Search results for: emergency (999) call

Authors: Ghazwan Al-Haji

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Most accidents occur in urban areas, and the most related casualties are vulnerable road users (pedestrians and cyclists). The traffic calming measures (TCMs) are widely used and considered to be successful in reducing speed and traffic volume. However, TCMs create unwanted effects include: noise, emissions, energy consumption, vehicle delays and emergency response time (ERT). Different vertical and horizontal TCMs have been already applied nationally (Sweden) and internationally with different impacts. It is a big challenge among traffic engineers, planners, and policy-makers to choose and priorities the best TCMs to be implemented. This study will assess the existing guidelines for TCMs in relation to safety and ERT with focus on data from Norrkoping city in Sweden. The expected results will save lives, time, and money on particularly Swedish Roads. The study will also review newly technologies and how they can improve safety and reduce ERT.

Keywords: traffic calming measures, traffic safety, delay time, vulnerable road users

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Authors: Traci A. Hefner

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Limited research exists on the readiness of emergency departments to respond to human trafficking (HT). The purpose of this qualitative case study was to improve the readiness of a Department of Emergency Medicine (ED), located in the southeast region of the United States, in identifying, assessing, and responding to trafficked individuals. The research objectives were to 1) provide an organizing framework to understand the ED’s readiness to respond to HT, using the Transtheoretical Model’s stages of change construct, 2) explain the readiness of the ED through a three-pronged contextual approach that included policies and procedures, patient data collection processes, and clinical practice methods, and 3) develop recommendations to respond to HT. Content analysis was used for document reviews and on-site observations, while thematic analysis identified themes of staff perceptions of the ED’s readiness in interviews of over 30 clinical and non-clinical healthcare professionals. Results demonstrated low levels of readiness to identify HT through the ED’s policies and procedures, data collection processes, and clinical practice methods. Clinical practice-related factors consisted of limited awareness of HT warning signs and low-levels of knowledge about community resources for possible HT referrals. Policy and practice recommendations to increase the ED’s readiness to respond to HT included: developing staff trainings across the ED system to enhance awareness of HT warning signs, incorporating HT into current policies and procedures for vulnerable patient populations as well as creating a HT protocol that addresses policies and procedures, screening tools, and community referrals.

Keywords: emergency medicine, human trafficking, organizational assessment, stages of change

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Authors: Nadeem Yousuf Khan

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This paper proposes the formation of a digital emergency response system (dERS) in the aged, long-term care, and chronic disease setups in the post-COVID healthcare ecosystem, focusing on the Asia Pacific market where the aging population is increasing significantly. It focuses on the use of digital technologies such as wearables, a global positioning system (GPS), and mobile applications to build an integrated care system for old folks with co-morbidities and other chronic diseases. The paper presents a conceptual framework of a connected digital health ecosystem that not only provides proactive care to registered patients but also prevents the damages due to sudden conditions such as strokes by alerting and treating the patients in a digitally connected and coordinated manner. A detailed review of existing digital health technologies such as wearables, GPS, and mobile apps was conducted in context with the new post-COVID healthcare paradigm, along with a detailed literature review on the digital health policies and usability. A good amount of research papers is available in the application of digital health, but very few of them discuss the formation of a new framework for a connected digital ecosystem for the aged care population, which is increasing around the globe. A connected digital emergency response system has been proposed by the author whereby all registered patients (chronic disease and aged/long term care) will be connected to the proposed digital emergency response system (dERS). In the proposed ecosystem, patients will be provided with a tracking wrist band and a mobile app through which the control room will be monitoring the mobility and vitals such as atrial fibrillation (AF), blood sugar, blood pressure, and other vital signs. In addition to that, an alert in case if the patient falls down will add value to this system. In case of any variation in the vitals, an alert is sent to the dERS 24/7, and dERS clinical staff immediately trigger that alert which goes to the connected hospital and the adulatory service providers, and the patient is escorted to the nearest connected tertiary care hospital. By the time, the patient reaches the hospital, dERS team is ready to take appropriate clinical action to save the life of the patient. Strokes or myocardial infarction patients can be prevented from disaster if they are accessible to engagement healthcare. This dERS will play an effective role in saving the lives of aged patients or patients with chronic co-morbidities.

Keywords: aged care, atrial fibrillation, digital health, digital emergency response system, digital technology

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Authors: Vinodhini Elangovan, Jen Heng Pek

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Background: An ectopic pregnancy is defined as any pregnancy implanted outside of the endometrial cavity. Cornual pregnancy, a rare variety of ectopic pregnancies, is seen in about 2-4% of ectopic pregnancies. It develops in the interstitial portion of the fallopian tube and invades through the uterine wall. This case describes a third-trimester cornual pregnancy that resulted in a uterine rupture. Case: A 38-year old Chinese lady was brought to the Emergency Department (ED) as a standby case for hypotension. She was 30+6 weeks pregnant (Gravida 3, Parous 1). Her past obstetric history included a live birth delivered via lower segment Caesarean section due to non-reassuring fetal status in 2002 and a miscarriage in 2012. She developed generalized abdominal pain. There was no per vaginal bleeding or leaking liquor. There was also no fever, nausea, vomiting, constipation, diarrhea, or urinary symptoms. On arrival in the ED, she was pale, diaphoretic, and lethargic. She had generalized tenderness with guarding and rebound over her abdomen. Point of care ultrasound was performed and showed a large amount of intra-abdominal free fluid, and the fetal heart rate was 170 beats per minute. The point of care hemoglobin was 7.1 g/dL, and lactate was 6.8 mmol/L. The patient’s blood pressure dropped precipitously to 50/36 mmHg, and her heart rate went up to 141 beats per minute. The clinical impression was profound shock secondary to uterine rupture. Intra-operatively, there was extensive haemoperitoneum, and the fetus was seen in the abdominal cavity. The fetus was delivered immediately and handed to the neonatal team. On exploration of the uterus, the point of rupture was at the left cornual region where the placenta was attached to. Discussion: Cornual pregnancies are difficult to diagnose pre-operatively with low ultrasonographic sensitivity and hence are commonly confused with normal intrauterine pregnancies. They pose a higher risk of rupture and hemorrhage compared to other types of ectopic pregnancies. In very rare circumstances, interstitial pregnancies can result in a viable fetus. Uterine rupture resulting in hemorrhagic shock is a true obstetric emergency that can result in significant morbidity and mortality for the patient and the fetus, and early diagnosis in the emergency department is crucial. The patient in this case presented with known risk factors of multiparity, advanced maternal age, and previous lower segment cesarean section, which increased the suspicion of uterine rupture. Ultrasound assessment may be beneficial to any patient who presents with symptoms and a history of uterine surgery to assess the possibility of uterine dehiscence or rupture. Management of a patient suspected of uterine rupture should be systematic in the emergency department and follow an ABC approach. Conclusion: This case demonstrates the importance for an emergency physician to maintain the suspicion for ectopic pregnancy even at advanced gestational ages. It also highlights how even though all emergency physicians may not be qualified to do a detailed pelvic ultrasound, it is essential for them to be competent with a point of care ultrasound to make a prompt diagnosis of conditions such as uterine rupture.

