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International emergency medicine: a review of the literature from 2006.

The field of international emergency medicine (IEM) has grown rapidly over the past several decades, with a rise in the number of IEM fellowship positions, sustained growth in the international sections of major emergency medicine organizations, and an increase in the range of topics included under its rubric. One of the greatest obstacles to the continued growth of IEM remains the lack of a high-quality, consolidated, and easily accessible evidence base of literature. In response to this perceived need, members of the Emergency Medicine Residents' Association IEM Committee, in conjunction with members of the Society for Academic Emergency Medicine International Health Interest Group, embarked on the task of creating a recurring review of IEM literature. This article reviews 25 IEM research articles published in 2006. Research articles were selected for the review according to explicit, predetermined criteria that included both methodological quality and perceived impact of the research. It is the authors' hope that this annual review will act as a forum for disseminating best practices while also stimulating further research in the field of IEM.

The effects of minimizing ambulance diversion hours on emergency departments.

This study explores the effects of minimizing Emergency Department (ED) bypass on individual hospital's ED census, ambulance transports, and admissions. Five hospitals in a geographic area collected data over 3 weeks. The first and third week represented controls, whereas the second week hospitals minimized their usage of bypass. Data collected included hours on bypass, ED census, ambulance runs, hospital admissions, and inter-facility transfers. The total number of hours on bypass for all hospitals for pre-trial, trial, and post-trial weeks were 112.2, 0.3, and 47, respectively. There were several statistical shifts in the proportion of ambulance runs and admissions seen by individual hospitals. Clinically, these shifts in patients were minor and within ED capacity. Hospitals in a given geographic area may successfully reduce the number of hours on bypass with possible minor shifting in the number of ambulance runs and admissions that are within ED capacity.

A survey of the use of foreign-purchased medications in a border community emergency department patient population.

Many reports suggest that the use of imported medications in the United States continues to grow, fueled mostly by the rising price of prescription drugs. This trend may be problematic for several reasons, including the potential for counterfeit or impure products, a lack of pharmacist support outside of the United States, and the ability to purchase agents without a prescription from some countries. We performed a survey of Emergency Department (ED) patients in a border community to observe the magnitude of imported medication use, and to begin to determine the rationale behind the practice. A survey was conducted of 1008 ED patient encounters of individuals reporting at triage to be on any prescription or over-the-counter medication. Participants were queried on their use of imported medications and implications of such use through a questionnaire. A total of 966 patient encounter surveys were included in the analysis. Of this number, 7% reported the use of medications purchased outside of the United States. Most of these were purchased in person and in Mexico. The most commonly cited reason for importing medications was decreased cost, and almost a quarter of those importing medications stated that their physician had recommended it. The most common medications imported were antibiotics, and nearly a third of all of those buying foreign medications had done so without a prescription. Our study suggests that many patients in our community purchase medications outside of the United States.