bluuebunny/crossref_metadata_2025_split huggingface dataset:
(P2-19) A Modular Portable Emergency Department Expansion Setup, Experience during the H1N1 Pandemic
Authors: Little C.M. , Evans B. , Yaron M. 
Published: May 2011

The recent H1N1 pandemic presented severe challenges to many emergency departments (ED). At our institution it caused overcapacity issues with increasing length of stay and increasing patients leaving before treatment. The emergency department space at the hospital was already fully used including hallway beds. Other clinical space could not be taken for ED expansion, as it was also all maximally used.MethodsPortable mobile ED expansion modules were developed consisting of ED supply carts, pharmacy items and a wireless ED information system (EDIS) integrated with computers on wheels. This EDIS provided internet access from anywhere in the hospital, enabling access to clinical databases, order entry for testing, medications and discharge instructions, providing full operability of ED functions. This complete assembly can be stored in a small storage area. The H1N1 pandemic allowed for practical testing of this system. This system was deployed to a nearby hospital clinic that closed at 5 pm. The expansion module operated from 6pm to 10pm staffed with two providers. Data was compared between days when the surge clinic was in operation and days it was not. Data was collected on patients seen and left without being seen rates.ResultsDuring the trial period of 9 days, 1323 patients were seen in the ED and 112 were seen in the modular clinic setting, representing 8.5% of the total ED volume. No technical problems were noted and the system worked as designed. We observed increased satisfaction from both staff and patients. No reduction in the number of patients leaving without treatment was noted in either group (5/day).ConclusionA modular portable ED expansion setup is practical and may increase ED capacity at times of maximal patient volumes. These materials are easily storable and build surge capacity for other events.
(P2-22) Proposed Model for Cellular Medical Record in Emergency Medicine
Authors: Friedman N. , Goldberg A. 
Published: May 2011

IntroductionIn a hypothetical situation, an emergency services team is launched to treat a man who collapsed in the street. The team finds John Doe's mobile phone, and within seconds retrieves the required clinical parameters from his Mobile Medical Record (MMR), thus, providing a life-saving treatment suited to his personal health condition. This study seeks to determine if the necessary clinical parameters, required at emergency situations have ever been examined in order to best match both emergency situations and cellular technology.ObjectiveTo characterize the clinical parameters that make up an MMR in the context of saving lives, and to propose a model for an MMR in emergency medicine.MethodsThe essential emergency medicine clinical parameters in the context of life-saving treatments were characterized through interviews with prehospital and hospital experts in emergency medicine. The results were analyzed with the help of a cellular multimedia expert in order to best incorporate the clinical parameters into cellular phones as MMRs.ConclusionEmergency medicine teams chose individual and specific clinical parameters in a certain order of appearance from the general medical record that should assembly, in their opinion, an emergency medicine MMR. A MMR was chosen by the emergency medicine treatment teams as one of their preferred communication methods. The MMR model, if applied correctly, will provide the emergency medicine treatment teams an available, reliable, homogeneous database of real time clinical parameters adapted to life-saving conditions. The MMR model represents a conceptual revolution of taking the medical record from the caregiver and transferring it to the patient, which can be constantly at hand at any given time or place in their mobile phones.
(P2-25) Evaluation of the Apache III Grading System in Predicting the Prognosis and Mortality of Patients Admitted to Emergency Room, in Need of Intensive Care Unit Admission
Authors: Hatamabadi H. , Darbandsar P. , Abdalvand A. , Kariman H. , Arhamidolatabadi A. 
Published: May 2011

