Articles: emergency-services.
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To determine if stress levels of emergency medical services (EMS) personnel can be reduced by adjusting work schedules to personnel preferences. ⋯ Stress in EMS personnel increased despite a new schedule pattern designed to accommodate the preferences of EMS personnel.
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To determine the response of physicians to a noncoercive prediction rule for the triage of emergency department patients with chest pain. ⋯ The physicians reported that they looked at the prediction rule during the triage of 115 (46%) of the 252 patients. The likelihood of using the prediction rule decreased significantly with increasing level of physician training. The most common reasons given for disregarding the prediction rule were confidence in unaided decision making and lack of time. The physicians reported that of the 115 cases for which the prediction rule was used, only one triage decision (1%) was changed by it. Future research should explore how prediction rules can be designed and implemented to surmount the barriers highlighted by these data.
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Records of 197 patients admitted to hospital with head injury were studied retrospectively to assess the influence of altered conscious state on injury misdiagnosis in the Emergency department (ED). Diagnostic errors were identified by discrepancies between an initial Injury Severity Score (ISS) calculated according to injuries diagnosed in the ED and a final ISS based on diagnoses confirmed on discharge from hospital, or death. The Glasgow Coma Scale (GCS) was used to assess neurological status. ⋯ The risk of injury misdiagnosis was greatest for thoracic, abdominal and spinal injury, followed in descending order by extremity (limb), head, and external (skin and subcutaneous) injury. Although there was no linear correlation between GCS and ISS discrepancy rate, ISS discrepancies were significantly more frequent in comatose patients that in non-comatose patients (chi 2 = 3.69, 1 df; P < 0.05). Individual staff performance is at least as important as head injury severity in determining diagnostic accuracy on initial assessment in the ED.
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Emerg. Med. Clin. North Am. · May 1994
ReviewEmergency department response to hazardous materials incidents.
Emergency physicians must stay alert to situations that involve toxic chemical exposures. An appropriate response to victims of chemical contamination is important for the victim's outcome and the safety of hospital personnel. ⋯ Chemical contamination may affect one or hundreds of victims. Community planning is essential for an effective response to toxic chemical accidents (Haz-Mat).
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A high proportion of patients admitted to a medical emergency department due to chest pain are directly sent home, since the initial suspicion of acute myocardial infarction (AMI) can be quickly ruled out. ⋯ Patients who came to a medical emergency department due to chest pain, and who were sent home, had a low risk of death and development of infarction during the following year. Survivors after 1 year do, however, more frequently report emotional and psychosomatic symptoms than survivors of AMI.