Annals of emergency medicine
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We surveyed the 66 accredited emergency medicine residency programs in the United States during 1986 on the issue of attending coverage. Responses were received from 411 residents and 288 faculty; this accounted for 42% of the residents and 56% of the faculty from the 56 responding programs. Seventy-three percent of emergency medicine residency programs had 24-hour attending coverage. ⋯ Ninety-five percent of faculty and 71% of residents thought that the quality of patient care was better when faculty were present in the ED (P less than .0001). Sixty-one percent of residents and 60% of faculty did not think that 24-hour attending coverage in academic emergency medicine should be mandated. The impact of night-time attending coverage in emergency medicine residency programs on patient care, resident education, and faculty development is unclear and minimally studied.
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Clinical prediction rules are used extensively by most regionalized trauma systems to identify which patients have sustained major injuries. Because of reported high misclassification rates of some of these rules and the known global difficulty of transporting prediction rules, four such rules (the Trauma Score, the CRAMS Scale, the Revised Trauma Score, and the Prehospital Index) and two newly derived rules were statistically analyzed using a cohort of 2,434 injured patients. All rules accurately predicted mortality with a minimum sensitivity and specificity of 85%. ⋯ In this instance, no rule was able to achieve a sensitivity of at least 70% while achieving a specificity of 70%. These results suggest that the problem with trauma prediction rules lies in the inherent limitations of the clinical data on which they are based. In view of this, the usefulness of existing prehospital trauma predictive rules must be questioned.
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In-flight medical emergencies were evaluated among passengers arriving at Los Angeles International Airport (LAX) from October 1985 through March 1986. All emergency department, LAX first-aid station, and paramedic records were examined. There were 8,735,000 passenger arrivals at LAX during the study period; 260 passengers (0.003%) developed medical complaints in flight, and of these 260, 115 (44.2%) had symptoms that lasted for more than one hour. ⋯ Most of the illnesses encountered did not require advanced medical treatment. We conclude that while in-flight medical illnesses occur more frequently than believed by airlines, true emergencies are rare. The rarity of true in-flight medical emergencies coupled with low physician availability bring into question the benefit of any comprehensive medical kit on airliners.