Keywords: cornual ectopic , ectopic pregnancy, emergency medicine, obstetric emergencies

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Authors: Todd R. Walton

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Social media would seem to be an ideal mechanism for crisis communication, yet it has been met with varied results. Natural disasters, such as hurricanes, provide a slow moving view of how social media can be leveraged to guide stakeholders and the public through a crisis. Crisis communication managers have struggled to reach target audiences with credible messaging. This Qualitative Evidence Synthesis (QES) analyzed the findings of eight studies published in the last year to determine how organizations effectively utilize social media for crisis communication. Additionally, the evidence was analyzed to note strategies for establishing credibility in a medium fraught with misinformation. Studies indicated wide agreement on the use of multiple social media channels in addition to frequent accurate messaging in order to establish credibility. Studies indicated mixed agreement on the use of text based emergency notification systems. The findings in this QES will help crisis communication professionals plan for social media use for crisis communication.

Keywords: crisis communication, crisis management, emergency response, social media

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Authors: Keiko Shimazu, Yasuhiro Maida, Tetsuya Sugata, Daisuke Tamakoshi, Kenji Makabe, Haruki Suzuki

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In this paper, we report how to acquire serious victims’ locations in the Acute Stage of Large-scale Disasters, in an Emergency Information Network System designed by us. The background of our concept is based on the Great East Japan Earthquake occurred on March 11^th, 2011. Through many experiences of national crises caused by earthquakes and tsunamis, we have established advanced communication systems and advanced disaster medical response systems. However, Japan was devastated by huge tsunamis swept a vast area of Tohoku causing a complete breakdown of all the infrastructures including telecommunications. Therefore, we noticed that we need interdisciplinary collaboration between science of disaster medicine, regional administrative sociology, satellite communication technology and systems engineering experts. Communication of emergency information was limited causing a serious delay in the initial rescue and medical operation. For the emergency rescue and medical operations, the most important thing is to identify the number of casualties, their locations and status and to dispatch doctors and rescue workers from multiple organizations. In the case of the Tohoku earthquake, the dispatching mechanism and/or decision support system did not exist to allocate the appropriate number of doctors and locate disaster victims. Even though the doctors and rescue workers from multiple government organizations have their own dedicated communication system, the systems are not interoperable.

Keywords: crisis management, disaster mitigation, messing, MGRS, military grid reference system, satellite communication system

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Authors: Ching-Shoei Chiang

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The Malfatti’s Problem is to ask for fitting 3 circles into a right triangle such that they are tangent to each other, and each circle is also tangent to a pair of the triangle’s side. This problem has been extended to any triangle (called general Malfatti’s Problem). Furthermore, the problem has been extended to have 1+2+…+n circles, we call it extended general Malfatti’s problem, these circles whose tangency graph, using the center of circles as vertices and the edge connect two circles center if these two circles tangent to each other, has the structure as Pascal’s triangle, and the exterior circles of these circles tangent to three sides of the triangle. In the extended general Malfatti’s problem, there are closed-form solutions for n=1, 2, and the problem becomes complex when n is greater than 2. In solving extended general Malfatti’s problem (n>2), we initially give values to the radii of all circles. From the tangency graph and current radii, we can compute angle value between two vectors. These vectors are from the center of the circle to the tangency points with surrounding elements, and these surrounding elements can be the boundary of the triangle or other circles. For each circle C, there are vectors from its center c to its tangency point with its neighbors (count clockwise) pi, i=0, 1,2,..,n. We add all angles between cpi to cp(i+1) mod (n+1), i=0,1,..,n, call it sumangle(C) for circle C. Using sumangle(C), we can reduce/enlarge the radii for all circles in next iteration, until sumangle(C) is equal to 2πfor all circles. With a similar idea, this paper proposed an algorithm to find the radii of circles whose tangency has the structure of Pascal’s triangle, and the exterior circles of these circles are tangent to the unit Realeaux Triangle.

Keywords: Malfatti’s problem, geometric constraint solver, computer-aided geometric design, circle packing, data visualization

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Authors: Sameer A. Pathan, Biswadev Mitra, Salman Mirza, Umais Momin, Zahoor Ahmed, Lubna G. Andraous, Dharmesh Shukla, Mohammed Y. Shariff, Magid M. Makki, Tinsy T. George, Saad S. Khan, Stephen H. Thomas, Peter A. Cameron

