Bruno P. Petinaux

Accuracy of radiographic readings in the emergency department

OBJECTIVES A review of radiology discrepancies of emergency department (ED) radiograph interpretations was undertaken to examine the types of error made by emergency physicians (EPs). METHODS An ED quality assurance database containing all radiology discrepancies between the EP and radiology from June 1996 to May 2005 was reviewed. The discrepancies were categorized as bone, chest (CXR), and abdomen (AXR) radiographs and examined to identify abnormalities missed by EPs. RESULTS During the study period, the ED ordered approximately 151 693 radiographs. Of the total, 4605 studies were identified by radiology as having a total of 5308 abnormalities discordant from the EP interpretation. Three hundred fifty-nine of these abnormalities were not confirmed by the radiologist (false positive). The remainder of the discordant studies represented abnormalities identified by the radiologist and missed by the EP (false negatives). Of these false-negative studies, 1954 bone radiographs (2.4% of bone x-rays ordered) had missed findings with 2050 abnormalities; the most common missed findings were fractures and dislocations. Of the 220 AXRs (3.7% of AXRs ordered) with missed findings, 240 abnormalities were missed; the most common of these was bowel obstruction. Of the 2431 CXRs (3.8% of CXRs ordered), 2659 abnormalities were missed; the most common were air-space disease and pulmonary nodules. The rate of discrepancies potentially needing emergent change in management based solely on a radiographic discrepancy was 85 of 151 693 x-rays (0.056%). CONCLUSIONS Approximately 3% of radiographs interpreted by EPs are subsequently given a discrepant interpretation by the radiology attending. The most commonly missed findings included fractures, dislocations, air-space disease, and pulmonary nodules. Continuing education should focus on these areas to attempt to further reduce this error rate.

Assessing physicians' in training attitudes and behaviors during the 2009 H1N1 influenza season: A cross-sectional survey of medical students and residents in an urban academic setting

Please cite this paper as: May et al. (2010) Assessing physicians’ in training attitudes and behaviors during the 2010 H1N1 influenza season: a cross‐sectional survey of medical students and residents in an urban academic setting. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2010.00151.x.

H1N1 Preventive Health Behaviors in a University Setting

Abstract Background: When H1N1 emerged in 2009, institutions of higher education were immediately faced with questions about how best to protect their community from the virus, yet limited information existed to help predict student preventive behaviors. Methods: The authors surveyed students at a large urban university in November 2009 to better understand how students perceived their susceptibility to and the severity of H1N1, which preventive behaviors they engaged in, and if policies impacted their preventive health decisions. Results: Preventive health behavior messaging had a mixed impact on students. Students made simple behavior changes to protect themselves from H1N1, especially if they perceived a high personal risk of contracting H1N1. Although policies were instituted to enable students to avoid classes when ill, almost no student self-isolated for the entire duration of their illness. Conclusions: These findings can help inform future decision making in a university setting to best influence preventive health behaviors.

Patient-driven resource planning of a health care facility evacuation.

INTRODUCTION The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old. METHODS Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period. RESULTS Survey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe. CONCLUSION Heath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within the facility and the community to provide for the safest evacuation of patients.

Extreme measures: field amputation on the living and dismemberment of the deceased to extricate individuals entrapped in collapsed structures

Collapsed structures, typically as a result of earthquakes, may result in individuals entrapped by their limbs under heavy structural elements. In addition, access to living persons may be blocked by the deceased. Individuals are often critically ill by the time they are found, and rapid extrication is warranted. This and other factors may necessitate field amputation of an extremity on a living person or dismemberment of the deceased to achieve a rescue. Although case reports have described industrial, mining, and transportation accidents, few discuss this potential in collapsed structures. Also, few specifically outline the indications or the decision process and associated administrative procedures that should be addressed before conducting these procedures. This report presents a review of the literature along with a limited case series. A discussion regarding relevant decision making is provided to encourage the development of protocols. An international consensus statement on these procedures is provided.

Emergency medicine Joint Fellowship Curriculum.

BACKGROUND The authors describe a Joint Fellowship Curriculum instituted for emergency medicine fellows in diverse fellowships. The curriculum is based on commonalities established among the varying fellowships offered within their Department of Emergency Medicine. Fellowships included in the curriculum development include Disaster/Emergency Medical Services, International Emergency Medicine, Health Policy, Ultrasonography, and Medical Toxicology. OBJECTIVES The focus of this educational activity is to promote the development of the fellow into an expert within their field of specialization. DISCUSSION Recognizing that topics such as scholarly activities, career development, clinical practice of medicine, business of medicine, and personal development are universally applicable to a variety of emergency medicine fellowships, the curriculum attempts to provide uniform instruction. The quality and applicability of this instruction was assessed and found to have been very well received by the participating fellows. CONCLUSION The authors encourage academic emergency medicine departments with a number of fellowship training opportunities to consider providing such a uniform curriculum of instruction as well.

District of Columbia emergency healthcare coalition burn mass casualty plan: development to exercise date

The District of Columbia Emergency Healthcare Coalition (DC EHC) brought together a Burn Task Force to tackle the issue of mass burn care in a metropolitan area in light of limited local burn center resources. This article outlines the development of the mass burn care plan. Using a tiered treatment approach, mass burn victims would be transported first to burn centers within the area, followed by nonburn center trauma centers, and finally to nonburn and nontrauma center acute care facilities. Once activated the Burn Task Force would triage and coordinate transfer of mass burn patients within the District for further care at burn centers using a strong link with the Eastern Regional Burn Disaster Consortium. This plan was exercised in the spring of 2014 to test all of the components. To strengthen mass burn care, this plan, put in place for the District of Columbia, has been expanded to include the National Capital Region as well.

Confined space medicine and the medical management of complex rescues: A case series

OBJECTIVE A variety of hazards can precipitate the full or partial collapse of occupied structures. The rescue of entrapped survivors in these situations can be complex, require a multidisciplinary approach, and last for many hours. METHODS The modern discipline of Urban Search and Rescue, which includes an active medical component, has evolved to address such situations. This case series spans several decades of experience and highlights the medical principles in the response to collapsed structure incidents. RESULTS Recurring concepts of confined space medicine include rescuer safety, inter-disciplinary coordination, patient protection, medical resuscitation in austere environments, and technical extrications. CONCLUSION Strategies have been developed to address the varied challenges in the medical response to collapsed structure incidents.