Pub Date : 2024-12-01DOI: 10.1007/s43678-024-00822-0
Zhenghong Liu, Marcus Eng Hock Ong
{"title":"The ECG: old test, new possibilities.","authors":"Zhenghong Liu, Marcus Eng Hock Ong","doi":"10.1007/s43678-024-00822-0","DOIUrl":"https://doi.org/10.1007/s43678-024-00822-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"26 12","pages":"844-845"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-09-27DOI: 10.1007/s43678-024-00781-6
Julien Turk, Scott Odorizzi, Sebastian Dewhirst, Jessica Maher, Jeffrey M Landreville
Purpose: This cohort study aimed to investigate resident physician productivity in an academic emergency department (ED) and assess the impact of longitudinal coaching relationships known as clinical coaching teams and co-learners (medical students) on resident productivity.
Methods: Data from patient visits to two academic EDs in Ottawa, Canada between April 2022 and March 2023 were analyzed. The attending physician schedule, learner arrangements, and patient ED treatment team information were collected. The presence or absence of clinical coaching teams was also recorded. Mean productivity, measured as patients per hour, was calculated for different shifts and learner arrangements. Linear regression and paired t tests were performed for analysis across ambulatory and non-ambulatory settings, with a focus on productivity differences across residents' training programs and level of training.
Results: A total of 142,386 ED visits were included in the analysis across 8161 attending physician shifts. Resident productivity increased with each year of training, with Royal College of Physicians and Surgeons of Canada emergency medicine residents being the most productive by year 5. There was no significant difference in productivity between residents on clinical coaching team shifts compared to non-clinical coaching team shifts. Productivity decreased slightly when residents worked with medical students as co-learners. There was no significant relationship between the difference in productivity on shifts with and without a medical student and year of training.
Conclusions: This study is the first of its kind to describe resident physician productivity in a Canadian emergency department. The results of this study demonstrate that resident physician productivity improves with seniority, and that co-learners and clinical coaching teams do not significantly impact productivity. This information will be useful to program directors and residents to help set realistic expectations around productivity and to ED physician leads in planning service delivery for patients in the context of a training program.
{"title":"Describing resident physician productivity in a Canadian academic emergency department.","authors":"Julien Turk, Scott Odorizzi, Sebastian Dewhirst, Jessica Maher, Jeffrey M Landreville","doi":"10.1007/s43678-024-00781-6","DOIUrl":"10.1007/s43678-024-00781-6","url":null,"abstract":"<p><strong>Purpose: </strong>This cohort study aimed to investigate resident physician productivity in an academic emergency department (ED) and assess the impact of longitudinal coaching relationships known as clinical coaching teams and co-learners (medical students) on resident productivity.</p><p><strong>Methods: </strong>Data from patient visits to two academic EDs in Ottawa, Canada between April 2022 and March 2023 were analyzed. The attending physician schedule, learner arrangements, and patient ED treatment team information were collected. The presence or absence of clinical coaching teams was also recorded. Mean productivity, measured as patients per hour, was calculated for different shifts and learner arrangements. Linear regression and paired t tests were performed for analysis across ambulatory and non-ambulatory settings, with a focus on productivity differences across residents' training programs and level of training.</p><p><strong>Results: </strong>A total of 142,386 ED visits were included in the analysis across 8161 attending physician shifts. Resident productivity increased with each year of training, with Royal College of Physicians and Surgeons of Canada emergency medicine residents being the most productive by year 5. There was no significant difference in productivity between residents on clinical coaching team shifts compared to non-clinical coaching team shifts. Productivity decreased slightly when residents worked with medical students as co-learners. There was no significant relationship between the difference in productivity on shifts with and without a medical student and year of training.</p><p><strong>Conclusions: </strong>This study is the first of its kind to describe resident physician productivity in a Canadian emergency department. The results of this study demonstrate that resident physician productivity improves with seniority, and that co-learners and clinical coaching teams do not significantly impact productivity. This information will be useful to program directors and residents to help set realistic expectations around productivity and to ED physician leads in planning service delivery for patients in the context of a training program.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"890-896"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-01DOI: 10.1007/s43678-024-00788-z
Hadas Katz-Dana, Rudica Stackievicz, Elad Dana, Nir Friedman, Gali Lackner, Ehud Rosenbloom, Ayelet Shles
Purpose: A new limp or refusal to weight-bear are common symptoms in children presenting to the pediatric emergency department (ED). This poses a diagnostic challenge, particularly among toddlers and nonverbal patients. Point-of-care ultrasound (PoCUS) used by pediatric emergency medicine physicians may detect hip effusion, which dramatically aids diagnostic workup and management. There is limited literature regarding the accuracy of hip PoCUS conducted by pediatric emergency medicine physicians. This study aims to assess the diagnostic performance of pediatric emergency medicine physician-performed PoCUS in identifying hip effusion.
