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Aim: To determine the prevalence and clustering of NANDA‐International nursing diagnoses in patients assisted by pre‐hospital emergency teams. Design: Retrospective descriptive study of electronic record review. Methods: Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two‐step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. Results: Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six‐cluster solution (n = 26.788) was found. Five clusters had a single high‐prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co‐occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). Conclusion: Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre‐hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. Implications for the profession and/or patient care: Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre‐hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre‐hospital clinical setting. Impact: What problem did the study address? There are different models of pre‐hospital emergency care services.The use of standardized nursing languages in the pre‐hospital setting is not homogeneous.Studies on NANDA‐I nursing diagnoses in the pre‐hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA‐I nursing diagnoses in the pre‐hospital care setting.Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance.Patients attended by pre‐hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre‐hospital setting, increasing the evidence of individualized and standardized care plans for pre‐hospital care. Reporting method: STROBE checklist has been used as a reporting method. No Patient or Public Contribution: Only patients' records were reviewed without further involvement. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMSs) face critical situations that require patient risk classification based on analytical and vital signs. We aimed to establish clustering-derived phenotypes based on prehospital analytical and vital signs that allow risk stratification. This was a prospective, multicenter, EMS-delivered, ambulance-based cohort study considering six advanced life support units, 38 basic life support units, and four tertiary hospitals in Spain. Adults with unselected acute diseases managed by the EMS and evacuated with discharge priority to emergency departments were considered between January 1, 2020, and June 30, 2023. Prehospital point-of-care testing and on-scene vital signs were used for the unsupervised machine learning method (clustering) to determine the phenotypes. Then phenotypes were compared with the primary outcome (cumulative mortality (all-cause) at 2, 7, and 30 days). A total of 7909 patients were included. The median (IQR) age was 64 (51–80) years, 41% were women, and 26% were living in rural areas. Three clusters were identified: alpha 16.2% (1281 patients), beta 28.8% (2279), and gamma 55% (4349). The mortality rates for alpha, beta and gamma at 2 days were 18.6%, 4.1%, and 0.8%, respectively; at 7 days, were 24.7%, 6.2%, and 1.7%; and at 30 days, were 33%, 10.2%, and 3.2%, respectively. Based on standard vital signs and blood test biomarkers in the prehospital scenario, three clusters were identified: alpha (high-risk), beta and gamma (medium- and low-risk, respectively). This permits the EMS system to quickly identify patients who are potentially compromised and to proactively implement the necessary interventions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate three prehospital early warning scores (EWSs): RTS,MGAP andMREMS, to predict short-term mortality in acute life-threatening trauma and injury/illness by comparing United States (US) and Spanish cohorts. Methods: A total of 8,854 patients, 8,598/256 survivors/nonsurvivors, comprised the unified cohort. Datasets were randomly divided into training and test sets. Training sets were used to analyse the discriminative power of the scores in terms of the area under the curve (AUC), and the score performance was assessed in the test set in terms of sensitivity (SE), specificity (SP), accuracy (ACC) and balanced accuracy (BAC). Results: The three scores showed great discriminative power with AUCs>0.90, and no significant differences between cohorts were found. In the test set, RTS/MREMS/MGAP showed SE/SP/ACC/BAC values of 86.0/89.9/89.6/87.1%, 91.0/86.9/87.5/88.5%, and 87.7/82.9/83.4/85.2%, respectively. Conclusions: All EWSs showed excellent ability to predict the risk of short-term mortality, independent of the country. [ABSTRACT FROM AUTHOR]

The research network of the Spanish Pediatric Emergency Society (RISeuP-SPERG Network) needs to establish its research agenda relevant to pediatric emergency medicine (PEM) to guide the development of future projects, as other networks have done before. The aim of our study was to identify priority areas in PEM for a collaborative network of pediatric emergency research in Spain. A multicenter study was developed including pediatric emergency physicians from 54 Spanish emergency departments, endorsed by the RISeuP-SPERG Network. Initially, a group of seven PEM experts was selected among the members of the RISeuP-SPERG. In the first phase, these experts elaborated a list of research topics. Then, using a Delphi method, we sent a questionnaire with that list to all RISeuP-SPERG members, to rank each item using a 7-point Likert scale. Finally, the seven PEM experts, using a modified Hanlon Process of Prioritization, weighted prevalence (A), seriousness of the condition (B), and feasibility of conducting research projects (C) on that condition to prioritize the selected items. Once the list of topics was chosen, the seven experts selected a list of research questions for each of the selected items. The Delphi questionnaire was answered by 74/122 (60.7%) members of RISeuP-SPERG. We established a list of 38 research priorities related to quality improvement (11), infectious diseases (8), psychiatric/social emergencies (5), sedoanalgesia (3), critical care (2), respiratory emergencies (2), trauma (2), neurologic emergencies (1), and miscellanea (4). Conclusion: The RISeuP-SPERG prioritization process identified high-priority PEM topics specific to multicenter research that may help guide further collaborative research efforts within the RISeuP-SPERG network to improve PEM care in Spain. What is Known: • Some pediatric emergency medicine networks have established their priorities for research. What is New: • After a structured process, we have set the research agenda for pediatric emergency medicine in Spain. By identifying high-priority pediatric emergency medicine research topics specific to multicenter research, we may guide further collaborative research efforts within our network. [ABSTRACT FROM AUTHOR]

