BMC Emergency Medicine最新文献

{"title":"Design and psychometric testing of a moral intelligence instrument for pre-hospital emergency medical services personnel: a sequential-exploratory mixed-method study.","authors":"Fateme Mohammadi, Rasoul Salimi, Salman Khazaei, Mostafa Bijani","doi":"10.1186/s12873-025-01171-6","DOIUrl":"10.1186/s12873-025-01171-6","url":null,"abstract":"<p><strong>Background: </strong>Moral intelligence is a significant and influential factor in the delivery of principled and high-quality care. This is because moral intelligence is the ability to recognize and be sensitive to moral issues, which contributes to the organization of appropriate behavior in the face of moral issues. This is particularly pertinent given that pre-hospital emergency medical services personnel (prehospital EMS personnel) frequently encounter stressful and tension-filled situations. Thus, intelligent reasoning and ethical conduct at the scene of an incident are of paramount importance. Also, there is no special tool available for measuring the moral intelligence of prehospital EMS personnel. Hence, there is a necessity for the design and psychometric evaluation of a specialized instrument to assess the moral intelligence of prehospital EMS personnel with a sequential exploratory approach. Accordingly, the present study was conceptualized and implemented with the objective of designing and psychometrically evaluating an instrument for measuring the moral intelligence of prehospital EMS personnel.</p><p><strong>Methods: </strong>This study employed a mixed-methods design with a sequential exploratory approach. The research was executed in two distinct phases. In the first phase, a conventional content analysis method was utilized to explore narratives expressed by 34 prehospital EMS personnel. It was in the second phase where the psychometric properties including face validity, content validity, construct validity and reliability were measured. A total of 210 prehospital EMS personnel participated for exploratory and confirmatory factor analysis. Kaiser-Meyer-Olkin, Bartlett's tests, Cronbach's alpha coefficient, as well as test-retest were used for data analysis.</p><p><strong>Results: </strong>The moral intelligence of prehospital EMS personnel was conceptualized as emotional stability coupled with intelligent reasoning, oriented towards the provision of ethical care and moral courage in patient advocacy. In the exploratory factor analysis (EFA) phase, the questionnaire was distilled into three dimensions: \"Emotional stability combined with intelligent reasoning\" (11 items), \"Ethical care\" (12 items), and \"Ethical courage\" (7 items), accounting for 74.38% of the observed variance. Confirmatory validity also confirmed the structure of the tool obtained from the previous step. The instrument's reliability, as assessed by Cronbach's alpha coefficient, was reported at 0.95 for the entire scale.</p><p><strong>Conclusion: </strong>The Moral Intelligence Scale for prehospital EMS personnel demonstrated acceptable psychometric properties. Consequently, healthcare administrators may employ this instrument to assess moral intelligence in prehospital EMS personnel. Furthermore, when deemed necessary, they can identify and implement the most appropriate strategies, including educational interventions, to enhance moral intelligence a","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"13"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027835","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":"Psychosocial working conditions and violence prevention climate in German emergency departments - a cross-sectional study.","authors":"Sonja Reißmann, Mannat Guliani, Tanja Wirth, David A Groneberg, Volker Harth, Stefanie Mache","doi":"10.1186/s12873-024-01155-y","DOIUrl":"10.1186/s12873-024-01155-y","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) are high pressure work environments with several psychosocial job demands, e.g., violence, and job resources, e.g., colleague support. So far, the perceptions of working conditions have been compared between doctors and nurses, but there is limited knowledge regarding their respective supervisors. In addition, the violence prevention climate has not been assessed in German EDs before. Thus, the current study focuses on differences in the perceptions of working conditions and the violence prevention climate between the groups of doctor-supervisors, doctor-employees, nurse-supervisors, and nurse-employees within the ED. Further analyses regarding the association between social relations and pressure for unsafe practices are performed, including the moderating role of belonging to one of the aforementioned groups.