La consultation infirmière dans un centre d'urgence pédiatrique universitaire suisse [The nurse consultation in a Swiss university paediatric emergency department].

In Switzerland, overcrowding in tertiary emergency departments is a frequent problem, resulting in lengthy waiting times, lower satisfaction on the part of families and a risk for patient's safety. The setting up of a nurse consultation in a university paediatric emergency centre has helped to improve the quality of care in this context.

Evaluation de l'application de la PCIME dans un hôpital de pays développé

1.1 Contexte1 Depuis 20 ans, l'OMS (Organisation Mondiale de la Santé) et l'UNICEF (United Nations International Children's Emergency Fund) ont élaboré un programme basé sur l'EBM (evidence Based Medicine) pour aider les pays en voie de développement à diminuer la mortalité infantile dans leur pays. Le succès de la Prise en Charge Intégrée de la Maladie de l'Enfant (PCIME) a permis de l'implanter dans plus de 100 pays en proposant une stratégie sur 3 plans : amélioration des compétences du personnel soignant, amélioration globale du système de santé et amélioration des pratiques familiales et communautaires en matière de santé. 1.2 Objectifs Cette étude évalue l'impact de l'utilisation des arbres décisionnels et des fiches-types de prise en charge proposés par la PCIME dans un hôpital de pays développé tel que l'HEL (Hôpital de l'Enfance). Nous adapterons les modèles pour 2 populations distinctes, le nourrisson âgé de 1 semaine à 2 mois et l'enfant dyspnéique âgé de 2 mois à 5 ans. 1.3 Méthode Dans une première phase, les prises en charge à l'HEL sont analysées par une grille d'évaluation standardisée permettant de les comparer à la prise en charge type PECIME. Les items insuffisamment effectués selon la grille d'évaluation sont présentés aux médecins avec un rappel du rôle de chacun. La seconde partie évalue l'amélioration obtenue dans les prises en charge. Les résultats des deux études vont permettre l'élaboration d'un premier questionnaire et d'une fiche de type check list pour les parents. L'étude évalue deux prises en charge cliniques distinctes. D'une part les nourrissons âgés de 1 semaine à 2 mois et d'autre part les jeunes enfants âgés entre 2 mois et 5 ans qui se présentent avec une dyspnée aux urgences de l'HEL. 1.4 Résultats escomptés Par le biais d'une récolte de données suffisante et d'une formation dispensée entre les deux phases de l'étude, nous nous attendons à une optimisation de la prise en charge des enfants et de leur famille. 1.5 Plus-value escomptée Nous aimerions qu'une telle étude puisse amener des clefs pour une prise en charge complète de l'enfant et de sa famille, en mettant l'accent sur les points essentiels des différentes parties d'une consultation.

Creació d'un sistema d'informació i una aplicació web per la visualització i consulta dels plans de Protecció Civil

En aquest document es mostra el treball realitzat com a projecte final del Màster en Tecnologies de la Informació Geogràfica de la Universitat Autònoma de Barcelona (UAB). El projecte final s'ha realitzat per i amb la col•laboració de la Direcció General de Protecció Civil (DGPC) del Departament d'Interior de la Generalitat de Catalunya. L'objectiu del projecte ha estat l'elaboració d'un sistema d'informació geogràfica de la Direcció General de Protecció Civil i un visualitzador sobre plataforma web que permetrà que els diferents tècnics puguin consultar i visualitzar els diferents plans de Protecció Civil. Es descriuen les fases de definició del projecte, disseny i implementació del sistema d'informació, i disseny i desenvolupament de l'aplicació web. Finalment es mostren els resultats obtinguts amb l'aplicació web i unes conclusions finals dels objectius i coneixements assolits amb el treball de projecte final de màster.

