Search results for: emergency department

Authors: Faranak Omidian

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This study has been carried out to examine the status of architecture department at bachelor's level of engineering architecture in Islamic Azad University of Dezful in 2012-13 academic year. The present research is a descriptive cross sectional study and in terms of measurement, it is descriptive and analytical, which was done based on 7 steps and in 7 areas with 32 criteria and 169 indicators. The sample includes 201 students, 14 faculty members, 72 graduates and 39 employers. Simple random sampling method, complete enumeration method, network sampling (snowball sampling) were used for students, faculty members and graduates respectively. All sample responded to the questions. After data collection, the findings were ranked on Likert scale from desirable to undesirable with the scores ranging from 1 to 3.The results showed that the department with a score of 1.88 in regard to objectives, organizational status, management and organizations, with a score of 2 in relation to students, with a score of 1.8 in regard to faculty members was in a relatively desirable status. Regarding training courses and curriculum, it gained a score of 2.33 which indicates the desirable status of the department in this regard. It gained scores of 1.75, 2, and 1.8 with respect to educational and research facilities and equipment, teaching and learning strategies, and graduates respectively, all of which shows the relatively desirable status of the department. The results showed that the department of architecture, with an average score of 2.14 in all evaluated areas, was in a desirable situation. Therefore, although the department generally has a desirable status, it needs to put in more effort to tackle its weaknesses and shortages and corrects its defects in order to promote educational quality, taking to the desirable level.

Keywords: internal evaluation, architecture department in Islamic, Azad University, Dezful

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Authors: Nicolas Koslover, Tamara Levene

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Aims: Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management. Methods: All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score (CENTOR or FEVERPain score) was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later. Results: Over the study period, 49 patients were included; only 35% (n=17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n=19) were treated with antibiotics. Of these, 63% (n=12) should not have been prescribed an antibiotic and 37% (n=7) were prescribed an inappropriate antibiotic. At re-audit, (n=50 cases), 58% (n=29) had a clinical score documented and 28% (n=14) were treated with antibiotics. Of these, 29% (n=4) should not have been prescribed antibiotics and 21% (n=3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs. 29%, p=0.026). Conclusions: A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.

Keywords: tonsilitis, education, emergency medicine, ENT

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Authors: Neslihan Cetin

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In this study, we will aim to analyze how the period of the state of emergency in Turkey lead to gaps in law and the formation of areas in which there was a complete lack of supervision. The state of emergency that was proclaimed following the coup attempt of July 15, 2016, continued until July 18, 2018, that is to say, 2 years, without taking into account whether the initial circumstances persisted. As part of this work, we claim that the state of emergency provided the executive power with important tools for governing, which it took constant use. We can highlight how the concern for security at the center of the basic considerations of the people in a city was exploited as a foundation by the military power in Turkey to interfere in the political, legal, and social spheres. The constitutions of 1924, 1961, and 1982 entrusted the army with the role of protector of the integrity of the state. This became an instrument at the hands of the military to legitimize their interventions in the name of public security. Its interventions in the political field are indeed politically motivated. The constitution, the legislative, and regulatory systems are modified and monopolized by the military power that dominates the legislative, regulatory, and judicial power, leading to a state of exception. With the political convulsions over a decade, the government was able to usurp the instrument called the state of exception. In particular, the decree-laws of the state of emergency, which the executive makes frequent and generally abusive use, became instruments in the hands of the government to take measures that it wishes to escape from the rules and the pre-established control mechanisms. Thus the struggle against the political opposition becomes more unbalanced and destructive. To this must also be added the ineffectiveness of ex-post controls and domestic remedies. This research allows us to stress how a legal concept, such as ‘the state of emergency’ can be politically exploited to make it a legal weapon that continues to produce victims.

Keywords: constitutional law, state of emergency, rule of law, instrumentalization of law

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Authors: Delna Shroff

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Merchant shipping is an occupation with a high rate of fatal injuries caused by organizational accidents and maritime disasters. In most accident investigations, the leader’s actions are under scrutiny and point out the necessity to investigate the leader’s decisions in critical conditions. While several leadership studies have been carried out in the past, there is a tendency for most research to focus on holders of formal positions. The unit of analysis in most studies has been the ‘individual.’ A need is, therefore, felt to adopt a practice-based perspective of leadership, understand how leadership emerges to affect maritime safety. This paper explores the phenomenon of distributed leadership among seafarers more holistically. It further examines the role of one form of distributed leadership, that is, planfully aligned leadership in the emergency response of the team. A mixed design will be applied. In the first phase, the data gathered by way of semi-structured interviews will be used to explore the seafarer’s implicit understanding of leadership. The data will be used to develop a conceptual framework of distributed leadership, specific to the maritime context. This framework will be used to develop a simulation. Experimental design will be used to examine the relationship between planfully aligned leadership and emergency response of the team members during navigation. Findings show that planfully aligned leadership significantly and positively predicts the emergency response of team members. Planfully aligned leadership leads to a better emergency response of the team members as compared to authoritarian leadership. In the third qualitative phase, additional data will be gathered through semi-structured interviews to further validate the findings to gain a more complete understanding of distributed leadership and its relation to emergency response. Above are the predictive results; the study expects to be a cornerstone of safety leadership research and has important implications for leadership development and training within the maritime industry.

