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Remote Health Care at U.S. Antarctic Stations: A Comparison with Standard Emergency Medical Practice
No full textBackground: The three U.S. Antarctic research stations' medical facilities exist in an isolated, harsh environment, typical of many such facilities throughout the world. Emergency physicians frequently staff these medical facilities; however, most who are considering this have many misconceptions about the stations and about the scope of medical practice that exists there. Objective: This article illuminates how Antarctic medical practice is comparable with and dissimilar to other emergency medicine experiences and highlights information that any emergency physician-applicant to an isolated medical position should learn prior to accepting the position. Discussion: Antarctic medical care both parallels and differs from typical emergency medical practice in many ways, including the patient population, facilities, supplies, equipment, clinical duties (e.g., providing out-and inpatient medical and dental care, performing laboratory tests and imaging), and nonclinical duties (e.g., disaster planning, teaching, food service inspection, and public health officer). Climate-related limitations on medical evacuation epitomize the stations' isolation. Medical practice may be complicated by ethical issues common in other small isolated settings, such as a lack of privacy and confidentiality. Clinicians considering an isolated practice opportunity should ask basic questions to learn as much detailed information as possible prior to taking the positions. Conclusion: Medical practice at U.S. Antarctic stations, as at many remote health care facilities throughout the world, has similarities to standard emergency medical practice. Even so, significant differences result in a steep learning curve. Any clinicians considering practicing in these locations should carefully evaluate the practice and the environment in advance of any deployment. (C) 2019 Elsevier Inc. All rights reserved.12 month embargo; published online: 16 March 2019This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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Integrating Disaster Response Tools for Clinical Leadership
Get PDFBackground: Disastrous situations in the emergency department (ED) or community can overwhelm even the best-prepared teams due to their complexity and dynamic nature. In this paper we propose an integrated approach to disaster management, combining six theoretical and practical frameworks to enhance decision-making and operational effectiveness.
Discussion: The approach begins with “sensemaking,” an instinctive process that helps leaders quickly gain situational awareness, a crucial foundation for the recognition-primed decision process (RPD). RPD enables swift, experience-based decisions without exhaustive analysis, aligning them with the appropriate domain in the Cynefin framework to guide subsequent interventions. In chaotic situations, rapid action is necessary, and the edge-of-chaos theory guides leaders to balance order and chaos for optimal adaptability. Complexity theory aids in managing the unpredictable elements of a crisis, highlighting the need for flexible responses. Finally, the Incident Command System ensures effective implementation by providing a standardized approach to command, control,and coordination. This cohesive strategy equips emergency physicians and incident commanders to manage both internal ED crises and broader community disasters effectively, with an emphasis on the importance of training in these frameworks to enhance the resilience of emergency medical services.
Conclusion: This multifaceted approach should improve disaster management by better preparing responders for the unpredictable nature of emergencies, enabling effective evaluation and management of complex scenarios, and leading to a more rapid restoration of order
Foregoing Prehospital Care: Should Ambulance Staff Always Resuscitate?
No full textApproximately 400,000 people die outside US hospitals or chronic care
facilities each year. While there has been some recent movement towards
initiating procedures for prehospital Do Not Resuscitate (DNR) orders, the
most common situation in the US is that emergency medical systems (EMS)
personnel are not authorised to pronounce patients dead, but are required to
attempt resuscitation with all of the modalities at their disposal in
virtually all patients...Prehospital DNR orders present several legal and
moral problems. These include proper patient identification, the nature of
the document itself, precautions incorporated into a DNR system to prevent
misuse, potential liability for EMS and hospital personnel, and potential
errors in implementation...Relatively few US jurisdictions as yet have a
prehospital DNR order system, although it is an idea whose time is
overdue...
Law Versus Life: The Ethical Imperative to Practice and Teach Using the Newly Dead Emergency Department Patient
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