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Effects of a media campaign on resuscitation performance of bystanders: a manikin study
Objective: Cardiac arrest is associated with a poor outcome if cardiopulmonary resuscitation (CPR) is delayed. Nevertheless, CPR performance by laypersons in witnessed cardiac arrest is frequently poor. The present study evaluated the effect of a media campaign on CPR performance. Participants and methods: CPR performance of 1000 individuals who did not have any medical background was evaluated using a resuscitation manikin. The media campaign consisted of flyers, posters, and electronic advertisement. Five hundred individuals were evaluated before the media campaign and 500 individuals after the media campaign. Age and m...
Source: European Journal of Emergency Medicine - February 23, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Prehospital thoracostomy in patients with traumatic circulatory arrest: results from a physician-staffed Helicopter Emergency Medical Service
Conclusion: The outcomes of patients with tCA who underwent prehospital thoracostomy were poor in our group. The early identification of TP and strict algorithm adherence in tCA may improve outcomes. In the future, to reduce the risk of unnecessary thoracic interventions in tCA, ultrasound examination may be useful to identify TP before thoracic decompression. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - February 23, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

A system-wide approach from the community to the hospital for improving neurologic outcomes in out-of-hospital cardiac arrest patients
This study used a before–after design. In 2011, compression-only cardiopulmonary resuscitation (CPR) for citizens, a state-wide standard dispatcher assisted-CPR protocol, medical control for regional emergency medical service (EMS), provision of high-quality advanced cardiac life support (ACLS) with capnography and extracorporeal CPR, and the standard postcardiac arrest care protocol were implemented in the system-wide CPR program. CPR provision and outcomes were compared between the 2009–2010 and the 2012–2013 periods. A multivariate logistic regression model for good outcome of OHCA was used to identify...
Source: European Journal of Emergency Medicine - February 23, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Commence, continue, withhold or terminate?: a systematic review of decision-making in out-of-hospital cardiac arrest
When faced with an out-of-hospital cardiac arrest patient, prehospital and emergency resuscitation providers have to decide when to commence, continue, withhold or terminate resuscitation efforts. Such decisions may be made difficult by incomplete information, clinical, resourcing or scene challenges and ethical dilemmas. This systematic integrative review identifies all research papers examining resuscitation providers’ perspectives on resuscitation decision-making for out-of-hospital cardiac arrest patients. A total of 14 studies fulfilled the inclusion criteria: nine quantitative, four qualitative and one mixed-me...
Source: European Journal of Emergency Medicine - February 23, 2017 Category: Emergency Medicine Tags: Review Article Source Type: research

Reviewing papers for publication: privilege, pain, or perhaps a responsibility
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - February 23, 2017 Category: Emergency Medicine Tags: Editorial Source Type: research

Intubation success rates of prehospital rapid sequence induction
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Intubation success rates of prehospital rapid sequence induction of anaesthesia by physicians versus paramedics
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Has the die been cast? Discharge of body stuffers from the Emergency Department
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

A retrospective analysis of the occurrence of accidents during 20 years of neonatal transport in Liguria region, Italy
The objective of this study is to determine the vehicle accident rate for a specialized emergency medical services-NETS transport system between 1995 and 2015. We reviewed 5035 medical records related to the activity of our NETS from its beginning, in February 1995 to June 2015. We identified the occurrence of three road accidents (rate ∼1 : 1600 transports; 1 : 170 000 driven km), no helicopter accidents and only one technical problem during helicopter use; our service was not involved in any crashes resulting in injury. We discussed some reasons possibly explaining these good result...
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Short Reports Source Type: research

Paediatric workload of an adult retrieval service in Scotland
This study describes the evolution of an adult retrieval service to cover paediatric patients in Scotland outside the remit of the paediatric retrieval service. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Short Reports Source Type: research

A comparison of pediatric basic life support self-led and instructor-led training among nurses
Conclusion: Self-training is not statistically different to instructor-led training in teaching PBLS. Self-evaluated confidence improved, but showed no difference between groups. PBLS may be disseminated through self-training. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

