BMC Emergency Medicine最新文献

{"title":"Human trafficking screening in Saskatoon Emergency Departments: What can be learned from high-risk patient presentations?","authors":"Shayan Shirazi, Tracy D Wilson, Maryellen Gibson, Lynsey Martin, James Stempien","doi":"10.1186/s12873-024-01130-7","DOIUrl":"10.1186/s12873-024-01130-7","url":null,"abstract":"<p><strong>Objective: </strong>Studies have shown that Emergency Department physicians have little to no training in recognizing and supporting victims of human trafficking despite being uniquely situated to identify and intervene on behalf of these patients. We assessed if screening for human trafficking was being completed by emergency physicians in three Saskatoon emergency departments.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients presenting to three Saskatoon emergency departments deemed to potentially be at risk of human trafficking, based on discharge diagnosis. Of the 223 included charts, data extracted included sex, age, ethnicity, chief complaint, diagnosis, disposition, HT Screening (Y/N), specific quotes relating to HT, time of visit, intimate partner violence (Y/N), and travel history. Both quantitative and qualitative thematic analyses were conducted on this data.</p><p><strong>Results: </strong>None of the charts (0%) included in this study had any documentation around screening for human trafficking. Furthermore, 21.1% of the high-risk patient charts included in this study -- which included many patients with a discharge diagnosis of sexually transmitted disease or pelvic inflammatory disease -- did not contain a documented sexual history. Thematic analysis revealed that the patients included in this study frequently had challenges with sexual health, substance use, and houselessness.</p><p><strong>Conclusion: </strong>This study found that Emergency physicians in Saskatoon were not routinely screening for human trafficking. Implementation of further training is needed to help these physicians recognize and subsequently support potential victims of human trafficking.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"228"},"PeriodicalIF":2.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Saudi paramedics' experiences in managing adult trauma cases: a qualitative study.","authors":"Ateeq Almuwallad, Naif Harthi, Hussin Albargi, Bahja Siddig, Rayan Jafnan Alharbi","doi":"10.1186/s12873-024-01145-0","DOIUrl":"10.1186/s12873-024-01145-0","url":null,"abstract":"<p><strong>Background: </strong>Saudi paramedics face numerous challenges while providing care for adult trauma patients affecting their care but little is known about these specific challenges.</p><p><strong>Methods: </strong>A qualitative study was conducted using a purposive sample of Saudi paramedics from the Saudi Red Crescent Authority (SRCA) across various cities. Data were collected through online semi-structured interviews and analyzed using the framework method.</p><p><strong>Results: </strong>A total of 20 paramedics were recruited and interviewed. They identified challenges in trauma response, including coordinating care, ensuring the accuracy and accessibility of patient information, and maintaining confidence and readiness. Participants emphasized the need for independent knowledge acquisition through courses, simulations, and peer discussions. They also highlighted the need for more paramedics, strategies to reduce burnout, and the importance of accurately assessing patient conditions. Additionally, they also stressed the importance of raising public awareness to enhance trauma care.</p><p><strong>Conclusion: </strong>This study explored Saudi paramedics' experiences in managing adult trauma patients. standardized handovers, more staff, and greater public awareness are the main key needs to improve daily practice.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"227"},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health problems among disaster responders to the 2023 Turkey-Syria earthquake: a cross-sectional study.","authors":"Karin Hugelius, Jason Murphy, Karin Blomberg","doi":"10.1186/s12873-024-01143-2","DOIUrl":"https://doi.org/10.1186/s12873-024-01143-2","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to describe perceived health problems among disaster responders after the earthquake in eastern Turkey/Syria in February 2023.</p><p><strong>Methods: </strong>A non-probability cross-sectional study was conducted using an online survey.