EDs Lacking in Palliative Care

From HealthLeaders Media:

Despite a slow decline and a realization that the end of life may be near, some terminally patients, accompanied by family, still seek care in the emergency room to manage symptoms or pain.

But emergency department staff lack necessary training to deal with palliative care, according to a report in the Annals of Emergency Medicine, which called it “a sadly neglected area of research, professional development and practice.”  The Annals is the scientific journal published by the American College of Emergency Physicians.

Grandmother Killed Rushing Child To Hospital

From JEMS:

Authorities say a Wilmington woman trying to rush her 1-year-old grandchild to the hospital died after she ran a red light and collided with another vehicle.

Wasabi-coated peas cause allergic reaction for Fire Captain

From JEMS:

A Salt Lake City fire captain found himself on the other end of a rescue operation Saturday night, and he credits the fast actions of his colleagues with saving his life.

Capt. Steve Hoffman had finished Saturday dinner when he began feeling ill. His eyes watered, his tongue felt like it was swelling.

He was beginning to blackout and had difficulty speaking, but managed to tell a paramedic he needed help. “His voice was slurred and he said, ‘What did you feed me? I need Benadryl.’ I thought he was teasing me because I’m the one who cooked dinner,” said paramedic Chad Dahle.

Patient-centered Integrated Networks of Emergency Care: Consensus-based Recommendations and Future Research Priorities

From SAEM:

Patient-centered care is defined by the Institute of Medicine (IOM) as care that is responsive to individual patient needs and values and that guides the treatment decisions. This article is a result of a breakout session of the 2010 Academic Emergency Medicine (AEM) consensus conference and describes the process of developing consensus-based recommendations for providing patient-centered emergency care. The objectives of the working group were to identify and describe the critical gaps in the provision of patient-centered care, develop a consensus-based research agenda, and create a list of future research priorities. Using e-mail and in-person meetings, knowledge gaps were identified in the areas of respect for patient preferences, coordination of clinical care, and communication among health care providers. Four consensus-based recommendations were developed on the following themes: enhancing communication and patient advocacy in emergency departments (EDs), facilitating care coordination after discharge, defining metrics for patient-centered care, and placing the locus of control of medical information into patients’ hands. The set of research priorities based on these recommendations was created to promote research and advance knowledge in this dimension of clinical care.

Advanced Trauma Life Support certified physicians in a non trauma system setting: Is it enough?

From Resuscitation:

The purpose of this study was to evaluate the impact of ATLS® on trauma mortality in a non-trauma system setting. ATLS represents a fundamental element of trauma training in every trauma curriculum. Nevertheless, there are limited studies in the literature as for the impact of ATLS training in trauma mortality, especially outside the US.

Design This is a prospective observational study. The primary end point was to investigate factors that affect mortality of trauma patients in our health care system. We performed a multivariate analysis for this purpose and we identified ATLS certification as a predictor of overall mortality. Following this finding we stratified patients according to the severity of injury as expressed by the ISS score and we compared outcome between those treated by an ATLS certified physician and those treated by non-certified ones.

Main outcome measures Trauma volume and demographics of trauma patients, factors that affect mortality of traumatized patients and mortality between patients treated by ATLS® certified and non-certified physicians.

Results In total, 8862 trauma patients were included in the analysis. The majority of trauma patients (5988, 67.6%) were treated by a general surgeon, followed by those treated by an orthopedic surgeon (2194, 24.8%). There were 446 deaths in the registry but, 260 arrived dead in the Emergency Department and were excluded from the analysis. Multivariate analysis of the 186 deaths that occurred in the hospital revealed age, high ISS score, low GCS score, urban location of injury, neck injury and ATLS® certification as factors predisposing to mortality. Cross tabulation of ATLS® certification and ISS of the trauma patients shows that those treated by certified physicians died more often in all subcategories of ISS score (p<0.05).

Conclusions In Greece, with no formal trauma system implementation, ATLS® certified physicians achieve worse outcomes than their non-certified colleagues when managing trauma patients. We believe that these findings must be interpreted in the context of the National health care system. There is considerable room for improvement in our country, and further analysis is required.

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