From April 2013, patients are being asked whether they would recommend hospital wards and emergency departments (EDs) to their friends and family if they needed similar care or treatment. Trusts are expected to collect qualitative feedback as well as ask the single ‘would you recommend?’ question. First impressions are lasting, thus the friends and family test (FFT) intensifies the pressure to ensure the patients first and ongoing impression of the service is recommendable to family and friends. Perhaps more importantly we need to understand why patients would not recommend our services. It is timely then to read the paper by Giacometti et al which describes and analyses interventions in the ED of an Italian hospital aimed at humanising the patient care pathway. Unsurprisingly patient satisfaction rose in those who attended the department following the interventions. Specifically what patients appreciated...]]>
Preceded by several days of slightly fevered media coverage, the Francis Report was finally published in the first week of February.
Here are a few snippets (from the section listing the inquiry's findings) that are of immediate interest to us: Hospital consultants at Stafford were not at the forefront of promoting change. Clinicians did not pursue management with any vigour with the concerns they may have had. Many kept their heads down. A degree of passivity about difficult personnel issues is all too common in the NHS as, perhaps, elsewhere. The national general acceptance of the importance...]]>
We had a visit from the Intensive Support Team recently. In common with other Emergency Departments (ED), we have struggled a little to achieve the national 4 h throughput target. The response of our health authority was to send in the IST.
The team, which did not contain an emergency physician, spent about an hour in the department, and of course we were interested to see what they had discovered in an hour which had not been apparent to us over many years. We hoped that their report would recognise that the main causes of our failure to meet the target were the increasing numbers of major cases being brought to the ED, and the inability of our hospital to find accommodation for these patients in a timely fashion.
We were therefore disappointed by the ED section of the report which suggested that senior emergency medicine (EM) physicians should...]]>
The 240 min total time in England stills...]]>
To evaluate a new tool to assess emergency physicians' non-technical skills.
This was a multicentre observational study using data collected at four emergency departments in England. A proportion of observations used paired observers to obtain data for inter-rater reliability. Data were also collected for test-retest reliability, observability of skills, mean ratings and dispersion of ratings for each skill, as well as a comparison of skill level between hospitals. Qualitative data described the range of non-technical skills exhibited by trainees and identified sources of rater error.
96 assessments of 43 senior trainees were completed. At a scale level, intra-class coefficients were 0.575, 0.532 and 0.419 and using mean scores were 0.824, 0.702 and 0.519. Spearman's for calculating test-retest reliability was 0.70 using mean scores. All skills were observed more than 60% of the time. The skill Maintenance of Standards received the lowest mean rating (4.8 on a nine-point scale) and the highest mean was calculated for Team Building (6.0). Two skills, Supervision & Feedback and Situational Awareness-Gathering Information, had significantly different distributions of ratings across the four hospitals (p<0.04 and 0.007, respectively), and this appeared to be related to the leadership roles of trainees.
This study shows the performance of the assessment tool is acceptable and provides valuable information to structure the assessment and training of non-technical skills, especially in relation to leadership. The framework of skills may be used to identify areas for development in individual trainees, as well as guide other patient safety interventions.
Bell's palsy is a non-life threatening disorder with important functional and psychosocial effects. While recent research has shown significant benefit from treatment with steroids in adults, there have been no conclusive studies demonstrating benefit in children. This study set out to explore the medium term resolution of symptoms in Bell's palsy presenting to the emergency department (ED).
This was a retrospective cohort study of children attending an Irish paediatric ED with a diagnosis of Bell's palsy. Patients were identified via the ED database. The primary outcome measure was resolution at follow-up call (6–18 months after presentation). Secondary outcome measures were ED treatment, imaging and time to resolution of symptoms.
There were 48 presentations, involving 45 patients. Left and right-sided palsies were equally represented. Of these, 16 (33%) received prednisolone. MRI was performed in five cases (10%), four were normal and one did not change management. In follow-up telephone contact, of 35 presentations, 28 (80%, 95% CI 63% to 91%) had complete resolution, six (17%, 95% CI 7% to 34%) partial resolution to variable degrees and one patient showed no improvement. Of the 13 patients who had received prednisolone, nine (69%, 95% CI 39% to 91%) had complete resolution; of the 22 patients who were not treated with prednisolone 19 (86%, 95% CI 65% to 97%) had complete resolution (p=0.22).
