International Journal of Emergency Medicine最新文献

Background: Ambulance offload delay (AOD) indicates the persistent and increasingly visible problem of Emergency Department (ED) crowding. AOD is defined as the extended time from ambulance arrival at the ED until patient care is transferred to ED staff. Despite its negative consequences and international attention, AOD is currently not monitored within the Dutch Emergency Care. It is also unknown whether or not AOD is associated with the ambulance diversion (AD) status. In the Dutch ED the AD status is monitored by means of the traffic light system. This study aims to monitor AOD at the EDs of Franciscus Gasthuis & Vlietland (FGV).

Methods: A 10-week observational study was conducted at both the EDs of FGV. Ambulance personnel was queried regarding AOD duration and traffic light statuses by means of paper questionnaires. Descriptive statistics are reported as frequencies, medians and interquartile ranges (IQR). Associations between the traffic light status and categorical AOD data were analyzed using Chi-square tests.

Results: During the study period, 2967 ambulances arrived at the EDs. In 229 cases (7.7%), the definition of AOD was met. The median AOD was 16 min (IQR: 10-25 min). In 95.6% (n = 2830) of the cases the handover time was less than 15 min. No statistically significant association was found between the traffic light status (green, orange, red) and offload delay categories (p = 0.109). A non-significant difference remained (p = 0.075) when comparing median AOD in the absence of an AD with the median AOD during an (impending) AD.

Conclusion: This is the first observational study conducted in the Netherlands collecting data regarding the AOD. The limited observation period, the reliance of self-reported data and the single-center design restricts the generalizability of the data. Consequently, the authors conclude hypothesis-generating findings which warrant validation through planned multicenter research. Nevertheless, besides the existing traffic light system, this unique study provides policy makers with a candidate complementary quality indicator for ED-crowding in the Dutch context.

Background: Penetrating thoracic and abdominal trauma presents a diagnostic and therapeutic challenge in the emergency department (ED). Traditionally managed with open laparotomy or thoracotomy, advances in minimally invasive surgery (MIS) have enabled safe, effective, and rapid diagnosis and intervention. We present a case series of four patients with penetrating gastric, hepatic, and pulmonary injuries successfully managed using MIS, highlighting its role in emergency care.

Case presentations: Four hemodynamically stable patients presented to the ED with penetrating abdominal or thoracic trauma: (1) Stab wound to epigastrium: Diagnostic laparoscopy revealed a 1 cm anterior gastric body perforation, repaired laparoscopically. The patient recovered uneventfully and remained asymptomatic at 3-year follow-up. (2) Gunshot to upper abdomen: Laparoscopic wedge resection of a gastric cardia perforation was performed. Recovery was uneventful, with 1-year follow-up showing no complications. (3) Gunshot to right upper abdomen with hepatic injury: Laparoscopic hemostasis and bullet extraction under fluoroscopy were successfully performed. Four-year follow-up was uneventful. (4) Gunshot to left upper chest: Video-assisted thoracoscopic left upper lobe segmentectomy and bullet extraction were carried out. Five-year follow-up revealed preserved pulmonary function and no complications.

Discussion: Early identification and triage in the ED, combined with MIS, enabled rapid diagnosis and definitive treatment while minimizing morbidity. Laparoscopy and thoracoscopy provide excellent visualization, reduce unnecessary open procedures, and shorten hospital stays.

Conclusion: MIS is a safe, effective, and feasible approach for selected hemodynamically stable penetrating thoracic and abdominal injuries in the ED. Careful patient selection and surgical expertise are essential for optimizing outcomes.

Background and objectives: Prehospital emergency dispatch centers play a pivotal role in disaster response, yet their preparedness is often inadequate, particularly in low-resource settings such as Iran. This study aimed to explore the factors influencing the disaster preparedness of these centers through a qualitative approach.

Methods: A conventional content analysis was conducted between October 2024 and May 2025. Twenty experts and managers from Emergency Medical Services (EMS) and dispatch centers were selected using purposive and snowball sampling. Data were gathered through semi-structured interviews and analyzed inductively using MAXQDA-2020. Trustworthiness was ensured following Guba and Lincoln's criteria.

Results: In this study, thirteen main categories were extracted from the data. The analysis revealed that disaster preparedness in emergency dispatch centers is influenced by a complex interaction of human, organizational, and environmental factors. Among the most influential dimensions were planning and training, communication and coordination systems, and the psychological and operational readiness of personnel. Collectively, these components determine the centers' ability to maintain functionality and ensure an effective response under disaster conditions.

Conclusion: Strengthening the preparedness of emergency dispatch centers requires a systems-based approach that integrates comprehensive planning, continuous training, resilient communication infrastructure, and mental health support for telecommunicators. However, as a qualitative study, the findings are context-specific and may not be generalizable to all settings. Nevertheless, they provide an in-depth understanding of the multidimensional factors influencing preparedness and response, offering valuable insights for policymakers, health system managers, and model developers in disaster management.

Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening acute complications of diabetes. Up to one-third of patients present with overlapping features of both syndromes, complicating diagnosis and management. This overlap is associated with higher mortality than isolated DKA or HHS.

Objective: This narrative review synthesizes current evidence on the epidemiology, pathophysiology, and management of DKA-HHS overlap in both adult and pediatric populations with either type 1 or type 2 diabetes, highlighting the distinct challenges in recognition, treatment, and outcomes across these groups.

Findings: While DKA is defined by ketosis and metabolic acidosis, and HHS by profound hyperglycemia and hyperosmolality, overlap presentations combine both abnormalities. These patients face increased risks of cerebral edema, thromboembolism, and acute kidney injury. Standardized management protocols remain lacking, and treatment must balance fluid resuscitation, insulin therapy, and electrolyte correction, with distinct approaches for adults and children. Emerging issues such as SGLT2 inhibitor-induced euglycemic DKA and disparities in outcomes between high- and low-resource settings further complicate care.

Conclusion: DKA-HHS overlap represents a high-risk clinical phenotype requiring early recognition and individualized therapy. Consensus guidelines, risk stratification tools, and studies of fluid and insulin strategies are urgently needed to improve outcomes in this vulnerable population.