Assistência à saúde mental nos serviços médicos de emergência: revisão integrativa / Asistencia a la salud mental en los servicios médicos de emergencia: revisión integrativa / Mental health care in emergency medical services: an integrative review

Objetivos: conhecer as características da assistência à saúde mental dispensada por profissionais de enfermagem nos serviços médicos de emergência. Método: revisão integrativa de literatura nas bases de dados Literatura Latino-Americano e do Caribe em Ciências da Saúde (LILACS), Publisher Medline (PUBMED), SciVerse Scopus (SCOPUS) e Cumulative Index to Nursing and Allied Health Literature (CINAHL), no período de março a junho de 2023, utilizando-se critérios de inclusão e exclusão previamente definidos. Resultados: obteve-se uma amostra final de 59 artigos os quais foram agrupados nas seguintes categorias temáticas: concepções em saúde mental, comunicação, intervenções, atendimento em rede, competência em cuidado em saúde mental e barreiras durante os atendimentos. Conclusão: o cuidado é feito de forma incipiente e permeado por elementos dificultadores. Os achados do presente estudo servem para rever e repensar práticas e políticas de cuidado em saúde mental e promover estratégias de aperfeiçoamento dos processos de trabalho.

Objetivos: conocer las características de la asistencia a la salud mental dispensada por profesionales de enfermería en los servicios médicos de emergencia. Método: revisión integrativa de literatura en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Publisher Medline (PUBMED), SciVerse Scopus (SCOPUS) y Cumulative Index to Nursing and Allied Health Literature (CINAHL), en el período de marzo a junio de 2023, utilizando criterios de inclusión y exclusión previamente definidos. Resultados: se obtuvo una muestra final de 59 artículos los cuales fueron agrupados en las siguientes categorías temáticas: concepciones en salud mental, comunicación, intervenciones, atención en red, competencia en atención en salud mental y barreras durante los atendimientos. Conclusión: el cuidado es hecho de forma incipiente y permeado por elementos difíciles. Los hallazgos del presente estudio sirven para revisar y repensar prácticas y políticas de cuidado en salud mental y promover estrategias de perfeccionamiento de los procesos de trabajo.

Objective: to know the characteristics of mental health care provided by nursing professionals in emergency medical services. Method: integrative literature review in the databases Latin American and Caribbean Health Sciences Literature (LILACS), Publisher Medline (PUBMED), SciVerse Scopus (SCOPUS) and Cumulative Index to Nursing and Allied Health Literature (CINAHL), from March to June 2023, using previously defined inclusion and exclusion criteria. Results: the final sample included 59 articles, which were grouped into the following thematic categories: conceptions in mental health, communication, interventions, network care, competence in mental health care and barriers during care. Conclusion: care is done incipient and permeated by difficult elements. The findings of this study serve to review and rethink mental health care practices and policies and promote strategies for improving work processes.

Confidence and knowledge in emergency management among medical students across Colombia: A role for the WHO basic emergency care course.

INTRODUCTION: Globally, medical students have demonstrated knowledge gaps in emergency care and acute stabilization. In Colombia, new graduates provide care for vulnerable populations. The World Health Organization (WHO) Basic Emergency Care (BEC) course trains frontline providers with limited resources in the management of acute illness and injury. While this course may serve medical students as adjunct to current curriculum, its utility in this learner group has not been investigated. This study performs a baseline assessment of knowledge and confidence in emergency management taught in the BEC amongst medical students in Colombia. METHODS: A validated, cross-sectional survey assessing knowledge and confidence of emergency care congruent with BEC content was electronically administered to graduating medical students across Colombia. Knowledge was evaluated via 15 multiple choice questions and confidence via 13 questions using 100 mm visual analog scales. Mean knowledge and confidence scores were compared across demographics, geography and prior training using Chi-Squared or one-way ANOVA analyses. RESULTS: Data were gathered from 468 graduating medical students at 36 institutions. The mean knowledge score was 59.9% ± 23% (95% CI 57.8-62.0%); the mean confidence score was 59.6 mm ±16.7 mm (95% CI 58.1-61.2). Increasing knowledge and confidence scores were associated with prior completion of emergency management training courses (p<0.0001). CONCLUSION: Knowledge and confidence levels of emergency care management for graduating medical students across Colombia demonstrated room for additional, specialized training. Higher scores were seen in groups that had completed emergency care courses. Implementation of the BEC as an adjunct to current curriculum may serve a valuable addition.

