Objectives: The objective was to validate a previously derived prediction rule for hospital admission using routinely collected out-of-hospital information. Methods:The authors performed a multicenter retrospective cohort study of 1,500 randomly selected, adult patients transported to six separate emergency departments (EDs; three community and three academic hospitals in three separate health systems) by a city-run emergency medical services (EMS) system over a 1-year period. Patients younger than 18 years or who bypassed the ED to be evaluated by trauma, obstetric, or psychiatric teams were excluded. The score consisted of six weighted elements that generated a total score (0-14): age ‡ 60 years (3 points); chest pain (3); shortness of breath (3); dizzy, weakness, or syncope (2); history of cancer (2); and history of diabetes (1). Receiver operator characteristic (ROC) curves for the decision rule and admission rates were calculated among individual hospitals and for the entire cohort.Results: A total of 1,102 patients met inclusion criteria. The admission rate for the entire cohort was 40%, and individual hospital admission rates ranged from 28% to 57%. Overall, 34% had a score of ‡4, and 29% had a score of ‡5. Area under the ROC curve (AUC) for the combined cohort was 0.83 for all admissions and 0.72 for intensive care unit (ICU) admissions; AUCs at individual hospitals ranged from 0.72 to 0.85. The admission rate for a score of ‡4 was 77%; for a score of ‡5 the admission rate was 80%. Conclusions:The ability of this EMS rule to predict the likelihood of hospital admission appears valid in this multicenter cohort. Further studies are needed to measure the impact and feasibility of using this rule to guide decision-making.ACADEMIC EMERGENCY MEDICINE 2009; 16:519-525 ª
IntroductionIn-flight medical emergencies on commercial aircraft are common in both domestic and international flights. We hypothesized that fourth-year medical students feel inadequately prepared to lend assistance during in-flight medical emergencies. This multicenter study of two U.S. medical schools obtains a baseline assessment of knowledge and confidence in managing in-flight medical emergencies.MethodsA 25-question survey was administered to fourth-year medical students at two United States medical schools. Questions included baseline knowledge of in-flight medicine (10 questions) and perceived ability to respond to in-flight medical emergencies.Results229 participants completed the survey (75% response rate). The average score on the fund of knowledge questions was 64%. Responses to the 5-point Likert scale questions indicated that, on average, students did not feel confident or competent responding to an in-flight medical emergency. Participants on average also disagreed with statements that they had adequate understanding of supplies, flight crew training, and ground-based management.ConclusionThis multicenter survey indicates that fourth-year medical students do not feel adequately prepared to respond to in-flight medical emergencies and may have sub-optimal knowledge. This study provides an initial step in identifying a deficiency in current medical education.
Objectives: Emergency medical services (EMS) was recently approved as a subspecialty by the American Board of Medical Specialties, highlighting the core content of knowledge that encompasses prehospital emergency patient care. This study aimed to describe the current state of EMS education at emergency medicine (EM) residency programs in the United States. Methods:The authors distributed an online survey containing multiple-choice and free-response questions pertaining to resident EMS education to the directors of EM residency programs in the United States between July 21 and September 10, 2010.Results: Of 154 programs, 117 (75%) responded to the survey, and 108 (70%) completed the survey by answering all required questions. Of completed surveys, 82 programs (76%) reported the cumulative time devoted to EMS didactic education during the course of residency training, a median of 20 hours (range = 3 to 300 hours; interquartile range [IQR] = 12 to 36 hours). There is a designated EMS rotation in 89% of programs, with a median duration of 3 weeks (range = 1 to 9 weeks; IQR = 2 to 4 weeks). Most programs involve residents on EMS rotations strictly as in-field observers (63%), some as in-field providers (20%), and the rest with some combination of the two roles. Ground ride-along is required in 94% of programs, while air ride-along is mandatory in 4% and optional in 81% of programs. Direct medical oversight (DMO) certification is required in 41% of residency programs, but not available in 26% of program jurisdictions. Residents in 92% of programs provide DMO. In those programs, most residents (77%) provide DMO primarily while working in the emergency department (ED), 13% during dedicated EMS or medical oversight shifts, and 4% during a combination of these shifts. Disaster-preparedness was most frequently listed as the component programs would like to add to their EMS curricula. Conclusions:There is a wide range in the didactic, online, and in-field EMS educational experiences provided as part of EM training. Most residents participate in ground ride-along activities, provide DMO, and have a dedicated EMS rotation. Disaster-preparedness is the most common desired addition to existing EMS rotations.ACADEMIC EMERGENCY MEDICINE 2012; 19:174-179 ª 2012 by the Society for Academic Emergency Medicine T he recent establishment of emergency medical services (EMS) as a subspecialty by the American Board of Medical Specialties underscores the unique body of knowledge that encompasses out-ofhospital emergency care. As this care is closely tied to the management of patients in the emergency department (ED), the Accreditation Council for Graduate Medical Education (ACGME) program requirements for
Disclaimer: Due to the rapidly evolving nature of this outbreak, and in the interests of rapid dissemination of reliable, actionable information, this paper went through expedited peer review. Additionally, information should be considered current only at the time of publication and may evolve as the science develops. On February 11, 2020, the World Health Organization renamed the virus COVID-19. BACKGROUND Originating within the city of Wuhan, Hubei Province, China, in December 2019 and January 2020, the disease COVID-19 has spread widely throughout the world. 1-3 On March 11, 2020, the World Health Organization (WHO) classified COVID-19 as a pandemic. COVID-19 is caused by the coronavirus SARS-CoV-2, and is believed to have originated from bats. 4-6 Its overall case fatality rate has been reported between 1% and 3.8%, although this number is likely to evolve as broader testing becomes available for less severe cases. 1,6,7 The WHO-China Joint Mission on Coronavirus determined that 75-85% of case clusters in China occurred within families, presumably in the household. 4 Across the world, efforts are underway to contain the spread and mitigate the impact of COVID-19. These include social distancing efforts such as working from home and meeting via teleconferences. 8 The nature of public safety both necessitates that first-responder personnel be present at the station and requires vigilance to keep them healthy to provide essential services to the community. As a result, the fire station represents a front line in the COVID-19 mitigation efforts. The impact on fire department staffing was demonstrated when 25 of 111 employees of the City of Kirkland, Washington, Fire Department were placed under quarantine after responding to calls at a single, skilled nursing facility later found to have a COVID-19 case cluster. 9 Given the annual presence of the influenza virus, comparing influenza to COVID-19 provides some basis to evaluate the threat. Where COVID-19's estimated case fatality rate is between 1% and 3.8%, the United States Centers for
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