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Medical emergencies in general dental practice in Great Britain - Part 1: their prevalence over a 10-year period

BRITISH DENTAL JOURNAL 1999年第2期186卷 72-79页

作者： Atherton, GJ McCaul, JA Williams, SA Univ Dent Hosp Manchester Dept Orthodont Manchester M15 6FH Lancs England Halifax Gen Hosp Calderdale Healthcare NHS Trust Halifax NS HX3 0PW Canada Univ Glasgow Western Infirm Dept Surg W Scotland Basic Surg Training Scheme Glasgow G11 6NT Lanark Scotland Univ Leeds Leeds Dent Inst Leeds LS2 9LU W Yorkshire England

Objective To assess the prevalence, nature and outcome of medical emergencies experienced by general dental practitioners (GDPs) over a 10-year period. Design Postal questionnaire survey of a random sample of GDPs in Great Britain. Subjects 1500 GDPs, 1000 in England & Wales and 500 in Scotland. Results There was a 74% response. Emergency events were reported by 70.2%: the number reported by a single individual ranged from none to 33. The most commonly experienced events, including those associated with general anaesthesia, were (as a percentage of the total) for England & Wales and Scotland, respectively: fits and seizures (31.0%, 36.3%);swallowed foreign bodies (15.7%, 18.1%);attacks of asthma (13.8%, 11.1%);chest pain associated with angina pectoris (10.1%, 11.0%) and diabetic events (10.6%, 9.0%): none of these resulted in any serious sequelae. More events were reported in Scotland. Overall, there were 20 deaths resulting from medical emergencies reported in the survey, 4 affecting passers-by and none associated with general anaesthesia. 8849 years of practice experience were represented (by 94% of respondents), from which an estimate of the frequency of events was made. Conclusions An emergency event was reported, on average, for every 4.5 practice years in England & Wales and 3.6 years in Scotland and death associated with general dental practice, on average, once in 758 and 464 years, respectively.

关键词：死亡原因急症/分类急症/流行病学急救医疗服务/统计学和数值数据开业医生牙科/统计学和数值数据患病率治疗结果人类

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Time trends in long-term mortality after out-of-hospital cardiac arrest, 1980 to 1998 and predictors for death

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AMERICAN HEART JOURNAL 2003年第5期145卷 826-833页

作者： Engdahl, J Bang, A Lindqvist, J Herlitz, J Sahlgrens Univ Hosp Div Cardiol SE-41345 Gothenburg Sweden

Background We studied time trends in long-term survival after out-of-hospital cardiac arrest (OHCA) for patient characteristics and described predictors far death after discharge. Because long-term prognosis among patients with coronary heart disease has improved in the last decades, we hypothesized that the prognosis after OHCA would improve with time. Methods We analyzed data that were prospectively collected from all patients discharged from the hospital after OHCA in the community of Goteborg, Sweden, from 1980 to 199$ and divided the data into 2 time periods, 1980 to 1991 and 1991 to 1998, with an equal number of patients. Results A total of 430 patients were included in the survey. Age, sex proportions, cardiovascular comorbidity, resuscitation factors, and inhospital complications did not change with tune. A diagnosis of a precipitating myocardial infarction was more common during period 1 (66% vs 54%). The prescription of aspirin (22% vs 52%), angiotensin-converting enzyme inhibitors (7% vs 29%), anticoagulants (13% vs 27%), and lipid-lowering agents (0% vs 6%) at discharge increased during period 2. Long-term survival did not improve with time;the 5-year mortality rates were 53% in period 1 and 52% in period 2. Independent predictors of an increased risk of death included age (risk ratio (RR) 1.06, 95% CI 1.05-1.08), history of myocardial infarction (RR 2.02, 95% CI 1.51-2.72), history of smoking (RR 1.77, 95% CI 1.29-2.44), and worse cerebral performance at discharge (RR 1.71, 95% CI 1.44-2.02). The prescription of beta-blockers at discharge was independently predictive of decreased risk of death (RR 0.63, 95%a CI 0.46-0.85). Conclusion The long-term survival rate after OHCA did not change. Baseline characteristics remained generally unchanged, but the drugs prescribed at discharge changed in several aspects. Age, a history of myocardial infarction, a history of smoking, cerebral performance category at discharge, and the prescription of beta-blockers were