Objective: The objective is to identify research priorities in prehospital care in Spain. Method: This was a Delphi-type study of three rounds with a panel of experts made up of members of the Red de Investigación en Emergencias Prehospitalarias (RINVEMER; Prehospital Emergency Research Network) Network and the Sociedad Española de Medicina de Urgencias y Emergencias (SEMES; Spanish Society of Emergency Medicine) Emergency Secretariat. In the first round, each participant identified up to 15 priorities. In the second round, they scored the 30 thematic areas on a Likert scale. In the third round, they ordered and scored from one to ten the first ten priorities among those that obtained a median greater than or equal to four in the second round. After adding the assigned scores, the ten priorities with the highest total score were obtained. Results: The ten identified research priorities were: special clinical codes and time-dependent conditions; mass-casualty incident (MCI) coordination and management; innovation in Emergency Medical Services (EMS); human factor in decision making; triage, analysis, and management of calls in the Emergency Call Center; new technologies, telemedicine, and emergencies; adverse events, clinical safety, and quality in emergencies; cardiac arrest; continuous education and training (methodology, quality, and evaluation); and big data and emergencies. Conclusions: The research priorities perceived by emergency professionals are related to clinical care and organizational aspects of EMS, in addition to the need to incorporate innovative aspects and new data analysis technologies. [ABSTRACT FROM AUTHOR]

Reducing patient decision delay – the time elapsed between symptom onset and the moment the patient decides to seek medical attention – can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. We developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. Patient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. The diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions. • Reducing patient decision delay can help improve acute coronary syndrome survival. • We developed a method to study anticipated delay in response to symptom clusters. • Delay varied by symptom cluster, socio-demographics, and medical history. • Women were consistently less likely to seek help. • The public and clinicians should be educated about symptom clusters. [ABSTRACT FROM AUTHOR]

Text: July 2 of this year saw the publication of Spanish Royal Decree 610/2024, which establishes emergency medicine as an official specialization. This event represents the culmination of a long-running effort to improve the care of patients in the emergency and urgent care system and throughout the national health service. This article offers a brief account of some of the legal, administrative, and political steps the Spanish Society of Emergency Medicine(SEMES) took to achieve this goal over the course of nearly 40 years. The effort has involved many SEMES members, who strictly speaking had the sole obligation of knowing how to care appropriately for patients based on clinical expertise along with organizational, scientific, and other professional skills. Competences in these areas have been shown to fall short in Spain. The article provides examples of some of the bright lights and dim shadows in our rule of law. Nonetheless, the long road traveled has also shown us how skills and knowledge are developed in adverse circumstances and crises, provided there is vocation for public service.

Background: The extraordinary situation caused by the onset of COVID-19 has meant that at prehospital level, the number of treatments, profile and time taken to respond for treating time-dependent pathologies has been greatly affected. However, it is not known whether the prehospital profile of polytrauma patients (PTP) has been affected. Objective: To determine differences in the epidemiological characteristics and the clinical variables of prehospital polytrauma patients during the first wave of the COVID-19 pandemic in Catalonia. Methodology: Analytical cross-sectional study. The number of prehospital activations and the clinical and epidemiological characteristics of polytrauma patients attended by the Emergency Medical System (EMS) of Catalonia, were compared for the period between 15 February and 15 May 2020 and the same period in the previous year. Priorities 0 and 1 are assigned to the most severely injured patients. An analysis was conducted using logistic regression and nonparametric tests. Results: 3023 patients were included. During the 2019 study period, 2045 (67.6%) patients were treated; however, during the pandemic period, 978 (32.4%) patients were treated, representing a 52% decrease (p = 0.002). The percentage of patients presenting priority 1 was higher during the pandemic period [240 (11.7%) vs 146 (14.9%), p = 0.032]. The percentage of priority 0 and 1 patients attended by a basic life support unit increased [201 (9.8%) vs 133 (13.6%), p = 0.006]. The number of traffic accidents decreased from 1211 (59.2%) to 522 (53.4%) and pedestrian-vehicle collisions fell from 249 (12.2%) to 92 (9.4%). Regarding weapon-related injuries and burns, there was an increase in the number of cases [43 (2.1%) vs 41 (4.2%), and 15 (0.7%) vs 22 (2.2%), p = 0.002 and p < 0.001, respectively]. Hospital mortality remained unchanged (3.9%). Conclusions: During the first wave of the pandemic, the number of polytrauma patients decreased and there was a change in the profile of severity and type of accident. [ABSTRACT FROM AUTHOR]

Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54–81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the feelings of safety among patients taken to hospital after requesting urgent care, based on their experiences and those of their carers and prehospital emergency care professionals. Background: Little research has been performed into the perception of safety in prehospital emergency care settings worldwide, from either the perspective of the patients or from that of healthcare professionals. Design: Exploratory qualitative study using focus groups in Spain. Methods: The participants were patients that requested care through the emergency telephone service, their carers and the professionals of the emergency care teams. The structured sampling design was based on an intentional, nonprobability selection following pragmatic criteria. Seven groups of patients/carers and two groups of professionals were formed (65 participants). The recordings were fully transcribed before their validation and codes were assigned to ensure anonymity. The ATLAS.ti software was used for the analysis. The authors took into account the COREQ checklist for qualitative studies. Findings: Neither group provided a clear definition of the meaning of feeling safe. It appeared easier to give examples that had a positive or negative influence on their perception of feeling safe. During the analysis of the discourse, six categories were detected after grouping the related codes. Conclusions: For most of the patients' feeling of being safe or very safe arose from the perception of calmness, trust and protection. Defining the perception of safety was not easy. The factors with the greatest effect on feeling safe were related to Information and communication, Person‐centred care and Professional competency, without losing sight of other factors such as Accessibility and response times of the emergency teams, Equipment and Healthcare setting. Relevance to clinical practice: The findings could be used as a knowledge base in future research and for implementing procedures for improving perceptions of safety among patients. [ABSTRACT FROM AUTHOR]

