Emergency medicine journal : EMJ
-
Previous investigators have demonstrated increased mortality with longer distance from hospital in respiratory patients but it is unclear if these findings are applicable to all patients/conditions. However, it is widely assumed that patients may deteriorate during long journeys, which contributes to fear of service reconfiguration by public and professionals alike. We wished to ascertain whether clinical deterioration occurs during long ambulance journeys (up to 70 miles) to hospital from our rural catchment area. ⋯ Our findings suggest that adult patients living further from hospital are not more unwell on pick-up, they are not deteriorating en-route, and longer journeys to hospital do not necessarily lead to patients coming to harm.However, we did not explore any relationship to later mortality/morbidity.We appeal to colleagues in those areas of the UK with electronic ambulance records linked to hospital records to repeat this work with a much larger sample and wider range of end-points, in order to provide a definitive answer to this important question.
-
A short cut review was carried out to establish whether local anaesthetic lubrication is necessary for urethral catheterisation in men. Two studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the use of local anaesthetic is effective in this population and should form part of the procedure.
-
A short cut review was carried out to establish whether therapeutic anticoagulation is required for patients who have an incidental diagnosis of subsegmental pulmonary embolism (PE), which is asymptomatic. 4 studies were relevant to the three-part question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The evidence suggests that patients with clinically unsuspected PE may have better prognostic outcomes than those with symptomatic presentations, especially if the PE is at the sub-segmental level. ⋯ However, this study included patients with cancer and was not restricted to patients with subsegmental PE. Consequently, the clinical bottom line is that level 1 evidence is required to answer this question. In the meantime decisions must continue to be informed by clinical judgment.
-
Comparative Study
Emergency medical services versus private transport of trauma patients in the Sultanate of Oman: a retrospective audit at the Sultan Qaboos University Hospital.
This study aims to assess the differences in the outcome of road traffic trauma patients between those transported by emergency medical services (EMS) and those privately transported to the Sultan Qaboos University Hospital in the Sultanate of Oman in 2011. ⋯ EMS transported trauma patients had a statistically non-significant 36% reduction in mortality compared with privately transported patients admitted to the Sultan Qaboos University Hospital in 2011. Further, research that incorporates prehospital factors such as crash to arrival of EMS services and transport time to definitive healthcare facility should be conducted to evaluate the effectiveness of such a system in trauma care. Since non-EMS transport is likely to continue, public first aid training is critical to reduce mortality and morbidity of road traffic trauma in Oman.