Background-While efforts have been made to address disparities in access to trauma care in the past decade, there is little evidence to show if utilization has changed. We use patient-level data to describe the changes in utilization of trauma centers in an eight-year period in California. Results-The proportion of severe injuries admitted increased by 3.6% (p < 0.05), with a concomitant rise in the proportion of trauma patients admitted to trauma centers (TCs), from 39.3% (95% CI 39.0% -39.7%) to 49.7% (49.4% -50.0%). Within the severely injured with injury severity scores > 15, 82.4% were treated in a TC if they resided in a county with a TC, compared to 30.8% of patients who did not live in a county with a TC. After adjustment, patients living greater than 50 miles away from a TC still had a likelihood ratio of 0.11 (p<0.0001) of receiving care in a TC compared to those less than 10 miles away. Similarly, even severely injured patients not living in a county with a TC had a likelihood ratio of 0.35 (p<0.0001) of being admitted to a TC compared to those residing in counties with trauma centers. Methods-We Conclusion-Admissions toTCs for all categories of injury severity are increasing. There remains, however, a large disparity in TC care depending on geographical distance and availability of a TC within county.
Abstract.Objectives: To present suggestions on planning for development of emergency medicine (EM) and out-of-hospital care in countries that are in an early phase of this process, and to provide basic background information for planners not already familiar with EM. Methods: The techniques and programs used by the authors and others in assisting in EM development in other countries to date are described. Conclusions: Some aspects of EM system development have applicability to most countries, but other aspects must be decided by planners based on country-specific factors. Because of the very recent initiation of many EM system development efforts in other countries, to the authors' knowledge there have not yet been extensive evaluative reports of the efficacy of these efforts. Further studies are needed on the relative effectiveness and cost-benefit of different EM development efforts. Key words: emergency medicine development; international emergency medicine; system development; EMS systems. ACA-DEMIC EMERGENCY MEDICINE 2000; 7:911-917 T HE specialty of emergency medicine (EM) is only now beginning to develop in a number of countries throughout the world, and in fact is a relatively new specialty even in countries where it is currently well established. For countries considering developing EM and for those just starting this process, to our knowledge there have not been previously published planning recommendations The goal of this article is to present general recommendations for development planning for the specialty of EM 1 that would be applicable to any country considering, or having already started, this specialty. We suggest sequential steps that can be considered by planners interested in developing EM and out-of-hospital care [or emergency medical services (EMS) systems] within any country. Our intended audience includes policy makers, government officials, and educators who may not necessarily already be familiar with EM as a specialty.Our suggestions are based on our collective experience involving assistance with EM system development in more than 20 countries. We acknowledge and emphasize that the content of this article is based solely on our experience, and the results of our development efforts to date have not been validated by published research studies. However, we hope that this paper will be useful in assisting and facilitating EM development in other countries and make the initial process easier and quicker for those involved. We also hope that this article will help planners avoid some of the mistakes and pitfalls that occurred during EM development in INTERNATIONAL EMHolliman et al.• EM DEVELOPMENT RECOMMENDATIONS countries where the specialty is now well established. Our interest in EM system development stems from a desire to promote optimum emergency patient care and quality EM clinical training programs, and not from a desire to promote any particular medical or cultural system. Not all of the features or considerations mentioned here will be applicable to, or adoptable by, all c...
The clinical presentation of children with anthrax is varied. The mortality rate is high in children with inhalational anthrax, gastrointestinal anthrax, and anthrax meningoencephalitis. Rapid diagnosis and effective treatment of anthrax in children requires recognition of the broad spectrum of clinical presentations of pediatric anthrax.
Background Injured patients who are not transported by ambulance to the hospital are often not included in trauma registries. The outcomes of these patients have until now been unknown. Understanding what happens to non-transports is necessary to better understand triage validity, patient outcomes, and costs associated with injury. We hypothesized that a subset of patients who were not transported from the scene would later present for evaluation and that these patients would have a non-zero mortality rate. Methods This is a population-based, retrospective cohort study of injured adults and children for three counties in California from 2006-2008. Pre-hospital data for injured patients for whom an ambulance was dispatched were probabilistically linked to trauma registry data from four trauma centers, state-level discharge data, ED records and death files (1-year mortality). Results A total of 69,413 injured persons that were evaluated at the scene by EMS were included in the analysis. Of these, 5,865 (8.5%) were not transported. Of those not transported, 1,616 (28%) were later seen in an ED and discharged and 92 (2%) were admitted. Seven (0.2%) patients later died. Conclusion Patients evaluated by EMS, but not initially transported from the field after injury often present later to the hospital. The mortality rate in this population was not zero and these patients may represent preventable deaths. Level of Evidence This is a Level III therapeutic study.
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