Articles: emergency-medicine.
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Despite the initial successes achieved in early emergency medical services (EMS) systems, many prehospital care services have developed without the intense involvement of physicians whose interest fueled the first experimental medical programs of prehospital care. Among a myriad of variables affecting EMS is the important element of intense, authoritative physician involvement in education, field supervision, and research. Recognizing this problem, many states now have legislated that EMS systems be closely supervised by medical directors. ⋯ It has been the experience of major urban EMS systems that field participation by physicians has lent irrefutable credibility to the authority of medical directors. Beyond the obvious benefits of quality assurance and supervision, the in-field EMS physician provides the impetus and leadership for EMS research conducted at the street level. Because EMS is the practice of medicine through physician surrogates in a prehospital setting, it sets the stage and tone for subsequent patient care and outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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The growing number of elderly in the United States will continue to increase the demand for emergency services. Although the emergency medicine core curriculum, as defined by the American College of Emergency Physicians, requires mandatory training in pediatrics, there is no mention of geriatric care. A special body of knowledge regarding normal aging as well as the special presentation of disease in the elderly is required to provide optimum care for the aged patient. ⋯ This curriculum identifies specific educational objectives for training in geriatric emergencies that can be summarized as follows: identify those impairments and functional disorders that often complicate diagnosis and therapy; acquire an understanding of how physiologic changes in aging affect normal laboratory and radiologic values; develop knowledge of drug side effects and interactions in this population; understand and treat the group of disease peculiar to the elderly; recognize diseases and injuries that present a different clinical picture in old age; and differentiate and treat common psychosocial emergencies in the elderly. These educational objectives are further defined using a specific interlinked framework of didactic presentations, journal clubs, case conferences, therapeutic audits, formal rotations, and consultants. This format will provide valuable educational experiences for the emergency medicine resident and may strengthen positive attitudes toward geriatric medicine.
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New guidelines on tetanus prophylaxis in wound management have been prepared by the American College of Surgeons and are available in a poster format or in bulletins. The purpose of this study was to determine the impact of these educational brochures on tetanus prophylaxis in a hospital setting. The results of this study indicate that these informational brochures and posters had insignificant impact on the quality of prophylaxis against tetanus in our hospital. Innovative programs of information exchange and quality assurance are urgently needed to improve the delivery of health care.