ObjectivesMany of critically ill patients are being cared for prolonged periods in ED just because of limited number of ICU beds and utilize of ED as the entry point to the health care system. The aim of this study is evaluation efficiency of APACHE III scoring system in predicting mortality rate of the mentioned patients.Materials and MethodsThis cross-sectional, observational, analytic study was performed in one year period. A hundred patients remaining in ED and necessitating ICU hospitalizing were enrolled by the convenience type of non-probability sampling. Then, the APACHE III scores, predicted and observed mortality rates were calculated using of information obtained from patients' files, interview with the patients' family and performing required physical exams and lab tests.ResultsIn the assessment of 100 patients, men group were 56% (56) and women group 44% (44). The age of patients and the ED lengths of stay were 66.07 ± 19.92 years and 5.11 ± 3.79 days respectively. The average (± SD) of APACHE III score of the enrolled patients was 58.89 ± 18.24 and the predicted mortality rate calculated 32.73%; while, the total of observed mortality rate was 55%. The average (± SD) of APACHE III score of survivors and non-survivors were 48.63 ± 16.35 and 67.63 ± 14.84 respectively. So, there was a significant deference (p < 0.001). Also, there was a significant deference in the ED lengths of stay between survivors and non-survivors (3.20 ± 1.34 and 6.57 ± 4.40 respectively, p < 0.001).ConclusionIn our study, APACHE III score and ED lengths of stay were higher versus other studies in Iran and other countries; which show more critical patients presenting to our hospital and limited ICU beds versus patients. This study results nevertheless there was significant difference between predicted and observed mortality rates, the APACHE III scoring system is applicable to evaluating care, treatment and prognosis of ED patients, as is used in ICU.
(P2-31) The Situation of the Development of Disaster Medical Assistant Team in Japan
Authors: Morino K. , Kondo H. , Otomo Y. , Honma M. , Nakayama S. , Koido Y. , Henmi H. 
Published: May 2011

BackgroundAfter the Great Hanshin-Awaji Earthquake, the disaster countermeasures concerning medical care in Japan changed drastically. In 2005, the Japanese government began to develop a domestic, rapid, medical response system called Disaster Medical Assistance Team (DMAT) for the purpose of rapid medical correspondence in the acute phase. As of 12 July 2010, 393 institutions and 734 teams (3,700 persons) were trained. A DMAT is important not only to the response to large disasters such as earthquakes, but also the response to local disasters. It is important to establish the DMAT system of each prefecture and district.MethodsThe DMAT system at the local level was described at the 15th World Congress on Disaster and Emergency Medicine. During the present Congress, the development and activities of the DMAT system over the past three years will be reported.Results and ConclusionEight local districts in the DMAT system have been developed, and progress has been made in the fields of policy, operative plans, and agreement among each province. The system of inter-prefecture mutual aid must be built upon in the near future.
(P2-51) Being Injured in a Cold Environment
Authors: Aléx J. , Saveman B. 
Published: May 2011

BackgroundPrehospital patients, irrespective of diseases or trauma, might experience discomfort due to a cold environment and are at risk for decreasing body temperature which can increase morbidity and mortality. Research concerning experiences of being injured in a cold environment is scarce.ObjectiveThe aim of this study was to explore the patients' descriptions of being injured in a cold environment.MethodsTwenty persons who have been injured in a cold environment during wintertime in the north of Sweden were interviewed; 14 of them were treated with active heat supply. They waited on snow or ice for an ambulance between 8 minutes and 4 hours and 10 minutes. The interviews were performed face-to-face and telephone interviews were used when the participants lived far away. The interviews had a storytelling run-up and the participants were asked to narrate the injury event, from just before the event until arrival at the emergency department. The interviews were transcribed verbatim and analyzed by content.ResultsIn the preliminary results three themes were formulated: (1) waiting for an ambulance; (2) being cared for; and (3) reflecting on changes in life after the traumatic event. The cold environment influenced the experience of being injured in a negative way. More suffering from the cold than from pain of the injury was described. Those who were treated with active heat experienced it in a positive way.ConclusionsDiscomfort from cold became the largest problem independent of their injury classification. Active heat should be used in prehospital care to reduce the negative experiences from cold.
(P2-62) An Infrequent Case of Orthopedic Emergencies – Open Dorsal Dislocation of the Proximal Interphalangeal (PIP) Joint Dislocation
Authors: Bayir A. , Kaldirim U. , Ardic S. , Eyi Y.E. , Arziman I. , Durusu M. 
Published: May 2011

