scholarly journals (P2-47) Emergency Response to a Mass Gathering Involving Hazardous Materials

2011 ◽  
Vol 26 (S1) ◽  
pp. s151-s151
Author(s):  
A.L. Soh ◽  
M.S. Lim ◽  
K.K. Soh
Keyword(s):  
Emergency Department ◽  
Emergency Response ◽  
Emergency Departments ◽  
Hazardous Materials ◽  
Individual Action ◽  
Response Mechanism ◽  
Good Communication ◽  
Mass Gatherings ◽  
Acute Response ◽  
Crowd Control

Mass gatherings involving hazardous materials (HAZMAT) poses unique challenges to the operations of any emergency department. A screening station is essential for risk stratification and identification of HAZMAT casualties. Existing patients and relatives in the emergency department must be restricted and controlled. Prompt segregation and decontamination of casualties is crucial in a HAZMAT incident. Identification of such a facility with planning of inflow and outflow routes must not be undermined. Crowd control should be performed by securing all entrances and exits, minimizing cross-contamination The topography of the emergency department must be examined with the objectives of minimizing acquaintance and cross-contagion in mind. Directional leadership is crucial during chaotic situations. Clarity of thought and decisiveness is critical. Good communication channels must be established with internal and external agencies in all phases of emergency department response. Apart from the acute response mechanism, training is an important factor in enhancing staff preparedness. Regular continuity of education is essential to keep staff up-to-date with the latest procedures and legislation. Drills and audits are useful for assessing staff competency levels. Familiarity and easy accessibility to overall response plans and detailed individual action cards also are important. The availability and adequacy of operationally ready equipments and consumables must not be underestimated. All equipment and consumables must be easily accessible and clearly labeled. Bimonthly audits are recommended to ensure defect-free equipment and validity of consumables. In conclusion, regardless of these difficulties, emergency departments continue to be the main provider of care to contaminated individuals. Thus, it is imperative that all emergency departments in Singapore be vigilant during peace time.

scholarly journals 140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Michael Hansen ◽  
Barbara Trautner ◽  
Roger Zoorob ◽  
George Germanos ◽  
Osvaldo Alquicira ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Safety Net ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Primary Care Patients ◽  
Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

Robust Hazardous Materials Closed-Loop Supply Chain Network Design with Emergency Response Teams Location

2021 ◽  
pp. 036119812199207
Author(s):  
Nasrin Mohabbati-Kalejahi ◽  
Alexander Vinel
Keyword(s):  
Supply Chain ◽  
Network Design ◽  
Emergency Response ◽  
Closed Loop ◽  
Hazardous Materials ◽  
Risk Exposure ◽  
Supply Chain Network Design ◽  
Supply Chain Network ◽  
Distribution Centers ◽  
Closed Loop Supply Chain

Hazardous materials (hazmat) storage and transportation pose threats to people’s safety and the environment, which creates a need for governments and local authorities to regulate such shipments. This paper proposes a novel mathematical model for what is termed the hazmat closed-loop supply chain network design problem. The model, which can be viewed as a way to combine several directions previously considered in the literature, includes two echelons in the forward direction (production and distribution centers), three echelons in the backward direction (collection, recovery, and disposal centers), and emergency response team positioning. The two objectives of minimizing the strategic, tactical, and operational costs as well as the risk exposure on road networks are considered in this model. Since the forward flow of hazmat is directly related to the reverse flow, and since hazmat accidents can occur at all stages of the lifecycle (storage, shipment, loading, and unloading, etc.), it is argued that such a unified framework is essential. A robust framework is also presented to hedge the optimization model in case of demand and return uncertainty. The performance of both models is evaluated based on a standard dataset from Albany, NY. Considering the trade-offs between cost and risk, the results demonstrate the design of efficient hazmat closed-loop supply chain networks where the risk exposure can be reduced significantly by employing the proposed models.

Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

2021 ◽  
pp. 1-3
Author(s):  
Joanne Huang ◽  
Zahra Kassamali Escobar ◽  
Todd S. Bouchard ◽  
Jose Mari G. Lansang ◽  
Rupali Jain ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Emergency Departments ◽  
Urgent Care ◽  
Complex Data ◽  
University Of Washington ◽  
Primary Care Clinics ◽  
Urgent Care Centers ◽  
The University

Abstract The MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.

The Model of Hospital Emergency Departments in 2,000 Bed Hospital in Hungary

1986 ◽  
Vol 2 (1-4) ◽  
pp. 116-117
Author(s):  
Attila Csepanyi ◽  
Mihaly Sebestyen
Keyword(s):  
Emergency Department ◽  
Research Program ◽  
Emergency Departments ◽  
County Hospital ◽  
Hospital Emergency ◽  
Ministry Of Health ◽  
Ground Floor ◽  
Hospital Emergency Departments

The first emergency department in Hungary was established in Hetenyi Geza County Hospital in 1976. It was organized as part of a research program commissioned by the Ministry of Health. Initially, the hospital had 1400 beds which have now increased to 2,000.The Emergency Department is located on the ground floor of a new building and occupies 1,100 square meters of surface. The operation of the department is divided into three main areas.

Routine Emergency Department Use for Sick Care by Children in the United States

PEDIATRICS ◽  
1996 ◽  
Vol 98 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Neal Halfon ◽  
Paul W. Newacheck ◽  
David L. Wood ◽  
Robert F. St Peter
Keyword(s):  
High School ◽  
Emergency Department ◽  
Child Care ◽  
Emergency Departments ◽  
Primary Care Physicians ◽  
The United States ◽  
Health Maintenance ◽  
Well Child Care ◽  
Usual Source ◽  
Us Children

Background. The use of the emergency departments as a regular source of sick care has been increasing, despite the fact that it is costly and is often an inappropriate source of care. This study examines factors associated with routine use of emergency departments by using a national sample of US children. Methods. Data from the 1988 National Health Interview Survey on Child Health, a nationally representative sample of 17 710 children younger than 18 years, was linked to county-level health resource data from the Area Resource File. Bivariate and multivariate analyses were used to assess the association between children's use of emergency departments as their usual sources of sick care and predisposing need and enabling characteristics of the families, as well as availability of health resources in their communities. Results. In 1988 3.4% or approximately 2 million US children younger than 18 years were reported to use emergency departments as their usual sources of sick care. Significant demographic risk factors for reporting an emergency department as a usual source of sick care included black versus white race (odds ratio [OR], 2.08), single-parent versus two-parent families (OR, 1.53), mothers with less than a high school education versus those with high school or more (OR, 1.76), poor versus nonpoor families (OR, 1.76), and living in an urban versus suburban setting (OR, 1.38). Specific indicators of need, such as recurrent health conditions (asthma, tonsillitis, headaches, and febrile seizures), were not associated with routine use of emergency departments for sick care. Furthermore, health insurance status and specifically Medicaid coverage had no association with use of the emergency department as a usual source of sick care. Compared with children who receive well child care in private physicians' offices or health maintenance organizations, children whose sources of well child care were neighborhood health centers were more likely to report emergency departments for sick care (OR, 2.01). Children residing in counties where the supply of primary care physicians was in the top quintile had half the odds (OR, 0.50) of reporting emergency departments as usual sources of sick care.

Factors Associated with Moral Distress and Caring Behavior of Nurses Working in Emergency Departments of Mazandaran University of Medical Sciences During COVID-19 Pandemic

2021 ◽  
Vol 15 (5) ◽  
pp. 1545-1550
Author(s):  
F. Talebian ◽  
T. Yaghoubi ◽  
R. Marzband
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Moral Distress ◽  
Final Conclusion ◽  
Validity And Reliability ◽  
Medical Sciences ◽  
Caring Behaviors ◽  
Factors Associated ◽  
Caring Behavior ◽  
Medical Centers

