Emergency medicine journal : EMJ
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Appropriate activation of multidisciplinary trauma teams improves outcome for severely injured patients but can disrupt normal service in the rest of the hospital. Derriford Hospital uses a two-tiered trauma team activation system. The emergency department trauma team (EDTT) is activated in response to a significant traumatic mechanism; the hospital trauma team (HTT) is activated when this mechanism coexists with physiological abnormality or specific anatomical injury. The aim of this study was to compare characteristics, process measures and outcomes between patients treated by EDTTs or HTTs to evaluate the approach in a UK setting. ⋯ A two-tiered trauma team activation system is an efficient and cost-effective way of dealing with trauma patients presenting to a major trauma centre in the UK.
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Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for extrication or the factors which affect this time. ⋯ This paper describes the development of a tool to predict extrication time for a trapped patient. A number of factors were identified which significantly contributed to the overall extrication time.
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Modified Early Warning Scores (MEWS), calculated from patients' vital signs, are used in hospital to identify patients who may benefit from admission or intensive care: higher MEWS indicates greater clinical risk. We aimed to evaluate MEWS to support paramedics' decisions to transport patients to hospital or treat and leave them at home. ⋯ MEWS had a minimal effect on transportation or revisit rates. Scores were frequently not calculated or recorded, or incorrectly calculated. Opportunities for ongoing training, clinical support and feedback were limited. A larger study, ensuring adequate ongoing support, is recommended before implementing MEWS on a wider scale.
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2,4-Dinitrophenol (DNP) increases energy consumption by uncoupling oxidative phosphorylation. Although not licensed as a medicine, it is sometimes used by 'body sculptors' and for weight loss as a 'fat burning' agent. This research was performed to characterise patterns of presentation, clinical features and outcomes of patients reported to the National Poisons Information Service (NPIS) in the UK after exposure to DNP. ⋯ The study indicates a substantial recent increase in clinical presentations with toxicity caused by exposure to DNP in the UK with an associated high mortality. Further steps are needed to warn potential users of the severe and sometimes fatal toxicity that may occur after exposure to this compound.
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Limited published evidence indicates a significant impact from mental health related calls on ambulance services (AS), however available routine data appear to underestimate the amount of these calls and the resources spent in response. Paramedics have reported feeling ill-equipped for informed clinical decision-making in mental health cases: leaving at home can risk self harm, but conveying to an emergency departments is often not the most appropriate place for patients with mental distress and unnecessarily ties up resources. ⋯ Both dispatch and on-scene condition codes underestimate the volume of mental health related emergency calls by nearly half. Our model of care provides considerable potential to support paramedics to assess and reduce transfers to emergency departments through access to pre-existing community care provision.