The majority of children with Bell's palsy have complete resolution of the facial weakness. Steroid use is highly variable and warrants a placebo controlled randomised trial.
Delayed access to specialist care for emergency patients is associated with increased risk of morbidity and mortality, and increased patient anxiety.
(1) To provide timelier access to inpatient and urgent outpatient specialist care for emergency patients. (2) To influence multiple stakeholders to modify their traditional practices and sustain changes.
National University Hospital of Singapore, an academic medical centre with 997 beds in Singapore and over 34 sub-specialties.
A set of six interventions was implemented to meet three goals: (1) provide timely access to urgent outpatient specialist care requested by the emergency department ED; (2) increase early inpatient discharges (in order to better match timing of emergency admissions); and (3) provide earlier defined care by inpatient specialists at the ED. An eight-step organisational change management plan was implemented to ensure all specialties complied with the changes.
The goals were achieved. (1) Specialist outpatient appointments given within the timeframe requested by the ED doctor increased from 51.7% to 80.8%. (2) Early discharges increased from 11.9% to 26.6% and were sustained at 27.2%. (3) 84% of eligible patients received earlier defined specialist care at the ED. The change management achieved excellent clinician compliance rates ranging from 84% to 100%. However the median wait for admission remained unchanged.
The interventions reduced the time for ED patients to access specialist outpatient and inpatient care. The systematic organisational change management approach resulted in sustained compliance.
An ideal triage system used in the emergency department (ED) should identify patients who need urgent medical care. The purpose of this study was to validate the Taiwan Triage and Acuity Scale (TTAS) for stratifying patients according to their severity, need for thrombolysis, resource utilisation, and outcome.
The authors retrospectively reviewed all admitted patients with a discharge diagnosis of acute ischaemic stroke from January 2010 to September 2011. Presenting complaints, activation of code stroke protocol, eligibility of intravenous tissue plasminogen activator treatment, time from ED arrival to treatment, and outcome at discharge were compared by the five-level triage system.
Of 706 enrolled patients (level 1, 55; level 2, 455; level 3, 192; level 4, 4; level 5, 0), there were 412 (58.4%) men and 294 women (41.6%), with a mean age of 69.4 years. The initial stroke severity, time from onset to arrival, time from arrival to imaging, proportion of patients for whom code stroke protocol was activated, length of hospital stay, and good functional outcome at discharge correlated with TTAS levels. A total of 84 patients were thrombolysis candidates, and 98.8% of them were designated as either level 1 or level 2. For those treated with thrombolytic therapy (n=47), the time from arrival to thrombolysis was not significantly different between TTAS level 1 and 2.
Acuity measured by the computerised TTAS demonstrated good validity in facilitating acute care of stroke patients with special regard to thrombolytic therapy.
Emergency Departments (ED) in the UK have seen increasing attendance rates in recent years. Departments are now seeking strategies to reduce their attendances. A review of all ambulance attendances to the ED at Ninewells Hospital was conducted to identify if patients presenting by ambulance could be seen and treated more appropriately in other parts of the health service.
A retrospective review of ambulance attendances to the ED at Ninewells Hospital over 7 non-consecutive days. The ambulance patient report form and the ED notes were reviewed by the duty consultant to deem whether it was appropriate for the patient to be presented to the ED. If inappropriate, an alternative destination was suggested. Additional data was collected on the source of the ambulance call.
There were 910 attendances in the 7 days. 295 (32%) presented by ambulance. 32 had incomplete data and were excluded. 185 (70%) and 179 (68%) of the 263 were deemed appropriate from review of the patient report form and notes respectively. Of the inappropriate, 74.4% and 79.7% had primary care suggested as an alternative. Patients who call for their own ambulance and NHS24 had higher rates of inappropriate attendances.
The ambulance services present one-third of the patients to the ED at Ninewells Hospital. 30%–32% were found to be attending inappropriately and 74%–80% of these could have been managed in primary care. Reducing inappropriate ambulance attendances could reduce the departmental patient load by 11%.
The patient visits to Norwegian emergency departments (EDs) have increased significantly over the last few years. A national evaluation revealed a lack of systematic activity control, resource management and quality improvement. This paper describes some variables in patient visits to an urban Norwegian university hospital.
