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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 457-462页

作者： Cone, DC Weir, SD Bogucki, S Yale Univ Sch Med Sect Emergency Med Div Emergency Med Serv New Haven CT USA

[ Ann Emerg Med. 2003;41:457-462.]

关键词：临床工作能力/标准临床方案决策组织救灾计划/组织和管理效率组织急救医疗服务/组织和管理急救医学/经济学急救医学/组织和管理机构间关系职务说明大众媒体需求估价纽约市俄克拉何马医师的作用救援作业/组织和管理安全措施/组织和管理恐怖主义/预防和控制志愿工作者/教育志愿工作者/组织和管理人类

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Evaluation of telemedical support to a free-standing minor accident and treatment service

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JOURNAL OF TELEMEDICINE AND TELECARE 1998年第3期4卷 140-145页

作者： Tachakra, S Wiley, C Dawood, M Sivakumar, A Dutton, D Hayes, J Cent Middlesex Hosp Dept Accident & Emergency Med London NW10 7NS England Cent Middlesex Hosp Dept Radiol London NW10 7NS England

We studied all patients attending a free-standing minor accident and treatment service (MATS) run by emergency nurse practitioners (ENPs). In a six-month period, 5563 patients were seen in the MATS, of whom 2843 (51%) were new attenders. A teleconsultation was carried out with 150 of these patients (2.7% of all cases). The most common reason (39%) was to discuss a radiograph with an accident and emergency consultant. The accuracy of the telemedicine-assisted radiographic diagnosis was checked subsequently by a review panel. The ENPs' working diagnoses (made by viewing the films) had a sensitivity of 90% and a specificity of 96%;this was improved by telemedicine assistance to 97% and 99%, respectively. The telemedicine patients were also surveyed several months after being seen in the MATS;their replies indicated that the telemedicine diagnoses had been correct.

关键词：事故门诊医疗设施/组织和管理门诊医疗设施/利用急救医疗服务/组织和管理急救医疗服务/利用评价研究伦敦/流行病学开业护士远程会诊/统计学和数值数据创伤和损伤/诊断创伤和损伤/流行病学人类

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A three-year review of telemedicine at the community level - clinical and fiscal results

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第Sup1期5卷 28-30页

作者： Chodroff, PH John Muir Mt Diablo Hlth Syst Walnut Creek CA USA

The Telemedical Emergency Neurosurgical Network (TENN) was developed to establish community-level access to neurosurgical critical care services for an underserved urban population. Since October 1994, the system has provided round-the-clock connectivity between a single peripheral hospital and a 10-station receiving network which includes physicians' homes and offices. Data from the first 35 months of operation confirm clinical efficacy and cost-effectiveness. The primary benefit was in providing rapid access to care for an 'at-risk' underserved population in emergencies. This undoubtedly resulted in the actual saving of life and prevention of permanent disability. The total costs over the 35 months were calculated as $64,375 and the total savings (mainly in avoided air transport) were $626,149, a net saving of $561,774.

关键词：费用效益分析急救医疗服务/经济学急救医疗服务/组织和管理急诊室医院/经济学急诊室医院/组织和管理缺医地区神经外科(学)/经济学神经外科(学)/组织和管理远程医学/经济学远程医学/仪器和设备远程医学/组织和管理美国市区卫生服务/经济学市区卫生服务/组织和管理人类

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Out-of-hours dental services: a survey of current provision in the United Kingdom

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BRITISH DENTAL JOURNAL 2000年第5期188卷 269-274页

作者： Anderson, R Thomas, DW Univ Wales Coll Cardiff Coll Med Dept Oral Surg Cardiff CF4 4XY S Glam Wales

Objective To describe the variety of arrangements for providing out-of-hours dental care in the UK. Design A telephone interview survey of health authorities and health boards. Setting United Kingdom. Subjects 104 health authority contacts, usually consultants in dental public health, dental advisers or others in a position to describe the local dental service arrangements. Results At weekends, 25 authorities have no formal dental care arrangements for unregistered patients, 55 have separate arrangements for registered and unregistered patients, and 44 have 'universal access' arrangements - for anyone in an area, regardless of their registration status. On weekday nights over two-thirds (82/124) of UK health authorities have no formal arrangements for unregistered patients. Where there are separate 'safety-net' services intended for unregistered patients only they are usually (in 48 of 55 authorities) emergency treatment sessions. A fifth of authorities reported planned changes to their local out-of-hours arrangements, including the introduction of telephone triage, and moves to make care available at more times, to more people or from centralised premises. Conclusions There is extremely wide geographical variation in the organisation of out-of-hours dental services provided in the United Kingdom. In many parts of the UK there are no formal out-of-hours care arrangements for unregistered patients, even at weekends. This unequal provision will mean inequitable access for many unregistered patients. With increasing demands from a growing unregistered population, and various government initiatives to make primary care services more integrated and accessible, the highly fragmented pattern of provision in many areas may no longer be acceptable.