</p><p><strong>Methods: </strong>A cross-sectional online survey was carried out among N = 370 participants, who were doctors or nurses from German EDs. The Questionnaire for Psychosocial Risk Assessment (QPRA) and the Violence Prevention Climate Scale (VPCS) were applied. Kruskal-Wallis tests were performed for group comparisons, followed by a hierarchical multiple linear regression model and moderation analyses.</p><p><strong>Results: </strong>Statistically significant differences between the groups were found for eight out of 13 variables. The highest number of significant pairwise comparisons was found between the groups of doctor-supervisors and nurse-employees. High job demands regarding work intensity and work interruptions became apparent across all groups. Nurse-employees reported the highest social and emotional demands as well as the highest pressure for unsafe practices regarding violence prevention, significantly differing from the other groups on these variables. The variables of supervisor support and social stressors were found to be significantly predictive of pressure for unsafe practices. Furthermore, there was no moderating effect of belonging to one of the above-mentioned groups in the relationships between variables of social relations and pressure for unsafe practices.</p><p><strong>Conclusions: </strong>Differences found in the current study can help tailor preventive measures according to the needs of distinct professions and positions in order to improve working conditions and the violence prevention climate in EDs. Furthermore, supervisor support should be strengthened while social stressors should be resolved in order to decrease pressure for unsafe practices regarding violence prevention.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"17"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027884","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":"Empowerment of volunteer nursing service providers during disasters: A qualitative study.","authors":"Mostafa Roshanravan, Shandiz Moslehi, Hesam Seyedin","doi":"10.1186/s12873-024-01161-0","DOIUrl":"10.1186/s12873-024-01161-0","url":null,"abstract":"<p><strong>Background: </strong>Volunteers providing nursing services are among the first individuals to arrive at the scene after an incident; therefore, they must use their skills and capabilities to provide necessary care for the injured to prevent problems from worsening and complications from arising. Consequently, having structured empowerment courses for volunteers before disasters seems essential. This research aimed to determine the dimensions and components of empowering volunteer nursing service providers in disasters.</p><p><strong>Methods: </strong>This qualitative study was conducted using a conventional qualitative content analysis approach. Purposeful sampling with maximum variation continued until data saturation was achieved. The participants in this study were 25 individuals. Data collection was performed using semi-structured interviews. The conventional content analysis approach by Graneheim and Lundman was utilized for data analysis. After each interview, the text was entered into MAXQDA software version 2020, and semantic units were identified and coded, with codes categorized based on their similarities. To ensure the data's trustworthiness, we applied key criteria including credibility, dependability, confirmability, transferability, and Authenticity throughout the research process.</p><p><strong>Results: </strong>Among the 25 participants, 16 were male, and nine were female. The Mean age was 45.2 ± 5.6 years, and the Mean work experience was 19.08 ± 4.5 years. After coding the interviews, 253 initial codes were extracted. By merging these codes, 43 subcategories, 15 categories, and six themes were identified. Extracted themes include Infrastructure Initiatives, Effective management, Research development and knowledge management, Cultural Action Measures, Policymaking and legal affairs, Individual Competency Areas.</p><p><strong>Conclusions: </strong>This study highlights the various dimensions and components that empower volunteers providing nursing services during disasters. Training and coordination between nursing managers and other leaders in health sectors are needed to ensure that these volunteers are equipped to provide frontline care in emergencies. Healthcare managers and policymakers can use this study's results to create supportive legislation and training programs to enhance the capabilities of volunteer nursing providers in disasters.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"15"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027854","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":"Enhancing trauma triage in low-resource settings using machine learning: a performance comparison with the Kampala Trauma Score.","authors":"Mike Nsubuga, Timothy Mwanje Kintu, Helen Please, Kelsey Stewart, Sergio M Navarro","doi":"10.1186/s12873-025-01175-2","DOIUrl":"10.1186/s12873-025-01175-2","url":null,"abstract":"<p><strong>Background: </strong>Traumatic injuries are a leading cause of morbidity and mortality globally, with a disproportionate impact on populations in low- and middle-income countries (LMICs). The Kampala Trauma Score (KTS) is frequently used for triage in these settings, though its predictive accuracy remains under debate. This study evaluates the effectiveness of machine learning (ML) models in predicting triage decisions and compares their performance to the KTS.