European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
Comparative Study
The role of protocols and professional judgement in emergency medical dispatching.
The task of evaluating incoming calls to Emergency Medical Services (EMS) systems in order to determine the most appropriate response is performed in many different ways in current EMS systems. At one end of the spectrum, the process is entirely dependent on the judgement of professionals, while at the other end protocols specify the exact questions to be asked and corresponding decisions. This case study describes the experience of the Montreal EMS system, Urgences santé, where professional telephone evaluation performed by nurses since 1981 was replaced by a protocolized system in 1992. ⋯ Many contextual factors influence the organization of telephone assessment in EMS systems. This case study suggests that professional judgement may be most useful in contexts where the demand for EMS services often exceeds the availability of resources. On the other hand, protocolized systems may be more appropriate in the absence of such constraints, and where the litigation context prohibits the occurrence of any false negative.
-
Clinical Trial
Patients intoxicated with heroin or heroin mixtures: how long should they be monitored?
Our investigation was carried out in subjects intoxicated with heroin or heroin mixtures to find out the time interval during which delayed life-threatening complications become manifest, such as pulmonary oedema or relapse into respiratory depression or coma after naloxone treatment. We studied prospectively all drug intoxications between 1991 and 1992. Of the 538 intoxications, we assessed in detail 160 outpatients who lived within the catchment area of our hospital. ⋯ Based on reliable report, the pulmonary oedema occurred between approximately 2 1/4 and 8 1/4 hours after intoxication. In the literature, only two cases of delayed pulmonary oedema have been reported with reliable time statements (4 and 6 h after hospitalization). We therefore conclude that surveillance for at least 8 h is essential after successful treatment to exclude delayed pulmonary oedema in patients intoxicated with heroin or heroin mixtures.
-
Routine pelvic radiography is carried out in all blunt trauma patients referred to our Emergency Department according to advanced trauma life support protocols. In this retrospective study, we questioned whether it is cost-effective to obtain 'routine' pelvic X-ray films. The notes and X-rays of all consecutive patients with blunt trauma who were referred to the Emergency Department of Dokuz Eylül University Hospital, Izmir, Turkey, between August and December, 1993 were re-evaluated. ⋯ The difference between the groups were statistically significant (p < 0.001). As a result, we concluded that 'routine' pelvic radiography should be performed in the setting of blunt trauma only if the patient is: (a) unconscious, uncooperative or intoxicated, or (b) conscious, fully orientated and cooperative and complaining of pain both in the history and on pelvic examination. These limitations would allow us to decrease the amount of irradiation received, render more cost-effective treatment, and reduce the workload of emergency and radiology departments.
-
Over a 3-year period, 663 children aged under 13 years were seen with a history of foreign body (FB) ingestion. Seventy-six per cent of the children were less than 6 years old. Coins and chicken or fish bones were the most common objects ingested. ⋯ All 224 FBs detected in the stomach or beyond were allowed to pass naturally, and delayed passage occurred in only one case. Passage of 11 alkaline disc batteries occurred without complication. No patient required surgical removal of an FB.