The retrospective data were collected from a database (Akuttdatabasen) and included all patients admitted to the main ED at the St. Olav's University Hospital between 1 December 2010 and 1 December 2011.
ED visits have increased by 44% over the last decade and show considerable timely variations. Almost 50% of the patients are older than 65 years of age. The rate of patients triaged with the highest acuity level was 11%, but only 1.3% of the patients were admitted to the Intensive Care Unit (ICU). The total admission rate was 89%.
The increase in ED visits to the St. Olav's Hospital in recent years follows the same trend as in other countries. The authors see a slightly higher percentage of high level acuity patients compared with international studies due the general practitioner's intended ‘gatekeeper’ function. The authors also found a high total admission rate and a low ICU admission rate compared with other countries. These differences cannot be explained solely by differences in the healthcare system in Norway. The cultural and traditional organisation of the Norwegian Health Care System needs to change and this creates an excellent opportunity to improve the competence by establishing emergency medicine as a specialty in Norway.
To assess public knowledge of stroke and transient ischaemic attack symptoms, and awareness of the content of a recent national health campaign.
Interviewer-administered questionnaire.
Leicester, UK.
1300 members of a mixed urban/rural, multiethnic population that was sampled in public areas, places of work and schools.
Knowledge of the terms ‘stroke’, ‘stroke risk factors’ and the ‘FAST campaign’. Awareness of stroke symptoms, and ability to distinguish from non-stroke symptoms.
70% of the public surveyed were aware of the FAST campaign, with highest penetration in the female, older and white population. Overall, high levels of awareness of FAST symptoms (facial weakness 89%, arm weakness 83%, speech problems 91%) as warning signs of stroke were observed, though significantly lower levels were reported in the black and minority ethnic population. However, poor recognition of other important signs, including leg weakness (57%) and visual loss (44%) were seen, and significantly more men were likely to report non-specific symptoms as being associated with stroke.
The survey has confirmed the effectiveness of the recent FAST campaign in raising public awareness of stroke and stroke warning signs, though poorest penetration was seen in the black and minority ethnic population. However, important stroke symptoms, including leg weakness and visual loss, were poorly recognised. This may lead to delays in presentation, specialist assessment and secondary prevention, and such stroke warning signs should be included in future public health campaigns.
To determine if human papillomavirus (HPV) DNA can be detected on the transvaginal sonography (TVS) probe in the emergency department (ED) and whether the current barrier method plus disinfection can prevent HPV contamination of the TVS probe.
This was a two-part cross-sectional study. In the first part, surveillance samples were taken from the TVS probe for HPV DNA detection daily for 2 months. In the second part, patients presenting with early pregnancy complications were identified in the ED and high vaginal swabs were taken for HPV DNA testing. Several probe swabs were taken to identify if contamination was possible in cases where the procedure was done on an HPV carrier.
A total of 120 surveillance samples were obtained, nine of which (7.5%) tested positive for HPV DNA. In the second part, 76 women were recruited, of whom 14 (18.4%) were HPV carriers. After the procedure and disinfection of the probe, three out of the 14 probe samples (21%) were HPV DNA positive.
HPV is commonly encountered in the ED and contamination of the TVS probe with HPV is possible. Although it is difficult to prove the viability and infectivity of the virus, vigilant infection control measures should be maintained.
To investigate the performance characteristics of prehospital paediatric triage tools for identifying seriously injured children in England.
Eight prehospital paediatric triage tools were identified by literature review and by survey of the Lead Trauma Clinicians across English Strategic Health Authorities. Retrospective clinical registry data from the Trauma Audit and Research Network were used to determine the performance characteristics of each tool, using ‘gold standards’ for under- and over-triage of <5% and <25–50%, respectively, as benchmarks for performance.
701 patient records were included. Inclusion criteria were all injured patients aged <16 years admitted to a receiving unit direct from the scene of accident in the period 2007–2010, for whom all key discriminator fields were recorded in the Trauma Audit and Research Network database.
The main outcome measure was how each tool functioned with regard to their under- and over-triaging features. Other performance characteristics, for example, predictive values and likelihood ratios were also calculated.
