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The main aim of this report is to describe the healthcare staff's perceptions and difficulties encountered in the relationship with foreign children and their families, collecting their personal judgment on their intercultural skills, on the necessity of training courses and their opinion related to the possible aid given by a linguistic and cultural mediator (LCM). We have carried out a survey in the paediatric health services of the Azienda Socio Sanitaria Territoriale (ASST) Lariana located in Como, through the provision of a questionnaire addressed to the healthcare staff. The questions presented in the survey relate to the relationship between the healthcare staff and the foreign patients, highlighting issues connected to linguistic and cultural factors in the use of the health services. The health professionals state that assistance to the minor and the foreign family is more complex (41.27%), more stressful (36.5%), more time-consuming (44.4%) but also more motivating (65.07%) than the assistance to native users. Referring to the figure of the LCM, 47 (74.6%) health workers believed it would be useful to integrate the role into the operational units. Through the analysis of data, the results obtained provide a picture of the challenges encountered between foreign citizens and medical staff, who admit a lack of intercultural skills. It is desirable to introduce the figure of a linguistic and cultural mediator, who could help both in terms of better management of the diagnostic and assistance path and in terms of staff satisfaction.

Introduction: Cardiopulmonary resuscitation is fundamental to improve the outcomes of a life-threatening event. The correct knowledge of first aid actions to provide may guarantee the victim's survival. This study was aimed at evaluating the competence about cardiopulmonary resuscitation and its predictors in a sample of Italian undergraduate students., Methods: Information on socio-demographic characteristics, first aid training, knowledge of stroke and heart attack symptoms and perceived ability to provide first aid, were collected through a web-based questionnaire., Results: On a total of 744 respondents (mean age 23.9±5.4 years, 62.5% female), 71.4% identified correctly first aid actions, 59.9% and 60.8% showed a good knowledge of stroke and heart attack symptoms, respectively. However, only 39.0% of them declared their ability to intervene in case of emergency. Attending a healthcare degree course and having had first aid training were associated with knowledge of symptoms and perceived ability to provide first aid. Female gender was negatively related with perceived ability to intervene., Conclusions: In spite of the satisfactory level of knowledge, these findings highlight the need to enhance the competence about cardiopulmonary resuscitation in the lay population, especially among females.

Italy has recently become a country of net immigration, posing new challenges for health care, particularly psychiatry. Previous studies on migration and mental health have focused predominantly on individual psychopathologies or individual immigrant populations. The aim of this work is to determine the demand by foreign citizens for intervention at Padova-based psychiatric services and to assess any differences in presentation of psychopathological symptoms in the various immigrant groups, with a view to developing adequate organisational and clinical responses. We reviewed 3,385 psychiatric consultations with Italian and immigrant patients, conducted between 2003 and 2004. Eleven per cent of these consultations were for immigrants, who were younger than their Italian counterparts. The most common geographical area of origin was Eastern Europe. North African immigrants were mainly male, while Eastern Europeans and Americans were chiefly female. Eastern European immigrants had a similar psychopathological pattern to Italians; North and Sub-Saharan African and Asian patients presented more psychotic symptoms. The results of this study may contribute to planning treatment and prevention of psychotic disorders and to improving management of somatoform disorders by strengthening access to psychiatric treatment in the community. [ABSTRACT FROM AUTHOR]

A medical anthropology research study was conducted in 2015 at the First Aid and Reception Center (CPSA) on the island of Lampedusa (Italy) as part of a larger health project carried out by the National Institute for Health, Migration and Poverty (INMP) in Rome. The study investigated the health conditions of migrants at the moment of their departure and on arrival, their migration journey, and their life plans and expectations for the future. The ethnographic method adopted for the study was based on participant observation and on data collection by means of a semi-structured interview (51 items simultaneously translated by cultural mediators into Tigrinya, Arabic, English, and French). Interviewed were 112 adults (82 men and 30 women) from the Gulf of Guinea and the Horn of Africa. The cooccurrence of forced migration and economic concerns was confirmed; violence and torture were constants throughout the migration journey in 81% of cases. Ethnographic data detailed the timing, countries, settings, perpetrators, and types of violence endured. A combination of qualitative and quantitative findings can both facilitate the identification of fragile health conditions and support clinicians in the diagnostic, therapeutic, and rehabilitation pathways. These data illustrate the importance and feasibility of multidisciplinary collaboration even in emergency contexts.

Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0–18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document. [ABSTRACT FROM AUTHOR]

Background/aim: SARS-CoV-2 pandemic imposed extraordinary restriction measures and a complete reorganization of the Health System. The aim of the study was to evaluate the impact of COVID-19 on emergency surgical department accesses., Patients and Methods: Patients admitted to surgical emergency departments was retrospectively recorded during the Lockdown (March 11, 2020-May 3, 2020) and compared with the same number of days in 2019 and immediately before Lockdown (January 16, 2020-March 10, 2020). Diagnoses, priority levels, modes of patient's transportation, waiting times and outcomes were analysed., Results: During the lockdown phase, we ob-served a reduction in the access to emergency surgical departments of 84.45% and 79.78%, com-pared with the Pre-Lockdown2019 and Pre-Lockdown2020 groups, respectively. Patient's transportation, hospitalization and patients discharge with indications to an outpatient visit, waiting and total times exhibited a significant difference during the lockdown (p<0.005)., Conclusion: We observed a reduction of surgical emergency accesses during the lockdown. Implementing the use of the regional systems and preventing overcrowding of emergency departments could be beneficial for reducing waiting times and improving the quality of treatments for patients., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background : The objective of this study is to evaluate the application of National guidelines for prevention and clinical management of traumatic dental injuries (NGPCMTDI) in developmental age published by the Italian Ministry of Health. Methods : In the present retrospective and multicenter study, 246 patients who underwent dental injury were selected to assess the management of the traumatic event compiled with the protocol provided by the National guidelines. Each health worker involved completed a form related to the dental injury in order to standardize the collected data. Two reference centers have been identified for data collection. Analyses for comparisons between groups were performed using the X 2 test for categorical variables or by Fisher exact test as appropriate. Statistical significance was assumed at p < 0.05. Results : Evaluating the distribution by age we concluded that: 27.24% of the enrolled patients were aged 1-5 years, 51.63% 6-10 years, and 19.92% 11-17 years. The dental injuries occurred in 10.16% of the situations at home, 50.81% at school, 28.86% during recreation, and 9.35% at the gym. The deciduous dentition is involved in 34.96% of the traumas while the permanent dentition is involved in 69.51%. Conclusion : From the present study it emerged that the National guidelines are not uniformly applied.

Systematic education based on internationally standardized programs is a well-established practice in Italy, especially in the emergency health care system. However, until recently, a specific program to treat burns was not available to guide emergency physicians, nurses, or volunteers acting as first responders. In 2010, two national faculty members, acting as ABA observers, and one Italian course coordinator, trained and certified in the United States, conducted a week-long training program which fully certified 10 Italian instructors. Authorized ABLS provider courses were conducted in Italy between 2010 and 2012, including one organized prior to the 20th annual meeting of the Italian Society of Burns (SIUst). In order to increase the effectiveness and diffusion of the course in Italy, changes were approved by the ABA to accommodate societal differences, including the translation of the manual into Italian. The ABA has also approved the creation and publication of a bilingual ABLS Italian website for the purpose of promoting the ABLS course in Italy. In response to high demand, a second ABLS Instructor course was organized in 2012 and has been attended by physicians and nurses from several Italian burn centers. In the following discourse the experiences of the first 15 Italian ABLS courses will be discussed., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

