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Emergency medicine continues to grow as an international specialty. With >30 countries developing emergency medicine training, supporting international physician education is imperative. The proposed Emergency Medicine International (EMI) observational fellowship is a systematic model for the academic and experiential training of future leaders.
Methods:
This program is a result of interest in academic emergency medicine and the responsibility of the educational institution. A literature review on the international development of emergency medicine was performed and the weaknesses were assessed. Based on this review, the goals for EMI are providing: (1) leadership; (2) exposure to education training models; and (3) research instruction. The EMI structure consists of four blocks: (1) emergency medicine clinical rotations; (2) emergency medical services (EMS) experience; (3) medical toxicology exposure; and (4) emergency medicine operations/administration. All blocks are tailored to the training background and interests of participants such as focusing on education methodology (conference organization, simulation) or departmental operations (quality improvement, faculty development). Overlapping all blocks is crucial to education in research methodology and evidence-based practice of medicine.
Results:
Assessment of the program includes pre-/post-survey completion by participants and yearly post-fellowship contact tracking the development of emergency medicine in their country.
Conclusions:
While different types of organizations can assist in other ways, only academic emergency medicine can help grow and mentor faculty to expand the specialty worldwide.
Accidental or voluntary chemical incidents create many health and environmental problems. According to the physico-chemical proprieties of the released agent, risks are present for all involved persons (victims, rescuers), either by primary contamination (contact with skin or mucosal surfaces, respiratory tract inhalation), or by secondary contamination from close contact with exposed victims. Recent descriptions of mass-chemical accidents with numerous spontaneous evacuations from the contaminated zone to nearby hospitals represent an important risk for secondary contamination to these hospitals.
Methods:
The use of an easy-to-set-up decontamination gate to protect or preserve hospitals from contamination of their site and personnel following a massive influx of contaminated patients was evaluated. A multi-disciplinary team equipped six regional hospitals with mass-decontamination gates without mobilizing excessive human or material resources.
Results:
Basic formation of hospital personnel took two hours; attaching the gate to a local fire hydrant took <10 minutes.
Conclusions:
This decontamination gate has several advantages and limitatins that will be discussed. However, it does have merit as an autonomous protection for non-specialized and equipped hospitals to prevent secondary contamination.
Four experienced burn care providers participated as advisors in two mass casualty exercises in an area where access to a bum center is severely limited. The role of the advisors, lessons learned, and recommendations for future exercises will be presented.
Methods:
Prior to the exercises, advisors provided a Justin-Time lecture orienting hospital workers to prehospital triage, emergent burn care, and burn center transfers. Exercise 1 consisted of a simulated train derailment with hazardous materials spill and involved 150 victims; many with burn injuries and associated trauma. An advisor was assigned to each car to provide guidance to victims and feedback to exercise evaluators on prehospital triage, victim management, and transfer decisions. Exercise two involved a terrorist attack at an oil refinery in a small community; 140 victims were moulaged, triaged, and transported to the hospital. A burn advisor was assigned to each of the following areas of the hospital: initial triage area, intensive care unit (ICU) for immediate/critical victims, rehabilitation area for patients triaged into delayed or minor injury categories, and the state Disaster Medical Assistance Team (DMAT) treatment area.
Results:
Overall, victims with injuries other than burns were more accurately triaged at the scene, assessed at the hospital, and managed. Although the state has provided burn courses to 150 nurses, physicians, and paramedics over the previous three years, there is a significant need for further burn training.
Conclusions:
The presence of experienced burn advisors provided the opportunity for healthcare providers to receive training, ask questions during the exercise, and receive feedback following the exercise.