</p><p><strong>Results: </strong>A total of 525 local (18%) and international disaster responders (81%) participated in the study. Of these responders, 46% reported physical or mental health problems during or after their deployment, 15% required medical care during the mission, and 7% required medical evacuation. The most common health problems during the field mission were feeling scared or unsafe, sleeping problems, and headache. After the mission, fatigue, sleeping problems, and feeling depressed were the most frequently reported health problems. The local responders perceived significantly more health problems than did the international responders. Approximately 11% of the participants could not return to their ordinary work after deployment because of infections or mental health issues.</p><p><strong>Conclusions: </strong>Physical and mental health problems are commonly perceived by disaster responders and may reduce the effectiveness of disaster response. Raising awareness of health risks among disaster response workers and employers is essential to ensure proper duty of care and should include reparations and medical support during and after disaster response operations.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"226"},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elderly patients re-transferred from long-term care hospitals to emergency departments within 48 h.","authors":"Tae Young Lee, Sung-Keun Ko, Seong Jung Kim, Jin-Hee Lee","doi":"10.1186/s12873-024-01140-5","DOIUrl":"10.1186/s12873-024-01140-5","url":null,"abstract":"<p><strong>Background & objectives: </strong>The increasing proportion of elderly populations has led to a rise in chronic diseases and frequent transfers between long-term care hospitals (LTCHs) and emergency departments (EDs). This study investigates the patterns of risk factors of initial-transfers and subsequent re-transfers among patients aged 65 or older. Specifically, we focus on those re-transferred from LTCHs to EDs within 48 h of discharge, often without adequate treatment.</p><p><strong>Method: </strong>This nationwide cross-sectional study used data from South Korea's National Emergency Department Information System (NEDIS) from January 1, 2017, to December 31, 2019. Patients aged 65 or older who were initially transferred from LTCHs to EDs and re-transferred within 48 h, were identified. Logistic regression was employed to analyze risk factors associated with re-transfers.</p><p><strong>Results: </strong>140,282 elderly patients were identified as having been transferred from LTCHs to EDs. Of these, 38,180 patients received emergency care in the EDs and were discharged back to LTCHs. Among them, 679 patients were returned to LTCHs after receiving acute treatment but revisited the EDs within 48 h. Hospital ward admission rates were higher for re-transferred patients (71.3%) compared to initial transfers (42.1%, p < 0.0001). Risk factors for re-transfer included male, nighttime admissions, and longer ED stays (> 6 h). Tertiary hospitals showed higher re-transfer rates to other facilities (13.1%) than general hospitals (2.9%).</p><p><strong>Conclusion: </strong>This study reveals that many health outcomes worsen upon re-transfer compared to the initial-transfer. These findings underscore the need for a coordinated healthcare system that ensures elderly patients from long-term care facilities are initially sent to appropriate hospitals during the initial transfer, which could mitigate repeated ED visits and ensure timely care.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"225"},"PeriodicalIF":2.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital telemedicine support for urban stroke care: Analysis of current state of care and conceptualization.","authors":"Daniel Weiss, Christian Rubbert, Marius Kaschner, Gregory Gordon Greiner, Nadja Kairies-Schwarz, Markus Vomhof, Andrea Icks, Linea Weitz, Hanna Hollenberg, Robin Jansen, Til Menge, Rüdiger J Seitz, Sebastian Jander, Michael Bernhard, John-Ih Lee, Tobias Ruck, Sven Guenther Meuth, Bernd Turowski, Julian Caspers, Michael Gliem","doi":"10.1186/s12873-024-01142-3","DOIUrl":"10.1186/s12873-024-01142-3","url":null,"abstract":"<p><strong>Background: </strong>The reduction of processing times in the treatment of acute ischemic stroke is of outstanding importance. Our objective is to analyze the acute stroke care chain from onset to treatment in a city in Germany comprising three stroke units. Additionally, we discuss solutions for detected treatment delays.</p><p><strong>Methods: </strong>We conducted an in-depth analysis of acute stroke care processing times across three local stroke centers in Düsseldorf among all emergency services transportations for suspected stroke. Isochrone mapping was performed to identify areas with prolonged transportation times.</p><p><strong>Results: </strong>Among the 1,714 transportations, 943 patients had confirmed strokes. Prehospital care constituted 58% of total emergency care time until imaging. Patients with confirmed stroke had reduced in-hospital times while patients receiving treatment experienced faster in-hospital times. Isochrone mapping revealed disparities in transportation times within the city.