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Traumatic injuries are the fifth leading cause of mortality in the province of Alberta, with more than 900 deaths (close to 5% of all deaths) per year. (1-3) Albertans living [...]

Author(s): Patricia Jabre [sup.1] [sup.2] [sup.3], Karim Tazarourte [sup.4], Elie Azoulay [sup.5], Stephen W. Borron [sup.6], Vanessa Belpomme [sup.7], Line Jacob [sup.8], Lionel Bertrand [sup.9], Frederic Lapostolle [sup.1], Xavier Combes [...], Purpose To evaluate the psychological consequences among family members given the option to be present during the CPR of a relative, compared with those not routinely offered the option. Methods Prospective, cluster-randomized, controlled trial involving 15 prehospital emergency medical services units in France, comparing systematic offer for a relative to witness CPR with the traditional practice among 570 family members. Main outcome measure was 1-year assessment included proportion suffering post-traumatic stress disorder (PTSD), anxiety and depression symptoms, and/or complicated grief. Results Among the 570 family members [intention to treat (ITT) population], 408 (72 %) were evaluated at 1 year. In the ITT population (N = 570), family members had PTSD-related symptoms significantly more frequently in the control group than in the intervention group [adjusted odds ratio, 1.8; 95 % confidence interval (CI) 1.1-3.0; P = 0.02] as did family members to whom physicians did not propose witnessing CPR [adjusted odds ratio, 1.7; 95 % CI 1.1-2.6; P = 0.02]. In the observed cases population (N = 408), the proportion of family members experiencing a major depressive episode was significantly higher in the control group (31 vs. 23 %; P = 0.02) and among family members to whom physicians did not propose the opportunity to witness CPR (31 vs. 24 %; P = 0.03). The presence of complicated grief was significantly greater in the control group (36 vs. 21 %; P = 0.005) and among family members to whom physicians did not propose the opportunity to witness resuscitation (37 vs. 23 %; P = 0.003). Conclusions At 1 year after the event, psychological benefits persist for those family members offered the possibility to witness the CPR of a relative in cardiac arrest.

Summary This article provides an overview of the mechanism of ballistic injuries. It also explores the management of patients with gunshot wounds in emergency departments. Aims and intended learning outcomes [...]

This article examines 14 studies that assessed the effectiveness of brief interventions (BIs) delivered to injury patients in emergency care settings. The aims were to review findings concerning the effectiveness of providing BI in these settings and to explore factors contributing to its effectiveness. Of the 12 studies that compared pre-and post-BI results, 11 observed a significant effect of BI on at least some of the outcomes: alcohol intake, risky drinking practices, alcohol-related negative consequences, and injury frequency. Two studies assessed only post-BI results. More intensive interventions tended to yield more favorable results. BI patients achieved greater reductions than control group patients, although there was a tendency for the control group(s) to also show improvements. Five studies failed to show significant differences between the compared treatment conditions. Variations in the study protocol, alcohol-related recruitment criteria, screening and assessment methods, and injury severity limit the specific conclusions that can be drawn. Keywords: Emergency care; Injury patients; Randomized, brief intervention; Results

Unexpected life threatening injury or illness requiring emergency admission can precipitate crises even in the most secure of families (Redley et al 2003). Although the impact of critical situations on [...]

The Institute of Medicine (IOM) studied the problem of deterioration in America's emergency and trauma care system, which has made hospitals incapable of handling large-scale emergencies. The study described an overburdened system that is rapidly approaching its limits as the main cause of deterioration because the number of patients needing care has increased whereas there are fewer resources such as nurses, doctors to care for them.

Byline: Guoqing Hu (1), Keqin Rao (2), Zhenqiu Sun (1) Keywords: Public health practice; Emergency preparedness; Framework Abstract: To provide a scientific guide for most countries in the world to build a complete public health emergency management system. Capacity assessment theory and emergency management theory were reviewed respectively and linked together to construct a preliminary, two-dimensional public health emergency response capacity framework. A preliminary framework for public health emergency response capacity was obtained, which consists of three levels: the systems level, the organizational level, and the individual level. A two-dimensional matrix or a set of two-dimensional matrixes that comprise capacity, dimension, and emergency function dimension formed the preliminary framework in three levels, respectively. This preliminary framework can act as a theoretical guide for a country or a region to set up their own public health emergency response systems. Author Affiliation: (1) Department of Epidemiology and Health Statistics, School of Public Health, Central South University, 110 Xiang-ya Road, 410078, Changsha, Hunan Province, People's Republic of China (2) Statistical and Information Center, Ministry of Health of Peoples's Republic of China, 1 Nanlu, XiZhiMenWai, Xicheng District, 100044, Beijing, People's Republic of China Article History: Registration Date: 20/10/2005 Received Date: 03/08/2005 Accepted Date: 19/10/2005 Online Date: 24/12/2005

