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). ^

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."

Mortality from asthma in the state of S. Paulo, Brazil (1970-1992)

Mortality from asthma has shown important variations over time in several countries. In Brazil, a mortality study performed in the 60s, covering the cities of S.Paulo and Ribeirão Preto, and other ten cities showed that S.Paulo presented the lowest death rate from asthma among of them all. It was decided to study the time trends of deaths from asthma and from the whole set of respiratory diseases from 1970 to 1992, in the population aged 15-34 yrs. old in the State of S.Paulo, as well as to compare them with those of other countries. Asthma mortality rates during the 23 years of observation since 1975, showed an oscillatory declining pattern with a peak of deaths in the initial years. The linearization of the curve allows the calculation of Pearson's correlation coefficient that was significantly negative, suggesting a decline in the mortality over this period, mainly in the 5-9 yrs. old and 30-34 yrs. old strata. The segmentation of data between the period of ICD-9, 1970 to 1978, and of ICD-9, 1979 and subsequent years, shows that there is stability within each period, in all age-groups, except for that of 5-9 yr. olds between 1970-1978. Comparing the rates of the population aged 15-34 yrs. old for the State of S. Paulo, Brazil, with trends observed in 14 other countries, an intermediate pattern for the first triennial period (1970-1972) as well as for the subsequent triennial periods, emerges. A prevalence study of asthma, a follow up program meant for using emergency rooms and a surveillance of deaths due to all respiratory diseases and specifically to asthma are strongly recommended.

Re-evaluation of the basic procedures involved in the storage of measles vaccine in public health units of the municipality of Niterói, state of Rio de Janeiro, Brazil

Four years after the first visit seventeen public health units were visited again and evaluated as to standards of storage recommended by the Brazilian Immunization Programme. In 100% of the units, refrigerators and proper inside location of vaccines in the refrigerator were adequatety or regularfy maintained and checked, respectively. However, when control of temperature was checked, onfy 64.7% presented adequate storage conditions. In 94.1 % of the units, health workers complained of lack of immediate technical support in emergency situations. In 55.2 % the titers vaccine samples of were under the minimal recommended potency. It is necessary that the factors concerning the cold chain be continualfy evaluated so that the quality of the vaccines that will be used is not affected.

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.

Final Report of Emergency Services Interim Study Committee, February 2007

The Legislative Council established the Emergency Services Interim Study Committee in 2006 and authorized the Committee to meet for two days during the 2006 Legislative Interim. Upon request by the Committee, the Legislative Council subsequently approved a third meeting. The Committee was charged to study the governance, structure, and funding of the state's emergency services and available training for emergency services providers, and receive input from the Department of Public Defense's Division of Homeland Security and Emergency Management; Departments of Human Services, Public Health, and Public Safety, including the State Fire Marshal; and representatives of emergency services providers, including the Iowa Firemen's Association, Iowa Fire Chiefs' Association, Iowa Association of Professional Fire Chiefs, Iowa Professional Fire Fighters, Iowa Emergency Medical Services Association, and emergency room physicians.

La chaîne des secours: le modèle vaudois [An efficient example of a Swiss pre-hospital chain of survival: the state of Vaud model].

The state of Vaud model of the pre-hospital chain of survival is an example of an efficient way to deal with pre-hospital emergencies. It revolves around a centrally located dispatch center managing emergencies according to specific key words, allowing dispatchers to send out resources among which we find general practitioners, ambulances, physician staffed fast response cars or physician staffed helicopters and specific equipment. The Vaud pre-hospital chain of survival has been tailored according to geographical, demographical and political necessities. It undergoes constant reassessment and needs continuous adaptations to the ever changing demographics and epidemiology of pre-hospital medicine.

Current state of knowledge on neuroendocrine small bowel tumours: non-systematic review of the literature based on one case.

More than 60% of neuroendocrine tumours, also called carcinoids, are localised within the gastrointestinal tract. Small bowel neuroendocrine tumours have been diagnosed with increasing frequency over the past 35 years, being the second most frequent tumours of the small intestine. Ileal neuroendocrine tumours diagnosis is late because patients have non-specific symptoms. We have proposed to illustrate as an example the case of a patient, and on its basis, to make a brief review of the literature on small bowel neuroendocrine tumours, resuming several recent changes in the field, concerning classification criteria of these tumours and new recommendations and current advances in diagnosis and treatment. This patient came to our emergency department with a complete bowel obstruction, along with a 2-year history of peristaltic abdominal pain, vomits and diarrhoea episodes. During emergency laparotomy, an ileal stricture was observed, that showed to be a neuroendocrine tumour of the small bowel.

Shelter study for the state of Iowa, 1958

This study examines the possible construction and use of shelters in the event of a nuclear weapon attack in seven target areas in Iowa. It covers such topics as cost, survival percentages, best location to build shelters and how many will be needed.