Keywords: authoritarian leadership, distributed leadership, emergency response , planfully aligned leadership

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Authors: Tamer Mohamed Atef

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The tourism and hospitality education is a branch of the overall tourism and hospitality industry that is dedicated to providing the industry with well-educated, well-trained, skilled, enthusiastic and committed workforce. The Tourism Department at the College of Arts and Social Sciences (Sultan Qaboos University), Oman, has been providing the Omani society with undergraduate tourism and hospitality educational services since Fall 2001. Despite the fact that Tourism Department graduates are not facing any employment concerns, fluctuation in the number of enrollees and graduates, however, has been a significant characteristic since the inception of the program. To address this concern, several tactical and strategic decisions have been made, notably that the program has received accreditation from two prestigious international accreditation institutions, which mark two major milestones in the educational journey of the Tourism Department. The current study, thus, aims to provide a tourism and hospitality education efficiency management model. To achieve this aim, the following objectives were identified: to analyze students in - graduates out matrix, and to assess graduates’ employment trends. A survey was conducted to assess the current employment status of the department graduates. Secondary data were collected from Deanship of Admission and Registration statistical reports on the Tourism Department. Data were tabulated and analyzed in such a way that set forth the major findings from the survey and the secondary data. This study sheds light on the educational system created and followed by the Tourism Department, in an effort to provide a tourism and hospitality education efficiency management model, that would help educators and administrators better manage their programs.

Keywords: tourism, hospitality, education, students, graduates, employability, indicators

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Authors: Sophie Kroeling, Agnetha Schuchardt

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Striving for sustainability brings a lot of challenges for different fields of interest, e. g. security or health concerns. In Germany, civil protection is predominantly carried out by emergency responders who perform essential tasks of civil protection. Based on theoretical concepts of different psychological stress theories this contribution focuses on the question, how the resilience of emergency responders can be improved. The goal is to identify resources and successful coping strategies that help to prevent and reduce negative outcomes during or after stressful events. The paper will present results from a qualitative analysis of semi-structured qualitative interviews with 20 emergency responders. These results provide insights into the complexity of coping processes (e. g. controlling the situation, downplaying perceived personal threats through humor) and show the diversity of stressors (like complexity of the disastrous situation, intrusive press and media, or lack of social support within the organization). Self-efficacy expectation was a very important resource for coping with stressful situations. The results served as a starting point for a quantitative survey (that was conducted in March 2017), the development of education and training tools for emergency responders and the improvement of critical incident stress management processes. First results from the quantitative study with more than 700 participants show that, e. g., the emergency responders use social coping within their private social network and also within their aid organization and that both are correlated to resilience. Moreover, missing information, bureaucratic problems and social conflicts within the organization are events that the majority of the participants considered very onerous. Further results from regression analysis will be presented. The proposed paper will combine findings from the qualitative study with the quantitative results, illustrating figures and correlations with respective statements from the interviews. At the end, suggestions for the improvement of the emergency responder’s resilience are given and it is discussed how this can make a contribution to strive for civil security and furthermore a sustainable development.

Keywords: civil security, emergency responders, stress, resilience, resources

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Authors: Osama Moustafa Zayed

