Emergency Medicine Journal最新文献

{"title":"Mass casualty decontamination following a chemical incident: evaluating improvised and interim decontamination protocols in a controlled cross-over volunteer study.","authors":"Louise Davidson, Felicity Southworth, Natalie Williams, Thomas James, Emily Orchard, Tim Marczylo, Samuel Collins, Richard Amlôt","doi":"10.1136/emermed-2024-214221","DOIUrl":"10.1136/emermed-2024-214221","url":null,"abstract":"<p><strong>Background: </strong>On-scene improvised and interim decontamination protocols in the Initial Operational Response to chemical incidents aim for rapid intervention to minimise injury before specialist capabilities arrive. This study examines the effectiveness of UK improvised and interim protocols conducted in sequence.</p><p><strong>Method: </strong>A simulant with methyl salicylate (MeS) in vegetable oil and a fluorophore was applied to participants' shoulders, arms and legs. Participants either received no decontamination or used one of four decontamination protocols: improvised dry, improvised wet, improvised dry followed by interim or improvised wet followed by interim. Remaining simulant on the skin was quantified using gas chromatography tandem mass spectrometry for MeS analysis and UV imaging for fluorophore detection. Additionally, urine samples were collected for 8 hours post application to analyse MeS levels.</p><p><strong>Results: </strong>Significantly less simulant was recovered from the skin post decontamination compared with no decontamination. There were no differences in the total simulant recovered across all decontamination conditions. However, significantly more simulant was recovered from the shoulder compared with the arm and leg. Variation in simulant recovery from different application areas was significantly higher in improvised-only conditions than in combined conditions. Decontamination did not affect the amount of MeS excreted in urine over 8 hours.</p><p><strong>Conclusion: </strong>This research supports current practice of starting decontamination as soon as possible after chemical exposure and highlights the importance of implementing interim decontamination following improvised decontamination.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"55-61"},"PeriodicalIF":2.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dying matters in the emergency department.","authors":"Sarah Edwards","doi":"10.1136/emermed-2024-214747","DOIUrl":"10.1136/emermed-2024-214747","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cadaveric Dissection Study of the Pericapsular Nerve Group Block: Role of the Iliopectineal Bursa.","authors":"Anirudh Ramachandran, Vinay Saggar, Sherry A Downie, William Murk, Jonathan Maik, John Mascia, Priti Mishall, Adi Pinkas, Michael Halperin","doi":"10.1136/emermed-2024-214240","DOIUrl":"https://doi.org/10.1136/emermed-2024-214240","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nebulised high-dose corticosteroids as add-on therapy for adults with asthma exacerbation: a randomised controlled trial.","authors":"Kumpol Kornthatchapong, Nat Chatchairatanavej, Nattaya Chormai, Winchana Srivilaithon, Chitlada Limjindaporn, Narongkorn Saiphoklang, Jiraporn Sri-On","doi":"10.1136/emermed-2024-213893","DOIUrl":"10.1136/emermed-2024-213893","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding high-dose inhaled corticosteroids (HDICS) in asthma exacerbations in adults is insufficient. This study compares the treatment outcomes of HDICS as add-on therapy to the outcomes of standard treatment in adult patients with acute asthma exacerbation in the ED.</p><p><strong>Methods: </strong>This was a single-centre, triple-blind, randomised controlled trial conducted in the ED in Thailand between March 2022 and April 2023. Adult patients with asthma exacerbation were randomly assigned to receive either a placebo (normal saline) or HDICS (budesonide 9000 µg) nebulisation combined with beta agonist and ipratropium within the first hour. The primary endpoints were length of ED stay, hospital admission and ED revisit. The secondary endpoints were dyspnoea scale, pulmonary functions, length of hospital stay and home exacerbation after ED discharge.</p><p><strong>Results: </strong>A total of 88 patients were randomly assigned to one of two groups: 44 patients received a HDICS and 44 patients were placed in the control group. The HDICS group had a significantly shorter ED length of stay (adjusted mean difference -133.6 min; 95% CI -242.4 to -24.8 min; p=0.016), and a higher proportion of ED discharged home within 8 and 16 hours compared with the control group. However, there were no significant differences between the two groups in hospital admission rates, ED revisit, dyspnoea scale, pulmonary functions, length of hospital stay or home exacerbation after ED discharge.</p><p><strong>Conclusions: </strong>HDICS may be useful as an add-on therapy to standard treatment for asthma exacerbation in adults to reduce ED stay.</p><p><strong>Trial registration number: </strong>TCTR20201214001.