The American journal of emergency medicine
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A dominant characteristic of critical-care medicine today is the emergence of powerful institutions functioning within a framework of a noncoherent set of values and philosophical perspectives. Anyone who would assign a significant role to the philosophy of medicine for today's era must not simply account for the quandaries of critical-care medicine, but also attend to the antecedent values, conflicts, and absurdities that form the ethical issues, as well as the models of ethical response (market ethos, professional ethos, etc.) that indicate which moral principles might be relevant. These considerations form the new agenda for the philosophy of critical-care medicine. This broad philosophical task is an urgent one, for critical-care medicine is rapidly molding the moral dimensions of all of medicine.
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Comparative Study
Emergency department utilization during a doctors' strike.
Emergency department (ED) patient volume at Jerusalem's Shaare Zedek Hospital was 33% higher during the 1983 doctors' strike as compared with the same period in 1982. Excess visits were recorded for both sexes (P less than 0.0001), but there were many more excess visits by females than males. ⋯ In contrast to excess ED visits, which were higher during the strike for both sexes, excess hospital admissions via the ED were recorded only among females (P = 0.007). The number of ED visits during the strike was increased on all three hospital work shifts (P less than 0.0001), with the greatest number of excess visits occurring between 7 AM and 3 PM.
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The telephone number 911 is designated for public use in requesting emergency assistance. It is thought to reduce response time by reducing the interval between the decision to call for assistance and the notification of an agency that can dispatch the appropriate services. The experience of the Twin Cities metropolitan area of Minneapolis-St. ⋯ Compliance (use of an appropriate emergency number for the first call) was demonstrated by 139 of 347 callers (40%) in the pre-911 phase, and 225 of 305 callers (74%) in the post-911 phase (P less than 0.001). Rapid activation of the EMS system was rarely achieved by calling a hospital or physician first. Overall, 911 was found to be a more efficient means of activating the EMS system.
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A prospective observation of cardiopulmonary resuscitation was made at an active municipal pediatric emergency department. Pediatric cardiorespiratory arrest, documented in only 26 patients over a 12-month period, was unusual. Fifteen were less than 1 year old, and four children survived to discharge. ⋯ Congenital abnormalities were present in 23% of patients; however, these accounted for 50% of the survivors. The overall survival rate was 15.4%. Suggestions for termination of resuscitation are given.