Assistência em urgência e emergência/pronto socorro obstétrico: revisão integrativa / Assistance in urgency and emergency/obstetric emergency care: an integrative literature review / Emergencia y asistencia de emergencia / primeros auxilios obstétricos: revisión integrativa

Objetivo: identificar o perfil das gestantes que buscam atendimento em unidades de pronto socorro a partir das evidências encontradas na literatura. Método: revisão integrativa, com busca de artigos em bases de dados na área da saúde, no período de janeiro de 2007 a dezembro de 2016, nas bases Indice Bibliográfico Español de Ciencias de la Salud, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Medical Literature Analysis and Retrieval System Online. Resultados: dos 3.964 artigos selecionados por meio das bases de dados, 22 pesquisas estavam elegíveis para a leitura na íntegra, destes apenas 4 artigos estavam de acordo com a questão norteadora do estudo. Quanto aos artigos incluídos dois eram de língua portuguesa e um inglesa e espanhola e todos dos últimos 3 anos. Conclusão: a clientela que busca atendimento obstétrico precisa ser mais informada na atenção básica por ocasião do pré-natal sobre os sinais e sintomas que caracterizam emergência e urgência, pois a grande a maioria das gestantes procuraram os serviços de prontos socorros desnecessariamente

Objective: to identify the profile of pregnant women seeking care in emergency room units based on the evidence found in the literature. Method: integrative review, with search of articles in databases in the health area, from January 2007 to December 2016, in the databases Index of Spanish Health Sciences, Latin American and Caribbean Literature in Sciences Health and Medical Literature Analysis and Retrieval System Online. Results: of the 3,964 articles selected through the databases, 22 surveys were eligible for full reading, of which only 4 articles were in agreement with the guiding question of the study. As for the articles included two were Portuguese and one English and Spanish and all of the last 3 years. Conclusion: the clientele seeking obstetric care needs to be more informed in the basic prenatal care about the signs and symptoms that characterize emergency and urgency, since the great majority of pregnant women have sought emergency care services unnecessarily

Objetivo: identificar el perfil de las gestantes que buscan atención en unidades de socorro a partir de las evidencias encontradas en la literatura. Método: revisión integrativa, con búsqueda de artículos en bases de datos en el área de la salud, en el período de enero de 2007 a diciembre de 2016, en las bases Indice Bibliográfico Español de Ciencias de la Salud, Literatura Latinoamericana y del Caribe en Ciencias de la Salud Salud y Medicina Literatura Análisis y Recuperación del sistema en línea. Resultados: de los 3.964 artículos seleccionados a través de las bases de datos, 22 encuestas eran elegibles para la lectura íntegra, de estos sólo 4 artículos estaban de acuerdo con la cuestión orientadora del estudio. En cuanto a los dos artículos fueron incluidos en portugués y en Inglés y Español y todos los últimos tres años. Conclusión: la clientela que busca atención obstétrica necesita ser más informada en la atención básica con ocasión del prenatal sobre los signos y síntomas que caracterizan emergencia y urgencia, pues la gran mayoría de las gestantes buscaban los servicios de prontos auxilios innecesariamente

Use of Tramadol or Other Analgesics in Patients Treated in the Emergency Department as a Risk Factor for Opioid Use.

