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1.
Emerg Med J ; 38(5): 371-372, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34449412

RESUMO

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people's services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.


Assuntos
COVID-19/epidemiologia , Serviços de Saúde Comunitária/organização & administração , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Serviços de Saúde para Idosos/organização & administração , Humanos , Neoplasias/terapia , Cuidados Paliativos/organização & administração , Pandemias , Alta do Paciente , SARS-CoV-2
2.
PLoS One ; 16(7): e0253978, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34310606

RESUMO

Coronavirus disease 2019(COVID-19) has brought great disasters to humanity, and its influence continues to intensify. In response to the public health emergencies, prompt relief supplies are key to reduce the damage. This paper presents a method of emergency medical logistics to quick response to emergency epidemics. The methodology includes two recursive mechanisms: (1) the time-varying forecasting of medical relief demand according to a modified susceptible-exposed-infected- Asymptomatic- recovered (SEIAR) epidemic diffusion model, (2) the relief supplies distribution based on a multi-objective dynamic stochastic programming model. Specially, the distribution model addresses a hypothetical network of emergency medical logistics with considering emergency medical reserve centers (EMRCs), epidemic areas and e-commerce warehousing centers as the rescue points. Numerical studies are conducted. The results show that with the cooperation of different epidemic areas and e-commerce warehousing centers, the total cost is 6% lower than without considering cooperation of different epidemic areas, and 9.7% lower than without considering cooperation of e-commerce warehousing centers. Particularly, the total cost is 20% lower than without considering any cooperation. This study demonstrates the importance of cooperation in epidemic prevention, and provides the government with a new idea of emergency relief supplies dispatching, that the rescue efficiency can be improved by mutual rescue between epidemic areas in public health emergency.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Defesa Civil/organização & administração , Serviços Médicos de Emergência/organização & administração , Pandemias , Saúde Pública/métodos , COVID-19/transmissão , COVID-19/virologia , China/epidemiologia , Defesa Civil/economia , Emergências/epidemiologia , Serviços Médicos de Emergência/economia , Humanos , Colaboração Intersetorial , Modelos Estatísticos , SARS-CoV-2/patogenicidade , SARS-CoV-2/fisiologia
3.
Scand J Trauma Resusc Emerg Med ; 29(1): 99, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289881

RESUMO

BACKGROUND: In chemical incidents, infrequent but potentially disastrous, the World Health Organization calls for inter-organizational coordination of actors involved. Multi-organizational studies of chemical response capacities are scarce. We aimed to describe chemical incident experiences and perceptions of Swedish fire and rescue services, emergency medical services, police services, and emergency dispatch services personnel. METHODS: Eight emergency service organizations in two distinct and dissimilar regions in Sweden participated in one organization-specific focus group interview each. The total number of respondents was 25 (7 females and 18 males). A qualitative inductive content analysis was performed. RESULTS: Three types of information processing were derived as emerging during acute-phase chemical incident mobilization: Unspecified (a caller communicating with an emergency medical dispatcher), specified (each emergency service obtaining organization-specific expert information), and aligned (continually updated information from the scene condensed and disseminated back to all parties at the scene). Improvable shortcomings were identified, e.g. randomness (unspecified information processing), inter-organizational reticence (specified information processing), and downprioritizing central information transmission while saving lives (aligned information processing). CONCLUSIONS: The flow of information may be improved by automation, public education, revised dispatcher education, and use of technical resources in the field. Future studies should independently assess these mechanism's degree of impact on mobilisation of emergency services in chemical incidents.


Assuntos
Vazamento de Resíduos Químicos , Operador de Emergência Médica/estatística & dados numéricos , Serviços Médicos de Emergência/organização & administração , Desastres , Feminino , Grupos Focais , Humanos , Masculino , Polícia , Suécia/epidemiologia
4.
West J Emerg Med ; 22(3): 608-613, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-34125035