关键词：年龄分布方差分析抗凝药/治疗应用心肺复苏术冠心病/死亡率冠心病/治疗急救医疗服务/统计学和数值数据心脏停搏/并发症心脏停搏/药物疗法心脏停搏/死亡率心肌梗死/诊断心肌梗死/治疗病人出院性别分布吸烟/流行病学存活率瑞典/流行病学时间因素青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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Emergency department contributors to ambulance diversion: A quantitative analysis

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 467-476页

作者： Schull, MJ Lazier, K Vermeulen, M Mawhinney, S Morrison, LJ Sunnybrook & Womens Coll Hlth Sci Ctr Dept Emergency Serv Toronto ON Canada Toronto Emergency Med Serv Prehosp Res Grp Toronto ON Canada Univ Toronto Div Emergency Med Dept Med Toronto ON Canada Univ Toronto Dept Hlth Adm Toronto ON Canada Dalhousie Univ Fac Med Halifax NS Canada Sunnybrook & Womens Coll Hlth Sci Ctr Clin Epidemiol Unit Toronto ON Canada

Study objective: We determine the relationship between physician, nursing, and patient factors on emergency department use of ambulance diversion. Methods: Data were collected at 1 ED in Toronto, Ontario, Canada, on the duration of ambulance diversion during consecutive 8-hour intervals from January to December 1999 (intervals=1,095). By using time series methods, the association between ambulance diversion and nurse hours, physician on duty, and boarded patients was determined. Covariates included patient volume, assessment time, and boarding time. Results: A total of 37,999 patients were treated in the ED over the study period (2% major trauma, 16% ambulance arrivals, and 22% admitted). Nurse hours per interval averaged 60. A mean of 3.2 admitted patients were boarded in the ED each interval. For admitted patients, the time from registration to admission order and from admission order to ED departure averaged 5.2 and 3.5 hours, respectively. There was no ambulance diversion during 170 (15.5%) intervals, whereas 17 (1.5%) intervals were continuously on diversion. In time series analyses, ambulance diversion increased with the number of admitted patients boarded in the ED (6.2 minutes per patient;95% confidence interval [Cl] 2.6 to 9.8 minutes), the number admitted per interval (4.6 minutes per patient;95% Cl 0.1 to 9.1 minutes), assessment time (9.9 minutes per hour;95% Cl 3.3 to 16.5 minutes), and boarding time (11.3 minutes per hour;95% Cl 5.6 to 17.0 minutes). Thirteen of 15 emergency physicians were not associated with ambulance diversion, 1 was associated with reduced use (-36.3 minutes;95% Cl -65.2 to -7.5 minutes), and 1 was associated with increased use (47.6 minutes;95% Cl 4.5 to 90.6 minutes). ED nurse hours were not associated with diversion. Ambulance-delivered patient volume was associated with diversion (5.2 minutes per patient;95% Cl 2.7 to 7.8 minutes), but walk-in patients and patients with major trauma were not. Conclusion: Admitted patients in th

关键词：救护车/统计学和数值数据方差分析拥挤急救医疗服务通信系统/统计学和数值数据急救医疗服务/统计学和数值数据急诊室医院/统计学和数值数据卫生服务研究医院病床数 500张以上医务人员医院/供应和分配护理人员医院/供应和分配安大略病人入院/统计学和数值数据病人转诊/统计学和数值数据人员配备和时间安排/组织和管理前瞻性研究单盲法时间因素时间和运动研究创伤诊治中心人类

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Can we define patients with no and those with some chance of survival when found in asystole out of hospital?

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第6期86卷 610-614页

作者： Engdahl, J Bång, A Lindqvist, J Herlitz, J Sahlgrens Univ Hosp Div Cardiol SE-41345 Gothenburg Sweden

