Planning for disasters involving children in Australia: A practical guide.

Children comprise 19% of the Australian population. Children are at risk of higher morbidity and mortality in disaster events than adults; however, there is a paucity of paediatric-specific disaster preparedness in Australia. Paediatric disaster plans should be developed, tested and renewed regularly. Plans need to address unaccompanied and unidentified children, medical and psychosocial needs and family reunification. Specific management is required for chemical, biological and radiological events.

Profiling patients suspected of drug seeking in an adult emergency department.

OBJECTIVES: (i) To profile ED consultations where drug seeking is considered; (ii) to clarify if an Australian patient cohort shares the characteristics identified in the literature, that is, high rate of psychiatric, chronic pain and drug dependency problems; and (iii) to quantify the extent of missed organic disease in suspected drug-seeking presentations. METHODS: Prospective descriptive study with an initial enrolment period of 3 months, follow up at 3 and 5 years. Tertiary hospital ED doctors voluntarily identified suspected drug-seeking behaviour. Patients' demographic information, past history, presenting features, investigations, management and missed diagnoses of organic pathology were collected. Recurrent presentations of drug seeking, self-harming, psychiatric, chronic pain and drug dependency complaints were documented. RESULTS: Thirty-seven presentations (31 patients) of 10,958 total attendances were analysed. All patients were less than 65 years. Twenty-one patients (68%, 95% confidence interval [CI 49.7-85.8]) were on unemployment or disability pension. Twenty-six presentations (70% [95% CI 54.2-86.3]) described psychiatric problems, whereas three presentations (8% [95% CI 0.0-18.3]) had chronic pain and 10 presentations (27% [95% CI 11.4-42.7]) had drug dependency problems. Twenty-six patients (84% [95% CI 69.3-98.4]) recurrently presented with self-harming and drug-seeking behaviour at 3 years. The risk of missing organic pathology was 8/37 (22% [95% CI 7.0-36.2]). CONCLUSIONS: Further characterization of this population would help accurate diagnosis of this aberrant behaviour and decrease the risk of missing organic pathology. The management of frequently presenting patients should prompt formulation of departmental plans to effectively assess and manage these people.

Diagnosing drug-seeking behaviour in an adult emergency department.

OBJECTIVE: The objective of the present study were to determine factors used by ED doctors to diagnose drug seeking and their attitude towards management of this patient group. METHODS: Prospective, descriptive study, of doctors working in a tertiary hospital ED. Doctors voluntarily identified patients they suspected were drug seeking and completed a written survey. RESULTS: Thirty-seven surveys were completed for presentations involving 31 patients. A patient's specific request for narcotics, previous documented episodes of suspected drug seeking, an unwillingness to try simple analgesia and demanding or aggressive behaviour were the most frequently used factors for diagnosing drug seeking. These factors are similar to, but not the same, as the criteria in the literature. Doctors commonly found consultations involving drug seeking to be unsatisfying. CONCLUSIONS: Factors, such as those used by doctors in the present study, should not be used as diagnostic markers. Further study is warranted in order to improve the effectiveness of consultations involving drug seeking.

CPR training in households of patients with chest pain.

The objectives of this study are to (1). quantify prior cardiopulmonary resuscitation (CPR) training in households of patients presenting to the Emergency Department (ED) with or without chest pain or ischaemic heart disease (IHD); (2). evaluate the willingness of household members to undertake CPR training; and (3). identify potential barriers to the learning and provision of bystander CPR. A cross-sectional study was conducted by surveying patients presenting to the ED of a metropolitan teaching hospital over a 6-month period. Two in five households of patients presenting with chest pain or IHD had prior training in CPR. This was no higher than for households of patients presenting without chest pain or IHD. Just under two in three households of patients presenting with chest pain or IHD were willing to participate in future CPR classes. Potential barriers to learning CPR included lack of information on CPR classes, perceived lack of intellectual and/or physical capability to learn CPR and concern about causing anxiety in the person at risk of cardiac arrest. Potential barriers to CPR provision included an unknown cardiac arrest victim and fear of infection. The ED provides an opportunity for increasing family and community capacity for bystander intervention through referral to appropriate training.