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1.
Medicine (Baltimore) ; 99(1): e18687, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895836

RESUMO

The impact of time of day or day of week on the survival of emergency trauma patients is still controversial. The purpose of this study was to evaluate the outcomes of these patients according to time of day or day of week of emergency admission by using data from the nationwide Japan Trauma Data Bank (JTDB).This study enrolled 236,698 patients registered in the JTDB database from 2004 to 2015, and defined daytime as 09:00 AM to 16:59 PM and nighttime as 17:00 PM to 08:59 AM, weekdays as Monday to Friday, and weekends as Saturday, Sunday, and national holidays. The outcome measures were death in the emergency room (ER) and discharge to death.In total, 170,622 patients were eligible for our analysis. In a multivariable logistic regression adjusted for confounding factors, both death in the ER and death at hospital discharge were significantly lower during the daytime than at nighttime (623/76,162 [0.82%] vs 954/94,460 [1.01%]; adjusted odds ratio [AOR] 0.79; 95% confidence interval [CI] 0.71-0.88 and 5765/76,162 [7.57%] vs 7270/94,460 [7.70%]; AOR 0.88; 95% CI 0.85-0.92). In contrast, the weekdays/weekends was not significantly related to either death in the ER (1058/114,357 [0.93%] vs 519/56,265 [0.92%]; AOR 0.95; 95% CI 0.85-1.06) or death at hospital discharge (8975/114,357 [7.85%] vs 4060/56,265 [7.22%]; AOR 1.02; 95% CI 0.97-1.06).In this population of emergency trauma patients in Japan, both death in the ER and death at hospital discharge were significantly lower during the daytime than at night, but the weekdays/weekends was not associated with outcomes of these patients.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Adulto , Idoso , Serviços Médicos de Emergência/normas , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Z Geburtshilfe Neonatol ; 223(6): 337-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801168

RESUMO

As far as prehospital but in part also clinical obstetrics is concerned, the acute nature of perinatal emergencies is overshadowed by limited diagnostic and therapeutic options. The need for acute and targeted intervention may result from both maternal and fetal indications. As common in emergency services for pregnant women, prehospital primary assessment and logistics management (e.g., transport time/type, choice of destination) define the prognosis. Non-specific emergencies coincident to pregnancy are to be distinguished from perinatal emergencies caused by expecting a child (hypertensive pregnancy disorders, perinatal bleeding, thrombosis, and embolism). In order to cope with rare and unpredictable emergencies, medical teams profit from standardized algorithms to support a high quality of prehospital care. Extensive information and training concepts are essential. The presented series on obstetric emergencies introduces the required knowledge and skills.


Assuntos
Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Obstetrícia , Complicações na Gravidez/epidemiologia , Descolamento Prematuro da Placenta , Criança , Embolia Amniótica , Feminino , Humanos , Parto , Placenta Prévia , Pré-Eclâmpsia , Gravidez , Tromboembolia , Inércia Uterina
3.
Medicine (Baltimore) ; 98(49): e18200, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804342

RESUMO

To determine the frequency of medication errors in prehospital care and to investigate the influencing factors - diagnostic agreement (DA), the medical educational status, the specialty, the approval for emergency medicine of the prehospital emergency physician, the patient age and sex and the time of deployment.We retrospectively reviewed 708 patients from 2013 to 2015, treated by the prehospital emergency physicians of the emergency medical service center Bad Belzig, Germany. The medication appropriateness was determined by a systematic comparison of the administered medication in prehospital deployments with the discharge diagnosis, according to current guidelines. The influencing factors were examined by univariate analysis of medication appropriateness (MA), using the χ, the Mann-Whtiney U and the Welch tests. We calculated a cut-off value with the Youden index to predict absent MA, according to patients age. The significance level was P = .05.MA was absent in 220 of 708 patients (31.1%). In the case of present DA, MA was absent in 103 of 491 patients (20.9%). In the case of absent DA, MA was absent in 117 of 217 patients (53.9%) (P = .01). MA was absent in 82 of 227 patients (36.1%), treated by specialist and in 138 of 481 patients (28.7%), treated by resident physicians (P = .04). The calculated cut-off value to predict absent MA was 75.5 years. MA was absent in 100 of 375 patients (26.7%) of the younger patient age group (≤75.5 years), MA was absent 120 of 333 patients (36.0%) of the older patient age group (>75.5 years) (P = .01). Absent MA showed peak values (46.7%-60%) at night from 3 to 6 AM (P = .01) The other investigated factors had no influence on MA.The correctness of medication as a quality feature in prehospital care shows a necessity for improvement with a proportion of 31.1% medication errors. The correct diagnosis by the prehospital emergency physician and his rapid accumulation of experience had an impact on the correctness of medication in prehospital care. Elderly patients (75+ years) and nighttime prehospital deployments (3-6 AM) were identified as high risk for medication errors by the emergency physicians.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Lactente , Masculino , Erros de Medicação/classificação , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
4.
Adv Clin Exp Med ; 28(11): 1495-1505, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31778597

