European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Road traffic accidents (RTAs) with entrapment are perceived as a challenge to emergency systems because of the severity of the ensuing traumas and the inherent complexity of the rescue procedures. To clarify these two aspects this prospective cohort study enrolling 244 entrapped trauma patients was conducted by a Regional Medical Helicopter Service. Forty-six victims (18.9%) were found dead, 101 (51%) of the 198 patients who reached the hospital alive had an injury severity score (ISS) > or = 16. ⋯ Fourteen patients (13.9%) died during hospitalization. These data demonstrate that a high percentage of entrapped patients require advanced life support (ALS), including on scene intubation and chest decompression. Aggressive field resuscitation and immediate transport to a level 1 trauma centre is associated with a mortality lower than that predicted by TRISS in spite of the prolonged prehospital time.
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During the extrication process the trauma victim is at high risk for additional injuries or aggravation of existing lesions. Improper handling during extrication with poor concern and knowledge of the ongoing resuscitation process may increase the time spent at the scene and expose the patient to unnecessary risks. Earlier studies report a significant number of neurological injuries that appear to be a result of the extrication process, or of inadequate immobilization during transport. ⋯ The complexity of the scenarios increases throughout the course and different extrication techniques and strategies are practised. Both the times to extrication and on-scene times were reduced during the 3-day course. Therapeutic interventions and handling of the patient were also improved, in terms of early recognition of medical and technical risks and reduction of the time of no therapy.
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The Trondheim region's (315 km2, population 154,000) emergency medical service (EMS) provides advanced cardiac life support (ACLS) with combined paramedic and physician response. This EMS system is commonly employed in Norway, yet no population based study of outcome in cardiac arrest has been published to date. This retrospective study reports incidence and outcome from every attempted out-of-hospital cardiopulmonary resuscitation (CPR) during 1990 through 1994 according to the Utstein template. ⋯ Most patients made a favourable cerebral outcome, although nine were severely disabled. This is the first population-based Norwegian study of outcome from out-of-hospital cardiac arrest in this combined paramedic/physician staffed EMS. Incidence, survival and neurological outcome are comparable with results obtained in other EMS systems.
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Comparative Study
How good are accident and emergency doctors in the evaluation of psychiatric patients?
The aim of this study was to find out the agreement between psychiatrists and emergency department (ED) doctors in the diagnosis and treatment of psychiatric emergencies. All patients presenting with a psychiatric complaint and who were subsequently referred to the psychiatrist were included. A standard form was used to collect demographic data, provisional diagnoses and initial treatment by ED doctors, diagnoses by psychiatrists, and compatibility of ED diagnoses and treatment as judged by consulting psychiatrists. ⋯ The agreements between psychiatrists and ED doctors in diagnosis and treatment were 61.4% and 89.5% respectively. Schizophrenia and bipolar disorders were least likely to be mis-classified. It is concluded that ED doctors were deficient in the diagnosis of psychiatric conditions especially in the less common diagnostic categories.
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The risk of violence directed at health care professionals in their working environment has aroused widespread concern in recent years. Clinical areas most associated with violence are accident and emergency departments, psychiatry, and general practice. Surveyed physicians reported rates of violence against them to vary from 54% to 79%. ⋯ This study was an attempt to measure the incidence and the severity of violence against doctors in accident and emergency departments in Kuwait. Eighty-seven (86%) out of 101 of our doctors reported having experienced verbal insults or imminent threat of violence; in addition, 28% had also experienced physical attacks, and 7% had experienced physical assaults likely to have caused serious or fatal injury. Similarly, out of a total of 781 violent incidents reported by our doctors, 73 involved physical attacks, and eight involved physical assaults likely to have caused serious or fatal injury.