Develop an effective First Aid's system in workplaces is significantly important to the outcomes of accidents at work, thus contributing positively to create healthy and safe environments, improving responsible attitude and risk perception by workers. The italian regulation (D. Lgs. 81/08; DM 388/03) gives an important role to First Aid within the system for managing health and safety in workplaces and requires the employers to designate and train workers and organize facilities in the workplace. However, to ensure that First Aid's system actually contributes to increasing health and safety in workplaces, it's necessary to verify its effectiveness, beyond the law compliance. The article stands to evaluate the critical issues and related innovations to be introduced in this context, by analyzing data from literature and field experiences involving actors in the prevention system. The goal is to provide suggestions and action proposals to improve first aid's system in workplaces, paying particular attention to the aiders training (selection, motivation, teaching methods, retraining), as well as introduce to innovations to allow an immediate and timely emergency response (company equipments, other useful devices). On this last aspect, it has given particular emphasis to the introduction of semi-automatic defibrillator (AED), which is essential in case of sudden cardiac arrest with ventricular fibrillation, and special aiders training by means of BLSD (Basic Life Support and Defibrillation) courses based on international guidelines.

Background: The presence of jellyfish along coasts constitutes a potentially serious public health problem because of the toxic effects of contact with them., Objective: To determine the epidemiology of jellyfish stings in the Province of Lecce, Italy, in 2007., Methods: The study involved the gathering and processing of data on patients seeking medical treatment at summer first aid centres and hospitals along the coast of Salento following contact with jellyfish., Results: In 2007, 446 bathers sought medical assistance following contact with jellyfish. The spatial distribution indicates a greater frequency of stings sustained along the Adriatic coast, while the time analysis shows patterns related to wind direction. Most of the injuries were seen in persons aged between 1 and 10 years and in females. In 24% of cases, injuries were sustained to several parts of the body, while single injuries were mainly to the lower limbs (33%). In 4.9% of cases, there were complications, including one case of anaphylactic shock., Conclusion: In the light of the significant level of medical assistance provided, there is a need to identify suitable strategies that will guarantee the best response in terms of both prevention and treatment.

The authors describe the planning, making and evaluation of a project aimed at primary school students attending their 4th year and at secondary school students attending their 5th year designed to promote first aid procedures in emergency situations. An educational video has been filmed to support these projects.

Background: Four years after the law concerning first aid in the workplace was passed in Italy (inter-ministerial decree 388/2003), which is a useful tool in improving safety at work, it is necessary to organize first aid courses specifically for those working in the road haulage sector which would also be effective in case of traffic accidents. In view of the characteristics of the working environment in this sector (the road) and of the working conditions (generally workers are isolated and far from the company's headquarters), it would be necessary to organize ad hoc first aid courses at the workplace for the category of professional drivers., Objectives and Methods: The aim of this article is to discuss some possible organizational aspects of first aid in the road haulage sector, such as: number of workers responsible for first aid, how to train workers for specific risks of traffic accidents, the requirements for teachers responsible for first aid and course targets that must be achieved., Results and Conclusions: A good level of training, achieved during the first aid course at the workplace, might therefore be useful to improve road safety and increase the quality of basic and advanced first aid in road traffic injuries.

Background: Laws D.Lgs. 626/94 and D.I. 388/03 attach particular importance to the organization of first aid in the workplace. Like every other enterprise, also hospitals and health care facilities have the obligation, as foreseen by the relevant legislation, to organize and manage first aid in the workplace., Objectives: To discuss the topic in the light of the guidelines contained in the literature., Methods: We used the references contained in the relevant literature and in the regulations concerning organization of first aid in health care facilities., Results: The regulations require the general manager of health care facilities to organize the primary intervention in case of emergencies in all health care facilities (health care or administrative, territorial and hospitals)., Conclusions: In health care facilities the particular occupational risks, the general access of the public and the presence of patients who are already assumed to have altered states of health, should be the reason for particular care in guaranteeing the best possible management of a health emergency in the shortest time possible.

