Annals of emergency medicine
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A study was conducted under the sponsorship of the Emergency Medical Services (EMS) Committee of the American College of Emergency Physicians (ACEP) that was intended to examine prospectively patients' and physicians' perceptions of the urgency of need for medical attention. Patients presenting to the emergency departments of 24 hospitals between February 25, 1980 and March 3, 1980, were surveyed. The hospitals represented a range of geographic areas and bed capacities. ⋯ Physicians concurred that 70% of these patients needed care within 13 hr. Twelve percent of patients rated the urgency of their condition lower than did the physicians, and 25% of patients that the physicians rated as needing immediate attention did not recognize the need for urgent care and thought they could wait from 1 hr to days. This study indicates that patients presenting to the emergency department need care more urgently than was previously supposed.
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There is often misunderstanding and conflict between the emergency physician and paramedic team, particularly as a new system is being implemented. This paper outlines a four-pronged approach to reduce this conflict: 1) community physician involvement in protocol development by means of a Paramedic Policy and Procedures Committee; 2) clinical training of paramedics in community hospitals; 3) involvement of community physicians in primary training and by riding rescue squads; and 4) formulation of a base station physician course to familiarize physicians with radio technique, system operation, and paramedic field work. An outline of the base station physician course is given and discussed. The reactions and outcome of the course and the positive changes it made in both physician and paramedic attitudes are discussed.