European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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We carried out a prospective evaluation of 172 patients using our own risk score for patients transferred from the emergency department of a community hospital in Tudela, Spain, to main centres, during 1988. Although the data go back almost 10 years, this scoring has not been internationally published and is at present widely applied in Spain. Patients scoring less than 7 points were transferred under specialized nursing supervision (Group I), and those scoring equal to or over 7 points were transferred in a specially equipped intensive care unit surface ambulance and supervised by a physician and a nurse (Group II). ⋯ Of a total of 23 deaths in hospital, nine were from Group I and 14 from Group II. During the first 24 hours after admission, six patients died from Group II and none from Group I. The application of risk scores has permitted to assign effectively technical and human resources for a safe interhospital transfer of critically ill patients.
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An ongoing collaborative partnership between the University of Massachusetts Medical Center, Boston University Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia has been established since 1993. The primary goal of this partnership is to reform and improve the delivery of emergency medical care through a process of education and training that is reproducible, practical, and self-sustaining for the advancement of health care into the future. A six-step educational process was developed, using Armenia as the initial model site for this format. ⋯ An ongoing trauma database collection also shows significant improvement in the number of advanced life support measures being implemented since the inception of this educational training programme. This educational strategy has subsequently been replicated in nine similar partnerships in other countries of the New Independent States, formed after the dissolution of the former Soviet Union in 1990. We believe this six-step educational format is effective for the development and improvement of emergency medical systems in developing countries worldwide.