload. BACKGROUND: The number of patients presenting to ED by ambulance is increasing. During periods of peak demand and access block in the ED, patients with ongoing care needs, requiring continual assessment and symptom management by emergency nurses can remain in the ambulance bay for extended periods of time...
October 7, 2016: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/27660386/factors-influencing-time-to-computed-tomography-in-emergency-department-patients-with-suspected-subarachnoid-haemorrhage
#20
Maryam Khan, Marco L A Sivilotti, Michael J Bullard, Marcel Émond, Jane Sutherland, Andrew Worster, Corinne M Hohl, Jacques S Lee, Mary Eisenhauer, Merril Pauls, Howard Lesiuk, George A Wells, Ian G Stiell, Jeffrey J Perry
BACKGROUND: CT has excellent sensitivity for subarachnoid haemorrhage (SAH) when performed within 6 hours of headache onset, but it is unknown to what extent patients with more severe disease are likely to undergo earlier CT, potentially inflating estimates of sensitivity. Our objective was to evaluate which patient and hospital factors were associated with earlier neuroimaging in alert, neurologically intact ED patients with suspected SAH. METHODS: We analysed data from two large sequential prospective cohorts of ED patients with acute headache undergoing CT for suspected SAH...
January 2017: Emergency Medicine Journal: EMJ
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