Emergency medicine journal : EMJ
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A capacity for field-level medical assistance for people exposed to chemical, biological, radiological or nuclear (CBRN) agents or medical support for people potentially exposed to these agents is intrinsically linked to the overall risk management approach adopted by the International Committee of the Red Cross (ICRC) for an international humanitarian response to a CBRN event. This medical assistance articulates: ▸the characteristics of the agent concerned (if known) ▸the need for immediate care particularly for people exposed to agents with high toxicity and short latency ▸the imperative for those responding to be protected from exposure to the same agents. This article proposes two distinct capacities for medical assistance--CBRN field medical care and CBRN first aid--that take the above into account and the realities of a CBRN event including the likelihood that qualified medical staff may not be present with the right equipment. ⋯ Training of those who will undertake CBRN field medical care and CBRN first aid must include: ▸knowledge of CBRN agents, their impact on health and the corresponding toxidromes ▸skills to use appropriate equipment ▸use of appropriate means of self-protection ▸an understanding of the additional complexities brought by the need for and interaction of triage, transfer and decontamination. The development of CBRN field medical care and CBRN first aid continues within the ICRC while acknowledging that the opportunities for learning in real situations are extremely limited. Comments from others who work in this domain are welcome.
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Appropriate activation of multi-disciplinary trauma teams improves outcome for severely injured patients, but can disrupt normal service in the rest of the hospital. Derriford Hospital uses a two-tiered trauma team activation system. The emergency department (ED) trauma team is activated in response to a significant traumatic mechanism; the hospital trauma team is activated when this mechanism co-exists with physiological abnormality or specific anatomical injury. The aim of this study was to compare characteristics, process measures and outcomes between patients treated by ED or hospital trauma teams to evaluate the approach in a UK setting and to estimate any cost savings involved. Figure 1 outlines the composition and activation criteria of the teams. Abstract 014 Figure 1(a) ED trauma team activation and (b) Hospital trauma team activation. ⋯ A two-tiered trauma team activation system is an efficient, safe and cost-effective way of dealing with trauma patients presenting to a Major Trauma Centre in the UK.
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Traditional management of Clinical Scaphoid Fractures has been to immobilise the wrist for 10-21 days and then reassess the injury. Birmingham Children's Hospital (BCH) has offered an Early MRI service for these patients for 12 years. The aim is to MRI the wrist within a few days of injury to get a definitive diagnosis and reduce unnecessary immobilisation. The objective of this review of the Early MRI service, was to analyse: Age, Sex and Hand dominance Percentage of actual scaphoid fractures & other carpal/radial fractures Time from presentation to MRI scan ⋯ It is possible to offer Early MRI scanning for Clinical Scaphoid Fractures, and most commonly our patients waited 3 days, reducing the length of immobilisation. A large number of other injuries were identified which were missed on initial Xrays. Half of all subjects have a fracture, however only half of these were scaphoid fractures. Only approximately a quarter of scans were normal, and therefore immobilised unnecessarily. Boys are more likely to actually have a scaphoid fracture on MRI than girls.
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The Redesigned Fracture Pathway has revolutionised fracture management, decreased orthopaedic workload and improved the patient journey. The Pathway consists of guideline driven treatment of patients with fractures. There is no follow up for many stable injuries, virtual review of other fractures and orthopaedic registrar referral for admission decisions. Many discharged patients never receive a clinic appointment necessitating the development of discharge information leaflets and a move from plaster casts to Velcro splints. Have orthopaedics simply passed their workload onto the Emergency Department? 1) Patients with fractures are discharged with no follow up, does this necessitate longer consultations in ED? 2) Without routine follow up do patients simply pitch back up to ED? 3) Has the admissions process actually improved? ⋯ Direct discharges from ED do not require longer consultations nor do they return to ED. Orthopaedic admission is increasingly efficient and breaches are down. Is Fracture Pathway Redesign good for the Emergency Department? Yes!
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We identified that there is a cohort of people who attend our Emergency Department (ED) extremely frequently (>24 times per year) or who have frequent admissions (>12 per year). Analysing hospital clinical records identified that in many cases medically unexplained symptoms (MUS) drive the frequent presentation. The needs of these patients were not being met by a traditional dualistic approach in which people are seen in either physical or mental health settings. Indeed, despite frequent medical investigations/treatments, their symptoms persist, their problems are not resolved, they frequently complain and they keep coming back. This carries risk and distress for the patients, and heavy use of resources for the hospitals involved. ⋯ Providing a psychological intervention to this patient cohort is effective in reducing hospital costs by containing the most frequent attenders. CBT and care plans have reduced attendance to under once per month and subsequently reduced medical interventions and prescribing costs.