</p><p><strong>Methods: </strong>Data from 4,109 trauma patients at Soroti Regional Referral Hospital, a rural hospital in Uganda, were used to train and evaluate four ML models: Logistic Regression (LR), Random Forest (RF), Gradient Boosting (GB), and Support Vector Machine (SVM). The models were assessed in regard to accuracy, precision, recall, F1-score, and AUC-ROC (Area Under the Curve of the Receiver Operating Characteristic curve). Additionally, a multinomial logistic regression model using the KTS was developed as a benchmark for the ML models.</p><p><strong>Results: </strong>All four ML models outperformed the KTS model, with the RF and GB both achieving AUC-ROC values of 0.91, compared to 0.62 (95% CI: 0.61-0.63) for the KTS (p < 0.01). The RF model demonstrated the highest accuracy at 0.69 (95% CI: 0.68-0.70), while the KTS-based model showed an accuracy of 0.54 (95% CI: 0.52-0.55). Sex, hours to hospital, and age were identified as the most significant predictors in both ML models.</p><p><strong>Conclusion: </strong>ML models demonstrated superior predictive capabilities over the KTS in predicting triage decisions, even when utilising a limited set of injury information about the patients. These findings suggest a promising opportunity to advance trauma care in LMICs by integrating ML into triage decision-making. By leveraging basic demographic and clinical data, these models could provide a foundation for improved resource allocation and patient outcomes, addressing the unique challenges of resource-limited settings. However, further validation is essential to ensure their reliability and integration into clinical practice.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"14"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027858","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":"Comparison of search and rescue operations involving emergency physicians in devastating earthquakes in Turkey: a 24-year experience study.","authors":"Mustafa Ferudun Celikmen, Gülbin Aydoğdu Umaç, Melih Imamoglu, Mümin Murat Yazici, Elif Çiğdem Keleş, Sarper Yilmaz","doi":"10.1186/s12873-025-01174-3","DOIUrl":"10.1186/s12873-025-01174-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the 21st century, disasters (particularly earthquakes, which remain the leading cause of death) continue to be among the foremost issues requiring global emergency response. While the impact of advancing technologies on the environmental and human damage caused by earthquakes is still a subject of debate, search and rescue (SAR) teams and emergency departments (ED), specifically emergency physicians (EPs), play a crucial role in the most acute management of the effects of these earthquakes on human life. This study aims to examine the injury dynamics of two catastrophic earthquakes that occurred in Turkey 24 years apart from the perspective of EPs, utilizing archival records from the SAR teams in which EPs served.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;This study is a cross-sectional investigation analyzing the injury and SAR dynamics of casualties, based on the archives of SAR teams that included 12 EPs, during the 1999 Marmara and 2023 Kahramanmaraş (Maraş) earthquakes (groups).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study, a total of 160 injured individuals who were rescued alive from the rubble were included, with 26.3% (n = 42) from the Maraş group and 73.8% (n = 118) from the Marmara group. Identification of the injured was achieved in 54.8% (n = 23) of the Maraş group and 88.1% (n = 104) of the Marmara group, with an overall identification rate of 79.4% (n = 127) (p &lt; 0.001). The most common injuries among the injured were lower extremity injuries (53.1%, n = 85) and upper extremity injuries (49.4%, n = 79), with the most frequent scenario being the extraction of two individuals from the same location (33.8%, n=54). The most common interventions provided to the injured were intravenous fluid therapy (63.8%, n =102) and oxygen support (57.5%, n =92). The rate of intubation at the scene was 16.1% (n = 19) in the Marmara group and 4.8% (n = 2) in the Maraş group (p &lt; 0.05). Additionally, cardiopulmonary resuscitation (CPR) was administered at the scene in 13.6% (n = 16) of the Marmara group, compared to 2.4% (n = 1) in the Maraş group (p &lt; 0.05). When examining the challenges encountered during SAR operations, the most frequent issue in the Maraş group was identification, affecting 57.1% of