In this work it's briefly described the experience in planning and realizing of first aid at work courses for workers of the building trade, realized by the UOOML in collaboration with CPT and CPTA of Bergamo. In particular this is a report of the activity of planning and realization of courses in the months from February till September 2004.

From 1996 the territory of Tuscany region and in particular that one of ASL 10 of Florence, has been interested from the realization of great works: the railway line to High Speed and varying of Valico of the A1 freeway between Florence and Bologna. ASL 10 has stipulated specific economic agreements with the been involved companies in the realization of the plans for a plan finalized to the prevention of the industrial accidents and to limit of the gravity with timely aids it adapts to you also in gallery, to guarantee to the workers the same performances sanitary of the city residents, to guarantee and to improve the quality of existing sanitary services on the territories in spite of the increase of the population weighing on the consequent territory to the takeover of the workers it engages to you in the realization of the great works. This plan has been realized with the creation of integrated aid system a to strengthen the territorial sanitary emergency, I extend the access to the base medicine to the workers and has not been able itself to answer to 93% of the question sanitary to the inside of the same yards with the infirmaries of yard without to resort to external structures.

Article 15 of the D.Lgs. 626/94 and D.M. 388/2003, performance regulations, have codified of the new modalities of management and organization of the Service of Ready business Aid. I previewed in the new approach, entrusted main tasks to the employer, they are of organizational and formative type.

First aid at work organization and management represents a complex and critical aspect of the manifold problems of hygiene and security at work; nevertheless, even in relatively well organized productions, these themes are often neglected, if not completely ignored. In this work the authors analize the laws which regulate the correct first aid at work organization and management and an approach to the problem based on the preliminary risk assessment is suggested.

The aid happens behind call of national the only number for the sanitary emergency: 118. The times of Aid you flavored yourself and indicates to you from the Institutions, regarding the moment of call, previews the arrival of a aid characterized within 8 minuteren for the area to high inhabited density and within 20 minuteren for the areas to lowland density. The Means breakup of Aid near yards with particular infortunistico risk, is possible, and case for case must be estimated: the demand must be placed to the responsible of It centers them Operating 118. Legislator previews that the reported formation, to the practical ones of ready aid, of the attache's to the emergency of the enterprises it is made from the where possible doctor 'in collaboration with the system of emergency-urgency of the sanitary service nazionale'. Also the demands for formation for specific risks must to be agreed with the responsibles of the Structures of the Emergency of the SSN in particular the Directors of the Structure of Ready Aid, of Center them Operating 118, or of the Department of Emergenza-Urgenza.

The introduction of D.M. 388/2003 about first aid procedures to be carried out in the place of work has brought specific questions on how to enforce them in the building industry field. The aim of the text is to deal, though not in a specific way, with the relationship between the enterprises and the ASL [Health Authority] in order to prepare First Aid Plans. More specifically, it deals with the duties of the Employer, of the safety supervisor, of the doctor in charge and of all the people responsible for helping. There are also strategies on how to plan first aid measures in the building industry and suggestions to supplement materials in the First Aid kit.

The aim of this project is to value, through a specific questionnaire, the effectiveness and utility of the professional training among the construction workers responsible of the First Aid. 48 construction firms, in Province of Bergamo, were examined and 100 first aid responsible were tested through to the questionnaire. The 21% of the subjects performed a practical first aid intervention. The 84% considers the professional training courses to be globally satisfactory, and one third underlines the necessity of an annual refresher course. This study tends to confirm the validity of this program of professional training, particularly in the construction trade, that is characterized by a high accidents rate.

