Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2021
Development of an emergency medical services system in Thailand: Roles of the universal health coverage and the national lead agency.
This paper describes how the Thai health sector developed nationwide emergency medical services (EMS), despite limited resources and we try to extract lessons applicable to other resource-constrained settings. The government of Thailand has strengthened EMS by integrating it into the general healthcare system and formulating a national development plan and lead agency for EMS. ⋯ In Khon Kaen Province, which has led the nationwide EMS development of Thailand, the availability of EMS (number of EMS units) and utilisation of EMS (proportion of severe trauma patients transported to hospital by EMS) greatly increased from 2000 to 2017. This success is due to the emphasis on the first-responder units through consistent national policies.
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Emerg Med Australas · Aug 2021
Spatiotemporal characteristics of asthma emergency department presentations in diverse geographical and climatic regions, Queensland, Australia.
Sudden acute episodes of asthma exacerbation are often treated by hospital EDs. It is hypothesised that determinants of acute asthma would differ across geographic regions. The objective of the present study was to detail seasonality, trends and spatiotemporal patterns of asthma ED presentations across Queensland (QLD), Australia, a state covering 1.8 million square kilometres, spanning multiple climates. ⋯ Asthma-related ED presentations exhibit spatiotemporal variation across QLD, which appears to be related to climate. Furthermore, aeroallergens and respiratory viruses may be responsible for asthma ED peaks outside the winter period. Socioeconomic status may influence asthma ED presentation rates between regions. This knowledge can guide ongoing management and assist public health policy response.
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Emerg Med Australas · Aug 2021
Is a nudge all we need to promote deliberate clinical inertia and thoughtful clinical decision making?
Deliberate clinical inertia is the art of doing nothing as a positive response. Individual clinicians can promote deliberate clinical inertia through teaching, re-framing the act of 'doing nothing' as 'doing something' and engaging in shared decision making. Behaviour change on a larger scale requires a systematic approach. ⋯ A nudge unit could be used to design environments to prompt clinicians to re-think before ordering unnecessary tests or treatments. Nudge units could improve knowledge translation, support continuous quality improvement and help build a learning health system. They could also boost collaboration and empower staff to evaluate their workplace decision-making frameworks.
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Emergency medicine researchers face the challenge of prioritising patients' immediate interests and maintaining hospital flow while attempting to collect clinical data. Even in low-risk scenarios, excessive consent processes can make it difficult to recruit patients while observing guidelines on efficient triage. ⋯ We then argue that there need be no conflict between the imperatives of patient wellbeing and clinical research. Apparent conflicts between treatment and research could be reduced through creative recruitment techniques: the adoption of an 'opt-out' approach; securing the budget for a dedicated research assistant; early consultation with the institution's human research ethics committee; and the use of a short, simple participant information and consent form with a QR code linking to a more detailed outline of the study.
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Emerg Med Australas · Aug 2021
Observational StudyKetamine as a rescue treatment for severe acute behavioural disturbance: A prospective prehospital study.
Rapidly and safely managing severe acute behavioural disturbance (ABD) in the prehospital setting is important for the welfare of both patient and prehospital clinician alike. We investigated the safety and effectiveness of ketamine as rescue sedation in patients with severe ABD. ⋯ The use of ketamine as rescue sedation in prehospital patients with severe ABD is effective. Adverse events are common but can be managed supportively.