The objective of this cohort study was to determine the association between the use of tramadol in emergency departments and the later consumption of opioids at the outpatient level in a group of patients from Colombia. Based on a medication dispensation database, patients over 18 years of age treated in different clinics in Colombia who for the first time received tramadol, dipyrone, or a nonsteroidal anti-inflammatory drug (NSAID) in the emergency room between January and December 2018 were identified. Three mutually exclusive cohorts were created, and each patient was followed up for 12 months after the administration of the analgesic to identify new formulations of any opioid. A Cox proportional-hazards regression model was constructed to identify variables associated with receiving a new opioid. A total of 12,783 patients were identified: 6020 treated with dipyrone, 5309 treated with NSAIDs, and 1454 treated with tramadol. The mean age was 47.1 ± 20.4 years, and 61.6% were women. A total of 17.3% (n = 2207) of all patients received an opioid during follow-up. Those treated with tramadol received a new opioid with a higher frequency (n = 346, 23.8%) than the other cohorts (14.7% NSAIDs and 17.9% dipyrone, both p < 0.001). In the tramadol group, using more than 10 mg of morphine equivalents was associated with a greater use of new opioids (HR:1.47, 95%CI:1.12-1.93). Patients treated with tramadol in emergency departments have a higher risk of opioid use at the one-year follow-up than those treated with NSAIDs or dipyrone.

Emergency Care Systems: The Missing Link for Effective Treatment of COVID-19 in Africa.

Cases of COVID-19 are rising quickly on the African continent. A critical element of any health system response to such a surge of active cases is the existence of functional emergency care systems. Yet, these systems are markedly underdeveloped in African countries. This short letter reviews the key role emergency medicine plays in epidemic disease response and actions that ministries of health can take now to shore up gaps in emergency care capacity to avoid needless death and suffering of COVID-19 patients.

Embracement of the person with mental illness at an emergency hospital service: a qualitative research.

OBJECTIVES: to understand actions of nurses who care for people person with mental illness at a Referenced Emergency Unit in a university hospital. METHODS: a qualitative research based on Alfred Schütz's social phenomenology. Data collection was performed between December 2015 and January 2016 through phenomenological interviews with 13 nurses from an Emergency Unit. RESULTS: nurses embrace according to their previous experiences. They easily identify biological complaints and, when they recognize psychiatric signs and symptoms, refer them to the psychiatrist. They raise doubts about what to do, so they expect to be qualified for such action, believing that a protocol could help as well as they need more time. FINAL CONSIDERATIONS: the understanding of the lived type of nurse who embraces people with mental distress made possible in this study need recognition for research and interventions that focus on biological, psychic and social dimension articulation at embracement.

Caracterización clínica y epidemiológica de pacientes con Covid-19 atendidos en Servicio de Emergencia del Hospital Clínico Universidad de Chile entre marzo y mayo 2020 / Clinical and epidemiological characterization of patients with Covid-19 treated in the Emergency Service of the Hospital Clínico Universidad de Chile between March and May 2020

In December 2019, a novel coronavirus (SARS-CoV-2) emerged in China and has spread globally, creating a pandemic. The objective of this is study is to determinate clinical and epidemiological characteristics of patients with coronavirus en emergency department. The HCUCH Emergency Service treated a total of 6959 patients between March 13th and May 31th, of whom 1.278 were positive and had confirmed with coronavirus. The male sex was the most prevalent (59.7%). The most frequent symptoms in both groups were cough, myalgia and fever. In the group of ambulatory patients, headache stood out in 50% and in hospitalized patients, dyspnea with 67%. The mortality rate in hospitalized patients was 15.6%. Of these, 66.6% were older than 65 years. Regarding diagnosis of hospital discharge, 87.5% correspond to pneumonia. There is a higher prevalence of coronavirus disease in male patients. The most frequent comorbidities in hospitalized patients were HT and DM2. The highest rate of hospitalization and case fatality in people over 65 years of age. This information helps to characterize the profile of patients at risk in which prevention efforts should be focused. (AU)

Embracement of the person with mental illness at an emergency hospital service: a qualitative research / Acogimiento de la persona em sufrimento mental en servicio de urgencia en hospital: investigación cualitativa / Acolhimento da pessoa em sofrimento mental em serviço hospitalar de emergência: pesquisa qualitativa

ABSTRACT Objectives: to understand actions of nurses who care for people person with mental illness at a Referenced Emergency Unit in a university hospital. Methods: a qualitative research based on Alfred Schütz's social phenomenology. Data collection was performed between December 2015 and January 2016 through phenomenological interviews with 13 nurses from an Emergency Unit. Results: nurses embrace according to their previous experiences. They easily identify biological complaints and, when they recognize psychiatric signs and symptoms, refer them to the psychiatrist. They raise doubts about what to do, so they expect to be qualified for such action, believing that a protocol could help as well as they need more time. Final considerations: the understanding of the lived type of nurse who embraces people with mental distress made possible in this study need recognition for research and interventions that focus on biological, psychic and social dimension articulation at embracement.