关键词：卫生服务范围社区牙科学牙科保健服务/组织和管理急救医疗服务/组织和管理开业医生牙科/组织和管理健康计划卫生服务易得程度/组织和管理卫生服务需求采访(主题) 初级卫生保健/组织和管理转诊和会诊登记公费医疗/组织和管理电话伤病员分拣人类

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Emergency medical services and mortality from heart disease: A community study

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 494-499页

作者： Rea, TD Eisenberg, MS Becker, LJ Lima, AR Fahrenbruch, CE Copass, MK Cobb, LA Seattle King Cty Dept Publ Hlth Emergency Med Serv Div Seattle WA 98104 USA Univ Washington Dept Med Seattle WA 98195 USA Washington Stat Dept Hlth Ctr Hlth Stat Olympia WA USA

Study objectives: Little is known regarding the potential effects of emergency medical services (EMS) on total heart disease mortality. Although EMS may provide health benefits in less acute cardiac conditions, its immediate, measurable, and direct effect on heart disease mortality is through resuscitation of persons suffering out-of-hospital cardiac arrest. The purpose of this study was to examine the involvement and potential mortality benefit of out-of-hospital EMS care of cardiac arrest on community heart disease mortality. Methods: The investigation was an observational study of all persons with death events resulting from heart disease as defined by heart disease deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in a single county from January 1, 2000, through December 31, 2000. The county of study has a population of nearly 2 million people and is composed of urban, suburban, and rural components. State vital records and EMS reports were used to ascertain deaths resulting from heart disease and deaths averted. Results: In the year 2000, 3,577 persons died as a result of heart disease, and 128 persons were successfully resuscitated and discharged from the hospital, for a total of 3,705 death events. EMS responded to 39% (1,428/3,705) of all heart disease death events and 57% (1,428/2,516) of out-of-hospital events, resulting in a 3.5% (128/3,705) reduction in overall heart disease mortality and a 5.1% (128/2,516) reduction in out-of-hospital mortality. Conclusion: EMS was involved in the majority of out-of-hospital heart disease death events, resulting in a measurable reduction in heart disease mortality.

关键词：心肺复苏术死亡原因死亡证急救医疗服务/组织和管理卫生服务研究心脏停搏/病因学心脏停搏/治疗心脏病/并发症心脏病/死亡率病人入院/统计学和数值数据病人出院/统计学和数值数据方案评价登记存活率治疗结果华盛顿/流行病学老年人女(雌)性人类男(雄)性中年人

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Emergency medicine in southern Brazil

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ANNALS OF EMERGENCY MEDICINE 2001年第2期37卷 223-228页

作者： Tannebaum, RD Arnold, JL De Negri, A Spadoni, VS Provena St Joseph Med Ctr Sect Emergency Med Joliet IL 60435 USA Univ Illinois Coll Med Dept Emergency Med Chicago IL USA Cedars Sinai Med Ctr Dept Emergency Med Los Angeles CA 90048 USA Univ Fed Rio Grande Sul Porto Alegre RS Brazil

Emergency medicine is developing rapidly in southern Brazil, where elements of both the France-German and the Anglo-American models of emergency care are in place, creating a uniquely Brazilian approach to emergency care. Although emergency medical services (EMS) in Brazil have been directly influenced by the French mobile EMS (SAMU) system, with physicians dispatched by ambulances to the scenes of medical emergencies, the first American-style emergency medicine residency training program in Brazil was recently established at the Hospital de Pronto Socorro (HPS) in Porto Alegre. Emergency trauma care appears to be particularly developed in southern Brazil, where advanced trauma life support is widely taught and SAMU delivers sophisticated trauma care en route to trauma centers designated by the state.

关键词：巴西卫生保健提供/组织和管理急救医疗服务/组织和管理急救医学/教育急救医学/组织和管理预测实习医师和住院医师职务/组织和管理生命支持疗法/组织和管理模型教育模型组织管理技术转让人类

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Emergency Medical Services Outcomes Project (EMSOP) II: Developing the foundation and conceptual models for out-of-hospital outcomes research

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 657-663页

作者： Spaite, DW Maio, R Garrison, HG Desmond, JS Gregor, MA Stiell, IG Cayten, CG Chew, JL MacKenzie, EJ Miller, DR O'Malley, PJ Univ Arizona Coll Med Div Emergency Med Arizona Emergency Med Res Ctr Tucson AZ USA Univ Michigan Med Ctr Dept Emergency Med Ann Arbor MI 48109 USA E Carolina Univ Brody Sch Med Dept Emergency Med Greenville NC 27834 USA Univ Ottawa Div Emergency Med Ottawa ON Canada Univ Ottawa Loeb Hlth Res Inst Ottawa ON Canada New York Med Coll Inst Trauma & Emergency Care Valhalla NY 10595 USA EMSSTAR Grp Annapolis MD USA Johns Hopkins Univ Sch Hyg & Publ Hlth Baltimore MD USA Hlth Span Transportat Serv St Paul MN USA Allina Hlth Syst St Paul MN USA Massachusetts Gen Hosp Pediat Emergency Serv Boston MA 02114 USA Massachusetts Dept Publ Hlth Emergency Med Serv Children Boston MA USA

