Articles: emergency-services.
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To determine the occurrence of weapon carriage by major trauma patients at a university/county hospital ED. ⋯ ED major trauma patients at one urban trauma center in Los Angeles frequently carry weapons, including automatic military weapons. In addition to violence prevention measures such as weapon confiscation, plans must be made and practiced for the management of violence within the "sacrosanct" hospital doors to protect both patients and ED personnel.
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Properly staffed and equipped EDs are essential to a modern system of health care. In a relatively brief period, emergency medicine has emerged as a major medical specialty. ⋯ If sufficient support for the specialty can be secured, the future of emergency medicine is bright. If not, the nature of emergency care in the United States will be profoundly changed for years to come.
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Traditionally, cost effectiveness has been overlooked in emergency departments because of a mandate to provide emergency care in every community regardless of expense. However, in the current era of managed care, reduced reimbursement, and cost controls, emergency departments are being examined more carefully to determine whether their costs can be contained or even whether they can become profit centers. Detailed billing, cost accounting, enhanced communication among emergency departments within a community, and linking of suburban and inner-city emergency departments are several means by which emergency departments can control costs and raise revenues.
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Comparative Study
Effect of gender on the emergency department evaluation of patients with chest pain.
To assess chest pain evaluation as reflected in the documentation of the evaluation process for women vs men in one emergency department (ED). ⋯ The authors' findings do not support the existence of a gender difference in ED chest pain evaluations, as reflected by documentation of the evaluation process. However, men were more likely to be admitted to the hospital for evaluation of coronary artery disease than were women.
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To describe cases of violence related to weapons in a university hospital and urban county ED and to provide related recommendations for ED staff security. ⋯ Emergency department staff should prepare for the possibility of violence by 1) recognizing the danger, 2) rehearsing response mechanisms, and 3) debriefing after incidents. In particular, plans must be made and practiced for the time when external violence follows the surviving victims of gang activity through the "sacrosanct" hospital doors. Protection of patients and ED personnel must be ensured. In many urban settings, appropriately armed security guards must be immediately accessible to the ED staff. Other suggestions for ED protection are given.