(P2-30) Development of Disaster and Emergency Medicine in Nepal

2011 ◽  
Vol 26 (S1) ◽  
pp. s145-s145
Author(s):  
R.K. Maharjan
Keyword(s):  
Emergency Medicine ◽  
Disaster Response ◽  
Emergency Services ◽  
Service Providers ◽  
Research Training ◽  
University Teaching ◽  
International Institute ◽  
Institute Of Medicine ◽  
Emergency Situations ◽  
National Stadium

Nepal, a landlocked country between China and India, is developing disaster and emergency medicine. In 2007, the Nepal Disaster and Emergency Medicine (NADEM) Center was formed with the aim of developing this specialty in Nepal. The first hospital was built in July 1889. It wasn't until 1988 that a Disaster Response Team was organized following a stampede incident in the national stadium in Kathmandu. The country often experiences disaster and emergency situations due to geographic and natural hazards and political tensions.In 1984, the Institute of Medicine, Tribhuvan University Teaching Hospital created emergency services with general practitioners (GPs) directing and providing services. Since then, almost all emergency services of different hospitals are run by GPs with house officers, nurses, and paramedics. There still is a lack of training and proper management, and limited equipment and infrastructure to provide needed disaster and emergency services to the people. The NADEM Center is developing coordination objectives between different emergency service providers to organize ways of service providing. This will be done through NADEM's continuing medical education and publication of Journal of Nepal Disaster and Emergency Medicine (J-NADEM) and NewsHealth; coordination among emergency medical services (prehospital), in-hospital services, and disaster and critical care medicine; and planning and implementation of different research, training, workshops, seminars, and conferences in disaster and emergency medicine with cooperation from the world. The NADEM Center will develop International Institute of Disaster and Emergency Medicine.

scholarly journals (P2-22) Proposed Model for Cellular Medical Record in Emergency Medicine

2011 ◽  
Vol 26 (S1) ◽  
pp. s142-s142
Author(s):  
N. Friedman ◽  
A. Goldberg
Keyword(s):  
Emergency Medicine ◽  
Medical Record ◽  
Emergency Services ◽  
Health Condition ◽  
Clinical Parameters ◽  
Emergency Situations ◽  
Life Saving ◽  
Proposed Model ◽  
Communication Methods ◽  
Conceptual Revolution

IntroductionIn a hypothetical situation, an emergency services team is launched to treat a man who collapsed in the street. The team finds John Doe's mobile phone, and within seconds retrieves the required clinical parameters from his Mobile Medical Record (MMR), thus, providing a life-saving treatment suited to his personal health condition. This study seeks to determine if the necessary clinical parameters, required at emergency situations have ever been examined in order to best match both emergency situations and cellular technology.ObjectiveTo characterize the clinical parameters that make up an MMR in the context of saving lives, and to propose a model for an MMR in emergency medicine.MethodsThe essential emergency medicine clinical parameters in the context of life-saving treatments were characterized through interviews with prehospital and hospital experts in emergency medicine. The results were analyzed with the help of a cellular multimedia expert in order to best incorporate the clinical parameters into cellular phones as MMRs.ConclusionEmergency medicine teams chose individual and specific clinical parameters in a certain order of appearance from the general medical record that should assembly, in their opinion, an emergency medicine MMR. A MMR was chosen by the emergency medicine treatment teams as one of their preferred communication methods. The MMR model, if applied correctly, will provide the emergency medicine treatment teams an available, reliable, homogeneous database of real time clinical parameters adapted to life-saving conditions. The MMR model represents a conceptual revolution of taking the medical record from the caregiver and transferring it to the patient, which can be constantly at hand at any given time or place in their mobile phones.

Clinical Presentations of Chronic Kidney Disease Patients on Regular Haemodialysis Attending in Tribhuvan University Teaching Hospital Emergency Services

2019 ◽  
Vol 2 (2) ◽  
pp. 138-143
Author(s):  
Tirtha Man Shrestha ◽  
Pratap Narayan Prasad ◽  
Laxman Bhusal ◽  
Ram Prasad Neupane ◽  
Rajan Ghimire
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Teaching Hospital ◽  
Emergency Services ◽  
University Teaching ◽  
Receiver Operating Curve ◽  
Maintenance Hemodialysis ◽  
Institute Of Medicine ◽  
Emergency Visit

