European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The purposes of the study were to determine the total cost of Ankara Emergency Aid and Rescue Services (EARS), to calculate the cost of a single ambulance response and the cost per patient responded to. A descriptive study was planned to find out the cost of Ankara EARS, conducted between 1 October 1995 and 30 September 1996. The main variables of the study were the capital and recurrent costs of the system. ⋯ On the other hand the cost per patient or injured person was US$180.50. In Ankara, Turkey, the costs of such ambulance services could not be afforded by the private sector. The ambulance service activities should continue to be a part of primary health care services and the Ministry of Health should continue to serve in this field.
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There is abundant evidence to suggest that doctors are increasingly being exposed to violent incidents at their workplace. The possible effects of aggression on an individual are varied and likely to depend on the severity and frequency of episodes and the perceived vulnerability to further episodes. The reported sequaelae of violent incidents towards doctors include varied psychological disturbances, and changes in behaviour, such as increasing prescribing, ongoing fear of violence at work, and poor staff morale. ⋯ The effects lasted for more than 4 weeks in 25, for 3-4 weeks in 17, and for 2-3 weeks in 21. The duration of symptoms was longer in doctors exposed to verbal insults or threats of imminent violence coupled with incidents involving single acts of violence. Out of a total of 101 doctors; 90 (89%) remained worried about violence at work and 72 (71%) thought training to deal with potentially violent situations would be useful.
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Brain oedema is a major factor contributing to the poor outcome of subjects with acute ischaemic stroke but the use of mannitol and other hyperosmolar agents in this setting is controversial and hardly debated. Recent data have demonstrated that mannitol at concentrations which may be achieved in clinical conditions and hyperosmotic stress itself can activate the process of apoptotic cell death. ⋯ Furthermore, apoptosis in ischaemic areas closely parallels the timing of brain oedema and this suggests that a cause-effect relationship links the two phenomena rather than simply a temporal correlation. On this basis, it is crucial that emergency-physicians critically rethink the management strategy of brain oedema associated with ischaemic stroke.
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A retrospective analysis of 118 prehospital missions involving vitally important therapy (anaesthesia or resuscitation with admission) was carried out. Primary mobilization of the emergency physician (EP) (i.e. before arrival of the rescue ambulance) was carried out by the alarm dispatch centre in only 36% of these missions. ⋯ The observations suggest that an improved assessment of possible involvement of an EP is necessary, both at the alarm central and the emergency site. Moreover, continued monitoring (quality control) of this delay is necessary.