Emergency medicine Australasia: EMA

Publisher: Australasian College for Emergency Medicine; Australasian Society for Emergency Medicine, Blackwell Publishing

Description

Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM) and aims to present papers and opinions on all aspects of emergency care in the prehospital and hospital environment. Authors are invited to submit any work that will contribute to the progress of emergency medicine within Australasia and worldwide. The Journal publishes original research articles, critical reviews, editorials, short reports, case reports, letters to the Editor and book and video reviews in the broad area of emergency medicine. Accepted papers become the copyright of the Journal. All original research articles, critical reviews and case reports are reviewed by at least two referees expert in the field of the submitted paper.

  • Impact factor
    0.99
  • 5-year impact
    1.12
  • Cited half-life
    4.90
  • Immediacy index
    0.41
  • Eigenfactor
    0.00
  • Article influence
    0.34
  • Website
    Emergency Medicine Australasia (EMA) website
  • Other titles
    Emergency medicine Australasia (Online), EMA
  • ISSN
    1742-6723
  • OCLC
    54312513
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Blackwell Publishing

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • Some journals impose embargoes typically of 6 or 12 months, occasionally of 24 months
    • no listing of affected journals available as yet
  • Conditions
    • See Wiley-Blackwell entry for articles after February 2007
    • Publisher version cannot be used
    • On author or institutional or subject-based server
    • Server must be non-commercial
    • Publisher copyright and source must be acknowledged with set statement ("The definitive version is available at www.blackwell-synergy.com ")
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley-Blackwell'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: ObjectiveED staff use a range of poisons information resources of varying type and quality. The present study aims to identify those resources utilised in the state of Victoria, Australia, and assess opinion of the most used electronic products.MethodsA previously validated self-administered survey was conducted in 15 EDs, with 10 questionnaires sent to each. The survey was then repeated following the provision of a 4-month period of access to Toxinz™, an Internet poisons information product novel to the region. The study was conducted from December 2010 to August 2011.ResultsThere were 117 (78%) and 48 (32%) responses received from the first and second surveys, respectively, a 55% overall response rate. No statistically significant differences in professional group, numbers of poisoned patients seen or resource type accessed were identified between studies. The electronic resource most used in the first survey was Poisindex® (48.68%) and Toxinz™ (64.1%) in the second. There were statistically significant (P < 0.01) improvements in satisfaction in 26 of 42 questions between surveys, and no decrements. Although the majority of responders possessed mobile devices, less than half used them for poisons information but would do so if a reputable product was available.Conclusion The order of poisons information sources most utilised was: consultation with a colleague, in-house protocols and electronic resources. There was a significant difference in satisfaction with electronic poisons information resources and a movement away from existing sources when choice was provided. Interest in increased use of mobile solutions was identified.
    Emergency medicine Australasia: EMA 10/2014;
  • Emergency medicine Australasia: EMA 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To describe the organisational demands on staff when arranging interhospital transfers (IHTs) from an ED.Method Prospective observational study of IHTs from three non-tertiary hospital EDs in the Perth metropolitan area. Data were collected over 14 consecutive days commencing 20 January, 26 March and 6 July 2010 for each respective site. Outcome measures were the time taken for transfer acceptance, the number of telephone calls required and the perceived degree of difficulty to arrange a transfer.ResultsWe examined 229 (70%) of the 325 IHTs conducted during the study period. Transfers took 1–11 telephone calls to arrange (median 2). More calls were required for urgent (median 4, IQR 3.5–9.4, n = 69) than non-urgent IHTs (median 3, IQR 2–4, n = 160, P = 0.04). Four or more calls were required in 23.5% of cases (n = 54) with 20 (9%) of these involving critically ill patients. The median time to transfer acceptance was similar for urgent (10 min, IQR 4–24, n = 69) and non-urgent IHTs (10 min, IQR 5–23, P = 0.48, n = 155). A post-hoc analysis describing IHTs that took over 1 h to organise, showed that urgent transfers took 155 min (IQR 132–213) compared with 120 min for non-urgent IHTs (IQR 79–157; P = 0.07). Arranging an IHT was perceived to be challenging in 6% of cases with the clarity of decision-making, receiving staff understanding of the limitations of referral hospital services and the effect of delays of prime importance.Conclusion While most IHTs are straightforward, critically ill transfers require considerable time, effort and teamwork to arrange.