 Background: Chronic kidney disease is increasing day by day and so is condition of renal replacement therapy mainly hemodialysis. Emergency visit of the patients under maintenance hemodialysis is frequent. The objective of the study is to study clinical parameters of these patients so that in future these deranged parameters can be focused during patient management and decrease their emergency visit. Methods: A prospective cross sectional study was conducted in emergency services of Tribhuvan University Teaching Hospital from 1st May 2018 to 31st October 2018 among the adult chronic kidney disease patients under maintenance hemodialysis. Ethical approval was taken from Institutional review board, Institute of Medicine, Tribhuvan University. Non-probability sampling method was used. Total of 300 patients were enrolled in the study. Patients’ age, sex, causes, laboratory parameter during emergency visit, need of emergency hemodialysis, and need of blood transfusion were studied. Results: Out of total 300 patients, mean age was 45.64 years (S.D =17.15). 190 (63.3 %) were male and 110(36.70%) were female. 152(50.70%) of patients had hypertension.Diabetes and Glomerulonephritis both had equal prevalence of 63(21%). Mean hemoglobin was 6.52gm% (S.D = 1.93). Mean pH was 7.17 (S.D =0.154). Mean serum potassium and creatinine level were 5.77 mEq/L (S.D =0.76) and 1076.03 mmol/l (S.D =367.25) respectively. Area under the Receiver Operating Curve was 0.660 for potassium and 0.598 for serum creatinine. Conclusion: Causes of chronic kidney disease, decreased hemoglobin level, increased serum creatinine and potassium level and metabolic acidosis are reasons of frequent emergency room visit among CKD patients. So these conditions need to be addressed to decrease emergency visit of these patients

scholarly journals (P2-75) Emergency Medicine Begins with General Practitioners in Nepal

2011 ◽  
Vol 26 (S1) ◽  
pp. s160-s160
Author(s):  
R.K. Maharjan
Keyword(s):  
Emergency Medicine ◽  
General Practitioners ◽  
University Teaching ◽  
Institute Of Medicine ◽  
Hospital Emergency ◽  
Foreign Countries ◽  
Long Time ◽  
Level Of Training ◽  
Almost All ◽  
Hospital Emergency Departments

IntroductionEmergency medicine (EM) is a long-awaited specialty to be established in Nepal, although it has been practiced for a long time starting with hospitals in Nepal. Currently, almost all hospital emergency departments in Nepal are run under general practitioners (GPs) as emergency consultants (emergency physicians) and medical officers work as 24-hour duty doctors.MethodsThis was a five-year observational study (2006–2010) after the Department of General Practice joined with MD in Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.ResultsThere are no academically trained MD physicians working in Nepal according to the Nepal Medical Council's Registered Doctors, however, there are Nepalese doctors trained and working in EM in foreign countries. There is a demand of training those GPs interested in EM in a Fellowship/MPhil/MD program. There is a need for developing curriculum of EM for the Fellowship/MPhil/MD or for a different level of training collaborating with universities abroad. There is no ideal prehospital EM/emergency medical services capable of ambulance services. There must be a national code for mobilization and it must be under an umbrella of a governmental Department of GP and EM. Development of infrastructure for the EM department in every hospital in different parts of country is also a challenging task. Standards must be developed for EM and the EMS according to the need of the country. All known and unknown challenges can be addressed by coordinating with international support.

IMPLEMENTATIONS EMERGENCY RESPONSE SYSTEM IN CASE OF ACCIDENTS AND EMERGENCY SITUATIONS (ERA-GLONASS) FOR CARS AND TRUCKS IN UZBEKISTAN

2020 ◽  
Author(s):  
Akmal Rustamov
Keyword(s):  
Emergency Response ◽  
Call Center ◽  
Emergency Services ◽  
Main Idea ◽  
Emergency Situation ◽  
High Mountain ◽  
Additional Information ◽  
Emergency Situations ◽  
Emergency Response System ◽  
Response System

