Annals of emergency medicine
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To measure the effectiveness of a multimodal strategy, including simultaneous implementation of a clinical decision support system, to sustain adherence to a clinical pathway for care of children with minor head trauma treated in general emergency departments (EDs). ⋯ Implementation of a minor head trauma clinical pathway using a multimodal approach, including a clinical decision support system, led to sustained improvements in adherence and a modest, yet safe, reduction in CT scans among generally low-risk patients in diverse general EDs.
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Observational Study
Patterns in the Pandemic: Disproportionate Patient Burdens Among Regional Hospitals.
To examine the distribution of hospitalized COVID-19 patients among adult acute care facilities in the Greater Philadelphia area and identify factors associated with hospitals carrying higher burdens of COVID-19 patients. ⋯ Substantial discrepancies in COVID-19 inpatient burdens existed among Philadelphia-region adult acute care facilities during the initial COVID-19 surge. Trauma center status, urban location, low household income, and high reliance on public insurance were associated with both higher COVID-19 burdens and longer periods of high occupancy. Improved data collection and centralized sharing of pandemic-specific data between health care facilities may improve resource balancing and patient care during current and future response efforts.
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Observational Study
Stability of Drugs Stored in Helicopters for Use by Emergency Medical Services: A Prospective Observational Study.
Drugs stored in rescue helicopters may be subject to extreme environmental conditions. The aim of this study was to measure whether drugs stored under the real-life conditions of a Swiss helicopter emergency medical service (HEMS) would retain their potency over the course of 1 year. ⋯ Drugs stored under the real-life conditions of Swiss HEMS are subjected to temperatures outside the manufacturer's approved storage requirements. Despite this, all drugs stored under these conditions remained stable throughout our study. Real-life stability testing could be a way to extend drug exchange intervals.
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One in 4 deaths from COVID-19 has been attributed to hospital crowding. We simulated how many ambulances would be required to rebalance hospital load through systematic interhospital transfers. We assessed the potential feasibility of such a strategy and explored whether transfer requirement was a helpful measure and visualization of regional hospital crowding during COVID-19 surges. ⋯ This simulation demonstrated that for most weeks during the pandemic, ambulance availability and bed capacity were unlikely to have been the main impediments to rebalancing hospital loads. Our metric provided an immediately available and much more complete measure of hospital system strain than counts of hospital admissions alone.