Background: The inter-ministerial decree (D.I.) 388/03 (the Italian law on first aid in the workplace) attaches particular importance to the organization of first aid and to the content of the teaching and training of designated workers, specifying teaching objectives, programme and duration of courses. However it provides less details on the requirements and qualifications of the teachers and trainers., Objectives: To discuss this topic in the light of the guidelines contained in the literature and the existing legislation., Methods: We used the specific references of literature and legislation concerning first aid training of designated workers., Results: The objectives and the content of the training courses call for a high level of professional competence and approach. Therefore, training of designated workers should be planned and carried out in accordance with the training standards used for the teaching and training of the so-called "lay rescuers"., Conclusions: The need to achieve high training standards for workers responsible for first aid at the workplace is to a large extent justified by the difficulty of the role of employees. This need follows the current tendency in regulations to guarantee adequate and up-dated training also for other agents operating within the system of workplace prevention. In this context the occupational physician plays a significant role in the training programmes for designated workers.

It has been calculated that, on average, 20% of the population should be trained to provide first aid, if a significant reduction of mortality is to be achieved. However, wide dissemination of the principles of emergency care poses a series of difficulties. As a partial solution, we have designed a first aid training course for children aged 8-11 years in their last three courses at primary school. According to the Italian school system, classes in primary school are indicated as I through V, from start to ending. The course addresses three issues: the broken tooth, nose bleeding and paediatric basic life support (PBLS). The course is divided into 17 didactic modules: each module contains a theoretical lecture, a practical demonstration by the trainer and a session for the trainees to practice under supervision. The aim of the study was to evaluate the benefit of teaching emergency procedures including practical sessions for pupils in primary schools. Four hundred and sixty-nine children were enrolled: the evaluation consisted of a 13 question multiple-choice written test taken at the end of the theoretical session and a semi-structured test at one month. Two hundred and seventy-one children attended to the theoretical lesson only, without going through the practical session (Group A), while the remaining 189 children completed the practical training (Group B). The outcome of the evaluation demonstrates that older children (in their V school class) score better than those in their IV and III class (p < 0.001). However, when comparing Group A and Group B in each class, the children that had also been exposed to the practical training (Group B) scored significantly better (V(B) versus V(A) p < 0.001; IV(B) versus IV(A) p < 0.001; III(B) versus III(A) p < 0.01). In conclusion, this proposed method of teaching emergency first aid could be successful in training primary school children. The permanent integration of the subject into the core curriculum of primary schools, and extended to higher school levels, could help in disseminating the culture of emergency care in the general population.

Background: One of the innovations introduced by law 626/94 [the Italian law on occupational health and safety of workers] is the obligation of the employer to designate workers responsible for first aid., Objectives: To identify and discuss the duties, the role and the medical and legal responsibility of workers appointed to carry out first aid measures., Methods: Analysis of legislation and current practice concerning medical and legal responsibility in first aid procedures., Results: The worker appointed to carry out first aid measures is, by virtue of his appointment, obliged to take action. Therefore, he could commit an illegitimate act both by "acting" and by "omitting" to carry out a duty that is his responsibility. In the first case the worker could be accused of committing an unpremeditated criminal offence when his actions involve negligence, imprudence, inexperience or violation of regulations concerning his duties. A "serious criminal offence" is committed when the most elementary rules of diligence, prudence and skill are violated; the offence is "slight" when negligence, imprudence or inexperience are involved in particularly complex situations. The reference parameter for inexperience is not a first aid volunteer, nor a member of the public, but a worker designated to carry out first aid possessing "average" attitudes, training and ability. Briefly, a guilty error by the appointed worker consists of the following: i) the professional conduct of the operator was clearly wrong, serious and unjustifiable; ii) the operator clearly omitted doing his/her duty; iii) the consequence of the error is physical personal damage., Conclusions: The observations made clearly illustrate the delicacy of the tasks of the worker appointed to carry out first aid measures. Essential elements for minimizing wrong and/or negligent conduct are appropriate choice of the designated workers and their adequate training.

