EMSSA Newsletter_August_2010

NewsletterAugust2010

HealthcareprofessionalsdedicatedtothedevelopmentofqualityemergencycarethroughoutSouthAfrica

EDITORIALHiEveryone

Welcome to thesecondnewsletterof2010. TheFIFA World Cup Soccer Tournament has finallycometoanend.WhatanamazingtimeforSouthAfrica! Thelackofanysignificantmajor incidentsisatestimony totheextensiveplanningandhardwork that went on for the past few years. Thisbehindthescenespreparationhasresultedintheformation of strong interdisciplinary links whichwill now continue into the future. The legacy ofthis tournament is going to affect almost everyaspect of South African life. All the emergencycarepersonnelinvolvedfromtheFanParks,Publicviewingareasandstadiums to thedefinitivecarefacilities need to be commended on a job welldone. This is a reflection on the excellence andhigh standard of emergency care that is beingdelivered in South Africa. Let us all strive toimprovestandardsandaccess to emergencycareinthiscountry.

Inthismonth’snewsletter,MartinBothaprovidesus with a comprehensive update on theResuscitation Council of South Africa. EMSSAwouldliketotakethisopportunitytocongratulatethe RCSAon21 years of exceptional training andresearch into thepractice of resuscitative care inSouthAfrica.

Ouranonymousbloggermakes commentson therecent World Cup from an emergency medicineperspective and we have a new ENSSA blogstartingthismonth.

There are no further CME days planned for thisyear but watch the website because we will beholding regional CME days next year. Theseeventshaveproventobeofaveryhighacademicstandardandextremelypopular.

Up to eight new practice guidelines are in theprocess of being published on the website or inthe developmental phase. Keep checking thewebsiteforthelatestdownloads.

Please remember to register for the EMSSASymposium, which is being held from 20 – 21November 2010 in Cape Town at the LeslieBuilding,UpperCampus,UCT.ThenewILCOR

Resuscitation guidelines will be presented anddiscussed as well as Patient Safety in EmergencyCare. A level 1 emergency point of careultrasound course will be held on 19 November2010. Find further details atwww.emssa2010.co.za

Once again please contact me with feedbackabout the new look newsletter. Let us know ofany specific content that you would like to seeadded.

Untilthenextissue…

MelanieStander

EMERGENCYMEDICINESYMPOSIUM

An exciting upcoming event is the 2010 EMSSASymposium which will be held from November 20th to 21st in Cape Townand will be of interest to all levels of staff involved in the emergency care ofpatients. ThetwothemesforthissymposiumwillbePatientSafety in Emergency Care and the 2010 ILCORResuscitation Guidelines. Emergency care ofteninvolves managing patientswithrapidlyevolvingconditions inpoorlycontrolled environments. All manner of Patient‐Safety factors can impact on theoutcome for anindividual patient ‐ whether it is delayed pre‐hospital care; long waiting times in EmergencyCentresorsub‐optimalcareasaresultofstafforequipment shortages. We are very fortunate tohave some of the world's leading experts onPatient Safety ‐ Professor Pat Croskerry andProfessor Terry Mulligan speaking at thesymposium. Topics covered will include:emergency centre design and management;adverse events in emergency care and howminimisethem;systemstohelprelieveemergencycentre overcrowding; safe discharge and transferof patients and the effects of shiftwork onperformance and how to make more tolerablerosters.

The symposium will also be the first nationaldiscussion forum for the 2010 ILCOR Resuscitation Guidelines. Eminent expertsand members of the SA Resuscitation Council ‐ MrMartin Botha and DrsWalter Kloeck, AshrafCoovadiaandSithembisoVelaphi‐willgiveupdates on the latest resuscitation advice for Basic and Advanced LifeSupport and special circumstances,aswellasPaediatricandNeonatalLife Support. There will beanExpertPanelQuestion&AnswerSessiononthe new resuscitation guidelines. Inadditiontherewillbeabstractpresentationsoforiginal research relevant to the field ofemergency care in South Africa. For further details of the conference please see:www.emssa2010.co.za

TheResuscitationCouncilofSouthernAfrica

Aim:TheResuscitationCouncilofSouthernAfrica(RCSA) is a voluntary co‐ordinating body whoseprimary aim is to foster and co‐ordinate thepractice and teaching of resuscitation, and topromote uniformity and standardization ofresuscitation techniques.Objectives:To gather and collate as much scientificinformation regarding resuscitation techniquesfromaswideavarietyofsourcesaspossible,andto disseminate this information to all interestedparties.

