Articles: emergency-medical-services.
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To assess the need for a trauma system in San Diego County, a concurrent audit of trauma care was performed by an independent consultant in 1982. During the study period from 15 March through 15 June 1982, 591 consecutive major trauma victims (MTV) were collected by the 30 participating hospitals. All medical records, including autopsy reports, were audited for the timeliness and appropriateness of diagnosis and definitive care. ⋯ The care of MTV was considered suboptimal in 32% of patients before regionalization, compared to 4.2% after regionalization (p less than 0.01). Preventable deaths occurred in 13.6% of fatalities occurring before implementation of a trauma system, compared to 2.7% after implementation (p less than 0.01). Regionalization of trauma care significantly reduced delays, inadequate care, and preventable deaths due to trauma.
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Physician assistants who work in community medicine must be aware of the need for, and limitations of, prehospital emergency care systems. In rural communities, effective emergency cardiac care systems lag behind those of urban areas: establishing and maintaining a rural paramedic-level ambulance service is expensive, and continued competency must be shown in complex skills even when the volume of emergency calls is low. ⋯ Defibrillation programs require strong medical control and well-designed quality assurance mechanisms. Medical control is ultimately the responsibility of the physician-medical director, but in many small communities day-to-day tasks of medical control and quality assurance are assumed by PAs.
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Medical control is an essential component of a prehospital care system. It is a method of ensuring quality and accountability of the care provided and thus provides a method of risk management for the system. Politicians, fire departments, ambulance companies, physicians, and others are struggling for control of prehospital emergency care. ⋯ Medical control includes three phases: prospective, immediate, and retrospective. The incorporation of medical control in a specific EMS system will be dependent on that system's characteristics; nevertheless, proper medical control is essential to ensure a high quality of prehospital care. Further studies will be necessary to evaluate medical control and determine the best mechanism for providing quality assurance in prehospital care.
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The triage process is a valid concept in the initial approach to multiple casualties. Triage tags are, in theory, a reasonable adjunct to the process, but have proved to be a failure in practice. Based on the historical perspective and on the authors' experience with approximately 180 mass casualty drills and incidents, it is recommended that the "daily routine doctrine" be applied and that conventional, color-coded triage tags be replaced by a process of "geographical triage." A valid model for disaster planning is needed, and organizers must conduct drills that are based on the actual threat to the community in order to determine the most efficacious way to manage medical response.
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This retrospective study is a review of patients referred from a network of eight freestanding emergency centers FECs to a hospital emergency department during January and February 1984. During that time, 17,387 patients were seen at the FECs. Sixty-three (0.36%) of these patients were referred to the base hospital, of which 28 (44%) were admitted and six (9.5%) were admitted to a critical care unit. ⋯ Of the patients discharged from the hospital 70% were satisfied with FEC and 97% with hospital treatment. Of admitted patients, 89% were satisfied with FEC and 100% were satisfied with hospital treatment. For a similar illness in the future, 23% of all patients would return to a FEC, 28% would go to a private practitioner, and 48% would go directly to a hospital.