RESUMO

Imperial County is in southern California, one of the state's two counties at the international United States-Mexico border. The county is one of the most resource-limited in the state, with only two hospitals serving its 180,000 citizens, and no tertiary care centers. A significant portion of the population cared for at the local hospitals commutes from Mexicali, a large city of 1.2 million persons, just south of Imperial County's ports of entry. Since May 2020, following an outbreak in Mexicali, Imperial County has seen a significant increase in the number of COVID-19 patients, quickly outpacing its local resources. In response to this surge an alternate care site (ACS) was created as part of a collaboration between the California State Emergency Medical Service Authority (EMSA) and the county. In the first month of operations (May 26-June 26, 2020) the ACS received 106 patients with an average length of stay of 3.6 days. The average patient age was 55.5 years old with a range of 19-95 years. Disposition of patients included 25.5% sent to the emergency department for acute care needs, 1.8% who left against medical advice, and 72.7% who were discharged home or to a skilled nursing facility. There were no deaths on site. This study shares early experiences, challenges, and innovations created with the implementation of this ACS. Improving communication with local partners was the single most significant step in overcoming initial barriers.


Assuntos
COVID-19/epidemiologia , Serviços Médicos de Emergência/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Feminino , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , SARS-CoV-2 , Adulto Jovem
5.
West J Emerg Med ; 22(3): 672-677, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-34125045

RESUMO

INTRODUCTION: The purpose of this study was to validate and assess the performance of the Emergency Heart Failure Mortality Risk Grade (EHMRG) to predict seven-day mortality in US patients presenting to the emergency department (ED) with acute congestive heart failure (CHF) exacerbation. METHODS: We performed a retrospective chart review on patients presenting to the ED with acute CHF exacerbation between January 2014-January 2016 across eight EDs in New York. We identified patients using codes from the International Classification of Diseases, 9th and 10 Revisions, or who were diagnosed with CHF in the ED. Inclusion criteria were patients ≥ 18 years of age who presented to the ED for acute CHF. Exclusion criteria included the following: end-stage renal disease related heart failure; < 18 years of age; pregnancy; palliative care; renal failure; and "do not resuscitate" directive. The primary outcome was seven-day mortality. We used mixed-effects logistic regression models to estimate C-statistics and continuous net reclassification index for events and nonevents. RESULTS: We identified 3,320 ED visits associated with suspected CHF among 2,495 unique patients. Of the 3,320 ED visits, 94.7% patients were admitted to the hospital and 3.4% were discharged. The median age was 78.6 (interquartile range 68.01 - 86.76). There was an overall seven-day mortality of 2%, an inpatient mortality rate of 2.4%, and no mortality among the discharge group. Adding EHMRG to the risk prediction model improved the C-statistic (from 0.748 to 0.772) and led to a higher degree of reclassification for both events and nonevents. CONCLUSION: The EHMRG can be used as a valuable and effective screening tool in the US while considering disposition decision for patients with acute CHF exacerbation. Emergency medical services transport and metolazone use is much higher in the US population as compared to the Canadian population. We observed minimal to no short-term mortality among discharged CHF patients from the ED.


Assuntos
Regras de Decisão Clínica , Insuficiência Cardíaca/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , New York , Estudos Retrospectivos
6.
Rev Esp Salud Publica ; 952021 Jun 23.
Artigo em Espanhol | MEDLINE | ID: mdl-34159951

RESUMO

OBJECTIVE: In recent years, it has been seen that, despite the existence of emergency services in Primary Care, some users attend emergency services of their referral hospital on their own initiative. The objective of this study was to explore the causes of the increase in the Northern Health Management Area of Huelva (Spain) population's own initiative to attend hospital emergency services, to the detriment of the provision of emergency services by Primary Care. METHODS: A qualitative study based on the Grounded Theory by Glasser and Strauss was carried out on a sample of nineteen patients and sixteen physicians from the Northern Health Management Area of Huelva (Spain), divided into four focus groups. This method has four phases: data collection, data organisation, data analysis, and theory development. RESULTS: The qualitative analysis process of the four focus groups resulted in 104 codes or minimum units of information. The main causes of the increase in this own initiative were related to delays in medical appointments and complementary tests, mistrust in Primary Care physicians and greater trust in hospital specialists, ignorance regarding the offer of services, proximity to the hospital, and the closure of the Riotinto (Huelva) emergency point. CONCLUSIONS: Lack of accessibility to specialised care, geographic dispersion, mistrust due to deterioration of the physician-patient relationship, lack of health education among the population, and the culture of immediacy are the main causes of the increase in attending hospital emergency services on their own initiative identified in this population.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Serviços Médicos de Emergência/organização & administração , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Espanha
7.
Medicine (Baltimore) ; 100(25): e26466, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160451

