International emergency nursing
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With the introduction of regional trauma networks in England, ambulance clinicians have been required to make triage decisions relating to severity of injury, and appropriate destination for the patient, which may require 'bypassing' the nearest Emergency Department. A 'Trauma Unit Bypass Tool' is utilised in this process. The Major Trauma Triage tool smartphone application (App) is a digital representation of a tool, available for clinicians to use on their smartphone. Prior to disseminating the application, validity and performance against the existing paper-based tool was explored. ⋯ The smartphone app version of the Trauma Unit Bypass Tool performs at least as well as the paper version and can be utilised safely by pre-hospital clinicians in supporting triage decisions relating to potential major trauma.
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Over the past four decades there has been a shift from operative to selective conservatism in trauma. Selective nonoperative management (SNOM) of stab wounds to the abdomen is widely accepted in trauma centres. However, selective conservatism with gunshot wounds to the abdomen is controversial. This collective review assesses the evidence of SNOM of gunshot wounds to the abdomen. ⋯ Current evidence supports SNOM of gunshot wounds to the abdomen. It is associated with a decreased rate of non therapeutic laparotomy. Careful patient selection and specially designed protocols should be established and adhered to.
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The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: (a) an innovative, interdisciplinary, team-based clinical training model, (b) a unique and low-resource emergency nursing curriculum and (c) a comprehensive and sustainable training program to increase in-country retention of nurses.
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Emergency department (ED) crowding and prolonged waiting times have been associated with adverse consequences towards quality and patient safety. ⋯ The number of patients simultaneously present is a moderate indicator of unsafe waiting times. Future initiatives to improve safe waiting times should not focus solely on occupancy, and expand their focus towards other factors affecting waiting time.