the cases (p &lt; 0.001), whereas the most common issue in the Marmara group was entrapment, occurring in 50.0% of cases (p &lt; 0.001). Lighting difficulties were observed at similar rates in both earthquakes (19.0% in Maraş, 19.5% in Marmara; p = 1.000). Additionally, weather conditions posed a challenge in 11.9% of cases in the Maraş group, whereas this issue was not encountered in the Marmara group (p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The 24 years of experience and expertise gained by EPs who served in Türkiye in these operations constitute a valuable global resource. Disseminating this knowledge is crucial not only for managing earthquakes but also for preparing for other catastrophic events that could cause widespread","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"10"},"PeriodicalIF":2.3,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999596","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":"Understanding and measuring workplace violence in healthcare: a Canadian systematic framework to address a global healthcare phenomenon.","authors":"Christian Schulz-Quach, Brendan Lyver, Charlene Reynolds, Trevor Hanagan, Jennifer Haines, John Shannon, Laura Danielle Pozzobon, Yasemin Sarraf, Sam Sabbah, Sahand Ensafi, Natasha Bloomberg, Jaswanth Gorla, Brendan Singh, Lucas B Chartier, Marnie Escaf, Diana Elder, Marc Toppings, Brian Hodges, Rickinder Sethi","doi":"10.1186/s12873-024-01144-1","DOIUrl":"10.1186/s12873-024-01144-1","url":null,"abstract":"<p><strong>Background: </strong>Globally, healthcare institutions have seen a marked rise in workplace violence (WPV), especially since the Covid-19 pandemic began, affecting primarily acute care and emergency departments (EDs). At the University Health Network (UHN) in Toronto, Canada, WPV incidents in EDs jumped 169% from 0.43 to 1.15 events per 1000 visits (p < 0.0001). In response, UHN launched a comprehensive, systems-based quality improvement (QI) project to ameliorate WPV. This study details the development of the project's design and key takeaways, with a focus on presenting trauma-informed strategies for addressing WPV in healthcare through the lens of health systems innovation.</p><p><strong>Methods: </strong>Our multi-intervention QI initiative was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework. We utilized the SEIPS 101 tools to aid in crafting each QI intervention.</p><p><strong>Results: </strong>Using the SEIPS 3.0 framework and SEIPS 101 tools, we gained a comprehensive understanding of organizational processes, patient experiences, and the needs of HCPs and patient-facing staff at UHN. This information allowed us to identify areas for improvement and develop a large-scale QI initiative comprising 12 distinct subprojects to address WPV at UHN.</p><p><strong>Conclusions: </strong>Our QI team successfully developed a comprehensive QI project tailored to our organization's needs. To support healthcare institutions in addressing WPV, we created a 12-step framework designed to assist in developing a systemic QI approach tailored to their unique requirements. This framework offers actionable strategies for addressing WPV in healthcare settings, derived from the successes and challenges encountered during our QI project. By applying a systems-based approach that incorporates trauma-informed strategies and fosters a culture of mutual respect, institutions can develop strategies to minimize WPV and promote a safer work environment for patients, families, staff, and HCPs.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"9"},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11727261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969586","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":"Modelling emergency response times for Out-of-Hospital Cardiac Arrest (OHCA) patients in rural areas of the North of England using routinely collected data.","authors":"Megan Harries, Anastasia Ushakova","doi":"10.1186/s12873-025-01170-7","DOIUrl":"10.1186/s12873-025-01170-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;National response time targets for ambulance services are known to be more strongly maintained in urban areas compared to rural. That may mean that responses in rural areas could be less immediate which can in turn affect survival of those experiencing cardiac arrest. Thus, analysis of variation in response times using routinely collected data can be used to understand which rural areas have the highest need for emergency intervention. In this study we have focused, given the heterogeneity of demographic make up, on a specific area of the North of England. Some areas in North England have shown to have a large proportion of cardiac arrests occurring in a rural setting, specifically, in the anonymised study region this was almost half of the cases at 46.3%. Response times to these areas were found to be over 3.5 minutes slower than