State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006

BACKGROUND Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. METHODS In 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012. RESULTS In 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available. CONCLUSIONS Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care.

The State of Defence in Europe: State of Emergency? Egmont Paper No. 62, November 2013

None.

The state of emergency management 2000: The process of emergency management professionalization in the United States and Florida

This dissertation analyzes the current status of emergency management professionalization in the United States and Florida using a qualitative case study. I investigate the efforts of various organizations at the national and state levels in the private and public sectors to organize emergency management as a profession. I conceptualize emergency management professionalization as occurring in two phases: the indirect institutionalization of the occupation of emergency management and the formal advancement toward an emergency management profession. The legislative, organizational, and procedural developments that occurred between approximately 1900 and the late 1970s became the indirect institutionalization of the occupation of emergency management. Over time, as our society developed and became increasingly complex, more disasters affect the security of the population. In order to adapt to increasing risks and vulnerabilities the emergency management system emerged and with it the necessary elements upon which a future profession could be established providing the basis for the formal advancement toward an emergency management profession. ^ During approximately the last twenty years, the formal advancement toward an emergency management profession has encompassed two primary strategies—certification and accreditation—motivated by the objective to organize a profession. Certification applies to individual emergency managers and includes all training and education. Accreditation of state and local emergency management agencies is reached by complying to a minimum level of proficiency with established standards of performance. Certification and accreditation are the mechanisms used to create an emergency management profession and thus act as axes around which the field of emergency management is organizing. ^ The purpose of this research is to provide a frame of reference for whether or not the field of emergency management is a profession. Based on sociology of professions literature, emergency management can be considered to be professionalizing. The current emergency management professionalization efforts may or may not be sufficient to achieve the ultimate goal of becoming a legitimate profession based on legal and public support for the exclusive right to perform emergency management tasks (monopoly) as well as self-regulation of those tasks (autonomy). ^

Emergency pre-hospital disaster response training. What's the state of play?

Study/Objective This study examines the current state of disaster response education for Australian paramedics from a national and international perspective and identifies both potential gaps in content and challenges to the sustainability of knowledge acquired through occasional training. Background As demands for domestic and international disaster response increase, experience in the field has begun to challenge traditional assumptions that response to mass casualty events requires little specialist training. The need for a “streamlined process of safe medical team deployment into disaster regions”1 is generally accepted and, in Australia, the emergence of national humanitarian aid training has begun to respond to this gap. However, calls for a national framework for disaster health education2 haven’t received much traction. Methods A critical analysis of the peer reviewed and grey literature on the core components/competencies and training methods required to prepare Australian paramedics to contribute to effective health disaster response has been conducted. Research from the past 10 years has been examined along with federal and state policy with regard to paramedic disaster education. Results The literature shows that education and training for disaster response is variable and that an evidence based study specifically designed to outline sets of core competencies for Australian health care professionals has never been undertaken. While such competencies in disaster response have been developed for the American paradigm it is suggested that disaster response within the Australian context is somewhat different to that of the US, and therefore a gap in the current knowledge base exists. Conclusion Further research is needed to develop core competencies specific to Australian paramedics in order to standardise teaching in the area of health disaster management. Until this occurs the task of evaluating or creating disaster curricula that adequately prepares and maintains paramedics for an effective all hazards disaster response is seen as largely unattainable.

Chemical emergency preparedness and prevention technical assistance bulletin : New York, New York : El Paso County, Colorado : Alexandria, Virginia : State of Maine.

"March 1990."

Chemical emergency preparedness and prevention technical assistance bulletin : Tinker Air Force Base, Oklahoma : State of Connecticut : Cumberland County, Maine : Wyandotte County, Kansas.

Mode of access: Internet.

Chemical emergency preparedness and prevention technical assistance bulletin : state of Ohio : Hamilton County, Ohio : Wallingford, Connecticut : Oauchita Parish, Louisiana.

Mode of access: Internet.

Aspects of state-wide emergency response programs, for municipal wastewater treatment facilities programs

Mode of access: Internet.

The April 13, 1992 Chicago Freight Tunnel Disaster : emergency management efforts by the State of Illinois /

"FEMA-941-DR-IL."

