Current Issue : January - March Volume : 2021 Issue Number : 1 Articles : 5 Articles
Flexible surge capacity aims to activate and utilize other resources than normally are\nsurged in a community during the primary and secondary surge capacity. The presence of\nalternative leadership, skilled and knowledgeable in hospital and prehospital emergency\nmanagement, is invaluable. Thai emergency physicians work at both levels, emphasizing their\nimportant role in emergency management of any source in a disaster-prone country. We aimed to\ninvestigate Thai emergency physiciansâ?? ability in terms of knowledge and preparedness to manage\npotential emergencies using tabletop simulation exercises. Using an established method for training\ncollaboration, two training courses were arranged for over 50 Thai emergency physicians, who were\ndivided into three teams of prehospital, hospital, and incident command groups. Three scenarios of\na terror attack along with a bomb explosion, riot, and shooting, and high building fire were\npresented, and the participantsâ?? performance was evaluated regarding their preparedness, response\nand gained knowledge. Two senior observers followed the leadership characteristic in particular.\nThai physiciansâ?? perceived ability in command and control, communication, collaboration,\ncoordination, and situation assessment improved in all groups systematically. New perspectives\nand innovative measures were presented by participants, which improved the overall management\non the final day. Tabletop simulation exercise increased the perceived ability, knowledge, and\nattitude of Thai emergency physicians in managing major incidents and disasters. It also enabled\nthem to lead emergency management in a situation when alternative leadership is a necessity as\npart of the concept of a flexible surge capacity response system....
Background: Vestibular symptoms are a frequent reason for presenting at the emergency department (ED).\nUnderlying conditions range in severity from life-threatening to benign, but often remain undiagnosed despite\nextensive investigations. We aimed to identify clinical characteristics that are associated with ED consultations by\npatients with vestibular symptoms of unknown origin (VUO) and to quantify the ED resources consumed during\nthe investigations.\nMethods: This retrospective one-year, single-centre, cross-sectional study assessed ED consultations with patients\nwhose chief complaint was â??vestibular symptomsâ??. Data on risk factors, clinical characteristics, management and ED\nresources were extracted from the administrative database and medical records. Consultations were grouped\naccording to the discharge diagnosis as either VUO or non-VUO. We determined clinical factors associated with\nVUO and compared ED resource consumption by the two patient groups using multivariable analysis.\nResults: A total of 1599 ED consultations were eligible. Of these, 14.3% (n = 229) were consultations with patients\nwith VUO. Clinical characteristics included in the final multivariable model to determine associations with VUO were\nsensory disorders, aural fullness, improvement at rest, absence of situational provocation, pre-existing neurological\nconditions, and age < 65 years. Patients with VUO had higher total ED resource consumption in terms of physiciansâ??\nwork and radiology resources, as a result of more use of computed tomography and magnetic resonance imaging.\nConclusion: One in seven emergency patients with vestibular symptoms is dismissed without a diagnosis. Clinical\ncharacteristics of VUO patients are distinct from patients in whom a diagnosis was made in the ED. VUO triggers\nhigher ED resource consumption, which can be justified if appropriately indicated....
Background: Clinical decision-making (CDM) is an important competency for young doctors especially under\ncomplex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is\ncharacterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is\nimportant to identify different definitions and their operationalizations in studies on GEM.\nObjective: A scoping review of empirical articles was conducted to provide an overview of the documented\nevidence of findings and conceptualizations of CDM in GEM.\nMethods: A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed,\nProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a\ndata extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized.\nResults: Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition,\nCDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how\nCDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity\nof this patient group was seen as a challenge for young physicians engaging in CDM.\nConclusions: This scoping review summarizes how different studies in GEM use the term CDM. It provides an\nanalysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead\nto better clinical practice....
Background: More than half of deaths in low- and middle-income countries (LMICs) result from conditions that\ncould be treated with emergency care - an integral component of universal health coverage (UHC) - through\ntimely access to lifesaving interventions.\nMethods: The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet\nevidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a\nresearch prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt,\nNepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and\nPhillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the\nstrengthening of emergency care systems in limited-resource settings.\nResults: The RPS proposed seven priority research questions addressing: identification of context-relevant\nemergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential\nquality improvement via registries; characteristics of people seeking emergency care; best practices for staff training\nand retention; and cost effectiveness of critical care - all within LMICs.\nConclusions: Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research\nNetwork project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for\nstrengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the\ncurrent evidence supporting the identified priorities....
Background: The World Health Organisation (WHO) recommends involving lay people in prehospital care. Several\ntraining programmes have been implemented to build lay responder first aid skills. Findings show that most\nprogrammes significantly improved participantsâ?? first aid skills. However, there is a gap in knowledge of what factors\ninfluence the use of these skills in real situations. The current study aimed to describe police officersâ?? views on and\nexperiences of factors that facilitate or hinder their use of trained first aid skills at work.\nMethods: Thirty-four police officers participated in five focus group discussions. A structured interview guide was\nused to collect data. Interviews were audio-recorded and transcribed verbatim. Data were analysed using qualitative\ncontent analysis.\nResults: We identified five categories of facilitators or hindrances. Training exposure was considered a facilitator;\nwork situation and hospital atmosphere were considered hindrances; and the physical and social environments and\nthe resources available for providing first aid could be either facilitators or hindrances.\nConclusion: Practical exposure during training is perceived to improve police officersâ?? confidence in applying their\nfirst aid skills at work. However, contextual factors related to the working environment need to be addressed to\npromote this transfer of skills....
Loading....