To provide an advisory and resource serviceregarding techniques, equipment, teachingmethodsandteachingaids.

To foster research into methods of practice andteachingofresuscitation.

To establish regular communications with otherbodies with similar objectives, both in SouthernAfrica and abroad, and to provide a forum fordiscussionofallaspectsofresuscitation.

Simply then the RCSA exists to deliver qualityresuscitation training and also to support adynamic and expanding network of instructorsandTCnetwork.

We strive toward a situation where everyone inour country is competent todoCPR and use anAED. The RCSA has begun to lobby keystakeholders,toenhancecommunity,governmentand public engagement on resuscitation matters,and to advocate for widespread awareness andtraining campaigns for CPR and emergencycardiovascularcare.WemustpassionatelycallforallHealthCareProviderstobeBLS,ACLSandPALStrained.Ourinitialpassionallthoseyearsagowasto teach the population CPR and the use of anAED, and to avidly create awareness aroundthese… we must persist and not lose that initialfocus.

The RCSA is proud to have been involved in theevidence‐based consensus on science process,having produced 3 worksheets in the currentILCOR evidence review. The RCSA must berecognised as the benchmark, indeed THE brandand quality mark of excellence in resuscitation

trainingandsystems.Wewillcontinuetodevelopand promote evidence‐based standards &guidelines, while pursuing interaction andinterdependence with affiliates. This all needs tobe inclusive, accessible, academically andoperationally relevant and credible, and indeedaffordabletoall.

Celebrating21years!

The phoenix has recently been adopted as thelogo for the newly launched RCSA newsletter.Here’sthebackgroundtothelegend:

The ancient myth of the Phoenix speaks to thethemesof renewal and rebirth. The flying flamesof the phoenix are a metaphor for the Sun, thespark of life, something essential for existence,whichdiesatnightandisreborninmorning.EarlyChristian tradition adopted the phoenix as asymbolofbothimmortality&resurrection.

As the legend goes, the phoenix is able toreproduce itself. It lives on frankincense andodoriferousgumsandwhenithaslived500years,itbuildsitselfanestinthebranchesofanoak,oratop a palm tree, and here collects cinnamon,spikenard and myrrh, and of with these builds apile on which it lies to die, breathing out its lastbreathamidsttheseodours.Fromthebodyoftheparentbird,ayoungphoenixrises.

Thus,accordingto legend,thephoenixconsumeditself by fire every 500 years, and a new, youngphoenixsprangfromitsashes.

That is a fitting metaphor for resuscitation! It’saboutreanimationandrenewal.Weteachpeopleto resuscitate and thus to offer a chance of newlife. That is both an awesome responsibility andindeedaprivilege!

The RCSAhas comeof age…celebrating 21proudyearsofactivity inour region. I’maware thatwearenot500yearsold,butcelebrating50yearsofCPR,wecannowstandontheshouldersofthosegiants before us and with gusto embrace theresponsibility of taking the organisation to thenextlevel.Everyoneneedstoconsistentlyespousethe samemessage, and takeup the cudgels: CPRsaveslives…butonlyifyouknowhow!

MartinBotha

Chairman:ResuscitationCouncilofSA

AnarticlethatappearedintherecentResuscitationCouncilofSAnewsletter:

SavedbyanAED

ArticlebyGavinMackintosh

“Iconsidermyselfastrongcyclistandat thetimeof this incident I was preparing for a multi‐day

mountain bike race in the Alps. Working longhours, travellingoverseas,andstill trying to fit inhardtrainingtime.