Aim: A feverish high temperature is the symptom that most frequently leads families to take their children to a Pediatric First Aid unit. In the differential diagnosis of the causes of hyperpyrexia the presence of infections of the genito-urinary tract have to be excluded. Infections of the urinary ways are often the cause of high temperatures in infancy, particularly during the 1st year of life; early identification at the moment of examination at the Paediatric First Aid clinic of patients with infections of the urinary ways makes it possible to prevent the onset of renal complications. We carried out a retrospective study with the purpose of evaluating the incidence of infections of the urinary ways and their complications in paediatric patients who had come to the First Aid unit for hyperpirexia and were later hospitalised after examination of the urine revealed and infection of the urinary ways., Methods: The study was carried out by consulting the registers listing arrivals at the First Aid unit and the subsequent discharge diagnosis. We then consulted the clinical records of patients who required admission to our Paediatrics Clinic arter the first aid examination., Results: Re-reading the registers of examination carried out and the clinica records of hospitalised patients there emerged an increase in the observation of this pathology, diagnosed at the moment of the First Aid examination by means of rapid tests and thereafter assessed by haematochemical and radiological tests., Conclusions: In our opinion this increase could be attributed to the greater attention paid to diagnosing the causes of fever of apparently unknown origin.

Background: The evaluation of chest pain is a constant challenge for cardiologists, due to its clinical, organizational, economical and legal implications. The costs of the diagnostic classification of non-specific thoracic pain during ordinary, albeit short, hospitalization are here compared with a quick screening of the same symptoms in a "Chest Pain Unit", which may form an appendix of the emergency room (ER)., Methods: The study involves patients admitted to the hospital used as reference during the year 2000 and discharged with a diagnosis of thoracic pain or precordial pain, as identified by ICD-9-CM codes 786.50, 786.51, 786.52, 786.59. According to DRG 143 tariffs, the hospitalization of such a patient costs Itl 4,346,000 epsilon 2244.52). If a Chest Pain Unit should monitor the same patients in the ER for at least 12 hours, during which time the examination at admission has to followed by two ECGs, 4 seriated evaluation of cardio-specific enzymes, an echocardiogram and a stress test, the individual cost concerning payment for ER services, would be of Itl 879,000 ([symbol: see text] 453.97). Even adding Itl 508,000 ([symbol: see text] 262.36) to pay the 12-hour monitoring provided for by the short protocol, the total amount would be Itl 1,387,000 epsilon 716.33). This evaluation has also been applied to the 47,775 patients hospitalized with the same diagnosis in all Italian hospitals during the year 1999., Results: Three hundred and thirty-eight patients admitted to the hospital used as reference were discharged with the above reported diagnosis. Among them 215 (64%) were hospitalized in the cardiology ward. The total cost for hospitalization for the 338 patients evaluated was Itl 1,468,948,000 epsilon 758,648.33) as compared to Itl 297,102,000 epsilon 153,440.37) that the short-term therapy would have required. Countrywide the same cost was Itl 207,543,230,000 epsilon 107,187,132.99) as compared to Itl 41,976,645,000 epsilon 21,679,127.91) for the short-term therapy, using which would have led to save Itl 166,566,585,000 epsilon 86,024,461.98)., Conclusions: The suggested strategy, corroborated by many previous experiences, is an effective and efficient alternative for thoracic pain evaluation, especially in a time when economical resources are being drastically reduced, thus requiring research and application of optimized diagnostic procedures.

Background: A first-aid station was implemented in Falconara Marittima airport (Ancona, Italy). It provided medical emergency care to war victims evacuated from former Yugoslavia in transit for further treatment., Materials and Methods: A descriptive analysis of the displaced population arriving at the first-aid station was performed using three independent datasets for administrative information, of which one included medical information. The implemented resources were also evaluated., Results: From August 1993 to March 1995, 2272 displaced persons were registered at the first-aid station, out of which 54.2% were accompanying family members. Among those needing medical intervention (45.8% of total), most frequent diagnoses were traumatisms and burns (59.8%), neoplasms (15.6%), and congenital malformations (13.2%). The medical care provided at the first-aid station was most often basic: a medical examination alone was performed on 77.0% of the patients, and a minor dressing on 17.3%. Median length of stay was 1 day. Patients were sent to 30 different countries and 8% were forwarded to the local regional hospital. Deployed logistical resources exceeded by far actual needs but a lack of psychological assistance was observed, mainly for children. The agencies involved did not coordinate data sharing and follow-up information., Conclusions: The medical assistance to the war victims was efficient regarding provided care and timeliness. Effectiveness of such a programme could be improved by a better coordination between partners, allowing more adequate logistics according to appropriate epidemiological information.

