Articles: emergency-medicine.
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A retrospective audit of 17,028 emergency charts at USAF Medical Center, Scott was performed over two time periods to compare patient waiting times and selected quality assurance parameters with two methods of physician staffing. Phase 1 consisted of 4 months when the Emergency Department (ED) was manned with five physicians assigned only to that department. Non-departmental physicians supplemented the full-time staff. ⋯ The time required to be seen by a physician decreased from an average of 25.6 minutes per patient in phase 1 to 13.7 minutes per patient in phase 2. Time to disposition also decreased from 71.9 minutes per patient in phase 1 to 59.5 minutes per patient in phase 2. In the second phase the number of "positive" x-ray findings increased, while the number of incomplete charts and patients who left without being seen by a physician diminished.
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Despite growing interest and activity by emergency physicians in injury prevention, we found no reports of any attempts to include injury control concepts in emergency medicine residency training. An existing course for graduate level public health students on motor vehicle injury was modified for emergency medicine residents, presented as a one-day short course, and evaluated. The objective of the course was to provide information regarding the dynamics and prevention of motor vehicle crashes. ⋯ The incorporation of injury prevention concepts and research methods into the grand rounds, journal club, and conferences of the emergency medicine residency is recommended. Educational objectives and practical suggestions for implementation are provided. A comprehensive reading list is available on request.
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Comparative Study
[Learning from mistakes. Thoughts on preclinical care of accident victims based on 10-year experience in a large city of West Germany].
On the occasion of the 25th anniversary of preclinical emergency medicine a review of the last decade of preclinical treatment of polytraumatized patients was performed. Initially preclinical emergency medical services were established for the immediate care of victims in road accidents. Therefore these services were first usually stationed in Centers for Surgery or Traumatology. ⋯ Only physicians of Search and Rescue helicopter teams and residents of surgical and trauma departments made significantly few mistakes in the early treatment of polytraumatized patients. Typical mistakes of less experienced physicians could be sorted into 5 groups: --volume treatment: incorrect estimation of the severity of polytrauma/incorrect estimation of the amount of blood loss/insufficient substitution of volume/logistical mistakes. --O2 treatment: incorrect estimation of the degree of blunt thoracic trauma/hesitant indication for early artificial respiration/hesitant indication for thoracic drainage. --local treatment: incorrect estimation of the severity of soft tissue trauma/incorrect treatment of amputated limbs. --logistics and transport: additional iatrogenic laceration of soft tissues due to insufficient reposition and retention/logistical mistakes in choosing in the best means of transport and the best suited hospital for the patient. --special types of trauma: incorrect estimation of the severity of burn trauma/lack of experience in triage in cases of major accidents. To get better results in the early treatment of polytraumatized patients, the installation of a specialized emergency medical service for trauma patients in the main trauma centers of major cities combined with the function of the surgeon in charge for major accidents and catastrophies is to be discussed.