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of emergency services in response to a flood: an account of the aftermath of the May 2023 flood in Romagna, Italy.","authors":"Andrea Portoraro, Giorgia Vallicelli, Andrea Strada, Gabriele Farina, Roberto De Giorgio, Simona Rosa, Davide Golinelli, Roberto Grilli","doi":"10.1136/emermed-2024-214176","DOIUrl":"10.1136/emermed-2024-214176","url":null,"abstract":"<p><strong>Background: </strong>Extreme weather events due to human activities have significantly increased the frequency and severity of hydrological disasters like floods, impacting human health and healthcare systems worldwide. This study analyses the patterns of emergency service utilisation of the May 2023 flood in Romagna, Italy, and specifically investigates the differences in emergency department (ED) visits and mortality between individuals exposed and not exposed to the flood.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including 813 724 citizens of Romagna, Italy, from 15 May to 31 August 2023 (ie, 14 weeks after flood inception). The study differentiated between individuals in flood-affected (exposed) and non-affected (unexposed) areas, assessing ED visit rates (overall and by disease category), hospitalisation odds and mortality. Data were analysed using multivariate regression models, adjusting for demographic variables, comorbidities and social frailty, assessed using the Deprivation Index.</p><p><strong>Results: </strong>Of the study population, 586 437 were exposed to the flood, while 227 287 were not exposed. ED visits totalled 33 331 for those exposed to the flood and 13 185 for the unexposed group. Overall, 27 527 (4.7%) of those in the exposed group and 10 829 (4.8%) in the unexposed group experienced at least one ED visit (OR 0.98; 95% CI 0.96 to 1.01). Frequency of access with severe triage scores was higher among those exposed as well as rate of hospitalisation after ED visit. Among those exposed, the rate of ED admission was lower for ophthalmology diseases (OR 0.84; 95% CI 0.77 to 0.92) and general disorders and minor problems (OR 0.85; 95% CI 0.78 to 0.93), and higher for trauma (OR 1.22; 95% CI 1.09 to 1.36) and mental health disorders (OR 1.40; 95% CI 1.17 to 1.75). Exposed individuals had a slightly increased risk of death in the subsequent weeks (OR: 1.09; 95% CI 1.00 to 1.19).</p><p><strong>Conclusion: </strong>The May 2023 flood in Romagna revealed enhanced vulnerability of the directly affected population, as shown by higher acuity ED presentations and subsequent hospitalisations, as well as more visits for trauma and mental health.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with late hospital arrival in acute stroke patients of Bangladesh.","authors":"Mohammad Azmain Iktidar, Ridwana Maher Manna, Muntasrina Akhter, Simanta Roy, Atia Sharmin Bonna, Sreshtha Chowdhury, Renessa Yousuf, Farzana Ahammad Mimi, Md Samee U Sayed, Miah Md Akiful Haque, Mohammad Delwer Hossain Hawlader","doi":"10.1136/emermed-2024-214182","DOIUrl":"10.1136/emermed-2024-214182","url":null,"abstract":"<p><strong>Objectives: </strong>Underutilisation of thrombolysis is a major problem in patients with stroke in Bangladesh as patients do not arrive within the therapeutic window due to delays in their way to emergency department. This study aims to assess the time delay from patients' symptom onset to arrival in the hospital and the factors that are associated with it.</p><p><strong>Methods: </strong>This cross-sectional survey of a prospective cohort of stroke patients was conducted between January and March 2023. 448 stroke patients meeting the inclusion criteria were enrolled in the study from five tertiary-level hospitals in Bangladesh. After obtaining informed consent, trained data collectors conducted face-to-face interviews of the patient/patients' guardians via a pretested structured questionnaire. Stata (V.16) was used to analyse data. Median and IQRs were used to summarise quantitative variables, and qualitative variables were summarised using frequency and relative frequency. Pearson's χ² test and Mann-Whitney U test were used to explore the bivariate relationship between predictor and outcome variables. Finally, a binary logistic regression model was fit to explore the factors associated with delayed arrival (>4.5 hours) at the hospital.</p><p><strong>Results: </strong>The median age of the patients was 61 years (54-70) and 63% were men. The majority hailed from rural (59.6%) areas and had primary (25.89%) education. The patients had an overall median prehospital delay of 14 (8-28) hours, 3 (1-6) hours of decision delay, 1 (0-2) hours of medical contact delay, and 14 (6.5-25.75) hours of referral delay. Patients with master's education (adjusted OR (AOR): 0.04, p=0.023) and private transport (AOR: 0.26, p=0.029) had a lower chance of late arrival. However, patients having unknown onset, self-medicating, having a previous history of stroke, and being admitted to a private hospital had a significantly higher chance of late arrival.</p><p><strong>Conclusion: </strong>Nearly 90% of the patients were late to arrive (>4.5 hours) at hospital and referral delay comprises the majority of the prehospital delay. Therefore, fast symptom recognition and the urgency of seeking healthcare as soon as symptoms appear should be the focus of public awareness efforts.