Methods: This prospective study was conducted in a single-center pediatric ED. Children presenting with limb pain or new limp were evaluated by pediatric emergency medicine physicians who also performed hip PoCUS and categorized findings as either "effusion" or "no effusion" based on standard sonographic definitions. Patients also underwent radiology department ultrasound reviewed by a pediatric radiologist. Diagnostic test characteristics with corresponding 95% confidence intervals (CI) were calculated using radiology department ultrasound findings as the reference standard.
Results: A total of 95 patients were enrolled by 8 pediatric emergency medicine physicians. Excellent agreement was observed between PoCUS performed by pediatric emergency medicine physicians and radiology department ultrasound for the presence or absence of hip effusion (kappa = 0.81 [95% CI 0.70-0.93]). Hip effusion was identified by PoCUS in 44 out of 49 effusion-positive patients, with a sensitivity of 89.8% (95% CI 77.7-96.6%), specificity of 91.3% (95% CI 79.2%-97.5%), positive likelihood ratio of 10.33 (95% CI 4.03-26.47), and negative likelihood ratio of 0.11 (95% CI 0.05-0.26).
Conclusion: PoCUS performed by pediatric emergency medicine physicians has reasonably high sensitivity and specificity for diagnosing hip effusion among pediatric patients presenting to the pediatric ED with a limp or leg pain. This practice may potentially expedite both diagnosis and treatment within this patient population.
目的:新出现的跛行或拒绝负重是儿科急诊室(ED)就诊儿童的常见症状。这给诊断带来了挑战,尤其是在幼儿和不善言语的患者中。儿科急诊医生使用的护理点超声波(PoCUS)可检测到髋关节积液,这大大有助于诊断工作和治疗。有关儿科急诊医生进行髋关节 PoCUS 的准确性的文献有限。本研究旨在评估儿科急诊医生进行的 PoCUS 在识别髋关节积液方面的诊断性能:这项前瞻性研究在一家单中心儿科急诊室进行。方法:这项前瞻性研究在一家单中心儿科急诊室进行,由儿科急诊内科医生对出现肢体疼痛或新出现跛行的儿童进行评估,他们也进行了髋关节 PoCUS 检查,并根据标准超声波定义将检查结果分为 "渗出 "或 "无渗出"。患者还接受了放射科超声检查,并由儿科放射科医生进行了复查。以放射科超声波检查结果为参考标准,计算诊断测试特征及相应的 95% 置信区间 (CI):结果:8 位儿科急诊医生共收治了 95 名患者。由儿科急诊医生进行的 PoCUS 与放射科超声检查在是否存在髋关节积液方面的结果非常一致(kappa = 0.81 [95% CI 0.70-0.93])。49例积液阳性患者中有44例通过PoCUS发现了髋关节积液,敏感性为89.8%(95% CI 77.7-96.6%),特异性为91.3%(95% CI 79.2%-97.5%),阳性似然比为10.33(95% CI 4.03-26.47),阴性似然比为0.11(95% CI 0.05-0.26):由儿科急诊医生实施的PoCUS对诊断因跛行或腿痛而就诊于儿科急诊室的儿科患者的髋关节积液具有相当高的敏感性和特异性。这种做法有可能加快对这类患者的诊断和治疗。
{"title":"Diagnostic accuracy of point-of-care ultrasound (PoCUS) for the diagnosis of hip effusion in the pediatric emergency department.","authors":"Hadas Katz-Dana, Rudica Stackievicz, Elad Dana, Nir Friedman, Gali Lackner, Ehud Rosenbloom, Ayelet Shles","doi":"10.1007/s43678-024-00788-z","DOIUrl":"10.1007/s43678-024-00788-z","url":null,"abstract":"<p><strong>Purpose: </strong>A new limp or refusal to weight-bear are common symptoms in children presenting to the pediatric emergency department (ED). This poses a diagnostic challenge, particularly among toddlers and nonverbal patients. Point-of-care ultrasound (PoCUS) used by pediatric emergency medicine physicians may detect hip effusion, which dramatically aids diagnostic workup and management. There is limited literature regarding the accuracy of hip PoCUS conducted by pediatric emergency medicine physicians. This study aims to assess the diagnostic performance of pediatric emergency medicine physician-performed PoCUS in identifying hip effusion.</p><p><strong>Methods: </strong>This prospective study was conducted in a single-center pediatric ED. Children presenting with limb pain or new limp were evaluated by pediatric emergency medicine physicians who also performed hip PoCUS and categorized findings as either \"effusion\" or \"no effusion\" based on standard sonographic definitions. Patients also underwent radiology department ultrasound reviewed by a pediatric radiologist. Diagnostic test characteristics with corresponding 95% confidence intervals (CI) were calculated using radiology department ultrasound findings as the reference standard.