Cerebral perfusion CT: Current state of the art : P44

Purpose: The aim of this educational poster is to introduce the technical principles of cerebral perfusion CT and to provide examples of its clinical applications and potential limitations in the everyday emergency practice. Methods and materials: Cerebral perfusion CT is a well established investigatory tool for many vascular and parenchymal brain dysfunctions. CT perfusion maps allow a semiquantitative assessment of cerebral perfusion. Results: Currently, cerebral perfusion CT has a pivotal role in differentiating reversible from irreversible ischemic parenchymal insult besides its integral role in grading vasospasm after subarachnoid hemorrhage. Furthermore, cerebral perfusion CT can be coupled to acetazolamide administration in order to assess the cerebrovascular reserve capacity before performing extra-/intra-cranial bypass surgery in patients with cerebral vascular insufficiency. Cerebral perfusion CT can also identify diffuse abnormalities of cerebral perfusion in children with traumatic brain injury showing a low initial GCS in order to predict the final outcome regarding the late occurrence of irreversible parenchymal damage. Cerebral Perfusion CT is also able to detect focal parenchymal perfusion abnormalities in acute epileptic seizures. Conclusion: Cerebral perfusion CT can be integrated in the management of many vascular, traumatic and functional disorders of the brain.

Cloud-assisted body area networks: state-of-the-art and future challenges

Body area networks (BANs) are emerging as enabling technology for many human-centered application domains such as health-care, sport, fitness, wellness, ergonomics, emergency, safety, security, and sociality. A BAN, which basically consists of wireless wearable sensor nodes usually coordinated by a static or mobile device, is mainly exploited to monitor single assisted livings. Data generated by a BAN can be processed in real-time by the BAN coordinator and/or transmitted to a server-side for online/offline processing and long-term storing. A network of BANs worn by a community of people produces large amount of contextual data that require a scalable and efficient approach for elaboration and storage. Cloud computing can provide a flexible storage and processing infrastructure to perform both online and offline analysis of body sensor data streams. In this paper, we motivate the introduction of Cloud-assisted BANs along with the main challenges that need to be addressed for their development and management. The current state-of-the-art is overviewed and framed according to the main requirements for effective Cloud-assisted BAN architectures. Finally, relevant open research issues in terms of efficiency, scalability, security, interoperability, prototyping, dynamic deployment and management, are discussed.

The emergency powers in Bangladesh: means for subversion of the rule of law?

The Constitution of Bangladesh empowers the President to proclaim an emergency on the actual or imminent ground of war or external aggression or internal disturbance. However, the insertion of ‘internal disturbance’ in the Constitution as a ground for invoking emergency has provided the executive with the opportunity to proclaim all the five emergencies in Bangladesh on this vague ground for purposes other than that of securing the life of the nation. Furthermore, in the absence of any effective constitutional mechanisms for scrutinising the exercise of emergency powers and a time limit on the continuation of a state of emergency, some of the proclamations of emergency continued even after the alleged threat posed to the life of the nation was over to perpetuate the survival of the party in power by repressing any political threat to the regime. This Article, therefore, recommends for insertion in the Constitution of Bangladesh detailed norms providing for legal limits on the wide power of the executive concerning the proclamation, administration and termination of emergency with a view to ensure that emergencies can no longer be resorted to as the effective means of discarding the rule of law.

Prediciton of emergency events: a multi-task multi-label learning approach

Prediction of patient outcomes is critical to plan resources in an hospital emergency department. We present a method to exploit longitudinal data from Electronic Medical Records (EMR), whilst exploiting multiple patient outcomes. We divide the EMR data into segments where each segment is a task, and all tasks are associated with multiple patient outcomes over a 3, 6 and 12 month period. We propose a model that learns a prediction function for each task-label pair, interacting through two subspaces: the first subspace is used to impose sharing across all tasks for a given label. The second subspace captures the task-specific variations and is shared across all the labels for a given task. The proposed model is formulated as an iterative optimization problems and solved using a scalable and efficient Block co-ordinate descent (BCD) method. We apply the proposed model on two hospital cohorts - Cancer and Acute Myocardial Infarction (AMI) patients collected over a two year period from a large hospital emergency department. We show that the predictive performance of our proposed models is significantly better than those of several state-of-the-art multi-task and multi-label learning methods.