Hospital bed surge capacity in the event of a mass-casualty incident

INTRODUCTION: Traditional strategies to determine hospital bed surge capacity have relied on cross-sectional hospital census data, which underestimate the true surge capacity in the event of a mass-casualty incident. OBJECTIVE: To determine hospital bed surge capacity for the County more accurately using physician and nurse manager assessments for the disposition of all in-patients at multiple facilities. METHODS: Overnight- and day-shift nurse managers from each in-patient unit at four different hospitals were approached to make assessments for each patient as to their predicted disposition at 2, 24, and 72 hours post-event in the case of a mass-casualty incident, including transfer to a hypothetical, onsite nursing facility. Physicians at the two academic institutions also were approached for comparison. Age, gender, and admission diagnosis also were recorded for each patient. RESULTS: A total of 1,741 assessments of 788 patients by 82 nurse managers and 25 physicians from the four institutions were included. Nurse managers assessed approximately one-third of all patients as dischargeable at 24 hours and approximately one-half at 72 hours; one-quarter of the patients were assessed as being transferable to a hypothetical, on-site nursing facility at both time points. Physicians were more likely than were nurse managers to send patients to such a facility or discharge them, but less likely to transfer patients out of the intensive care unit (ICU). Inter-facility variability was explained by differences in the distribution of patient diagnoses. CONCLUSIONS: A large proportion of in-patients can be discharged within 24 and 72 hours in the event of a mass-casualty incident (MCI). Additional beds can be made available if an on-site nursing facility is made available. Both physicians and nurse managers should be included on the team that makes patient dispositions in the event of a MCI.     

Medical rehabilitation from the viewpoint of the established physician

In view of the not inconsiderable numbers of pension insured who have undergone no medical rehabilitation prior to their being pensioned prematurely, the principle of "rehabilitation comes before pensioning" hence not being implemented for this population, it is deemed justified to inquire into the causes of this situation. In the framework of the present study of 902 questionnaires returned by office practice physicians, it is presumed that the office practice physician is the controlling agent in inducing appropriate patients at the right time to participate in a rehabilitation measure. The following indicators are presumed to decisively influence this steering function: Attitude towards medical rehabilitation; Disease/disability-specific experience with medical rehabilitation measures; Satisfaction with the rehabilitation clinic selected by the pension insurance administration; Awareness of the rehabilitation clinics' range of rehabilitative services and the various treatment modalities available; Awareness of pertinent legal provisions; Cooperation between office-practice physician and pension insurance administration.     

Assessment of changes in cardiac autonomic tone resulting from inflammatory response to the influenza vaccination

A total of 71 healthy volunteers opting to have a routine influenza vaccination were investigated for potential changes in cardiovascular autonomic tone resulting from the temporary inflammatory effects of an influenza vaccination. A number of temporal and frequency domain parameters of heart rate and breathing were assessed 2–5 days prior to vaccination and 1–4 days postvaccination. Three lead electrocardiograph (ECG), beat‐to‐beat finger blood pressure and chest plethysmography signals were measured. After an extended resting period, patients performed metronome‐guided breathing at six breaths per min for a period of 2 min. Standard Ewing tests of autonomic function were also performed. All volunteers completed a vaccine symptom questionnaire. A subgroup of 15 volunteers who reported significant symptomatic reaction to the vaccination for at least 24 h following vaccination were identified based on the results of the questionnaire. A significant reduction in measures of heart rate variability (HRV) obtained during metronome‐guided breathing was noted following vaccination in the subgroup of 15 symptomatic volunteers. No significant changes were observed in standard Ewing assessment, fractal dimension analysis, baroreflex sensitivity assessment or resting HRV. There was no evidence of significant reduction in autonomic tone following vaccination in the full sample of 71 volunteers. Results suggest a significant change in HRV response to a small inflammatory provocation and suggest further investigation of the inflammatory causes of dysautonomia is of value.     

Medical decision-making in the nursing home: a comparison of physician and nurse perspectives

The purpose of this study is to clarify the perspectives of physicians and nurses in the medical decision-making process at the time of status change events in nursing home residents. The decision-making processes studied involved 28 cognitively impaired nursing home residents in a large suburban nursing home. In interviews, the authors ascertained the personal opinions of physicians and the nurses related to the status change event and the decision-making process using the Medical Decision-Making During a Status Change Event Questionnaire. Nurses reported a greater degree of familiarity with the family's and resident's wishes than did physicians. Physicians reported considering more treatment options and choosing more treatments for residents than nurses. Both physicians and nurses reported that the physicians had a major role in decision-making and that nurses did not, yet the gap in reported roles was greater based on physicians' reports in comparison to nurse reports. In a third of the reported cases, physicians and nurses disagreed about whether advance directives had been followed. These findings reflect a division of roles and perspectives of nurses versus physicians in the medical decision-making process. This study demonstrates the ability of the questionnaire to reveal several key differences in perceptions of care. This information could be useful in developing forums for communication among the professionals to enhance mutual understanding.     

