First aid: level of knowledge of relatives and bystanders in emergency situations.

Bystanders who are able to provide immediate first aid to patients who require emergency care can make a big difference in the outcome. Thus, first-aid training should be made available to as many people as possible. The aims of this study were to assess the level of first-aid knowledge among bystanders in emergency situations and to identify factors that affected this level of knowledge. At Dokuz Eylul University Emergency Service between February 1 and February 15, 2002, 318 bystanders were given a questionnaire. The first part of the questionnaire was concerned with demographic characteristics and factors that would affect first-aid knowledge level. The second part consisted of 16 multiple choice questions about first aid. Bystanders answered an average of 7.16+/-3.14 questions correctly. Bystanders who had graduated from a university, were health care personnel, had taken a first-aid course, had a first-aid certificate, or had a driver's license were considered to be more successful.

[Assessment of physicians employed in emergency medical services about their level of knowledge on basic life support, advanced cardiac life support and medicolegal responsibilities]. / 112 Acil Saglik Hizmetleri'nde görevli doktorlarin temel yasam destegi, ileri kardiyak yasam destegi ve doktorun adli sorumluluklari konularindaki bilgi düzeylerinin degerlendirilmesi.

BACKGROUND: We aimed to determine the level of knowledge of Emergency Medical Services (EMS) physicians on Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and medicolegal responsibilities in conjunction with related factors. METHODS: Fifty-three physicians (43 male, 10 females; mean age 39 years; range 28 to 50 years) employed in EMS were required to respond a questionnaire consisting of demographic data and educational background. They also answered 25 multiple-choice questions about BLS, ACLS and medicolegal responsibilities of physicians in a face-to-face manner. The data were analyzed using Mann-Whitney U-test and Kruskal-Wallis Analysis of Variance test. RESULTS: Mean level of knowledge was 45.4 on a hundred-point scale. Attendance to courses covering emergency aid and working as an ambulance physician for more than one year were associated with higher levels of knowledge (p=0.012; p=0.015). CONCLUSION: In-service training should be undertaken to raise the level of knowledge of the physicians employed in rural EMS and to improve the quality of field care.

Acute subdural hemorrhage while traveling by bus: a risk factor in the elderly?

A 71-year-old man was delivered to our emergency department by an intercity bus. About 4 hours into a journey, he had complained of a headache to his wife. After one more hour, she noted a change in his level of alertness and notified the bus driver. A computed tomography scan of the head showed a subdural hemorrhage.

Evaluation of prehospital emergency care in the field and during the ambulance drive to the hospital.

This study was conducted to evaluate the appropriateness of ambulance procedures and interventions in the management of patients dispatched to 2 emergency departments (EDs) of urban hospitals in Izmir. Use of trauma boards and cervical collars, airway patency, breathing, and circulation problems were recorded in both EDs. Eighty-one patients with a mean age of 47.54 +/- 2.36 years (range, 4-89) brought into the ED via ambulances were enrolled in the study. Airway maneuvers were performed in patients with airway and breathing problems. There was no significant relationship between administration of IV fluids and the presence of circulatory impairment (P=.053). A trauma board was used in 9 of 30 trauma cases (30%) and a cervical collar in 6 of 30 (20%). It was concluded that basic procedures used in the management of patients brought into the ED via ambulances were inadequate.

Analysis of factors affecting satisfaction in the emergency department: a survey of 1019 patients.

The objective of this study was to identify factors that affect overall satisfaction of patients admitted to the emergency department (ED). All consecutive adult patients in the ED during a 14-day period who could communicate well were enrolled into this cross-sectional analytic study. Patients' demographic data, information on care, and level of satisfaction were recorded. Patients were asked to rate specific issues concerning their satisfaction (good and excellent) on a 5-point Likert scale. Response to the survey was obtained from 1019 (91.6%) of 1113 patients for analysis during the study. Satisfaction with physician experience, physician attitude, triage, explanation of health status and treatment, and discharge instructions were found to have significant impact on satisfaction (P < .001 for each). Satisfaction with physician experience level was the most important factor affecting overall satisfaction. Patient perception of the total time spent in the ED as "short" and "very short" was not demonstrated to be significantly related to overall satisfaction (P = .162). Temporal perceptions as "long" and "very long" were shown to be significantly related to overall satisfaction (P < .001). Behavioral characteristics of the healthcare providers and the hospital itself were the factors that had the greatest impact on overall satisfaction of the ED population evaluated.

Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: a double-blind, randomized controlled trial.

This double-blind, randomized, prospective study was conducted to compare the analgesic and sedative efficacy of fentanyl and meperidine in orthopedic closed reduction of fractures and dislocations undertaken in the emergency department. Seventy consecutive adult patients with fractures or dislocations suitable for reduction were randomized to receive fentanyl (1 mcg/kg; n = 36) or meperidine (0.5 mg/kg; n = 34) in combination with midazolam (0.02 mg/kg). Vital signs and alertness scale scores of the patients were monitored. The Visual Analog Scale (VAS) was used to determine the degree of pain. There was no statistically significant difference between the VAS mean scores of the fentanyl and meperidine groups (t test, P = .772). The need for additional analgesic drugs was significantly more frequent in patients receiving meperidine (P = .018). No adverse events, such as hypotension or respiratory depression, were noted. Euphoria occurred in one patient in the fentanyl group. Although dose requirements differ, fentanyl and meperidine provide effective and reliable analgesia in closed reduction of fractures and dislocations.

Paramedics and triage: effect of one training session on triage in the emergency department.

This 3-stage intervention study enrolled all adult patients referred to a university-based emergency department (ED) during randomly assigned 1-week preeducation or posteducation periods. Triage decisions recorded by ED paramedics (n = 8) both before and after an educational training session were compared to decisions made by emergency physicians (EPs). Triage decisions of paramedics and EPs in the preeducation phase showed poor consistency (K = 0.317, K = 0.388). Triage decisions in the posteducation phase increased slightly but were still found to be low. On the other hand, consistency between the triage assessments recorded by paramedics and EPs of the general appearance of patients increased from low in the preeducation phase to moderate in the posteducation phase (K = 0.327, K = 0.500, respectively). The training session was associated with a slight increase in the consistency of triage decisions recorded by paramedics and EPs.

Prilocaine versus plain or buffered lidocaine for local anesthesia in laceration repair: randomized double-blind comparison.

AIM: To compare the effectiveness of 2% prilocaine plain solution, 1% lidocaine hydrochloride, and 1% buffered lidocaine in local anesthesia and pain reduction during injection in laceration repair. METHODS: A double-blind randomized prospective comparison study included 183 consecutive eligible adult patients with simple lacerations, admitted to the emergency department between January 2001 and June 2002. Each of the three groups of patients received different local anesthetic before laceration suturing (1% lidocaine, 2% prilocaine, or buffered 1% lidocaine). The patients were asked to assess the pain intensity on a 0-100 numerical rating scale at the site of needle entry into the skin (P1), immediately after the completion of injection (P2), and after the first puncture of the suturing needle (P3). The differences among the three patient groups were tested with one-way analysis of variance and chi-square test. RESULTS: The three groups of 61 patients each (one patient declined from prilocaine group) did not significantly differ in mean P1 scores (29.1+/-20.9 in the prilocaine, 32.2+/-22.9 in the lidocaine, and 33.2+/-21.7 in the buffered lidocaine group; p=0.56). Mean P2 scores were highest in the prilocaine group (24.0+/-16.0), followed by lidocaine (20.9+/-14.9) and buffered lidocaine (16.1+/-11.3) groups (p=0.007). Mean P3 score was significantly lower in the lidocaine group (13.4+/-11.3) then in the prilocaine (18.4+/-13.1) and buffered lidocaine (20.4+/-16.2) groups (p=0.014). The number of patients who required additional anesthetic administration in each group was not significantly different (p=0.09). CONCLUSION: Injection of 1% lidocaine was associated with lower pain ratings on suturing needle puncture than with 2% prilocaine or buffered 1% lidocaine.