Troubled kids in ER: Psych illness or just unruly?

From NBC:

American children visit the emergency room as often as 825,000 times a year — not for broken bones or bellyaches — but to urgently see a psychiatrist. Yet, aside from the select few who are suicidal, a threat to others or severely debilitated, most are discharged and sent home.

It turns out that a surprising number of ER patients are being seen for behavioral issues or a minor psychiatric crisis. A review of 2,900 records of ER patients ages 17 and younger showed the majority were brought to the hospital because of issues such as disruptive classroom behavior, verbal altercations and running away, according to a 2011 John Hopkins study.

Experts question whether these children need to visit the ER at all and whether they are unnecessarily taxing an already overstretched emergency care system.

Earlier reperfusion in patients with ST-elevation Myocardial infarction by use of helicopter

From the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine:

Background

In patients with ST-elevation myocardial infarction (STEMI) reperfusion therapy should be initiated as soon as possible. This study evaluated whether use of a helicopter for transportation of patients is associated with earlier initiation of reperfusion therapy.

Material and methods

A prospective study was conducted, including patients with STEMI and symptom duration less than 12 hours, who had primary percutaneous coronary intervention (PPCI) performed at Aarhus University Hospital in Skejby. Patients with a health care system delay (time from emergency call to first coronary intervention) of more than 360 minutes were excluded. The study period ran from 1.1.2011 until 31.12.2011. A Western Denmark Helicopter Emergency Medical Service (HEMS) project was initiated 1.6.2011 for transportation of patients with time-critical illnesses, including STEMI.

Results

The study population comprised 398 patients, of whom 376 were transported by ambulance Emergency Medical Service (EMS) and 22 by HEMS. Field-triage directly to the PCI-center was used in 338 of patients. The median system delay was 94 minutes among those field-triaged, and 168 minutes among those initially admitted to a local hospital. Patients transported by EMS and field-triaged were stratified into four groups according to transport distance from the scene of event to the PCI-center: <=25 km., 26–50 km., 51–75 km. and > 75 km. For these groups, the median system delay was 78, 89, 99, and 141 minutes. Among patients transported by HEMS and field-triaged the estimated median transport distance by ground transportation was 115 km, and the observed system delay was 107 minutes. Based on second order polynomial regression, it was estimated that patients with a transport distance of >60 km to the PCI-center may benefit from helicopter transportation, and that transportation by helicopter is associated with a system delay of less than 120 minutes even at a transport distance up to 150 km.

Conclusion

The present study indicates that use of a helicopter should be considered for field-triage of patients with STEMI to the PCI-center in case of long transportation. Such a strategy may ensure that patients living up to 150 km. from the PCI-center can be treated within 120 minutes of emergency call.