for urban areas making it worthy of further exploration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective observation analysis was conducted on routinely collected data from regional ambulance services for areas within the North of England from April 2016 to March 2021. Information was collected on service and geographic characteristics for 1915 incidents. A multivariable linear mixed effect regression model was used to understand the association between geographical, service factors and response times to cardiac arrest patients. To advance previous research which up to now only used visualisations to analyse ambulance response times, the study used a mixed effects model with a variety of predictors, capturing geographical variation alongside service characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From the cases analysed it was found that the mean response time to scene was 9.1 minutes, with a standard deviation of 6.4 minutes. After adjustment for geographic variation and incorporating robust standard errors into the model: distance to the nearest ambulance station (coefficient = 0.61, 95% confidence interval [CI]: 0.56-0.66), urgency of the call (Category 2, second most urgent, compared to the most urgent coefficient = 1.66, 95% CI: 1.13 - 2.18), location of the nearest ambulance station to the incident and the type of crew who attended the incident (Advanced Paramedic when compared to just Paramedic, coefficient = -0.70, 95% CI: -1.24 - -0.16) were all factors which affected response times to scene.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;For each extra km the incident was away from an ambulance station, the response time to scene increased by 37 seconds. The ambulance station which displayed the largest increase in response time, Station L was 170 seconds (95% CI: 79, 261) longer than Station N, which had a median performance across all stations, as measured by median survival rate to return of spontaneous circulation (ROSC). The rural geography of the North of England means that lots of cardiac arrest incidents occur a considerable distance away from the stations, emphasising the need to ","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"8"},"PeriodicalIF":2.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963731","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":"Paramedics and emergency medical technicians' perceptions of geriatric trauma care in Saudi Arabia.","authors":"Naif Harthi, Steve Goodacre, Fiona C Sampson, Meshary Binhotan, Abdullah Suhail Alotaibi","doi":"10.1186/s12873-024-01167-8","DOIUrl":"10.1186/s12873-024-01167-8","url":null,"abstract":"<p><strong>Background: </strong>Saudi ambulance clinicians face unique challenges in providing prehospital care to older trauma patients. Limited geriatric-specific training and complex needs of this population hinder effective management, leading to adverse outcomes. This study explores the perceptions of Saudi ambulance clinicians regarding geriatric trauma care and identify facilitators and barriers to improved care.</p><p><strong>Methods: </strong>A qualitative study was conducted using a purposive sample of Saudi paramedics and ambulance technicians from Riyadh and Makkah using online semi-structured interviews and analysed using the framework method.</p><p><strong>Results: </strong>The qualitative study recruited twenty participants and identified that they reported age-related challenges including physiological changes, polypharmacy, and communication difficulties. They all wanted training and guidelines to improve their knowledge. They reported struggling with communication difficulties, inaccurate adverse outcomes predictions, difficult intravenous cannulations, and cultural restrictions affecting care provision for female patients. We identified organisational barriers (e.g. lack of shared patient records and lack of guidelines) and cultural barriers (e.g. barriers to assessing women, attitudes towards older people, and attitudes towards paramedics) that influenced implementation of knowledge.</p><p><strong>Conclusion: </strong>Ambulance clinicians in Saudi Arabia want guidelines and training in managing older trauma patients but these need to take into account the organisational and cultural barriers that we identified to facilitate implementing knowledge and changing practice to providing improved care.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"6"},"PeriodicalIF":2.