RESUMO

BACKGROUND: Patients with acute myocardial infarction (AMI) or acute trauma (AT) are transported by air to save time. Helicopter Emergency Medical Service (HEMS) provides both flights to and from the emergency scene, as well as interhospital transport (interHtransport). OBJECTIVES: The objective of this study was to compare aeromedical transport and HEMS missions of AMI and AT patients regarding safety, medical procedures and the length of flights. MATERIAL AND METHODS: This is a case-control study analyzing the medical history records of AMI and AT patients transported between hospitals and from the scene identified using ICD-10 codes. Research of customary data (age, sex and general health status measured with Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS)) was performed. RESULTS: There were 48,555 flights in the years 2011-2016, of which 7,645 (15.7%) were interhospital (19% AMI and 12% AT). Out of these, 40,910 (84.3%) HEMS missions were to patients on the scene (10% AMI and 13% AT). No fatalities were noted. The AMI GCS score was higher than in AT patients: 15.0 vs 14.0, respectively. The medical procedures during transport of AMI patients between hospitals and from the scene were the following: cardiopulmonary resuscitation (CPR): 6 vs 73 cases (p < 0.001); oxygen therapy: 41.1% vs 50.2%, respectively. The median distance was 59.4 km vs 52.1 km (p < 0.001), while median flight time was 45.0 min vs 38.0 min (p < 0.001), respectively. Regarding AT patients, the procedures performed (during interhospital and from the scene transport) were the following: CPR: 5 vs 244 cases (p < 0.001); intubation: 10.7% vs 17.3% (p < 0.001); sedation: 50.1% vs 24.3% (p < 0.001); oxygen therapy: 17.6% vs 36.6% (p < 0.001); spinal board: 17.1% vs 66% (p < 0.001); cervical collar: 15.9% vs 63.4% (p < 0.001), respectively. Interhospital transport and HEMS mission median flight distance was 135.9 km vs 56.3 km (p < 0.001), while median flight time was 66.0 min vs 45.0 min (p < 0.001), respectively. CONCLUSIONS: Aeromedical transport is safe and very rarely requires resuscitation during the flight. The long distances of flights and time required can reflect the scarcity of trauma centers (TCs) compared to cardiovascular wards. The location of hemodynamic centers in Poland is optimal.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Infarto do Miocárdio , Transporte de Pacientes/métodos , Estudos de Casos e Controles , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Infarto do Miocárdio/terapia , Polônia , Estudos Retrospectivos , Fatores de Tempo
5.
BMC Health Serv Res ; 19(1): 812, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699084

