Glenn C. Hamilton

Optimal positioning for cervical immobilization.

STUDY OBJECTIVE We hypothesized that optimal positioning of the head and neck to protect the spinal cord during cervical spine immobilization can be determined with reference to external landmarks. In this study we sought to determine the optimal position for cervical spine immobilization using magnetic resonance imaging (MRI) and to define this optimal position in a clinically reproducible fashion. METHODS Our subjects were 19 healthy adult volunteers (11 women, 8 men). In each, we positioned the head to produce various degrees of neck flexion and extension. This positioning was followed by quantitative MRI of the cervical spine. RESULTS The mean ratio of spinal canal and spinal cord cross-sectional areas was smallest at C6 but exceeded 2.0 at all levels from C2 to T1 (P < .05). At the C5 and C6 levels, the maximal area ratio was most consistently obtained with slight flexion (cervical-thoracic angle of 14 degrees) (P < .05). For a patient lying flat on a backboard, this corresponds to raising the occiput 2 cm. More extreme flexion or extension produced variable results. CONCLUSION In healthy adults, a slight degree of flexion equivalent to 2 cm of occiput elevation produces a favorable increase in spinal canal/spinal cord ration at levels C5 and C6, a region of frequent unstable spine injuries.

Influence of emergency medical services systems and prehospital defibrillation on survival of sudden cardiac death victims

This article reviews the influence of emergency medical systems and prehospital defibrillation on survival of sudden cardiac death. The historical perspective and epidemiologic considerations of prehospital sudden cardiac death are highlighted. Factors predictive of successful resuscitation and impact of community activity on sudden death are discussed. Influences of emergency medical services on outcome of prehospital cardiac arrest are reviewed, with emphasis on the role of dispatchers, emergency medical technicians, and paramedics. The recent emergence of prehospital automatic defibrillation by emergency medical technicians, first responders, and lay persons is discussed in depth, as it has great potential to positively influence outcome of prehospital sudden cardiac death.

Emergency medicine Education and health care disparities

Education is the means by which learning occurs and, thereby, behavior is changed. One means of improving health care disparities is changing the behavior and understanding of key personnel in academic health centers. These individuals influence policy and procedure, design and evaluate health systems, and define curricular standards for graduate and undergraduate medical education. Emergency medicine provides many opportunities to educate at all levels, including faculty, residents, and students. In addition to our responsibilities in educating emergency medicine residents, the emergency department also provides an ideal learning environment for medical students and other health care providers. The broad issue of disparities in emergency health care may be approached from a variety of directions. The Consensus Group on Education chose to focus on cultural competency education at several levels as a means of tangibly changing its status for both the immediate and long terms.

Objectives to direct the training of emergency medicine residents on off-service rotations: Emergency medical services

Emergency Medical Services are an area of special interest in emergency medicine. Many emergency physicians are called upon to direct, train, or manage emergency medical services. Residents training in emergency medicine have a need for a defined curriculum in emergency medical services. Residency training should provide a basic foundation in EMS including on- and off-line medical control, medicolegal aspects, communications, disaster management, and EMS history, structure, and function. The resident must gain experience through on-scene observation, EMT/Paramedic education, medical direction, and quality assurance activities. This paper is one in a continuing series of goals and objectives to direct resident training in off-service rotations. Specific resources, learning objectives, and experiences are suggested.

A preliminary epidemiological study of the patient population visiting an urban ED in the Republic of China

The objective of this study was to evaluate the characteristics of the patient population of an urban emergency department (ED) in The Peoples Republic of China. A prospective observational study was conducted at a university-affiliated hospital adult ED medical unit and included all patients visiting the medical unit of the ED during a 2-week period. A data collection log was designed and placed in the ED. Data were recorded by the attending ED physician for all patients presenting during the study period. There were 569 patients recorded in the 2-week period. The major presenting complaints were fever (20.9%), abdominal pain (20.1%), and chest pain (11.4%). The most common diagnosis were upper respiratory tract infection (11.6%), angina pectoris (6.3%), and acute gastritis (4.9%). Eight percent of the patients were admitted, 29.0% were held in an observation unit, and 0.6% died. The average length of stay in the ED observation unit was 5.6 days. These data offer emergency physicians a preliminary understanding of the clinic presentations and diagnoses of patients seen in a university-affiliated urban hospital ED in China. The number and length of time patients were held in observation unit point out the shortage of in-hospital beds. This study is useful for describing and understanding characteristics of the patient encounter and for improving the delivery of emergency care in China.

Faculty development: what is faculty development?

Faculty development is an organized, goal-directed process to achieve career progression and growth. Inherent in this process is the acquisition of skills that enable one to contribute in a meaningful way to the advancement of a field of interest, whether educational, operational, or scientific. The process requires attention to technical skills, personal attributes, and explicit goals. Supportive mentorship is optimal. This document outlines important concepts and identifies helpful resources for academic faculty members. Additional resources are available at http://www.saem.org/facdev/index.htm.

Integrating Emergency Medicine Principles and Experience Throughout the Medical School Curriculum: Why and How

The management of acutely ill and injured patients is an essential component of medical student education, yet the formal integration of emergency medicine (EM) into the medical school curriculum has progressed slowly since the inception of the specialty. Medical student interest and the number of resident positions in the National Resident Matching Program are higher than any time in the past, yet students often find access to EM faculty and clinical experience limited to a fourth-year rotation. Incorporating EM into all years of the undergraduate medical student curriculum can offer unique educational experiences and enhance exposure to the necessary and recommended knowledge and skills students must attain prior to graduation. Academic emergency physicians (EPs) should advocate our specialtys importance in their medical school curricula using a proactive approach and actively involve themselves in medical student education at all stages of training. The goals of this article are to describe several approaches for EM faculty to expand medical student exposure to the specialty and enhance student experiences in the core principles of EM throughout the undergraduate medical curriculum.

Objectives to direct the training of emergency medicine residents on off-service rotations: Critical care medicine, Part 2

This article is the second of two parts outlining the objectives for resident rotations in intensive care units. It is part of a larger continuing series on the goals and objectives to direct the training of emergency medicine residents on off-service rotations. The critical care unit allows the resident an opportunity to provide continuing care for critically ill patients, many of whom enter the health care system through the emergency department. Critical care medicine is a natural continuum of emergency medicine, and provides the resident with the ability to follow the natural progression of seriously ill patients, as well as build confidence and experience in caring for the critically ill and injured. These objectives are designed to help focus the residents reading and study during the rotation.

Objectives to direct the training of emergency medicine residents on off-service rotations: Psychiatry☆

Objectives for Emergency Medicine residents on a Psychiatry rotation is the 33rd article in this continuing series of off-service objectives. Psychiatric presentations, including substance abuse and violent behavior, are ubiquitous in the emergency department. In addition, psychological issues influence every aspect of clinical care. A psychiatry rotation can be valuable in emergency medicine training. This experience can be enhanced by clearly defined learning objectives in clinical psychiatry.

Objectives to direct the training of emergency medicine residents in pediatric emergency medicine

This article outlines the objectives for a resident rotation on a pediatric emergency medicine service that is geographically separate from adult-oriented facilities. In this setting, pediatric emergency department care is considered an off service. However, these objectives incorporate key pediatric knowledge and techniques in a practical format for emergency medicine trainees who have no separate pediatric emergency department experience. The content of the pediatric emergency department educational exposure can be attained in a concentrated 2-month exposure at a pediatric facility or extracted throughout the course of multiple pediatric encounters at a general emergency department. These objectives are a part of a continuing series on the goals and objectives to direct emergency medicine resident training on off-service rotations.