Modified Shock Index as a Predictor of Admission and In-hospital Mortality in Emergency Departments; an Analysis of a US National Database.

Introduction: The modified shock index (MSI) is the ratio of heart rate to mean arterial pressure. It is used as a predictive and prognostic marker in a variety of disease states. This study aimed to derive the optimal MSI cut-off that is associated with increased likelihood (likelihood ratio, LR) of admission and in-hospital mortality in patients presenting to emergency department (ED).

Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments.

Study Objectives: The shock index (SI), defined as the ratio of the heart rate (HR) to the systolic blood pressure (BP), is used as a prognostic tool in trauma and in specific disease states. However, there is scarcity of data about the utility of the SI in the general emergency department (ED)population. Our goal was to use a large national database of EDs in the United States (US) to determine whether the likelihood of inpatient mortality and hospital admission was associated with initial SI at presentation.

The Emergency Department Crash Cart: A systematic review and suggested contents.

Background: As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specifically discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients.

Methods: The authors performed a systematic review of EDCC-specific literature indexed in Pubmed and Embase on December 20, 2016.

Hospital Surge Capacity: A Web-Based Simulation Tool for Emergency Planners.

The National Center for the Study of Preparedness and Catastrophic Event Response (PACER) has created a publicly available simulation tool called Surge (accessible at http://www.pacerapps.org) to estimate surge capacity for user-defined hospitals.

Clinical metrics in emergency medicine: the shock index and the probability of hospital admission and inpatient mortality.

Study Objectives: The shock index (SI), defined as the ratio of HR to systolic BP, has been studied as an alternative prognostic tool to traditional vital signs in specific disease states and subgroups of patients. However, literature regarding its utility in the general ED population is lacking. Our main objective was to determine the probability of admission and inpatient mortality based on the first measured SI at initial presentation in the general adult ED population in our tertiary care centre.

Pediatric Emergency Department Return: A Literature Review of Risk Factors and Interventions.

Background And Objective: Children discharged from emergency departments (EDs) are often at risk for ED return. The objective was to identify risk factors and interventions to mitigate or prevent ED return among this patient population.

Methods: Structured literature review of PubMed and clinicaltrials.

Disaster Metrics: Evaluation of de Boer's Disaster Severity Scale (DSS) Applied to Earthquakes.

Introduction: Quantitative measurement of the medical severity following multiple-casualty events (MCEs) is an important goal in disaster medicine. In 1990, de Boer proposed a 13-point, 7-parameter scale called the Disaster Severity Scale (DSS). Parameters include cause, duration, radius, number of casualties, nature of injuries, rescue time, and effect on surrounding community.

Troponin elevations only detected with a high-sensitivity assay: clinical correlations and prognostic significance.

Objectives: With clinical use of high-sensitivity troponin I (hsTnI), more frequent troponin elevations will occur. However, the burden and implications of these elevations are not well understood. The authors quantified the prevalence of elevated hsTnI in patients presenting with possible acute coronary syndrome (ACS) who do not have elevated troponin with a current generation assay (cardiac troponin I [cTnI]) and determined the association of these newly detected elevations with a composite of all-cause mortality and subsequent cardiac hospitalization.

Availability and diversity of training programs for responders to international disasters and complex humanitarian emergencies.

Introduction: Volunteers and members of relief organizations increasingly seek formal training prior to international field deployment. This paper identifies training programs for personnel responding to international disasters and complex humanitarian emergencies, and provides concise information - if available- regarding the founding organization, year established, location, cost, duration of training, participants targeted, and the content of each program.

Methods: An environmental scan was conducted through a combination of a peer-reviewed literature search and an open Internet search for the training programs.

Comparing the accuracy of syndrome surveillance systems in detecting influenza-like illness: GUARDIAN vs. RODS vs. electronic medical record reports.

Background: A highly sensitive real-time syndrome surveillance system is critical to detect, monitor, and control infectious disease outbreaks, such as influenza. Direct comparisons of diagnostic accuracy of various surveillance systems are scarce.

Objective: To statistically compare sensitivity and specificity of multiple proprietary and open source syndrome surveillance systems to detect influenza-like illness (ILI).

Critical resources for hospital surge capacity: an expert consensus panel.

Background: Hospital surge capacity (HSC) is dependent on the ability to increase or conserve resources. The hospital surge model put forth by the Agency for Healthcare Research and Quality (AHRQ) estimates the resources needed by hospitals to treat casualties resulting from 13 national planning scenarios. However, emergency planners need to know which hospital resource are most critical in order to develop a more accurate plan for HSC in the event of a disaster.

Fellowships in international emergency medicine in the USA: a comparative survey of program directors' and fellows' perspectives on the curriculum.

Objective: Experts have proposed core curriculum components for international emergency medicine (IEM) fellowships. This study examined perceptions of program directors (PDs) and fellows on whether IEM fellowships cover these components, whether their perspectives differ and the barriers preventing fellowships from covering them.

Methods: From 1 November 2011 to 30 November 2011, a survey was administered to PDs, current fellows and recent graduates of the 34 US IEM fellowships.