On27April2008 Iwasparticipating in theGiants

MTB race. I was riding withmywife. About 5kmfrom the finish sheneeded to pushharder if shewastomaintainheroverallpositionsoweagreed

(after a bit of an argument from her!) that sheshould continue on her own. Shortly after thisabout2kmfromtheend,Isufferedaheartattack.

A fellow competitorwas nearby and sawmeput

downmybikea then liedownon it.AlthoughhehadnoformalCPRtrainingheknewhehadtodochestcompressionsandbreathe formewhichhe

startedprobably in lessthan1minofmycollapse.Afurther5orsoriders(includingmywife) joinedhim taking turnsatdoing thechest compressions

&breathing.Themedicalbackuparrivedwithin5‐10min and were top class in their knowledge,

abilityandequipment.Ittookbetween30‐40minsofCPR,severaldosesofadrenaline&about3joltswith the defibrillator to re‐establish a normal

heart rhythm. After they stabilised me, I wasairlifted to the nearest hospital inPietermaritzburg. The first memory I have after

theincidentwas8dayslaterinICU.

IftheparamedicsdidnothaveanAEDIwouldnotbealivetotellthisstory.

Itmademeaware that it isall verywell to knowhowtocarryoutCPRbutonoccasionssuchasthis

where the heart is fibrillating, unless you haverapidaccesstoanAEDyouwilldie.

Realisingthattherearemanypeoplewhofallintothe"highstressworkcategory"whoaremembers

of Club 100 (my cycling club), I suggested to our

committeethatthepurchaseofanAEDwouldbeworthwhile.Club100supportsbothroadridingas

wellmountain biking so 2 units were purchased.Theroadridersgenerallyhaveamotorvehiclefortechnicalback‐up,sothetransport,size&weight

of an AED are not an issue. For off‐road ridingthereisnoback‐up,sotheAEDhastobecompactand as lightweight as possible. The unit that the

MTBridemastercarriesweighslessthan750gandissmallenoughtofitintoahydrationpack.

I was unaware of my relatively high cholesterollevel or the fact that it is genetic. It is also

apparentthatfewpeopleareawareoftheirstatusand believe "If you are fit you won't have highcholesterol,sothereisnoriskofaheartattack!!"I

proved otherwise and am also proof of theinvaluable role of CPR training and theuse of anAED.”

RESUSCITATIONCOUNCILOFSOUTHERNAFRICA

RESPONSETODRAFTBY‐LAWSFORTHESAFEGUARDINGOFSWIMMINGPOOLS

In a letter sent to the City of JohannesburgMetropolitan Municipality, the RCSA wasdelightedtonotetheplannedby‐lawsforthesafeguarding of swimming pools in Johannesburg. Itstrongly endorses the proposal in principle, andwouldactivelysupportanyinitiativeattemptingtoreducedeathsfromdrowning.

Furthermore the RCSA recommended that allswimming pool owners and every adult residenton the premises should be currently certified incardio‐pulmonary resuscitation (CPR). This shouldbemandatorywhere children andnon‐swimmingadultshaveaccesstothatswimmingpool.Besidesbeing CPR trained, pool owners ought toprominentlydisplaya laminatedCPRcharton theswimming pool fence, as has already beenbenchmarkedvialegislationinpartsofAustralia.

TheEXCOoftheRCSAencouragedtheCityof JhbMetrotourgentlyimplementtheseby‐laws,which

would undoubtedly save many innocent lives.Deaths fromdrowningarepreventable,and earlyawarenessistheveryfirstandmosteffectivewayof influencing survival. We applaud the City ofJohannesburginaddressingthisissueandwilltakeupthecudgelstobolsteryourbidtocompelpoolowners to be more responsible and proactive inpreventingdrowningdeaths.Childsafetyisindeednoaccident!

ResuscitationCouncilofSAProfessionalMembership

InadditiontoallregisteredRCSAinstructors,newmembershipcategorieshavebeeninstitutedinlinewithourvisiontodevelopandaffiliatewith

moreindividualsandorganisations.