We describe the epidemiology, prognosis, and circumstances at resuscitation among a consecutive population of patients with our-of-hospital cardiac arrest (OHCA) with asystole as the arrhythmia first recorded by the Emergency Medical Service (EMS), and identify factors associated with survival. We included all patients in the municipality of Goteborg, regardless of age and etiology, who experienced on OHCA between 1981 and 1997. There were a total of 4,662 cardiac arrests attended by the EMS during the study period. Of these, 1,635 (35%) were judged as having asystole as the first-recorded arrhythmia: 156 of these patients (10%) were admitted olive to hospital, and 32 (2%) were discharged olive. Survivors were younger (median age 58 vs 68 years) and held a witnessed cardiac arrest more often than nonsurvivors (78% vs 50%). Survivors also had shorter intervals from collapse to arrival of ambulance (3.5 vs 6 minutes) and the mobile coronary care unit (MCCU) (5 vs 10 min), and they received atropine less often on scene. There were also a greater proportion of survivors with noncardiac etiologies of cardiac arrest (48% vs 27%). Survivors to discharge also displayed higher degrees of consciousness on arrival to the emergency department in comparison to nonsurvivors. Multivariate analysis among oil patients with asystole indicated age (p = 0.01) and witnessed arrest (p = 0.03) as independent predictors of an increased chance of survival, Multivariate analysis among witnessed arrests indicated short time to arrival of the MCCU (p <0.001) and no treatment with atropine (p = 0.05) as independent predictors of survival, Fifty-five percent of patients discharged olive had none or smell neurologic deficits (cerebral performance categories 1 or 2). No patients >70 years old with unwitnessed arrests (n = 211) survived to discharge, (C) 2000 by Excerpta Medica, Inc.

关键词：年龄分布急救医疗服务/统计学和数值数据心脏停搏/病因学心脏停搏/死亡率心脏停搏/治疗复苏术回顾性研究存活率瑞典/流行病学青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Effect of socioeconomic status on out-of-hospital transport delays of patients with chest pain

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 481-490页

作者： Govindarajan, A Schull, M Sunnybrook & Womens Coll Hlth Sci Ctr Clin Epidemiol Unit Toronto ON M4N 3M5 Canada Univ Toronto Fac Med Toronto ON Canada

Study objective: The effect of socioeconomic status on out-of-hospital care has not been widely examined. We determine whether socioeconomic status was associated with out-of-hospital transport delays for patients with chest pain. Methods: A retrospective study of patients with chest pain transported by means of ambulance in Toronto, Ontario, Canada, in 1999 was conducted. The primary outcome measure was the 90th percentile system response interval, with secondary outcomes being the 90th percentile on-scene interval, transport interval, and total out-of-hospital interval. Socioeconomic status was the primary independent variable. Covariates were age, sex, case severity, dispatch and return priority, time and day of transport, paramedic training, and percentage of high-rise apartments in the region. Results: Four thousand three hundred fifty-six patients met the inclusion criteria. The 90th percentile system response interval and total out-of-hospital interval were 11 minutes and 49 minutes, respectively. In multivariate analyses, the highest socioeconomic status neighborhoods were significantly associated with decreased system response interval (34.0 seconds;95% confidence interval [Cl] 6.2 to 70.9 seconds) and transport interval (132.3 seconds;95% Cl 24.1 to 229.6 seconds). In addition, age (+45.3 seconds per 10 years;95% Cl 13.3 to 75.1 seconds), female sex (+205.0 seconds;95% C1 78.1 to 287.7 seconds), and advanced care paramedic crews (+371.6 seconds;95% Cl 263.3 to 490.1 seconds) were associated with delays in total out-of-hospital interval. Lastly, calls originating from the highest socioeconomic status neighborhoods were dispatched the highest proportion of advanced care paramedic crews, despite similar dispatch priorities and case severities. Conclusion: High socioeconomic status neighborhoods were associated with shorter out-of-hospital transport intervals for patients with chest pain. In addition, out-of-hospital delays were associated with age, sex, and a

关键词：急救医疗服务/经济学急救医疗服务/统计学和数值数据卫生服务研究收入/统计学和数值数据安大略贫困区试验预期值回归分析居住特征/统计学和数值数据回顾性研究疾病严重程度指数性别因素社会阶级时间因素病人转送/经济学病人转送/统计学和数值数据女(雌)性人类男(雄)性中年人

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Home accidents in elderly patients presenting to an emergency department.

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Accident and emergency nursing 1999年第2期7卷 96-102页

作者： Lee, V.M. Wong, T.W. Lau, C.C. Accident &amp Emergency Department Pamela Youde Nethersole Eastern Hospital Chaiwan Hong Kong