Two (of eight) triage tools demonstrated acceptable under-triage rates (3% and 4%) but had unacceptably high over-triage rates (83% and 72%). Two tools demonstrated acceptable over-triage rates (7% and 16%), but with unacceptably high under-triage rates (61% and 63%). Four tools had unacceptably high under- and over-triage rates.
None of the prehospital triage tools currently used or being developed in England meet recommended criteria for over- and under-triage rates. There is an urgent need for the development of triage tools to accurately risk-stratify injured children in the prehospital setting.
Supracondylar fractures are associated with a high incidence of neurovascular complications. Comprehensive clinical evaluation is a necessity when children with these injuries present to the emergency department. Neurovascular assessment can be difficult due to pain, anxiety and the young age of these patients; however, it is crucial findings are well documented to identify patients requiring urgent surgical intervention, in addition to allowing the neurovascular status to be monitored over time. The aim of this study was to evaluate the preoperative neurovascular documentation in children presenting with displaced supracondylar fractures and devise an emergency department assessment proforma to facilitate comprehensive evaluation.
A retrospective case-note review was performed on patients with Gartland grades 2 and 3 supracondylar fractures observed in a 2-year period from July 2008 to July 2010.
137 patients were included; only 12 patients (8.8%) and 19 patients (13.9%), respectively, had a complete preoperative neurological or vascular assessment documented. Regarding the individual nerves, 59 (43.1%) patients had median nerve integrity documented, 55 (40.1%) ulnar nerve and 49 (35.8%) radial nerve integrity documented. Only 18 patients (13.1%) had their anterior interosseous nerve (AIN) function documented.
Preoperative documentation of neurovascular status in children with displaced supracondylar fractures was poor. Documentation of AIN examination was particularly poor. The introduction of a proforma (Liverpool upper limb fracture assessment) is proposed to increase documentation of neurovascular assessment and optimise emergency department evaluation of children presenting with upper limb injuries.
To explore areas of consensus and disagreement concerning the interhospital transfer of patients with a clinical diagnosis of ruptured abdominal aortic aneurysm.
A three-round Delphi questionnaire approach was used among vascular and endovascular surgery and emergency medicine specialists to explore patient characteristics and clinical management issues for emergency interhospital transfer. Analysis is based on 38 responses to rounds 2 and 3 (19 vascular surgeons, 6 interventional radiologists, 13 emergency care specialists) with agreement reported when 70% of respondents were in agreement.
Initially there was agreement that transfer patients should be <85 years of age, either alert or with fluctuating consciousness, with moderate or minimal systemic disease, needing no/some help with daily living. Round 3 clarified that patients requiring inotropes and those institutionalised for mental infirmity should be transferred. Those with cardiac arrest in current episode should not be transferred. There was no agreement as to whether those institutionalised with physical infirmities, unconscious/intubated patients or those with severe systemic disease should be transferred. Speed was accepted as important, with agreement for specialty trainees to arrange transfer if consultants were not on site. Consultant–consultant discussion was recommended for patients with severe systemic disease. CT confirmation of diagnosis was considered unnecessary before transfer but ultrasound assessment was desirable, and transfers should not be delayed by waiting for specific tests. There was no agreement about blood tests and ECG before transfer or whether blood should accompany the patient being transferred. There was no agreement as to whether specific staff/facilities needed to be in place at the specialist hospital. A systolic blood pressure ≥70 mm Hg was sufficient for transfer without the need for intravenous fluids unless deterioration occurred.
There is broad agreement about the type of patient who should be eligible for transfer but disagreements about patient management before and during transfer remain.
The goal of this study was to describe and analyse interventions performed in the emergency department (ED) of an Italian hospital with the aim of humanising the patient care pathway. The actions taken are described and the changes analysed to determine whether they resulted in an increased level of patient satisfaction.
An observational study was conducted between October 2010 and March 2011. The data were collected via a telephone questionnaire administered to patients who were admitted to the ED before and after humanisation interventions. The respondents were questioned about their general condition and their level of satisfaction.
The study population included 297 patients (158 before and 139 after the interventions). The highest overall patient satisfaction after the interventions was highly correlated with the humanisation interventions and not with other factors such as gender, age, educational level or the severity code triage. Specifically, in patients who went to the ED after the changes had been made, there was a greater level of satisfaction regarding comfort in the waiting room, waiting time for the first visit and the privacy experienced during the triage.
