Articles: emergency-medical-services.
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The increasing emphasis on the emergency physician's role in the community led us to investigate the role of residency training programs in providing more than clinical competence to their graduates. Using guidelines provided by the American College of Emergency Physicians, the Joint Commission on Accreditation of Hospitals, the Department of Health, Education and Welfare, and program alumni, we set about to determine methods of enhancing the EMS and administrative aspects of the residency program at Charity Hospital. We describe the curriculum that was developed.
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An Army corpsman used physician-written triage algorithms to rate the urgency of the chief complaints of 2,000 pediatric outpatients. His ratings agreed with subsequent ratings by physicians in 84% of cases. ⋯ Use of a "nonprofessional" as a triage agent spares the pediatrician, pediatric nurse practitioner, and nurse for providing health care. With increasing use of acute care facilities by patients without appointments, physician-written algorithms allow triage agents who lack formal medical training to determine safely the need for care of patients.
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Injury severity scales of proven reliability and validity are essential for the appropriate allocation of therapeutic resources, for prediction of outcome, and for evaluation of the quantity and quality of emergency medical care in differing facilities and over time. Quantitation of injury severity in the field is particularly necessary. ⋯ The Triage Index has been developed with state-of-the-art multivariate statistical techniques, meets the requirements of an interval ranking scale, and has been both validated and assessed for interuser reliability. The Triage Index is proposed as a validated system of early, rapid, noninvasive, accurate patient assessment permitting appropriate matching of trauma victims with available therapeutic resources as a means of reducing mortality and morbidity.