Background: The guarantee of nursing competence in prehospital urgent care requires the identification and delimitation of the specific competencies. This work describes the importance attributed by professors of Spanish universities to the competencies of prehospital nursing positions and indicates the most appropriate training level required to achieve them. Method: The current work consisted of a survey with an online questionnaire. Sixty competencies over 10 domains were studied. Results: The most valued domains were those of general and personal competencies. The competencies considered most important were "Recognizes the vital risk and knows how to perform basic and advanced life support maneuvers" and "Provides quality health care." The nursing degree is considered appropriate to train students to the required level in only eight competencies. Conclusion: The proposed competencies can be considered as specific competencies necessary in prehospital emergency nursing. Effective performance requires training to a higher level than a nursing degree. The proposed competencies can be considered as specific competencies necessary in prehospital emergency nursing. Effective performance requires training to a higher level than a nursing degree. [[J Contin Educ Nurs. 2020;51(12):556–567.] [ABSTRACT FROM AUTHOR]

Background: In mass casualty incidents (MCI), death usually occurs within the first few hours and thus early transfer to a trauma centre can be crucial in selected cases. However, most triage systems designed to prioritize the transfer to hospital of these patients do not assess the need for surgery, in part due to inconclusive evidence regarding the value of such an assessment. Therefore, the aim of the present study was to evaluate the capacity of a new triage system—the Prehospital Advanced Triage Method (META)—to identify victims who could benefit from urgent surgical assessment in case of MCI. Methods: Retrospective, descriptive, observational study of a multipurpose cohort of patients included in the severe trauma registry of the Gregorio Marañón University General Hospital (Spain) between June 1993 and December 2011. All data were prospectively evaluated. All patients were evaluated with the META system to determine whether they met the criteria for urgent transfer. The META defines patients in need of urgent surgical assessment: (a) All penetrating injuries to head, neck, torso and extremities proximal to elbow or knee, (b) Open pelvic fracture, (c) Closed pelvic fracture with mechanical or haemodynamic instability and (d) Blunt torso trauma with haemodynamic instability. Patients who fulfilled these criteria were designated as "Urgent Evacuation for Surgical Assessment" (UESA) cases; all other cases were designated as non-UESA. The following variables were assessed: patient status at the scene; severity scales [RTS, Shock index, MGAP (Mechanism, Glasgow coma scale, Age, pressure), GCS]; need for surgery and/or interventional procedure to control bleeding (UESA); and mortality. The two groups (UESA vs. non-UESA) were then compared. Results: A total of 1882 cases from the database were included in the study. Mean age was 39.2 years and most (77%) patients were male. UESA patients presented significantly worse on-scene hemodynamic parameters (systolic blood pressure and heart rate) and greater injury severity (RTS, shock index, and MGAP scales). No differences were observed for respiratory rate, need for orotracheal intubation, or GCS scores. The anatomical injuries of patients in the UESA group were less severe but these patients had a greater need for urgent surgery and higher mortality rates. Conclusion: These findings suggest that the META triage classification system could be beneficial to help identify patients with severe trauma and/or in need of urgent surgical assessment at the scene of injury in case of MCI. These findings demonstrate that, in this cohort, the META fulfils the purpose for which it was designed. [ABSTRACT FROM AUTHOR]

Background and purpose Our aim was to revalidate the race scale, a prehospital tool that aims to identify patients with large vessel occlusion (lVO), after its region-wide implementation in catalonia, and to analyze geographical differences in access to endovascular treatment (EVT). Methods We used data from the prospective cicaT registry (stroke code catalan registry) that includes all stroke code activations. The race score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. sensitivity, specificity, and area under the curve (AUC) for the race cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC). results The race scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the national institute of health stroke scale evaluated at hospital (r=0.74, P<0.001). a race score ≥5 detected lVO with a sensitivity 0.84 and specificity 0.60 (AUC 0.77). Patients with race ≥5 harbored a LVO and received EVT more frequently than race <5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P<0.001). Direct admission at a CSC was independently associated with higher odds of receiving EVT compared with admission at a referral center (Or 2.40; 95% CI 1.66 to 3.46), and symtoms onset to groin puncture was 133 min shorter. Conclusions This large validation study confirms race accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas. [ABSTRACT FROM AUTHOR]

