A survey of Canadians enrolled in American Emergency Medicine residencies.

Despite the existence of Emergency Medicine (EM) residency programs in Canada, Canadian physicians continue to pursue EM training in the United States. To determine the factors that may influence these Canadian physicians to return to practice in Canada, a survey was sent to all Canadians enrolled in U.S. EM training programs. Seventeen of 22 (77%) post-graduate trainees responded. Residents said they had chosen U.S. training mainly because of the low number of residents in Canadian EM specialty programs, and they also had the perception that U.S. EM training was superior. Lower salaries, restrictions on location of practice, and an inability to obtain Royal College certification were the factors most likely to prevent a return to Canada. Six of the 17 respondents (35%) said they were definitely or probably returning to Canada. Given the limited number of Canadian training positions and the Canadian Emergency Physician workforce shortfall, the U.S. training route appears to be underutilized.

Out-of-hospital treatment of hypoglycemia: refusal of transport and patient outcome.

OBJECTIVES: Patient refusal of transport after treatment of hypoglycemia is common in urban emergency medical services (EMS) systems. The rate of relapse is unknown. The goal of this study was to compare the outcomes of diabetic patients initially refusing transport (refusers) and those transported to an ED. METHODS: All paramedic runs from January to July 1995 were retrospectively reviewed. Inclusion criteria were adult patients with a field assessment of hypoglycemic signs/symptoms, and a fingerstick glucose <80 mg/dL. Data for analysis included paramedic run duration, patient demographics, and refusal or acceptance of transport. Patient outcome was obtained from a review of hospital and medical examiner records. Relapse was defined as hypoglycemia necessitating EMS activation or an ED visit within 48 hours of the initial episode. Student's t-test and chi2 analysis were used to compare means and rates, respectively. RESULTS: Over the 7 months, 374 patients made 571 calls to 9-1-1 that met inclusion criteria (5.2% of all paramedic runs). Of these, 412 were refusers (72.2%) and 159 were transported patients (27.8%). The hospital records of 4 transported patients were unavailable. Sixty-three transported patients were admitted (11.2%), with 1 death from prolonged hypoglycemia. The rates of relapse did not differ between the refusers and the transported patients (p > 0.05). Twenty-five relapses occurred among the refusers (6.1%), with 14 repeat refusals, 11 transports, 5 admissions, and no deaths. There were 7 relapses among the transported patients (4.4%), with 2 refusals, 5 transports, 2 admissions, and no deaths. The paramedic run time was significantly shorter for the refusers than for the transported patients (p < 0.05). CONCLUSIONS: The out-of-hospital treatment of hypoglycemic diabetic patients appears to be effective and efficient. Independent of the patient's refusal or acceptance of transport, the out-of-hospital treatment of hypoglycemic patients in this system appears to be safe.