The New Zealand medical journal
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Comparative Study
Outcomes from out-of-hospital cardiac arrest in the Wellington region of New Zealand. Does use of the Fire Service make a difference?
Survival from community cardiac arrest in the Wellington region was analysed and compared with similar data reported nationally and internationally. In particular, the impact of a dual fire and ambulance service response was studied. ⋯ Survival from out-of-hospital cardiac arrest in Wellington is similar to that of other New Zealand cities and better than that reported from several large centres overseas. The combined fire and ambulance response was not shown to have any beneficial impact on survival over and above that achieved by the ambulance service alone. System changes are proposed to try and improve survival from community cardiac arrest in Wellington.
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Comparative Study
Manipulation of simple paediatric forearm fractures: a time-based comparison of emergency department sedation with theatre-based anaesthesia.
Procedural sedation has become widespread in emergency departments (ED) worldwide due to the ability to perform short turnaround noxious procedures beyond the confines of the operating theatre. We report one institution's experience with paediatric forearm fracture reduction and compare key time-based metrics for ED manipulation under procedural sedation (MUS), with traditional theatre-based manipulation under anaesthesia (MUA). ⋯ Manipulation of simple closed paediatric forearm fractures under procedural sedation was associated with lesser delay to reduction, and shorter hospital length of stay, compared with traditional manipulation under anaesthesia in the operating theatre.
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Procedural sedation is commonly employed in the emergency department to assist in performance of noxious or invasive procedures. Numerous studies exist purporting the safety and efficacy of procedural sedation in North America and Australia, however, little data on sedation practice within New Zealand has been reported. We present one-year experience of all procedural sedations performed at Waikato Hospital. ⋯ Procedural sedation appears both safe and effective in performance of time-limited noxious manipulations in a 'real-life' emergency department setting in New Zealand.
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To determine the most common challenges to improving acute patient flow and resolving emergency department (ED) overcrowding in New Zealand hospitals, and to share some of the promising initiatives that have been implemented in response to them. ⋯ To improve acute care, resolve ED overcrowding and achieve the Target we need a comprehensive, whole of system approach and some significant changes to the way we use our physical and human resources. To address common challenges we need to share our experiences and expertise.