Frontiers in Disaster and Emergency Medicine最新文献

{"title":"“I feel like I don't matter because of my status as a person”— A mixed-methods, cross-sectional study of emergency department care experiences among equity-deserving groups in Ontario, Canada","authors":"Melanie Walker, Meredith MacKenzie, Stuart L. Douglas, A. Collier, J. Pritchard, Sharleen Hoffe, Patrick A. Norman, Eva Purkey, David Messenger, Susan A. Bartels","doi":"10.3389/femer.2024.1397597","DOIUrl":"https://doi.org/10.3389/femer.2024.1397597","url":null,"abstract":"Equity-deserving groups (EDGs) have increased emergency department (ED) use, and often report negative ED care. Past studies have largely been qualitative and suffer from methodological bias and lack of comparison groups, thereby limiting their identification of interventions to ensure equitable care among equity-deserving populations. This study sought to better understand ED care experiences among EDGs in our local setting.We conducted a community-engaged, mixed-methods cross-sectional study using sensemaking methodology at the Kingston Health Sciences Centre's ED and Urgent Care Centre (Ontario, Canada), as well as at community partner organizations. From June-August 2021, eligible participants were invited to complete a survey about an ED care experience within the previous 24 months. Multiple-choice questions collected demographic/ED visit information including self-identification with up to three EDGs (Indigenous; having a disability; experiencing mental health concerns; persons who use substances (PWUS); 2SLGBTQ+; people who experience homelessness (PWEH); a visible minority; or having experienced violence). We evaluated differences in overall ED care experiences by EDG self-identification using chi-squared tests. Quantitative analysis of survey questions disaggregated by EDG status, and a thematic analysis of participant experiences are presented.Overall, 1,973 unique participants completed the survey (949 controls and 994 EDGs) sharing 2,114 ED care experiences in total. Participants who identified as PWUS, having mental health concerns, 2SLGBTQ+, PWEH, or having a disability, reported more negative overall experiences (p < 0.001). Compared with controls, each of the eight EDGs were statistically more likely to report feelings of judgement/disrespect, that there was too little attention paid to their needs (p < 0.001), and that it was more important to be treated with kindness/respect than to receive the best possible care (p < 0.001). Thematic analysis supported quantitative findings and identified four themes: stigma/judgement, poor staff communication, lack of compassionate care, and patients feeling unsupported.Negative ED care experiences were pervasive among EDGs including feelings of judgement/stigma and a perception that a better understanding of personal situation/identity/culture was needed to improve care. Qualitative findings identified the following future interventions: universal trauma-informed care, improved care for addiction/substance use, and improved access to mental health care resources.","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"100 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of physical therapists in providing care to older adults in welfare shelters during the hyper-acute phase of a disaster: lessons learned in Wajima City, Japan, after the 2024 Noto Peninsula earthquake","authors":"Toshiki Abe, Hiroaki Saito, C. Yamamoto, Yuichiro Eguchi, Kei Sato, Misato Matsumoto, Kengo Hitachi, Sakiko Inoue, Tianchen Zhao, Michioki Endo, T. Sawano, Akihiko Ozaki, M. Tsubokura, Hiroyuki Beniya","doi":"10.3389/femer.2024.1425788","DOIUrl":"https://doi.org/10.3389/femer.2024.1425788","url":null,"abstract":"Natural disasters pose significant challenges to affected communities, particularly vulnerable populations such as older adults. The aftermath of the Great East Japan Earthquake highlighted the necessity of welfare shelters to provide essential care. However, little is known about the specific role of physical therapists in these shelters. The aim of this article is to share the experiences and contributions of physical therapists in a welfare shelter in Wajima, Ishikawa Prefecture, immediately after the 2024 Noto Peninsula earthquake. The earthquake, with a magnitude of 7.6, damaged 76,589 houses, injured over 1,100 people, resulting in 245 deaths. The authors comprised a multidisciplinary team, including physical therapists, that provided short-term medical support at a welfare shelter in Wajima. Through several examples, we describe the contribution of physical therapists to evacuees' health outcomes. Physical therapists played multifaceted roles in the welfare shelter, optimizing living environments, conducting physical screenings, and