Annals of emergency medicine
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Although many emergency medicine residency programs are located in major trauma centers, trauma often is managed by a multispecialty team. In order to define the role of the emergency medicine resident at such centers, we sent surveys to the directors of all 64 approved emergency medicine residency programs. Of the 54 programs (84%) responding, 39 (72%) had trauma teams. ⋯ With the exceptions of peritoneal lavage and intubation, resuscitation procedures were shared between the general surgery and emergency medicine residents. Thirty-one percent of the respondents had air ambulances, 70% of which were staffed by emergency physicians. We conclude that emergency medicine residents are active trauma team leaders and providers.
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Surveys of current training show that many areas of pediatric emergency medicine are not taught in emergency medicine residencies. Furthermore, published recommendations for minimum pediatric core content in emergency medicine are scant and conflicting. To address this issue we have compiled from a variety of sources a detailed pediatric emergencies curriculum for emergency residency training. This curriculum is complete, and yet may be carried out with currently available resources.
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Comparative Study
Therapeutic intervention scoring as a measure of performance in a helicopter emergency medical services program.
Helicopter emergency medical services (HEMS), which are both expensive and resource intensive, lack objective measures for system evaluation. We computed the Therapeutic Intervention Scoring System (TISS) score for all patients during six consecutive months of service in a HEMS program to assess the value of this score for measuring the performance of the program. The TISS assigns values ranging from 1 to 4 for 57 medical and surgical interventions to measure the intensity of care during a 24-hour period. ⋯ Thirty-four flights (17%) were thought to be appropriate using the information available at flight time, but not after the diagnostic workup was completed (mean TISS, 10.0). Thirty-six patients (18%) did not appear to require helicopter transport at any time, and had a mean TISS of 9.0. We conclude that TISS is a useful, objective measure of the performance of a HEMS program, and it should be tested in other HEMS programs.
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We conducted a study to determine the number of items and successful response rate to questions specific to emergency medicine on the National Board of Medical Examiners Test, Part II (NBME-II). The 1979 and 1983 NBME-II examinations were reviewed by a subcommittee of the Society of Teachers of Emergency Medicine. Items pertaining directly to the core content knowledge base were selected and classified by core content topic and NBME subspecialty. ⋯ Analysis of the data by core content topic showed that some areas (orientation to emergency medicine, ophthalmologic diseases, environmental emergencies, and behavioral emergencies) had two items or fewer on both examinations. Other topics, such as trauma, showed a consistent pattern of questions on both examinations. Our study emphasizes the difficulty of attempting to test competency in the clinical knowledge base of medicine within the artificiality of knowledge base departmental boundaries.
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In the 1950s, researchers devised the best methods of ventilation. In the 1960s, a method of maintaining circulation and ventilation simultaneously was introduced. In the 1970s, refinements of the understanding of the mechanisms of blood flow during CPR were defined and were accompanied by an aggressive research effort to identify means to improve brain protection during and after cardiac arrest. It is hoped that the fruits of this work will lead to knowledge of better ways to effect resuscitation and will maximize the quality of life in survivors of cardiac arrest.