    Emergency medicine Australasia: EMA 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives The Myanmar Ministry of Health has formed a partnership with Australasian professional colleges and international medical specialists to deliver a comprehensive programme for emergency care training and development. We describe this programme, emphasising the training of the first emergency specialists for Myanmar.Methods Eighteen junior specialists (EM18) joined a new postgraduate diploma in emergency medicine (Dip EM) through the University of Medicine (1) (UM1), Yangon. Diploma content included an introductory course, clinical rotations, 2 months in the emergency receiving centre (ERC) of the Yangon General Hospital (YGH) supervised by a volunteer Australasian emergency physician (FACEM), several short courses and an educational visit to Hong Kong. Curriculum and assessments comprising written and oral exams were devised and delivered by volunteer FACEMs and Hong Kong specialists.ResultsAll EM18 completed the 18 month programme and passed the final assessments to graduate in February 2014. Course strengths included the supervised clinical rotation to the ERC and short course teaching on emergency medical, surgical, trauma, paediatric and disaster topics. The educational visit to Hong Kong enabled the EM18 to visualise more advanced EM systems that could be adapted to the Myanmar context. The participating international clinicians provided expert strategic advice on ED design, staffing, equipment, nursing and pre-hospital systems to leaders within universities, hospitals and the Ministry of Health.Conclusion The first Myanmar postgraduate diploma in EM provides an example of collaborative and responsive clinical health capacity building in a context of very limited resources.
    Emergency medicine Australasia: EMA 10/2014;
  • Emergency medicine Australasia: EMA 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective During a paediatric emergency, it is often impractical to weigh a child. Many resuscitative measures require a child's weight; therefore, estimation is often used. Different methods are available to do this, usually based on a child's age or length. The accuracy of these methods has not been validated in Aboriginal and Torres Strait Islander children from remote communities. The objective of this study was to determine how well these paediatric emergency weight estimation methods predict weight for this group of children.MethodA retrospective descriptive study using the measured weights and heights of Aboriginal and Torres Strait Islander children from remote locations across the Northern Territory (NT) was used. The weight estimation methods chosen to evaluate were the APLS, ‘Best Guess’, Luscombe and Nelson's formulae, Argall's modification, the Broselow® and Sandell® tapes, and the World Health Organization standard reference growth charts. Adjusted R-squared values for each method are reported, and agreement was measured in terms of mean percentage error (MPE).ResultsA total of 2102 children were included. The length-based methods performed the best. The Broselow Tape had the highest adjusted R-squared value at 0.8886 in all age groups. The APLS, Luscombe and Argall's methods were the worst performing methods. The Broselow® Tape was also the best performing in terms of accuracy and precision, with an MPE of −0.35% (95% CI −0.82–0.1).Conclusion Our data support the use of the Broselow® Tape as the recommended method when estimating weight in an emergency for remote Aboriginal and Torres Strait Islander children in the NT for the 0–5 year age group.
    Emergency medicine Australasia: EMA 10/2014;
  • Emergency medicine Australasia: EMA 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Kite flying has been popular in India since ancient times, especially during harvest festivals of Lohri, Basant and Makar Sankranti. It often takes form of a competitive sport and in recent times has been associated with multiple, sometimes fatal injuries. This prognostic study was conducted to try and understand the epidemiology and factors associated with kite flying injuries in the state of Punjab, India.Methods Case reports of patients who presented to the ED with trauma as a result of kite flying were reviewed. The study included patients reporting to the Christian Medical College, Ludhiana, between January 2005 and January 2010. Details of the type and mode of injury, and outcomes were recorded.ResultsThe highest incidence of injuries occurred during months of the kite flying festivals. The most common mode of injury was fall from heights, associated with traumatic brain injury. The mortality rate in this series was 6.25%.Conclusions This study highlights the importance of kite flying injuries as a common mode of injury in children and adolescents. It is an easily preventable mode of injury with simple safety regulations and possibly stronger legislation.