The aim of this report is to provide a medical form to use in case of sexual assault, prepared taking into consideration the information lacking at present in most medical reports on the subject. This call for the necessity to conform the medical approach to the same protocol which may also be used from the forensic medicine point of view. More precise information should be obtained about the assault and the injuries inflicted, and also an immediate psychological support should be given to the victim. This information will then serve as a guide to the medical staff.

The priorities of a modern emergency care unit with more than 20,000 patients/year are analysed underlining that only a professional organization can offset the increasing demand of the population. The importance of a pre-evaluation of the patients in a triage unit to privilege the real emergency cases is underlined. These emergency units also need an information network in a real-time contact with the nearby sanitary structures and the Operative Center. This for a faster hospitalization of the patients who need it. The opportunity to improve the contacts between the family doctor and the Hospital to a better use of the Sanitary System is stressed.

Aim of the Study: The delay between onset of symptoms and coronary care unit admission is decisive in the outcome of patients with acute myocardial infarction. The objective of the GISSI-Avoidable Delay Study was to evaluate the influence of the factors that affect the delay in acute myocardial infarction treatment., Methods: This study was a nationwide multicentre case-control study conducted in Italy by the 118 Coronary Care Units (CCUs) participating in GISSI-network. The median and mean times in cases and controls were compared for decision time, home-to-hospital time, and in-hospital time, and the influence of several potential risk factors on the delay was evaluated by comparison of patients admitted more than 6 hours after onset of symptoms with those admitted within 6 hours after onset. Among 5301 patients with acute myocardial infarction, 590 who came to a coronary care unit after 12 hours were considered cases. Controls included 600 patients treated within 2 hours, 603 between 2 and 6 hours, and 466 between 6 and 12 hours., Results: The median decision time among cases was 50-fold higher than that of controls who presented within 2 hours. Home-to-hospital time and in-hospital time appeared to play a less important role. Considering the patient-related variables, the delay seemed to be significantly affected by advanced age, living alone, low intensity of initial symptoms, history of diabetes, strong pain at onset of the infarction, occurrence of symptoms at night, and involvement of a general practitioner., Conclusions: These data suggest that interventions aimed at reducing the delay in acute myocardial infarction treatment should primarly focus on the help-seeking behaviour of patients.

The activity at an ED, primarily aiming at providing rational and qualified support to critically ill patients, is forced to manage very different nosographic entities, including infectious, often contagious, pathologies. In this context the diffusion of HIV infection poses a number of problems concerning both the kind of patients presenting to the ED and the professional risk of health-care workers. In the first four months of 1992 the incidence of patients with recognized or presumed HIV infection at the "Pronto Soccorso Medico" was of 1.78% of 2327 patients admitted. This study aims to contribute to the epidemiologic definition of the risk of HIV infection due to occupational exposure, stressing the peculiar conditions of urgency-emergency often characterizing the activity within the ED.

Antiquated first-aid procedures, such as the incision and sucking of the wound and the application of a tourniquet, are still used in Italy consequent to the bite of vipers. The A. hope that such procedures will be finally abandoned, since they are ineffective, impractical, painful and can furthermore produce invalidating or disfiguring permanent outcomes. In this report they extensively describe Australian first-aid measures consequent to snakebites, constituted by a compressive bandage and by immobilization of the bitten limb by splinting. They hope therefore that the divulgation of this procedure in Italian will bring about, within a short period of time, its extensive use in Italy consequent to viper bites, as it is very effective, practical and easy to carry out.