Emergency medicine journal : EMJ
-
Forearm fractures are the most common paediatric injury presenting to A+E.1,2 Literature supports safe and effective treatment of these injuries in A+E using a variety of sedation methods, including ketamine.3,4 The Paediatric Orthopaedic Trauma Snapshot (POTS) study showed that only 35% of A+Es nationally allow manipulation of these injuries in the department. ⋯ With adequate and appropriate training, the majority of simple radius and ulna fractures can be reduced and definitively treated safely and effectively using Es-ketamine in the emergency department. This technique has significant benefits in terms of resource management and finance whilst maintaining optimum patient care.
-
The most common route to a hospital bed in an emergency is via an Emergency Department (ED). Many recent initiatives and interventions have the objective of reducing the number of unnecessary emergency admissions. We aimed to assess whether ED admission thresholds had changed over time taking account of the casemix of patients arriving at ED. ⋯ The casemix-adjusted odds of admission via ED to NHS hospitals in England have decreased since April 2010. EDs are admitting a similar proportion of patients to hospital despite increases in the complexity and acuity of presenting patients. Without these threshold changes, the number of emergency admissions would have been 11.9% higher than was the case in year 5.
-
: In recent years the RVH Emergency Department (ED) had been under intense pressure and public scrutiny. This led to a demoralised workforce who had become disengaged with quality improvement (QI). QI projects had become an exercise in data collection with little focus on improving care for patients. ⋯ We have also increased efficiency with senior review for Ambulance patients and subsequent significant decrease in waiting times. A recent project targeting the waste associated with unnessecary triage blood tests is showing promising early results.emermed;34/12/A880-a/F2F2F2Figure 2The ED improvement team have endeavoured to improve the environment for staff by developing a 'Grrr to Great' board, through which staff are empowered to highlight problems but are also tasked with developing solutions. We have also increased accessibility of QI data by producing a QI update board and displaying data openly and transparently in the department.emermed;34/12/A880-a/F3F3F3Figure 3.
-
Since the end of World War II, there has been an emergence of explosives used amongst civilian populations resulting in mass-casualty incidents. The development of pre-hospital medical systems, worldwide, has resulted in an increased response at these incidents. However, information about the pre-hospital medical response is sparse and not collated. This review aimed to collect and appraise the literature on the pre-hospital management of mass-casualty bombing incidents. The primary objective was to identify and discuss the common themes highlighted as problems in the pre-hospital medical response. The secondary objectives reviewed the injury patterns in victims and psychological impacts on pre-hospital responders. ⋯ Functioning and reliable communication, alongside regular training exercises with other emergency services, is important in the pre-hospital response. This is aided through accurate triage, in a safe area, to ensure even casualty distribution. A visible and established command and control enables scenes to be led effectively. Access to suitable and adequate supplies of equipment fosters improvement in patient outcomes. Awareness of secondary devices, as well as chemical, radiological and nuclear exposure, is vital in ensuring responder safety. A variety of injury patterns was found. Finally, psychological complications and support systems amongst pre-hospital responders varied.
-
Nearly half a million people are killed each year as a consequence of intentional injury and many more seriously injured. Information sharing by Emergency Departments with local government for crime prevention purposes has previously been described as an effective, cost effective, low cost and low risk intervention for tackling community violence. The UK Department of Health and the Home Office support this process known as the Information Sharing to Tackle Violence (ISTV) program. In 2007, we implemented ISTV and have witnessed a substantial reduction in assault related attendances. We aimed to examine the epidemiology of our assault victims over the introduction period. We hypothesised a priori that there would be reductions in the proportions of patients who attended at the weekend and late at night, reductions in the proportions of young adult males, and reductions in the more seriously injured patients. ⋯ The ISTV program in this single ED has been associated with substantial reductions in violence related presentations. This effect is most marked in presentations at the weekend, younger patients and in those who appear to be least seriously injured.