Anyhealthcareprofessional(whoisnotalreadyanregisteredinstructorwiththeRCSA):

whoattendsandcompletesanyofficialRCSAcourse,andwhowantstosupporttheRCSA&

endorse

theirvisionandobjectives,&iscommittedtostrengtheningthechainofsurvivalintheir

community,

Isinvitedtobecomea

PROFESSIONALMEMBERoftheRCSA,

&insodoing,affiliatewiththeRCSA,

whichiscelebratingits21stanniversary!

RCSAProfessionalMembershipbenefits

include:

MembershipfeeofonlyR150peryear,

RCSAProfessionalMembershipcard,

Countlessnetworkingopportunitieswithlike‐mindedprofessionals,

RCSAquarterlynewsletter,

Opportunitytoparticipateinmentoringprograms.

Save20%onRCSACPDofferingsandupdates/symposiums,

Save15%onaccesstoMELISA–theMedicalElectronicLibraryofSA,

plusgetlinkstovaluableresources;

Savebyhavingaccesstospecialdiscountsfromcertainemergencyequipmentsuppliers.

CompletedMembershipapplicationformsand

proofofpayment

canbesenttoLorraine:086‐607‐3930,ore‐mailto:[email protected]

ProfessionalMembershipapplicationsarepostedonourwebsite:www.resuscitationcouncil.co.za

EMERGENCY CARE PRACTITIONER INCREASEDSCOPEOFPRACTISE

The recently promulgated Emergency CarePractitioner (ECP) scope of practise published bytheHPCSAProfessionalBoardforEmergencyCarenow includes out‐of‐hospital RSI (rapid sequenceintubation) and fibrinolysis for STEMI. Theseinterventions are directed by detailed protocolsand are predicated on apposite clinicalgovernance, with appropriate equipment, and asystem allowing for analysis of data andevaluation of practice. Operationalising thiseffectivelyandsafelymustbesystems‐based,withstrong prospective, ongoing, and retrospectivesupervision essential to ensure high proceduresuccess rates. Each emergency medical serviceshould institute a robust clinical governancestructure that includes audit, qualityimprovement, self‐regulation, reflection, trackingofdataandperformance.

Thedebatearoundwhetherout‐of‐hospital(OOH)RSI is appropriate continues. The most recentposition statement released by the National

Associationof EmergencyPhysicians (NAEMSP) inthe USA declares that OOH RSI should beemployed only by EMS systems that specifically

require the procedure and have adequateresources to develop, maintain and audit thisprotocol.

Thetrendevidentfromtheliteratureappearsnot

to dispute the tracheal intubation per se, butrather how it is performed. The gold standardofadvanced airway management remains ETI and

thepatient, whether in‐hospital or out, it canbe

argued deserves the same level of competentcare. It is imperative that the skill is performed

safelyand in linewith internationalbest‐practice,toprotect thepatient fromharmand indeed thepractitionerfromliability.

PREPARINGYOUREMERGENCYDEPARTMENTTOMANAGETHESUDDENDEATHOFAPATIENT

DrPetraBrysiewicz,President:EmergencyNursesSociety of South Africa, School of Nursing,UniversityofKwaZulu‐Natal

Introduction

The environment of the Emergency Department(ED) is unique and this makes incorporatingpalliativecareintotheEDdifficultforanumberofreasons. A sudden death is always a tragicoccurrence which is very seldom peaceful ordignified.The careofa dyingpatient in the ED isnotveryclearandnotmuchattentionispaidtoitasthisisusuallysomethingtoofferwhenallothermeasures have failed. The public value a deathwithdignitywhichisfreeofmachines,equipmentandvarious invasivelifesavingmeasuresbuttheyalso value the high technology of emergency orcritical care where dramatic interventions cansave the life of the client (Mosenthal &Murphy,2003).

The ED culture is geared towards caring for thephysical rather than the psychological aspects ofthe client’s care (Crowley, 2000) as the ED is anopen,busyenvironmentwhichisnoisyandofferslittle privacy. Iserson (1999) states that the EDstaffhavelimitedtimeastheyneedtotreatotherpatients and may often be interrupted to makeother decisions, often concerning other clients.Thebacklogofclientswhowereneglectedduringthe resuscitation of a critical client need to beattended to and thus the families of clients areoften given little attention. Therapeuticmanagementofthedeadordyingclientandtheir

bereaved family can also be extremely time‐consuming.