LAT gel for laceration repair in the emergency department: not only for children?
Objective: LAT (lidocaine, adrenaline, and tetracaine) gel is a topical anesthetic that can be applied on lacerations before suturing. It is considered easy to use and less painful than infiltrative anesthesia. Its use in laceration management has been studied the most in younger children. We aimed to describe the potential value of the use of LAT gel in older children and adults with simple lacerations. Materials and methods: As part of a quality audit project, we reviewed all emergency department records of patients who had LAT gel applied for laceration repair in a 3-month period following the initial protocol impleme...
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Incidence and etiology of mortality in polytrauma patients in a Dutch level I trauma center
Conclusion: The mortality rate in polytrauma patients in our institute is considerable and comparable with the international literature. Most patients die because of the effects of the accident (primary trauma). Autopsy and organ donation rates are low in our institution and leave room for substantial improvements in the future. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Tranexamic acid in major trauma: implementation and evaluation across South West England
Conclusion: This is the first study to evaluate the use of TXA in civilian practice in the UK. Our study shows that ambulance service personnel and emergency departments can effectively administer TXA. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Ambulance patients with nondocumented sepsis have a high mortality risk: a retrospective study
Objective: Sepsis is a serious disease leading to high mortality. Early recognition is important because treatment is most effective when started quickly. The primary aim of this retrospective cohort study was to assess how many sepsis patients are documented as septic by ambulance staff. The secondary aims were to investigate how many sepsis patients are transported by ambulance, to compare them with patients transported otherwise, to investigate which factors influence documentation of sepsis and to assess whether documentation influences mortality. Methods: We retrieved all data from ambulance and emergency department...
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Factors influencing intensive care admission: a mixed methods study of EM and ICU
Conclusion: We have described the attitudes of physicians towards ED to ICU referrals in two west of Scotland hospitals, and we have demonstrated that there is a difference in the aspects of the decision-making process. We have developed a model encompassing all factors considered by participants when assessing these difficult referrals. It is hoped that this model will promote shared and more efficient decision-making in the future. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

The 4-hour standard is a meaningful quality indicator: correlation of performance with emergency department crowding
Background: The 4-h standard performance is a controversial quality indicator. Crowding in emergency departments (EDs) causes increased patient morbidity and mortality. The aim of this study was to investigate the relationship between 4-h standard performance and ED crowding as measured by occupancy. Methods: A retrospective observational study was carried out using the computerized Emergency Department Information System. Daily occupancy was considered in three ways: as minutes per day spent at occupancy thresholds of 70, 80, 90 and 100%; as the peak occupancy of resuscitation and majors beds at any point in the day; and...
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

The Swedish specialist examination in emergency medicine: form and function
Conclusion: This model may be of interest to other European countries. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Emergency department-based interventions for women suffering domestic abuse: a critical literature review
Domestic abuse represents a serious public health and human rights concern. Interventions to reduce the risk of abuse include staff training and standardized documentation improving detection and adherence to referral pathways. Interventional studies have been conducted in primary care, maternity and outpatient settings. Women disclosing abuse in emergency departments differ from women attending other healthcare settings, and it is unclear whether these interventions can be transferred to the emergency care setting. This review examines interventional studies to evaluate the effectiveness of emergency department-based inte...
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Review Articles Source Type: research

Disposition of emergency department patients diagnosed with acute heart failure: an international emergency medicine perspective
Many patients with acute heart failure are initially managed in emergency departments (EDs) worldwide. Although some require hospitalization for further management, it is likely that a sizeable proportion could be safely discharged either directly from the ED or after a more extended period of management in an observation-type unit. Identification of low-risk patients who are safe for such an approach to management continues to be a global unmet need. This is driven in part by a lack of clarity on postdischarge outcomes for lower risk patients and a nonexistent consensus on what may be acceptable event rates. The current p...
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Review Articles Source Type: research

Outcomes in emergency care research
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - December 19, 2016 Category: Emergency Medicine Tags: Editorial Source Type: research

Best Abstracts from the Ninth European Congress on Emergency Medicine held in Torino, Italy, 10 to 14 October 2015
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Abstracts Source Type: research

Massive paracetamol overdose associated with mitochondrial dysfunction and pancytopenia, without hepatotoxicity
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Lessons from the REVERT trial
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Modified Valsalva and much more: lessons learned from the REVERT trial
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Contrast Enhanced Ultrasonography in suspected renal colic: response
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