RESUMO

ABSTRACT: Following the lifting of the evacuation order due to the Fukushima Daiichi Nuclear Power Plant accident, the medical demand and emergency medical system (EMS) in the area where the evacuation orders were lifted have not been well-investigated. This study aimed to evaluate the emergency transportation in such areas and compare the differences with areas that had minimal impact.Using the local EMS transport records, the characteristics of patients who were transferred by an EMS vehicle in Minamisoma City were collected between July 12, 2016 and July 31, 2018, and were compared between former evacuation zones and outside the evacuation zones in the city.The number of emergency transports in the study period in Minamisoma City were 325 cases in the area where the evacuation orders were lifted and 4307 cases in the other areas. The total EMS time was significantly longer in the area where the evacuation order was lifted (48 ±â€Š16 minutes) than in the other areas (40 ±â€Š15 minutes) (P < .001). In the analysis of each component of EMS times, the transport time, which is the time from departure from the patient's location to arrival at a hospital, was significantly longer in the former evacuation zone than in the other areas (16 ±â€Š9 vs 9 ±â€Š9 minutes, P < .001), suggesting that transport time contributed to the longer EMS response times.In areas where the evacuation orders were lifted, the EMS transport time was significantly longer than that in the area outside the former evacuation zone; correspondingly, the total EMS time significantly increased in the former evacuation zone. A plausible reason for this may be the closure of local medical facilities following the evacuation order after the nuclear accident.


Assuntos
Ambulâncias/estatística & dados numéricos , Emergências , Serviços Médicos de Emergência/estatística & dados numéricos , Acidente Nuclear de Fukushima , Adolescente , Adulto , Idoso , Ambulâncias/organização & administração , Criança , Pré-Escolar , Cidades , Estudos Transversais , Serviços Médicos de Emergência/organização & administração , Feminino , Humanos , Lactente , Recém-Nascido , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
8.
Pediatr Emerg Care ; 37(7): 389-396, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34091572

RESUMO

OBJECTIVES: The Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in pediatric emergency care to organize globally for the conduct of collaborative research across networks. METHODS: The Pediatric Emergency Research Network has grown from 5- to 8-member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed, and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children. RESULTS: Beginning as a pandemic response with a high-quality retrospective case-controlled study of H1N1 influenza risk factors, PERN research has progressed to multiple observational studies and ongoing global randomized controlled trials. As a recent example, PERN has developed sufficient network infrastructure to enable the rapid initiation of a prospective observational study in response to the current coronavirus disease 2019 pandemic. In light of the ongoing need for translation of research knowledge into equitable clinical practice and to promote health equity, PERN is committed to a coordinated international effort to increase the uptake of evidence-based management of common and treatable acute conditions in all emergency department settings. CONCLUSIONS: The Pediatric Emergency Research Network's successes with global research, measured by prospective observational and interventional studies, mean that the network can now move to improve its ability to promote the implementation of scientific advances into everyday clinical practice. Achieving this goal will involve focus in 4 areas: (1) expanding the capacity for global randomized controlled trials; (2) deepening the focus on implementation science; (3) increasing attention to healthcare disparities and their origins, with growing momentum toward equity; and (4) expanding PERN's global reach through addition of sites and networks from resource-restricted regions. Through these actions, PERN will be able to build on successes to face the challenges ahead and meet the needs of acutely ill and injured children throughout the world.


Assuntos
Serviços Médicos de Emergência/organização & administração , Medicina de Emergência/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Pediatria/organização & administração , Criança , Promoção da Saúde , Humanos , Cooperação Internacional
9.
Semin Vasc Surg ; 34(2): 51-59, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34144748

RESUMO

Mass casualty incidents can be devastating events associated with a large number of fatalities, morbidities, and long-lasting sequelae. The negative outcomes can be further amplified if the incident occurred during a pandemic surge, such as what occurred in Beirut, Lebanon with the August 4, 2020 Beirut Port explosion. To decrease the mortality and morbidity and avoid inefficiency, management depends on having an established coordinated multidisciplinary approach from transport and triage to emergency department care and in-hospital management. In this article, the mass casualty management and the impact of the coronavirus disease 2019 pandemic will be discussed based on the American University of Beirut Medical Center experience.


