The American journal of emergency medicine
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Health care planners in Costa Rica, seeking to upgrade their emergency medical services, contracted with United States agencies for additional funding and established a national program for the development of an emergency medical service system. Three years later some of the problems and accomplishments of both the planning and early implementation phases have been identified and include the importance of a detailed assessment of current system components, resources, and priorities; the early implementation of an accurate data collection system; early planning for system self-sufficiency; the vital role of the lead agency with formal lines of authority; the careful development of local expertise and leadership. The continuing efforts in Costa Rica provide a valuable resource for other countries as they face their emergency health care needs.
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An unusual case is described featuring traumatic asphyxia and blunt cardiac injury. An association between these is possible but not previously described. Coronary artery contusion, malignant arrhythmias, and a normal electrocardiogram were also noted and discussed. The relevant literature was reviewed.
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Ethical issues are becoming increasingly complicated. As with all specialties, emergency medicine has ethical dilemmas unique to the field. ⋯ The course is designed for clinical medical students and house officers and is structured around various situations in which the students role-play. The course requires about 20 to 30 hours and covers a variety of topics from consent to treatment and confidentiality to teaching and education in the emergency department.