Accessibility and demand at an Emergency Care Unit: the user's perspective

AIM: To analyze the search for Emergency Care (EC) in the Western Health District of Ribeirão Preto (São Paulo), in order to identify the reasons why users turn to these services in situations that are not characterized as urgencies and emergencies. METHODS: A qualitative and descriptive study was undertaken. A guiding script was applied to 23 EC users, addressing questions related to health service accessibility and welcoming, problem solving, reason to visit the EC and care comprehensiveness. RESULTS: The subjects reported that, at the Primary Health Care services, receiving care and scheduling consultations took a long time and that the opening hours of these services coincide with their work hours. At the EC service, access to technologies and medicines was easier. CONCLUSION: Primary health care services have been unable to turn into the entry door to the health system, being replaced by emergency services, putting a significant strain on these services' capacity.

Epidemiological and clinical characteristics of injuries among adolescents attended at an emergency service in the city of Ribeirão Preto, São Paulo

CONTEXT AND OBJECTIVE: Injuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries among adolescents attended at an emergency service. DESIGN AND SETTING: Retrospective descriptive study on adolescents attended at the emergency service of the Teaching Health Center, Faculdade de Medicina de Ribeirão Preto (FMRP), between January 1, 2009, and September 30, 2009. METHODS: Age, sex, type of injury, site, day and time of occurrence, part of body involved, care received, whether the adolescent was accompanied at the time of injury and whether any type of counseling regarding injury prevention had been given were analyzed. RESULTS: Among 180 adolescents attended, 106 (58.8%) were boys and 74 (41.1%) were girls. Their ages were: 10 to 12 (66/36.6%), 12 to 14 (60/33.3%) and 14 to 16 years (54/30%). The injuries had occurred in public places (47.7%) and at home (21.1%). The main types were bruises (45.1%) and falls (39.2%), involving upper limbs (46.1%), lower limbs (31%) and head/neck (13.1%). The injuries occurred in the afternoon (44.4%) and morning (30%), on Mondays (17.7%) and Thursdays (16.6%). Radiological examinations were performed on 53.8%. At the time of injury, 76.1% of the adolescents were accompanied. Some type of counseling about injury prevention had been received by 39.4%. CONCLUSIONS: Although the injuries were of low severity, preventive attitudes need to be incorporated in order to reduce the risks and provide greater safety for adolescents.

Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a Pediatric emergency room

OBJECTIVE: To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. METHODS: This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS: 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. CONCLUSIONS: The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.

Emergency response to railroad accidents involving hazardous materials

The chemical industry has to face safety problems linked to the hazards of chemicals and the risks posed by the plants where they are handled. However, their transport may cause significant risk values too: it’s not totally possible to avoid the occurrence of accidents. This work is focused on the emergency response to railway accidents involving hazardous materials, that is what has to be done once they happen to limit their consequences. A first effort has been devoted to understand the role given to this theme within legislations: it has been found out that often it’s not even taken into account. Exceptionally a few countries adopt guidelines suggesting how to plan the response, who is appointed to intervene and which actions should be taken first. An investigation has been made to define the tools available for the responders, with attention on the availability of chemical-specific safety distances. It has emerged that the ERG book adopted by some American countries has suggestions and the Belgian legislation too establishes criteria to evaluate these distances. An analysis has been conducted then on the most recent accidents occurred worldwide, to understand how the response was performed and which safety distances were adopted. These values were compared with the numbers reported by the ERG book and the results of two devoted software tools for consequence analysis of accidental spills scenarios. This comparison has shown that there are differences between them and that a more standardized approach is necessary. This is why further developments of the topic should focus on promoting uniform procedures for emergency response planning and on a worldwide adoption of a guidebook with suggestions about actions to reduce consequences and about safety distances, determined following finer researches. For this aim, the development of a detailed database of hazardous materials transportation accidents could be useful.

Emergency direct: studio e implementazione di un'applicazione android per disseminazione di messaggi d'allarme in reti spontanee