Assuntos
COVID-19/epidemiologia , Serviços Médicos de Emergência/organização & administração , Controle de Infecções/organização & administração , Incidentes com Feridos em Massa , Centros Médicos Acadêmicos , COVID-19/prevenção & controle , COVID-19/transmissão , Humanos , Líbano/epidemiologia , Estudos Retrospectivos
10.
Pan Afr Med J ; 38: 272, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122699

RESUMO

Introduction: emergency obstetric care (EmOC) is a high-impact priority intervention strongly recommended for improving maternal health outcomes. The objectives of this study were to assess the availability, utilization, and quality of emergency obstetric care services in the Governorate of Sousse (Tunisia). Methods: a cross-sectional study was conducted among public health facilities which performed deliveries in Sousse in 2017. Data were collected by consulting clinical records and registers and interviewing staff using WHO EmOC tools. Emergency obstetric care (EmOC) indicators were calculated. Results: only the University maternity Unit functioned as full comprehensive EmOC facility. No other public facility provided all the 7 Basic EmOC signal functions 3 months prior to the survey. The unperformed signal functions were: administration of parenteral antibiotics, manual removal of placenta and assisted vaginal delivery. The number of EmOC facilities was 0.72 per 500,000 inhabitants. The met need for EmOC was 89.5%. The proportion of caesarean section was 24.2%. The direct obstetric case fatality rate was 0.159% and intrapartum and very early neonatal death rate was 0.65%. Conclusion: raising maternity facilities to a minimum level of basic EmOC status would be a major contributing step towards maternal mortality reduction.


Assuntos
Serviços Médicos de Emergência/organização & administração , Serviços de Saúde Materna/organização & administração , Obstetrícia/organização & administração , Qualidade da Assistência à Saúde , Cesárea/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Feminino , Instalações de Saúde/normas , Instalações de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Serviços de Saúde Materna/normas , Mortalidade Materna , Obstetrícia/normas , Morte Perinatal , Gravidez , Tunísia
11.
Epilepsia Open ; 6(2): 331-338, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34033243

RESUMO

OBJECTIVE: To determine whether the portable Ceribell® electroencephalograph (EEG) (Mountain View, CA) used for suspected status epilepticus (SE) can reduce time to diagnosis and on-call workforce demands and whether it can be applied to patients in respiratory isolation. METHODS: A multidisciplinary team developed a protocol for the use of the Ceribell EEG. The staff deploying the device, the attending physician, and the interpreting neurologist completed evaluation tools for each patient. Data maintained for quality and resource planning of 18-channel electroencephalography ordered for suspected SE were used as controls. Times to diagnosis were compared by application of Welch-Satterthwaite tests and workforce call-in demands by Fisher's exact t test. We evaluated qualitative data related to the use of the EEG in COVID-19 isolation rooms and on its technical aspects and acceptance by staff members. RESULTS: The Ceribell EEG reduced diagnosis time (P = .0000006) and on-call workforce demand (P = .02). The device can be used at any time of day in any hospital care area and has advantages in respiratory isolation rooms. SIGNIFICANCE: Compared with a standard 18-channel EEG, the Ceribell device allowed earlier diagnosis of SE and non-SE conditions and reduced workforce demands. Due to the ease of its use and its simple components, which can be readily disinfected, it is advantageous for COVID-19 patients in isolation.