Background: During the transfer of patients, both ambulance and hospital emergency service professionals need to exchange necessary, precise, and complete information for an effective handover. Some factors threaten a quality handover such as excessive caseload, patients with multiple comorbidities, limited past medical history, and frequent interruptions. Purpose: To explore the viewpoint of nurses on their experience of patient handovers, describing the essential aspects of the process and areas for improvement, and establishing standardized elements for an effective handover. Methods: A qualitative research method was used. Results: Nurses identified the need to standardize the patient transfer process by a written record to support the verbal handover and to transmit patient information adequately, in a timely manner, and in a space free of interruptions, in order to increase patient safety. Conclusions: An organized method does not exist. The quality of handovers could be enhanced by improvements in communication and standardizing the process. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between the age of an urgently hospitalized patient and his or her probability of admission to an intensive care unit (ICU)., Design: Observational, retrospective, multicenter study., Setting: 42 Emergency Departments from Spain., Time-Period: April 1-7, 2019., Patients: Patients aged ≥65 years hospitalized from Spanish emergency departments., Interventions: None., Main Variables of Interest: ICU admission, age sex, comorbidity, functional dependence and cognitive impairment., Results: 6120 patients were analyzed (median age: 76 years; males: 52%. 309 (5%) were admitted to ICU (186 from ED, 123 from hospitalization). Patients admitted to the ICU were younger, male, and with less comorbidity, dependence and cognitive impairment, but there were no differences between those admitted from the ED and from hospitalization. The OR for ICU-admission adjusted by sex, comorbidity, dependence and dementia reached statistical significance >83 years (OR: 0.67; 95%CI: 0.45-0.49). In patients admitted to the ICU from ED, the OR did not begin to decrease until 79 years, and was significant >85 years (OR: 0.56, 95%CI: 0.34-0.92); while in those admitted to ICU from hospitalization, the decrease began 65 years of age, and were significant from 85 years (OR: 0.55, 95%CI: 0.30-0.99). Sex, comorbidity, dependency and cognitive deterioration of the patient did not modify the association between age and ICU-admission (overall, from the ED or hospitalization)., Conclusions: After taking into account other factors that influence admission to the ICU (comorbidity, dependence, dementia), the chances of admission to the ICU of older patients hospitalized on an emergency basis begin to decrease significantly after 83 years of age. There may be differences in the probability of admission to the ICU from the ED or from hospitalization according to age., (Copyright © 2023 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Abstract: Aims: To explore and understand the experiences of terminally ill patients and their relatives regarding dignity during end‐of‐life care in the emergency department. Background: The respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end‐of‐life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in‐hospital emergency departments, where there is a lack of research which takes the experiences of end‐of‐life patients and their relatives into account. Design: A phenomenological qualitative study. Methods: The protocol was approved in December 2016 and will be carried out from December 2016–December 2020. The Gadamer's philosophical underpinnings will be used in the design and development of the study. The data collection will include participant observation techniques in the emergency department, in‐depth interviews with terminally ill patients and focus groups with their relatives. For the data analysis, the field notes and verbatim transcriptions will be read and codified using ATLAS.ti software to search for emerging themes. Discussion: Emerging themes that contribute to comprehending the phenomenon of dignity in end‐of‐life care in the emergency department are expected to be found. This study's results could have important implications in the implementation of new interventions in emergency departments. These interventions would be focused on improving: the social acceptance of death, environmental conditions, promotion of autonomy and accompaniment and assumption (takeover) of dignified actions and attitudes (respect for human rights). [ABSTRACT FROM AUTHOR]

Objective: To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time.Design: A prospective interventional study.Setting: An ED of a tertiary care hospital.Participants: Triage acuity level-3 patients.Intervention(s): To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff.Main Outcome Measure(s): Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation.Results: Despite an increment in the daily number of visits (+8.3%, P < 0.001), significant reductions in process time of discharged (182 vs 160 min, P < 0.001) and transferred to observation (186 vs 176 min, P < 0.001) patients, in length of stay (389 vs 329 min, P < 0.001), and in waiting time (71 vs 48 min, P < 0.001) were achieved after lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%).Conclusion: Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time. [ABSTRACT FROM AUTHOR]

Objective: To analyze the influence of fins and rescue tube use in a water rescue, assessed by time and distance to salvage position, physiological parameters, and cardiopulmonary resuscitation (CPR).Methods: Twenty professional lifeguards (10 men, 10 women) conducted 3 tests: a baseline test of 5 minutes of CPR and 2 water rescues, 1 without rescue equipment (NRE), and the other with fins and rescue tube (FRT). They also had to perform 5 minutes of CPR after each rescue. Time and distance of the rescues, physiological parameters (blood lactate concentration and heart rate), and quality of CPR were analyzed.Results: CPR quality worsened by 26 to 28% (P < .001) after rescue. However, there were no differences using FRT. The use of rescue equipment reduced the time (FRT: 216±57 seconds; NRE: 319±127 seconds; P < .001) and distance covered (FRT: 265±52 m; NRE: 326±41 m; P < .001). No differences were found in lactate levels between FRT and NRE just after the rescues, but there were some after 5 minutes of subsequent CPR (FRT: 10.7±2.2 mmol/L; NRE: 12.6±1.8 mmol/L; P < .001). Comparing women with men, we found significant differences in lactate concentrations only in FRT (women: 9.6±1.4 mmol/L; men: 8.1±1.2 mmol/L; P = .031).Conclusions: The use of fins and rescue tube provides a comprehensive benefit in an aquatic emergency. However, FRT did not have any effect on the quality of the postrescue CPR. [ABSTRACT FROM AUTHOR]

