European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
Prehospital recognition of an acute stroke improves the time from onset to thrombolysis and rates of reperfusion therapy. Studies conducted to evaluate paramedic and dispatcher performance in suspecting stroke are disappointing. This study addresses the specific issue of stroke recognition by dispatchers, taking into account delay in reporting the onset of symptoms (<5 h). ⋯ The revised Cincinnati Stroke Scale for dispatch adds the notion of delay in the process of triage. It identifies 67.8% and misses 32.2% of the stroke patients treated by thrombolysis. Its performance is similar to previous results using the regular Cincinnati Stroke Scale, but allows for targeting acute strokes.
-
Previous work has demonstrated that much violence requiring medical help is not recorded by the police. Sharing emergency department data on victims of violence is associated with reductions in community violence and is well established throughout the UK. We undertook a critical literature review to determine whether sharing ambulance data was useful to identify violence hotspots and offered unique information for violence prevention. ⋯ Although the standard of evidence was generally low, most studies demonstrated that ambulance services detected a substantial proportion of assaults that were not recorded by the police or the emergency departments. We identified only two interventional studies, but they were of low quality. Although the interventional evidence base is currently weak, ambulance data provide a unique source of information about the epidemiology of community violence and have the potential to improve current violent crime surveillance methods.
-
Multicenter Study Observational Study
Emergency department procedural sedation: the London experience.
The aim of this study was to develop a procedural sedation guideline and an audit tool to identify the medications chosen, the incidence of predefined adverse events and the factors associated with their occurrence. ⋯ Procedural sedation and analgesia can be safely and effectively performed in the ED by appropriately trained emergency physicians.
-
Observational Study
Understanding the prehospital physician controversy. Step 2: analysis of on-scene treatment by ambulance nurses and helicopter emergency medical service physicians.
In our previous study, we identified the similarities and differences in competencies of ambulance nurses and helicopter emergency medical service (HEMS) physicians in the Netherlands. This ensuing study aims to quantify the frequency with which the additional therapeutic competencies of the HEMS physician are utilized and to determine whether this is the main reason for usefulness as perceived by ambulance nurses and HEMS physicians. ⋯ HEMS physicians provide additional treatment in 45% of patients. The additional treatment increases the perceived usefulness of the HEMS physician. The presence of the HEMS physician was also considered useful when the physician did not provide any additional treatment, possibly because of diagnostic competence and clinical decision-making.
-
Observational Study
Goal-directed ultrasound in emergency medicine: evaluation of a specific training program using an ultrasonic stethoscope.
This observational study aimed to define the learning curve in goal-directed ultrasound (US) after a 2-day training course dedicated to novice emergency residents. ⋯ The performance of 30 supervised and goal-oriented examinations appeared adapted to adequately answer clinical questions covered by core applications of emergency US.