Assuntos
COVID-19 , Eletroencefalografia , Serviços Médicos de Emergência , Controle de Infecções , Estado Epiléptico/diagnóstico , Tempo para o Tratamento/normas , Serviços de Atendimento/instrumentação , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Diagnóstico Precoce , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Pesquisa sobre Serviços de Saúde , Mão de Obra em Saúde , Hospitalização , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Estudo de Prova de Conceito , Melhoria de Qualidade , SARS-CoV-2 , Gestão da Segurança , Estado Epiléptico/terapia
13.
BMC Emerg Med ; 21(1): 47, 2021 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853531

RESUMO

BACKGROUND: Suicide is a painful consequence of many psychiatric disorders and one of the most frequent psychiatric emergencies. Generally, pre-hospital technician is the first person in the treatment chain who attends the situation; hence, his/her sound clinical judgment and professional behavior can play an important role in preventing or stopping the suicide process. We tried to develop a concise, evidence-based, and step-by-step guide for dealing with a suicidal patient, which could be quickly reviewed by technicians before confronting a suicide situation. METHOD: We reviewed the literature for suicide management plans and protocols, to extract the evidence-based interventions and instructions for dealing with a suicide situation. Then, we discussed the extracted material in an expert panel, and developed the initial version of the protocol considering the local socio-cultural issues and available facilities. Subsequently, we reviewed the protocol in a meeting with pre-hospital technicians and emergency physicians, to receive their feedback and address any possible executive problems. Finally, we revised the protocol to its final version considering the feedbacks. RESULTS: The basic principles of dealing with a suicidal patient are similar to other psychiatric emergencies and include: Patient Safety; Patient evaluation and diagnosis; and Patient (behavioral and pharmacological) management. However, specific considerations should be taken into account and special arrangements are necessary for suicidal patients. Whether the patient has attempted suicide or not, would guide the management to one of the two major paths. In addition, the needs of the family should be considered. CONCLUSION: A locally adapted protocol considering existing facilities in the emergency system and cultural issues in Iranian society is provided for pre-hospital emergency technicians.


Assuntos
Emergências , Serviços Médicos de Emergência/organização & administração , Ideação Suicida , Tentativa de Suicídio , Serviços de Emergência Psiquiátrica , Feminino , Hospitais , Humanos , Irã (Geográfico) , Masculino , Literatura de Revisão como Assunto , Tentativa de Suicídio/prevenção & controle
14.
JAMA Netw Open ; 4(4): e215700, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33847751

RESUMO

Importance: The early identification of patients at high risk of clinical deterioration represents one of the greatest challenges for emergency medical services (EMS). Objective: To assess whether use of the ratio of prehospital oxygen saturation measured by pulse oximetry (Spo2) to fraction of inspired oxygen (Fio2) measured during initial contact by EMS with the patient (ie, the first Spo2 to Fio2 ratio) and 5 minutes before the patient's arrival at the hospital (ie, the second Spo2 to Fio2 ratio) can predict the risk of early in-hospital deterioration. Design, Setting, and Participants: A prospective, derivation-validation prognostic cohort study of 3606 adults with acute diseases referred to 5 tertiary care hospitals in Spain was conducted between October 26, 2018, and June 30, 2020. Eligible patients were recruited from among all telephone requests for EMS assistance for adults who were later evacuated with priority in advanced life support units to the referral hospitals during the study period. Main Outcomes and Measures: The primary outcome was hospital mortality from any cause within the first, second, third, or seventh day after EMS transport to the hospital. The main measure was the Spo2 to Fio2 ratio. Results: A total of 3606 participants comprised 2 separate cohorts: the derivation cohort (3081 patients) and the validation cohort (525 patients). The median age was 69 years (interquartile range, 54-81 years), and 2122 patients (58.8%) were men. The overall mortality rate of the patients in the study cohort ranged from 3.6% for 1-day mortality (131 patients) to 7.1% for 7-day mortality (256 patients). The best model performance was for 2-day mortality with the second Spo2 to Fio2 ratio with an area under the curve of 0.890 (95% CI, 0.829-0.950; P < .001), although the other outcomes also presented good results. In addition, a risk-stratification model was generated. The optimal cutoff resulted in the following ranges of Spo2 to Fio2 ratios: 50 to 100 for high risk of mortality, 101 to 426 for intermediate risk, and 427 to 476 for low risk. Conclusions and Relevance: This study suggests that use of the prehospital Spo2 to Fio2 ratio was associated with improved management of patients with acute disease because it accurately predicts short-term mortality.


