Articles: emergency-medical-services.
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This case demonstrates the necessity of adequate emergency management during dental treatment. A 57-year-old man loses consciousness immediately after the injection of a dental local anesthetic. For medical assistance, a neighboring general practitioner is first telephoned without success. ⋯ Finally, an emergency doctor is dispatched and arrives approximately 35 minutes after the emergency situation began. The electrocardiogram shows a supraventricular tachycardia which, after an immediate cardioversion, converts to a sinus rhythm connected with a restoration of the circulatory function. This case exemplifies the consequences of an inadequate response to a sudden emergency.
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In Denmark, emergency ambulances are dispatched by 41 centres manned either by trained firemen (in Copenhagen) or policemen (outside Copenhagen). In 1990, emergency ambulance calls totalled 284,000. Utilisation of emergency ambulance services increases with urbanisation. ⋯ In less populated areas, some general practitioners give advanced life-support. Although many areas are serviced by ambulances equipped with defibrillators, the majority of patients receive only basic life-support from ambulance personnel. New initiatives resulting from a recent report by a commission appointed by central authorities, and focused on prehospital treatment, are expected to improve the service by raising the level of training given to ambulance personnel.
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The specialized care provided at the trauma centre in Baltimore, Maryland, in the USA is described. By means of a sophisticated communications system, prehospital and hospital care are coordinated with a view to providing optimal care to people with various types of injuries. It is suggested how the American experience might be applied to conditions in the Nordic countries in order to improve the quality of trauma care.
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Because of the need for rapid diagnosis and management of patients acutely stricken by either injury or illness, critical care delivery cannot be limited to intensive care units. Instead, it must span the continuum from the scene of injury or illness to the patient's eventual arrival at the intensive care unit. University Hospital in Ghent, Belgium, has developed a comprehensive system that involves prehospital and in-hospital critical care, as well as a rapid and efficient interhospital and intrahospital transportation system. ⋯ The emergency department and its staff are available 24 hours a day to ensure uninterrupted delivery of critical care, including when patients are transported between various hospital departments. In addition, critical care specialists with at least 2 years' intensive care experience are available 24 hours a day. They also serve as coordinators for disaster planning for the hospital and the city of Ghent and its province.