The American journal of emergency medicine
-
Large events have been defined in many ways, from the vague description of a focused gathering of people to the more specific description of an event with at least 1,000 spectators and participants who are gathered at a specific location for a defined period of time. Regardless of the definition applied, the actual medical requirements vary considerably from one event to the next. ⋯ Many factors contribute to medical need at a large event, including event type, weather (particularly heat index), the presence of alcohol and / or illicit drugs, the number of participants, event duration, crowd demographics, and venue characteristics. This review will focus on the various features of large events such that the medical planner can better understand the challenge and provide adequate resource for patient care.
-
Clinical trials are the foundation underlying clinical decision-making. However, stringent inclusion and exclusion criteria may reduce the generalizability of their results, especially for patients seen in the emergency department (ED). Guideline recommendations, based on clinical trials and pertinent registries, apply to broad populations, but not all patients cared for at the bedside fit the predefined categories that make guidelines practical. Furthermore, these documents may not incorporate the latest evidence. As a result, other factors (eg, individual patient characteristics, clinician experience, cost, regulatory labels, expert opinions) often result in clinical decision-making that varies from strict adherence to guideline recommendations. ⋯ Although guidelines and clinical registries can provide broad direction for practice, there is no substitute for a prospective, multidisciplinary, institution-specific, consistent, evidence-based approach to patient management.