Emergency medicine journal : EMJ
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The role of ambulance clinicians in providing psychosocial care in major incidents and emergencies is recognised in recent Department of Health guidance. The study described in this paper identified NHS professional first responders' needs for education about survivors' psychosocial responses, training in psychosocial skills, and continuing support. ⋯ Ambulance clinicians recognise their own education needs and the importance of their being offered psychosocial training and support. The authors recommend that, in order to meet patients' psychosocial needs effectively, ambulance clinicians are provided with education and training in a number of skills and their own psychosocial support should be enhanced.
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Emergency department crowding is recognised as a major public health problem. While there is agreement that emergency department crowding harms patients, there is less agreement about the best way to measure emergency department crowding. We have previously derived an eight point measure of emergency department crowding by a formal consensus process, the International Crowding Measure in Emergency Departments (ICMED). We aimed to test the feasibility of collecting this measure in real time, and to partially validate this measure. ⋯ We obtained 84 measurements, spread evenly across the four emergency departments. The measure was feasible to collect in real time, except for the 'Left Before Being Seen' variable. Increasing numbers of violations of the measure were associated with increasing clinician concerns. The Area under the Receiving Operator Curve was 0.80 (95% CI 0.72-0.90) for predicting crowding and 0.74 (95% CI 0.60-0.89) for predicting danger. The optimal number of violations for predicting crowding was three, with a sensitivity of 91.2 (95% CI 85.1-97.2) and a specificity of 100.0 (92.9-100). The measure predicted clinician concerns better than individual variables such as occupancy. Abstract 007 Table 1BeforeAfterResearch 'hotline'2 (3%)0Verbal10 (15%)3 (3%)Notes label21 (32%)14 (14%)iPad030 (30%)Not notified32 (49%)52 (52%)Total6599 CONCLUSION: The ICMED is easily to collect in multiple emergency departments with different IT systems. The ICMED seems to predict clinician's concerns about crowding and safety well, but future work is required to validate this before it can be advocated for widespread use.
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Computed tomography (CT) is becoming increasingly popular as a primary imaging modality in adult trauma patients. This study aims to examine the added value of thoracic CT (TCT) in the context of paediatric trauma. ⋯ This study indicates a need for a comprehensive guideline for imaging in paediatric trauma, where the use of TCT is limited to specific patients, especially in view of the health implications that CT poses and source of financial burden for the NHS.
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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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WHO ETAT training courses provide comprehensive training in paediatric emergency care over 3.5-5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost and impact on local service delivery of a five-day course may limit training opportunities in some settings. In this context, we aimed to determine whether a shorter, more focused course would be feasible. ⋯ 'Essential ETAT' was well received by participants and improvements in post-course test scores compared well to results from standard ETAT courses. Further evaluation is required to indicate whether knowledge is retained and changes clinical practice. Focused, short duration resuscitation training may offer a pragmatic and potentially cost-effective alternative to standard courses.