Introduction: Moral distress is one of the prevalent problems of nursing which causes stress, that leads to nurses being unable to show a proper moral function in the critical situations. Moreover, due to the stressful conditions in emergency department, caring behaviors of nurses is of great importance. This study aimed to determine the factors associated with moral distress and caring behaviors of nurses working in emergency departments in educational-medical centers of Mazandaran University of Medical Sciences during COVID-19 pandemic. Methodology: This study was descriptive-analytical which was conducted through stratified and convenience sampling, and by participation of 188 nurses working in emergency departments in 5 educational-medical centers of Mazandaran University of Medical Sciences in 2020. Data was collected through standard three-section questionnaire of demographic information, Corley moral distress and Wolf caring behaviors of nurses, and its validity and reliability was confirmed. Data was analyzed by using descriptive (mean and standard deviation, frequency and percentage) and analytical statistics (Mann–Whitney, Kruskal-Wallis, and Spearman correlation coefficient). Finding: Moral distress mean score of nurses working in emergency was 20/97±101/60 and they had 92/4% of average moral distress. Caring behavior of nurses was 8/62±101/60. Gender and marital status variables had a significant relation with caring behavior, in a way that male nurses and married nurses had a lower score (p<0.05). the relation between moral distress and caring behavior was NOT statistically significant. Final conclusion: Nursing staff must have a good command of their caring behavior so that caring will be presented in high quality, and patients and help-seekers’ satisfaction who come to the emergency, especially in COVID-19 pandemic, will be met. Thus, it is necessary that health and medical system managers provide educational programs to draw nurses’ attention to their caring behavior dimensions, especially in emergency departments. Key words: moral distress, caring behavior, emergency department nurse, COVID-19 pandemic

scholarly journals Skåne Emergency Department Assessment of Patient Load (SEAL)—A Model to Estimate Crowding Based on Workload in Swedish Emergency Departments

PLoS ONE ◽  
2015 ◽  
Vol 10 (6) ◽  
pp. e0130020 ◽  
Author(s):  
Jens Wretborn ◽  
Ardavan Khoshnood ◽  
Mattias Wieloch ◽  
Ulf Ekelund
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Patient Load

A national survey of telemedicine use by US emergency departments

2018 ◽  
Vol 26 (5) ◽  
pp. 278-284 ◽  
Author(s):  
Kori S Zachrison ◽  
Krislyn M Boggs ◽  
Emily M Hayden ◽  
Janice A Espinola ◽  
Carlos A Camargo
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Multivariable Analysis ◽  
Clinical Applications ◽  
Future Research ◽  
Emergency Medical Care ◽  
Adults And Children ◽  
Annual Total ◽  
National Emergency ◽  
Total Visit

Objective Telemedicine has the potential to improve the delivery of emergency medical care: however, the extent of its adoption in United States (US) emergency departments is not known. Our objective was to characterise the prevalence of telemedicine use among all US emergency departments, describe clinical applications for which it is most commonly used, and identify emergency department characteristics associated with its use. Methods As part of the National Emergency Department Inventory-USA survey, we queried all 5375 US emergency departments open in 2016. Multivariable logistic regression analyses identified characteristics associated with emergency department receipt of telemedicine services. Results Overall, 4507 emergency departments (84%) responded to our survey, with 4031 responding to both telemedicine questions (75%). Although 1694 emergency departments (42%) reported no telemedicine in 2016, most did: 1923 (48%) emergency departments received telemedicine services, 149 (4%) emergency departments received telemedicine services and were in hospitals that provided telemedicine, and 265 emergency departments (7%) did not receive telemedicine but were in hospitals that provided telemedicine services. Among emergency departments receiving telemedicine, the most common applications were stroke/neurology (76%), psychiatry (38%), and paediatrics (15%). In multivariable analysis, telemedicine-receiving emergency departments had higher annual total visit volume for adults and lower annual total visit volume by children; were less likely to be academic or freestanding; and varied by region. In multivariable analysis, emergency departments in telemedicine-providing hospitals had higher annual total visit volume for adults and children, were more likely to be academic and were less likely to be freestanding. Conclusion In 2016, telemedicine was used in most US emergency departments (58%), especially for stroke/neurology and psychiatry. Future research is needed to understand the value of telemedicine for different clinical applications, and the barriers to its implementation.

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