A Multiagent System for Coordinating Ambulances for Emergency Medical Services

To coordinate ambulances for emergency medical services, a multiagent system uses an auction mechanism based on trust. Results of tests using real data show that this system can efficiently assign ambulances to patients, thereby reducing transportation time. Emergency transportation on specialized vehicles is needed when a person's health is in risk of irreparable damage. A patient can't benefit from sophisticated medical treatments and technologies if she or he isn't placed in a proper healthcare center with the appropriate medical team. For example, strokes are neurological emergencies involving a limited amount of time in which treatment measures are effective

Emergency Management and Wildland-Urban Interface Fires in the United States of America

FEMA's mission is to support our citizens and first responders to ensure that as a Nation we work together to build, sustain, and improve our capability to prepare for, protect against, respond to, recover from, and mitigate all hazards.

Emergency Management in the United States of America

Core capabilities are under the above mission areas as outlined in the National Preparedness Goal. Planning, Public Information and Warning, and Operational Coordination cut across all five mission areas. Without these three cross-cutting capabilities, the other capabilities might not be achieved or could be weakened. Other core capabilities are aligned under a specific mission area, based on where it had the most relevance. Core capabilities alignment: Prevention capabilities focus on things related to preventing an imminent terrorist attack; by imminent, we mean an attack that is about to happen ; Protection capabilities focus on security— making sure things, systems, and people are protected ; Mitigation capabilities focus on risk, resilience and building a culture of preparedness; Response capabilities focus on meeting a community’s immediate needs when disaster strikes and finally, recovery capabilities focus on getting communities back on their feet.

La gestió del regadiu a Catalunya: plans, actors i reptes de futur

Irrigation has traditionally constituted one of the most characteristic and emblematic agricultural mosaics of the Mediterranean as a key factor of socio-economic dynamism of the territorial matrix. In recent years there has been an important scientific, intellectual and social environment mobilization around water uses and, in particular, around the main socio-economic use of resource: irrigation, which is undergoing an intense and accelerated transformation process. Thus, in parallel with the decline of traditional irrigation systems, located in areas with natural availability of water, fertile soil and appropriate topographic conditions, the socio-economic changes in the last decade have stimulated the appearance of new irrigated areas with environmental, social and economic disparate characteristics. As a result, the irrigation management model has been conditioned to respond to the new parameters of water scarcity and resource efficiency. In addition, policies and actors have evolved over time as a consequence of disparate priorities –and often conflicting– in terms of irrigation, making necessary the gear of different discourses. In this context, the Model of social commitment of irrigation proposed by the Institutional and Social Innovations in Irrigation Mediterranean Management (ISIIMM) can become a starting example

Air pollution and emergency admissions for cardiorespiratory diseases in Lisbon (Portugal)

Daily records of hospital admissions due to cardiorespiratory diseases and levels of PM10, SO2, CO, NO, NO2, and O3 were collected from 1999-2004 to evaluate the relationship between air pollution and morbidity in Lisbon. Generalised additive Poisson regression models were adopted, controlling for temperature, humidity, and both short and long-term seasonality. Significant positive associations, lagged by 1 or 2 days, were found between markers of traffic-related pollution (CO and NO2) and cardiocirculatory diseases in all age groups. Increased childhood emergency admissions for respiratory illness were significantly correlated with the 1-day lagged SO2 levels coming from industrial activities.

Problems and potentialities of e-Learning for regular undergraduate courses in emergency medicine

BACKGROUND: E-learning techniques are spreading at great speed in medicine, raising concerns about the impact of adopting them. Websites especially designed to host courses are becoming more common. There is a lack of evidence that these systems could enhance student knowledge acquisition. GOAL: To evaluate the impact of using dedicated-website tools over cognition of medical students exposed to a first-aid course. METHODS: Prospective study of 184 medical students exposed to a twenty-hour first-aid course. We generated a dedicated-website with several sections (lectures, additional reading material, video and multiple choice exercises). We constructed variables expressing the student's access to each section. The evaluation was composed of fifty multiple-choice tests, based on clinical problems. We used multiple linear regression to adjust for potential confounders. RESULTS: There was no association of website intensity of exposure and the outcome - beta-coeficient 0.27 (95%CI - 0.454 - 1.004). These findings were not altered after adjustment for potential confounders - 0.165 (95%CI -0.628 - 0.960). CONCLUSION: A dedicated website with passive and active capabilities for aiding in person learning had not shown association with a better outcome.

