1,091 research outputs found
Emergency Medical Assistance Team Response Following Taiwan Chi-Chi Earthquake
No full textINTRODUCTION: On 21 September, 1999, an earthquake measuring 7.3 on the Richter scale, struck central Taiwan near the town of Chi-Chi. The event resulted in 2,405 deaths and 11, 306 injuries. Ad hoc emergency medical assistance teams ( EMATs) from Taiwan assumed the responsibility for initiating early assessments and providing medical care. OBJECTIVE: To determine whether the EMATs served a key role in assisting critically injured patients through the assessment of number and level of hospitals responding, training background, timeliness of response, and acuity of patient encounters. METHODS: Local and national health bureaus were contacted to identify hospitals that responded to the disaster. A comprehensive questionnaire was piloted and then, sent to those major medical centers that dispatched EMATs within the first 72 hours following the quake. In-depth interviews also were conducted with team leaders. RESULTS: A total number of 104 hospitals/clinics responded to the disaster , including nine major medical centers and 12 regional hospitals. Each of the major medical centers/regional hospitals that dispatched EMATs during the first 72 hours following the quake were surveyed. Also, 20 individual team leaders were interviewed. Seventy-nine percent of the EMATs from the hospitals responded spontaneously to the scene, while only 21% were dispatched directly by national or local health authorities. Combining the phases of the disaster response, it is estimated that only 7% of EMATs were providing on-site care within the first 12 hours following the earthquake, 17% within 24 hours to respond to the site. Based on a ED I- IV triage system (Level -I, highest acuity; Level-IV, lowest acuity), the vast majority of patient encounters consisted of Level-III and Level-IV patients. Fewer than 16% of teams encountered > 10 Level-I patients, and 10 Level-II patients. CONCLUSIONS: 1. The response from EMATs was impressive, but largely uncoordinated in the absence of a pre-existing dispatching mechanism. 2. Most of the EMATs required > 24 hours to reach the disaster sites, and generally, did not arrive in time of affect the outcome of victims with preventable deaths. Therefore, there is an urgent need to strengthen local prehospital care. 3 . A central governmental body that ensures better horizontal and vertical integration, and a comprehensive emergency management system is required in order to improve future disaster response and mitigation efforts
The effect of system performance improvement on patients with cardiac arrest: A systematic review.
No full textAIM
The aim of our review was to understand the effect of interventions to improve system-level performance on the clinical outcomes of patients with cardiac arrest.
METHODS
We searched PubMed, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify randomised controlled trials and non-randomised studies published before July 21, 2020 reporting systems interventions to improve outcomes. Characteristics, study design, evaluation methods and outcomes of included studies were extracted. (PROSPERO registration CRD42020161882).
RESULTS
One cluster randomised trial and 26 non-randomised studies were included. There were 18 studies focusing on interventions for patients with out-of-hospital cardiac arrest and 9 studies for patients with in-hospital cardiac arrest. Interventions included implementation of a bundle of care strategy, evaluation of cardiopulmonary resuscitation (CPR) quality with feedback/debriefing, data surveillance, and CPR training programs. Although improved survival with favorable neurologic outcome at discharge after the implementation of specific interventions was found in 13 studies, improved survival to hospital discharge in 14 studies and improved survival to admission in 3 studies, there were still 7 studies showing no significant improvement of clinical outcomes after interventions.
CONCLUSION
Although only moderate to very low certainty of evidence exists to support the effect of system-level performance improvement on the clinical outcomes of patients, we recommend that organisations or communities evaluate their performance and target key areas with the goal to improve performance because of no known risks and the potential for a large beneficial effect
Detection of Major Aortopulmonary Collateral Arteries by Transesophageal Echocardiography in Pulmonary Atresia with Ventricular Septal Defect
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