Adherence to Universal Travel Screening in the Emergency Department During Epidemic Ebola Virus Disease.

BACKGROUND: During the 2014 West African Ebola Virus Disease (EVD) outbreak, the U.S. Centers for Disease Control and Prevention recommended that all emergency department (ED) patients undergo travel screening for risk factors of importing EVD. OBJECTIVES: We sought to determine the overall adherence rate to the recommended travel screening protocol and to identify factors associated with nonadherence to the protocol. METHODS: We conducted a multicenter, retrospective analysis of adherence to the travel screening program in an academic hospital and three affiliated community hospitals. A regression model identified patient and hospital factors associated with nonadherence. RESULTS: Of the 147,062 patients included for analysis, 93.7% (n = 137,834) had travel screenings completed. We identified several characteristics of patients that were most likely to be missed by the screening protocol-patients with low English proficiency, patients who arrive via ambulance or helicopter, and patients with more severe illness or injury based on initial triage acuity. CONCLUSIONS: These findings should be used to improve adherence to the travel screening protocol for future emerging infectious disease threats.

Free Open Access Medical Education (FOAM) in Emergency Medicine: The Global Distribution of Users in 2016.

INTRODUCTION: Free open-access medical education (FOAM) is a collection of interactive online medical education resources-free and accessible to students, physicians and other learners. This novel approach to medical education has the potential to reach learners across the globe; however, the extent of its global uptake is unknown. METHODS: This descriptive report evaluates the 2016 web analytics data from a convenience sample of FOAM blogs and websites with a focus on emergency medicine (EM) and critical care. The number of times a site was accessed, or "sessions", was categorized by country of access, cross-referenced with World Bank data for population and income level, and then analyzed using simple descriptive statistics and geographic mapping. RESULTS: We analyzed 12 FOAM blogs published from six countries, with a total reported volume of approximately 18.7 million sessions worldwide in 2016. High-income countries accounted for 73.7% of population-weighted FOAM blog and website sessions in 2016, while upper-middle income countries, lower-middle income countries and low-income countries accounted for 17.5%, 8.5% and 0.3%, respectively. CONCLUSION: FOAM, while largely used in high-income countries, is used in low- and middle-income countries as well. The potential to provide free, online training resources for EM in places where formal training is limited is significant and thus is prime for further investigation.

Emergency Physicians as Good Samaritans: Survey of Frequency, Locations, Supplies and Medications.

INTRODUCTION: Little is known about the frequency and locations in which emergency physicians (EPs) are bystanders to an accident or emergency; equally uncertain is which contents of an "emergency kit" may be useful during such events. The aim of this study was to describe the frequency and locations of Good Samaritan acts by EPs and also determine which emergency kit supplies and medications were most commonly used by Good Samaritans. METHODS: We conducted an electronic survey among a convenience sample of EPs in Colorado. RESULTS: Respondents reported a median frequency of 2.0 Good Samaritan acts per five years of practice, with the most common locations being sports and entertainment events (25%), road traffic accidents (21%), and wilderness settings (19%). Of those who had acted as Good Samaritans, 86% reported that at least one supply would have been useful during the most recent event, and 66% reported at least one medication would have been useful. The most useful supplies were gloves (54%), dressings (34%), and a stethoscope (20%), while the most useful medications were oxygen (19%), intravenous fluids (17%), and epinephrine (14%). CONCLUSION: The majority of EPs can expect to provide Good Samaritan care during their careers and would be better prepared by carrying a kit with common supplies and medications where they are most likely to use them.

Availability and potential impact of international rotations in emergency medicine residency programs.

BACKGROUND: Interest in international emergency medicine (IEM) is growing. With the globalization of medicine, IEM as a field has expanded from disaster relief efforts to opportunities for resident education. Numerous accounts have been published voicing the educational benefits of international rotations (IRs). As such, many residencies now offer opportunity for IRs. OBJECTIVE: To evaluate the availability and utilization of IRs in emergency medicine (EM) residency programs. METHODS: EM residency program directors were surveyed from the 126 Accreditation Council for Graduate Medical Education-accredited programs with ≥2 years of residency graduates. Directors were asked about availability of IR, categorized as: 1) required; 2) elective (with or without pre-designated sites); or 3) not available. RESULTS: One hundred eleven (88%) program directors reported data on 2240 graduates over 2 years. IRs were offered by 101 (91%) programs. No program required an IR. Among programs offering IRs, most (69%) did not have pre-designated sites. Eighty-nine of 101 programs (88%) allowing IRs had at least one resident completing an IR; 23 of 111 programs (21%) had more than 30% resident participation in IRs. Programs offering IRs at pre-designated sites had 210 of 727 (29%) residents complete an IR, compared to 272 of 1469 (19%) in programs without pre-designated sites (p < 0.001). Four-year programs had twice as many IR participants (32%) compared to 3-year programs (17%; p < 0.001). CONCLUSIONS: More residents participated in IRs when a pre-designated site was available compared to programs without. This suggests that programs interested in supporting IRs consider developing pre-designated sites to accommodate residents.

Training medical students in bag-valve-mask technique as an alternative to mechanical ventilation in a disaster surge setting.

OBJECTIVE: The objective of this study was to evaluate the rapid training of medical students and their ability to provide effective manual ventilation using the bag-valve-mask technique. METHODS: A rapid training session highlighting essential aspects of the correct bag-valve-mask technique was given to 31 medical students. This was followed by a simulated experience with a certified respiratory therapist, monitored according to a checklist of essential bag-valve-mask (BVM) competency requirements. Pre-test and post-test surveys assessed the medical students' knowledge and ability to provide adequate BVM technique. RESULTS: Thirty-one students participated. Pre-survey results demonstrated a clear identification of the potential risk for a disaster (pandemic, natural, bioterrorist) with 55% of students responding that a definite risk did exist. Their usefulness in such an event also was ascertained with 55% of students replying they would assist with basic medical tasks, assist doctors, or assist with cardiopulmonary resuscitation. Post-survey results administered after a 30-minute didactic session on the basic features of resuscitation equipment and the essential components of BVM technique demonstrated that a majority of students knew the proper head positioning maneuvers in cases not involving trauma (93%) and in cases involving trauma (72%). All students completed and passed the competency checklist. CONCLUSIONS: Medical students can be rapidly trained and be utilized as a potential resource to carry out the potentially lifesaving task of manual ventilation using the BVM technique in a disaster situation in which the availability of mechanical ventilators and respiratory therapists may be limited.