A proposal algorithm for patients presenting to the Emergency Department with renal colic
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Supraglottic airways in difficult access – confirming results in both studies
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Which airways management technique is optimal for trauma patient ventilation?
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Outcomes of electrical injuries in the emergency department: a 10-year retrospective study
Conclusion: No cardiac complications occurred during ED stay or during the 90-day follow-up period. Therefore, the need for continued cardiac monitoring after electrical injury is not supported by our data. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

The prehospital intravenous access assessment: a prospective study on intravenous access failure and access delay in prehospital emergency medicine
Conclusion: Our study offers a simple assessment to identify cases of difficult intravenous access in prehospital emergency care. Of the numerous factors subjectively perceived as possibly exerting influences on cannulation, only the universal – not exclusive to emergency care – factors of lighting, vein visibility and palpability proved to be valid predictors of cannulation failure and exceedance of a 2 min threshold. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Short-term predictive capacity of two different triage systems in patients with acute heart failure: TRICA-EAHFE study
Conclusion: The prediction of the outcome of patients with AHF determined with the MAT/SET or MTS showed scarce differences between the two systems, and their discriminative capacity does not seem to be clinically relevant. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Assessing the inter-rater reliability and agreement of a hybrid assessment framework in the Emergency Department
Conclusion: The use of our hybrid framework improved the inter-rater reliability and agreement in our Emergency Department for a specific group of learners who have had previous Emergency Medicine experience. To improve the reliability of ratings, faculty development has to address how observations and assessments should be synthesized into an overall rating. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Management of body stuffers presenting to the emergency department
Conclusion: Patients developed new or worsening features of drug toxicity within 6 h of presentation. Toxidromes observed are often not drug/class specific, and treatment including gut decontamination and radiography do not aid in expediting discharge. We propose an observation period of 6 h from the time of admission as the time required if the patient is asymptomatic or there is resolution of presenting signs and symptoms. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Interactive videoconferencing versus audio telephone calls for dispatcher-assisted cardiopulmonary resuscitation using the ALERT algorithm: a randomized trial
Objectives: The ALERT algorithm, a telephone cardiopulmonary resuscitation (CPR) protocol, has been shown to help bystanders initiate CPR. Mobile phone communications may play a role in emergency calls and improve dispatchers’ understanding of the rescuer’s situation. However, there is currently no validated protocol for videoconference-assisted CPR (v-CPR). We initiated this study to validate an original protocol of v-CPR and to evaluate the potential benefit in comparison with classical telephone-CPR (t-CPR). Materials and methods: We developed an algorithm for v-CPR, adapted from the ALERT t-CPR protocol. A...
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

The Stop-Only-While-Shocking algorithm reduces hands-off time by 17% during cardiopulmonary resuscitation – a simulation study
Introduction: Reducing hands-off time during cardiopulmonary resuscitation (CPR) is believed to increase survival after cardiac arrests because of the sustaining of organ perfusion. The aim of our study was to investigate whether charging the defibrillator before rhythm analyses and shock delivery significantly reduced hands-off time compared with the European Resuscitation Council (ERC) 2010 CPR guideline algorithm in full-scale cardiac arrest scenarios. Methods: The study was designed as a full-scale cardiac arrest simulation study including administration of drugs. Participants were randomized into using the Stop-Only-...
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Modified Early Warning Score and VitalPac Early Warning Score in geriatric patients admitted to emergency department
Objective: The aim of this study was to evaluate the value of the Modified Early Warning Score (MEWS) and the VitalPac Early Warning Score (VIEWS) in predicting hospitalization and in-hospital mortality in geriatric emergency department (ED) patients. Patients and methods: This prospective, single-centered observational study was carried out over 1 month at the ED of a university hospital in patients 65 years of age and older presenting to the ED. The vital parameters of the patients measured on admission to ED were recorded. The MEWS and VIEWS were calculated using the recorded physiological parameters of the patients. H...
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Emergencies and acute diseases in the collected works of Hippocrates: observation, examination, prognosis, therapy
The collected works οf Hippocrates include a wealth of references to emergencies and acute conditions; if the physician could treat these, he would be considered superior to his colleagues. Works most relevant to current Emergency Medicine are presented. They indicate Hippocrates’ remarkable insight and attention to the value of close observation, meticulous clinical examination, and prognosis. Hippocrates and his followers disdained mystery and were not satisfied until they had discovered a rational cause to diseases. They assigned great significance to distressing signs and symptoms – the famous Hippo...
Source: European Journal of Emergency Medicine - October 20, 2016 Category: Emergency Medicine Tags: Review Article Source Type: research

