The American journal of emergency medicine
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Healthcare facilities and medical providers are not immune to aggression and threat from terrorists, criminals and rogue states. The concept of Hybrid Warfare is often described as a mix of conventional warfare, irregular warfare, terrorism, criminality and different types of other hybrid threats such as cyberattacks and drone technology. Healthcare systems can either be primary or secondary targets of hybrid warfare with potentially devastating consequences. ⋯ Clinicians and healthcare managers of all levels should have a basic knowledge of the different components of hybrid warfare so as to mitigate effects of an attack. It is suggested that an emergency department do not aim to create totally new solutions for hybrid threats but use an all hazards approach and the available guidelines for handling generic threats. However, there must be a preparedness for the different ways hybrid warfare can play out, how the threats can be combined in synergistic ways and the potential compounding effects on healthcare and society.
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Law enforcement officer (LEO) administered naloxone is an effective intervention for treating prehospital opioid overdoses. Our objective is to determine the rate and factors associated with adverse behavioral effects and efficacy following LEO naloxone administration. ⋯ LEO administered naloxone remains an effective intervention for overdose victims, with higher perceived efficacy when opioids are specifically implicated. Combativeness is rare following LEO naloxone administration. Further research is needed to understand a relationship between suspected fentanyl intoxication and post-naloxone behavioral disturbances.
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The Centers for Medicare and Medicaid Services introduced the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) as a national quality measure in October 2015. The purpose of SEP-1 is to facilitate the efficient, effective, and timely delivery of high-quality care to patients presenting along the spectrum of sepsis severity. ⋯ Overall, there were no clinically or statistically meaningful changes in fluid volume resuscitation strategies for suspected septic shock patients following SEP-1. Broad mandates may not be effective tools for promoting practice change in the ED setting. Further research investigating barrier to changes in practice patterns surrounding fluid administration and other SEP-1 bundle elements is warranted.
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This case demonstrates a complex patient presenting with diagnosis of pulmonary embolism. He received heparin therapy, then subsequently found to have an intracranial hemorrhage, which rapidly progressed, leading to patient demise. Through this case, the reader should better understand the therapeutic conundrums in critical PE patients and complications of anticoagulation.
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The trauma team leader (TTL) is a "model" of a specifically dedicated team leader in the emergency department (ED), but its benefits are uncertain. The primary objective was to assess the impact of the TTL on 72-hour mortality. Secondary objectives included 24-hour mortality and admission delays from the ED. ⋯ TTL implementation was not associated with changes in mortality or admission delays from the ED. Future studies should assess the potential impact of TTL programs on other patient-centred outcomes using different quality of care indicators.