Articles: emergency-medical-services.
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Prehospital care delivered by multiple agencies and their paramedics in a suburban emergency medical services (EMS) system was compared to assess the impact of a receiving hospital quality assurance audit on paramedic and agency performance. A committee of physicians, nurses, and paramedics developed performance criteria based on a county EMS protocol. Run tapes were reviewed to assess accuracy of runsheets. ⋯ A mean deficiency per run of 0.39 +/- 0.55 was found, with four paramedics performing more than two standard deviations from the mean. This receiving hospital EMS quality assurance audit has helped document problems in agency procedure performance and individual paramedic performance. It also has improved compliance with county protocol on patients delivered to our institution.
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Vestn. Khir. Im. I. I. Grek. · Mar 1990
[Organization of medical services for the victims of the earthquake in the city of Spitak, Armenian S.S.R].
Sanitary losses in the city of Spitak were about 47.8%, injures of the middle and critical degree being diagnosed in 9.5%. During the first period (from December 9 to 14, 1988) patients admitted to the hospitals predominantly had traumas of the head, chest, extremities, vertebral column (86.3%). ⋯ Success of treatment of the patients with this pathology was promoted by their having obtained qualified surgical and anesthesiological aid before evacuation to medical institutions of the Center in full value in combination with temporary admittance to the hospital at an average for 12-18 hours up to complete arrest of shock. During the first steps of evacuation the amputation of extremities was fulfilled in 3 cases.
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In July 1988, our emergency department adopted a policy of refusing to treat patients in the ED if they failed to have what was considered an emergency condition. Screening examinations were performed by triage nurses to determine whether patients were eligible to be seen in the ED. Patients whose vital signs fell within specific categories and who had one of 50 minor chief complaints were refused care in the ED and referred to off-site clinics. ⋯ Follow-up letters and telephone calls to their clinics identified no patients who needed retriage to an ED, and only 54 patients (1.3%) complained about their referral out of the ED. Only 42 patients returned to the ED within 48 hours of initial triage, and none had a deterioration of their condition. In conclusion, a selective triage system may be used to effectively decompress an ED, although further study is needed to identify potential rare adverse outcomes.