IntroductionReducible open dorsal dislocation of the single finger's PIP joint is an infrequent case of orthopedic emergencies. The severity of this injury may be underestimated. These injuries are associated with long-term complications such as synovitis, stiffness, degenerative arthrosis, septic arthritis, and loss of the digit if suboptimally treated.CaseA 90-year-old male came to the emergency department with an open dorsal PIP dislocation due to a fall on his right hand. There was a transverse skin laceration just proximal to the PIP flexion crease of his small and ring fingers. The condyles of his small finger's proximal phalanx protruded through the wound. X-rays showed a dorsal dislocation of the PIP joint without fracture. There was no neurovascular injury determined. The proximal phalanx was hyperextended slightly with gentle axial traction. After irrigation, the skin wound was closed primarily without repair of damaged structures, and systemic antibiotherapy was performed for a week. The PIP joint was immobilized for three weeks by applying the splint dorsally with the joint in 20 degrees of flexion. Active range of motion exercises were then implemented, and the patient regained full digital flexion with only a 10 degree loss of extension within eight weeks.DiscussionForced hyperextension with axial compression causes a dorsal dislocation of the PIP joint. Dorsal PIP dislocations are more common than volar IP dislocation. Open dorsal dislocation of the PIP joint is an infrequent case of orthopedic emergencies. Such injuries can be treated safely in the emergency department by closed reduction and extensor splinting until a definite treatment plan is made by an orthopedic hand surgeon. The complications must be taken into consideration. Early active motion leads to significantly superior results in the range of motion than static splinting, because prolonged immobilization may result in flexion contracture.
(P2-65) Perception of Emergency Care Providers Toward the Implementation of an Electronic Medical Record System in the Emergency Department of a Level-1 Trauma Center
Authors: Chauhan S. , Bhoi S. , Sinha D.T. , Rodha M. , Adhikari G. , Sharma G. , Sharma K. , Kumar R. 
Published: May 2011

BackgroundManual documentation has an inherent problem of improper communication, manipulation, and validity. An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital. EMRs tend to be a part of a local, stand-alone, health information system that allows for storage and retrieval.ObjectivesThe objective of this study was to assess the perception of emergency care providers toward the implementation of an EMR System in the emergency department of a Level-1 Trauma Center.MethodsA qualitative survey was conducted among consenting doctors and nurses in the emergency department of the All India Institute of Medical Sciences February to October 2010. Data were collected from a sample of 22—eight doctors and 14 nurses. The collection tool was a structured, closed-ended questionnaire of 12 questions based on usability, applicability, and security, of EMR. A Likert scale (LS) was used (1 = worst, 4 = best). Surveys were done on Day 20, Day 45, and after nine months of implementation of. Responses of emergency care providers were compiled and analyzed using SPSS version 16.ResultsThree surveys consisted of 22 participants in each survey. The survey domain of usability improved on Survey 3 (LS = 2.57), Survey 2 (LS = 2.46), Survey 1 (LS = 2.24). Application of EMR improved from Survey 1 to Survey 3. The data regarding perception of security concerns such as manipulation of data, transparency, and accountability were comparable among Survey 1, Survey 2, and Survey 3. Initial satisfaction was strongly associated with perception of usefulness of data mining for research purposes.ConclusionsSatisfaction with an EMR system at its implementation generally persisted through the first year of use. Implementation plans must include positive reinforcement regarding EMR among emergency care providers.
(P2-69) Diagnosis and Management of Bile Leaks After Blunt Liver Injury by Dicct
Authors: Mitsusada M. 
Published: May 2011