</p><p><strong>Results: </strong>A total of 95 patients were enrolled by 8 pediatric emergency medicine physicians. Excellent agreement was observed between PoCUS performed by pediatric emergency medicine physicians and radiology department ultrasound for the presence or absence of hip effusion (kappa = 0.81 [95% CI 0.70-0.93]). Hip effusion was identified by PoCUS in 44 out of 49 effusion-positive patients, with a sensitivity of 89.8% (95% CI 77.7-96.6%), specificity of 91.3% (95% CI 79.2%-97.5%), positive likelihood ratio of 10.33 (95% CI 4.03-26.47), and negative likelihood ratio of 0.11 (95% CI 0.05-0.26).</p><p><strong>Conclusion: </strong>PoCUS performed by pediatric emergency medicine physicians has reasonably high sensitivity and specificity for diagnosing hip effusion among pediatric patients presenting to the pediatric ED with a limp or leg pain. This practice may potentially expedite both diagnosis and treatment within this patient population.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"875-882"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1007/s43678-024-00820-2
Brit Long, Morgan Langille, Hans Rosenberg, Paul Atkinson
{"title":"Just the facts: evaluation and management of epistaxis.","authors":"Brit Long, Morgan Langille, Hans Rosenberg, Paul Atkinson","doi":"10.1007/s43678-024-00820-2","DOIUrl":"https://doi.org/10.1007/s43678-024-00820-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-10DOI: 10.1007/s43678-024-00809-x
Muhammad Taha Khan, Ammar Ishaq, Samia Rohail, Samia Aziz Sulaiman, Fatima Ali Raza, Haris Habib, Aman Goyal
Objective: Our meta-analysis aimed to evaluate the safety of procedural sedation and analgesia in pediatric emergency department (ED) settings by investigating the incidence of cardiac, respiratory, gastrointestinal, and neurological adverse events associated with different sedation medications.
Methods: In accordance with PRISMA guidelines, a comprehensive database search for randomized controlled trials was performed across ten databases from January 2005 to June 2024. Our inclusion criteria included randomized controlled trials involving children under 18 years old undergoing pediatric sedation and analgesia in the ED. Data on medication types, dosages, administration routes, and adverse events were extracted and analyzed. Primary endpoints included cardiac, respiratory, gastrointestinal, and neurological adverse events.
Results: Seventeen studies met the inclusion criteria, a total of 2,302 procedural sedations. The most common adverse events were vomiting, agitation, and hypoxia, which occurred in 104.9 [95% CI = 76.9-132.9], 37.5 [95% CI = 20.6-54.4], 38.3 [95% CI = 23.9-52.6] of each 1000 sedations, respectively. Other adverse events included apnea, hypotension, and the need for bag-valve mask ventilation, which occurred in 8.6 [95% CI: 3.5-13.6], 9.3 [95% CI: -1.4 to 20.1], and 13.5 [95% CI: 3.2-23.8] of each 1,000 sedations, respectively. Severe adverse events were rare, with no reported instances of intubation and only one case of laryngospasm. Subgroup analyses revealed varying incidence rates of adverse events across different sedation protocols, with ketamine and its combinations showing higher rates of specific respiratory complications.