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Study objective: Emergency physician’s (EP) ability to identify hydronephrosis on point-of-care ultrasound (POCUS) has been assessed in the past using CT scan as the reference standard. We aimed to assess EP interpretation of POCUS to identify and grade the hydronephrosis in a direct comparison with the consensus-interpretation of POCUS by radiologists, and also to compare the EP and radiologist performance using CT scan as the criterion standard. Methods: Using data from a POCUS databank, a prospective interpretation study was conducted at an urban academic emergency department. All POCUS exams were performed on patients presenting with renal colic to the ED. Institutional approval was obtained for conducting this study. All the analyses were performed using Stata MP 14.0 (Stata Corp, College Station, Texas). Results: A total of 651 patients were included, with paired sets of renal POCUS video clips and the CT scan performed at the same ED visit. Hydronephrosis was reported in 69.6% of POCUS exams by radiologists and 72.7% of CT scans (p=0.22). The κ for consensus interpretation of POCUS between the radiologists to detect hydronephrosis was 0.77 (0.72 to 0.82) and weighted κ for grading the hydronephrosis was 0.82 (0.72 to 0.90), interpreted as good to very good. Using CT scan findings as the criterion standard, Eps had an overall sensitivity of 81.1% (95% CI: 79.6% to 82.5%), specificity of 59.4% (95% CI: 56.4% to 62.5%), PPV of 84.3% (95% CI: 82.9% to 85.7%), and NPV of 53.8% (95% CI: 50.8% to 56.7%); compared to radiologist sensitivity of 85.0% (95% CI: 82.5% to 87.2%), specificity of 79.7% (95% CI: 75.1% to 83.7%), PPV of 91.8% (95% CI: 89.8% to 93.5%), and NPV of 66.5% (95% CI: 61.8% to 71.0%). Testing for a report of moderate or high degree of hydronephrosis, specificity of EP was 94.6% (95% CI: 93.7% to 95.4%) and to 99.2% (95% CI: 98.9% to 99.5%) for identifying severe hydronephrosis alone. Conclusion: EP POCUS interpretations were comparable to the radiologists for identifying moderate to severe hydronephrosis using CT scan results as the criterion standard. Among patients with moderate or high pre-test probability of ureteric calculi, as calculated by the STONE-score, the presence of moderate to severe (+LR 6.3 and –LR 0.69) or severe hydronephrosis (+LR 54.4 and –LR 0.57) was highly diagnostic of the stone disease. Low dose CT is indicated in such patients for evaluation of stone size and location.

Keywords: renal colic, point-of-care, ultrasound, bedside, emergency physician

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Authors: Amrita Anil Agashe, Sumant Tapas, Ajay Verma Yogesh Sonavane, Sourabh Yeravar

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Due to advancement in MEMS technology today wireless sensors network has gained a lot of importance. The wide range of its applications includes environmental and habitat monitoring, object localization, target tracking, security surveillance etc. Wireless sensor networks consist of tiny sensor devices called as motes. The constrained computation power, battery power, storage capacity and communication bandwidth of the tiny motes pose challenging problems in the design and deployment of such systems. In this paper, we propose a ubiquitous framework for Real-Time Tracking, Sensing and Management System using IITH motes. Also, we explain the algorithm that we have developed for location management in wireless sensor networks with the aspect of mobility. Our developed framework and algorithm can be used to detect emergency events and safety threats and provides warning signals to handle the emergency.

Keywords: mobility management, motes, multihop, wireless sensor networks

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Authors: Abhishek Oswal

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Background: Inconsistencies between the guidelines for childhood asthma can pose a diagnostic challenge to clinicians. NICE guidelines are the most commonly followed guidelines in primary care in the UK; they state that to be diagnosed with asthma, a child must be more than 5 years old and must have objective evidence of the disease. When diagnoses are coded in general practice (GP), these guidelines may be superseded by communications from secondary care. Hence it is imperative that diagnoses are correct, as per up to date guidelines and evidence, as this affects follow up and management both in primary and secondary care. Methods: A snapshot audit at a general practice surgery was undertaken of children (less than 16 years old) with a coded diagnosis of 'asthma', to review the age at diagnosis and whether any objective evidence of asthma was documented at diagnosis. 50 cases of asthma in children presenting to the emergency department (ED) were then audited to review the age at presentation, whether there was evidence of previous asthma diagnosis and whether the patient was discharged from ED. A repeat audit is planned in ED this winter. Results: In a GP surgery, there were 83 coded cases of asthma in children. 51 children (61%) were diagnosed under 5, with 9 children (11%) who had objective evidence of asthma documented at diagnosis. In ED, 50 cases were collected, of which 4 were excluded as they were referred to the other services, or for incorrect coding. Of the 46 remaining, 27 diagnoses confirmed to NICE guidelines (59%). 33 children (72%) were discharged from ED. Discussion: The most likely reason for the apparent low rate of a correct diagnosis is the significant challenge of obtaining objective evidence of asthma in children. There were a number of patients who were diagnosed from secondary care services and then coded as 'asthma' in GP, without having objective documented evidence. The electronic patient record (EPR) system used in our emergency department (ED) did not allow coding of 'suspected diagnosis' or of 'viral induced wheeze'. This may have led to incorrect diagnoses coded in primary care, of children who had no confirmed diagnosis of asthma. We look forward to the re-audit, as the EPR system has been updated to allow suspected diagnoses. In contrast to the NICE guidelines used here, British Thoracic Society (BTS) guidelines allow for a trial of treatment and subsequent confirmation of diagnosis without objective evidence. It is possible that some of the cases which have been classified as incorrect in this audit may still meet other guidelines. Conclusion: The diagnosis of asthma in children is challenging. Incorrect diagnoses may be related to clinical pressures and the provision of services to allow compliance with NICE guidelines. Consensus statements between the various groups would also aid the decision-making process and diagnostic dilemmas that clinicians face, to allow more consistent care of the patient.

Keywords: asthma, diagnosis, primary care, emergency department, guidelines, audit

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Authors: Masuma Novak, Daniel Novak

