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Results for “Patient Escort Service”

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At least 145 records · Page 8Linked to original sources

PubMed1998

[Prehospital treatment of heroin intoxication in Oslo in 1996].

The number of heroin overdoses among drug addicts in Oslo is increasing. In 1996 overdoses counted for 1,248 (12%) of all emergency call-outs by the ambulance service. Heroin can cause fatal respiratory insufficiency, and in 1996 a total of 104 deaths related to heroin overdoses were reported in Oslo. Heroin overdoses are treated on site by ambulance personnel. Advanced cardiopulmonary resuscitation was started on 18 of the 79 addicts who were found unconscious, and 11 persons were treated successfully. A total of 846 drug addicts had to be given the antidote naloxone, and among these 678 (80%) persons were found in a coma. Only 29 persons had to be transported to hospital. Early treatment probably prevented both morbidity and mortality, no time being wasted transporting the patients to hospital. Ambulance personnel treat all drug addicts with the same respect as they do other patients. They have no police escort; they are familiar with the addicts and their environment and they have gained their confidence. Prehospital treatment saves on health services resources, and should, in our experience, be carried out in collaboration with a hospital or other health institutions for mutual and optimal benefit.

Adult↗

PubMed1991

Aeromedical patient transfer.

Aeromedical evacuation involves the transfer of patients in a variety of aircraft types (both fixed-wing and helicopters). The patients' condition will hopefully be maintained or improved during the transfer. The escorting doctor should be aware of the differences between working in the airborne environment and working in the static ground-based facility.

Aircraft↗

PubMed1996

The use of thrombolytic therapy in patients presenting to a peripheral metropolitan emergency department with acute myocardial infarction.

BACKGROUND: While use of thrombolytic therapy in the management of acute myocardial infarction has become accepted practice in major teaching hospitals, its use in peripheral metropolitan hospitals has not been well accepted. AIM: To evaluate the use of thrombolytic therapy in the management of acute myocardial infarction in the Emergency Department (ED) of a peripheral metropolitan hospital. METHODS: A mixed prospective and retrospective observational study of 69 patients with acute myocardial infarction, who received thrombolytic therapy during a three year period, was conducted in a community based ED. RESULTS: Demographic data, door to drug interval, complications occurring during administration of thrombolytics and subsequent interhospital transfer were recorded. The mean door to drug interval in 1992 was 79.7 minutes (95% CI: 50.7 to 109.1) and by 1994 this had fallen to 25.6 minutes (95% CI: 18.9 to 32.3). Hypertension (22%) was the most common complication of therapy observed and cardiac arrest occurred in two cases (3.2%). A single episode of hypotension and vomiting were the only complications that occurred during interhospital transfer. There were no deaths during therapy or transfer. CONCLUSION: Thrombolytic therapy can be undertaken in the EDs of peripheral metropolitan hospitals in a safe and timely manner. There is little justification for routine medical escorts in the clinically stable post thrombolysis patient.

Adult↗

PubMed2006

B12 trafficking in mammals: A for coenzyme escort service.

Many coenzymes are vitamins that are assimilated in mammals into their active form from precursors obtained from the diet. They are often both rare and reactive rendering the likelihood low that the cell uses a collision-based strategy for their delivery to dependent enzymes. In humans, there are only two known B12 or cobalamin-dependent enzymes: methionine synthase and methylmalonyl-CoA mutase. However, the pathway for intracellular assimilation and utilization of this cofactor is complex as revealed by careful clinical analyses of fibroblasts from patients with disorders of cobalamin metabolism. In the recent past, six of the eight human genes involved in the B12 pathway have been identified and these have yielded important insights into their roles. The recent literature on the encoded proteins is reviewed, and a model for intracellular B12 trafficking is proposed in which B12 is escorted to its target proteins in the cytoplasmic and mitochondrial compartments in complex with chaperones, thereby averting problems of dilution and adventitious side reactions.

Animals↗

PubMed1996

Interhospital transfers: decision-making in critical care areas.