Background: Comorbidity remains a matter of international interest, given growing prevalence of chronic conditions.Objective: To evaluate the impact that adding a telephone coaching intervention by a family physician to usual care has on reducing resource consumption and improving health status, caregiver burden and quality of life among complex chronic patients (CCP) compared with usual care.Methods: A randomized controlled trial was conducted on a random sample of CCP from three primary care teams in Barcelona. Patients were randomly allocated into intervention or control groups. Evaluations were conducted at baseline and after six-month follow-up. Intervention patients were phoned twice a month by a family physician. Both groups received usual care. Primary endpoint was change in total number of urgent visits per patient. Secondary endpoints were changes in health and mental status, quality of life and caregiver burden.Results: Hundred and sixty-one CCP were included. During follow-up, 9 patients died and 2 were lost. At baseline, patients' characteristics and resource consumption were similar for both groups. After six months, urgent visits per patient decreased in intervention (1.27 baseline versus 0.89 follow-up, P = 0.091) and control (1.06 baseline versus 0.86 follow-up, P = 0.422) groups, mean difference 0.18 [confidence interval (CI) 95% -0.48 to 0.84]. Intervention patients improved in the physical component of the SF-12 questionnaire, while worsening in control patients, mean difference 4.71 (CI 95% -9.03 to -0.41). Differences were not found in the rest of the endpoints.Conclusion: The intervention did not reduce urgent visits among CCP neither improved patient's health. [ABSTRACT FROM AUTHOR]

Background: Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. Objective: The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. Research design: A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013-2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). Findings: The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Discussion: Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Conclusion: Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses. [ABSTRACT FROM AUTHOR]

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Introduction In recent years, there has been a significant increase in the demand for prehospital emergency care in different countries. Objective The aim of the present study was to identify the variables associated with psychiatric calls to the Prehospital Emergency Care Services (PECS) in the province of Malaga. Method An observational retrospective study based on calls made to the PECS and registered in the computerized database of the Coordination Emergency Centre during one year (N = 163 331). Independent variables included 1. sociodemographic variables: sex and age; and 2. variables related with the characteristics of each call: time of day, type of day, time of year, caller identification, number of resources needed, number of patients attended and type of solution. The χ2 test was used to compare of the variables. A multivariant logistic regression analysis was also carried out. Results Psychiatric calls accounted for 7% of the total calls and were associated with: younger age, female gender, calls made in the evenings and afternoons, a lower number of patients attended, the call being performed by other individual calling on the patient's behalf, and no ambulance transportation. Discussion and conclusion The calls concerned with mental health problems have specific characteristics which need to be taken into account in order to provide a better care for psychiatric patients. [ABSTRACT FROM AUTHOR]

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Objectives: This paper describes verdicts in court involving injury-producing medical errors in Spain.Design, Setting and Participants: A descriptive analysis of 1041 closed court verdicts from Spain between January 2002 and December 2012. It was determined whether a medical error had occurred, and among those with medical error (n = 270), characteristics and results of litigation were analyzed. Data on litigation were obtained from the Thomson Reuters Aranzadi Westlaw databases.Main Outcome Measures: All verdicts involving health system were reviewed and classified according to the presence of medical error. Among those, contributory factors, medical specialty involved, health impact (death, disability and severity) and results of litigation (resolution, time to verdict and economic compensations) were described.Results: Medical errors were involved in 25.9% of court verdicts. The cause of medical error was a diagnosis-related problem in 25.1% and surgical treatment in 22.2%, and Obstetrics-Gynecology was the most frequent involved specialty (21%). Most of them were of high severity (59.4%), one-third (32%) caused death. The average time interval between the occurrence of the error and the verdict was 7.8 years. The average indemnity payment was €239 505.24; the highest was psychiatry (€7 585 075.86) and the lowest was Emergency Medicine (€69 871.19).Conclusions: This study indicates that in Spain medical errors are common among verdicts involving the health system, most of them causing high-severity adverse outcomes. The interval between the medical error and the verdict is excessive, and there is a wide range of economic compensation. [ABSTRACT FROM AUTHOR]

Background: Pre-hospital emergency care is a particularly vulnerable setting for workplace violence. However, there is no literature available to date on the psychological consequences of violence in pre-hospital emergency care. Objectives: To evaluate the psychological consequences of exposure to workplace violence from patients and those accompanying them in pre-hospital emergency care. Design: A retrospective cross-sectional study. Setting: 70 pre-hospital emergency care services located in Madrid region. Participants: A randomized sample of 441 health care workers (135 physicians, 127 nurses and 179 emergency care assistants). Methods: Data were collected from February to May 2012. The survey was divided into four sections: demographic/professional information, level of burnout determined by Maslach Burnout Inventory (MBI), mental health status using General Health Questionnaire (GHQ-28) and frequency and type of violent behaviour experienced by staff members. Results: The health care professionals who had been exposed to physical and verbal violence presented a significantly higher percentage of anxiety, emotional exhaustion, depersonalization and burnout syndrome compared with those who had not been subjected to any aggression. Frequency of verbal violence (more than five times) was related to emotional exhaustion and depersonalization. Conclusion: Type of violence (i.e. physical aggression) is especially related to high anxiety levels and frequency of verbal aggression is associated with burnout (emotional exhaustion and depersonalization). Psychological counselling should be made available to professional staff who have been subjected to physical aggression or frequent verbal violence. [ABSTRACT FROM AUTHOR]