BackgroundAlthough bile leaks are emerging as frequent complications of non-operative management of liver injury, the best method to use to diagnose intrahepatic biliary injury (IHBI) has not been established.MethodsFifteen patients with a blunt liver injury admitted to the hospital during a two-year period, were diagnosed by computed tomography as having a grade 3–4 injury, and underwent DIC-MDCT intended to diagnose IHBI in its early stages. These 15 patients included 11 with a grade 4 (Group A: five patients who underwent TAE; Group B: six patients who did not undergo TAE) and four with a grade 3.ResultsIn Group A, all of the patients were found to have some signs of IHBI in DIC-CT. Of these patients, two were found to have extrahepatic leakage and underwent local drainage; one also underwent ENBD. Three patients were not found to have extrahepatic leakage even though they had signs of IHBI; these three underwent conservative therapy with no other care, and had a satisfactory course. In Group B, only one patient was found to have IHBI. However, all of the patients, including those not found to have signs of IHBI in DIC-CT, recovered. Patients with grade 3 did not have signs of IHBI. Compared to Group B, Group A had a high Injury Severity Scale Score of 38.5 ± 11.2, and a higher incidence of IHBI.ConclusionsDIC-MDCT may, in cases of severe liver injury that might require TAE, help to diagnose IHBI in its early stages, and help to determine if additional treatment is needed based on the site and extent of the injury and whether extrahepatic bile leakage is present.
(P2-74) Does Implementation of Protocols Improve the Red Area Disposition Time of Emergency Department at a Level-1 Trauma Center?
Authors: Kumar R. , Shyamla K. , Bhoi S. , Sinha T.P. , Chauhan S. , Adhikari G. , Sharma G. 
Published: May 2011

BackgroundAcute care addresses immediate resuscitation and early disposition to definitive care. Delay in final disposition from the emergency department (ED) affects outcomes in terms of morbidity and mortality. An audit was performed to assess the impact of protocols on red area disposition time.MethodsAn audit of red (resuscitation) area disposition time was performed among patients with compromised airway, breathing, and circulation. The red area disposition time was defined as the time from ED arrival to red area disposition. Pre-protocol data from nursing report books were reviewed for ED to operating room (OR), ED to intensive care unit (ICU), and overall disposition time between September 2007 and January 2008. Similar outcomes were documented after implementation of protocols during February to December 2008.ResultsIn the pre-protocol period, 992 red area patients were enrolled out of 10,000 ED visits. Out of which 527 (53.1%) were shifted to the OR and 222 (22.3%) to ICU. The average ED disposition time was 3.5 hours (range 2–5). Similarly, 1797 red area patients were enrolled in the post-protocol period out of 25,928. Of these, 453 (25.2%) patients were shifted to the OR, and 423 (23.7%) were shifted to the ICU. The average ED disposition time was 1.5 hours (range 10 minutes–3 hours).ConclusionsImplementation of protocols improves the red area disposition time of the ED. Auditing is an important tool to address patient safety issues.
(P2-75) Emergency Medicine Begins with General Practitioners in Nepal
Authors: Maharjan R.K. 
Published: May 2011

IntroductionEmergency medicine (EM) is a long-awaited specialty to be established in Nepal, although it has been practiced for a long time starting with hospitals in Nepal. Currently, almost all hospital emergency departments in Nepal are run under general practitioners (GPs) as emergency consultants (emergency physicians) and medical officers work as 24-hour duty doctors.MethodsThis was a five-year observational study (2006–2010) after the Department of General Practice joined with MD in Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.ResultsThere are no academically trained MD physicians working in Nepal according to the Nepal Medical Council's Registered Doctors, however, there are Nepalese doctors trained and working in EM in foreign countries. There is a demand of training those GPs interested in EM in a Fellowship/MPhil/MD program. There is a need for developing curriculum of EM for the Fellowship/MPhil/MD or for a different level of training collaborating with universities abroad. There is no ideal prehospital EM/emergency medical services capable of ambulance services. There must be a national code for mobilization and it must be under an umbrella of a governmental Department of GP and EM. Development of infrastructure for the EM department in every hospital in different parts of country is also a challenging task. Standards must be developed for EM and the EMS according to the need of the country. All known and unknown challenges can be addressed by coordinating with international support.
(P2-76) Mortality Pattern in the Emergency Department in Tribhuvan University Teaching Hospital, Kathmandu, Nepal
Authors: Maharjan R.K. 
Published: May 2011

