Willingness to respond: of emergency department personnel and their predicted participation in mass casualty terrorist events.

In May 2003, the TOPOFF 2 national disaster drill demonstrated inadequate preparedness for mass casualty terrorist events and failed to address the willingness of Emergency Department (ED) personnel to assist with these events. The objective of this study was to examine ED personnel willingness to respond to various multiple casualty events. A prospective voluntary survey of ED personnel from multiple hospitals was randomly administered in the form of vignette-based questionnaires. The survey of 204 participants at eight hospitals in the Chicago area revealed that staff members were more willing to work additional hours for victims of an airplane crash (98.0%), than for a radioactive bomb (85.3%), or a biologic agent (54.0%). For the biologic agent only, men were significantly more likely to respond than women. Hospital management should anticipate significant reductions in workforce during biologic and radioactive disaster events. Employees' willingness to respond was not augmented by any incentives offered by hospitals, although enhanced financial remuneration and disability coverage showed the most potential to increase response.

Risk factors for dive injury: a survey study.

Scuba diving is a world sport, but it is not medically regulated. Study objectives sought to identify risk behaviors, preexisting medical conditions, compliance to dive guidelines, and injury patterns of recreational scuba divers. An Internet-based survey examined risk behaviors and diver safety practices. Responses from 682 of 770 (88.6%) divers revealed that 80.6% were certified; 51.7% of certified divers reported diving injuries versus 75.0% for noncertified divers (RR = 1.31; 95% CI: 1.16-1.48; P < 0.001); suspected decompression symptoms were witnessed by 52.6% of divers; 32.7% of certified divers reported medical problems including hypertension, asthma, diabetes, and epilepsy. No significant differences were observed in injuries among the certified divers based on dive frequency (P = 1.000), medical conditions (P = 0.750), smoking (P = 0.545), alcohol (P = 0.649), or illicit substances use (P = 0.230). Among certified divers, there was a positive association with fewer diving injuries but not with diving frequency, preexisting medical condition(s), smoking, alcohol, or illicit substance use.

Injuries sustained at Yellowstone National Park requiring emergency medical system activation.

OBJECTIVE: Outdoor-related activity has been on the rise in recent years, and hiking and backpacking are among those activities with the largest growth in participation. As the number of participants with varying experience increases, it is expected that there will be an increase in injuries related to these activities. Little empirical data exist related to outdoor injury types and rates. Our objectives were to determine incidence and frequency of injuries related to outdoor activity and requiring emergency medical system (EMS) activation at a national park. METHODS: This retrospective study examines injuries within Yellowstone National Park. Subjects were selected from a database containing all EMS calls within Yellowstone National Park from calendar year 2003 through 2004. Data collected included age, gender, type of injury, location, activity at the time of injury, and EMS response. RESULTS: There were 306 injuries reviewed. The mean age of patients was 40.9 years (SD: 23.0), and the group comprised 49.0% males. Emergency medical system transport was not required in 59.2% of injuries, and of those transported, 58.4% of patients required basic life support only. Of all injuries, 77.4% involved soft tissue, including lacerations. Hiking and walking accounted for 38.0% of all injuries, and 56.0% of those injuries involved the lower extremity. Only 8.8% of the injuries involved fractures and/or dislocations. CONCLUSIONS: In this study of EMS responses at a national park, the majority of injuries sustained were minor in nature. More than one third of injuries occurred while patients were hiking or walking, and most of those injuries involved the lower extremity. These results will help optimize resource planning in the national park setting.

Sources of conflict between families and health care professionals.

It is essential to examine conflict between patients and health care professionals from the patient's perspective. The purposes of this study were to 1) identify sources of conflict, 2) determine nursing interventions that alleviate conflict, and 3) test a conceptual framework of sources of conflict. This phenomenological study focused on children with cancer and their parents' perceptions of conflicts with health care professionals as well as what they thought helped with such conflicts. Their reports of conflict were compared to C. W. Moore's circle of conflict conceptual framework. A purposive sample of 27 participants (9 children, 14 mothers, and 4 fathers) participated in the study. Study findings showed that conflict occurred between health care professionals and families originating from differences in expectations and desires regarding data, interests, structure, relationships, and values, consistent with C. W. Moore's conceptual framework. Nursing interventions reported by children and parents to be helpful in preventing or alleviating conflict were identified. C. W. Moore's framework may provide a valuable structure for assessing conflict and designing nursing interventions to alleviate conflict.

Clinical guidelines, computed tomography scan, and negative appendectomies: a case series.

INTRODUCTION: Prior studies suggest that preoperative abdominal computed tomography (CT) scan can contribute to a low negative appendectomy rate. Our study objective was to evaluate cases of negative appendectomies for clinical criteria and CT use. METHODS: Retrospective 1-year study of all negative appendectomies at a community hospital. Data included clinical evidence for appendicitis as well as CT results if performed. RESULTS: Of 122 cases reviewed, 8 (6.6%) were negative appendectomies. Six were younger than 20 years. Four had a preoperative CT scan. Overall, 106 (87%) of 122 cases received preoperative CT and had a negative appendectomy rate of 3.8%. Sixteen cases did not have preoperative CT and had a negative appendectomy rate of 25% (odds ratio, 8.5; 95% confidence interval, 1.9-38.5; Fisher exact test P = .01). CONCLUSION: Patients who had a CT scan for suspected appendicitis had a lower rate of negative appendectomies than those who had no CT. Most of the negative appendectomies occurred in patients younger than 20 years.

Correlation between chest x-ray and B-type natriuretic peptide in congestive heart failure.

INTRODUCTION: B-Type natriuretic peptide (BNP) values greater than 400 pg/mL have high positive likelihood ratio (>10) for the diagnosis of clinical congestive heart failure (CHF). However, in patients with CHF, it is not known what correlation, if any, exists for the BNP levels above 400 pg/mL and the findings on the initial chest x-ray (CXR). METHODS: Retrospective review of emergency department patients with CHF and initial BNP greater than 400 pg/mL. Descriptive statistics were analyzed and logistic regression was performed. RESULTS: Fifty-four patients mean age of 81.7 (SD, 8.2), 64.8% women. The mean BNP was 1493 pg/mL (SD, 1106). Only 68.5% had a finding of CHF on CXR. Logistic regression showed no correlation (Wald P = .568; R 2 = 0.8%). CONCLUSION: In patients with clinical CHF, there is no correlation between very high BNP levels (>400 pg/mL) and CXR readings. Clinicians should not be surprised to find patients with very high BNP levels but negative CXR.