An individual’s behaviour is greatly influencedbyones beliefs and values, and health professionalsneed to acknowledge that they are unable toseparate this from themselves when they are atworkor,ratherthattheyshouldn’tbetryingtodothis. Death views are personal and reflect onesownexperiences,religionandculture.

Inordertoensurethetherapeuticmanagementofthe sudden death of a patient in the ED it isimportantthattheEDispreparedbeforehandforthisrole(Brysiewicz&Uys,2006).Thispreparationincludesthefollowing;

• Acknowledgement of the uniqueness ofthe ED environment by hospitalmanagement.

• The ED is an area where the healthprofessionals are expected to delivercomplexphysiologiccareandthisincludesperforming a number of medical andtechnological procedures. Healthprofessionals who practice in this wayoften view the family as anobstacle, andwhen staff exclude the family and givepurely technological care, the results canbe devastating as the families areneglected. Flam (1999) suggests that thehealthprofessionals shouldstrive tohavea “high touch” approach to managingsuddendeathinordertocomplementthealready “high tech” care that is beinggiven.

• Health professionals in the ED need todebate“witnessedresuscitation”– that isthe process of actively resuscitating thepatient in the presence of familymembers. Historically, the family wasprevented from being present as healthprofessionals felt it would be tootraumaticforthemtowatchand thatthefamilymaygetinthewayandhamperanyprogress. There is research available onthe positive effects that witnessedresuscitationhasonthefamilyandthat itimproves the ability of the bereaved to

cope with the grieving process after thelossoftheirlovedone(Rattrie,2000).

• Healthprofessionalscanensureadequateresourcesformanagingthesuddendeathin the ED by ensuring privacy for thefamilies and obtaining and makingavailable the necessary information (e.g.an informationpamphlet for the families)andsupportforthefamilies.

• Witnessingthetraumaofothersonadailybasis places the health professionalsworking in the ED at risk for developingvarious stress disorders. Theseprofessionals need to acknowledge thatthe work in the ED is difficult and thatbeing exposed to sudden deaths inparticular makes this environment evenmoredifficulttocopewith.

• Psychological support for the healthprofessionalsneeds tobe consideredandmadeavailable toall themembersof thehealth team. This support should beoffered continuously and not onlyarranged when it becomes apparent thatthestaffneedit.

• Doctorsandnursesneedtobesupportiveof each other and see themselves ascomplementary teammembers in the ED(Hojat, et al., 2003). It is also importantthat there is good communicationbetween the ED health professionals andother members of the team e.g.transplant coordinators, mortuary staff,policeetc.

• Attention needs to be given to new staffas they need to be supported andorientatedintheirroleintheED.

References

Brysiewicz,P.&Uys,L.R.2006.Amodelfordealingwithsuddendeath.AdvancesinNursingScience29(3),E1‐E11.

Crowley,J.J.2000.Aclashofcultures:A&Eandmentalhealth.AccidentandEmergencyNursing,8,2‐8.

Flam,R.1999.HelpingtheBereavedattheEmergencyDepartment:AStudyattheBrusselsUniversityHospital.InternationalJournalofTraumaNursing,5,95‐98.

Hojat,M.,Gonnella,J.S.,Nasca,T.J.,etal.2003.ComparisonsofAmerican,Israeli,ItalianandMexicanphysiciansandnursesonthetotalandfactorscoreoftheJeffersonscaleofattitudestowardphysician‐nursecollaborativerelationships.InternationalJournalofNursingStudies,40,427‐435.

Iserson,K.V.1999.Graveword:notifyingSurvivorsaboutSudden,UnexpectedDeaths.Tuson:GalenPress.

Mosenthal,A.C.&Murphy,P.A.2003.Traumacareandpalliativecare:Timetointegratethetwo?JournaloftheAmericanCollegeofSurgeons,197(3),509‐516.