The paper addresses the problem of increasing transportation safety due to usage of new possibilities provided by modern technologies. The proposed approach extends such systems as ERA-GLONASS and eCall via service network composition enabling not only transmitting additional information but also information fusion for defining required emergency means as well as planning for a whole emergency response operation. The main idea of the approach is to model the cyber physical human system components by sets of services representing them. The services are provided with the capability of self- contextualization to autonomously adapt their behaviors to the context of the car-driver system. The approach is illustrated via an accident emergency situation response scenario. “ERA-GLONASS” is the Russian state emergency response system for accidents, aimed at improving road safety and reducing the death rate from accidents by reducing the time for warning emergency services. In fact, this is a partially copied European e Call system with some differences in the data being transmitted and partly backward compatible with the European parent. The principle of the system is quite simple and logical: in the event of an accident, the module built into the car in fully automatic mode and without human intervention determines the severity of the accident, determines the vehicle’s location via GLONASS or GPS, establishes connection with the system infrastructure and in accordance with the protocol, transfers the necessary data on the accident (a certain distress signal). Having received the distress signal, the employee of the call center of the system operator should call the on-board device and find out what happened. If no one answers, send the received data to Sistema-112 and send it to the exact coordinates of the team of rescuers and doctors, and the last one to arrive at the place is given 20 minutes. And all this, I repeat, without the participation of a person: even if people caught in an accident will not be able to independently call emergency services, the data on the accident will still be transferred. In this work intended to add some information about applying system project in Uzbek Roads especially mountain regions like “Kamchik” pass. The Kamchik Pass is a high mountain pass at an elevation of 2.306 m above the sea level, located in the Qurama Mountains in eastern Uzbekistan and its length is about 88km.The road to reach the pass is asphalted, but there are rough sections where the asphalt has disappeared. It’s called A373. The old road over the pass was by passed by a tunnel built in 1999. On the horizon, the snow-capped peaks of the Fan Mountains come into view. The pass is located in the Fergana Valley between the Tashkent and Namangan Regions.

scholarly journals Correlation of FNAC and histopathology in diagnosis of salivary gland lesions

2014 ◽  
Vol 4 (8) ◽  
pp. 654-657 ◽  
Author(s):  
S Koirala ◽  
G Sayami ◽  
AD Pant
Keyword(s):  
Salivary Gland ◽  
Preoperative Diagnosis ◽  
Needle Aspiration ◽  
University Teaching ◽  
Malignant Neoplasms ◽  
Histopathological Diagnosis ◽  
Institute Of Medicine ◽  
Needle Aspiration Cytology ◽  
Sensitivity Specificity ◽  
Diagnostic Pitfalls

Background: Value of fine needle aspiration cytology in preoperative diagnosis of salivary gland lumps has been established in various studies. This study aims to calculate sensitivity, specificity accuracy of FNAC, correlate FNAC findings with histopathology and find out reasons for common diagnostic pitfalls in FNAC.Materials and methods: This study was performed in 67 patients that presented with salivary gland lumps at Department of pathology, Tribhuvan University Teaching Hospital, Institute of medicine, Kathmandu, Nepal from January 2009 to June 2010. FNAC was performed and was correlated with histopathological diagnosis to judge the sensitivity, specificity and accuracy of FNAC.Results: Out of 36 cases there was cyto-histological correlation in 28 cases. Pleomorphic adenoma was the most frequent lesion in this study. Parotid gland was the most common site affected by salivary gland lesions. The sensitivity, specificity and accuracy for non-neoplastic lesions was 100%, 89.28%, 91.67%, for benign neoplasms was 100%, 86.95%, 91.67% and for malignant neoplasms was 57.14%, 100%, 83.33% respectively.Conclusion: FNAC is a useful tool in preoperative diagnosis of salivary gland lesions and can be crucial for the management of the patient. Aspiration and reporting of salivary gland lesions demands a competent pathologist who considers all the possible diagnostic pitfalls in mind.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11593 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 654-657

scholarly journals Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alayne M. Adams ◽  
Rushdia Ahmed ◽  
Shakil Ahmed ◽  
Sifat Shahana Yusuf ◽  
Rubana Islam ◽  
...  
Keyword(s):  
Critical Care ◽  
Urban Poor ◽  
Emergency Services ◽  
Census Data ◽  
Service Providers ◽  
Healthcare Services ◽  
Tertiary Hospital ◽  
Care Services ◽  
Referral Systems ◽  
Alternative Scenarios

Abstract Background An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours. Methods Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a “distance matrix” which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled. Results The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5–1.9 km (p < 0.05) compared to 2.5–2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City’s major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor. Conclusions For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City’s largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.

scholarly journals Prepaid Mobile Phone Service and the Anonymous Caller: Considering Wireless E9-1-1 in Canada.