Research into the evidence basis for widely used emergency department performance indicators should be prioritized
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Throwing good money after bad: should research into Emergency Department performance indicators be prioritized?
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Advanced prehospital airway management in patients with traumatic brain injury
No abstract available (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Correspondence Source Type: research

Hemostatic dressings in civil prehospital practice: 30 uses of QuikClot Combat Gauze
To report the use and describe the interest of hemostatic dressings in a civilian setting, we provided medical prehospital teams with QuikClot Combat Gauze (QCG) and asked physicians to complete a specific questionnaire after each use. Thirty uses were prospectively reported. The wounds were mostly caused by cold steel (n=15) and were primarily cervicocephalic (n=16), with 19/30 active arterial bleedings. For 26/30 uses, hemostatic dressing was justified by the inefficiency of other hemostasis techniques. Those 30 applications were associated with 22 complete cessations of bleeding, six decreases of bleeding, and ineffecti...
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Short Report Source Type: research

Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study
Conclusion: The classical signs and symptoms or rAAA are not always present and patients frequently show additional features that may confound the diagnosis. A high level of suspicion should be adopted for rAAA alongside a low threshold for immediate computed tomography. Further research is required to develop an objective clinical risk score or predictive tool for characterizing patients at risk. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Opportunities and barriers to cardiopulmonary resuscitation training in English secondary schools
Conclusion: The establishment of cardiopulmonary resuscitation training in secondary schools in the UK is achievable. The commonly perceived barriers to establishment of training are all surmountable, but solving them does not necessarily ensure universal coverage. Support from healthcare professionals, in particular public health, is essential to ensure that the training is as widespread as possible. Mandatory inclusion of this training on the school curriculum, as seen in other countries, would result in significantly improved survival rates from out-of-hospital cardiorespiratory arrest. Solutions to improve training hav...
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Epidemiology and aetiology of impaired level of consciousness in prehospital nontrauma patients in an urban setting
Conclusion: Of all EMS calls, patients who presented with an impaired level of consciousness represented 1.4% of all patients, but the fatality rate in those who remained with an impaired level of consciousness during the prehospital phase was considerable. Impaired level of consciousness was associated with a multitude of aetiologies, of which seizures were the most common. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Patient satisfaction in out-of-hospital emergency care: a multicentre survey
Conclusion: Patient satisfaction in out-of-hospital physician-based EMS is generally high. There is room for improvement in areas such as the social skills of dispatchers and EMS-team members and the comfort of the patients during transport. A checklist should be developed for basic articles that patients should take along to hospital and for questions on responsibilities for children, dependent people or pets. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Intravenous dexamethasone in acute management of vestibular neuritis: a randomized, placebo-controlled, single-blind trial
Conclusion: The value of dexamethasone cannot be established, given the small sample and limitations of the present study. Some observations consistent with clinical improvement cannot exclude a true treatment effect, and further study is still warranted. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

A retrospective review of sudden onset severe headache and subarachnoid haemorrhage on the clinical decision unit: looking for a needle in a haystack?
Conclusion: The management of neurologically pristine patients with sudden onset severe headache on a CDU pathway is feasible. In light of the low prevalence of SAH in this population, the decision to follow a negative CT with an LP in all cases needs careful consideration, as CSF results may only rarely confer therapeutic benefit to patients suspected of SAH. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

Characteristics of people who rapidly and frequently reattend the emergency department for mental health needs
Conclusion: Individuals with certain clinical and social characteristics were significantly more likely to reattend EDs and have referral to MHLS rapidly and frequently (i.e. intensely). (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research

A case management intervention targeted to reduce healthcare consumption for frequent Emergency Department visitors: results from an adaptive randomized trial
Conclusion: Our study provides evidence that a carefully designed telephone-based intervention with accurate and systematic patient selection and appropriate staff training in a centralized setup can lead to significant decreases in healthcare consumption and costs. Further, our results also show that the effects are sensitive to the delivery model chosen. (Source: European Journal of Emergency Medicine)
Source: European Journal of Emergency Medicine - September 8, 2016 Category: Emergency Medicine Tags: Original Articles Source Type: research