OBJECTIVES: To evaluate the training of clinical staff in the use of interhospital transfer guidelines and to examine the underlying decision-making behavior in organizing patient transfers between hospitals. DESIGN: Prospective assessment of clinical scenarios, given before (time 1), immediately after (time 2), and 3 months after (time 3) a program informing clinical staff about the use of interhospital transfer guidelines. SETTING: Three emergency departments and one intensive care unit at three hospitals and a medical retrieval service in Sydney, Australia. SUBJECTS: Physicians, nurses, and a paramedic working in critical care areas and at a medical retrieval service. MEASUREMENTS AND MAIN RESULTS: A questionnaire containing clinical scenarios was administered to clinical staff. There was a significant difference in mean scores for selecting the appropriate escort levels across time (F2,78 = 24.2; p < .01) and for participant's experience with interhospital transfer (F2,39 = 4.63; p = .02). Significant improvement in mean scores occurred between time 1 (7.55 +/- 1.84 and time 2 (9.48 +/- 1.47) (t41 = -6.21; p < .01). The improvement in selecting appropriate escorts was maintained at time 3 (mean score 9.86 +/- 2.01). The error rate for inappropriate assignment of low levels of escorts decreased from 35% (time 1) to 10% (time 2) and 14% (time 3). Using conjoint analysis, there were large variations in the decision-making behaviour between each time period. The relative importance of each factor in influencing the decision to organize an escort at time 3 were as follows: treatment (43%); physiology (29%); patient age (24%); and diagnosis (4%). The decision-making model observed at time 3 had a high predictive value (87%) as compared with the model at time 1 (48%). CONCLUSION: Clinical staff can make informed and appropriate decisions by using standardized guidelines when organizing interhospital transfers.

Analysis of Variance↗

PubMed1996

Pediatric prehospital care provided by a physician-staffed emergency medical helicopter unit in Finland.

During an 18-month period ending on March 15, 1994, data on all patients treated by the Helsinki Area Emergency Medical Air Service (HEMS) in Southern Finland were collected. The HEMS operates a physician-staffed helicopter unit which is dispatched by alarm centers connected to a national 112 emergency phone system. Of 1481 emergency missions during the study period, 89 (8%) involved children less than 17 years old. Common pediatric emergencies were trauma (31%), seizures (29%), respiratory problems (14%), and cardiac arrest (9%). Fourteen patients were intubated, an intravenous line was started in 58 patients, and 32 patients received intravenous medication. Cardiopulmonary resuscitation was initiated in nine patients. Ten patients were evacuated by helicopter, and 22 patients were transported by ground ambulance with a HEMS physician escort to the hospital. According to this study, the HEMS physician play an important role also in pediatric prehospital care in their operating area.

Adolescent↗

PubMed2004

Trading patients. Lessons from Scandinavia.

The next few decades will bring about more trade in services, among them health care. This paper describes a recent project on cross-border trading of patients initiated by the Norwegian parliament (The Patient Bridge). This health policy reform met some resistance among hospital physicians. However, patients were willing to participate if being properly informed and supported by local health care workers. The Patient Bridge turned out to be a relatively expensive project partly because of the transaction costs involved (transportation and escort) and partly because of high treatment costs. Excessive treatment costs were a result of insufficient cost-consciousness in the purchasing organization. The Patient Bridge revealed large price differentials not only between Norwegian and foreign hospitals, but also between hospitals abroad, even within the same country. This finding points to the possibilities of reaching mutual gains from trading patients across borders.

Attitude of Health Personnel↗

PubMed1979

Using the resources of AA in treating alcoholics in a general hospital.

At Cleveland Metropolitan General Hospital a small number of staff and a large number of volunteers from Alcoholics Anonymous have collaborated to meet the treatment needs of the community's alcoholics. Recovered alcoholics serve as volunteers staffing a friendship room, located close to the emergency room and open weeknights between 6 and 10 p.m. They also provide counseling on AA, escort patients to AA meetings, help in postdischarge follow-up, and act as casefinders in the community. The hospital staff have become more aware of problems of alcoholism and are better able to treat alcoholics and to provide counseling and referral services.

Alcoholics Anonymous↗

PubMed2006

Awareness in retrieval medicine.