RESUMEN Objetivos: comprender las acciones de las enfermeras que reciben a la persona con enfermedad mental en una Unidad de Emergencia recomendada en un hospital universitario. Métodos: investigación cualitativa, basada en la fenomenología social de Alfred Schütz. La recolección de datos se realizó entre diciembre de 2015 y enero de 2016, a través de entrevistas fenomenológicas con 13 enfermeras de una Unidad de Emergencia. Resultados: las enfermeras aceptan de acuerdo con sus experiencias anteriores, identifican fácilmente las quejas biológicas y, cuando reconocen los signos y síntomas psiquiátricos, los remiten al psiquiatra. Tienen preguntas sobre qué hacer, por lo que esperan estar calificados para tal acción, creen que un protocolo podría ayudar y necesitar más tiempo. Consideraciones finales: la comprensión del tipo vivido de la enfermera que recibe a la persona en sufrimiento mental hizo posible en este estudio el reconocimiento de la necesidad de investigación e intervenciones que se centren en la articulación de la dimensión biológica, psíquica y social en lo acogimiento.

RESUMO Objetivos: compreender a ação do enfermeiro que realiza acolhimento da pessoa em sofrimento mental em Unidade de Emergência Referenciada em um hospital universitário. Métodos: pesquisa qualitativa, fundamentada na fenomenologia social de Alfred Schütz. A coleta de dados foi realizada entre dezembro de 2015 e janeiro de 2016, por meio de entrevistas fenomenológicas com 13 enfermeiros de uma Unidade de Emergência. Resultados: os enfermeiros acolhem de acordo com suas experiências prévias, identificam facilmente queixas biológicas e, quando reconhecem sinais e sintomas psiquiátricos, encaminham ao psiquiatra. Apresentam dúvidas sobre o que fazer, portanto, esperam ser qualificados para tal ação, acreditam que um protocolo poderia ajudar, bem como necessitam de mais tempo. Considerações finais: a compreensão do tipo vivido do enfermeiro que acolhe a pessoa em sofrimento mental possibilitou, neste estudo, o reconhecimento da necessidade de pesquisas e intervenções que foquem na articulação da dimensão biológica, psíquica e social na ação do acolhimento.

Interprofessional Practice in the Emergency Service: specific and shared assignments of nurses.

OBJECTIVE: To map and categorize, according to the Nursing Interventions Classification (NIC), the specific assignments of the nurses and to identify the assignments shared with doctors and physiotherapists in the Emergency Service. METHOD: Descriptive exploratory study, carried out in two phases: first, the analysis of dissertations /theses from the database of the Center for Studies and Research of the Brazilian Nursing Association; Second, the use of the Delphi Technique to reach the consensus about which assignments were specific to the nurse and which were shared with physiotherapists and doctors. RESULTS: The results were 45.7% for specific to the nurses, 14.2% for shared with physiotherapists and/or doctors, and in 40% (n=42) there was no consensus about the sharing of assignments. CONCLUSION: The sharing of actions among professionals shows an increase in the scope of the practice of professions and the constitution of a common sphere of work, but the high number of assignments with no consensus among specialists can be a potential factor in conflicts due to the lack of definition of these assignments.

Interprofessional Practice in the Emergency Service: specific and shared assignments of nurses / La práctica interprofesional en el Servicio de Emergencia: asignaciones específicas y compartidas de los enfermeros / Prática interprofissional no Serviço de Emergência: atribuições específicas e compartilhadas dos enfermeiros

ABSTRACT Objective: To map and categorize, according to the Nursing Interventions Classification (NIC), the specific assignments of the nurses and to identify the assignments shared with doctors and physiotherapists in the Emergency Service. Method: Descriptive exploratory study, carried out in two phases: first, the analysis of dissertations /theses from the database of the Center for Studies and Research of the Brazilian Nursing Association; Second, the use of the Delphi Technique to reach the consensus about which assignments were specific to the nurse and which were shared with physiotherapists and doctors. Results: The results were 45.7% for specific to the nurses, 14.2% for shared with physiotherapists and/or doctors, and in 40% (n=42) there was no consensus about the sharing of assignments. Conclusion: The sharing of actions among professionals shows an increase in the scope of the practice of professions and the constitution of a common sphere of work, but the high number of assignments with no consensus among specialists can be a potential factor in conflicts due to the lack of definition of these assignments.