Introduction: On 14 March 2020, a state of alarm was declared in Spain because of the pandemic of coronavirus disease (COVID-19). After 12 weeks from the beginning of the pandemic, the number of confirmed cases stoods at 5781 in Aragon: 46% hospitalised, 5% admitted to intensive care unit, and 15% died. The absence of controlled trials in SARS-CoV-2 infection and the fast progression of the disease has promoted the use of treatments with unproven potential benefit. The objective of this study is to define the prescription profile in patients with SARS-CoV-2 infection hospitalised in Aragon, Spain during the pandemic and its adaptation to the official recommendations., Patients and Methods: Descriptive retrospective study of the consumption and inpatient dispensation of drugs in a sample of COVID-19 infected inpatients (with positive PCR test result) admitted to hospitals of Aragon, between 1 March and 8 May 2020. Data were collected by an inpatient dispensation software program., Results: 1482 positive COVID-19 patients were analysed: 54.9% male, median age 75 years (IQR 62-85); 12% were admitted to the intensive care unit. Median prescription: 13 active ingredients per patient (IQR 9-19). 73% (1093 patients) received hydroxychloroquine, lopinavir/ritonavir, or azithromycin, 81% as combination therapy. 4.3% (52) received other antivirals. 46% received corticosteroids (84% methylprednisolone, 8.7% dexamethasone) and 2.2% tocilizumab., Discussion: At the time of the study period there was not enough quality evidence to issue a recommendation on any treatment. There are several clinical trials ongoing to clarify what is the best treatment for patient with SARS-CoV-2 infection., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

“Global health” has expanded a great deal in the past 10 to 15 years through expansion of training programs, implementation of best practices, funding and performance of clinical research, and in educational experiences for trainees. One aspect of health care, pediatric emergency medicine, has roots in many parts of the world; it is clear that there are many places where it is either not recognized as an important subspecialty and where the quality of care can be highly variable. Our article will describe how partnerships between institutions in the United States (Cincinnati Children''s Hospital Medical Center) and Spain (Hospital Universitario de Cruces in Vizcaya) help in the development of pediatric emergency services as well as in the establishment of the subspecialty in Spain. [Copyright &y& Elsevier]

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ACADEMIC EMERGENCY MEDICINE 2011; 18:1358-1370 © 2011 by the Society for Academic Emergency Medicine Abstract The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Injury due to external causes is an important health problem in our society today. Emergency care systems based on the concept of “comprehensive care” can prevent deaths and disabilities as well as limit the severity and pain caused by trauma. Objective: To investigate the frequency and characteristics of different mechanisms of injury and to estimate mortality, comparing two comprehensive emergency systems: Atlantic Pyrenees (AP) in France and Navarra (NA) in Spain. Material and Methods: A prospective cohort study of severe multiple-injury patients attended to by the comprehensive emergency care systems of AP and NA from April 1, 2001 to March 31, 2002. Data were collected from personal patient data, the emergency coordination center “112,” pre-hospital and hospital health care levels, and discharge data. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management. Results: There were 614 severe multiple trauma patients recorded, 278 in AP and 336 in NA. Significant differences were observed in arrival time, pre-hospitalization care, pre-hospital Revised Trauma Score (RTS), Injury Severity Score (ISS) at the intensive care unit, and procedures used (intubation, administration of fluids, immobilization, and diagnostic methods). Logistic regression showed significant differences in patient death, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01–1.03), penetrating or accidental injuries, (OR 3.85, 95% CI 1.1–13.1), RTS (OR 0.58, 95% CI 0.5–0.7), and ISS score (OR 1.05, 95% CI 1.0–1.1). Conclusion: Despite a more aggressive approach and employment of greater resources, the French comprehensive trauma system does not show greater survival rates among injured patients compared to Navarra, even when controlling for confounding factors like age, injury mechanism, RTS, ISS, and others. [Copyright &y& Elsevier]

Background: The impact of immigration on health services utilisation has been analysed by several studies performed in countries with lower levels of immigration than Spain. These studies indicate that health services utilisation is lower among the immigrant population than among the host population and that immigrants tend to use hospital emergency services at the expense of primary care. We aimed to quantify the relative over-utilisation of emergency services in the immigrant population. Methods: Emergency visits to Hospital del Mar in Barcelona in 2002 and 2003 were analysed. The country of origin, gender, age, discharge-related circumstances (hospital admission, discharge to home, or death), medical specialty, and variable cost related to medical care were registered. Immigrants were grouped into those from high-income countries (IHIC) and those from lowincome countries (ILIC) and the average direct cost was compared by country of origin. A multivariate linear mixed model of direct costs was adjusted by country of origin (classified in five groups) and by the individual variables of age, gender, hospital admission, and death as a cause of discharge. Medical specialty was considered as a random effect. Results: With the exception of gynaecological emergency visits, costs resulting from emergency visits by both groups of immigrants were lower than those due to visits by the Spanish-born population. This effect was especially marked for emergency visits by adults. Conclusion: Immigrants tend to use the emergency department in preference to other health services. No differences were found between IHIC and ILIC, suggesting that this result was due to the ease of access to emergency services and to lack of knowledge about the country's health system rather than to poor health status resulting from immigrants' socioeconomic position. The use of costs as a variable of complexity represents an opportunistic use of a highly exhaustive registry, which is becoming ever more frequent in hospitals and which overcomes the lack of clinical information related to outpatient activity. [ABSTRACT FROM AUTHOR]