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Aim of the work: To evaluate the effectiveness of venous glucose, levels of serum lactate and base deficit in polytraumatized patients as simple parameters to predict the mortality in these patients. Compared to the predictive value of Trauma and injury severity (TRISS) and Acute Physiology And Chronic Health Evaluation IV (APACHE IV). Introduction: Trauma is a serious global health problem, accounting for approximately one in 10 deaths worldwide. Trauma accounts for 5 million deaths per year. Prediction of mortality in trauma patients is an important part of trauma care. Several trauma scores have been devised to predict injury severity and risk of mortality. The trauma and injury severity score (TRISS) was most common used. Regardless of the accuracy of trauma scores, is based on an anatomical description of every injury and cannot be assigned to the patients until a full diagnostic procedure has been performed. So we hypothesized that alterations in admission glucose, lactate levels and base deficit would be an early and easy rapid predictor of mortality. Patient and Method: a comparative cross-sectional study. 282 Polytraumatized patients attended to the Emergency Department(ED) of the Suez Canal university Hospital constituted. The period from 1/1/2012 to 1/4/2013 was included. Results: We found that the best cut off value of TRISS probability of survival score for prediction of mortality among poly-traumatized patients is = 90, with 77% sensitivity and 89% specificity using area under the ROC curve (0.89) at (95%CI). APACHE IV demonstrated 67% sensitivity and 95% specificity at 95% CI at cut off point 99. The best cutoff value of Random Blood Sugar (RBS) for prediction of mortality was>140 mg/dl, with 89%, sensitivity, 49% specificity. The best cut off value of base deficit for prediction of mortality was less than -5.6 with 64% sensitivity, 93% specificity. The best cutoff point of lactate for prediction of mortality was > 2.6 mmol/L with 92%, sensitivity, 42% specificity. Conclusion: According to our results from all evaluated predictors of mortality (laboratory and scores) and mortality based on the estimated cutoff values using ROC curves analysis, the highest risk of mortality was found using a cutoff value of 90 in TRISS score while with laboratory parameters the highest risk of mortality was with serum lactate > 2.6 . Although that all of the three parameter are accurate in predicting mortality in poly-traumatized patients and near with each other, as in serum lactate the area under the curve 0.82, in BD 0.79 and 0.77 in RBS.

Keywords: APACHE IV, emergency department, polytraumatized patients, serum lactate

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Authors: Michael Zhang, Nicholas Marriage, Valerie Astle, Marie-Louise Ratican, Jonathan Ash, Haddijatou Hughes

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Objective: Young infants are often brought to the Emergency Department (ED) with a variety of complaints, some of them are non-specific and present as a diagnostic challenge to the attending clinician. Whilst invasive investigations such as blood tests and lumbar puncture are necessary in some cases to exclude serious infections, some basic clinical tools in additional to thorough clinical history can be useful to assess the risks of serious conditions in these young infants. This study aimed to examine the utilization of one of clinical tools in this regard. Methods: This retrospective observational study examined the medical records of infants under 6 months presenting to a mixed urban ED between January 2013 and December 2014. The infants deemed to have non-specific complaints or diagnoses by the emergency clinicians were selected for analysis. The ones with clear systemic diagnoses were excluded. Among all relevant clinical information and investigation results, utilization of Standard Paediatric Observation Chart (SPOC) was particularly scrutinized in these medical records. This specific chart was developed by the expert clinicians in local health department. It categorizes important clinical signs into some color-coded zones as a visual cue for serious implication of some abnormalities. An infant is regarded as SPOC positive when fulfills 1 red zone or 2 yellow zones criteria, and the attending clinician would be prompted to investigate and treat for potential serious conditions accordingly. Results: Eight hundred and thirty-five infants met the inclusion criteria for this project. The ones admitted to the hospital for further management were more likely to have SPOC positive criteria than the discharged infants (Odds ratio: 12.26, 95% CI: 8.04 – 18.69). Similarly, Sepsis alert criteria on SPOC were positive in a higher percentage of patients with serious infections (56.52%) in comparison to those with mild conditions (15.89%) (p < 0.001). The SPOC sepsis criteria had a sensitivity of 56.5% (95% CI: 47.0% - 65.7%) and a moderate specificity of 84.1% (95% CI: 80.8% - 87.0%) to identify serious infections. Applying to this infant population, with a 17.4% prevalence of serious infection, the positive predictive value was only 42.8% (95% CI: 36.9% - 49.0%). However, the negative predictive value was high at 90.2% (95% CI: 88.1% - 91.9%). Conclusions: Standard Paediatric Observation Chart has been applied as a useful clinical tool in the clinical practice to help identify and manage young sick infants in ED effectively.

Keywords: clinical tool, infants, non-specific complaints, Standard Paediatric Observation Chart

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Authors: S. M. Amin Hosseini, Ana Blanco, Albert De La Fuente, Sergio Cavalaro

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In emergency situations, it is fundamental to provide with a safe shelter to the population affected. However, the lack of resources and short time often represent a barrier difficult to overcome. A sustainable, rapid and low-cost construction technique is earthbag construction. This technique has spread as an alternative to the construction of emergency shelter, social housing, and even ecovillages. The earthbag construction consists of introducing soil in degradable bags that are stacked to form adobe structures. The present study aims to assess characteristics of the earthbag construction technique based on sustainability requirements and features of other methods used for temporary housing. In this case, after defining the sustainability criteria and emergency situation necessities, this study compares earthbag construction with other types of prefabricated temporary housing. Finally, the most suitable conditions for applying this technique based on the particular local properties and second life scenarios of superadobe temporary housing. The results of the study contribute to promote the earthbag and superadobe techniques as sustainable alternatives for temporary housing. However, the sustainability index of this technology highly depends on affected local conditions and characteristics. Consequently, in order to achieve a high sustainability index, emergency managers need to decide about this technology based on the highlighted results of this study, attention to the importance of specific local conditions and next functions of temporary housing.