Conclusions: Procedural sedation in pediatric EDs is generally safe, with a low incidence of adverse events, such as vomiting, agitation, and hypoxia. Life-threatening respiratory adverse events are extremely rare. Our findings thus support the careful selection and monitoring of sedation protocols to minimize risks.
目的我们的荟萃分析旨在通过调查与不同镇静药物相关的心脏、呼吸、胃肠道和神经系统不良事件的发生率,评估儿科急诊室(ED)手术镇静和镇痛的安全性:根据 PRISMA 指南,我们对 2005 年 1 月至 2024 年 6 月期间的 10 个数据库进行了随机对照试验的全面数据库检索。我们的纳入标准包括涉及在急诊室接受儿科镇静和镇痛治疗的 18 岁以下儿童的随机对照试验。我们提取并分析了有关药物类型、剂量、给药途径和不良事件的数据。主要终点包括心脏、呼吸、胃肠道和神经系统不良事件:17项研究符合纳入标准,共进行了2302次手术镇静。最常见的不良事件是呕吐、躁动和缺氧,在每1000次镇静中分别发生104.9次[95% CI = 76.9-132.9]、37.5次[95% CI = 20.6-54.4]、38.3次[95% CI = 23.9-52.6]。其他不良事件包括呼吸暂停、低血压和需要进行袋阀面罩通气,在每1000例镇静剂中分别发生8.6例[95% CI:3.5-13.6]、9.3例[95% CI:-1.4-20.1]和13.5例[95% CI:3.2-23.8]。严重不良事件很少发生,没有插管的报道,只有一例喉痉挛。亚组分析显示,不同镇静方案的不良事件发生率不同,氯胺酮及其复合制剂的特定呼吸系统并发症发生率较高:结论:在儿科急诊室进行手术镇静总体上是安全的,呕吐、躁动和缺氧等不良事件的发生率较低。危及生命的呼吸系统不良事件极为罕见。因此,我们的研究结果支持谨慎选择和监控镇静方案,以最大限度地降低风险。
{"title":"Evaluating the safety of procedural sedation in emergency department settings among the pediatric population: a systematic review and meta-analysis of randomized controlled trials.","authors":"Muhammad Taha Khan, Ammar Ishaq, Samia Rohail, Samia Aziz Sulaiman, Fatima Ali Raza, Haris Habib, Aman Goyal","doi":"10.1007/s43678-024-00809-x","DOIUrl":"https://doi.org/10.1007/s43678-024-00809-x","url":null,"abstract":"<p><strong>Objective: </strong>Our meta-analysis aimed to evaluate the safety of procedural sedation and analgesia in pediatric emergency department (ED) settings by investigating the incidence of cardiac, respiratory, gastrointestinal, and neurological adverse events associated with different sedation medications.</p><p><strong>Methods: </strong>In accordance with PRISMA guidelines, a comprehensive database search for randomized controlled trials was performed across ten databases from January 2005 to June 2024. Our inclusion criteria included randomized controlled trials involving children under 18 years old undergoing pediatric sedation and analgesia in the ED. Data on medication types, dosages, administration routes, and adverse events were extracted and analyzed. Primary endpoints included cardiac, respiratory, gastrointestinal, and neurological adverse events.</p><p><strong>Results: </strong>Seventeen studies met the inclusion criteria, a total of 2,302 procedural sedations. The most common adverse events were vomiting, agitation, and hypoxia, which occurred in 104.9 [95% CI = 76.9-132.9], 37.5 [95% CI = 20.6-54.4], 38.3 [95% CI = 23.9-52.6] of each 1000 sedations, respectively. Other adverse events included apnea, hypotension, and the need for bag-valve mask ventilation, which occurred in 8.6 [95% CI: 3.5-13.6], 9.3 [95% CI: -1.4 to 20.1], and 13.5 [95% CI: 3.2-23.8] of each 1,000 sedations, respectively. Severe adverse events were rare, with no reported instances of intubation and only one case of laryngospasm. Subgroup analyses revealed varying incidence rates of adverse events across different sedation protocols, with ketamine and its combinations showing higher rates of specific respiratory complications.</p><p><strong>Conclusions: </strong>Procedural sedation in pediatric EDs is generally safe, with a low incidence of adverse events, such as vomiting, agitation, and hypoxia. Life-threatening respiratory adverse events are extremely rare. Our findings thus support the careful selection and monitoring of sedation protocols to minimize risks.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1007/s43678-024-00800-6
Gillian Sheppard, Keerat Grewal, Teresa M Chan
{"title":"What's luck got to do with it? Taking an institutional approach to gender inequity in academic EM leadership.","authors":"Gillian Sheppard, Keerat Grewal, Teresa M Chan","doi":"10.1007/s43678-024-00800-6","DOIUrl":"https://doi.org/10.1007/s43678-024-00800-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"26 11","pages":"765-767"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-10DOI: 10.1007/s43678-024-00761-w
Benjamin Gompels, Luke McCarron, Luka Jovanovic, Thomas Molloy, Vazeer Ahmed, Martin Gargan, Mike Barrett
{"title":"Just the Facts: Assessing and managing soft tissue knee injuries in the Emergency Department.","authors":"Benjamin Gompels, Luke McCarron, Luka Jovanovic, Thomas Molloy, Vazeer Ahmed, Martin Gargan, Mike Barrett","doi":"10.1007/s43678-024-00761-w","DOIUrl":"10.1007/s43678-024-00761-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"778-780"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-30DOI: 10.1007/s43678-024-00779-0
Kwasi Nkansah-Junior, Rawaan S Elsawi, Ian R Drennan, Melissa McGowan, Brodie Nolan