Unlike most countries in the world, Spain has a unique and huge system of highly specialized out-of-hospital emergency service, led by the best trained family doctors, specialists in Emergency Medicine. While the ambulance went down the street at 20th with sirens and music to cheer on the people of city Ibiza, Balearic Islands, Spain, on April 7, 2020, a BOY approached unsurely, under the supportive and complicit eyes of the people from the balconies and without saying a word passed the ambulance health workers, his drawing through the window. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of burnout syndrome is increasing among doctors and nurses. The aim of this study was to analyse the relationship between the psychosocial work environment and burnout syndrome among emergency medical and nursing staff in Spain. A secondary aim was to determine if the effect of this psychosocial work environment on burnout was different for doctors and nurses. Methods: A cross-sectional survey was carried out by means of a mail questionnaire among 945 emergency doctors and nursing staff of Spain. The outcome variable was three dimensions of burnout syndrome [emotional exhaustion (EE), personal accomplishment (PA), depersonalisation (DP)]. The explanatory variable was that psychosocial work environment evaluated according to Karasek and Johnson’s demand-control model. The adjusted odds ratios (OR) and their 95% confidence intervals were calculated by logistical regression. Results: The probability of high EE was greater among those exposed to high psychological demands, OR 4.66 (2.75–7.90), low job control, OR 1.65 (1.04–2.63), and low supervisors’ social support, OR 1.64 (1.01–2.59). Emotional exhaustion dimension was negatively influenced by low control only among doctors. Those exposed to low job control had a higher risk of low PA, OR 2.55 (1.66–3.94). There was no evidence of negative effect of psychosocial risk factors on the DP. Prevalence of EE and PA was higher among doctors and nurses. Conclusions: The presence of risk factors derived from work organisation within the work place (psychosocial risk factors) increases the probability of presenting burnout syndrome and, above all, EE. [ABSTRACT FROM AUTHOR]

Objective: Drowning is a major problem of public health in Spain, with a high number of deaths. The main strategy to address it is prevention, going through knowledge and education. The aim of this study was to analyze from a public health perspective a) the knowledge of young participants from 14 to 16 years old about drowning prevention, swimming skills and risks on the beach and b) to evaluate a pilot program with educational video for drowning prevention due to rip currents., Methods: For this purpose, a three-phase study was carried out: (1) application of a questionnaire to identify bath habits, risk perception in relation to rip currents and swimming level, (2) evaluation of a video for the identification of rip current risk and (3) evaluation of the assimilation of the visualized content one month after the intervention. 120 adolescents participated in this study during march, april and may, 2019. A descriptive analysis and comparisons with Chi-Square were performed in SPSS., Results: 120 adolescents participated in this study during March, April and May, 2019. 96.7% knew how to swim, but 44.1% had a basic level. More than half of the participants did not know rip currents or did not identify them in swimming areas. The video achieves the assimilation of concepts related to rip currents and drowning prevention., Conclusions: These findings suggest that adolescents have a lack of knowledge about rip currents and are not able to identify safe swimming areas. The use of health communication strategies based on the interests and profiles of young people have shown an improvement in the perception of risks at beaches on the sample studied.

Objectives: The goal of this study was to identify and analyze the 100 most frequently cited journal articles pertaining to the field of pediatric emergency medicine (PEM) and published in emergency medicine (EM) peer-reviewed literature., Methods: The 3 databases, Scopus Library, Google Scholar, and Web of Science, were subjected to a search by topic, keyword, and publication journal to identify the 100 most frequently cited articles addressing PEM issues in the EM literature. Our search included articles published beginning in 1983 and ending in 2016. Median citation frequency, study topics within the specialty of PEM, years of publication, and countries of origin were each compiled and analyzed. Mean citation frequencies were used to rank the articles, which accounted for differences in the results among the 3 databases. Once organized into a list of the 100 most often cited articles in PEM, those with an outcome of the same mean citation frequency were ranked in alphabetical order, according to the initial letter of last name of the first author of the publication., Results: A ranking was created of the 100 most frequently cited articles in pediatric emergency medicine by the mean number of citations. Citation counts ranged from a high of 249 to a low of 71, with a median frequency of 101. The United States had 92 articles on the list, whereas the remainder was comprised of the following countries: Australia (3), Canada (3), Germany (1), and Spain (1). The most common topic areas (and their numbers) noted were related to resuscitation (23) and anesthesia (22). The most frequently cited 100 articles were all published between the years 1983 and 2010. Top publication years (and number of articles) included 2000 (11), 2002 (8), and 2003 (8). The years ranging from 1993 to 2005 covered 69% of published articles. Journals of publications (and article counts) were Annals of Emergency Medicine (69), Pediatric Emergency Care (15), Academic Emergency Medicine (12), and Resuscitation (4)., Conclusions: This analysis provides a review of citation frequency of top-cited PEM articles published in EM journals. This determines the influence of these PEM publications on the EM specialty. The importance of education on resuscitation and anesthesia topics in PEM was evident. Most of the articles were published more than 10 to 15 years ago, indicating that they could be considered landmarks in the subspecialty of PEM. This signifies their importance to other authors in this field, who chose to cite them as having created a significant impact on their own publications., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.)

We developed an integrated model of telemedicine services in emergency medical care. The architecture was designed to support pre-hospital management. The experimental work was carried out with the collaboration of the emergency medical services (EMS) in Madrid. Two different study populations were defined: a control population using conventional EMS protocols and a population using the telemedicine system. The telemedicine system was based on a telepresence service; electrocardiograms and images were transmitted from the ambulance to the health emergency coordination centre. The cost of dealing with 100 patients using telemedicine was C6030 less than the cost of conventional care. The response times using telemedicine were significantly lower. [ABSTRACT FROM AUTHOR]