2002 ◽  
Vol 1 (4) ◽  
Author(s):  
Gordon A. Gow ◽  
Mark Ihnat
Keyword(s):  
Mobile Phone ◽  
Emergency Service ◽  
Emergency Services ◽  
Service Providers ◽  
Privacy Rights ◽  
Privacy Concerns ◽  
Wireless Service ◽  
Commercial Networks ◽  
Phone Service ◽  
The Right

This paper reports on a recently concluded empirical study into the development of Wireless E9-1-1 (emergency service) in Canada that initially focussed on privacy concerns raised in the context of an emerging location based service (LBS) for mobile phone users. In light of existing regulatory arrangements this paper concludes that in Canada the emerging Wireless E9-1-1 system establishes a reasonable level of protection for the privacy rights of mobile phone users who choose to contact emergency services. However, an important and surprising issue was raised in the proceedings regarding the obligation of wireless service providers offering prepaid mobile phone service to obtain verifiable subscriber records from their customers. This paper provides details regarding the issue and contributes a number of points to an emerging debate concerning the right to anonymity for customers who elect to use prepaid or other services provided over commercial networks.

scholarly journals Difficulties in the diagnosis of soft tissue sarcomas

1970 ◽  
Vol 32 (2) ◽  
pp. 26-29
Author(s):  
R Jha
Keyword(s):  
Soft Tissue ◽  
Age Distribution ◽  
Age Groups ◽  
Soft Tissue Sarcomas ◽  
Vascular Tumor ◽  
University Teaching ◽  
Institute Of Medicine ◽  
Diagnostic Challenge ◽  
Study Results ◽  
Common Diagnosis

Introduction: Soft tissue tumors represent diagnostic challenge to general practicing pathologists because of overlap in morphologic features. The usual approach is to diagnose by presumed cell lineage. A major utility of immunohistochemistry is to identify a tumor being mesenchymal or nonmesenchymal and once mesenchymal lineage has been confirmed, histologic sub typing according to specific lineage may be achieved with help of lineage specific markers. Methods: The objective of this study was to analyse different types of soft tissue malignancies according to their type, site and age distribution, discuss the difficulties faced during morphologic examination and review the literature for role of ancillary techniques, particularly immunohistochemistry in diagnosing soft tissue sarcomas.All soft tissue malignancies reported from Tribhuvan University Teaching Hospital in three years period from April 2008 to March 2010 were included in the study. Results: Total 87 soft tissue malignancies were reported during study period. Most of these patients (58.6%) were male and the rest were female. These malignancies were found in all age groups. Youngest patient was newborn who was born with tongue mass and biopsy was performed on 13th day of life. However maximum numbers of tumors (41.4%) were seen in first two decades of life. Head and neck was the most common site .Rhabdomyosarcoma was the most common diagnosis. In 20 cases (23%) a definite opinion was not possible and vague terms like sarcoma, small round cell tumor, spindle cell malignancy, vascular tumor “likely” were used. Immunohistochemistry was advised in these cases. Conclusions: Only light microscopic examination of hematoxylin and eosin stained slide not sufficient at all times because there is morphologic overlap of soft tissue sarcomas with each other and with carcinomas and melanomas. Though immunohistochemistry is not a substitute for skilled interpretation of routinely stained slides but prove helpful to reach a more definite diagnosis. Keywords: Immunohistichemistry; sarcoma; soft tissue DOI: http://dx.doi.org/10.3126/joim.v32i2.4941 Journal of Institute of Medicine, August, 2010; 32: 26-29

Best practice relief supply for emergency services in a developed economy

2018 ◽  
Vol 8 (1) ◽  
pp. 107-132 ◽  
Author(s):  
Mark M.J. Wilson ◽  
Peter Tatham ◽  
John Payne ◽  
Cécile L’Hermitte ◽  
Michael Shapland
Keyword(s):  
Disaster Response ◽  
Best Practice ◽  
Local Community ◽  
Emergency Services ◽  
Developed Country ◽  
Middle Income ◽  
Emergency Relief ◽  
Content Type ◽  
Emergency Logistics ◽  
Community Outcomes

Purpose The purpose of this paper is to discuss the challenges inherent in planning and responding to disaster events in a multi-agency context where numerous governmental and non-governmental actors and agencies are involved in the planning and response phases. In particular, the authors examine a situation where a lead agency has recently been delegated the responsibility for emergency relief logistics and how it might determine and implement best practice. Design/methodology/approach Adopting an iterative inductive approach, the authors gather data and insights from academic literature, emergency management policies, frameworks and documents and exploratory in-depth interviews with 12 key informants who have considerable experience with the challenges of logistic preparation and response to disasters in a developed country context. The data and context are limited to developed counties, especially the state of Queensland, Australia. Findings The authors discuss the challenge of achieving coordinated supply chain management where mandated/lead response agencies are required to meet stakeholder and local community expectations and outcomes. From these findings, the authors offer 11 practical recommendations to assist the delivery of best practice in emergency logistics. Originality/value Humanitarian logistics is usually examined from a low/middle-income country perspective, yet an efficient and effective disaster response is no less important for developed economies. In this respect, the authors offer a fresh examination of the challenges of delivering best practice for emergency logistics in order to achieve expected community outcomes.

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