RESUMEN Objetivo: Mapear y categorizar de acuerdo con la Clasificación de las Intervenciones de Enfermería las atribuciones específicas de los enfermeros e identificar las compartidas con médicos y fisioterapeutas en el Servicio de Emergencia. Método: Estudio exploratorio descriptivo, realizado en dos fases: la primera constituida por análisis de disertaciones/tesis de la base de datos del Centro de Estudios e Investigaciones de la Asociación Brasileña de Enfermería (Centro de Estudos e Pesquisas da Associação Brasileira de Enfermagem). En la segunda, fue utilizada la Técnica Delphi para obtener consenso sobre cuáles atribuciones eran específicas de los enfermeros y cuáles eran compartidas con fisioterapeutas y médicos. Resultados: 45,7% específicas de los enfermeros; 14,2% compartidas con fisioterapeutas y/o médicos; y en 40% (n = 42) no hubo consenso sobre el reparto de las atribuciones. Conclusión: El intercambio de acciones entre los profesionales muestra la ampliación del alcance de la práctica de las profesiones y la constitución de una esfera común de trabajo, pero el elevado número de atribuciones sin consenso entre los especialistas puede ser un área de potenciales conflictos por la indefinición de las atribuciones.

RESUMO Objetivo: Mapear e categorizar, de acordo com a Classificação das Intervenções de Enfermagem, as atribuições específicas dos enfermeiros e identificar as compartilhadas com médicos e fisioterapeutas nos Serviço de Emergência. Método: Estudo exploratório descritivo, realizado em duas fases: a primeira, constituída por análise de dissertações/teses da base de dados do Centro de Estudos e Pesquisas da Associação Brasileira de Enfermagem. Na segunda, utilizou-se a Técnica Delphi para obtenção de consenso sobre quais atribuições eram especificas do enfermeiro e quais eram compartilhadas com fisioterapeutas e médicos. Resultados: 45,7% específicas dos enfermeiros, 14,2% compartilhadas com fisioterapeutas e/ou médicos e em 40% (n=42) não houve consenso sobre o compartilhamento das atribuições. Conclusão: O compartilhamento de ações entre os profissionais mostra ampliação do escopo de prática das profissões e constituição de esfera comum de trabalho, mas o elevado número de atribuições sem consenso entre os especialistas pode ser área de potenciais conflitos pela indefinição das atribuições.

Edad de inicio y consumo de alcohol en pacientes lesionados atendidos en los Servicios de Urgencias en XALAPA, MÉXICO / Idade do início e consumo de álcool Em pacientes lesados atendidos nos Serviços de emergência em Xalapa, México / Onset age and alcohol intake in injured patients treated at emergency rooms in Xapala, México

Objetivo: Identificar la asociación entre la edad de inicio del consumo de alcohol con el patrón de consumo y el consumo problemático en pacientes lesionados. Método: Estudio transversal en lesionados atendidos en el servicio de urgencias de dos hospitales públicos y que reporta-ron consumo de alcohol alguna vez en la vida. Variables: sexo, edad de inicio, consumo de alcohol antes de la lesión, patrón de consumo en el último año y consumo problemático. Resultados: Se incluyeron 354 pacientes, la media de edad de inicio del consumo de alcohol fue 17±4 años. Se observaron diferencias significativas entre la edad de inicio con: sexo (p=0.006), consumo de alco-hol antes de la lesión(p=0.001) y consumo problemático (p=0.001). Conclusión: En el presente estudio se observó que a menor edad de inicio del consumo de alcohol ma-yor consumo problemático y un patrón de consumo alto y consuetudinario. Es necesario establecer estrategias es-pecíficas de intervención para la reducción del consumo de alcohol a edades tempranas.

