Emergency medicine journal : EMJ
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Multicenter Study
A state-wide survey of medical emergency management in dental practices: incidence of emergencies and training experience.
Only a few data exist about the occurrence of emergencies in dental practice and the training experience of dental practice teams in life support. This study evaluates the incidence of emergencies in dental practices, the attitude of dentists towards emergency management and their training experience. ⋯ Medical emergencies are not rare in dental practice, although most of them are not life-threatening. Improvement of competence in emergency management should include repeated participation in life support courses, standardisation of courses and offering courses designed to meet the needs of dentists.
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Multicenter Study
The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents.
The project investigated the experiences of ambulance paramedics in applying the principles and protocols of prehospital multiple casualty triage at the scene of motor vehicle accidents. Key objectives included investigation of the situational cues and other contextual factors influencing triage practice and the development of recommendations for the future education of ambulance paramedics. ⋯ The research describes an extended and broadened triage process returning to a more authentic definition of triage as the practice of sorting of casualties to determine priority. The findings highlight the need to consider triage as an extended and complex process that incorporates evidence based physiological cues to assist decision making and the management of the process of triage from call out to conclusion including assessment of contextual and situational variables.
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Emergency departments (EDs) may be the first point at which children who have been subject to abuse or neglect come into contact with professionals who are able to act for their protection. In order to ascertain current procedures for identifying and managing child abuse, we conducted a survey of EDs in England and Northern Ireland. ⋯ There is a lack of consistency in the approach to identifying and responding to child abuse in EDs. Drawing on the results of this survey, we are able to suggest good practice guidelines for the management of suspected child abuse in EDs. Minimum standards could improve management and facilitate clinical audit and relevant training.
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Multicenter Study
Validation of a diagnostic reminder system in emergency medicine: a multi-centre study.
Diagnostic error is a significant problem in emergency medicine, where initial clinical assessment and decision making is often based on incomplete clinical information. Traditional computerised diagnostic systems have been of limited use in the acute setting, mainly due to the need for lengthy system consultation. We evaluated a novel web-based reminder system, which provides rapid diagnostic advice to users based on free text search terms. ⋯ The Isabel diagnostic aid has been shown to be of potential use in reminding junior doctors of key diagnoses in the emergency department. The effects of its widespread use on decision making and diagnostic error can be clarified by evaluating its impact on routine clinical decision making.
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Multicenter Study
Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study.
The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. Use of a rapid immunoassay (Tétanos Quick Stick, the TQS), combined with knowledge of certain demographic characteristics, may improve the evaluation of tetanus immunity and thus help to avoid inadequate prophylactic measures and reduce costs. ⋯ In selected patients, the TQS is a cost-effective tool to evaluate tetanus immunity. An algorithm is proposed for ED assessment of tetanus immunity integrating age and the TQS result.