J Emerg Med
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Observational Study
Can Emergency Medical Services Use Turnaround Time as a Proxy for Measuring Ambulance Offload Time?
"Offload delay" occurs when the transfer of care from paramedics to the emergency department (ED) is prolonged. Accurately measuring the delivery interval or "offload" is important, because it represents the time patients are waiting for definitive care. Because recording this interval presents a significant challenge, most emergency medical services systems only measure the complete at-hospital time or "turnaround interval," and most offload delay research and policy is based on this proxy. ⋯ The results show that the correlation between the delivery and turnaround intervals is good. However, there remains much to be learned about the at-hospital time intervals and how to use these data to make decisions that will improve resource utilization and patient care. Efforts to establish a method to accurately record the delivery interval and to understand the at-hospital portion of the ambulance response are necessary.
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As the specialty of emergency medicine (EM) continues to spread around the world, a growing number of academic emergency physicians have become involved in global EM development, research, and teaching. While academic departments have always found this work laudable, they have only recently begun to accept global EM as a rigorous academic pursuit in its own right. ⋯ Reflecting a growing interest in global health, more of today's EM faculty members are ascending the academic ranks as global EM specialists. Whether attempting to climb the academic ladder as a clinician-educator or clinician-researcher, advanced planning and the firm support of one's academic chair is crucial to the success of the promotion process. Given the relative youth of the subspecialty of global EM, however, it will take time for the pathways to academic promotion to become well delineated.
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Electronic cigarettes (e-cigarettes) are a technology that has been touted as a safe and effective alternative to traditional cigarettes. There is, however, a paucity of literature showing the adverse outcomes of e-cigarettes and a correlation with acute eosinophilic pneumonia (AEP). ⋯ Though an alternative to traditional cigarettes, e-cigarettes can have unpredictable and potentially serious adverse effects. More research needs to be conducted to determine their safety. If seeing a patient in the ED with pulmonary symptoms after use of e-cigarettes, AEP should be considered in the differential.
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Disclosing potential future malignancy risks from diagnostic tests that expose children to ionizing radiation in the emergency department may be challenging. ⋯ Approximately one-third of pediatric emergency physicians were able to identify the best available estimate of the malignancy risk from a head CT. Although there are some barriers, many PEM physicians report regularly participating in risk-benefit disclosures.
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Point of care ultrasound (POCUS) is a rapidly expanding aspect of both the practice and education of emergency physicians. The most effective methods of teaching these valuable skills have not been explored. ⋯ The methods perceived as most effective for POCUS education are small-group format, video-clip examples, and hands-on scanning sessions.