The American journal of emergency medicine
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The Ottawa ankle rules (OAR) have been validated in many Western countries. However, a recent study performed in an accident and emergency department in Singapore failed to validate the OAR. Therefore, the implementation of the use of OAR in accident and emergency departments in Hong Kong may be treated with skepticism. ⋯ The sensitivity and specificity of the OAR for ankle injuries was 98% and 40.8%. For midfoot injuries, the sensitivity and specificity of the OAR was 100% and 43.8%. We concluded that the OAR are applicable in our population with potential advantages for reducing the number of unnecessary investigations and shortening the patients' length of stay in accident and emergency departments.
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The objective of this study was to assess the attitudes of emergency medical technicians (EMTs) toward tabletop drills to determine the effect of tabletop simulation on the EMT student perception of disaster preparedness and management. In November 1998 and April 1999, 59 firefighters underwent 260 hours of EMT intermediate level training at the National Cheng Kung University Hospital in Tainan, Taiwan. All participants had experience in field disaster exercise training before they attended this EMT training course. ⋯ Tabletop exercise also provided a better chance than field exercise to evaluate the response without the use of telephones, which are not always reliable in real emergency situation. For disaster exercises, limitations of field operation drills such as communications, coordination, assignment of responsibilities, and postevent mitigation priorities were noted, and tabletop drills provided additional benefits for these settings. Large-scale effect evaluation of different drills may be necessary to design future disaster preparedness programs.
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Commotio cordis is the condition of sudden cardiac death or near sudden cardiac death after blunt, low-impact chest wall trauma in the absence of structural cardiac abnormality. Ventricular fibrillation is the most commonly reported induced arrhythmia in commotio cordis. Blunt impact injury to the chest with a baseball is the most common mechanism. Survival rates for commotio cordis are low, even with prompt CPR and defibrillation.
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The purpose of this study was to evaluate emergency department (ED) patient expectations for the delivery of pain medication and correlation of satisfaction with meeting patient needs for pain relief. In this prospective survey of 458 ED patients with pain, the patients reported a mean of 23 minutes as a reasonable wait for pain medication versus 78 minutes for the actual delivery of pain medication. Forty-five percent of patients received pain medication and 70% had their needs for pain relief met. ⋯ Patients expect rapid delivery of pain medication after arrival in the ED. Time to delivery of pain medication in this ED does not meet patient expectations. Patients who had their needs for pain relief met were more satisfied with ED care.
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Emergency medical care in Ecuador is limited by geographic, economic, political, and infrastructural barriers. Afflictions of the developing world (eg, tropical infections and natural disasters) combine with ailments of the developed world (eg, trauma and cardiovascular disease) to mandate improved emergency medical systems. ⋯ Furthermore, a dedicated residency program in Emergency and Disaster Medicine recently graduated its first class. Although more programs and funding are necessary to sustain the effort, Ecuador has begun to develop a modern emergency medical system.