Intoxications alcooliques massives aux urgences: combien, qui, quoi et comment [Massive alcoholic poisoning in the emergency department: how many, who, what and how?].

Alcohol abuse causes numerous medical and social problems. In spite of the decrease of the global consumption of alcohol per capita in Switzerland during the last years, the cases of massive alcoholic poisoning seem increasing in emergency departments. Very few data is available at the moment on this phenomenon. The present article focuses on this problem within the framework of the emergency department of the CHUV. It aims at bringing to light on the sociodemographic and medical characteristics, as well as on the characteristics of the stay of these patients who are admitted with such a problem, to have a global vision of this phenomenon.

Médecine d'urgence [Emergency medicine: update 2008]

The emergency medicine appears more and more as a transversal discipline, leaning on specific competences regularly updated with evidence-based medicine concepts. This selection of recent articles presents an update on frequent conditions, including the place of neuroimaging for patients with seizures or minor head injuries, the management of acute cocaine intoxications, the diagnosis of aortic dissections, or the management of cardiopulmonary arrest. The primary care physician will find elements of diagnostic or therapeutic strategies. This selection reflects the dynamism of emergency medicine.

Rebuild Iowa Office Quarterly Report, October 2009

The RIO’S October Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Bilan préopératoire pour la chirurgie cardio-vasculaire en urgence [Preoperative assessment in emergency cardiovascular surgery].

In the emergency situation, preoperative patient work-up for cardio-vascular surgery is quite different from the elective setting. We have analyzed a consecutive series of 5576 cases out of which 823 underwent emergency procedures (14.8%). The most frequent problems requiring emergent intervention were peripheral vascular (186 cases; 22.6% of the emergent procedure), followed by coronary artery disease (156 cases; 19.0%), thoracic aortic aneurysms (86 cases; 10.4%), abdominal aortic aneurysms (54 cases; 6.6%), congenital heart disease (36 cases: 4.4%), heart and heart lung transplantation (31 cases; 3.8%), problems with cardiac rythm (25 cases: 3.0%), and others (267 cases: 32.4%). Classification by proportion of urgent procedures with reference to elective operations shows a different picture. As a matter of fact transplantations were always emergency procedures (100%), whereas repair of aortic dissections type A and B was an emergency procedure in 81.5%. Emergency thoracic and abdominal aortic aneurysm repair accounted for 30% and 20% respectively and the corresponding proportion for peripheral vascular surgery is 19%. However, emergency surgery for acute coronary ischemia, valvular and congenital heart disease accounted for somewhat less than 10% for each group of these pathologies. Systematic pre-operative diagnostic work-up is a recognized tool for procedure related risk assessment and superior management of diseases. However, hemodynamic instability and other time related events correlated with negative outcome, are the main driving forces for accelerated diagnostic pathways

Wireless E911 Emergency Communications Fund Iowa Homeland Security and Emergency Management Division of the Iowa Department of Public Defense independent auditor's reports, basic financial statements and supplementary information, June 30, 2009.

Audit report on the Wireless E911 Emergency Communication Fund of the Iowa Homeland Security and Emergency Management Division of the Iowa Department of Public Defense for the year ended June 30, 2009

Iowa 2008 Summer Storms After-Action Report, April 27, 2009

In the summer of 2008, the state of Iowa suffered from a series of severe storms that produced tornadoes and heavy rainfall, which resulted in widespread flooding. The Summer Storms1 lasted from late May through mid-August, with the most intense storms occurring over a month-long period from May 25 to June 25. The Summer Storms exacted a major human and economic toll on Iowa, resulting in 18 fatalities and 106 injuries, forcing the evacuation of approximately 38,000 Iowans, and impacting 21,000 housing units. Iowa’s public and private sectors suffered significant monetary damages. Eighty-six of the ninety-nine counties in the state were included in the Governor’s disaster declarations.

