Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport.
To determine whether emergency medical technicians (EMTs) can safely apply protocols to assign transport options and to assess agreement between groups of providers on application of the protocols. ⋯ From 3% to 11% of patients determined on scene not to need an ambulance had a critical event. Emergency medical services systems need to determine an acceptable rate of undertriage. Further study is needed to determine whether better adherence to the protocols might increase safety.
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Many rural communities have difficulty maintaining a medical director for their emergency medical services (EMS). Local physicians may be overwhelmed, be hesitant to take on additional responsibilities, and feel unskilled in providing the necessary leadership. Without a medical director, rural EMS agencies are frequently forced to shut down, thus depriving the community of local out-of-hospital care. ⋯ This unique program enables local EMS agencies to continue their service while providing clear educational benefit for the EM residents. This paper demonstrates how this program has been working successfully in the state of Colorado by placing residents in four distinct rural and mountainous communities.
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Los Angeles County-University of Southern California Medical Center, like many large urban hospitals, has a large immigrant population from regions of the world where leprosy is endemic. Emergency physicians (EPs) in these settings can expect to encounter leprosy patients. This study reviewed the emergency department (ED) course of patients with confirmed leprosy in an attempt to describe the most common presenting patterns so that future cases can be more easily recognized. ⋯ Patients with leprosy present to U.S. EDs, and new cases can be identified. Early recognition is important given leprosy's devastating consequences, major drug side effects of medications used for treatment, and improved prognosis with multidrug therapy. A history of leprosy and associated medications are often not documented in the ED chart, which may reflect a continued fear of stigmatization among these patients.