    Emergency medicine Australasia: EMA 10/2014;
  • Emergency medicine Australasia: EMA 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective The present study aims to inform the use of discharge summaries as a marker of the quality of communication between ED and primary care; this systematic review aims to identify a consensus on the key components of a high-quality discharge summary.MethodA systematic search of the major medical and allied health databases and Google Scholar was conducted, using predetermined criteria for inclusion. Two authors independently reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Data were extracted using a standard form, and the level of evidence was assessed using a predetermined scale.ResultsWe screened 827 articles, and 84 articles underwent full-text review. Thirty-two studies were included, and 15 studies were level A or B studies. The agreement between authors for level of evidence was good: k = 0.62 (95% confidence interval [CI] 0.4–0.84) and for which components were included was 1011/1056, 95.7% (95% CI 94.3–96.8%). Thirty-four components were identified; however, only four were ranked as important by ≥80% of respondents or scored ≥80% on a scale of importance. These were: discharge diagnosis, treatment received, investigation results and follow-up plan. The quality of information contained in summaries was incompletely assessed in most studies.Conclusion The key components to include in a discharge summary are the discharge diagnosis, treatment received, results of investigations and the follow up required. The limited evidence pertaining to ED discharges was consistent with this. The adequacy of the components rather than just their presence or absence should also be considered when assessing the quality of discharge summaries.
    Emergency medicine Australasia: EMA 10/2014;
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    ABSTRACT: Objective This study aims to establish current practice among Australasian emergency physicians and trainees on several aspects of the investigation of suspected subarachnoid haemorrhage (SAH).Methods An electronic questionnaire (SurveyMonkeyTM) was distributed to emergency physicians and trainees by email through the ACEM. Survey recipients were asked about demographics, followed by a series of questions relating to the investigation of SAH.ResultsThere were 878 survey respondents (response rate 24%). Our data showed that 47.3% of respondents agreed or strongly agreed that a CT brain within 6 h of headache onset is sufficient to exclude a diagnosis of SAH. For a CT performed within 12 h of ictus, 14.4% were satisfied that SAH could be excluded. After a negative CT scan, for further investigation of SAH, 88% of respondents preferred lumbar puncture to CT angiography. For detection of xanthochromia in the cerebrospinal fluid, 57.7% of respondents felt that spectrophotometry (vs visual inspection) is necessary to accurately diagnose SAH.ConclusionsA range of information was collected regarding the investigation of suspected SAH. We report significant differences in the diagnostic approach of Australasian emergency physicians and trainees to this condition, in particular the utility of CT within 6 h for exclusion of SAH.
    Emergency medicine Australasia: EMA 10/2014;
  • Emergency medicine Australasia: EMA 10/2014;
  • Emergency medicine Australasia: EMA 10/2014;
  • Emergency medicine Australasia: EMA 10/2014;
  • Emergency medicine Australasia: EMA 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine whether ED doctors, comprising both consultants and registrars, can accurately identify the 4th or 5th intercostal space (ICS), commonly used for intercostal catheter insertion.Methods An observational study was designed using a sample of ED doctors applying their clinical skills to a convenience sample of patients reflecting a heterogeneous mix of ED patients. Patients already receiving a CXR in our ED were examined by a registrar or consultant who placed a radiopaque marker on the patients' chest wall over the site they determined to be the 4th or 5th ICS. Consultant radiologists reported the marker's position from postero-anterior projection CXRs, and results were analysed comparing consultants with registrars, right to left hemithoraces and male to female patients.ResultsED doctors participating in the present study placed the marker over the 4th or 5th ICS 36.2% of the time, with no significant difference between consultant and registrar groups, nor right or left hemithoraces. Accuracy was improved in female patients compared with male patients.Conclusion Emergency registrars and consultants sampled from a regional ED appeared unable to reliably identify the 4th or 5th ICS, as evidenced by marker position, in a heterogeneous patient population.
