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Training in pre-hospital emergency medicine (PHEM)
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
As a guide, pre-hospital emergency medicine (PHEM) refers to clinical intervention by doctors, and pre-hospital emergency care (PHEC) refers to treatment in the pre-hospital environment more generally. An Intercollegiate Board for Training in PHEM (IBTPHEM) was formed in May 2009. PHEM was subsequently approved by the General Medical Council (GMC) as a medical sub-specialty of emergency medicine and anaesthetics in July 2011 and of acute internal medicine and intensive care medicine in October 2013. There are now PHEM training programmes across the UK with a national recruitment framework and the aim that all UK ambulance services should have consistent immediate access to deployable sub-specialist PHEM services 24 hours a day to support personnel and patients on the ground.
Traumatized Airway
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Edgar J. Pierre, Stephen L. Freiberg, Megan Rashid, Pedro Mascaro
Data in the literature regarding the safety and efficacy of pre-hospital intubation are almost entirely derived from retrospective and descriptive studies, as randomization and standardization of such an intervention are nearly impossible to achieve. Studies from the United States suggest a success rate of pre-hospital endotracheal intubation of 86%–90%, but it can be as low as 50% when performed by rescuers that do not often perform the procedure [7]. Additionally, pre-hospital intubation routinely fails to show benefit in the literature: in a prospective observational study at a large Level I trauma center study by Cobas et al., there was a 31% incidence of failed pre-hospital intubation, and there was no difference in mortality between patients who were properly intubated and those who were not [7]. Furthermore, pre-hospital intubation has been associated with increased mortality both in patients with traumatic brain injury [6] and in patients with penetrating trauma [5]. Also, in another retrospective study by Stockinger et al., trauma patients who underwent pre-hospital intubation had increased mortality compared to those ventilated with a bag-valve-mask. Given the limitations of pre-hospital emergency medicine providers in the United States (who are generally paramedics and often are unable to administer neuromuscular blocking agents) and a lack of difference in mortality between patients who were properly intubated and those who were not, pre-hospital endotracheal intubation in the United States should be limited to experienced providers only if ventilation with a bag-valve-mask is unsuccessful.
Self reported involvement in emergency medicine among GPs in Norway
Published in Scandinavian Journal of Primary Health Care, 2018
Magnus Hjortdahl, Erik Zakariassen, Peder A. Halvorsen
General practitioners (GPs) are involved in emergency medicine in different ways in different countries. They encounter emergency medicine during office hours, outside of office hours, and in both metropolitan and rural areas [1–3]. In some countries, GPs’ involvement both before and after the patient arrives at the hospital is thought to improve patient care and ease the strain on overcrowded emergency departments [4–6]. In Norway, GPs are totally integrated into pre hospital emergency medicine [7] and GP-staffed casualty clinics (out-off-hours emergency primary care services) together with the emergency medical technician (EMT) staff of ambulances are the primary prehospital emergency resources. All GPs in Norway are obliged to be on call at the local casualty clinic, but how often they do this differs between municipalities. The organization and structure of the casualty clinics are heterogeneous because they vary in size, staffing, population served, and area covered. The casualty clinic can serve a single municipality or several municipalities, or a sparsely populated area or a large city. The municipality is responsible for offering its inhabitants a casualty clinic staffed with a physician on call 24 h, 7 days per week, but otherwise the staffing varies from a single physician, with or without a colleague on standby at home, to several physicians working at the same time. Some have no nursing staff, whereas others might have several nurses and other ancillary personnel. Some casualty clinics are equipped with a response vehicle for the physician on duty, with or without a dedicated driver.
Medical students in the pre-hospital environment – An untapped resource for undergraduate acute care and interprofessional education
Published in Medical Teacher, 2022
Aditi Nijhawan, Joyce Kam, Jonathan Martin, Lewis Forrester, Sam Thenabadu, Shadman Aziz
Pre-hospital emergency medicine (PHEM) is the provision of care to seriously ill or injured individuals in the out-of-hospital environment (IBTPHEM 2015.) Care in the pre-hospital environment is organised by regional emergency medical services (EMS) (Mehmood et al. 2018), and is provided by a variety of professionals including paramedics, emergency medical technicians, first responders and doctors, as well as allied professionals such as police and fire brigade (Fairhurst 2005; Strote and Harper 2019). Some countries including many in Europe have predominantly physician-led responses (Fairhurst 2005), while others have physician involvement for only the minority of critically unwell patients (Valentin and Jensen 2019).
Trend analysis of the loss and gain of patients on HIV treatment in the context of COVID-19 in South West Shewa Zone, Oromia, Ethiopia from 2016 to 2020: a short report
Published in AIDS Care, 2022
Teka Haile Uma, Tekalign Woldesemayat Bikila, Tesfaye Dejene Gutema, Tolesa Regasa Dugasa, Haile Abera Gudicha, Guteta Degefa Buta, Engida Kabeta Merga, Meseret Biratu Aga
Legal permission was obtained from the Public Health Emergency Management (PHEM) and Rapid Response Committee (RRC) of South West Shewa Zone Health Office with Reference No. WEFG/3/316. A formal legal permission letter was submitted to the two selected hospitals in South West Shewa Zone, Tulu Bolo General Hospital and St. Luke Catholic General Hospital to use all available data.