RESUMO

BACKGROUND: Human workload is a key factor for system performance, but data on emergency medical services (EMS) are scarce. We investigated paramedics' workload and the influencing factors for non-emergency medical transfers. These missions make up a major part of EMS activities in Germany and are growing steadily in number. METHODS: Paramedics rated missions retrospectively through an online questionnaire. We used the NASA-Task Load Index (TLX) to quantify workload and asked about a variety of medical and procedural aspects for each mission. Teamwork was assessed by the Weller teamwork measurement tool (TMT). With a multiple linear regression model, we identified a set of factors leading to relevant increases or decreases in workload. RESULTS: A total of 194 non-emergency missions were analysed. Global workload was rated low (Mean = 27/100). In summary, 42.8% of missions were rated with a TLX under 20/100. TLX subscales revealed low task demands but a very positive self-perception of performance (Mean = 15/100). Teamwork gained high ratings (Mean TMT = 5.8/7), and good teamwork led to decreases in workload. Aggression events originating from patients and bystanders occurred frequently (n = 25, 12.9%) and increased workload significantly. Other factors affecting workload were the patient's body weight and the transfer of patients with transmittable pathogens. CONCLUSION: The workload during non-emergency medical transfers was low to very low, but performance perception was very positive, and no indicators of task underload were found. We identified several factors that led to workload increases. Future measures should attempt to better train paramedics for aggression incidents, to explore the usefulness of further technical aids in the transfer of obese patients and to reconsider standard operating procedures for missions with transmittable pathogens.


Assuntos
Pessoal Técnico de Saúde , Serviços Médicos de Emergência/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Alemanha , Pesquisa sobre Serviços de Saúde , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
6.
BMC Health Serv Res ; 19(1): 813, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699103

RESUMO

BACKGROUND: Out-of-hours (OOH) healthcare services in Western countries are often differentiated into out-of-hours primary healthcare services (OOH-PC) and emergency medical services (EMS). Call waiting time, triage model and intended aims differ between these services. Consequently, the care pathway and outcome could vary based on the choice of entrance to the healthcare system. We aimed to investigate patient pathways and 1- and 1-30-day mortality, intensive care unit (ICU) stay and length of hospital stay for patients with acute myocardial infarction (AMI), stroke and sepsis in relation to the OOH service that was contacted prior to the hospital contact. METHODS: Population-based observational cohort study during 2016 including adult patients from two Danish regions with an OOH service contact on the date of hospital contact. Patients <18 years were excluded. Data was retrieved from OOH service databases and national registries, linked by a unique personal identification number. Crude and adjusted logistic regression analyses were performed to assess mortality in relation to contacted OOH service with OOH-PC as the reference and cox regression analysis to assess risk of ICU stay. RESULTS: We included 6826 patients. AMI and stroke patients more often contacted EMS (52.1 and 54.1%), whereas sepsis patients predominately called OOH-PC (66.9%). Less than 10% (all diagnoses) of patients contacted both OOH-PC & EMS. Stroke patients with EMS or OOH-PC & EMS contacts had higher likelihood of 1- and 1-30-day mortality, in particular 1-day (EMS: OR = 5.33, 95% CI: 2.82-10.08; OOH-PC & EMS: OR = 3.09, 95% CI: 1.06-9.01). Sepsis patients with EMS or OOH-PC & EMS contacts also had higher likelihood of 1-day mortality (EMS: OR = 2.22, 95% CI: 1.40-3.51; OOH-PC & EMS: OR = 2.86, 95% CI: 1.56-5.23) and 1-30-day mortality. Risk of ICU stay was only significantly higher for stroke patients contacting EMS (EMS: HR = 2.38, 95% CI: 1.51-3.75). Stroke and sepsis patients with EMS contact had longer hospital stays. CONCLUSIONS: More patients contacted OOH-PC than EMS. Sepsis and stroke patients contacting EMS solely or OOH-PC & EMS had higher likelihood of 1- and 1-30-day mortality during the subsequent hospital contact. Our results suggest that patients contacting EMS are more severely ill, however OOH-PC is still often used for time-critical conditions.


