Medical necessity in emergency medical services transports.

The purpose of this study was to generate national estimates of the prevalence of medically unnecessary emergency medical services (EMS) transports to emergency departments (EDs) over time and to identify characteristics that may be associated with medically unnecessary transports. A previously published algorithm was applied to operationalize medical necessity based on ED diagnosis to 10 years of data from the National Hospital Ambulatory Medical Care Survey. The trend over time was reported using descriptive statistics weighted to produce national estimates. Nationally, the proportion of EMS transports that were medically unnecessary increased from 13% to 17% over the 10-year study period. Individual demographic characteristics, including insurance status, were not predictive of inappropriate utilization. EMS transports for medically unnecessary complaints increased from 1997 to 2007. Our findings from a nationally representative sample highlight the opportunity for alternative patient delivery strategies for select patients seeking EMS services.

Changes in the patterns, presentation and management of penetrating chest trauma patients at a level II trauma centre in southern Pakistan over the last two decades.

Penetrating chest trauma can be used as an indicator of violence in the country. We aimed to look at the changes in its incidence and management at a major trauma centre in the country. We also wanted to look at any effect of prehospital time on surgical intervention and outcome of the victim. In this retrospective descriptive study, we observed the presentation and management of 191 penetrating chest injury patients at a level II trauma hospital in Pakistan in the last 20 years. The study sample was divided into two groups: Group 1, 1988-1998 and Group 2, 1999-2009. No significant change in incidence of trauma was observed between the two groups. The delay in the time between event and arrival showed an increase in the number of surgical procedures performed. Also the number of thoracotomies performed went up significantly in the second decade from 5.7 to 16.5% with a P<0.05. Six (3.1%) mortality cases were observed in 20 years. It was seen that the greater the prehospital time, the greater the chances of surgery. Also seen was the increase in mortality as critical cases could make it to the hospital alive in recent times due to improved transportation services.

Transfer delay and in-hospital mortality of trauma patients in Pakistan.

BACKGROUND: Mortality and morbidity in trauma remain a major problem in developing countries. Organized emergency response systems for transfer of trauma patients to hospitals are absent and the consequent delays could cause significant complications. AIMS: This study assessed the outcomes as a result of hospital transfer and delays in trauma patients. METHODS: The study was based on trauma patients presenting to the Aga Khan University Hospital (AKUH), Karachi, Pakistan from 1998 to 2005, meeting the trauma team activation criteria. Data were collected and entered in a Trauma Registry. The study focused on analyzing the outcomes of injury to delay in definitive treatment and survival. RESULTS: Out of 978 patients, only 303 (30.9%) patients reached the emergency room (ER) within an hour. The mean time from injury occurrence to arrival in the ER was 4.7h. There was no significant difference in mortality between all patients presenting early and those with more than 1h delay (OR=0.9, 95% CI: 0.6, 1.5). CONCLUSIONS: Transfer and delay in admission to a tertiary care center does not affect in-hospital mortality of trauma patients in a setting with no emergency response system. This may be due to self selection of patients who survive long enough to reach the hospital.

Relationship between distance from major roads and adolescent health in Japan.

A relationship between distance from major roads and the prevalence of allergic disorders and general symptoms among junior high school students was assessed, separating the effects of distance of residence and school from the roads. Study subjects were 5,652 students aged 12 to 15 years. This study used diagnostic criteria from the International Study of Asthma and Allergies in Childhood. The questionnaire also asked about symptoms of headache, stomachache, tiredness, and cough and the shortest distance from residence to major roads. Distance from school to the nearest major road was measured on a map. Adjustment was made for gender, grade, the number of older siblings, smoking in the household, and maternal history of allergy. A shorter distance between residence and major roads was associated with an increased prevalence of headache, stomachache, tiredness, and cough. There was a marginally significant positive association between residence facing major roads and the prevalence of allergic rhinoconjunctivitis. Residence within 100 m of major roads showed a tendency for a positive relationship with the prevalence of wheeze and atopic dermatitis. There was no apparent relationship between distance of school from major roads and allergic disorders or the general symptoms. The findings suggest that proximity of residence, not school, to major roads may be associated with an increased prevalence of allergic disorders, headache, stomachache, and tiredness among Japanese adolescents. Further investigations with more precise and detailed exposure and health outcome measurements are needed to corroborate the relationship between traffic related factors and allergic disorders and general symptoms.

Utilization of specialized services by air transported cardiac patients: an indicator of appropriate use.

Recent studies of appropriateness of air medical transport have not specifically examined the need of cardiac patients for specialized services not available in the original community setting. This study examined the subsequent use of specialized services (i.e., coronary bypass surgery, angioplasty) by 796 consecutively aeromedically transported cardiac patients as an indicator of appropriate use of air transport. At least one specialized service was received by 552 (69.3%) patients. Preflight or transport interventions outside the clinical scope of the available ground transport system--a narrow, but objective assessment of appropriateness--were received by 507 patients and were associated with subsequent receipt of posttransport specialized services (p less than 0.0001). We conclude that the use of specialized services by cardiac patients was high and associated with an objective measure of appropriateness of transport. Studies of aeromedical transport should consider the need for specialized services in addition to intensity of care in the determination of appropriate use.

Sixteen years with the Danish Search and Rescue Helicopter Service.

The Danish helicopter rescue service in its present form was founded in 1966. The use of the Sikorsky (S-61) helicopter has generally been satisfactory. In 1973, the crew was supplemented by an aerospace-medically-educated and helicopter-trained physician. From 1973 to 1989 there were 5,733 missions, of which direct medical intervention occurred in 2075 cases; 94% of the missions supported the civilian public health service in Denmark. Many sorts of diseases and injuries have been seen, but especially trauma, abdominal, and cardiopulmonary diseases. Experience has shown the benefit of having a designated physician, specially trained in aerospace medicine and acute medicine/surgery, as a permanent crewmember.