848 e-Letters

  • 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
    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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  • HIRT - the pain of prehospital research
    Minh Le Cong

    Dear editor I wish to congratulate the authors of the HIRT trial on finally publishing their results. Whilst a negative trial for primary outcomes, to me it highlighted the major challenges in conducting high quality RCTs in prehospital setting. Few countries have been able to perform this level of prehospital research and it can only advance the future planning of prehospital studies trying to examine the very same questi...

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  • Re: A simple tool to predict admission at the time of triage. More ammunition in the fight against blaming patients.
    Luke A Evans

    We congratulate the authors on this excellent piece of work and are particularly pleased to see method of arrival in their tool as a predictor of admission. In a similar piece of work to predict surgical admissions in our institution we found the same effect (1). At a time when it seems to be politically expedient to scapegoat patients for the overcrowding in our departments and lack of available beds on the wards it is...

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