Review of emergency preparedness in the office setting: How best to prepare based on your practice and patient demographic characteristics.

OBJECTIVE: To outline an approach to assessing the risk of emergencies in one's medical practice and determining the equipment and medications required for emergencies and the necessary staff training to meet this important facet of patient care. SOURCES OF INFORMATION: The emergency preparedness recommendations presented in this article are based on data collected from family physicians' current preparedness plans, formal physician evaluation and informal feedback provided after 2 large group presentations, and the authors' expertise in areas including family medicine, emergency medicine, prehospital care, and pharmacology. MAIN MESSAGE: Delineating risk based on practice profile, location, and demographic characteristics will inform the development of an appropriate plan to meet both public expectations and professional obligations. Reviewing the plan or having a practice drill of the plan once developed will improve the process in the event of an emergency. It is also essential to have medication and equipment checked periodically for expiry dates and proper functioning. CONCLUSION: Physicians will encounter office emergencies at some time in their practice. Appropriate risk assessment, planning, and preparedness will allow the provision of high-quality care, safety for staff members, the best patient outcomes, and the reward of having managed a time-sensitive problem in an efficient and effective manner.

Revue de la préparation aux situations d'urgence à la clinique: Comment mieux se préparer en fonction de votre pratique et des caractéristiques démographiques de vos patients.

OBJECTIF: Présenter une approche pour évaluer les risques d'urgences dans sa propre clinique médicale, et déterminer le matériel et les médicaments nécessaires pour de telles urgences, de même que la formation du personnel requise pour aborder cette importante facette des soins aux patients. SOURCES DE L'INFORMATION: Les recommandations sur la préparation aux urgences dans cet article se fondent sur des données colligées à partir de plans de préparation aux urgences déjà existants chez les médecins de famille, d'une évaluation formelle faite par des médecins et d'une rétroaction informelle fournie à la suite de 2 présentations à de grands groupes, de même que sur l'expertise des auteurs dans des domaines comme la médecine familiale, la médecine d'urgence, les soins préhospitaliers et la pharmacologie. MESSAGE PRINCIPAL: La définition des risques en fonction du profil, de l'emplacement et des caractéristiques démographiques de la pratique éclairera l'élaboration d'un plan approprié pour répondre à la fois aux attentes de la population et aux obligations professionnelles. La révision du plan ou un exercice d'entraînement une fois qu'il est élaboré améliorera le processus dans l'éventualité d'une urgence. Il est aussi essentiel de vérifier périodiquement les dates de péremption des médicaments et le bon fonctionnement du matériel. CONCLUSION: À un moment ou l'autre, les médecins auront à faire face à des urgences à leur clinique. Une évaluation des risques, une planification et un état de préparation appropriés leur permettront de fournir des soins de grande qualité, d'assurer la sécurité de leur personnel, d'obtenir les meilleurs résultats pour les patients et de ressentir la satisfaction d'avoir géré un problème urgent d'une manière efficiente et efficace.

Procedural sedation by advanced care paramedics for emergency gastrointestinal endoscopy.

OBJECTIVES: At the QEII Health Sciences Centre Emergency Department (ED) in Halifax, Nova Scotia, advanced care paramedics (ACPs) perform procedural sedation and analgesia (PSA) for many indications, including orthopedic procedures. We have begun using ACPs as sedationists for emergent upper gastrointestinal (UGI) endoscopy. This study compares ACP-performed ED PSA for UGI endoscopy and orthopedic procedures in terms of adverse events, airway intervention, vasopressor requirement, and PSA medication use. METHODS: A data set was built from an ED PSA quality control database matching 61 UGI endoscopy PSAs to 183 orthopedic PSAs by propensity scores calculated using age, gender, and the American Society of Anesthesiologists (ASA) classification. Outcomes assessed were hypotension (systolic BP30 sec), vomiting, arrhythmias, death, airway intervention, vasopressor requirement, and PSA medication use. RESULTS: UGI endoscopy patients experienced hypotension more frequently than orthopedic patients (OR=4.11, CI: 2.05-8.22) and required airway repositioning less often (OR=0.24, CI: 0.10-0.59). They received ketamine more frequently (OR=15.7, CI: 4.75-67.7) and fentanyl less often (OR=0.30, CI: 0.15-0.63) than orthopedic patients. Four endoscopy patients received phenylephrine, and one required intubation. No patient died in either group. CONCLUSIONS: In ACP-led sedation for UGI endoscopy and orthopedic procedures, adverse events were rare with the notable exception of hypotension, which was more frequent in the endoscopy group. Only endoscopy patients required vasopressor treatment and intubation. We provide preliminary evidence that ACPs can manage ED PSA for emergent UGI endoscopy, although priorities must shift from pain control to hemodynamic optimization.

Development of a Medical Humanities Program at Dalhousie University Faculty of Medicine, Nova Scotia, Canada, 1992-2003.

The Medical Humanities Program at Dalhousie University Faculty of Medicine in Nova Scotia, Canada, was initiated in 1992 to incorporate the medical humanities into the learning and experiences of medical students. The goal of the program was to gain acceptance as an integral part of the medical school. The program assumed a broad concept of the medical humanities that includes medical history, literature, music, art, multiculturalism, philosophy, epistemology, theology, anthropology, professionalism, history of alternative therapies, writing, storytelling, health law, international medicine, and ethics. Phase I of the program has provided the same elective and research opportunities in the medical humanities that are available to the students in clinical and basic sciences, and has encouraged and legitimized the involvement of the humanities in the life and learning of the medical student through a wide array of programs and activities. Phase II will focus on further incorporation of the humanities into the curriculum. Phase III will be the development of a graduate program in medical humanities to train more faculty who will incorporate the humanities into their teaching and into the development of education programs.