Timely identification and transport are crucial for the pre-hospital management of stroke by emergency medical service (EMS) providers. In this preliminary study, our aim was to develop an ...educational program which can improve 1) stroke knowledge and 2) triage accuracy of identifying acute stroke within 3 hours of symptom onset by dedicated EMS providers in Tainan city.
A total of 33 providers received a written test before, immediately after, and 3 months after completing the educational program, which was about stroke knowledge, diagnosis, and management. The test (total score, 39) contained three sections: two on stroke knowledge (consisting of true-false and choice questions) and one on clinical scenarios (situational descriptions and videos).
The mean total score improved significantly immediately after the program. An increase in mean score was also noted for all three sections. The increase in total score lasted 3 months. The linear regression model showed greater improvement on scores correlated with lower pretest total score only, not correlated with age, gender, work year and the learning or working experience.
The educational program increased knowledge about stroke and improved the accuracy of triage by dedicated EMS providers. Further investigation is needed to determine the effectiveness of similar educational programs for non-dedicated EMS responders.
. Objective: Suicide attempts with agricultural chemicals are common in southern Taiwan. Among them, glyphosate—surfactant herbicide (GlySH) intoxication has been encountered with increasing ...frequency. Although a number of reports have described the clinical course and outcomes following ingestion, predictors of serious complications and mortality have not been elucidated. The purpose of this study was to define predictors of serious complications and probable mortality. Methods: This was a retrospective study of 131 GlySH‐intoxicated patients treated at the National Cheng Kung University Hospital from 1988 to 1995. Medical charts were reviewed and clinical and laboratory variables were ed, looking for predictors of mortality. Results: The most common symptoms included sore throat (79.5%), and nausea with or without vomiting (73.8%). The most common laboratory findings were leukocytosis (68.0%), low serum bicarbonate (48.1%), and acidosis (35.8%). Overall, 11 of 131 patients (8.4%) died; the mean ± SEM time to death was 2.8 ± 0.8 days after presentation. When comparing the clinical and laboratory characteristics among the survivor and fatality groups, significant differences were identified. Respiratory distress, pulmonary edema, respiratory distress necessitating intubation, shock (systolic blood pressure less than 90 mm Hg), altered consciousness, abnormal chest x‐ray, renal failure necessitating hemodialysis, larger amount of ingestion (>200 mL), and hyperkalemia were predictors highly associated with poor outcomes and mortality. Using multiple logistic regression, three predictors were identified, which may predict mortality in severely intoxicated patients. Conclusions: In managing patients who have larger amount of GlySH ingestion, airway protection, early detection of pulmonary edema, and prevention of further pulmonary damage and renal damage appear to be of critical importance.
During the period of the COVID-19 pandemic, there is a notable change in the congestion levels of emergency departments (ED). This phenomenon offers an opportunity to study the influence factors of ...ED crowding. In this work, we crawl real-time information from the ED of major hospitals in Taiwan and conduct data analytics to obtain a comprehensive view of the situation during the COVID-19 pandemic. Note that the data we used contain nonprivate information, avoiding the issue of confidentiality of data. Our goal is to provide valuable information on the appropriate timing of nonemergency patients' visits to the ED and to help nonemergency patients make informed decisions about when to visit the ED, ultimately improving their experience and the overall quality of medical care. The findings of this work have potential applications in developing intelligent systems or mobile applications that could offer valuable insights into optimizing nonemergency patient visits, thereby relieving the ED crowding problem.
Few disaster rescue support information systems would integrate disaster response robot collected information and vicinity medication institution information. This research proposes such a system ...that can display the disaster area overview, geographic information, medical institution's emergency current processing capability, 3D building model and the robot captured data. A user can observe disaster situations, mark interested subarea, pin(associate) some video captured by the robot with the 3D model.
The importance of accurate triage in Taiwan is becoming more apparent with the increasing number of emergency department (ED) patients, and resources for the National Health Insurance becoming ...constrained. This study compared the ability of the Taiwan triage system (TTS) and the standardized 5-level Emergency Severity Index (ESI) triage system to predict ED resource utilization.
Patients arriving at the ED were triaged by both TTS and by using a two-page checklist of ESI criteria during the 3-month study period. The ESI triage level was calculated independently to avoid bias. Disease category (trauma vs. nontrauma), length of stay (LOS) and hospitalization data were evaluated.
A total of 3172 patients with both ESI and TWN evaluation were included. The distributions of ESI ratings within TTS level 1 were: ESI 1, 21.1%; ESI 2, 68.1%; ESI 3, 7.4%; ESI 4, 3.4%; ESI 5, 0%. For TTS level 3, they were: ESI 1, 0.1%; ESI 2, 26.2%; ESI 3, 39.5%; ESI 4, 27.5%; ESI 5, 6.8%. Hospitalization rates were 74.5%, 40.9% and 22.2% in TTS levels 1, 2 and 3, respectively; and were 96.2%, 47.0%, 30.9%, 6.7%and 6.6% in ESI levels 1, 2, 3, 4 and 5, respectively. TTS triaged more trauma patients as life-threatening/emergent condition than nontrauma patients (68.8% vs. 48.4%, p < 0.001). Triage by ESI, however, showed no significant difference in the percentage of trauma and nontrauma patients with highly acute conditions (44.2% vs. 46.6%, p = 0.230). Patients with ESI level 4 or 5 have significantly shorter ED LOS than those with ESI level 3.
ESI produces more accurate discriminating patient acuity, ED LOS and hospitalization rate than TTS. Adopting a standardized 5-level triage tool might improve resource utilization planning of ED practice.
