[Rapid Response obstetrics Team at Instituto Mexicano del Seguro Social,enabling factors]. / Equipo de Respuesta Inmediata obstétrico en el Instituto Mexicano del Seguro Social, factores facilitadores.

BACKGROUND: There are barriers and enablers for the implementation of Rapid Response Teams in obstetric hospitals. The enabling factors were determined at Instituto Mexicano del Seguro Social (IMSS) MATERIAL AND METHODS: An observational, retrospective study was conducted by analysing the emergency obstetric reports sent by mobile technology and e-mail to the Medical Care Unit of the IMSS in 2013. Frequency and mean was obtained using the Excel 2010 program for descriptive statistics. RESULTS: A total of 164,250 emergency obstetric cases were reported, and there was a mean of 425 messages per day, of which 32.2% were true obstetric emergencies and required the Rapid Response team. By e-mail, there were 73,452 life threatening cases (a mean of 6 cases per day). A monthly simulation was performed in hospitals (480 in total). Enabling factors were messagés synchronisation among the participating personnel,the accurate record of the obstetrics, as well as the simulations performed by the operational staff. The most common emergency was pre-eclampsia-eclampsia with 3,351 reports, followed by obstetric haemorrhage with 2,982 cases. DISCUSSION: The enabling factors for the implementation of a rapid response team at IMSS were properly timed communication between the central delegation teams, as they allowed faster medical and administrative management and participation of hospital medical teams in the process. CONCLUSION: Mobile technology has increased the speed of medical and administrative management in emergency obstetric care. However, comparative studies are needed to determine the statistical significance.

Do elderly patients call 911 when presented with clinical scenarios suggestive of acute stroke? A cross-sectional study.

BACKGROUND AND PURPOSE: Among patients with acute stroke symptoms, delay in hospital admission is the main obstacle for the use of thrombolytic therapy and other interventions associated with decreased mortality and disability. The primary aim of this study was to assess whether an elderly clinical population correctly endorsed the response to call for emergency services when presented with signs and symptoms of stroke using a standardized questionnaire. METHODS: We performed a cross-sectional study among elderly out-patients (≥60 years) in Buenos Aires, Argentina randomly recruited from a government funded health clinic. The correct endorsement of intention to call 911 was assessed with the Stroke Action Test and the cut-off point was set at ≥75%. Knowledge of stroke and clinical and socio-demographic indicators were also collected and evaluated as predictors of correct endorsement using logistic regression. RESULTS: Among 367 elderly adults, 14% correctly endorsed intention to call 911. Presented with the most typical signs and symptoms, only 65% reported that they would call an ambulance. Amaurosis Fugax was the symptom for which was called the least (15%). On average, the correct response was chosen only 37% of the time. Compared to lower levels of education, higher levels were associated to correctly endorsed intention to call 911 (secondary School adjusted OR 3.53, 95% CI 1.59-7.86 and Tertiary/University adjusted OR 3.04, 95% CI 1.12-8.21). CONCLUSIONS: These results suggest the need to provide interventions that are specifically designed to increase awareness of potential stroke signs and symptoms and appropriate subsequent clinical actions.

An analysis of prehospital care for victims of accidents and violence in Recife, Brazil.

OBJECTIVES: This study was aimed at carrying out a situational diagnosis of the prehospital healthcare network for victims of accidents and violence in Recife, Brazil. METHODS: National policy for reducing accident- and violence-related morbidity and mortality was used as reference. Questionnaires were applied and half-structured interviews conducted with managers and healthworkers from thirteen prehospital fixed units and one mobile unit. RESULTS: Children, adolescents and females predominantly sought attention; there were few preventative actions, little social coverage and deficient referral, counterreferral and communication with other sectors. A lack of equipment and basic materials, insufficient multidisciplinary teams and the need for ongoing training were also observed. Notifying and recording accidents and violence also lacked precision; ensuring that these were done properly would allow track to be kept of them as well as developing a proper assessment and action plan. However, important state, city and academic initiatives towards preventing and reducing morbidity and mortality caused by accidents and violence in particular municipalities were identified. CONCLUSIONS: Taking national policy for reducing accident- and violence-related morbidity and mortality as a point of reference, then it can be seen that some advances have been made in the city of Recife; however, many shortcomings can still be seen in terms of introducing such policy.