Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2022
ReviewReview article: Impact of pandemics on rural emergency departments: A scoping review.
Pandemics can cause much distress to communities and present a major burden to the resources and functioning of hospitals. This scoping review aimed to identify, evaluate and summarise current literature regarding how pandemics impact rural EDs in terms of staff wellbeing, structure, function and resources. A systematic search of six databases using search terms including pandemic, ED and rural and remote was undertaken. ⋯ Rural ED functioning was affected in terms of input; with an increase in patient presentations and time to physician assessment during H1N1, but a decrease in patient presentations and transfers during COVID-19. Rural ED resources were impacted in regard to staffing, difficulty in obtaining stocks of personal protective equipment and medication, and community response. Further research to understand and address the short- and long-term impacts pandemics may have on rural EDs is required.
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Emerg Med Australas · Jun 2022
Observational StudyEmergency intubation practices in a tertiary teaching hospital in Jakarta, Indonesia: A prospective observational study.
Intubation is an important competency for emergency doctors. Emergency patients are often unstable, with undifferentiated conditions. There is little time to prepare these patients prior to intubation and so ED intubation may differ from intubation in intensive care units and operating theatres. The present study aims to describe the characteristics of emergency intubation after an administrative policy change within a tertiary teaching hospital in Jakarta, allowing non-anaesthetists to perform intubation in the ED. ⋯ The first-pass success rate is comparable with international data. Non-anaesthetic physicians must improve their experience to achieve a favourable success rate. The data on complications highlight the need for improvement in Indonesian ED intubation practices.
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Emerg Med Australas · Jun 2022
An initial Glasgow Coma Scale score of 8 or less does not define severe brain injury.
The wide-spread use of an initial 'Glasgow Coma Scale (GCS) 8 or less' to define and dichotomise 'severe' from 'mild' or 'moderate' traumatic brain injury (TBI) is an out-dated research heuristic that has become an epidemiological convenience transfixing clinical care. Triaging based on GCS can delay the care of patients who have rapidly evolving injuries. ⋯ Nearly 50 years after the development of the GCS - and the resultant misplaced clinical and statistical definitions - TBI remains a heterogeneous entity, in which 'best practice' and 'prognoses' are poorly stratified by GCS alone. There is an urgent need for a paradigm shift towards more effective initial assessment of TBI.
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Emergency ultrasound (EUS) has become an integral part of emergency medicine, and the core pillars of governance, infrastructure, administration, education and quality assurance (QA) are vital for its quality and continued growth. We aimed to assess the status of these vital pillars among Australasian EDs. ⋯ Despite ACEM recommendations for the practice of EUS, Australasian EDs still lack vital governance, administrative support, infrastructure, education and QA processes. Prompt actions such as ACEM mandating these recommendations are required to improve resource allocation by health services.
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Emerg Med Australas · Jun 2022
Acceptability of emergency department triage nurse's advice for patients to attend general practice: A cross-sectional survey.
Demand for ED care is increasing at a rate higher than population growth. Strategies to attenuate ED demands include diverting low-acuity general practice-type ED attendees to alternate primary healthcare settings. The present study assessed the ED attendees' receptiveness to accept triage nurse's face-to-face advice to explore alternate options for medical care and what factors influence the level of acceptance. ⋯ Most of the participants believed that EDs were for emergent care and they attended the ED because they perceived their presenting condition/s to be serious and/or urgent. The acceptability of face-to-face advice by triage nurse to seek help in general practice was influenced by perceived threats of the illness, and the underlying beliefs about availability, accessibility, suitability and affordability of the service.