Assuntos
Plantão Médico/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Infarto do Miocárdio/terapia , Atenção Primária à Saúde/estatística & dados numéricos , Sepse/terapia , Acidente Vascular Cerebral/terapia , Idoso , Estudos de Coortes , Dinamarca , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Resultado do Tratamento
7.
Pan Afr Med J ; 33: 289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692808

RESUMO

Introduction: This study explores why resuscitation is withheld when mobile emergency medical team arrive at the scene of a cardiac arrest. Methods: We conducted a prospective, observational study in pre hospital emergency services. We included adults' patients, with a suspicion of non-traumatic cardiac arrest (CA) in an out of hospital environment, who received or not cardiopulmonary resuscitation (CPR) by our mobile emergency medical service teams. An analytic study was conducted in order to identify independent factors that could influence the decision to resuscitate OHCA. Results: During study, 228 patients were enrolled, the mean age was 64 +/- 14 years and 59% were men. Eighteen patients (8%) received bystander CPR by witnesses. The median time elapsed to arrive at the scene was 13 [8-25] min. The median "noflow" was 22 [10-34] min. The resuscitation decision was taken by the mobile EMS staff for 106 patients (46.5%). For other patients, the decision not to resuscitate was motivated solely by the finding of a confirmed state of death in an elderly patient (p = 0.045). The predictive decision factor for resuscitation was the no flow time less than 18.5 min, Odds Ratio adjusted with 95% confidence interval to: 1.38 (1.24 - 3.55) (p <0.001). Overall out of hospital survival rate was 17% of resuscitated patients. Conclusion: The decision to resuscitate a cardiac arrest outside of the hospital depends more on the "no flow" time than on the presumed etiologies.


Assuntos
Reanimação Cardiopulmonar/métodos , Tomada de Decisões , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo
8.
Medicine (Baltimore) ; 98(45): e17881, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702660

RESUMO

This study aimed to investigate the prognostic difference between AUTOPULSE and LUCAS for out-of-hospital cardiac arrest (OHCA) adult patients.A retrospective observational study was performed nationwide. Adult OHCA patients after receiving in-hospital mechanical chest compression from 2012 to 2016 were included. The primary outcomes were sustained return of spontaneous circulation (ROSC) of more than 20 minutes and survival to discharge.Among 142,906 OHCA patients, 820 patients were finally included. In multivariate analysis, female (OR, 0.57; 95% CI, 0.33-0.99), witnessed arrest (OR, 2.10; 95% CI, 1.20-3.69), and arrest cause of non-cardiac origin (OR, 0.25; 95% CI, 0.10-0.62) were significantly associated with the increase in ROSC. LUCAS showed a lower survival than AUTOPULSE (OR, 0.23; 95% CI, 0.06-0.84), although it showed no significant association with ROSC. Percutaneous coronary intervention (OR, 6.30; 95% CI, 1.53-25.95) and target temperature management (TTM; OR, 7.30; 95% CI, 2.27-23.49) were the independent factors for survival. We categorized mechanical CPR recipients by witness to compare prognostic effectiveness of AUTOPULSE and LUCAS. In the witnessed subgroup, female (OR, 0.46; 95% CI, 0.24-0.89) was a prognostic factor for ROSC and shockable rhythm (OR, 5.04; 95% CI, 1.00-25.30), percutaneous coronary intervention (OR, 12.42; 95% CI, 2.04-75.53), and TTM (OR, 9.03; 95% CI, 1.86-43.78) for survival. In the unwitnessed subgroup, no prognostic factors were found for ROSC, and TTM (OR, 99.00; 95% CI, 8.9-1100.62) was found to be an independent factor for survival. LUCAS showed no significant increase in ROSC or survival in comparison with AUTOPULSE in both subgroups.The in-hospital use of LUCAS may have a deleterious effect for survival compared with AUTOPULSE.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Massagem Cardíaca/instrumentação , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/mortalidade , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Massagem Cardíaca/mortalidade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , República da Coreia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
9.
J Opioid Manag ; 15(4): 295-306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637682