Keywords: temporary housing, temporary shelter, earthbag, superadobe, sustainability, emergency

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Authors: Ajay Kumar Yadav, Masum Paudel, Ritesh Chaudhary

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Background: Understanding the diagnosis and the treatment plan is very important for the patient which reflects the effectiveness of the patient care as well as counseling. Large groups of patients do not understand their emergency care plan or their discharge instructions. With only a little more than 2/3ʳᵈ of the adult population is literate and poorly distributed health service institutions in Nepal, exploring the current status of patient understanding of their diagnosis and treatment would help identify interventions to improve patient compliance with the provided care and the treatment outcomes. Objectives: This study was conducted to identify and describe the areas of patients’ understanding and confusion regarding emergency care and discharge instructions at the Emergency ward of B. P. Koirala Institute of Health Sciences teaching hospital, Dharan, Nepal. Methods: A cross-sectional study was conducted among 426 patients discharged from the emergency unit of BPKIHS. Cases who are leaving against medical advice absconded cases and those patients who came just for vaccination are excluded from the study. Patients’ understanding of the treatment plan and diagnosis was measured. Results: There were 60% men in this study. More than half of the participants reported not being able to read English. More than 90% of the respondents reported they could not read their prescription at all. While patient could point out their understanding of their diagnosis at discharge, most of them could not tell the names and the dosage of all the drugs prescribed to them at discharge. More than 95% of the patients could not tell the most common side effects of the drugs that they are prescribed. Conclusions: There is a need to further explore the factors influencing the understanding of the patients regarding their treatment plan. Interventions to understand the health literacy needs and ways to improve the health literacy of the patients are needed.

Keywords: discharge instruction, emergency ward, health literacy, treatment plan

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Authors: Jihene Jlassi, Ahmed Frikha, Wazna Kortli

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The objectives of Nurse-Patient Assignment are the minimization of the overall hospital cost and the maximization of nurses ‘preferences. This paper aims to assess nurses' satisfaction related to the implementation of patient acuity tool-based assignments. So, we used an integer linear program that assigns patients to nurses while balancing nurse workloads. Then, the proposed model is applied to the Paediatrics Department at Kasserine Hospital Tunisia. Where patients need special acuities and high-level nursing skills and care. Hence, numerical results suggested that proposed nurse-patient assignment models can achieve a balanced assignment

Keywords: nurse-patient assignment, mathematical model, logistics, pediatrics department, balanced assignment

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Authors: Novawiguna Kemalasari, Ahmad Badawi Saluy

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This research is a planned activity to find an objective answer to PT XYZ problem through scientific procedure. In this study, It was used quantitative research methods by using samples taken from a department selected by researchers. This study aims to analyze the influence of organizational culture, work discipline and work motivation on employee performance of Personal Care & Cosmetic Department (PCC) Flammable PT XYZ. This research was conducted at PT XYZ Personal Care & Cosmetic Department (PCC) Flammable involving 82 employees as respondents, the data were obtained by using questionnaires filled in self-rating by respondents. The data were analyzed by multiple linear regression model processed by using SPSS version 22. The result of research showed that organizational culture variable, work discipline and work motivation had significant effect to employee performance.

Keywords: organizational culture, work discipline, employee motivation, employees performance

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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Authors: Maeng-Hwan Hyun, Dae-Man Do, Young-Bok Choi

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Around the world, there are frequent incidents of natural disasters, such as earthquakes, tsunamis, floods, and snowstorms, as well as man made disasters such as fires, arsons, and acts of terror. These diverse and unpredictable adversities have resulted in a number of fatalities and injuries. If disaster occurrence can be assessed quickly and information such as the exact location of the disaster and evacuation routes can be provided, victims can promptly move to safe locations, minimizing losses. This paper proposes a behavior analysis method based on a nine degrees-of-freedom (9-DOF) sensor that is effective for the emergency rescue evacuation support system (ERESS), which is being researched with an objective of providing evacuation support during disasters. Based on experiments performed using the acceleration sensor and the gyroscope sensor in the 9-DOF sensor, data are analyzed for human behavior regarding stationary position, walking, running, and during emergency situation to suggest guidelines for system judgment. Using the results of the experiments performed to determine disaster occurrence, it was confirmed that the proposed method quickly determines whether a disaster has occurred.

