Journal of accident & emergency medicine
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To examine current patterns of deployment and use of emergency ambulance crews in Nottinghamshire, with particular reference to crew status (technician or paramedic), case mix, interventions performed, and operational times. ⋯ The additional time taken by paramedics at the scene of an emergency incident relates to their performance of an intervention, rather than time spent assessing the patient to decide whether stabilisation or immediate evacuation would be most appropriate. Paramedic interventions were most often performed for medical emergencies. The performance of paramedic interventions also extended turnaround times and total out-of-service times.
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To assess the workload generated by police inquiries to an accident and emergency (A&E) department and the adherence of medical staff to departmental guidelines relating to these inquiries. ⋯ Police inquiries generate a significant workload for an A&E department, often at clinically busy times. Medical staff need further education to ensure that patient confidentiality is respected while assisting the police with their investigations.
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To explore the possibility that homeless people use the accident and emergency (A&E) department as a substitute for primary care and to quantify the role of alcohol abuse in their attendances. ⋯ The local homeless population may be using the A&E department as a substitute for primary care even in the presence of homeless healthcare facilities in the community. Heightened awareness of these facilities may improve their uptake. Alcohol plays a large role in homeless people seeking medical help in the A&E department. More accessible community facilities for dealing with this problem in this patient group are needed.
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Case Reports
Chest wall thickness may limit adequate drainage of tension pneumothorax by needle thoracocentesis.
Tension pneumothorax in a large man was inadequately drained by needle thoracocentesis with a 4.5 cm cannula. Unsuccessful needle thoracocentesis of a clinical tension pneumothorax in a large patient should be followed immediately by chest drain insertion, without local anaesthetic, as dictated by clinical urgency. If the clinical situation is still not improved other diagnoses should be considered.