Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.
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More than 300,000 sudden coronary deaths occur annually in the United States, despite declining cardiovascular death rates. In 2000, deaths from heart disease left an estimated 190,156 new widows and 68,493 new widowers. ⋯ Based on a review of the literature, the authors suggest that more research is needed to answer this question, to assess the current immediate needs and care of survivors, and to find ways to improve care of the surviving family of unexpected cardiac death victims. This would include improving quality of death disclosure, improving care for relatives during cardiopulmonary resuscitation of their family member, and improved methods of referral for services for prevention of psychological and cardiovascular morbidity during bereavement.
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To review the current literature on the effects of ambulance diversion (AD). ⋯ Despite its common use, there is a relative paucity of studies on the effects of AD. Further research into these effects should be performed so that we may understand the role of AD in the health system.
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To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters. ⋯ As part of planning for sudden-impact disasters, communities should be expected to sustain medical services for 24 hours, and up to 96, before arrival of external resources. For effective medical surge-capacity response during sudden-impact disasters, there should be a priority for emergency medical care with a focus on ambulatory injuries and illnesses.
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Bedside teaching is a valuable instructional method that facilitates the development of history and physical examination skills, the modeling of professional behaviors, and the direct observation of learners. The emergency department (ED) is an ideal environment for the practice of bedside teaching, because its high patient volume, increased acuity of illness, and variety of pathology provide plentiful patient-centered teaching opportunities. ⋯ The authors propose several practical strategies to increase bedside teaching by academic emergency physicians (EPs). These techniques emphasize careful preparation and a focused teaching approach to overcome the inherent challenges of a typically busy ED shift.