delivering continuous medical care, including respiratory care and exercise programs. The involvement of physical therapists in post-disaster evacuation shelters is crucial for enhancing emergency health care delivery and promoting community resilience.","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141830989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of advanced practitioners on patients in acute care—A mini review","authors":"Lydia Bauernfeind, Milena Fels, Philipp Dahlmann, Christian Rester, Fritz Sterr","doi":"10.3389/femer.2024.1399779","DOIUrl":"https://doi.org/10.3389/femer.2024.1399779","url":null,"abstract":"Acute patient care is becoming increasingly complex due to various factors (e.g., demographic changes, multimorbidity, organizational changes). Educating healthcare professionals as advanced practitioners at Master's level is one response to these challenges. Meanwhile, there are several empirical insights into advanced roles.To provide an overview on the impact of advanced practitioners on acute care patients' outcomes and safety.We conducted a mini-review. Therefore, a systematic literature search was carried out in the four databases Medline, CINAHL, Cochrane Library, and PEDro. After four researchers screened the results and extracted the data independently, the included studies were analyzed thematically and clustered along patients' outcomes. The results are presented narratively.4,332 records were identified in the systematic search, and 67 articles were included in our review. Of these, the majority (n = 57) addressed the nursing profession. Advanced practitioners demonstrated an overall positive impact on acute care patients. They improved patients' vital signs, and reduced their mortality and adverse events (e.g., thrombosis, pneumonia, pressure injury). In addition, they shortened patients' length of stay and waiting times, and reduced admission rates. Patient satisfaction also increased after their implementation. When being compared to physicians, advanced practitioners in acute care demonstrated similar to equal patient outcomes and safety.The identified studies highlight the benefits of advanced practitioners for acute care patients. While most studies were conducted in emergency departments or intensive care units, further research concerning other acute settings (e.g., psychiatry) or clinical conditions (e.g., cognitive impairment) is recommended.","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"135 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoop and treat: from an historical controversy to the emergency future","authors":"Edouard Lansiaux, Nicholas Cozzi, Oren Wacht, Stéphane Travers, Emmanuel Drouin, Eric Wiel","doi":"10.3389/femer.2024.1340348","DOIUrl":"https://doi.org/10.3389/femer.2024.1340348","url":null,"abstract":"Within the intricate narrative of emergency medical services (EMS), there lies a rich and evolving history of innovation and strategy, a saga that weaves through the fabric of prehospital emergency care. At the heart of this narrative is a compelling dichotomy, often whimsically encapsulated as the “stay and play” vs. “scoop and run” philosophies. These seemingly polar approaches to emergency care represent a tapestry of diverse opinions and practices, each tailored to its unique environmental context, clinical demands, and the relative availability of prehospital and hospital resources. Our comprehensive review delves into the historical evolution of these notions, tracing their roots from the ancient world to the present day. We cast a particular focus on the French model of “prehospital medicalization” and the Anglophone “Scoop and Run” approach, exploring their distinct trajectories and influences. Additionally, we turn our gaze to the Israeli system, a unique hybrid shaped by the American prehospital framework yet distinctively molded by the region's enduring conflict. By drawing on an array of interviews, historical records, and scholarly discourse, this document presents an in-depth exploration of the development of prehospital emergency medicine and its pivotal role in contemporary healthcare. Through this investigation, we aim to elucidate the historical tensions surrounding these concepts, shedding light on their implications for the landscape of modern emergency medical services and the intricate web of factors that shape their organization.","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoop and treat: from an historical controversy to the emergency future","authors":"Edouard Lansiaux, Nicholas Cozzi, Oren Wacht, Stéphane Travers, Emmanuel Drouin, Eric Wiel","doi":"10.3389/femer.2024.1340348","DOIUrl":"https://doi.org/10.3389/femer.2024.1340348","url":null,"abstract":"Within the intricate narrative of