</p><p><strong>Conclusions: </strong>In conclusion, we identified confirmation of stroke symptoms as pre- and in-hospital and treatment eligibility as in-hospital process accelerators in stroke care. We propose the introduction of an in-ambulance video consulting model to accelerate contact to stroke-experts and accelerate processing times for patients eligible for treatment. Furthermore, we discuss the combination of in-ambulance video consulting with imaging and starting treatment outside traditional stroke centers, followed by transportation to a stroke center during thrombolysis, which might further accelerate treatment in specific cases.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"224"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels.","authors":"Sharon A Greenberg, Neta Cohen, Noa Shopen, Reut Aviv Mordechai, David Zeltser, Julieta Werthein","doi":"10.1186/s12873-024-01128-1","DOIUrl":"10.1186/s12873-024-01128-1","url":null,"abstract":"<p><strong>Background: </strong>Chest pain is a common condition in the emergency department (ED). High-sensitivity cardiac troponin (hs-cTn) assays are crucial for diagnosing acute coronary syndrome, but the implications of \"negative but measurable\" hs-cTn levels are not well understood. This study assesses the outcomes of patients with acute chest pain discharged from the ED based on their hs-cTn levels.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed medical records of patients aged 18 and older presenting with chest pain to the Tel Aviv Sourasky Medical Center ED from 2017 to 2022. We compared patients with negative but measurable hs-cTn levels (3-50 ng/L) to those with very low hs-cTn levels (< 3 ng/L). Primary outcomes included 90- days coronary angiogram (CAG), and secondary outcomes were 7- days ED revisits, 14-days hospital admissions, and 30- days mortality.</p><p><strong>Results: </strong>Of 32,162 eligible patients, 23,297 had hs-cTn levels ≤ 50 ng/L. Patients with negative but measurable hs-cTn levels had higher rates of 90-days CAG (1.8% vs. 0.5%, p < 0.001), 7-day ED revisits (5.2% vs. 3.3%, p < 0.001), 14-day hospital admissions (3.1% vs. 0.9%, p < 0.001), and 30-day mortality (0.3% vs. 0.01%, p < 0.001) compared to those with very low hs-cTn levels. Independent predictors for 90 days CAG included age ≥ 57 years, male sex, and hs-cTn ≥ 3.5 ng/L.</p><p><strong>Conclusions: </strong>Negative but measurable hs-cTn levels are linked to worse outcomes than very low hs-cTn levels in discharged ED patients. Closer follow-up and further cardiac evaluation may be warranted for these patients.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"223"},"PeriodicalIF":2.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142725775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triage processes in primary, secondary, and tertiary health care facilities in the Kathmandu Valley, Nepal: a mixed-methods study.","authors":"Lava Shrestha, Bipin Adhikari, Manjita Bajracharya, Nishika Aryal, Anuja Rajbhandari, Sweekriti Shrestha, Rakesh Pariyar, Ramesh K Maharjan, Michael Otieno, Mikaela Watson, Jyotshna Sapkota, Sabine Dittrich, Kevin K A Tetteh, Debashish Das","doi":"10.1186/s12873-024-01139-y","DOIUrl":"10.1186/s12873-024-01139-y","url":null,"abstract":"<p><strong>Background: </strong>In healthcare facilities, an efficient triage system is critical to optimize patient care. The main objective of this study was to explore the triage processes and practices in three different tiers of healthcare facilities in the Kathmandu Valley, Nepal.</p><p><strong>Methods: </strong>A mixed-methods approach in this study comprised observations and interviews in ten healthcare settings across primary care centers (PHC; n = 6), secondary care centers (SHC; n = 3), and tertiary care hospital (n = 1). Data were collected from June to November 2023. Semi-structured interviews were conducted among patients (n = 30) including survey questionnaires among 144 healthcare workers (HCWs) focused on triage. The qualitative data were analyzed using Interpretative Phenomenological Analysis and quantitative data were analyzed to explore the median score on the consistent practice of triage based on the Likert scale.