eLetters

820 e-Letters

  • Primary care services located with EDs: Effectiveness depends on matching patients to the right clinician
    Tim Daniel

    We read with interest the paper by Ramlakhan et al (10.1136/emermed- 2015-204900) on the effectiveness of primary care services located in EDs. We have just completed a test cycle week of a GP led model for managing lower acuity patients who present to the Clinical Decisions Unit (CDU) at the Glenfield Hospital, Leicester; however, we reached different conclusions. The CDU is a cardiorespiratory unit that receives mixed...

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  • Bland-Altman comparison of haemodynamic monitoring methods; not simply a matter of black and white.
    Robert A. Phillips

    This comparison of non-invasive haemodynamic devices, although valuable, demonstrates some methodological aspects of the Bland-Altman method that should be considered to ensure the accuracy of any proposed conclusions.

    The statistical minimum for comparison of two medical device measurement methods includes reporting mean ?SD values for both methods, correlation, and Bland-Altman bias and precision, mean % diff...

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  • Paediatric Early Warning Scores: Acute Paediatrics' Cinderella's Slipper
    Julian M Sandell

    Paediatric Early Warning Scores: Acute Paediatrics' Cinderella's Slipper

    Lillitos et al are to be congratulated on a most helpful paper clarifying whether disease severity and the need for hospital admission can be predicted using two similar PEWS systems (Brighton PEWS and COAST - the Children's Observation And Severity Tool).

    There has been a proliferation in the uptake and usage of Paediatric Earl...

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  • Air ambulance tasking: mechanism of injury, telephone interrogation or ambulance crew assessment?
    James M Vassallo

    We wish to thank Wilmer et al for their recent article "Air ambulance tasking: mechanism of injury, telephone interrogation or ambulance crew assessment", which we read with interest. As researchers in the field of triage we feel it raises a number of interesting questions. We believe that there are considerable similarities between triaging for enhanced trauma team despatch (eg LAA) and effective triage for direct trans...

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  • Preparing medical students for the front line: experiences from a curricular innovation in Ireland
    Gerard T. Flaherty

    Dear Editor,

    We read with interest the article by Seligman and colleagues (1) which evaluated a novel first responder scheme for medical students as a collaborative venture between a medical school and the local ambulance service. Previous authors have advocated the early introduction of Emergency Medical Technician teaching in an undergraduate medical curriculum in the United States.(2) We would like to report...

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  • Encouraging task-orientated coping mechanisms
    Lucy E Joslin

    Dear Editor,

    This article by Howlett et al. makes for interesting reading as a junior doctor at the start of Emergency Medicine training.

    This study suggests that in order for trainees (and Consultants) to maintain successful, long, enjoyable and fruitful careers, and avoid 'burnout', we should develop 'task-orientated coping' mechanisms. Currently one may argue that this is encouraged via personal ref...

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  • RE: Bowness J, Kilgour PM, Whiten S, et al. Emerg Med J 2015;32: 620-625.
    Timothy C Hardcastle

    We read this article with interest, given the high prevalence of penetrating chest trauma in South Africa and the fact that we and others (1,2) have published on the challenges faced in high-volume systems with errant tube placement. While we also advocate the "safe-triangle" approach, we aim to place the tube rather in the 4th ICS to avoid the risk of trans-diaphragmatic injury. We are also adamant that the "finger-sweep...

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  • A pinch of salt or a drop of saline?
    C Andrew Eynon

    We were surprised by the EMJ decision to publish the study by Scotter et al (1) A number of previous studies including those studied by Scotter and colleagues have concluded that bilateral, fixed, dilated pupils in the context of severe head injury are not universally predictive of poor outcome. Performing a meta-analysis of five, retrospective, cohort studies, one of which was conducted before 1988 does not change this m...

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  • Cutting Titanium Rings off in an Emergency. (Advice for A&E Staff)
    Alan J Hadley

    Just to clarify, they can be cut off using the same tool for cutting off precious metal rings found in most high street jewellers. Probably the only stipulation is that the blade is in new/really good condition and lubrication is used e.g. Aquagel,(although a lubrication oil on the blade such as WD40 would be better for prolonging the blade life)

    It can heat up quite rapidly as well so keeping it cool with irrig...

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  • Mortality is key
    FERGUS HAMILTON
    Dear Editor, I read with interest this article by Keep et al. There is clearly growing interest in research aiming to identify patients with sepsis earlier in emergency departments, given evidence that early treatment seems to improve outcomes. However, I am not sure of the usefulness of comparing one scoring system (NEWS) to another (Surviving Sepsis Campaign definitions). As both are composites of mostly physiological variable...
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