Lawrence Proano

Peer Review and Feedback Can Modify Pain Treatment Patterns for Emergency Department Patients With Fractures

Consecutive fracture patients presenting to an adult (AED) or pediatric trauma center (PED) or a community teaching hospital (CED) were reviewed for treatment. Physicians received individual and group feedback. Data were dichotomized by age, gender, race and insurance status. Logistic regression analysis modeled variables approaching statistical significance. A total of 1454 patients participated in the study. The aggregate initial treatment rate was 54%, with no subgroup differences. Significant improvements were seen in all sites/subgroups; the final aggregate treatment rate was 84% ( P < .001). PED and CED patients were less likely to receive treatment than AED patients (odds ratios = 0.49, 0.68). After feedback, whites were treated more often than were non-whites (84% vs 71%, P < .0001); CED alone did not show this pattern (odds ratios = AED 4.14, PED 2.67, CED1.28). Patients at all sites received improved pain treatment in association with directed feedback. Race and treatment site were significant factors.

Medical support for emergency relief workers after typhoon Sudal in Yap, Micronesia.

INTRODUCTION On 09 April 2004, Typhoon Sudal struck the Island of Yap in the Federated States of Micronesia (FSM). Over 90% of homes, public utilities, and public property were damaged or destroyed. Nearly 10% of the population was displaced to shelters, and the majority of the population was without drinking water or power. United States disaster workers were deployed to Yap for three months to assist in the recovery and relief efforts. OBJECTIVE The objective of this study was to evaluate the acute healthcare needs of the US disaster relief population serving in a remote setting with limited medical resources. METHODS A retrospective chart review of all disaster relief workers presenting to an emergency clinic in Yap during the disaster relief effort from April 2004-July 2004 was performed. Investigators extracted demographic data, chief complaints, medical histories, medical management, disposition, and outcome data from the clinic charts. RESULTS Together, the 60 disaster workers present on Yap during the relief effort made 163 patient contacts in the disaster emergency clinic. A total of 92% of patient contacts were for minor medical complaints or minor trauma, 13% were for upper-respiratory infections, 9% were for gastrointestinal illness, and 9% were for dermatological problems. Eight percent of visits were for serious medical problems or trauma. Life-threatening illnesses or injuries did not occur. CONCLUSIONS Disaster relief workers on Yap frequently utilized the disaster relief clinic. In general, disaster workers remained healthy during the relief effort in Yap, and most injuries and illnesses were minor. On-site medical providers resulted in rapid care and stabilization, and after treatment, disaster workers were able to return to duty.

Emergency medical training for health promoters in Central and South America

Los promotores de salud, las parteras y otros proveedores de cuidados medicos basicos trabajan en comunidades locales de todo el mundo para mejorar y facilitar la atencion sanitaria. No hay suficiente informacion que describa los programas educacionales dirigidos a mejorar los conocimientos y las habilidades de los promotores de salud y sobre su impacto sanitario a largo plazo. Muchas iniciativas educacionales dirigidas a los promotores de salud consisten en intervenciones aisladas que permiten evaluar sus conocimientos inmediatamente despues de la intervencion, pero no miden los progresos a largo plazo en la base de conocimientos o la atencion sanitaria. La Alianza Pediatrica Global -una organizacion sin animo de lucro basada en los EE.UU. que trabaja con personal medico y sanitario local- creo un programa educacional para promotores sanitarios y parteras en Ecuador, Guatemala, Mexico y Nicaragua con un enfoque centrado en reducir la mortalidad materna e infantil y en mejorar la atencion primaria y de urgencias. En este articulo se describen estas iniciativas educacionales disenadas para mejorar las habilidades de los promotores de salud y las parteras mediante un entrenamiento medico avanzado y sostenible, ajustadas a las necesidades especificas de cada comunidad.(AU)

Disaster-related fatalities among US citizens traveling abroad

OBJECTIVE To describe the locations and risk of death associated with natural disaster fatalities for US citizens traveling abroad. DESIGN, SETTING, AND PARTICIPANTS A retrospective database review of US citizen disaster deaths occurring worldwide. INTERVENTIONS None. MAIN OUTCOME MEASURES Information on fatalities due to disasters was abstracted from the US Department of State Web site reporting deaths of US citizens abroad by non-natural causes from October 2002 through June 2012. The main outcome measures were the frequency of disaster deaths and countries where disasters occurred. Descriptive statistics and rates were used to evaluate the study data. RESULTS There were 7,963 total non-natural deaths of US citizens traveling abroad during the study period. Of these, 163 (2.0 percent) were disaster-related deaths, involving 19 disaster events in 15 countries. Only two disaster-related events resulted in more than two deaths of US travelers-the 2010 earthquake in Haiti causing 121 fatalities (74.2 percent of disaster deaths), and the 2004 tsunami in Thailand causing 22 fatalities (13.5 percent of disaster deaths). The approximate annual mean death rate for US citizen travelers as a result of disaster events is 0.27 deaths/1 million travelers, compared with 1.4 deaths/1 million residents due to disaster annually within the United States. CONCLUSIONS The risk of disaster-related fatality is low for US citizens traveling abroad. Although disaster-related death among travelers is unpredictable, during a period of almost 10 years, there was only one reported death due to disaster in the five countries most frequently visited by US travelers. Further investigation may identify population-, seasonal-, country-, or location-specific risks from which prevention strategies can be developed.

Circus disaster: Case report, response, and review of injuries

Circus acts with human artists performing acrobatic feats are a popular spectator pastime in the United States and in international venues. There is little data in the literature regarding injuries sustained during circus acts. Some injuries are minor, but others can be serious, or even fatal. This article describes a recent circus disaster, a review of the relevant literature, and an analysis of the disaster response.

High Risk Acute Care

In the 1990s emergency physicians have come under increasing scrutiny in the performance of their profession. This problem is ongoing in the United States and may soon be the subject of intense government scrutiny, monitoring and regulation. In the past decade jury awards for malpractice suits have continued to increase, with seemingly no ceiling in sight.