Freestanding emergency departments and the trauma patient.

BACKGROUND: Freestanding emergency departments (FEDs) continue to grow in number and more research is needed on these facilities. OBJECTIVE: We sought to characterize the types of injuries and patients who initially presented to two FEDs and were transferred to the main tertiary care ED for trauma team consult and admission. METHODS: This retrospective cohort descriptive study examined medical records of adult trauma patients who were initially seen at an FED and then transferred to the main ED. All patients who received a trauma consultation were included. Data collection included demographics, initial mode of transport to the ED, injury, mechanism of injury, ED, hospital course and outcome. RESULTS: Mean age was 61.8 ± 23.8, 96.7% were Caucasian and 52.5% were male. Mode of transport to the FEDs included private vehicle (46.4%) and emergency medical services (53.6%). The main injury mechanisms were fall from standing (51.9%) and fall from an object (16%). A total of 12.7% were from motor vehicle accidents and 6.6% presented from bicycle and all-terrain vehicle accidents. Blunt traumatic injuries accounted for 97.8% (n = 177) patients. Computed tomography scanning was performed on 90.1% of patients. Median ED length of stay was 189 min. Mean hospital length of stay was 3 days and 2.2% (n = 4) of patients died from their injuries. CONCLUSIONS: Understanding the patients and traumatic injuries that present to FEDs will guide training and identify resources needed for patients requiring additional care at a trauma center.

Door-to-balloon times from freestanding emergency departments meet ST-segment elevation myocardial infarction reperfusion guidelines.

BACKGROUND: Freestanding emergency departments (FEDs) introduce a challenge to physicians who care for the patient with an ST-segment elevation myocardial infarction (STEMI) because treatment is highly time dependent. FEDs have no percutaneous coronary intervention (PCI) capabilities, which necessitates transfer to a PCI-capable facility or fibrinolysis. STUDY OBJECTIVE: Our aim was to determine the proportion of STEMI patients who arrived to an FED and were subsequently transferred for PCI and met the door-to-balloon reperfusion guidelines of 90 min. METHODS: This was a dual-center retrospective cohort review of all patients 18 years and older who were diagnosed with an STEMI and presented to the main hospital-affiliated FEDs. Electronic medical records and emergency medical services documentation were reviewed for all cases since the opening of the FEDs in July 2007 and August 2009, respectively. Key time points were abstracted and statistical evaluation was performed using Fisher's exact test. RESULTS: A total of 47 patients met inclusion criteria. Median door-to-transport time was 34 min (interquartile range [IQR] 15 min). Median transport time from the FEDs to the main hospital catheterization laboratory was 21 min (IQR 5 min). Median arrival at the catheterization laboratory-to-balloon time was 25 min (IQR 13 min). Median total door-to-balloon time was 83 min (IQR 10.5 min), with 78.7% meeting the American Heart Association's recommended guidelines of ≤ 90 min. CONCLUSION: STEMI patients initially seen at two FEDs achieved door-to-balloon time goals of < 90 min.

Improved auscultation skills in paramedic students using a modified stethoscope.

BACKGROUND: The Ventriloscope® (Lecat's SimplySim, Tallmadge, OH) is a modified stethoscope used as a simulation training device for auscultation. OBJECTIVE: To test the effectiveness of the Ventriloscope as a training device in teaching heart and lung auscultatory findings to paramedic students. METHODS: A prospective, single-hospital study conducted in a paramedic-teaching program. The standard teaching group learned heart and lung sounds via audiocassette recordings and lecture, whereas the intervention group utilized the modified stethoscope in conjunction with patient volunteers. Study subjects took a pre-test, post-test, and a follow-up test to measure recognition of heart and lung sounds. RESULTS: The intervention group included 22 paramedic students and the standard group included 18 paramedic students. Pre-test scores did not differ using two-sample t-tests (standard group: t [16]=-1.63, p=0.12) and (intervention group: t [20]=-1.17, p=0.26). Improvement in pre-test to post-test scores was noted within each group (standard: t [17]=2.43, p=0.03; intervention: t [21]=4.81, p<0.0001). Follow-up scores for the standard group were not different from pre-test scores of 16.06 (t [17]=0.94, p=0.36). However, follow-up scores for the intervention group significantly improved from their respective pre-test score of 16.05 (t [21]=2.63, p=0.02). CONCLUSION: Simulation training using a modified stethoscope in conjunction with standardized patients allows for realistic learning of heart and lung sounds. This technique of simulation training achieved proficiency and better retention of heart and lung sounds in a safe teaching environment.

A study of the psychological factors in outcomes for officers who survive ballistic assault.

Among law enforcement personnel, who are subject to assault with firearms, there has been a trend toward decreased mortality and physical morbidity associated with the use of personal protective armor (PPA). Although there has been an increase in the rate of survival, studies of the unique psychological factors associated with this type of assault are essentially nonexistent. The prevalence and nature of the negative psychological sequelae associated with this type of assault and psychological injury, along with effective prevention techniques, were studied through retrospective interviews of registrants in two "body armor survival clubs." Significant relationships were found between available interventions and behavioral health outcomes. In addition to reducing the likelihood of poor health outcomes, departmentally based interventions were related to officers' ability to develop positive interpretations of the event and engage in fewer high risk behaviors. These findings suggest that departmental interventions, such as debriefings, are meaningful and may help improve outcomes for officers fired upon, but not wounded, in the line of duty.