The results demonstrate that the interventions implemented in this study, designed to humanise the ED, improved overall patient satisfaction. Interventions may be taken to reduce the depersonalisation of patients in the emergency room.
To conduct a survey of current alcohol identification and brief advice activity in English Emergency Departments, and to compare the results with the previous survey conducted in 2007.
Cross-sectional survey of all 187 Emergency Departments in England.
Significant increases (p<0.001) in the proportion of departments routinely asking about alcohol, using a screening questionnaire, offering help/advice for alcohol problems, and having access to Alcohol Health Workers or Clinical Nurse Specialists. More than half of all departments indicated that they had an ‘alcohol champion’, and this was significantly associated with access to training on both identification and provision of brief advice (p<0.001). Departments that routinely asked questions were the most likely to use a formal screening tool (p<0.05), and the Paddington Alcohol Test was the most frequently used measure (40.5%).
There have been significant improvements in ED alcohol identification and brief advice activity since 2007 in line with the recommendations of the Royal College of Physicians, Department of Health and NICE guidelines. English EDs are beginning to maximise the likelihood of identifying patients who may benefit from further help or advice about their alcohol consumption, and are able to offer access to specialist staff who can provide appropriate interventions.
Out-of-hospital cardiac arrest (OHCA) in Ireland accounts for approximately 5000 deaths annually. Little published evidence exists on survival from OHCA in this country to date. We aimed to characterise and describe ‘presumed cardiac’ OHCA in Cork City and County attended by the Ambulance Service.
Dispatch records, ambulance patient records and hospital records for a 1-year period were examined for patient demographics, OHCA characteristics, interventions and patient outcomes.
There were 231 ‘presumed cardiac’ OHCAs attended over the study period; 130 (56%) were in urban locations and 101 (44%) in rural. OHCAs were lay-witnessed in 20% (n=46), and 22% (n=50) received bystander CPR. Shockable rhythm was present in 36 cases (16%) on initial assessment, and there was no difference in presence of shockable rhythm between urban and rural OHCAs (18% vs 13%, p=0.31). Resuscitation was attempted in 176 cases (77.5%), of whom 27 (15%) achieved return of spontaneous circulation and 13 (7.4%) survived to leave hospital. Survival when the initial rhythm was shockable was 16.7% (6 of 36 patients). Despite longer response times for rural compared with urban OHCAs (median (IQR) 16.5 (11.0–23.5) vs 9 (7–12) min, p<0.001), survival to leave hospital alive where resuscitation was attempted was similar (7.4% vs 7.4%, p=0.99, respectively).
A survival rate of 16.7% in shockable rhythms indicates scope for improvement which would influence the overall survival rate which was found to be 7.4%. Real-time feedback of performance and quality of the continuum of patient care through a clinical-quality cardiac arrest registry would monitor and incentivise such initiatives.
A chest radiograph showed a massive gastrothorax with mediastinal shift (
To assess the effectiveness of analgesia used in mountain rescue (MR) in casualties with moderate or severe pain. To determine if a verbal numeric pain score is practical in this environment. To describe the analgesic strategies used by MR.
Prospective, descriptive study.
Fifty-one MR teams in England and Wales. The study period was 1 September 2008 to 31 August 2010.
92 MR casualties with a pain scoreof 4/10 or greater.
38% of casualties achieved a pain reduction of 50% or greater in their initial score at 15 min and 60.2% had achieved this at handover.
The initial pain score was 8 (median), reducing to 5 at 15 min and 3 at handover. The mean pain reduction was 2.5±2.4 at 15 min and 3.9±2.5 at handover. 80 casualties (87%) were treated with an opioid and seven had two different opioids administered. Seven main strategies were identified in which the principal agent was entonox, intramuscular opioid, oral analgesia, fentanyl lozenge, intranasal or intravenous opioid. The choice of strategy varied with the skills of the casualty carer.
Pain should be assessed using a pain score. When possible, intravenous opioid is the gold standard to achieve early and continuing pain control in patients with moderate or severe pain. Entonox and oral analgesics, as sole agents, have limited use in moderate or severe pain. Intranasal opioid and fentanyl lozenge are effective, and appropriate in MR. Research priorities include bioavailability in different environmental conditions and patient's satisfaction with their pain management.
This study evaluated the feasibility of prehospital tissue oxygen saturation (StO2) in major trauma patients.