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Background: Sweden along with other Nordic countries has the highest incidence of type 1 diabetes mellitus (T1DM) worldwide. The trend is increasing globally. The diagnosis is often given at the emergency clinic when children arrive with cardinal symptom of T1DM. Children with T1DM are known to have an increased risk of microvascular- and macrovascular complications. A family history of cardiovascular complications may further increase their risk. Clinically evident diabetes-related vascular complications are however rarely visible in childhood and adolescence, whereby an intensive diabetes treatment and normoglycemic control is a goal for every child. This study is a risk evaluation of children with T1DM based on their family’s cardiovascular history. Method: Since 2005 the Better Diabetes Diagnosis (BDD) study is a nationwide Swedish prospective cohort study that recruits new-onset T1DM who are less than 18 years old at time of diagnosis. For each newly diagnosed child, blood samples are collected for specific HLA genotyping and islet autoantibody assays and their family’s cardiovascular history is evaluated. As part of the BDD study, during the years 2010-2013 all children diagnosed with T1DM at the Queen Silvia’s Children’s Hospital in Sweden were asked about their family’s cardiovascular history. Questions regarded maternal and paternal high blood pressure, stroke, and myocardial infarction before the age of 55 years, and hyperlipidemia were answered. A maximum risk score of eight was possible. All children are clinically observed prospectively for early functional and structural abnormalities such as protein uremia, blood pressure, and retinopathy. Results: A total of 275 children aged 0 to 18 years were diagnosed with T1DM at the Queen Silvia’s Children’s Hospital emergency clinic during this four year period. The participation rate was 99.7%. 26.4% of the children had no hereditary cardiovascular risk factors. 22.7 % had one risk factor and 18.8% had two risk factors. 14.8% had three risk factors. 9.7% had four risk factors and 7.5% had five risk factors or more. Conclusion: Among children with T1DM in Sweden there is a difference in hereditary cardiovascular risk factors. These results indicate that children with T1DM who also have increased hereditary cardiovascular risk factors should be monitored closely with early screening for functional and structural cardiovascular abnormalities. This is a very preliminary and ongoing study which will be complemented with the cardiovascular risk analysis among children without T1DM.

Keywords: children, type I diabetes, emergency clinic, CVD risk

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Authors: Ivana Kašparová, Emilie Pecharová

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The experience of radiological contamination of land, especially after the Chernobyl and Fukushima disasters have shown the need to explore possibilities to the capture of radionuclides in the area affected and to adapt the landscape management to this purpose ex –ante the considered accident in terms of prevention. The project‚ Minimizing the impact of radiation contamination on land in the emergency zone of Temelin NPP‘ (2012-2015), dealt with the possibility of utilization of wetlands as retention sites for water carrying radionuclides in the case of a radiation accident. A model artificial wetland was designed and adopted as a utility model by the Ministry of Industry and Trade of the Czech Republic. The article shows the conditions of construction of designed wetlands in the landscape with regard to minimizing the negative effect on agricultural production and enhancing the hydrological functionality of the landscape.

Keywords: artificial wetland, land use/ land cover, old maps, surface-to-water transport of radionuclides

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Authors: Siti Juryiah Mohd Khalid, Norazlina Dol

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Academic libraries in Malaysia are still not prepared for disaster even though several occasions have been reported. The study sets out to assess the current status of preparedness in disaster management among Malaysian academic libraries in the State of Selangor and the Federal Territory of Kuala Lumpur. To obtain a base level of knowledge on disaster preparedness of current practices, a questionnaire was distributed to chief librarians or their assignees in charge of disaster or emergency preparedness at 40 academic libraries and 34 responses were received. The study revolved around the current status of preparedness, on various issues including existence of disaster preparedness plan among academic libraries in Malaysia, disaster experiences by the academic libraries, funding, risk assessment activities and involvement of library staff in disaster management. Frequency and percentage tables were used in the analysis of the data collected. Some of the academic libraries under study have experienced one form of disaster or the other. Most of the academic libraries do not have a written disaster preparedness plan. The risk assessments and staff involvement in disaster preparedness by these libraries were generally adequate.

Keywords: academic libraries, disaster preparedness plan, disaster management, emergency plan

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Authors: Jansirani Natarajan, Mickael Antoinne Joseph

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The COVID-19 pandemic has interrupted face-to-face education and forced universities into an emergency remote teaching curriculum over a short duration. This abrupt transition in the Spring 2020 semester left both faculty and students without proper preparation for continuing higher education in an online environment. Online learning took place in different formats, including fully synchronous, fully asynchronous, and blended in our university through the e-learning platform MOODLE. Studies have shown that students’ engagement, is a critical factor for optimal online teaching. Very few studies have assessed online engagement with ERT during the COVID-19 pandemic. Purpose: Therefore, this study, sought to understand how the sudden transition to emergency remote teaching impacted nursing students’ engagement with online courses in a Middle Eastern public university. Method: A cross-sectional descriptive research design was adopted in this study. Data were collected through a self-reported online survey using Dixon’s online students’ engagement questionnaire from a sample of 177 nursing students after the ERT learning semester. Results The maximum possible engagement score was 95, and the maximum scores in the domains of skills engagement, emotional engagement, participation engagement, and performance engagement were 30, 25, 30, and 10 respectively. Dixson (2010) noted that a mean item score of ≥3.5 (total score of ≥66.5) represents a highly engaged student. The majority of the participants were females (71.8%) and 84.2% were regular BSN students. Most of them (32.2%) were second-year students and 52% had a CGPA between 2 and 3. Most participants (56.5%) had low engagement scores with ERT learning during the COVID lockdown. Among the four engagement domains, 78% had low engagement scores for the participation domain. There was no significant association found between the engagement and the demographic characteristics of the participants. Conclusion The findings supported the importance of engaging students in all four categories skill, emotional, performance, and participation. Based on the results, training sessions were organized for faculty on various strategies for engaging nursing students in all domains by using the facilities available in the MOODLE (online e-learning platform). It added value as a dashboard of information regarding ERT for the administrators and nurse educators to introduce numerous active learning strategies to improve the quality of teaching and learning of nursing students in the University.

Keywords: engagement, perception, emergency remote learning, COVID-19

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Authors: Mohammad H. Yarmohammadian, Reza Safdari, Mahmoud Keyvanara, Nahid Tavakoli

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One of the greatest challenges in disaster and emergencies is patient tracking. The concept of tracking has different denotations. One of the meanings refers to tracking patients’ physical locations and the other meaning refers to tracking patients ‘medical needs during emergency services. The main goal of patient tracking is to provide patient safety during disaster and emergencies and manage the flow of patient and information in different locations. In most of cases, there are not sufficient and accurate data regarding the number of injuries, medical conditions and their accommodation and transference. The objective of the present study is to survey on patient tracking issue in natural disaster and emergencies. Methods: This was a narrative study in which the population was E-Journals and the electronic database such as PubMed, Proquest, Science direct, Elsevier, etc. Data was gathered by Extraction Form. All data were analyzed via content analysis. Results: In many countries there is no appropriate and rapid method for tracking patients and transferring victims after the occurrence of incidents. The absence of reliable data of patients’ transference and accommodation, even in the initial hours and days after the occurrence of disasters, and coordination for appropriate resource allocation, have faced challenges for evaluating needs and services challenges. Currently, most of emergency services are based on paper systems, while these systems do not act appropriately in great disasters and incidents and this issue causes information loss. Conclusion: Patient tracking system should update the location of patients or evacuees and information related to their states. Patients’ information should be accessible for authorized users to continue their treatment, accommodation and transference. Also it should include timely information of patients’ location as soon as they arrive somewhere and leave therein such a way that health care professionals can be able to provide patients’ proper medical treatment.