Keywords: behavior analysis, nine degrees of freedom sensor, emergency rescue, disaster

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Authors: Mohammed Abdurabu, Akram Al-Warqi, Ebrahim M. A. Ebrahim, Jouhar Kollari, Salman Mirza

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The novel coronavirus (COVID-19) is one of the most recent pandemics that invaded earth that left and still leaving hundreds of thousands of patients and ended with high morbidity and mortality rates with no clear cure till this moment. COVID-19 has been proven to be associated with pathologic changes in coagulation, characterized by either thromboembolic or bleeding events. We present this case of a 44-year-old male patient that presented to our Emergency Department with flank pain that later was found to have renal angiomyolipoma (AML) rupture during his COVID-19 infection, ultimately requiring admission for hemorrhage control via Interventional Radiology (IR) drainage. Here, we discuss the role of the front-line physicians and how they should keep a low threshold for the different presentations that could be associated with COVID-19 infection.

Keywords: angiomyolipoma, COVID-19, renal, rupture

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Authors: Junaid C, Sabique MK

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Introduction: MES Mamapd College is an autonomous college established in 1964 affiliated with the University of Calicut run by the Muslim Educational Society Kerala. The department of Arabic of the college is having a pivotal role in promoting Arabic language learning, teaching, research, and other allied academic activities. State of Problem: Department of Arabic of the college introduced before the academic committee the culture of international seminars. The department connected the academic community with foreign scholars and introduced industry-academia collaboration programs which are beneficial to the job seekers. These practices and innovations should be documented. Objectives: Create awareness of innovative practices implemented for the promotion of the Arabic language. Infuse confidence in learners in learning of Arabic language. Showcase the distinctive academic programs initiated by the department Methodology: Data will be collected from archives, souvenirs, and reports. Survey methods and interviews with authorities and beneficiaries will be collected for the data analysis. Major results: MES Mampad College introduced before its stakeholders different unique academic practices related to the Arabic language and literature. When the unprecedented pandemic situation pulled back all of the academic community, the department come forward with numerous academic initiatives utilizing the virtual space. Both arenas will be documented. Conclusion: This study will help to make awareness on the promotion of the Arabic language studies and related practices initiated by the department of Arabic MES Mampad College. These practices and innovations can be modeled and replicated.

Keywords: teaching Arabic language, MES mampad college, Arabic webinars, pandemic impacts in literature

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Authors: V. Miller, T. Jariel, C. Cooper-Chadwick

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Early treatment of stroke leads to higher survival and lower disability rates. Increasing knowledge to activate the emergency medical system for signs of stroke can improve outcomes for patients with stroke and decrease morbidity and mortality. Even though patients who get discharged from the hospital receive standard verbal and printed education, nearly 20% of them answer the question incorrectly when asked, “What will you do if you or someone you know have signs of stroke?” The main goal of this evidence-based project was to improve patients’ knowledge of what to do if they have signs of stroke. Evidence suggests that using video education in conjunction with verbal and printed education improves patient comprehension and retention. The percentage of patients who noted that they needed to call 911 for stroke symptoms increased from 80% to 87% in six months after project implementation. The results of this project demonstrate significant improvement in patients’ knowledge about the necessity of activation of emergency medical systems for stroke symptoms.

Keywords: emergency medical systems activation, evidence-based practice nursing, stroke education, video education

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Authors: Ali Vaezi, Jyotirmoy Dalal, Manish Verma

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The railroad is one of the primary transportation modes for hazardous materials (hazmat) shipments in North America. Installing an emergency response network capable of providing a commensurate response is one of the primary levers to contain (or mitigate) the adverse consequences from rail hazmat incidents. To this end, we propose a two-stage stochastic program to determine the location of and equipment packages to be stockpiled at each response facility. The raw input data collected from publicly available reports were processed, fed into the proposed optimization program, and then tested on a realistic railroad network in Ontario (Canada). From the resulting analyses, we conclude that the decisions based only on empirical datasets would undermine the effectiveness of the resulting network; coverage can be improved by redistributing equipment in the network, purchasing equipment with higher containment capacity, and making use of a disutility multiplier factor.

Keywords: hazmat, rail network, stochastic programming, emergency response

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Authors: Mohamed Chabi

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The project of helping students at risk started at the Math department in the new foundation program at Qatar University in the fall 2012 semester. The purpose was to find ways to help students who were struggling with their math courses Elementary algebra or Precalculus course due to many factors. Department had formed the Committee “students at Risk” at the start of 12-13 to assist struggling students in our math courses to get their studies on track. A mechanism was developed to support students who are at risk using a developed E-Monitoring system. E-Monitoring system was developed to manage automatically all transactions relevant to the students’ attendance, Students ‘‘warning Students’’ grading, etc. E-Monitoring System produce various statistics such as, Overall course statistics, Performance, Students at Risk… to help department to develop a higher quality of education in the Foundation Program at Math department. The mechanism was studies and evaluated. Whatever the cause, the sooner we identify students who are not performing well academically, the sooner we can provide, or direct them to the resources that are available to them. In this paper, we outline the mechanism and its effect on students’ performance. The collected data from various exams shows that students had benefited from the mechanism.

