Articles: emergency-services.
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In all, 160 serious pedestrian accidents (ISS > 15 or death), were recorded during a 12-month prospective study of all trauma in a population of 3.2 million. Of these, 35 died at scene, 125 arrived at hospital alive and 68 (54 per cent) subsequently died. There were 35 (22 per cent) children, and 62 per cent (39) were more than 60 years of age. ⋯ The Revised Trauma Score and APACHE II score showed significant differences between those who lived and died. TRISS analysis revealed that 32 per cent of deaths and 12 per cent of survivors were unexpected. ATLS treatment protocols should be instituted for prehospital care and in all accident and emergency departments (A&E).
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To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses. ⋯ Appropriate use of the PED was positively influenced by seeking prior advice from both a physician and family member, having a regular physician, and having prior child care experience.
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J Epidemiol Community Health · Aug 1993
Differences in priorities assigned to patients by triage nurses and by consultant physicians in accident and emergency departments.
To investigate whether the greater urgency assigned to accident and emergency patients by triage nurses than by accident and emergency doctors was uniform across all patient groups. ⋯ These findings have implications for all those involved in the organisation of triage systems and in the training of nurses in accident and emergency departments. It is essential that judgements on how urgently patients need to be seen are made in a completely objective manner.
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The ethical framework established for most health care decision making should apply to elderly patients in the ED, i.e., the authority to decide should rest either with the competent patient or, in case of incapacity, with the patient's surrogate. Whenever possible, ethical dilemmas in the ED should be prevented from occurring through the judicious use of advance directives crafted in the doctor's office. DNR orders should be based upon the wishes of a competent patient or upon a surrogate's estimation of the patient's values and best interests. ⋯ Attention to these important problems bearing on the substance and procedures for life and death decision making in the ED should not obscure the manifest injustice of the context in which these decisions are often made. At many inner-city hospitals serving a largely poor and elderly clientele, the ED has become nothing short of a torture chamber for many critically ill elderly persons. An ethical framework for decision making, no matter how urgently needed, will not address the unnecessary pain and confusion of frail elderly patients subjected to an impersonal, overcrowded, and depersonalizing environment.
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To delineate the topics discussed with families during the death notification process and to identify which of these topics are stressful to the physician. Also, the survey served as a needs assessment in designing an educational program for emergency medicine residents in death notification. ⋯ Factual information is discussed most often, and emotional issues are considered most stressful. Therefore, a program in death notification must address those issues that must be handled during a notification and provide mechanisms for residents to feel comfortable with emotional responses from the family.