Objective: To identify the association between alcohol consumption onset age with consumption pattern and troublesome consumption in injured patients. Method: Cross sectional study in injured patients treated in emergency rooms in two public hospitals who reported alcohol consumption at least once in their lives. Variables: sex; onset age, alcohol consumption before the lesion, consumption pattern in the last year and troublesome consumption. Results: 354 patients were included; average alcohol consumption onset age was 17±4. Significant differences were observed between onset age with: sex (p=0.006), alcohol consumption before the lesion (p=0.001) and troublesome consumption (p=0.001). Conclusion: In this study it was observed that younger consumption onset age was associated with more troublesome alcohol consumption and high and customary consumption pattern. It is necessary to establish specific intervention strategies to reduce alcohol intake at early ages.

Objetivo: Identificar a associação entre a idade de início do consumo de álcool e o padrão de consumo e consumo problemático em pacientes lesados. Método: Estudo transversal de pacientes lesados atendidos no pronto-socorro de dois hospitais públicos e que relataram consumo de álcool em algum momento de suas vidas. Variáveis: sexo, idade de início, consumo de álcool antes da lesão, padrão de consumo no último ano e consumo problemático. Resultados: 354 pacientes foram incluídos, a idade média de início do consumo de álcool foi de 17 ± 4 anos. Diferenças significativas foram observadas entre a idade de início com: sexo (p = 0,006), consumo de álcool antes da lesão (p = 0,001) e consumo problemático (p = 0,001). Conclusão: No presente estudo, observou-se que quanto menor a idade de início do consumo de álcool, maior o consumo problemático e um padrão de consumo alto e habitual. É necessário estabelecer estratégias de intervenção específicas para a redução do consumo de álcool em idade precoce.

Response time in the emergency services. Systematic review

Abstract The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

Removal of the Long Spine Board From Clinical Practice: A Historical Perspective.

Since the early 1970s, initial management of patients with suspected spinal injuries has involved the use of a cervical collar and long spine board for full immobilization, which was thought to prevent additional injury to the cervical spine. Despite a growing body of literature demonstrating the detrimental effects and questionable efficacy of spinal immobilization, the practice continued until 2013, when the National Association of EMS Physicians issued a position statement calling for a reduction in the use of spinal immobilization and a shift to spinal-motion restriction. This article examines the literature that prompted the change in spinal-injury management and the virtual elimination of the long spine board as a tool for transport.

Response time in the emergency services. Systematic review.

The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

A Systematic Review on Recent Advances in mHealth Systems: Deployment Architecture for Emergency Response.

The continuous technological advances in favor of mHealth represent a key factor in the improvement of medical emergency services. This systematic review presents the identification, study, and classification of the most up-to-date approaches surrounding the deployment of architectures for mHealth. Our review includes 25 articles obtained from databases such as IEEE Xplore, Scopus, SpringerLink, ScienceDirect, and SAGE. This review focused on studies addressing mHealth systems for outdoor emergency situations. In 60% of the articles, the deployment architecture relied in the connective infrastructure associated with emergent technologies such as cloud services, distributed services, Internet-of-things, machine-to-machine, vehicular ad hoc network, and service-oriented architecture. In 40% of the literature review, the deployment architecture for mHealth considered traditional connective infrastructure. Only 20% of the studies implemented an energy consumption protocol to extend system lifetime. We concluded that there is a need for more integrated solutions specifically for outdoor scenarios. Energy consumption protocols are needed to be implemented and evaluated. Emergent connective technologies are redefining the information management and overcome traditional technologies.

Global Emergency Medicine: A Review of the Literature From 2016.

OBJECTIVES: The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS: This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS: A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. CONCLUSIONS: In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review.

Experience With a Novel, Global, Open-Access Template for Major Incidents: Qualitative Feasibility Study.