Rattrie,E.2000.Witnessedresuscitation:goodpracticeornot?NursingStandard,14(24),32‐34.

EMSSABlogIstherelifeaftertheWorldCup?

TheWorldCupisover.Peoplearebroke.Flagsoncarsandthoseweirdmirrorsockshavebeentakendown. Now what? What possible reason do westillhavetogetupinthemorning?

There is so much that we can learn from theWorldCup.We’veproven totheworld,butmoreimportantly to ourselves, that the mythicalconceptofcustomerservicecanbeachieved.ForthefirsttimesincemaybetheRugbyWorldCupin1995,wereweallproud tobeSouthAfrican.Thegeneral atmosphere was one of celebration. Amonth long party. What an amazing experience.Wewillalltreasurethememories.Wehavetosaywell done and thank you to everyonebehind thescenes thatmade thisWCamemorableandsafeone.Toeveryoneinthehealthservice,welldone.

Butafteramonthofpositivedailynewsheadlines,the status quo is returning. It disturbed thisrandom doctor to see the return of thexenophobic hatred that plagued this country lastyear. This after everyone was singing, “WakaWakait’stimeforAfrica.”EveryonewassoproudtobeAfricansupportingalltheAfricanteams.Yettherewere threats of violence against our fellowAfricans. I refuse to give this kind of violence aspecialnamelikexenophobia. Let’scall itwhat itis. Racism. Violence carried out by a handful ofthugs.

Back to the things I learned from theWC. I wasamazed by the acrobatics of soccer players. I’mnot at all referring to the bicycle kicks or peoplesoaring into theair to head theball into thenet.I’m talking about all the tumbling. It’s the onlysportwhereplayersdon’tjustfallbutcontinuetoroll and hold onto either their leg or head,whether or not that was the injured body part.What was even stranger was that there wasusuallynoonenearthemwhensaidtumblingtookplace. My conclusions are: 1. someonestrategicallyplacedrocksonthepitchespeciallyinthe penalty box. 2. Their laces were loose (aproblemIexperiencequiteoften)3.Theopposingteam had invisible substitutes run onto the fieldandtriptheseplayersheadingtowardsgoal.

What also amazed me was the miraculousrecovery these players made. One minute theplayerwouldbetumblingandholdingontoeitherleg or head and pleading for someone to noticethem.Much like an attention hungry 5 year old.Muchlikea5yearold ifnoonepaidattention tothe tumbling player he immediately sulked a bitbutcontinuedplayingwithhisfriends.

I cannot talk about the WC without mentioningthe vuvuzela. Whether you blew it to irritateothers (you succeeded) or you were the personwithearplugswishingtoimpaletheuserwiththehorn, the vuvu made an impact. I was thinkingabout alternative uses for the vuvu. A fewpossibilities: avase,abeerfunnel,hardcollarforagiraffe,asanalternative toadefectivesirenonthe ambulance of response vehicle (this actuallyhappened to me). If you have any suggestions,pleaseletmeknow.

What was interesting were the vuvu‐relatedinjuries. People smacked on the head with awayward vuvu that was recklessly waved aroundduring the “Wavin’ flag” song. People werecomplaining about vuvu lips. I’m sure there is anICD‐10codeforit.Let’snotforgetthecaseofthewomanwhoblewaholeinherthroatduetopoortechnique.Amateurs!

But in the end a German octopus correctlypredictedthatSpainwouldproveeveryonewrongandfinallyraisethatCup.

Welldone,Spain.Welldone,SouthAfrica.