Keywords: patient tracking, challenges, disaster, emergency

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Authors: Ashley L. Freeman, Jessica D. Watkins

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TeleEmergency Medicine (TeleEM) is an innovative approach leveraging virtual technology to deliver specialized emergency medical care across diverse healthcare settings, including internal acute care and critical access hospitals, remote patient monitoring, and nurse triage escalation, in addition to external emergency departments, skilled nursing facilities, and community health centers. TeleEM represents a significant advancement in the delivery of emergency medical care, providing healthcare professionals the capability to deliver expertise that closely mirrors in-person emergency medicine, exceeding geographical boundaries. Through qualitative research, the extension of timely, high-quality care has proven to address the critical needs of patients in remote and underserved areas. TeleEM’s service design allows for the expansion of existing services and the establishment of new ones in diverse geographic locations. This ensures that healthcare institutions can readily scale and adapt services to evolving community requirements by leveraging on-demand (non-scheduled) telemedicine visits through the deployment of multiple video solutions. In terms of financial management, TeleEM currently employs billing suppression and subscription models to enhance accessibility for a wide range of healthcare facilities. Plans are in motion to transition to a billing system routing charges through a third-party vendor, further enhancing financial management flexibility. To address state licensure concerns, a patient location verification process has been integrated through legal counsel and compliance authorities' guidance. The TeleEM workflow is designed to terminate if the patient is not physically located within licensed regions at the time of the virtual connection, alleviating legal uncertainties. A distinctive and pivotal feature of TeleEM is the introduction of the TeleEmergency Medicine Care Team Assistant (TeleCTA) role. TeleCTAs collaborate closely with TeleEM Physicians, leading to enhanced service activation, streamlined coordination, and workflow and data efficiencies. In the last year, more than 800 TeleEM sessions have been conducted, of which 680 were initiated by internal acute care and critical access hospitals, as evidenced by quantitative research. Without this service, many of these cases would have necessitated patient transfers. Barriers to success were examined through thorough medical record review and data analysis, which identified inaccuracies in documentation leading to activation delays, limitations in billing capabilities, and data distortion, as well as the intricacies of managing varying workflows and device setups. TeleEM represents a transformative advancement in emergency medical care that nurtures collaboration and innovation. Not only has advanced the delivery of emergency medicine care virtual technology through focus group participation with key stakeholders, rigorous attention to legal and financial considerations, and the implementation of robust documentation tools and the TeleCTA role, but it’s also set the stage for overcoming geographic limitations. TeleEM assumes a notable position in the field of telemedicine by enhancing patient outcomes and expanding access to emergency medical care while mitigating licensure risks and ensuring compliant billing.

Keywords: emergency medicine, TeleEM, rural healthcare, telemedicine

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Authors: S. Nasri, H. Bouziri

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Disasters are quite experienced in our days. They are caused by floods, landslides, and building fires that is the main objective of this study. To cope with these unexpected events, precautions must be taken to protect human lives. The emphasis on disposal work focuses on the resolution of the evacuation problem in case of no-notice disaster. The problem of evacuation is listed as a dynamic network flow problem. Particularly, we model the evacuation problem as an earliest arrival flow problem with load dependent transit time. This problem is classified as NP-Hard. Our challenge here is to propose a metaheuristic solution for solving the evacuation problem. We define our objective as the maximization of evacuees during earliest periods of a time horizon T. The objective provides the evacuation of persons as soon as possible. We performed an experimental study on emergency evacuation from the tunisian children’s hospital. This work prompts us to look for evacuation plans corresponding to several situations where the network dynamically changes.

Keywords: dynamic network flow, load dependent transit time, evacuation strategy, earliest arrival flow problem, tabu search metaheuristic

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Authors: Ridhish Kumar, Sudeep Nadukkandy, Anirban Roy

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The development of reverse osmosis happened in 1960. Along the years this technique has been widely accepted all over the world for varied applications ranging from seawater desalination to municipal water treatment. Forward osmosis (FO) is one of the foremost technologies for low energy consuming solutions for water purification. In this study, we have carried out a detailed analysis on selection, design, and pricing for a prototype of potable water system for purifying water in emergency situations. The portable and light purification system is envisaged to be driven by FO. This pouch will help to serve as an emergency water filtration device. The current effort employs a model to understand the interplay of permeability and area on the rate of purification of water from any impure source/brackish water. The draw solution for the FO pouch is considered to be a combination of salt and sugar such that dilution of the same would result in an oral rehydration solution (ORS) which is a boon for dehydrated patients. However, the effort takes an extra step to actually estimate the cost and pricing of designing such a prototype. While the mathematical model yields the best membrane (compositions are taken from literature) combination in terms of permeability and area, the pricing takes into account the feasibility of such a solution to be made available as a retail item. The product is envisaged to be a market competitor for packaged drinking water and ORS combination (costing around $0.5 combined) and thus, to be feasible has to be priced around the same range with greater margins in order to have a better distribution. Thus a proper business plan and production of the same has been formulated in order to be a feasible solution for unprecedented calamities and emergency situations.