RESUMO

OBJECTIVE: To understand the needs of Emergency Medical Service (EMS) providers caring for substance users in an urban setting. DESIGN: Qualitative interviews with EMS providers regarding perceptions of substance users and treatment programs. SETTING: Baltimore City. PARTICIPANTS: Twenty-two Baltimore City Fire Department EMS providers. INTERVENTIONS: Semistructured in-depth interviews were conducted with 22 EMS providers. Topics included experiences caring for substance-using patients and attitudes about local harm reduction approaches. MAIN OUTCOME MEASURE: Providers were asked their views on receiving training to deliver a brief motivational intervention to encourage patients to enter drug treatment. Interviews were transcribed and analyzed using constant comparison. RESULTS: Participants were mostly Male (68.2 percent), White (66.6 percent), and had Advanced Life Skills training (90.9 percent). Mean experience was 8.7 years. Many providers described EMS misusers as mostly male and middle-aged, although there were variations in substance use patterns among all races and income levels. Most stated that repeated care provision to a small number of substance-users negatively impacted care quality. Provider demands included departmental policies and resource limitations. Many expressed willingness to deliver motivational messages to substance-using patients to consider drug treatment. Other stated that behavioral interventions were beyond their job duties and most reported having little-to-no knowledge of local treatment programs. CONCLUSIONS: EMS providers may be uniquely positioned to deliver substance use treatment messages to substance users. This could be a life- and cost-saving improvement to EMS in Baltimore City with incentivized training. More research is needed to inform opioid use preparedness in urban settings, which remain at the center of the opioid epidemic.


Assuntos
Analgésicos Opioides , Serviços Médicos de Emergência , Auxiliares de Emergência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias , Adulto , Baltimore , Serviços Médicos de Emergência/estatística & dados numéricos , Epidemias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
10.
Lakartidningen ; 1162019 Oct 18.
Artigo em Sueco | MEDLINE | ID: mdl-31638708

RESUMO

Since 2016, a number of companies offering primary care services via chats or video calls have entered the Swedish primary care market. This is the first study to investigate whether these services replace other primary care services or if they induce more care and potentially even increase the workload of traditional caregivers. Using administrative care register data from a Swedish region, we find that the use of telemedicine services is associated with higher use of other primary care services (visits and telephone/mail contacts). Further, telemedicine users visit the emergency room at least as often as other residents. We obtain similar results when using various strategies to account for differences between telemedicine users and non-users. However, we cannot completely rule out that an association between transitory health problems and telemedicine use explains the results.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Grupos Étnicos , Feminino , Humanos , Renda , Lactente , Masculino , Pessoa de Meia-Idade , Suécia , Adulto Jovem
11.
Am Surg ; 85(10): 1142-1145, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657311

RESUMO

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC+USC (January 2008-July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23-53]. The median Injury Severity Score was 4 [1-10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/etiologia , Ferimentos Penetrantes/etiologia , Escala Resumida de Ferimentos , Adulto , California/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Triagem , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgia , Adulto Jovem
12.
Orv Hetil ; 160(43): 1698-1705, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31630553

RESUMO

Introduction: According to WHO data, more than 2 million people die because of alcohol consumption during one year. One part of these people are displayed in the emergency departments. There are those who are just about to be detoxicated, those who suffered alcohol-related accidents or alcohol-related internal illness. Aim: To find out how many alcohol-influencing patients are being in the emergency care system and how much of the financing are used for these patients. Method: Our research was conducted at the Department of Emergency Medicine, Clinical Centre, University of Pécs. The research period was between January 1 and December 31, 2016. Our sample was made up of patients who were exposed due to alcohol in the emergency room (n = 1326). We made document analysis. We analysed data using statistical software SPSS 22.0. Results: 78% of the patients were male. The mean age of the sample was 49.78 ± 14.215 years. 71.1% of patients had a home, but 28.9% were homeless. According to the Triage scale, 608 patients were in category T5 because they needed only detoxification. In terms of the level of consciousness, 93.7% of patients had 14 or 15 points according to the Glasgow Coma Scale. 14.6% of patients did not expect a medical examination. Within the framework of incoming and outpatient care, the provision of these patients is profitable. Conclusion: The diagnosis and care of the injuries is done in accordance with the domestic guidelines. Contrary to expectations, the care of these patients is profitable for the emergency department, although only fixed costs were included. Orv Hetil. 2019; 160(43): 1698-1705.