</p><p><strong>Results: </strong>PHCs had designated space for triage with less equipped emergency services and outpatient departments (OPDs) and received severely ill patients rarely. Although prioritizing critical patients and prompt care was part of the services, there was a lack of triage protocols with more than half of the HCWs (56.3%; 36/64) from the tertiary hospital reporting the availability of triage guidelines compared to SHCs (28.1%; 9/32) and PHCs (6.3%; 3/48). The majority of HCWs from the tertiary level recognized triage's effectiveness in reducing time lag, and prioritizing patients. Tertiary level had the consistent use of triage (94%; 60/64) compared to only around two-thirds in SHCs (66%; 19/29) and PHCs (62%; 28/45). Patients often attended PHC services for routine check-ups and were motivated by health insurance, affordability, free medicines, referral cards, and proximity. In the SHC, there was a well-equipped emergency department (ED) with specific guidelines, but its use was infrequent. Patients were unaware of the triage process and its utility. In all settings, while most HCWs had a basic knowledge of triage, some were not confident due to limited exposure to the triage process and training. Many HCWs reported the need for triage-related training and its' consistent implementation.</p><p><strong>Conclusions: </strong>Consistent utilization of triage protocols, coupled with improved infrastructure, resource allocation, and training for healthcare workers is critical for the optimization of triage processes in healthcare settings in the Kathmandu Valley, Nepal.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"222"},"PeriodicalIF":2.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of video laryngoscopy versus direct laryngoscopy for emergency tracheal intubation in emergency department: a propensity score matching analysis.","authors":"Triratana Kongsawaddee, Kumpol Kornthatchapong, Winchana Srivilaithon","doi":"10.1186/s12873-024-01136-1","DOIUrl":"10.1186/s12873-024-01136-1","url":null,"abstract":"<p><strong>Background: </strong>The high incidence of airway management failure in the emergency department (ED) necessitates a comparative analysis of laryngoscopy methods. This study aims to compare the success and complications associated with video-assisted laryngoscopy (VL) and direct laryngoscopy (DL) in emergency tracheal intubation in ED.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at the ED of Thammasat University Hospital. It involved adult patients undergoing emergency tracheal intubation using either VL (GlideScope^®) or DL (Macintosh^®). The outcomes assessed were success rates of intubation and occurrence of peri-intubation adverse events. Propensity score matching and multivariable risk regression analysis were employed for statistical evaluation.</p><p><strong>Results: </strong>The study included 3,424 patients, with 342 in the VL group and 3,082 in the DL group. The initial analysis revealed no significant differences in the intubation success rates between the two methods. However, the VL group experienced fewer peri-intubation adverse events (33% compared to 40%). After propensity score matching, a higher first-attempt success rate was observed in the DL group (88.9% vs. 81.3%, risk difference: 7.6, 95% CI: 1.9 to 13.2, p=0.009), but there was no statistically significant difference in peri-intubation adverse events. VL had a lower first-attempt success rate among low-experience intubators. Subgroup analyses of intubators with moderate and high experience, as well as patients who received both induction agents and neuromuscular blocking agents, show results consistent with the analysis of the entire cohort.</p><p><strong>Conclusion: </strong>Both VL and DL have comparable first-attempt success rates and peri-intubation adverse events. VL is particularly beneficial when used by moderately or highly experienced intubator. The choice of intubation method, combined with clinical experience and technique plays a critical role in the success and safety of emergency intubations.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"221"},"PeriodicalIF":2.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis management in pre-hospital care - the earlier, the better?","authors":"Taline Lazzarin, Raquel Simões Ballarin, Leonardo Zornoff, Suzana Erico Tanni, Sergio Alberto Rupp de Paiva, Paula Schmidt Azevedo, Marcos Ferreira Minicucci","doi":"10.1186/s12873-024-01137-0","DOIUrl":"10.1186/s12873-024-01137-0","url":null,"abstract":"<p><p>Emergency medical services often serve as the initial point of contact for septic patients, offering crucial pre-hospital intervention opportunities. However, the efficacy of pre-hospital interventions remains uncertain. From this perspective, we'll talk about the available evidence of pre-hospital sepsis and septic shock treatment and the barriers to its implementation.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"220"},"PeriodicalIF":2.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Prehospital neurological emergencies- a survey on the state of prehospital neurological assessment by emergency medical professionals.","authors":"Vesta Brauckmann, Dominica Hudasch, Pascal Gräff, Torben Riecke, Gökmen Aktas, Jorge Mayor, Christian Macke","doi":"10.1186/s12873-024-01138-z","DOIUrl":"10.1186/s12873-024-01138-z","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"218"},"PeriodicalIF":2.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}