Medical fee and service advertising: a response from physicians

Restrictions on advertising about services performed by professional groups have recently been questioned by the government and consumerists. The purpose of this study was to determine physicians' attitudes about the use of advertising in their profession and also to compare these results with responses from dentists, attorneys, and accountants. While a survey of these groups in three metropolitan areas indicate mild support for advertising in general, there was a definite negative reaction to advertising in the respective professions. Participants also reported their attitudes about the effects of advertising on prices and fees, quality of services, and public expectation and governmental regulations. The concepts of social marketing and informative advertising are suggested as approaches that may meet the requirements of both the government and the professions.     

Practice changes in response to the malpractice litigation climate. Results of a Maryland physician survey

Data from a 1987 survey of Maryland physicians in three specialties (internal medicine, family or general practice, and obstetrics-gynecology) were used to study the types of changes physicians have made in their practices during the last 2 years as a result of the current malpractice litigation climate. Overall, 51% reported making some type of practice change. The practice changes that physicians reported reflect both risk-reduction (e.g., increased use of tests) and risk-avoidance (e.g., cutting back high-risk patients) strategies, although risk-reduction actions were reported more frequently. Raising patient fees was also reported. Specialty predicts whether or not physicians make each type of change; in particular, obstetrician-gynecologists are more likely to report practice changes of all types. Prior litigation experience does not, in general, predict practice changes. The implications of the types of changes reported for access to care and costs of care were considered.     

Comparative study of psychiatric morbidity among the displaced and non-displaced populations in the Andaman and Nicobar Islands following the tsunami

OBJECTIVE: The objective of this study was to compare the psychiatric morbidity between the displaced and non-displaced populations of the Andaman and Nicobar Islands during the first three months following the 2004 earthquake and tsunami. METHODS: The study was conducted at the 74 relief camps in the Andaman and Nicobar Islands. Port Blair had 12 camps, which provided shelter to 4,684 displaced survivors. There were 62 camps on Car-Nicobar Island, which provided shelter to approximately 8,100 survivors who continued to stay in their habitat (non-displaced population). The study sample included all of the survivors who sought mental health assistance inside the camp. A psychiatrist diagnosed the patients using the ICD-10 criteria. RESULTS: Psychiatric morbidity was 5.2% in the displaced population and 2.8% in the non-displaced population. The overall psychiatric morbidity was 3.7%. The displaced survivors had significantly higher psychiatric morbidity than did the non-displaced population. The disorders included panic disorder, anxiety disorders not otherwise specified, and somatic complaints. The existence of an adjustment disorder was significantly higher in the non-displaced survivors. Depression and post-traumatic stress disorder (PTSD) were distributed equally in both groups. CONCLUSIONS: Psychiatric morbidity was found to be highest in the displaced population. However, the incidence of depression and PTSD were distributed equally in both groups. Involvement of community leaders and survivors in shared decision-making processes and culturally acceptable interventions improved the community participation. Cohesive community, family systems, social support, altruistic behavior of the community leaders, and religious faith and spirituality were factors that helped survivors cope during the early phase of the disaster.     

护士对不良事件报告的现状及相关因素探讨

目的 了解护士对不良事件报告现状及探讨相关影响因素.方法 翻译美国医院患者安全文化评估问卷,将所形成的中文版量表对801名护士进行评估.结果 82.65%的被调查护士在过去12个月内未报告过不良事件,维度"不良事件的报告频率"和"对错误的非惩罚性反应"的积极反应率分别为29.92%、29.38%.本科及以上学历护士在维度"不良事件的报告频率"的得分高于大中专护士,门诊护士的得分低于其他科室护士.结论 护士对不良事件的报告亟待提高,主要影响因素为报告文化是否具有惩罚性以及护士的学历等.     

Half-a-million strong: the emergency medical services response to a single-day, mass-gathering event

INTRODUCTION: Emergency medical services (EMS) responses to mass gatherings have been described frequently, but there are few reports describing the response to a single-day gathering of large magnitude. Objective: This report describes the EMS response to the largest single-day, ticketed concert held in North America: the 2003 "Toronto Rocks!" Rolling Stones Concert. METHODS: Medical care was provided by paramedics, physicians, and nurses. Care sites included ambulances, medically equipped, all-terrain vehicles, bicycle paramedic units, first-aid tents, and a 124-bed medical facility that included a field hospital and a rehydration unit. Records from the first-aid tents, ambulances, paramedic teams, and rehydration unit were obtained. Data abstracted included patient demographics, chief complaint, time of incident, treatment, and disposition. RESULTS: More than 450,000 people attended the concert and 1,870 sought medical care (42/10,000 attendees). No record was kept for the 665 attendees simply requesting water, sunscreen, or bandages. Of the remaining 1,205 patients, the average of the ages was 28 +/- 11 years, and 61% were female. Seven-hundred, ninety-five patients (66%) were cared for at one of the first-aid tents. Physicians at the tents assisted in patient management and disposition when crowds restricted ambulance movement. Common complaints included headache (321 patients; 27%), heat-related complaints (148; 12%), nausea or vomiting (91; 7.6%), musculoskeletal complaints (83; 6.9%), and breathing problems (79; 6.6%). Peak activity occurred between 14:00 and 19:00 hours, when 102 patients per hour sought medical attention. Twenty-four patients (0.5/10,000) were transferred to off-site hospitals. CONCLUSIONS: This report on the EMS response, outcomes, and role of the physicians at a large single-day mass gathering may assist EMS planners at future events.