Assuntos
Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Doença Aguda , Adulto , Distribuição por Idade , Idoso , Intoxicação Alcoólica/terapia , Gerenciamento Clínico , Serviço Hospitalar de Emergência , Etanol , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Distribuição por Sexo
13.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(3): 362-366, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31631604

RESUMO

Objective: To determine the association between daily particulate matter 2.5 (PM 2.5) mass and emergency calls for help with respiratory diseases. Methods: Semi-parametric generalized additive model was established to determine the association between daily PM 2.5 and emergency calls for help with respiratory diseases in 2017 in Chengdu, after adjustments for time trend and variations in the days of the week and weather conditions. Results: In 2017, a total of 9 309 emergency calls for help with respiratory diseases were recorded in Chengdu: on average 26 calls a day. Over the year, Chengdu reported a mean PM 2.5 mass concentration of 53.6 µg/m 3, an average temperature of 16.6 ℃, and an average relative humidity of 81.2%. The single pollutant model with lag time effect showed that a 10 µg/m 3 increase in PM 2.5 was associated with an increase of 1.26% (95% confidence interval ( CI) 0.56%-1.97%) emergency calls for help with respiratory diseases. The exposure-response was almost in a direct line. The dual pollutant model found that O 3 8-hour sliding average (O 3-8 h) enhanced the effect of PM 2.5 on emergency calls for help with respiratory diseases. Conclusion: Outdoor PM 2.5 is a significant predictor of emergency calls for help with respiratory diseases in Chengdu.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Serviços Médicos de Emergência/estatística & dados numéricos , Material Particulado/efeitos adversos , Doenças Respiratórias/epidemiologia , China , Humanos , Temperatura Ambiente
15.
BMC Health Serv Res ; 19(1): 632, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488142

RESUMO

BACKGROUND: Overdose deaths can be prevented by distributing take home naloxone (THN) kits. The emergency department (ED) is an opportune setting for overdose prevention, as people who use opioids frequently present for emergency care, and those who have overdosed are at high risk for future overdose death. We evaluated the implementation of an ED-based THN program by measuring the extent to which THN was offered to patients presenting with opioid overdose. We analyzed whether some patients were less likely to be offered THN than others, to identify areas for program improvement. METHODS: We retrospectively reviewed medical records from all ED visits between April 2016 and May 2017 with a primary diagnosis of opioid overdose at a large, urban tertiary hospital located in Alberta, Canada. A wide array of patient data was collected, including demographics, opioid intoxicants, prescription history, overdose severity, and whether a naloxone kit was offered and accepted. Multivariable analyses were used to identify patient characteristics and situational variables associated with being offered THN. RESULTS: Among the 342 ED visits for opioid overdose, THN was offered in 49% (n = 168) of cases. Patients were more likely to be offered THN if they had been found unconscious (Adjusted Odds Ratio 3.70; 95% Confidence Interval [1.63, 8.37]), or if they had smoked or injected an illegal opioid (AOR 6.05 [2.15,17.0] and AOR 3.78 [1.32,10.9], respectively). In contrast, patients were less likely to be offered THN if they had a current prescription for opioids (AOR 0.41 [0.19, 0.88]), if they were admitted to the hospital (AOR 0.46 [0.22,0.97], or if they unexpectedly left the ED without treatment or before completing treatment (AOR 0.16 [0.22, 0.97). CONCLUSIONS: In this real-world evaluation of an ED-based THN program, we observed that only half of patients with opioid overdose were offered THN. ED staff readily identify patients who use illegal opioids or experience a severe overdose as potentially benefitting from THN, but may miss others at high risk for future overdose. We recommend that hospital EDs provide additional guidance to staff to ensure that all eligible patients at risk of overdose have access to THN.