Keywords: forward osmosis, water treatment, oral rehydration solution, prototype

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Authors: Anne T. Herr, Clemens Lorei

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Employees of organizations with security tasks, such as emergency services, public order services, or police forces, work every day to ensure people's safety. Violence against police is, therefore, a relevant topic both socially and politically. An increase in violence is often discussed without there being any verifiable and generally valid data. So far, scientific research has mainly focused on offender characteristics and crime statistics. These surveys are mostly subjective, retrospective, and neglect the dynamics and interactions in concrete violent situations. Therefore, more recent research methods attempt to capture the issue of violence against emergency forces more comprehensively. However, the operationalization of the constructs and the methodological approach pose particular challenges. This contribution provides an overview of new perspectives on the understanding of violent assaults and identifies current research gaps. In addition, a new research project of the Hessian University of Police and Administration in Germany is presented. In the 'AMBOSafe' study, different theoretical backgrounds for understanding violence against police and emergency services personnel will be combined in order to capture as many different perspectives of violent assaults as possible in a multimodal research approach. In a retrospective as well as in a longitudinal survey, the conditions of escalation dynamics in the assaults are recorded and supplemented by the current and valid prevalence of physical and verbal assaults in a period of four months. In addition, qualitative interviews with those affected will be used to record more detailed descriptions of and the feelings during the assaults, as well as possible causes and connections between the different groups of people. In addition to the reports of the police forces, the motives of the attackers will be collected and supplemented by analyzing the criminal case files. This knowledge can contribute to a more comprehensive understanding of violent assaults against police forces in order to be able to derive scientifically based preventive measures.

Keywords: assaults, crime statistics, escalation dynamics, police

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Authors: Christopher Oyediran, Nicola Ubayasiri, Christopher Gough

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Splenic artery aneurysms are often clinically occult, occasionally identified incidentally with imaging. The pathogenesis of aneurysms is complex, but certain factors are thought to contribute to their development. Given the potential fatal complications of rupture, a high index of suspicion is required to make an early diagnosis. We present a case of a 36-year-old female with a history of endometriosis and multiple sclerosis who presented to the Emergency Department with sudden onset epigastric pain and collapse. On arrival, she was pale and clammy with profound tachycardia and hypotension. An ultrasound done in the resuscitation department revealed abdominal free fluid. She was resuscitated with blood and transferred for emergent laparotomy. Laparotomy revealed massive haemoperitoneum from the spleen. She underwent emergency splenectomy and inspection of the spleen revealed a splenic artery aneurysm. She received our massive transfusion protocol followed by a short stay on ITU, making a good post-operative recovery and was discharged home a week later.

Keywords: aneurysm, human chorionic gonadotrophin (hCG), resuscitation, laparotomy

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Authors: Visith Siriphuwanun, Yodying Punjasawadwong, Suwinai Saengyo, Kittipan Rerkasem

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Objective: To determine incidences and factors associated with perioperative cardiac arrest in trauma patients who received anesthesia for emergency surgery. Design and setting: Retrospective cohort study in trauma patients during anesthesia for emergency surgery at a university hospital in northern Thailand country. Patients and methods: This study was permitted by the medical ethical committee, Faculty of Medicine at Maharaj Nakorn Chiang Mai Hospital, Thailand. We clarified data of 19,683 trauma patients receiving anesthesia within a decade between January 2007 to March 2016. The data analyzed patient characteristics, traumas surgery procedures, anesthesia information such as ASA physical status classification, anesthesia techniques, anesthetic drugs, location of anesthesia performed, and cardiac arrest outcomes. This study excluded the data of trauma patients who had received local anesthesia by surgeons or monitoring anesthesia care (MAC) and the patient which missing more information. The factor associated with perioperative cardiac arrest was identified with univariate analyses. Multiple regressions model for risk ratio (RR) and 95% confidence intervals (CI) were used to conduct factors correlated with perioperative cardiac arrest. The multicollinearity of all variables was examined by bivariate correlation matrix. A stepwise algorithm was chosen at a p-value less than 0.02 was selected to further multivariate analysis. A P-value of less than 0.05 was concluded as statistically significant. Measurements and results: The occurrence of perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was 170.04 per 10,000 cases. Factors associated with perioperative cardiac arrest in trauma patients were age being more than 65 years (RR=1.41, CI=1.02–1.96, p=0.039), ASA physical status 3 or higher (RR=4.19–21.58, p < 0.001), sites of surgery (intracranial, intrathoracic, upper intra-abdominal, and major vascular, each p < 0.001), cardiopulmonary comorbidities (RR=1.55, CI=1.10–2.17, p < 0.012), hemodynamic instability with shock prior to receiving anesthesia (RR=1.60, CI=1.21–2.11, p < 0.001) , special techniques for surgery such as cardiopulmonary bypass (CPB) and hypotensive techniques (RR=5.55, CI=2.01–15.36, p=0.001; RR=6.24, CI=2.21–17.58, p=0.001, respectively), and patients who had a history of being alcoholic (RR=5.27, CI=4.09–6.79, p < 0.001). Conclusion: Incidence of perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was very high and correlated with many factors, especially age of patient and cardiopulmonary comorbidities, patient having a history of alcoholic addiction, increasing ASA physical status, preoperative shock, special techniques for surgery, and sites of surgery including brain, thorax, abdomen, and major vascular region. Anesthesiologists and multidisciplinary teams in pre- and perioperative periods should remain alert for warning signs of pre-cardiac arrest and be quick to manage the high-risk group of surgical trauma patients. Furthermore, a healthcare policy should be promoted for protecting against accidents in high-risk groups of the population as well.

Keywords: perioperative cardiac arrest, trauma patients, emergency surgery, anesthesia, factors risk, incidence

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Authors: Hancy Issac, Gerben Keijzers, Ian Yang, Clint Moloney, Jackie Lea, Melissa Taylor

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Introduction: Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD. Aim: The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED. Methods: This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator. Results: The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively. Conclusion: Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence.