Email:[email protected]

ENSSABlogIwasfortunateenoughtobeinvolvedinprovidingemergencycareatoneoftheFIFAsoccerstadiumsandIwitnessedthishistoriceventfromacrosstheroad.Iwasextremelyhonouredandimpressedtobeapartofthisemergencyteamwhichwasmadeupofdoctors,pre‐hospitalstaffandanurse(me)all working together to ensure high qualityemergency care ‐ which fortunately was neveractuallyneeded!TellushowyouasanemergencynurseswereinvolvedintheFIFAWorldCup.Thanks,ByeP.BrysiewiczEmail:[email protected]

CalendarNovember1‐3November:MIMMS4–5November:HMIMMSCapeTown20‐21November:EMERGENCYMEDICINESYMPOSIUM

CapeTown

27November:LEVEL2ULTRASOUNDCOURSEJohannesburg

LetterstotheEditor

This is a call for all involved in emergencymedicine,nursingandEMStosubmitletterstotheeditorEmail:[email protected]

EMSSAEXCO Chairperson: [email protected] Vice Chairperson: [email protected] Secretary & Treasurer: [email protected] Executive Members: [email protected] [email protected] [email protected]@gmail.comEfraimKramerEfraim.kramer@[email protected] Co-opted Members: [email protected] [email protected]

Journal watch submission form

1. Journal name: EmergencyMedicineJournalMonth: July

1. Article title: (actualorrevised)

Doemergencydepartmentattendancesbyhomelesspeopleincreaseincoldweather?

URL: Reference:(year,vol,page) EmergMedJ2010;27:526‐529

Articlesummary:

ThisretrospectivereviewofadmissionstoNorthernGeneralEmergencyDepartmentinSheffieldfrom2003to2008evaluatedwhetherhomelesspeopleattendedtheEDmorefrequentlyinwintertoescapetheweather.Theyfoundthatofthe528573attendencesinthe6yearperiod,2930(0.55%)weredescribedashavingnofixedabode.63%ofthesearrivedbyambulance.17.4%leftwithoutbeingseen.Comment:Therewasnoincreaseinattendenceincoldweather.Theauthorssuggestthatthismaybeduetotheincreasednumberofsheltersandotheraccomodationmadeavailabletothehomelessinwinter.

2. Journal name: PaediatricEmergencyCareMonth: July


OccultPneumoniainInfantsWithHighFeverWithoutSourceAProspectiveMulticenterStudy

URL: www.pec‐online.comReference:(year,vol,page) PediatrEmerCare2010;26:470‐474

Articlesummary:

Thisarticlesevaluatestheincidenceanddiagnosisofoccultpneumoniainchildrenunder3yearsofagewhopresenttotheEDwithfever(≥39°C)andhighWCC(≥20)butnofocalsignsofinfection.Aprospectivestudyof4paediatricED’sinSpainevaluated188wellappearingchildrenwhometcriteria.CXRshowedconsolidationin25(13%)ofcases.Inthegroup<12monthsofage9of115(7.8%)hadradiologicallyconfirmedpneumoniacomparedto16of73(21.9%)inthe>12monthsgroup.WCC>20,000/mm3andCRP>100mg/Lappearedtobemoresuggestiveofseriousbacterialinfectionbutnostatisticalcorrelationwasfound.Comment:TheauthorssuggestthatroutineCXRmaybeindicatedinthispopulation–children<3yrswithfever≥39°CandWCC≥20.


3. Journal name: HongKongJournalofEmergencyMedicineMonth: July


Asimplifiedappendicitisscoreinthediagnosisofacuteappendicitis

URL: Reference:(year,vol,page) HongKongj.emerg.med.2010;17:230‐235

Articlesummary:

DiagnosingAcuteappendicitisisoftendifficult.UseofscoringsystemssuchastheModifiedAlvaradoscore(MAS)maybeusefulbutareoftencumbersome.Inthisstudy,amoreuser‐friendlySimplifiedAppendicitisScore(SAS)wasevaluatedin238patientsadmittewithsuspectedappendicitis.5variableswereincluded:migratorypain,rightlowerquadrant[RLQ]tenderness,reboundpain,fever>37.3°CandWBC>12,000/uLwithRLQpainandWBCscoringdouble.InthisstudytheSASperformedaswellastheMASwithsensitivitiesaround91%forscores≥6andspecificitiesof90%.Comment:Whilethesescoringsystemsmaybeusefultheyarenotabletoreplacegoodclinicaljudgement.