Helicopter emergency medical rescue for the traumatized: experience in the metropolitan region of Campinas, Brazil

OBJECTIVE: To analyze the profile of patients served by the air medical rescue system in the Metropolitan Region of Campinas, evaluating: triage and mobilization criteria; response time; on-site care and transport time; invasive procedures performed in the Pre-Hospital Care (PHC); severity of patients; morbidity and mortality.METHODS: We conducted a prospective, descriptive study in which we analyzed medical records of patients rescued between July 2010 and December 2012. During this period, 242 victims were taken to the HC-Unicamp. Of the 242 patients, 22 were excluded from the study.RESULTS: of the 220 cases evaluated, 173 (78.6%) were male, with a mean age of 32 years. Blunt trauma was the most prevalent (207 cases - 94.1%), motorcycle accidents being the most common mechanisms of injury (66 cases - 30%), followed by motor vehicle collisions (51 cases - 23.2%). The average response time was 10 ± 4 minutes and the averaged total pre-hospital time was 42 ± 11 minutes. The mean values of the trauma indices were: RTS = 6.2 ± 2.2; ISS = 19.2 ± 12.6; and TRISS = 0.78 ± 0.3. Tracheal intubation in the pre-hospital environment was performed in 77 cases (35%); 43 patients (19.5%) had RTS of 7.84 and ISSd"9, being classified as over-triaged. Of all patients admitted, the mortality was 15.9% (35 cases).CONCLUSION: studies of air medical rescue in Brazil are required due to the investments made in the pre-hospital care in a country without an organized trauma system. The high rate of over-triage found highlights the need to improve the triage and mobilization criteria.

Critical analysis of thoracotomies performed in the emergency room in 10 years

OBJECTIVE: To conduct a critical analysis of thoracotomies performed in the emergency rooms.METHODS: We analyzed mortality rates and survival as outcome variables, mechanism of injury, site of injury and anatomic injury as clinical variables, and gender and age as demographic variables of patients undergoing thoracotomy in the emergency room after traumatic injury.RESULTS: Of the 105 patients, 89.5% were male. The average age was 29.2 years. Penetrating trauma accounted for 81% of cases. The most common mechanism of trauma was wound by a firearm projectile (gunshot), in 64.7% of cases. Patients with stab wounds (SW) accounted for 16.2% of cases. Overall survival was 4.7%. Survival by gunshot was 1.4%, and by SW, 23.5%. The ERT following blunt trauma showed a 100%mortality.CONCLUSION: The results obtained in the Emergency Hospital of Porto Alegre POA-HPS are similar to those reported in the world literature.

Transoperative refusion: a simple and safe method in emergency surgery

The objective is to reinforce the importance of blood reinfusion as a cheap, safe and simple method, which can be used in small hospitals, especially those in which there is no blood bank. Moreover, even with the use of devices that perform the collection and filtration of blood, more recent studies show that the cost-benefit ratio is much better when autologous transfusion is compared with blood transfusions, even when there is injury to hollow viscera and blood contamination. It is known that the allogeneic blood transfusion carries a number of risks to patients, among them are the coagulation disorders mediated by excess enzymes in the conserved blood, and deficiency in clotting factors, mainly the Factor V, the proacelerin. Another factor would be the risk of contamination with still unknown pathogens or that are not investigated during screening for selection of donors, such as the West Nile Fever and Creutzfeldt-Jacob, better known as "Mad Cow" disease. Comparing both methods, we conclude that blood autotransfusion has numerous advantages over heterologous transfusion, even in large hospitals. We are not against blood transfusions, just do not agree that the patient's own blood is discarded without making sure there will be enough blood in stock to get him out of the hemorrhagic shock.