Keywords: students at risk, e-monitoring system, warning students, performance

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Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon

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In a disaster event, sharing patient information between the pre-hospital Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre- EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors that are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality, and the data were analyzed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system that can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analyzed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospital staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.

Keywords: emergency medical teams, communication, information and communication technologies, disaster

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Authors: Mekroud Amel

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Emergency departments are known for the workload, the variety of pathologies and the difficulties in their management with the continuous influx of patients The role of our service in the management of patients with two or three mild to moderate organ failures, involving several disciplines at the same time, as well as the effect of this management on the skills and efficiency of our team has been demonstrated Borderline cases between two or three or even more disciplines, with instability of a vital function, which have been successfully managed in the emergency room, the therapeutic procedures adopted, the consequences on the quality and level of care delivered by our team, as well as that the logistical consequences, and the pedagogical consequences are demonstrated. The consequences found are Positive on the emergency teams, in rare situations are negative Regarding clinical situations, it is the entanglement of hemodynamic distress with right, left or global participation, tamponade, low flow with acute pulmonary edema, and/or state of shock With respiratory distress with more or less profound hypoxemia, with haematosis disorder related to a bacterial or viral lung infection, pleurisy, pneumothorax, bronchoconstrictive crisis. With neurological disorders such as recent stroke, comatose state, or others With metabolic disorders such as hyperkalaemia renal insufficiency severe ionic disorders with accidents with anti vitamin K With or without septate effusion of one or more serous membranes with or without tamponade It’s a Retrospective, monocentric, descriptive study Period 05.01.2022 to 10.31.2022 the purpose of our work: Search for a statistically significant link between the type of moderate to severe pathology managed in the emergency room whose problems are multivisceral on the efficiency of the healthcare team and its level of care and optional care offered for patients Statistical Test used: Chi2 test to prove the significant link between the resolution of serious multidisciplinary cases in the emergency room and the effectiveness of the team in the management of complicated cases Search for a statistically significant link : The management of the most difficult clinical cases for organ specialties has given general practitioner emergency teams a great perspective and has been able to improve their efficiency in the face of emergencies received

Keywords: emergency care teams, management of patients with dysfunction of more than one organ, learning curve, quality of care

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Authors: Sengul Celik, Alper Ketenci

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In Turkish Constitution about health care in Article 56, it is said that: everyone has the right to live in a healthy and balanced environment. It is the duty of the state and citizens to improve the environment, protect environmental health, and prevent environmental pollution. The state ensures that everyone lives their lives in physical and mental health; it organizes the planning and service of health institutions from a single source in order to realize cooperation by increasing savings and efficiency in human and substance power. The state fulfills this task by utilizing and supervising health and social institutions in the public and private sectors. General health insurance can be established by law for the widespread delivery of health services. To have health care is one of the basic rights of patients. After the coupe attempt in July 2016, the Government of Turkey has announced a state of emergency and issued lots of emergency decrees. By these emergency decrees, lots of people were dismissed from their jobs and lost their some basic social rights. The violations occur in social life. One of the most common observations is the discrimination by government in health care system. This study aims to put forward the violation of human rights in health care system in Turkey due to their discriminated position by an emergency decree. The study is a case study that is based on nine interviews with the people or relatives of people who lost their jobs by an emergency decree in Turkey. In this study, no personally identifiable information was obtained for the safety of individuals. Also no distinctive questions regarding the identity of individuals were asked. The interviews are obtained through internet call applications. The data were analyzed through the requirements of regular health care system in Turkey. The interviews expose that the people or the relatives of people lost their right to have regular health care. They have to pay extra amount both in clinical services and in medication treatment. The patient right to quality medical care without prejudice is violated. It was assessed that the people who are involved in emergency decree and their relatives are discriminated by government and deprived of regular medical care and supervision. Although international legal arrangements and legal responsibilities of the state have been put forward by Article 56, they are violated in practice. To prevent these kinds of violations, some measures should be taken against the deprivation in health care system especially towards the discriminated people by an emergency decree.