Objective: Giving the absence of specialized training to work as a physician in the Emergency Department in Spain, the aim of the study was to describe the variability of specialties in these departments nationally, by regions and hospital complexity., Methods: A descriptive cross-sectional study was carried out through a survey addressed to Emergency Chiefs of Spanish public hospitals, 65 of whom answered between January 2018 and September 2019. Descriptive and correlative analyzes of the variables were performed, assuming those with p<0.05 as statistically significant., Results: 1,706 emergency physicians of 29 different specialties were described, of which 1,336 (78.31%) were Family and Community Medicine specialists. Different number of specialties among regions and hospitals of different complexities were described. 98.46% of surveyed chiefs demanded specialized formation on Emergency Medicine. Direct correlations were found between the complexity of the hospital and the number of specialties in the Emergency Department (r=0.2921, CI: 0.04445-0.5059; p<0.05); the complexity of the hospital and the number of emergency physicians (r=0.69, CI: 0.5310-0.8020; p<0.0001), as well as between the number of emergency physicians and the number of different specialties in the Emergency Department (r=0.3901, CI: 0.1543-0.5838; p<0.005)., Conclusions: Physicians of 29 different specialties were described working in the Emergency Departments. The variability of specialties changed among regions and hospitals of different complexities. Heads of Emergency Departments agreed on the need for specialized formation on Emergency Medicine., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objectives: To analyze the characteristics of the visits attended to in an ENT Emergency Department (ENT-ED) during the first wave of COVID-19, comparing them with the emergencies attended to during the same period of time in 2019., Methods: Descriptive and analytical observational retrospective study of all emergency consultations between March 1, 2020, and May 21, 2020, carried out by the Otorhinolaryngology-Head and Neck Surgery Department of a tertiary university hospital. The adequacy of consultations was assessed with the Hospital Emergency Suitability Protocol (HESP). The correlation between the emergencies and the SARS-CoV-2 confirmed cases was assessed with a generalized linear model., Results: Although there was a decrease of almost 50% in ENT-ED visits during the first wave of COVID-19, the pattern of most cases remained similar to the pre-COVID-19 era: non-urgent consultations, not previously assessed by Primary Care (PC), being considered inadequate by the HESP. The three main reasons for consultation were otalgia, odynophagia, and epistaxis. The number of ENT-ED visits and the total number of confirmed cases of SARS-CoV-2 in the health area were correlated., Conclusions: SARS-CoV-2 pandemic was a challenge for the Spanish health system. The critical epidemiological situation experienced during March, April, and May explains the reduction in the number of visits to the ENT-ED. However, this condition did not affect the predominant pattern of visits with respect to the pre-COVID-19 era, which were mostly inadequate. A strengthening of PC and an improvement in the population's health education is essential., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To investigate the presence of fundamental concepts in emergency medicine on the entrance examination taken by candidates for medical internships and residency training in Spain, and to identify changes over time., Material and Methods: Longitudinal retrospective study. Three independent researchers reviewed questions on the entrance examinations of the past 10 years (2010-2019) and classified them as directly, indirectly, or not related to emergency medicine. The topics of directly related questions were also classified according to the categories listed in Tintinalli's Emergency Medicine and subject areas in the Citation Index Expanded (SCIE) of the Web of Science. Changes in the number of questions and range of topics were analyzed with simple linear regression models., Results: A total of 2300 questions were reviewed; 487 (22%) were directly related to emergency medicine, and 313 of them specifically referred to an emergency or urgent care setting. The proportion of directly related questions held steady over the 10-year period (P=.172). The most frequently mentioned categories listed by Tintinalli were cardiovascular (12.2%), infectious (11.1%), and gastrointestinal (10.9%) emergencies, and no significant differences were noted over time. However, proportions assigned to the SCIE categories did change over time, as follows. Questions about emergency care in general (11.9% during the period overall) increased significantly with time (P=.005) whereas cardiovascular questions (11.3%) decreased (P=.037). The proportion of infectious disease topics remained the same (10.7%)., Conclusion: Even though emergency medicine is not a recognized specialty for medical residency training in the public health system, questions on emergencies are considered important for evaluating candidates, judging by the high percentage of questions on the examinations.

Objectives: To describe the main characteristics of all prehospital emergency services (SEPHs, the Catalan acronym) in Catalonia (the SEPHCAT study)., Material and Methods: A professional survey researcher interviewed the medical directors of all services in Catalonia, using a questionnaire prepared by the authors. Questions covered aspects related to organization, professional staffing and employment conditions, as well as the staff's training, instructional activity and research. Only closed answers were collected. The survey reflected the situation in 2015., Results: We identified 13 SEPHs (11 in the public health service and 2 private companies). Together they received 2 482 627 calls (16.4% to private services) and attended 943 849 emergencies (11.8% attended by private companies). Three hundred thirty-six basic life support units and 73 advanced life support units were reported. They were mostly considered to be of sufficient size and quality. The SEPHs contracted 1374845 person-hours/y (753995 physician-hours and 620 850 nurse-hours; 23.4% in private companies). These figures correspond to 815 full-time staff positions (447 for physicians and 368 for nurses). The numbers of physicians and nurses working were relatively stable during the morning, afternoon and evening shifts but decreased during the midnight-to-early-morning shift (physicians, by 31%; nurses, by 9%). A majority of the physicians employed were trained in family and community medicine (56.8%), but 21.3% had no specialized training; 6.5% had PhD degrees. SEPH physicians (61.5%) and nurses (46.2%) also taught undergraduate medical students; 46.2% of physicians and 84.6% of nurses taught postgraduate medical courses. Both undergraduate medical and nursing students were received in the same measure for practical training by 15.4% of the SEPHs; 69.2% also offered practical training for physicians at the postgraduate level and 76.9% trained postgraduate nurses., Conclusion: SEPHs in Catalonia are very active, and private companies account for nearly 12% of the activity. Together the public and private sectors employ a large number of physicians and nurses. Staff members are involved in training others but are less involved in research.