Interventions to mitigate emergency department and hospital crowding during an infectious respiratory disease outbreak: results from an expert panel.

Objective: To identify and prioritize potential Emergency Department (ED) and hospital-based interventions which could mitigate the impact of crowding during patient surge from a widespread infectious respiratory disease outbreak and determine potential data sources that may be useful for triggering decisions to implement these high priority interventions.

Design: Expert panel utilizing Nominal Group Technique to identify and prioritize interventions, and in addition, determine appropriate "triggers" for implementation of the high priority interventions in the context of four different infectious respiratory disease scenarios that vary by patient volumes (high versus low) and illness severity (high versus low).

Setting: One day in-person conference held November, 2011.

The Rush University advanced trauma training program, a novel approach for military trauma training.

Nearly 90% of combat deaths occur on the battlefield before the casualty reaches a treatment facility. It has been shown that early intervention in trauma patients improves morbidity and mortality. Hence, the training of military health care providers in lifesaving measures is imperative to saving lives on the battlefield.

State of virtual reality based disaster preparedness and response training.

The advent of technologically-based approaches to disaster response training through Virtual Reality (VR) environments appears promising in its ability to bridge the gaps of other commonly established training formats. Specifically, the immersive and participatory nature of VR training offers a unique realistic quality that is not generally present in classroom-based or web-based training, yet retains considerable cost advantages over large-scale real-life exercises and other modalities and is gaining increasing acceptance. Currently, numerous government departments and agencies including the U.

Improving knowledge and process for international emergency medicine fellowship applicants: a call for a uniform application.

Background. There are currently 34 International Emergency Medicine (IEM) fellowship programs. Applicants and programs are increasing in number and diversity.

Earthquake-related injuries in the pediatric population: a systematic review.

Background: Children are a special population, particularly susceptible to injury. Registries for various injury types in the pediatric population are important, not only for epidemiological purposes but also for their implications on intervention programs. Although injury registries already exist, there is no uniform injury classification system for traumatic mass casualty events such as earthquakes.

Prehospital emergency medical services in Lebanon: overview and prospects.

Prehospital emergency medical services in Lebanon are based on volunteer systems with multiple agencies. In this article, a brief history of the development of prehospital care in Lebanon is presented with a description of existing services. Also explored are the different aspects of prehospital care in Lebanon, including funding, public access and dispatch, equipment and supplies, provider training and certification, medical direction, and associated hospital-based emergency care.

Disaster metrics: quantitative estimation of the number of ambulances required in trauma-related multiple casualty events.

Introduction: Estimating the number of ambulances needed in trauma-related Multiple Casualty Events (MCEs) is a challenging task.

Hypothesis/problem: Emergency medical services (EMS) regions in the United States have varying "best practices" for the required number of ambulances in MCE, none of which is based on metric criteria. The objective of this study was to estimate the number of ambulances required to respond to the scene of trauma-related MCE in order to initiate treatment and complete the transport of critical (T1) and moderate (T2) patients.

Disaster Metrics: A Proposed Quantitative Assessment Tool in Complex Humanitarian Emergencies - The Public Health Impact Severity Scale (PHISS).

Background: Complex Humanitarian Emergencies (CHE) result in rapid degradation of population health and quickly overwhelm indigenous health resources. Numerous governmental, non-governmental, national and international organizations and agencies are involved in the assessment of post-CHE affected populations. To date, there is no entirely quantitative assessment tool conceptualized to measure the public health impact of CHE.

The impact of alternative diagnoses on the utility of influenza-like illness case definition to detect the 2009 H1N1 pandemic.

Objective: To investigate the impact of excluding cases with alternative diagnoses on the sensitivity and specificity of the Centers for Disease Control and Prevention's (CDC) influenza-like illness (ILI) case definition in detecting the 2009 H1N1 influenza, using Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification, a disease surveillance system.

Design: Retrospective cross-sectional study design.

Setting: Emergency department of an urban tertiary care academic medical center.

Prairie North: a joint civilian/military mass casualty exercise highlights the role of the National Guard in community disaster response.

In a joint military/civilian exercise conducted in June 2010, military National Guard medical and decontamination response efforts proved to be paramount in supporting hospital resources to sustain an adequate response during a simulated terrorist event. Traditionally, hospitals include local responders in their disaster preparedness but overlook other available state and federal resources such as the National Guard. Lessons learned from the exercise included the value of regular joint disaster planning and training between the military and civilian medical sectors.

Disaster metrics: a proposed quantitative model for benchmarking prehospital medical response in trauma-related multiple casualty events.

Introduction: Quantitative benchmarking of trauma-related prehospital response for Multiple Casualty Events (MCE) is complicated by major difficulties due to the simultaneous occurrences of multiple prehospital activities.

Hypothesis/problem: Attempts to quantify the various components of prehospital medical response in MCE have fallen short of a comprehensive model. The objective of this study was to model the principal parameters necessary to quantitatively benchmark the prehospital medical response in trauma-related MCE.