Assuntos
Analgésicos Opioides/envenenamento , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Adulto , Alberta , Overdose de Drogas/reabilitação , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Masculino , Registros Médicos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Estudos Retrospectivos
16.
Croat Med J ; 60(4): 325-332, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31483118

RESUMO

AIM: To assess the effect of the time for emergency medical services (EMS) arrival on resuscitation outcome in the transition period of the EMS system in Istra County. METHODS: This retrospective study analyzed the data from 1440 patients resuscitated between 2011 and 2017. The effect of demographic data, period of the year, time for EMS arrival, initial cardiopulmonary resuscitation (CPR) provider, initial cardiac rhythm, and airway management method on CPR outcome was assessed with multivariate logistic regression. RESULTS: Survivors were younger than non-survivors (median of 66 vs 70 years, P<0.001) and had shorter time for EMS arrival (median of 6 vs 8 min, P<0.001). The proportion of non-survivors was significantly higher when initial basic life support (BLS) was performed by bystanders without training (83.8%) or when no CPR was performed before EMS team arrival (87.3%) than when BLS was performed by medical professionals (66.8%) (P<0.001). Sex, airway management, and tourist season had no effect on CPR outcome. CONCLUSION: Since the time for arrival and level of CPR provider training showed a significant effect on CPR outcome, further organizational effort should be made to reduce the time for EMS arrival and increase the number of individuals trained in BLS.


Assuntos
Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/métodos , Croácia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Taxa de Sobrevida , Fatores de Tempo
17.
BMC Health Serv Res ; 19(1): 645, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492134

RESUMO

BACKGROUND: Maternal and perinatal mortality is a major public health concern across the globe and more so in low and middle-income countries. In Kenya, more than 6000 maternal deaths, and 35,000 stillbirths occur each year. The Government of Kenya abolished user fee for maternity care under the Free Maternity Service policy, in June of 2013 in all public health facilities, a move to make maternity services accessible and affordable, and to reduce maternal and perinatal mortality. METHOD: An observational retrospective study was carried out in 3 counties in Kenya. Six maternal health output indicators were observed monthly, 2 years pre and 2 years post- policy implementation. Data was collected from daily maternity registers in 90 public health facilities across the 3 counties all serving an estimated population of 3 million people. Interrupted Time Series Analysis (ITSA) with a single group was used to assess the effects of the policy. Standard linear regression using generalized least squares (gls) model, was used to run the results for each of the six variables of interest. Absolute and relative changes were calculated using the gls model coefficients. RESULTS: Significant sustained increase of 89, 97, and 98% was observed in the antenatal care visits, health facility deliveries, and live births respectively, after the policy implementation. An immediate and significant increase of 27% was also noted for those women who received Emergency Obstetric Care (EmONC) services in either the level 5, 4 and 3 health facilities. No significant changes were observed in the stillbirth rate and caesarean section rate following policy implementation. CONCLUSION: After 2 years of implementing the Free Maternity Service policy in Kenya, immediate and sustained increase in the use of skilled care during pregnancy and childbirth was observed. The study suggest that hospital cost is a major expense incurred by most women and their families whilst seeking maternity care services and a barrier to maternity care utilization. Overall, Free Maternity Service policy, as a health financing strategy, has exhibited the potential of realizing the full beneficial effects of maternal morbidity and mortality reduction by increasing access to skilled care.


Assuntos
Serviços de Saúde Materna/economia , Cesárea/economia , Cesárea/estatística & dados numéricos , Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Instalações de Saúde/economia , Instalações de Saúde/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Quênia/epidemiologia , Saúde Materna/economia , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Mortalidade Perinatal , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Natimorto/epidemiologia
18.
BMC Health Serv Res ; 19(1): 545, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375098

RESUMO

BACKGROUND: Emergency Medical call-takers working in Emergency Medical Communication Centers (EMCCs) are addressing complex and potentially life threatening problems. The call-takers have to make fast decisions, responding to problems described in phone calls. Recent studies focus mainly on individual aspects of call-takers' work. The objectives of this study were to explore 1) What characterizes individual work performance of call takers in EMCCs? and 2) What characterizes work organizational factors call takers see as most relevant to the performance of their work? METHODS: The research is based upon in-depth interviews with call takers at three EMCCs in Norway (n = 19). Interviews were performed during the period May 2013 to September 2014. Data was analyzed using thematic analysis. RESULTS: Two main themes that related to individual work performance and to work organizational factors in EMCCs were identified, namely: 1) "Core technologies" and 2) "Environmental issues" . The theme "Core technologies" included the subthemes a) multiple tasks, b) critical incidents, and c) unpredictability. The theme "Environmental issues" included the subthemes a) lack of support, b) lack of resources, c) exposure to complaints, and d) an invisible service. CONCLUSION: At the individual level, multiple tasks, how to cope with critical incidents, and the unpredictability of daily work when calls are received, make the work of call takers both stressful and challenging. The individual call taker's ability to interprete the situation by intuition and experience when calls are received, is the main factor behind the peculiarities working in the centers at the individual level. At the organizational level, the lack of resources and managerial support seems to provoke concerns about the quality of services rendered by the centers. These aspects should be taken into account in the managing of these services, making them a more integrated part of the health service system.