A prospective, pilot feasibility study carried out in a physician based prehospital trauma service.
Prehospital StO2 was recorded on 13 patients. Continuous StO2 monitoring was achieved on all patients, despite intermittent failure of pulse oximetry and non-invasive blood pressure monitoring in six patients. No adverse outcomes of StO2 monitoring were reported. The specific equipment used was reported to be inconveniently bulky and heavy for use in the prehospital setting.
Prehospital measurement and monitoring of StO2 is feasible in trauma patients undergoing prehospital anaesthesia and may be useful in the early identification of shock, triggering of transfusion protocols and guiding fluid resuscitation.
Isolated spontaneous subclavian artery dissection is extremely rare.
Checked by: Dr John-Paul Williamson, Registrar Emergency Medicine
Institution: Manchester Royal Infirmary
A short-cut review of the literature was carried out to establish whether biological markers (namely carbohydrate-deficient transferrin (CDT), gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV)) could reliably predict patients at risk of developing alcohol withdrawal syndrome. Using the below outlined search method and after exclusion of the non-relevant papers, five papers were found to be relevant to the specific question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are shown in table 1. The clinical bottom line is that CDT/GGT/MCV are not reliable enough as stand-alone markers to predict alcohol withdrawal syndrome in chronic alcohol abusers.
In [Adult patients with chronic alcohol abuse presenting to the ED] are [CDT, Gamma GT and MCV reliable biological...]]>
Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line, which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four stages that have been described elsewhere.2 The BETs shown here together with those published previously and those currently under...]]>
Search checked by: Charlotte E Cross, ST4 Trauma & Orthopaedics
Institution: Manchester Royal Infirmary
A short-cut review of the literature was carried out to establish whether a functional brace was as good as a traditional plaster of Paris to immobilise a stable ankle fracture in terms of functionality and recovery speed. A total of 260 papers was found using the below outlined search method, of which five were thought to represent the best evidence to answer the specific clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are shown in table 2. The clinical bottom line is that the limited evidence seems to suggest that a functional brace appears to give more favourable outcomes. Good quality studies involving large populations are, however, needed...]]>
Search checked by: Katie Cole Grimes, Specialty Registrar
Institution: Starship Children's Hospital (Auckland, NZ), Manchester Royal Infirmary (UK)
A short-cut review of the literature was carried out to establish whether the biological marker procalcitonin could safely rule out the diagnosis of meningococcal disease (MCD) in children. Using the below outlined search method and after the exclusion of the non-relevant papers, two were found to be relevant to the specific question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are shown in table 3. The clinical bottom line is that the currently available evidence is not sufficient to support the sole use of procalcitonin to rule out the diagnosis of MCD.
In [well appearing children with a suspicion of meningococcal disease] can [procalcitonin] [reduce the need for...]]>
The majority of studies relating to the clinical effectiveness of rigid collars and head blocks as a means of immobilisation have utilised healthy volunteers, and measure gross movement of head in relation to the shoulders. The recently published study by Holla
The article by Hallas et al
UK Role One (prehospital care) military clinicians deployed in operations in Afghanistan attend a Battlefield Advanced Trauma Life Support Course
The clinical background of Role One personnel varies from combat medical technicians to state registered paramedics and medical officers.
All UK Role One clinicians deployed in Afghanistan during September 2012 were invited to participate in a survey to assess the level of experience and confidence rating in using IO and IV routes of vascular access with the devices available.
Thirty-three...]]>
Debate continues over a ‘scoop and go’ versus a ‘stay and stabilise’ approach to patient care in the prehospital trauma setting. Analysis of data from more than 19 000 patients presenting to a level 1 trauma centre in California revealed increased odds of mortality if the scene time was greater than 20 min in the case of penetrating trauma. Interestingly, this association was not demonstrated amongst patients who had sustained blunt trauma (Ann Emerg Med 2013;61:167–74).
There is evidence to suggest that the risk of road traffic collisions is up to 13 times higher for emergency ambulances per mile travelled than other vehicles. Researchers from Turkey reviewed forensic records and identified 21 deaths of patients who were injured in a road traffic collision whilst being transported in an emergency ambulance (J Forensic Leg Med 2012;19:474–9). Their report is a grim reminder of the...]]>