Assuntos
Deterioração Clínica , Mortalidade Hospitalar , Oxigênio/sangue , Doença Aguda/mortalidade , Doença Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Valor Preditivo dos Testes , Estudos Prospectivos
15.
West J Emerg Med ; 22(2): 308-318, 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33856317

RESUMO

BACKGROUND: Symptoms concerning for acute coronary syndromes (ACS) such as chest pain and dyspnea are some of the most common reasons for presenting to an emergency department (ED). The HEART score (history, electrocardiogram, age, risk factors and troponin) was developed and has been externally validated in an emergency setting to determine which patients with chest pain are at increased risk for poor outcomes. Our hospital adopted a HEART score-based protocol in late 2015 to facilitate the management and disposition of these patients. In this study we aimed to analyze the effects of the adoption of this protocol. Prior studies have included only patients with chest pain. We included both patients with chest pain and patients with only atypical symptoms. METHODS: This was a retrospective chart review of two cohorts. We identified ED charts from six-month periods prior to and after adoption of our HEART score-based protocol. Patients in whom an electrocardiogram and troponin were ordered were eligible for inclusion. We analyzed data for patients with typical symptoms (chest pain) and atypical symptoms both together and separately. RESULTS: We identified 1546 charts in the pre-adoption cohort and 1623 in the post-adoption cohort that met criteria. We analyzed the first 900 charts in each group. Discharges from the ED increased (odds ratio [OR[1.56, P<.001), and admissions for cardiac workup decreased (OR 0.46, P <.001). ED length of stay was 17 minutes shorter (P = .01). Stress testing decreased (OR 0.47, P<.001). We estimate a cost savings for our hospital system of over $4.5 million annually. There was no significant difference in inpatient length of stay or catheterization rate. When analyzing typical and atypical patients separately, these results held true. CONCLUSION: After adoption of a HEART score-based protocol, discharges from the ED increased with a corresponding decrease in admissions for cardiac evaluations as well as cost. These effects were similar in patients presenting without chest pain but with presentations concerning for ACS.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Protocolos Clínicos/normas , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/organização & administração , Síndrome Coronariana Aguda/terapia , Diagnóstico Diferencial , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos
16.
West J Emerg Med ; 22(2): 326-332, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33856319

RESUMO

INTRODUCTION: Suicide claimed 47,173 lives in 2017 and is the second leading cause of death for individuals 15-34 years old. In 2017, rates of suicide in the United States (US) were double the rates of homicide. Despite significant research funding toward suicide prevention, rates of suicide have increased 38% from 2009 to 2017. Recent data suggests that emergency medical services (EMS) workers are at a higher risk of suicidal ideation and suicide attempts compared to the general public. The objective of this study was to determine the proportionate mortality ratio (PMR) of suicide among firefighters and emergency medical technicians (EMT) compared to the general US working population. METHODS: We analyzed over five million adult decedent death records from the National Occupational Mortality Surveillance database for 26 states over a 10-year non-consecutive period including 1999, 2003-2004, and 2007-2013. Categorizing firefighters and EMTs by census industry and occupation code lists, we used the underlying cause of death to calculate the PMRs compared to the general US decedent population with a recorded occupation. RESULTS: Overall, 298 firefighter and 84 EMT suicides were identified in our study. Firefighters died in significantly greater proportion from suicide compared to the US.working population with a PMR of 172 (95% confidence interval [CI], 153-193, P<0.01). EMTs also died from suicide in greater proportion with an elevated PMR of 124 (95% CI, 99-153), but this did not reach statistical significance. Among all subgroups, firefighters ages 65-90 were found to have the highest PMR of 234 (95% CI, 186-290), P<0.01) while the highest among EMTs was in the age group 18-64 with a PMR of 126 (95% CI, 100-156, P<0.05). CONCLUSION: In this multi-state study, we found that firefighters and EMTs had significantly higher proportionate mortality ratios for suicide compared to the general US working population. Firefighters ages 65-90 had a PMR more than double that of the general working population. Development of a more robust database is needed to identify EMS workers at greatest risk of suicide during their career and lifetime.


Assuntos
Serviços Médicos de Emergência , Socorristas/estatística & dados numéricos , Bombeiros , Pessoal de Saúde , Suicídio , Adulto , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Bombeiros/psicologia , Bombeiros/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Mortalidade/tendências , Ideação Suicida , Suicídio/prevenção & controle , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Suicídio/tendências , Estados Unidos/epidemiologia
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