Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 20

POSTERS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
factors, and appears to be most strongly related to inpatient ward
service operating hours. In this sample this effect accounts for the
use of 700 bed-days annually.
P 09 - ED Systems: Efficiency, Productivity
Frequency of recorded observations decreases with increasing
ED demand
Richardson DB
The Canberra Hospital, Australia
Objectives: Process measures, such as recording of observations,
may be confounded by differences between patients. This study
aims to determine the relationship between recorded observations
and ED demand in a uniform population.
Methods: Retrospective chart review of all presentations to a
tertiary ED in 2000 categorised in Australasian Triage Category 3
with ED diagnosis in ICD10 J0.0-J99.9 (respiratory). The number
of written observations in the first 15 min and 60 min after arrival
and whether observations were recorded at Triage were deter-
mined from the chart, and the waiting time and number of patients
waiting on arrival were determined from the ED register. Presenta-
tions were classified as “high” or “low” demand according whether
the number of patients waiting on presentation was above or below
the median for this sample. The null hypothesis was that there was
no relationship between observation frequency and the number of
patients wailing, and significance was assessed by the Chi-square
and t-test.
Results: 278 charts were reviewed, of which 272 contained a valid
observation sheet. The median number of patients waiting on
arrival was 7 (range 1-22). “High” demand presentations waited
longer for treatment (18 min vs. 14 min, P<0.01) and were asso-
ciated with: less observations recorded in the first hour (1.86 vs.
2.24, P<0.002), twice the incidence of no observations in the first
15min (22.6% vs. 11.5%, P<0.02), but a greater probability of
observations at Triage (39.1% vs. 25.9%, P<0.02).
Conclusions: Increased ED demand is associated with reduced
recorded observation frequency in this group. The higher incidence
of recorded observation at Triage during times of high demand was
unexpected and may reflect a response to increased waiting times.
P 11 - International EM systems
Hospítal admission, diagnosis and survival in emergency
ambulance users after the introduction of an anesthesiologist
staffed mobile care unit
Christensen EF
Department of Anesthesia and Intensive Care, Aarhus Kommunehospital, Aarhus
University Hospital, Denmark
Objective: The aim was lo evaluate the impact of a mobile emer-
gency care unit (MECU) staffed with an anesthesiologist in terms of
change in hospital admission and mortality among ambulance users.
Design: Quasi-experimental before-and-after-study including con-
secutive emergency calls during two three-month periods, with a
MECU included in the second period.
Setting: Prehospital emergency care in a Danish urban area.
Participants There were 2950 consecutive emergency ambulance
users in Period 1 and 2869 in Period 2. The MECU attended 27.7%
of Period 2 users.
Main outcoine measures: Information on hospital admission, diag-
nosis and 180-day mortality was collected from relevant registers.
Results: A significantly smaller proportion of Period 2 users were
brought to hospital, 87.9% versus 93.8% in Period 1 (p<0.0001).
Among users wilh hospital contact, the diagnostic pattern and the
180-day mortality (Period 1, 9.9%; Period 2, 10.3%) was nearby
identical in the two periods. In some diagnostic subgroups there was a
tendency towards a lower mortality among Period 2 patients
(ischemic disease day 0-28, 8.2% in 1997 versus 14.6% in 1996
patients, P<0.05; acute myocardial infarction: day 0-2, 8.2% versus
19.0%, P<0.05; day 0-180,13.3% versus 40.5%, P<0.001; diseases of
the respiratory system day 0-1 mortality, 0.0% versus 2.4%, P<0.05).
In comprehensive multivariate analyses, increased survival was found
in Period 2 patients with AMI, ischemic disease and lung disease.
Conclusions: The introduction of a MECU may result in fewer
users brought to emergency departments and hospitals. The
mortality in the total group of emergency ambulance users was not
affected by the implementation of the MECU. However, a signifi-
cantly lower mortality in users with AMI was found in the MECU
period. Whether the MECU contributed to this can not be clearly
elucidated due to the dispatch of the MECU towards the more
severe cases. Considering the relatively poor health of patients
selected for the MECU, the lack of association with changes in
survival actually may mirror a beneficial effect.
P 12 - International EM systems
International cooperation of the center for resuscitation &
emergency medicine education to develop intensive care &
emergency medicine
Benin-Goren O', Lev A**, Halpern P*
Tel Aviv Sourasky Medical Center, Tel Aviv*, GICU and PICU, HaEmek Medical
Center, Afula**, Israel
Although Israel is a young state. it's involved with disaster relief to
needy countries, mostly because of geo-political reasons as well as
local expertise gained and a high-quality team that gained its quali-
fication the hard way. Some of the countries supported by Israel are
Armenia, Ruanda, Argentina, Kosovo, Cameroon, Kenya, E1
Salvador, and Turkey.
The Center for Resuscitation & Emergency Medicine
Education (CREME) is involved in international cooperation to
develop emergency medicine (EM), emergency medical services
(EMS) & intensive care units (ICUs) all over the world. CREME
cooperates with the Israeli Ministry of Foreign Affairs, and has
helped to establish and developed EM /EMS in: Ethiopia,
Azerbaijan, Uzbekistan, India, and DR of Congo and Turkey. It’s
also helped to fund an ICU in Ukraine, Turkey and Jordan.
CREME operators believe that there is a need for enhancement
of emergency medicine and disaster preparedness systems in many
parts of the world. There is a growing awareness of this need and
the will on the part of the relevant governments to support such
efforts.
This paper presents the activity of CREME as well as the status
of EM/EMS and intensive care in the countries we are involved
with and the status of the local services after the cooperation.
20 Læknablaðið/Fylgirit 45 2002/88