Keywords: emergency decree in Turkey, health care, discriminated people, patients rights

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Authors: Savaş Durduran, Ceren Yağci

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The nature of the events going on in the world, when people’s lives are considered significantly affects natural disasters. Considering thousands of years of earth history, it is seen that many natural disasters, particularly earthquakes located in our country. Behaving cautious, without occurring hazards, after being disaster is much easier and cost effective than returning to the normal life. The four phases of disaster management in the whole world has been described as; pre-disaster preparedness and mitigation, post-disaster response and rehabilitation studies. Pre-disaster and post-disaster phases has half the weight of disaster management. How much would be prepared for disaster, no matter how disaster damage reducing work gives important, we will be less harm from material and spiritual sense. To do this in a systematic way we use the Geographic Information Systems (GIS). The execution of the emergency services to be on time and emergency control mechanism against the development the most appropriate decision Geographic Information System GIS) can be useful. The execution of the emergency services to be on time and emergency control mechanism towards for developing to be the most appropriate decision Geographic Information System (GIS) can be useful. The results obtained by using products with GIS analysis of seismic data to the city, manager of the city required information and data that can be more healthy and satisfies the appropriate policy decisions can be produced. In this study, using ArcGIS software and benefiting reports of the earthquake that occurred in the Konya city, spatial and non-spatial data consisting databases created, by the help of this database a potential disaster management aimed in the city of Konya regard to urban earthquake, GIS-aided analyzes were performed.

Keywords: geographic information systems (GIS), disaster management, emergency control mechanism, Konya

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Authors: Xiyang Li, Qi Yu, Lun Zhang

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In the face of natural disasters and other emergency situations, determining the optimal location of rescue centers is crucial for improving rescue efficiency and minimizing impact on affected populations. This paper proposes a method that integrates genetic algorithms (GA) and backpropagation neural networks (BPNN) to address the site selection optimization problem for emergency rescue centers. We utilize BPNN to accurately estimate the cost of delivering supplies from rescue centers to each temporary camp. Moreover, a genetic algorithm with a special partially matched crossover (PMX) strategy is employed to ensure that the number of temporary camps assigned to each rescue center adheres to predetermined limits. Using the population distribution data during the 2022 epidemic in Jiading District, Shanghai, as an experimental case, this paper verifies the effectiveness of the proposed method. The experimental results demonstrate that the BPNN-GA method proposed in this study outperforms existing algorithms in terms of computational efficiency and optimization performance. Especially considering the requirements for computational resources and response time in emergency situations, the proposed method shows its ability to achieve rapid convergence and optimal performance in the early and mid-stages. Future research could explore incorporating more real-world conditions and variables into the model to further improve its accuracy and applicability.

Keywords: emergency rescue centers, genetic algorithms, back-propagation neural networks, site selection optimization

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

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Authors: Mary Bernardin, Margie Batek, Joseph Moen, David Schnadower

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Background: Exposure to violence not only has negative psychological impact on children but is a risk factor for children becoming recurrent victims of violence. However, little is known regarding the degree to which child victims of violence are exposed to trauma at home and in their community, or its association with specific psychological diagnoses. Objective: The aims of this study were to perform in-depth characterizations of family, community and psychological wellness amongst pediatric victims of interpersonal violence. Methods: As standard of care at the Saint Louis Children’s Hospital pediatric emergency department (ED), social workers perform in-depth interviews with all children presenting due to violent interpersonal encounters. In this retrospective cross-sectional study, we collected data from social work interviews on family structure, exposure to violence in the community and the home, as well as history of psychological diagnoses amongst children ages 8-19 years who presented to the ED for injuries related to interpersonal violence from 2014-2017. Results: A total of 407 patients presenting to the ED for an interpersonal violent encounter were analyzed. The average age of studied youths was 14.7 years (SD 2.5). Youths were 97.5% African American ethnicity and 66.6% male. 67.8% described their home having a nonnuclear family structure, 50% of which reported living with a single mother. Of the 21% who reported having incarcerated family members, 56.3% reported their father being incarcerated, 15% reported their mother being incarcerated, and 12.5% reported multiple family members being incarcerated. 11.3% reported witnessing domestic violence in their home. 12.8% of youths reported some form of child abuse. The type of child abuse was not specified in 29.3% of cases, but physical abuse (32.8%) followed by sexual abuse (22.4%) were the most commonly reported. 14.5% had history of placement in foster care and/or adoption. 64% reported having witnessed violence in their community. 30.2% reported having lost friends or family due to violence, and of those, 26.4% reported the loss of a cousin, 18.9% the loss of a friend, 16% the loss of their father, and 12.3% the loss of their brother due to violence. Of the 22.4% youths with psychiatric diagnose(s), 48.4% had multiple diagnoses, the most common of which were ADD/ADHD (62.6%), followed by depression (31.9%), bipolar disorder (27.5%) and anxiety (15.4%). Conclusions: A remarkable proportion of children presenting to EDs due to interpersonal violence have a history of exposure to instability and violence in their homes and communities. Additionally, psychological diagnoses are frequent among pediatric victims of violence. More research is needed to better understand the association between trauma exposure, psychological health and violent victimization amongst children.

