Annals of emergency medicine
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We reviewed the patterns of injuries sustained by 12 consecutive fallers and jumpers in whom primary impact was onto the feet. The fall heights ranged from 20 to 100 ft. The 12 patients sustained 49 significant injuries. ⋯ Chronic neurologic disability and prolonged morbidity were common. One patient died; the patient who fell 100 ft survived. After initial stabilization, survival is possible after falls or jumps from heights as great as 100 feet It is important to recognize the skeletal and internal organs at risk from high-magnitude vertical forces.
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To evaluate the effect of prolonged environmental extremes on common prehospital medications, four identical sets of 23 drugs were placed in a simulated environment for up to four weeks. Subsequently, the samples were analyzed by gas chromatography-mass spectrometry for evidence of degradation byproducts. ⋯ Epinephrine manifested a change in its ionized state after exposure to heat; the physiologic effect of this change was not determined. Our results suggest that rural and suburban emergency medical services providers, whose medications may not be replaced until they are used in patient care, must monitor their drug boxes' duration of exposure to uncontrolled conditions.
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We developed a computer simulation model of emergency department operations using simulation software. This model uses multiple levels of preemptive patient priority; assigns each patient to an individual nurse and physician; incorporates all standard tests, procedures, and consultations; and allows patient service processes to proceed simultaneously, sequentially, repetitively, or a combination of these. Selected input data, including the number of physicians, nurses, and treatment beds, and the blood test turnaround time, then were varied systematically to determine their simulated effect on patient throughput time, selected queue sizes, and rates of resource utilization. ⋯ Resource utilization rates varied inversely with resource availability, and patient waiting time and patient throughput time varied indirectly with the level of patient acuity. The simulation can be animated on a computer monitor, showing simulated patients, specimens, and staff members moving throughout the ED. Computer simulation is a potentially useful tool that can help predict the results of changes in the ED system without actually altering it and may have implications for planning, optimizing resources, and improving the efficiency and quality of care.
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A retrospective audit was conducted evaluating the effectiveness of the computerized algorithm-directed triage at Brooke Army Medical Center. A total of 98,086 charts were reviewed. ⋯ Of these, 733 patients (1.2%) were retriaged from the acute care clinic to the ED. Based on these data, we conclude that the computerized algorithm-directed triage, using minimally trained personnel, appears to be an effective system.