    Emergency medicine Australasia: EMA 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective The objective of this study is to investigate reliability and accuracy of the information on YouTube videos related to CPR and BLS in accord with 2010 CPR guidelines.Methods YouTube was queried using four search terms ‘CPR’, ‘cardiopulmonary resuscitation’, ‘BLS’ and ‘basic life support’ between 2011 and 2013. Sources that uploaded the videos, the record time, the number of viewers in the study period, inclusion of human or manikins were recorded. The videos were rated if they displayed the correct order of resuscitative efforts in full accord with 2010 CPR guidelines or not.ResultsTwo hundred and nine videos meeting the inclusion criteria after the search in YouTube with four search terms (‘CPR’, ‘cardiopulmonary resuscitation’, ‘BLS’ and ‘basic life support’) comprised the study sample subjected to the analysis. Median score of the videos is 5 (IQR: 3.5–6). Only 11.5% (n = 24) of the videos were found to be compatible with 2010 CPR guidelines with regard to sequence of interventions. Videos uploaded by ‘Guideline bodies’ had significantly higher rates of download when compared with the videos uploaded by other sources. Sources of the videos and date of upload (year) were not shown to have any significant effect on the scores received (P = 0.615 and 0.513, respectively). The videos' number of downloads did not differ according to the videos compatible with the guidelines (P = 0.832). The videos downloaded more than 10 000 times had a higher score than the others (P = 0.001).Conclusion The majority of You-Tube video clips purporting to be about CPR are not relevant educational material. Of those that are focused on teaching CPR, only a small minority optimally meet the 2010 Resucitation Guidelines.
    Emergency medicine Australasia: EMA 09/2014;
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    ABSTRACT: Background Medical-specific incident reporting systems are critical to understanding error in healthcare but underreporting by doctors reduces their value.Objective We conducted a pilot study of the implementation of an online ED-specific incident reporting system in Australasian hospitals and evaluated its use.Methods The reporting system was based on the literature and input of experts. Thirty-one hospital EDs were approached to pilot the Emergency Medicine Events Register (EMER). The pilot evaluated: website usage and analytics, reporting behaviours and rates, the quality of information collected in EMER. Semi-structured interviews of three site champions responsible for implementing EMER were conducted.ResultsSeventeen EDs expressed interest; however, due to delays and other barriers reporting only occurred at three sites. Over 354 days, the website received 362 unique visitors and 77 incidents. The median time to report was 4.6 min. The reporting rate was 0.07 reports per doctor month, suggesting a reporting rate of 0.08% of ED presentations. Data quality, as measured by the number of completed non-mandatory fields and ability to classify incidents, was very high. The interviews identified enablers (the EMER system, site champions) and barriers (chiefly the context of EM) to EMER uptake.Conclusions Collecting patient safety information by frontline doctors is essential to actively engage the profession in patent safety. Although the EMER system allowed easy online reporting of high quality incident data by doctors, site recruitment and system uptake proved difficult. System use by ED doctors requires dedicated and conscious effort from the profession.
    Emergency medicine Australasia: EMA 09/2014;
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    ABSTRACT: Objective To investigate if wearing protective gloves during paediatric intravenous cannulation affects performance of the procedure.Methods This was a prospective observational study. Peripheral intravenous cannulation (PIVC) performed within the Paediatric ED was observed and recorded over a 12 month period. Data were compared between those clinicians wearing gloves and those not wearing gloves during PIVC.ResultsOne thousand and twenty paediatric cannulations were recorded during the observed period. The mean age of the children was 5.79 years. The overall success rate of cannulation was 86.18% and first attempt success rate 76.08%. Overall, gloves were used by 54.31% of clinicians to establish vascular access; glove use was lowest in the registrar group (41.11% compliance rate). The glove-wearing group had comparable overall success rate of 85.74% (475/554) to the no-gloves group of 86.70% (404/466). The difference was not statistically significant (P > 0.05). Higher incidence of significant blood spillage during the procedure was observed among clinicians wearing no gloves (16.74%) in comparison with their glove-wearing counterparts (9.03%, P < 0.05). One needlestick injury was recorded in the present study period. There was no difference in blood culture contamination rate between glove-wearing group and no-gloves group (3.94% vs 3.76%, P > 0.05).Conclusions The present study shows that the use of protective gloves was not associated with adverse outcomes of clinical performance during paediatric cannulation. The low compliance rate of gloves use is alarming, and many clinicians might be exposed to potential blood-borne infections. Clinicians should be encouraged and supported to use gloves for paediatric cannulation.
    Emergency medicine Australasia: EMA 09/2014;
  • Emergency medicine Australasia: EMA 09/2014;

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