Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause.

The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.

Teaching medicine through film: Wiseman's medical trilogy revisited.

BACKGROUND: Between the late 1960s and early 1980s, Frederick Wiseman filmed hundreds of hours in an emergency department, intensive care unit and asylum. These films recorded events as they happened without rehearsal and narration. MAIN BODY: Cinema and Medicine meet each other in feature fiction film and in documentary format. Showing films in hospitals is revealing for both the unexpected audience but also the medical establishment. This paper revisits Wiseman's edited but explicit films and their revelation of the complexity of care in this era in the United States. Although they offer a narrow view of medical institutions and the issue of informed consent later became problematic, the films provide an intriguing glimpse of US healthcare and decision making. These films are largely unknown but would be an invaluable resource in a masterclass on medical ethics in urgent care and end-of-life decisions. CONCLUSIONS: Despite their flaws, Wisemans' medical films have a significant educational value. Each documentary can be used in a masterclass on medical ethics. The films provide ample opportunities to discuss core issues in healthcare, professional interactions, and decision making in critically ill patients.

Taiwan's Experience in Hospital Preparedness and Response for Emerging Infectious Diseases.

The Communicable Disease Control Medical Network (CDCMN), established in 2003 after the SARS outbreak in Taiwan, has undergone several phases of modification in structure and activation. The main organizing principles of the CDCMN are centralized isolation of patients with severe highly infectious diseases and centralization of medical resources, as well as a network of designated regional hospitals like those in other countries. The CDCMN is made up of a command system, responding hospitals, and supporting hospitals. It was tested and activated in response to the H1N1 influenza pandemic in 2009-10 and the Ebola outbreak in West Africa in 2014-2016, and it demonstrated high-level functioning and robust capacity. In this article, the history, structure, and operation of the CDCMN is introduced globally for the first time, and the advantages and challenges of this system are discussed. The Taiwanese experience shows an example of a collaboration between the public health system and the medical system that may help other public health authorities plan management and hospital preparedness for highly infectious diseases.

Ultrasonography in the emergency department.

Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography. Some applications of POCUS unique to the emergency department include abdominal ultrasonography of the right upper quadrant and appendix, obstetric, testicular, soft tissue/musculoskeletal, and ocular ultrasonography. Ultrasonography has become an integral part of EM over the past two decades, and it is an important skill which positively influences patient outcomes.

Fifty Years of Modern EMS: Looking Back at the Paper That Started It All: Accidental Death and Disability still greatly influences EMS today.

For the most part EMS, despite all of its challenges, has kept up with the needs of its communities and adapted to its role as a de facto safety net. When the white paper was written, treatment for the injured varied radically from the state to state and city to city. While some may feel the white paper was not the impetus for all the changes outlines, it's difficult to argue these changes would have happened as quickly without such and influential document. We must keep its findings in mind to stay at the forefront of prehospital advancements, as opposed to reacting as a necessity of survival.

La especialidad de Medicina de Urgencias y Emergencias en Europa: estamos quedándonos solos / Specialization in emergency medicine in Europe: Spain is in danger of being left behind

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TV news and concerns about - the EHEC-outbreak 2011 in Germany.

BACKGROUND AND AIM: In the beginning of May 2011 and finally terminated on July 26th 2011 an outbreak of infections with enterohaemorrhagic Escherichia (E.) coli (EHEC) strain O104:H4 occurred in Germany. The aim of this study is to analyse whether media coverage of the outbreak influenced the number of patients presenting with diarrhoea to the emergency room of a tertiary centre and to evaluate the influence of information on perception and rating of symptoms. METHODS: Prospectively collected data in a tertiary centre on the number of patients presenting to the emergency room with diarrhea during the EHEC outbreak was correlated with retrospectively collected data about the media coverage of the outbreak on TV and compared to the number of patients that had presented with diarrhea during a comparative period in 2010. RESULTS: A total of 1,625 patients presented to our emergency room during the observation period in 2011 between May 31st and June 13th, including 72 patients (4.4%) presenting with the predominant symptom of diarrhoea, of whom six patients (0.4%) reported haemorrhagic diarrhoea. In the comparative period in 2010, between May 31st and June 13th, twelve patients (1.6%) presenting the symptom of diarrhea were treated in our emergency room. The analysis of the news reports in 2011 revealed a total of 1,150 reports broadcast in the ARD and a total of 173 reports broadcast in the regional news channel MDR between May 29th and June 11th. In 2010 not a single report regarding our search terms was broadcast in the corresponding time period. CONCLUSION: Our data suggest a clear positive correlation of the frequency of TV reports dealing with the epidemic disease outbreak and the rate of outpatient consultations in emergency rooms because of diarrhoea and could make an important contribution for future discussions.

The rise of emergency medicine in the sixties: paving a new entrance to the house of medicine.

Emergency medicine evolved into a medical specialty in the 1960s under the leadership of physicians in small communities across the country. This paper uses three case studies to investigate the political, societal, and local factors that propelled emergency medicine along this path. The case studies-Alexandria Hospital, Hartford Hospital, and Yale-New Haven Hospital-demonstrate that the changes in emergency medicine began at small community hospitals and later spread to urban teaching hospitals. These changes were primarily a response to public demand. The government, the American public, and the medical community brought emergency medical care to the forefront of national attention in the sixties. Simultaneously, patients' relationships with their general practitioners dissolved. As patients started to use the emergency room for non-urgent health problems, emergency visits increased astronomically. In response to rising patient loads and mounting criticism, hospital administrators devised strategies to improve emergency care. Drawing on hospital archives, oral histories, and statistical data, I will argue that small community hospitals' hiring of full-time emergency physicians sparked the development of a new specialty. Urban teaching hospitals, which established triage systems and ambulatory care facilities, resisted the idea of emergency medicine and ultimately delayed its development.

Emergency care: then, now, and next.

Five decades ago, hospitals staffed their emergency rooms with rotating community physicians or unsupervised hospital staff. Ambulance service was frequently provided by a local funeral home. Beginning in the late 1960s and accelerating thereafter, emergency care swiftly evolved into its current form. Today, modern emergency departments not only are capable of providing around-the-clock lifesaving care in individual emergencies and disasters. They also conduct timely diagnostic workups, provide access to after-hours acute care, and serve as the "safety net of the safety net" for millions of low-income and uninsured patients. But the field's success has led to a new set of challenges. To overcome them, emergency care must become more integrated, regionalized, prevention oriented, and innovative.

IT in the ED: past, present, and future.

Over the past 40 years, information technology in the emergency department (ED) has evolved from primitive tracking, order entry, and laboratory reporting systems to complex multifunctional applications that permeate all aspects of patient care and ED operations. Spurred by incentive programs and technological improvements, both ED physicians and administrators view these systems as a way to increase staff efficiency, to improve patient care quality and safety, to satisfy compliance and reporting obligations, and to reduce costs. As organizations implement and optimize systems, it is helpful to look back at how these technologies were developed, to review the current impacts and effects of their use, and to glimpse the future of information technology in the ED.

Mass casualty response in the 2008 Mumbai terrorist attacks.

OBJECTIVES: The November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists. METHODS: A retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants. RESULTS: Among the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries). CONCLUSIONS: The use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar "Mumbai-style" attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.