Emergency medicine journal : EMJ
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Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured patients with pre-hospital care. ⋯ There is wide geographical and diurnal variability in availability and utilisation of physician-based pre-hospital critical care support. Only London ambulance service has access to NHS-commissioned 24 h physician-based pre-hospital critical care support. Throughout the rest of the UK, extensive use is made of volunteer doctors and charity sector providers of varying availability and capability.
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For serious motor vehicle crashes (MVC) occurring in a rural area to quantify: how many occur more than 45 min by road to a major trauma centre (MTC); how many occur more than 45 min by helicopter to an MTC; and how many patients might have to be taken to a local trauma unit if their incident occurs more than 45 min by road from an MTC and when the helicopter cannot fly. ⋯ The transportation of patients from remote and rural areas to MTC remains problematical. Further work is required to develop more efficient systems of retrieval and transfer, and in particular to consider how emergency medical helicopters might operate safely at night.
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Driven by the need for rapid assessment, treatment and appropriate disposition of patients in the emergency department (ED), blood tests are often performed in a protocolised fashion before full clinical assessment. The cardiologists at this institution currently insist upon a coagulation profile in each patient referred with a possible acute coronary syndrome. ⋯ Routine coagulation testing in adults presenting to ED with chest pain is unnecessary. This practice should be replaced by a coagulation testing policy based on an increased risk of coagulopathy due to warfarin or heparin use or a history of liver disease.
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Mental and physical symptoms are common in paramedics, which may relate to high work stress, including critical incidents. As previous trauma is a risk factor for psychological symptoms after exposure to critical incidents, the prevalence of childhood experiences with abuse and neglect and paramedics' adaptation to critical incidents may be important. ⋯ Childhood abuse may be more common in paramedics than in other healthcare workers, at least in women. Childhood abuse and neglect is associated with acute stress responses to critical incidents and to current physical and mental symptoms. These results are based on a low response rate and may not be generalisable.