Keywords: community violence, emergency department, pediatric interpersonal violence, pediatric trauma, psychological effects of trauma

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Authors: Scott Ashby, Emily Granger, Mark Connellan

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Objectives: 1) To identify if emergency coronary angiography improves outcomes in studies examining OHCA from assumed cardiac aetiology? 2) If so, is it indicated in all patients resuscitated following OHCA, and if not, who is it indicated for? 3) How effective are investigations for screening for the appropriate patients? Background: Out-of-hospital cardiac arrest is one of the leading mechanisms of death, and the most common causative pathology is coronary artery disease. In-hospital treatment following resuscitation greatly affects outcomes, yet there is debate over the most effective protocol. Methods: A literature search was conducted over multiple databases to identify all relevant articles published from 2005. An inclusion criterion was applied to all publications retrieved, which were then sorted by type. Results: A total of 3 existing reviews and 29 clinical studies were analysed in this review. There were conflicting conclusions, however increased use of angiography has shown to improve outcomes in the majority of studies, which cover a variety of settings and cohorts. Recommendations: Currently, emergency coronary angiography appears to improve outcomes in all/most cases of OHCA of assumed cardiac aetiology, regardless of ECG findings. Until a better tool for screening is available to reduce unnecessary procedures, the benefits appear to outweigh the costs/risks.

Keywords: out of hospital cardiac arrest, coronary angiography, resuscitation, emergency medicine

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Authors: Bindhiya Thomas, Rehana Hafeez

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Background: The Surgical Ambulatory Unit (SAU) also known as the Same Day Emergency Care (SDEC) is an established part of many hospitals providing same day emergency care service to surgical patients who would have otherwise required admission through the A&E. Prior to Covid, the SAU was functioning as a 12-hour service, but during the Covid crisis this service was transformed to a 24 hour functioning Surgical Ambulatory Assessment unit (SAAU). We studied the effects that this change brought about in-patient care in our hospital. Objective: The objective of the study was to assess the impact of a 24-hour Surgical Ambulatory Assessment unit on patient care during the time of Covid, in particular its role in freeing A&E capacity and delivering effective patient care. Methods: We collected two sets of data retrospectively. The first set was collected over a 6-week period when the SAU was functioning at the Princess Royal University Hospital. On March 23rd, 2020, the SAU was transformed into a 24-hour SAAU. Following this transformation, a second set of patient data was collected over a period of 6 weeks. A comparison was made between data collected from when the hospital had a 12-hour Surgical Ambulatory unit and later when it was transformed into a 24-hour facility. Its effects on the change in the number of patients breaching the four hour waiting period and the number of emergency surgical admissions. Results: The 24-hour Surgical Ambulatory Assessment unit brought significant reductions in the number of patients breaching the waiting period of 4 hours in A&E from 44% during the period of the 12-hour Surgical Ambulatory care facility to 0% from when the 24-hour Surgical Ambulatory Assessment Unit was established. A 28% reduction was also seen in the number of surgical patients' admissions from A&E. Conclusions: The 24-hour SAAU was found to have a profound positive impact on emergency care of surgical patients. Especially during the Covid crisis, it played a crucial role in providing not only effective and accessible patient care but also in reducing the A&E workload and admissions. It thus proved to be a strategic tool that helped to deal with the immense workload in emergency care during the Covid crisis and helped free much needed headspace at a time of uncertainty for the A&E to better configure their services. If sustained, the 24-hour SAAU could be relied on to augment the NHS emergency services in the future, especially in the event of another crisis.

Keywords: Princess Royal University Hospital, surgical ambulatory assessment unit, surgical ambulatory unit, same day emergency care

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Authors: Jennifer E. Lynette

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The purpose of this study is to develop a nation-wide assessment tool to gauge the quality and efficiency of response activities by emergency personnel to fires in Denmark. Current fire incident reports lack detailed information that can lead to breakthroughs in research and improve emergency response efforts. Information generated from the report database is analyzed and assessed for efficiency and quality. By utilizing information collection gaps in the incident reports, an improved, indepth, and streamlined quality gauging system is developed for use by fire brigades. This study pinpoints previously unrecorded factors involved in the response phases of a fire. Variables are recorded and ranked based on their influence to event outcome. By assessing and measuring these data points, quality standards are developed. These quality standards include details of the response phase previously overlooked which individually and cumulatively impact the overall success of a fire response effort. Through the application of this tool and implementation of associated quality standards at Denmark’s fire brigades, there is potential to increase efficiency and quality in the preparedness and response phases, thereby saving additional lives, property, and resources.

Keywords: emergency management, fire, preparedness, quality standards, response

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