Nonfatal heroin overdoses in Queensland, Australia: an analysis of ambulance data.
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In the past decade, the utilization of ambulance data to inform the prevalence of nonfatal heroin overdose has increased. These data can assist public health policymakers, law enforcement agencies, and health providers in planning and allocating resources. This study examined the 672 ambulance attendances at nonfatal heroin overdoses in Queensland, Australia, in 2000. Gender distribution showed a typical 70/30 male-to-female ratio. An equal number of persons with nonfatal heroin overdose were between 15 and 24 years of age and 25 and 34 years of age. Police were present in only 1 of 6 cases, and 28.1% of patients reported using drugs alone. Ambulance data are proving to be a valuable population-based resource for describing the incidence and characteristics of nonfatal heroin overdose episodes. Future studies could focus on the differences between nonfatal heroin overdose and fatal heroin overdose samples. (+info)
Patterns and characteristics of ambulance attendance at heroin overdose at a local-area level in Melbourne, Australia: implications for service provision.
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The monitoring of heroin use and related harms is undertaken in Australia with a view to inform policy responses. Some surveillance data on heroin-related harms is well suited to inform the planning and delivery of heroin-related services, such as needle and syringe provision. This article examines local-area variation in the characteristics of nonfatal heroin overdoses attended by ambulances in Melbourne over the period June 1998 to October 2000 to inform the delivery of services to the heroin-using population in Melbourne. Five so-called hot spot local government areas were considered in relation to the remainder of the Melbourne metropolitan area. Significant local-area variations in the characteristics of nonfatal heroin overdoses were evident over the study period, including the number of heroin overdoses, the age and sex of the people attended, the time of the attendance, the likelihood of hospitalization, and the likelihood of police coattendance. The implications of the findings are discussed in terms of service provision (e.g., opening hours) within the five hot spot local government areas, and it is argued that the analyses undertaken could easily be applied to other jurisdictions for which comparable data are available. (+info)
Entry overload, emergency department overcrowding, and ambulance bypass.
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OBJECTIVES: To describe an experience of emergency department (ED) overcrowding and ambulance bypass. METHODS: A prospective observational study at Royal Perth Hospital, a major teaching hospital. Episodes of ambulance bypass and their characteristics were recorded. RESULTS: From 1 July 1999 to 30 June 2001, there were 141 episodes of ambulance bypass (mean duration 187 min, range 35-995). Monday was the most common day with 39 (28%) episodes. Entry block alone was the most common reason bypass was activated (n=38, 30.4%). The mean number of patients in ED at these times was 40 (occupancy 174%), including nine in the corridor, seven awaiting admission, and 14 waiting to be seen. Episodes attributable to entry block were typically preceded by a presentation rate of >/=10 patients per hour for >/=2 hours (OR 6.2, 95% CI 4.3 to 8.5). Mid-afternoon to early evening was the most common time for activation. Ambulance bypass is increasing in frequency and duration. CONCLUSIONS: Entry overload resulting in entry block results from overwhelming numbers of patients presenting to the ED in a short space of time. Entry block impairs access to emergency care. Unless something is done in the near future, the general public may no longer be able to rely on EDs for quality and timely emergency care. A "whole of system" approach is necessary to tackle the problem. (+info)
The epidemiology of assault across the West Midlands.
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OBJECTIVES: The purpose of this study is to look at accident and emergency (A&E) attendances and admissions after assault in the West Midlands NHS region across a wide range of acute units. METHODS: This study used data from two sources, the A&E Minimum Data Set and the Hospital Episode Statistics database. Analyses were based on data from 12 of the 21 acute trusts in the West Midlands NHS region for the period 1 April 1999 to 31 March 2000. RESULTS: Analyses were performed on 15 969 A&E attendances and 1596 admissions. Some 67.4% of attenders and 84.2% of those admitted were male. The mean age of the patients was between 27 and 29 years. Attendance peaked between 2100 and 0259, especially on Friday and Saturday night. The most common injury was to the head. Some 75.3% of A&E attenders were discharged home. The average stay in hospital was two days and six deaths were recorded. Those living in the most deprived areas were nearly four times more likely to be admitted than those in the least deprived areas (175.9 per 1000 compared with 45.1 per 1000). CONCLUSIONS: This study shows assault is predominately a male phenomenon, worst in the evenings and at weekends, and is positively related to deprivation. It is probable that the levels recorded will be an underestimate, however with some additions to the information collected hospital records could create the basis for a comprehensive surveillance system. (+info)
A preliminary investigation into bacterial contamination of Welsh emergency ambulances.
