Articles: emergency-medicine.
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Though the disease burden addressable by prehospital and out-of-hospital emergency care(OHEC) spans communicable diseases, maternal conditions, chronic conditions and injury, the single largest disability-adjusted life year burden contributor is injury, primarily driven by road traffic injuries(RTIs). Establishing OHEC for RTIs and other common emergencies in low- and middle-income countries(LMICs) where the injury burden is disproportionately greatest is a logical first step toward more comprehensive emergency medical services(EMS). However, with limited efforts to formalize and expand existing informal bystander care networks, there is a lack of consensus on how to develop and maintain bystander-driven Tier-1 EMS systems in LMICs. Resultantly, Tier-1 EMS development is fragmented among non-governmental organizations and the public sector globally. ⋯ Consensus is necessary to avoid duplicative and disorganized efforts due to the fragmented nature of parallel Tier-1 EMS efforts globally. A Delphi-like multi-round expert discussion among the members of the largest collaboration between organizations directing Tier-1 EMS programs globally generated relevant priorities to direct future efforts.
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The growing prevalence of heat stroke as a public health issue, exacerbated by climate change and increasing global temperatures, demands an immediate and strategic response to prevent weather-related morbidity and mortality. Heat stroke results from the body's inability to cope with excessive heat, leading to systemic inflammatory responses, cellular apoptosis, and potential multiorgan dysfunction or failure. However, little information explicitly outlines how to perform cold-water immersion in the emergency department (ED), including potential patient selection, how much water or ice to use, target temperatures, when to stop, and complications or challenges with the process. ⋯ Additionally, the article addresses challenges and lessons learned during the protocol's implementation, emphasizing the importance of multidisciplinary collaboration, staff education, and the adaptation of ED infrastructure to support this lifesaving treatment based on its use during the last 3 years. The successful resolution of the presented cases, along with the protocol's potential for widespread adoption, illustrates the critical role of cold-water immersion in enhancing ED responses to heat stroke, offering a blueprint for future research and the development of similar protocols across health care settings. This work contributes to the evolving landscape of emergency medicine and aligns with the global effort to combat the adverse health effects of climate change.
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Droperidol is used commonly to treat agitation in the emergency department (ED), however, data comparing doses are lacking. ⋯ In this large cohort, patients deemed appropriately treated with 5 mg of droperidol required less rescue sedation than patients determined to need 10 mg.