Emergency medicine journal : EMJ
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The quality of cardiopulmonary resuscitation (CPR) has been shown to affect the survival of out-of-hospital cardiac arrest cases (OHCA). There are various individual factors that can affect the quality of chest compression. We aimed to determine if age, gender and physical attributes (height, weight and BMI) affected the quality of chest compressions administered by laypersons during training. ⋯ Overall, at least 1 parameter of chest compression quality decreased with age, and was better in males than females. A possible application of these results is to have differences in training methods for different ages and sexes, targeting parameters that they are weaker at.
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The most common route to a hospital bed in an emergency is via an Emergency Department (ED). Many recent initiatives and interventions have the objective of reducing the number of unnecessary emergency admissions. We aimed to assess whether ED admission thresholds had changed over time taking account of the casemix of patients arriving at ED. ⋯ The casemix-adjusted odds of admission via ED to NHS hospitals in England have decreased since April 2010. EDs are admitting a similar proportion of patients to hospital despite increases in the complexity and acuity of presenting patients. Without these threshold changes, the number of emergency admissions would have been 11.9% higher than was the case in year 5.
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: In recent years the RVH Emergency Department (ED) had been under intense pressure and public scrutiny. This led to a demoralised workforce who had become disengaged with quality improvement (QI). QI projects had become an exercise in data collection with little focus on improving care for patients. ⋯ We have also increased efficiency with senior review for Ambulance patients and subsequent significant decrease in waiting times. A recent project targeting the waste associated with unnessecary triage blood tests is showing promising early results.emermed;34/12/A880-a/F2F2F2Figure 2The ED improvement team have endeavoured to improve the environment for staff by developing a 'Grrr to Great' board, through which staff are empowered to highlight problems but are also tasked with developing solutions. We have also increased accessibility of QI data by producing a QI update board and displaying data openly and transparently in the department.emermed;34/12/A880-a/F3F3F3Figure 3.
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Triage, the process of prioritising patients on the basis of clinical acuity, is a key principle in the effective management of a major incident. The overall effectiveness of the triage process is not only a balance between identifying those who need or don't need a life-saving intervention, but also those who are under or over-triaged as either incorrectly needing/not needing intervention. The primary aim of this study was to describe the implications of under-triage using existing major incident triage tools, including the 2013 National Ambulance Resilience Unit (NARU) Sieve. The secondary aim was to describe the safety profile of the Modified Physiological Triage Tool (MPTT) in comparison to other triage tools, and to report mortality and identification of serious injury (AIS>3) in discrete AIS body regions. ⋯ During the study period, 2 18 985 adult patients were included with 24 791 (19.5%) identified as Priority One. 70% were male, aged 51 years [33-71], ISS 16 [9-25] with road traffic collision the most common mechanism (34%). The MPTT demonstrated the lowest rate of under-triage (42.4%, p<0.001). Overall 30 day mortality for the Priority One cohort was 12.4%. Compared to existing methods, the MPTT under-triage population had significantly lower mortality (5.7%, p<0.001), identical to the overall study population. Patients under-triaged by the MPTT had significantly lower requirement for intubation, thoracocentesis and massive transfusion than both the NARU Sieve and Triage Sieve (p<0.001). Serious injuries to the thorax (47.0%) and head (27.4%) predominated, with the MPTT again significantly under-triaging fewer of these patients (p<0.001).emermed;34/12/A871-a/F1F1F1Figure 1 CONCLUSION: This study has defined the effects of and compared the implications of under-triage when different triage tools are used in the context of a major trauma population. The MPTT misses fewer severely injured patients, with fewer LSIs necessary in the under-triaged population. We suggest that the MPTT should be considered as an alternative to existing major incident triage tools.emermed;34/12/A871-a/T1F2T1Table 1Frequency of interventions performed in the priority one cohort and patients under-triaged by the MPTT, UK NARU sieve and MIMMS triage sieve2Defined as administration of 4 or more units of blood/blood products 3Defined as craniotomy, burr holes or removal of intracranial haemorrhageemermed;34/12/A871-a/T2F3T2Table 2Frequency of severe injuries (AIS ≥ 3) by body region within the whole study population, the priority one cohort and in those under-triaged by the MPTT, the UK NARU sieve and the MIMMS triage sieve.
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Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA. ⋯ Few patient and arrest characteristics were associated with outcomes in traumatic OHCA. These findings suggest there is a need to incorporate additional information into cardiac arrest registries to assist prognostication and the development of novel interventions in these trauma patients.