White Paper Proposes EMS Expand its Role in Patient Care

From JEMS:

A group of leaders within the prehospital care arena want to get the entire field of EMS to think differently about roles within the healthcare field.

The first step from the group is a white paper proposing a Mobile Integrated Healthcare Practice (MIHP) designed to make EMS part of a broad range of services working together to fill gaps in local communities and make the entire healthcare system work more efficiently.

ED Patient On PCP Attempted To Gulp Down His Cellphone

From Opposing Views:

Image

A man on phencyclidine (PCP), a drug that can cause hallucinations, attempted to swallow his cellphone.

The Internal and Emergency Medicine journal reports that the 35-year-old patient attempted to consume his 4 cm x 8 cm device in response to “auditory hallucinations.” When the man arrived at the emergency room, the phone could be seen sticking out from his throat. Physicians noted that he was breathing very quickly in his agitation; he had 24 respirations per minute while a healthy adult will take about 12 to 16 breaths per minute.

Are CT scans obtained at referring institutions justified prior to transfer to a pediatric trauma center?

From the Journal of Pediatric Surgery:

Purpose

To assess whether pediatric trauma patients initially evaluated at referring institutions met Massachusetts statewide trauma field triage criteria for stabilization and immediate transfer to a Pediatric Trauma Center (PTC) without pre-transfer CT imaging.

Methods

A 3-year retrospective cohort study was completed at our level 1 PTC. Patients with CT imaging at referring institutions were classified according to a triage scheme based on Massachusetts statewide trauma field triage criteria. Demographic data and injury profile characteristics were abstracted from patient medical records and our pediatric trauma registry.

Results

A total of 262 patients with 413 CT scans were reviewed from 2008 to 2011. 172 patients scanned (66%, 95% CI: 60%, 71%) met criteria for immediate transfer to a pediatric trauma center. Notably, 110 scans (27% of the total performed at referring institutions) were duplicated within four hours upon arrival to our PTC. GCS score <14 (45%) was the most common requirement for transfer, and CT scan of the head was the most frequent scan obtained (53%).

Conclusion

The majority of pediatric trauma patients were subjected to CT scans at referring institutions despite meeting Massachusetts trauma triage guidelines that call for stabilization and immediate transfer to a pediatric trauma center without any CT imaging.