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OBJECTIVES: The objective of this regional study across Wales was to perform a preliminary examination of Welsh emergency vehicles to determine levels of bacterial contamination. METHODS: Specific sites within emergency vehicles were swabbed, before and after vehicle cleaning, over a 12 month period, on a monthly basis. All swabs were sent to pathology laboratories for culturing and analysis. RESULTS: Results showed that most sites within emergency vehicles across Wales were contaminated with a range of bacterial species before vehicle cleaning. After vehicle cleaning, many sites in vehicles were still contaminated, and some sites that were previously uncontaminated, became freshly contaminated as a result of cleaning methods used. CONCLUSIONS: The authors conclude that the Welsh emergency vehicles examined exhibited an unacceptable level of bacterial contamination. This finding should be carefully considered and all attempts must be made to tackle the problem of vehicle cleanliness and infection control. (+info)
General practitioners and emergency treatment for patients with suspected myocardial infarction: last chance for excellence?
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Pre-hospital coronary care usually consists of a medically staffed coronary care ambulance going into the community from a hospital base, as pioneered in Northern Ireland. In today's medicopolitical and economic climate, this model is not viable in mainland United Kingdom. Current proposals seem to favour a 'scoop and run' policy for heart attack victims, that utilizes the ambulance service but bypasses the general practitioner. Since the majority of telephone calls from people with suspected myocardial infarction are directed to general practitioners, a preferable alternative would be a 'stay and stabilize' strategy that uses the existing referral pattern and builds on general practitioners' medical education and skills. The role of the general practitioner in the management of patients with suspected myocardial infarction is discussed. (+info)
The effect of the Cornwall and Isles of Scilly helicopter ambulance unit on the ambulance services' ability to deliver acutely traumatized patients to hospital.
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OBJECTIVE: to determine whether the use of a helicopter ambulance unit enabled an ambulance service to deliver acutely traumatized patients to hospital more quickly. DESIGN: retrospectively collected ambulance service and hospital records data analysed longitudinally. SETTINGS: The ambulance service and the major casualty department in Cornwall. INTERVENTION: the provision of a helicopter ambulance unit to a county ambulance service. SUBJECTS: patients with compound lower limb fractures carried as emergencies by an ambulance service. Principle outcome measure: ambulance 'mission times'. RESULTS: the ambulance services' ability to deliver emergency patients to hospital more quickly when the helicopter unit was available was not demonstrated. In some instances availability of the helicopter unit probably delayed the timely delivery of emergency patients to the casualty department. CONCLUSION: until a more effective helicopter deployment strategy is in operation it is unlikely that mission time savings will occur. (+info)
Flying squad response to out-of-hospital cardiac arrest--a decade of experience.
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The Flying Squad (MEDIC I) based at the Royal Infirmary, Edinburgh, commenced operation in 1980. The MEDIC I response to out of hospital non-traumatic cardiac arrest over the past decade is reported. On-scene resuscitation was attempted in 384 patients. A total of 149 (39%) patients were successfully resuscitated and transferred to hospital. Thirty-six (9.4%) patients survived to discharge from hospital. Patients receiving basic life support prior to the arrival of MEDIC I and in ventricular fibrillation had a survival rate of 14.5% (25/174). During 1988-89, 21 patients were initially attended by ambulance crews equipped with semi-automatic external defibrillators and eight (38%) of these patients survived. The response of a hospital-based flying squad to support trained ambulance crews, especially when equipped with a defibrillator may provide an economically and operationally feasible alternative to training all first responders in the full range of paramedic skills. (+info)