Articles: emergency-services.
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In July 1988, our emergency department adopted a policy of refusing to treat patients in the ED if they failed to have what was considered an emergency condition. Screening examinations were performed by triage nurses to determine whether patients were eligible to be seen in the ED. Patients whose vital signs fell within specific categories and who had one of 50 minor chief complaints were refused care in the ED and referred to off-site clinics. ⋯ Follow-up letters and telephone calls to their clinics identified no patients who needed retriage to an ED, and only 54 patients (1.3%) complained about their referral out of the ED. Only 42 patients returned to the ED within 48 hours of initial triage, and none had a deterioration of their condition. In conclusion, a selective triage system may be used to effectively decompress an ED, although further study is needed to identify potential rare adverse outcomes.
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We evaluated the frequency with which blood alcohol concentrations were obtained in emergency department patients with presumed alcohol impairment, whether physicians counseled impaired patients not to drive, and whether safe transportation was available. ⋯ Presumed alcohol-impaired patients seen in emergency departments frequently have blood alcohol concentrations measured. Despite documented evidence of driving impairment there is little evidence that such patients are counseled not to drive or that safe transportation home is available.
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The AIDS epidemic is having an increasing impact on the practice of emergency medicine. In inner-city emergency departments, significant numbers of patients have unrecognized human immunodeficiency virus (HIV) infection. Transmission of HIV in the health care setting has been predominantly from exposure to patients' infected blood, but most of the exposures (80%) are due to injuries from sharp instruments. ⋯ However, due to methodologic limitations, these figures may be underestimations. The effectiveness of azidothymidine for postexposure prophylaxis has not been shown. Currently, the best protection against HIV and other blood-borne pathogens remains use of universal precautions.
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J Burn Care Rehabil · Mar 1990
Practice Guideline GuidelineHospital and prehospital resources for optimal care of patients with burn injury: guidelines for development and operation of burn centers. American Burn Association.
Each year in the United States burn injuries result in more than 500,000 hospital emergency department visits and approximately 70,000 acute inpatient admissions. Most burn injuries are relatively minor, and patients are discharged following outpatient treatment at the medical facility where they are first seen. Of those patients with injuries serious enough to require hospitalization, about 20,000 are admitted directly or by referral to hospitals with special capabilities in the treatment of burn injury. Hospitals with these service capabilities are normally termed "burn centers." This document defines the system, organizational structure, personnel, program, and physical facilities involved in establishing the eligibility of hospitals with the capability of being identified as burn centers.
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Pediatric emergency care · Mar 1990
Pediatric critical care transport survey: team composition and training, mobilization time, and mode of transportation.
A survey was conducted to determine the current standard of care with regard to team composition and training, mobilization time, and vehicle use for pediatric critical care transport. An evaluation of 30 pediatric referral centers revealed that 60% provide a critical care transport team. Of those teams, the mean number of transports per year was 304. ⋯ All teams included a physician all or most of the time; 100% of teams included a critical care nurse, and 50% always included a respiratory therapist. Ambulances alone are used in 28% of systems, with the remainder using combinations of ambulances, helicopters, and fixed wing aircraft. A proposal is presented for future standards in pediatric critical care transport with regard to the factors discussed.