Development of methodologically acceptable outcomes models for emergency medical services (EMS) is long overdue. In this article, the Emergency Medical Services Outcomes Project proposes a conceptual framework that will provide a foundation for future EMS outcomes research. The "Episode of Care Model" and the "Out-of-Hospital Unit of Service Model" are presented. The Episode of Care Model is useful in conditions in which interventions and outcomes, especially survival and major physiologic dysfunction, are linked in a time-dependent manner. Conditions such as severe trauma, anaphylaxis, airway obstruction, respiratory arrest, and nontraumatic cardiac arrest are amenable to this methodology. The Out-of-Hospital Unit of Service Model is essentially a subunit of the Episode of Care Model. it is valuable for evaluating conditions that have minimal-to-moderate therapeutic time dependency. This model should be used when studying outcomes limited to the out-of-hospital interval. An example of this is pain management for injuries sustained in motor vehicle crashes. These models can be applied to a wide spectrum of conditions and interventions. With the scrutiny of health care expenditures ever increasing, the identification of clinical interventions that objectively improve patient outcome takes on growing importance. Therefore, the development, dissemination, and use of meaningful methodologies for EMS outcomes research is key to the future of EMS system development and maintenance.

关键词：出院后医疗/组织和管理急救医疗服务/组织和管理治疗过程片断卫生工作重点卫生服务研究/组织和管理模型组织管理年患病率结果评价(卫生保健)/组织和管理规划制订/方法研究设计/标准风险调节/组织和管理存活率分析时间因素美国/流行病学人类

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Convergence behavior in disasters

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 463-466页

作者： de Heide, EA US DHHS Agcy Tox Subst & Dis Registry Div Hlth Educ & Promot Atlanta GA USA

[ Ann Emerg Med. 2003;41:463-466.]

关键词：救灾计划/组织和管理急救医疗服务/组织和管理急救医学/教育急救医学/组织和管理地理信息系统机构间关系大众媒体需求估价救援作业/组织和管理恐怖主义/预防和控制志愿工作者/组织和管理志愿工作者/心理学人类

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The role of the emergency physician in emergency medical services for children

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 206-215页

作者： Gausche-Hill, M Johnson, RW Warden, CR Brennan, JA Univ Calif Los Angeles Geffen Sch Med Dept Emergency Med Torrance CA 90509 USA Univ Calif Los Angeles Little Co Mary Hosp Ctr Med Torrance CA USA Childrens Hosp Mission Mission Med Hosp Reg Med Mission Viejo CA USA Oregon Hlth & Sci Univ Doernbecher Mem Hosp Children Pediat Emergency Serv Portland OR 97201 USA Univ Med & Dent New Jersey Dept Emergency Med New Brunswick NJ USA St Barnabas Hlth Care New Brunswick NJ USA

Emergency physicians have a duty to advance the care of pediatric patients in the emergency medical services (EMS) system. This policy resource and education paper, designed to support the American College of Emergency Physicians policy paper "The Role of the Emergency Physician in Emergency Medical Services for Children," describes the development of the federal EMS for Children Program, the importance of the integration of EMS for children into EMS systems, and the role of the emergency physician in EMS for children.

关键词：儿童保健服务/组织和管理儿童福利临床方案病人医护连续性/组织和管理数据库事实型急救医疗服务/组织和管理急救医学/教育急救医学/组织和管理卫生政策美国国立医学研究所医疗差错/预防和控制模型组织管理儿科学/教育儿科学/组织和管理医师的作用学会医学全面质量管理/组织和管理美国美国卫生和人类服务部儿童人类

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EMERGENCY MEDICAL-CARE ON SPACE STATIONS

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ACTA ASTRONAUTICA 1980年第12期7卷 1483-1484页

作者： FREY, R DURNER, P VONBAUMGARTEN, R VOGEL, H UNIV MAINZ PHYSIOL INST JOHANNES GUTENBERGD-6500 MAINZFED REP GER

This Note emphasizes the need, in a space station, of an emergency room, especially equipped with regard to clean air and competent paramedical personnel. The establishment of some degree of artificial gravity is desi... 详细信息

关键词：航天医学/方法航天医学/组织和管理心肺复苏术急救医疗服务/组织和管理宇宙飞行/仪器和设备宇宙飞行/组织和管理宇宙飞船/仪器和设备失重人类

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