Journal Reviews
Journal Reviews
Mayer BWM, Smith FB, King CA, et al. Factors associated with victimization of personnel in emergency departments. J Emerg Nurs 1999; 25:361-366.
The incidence of physical assault among ED staff was reported to be 42% during 1998 and 72% during the respondents’ careers, according to this study. The study examined incidents of ED personnel victimization in Central Florida and characteristics of the patient/perpetrator, the personnel victimized, and the ED environment.
A survey of 226 ED personnel collected data anonymously, with questions about violence in the ED. Respondents reported avoiding identification on duty, underreporting, post-victimization staff turnover, dissatisfaction with security, and the desire for every security provision listed.
These are all indicators of fear and stress, note the researchers.
Other findings include:
• In rating overall satisfaction with security, 57% indicated they were "dissatisfied" or "extremely dissatisfied."
• Alcohol use was associated with violent incidents.
• Verbal abuse was significantly higher on the day shift.
• The most desired environmental variable was 24-hour security attendants.
• More than a fourth of the subjects reported that they had completed no coursework or had no continuing education in violence prevention.
• 38% of respondents indicated there was no effect of victimization on job performance.
Women were significantly more likely to avoid identification in the ED area through practices such as turning their name tags over, despite a trend of using only first names on name tags.
The goals of reducing the fears and victimization of ED personnel should become a priority within the health care system, say the researchers. They recommend open communication between ED staff and managers about violence concerns, protocols, data bases for better reporting, education, problem solving, and policy development for prevention, intervention, and post-victimization follow-up.
Lerner EB, Billittier AJ, Sikora J, et al. Use of a geographic information system to determine appropriate means of trauma patient transport. Acad Emerg Med 1999; 6:1,127-1,133.
Inappropriate choice of transport mode is linked with increased out-of-hospital time, according to this research from the Center for Transportation Injury Research in Buffalo, NY. Minimizing out-of-hospital time is considered to be an important factor for trauma patient survival.
The study found that a geographical information system and historical transport data can be used to create a map that identifies locations (zones) from which either ambulance or helicopter transport will result in shorter out-of-hospital times. A review of 6,185 patient transports at a trauma center was conducted over three years. Patients transported by helicopter from locations within the outer air zone arrived at the trauma center 13 minutes sooner than those transported by ground ambulance. Patients transported by ambulance from locations within the inner ground zone arrived at the trauma center 36 minutes sooner than those transported by helicopter.
It appears that an "inappropriate" choice of transport mode was associated with significant delays in patient arrival at the trauma center.
Planners from other systems of emergency medical services might choose to perform similar evaluations of their regions, note the researchers. "Alternatively, they may generically apply distance and topographic principles learned from this and future studies to create trauma triage and helicopter utilization guidelines for their systems," they suggest.
Abrunzo T, Gerardi M, Dietrich A, et al. The role of emergency physicians in the care of the child at school. Ann Emerg Med 2000; 35:155-161.
ED physicians may contribute significantly to the health of children in the school setting, according to this research by the school health task force of the American College of Physicians’ pediatric emergency medicine committee in Dallas.
Because school health emergencies are so common, the expertise of emergency physicians is needed, the researchers argue. ED physicians have an important role in ensuring the proper treatment of these emergency medical problems, they say. Physicians need to be involved in the development and organization of systems for prevention, initial stabilization, management, and follow-up of injuries, the researchers add.
Address these 6 issues
ED physicians should meet with administrators at the local school district level to address the following issues, the researchers recommend:
• assist in creating, modifying, or supporting a school-based emergency plan or system;
• inform and educate school personnel of the community’s emergency medical services system;
• advocate and assist with school personnel training in first aid and cardiopulmonary resuscitation;
• encourage injury prevention and regularly reviewed accident reporting systems and ensure input from emergency medical caretakers in the education and training of school-based health personnel;
• ensure availability of emergency medicine consultants for establishing triage systems, developing guidelines, ensuring immediacy of referrals, and creating standing orders as deemed necessary for a local population;
• assist schools in disaster planning.
Physicians should become involved in children’s health by making presentations at schools and involving the school health community in hospital-based, ED-sponsored educational presentations, the researchers suggest.
Specific areas of assistance to school districts might include development and promulgation of an emergency data set for students by outlining identification data, caretaker contact information, primary care physician information, significant past illnesses, allergies, medications, insurance data, and consent, they recommend.
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