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944143","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":"Prediction of post-contrast acute kidney injury by bedside ultrasonography.","authors":"Mümin Murat Yazici, Enes Hamdioğlu, Nurullah Parça, Gürkan Altuntaş, Özcan Yavaşi, Özlem Bilir","doi":"10.1186/s12873-025-01172-5","DOIUrl":"10.1186/s12873-025-01172-5","url":null,"abstract":"<p><strong>Background: </strong>The incidence of contrast-induced acute kidney injury (CI-AKI) in the general population ranges from 0.6 to 2.3%, whereas for specific high-risk patients, the incidence can reach more than 30-40%. Ultrasound measurements of the development of CI-AKI after contrast-enhanced imaging for diagnosis in the emergency department (ED) have yet to be adequately studied. Accordingly, we aimed to evaluate the usefulness of Doppler ultrasound measurements for predicting CI-AKI in patients with normal renal function.</p><p><strong>Methods: </strong>This prospective, observational, single-center study was conducted in the ED of a tertiary teaching and research hospital between 1 January and 1 July 2024. All patients who presented to the tertiary training and research hospital ED, who were admitted to the hospital with a decision to undergo contrast-enhanced tomography for diagnosis, and who did not meet any exclusion criteria were included in the study. Patients included in the study were evaluated by ultrasonographic measurements (interlobar renal artery peak systolic velocity (PSV), interlobar renal artery end-diastolic velocity (EDV), inferior vena cava (IVC) collapsibility index, and renal resistive index (RRI)).</p><p><strong>Results: </strong>The postcontrast RRI cutoff values were calculated to predict CI-AKI. The area under the curve (AUC) for the postcontrast RRI was 0.914, and the cutoff value for the postcontrast RRI was 0.70 (≥), exhibiting 72.7% sensitivity and 95.6% specificity.</p><p><strong>Conclusion: </strong>Postcontrast RRI ultrasound measurements performed after diagnostic contrast imaging in the ED show high specificity in predicting CI-AKI development. Postcontrast ultrasound measurements may predict CI-AKI development, allowing further measures to be taken. Further studies are needed to confirm these findings.</p><p><strong>Trial registration: </strong>Clinical trial number: not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"7"},"PeriodicalIF":2.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944149","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 an Emergency Department opioid alternatives Program implemented within a safety-net hospital system.","authors":"Magda Montague, Charlotte Hopson, Claire Layton, Jennifer Fishe, Ashley Norse, L Kendall Webb, Petra Duran-Gehring, Andrew Bertrand, Jennifer Brailsford, Taylor Munson, Rui Wang, Nolan Menze, Katelyn Perl, Phyllis Hendry, Sophia Sheikh","doi":"10.1186/s12873-024-01168-7","DOIUrl":"https://doi.org/10.1186/s12873-024-01168-7","url":null,"abstract":"<p><strong>Background: </strong>The ongoing opioid epidemic in the United States has reinforced the need to provide multimodal and non-opioid pain management interventions. The PAMI-ED ALT program employed a multifaceted approach in the Emergency Department (ED) developing electronic health record (EHR) pain management order panels and discharge panels, as well as educating patients, clinicians, and ED staff on opioid alternatives, including non-pharmacologic interventions. The primary objective of this analysis was to compare changes in opioid and non-opioid analgesic administrations and prescribing in ED patients with select pain conditions (renal colic, headache, low back, and non-low back musculoskeletal pain) before and after implementation of PAMI ED-ALT. Secondary outcomes included characterizing changes in 30-day ED all-cause recidivism and hospital all-cause admissions within these pain populations.</p><p><strong>Methods: </strong>Demographics, opioid and opioid alternative utilization, hospital admission, 30-day ED returns and change in pain intensity score were collected from January 2019-March 2020 (pre-program implementation) and January 2021-March 2023 (post-program implementation) for both the ED aggregate and program target pain populations.</p><p><strong>Results: </strong>Pain management order panel utilization increased throughout the post-implementation period. When comparing pre to post program data, there was a reduction in opioid administrations and prescriptions for most of the target pain conditions, as well as within the ED aggregate population. Opioid alternative administrations and prescriptions increased for all pain conditions except renal colic. Hospital admissions decreased significantly amongst those with low back pain and headache/migraine and 30-day ED returns significantly declined in those with musculoskeletal pain.</p><p><strong>Conclusion: </strong>Our findings demonstrate an opioid-alternatives program implemented within a safety-net hospital system serving a predominantly socially disadvantaged patient population can lead to changes in ED pain management and potentially reduce 30-day ED recidivism and hospitalizations.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"5"},"PeriodicalIF":2.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944139","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}