We sought to describe the implementation of the Hospital Emergency Incident Command System (HEICS) at National Cheng Kung University Hospital (NCKUH) in Taiwan, ROC during the outbreak of severe ...acute respiratory syndrome (SARS) in early 2003. We administered a 14-question survey via structured interviews to individuals occupying activated HEICS leadership positions at NCKUH to identify the organization, structure, and function of the HEICS units and subunits they led and the job actions they performed from 25 March to 16 June 2003 Thirty-three of 38 persons (87%) occupying 39 of 44 (89%) activated HEICS leadership positions directly participated in the survey. The participants collectively reported: 1) the creation of four new HEICS unit leader positions and corresponding units during the outbreak, including the infection control officer (administrative section) and SARS assessment, isolation, and critical care unit leaders (operations section); 2) the creation of six new HEICS subunits, including functional areas for fever screening, SARS assessment, and resuscitation outside the hospital, and SARS patient care, SARS critical care, and employee isolation inside the hospital; and 3) the performance of new job actions related to infection control by all HEICS unit leaders. HEICS provides a flexible framework that seems to have assisted NCKUH in the organization of its emergency response to the SARS outbreak in Taiwan, ROC.
Recent investigations suggest that oxidative stress markers are useful in the evaluation of some types of abdominal pathology. We hypothesized that the severity of abdominal pain is correlated with ...oxidative stress as quantified by total antioxidant capacity (TAC) and malondialdehyde (MDA). The objective of this study was to determine the plasma TAC and MDA levels in patients with acute abdominal pain and to examine their relation to abdominal emergency. We recruited 128 patients presenting with acute abdominal pain at the emergency department. Medical history, vital signs and laboratory data were collected on arrival. TAC and MDA levels were determined using serums obtained from the initial blood sampling. Patients with acute abdominal pain had lower levels of TAC and higher levels of MDA than normal control. When patients were grouped according to whether they were discharged early (less than 24 hours) or hospitalized longer than 24 hours, Patients with hospital stay > 24 hours had significantly elevated pulse rate, temperature, leukocyte count, and C reactive protein (CRP) and lower TAC. No significant difference was found in age, sex, temperature, respiratory rate, blood pressure, and MDA level. Multivariate logistic regression analysis revealed that CRP and TAC were significant indicators of quantitative variables for disposition. This study found a correlation exists between oxidative stress and disease severity in patients with abdominal pain. This suggests that TAC might be useful as a guide for patient disposition in the emergency department. (Am J Emerg Med 2002;20:79-82. Copyright 2002, Elsevier Science (USA). All rights reserved.)
An important step during spine immobilization is application of a cervical collar. Clothing or hair covering the neck may impinge on this process. The purpose of this study was to evaluate the effect ...of clothing and hair covering the neck on immobilization using a cervical collar. Study participants were 18 female volunteers with long hair aged 20 to 28 years. Cervical range of motion (ROM) was tested in 6 directions (flexion, extension, right and left lateral bending, right and left axial rotation) using a cervical ROM (CROM) device. After measuring unrestricted ROM (no cervical collar), a 1-piece rigid cervical collar was placed the neck (1) covered by hair and clothing; (2) covered by clothing; (3) covered by hair; or (4) uncovered. Range of motion was retested under all 4 conditions. Data were compared using crossover-design analysis of variance (
P < .05 statistically significant). Range of motion in all directions was significantly restricted by cervical collar placement under all conditions. Unrestricted ROM in all directions ranged from 41.50° (7.25°) to 70.76° (15.4°). In contrast, ROM with a cervical collar under the 4 conditions in all directions ranged from 10.80° (5.10°) to 18.81° (7.37°). We were unable to detect any significant differences in ROM between the 4 conditions. Our data suggest that long hair and clothing, which cover the neck, do not alter the effectiveness of cervical collar immobilization as measured by the cervical ROM device.
We evaluated a realtime, distance-learning first-aid course at three schools. From September 1997 to January 1998, 180 students took the course (60 at each of three sites, one of which was the ...broadcast site). Self-administered questionnaires were distributed to students at the end of the course. The overall response rate was 86%. Sixty-three per cent of students at the remote sites and 83% of students at the broadcast site rated the programme as good or excellent. Students at the broadcast site had a significantly higher degree of satisfaction with the video (79% vs 30%) and audio (83% vs 44%) quality than those at the remote sites. Students at the broadcast site also had a significantly higher degree of satisfaction with slides (75% vs 43%) and transparencies (60% vs 44%) as teaching tools than those at remote sites. The three most important factors affecting the course at the remote sites were teaching aids (video, slides, transparencies), the teacher's body language and self-expression, and equipment stability. Satisfaction at the broadcast site was significantly lower when the course involved demonstrations or practice procedures such as cardiopulmonary resuscitation, dressing, bandaging or splinting. Teaching aids and equipment therefore appear to be important factors at remote sites for a first-aid telemedicine course. Limitations in teachers' movements during demonstration and practice were important at the broadcast site. The evaluation and selection of appropriate teaching models, teaching tools and methods are important when implementing these types of educational programme.
The incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and ...this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBL-producer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB).In a retrospective cohort, multicenter study, adults with CoMEB in the emergency department (ED) were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype. Clinical information was obtained from chart records.Of the total 1141 adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs)-recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98)-were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6%) and an acceptable specificity (92.5%); the area under the receiver operating characteristic curve was 0.92.In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.
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