Keywords: COPD, electronic proforma, modified delphi study, interdisciplinary, guideline adherence, COPD-X plan

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Authors: Saeed Abbasi, Davood Farsi, Soudabeh Shafiee Ardestani, Neda Valizadeh

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Objectives: Peripheral vertigo is a common complaint of patients who are visited in emergency departments. In our study, we wanted to evaluate the effect of betahistine as an oral drug vs. intravenous diazepam for the treatment of acute peripheral vertigo. We also wanted to see the possibility of substitution of parenteral drug with an oral one with fewer side effects. Materials and Methods: In this randomized, double-blind study, 101 patients were enrolled in the study. The patients were divided in two groups in a double-blind randomized manner. Group A took oral placebo and 10 mg of intravenous diazepam. Group B received 8mg of oral betahistine and intravenous placebo. Patients’ symptoms and signs (Vertigo severity, Nausea, Vomiting, Nistagmus and Gate) were evaluated after 0, 2, 4, 6 hours by emergency physicians and data were collected by a questionnaire. Results: In both groups, there was significant improvement in vertigo (betahistine group P=0.02 and Diazepam group P=0.03). Analysis showed more improvement in vertigo severity after 4 hours of treatment in betahistine group comparing to diazepam group (P=0.02). Nausea and vomiting were significantly lower in patients receiving diazepam after 2 and 6 hours (P=0.02 & P=0.03).No statistically significant differences were found between the groups in nistagmus, equilibrium & vertigo duration. Conclusion: The results of this randomized trial showed that both drugs had acceptable therapeutic effects in peripheral vertigo, although betahistine was significantly more efficacious after 4 hours of drug intake. As for higher nausea and vomiting in betahistine group, physician should consider these side effects before drug prescription.

Keywords: acute peripheral vertigo, betahistine, diazepam, emergency department

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Authors: U. K. Tamuli

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Introduction: North East India is graced with natural beauty and hazards. This area is prone to major earthquakes, floods, landslides, accidents, terrorist activities etc. Academy of Trauma (AOT), an NGO of Doctors, conducts training programs, mock drills, field trials amongst the doctors and paramedics in North East India. The present study is to evaluate the efficacy of such training in terms of sensitivity, awareness, and delivery systems of the products. Here the health care delivery system for disaster management is inadequate. Clear guideline of mass casualty management is unavailable. AOT has initiated steps to increase the awareness and handling of mass casualty management to improve the emergency health care delivery system. Method: AOT has conducted training programmes on emergency health management, mass casualty management and hospital preparedness amongst 800 doctors and 1200 paramedics in twenty-two districts of Assam in Northeast India. The training module consists of lectures, hands-on workshop using manikins, mock drills, distribution of manuals, emergency management exercises, periodic exchange of experience and debriefings. AOT evaluates the impact of these trainings by conducting pre and post tests of delegates, trainer’s evaluation, delegate’s satisfaction and confidence level and their suggestions. Results: The module, training, hands-on workshops, mock drills were highly appreciated. There is significant improvement in scores on the post-training tests. The confidence level of the participants has risen to deal with emergency medical situation Conclusion: These kinds of trainings increase the awareness of the medical members to handle mass casualties in different situations. One such training actually sensitises the delegates. Repetition of such training, TOT (Training-of-Trainers) programs, and individual efforts of delegates are extremely important for sustenance and success of health care delivery service during disasters in the developing countries. Further collaboration, assistance, networking, suggestions from established global agencies in this field will be highly appreciated.

Keywords: capacity building, North East India, non-governmental organization, trauma

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Authors: Latif Duran, Erdem Aydin, Ahmet Baydin, Ali Kemal Erenler, Iskender Aksoy

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Aim: In this retrospective study, we aim to contribute to the literature by presenting the proposals for taking measures to reduce the mortality by examining the demographic characteristics of the pediatric age group patients presenting with trauma and the factors that may cause mortality Material and Method: This study has been performed by retrospectively investigating the data obtained from the patient files and the hospital automation registration system of the pediatric trauma patients who applied to the Adult Emergency Department of the Ondokuz Mayıs University Medical Faculty between January 1, 2016, and December 31, 2016. Results: 289 of 415 patients involved in our study, were males. The median age was 11.3 years. The most common trauma mechanism was falling from the high. A significant statistical difference was found on the association between trauma mechanisms and gender. An increase in the number of trauma cases was found especially in the summer months. The study showed that thoracic and abdominal trauma was relevant to the increased mortality. Computerized tomography was the most common diagnostic imaging modality. The presence of subarachnoid hemorrhage has increased the risk of mortality by 62.3 fold. Eight of the patients (1.9%) died. Scoring systems were statistically significant to predict mortality. Conclusion: Children are vulnerable to trauma because of their unique anatomical and physiological differences compared to adult patient groups. It will be more successful in the mortality rate and in the post-traumatic healing process by administering the patient triage fast and most appropriate trauma centers in the prehospital period, management of the critical patients with the scoring systems and management with standard treatment protocols

Keywords: emergency service, pediatric patients, scoring systems, trauma, age groups

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Authors: A. Kourou, A. Ioakeimidou, S. Hadjiefthymiades, V. Abramea

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During the last decades, the task of engaging governments, communities and citizens to reduce risk and vulnerability of the populations has made variable progress. Experience has demonstrated that lack of awareness, education and preparedness may result in significant material and other losses both on the onset of the disaster. Schools play a vital role in the community and are important elements of values and culture of the society. A proper school education not only teaches children, but also is a key factor in the promotion of a safety culture into the wider community. In Greece School Earthquake Safety Initiative has been undertaken by Earthquake Planning and Protection Ogranization with specific actions (seminars, lectures, guidelines, educational material, campaigns, national or EU projects, drills etc.). The objective of this initiative is to develop disaster-resilient school communities through awareness, self-help, cooperation and education. School preparedness requires the participation of Principals, teachers, students, parents, and competent authorities. Preparation and earthquake readiness involves: a) learning what should be done before, during, and after earthquake; b) doing or preparing to do these things now, before the next earthquake; and c) developing teachers’ and students’ skills to cope efficiently in case of an earthquake. In the above given framework this paper presents the results of a survey aimed to identify the level of education and preparedness of school community in Greece. More specifically, the survey questionnaire investigates issues regarding earthquake protection actions, appropriate attitudes and behaviors during an earthquake and existence of contingency plans at elementary and secondary schools. The questionnaires were administered to Principals and teachers from different regions of the country that attend the EPPO national training project 'Earthquake Safety at Schools'. A closed-form questionnaire was developed for the survey, which contained questions regarding the following: a) knowledge of self protective actions b) existence of emergency planning at home and c) existence of emergency planning at school (hazard mitigation actions, evacuation plan, and performance of drills). Survey results revealed that a high percentage of teachers have taken the appropriate preparedness measures concerning non-structural hazards at schools, emergency school plan and simulation drills every year. In order to improve the action-planning for ongoing school disaster risk reduction, the implementation of earthquake drills, the involvement of students with disabilities and the evaluation of school emergency plans, EPPO participates in E-PreS project. The main objective of this project is to create smart tools which define, simulate and evaluate all hazards emergency steps customized to the unique district and school. The project comes up with a holistic methodology using real-time evaluation involving different categories of actors, districts, steps and metrics. The project is supported by EU Civil Protection Financial Instrument with a duration of two years. Coordinator is the Kapodistrian University of Athens and partners are from four countries; Greece, Italy, Romania and Bulgaria.