Awareness is the spontaneous recall of an event(s) that occurred during general anaesthesia and surgery. The incidence of awareness is approximately 0.2% of cases where neuromuscular blockers are used and half that where they are omitted. The majority of data relating to awareness is from anaesthetic practice. We report a case of awareness associated with an out-of-hospital transportation of a critically ill patient requiring a medical escort (retrieval). We discuss the risk factors associated with awareness during retrieval, in particular the trend toward excessive administration of neuromuscular blockers, and the unique challenges for the prevention of awareness within the retrieval environment.

Adult↗

PubMed2005

Interhospital transfers of patients with surgical emergencies: areas for improvement.

OBJECTIVE: To review mortality associated with interhospital transfers of patients with surgical emergencies from rural and peripheral metropolitan areas. DESIGN: A retrospective case note review. SETTING: All hospitals within an area health service including metropolitan and rural hospitals. SUBJECTS: All patients with a surgical emergency who died in hospital after interhospital transfer within an area health service. MAIN OUTCOME MEASURES: Factors associated with death and interhospital transfer. RESULTS: In total, 22 patients were identified. The mean age was 77 years. Thirty-six per cent of patients were assessed by a surgeon prior to transfer. The mean time taken for transfer was five hours. Ten patients were physiologically unstable prior to transfer. No medical escort accompanied these patients. Four patients deteriorated during the transport process. Seventy-three per cent of patients arrived out of normal working hours. Fifty per cent of patients required an operation within 24 hours of arrival. All of these patients had significant medical co-morbidities. Seventy-two per cent of these operations were performed out of hours as an emergency case. Twenty-three per cent did not receive any operative intervention or intensive care admission at the tertiary referral centre. Forty-one per cent of deaths were related to peritonitis and intra-abdominal soiling. CONCLUSIONS: Hospital systemic issues associated with mortality included extensive time delays in transfers, an inadequate transport process and frequent out-of-hours emergency operations. Patient features related to mortality included advanced age, significant medical co-morbidity and surgical pathology with a poor prognosis. Improvements concerning interhospital transfers of patients should address both systemic and patient issues.

Aged↗

PubMed1990

Interhospital transfer in the management of acute trauma.

During an 8-month period, 538 injured patients were transferred from primary hospitals to a referral hospital for further management of their injuries. Delay at the primary hospital was identified in 20% of all transfers and in 40% of patients transferred for management of head injury or multisystem injury. Delay at the primary hospital resulted in a median time from injury to arrival at the second hospital of 4 h. Defects in clinical management during transport included inexperienced escorts, inadequate airway control, ventilation, fluid resuscitation and stabilization of chest injuries. Nearly half of transfers were inappropriate because of the relatively minor nature of the injuries. Most of these had solitary musculoskeletal injuries to the extremities. These patients reflect the marked deficiency of specialist orthopaedic services in western Sydney during the study. Development of a metropolitan regional system of trauma care in western Sydney requires urgent action towards reducing the frequency of transfer, minimizing delays in transfer and maximizing basic resuscitation of seriously injured patients. Some designation of hospital roles is required and needs to be accompanied by a prehospital triage process. The population also has a right to expect adequate specialty services at suburban hospitals to enable treatment of minor and moderate single system injuries. Future trauma system developments should adequately reflect population growth and technological advances in clinical care.

Adolescent↗

PubMed1998

Barriers to the uptake of cataract surgery.

In The Gambia many patients identified as blind or as having low vision are not attending for surgery. The aim of this study was to investigate the reasons for non-attendance. Three methods were used: semi-structured interviews; focus group discussions; and written questionnaires completed by staff. The most frequently identified barrier by all three methods was cost, closely followed by lack of information about services, fear, transport difficulties, and the lack of an escort. In addition to the existing measures taken by the National Eye Care Programme (NECP) to reduce these barriers, further research into both the public's knowledge and attitudes regarding surgery for cataract is needed. More contact between members of the eye care programme and the communities would aid the transfer of information about the surgery.

Cataract Extraction↗

PubMed1990

The Special Olympic Games for the mentally handicapped--United Kingdom 1989.