Purpose: This study aimed to understand current prehospital trauma air-ambulance policies and triage guidelines across Canada. The research question centered on understanding the guidelines used by provinces and territories and identifying potential regional variations in air-ambulance triage.
Methods: We conducted a cross-sectional survey from November 2022 to May 2023, involving trauma leaders from Canada's 13 provinces and territories. Participants were identified via the Trauma Association of Canada and professional networks. The survey, developed with expert input and pilot tested for clarity, focused on prehospital trauma-triage guidelines, level of adoption of Center for Disease Control and Prevention (CDC) triage guidelines, and auto-launch air-ambulance policies. Data were collected using an 18-item electronic survey. Potential response bias was considered, and confidentiality was maintained. A cross-sectional qualitative analysis was used to evaluate the guidelines' adoption and variations, with responses compared across regions.
Results: The analysis revealed a nationwide adoption (11 of 11 respondents) of the CDC guidelines, indicating a standardized approach to patient transportation. Notably, many provinces and territories (5 of 11) endorse auto-launch protocols for air ambulances in specific scenarios. These policies offer advantages in geographically vast regions weighed against the cost of over-triage and inefficient resource allocation. Each province and territory tailors its approach based on factors such as geographic areas served, and available resources.
Conclusion: This study provides a snapshot of the current state of prehospital trauma-triage guidelines in Canada. With some differences in nomenclature, Canadian provinces and territories widely apply the CDC guidelines to serve their populations. There is some regional variation on how transport is initiated within their borders. The findings underscore the delicate balance required for optimizing air-ambulance policies, considering factors such as timely access, resource allocation, and the local application of guidelines.
{"title":"Ready to launch: a cross-sectional study of field trauma triage and air-ambulance policies across Canada.","authors":"Kwasi Nkansah-Junior, Rawaan S Elsawi, Ian R Drennan, Melissa McGowan, Brodie Nolan","doi":"10.1007/s43678-024-00779-0","DOIUrl":"10.1007/s43678-024-00779-0","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to understand current prehospital trauma air-ambulance policies and triage guidelines across Canada. The research question centered on understanding the guidelines used by provinces and territories and identifying potential regional variations in air-ambulance triage.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey from November 2022 to May 2023, involving trauma leaders from Canada's 13 provinces and territories. Participants were identified via the Trauma Association of Canada and professional networks. The survey, developed with expert input and pilot tested for clarity, focused on prehospital trauma-triage guidelines, level of adoption of Center for Disease Control and Prevention (CDC) triage guidelines, and auto-launch air-ambulance policies. Data were collected using an 18-item electronic survey. Potential response bias was considered, and confidentiality was maintained. A cross-sectional qualitative analysis was used to evaluate the guidelines' adoption and variations, with responses compared across regions.</p><p><strong>Results: </strong>The analysis revealed a nationwide adoption (11 of 11 respondents) of the CDC guidelines, indicating a standardized approach to patient transportation. Notably, many provinces and territories (5 of 11) endorse auto-launch protocols for air ambulances in specific scenarios. These policies offer advantages in geographically vast regions weighed against the cost of over-triage and inefficient resource allocation. Each province and territory tailors its approach based on factors such as geographic areas served, and available resources.</p><p><strong>Conclusion: </strong>This study provides a snapshot of the current state of prehospital trauma-triage guidelines in Canada. With some differences in nomenclature, Canadian provinces and territories widely apply the CDC guidelines to serve their populations. There is some regional variation on how transport is initiated within their borders. The findings underscore the delicate balance required for optimizing air-ambulance policies, considering factors such as timely access, resource allocation, and the local application of guidelines.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"797-803"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1007/s43678-024-00794-1
Lauren Lacroix, Lisa Calder