OBJECTIVE: The transfer of experiences gained after prehospital medical responses to major incidents has largely been nonsystematic, and better-structured reporting methods have been advocated. A consensus-based template was recently created and implemented as an open-access website. This qualitative study assessed the feasibility of using the template and reporting site. METHODS: Informants who had used or who had been asked to use the template were interviewed. The semi-structured interviews were transcribed verbatim, and the transcripts were analyzed by using an inductive approach based on grounded theory methodology. RESULTS: The major theme identified was a need for "defining purpose" as explained by the minor themes "relevance," "scope," "resources," and "usefulness." Informants reported that the template content needed to be revised and that the scope and rationale behind each question should be conveyed to the user. Resources necessary for reporting and clarity regarding the aim and outcome also need to be communicated to users and policy-makers. The interface between informants and the template is critical. CONCLUSIONS: Informants considered the template and website useful but reported that the workload exceeded their expectations. Despite pilot testing of the template before implementation, early revision of the template is recommended. (Disaster Med Public Health Preparedness. 2017;11:403-406).

Operational implementation and lessons learned from Haiti's first helicopter air ambulance.

Critical-care helicopter transport has demonstrated improvements in morbidity and mortality to those patients who utilise the service, but this has largely excluded developing country populations due to set up costs. Haiti Air Ambulance is the first completely publicly-available helicopter ambulance service in a developing country. US standards were adopted for both aviation and aeromedical care in Haiti due to proximity and relationships. In order to implement properly, standards for aviation, critical care, and insurance reimbursement had to be put in place with local authorities. Haiti Air Ambulance worked with the Ministry of Health to author standards for medical procedures, medication usage, and staff training for aeromedical programs in the country. Utilisation criteria for the helicopter were drafted, edited, and constantly updated to ensure the program adapted to the clinical situation while maintaining US standard of care. During the first year, 76 patients were transferred; 13 of whom were children and 3 pregnant women. Three patients were intubated and two required bi-level mask ventilation. Traumatic injury and non-emergency interfacility transfers were the two most common indications for service. More than half of the transfers (54%) originated at one of six hospitals, mostly as a result of highly-involved staff. The program was limited by weather and the lack of weather reporting, radar, visual flight recognition, thus also causing an inability to fly at night. In partnership with the government and other non-governmental organisations, we seek to implement a more robust pre-hospital system in Haiti over the next 12-24 months, including more scene call capabilities.

Influence of gender on the risk of death and adverse events in patients with acute myocardial infarction undergoing pharmacoinvasive strategy.

Pharmacoinvasive treatment is an acceptable alternative for patients with ST-segment elevation myocardial infarction (STEMI) in developing countries. The present study evaluated the influence of gender on the risks of death and major adverse cardiovascular events (MACE) in this population. Seven municipal emergency rooms and the Emergency Mobile Healthcare Service in São Paulo treated STEMI patients with tenecteplase. The patients were subsequently transferred to a tertiary teaching hospital for early (<24 h) coronary angiography. A total of 469 patients were evaluated [329 men (70.1%)]. Compared to men, women had more advanced age (60.2 ± 12.3 vs. 56.5 ± 11 years; p = 0.002); lower body mass index (BMI; 25.85 ± 5.07 vs. 27.04 ± 4.26 kg/m2; p = 0.009); higher rates of hypertension (70.7 vs. 59.3%, p = 0.02); higher incidence of hypothyroidism (20.0 vs. 5.5%; p < 0.001), chronic renal failure (10.0 vs. 8.8%; p = 0.68), peripheral vascular disease (PVD; 19.3 vs. 4.3%; p = 0.03), and previous history of stroke (6.4 vs. 1.3%; p = 0.13); and higher thrombolysis in myocardial infarction risk scores (40.0 vs. 23.7%; p < 0.001). The overall in-hospital mortality and MACE rates for women versus men were 9.3 versus 4.9% (p = 0.07) and 12.9 versus 7.9% (p = 0.09), respectively. By multivariate analysis, diabetes (OR 4.15; 95% CI 1.86-9.25; p = 0.001), previous stroke (OR 4.81; 95% CI 1.49-15.52; p = 0.009), and hypothyroidism (OR 3.75; 95% CI 1.44-9.81; p = 0.007), were independent predictors of mortality, whereas diabetes (OR 2.05; 95% CI 1.03-4.06; p = 0.04), PVD (OR 2.38; 95% CI 0.88-6.43; p = 0.08), were predictors of MACE. In STEMI patients undergoing pharmacoinvasive strategy, mortality and MACE rates were twice as high in women; however, this was due to a higher prevalence of risk factors and not gender itself.