The games took place in the City of Leicester in August 1989. Over 1500 mentally handicapped competitors took part, many of whom had severe physical handicaps as well. There were 14 different classes of competition, held in seven separate venues, as well as ceremonies and recreational activities. A medical team of over 100 doctors, nurses and physiotherapists, mostly part-time volunteers, was formed to service the seven medical posts. As it may be of interest to doctors and others involved in any such games in the future, details are given of conditions recorded in pre-games medical examinations, of injuries and other medical conditions treated by the medical team, and some details of the administration and equipping of the medical services. Although the main responsibility of the medical team was to the competitors, many coaches, officials, escorts and a few spectators were also treated.

Athletic Injuries↗

PubMed1998

Managing terminally ill prisoners: reflection and action.

In 1997 a young remand prisoner was 'shackled' to his bed until shortly before his death. An outcry ensued. This paper discusses issues concerning care of terminally ill prisoners. In Cardiff, the Prison Service, local National Health Service trusts and the hospice have produced joint guidance on the escorting of ill prisoners and managing a bedwatch; these are outlined.

Delivery of Health Care↗

PubMed2006

Social support among women who died of ovarian cancer.

GOALS OF WORK: We investigated the effects of social support in the last 6 months of life for women who died of ovarian cancer. MATERIALS AND METHODS: The study population included women enrolled in one of three Managed Care Organizations who died of ovarian cancer (1995-2000). Information was collected on demographics, living environment, presence of escorts to oncology encounters, comorbidities, medications, outpatient and inpatient encounters, and referrals to home health and hospice. Two characteristics of social support were examined: living with others and being escorted to one or more oncology visits. RESULTS: Of 421 subjects, both aspects of social support were known for 345 (82%). Of these, 227 (66%) lived with others and were escorted, 33 (10%) lived with others but were never escorted, 59 (17%) lived alone but were escorted, and 26 (8%) lived alone and never were accompanied. Women living alone were less likely to be taking a psychotropic medication (57% vs 70%, p = 0.021) and were somewhat less likely to receive hospice referral (42% vs 53%, p = 0.054). Women who were never escorted had fewer outpatient encounters (12.60 vs 15.77, p = 0.033) and were less likely to be referred to home health (18% vs 30%, p = 0.046). CONCLUSIONS: This study indicates that social support has some beneficial effects on receipt of personal health services. Friends and family may act as proponents for the patient in obtaining services. Health care professionals should be encouraged to assess the cancer patient's social situation and identify areas where help may be needed.

Aged↗

PubMed1997

Come fly with me.

We have both worked performing medical retrievals of tourists who have become injured or sick overseas and required a nursing escort. Back to Australia, such services are covered by travel insurance policies. Through this work we have had the opportunity to visit, albeit briefly, some beautiful places with some fantastic health care facilities (we use the term 'fantastic' in the entire spectrum of its meaning!). All our adventurous stories are true, but those recounted here are an amalgam of a number of trips and a number of patients. The places, names and diagnoses of patients have been changed to protect the hospitals, and those people in our care.

Australia↗

PubMed1995

Preparation of the critically ill for transfer in metropolitan Sydney.

The transfer of the critically ill patient is often complex and difficult, and may contribute to increased morbidity. It is therefore valuable to have an understanding of the practical problems relating to patient transfer, and common management strategies, in order to minimise adverse outcomes. Key issues in the process of transporting the critically ill patient in metropolitan Sydney include: (i) particular problems and pitfalls during the transfer process; (ii) risk factors in transferring patients and the appropriateness of escorts and transfer procedures; (iii) procedures for arranging a patient transfer; (iv) the role of the NSW Medical Retrieval Co-ordination Centre (MRCC); (v) preparation of the patient for transfer, (vi) education of staff on the concept of safe matching of patient needs to appropriate escorts; and (vii) the need for a co-ordinated patient transfer system to Sydney metropolitan hospitals. An understanding of these issues, and an appropriate response to them from hospital staff will ensure safe and efficient transportation of critically ill patients in metropolitan Sydney.

Ambulances↗

PubMed2001

Costs of accessing surgical specialists by rural and remote residents.

INTRODUCTION: Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting. METHODS: A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non-clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan-based service. RESULTS: An estimated saving of AU$1,077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time. CONCLUSION: The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available.

Adult↗