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Background-More than 300 000 out-of-hospital cardiac arrests (OHCA)

There are few evidence-based measures of emergency medical services (EMS) system performance. In many jurisdictions, response-time intervals for advanced life support units and resuscitation rates for victims of cardiac arrest are the primary measures of EMS system performance. The association of the former with patient outcomes is not supported explicitly by the medical literature, while the latter focuses on a very small proportion of the EMS patient population and thus does not represent a sufficiently broad selection of patients. While these metrics have their place in performance measurement, a more robust method to measure and benchmark EMS performance is needed. The 2007 U.S. Metropolitan Municipalities' EMS Medical Directors' Consortium has developed the following model that encompasses a broader range of clinical situations, including myocardial infarction, pulmonary edema, bronchospasm, status epilepticus, and trauma. Where possible, the benefit conferred by EMS interventions is presented in the number needed to treat format. It is hoped that utilization of this model will serve to improve EMS system design and deployment strategies while enhancing the benchmarking and sharing of best practices among EMS systems.

Abstract. Objective: To establish the prevalence of domestic violence committed by women against male patients presenting to an urban ED for any reason. Methods: This was a prospective survey in which male patients of legal age presenting to the ED over a 13-week period were interviewed. Patients answered a series of six questions adapted from the George Washington University Universal Violence Prevention Screening Protocol. Patients who could not speak English, those refusing to participate, those unable to give informed consent, and those meeting regional criteria for major trauma were excluded. Results: Of 866 male patients interviewed, 109 (12.6%) had been the victims of domestic violence committed by a female intimate partner within the preceding year. Victims were more likely to be younger, single, African American, and uninsured. The most common forms of assault were slapping, grabbing, and shoving (60.6% of victims). These were followed by choking, kicking, biting, and punching (48.6%), or throwing an object at the victim (46.8%). Thirty-seven percent of cases involved a weapon. Seven percent of victims described being forced to have sex. Nineteen percent of victims contacted the police; 14% required medical attention; 11% pressed charges or sought a restraining order; and 6% pursued follow-up counseling. Conclusions: Almost 13% of men in this sample population had been victims of domestic violence committed by a female intimate partner within the previous year. Further attention to the recognition and management of domestic violence committed by women against men may be warranted. 8 These data did not distinguish between same-sex and heterosexual partners. In 1981, Goldberg and Tomlanovich surveyed 492 ED patients regarding domestic violence victimization. Twenty-two percent of the patients described previous victimization, with 38% of victims being male.9 Once again, these data did not distinguish between same-sex and heterosexual partners. Finally, a 1995 survey of 516 men and women pre-ACADEMIC EMERGENCY MEDICINE • August 1999, Volume 6, Number 8 787 senting to an urban ED revealed that 28% of men and 33% of women had been victims of physical violence in previous relationships.10 Therefore, domestic violence committed by women against men may not be as rare as is commonly believed.The objectives of this study were 1) to determine the prevalence of domestic violence committed by women against men presenting to an urban ED, 2) to identify demographic differences between male victims of domestic violence and nonvictims, and 3) to establish how often male victims pursue legal action or counseling. METHODSStudy Design. This was a prospective survey of male patients presenting to an urban ED. Patients were verbally administered a brief questionnaire addressing issues of violence victimization within the preceding year. Emphasis was placed on violence committed by female intimate partners. The study was approved by the institutional review board of the University of Pennsylvania.Study Population and Setting...