Articles: emergency-medicine.
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We conducted a retrospective study of 262 malpractice claims against emergency physicians insured in Massachusetts by the state-mandated insurance carrier; these 262 claims were closed in the years 1980 through 1987. A total of $11,800,156 in indemnity and expenses was spent for these 262 claims. In 211 cases, the allegation was failure to diagnose a medical or surgical problem. ⋯ Because of the high incidence and dollar losses attached to these eight diagnostic categories, the Massachusetts Chapter of the American College of Emergency Physicians (MACEP) has developed clinical guidelines for the evaluation of these high-risk areas. Of the 184 high-risk claims, 99 claim files were reviewed; 45 of these reviewed claims were judged by physician reviewers as preventable by the application of the MACEP high risk clinical guidelines. From 22.26% to 46.4% of the $11,800,156 spent on the 262 claims could have been saved by the application of the MACEP clinical guidelines.
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Prehospital care has undergone a significant evolution during the past two decades and has been transformed from a transportation service into an advanced life support (ALS) delivery system. Crucial to the quality of such a program is physician knowledge and medical control. ⋯ The resident physician is exposed to a number of varying emergency medical services (EMS) systems, administrative experiences, and most uniquely, functions as a paramedic within our own ALS EMS system. In this manner, we believe the resident best obtains an understanding of the environment, attitudes, and behavior of prehospital personnel.