A prospective study was carried out in an Accident and Emergency department (A&E) to (1) examine the pattern of home accidents in elderly patients presenting to the A&E;(2) determine the nature and mechanisms of the accidents;and (3) investigate the associated factors in these accidents. All patients aged 65 or above with a history of injury at home within one week were included. Patients who needed immediate resuscitation and patients with mental illness or violent behaviour were excluded. A convenient sample was chosen during an 8-week period. A standardized questionnaire was used to collect data on (1) demographics;(2) nature of the accident and injury;and (3) health status. Health status assessment involved three components: physical status, drug history and past health. A total of 100 subjects were included giving an average occurrence of 3.3 cases per shift. The mean age of the group was 75 with female patients (66) outnumbering the males by about two to one. The toilet was the most common site (29%) of home accident, followed by the sitting room (18%), the kitchen (14%), the bedroom (11%) and the dining room (10%). In 79 cases the patient was alone at home during the accident. Falls were the most common (75%) type of accident. The remaining 25% of injuries were categorized as sharps injury (8%), foreign body ingestion (6%), crush injury (4%), burns/scald (3%), hit by/onto fallen objects (3%) and finally, electric shock (1%). Eighteen fractures were recorded. Thirty-two patients were admitted, 16 to the surgical ward and 16 to the orthopedic ward. In the functional assessment only 34 patients could perform the get-up-and-go test satisfactorily and only 61 patients had good hand grasp. Visual and hearing impairment were common. Over 45% of the patients had more than one disease and the majority of patients (80) were taking some medication. The roles of A&E staff in the prevention of home accidents in the elderly are discussed.

关键词：事故家庭/预防和控制事故家庭/统计学和数值数据年龄分布急救医疗服务/统计学和数值数据急救医疗服务/利用老年人身心健康评价香港医院综合/统计学和数值数据前瞻性研究创伤和损伤/病因学老年人老年人 80以上女(雌)性人类男(雄)性

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UTILIZATION OF EMERGENCY DENTAL SERVICES BY RURAL, NONRESERVATION INDIANS

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Journal of Public Health Dentistry 1975年第3期35卷 165-169页

作者： Freed, James R. Bernstein, Allan S. Section of Public Health and Preventive Dentistry School of Dentistry University of California Los Angeles California 90024 United States Shasta-Trinity-Siskiyou Dental Clinic Los Gatos California 95030 322 Penn Way United States

The Shasta-Trinity-Siskiyou Indian dental clinic, which serves rural, nonreservation Indians in California, implemented a health education program designed to convert patients from an emergency to a routine care basis. A study was conducted, therefore, of the utilization patterns of 109 emergency patients treated at a clinic from September, 1971, through November, 1972, in order to provide information to improve this educational program. The results of the study showed that 58.7 percent of the emergency patients returned for routine care. Analyses of those patients who returned and those who did not return for care were made with regard to age, sex, time since last dental visit, and type of emergency treatment received. There were significant differences between the two groups of emergency patients with regard to age and type of treatment received. Those most likely to return for routine care were the patients 15 years or younger, and those who had received operative care. The emergency patients in the 16-25 age group, and those who received periodontal care were the least likely to return. No significant differences were found with regard to sex, or time since last dental visit. The emergency patients and patients whose initial visit to the clinic was for routine care were compared. A significant difference was found with regard to age. The patients 15 years or younger had the lowest percentage of initial visits for emergency care, and the 16-25 year age group had the highest. No significant differences were found with regard to sex, or time since last dental visit. This study may well be the first to examine the utilization of dental services by rural, non reservation Indians. The findings presented can serve as a basis for future investigation to improve the provision of dental services to this patient population.

关键词：年龄因素加利福尼亚牙科医疗牙科诊所急救医疗服务/统计学和数值数据随访研究印第安人北美洲口腔疾病/外科学牙周疾病/治疗根管疗法农村人口性别因素拔牙青少年成年人老年人儿童儿童学龄前女(雌)性人类男(雄)性中年人

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Avionics and airframe options: Current usage and future plans

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Air Medical Journal 1994年第1期13卷 21-23页

作者： Mayfield, Ty Cady, Geoffrey Emergency Care Information Center Carlsbad CA United States

The 1994 Avionics and Airframe Survey was sent to 178 chief or lead pilots of helicopter emergency medical services (HEMS) programs in October 1993, and 100 (56%) were returned. Sixty-four programs (64%) reported that they operate one helicopter exclusively for EMS, 24 (24%) operate two, and 12 (12%) reported using three or more aircraft. Interestingly, the reported percentage of programs with two or more exclusive helicopters continues to rise, increasing by 5.6% to 36%.

关键词：数据收集急救医疗服务/统计学和数值数据设备和供应/统计学和数值数据设备和供应/供应和分配评价研究美国

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Another look at the emergency medical services safety report

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ANNALS OF EMERGENCY MEDICINE 2003年第1期42卷 159-159页

作者： McCann, BP Franklin Mem Hosp Dept Emergency Med Farmington CT USA

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