The American journal of emergency medicine
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There are gender differences in emergency medical services (EMS) transports and management based on diagnosis. Data were extracted from the EMS State Ambulance Transport database. This database exists because of a legal requirement that all EMS transports generated by 911 calls and all interhospital transports be reported to the State EMS Bureau. ⋯ There are numerous disease-specific gender differences in the demographics of illness and injury transported by EMS. The use of various medications and procedures may also be related to gender. Understanding these differences may help in preparing EMS professionals for patient management.
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The objective of this study was to analyze ambulance usage by highest acuity patients as compared with all patients in a suburban pediatric hospital ED. A 1-year retrospective records analysis was conducted of all highest acuity patients (those patients triaged as emergent or critical or admitted to the intensive care unit). A total of 245 patients made 270 high-acuity visits to the ED in 1995. ⋯ There was no significant difference in ambulance usage between insurance groups in the high-acuity patients. Only high-acuity patients with neurologic symptoms (primarily seizures) had a greater relative use of EMS transportation, with 39% of these patients arriving via ambulance (odds ratio 6.6, 95% confidence interval 2.6,16.6). High-acuity patients account for the minority of total ambulance usage in our ED.
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A prospective observational study was performed in 706 chest pain patients who underwent our chest pain evaluation protocol which consists of continuous 12-lead ST-segment monitoring with automated serial ECG (SECG) and a 2-hour delta (delta) CK-MB level determination before ED physician making final disposition decision to determine the incremental value of our 2-hour protocol for identifying myocardial infarction (MI) as compared with the initial ECG in combination with a baseline CK-MB. The initial ECG was obtained on presentation and considered positive if it revealed injury or ischemia. SECGs were obtained at least every 10 minutes and considered positive if it revealed new injury or ischemia. ⋯ MI was defined as acute myocardial infarction (AMI) or recent AMI (ie, AMI patients presenting on falling curve of CK-MB). The incremental value of the 2 hour protocol (ie, SECG in conjunction with deltaCK-MB) was more sensitive for identification of MI than the baseline protocol (ie, initial ECG in conjunction with the baseline CK-MB) (94.0% versus 55.4%; P < .0001) and reliably both identified (+LR = 14.6) and excluded MI (-LR = 0.06). SECG monitoring in conjunction with the 2 hour deltaCK-MB allows for early identification and exclusion of MI, and can assist the ED physician in making appropriate treatment and disposition decisions.
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The study objective was to determine patient satisfaction with physician assistants (PAs) in an emergency department (ED) fast track (FT). An additional goal was to determine if patients would be willing to wait longer to be seen primarily by an emergency physician (EP) rather than a PA. The study was conducted between March 1, 1999 and May 1, 1999 at a community hospital with an annual ED census of 48,644 patients; 18% are seen in the ED FT. ⋯ Only 13 patients (12%) indicated they would be willing to wait longer to be seen primarily by an EP rather than a PA. Patients seen in an ED FT are very satisfied with the care rendered by a PA. Few patients would be willing to wait longer in such a setting to be seen primarily by an EP.