IntroductionThe emergency department (ED) deals with serious diseases, trauma, and terminal stage cases. The mortality pattern of cases in the ED must be assessed for future planning and development.ObjectivesThe aim of this study is to evaluate the pattern of the mortality cases in ED.MethodsRetrospective mortality data were collected and analyzed during April to September 2010 from the Tribhuvan University Teaching Hospital.ResultsThere were 81 mortality records found during the study period. The mortality rate among the ED cases was 36 per 10,000 (0.36%). Sixteen (19.75%) were dead upon arrival to the ED. Among the remaining 65 mortality cases, 30 (46.2%) were male and 35 (53.8%) female. The ages ranged from 1 to 80 years; the mean age for males was 43.8 years and 55.0 years for females. The mean time duration from when the patient was bought to the ED to death was 6.7 hours. The primary causes of mortality were hypovolumic with hemorrhagic shock (10, 15.5%), aspiration pneumonitis (9, 13.8%), cardiopulmonary arrest (8, 12.4%), sepsis and septic shock (7, 10.8%), severe head injury (6, 9.3%), acute exacerbations of chronic obstructive pulmonary disease (6, 9.3%), hemorrhagic cerebrovascular accident (3, 4.7%), hepatic encephalopathy (3, 4.7%), cardiogenic shock (2, 3%), chronic renal failure (2, 3%), dyselectrolytemia (2, 3%), anaphylaxis (1, 1.5%), acute respiratory distress syndrome (1, 1.5%), meningoencepahalitis (1, 1.5%), acute myocardial infarction (1, 1.5%), OP poisoning (1, 1.5%), pulmonary edema (1, 1.5%), and severe pneumonia (1, 1.5%).ConclusionsThe mortality in the ED is due to the high rate of severe and serious cases that arrive at late stages of disease. It also is accounted with severe trauma cases despite vigorous treatment at the ED. The rate also is increased by “Brought Dead” cases which could be reduced with proper emergency medical services.
(P2-77) The Unique Role of Emergency Medical Services (EMS) in an Earthquake – A Community Based Approach
Authors: Jaffe E. , Ben-zvi S. 
Published: May 2011

IntroductionTimely actions can facilitate the efficacy of Emergency Medical Services (EMS) response in disaster by understanding the scale of event and shifting of traditional tasks. A simple scaling system of earthquakes/disasters by ABC is proposed: Level A treated by the local EMS. One or more Multi Casualty Incident's (MCI) in a defined geographical area that can easily be Level B hours, by reinforcement of regional and national aid coordinated by automatic autonomic response. An earthquake/disaster where the EMS and medical community can complete their task within 48 Level C - An earthquake/disaster that even joint national forces cannot eliminate within 48 hours.MethodsInformation from medical systems around the world was gathered to help develop strategies to minimize the weaknesses whilst achieving the objectives of the EMS via adapting to shifting conditions.ResultsEMS goal is to provide treatment to those in need of urgent medical care and arrange for timely transfer of the patient to definitive care. EMS are not qualified or equipped to delay victims in the field for hours or days. However, many patients in earthquakes do not require definitive treatment or have an immediate lifethreatening.ConclusionBy scaling the event by the ABC - a timely coordinated autonomic regional / national response can begin immediately. An area defined as level A will automatically back-up a level B/C area, in an event that the standard communication and activation systems collapse. Moreover, a clear shift in EMS roles will take place in a level B or C events. Available-Hours Busy-48-Hours Catastrophe-weeks Types of Levels area for delaying evacuation. Prioritizing, sorting and sending patients that require immediate attention to definitive care whilst considering availability of destination facilities and transportation resources. Patients that do not require immediate attention or cannot be saved shall await evacuation.