4. Journal name: EuropeanJournalofEmergencyMedicineMonth: July


Patients’andrelatives’viewonwitnessedresuscitationintheemergencydepartment:aprospectivestudy

URL: Reference:(year,vol,page) EuropeanJournalofEmergencyMedicine17:203–207

Articlesummary:

Thisstudywasasurveyofthefamiliesofa150patientswithlife‐threateningconditionsinanEDinBelgium.Familieswerequestionedastotheirbeliefsregardingresuscitationandwhethertheywouldwanttobepresent.Theyfoundthat75%offamilymemberswishedtobepresentbutonly49%didnotfearthatitwouldbetootraumatic.OneofthelimitationswasthatthissurveywasdoneoncepatientshadreachedICUandsodidnotincludefamilieswhoselovedoneshaddiedintheED.Comment:Thisstudyaddstothegrowingbodyofevidencethatfamiliedwishtobepresentduringresuscitation.Howevertheauthorsnotethatinstitutionofthispolicydoesinvolveeducationofstaffandfamiliestoallaytheirfears.


5. Journal name: NewEnglandJournalofMedicineMonth: July


CPRwithChestCompressionAloneorwithRescueBreathing

URL: Reference:(year,vol,page) NEnglJMed2010;363:423‐33

Articlesummary:

ThisisamulticentrerandomisedcontroltrialcomparingprehospitalbystanderCPRwithandwithoutrescuebreathing.Theprimaryoutcomeevaluatedwassurvivaltohospitaldischargeandfavourableneurologicoutcome.DispatcherassistedCPRinstructionto911callswasrandomisedtochestcompressionsaloneor15compressionsto2breaths.1941patientswereincludedinthetrial:981inthecompressiononlygroupand960intherescuebreathinggroup.Therewasnosignificantdifferenceinthesurvivaltohospitaldischargegroup(12.5%vs11%)andfavourableneurologicoutput(14.4%vs11.5%).Comment:Thisisoneof2studiesonprehospitalchestcompressiononlyCPRpublishedinthisjournal.TheseaddtothegrowingbodyofevidencesupportingcompressiononlybystanderCPR.

6. Journal name: ResuscitationMonth: July


Arandomised,simulatedstudyassessingauscultationofheartrateatbirth

URL: www.elsevier.com/locate/resuscitationReference:(year,vol,page) Resuscitation2010,81:1000–1003

Articlesummary:

Heartrate(HR)assessmentisanimportantpartoftheinitialevaluationofthenewborn.Itmaypromptinterventionforresuscitationorstabilisation.Theaimofthisstudywastoevaluatewhetherbirthattendants(doctors,midwivesandnurses)wereabletorapidlyandaccuratelyassessneonatalheartrateusingastethoscopein3differentscenariosonavitalsimneonatalmannequin.ThemeantimetoestimateHRvariedbetween7.8sinscenario3and17sinscenario1.Inaccurateassessmentsweremadein31%(1),28%(2)and26%(3).73%ofthesewereoverestimates.28%ofallincorrectassessmentswouldhavepromptedincorrectmanagement.Comment:Theauthorsnotethatmoretrainingisrequiredandmoreresearchintomoreaccurateassessmentsinneonates.


7. Journal name: AcademicEmergencyMedicineMonth: July


EmergencyMedicineintheDevelopingWorld:ADelphiStudy

URL: www.aemj.orgReference:(year,vol,page) ACADEMERGMED2010;17:765–774

Articlesummary:

ThispaperreportstheresultsofaDelphistudywhichaimedtoestablishthekeyareasofEmergencyMedicine(EM)developmentindevelopingworldsettings.The3roundsoftheDelphiproducedconcensuson168of208(81%)statements.Thesestatementsincludedbroadareassuchas:thescopeofEmergencyMedicine,staffingofED’sindevelopingcountries,traininginEMandresearchinEM.Comment:ThisisanimportantresourcefordevelopingcountriesaimingtoestablishEMsystemsandpolicies.ItmayguidefutureEMresearchandtraining.

EMSSA Newsletter_August_2010

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