PubMed · 15326461
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Keri Losavio. 2004. Multi-function disaster trailer ready to roll.. https://pubmed.ncbi.nlm.nih.gov/15326461/
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OBJECTIVE: The increased demand for emergency department (ED) services over the past decade has resulted in crowding. This report presents estimates of structure and process characteristics of hospital EDs related to their capacity to treat medical and surgical emergencies. Estimates of EDs experiencing crowded conditions are also presented. METHODS: Several facility supplements were added to the 2003-04 National Hospital Ambulatory Medical Care Survey (NHAMCS), which were completed by hospital staff. NHAMCS samples nonfederal, short-stay, and general hospitals in the United States. Of all sample hospitals that operated 24-hour EDs, 83 percent completed the supplemental questionnaires. Data from 467 hospitals were weighted to produce national annual estimates of ED characteristics. RESULTS: There was an annual average of 4,500 EDs operating in the United States during 2003 and 2004. Over one-half of EDs saw less than 20,000 patients annually, but 1 out of 10 had an annual visit volume of more than 50,000 patients. Although 16.1 percent of hospitals expanded their ED physical space within the last 2 years, approximately one-third of others planned to do so within the next 2 years. Most EDs used outside contracts to provide physicians (64.7 percent). One-half of EDs in metropolitan statistical areas (MSAs) had more than 5 percent of their nursing positions vacant. Of all on-call specialists, the services of plastic and hand surgeons were most frequently reported as somewhat or very difficult to obtain (49.4 percent). Approximately one-third of U.S. hospitals reported going on ambulance diversion sometime in the previous year. About 12 percent of hospitals in MSAs reported having spent between 5 and 19 percent of their operating time in diversion status. Between 40 and 50 percent of U.S. hospitals experienced crowded conditions in the ED with almost two-thirds of metropolitan EDs experiencing crowding.
OBJECTIVES: Assessment of the intubating Laryngeal Mask Airway(trade mark) in a prehospital emergency mobile unit (PEMU). STUDY DESIGN: Observational study. METHODS: All the emergency physicians and nurses of the PEMU were trained with the intubating laryngeal mask (ILMA) handling on manikin and a learning curve was carried out. One year after the initial formation, a reassessment of the operators was performed. Following the initial formation, all the vehicles of the PEMU were equipped with ILMA and during 15 months all cases of ILMA use were recorded. The success rate and the difficulties met were analysed. RESULTS: Initial formation on manikin showed that at least 8 handling of the device were mandatory to achieve a 100% success rate. A significant reduction of tracheal tube insertion delay was observed up to the eight manipulations. One year after the initial formation, a significant loss of performance was observed. Over the clinical study period 20 ILMA were used with adequate ventilation through the mask in all cases and a possible intubation in 80% of the patients. CONCLUSION: The ILMA is a potential useful device in the prehospital setting. Initial formation and maintenance of the skill acquired with this technique are essential.
OBJECTIVES: To review the current literature on the effects of ambulance diversion (AD). METHODS: The authors performed a systematic review of AD and its effects. PubMed, EMBASE, the Cochrane database, societal meeting abstracts, and references from relevant articles were searched. All articles were screened for relevance to AD. RESULTS: The authors examined 600 citations and reviewed the 107 articles relevant to AD. AD is a common occurrence that is increasing in frequency. AD is associated with periods of emergency department (ED) crowding (Mondays, mid-afternoon to early evening, influenza season, and when hospitals are at capacity). Interventions that redesign the AD process or that provide additional hospital or ED resources reduce diversion frequency. AD is associated with increased patient transport times and time to thrombolytics but not with mortality. AD is associated with loss of estimated hospital revenues. Short of anecdotal or case reports, no studies measured the effect of AD on ED crowding, morbidity, patient and provider satisfaction, or EMS resource utilization. CONCLUSIONS: Despite its common use, there is a relative paucity of studies on the effects of AD. Further research into these effects should be performed so that we may understand the role of AD in the health system.