{"title":"This is a call to action for all leaders in Emergency Medicine: men and women.","authors":"Lauren Lacroix, Lisa Calder","doi":"10.1007/s43678-024-00794-1","DOIUrl":"https://doi.org/10.1007/s43678-024-00794-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"26 11","pages":"763-764"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-03DOI: 10.1007/s43678-024-00777-2
Lara Murphy, Nelson Huang, Sujane Kandasamy, Gita Wahi, Jeffrey M Pernica
Objectives: The objective of this study was to better understand caregiver perspectives on educational materials relating to paediatric community-acquired pneumonia and antibiotic stewardship in the emergency department setting.
Methods: This was a phenomenologically informed qualitative study. Caregivers of young children in Hamilton, Ontario were presented with four educational materials (animated video, physician led lecture-style video, caregiver led testimony-style video, and a printed brochure) providing information relating to treatment strategies for community-acquired pneumonia. Caregivers were then asked open-ended questions about how they felt about the effectiveness of the media used. The principles of conventional content analysis guided the coding and synthesis of the transcribed interviews.
Results: Eleven caregivers were interviewed. Most caregivers preferred the animated video and brochure to the lecture-style physician video and caregiver testimonial video. Common themes for effective educational materials included visually attention-grabbing graphics, accessible language, and formats they could reference following their visit (e.g. brochure).
Conclusions: The busy nature of the emergency department setting can impede effective communication between clinicians and parents. Employing educational materials may allow for more informed parent-provider communication on care decision making. Caregivers in our study prioritized the simplest information formats for education around community-acquired pneumonia and antimicrobial stewardship which could be referenced following discharge. This was best accomplished by short, animated videos and brochures. Results from this study can inform development of future educational materials used in paediatric emergency department settings to optimize caregiver education and corresponding care plan adherence.
{"title":"Effectiveness of caregiver educational materials for paediatric community-acquired pneumonia in the emergency department: a qualitative study.","authors":"Lara Murphy, Nelson Huang, Sujane Kandasamy, Gita Wahi, Jeffrey M Pernica","doi":"10.1007/s43678-024-00777-2","DOIUrl":"10.1007/s43678-024-00777-2","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to better understand caregiver perspectives on educational materials relating to paediatric community-acquired pneumonia and antibiotic stewardship in the emergency department setting.</p><p><strong>Methods: </strong>This was a phenomenologically informed qualitative study. Caregivers of young children in Hamilton, Ontario were presented with four educational materials (animated video, physician led lecture-style video, caregiver led testimony-style video, and a printed brochure) providing information relating to treatment strategies for community-acquired pneumonia. Caregivers were then asked open-ended questions about how they felt about the effectiveness of the media used. The principles of conventional content analysis guided the coding and synthesis of the transcribed interviews.</p><p><strong>Results: </strong>Eleven caregivers were interviewed. Most caregivers preferred the animated video and brochure to the lecture-style physician video and caregiver testimonial video. Common themes for effective educational materials included visually attention-grabbing graphics, accessible language, and formats they could reference following their visit (e.g. brochure).</p><p><strong>Conclusions: </strong>The busy nature of the emergency department setting can impede effective communication between clinicians and parents. Employing educational materials may allow for more informed parent-provider communication on care decision making. Caregivers in our study prioritized the simplest information formats for education around community-acquired pneumonia and antimicrobial stewardship which could be referenced following discharge. This was best accomplished by short, animated videos and brochures. Results from this study can inform development of future educational materials used in paediatric emergency department settings to optimize caregiver education and corresponding care plan adherence.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"784-789"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}