Support services for vulnerable patients by a multidisciplinary team in an emergency department

Introduction: Individuals with poor social determinants of health aremore likely to receive improper healthcare. Frequent Users (FUs) ofEmergency Departments (ED) (defined as >4 visits in the previous12 months) represent a subgroup of vulnerable patients presentingwith specific medical and social needs. They usually account for highhealthcare costs by overusing the healthcare system. In 2008-2009,FUs accounted for 4% of our ED patients but 17% of all our ED visits.Methods: We conducted a prospective cohort of patients admitted toour ED with vulnerabilities in ≥3 specific domains (somatic or mentaldiseases, risk behaviors, social determinants of health, and healthcareuse). Patients were either directly identified by a multidisciplinary team(two nurses, one social worker, one physician) or referred to that teamby the ED staff during opening hours from July 1st 2010 to April 30th2011.Results: 127 patients were included (67% males), aged 43 years (SD15); 65% were migrants. They had a median of 6 ED visits (interquartilerange (IQR) 8-1) in the previous 12 months, representing a total of 697visits. The most frequently affected domains during the index visit were:71% somatic, 61% psychiatric, 75% risk behaviors, 97% social and84% healthcare use issues. Each case required a median of 234minutes (IQR 300-90) dedicated to assess their outpatient network(99% of the patients), to set up an ambulatory medical follow-up (43%)or a meeting with social services (40%).Conclusions: Vulnerability affected ED patients in more than onedomain. Vulnerable patients have complex needs that were difficult toaddress in the time-pressured ED setting. Although ED consultationoffers immediate access to medical care, EDs are dedicated more foracute short-term somatic care. Caring for a growing number ofvulnerable patients requires a different type of management. Limitedevidence shows that multidisciplinary case-management interventionshave demonstrated positive outcomes in terms of reducing ED useand costs, and improvement of patient's medical and social outcomes.A randomized trial of case-management is underway to confirm theresults of observational studies.

Analysis of patient physical restraints usage in a Swiss emergency service

Introduction: Emergency services (ES) are often faced with agitated,confused or aggressive patients. Such situations may require physicalrestraint. The prevalence of these measures is poorly documented,concerning 1 to 10% of patients admitted in the ES. The indications forrestraint, the context and the related complications are poorly studied.The emergency service and the security service of our hospital havedocumented physical restraint for several years, using specific protocolsintegrated into the medical records. The study evaluated the magnitudeof the problem, the patient characteristics, and degree of adherence tothe restraint protocol.Methods: Retrospective study of physical restraint used on adultpatients in the ES in 2009. The study included analysis of medical anddemographic characteristics, indications justifying restraint and qualityof restraint documentation. Patients were identified from computerizedES and security service records. The data were supplemented byexamination of patients' medical records.Results: In 2009, according to the security service, 390 patients (1%)were physically restrained in the ES. The ES computerized systemidentified only 196 patients. Most patients were male (62%). The medianage was 40 years (15-98 years; P90 = 80 years). 63 % of the situationsoccurred between 18h00 and 6h00, and most frequently on Saturday(19%). Substance or alcohol abuse was present in 48.7% of cases andacute psychiatric crisis was mentioned in 16.7%. In most cases,restraint was motivated by extreme agitation or auto / hetero-aggressiveviolence. Most patients (68 %) were restrained with upper limb andabdominal restraints. More than three anatomic restraints werenecessary in 52 % of the patients. Intervention of security guards wasrequired in 77% of the cases. 61 restraint protocols (31 %) were missingand 57% of the records were incomplete. In many cases, the protocolsdid not include the signature of the physician (22%) or of the nurse(43.8%). Medical records analysis did not allow reliable estimation ofthe number of restraint-induced complications.Conclusions: Physical restraint is most often motivated by majoragitation and/or secondary to substance abuse. Caregivers regularlycall security guards for help. Restraint documentation is often missing orincomplete, requiring major improvement in education and prescription.

Rebuild Iowa Office Quarterly Report, January 2010

The RIO’S January 2010 Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Rebuild Iowa Office Quarterly Report, April 2010

The RIO’S April 2010 Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Rebuild Iowa Office Quarterly Report, July 2010

The RIO’S July 2010 Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Rebuild Iowa Office Quarterly Report, October 2010

The RIO’S October 2010 Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.