emergency medical services (EMS), there lies a rich and evolving history of innovation and strategy, a saga that weaves through the fabric of prehospital emergency care. At the heart of this narrative is a compelling dichotomy, often whimsically encapsulated as the “stay and play” vs. “scoop and run” philosophies. These seemingly polar approaches to emergency care represent a tapestry of diverse opinions and practices, each tailored to its unique environmental context, clinical demands, and the relative availability of prehospital and hospital resources. Our comprehensive review delves into the historical evolution of these notions, tracing their roots from the ancient world to the present day. We cast a particular focus on the French model of “prehospital medicalization” and the Anglophone “Scoop and Run” approach, exploring their distinct trajectories and influences. Additionally, we turn our gaze to the Israeli system, a unique hybrid shaped by the American prehospital framework yet distinctively molded by the region's enduring conflict. By drawing on an array of interviews, historical records, and scholarly discourse, this document presents an in-depth exploration of the development of prehospital emergency medicine and its pivotal role in contemporary healthcare. Through this investigation, we aim to elucidate the historical tensions surrounding these concepts, shedding light on their implications for the landscape of modern emergency medical services and the intricate web of factors that shape their organization.","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"35 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139778361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical assessment to identify pelvic injuries in the prehospital setting: a prospective cohort study","authors":"Pascale Coulombe, Maxime Robitaille-Fortin, A. Nadeau, C. Malo, P. Blanchard, A. Benhamed, M. Émond, Eric Mercier","doi":"10.3389/femer.2024.1346681","DOIUrl":"https://doi.org/10.3389/femer.2024.1346681","url":null,"abstract":"Pelvic injuries can be life-threatening and are challenging to identify in the prehospital phase. This study aimed to assess how pelvic examination is performed by paramedics and to determine the accuracy of their clinical examination when identifying pelvic fractures.This was a prospective cohort study of prehospital interventions including both real and simulated trauma patients between July and August 2022. Data collection for the injured patient was made by an observer who was paired with teams of two consenting paramedics. Data pertaining to the clinical assessment for potential pelvic injuries during all interventions with a trauma patient were collected. Additionally, data were collected during four simulated scenarios of patients with an open-book type pelvic fracture following high-energy trauma mechanisms.A total of 29 trauma-related clinical interventions were assessed. Most patients were female (n = 22, 75.9%) with a mean age of 69.8 (SD 22.2) years. Fall from standing was the main trauma mechanism (n = 21, 72.4%). During 72.4% (n = 21) of all trauma-related interventions, an assessment for pelvic injuries was performed, mostly by pelvic palpation (n = 19, 65.5%), inquiring about the presence of pain (n = 12, 41.4%), searching for deformation (n = 7, 24.1%), and/or assessing leg length (n = 8, 27.6%). No pelvic injury was suspected by the paramedics, but two patients (6.9%) had a pelvic fracture and two (6.9%) had a hip fracture. Simulated cases of high-velocity mechanisms with an open-book pelvic fracture were completed by 11 pairs of paramedics. Most did a clinical pelvic assessment (n = 8, 72.7%) using palpation. When asked after the simulation, nine pairs (81.8%) suspected a pelvic fracture.Pelvic injuries are challenging to identify, and pelvic assessment on the field is not standardized among paramedics. Training is needed to increase awareness relative to pelvic injuries and to improve detection.","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"53 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139844811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical assessment to identify pelvic injuries in the prehospital setting: a prospective cohort study","authors":"Pascale Coulombe, Maxime Robitaille-Fortin, A. Nadeau, C. Malo, P. Blanchard, A. Benhamed, M. Émond, Eric Mercier","doi":"10.3389/femer.2024.1346681","DOIUrl":"https://doi.org/10.3389/femer.2024.1346681","url":null,"abstract":"Pelvic injuries can be life-threatening and are challenging to identify in the prehospital phase. This study aimed to assess how pelvic examination is performed by paramedics and to determine the accuracy of their clinical examination when identifying pelvic fractures.This was a