PubMed · 11225189
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R Suter. 2001. Point/counterpoint. ED managers: do not stop restocking.. https://pubmed.ncbi.nlm.nih.gov/11225189/
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In 1998, the New York City Department of Health and the Mayor's Office of Emergency Management began monitoring the volume of ambulance dispatch calls as a surveillance tool for biologic terrorism. We adapted statistical techniques designed to measure excess influenza mortality and applied them to outbreak detection using ambulance dispatch data. Since 1999, we have been performing serial daily regressions to determine the alarm threshold for the current day. In this article, we evaluate this approach by simulating a series of 2,200 daily regressions. In the influenza detection implementation of this model, there were 71 (3.2%) alarms at the 99% level. Of these alarms, 64 (90%) occurred shortly before or during a period of peak influenza in each of six influenza seasons. In the bioterrorism detection implementation of this methodology, after accounting for current influenza activity, there were 24 (1.1%) alarms at the 99% level. Two occurred during a large snowstorm, 1 is unexplained, and 21 occurred shortly before or during a period of peak influenza activity in each of six influenza seasons. Our findings suggest that this surveillance system is sensitive to communitywide respiratory outbreaks with relatively few false alarms. More work needs to be done to evaluate the sensitivity of this approach for detecting nonrespiratory illness and more localized outbreaks.
Major trauma presents a time-critical medical emergency. Successful and expeditious management with early definitive treatment is required to prevent secondary injury. The resources in the prehospital setting, at the hospital of first treatment, and at the tertiary referral (major trauma) center all have an impact on the ability of an integrated trauma system to deliver optimal care to a patient. The time between leaving the injury site and instituting definitive care does not always equate with distance. Retrieval resources must be allocated carefully. Potentially preventable morbidity and mortality has been identified and is specifically related to the time between injury and definitive care and the efficiency of the retrieval and hospital transfer processes. These problems are being addressed with a further sophistication of integrated trauma systems. Regional trauma committees, unified and sophisticated ambulance services, good communication lines, adequate resources at major trauma services, and well developed surgical services are all essential for the appropriate and expeditious management of major trauma patients injured at a distance from tertiary referral (major trauma) centers.
The spinal board is widely used as a means of extrication and efficient transport during the pre-hospital phase of trauma management. A number of concerns have been raised regarding its subsequent usage once the patient arrives in the emergency department. We undertook a telephone study of 100 A+E departments in the United Kingdom to ascertain current spinal board usage. Our study demonstrated great variability in practice across the UK and a marked lack of on-going audit or defined protocols governing spinal board usage following the pre-hospital phase of trauma management.