Keywords: drills, earthquake, emergency plans, E-PreS project

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Authors: Jordan Daud, Satriya Wibawa, Wahyu Wardhana

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In the summer of 2014, the leaders of the Islamic State of Iraq and Syria proclaimed the founding of religious-political system known as the caliphate which titled Islamic State (IS). As Caliph, Abu Bakr Baghdadi advocated Jihad from the Ummah (the Muslim community) to defend the Islamic state from unbelievers. This call for Jihad by IS had encouraged some radical organization in Southeast Asia pledge allegiance to IS and established bases for IS operation in Southeast Asia. This development had increased security concern for possible terrorism action in Southeast Asia, which currently not very active due to counterterrorism efforts from ASEAN member states and its cooperation with the world. This paper firstly tries to draw understanding from Ulema (Muslim cleric) about the conception of caliphate and Jihad based on Quran and Hadith. Secondly, this paper will elaborate counterterrorism efforts from ASEAN countries to prevent radicalization and terrorism act in addressing the call for jihad to establish IS in Southeast Asia. The third, this paper will recommend the role of the social community, especially Ulema, in Southeast Asia to prevent the misunderstanding of Jihad which usually used by terrorist to justify their action. Hopefully, this social community role will decrease the radicalization of Muslim community in Southeast Asia alongside with the counterterrorism efforts to create secure and stable ASEAN community based on shared norm and values.

Keywords: caliphate, jihad, ASEAN, counterterrorism, social community

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Authors: Breanna Wright, Peter Bragge

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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.

Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error

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Authors: G. Kaushik, A. Gupta, S. Lalwani, K. D. Soni, S. Kumar, S. Sagar

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Objective: Alcohol is a leading risk factor associated with the disability and death due to RTI. Present study aims to demonstrate the demographic profile, injury pattern, physiological parameters of victims of trauma following alcohol consumption arriving in the emergency department (ED) and mortality in alcohol intoxicated trauma patients admitted to Apex Trauma Center in Delhi. Design and Methods: Present study was performed in randomly selected 182 alcohol breath analyzer tested RTI patients from the emergency department of Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences, New Delhi for over a period of 3 months started from September 2013 to November 2013. Results: A total 182 RTI patients with blunt injury were selected between 30-40 years of age and equally distributed to male and female group. Of these, 93 (51%) were alcohol negative and 89 (49%) were alcohol positive. In 89 alcohol positive patients, 47 (53%) had Artificial Airway as compared to 17 (18%), (p < 0.001) in the other group. The Glasgow Coma Scale (GCS) score was lower (p < 0.001) and higher Injury Severity Score (ISS) was observed in alcohol positive group as compared to other group (p < 0.03). Increased number of patients (58%) were admitted to Intensive Care Unit (ICU), in alcohol positive group (p < 0.001) and they were in ICU for longer time compare to other group (p < 0.001). The alcohol positive patients were on ventilator support for longer duration as compared to non-alcoholic group (p < 0.001). Mortality rate was higher in alcohol intoxicated patients as compared to non-alcoholic RTI patients, however, the difference was not statistically significant. Conclusion: This study revealed that GCS, mean ISS, ICU stay, ventilation time etc. might have considerable impact on mortality in alcohol intoxicated patients as compared to non-alcoholic group.

Keywords: road traffic injuries, alcohol, trauma, emergency department

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Authors: Mohamed Hendawy Mousa, Warda Youssef Mohamed Morsy

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Background: Sepsis is a major cause of mortality and morbidity in trauma patients. Body mass index as an indicator of nutritional status was reported as a predictor of injury pattern and complications among critically ill injured patients. Aim: The aim of this study is to investigate the relationship between body mass index and the development of sepsis, systemic inflammatory response syndrome among adult trauma patients at emergency hospital - Cairo University. Research design: Descriptive correlational research design was utilized in the current study. Research questions: Q1. What is the body mass index profile of adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?, Q2. What is the frequency of systemic inflammatory response syndrome and sepsis among adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?, and Q3. What is the relationship between the development of sepsis, systemic inflammatory response syndrome and body mass index among adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?. Sample: A purposive sample of 52 adult male and female trauma patients with revised trauma score 10 to 12. Setting: The Emergency Hospital affiliated to Cairo University. Tools: Four tools were utilized to collect data pertinent to the study: Socio demographic and medical data tool, Systemic inflammatory response syndrome assessment tool, Revised Trauma Score tool, and Sequential organ failure assessment tool. Results: The current study revealed that, (61.5 %) of the studied subjects had normal body mass index, (25 %) were overweight, and (13.5 %) were underweight. 84.6% of the studied subjects had systemic inflammatory response syndrome and 92.3% were suffering from mild sepsis. No significant statistical relationship was found between body mass index and occurrence of Systemic inflammatory response syndrome (2= 2.89 & P = 0.23). However, Sequential organ failure assessment scores were affected significantly by body mass index was found mean of initial and last Sequential organ failure assessment score for underweight, normal and obese where t= 7.24 at p = 0.000, t= 16.49 at p = 0.000 and t= 9.80 at p = 0.000 respectively. Conclusion: Underweight trauma patients showed significantly higher rate of developing sepsis as compared to patients with normal body weight and obese. Recommendations: based on finding of this study the following are recommended: replication of the study on a larger probability sample from different geographical locations in Egypt; Carrying out of further studies in order to assess the other risk factors influencing trauma outcome and incidence of its complications; Establishment of standardized guidelines for managing underweight traumatized patients with sepsis.

Keywords: body mass index, sepsis, systemic inflammatory response syndrome, adult trauma

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