Objective: To describe the demographic and clinical characteristics of patients who are not transported to hospital after an emergency (999) call to the East Midlands Ambulance Service, the reason for non-transportation, and the priority assigned when the ambulance is dispatched. Methods: The first 500 consecutive non-transported patients from 1 March 2000 were identified from the ambulance service command and control data. Epidemiological and clinical data were then obtained from the patient report form completed by the attending ambulance crew and compared with the initial priority dispatch (AMPDS) code that determined the urgency of the ambulance response. Results: Data were obtained for 498 patients. Twenty six per cent of these calls were assigned an AMPDS delta code (the most urgent category) at the time the call was received. Falls accounted for 34% of all non-transported calls. This group of patients were predominantly elderly people (over 70 years old) and the majority (89%) were identified as less urgent (coded AMPDS alpha or bravo) at telephone triage. The mean time that an ambulance was committed to each non-transported call was 34 minutes.Conclusions: This study shows that falls in elderly people account for a significant proportion of nontransported 999 calls and are often assigned a low priority when the call is first received. There could be major gains if some of these patients could be triaged to an alternative response, both in terms of increasing the ability of the ambulance service to respond faster to clinically more urgent calls and improving the cost effectiveness of the health service. The AMPDS priority dispatch system has been shown to be sensitive but this study suggests that its specificity may be poor, resulting in rapid responses to relatively minor problems. More research is required to determine whether AMPDS prioritisation can reliably and safely identify 999 calls where an alternative to an emergency ambulance would be a more appropriate response. E ach year, in the UK, a large number of emergency (999) calls received by ambulance services do not result in a patient being transported to hospital. These calls have implications both in terms of how rapidly an ambulance can respond to other emergencies and the efficiency of service delivery.1 To date, little has been published on this group of 999 calls.Chen et al 2 in Taiwan reported that 32% of all ambulances dispatched led to no patient being transported. In the United States, Hipskind et al 3 found 30% of ambulance responses resulted in the patient refusing transportation. These patients were commonly asymptomatic, 11-40 years old and involved in motor vehicle accidents. However, this study did not investigate calls where the ambulance crew decided not to transport the patient and differences in the organisation and delivery of emergency health care may limit the relevance of such findings in the UK.Currently, in England and Wales, 17% of patients are not conveyed to hospital after an emergency ambulance has attended a 999 cal...
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The restraint, recovery and repatriation of the corruptly acquired assets of public officials are key elements of the fight against corruption. This is a case-study of international efforts to recover the assets of a former Nigerian State Governor. The full range of criminal and civil asset recovery mechanisms were deployed, including criminal confiscation, civil forfeiture and private civil proceedings, according to the country and assets in question, and the changing circumstances of the case. The article contains an overview of the advantages and disadvantages of the various asset recovery mechanisms, and summarises the success factors in the case-study under consideration.
Hardware implants & counterfeit devices in the US power grid pose a significant national security threat. Asset owners currently have few options for detecting the presence of such devices "in the wild". The goal of this work is to develop a non-invasive sensing method to solve this problem. In this work we evaluate the feasibility of implementing a nonlinear UWB radar tomography system to differentiate between electronic internals of externally-similar devices using low-cost off-the-shelf hardware.
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