Emergency services are both a safety net and a locus for acute treatment. While the population with severe, persistent mental illness uses emergency services at a high rate, few studies have systematically examined the causes of this service use. This study examines a random sample of 179 people who were high utilizers of services from the Los Angeles County Department of Mental Health. Interviews were conducted and 5 years of service use data were studied. Greater use of emergency services was associated with male gender, minority race, severe illness, homelessness, and less family support. Efforts to reduce emergency services need to improve access to appropriate community services, particularly for people who are homeless or lack family support. KEY WORDS: adult; emergency services; psychiatric; mental disorders; schizophrenia; mental health services; health care utilization; African Americans; needs; health services accessibility; human; United States.

ABBREVIATIONS. ED, emergency department, EMS, emergency medical services, EMLA, eutectic mixture of local anesthetics, LM[X.sub.4], liposomal 4%, lidocaine cream, LET, lidocaine, epinephrine, and tetracaine, AAP, American Academy of Pediatrics, ASA, [...], . Whether a component of a disease process, the result of acute injury, or a product of a diagnostic or therapeutic procedure, pain should be relieved and stress should be decreased for pediatric patients. Control of pain and stress for children who enter into the emergency medical system, from the prehospital arena to the emergency department, is a vital component of emergency care. Any barriers that prevent appropriate and timely administration of analgesia to the child who requires emergency medical treatment should be eliminated. Although more research and innovation are needed, every opportunity should be taken to use available methods of pain control A systematic approach to pain management and anxiolysis, including staff education and protocol development, can have a positive effect on providing comfort to children in the emergency setting. Pediatrics 2004;114:1348-1356; pain, stress, anxiety, analgesia, opiates, topical anesthesia.

ABBREVIATIONS. ED, emergency department; PEM, pediatric emergency medicine; GEM, general emergency medicine; CI, confidence interval. Because the priority of care often is based on triage categorization, consistent and appropriate triage [...], Objective. To compare triage categorization as a measure of perceived patient acuity on presentation to the emergency department by pediatric emergency medicine (PEM) attending physicians, nurses, and pediatric residents with their general emergency medicine (GEM) counterparts. Methods. A questionnaire that contained 12 pediatric triage scenarios was sent to all PEM attending physicians, triage-trained nurses, and pediatric residents and their GEM counterparts at a large urban hospital with separate pediatric and general emergency departments. Participants were asked to use a 3-tier triage system (emergent, urgent, nonurgent) to assign a triage level for each patient scenario. Results. The response rate was 99%. The κ level of agreement was highest (.39) among the PEM physicians. Significantly more GEM attending physicians triaged the following scenarios at a higher acuity level as compared with PEM attending physicians with a trend toward emergent triage: simple febrile seizure, 50% (95% confidence interval [CI]: 30%-70%) versus 7.7% (95% CI: 1%-34%); 18-month-old with fever and bumps on lips, 21% (95% CI: 9%-43%) versus 0% (95% CI: 0%-23%); and 15-month-old well-appearing child with high fever, 50% (95% CI: 30%-70%) versus 7.7% (95% CI: 1%-34%). Significant differences were found between GEM and PEM triage-trained nurses only in the 15-month-old high fever scenario and between GEM and pediatric residents in the 15-month-old high fever scenario, the 18-month-old with fever and bumps on lips scenario, and a fever/limp scenario. Conclusions. The level of agreement of triage assignment within each group was only fair. GEM participants and PEM participants agreed on most scenarios. However, GEM participants were more likely to triage children with certain febrile illnesses at higher acuity levels as compared with their PEM counterparts. Pediatrics 2004;114:356-360; emergency, triage, fever, child.