Assuntos
Sistemas de Comunicação entre Serviços de Emergência/organização & administração , Serviços Médicos de Emergência/organização & administração , Sistemas de Comunicação entre Serviços de Emergência/normas , Sistemas de Comunicação entre Serviços de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Noruega , Pesquisa Qualitativa
19.
J Surg Res ; 243: 481-487, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31377487

RESUMO

BACKGROUND: Left ventricular assist devices (LVADs) are increasingly used to supplant the limited number of orthotopic heart transplantation (OHT). The present study aimed to perform a contemporary analysis of emergency abdominal operations after LVAD and OHT at a national level. METHODS: The 2005-2015 National Impatient Sample, the largest all-payer hospitalization database in the United States, was used to identify all adult patients who had received LVAD or OHT. The primary outcome of interest was the rate of emergency general surgery (EGS), which included laparotomy, small or large bowel resection, peptic ulcer operation, adhesiolysis, and cholecystectomy, during the same hospitalization as LVAD or OHT. Logistic regression was used to determine risk factors for EGS as well as the association between EGS and mortality in both the LVAD and OHT populations. RESULTS: Of the estimated 19,395 OHT and 23,441 LVAD performed, 445 (2.3%) OHT and 719 (3.1%) LVAD patients required EGS. The incidence of EGS in LVAD decreased from 5.4 to 3.3%, whereas it increased among OHT patients from 1.9 to 3.7%, P = 0.003. Occurrence of EGS after OHT and LVAD was associated with significantly higher inpatient risk-adjusted mortality (OHT adjusted odds ratio, 3.0; P = 0.004; LVAD adjusted odds ratio, 2.5; P < 0.001), incremental hospitalization costs (OHT, $106,778; P < 0.001; LVAD, $61,965; P < 0.001), and length of stay (OHT, 27.9 d; P < 0.001; LVAD, 20.8 d; P < 0.001). CONCLUSIONS: EGS remains an infrequent but high mortality and cost complication of OHT and LVAD. Further investigation of the impact of immunosuppression, anticoagulation, and perfusion strategies on incidence of abdominal complications is warranted.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Transplante de Coração , Coração Auxiliar , Complicações Pós-Operatórias/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Estados Unidos/epidemiologia
20.
Rev Gaucha Enferm ; 40: e20180431, 2019 Jul 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31365737

RESUMO

OBJECTIVE: To know the profile of service and satisfaction of users served by the Mobile Emergency Care Service (SAMU). METHODS: A cross-sectional study of the 854 services performed by the Advanced Life Support (SAV) teams from SAMU of Porto Alegre/RS, in the first quarter of 2016. A total of 164 users or respondents answered by phone to the questions regarding the service performed. Analysis performed using the Spearman and Chi-square tests. Study approved in Ethics and Research Committee of the Institutions involved. RESULTS: A higher percentage of clinical visits (48.2%) followed by trauma care (32.8%). Regarding telephone calls, 71.4% of respondents rated the service as 'very good' while the service was classified by 76.8% of the respondents. From them, 81.1% stated that the service was resolving. CONCLUSIONS: The clinical type stands out among the assistances and the users reveal satisfaction with the service provided, considering that it serves the population resolutely.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Unidades Móveis de Saúde/estatística & dados numéricos , Satisfação do Paciente , Cuidados de Suporte Avançado de Vida no Trauma/organização & administração , Estudos Transversais , Serviços Médicos de Emergência/métodos , Humanos , Telefone/estatística & dados numéricos , Fatores de Tempo
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