In questa tesi inizialmente ci si è occupati di definire ed approfondire le caratteristiche della tecnologia Wi-Fi Direct, illustrandone il funzionamento, l’architettura e gli scenari di utilizzo. Successivamente è stata sviluppata un’applicazione basata su tale tecnologia, con lo scopo di fornire un servizio di disseminazione di messaggi d’aiuto in situazioni di emergenza o di catastrofi naturali, nelle quali la rete cellulare viene inevitabilmente meno. In queste occasioni c’è il bisogno di avere uno strumento che permetta di comunicare in maniera facile, veloce e che sia alla portata di tutti. Caratteristiche e qualità proprie di uno smartphone, dispositivo che oggigiorno è presente nelle tasche di ognuno di noi. L’obiettivo finale infatti, sarebbe quello di creare un applicativo che possa idealmente essere preinstallato in ogni nostro dispositivo, un servizio che sia diffuso, compreso ed utilizzabile istantaneamente da tutti, in modo tale da essere una sicurezza e un aiuto di vitale importanza in situazioni di pericolo. Per lo sviluppo di una tale applicazione ci si è basati sul sistema operativo Android, che è il più diffuso tra gli utenti di tutto il mondo. Nel primo capitolo ci si è occupati di di presentare ed approfondire la tecnologia Wi-Fi Direct, definendone gli ambiti generali di utilizzo e le problematiche che vengono affrontate. Nel secondo capitolo si prosegue con la presentazione della tecnologia in ambiente Android, descrivendo le API fornite da Google per l’utilizzo del servizio in questione. Nel terzo capitolo, dopo un’analisi dei progetti che coinvolgono tale tecnologia, viene illustrata l’applicazione creata, le sue funzionalità e caratteristiche ed eventuali casi d’uso. Nel quarto capitolo è stata inserita la parte più tecnica, dove illustro i problemi incontrati e le modalità di risoluzione degli stessi, insieme alle strutture ed agli oggetti messi a disposizione da Java che sono stati utilizzati. Infine nel capitolo conclusivo è stato fatto un riepilogo del lavoro svolto, indicando le difficoltà incontrate ed eventuali possibili miglioramenti e sviluppi futuri del mio progetto.

Prehospital ultrasound in emergency medicine: incidence, feasibility, indications and diagnoses

Sonography is an established diagnostic procedure in hospitals, but is not routinely used in prehospital emergency medicine. Several studies have addressed the use of ultrasound during helicopter flights and in emergency rooms, few in prehospital settings, but most focused on abdominal blunt trauma. Several case reports describe crucial decisions distinguished by ultrasound.

Emergency skill training--a randomized controlled study on the effectiveness of the 4-stage approach compared to traditional clinical teaching

The "4-stage approach" has been widely accepted for practical skill training replacing the traditional 2 stages ("see one, do one"). However, the superior effectiveness of the 4-stage approach was never proved.

Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

Referral practice among Swiss and non-Swiss walk-in patients in an urban surgical emergency department

To assess the relationship between nationality, gender and age and use of health services among patients visiting an urban university hospital emergency department (ED).

Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department

Introduction The survival of patients admitted to an emergency department is determined by the severity of acute illness and the quality of care provided. The high number and the wide spectrum of severity of illness of admitted patients make an immediate assessment of all patients unrealistic. The aim of this study is to evaluate a scoring system based on readily available physiological parameters immediately after admission to an emergency department (ED) for the purpose of identification of at-risk patients. Methods This prospective observational cohort study includes 4,388 consecutive adult patients admitted via the ED of a 960-bed tertiary referral hospital over a period of six months. Occurrence of each of seven potential vital sign abnormalities (threat to airway, abnormal respiratory rate, oxygen saturation, systolic blood pressure, heart rate, low Glasgow Coma Scale and seizures) was collected and added up to generate the vital sign score (VSS). VSSinitial was defined as the VSS in the first 15 minutes after admission, VSSmax as the maximum VSS throughout the stay in ED. Occurrence of single vital sign abnormalities in the first 15 minutes and VSSinitial and VSSmax were evaluated as potential predictors of hospital mortality. Results Logistic regression analysis identified all evaluated single vital sign abnormalities except seizures and abnormal respiratory rate to be independent predictors of hospital mortality. Increasing VSSinitial and VSSmax were significantly correlated to hospital mortality (odds ratio (OR) 2.80, 95% confidence interval (CI) 2.50 to 3.14, P < 0.0001 for VSSinitial; OR 2.36, 95% CI 2.15 to 2.60, P < 0.0001 for VSSmax). The predictive power of VSS was highest if collected in the first 15 minutes after ED admission (log rank Chi-square 468.1, P < 0.0001 for VSSinitial;,log rank Chi square 361.5, P < 0.0001 for VSSmax). Conclusions Vital sign abnormalities and VSS collected in the first minutes after ED admission can identify patients at risk of an unfavourable outcome.

Optimising care in a Swiss University Emergency Department by implementing a multicentre trauma register (TARN): report on evaluation, costs and benefits of trauma registries

Diagnostic and therapeutic approaches to trauma patients are, depending on experience, equipment and different therapeutic doctrines, subject to wide variations. The ability to compare trauma centres using a standardised trauma register helps to reveal unresolved systemic issues and simplifies the quality management in an Emergency Department (ED).