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency clinician perceptions of end-of-life care in Irish emergency departments: a cross-sectional survey.","authors":"James Foley, Etimbuk Umana, Saema Saeed, Jeffrey Mulcaire, Owen Keane, Leonard Browne, Mary Jane O' Leary, Conor Deasy","doi":"10.1136/emermed-2023-213534","DOIUrl":"10.1136/emermed-2023-213534","url":null,"abstract":"<p><strong>Background: </strong>Patients with end-of-life care (EoLC) needs present to the emergency departments (ED) frequently and at times, it can be difficult to provide a high standard of care. Within the Irish setting, there is limited literature on the provision of EoLC in EDs and this study, therefore, aimed to evaluate the perceptions of emergency medicine (EM) clinicians regarding the provision of EoLC in EDs in Ireland.</p><p><strong>Methods: </strong>The End-of-Life Care in Emergency Department Study was a cross-sectional electronic survey study of EM doctors working across 23 of the 29 EDs in the Ireland. This study was conducted through the Irish Trainee Emergency Research Network over a 6-week period from 27 September 2021 to 8 November 2021. Analysis of the survey domains regarding knowledge and attitude has been published previously by the present authors, with this current analysis focusing on communication, education and resources for the provision of EoLC in EDs. Descriptive data on outcomes are reported with additional subgroup analysis according to years of experience in EM.</p><p><strong>Results: </strong>Of the 694 potential respondents, 311 (44.8%) had fully completed surveys. The majority (62% n=193) were between 25 and 35 years of age with 60% (n=186) having <5 years' experience in EM; 58% (n=180) were men. Experienced respondents (>10 years' experience) were more likely to agree that they were comfortable discussing EoL with patients and families than those with <5 years' experience (80% vs 32%) (p<0.001). Questions on ED infrastructure revealed that just 23.5% agreed that appropriate rooms are allocated for EoL patients, with just 11.6% agreeing that the physical environment is conducive to the provision of EoLC.</p><p><strong>Conclusion: </strong>EM clinicians agree that they are comfortable breaking bad news and discussing EoLC with patients and families, but disagree that adequate resources and infrastructure are in place to provide a high standard of EoLC in Irish EDs. Challenges exist centred on training and infrastructure and addressing these may lead to enhanced EoLC in the future.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on 'Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools' by Xu <i>et al</i>.","authors":"Giles N Cattermole, Colin A Graham","doi":"10.1136/emermed-2024-214135","DOIUrl":"10.1136/emermed-2024-214135","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in the intention and decision to use emergency medical services for acute coronary syndrome in Australia: a retrospective study.","authors":"Kathryn J Eastwood, Annie Shi, Stuart Howell, Amanda Buttery, Janet E Bray","doi":"10.1136/emermed-2023-213800","DOIUrl":"10.1136/emermed-2023-213800","url":null,"abstract":"<p><strong>Background: </strong>Sex-based disparities in acute coronary syndrome (ACS) presentations exist and women often have worse outcomes after an ACS event. Calling the emergency medical services (EMS) initiates prehospital diagnosis and treatment and reduces in-hospital time to treatment. This study aims to identify factors affecting the intention to call EMS and EMS usage in Australian women and men.</p><p><strong>Methods: </strong>A retrospective cross-sectional analysis was conducted to identify sex differences and associated characteristics in the (1) intention to call EMS and (2) EMS use in the setting of ACS. Data sources included national survey data (2018-2020) and the Victorian Emergency Minimum Dataset (2016-2021). Multivariable analysis identified factors associated with intention and EMS use by sex.</p><p><strong>Results: </strong>Of 34 328 survey participants, fewer men expressed an intention to call EMS if experiencing ACS symptoms than women (62.7% vs 70.4%, p<0.001). Associated factors in men included being of Aboriginal or Torres Strait Islander origin, living in Western Australia, having diabetes or having a lower education level. In both sexes, preferring a non-English language, having cardiovascular risk factors, poor symptom knowledge, living in the Northern territory or no/unclear EMS insurance status were associated with lower intentions to call EMS. Finally, women were less comfortable with calling EMS and more likely to hesitate (69.1 vs 76.7%, p<0.001).Among 51 165 ACS presentations (33.6% women) to Victorian public hospitals, fewer men presented by EMS (62.5% vs 67.7%, p<0.001), however, no associated male-specific characteristics were identified. Women preferring a non-English language or living in outer regional/remote Victoria were less likely to use EMS. Being born overseas or being referral by a healthcare provider was associated with lower EMS use in both sexes.</p><p><strong>Conclusion: </strong>Sex differences were identified in the intention and use of EMS during an ACS event based on cultural background, preferred language and residential regionality. These subgroups' characteristics can be targeted with education to improve EMS use.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where the road ends: emergency care sensitive conditions drive excess mortality in medevac-dependent rural Alaska.","authors":"Brian Rice, Carla Britton, Stacy Rasmus, Tina Hernandez-Boussard","doi":"10.1136/emermed-2024-214444","DOIUrl":"10.1136/emermed-2024-214444","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}