Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Naloxone frequently is used to treat suspected heroin and opioid overdoses in the out-of-hospital setting. The authors' emergency medical services system has operated a policy of allowing these patients, when successfully treated, to sign out against medical advice (AMA) in the field. ⋯ Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.
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Multicenter Study Comparative Study
Multivariate predictors of failed prehospital endotracheal intubation.
Conventionally trained out-of-hospital rescuers (such as paramedics) often fail to accomplish endotracheal intubation (ETI) in patients requiring invasive airway management. Previous studies have identified univariate variables associated with failed out-of-hospital ETI but have not examined the interaction between the numerous factors impacting ETI success. This study sought to use multivariate logistic regression to identify a set of factors associated with failed adult out-of-hospital ETI. ⋯ The authors used multivariate logistic regression to identify a set of factors associated with failure to accomplish ETI in adult out-of-hospital patients. Findings from this analysis could provide the basis for clinical protocols or decision rules aimed at minimizing the incidence of out-of-hospital ETI failure.
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Comparative Study
Surveillance of infectious disease occurrences in the community: an analysis of symptom presentation in the emergency department.
To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community. ⋯ Surveillance of ED symptom presentation has the potential to identify clinically important ID occurrences in the community 24 hours prior to HD identification. Lack of weekend HD data collection suggests that the ED is a more appropriate setting for real-time ID surveillance.
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To examine the influence of emergency medicine (EM) certification of clinical teaching faculty on evaluations provided by residents. ⋯ Significant differences exist among instructors in the EM setting that affect their teaching rating scores. National certification in EM, academic track, rotation year, and site are all correlated with better teaching performance.
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Comparative Study
Emergency medicine resident scheduling and patient exposure.
As a result of increasing emergency department census and patient waiting times at the authors' institution, attending physician staffing was increased, followed by a change in resident shift schedule. A study was undertaken to ascertain any change in residents' exposure to patients during the times before and immediately following the staffing and scheduling changes. ⋯ After an increase in attending coverage, there was no change in the number or triage acuity of patients seen by residents. Staggered scheduling may decrease residents' exposure to patients compared with simultaneous scheduling.