prospective cohort study of prehospital interventions including both real and simulated trauma patients between July and August 2022. Data collection for the injured patient was made by an observer who was paired with teams of two consenting paramedics. Data pertaining to the clinical assessment for potential pelvic injuries during all interventions with a trauma patient were collected. Additionally, data were collected during four simulated scenarios of patients with an open-book type pelvic fracture following high-energy trauma mechanisms.A total of 29 trauma-related clinical interventions were assessed. Most patients were female (n = 22, 75.9%) with a mean age of 69.8 (SD 22.2) years. Fall from standing was the main trauma mechanism (n = 21, 72.4%). During 72.4% (n = 21) of all trauma-related interventions, an assessment for pelvic injuries was performed, mostly by pelvic palpation (n = 19, 65.5%), inquiring about the presence of pain (n = 12, 41.4%), searching for deformation (n = 7, 24.1%), and/or assessing leg length (n = 8, 27.6%). No pelvic injury was suspected by the paramedics, but two patients (6.9%) had a pelvic fracture and two (6.9%) had a hip fracture. Simulated cases of high-velocity mechanisms with an open-book pelvic fracture were completed by 11 pairs of paramedics. Most did a clinical pelvic assessment (n = 8, 72.7%) using palpation. When asked after the simulation, nine pairs (81.8%) suspected a pelvic fracture.Pelvic injuries are challenging to identify, and pelvic assessment on the field is not standardized among paramedics. Training is needed to increase awareness relative to pelvic injuries and to improve detection.","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"4 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139784871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevating emergency care: unleashing the potential of unmanned aerial vehicles in shaping the future of emergency medicine","authors":"Sudip Bhattacharya, Saurabh Varshney, Amarjeet Singh","doi":"10.3389/femer.2023.1289334","DOIUrl":"https://doi.org/10.3389/femer.2023.1289334","url":null,"abstract":"","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of invasive, non-invasive, and pharmacological measures by emergency physicians in the German emergency medical services. A retrospective cross-sectional study from the rescue association Südwestsachsen","authors":"Sebastian Koch, Michelle Suffeda","doi":"10.3389/femer.2023.1302612","DOIUrl":"https://doi.org/10.3389/femer.2023.1302612","url":null,"abstract":"Every citizen in Germany is entitled to qualified emergency medical assistance. Due to annually increasing deployment figures and personnel shortages, it is no longer possible to guarantee 24/7 coverage of all emergency physician locations throughout Germany. Relief can be achieved through changes in the supply structures. Professional field analyses are the basis for the further development of training and care structures.All emergency physician deployments of a location in the rescue association Südwestsachsen that took place between 01.10.2022 and 31.01.2023 were retrospectively evaluated. For this purpose, the analogously created deployment protocols were examined with regard to demographic data as well as the invasive, non-invasive and pharmacological measures performed by emergency physicians.In N = 684 emergency missions, n = 471 (100%) invasive or non-invasive measures were performed by an emergency physician. At n = 383 (81.3%), the most frequently performed invasive measure was intravenous (i.v.) access. There were n = 710 (100%) pharmacological measures performed by an emergency physician. The most frequently performed pharmacologic measure was administration of a full electrolyte solution, with n = 223 (31.4%)Emergency physician interventions do not necessarily involve invasive, non-invasive, or pharmacologic measures. The emergency paramedic learns a variety of invasive, non-invasive, and pharmacologic measures in his or her training and could contribute to the reduction of emergency physician interventions. An adaptation of prehospital care structures based on evidence-based data and an update of the catalog of indications for emergency physician interventions would be elementary for this goal.","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"36 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specialty grand challenge: emergency health services","authors":"Theodore C. Chan","doi":"10.3389/femer.2023.1310474","DOIUrl":"https://doi.org/10.3389/femer.2023.1310474","url":null,"abstract":"","PeriodicalId":470565,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"35 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139010249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}