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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.
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.
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.
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.
Physicians practicing internationally provide comprehensive health care and often prepare with global health courses. These can be limited by timing and do not provide primary care training to sub-specialists. It is hypothesized that Oregon physicians are interested in global health education and want an accessible course that reviews skills used in international medicine.
A survey-based needs assessment was conducted of licensed Oregon physicians that determined the level of interest in global health training. A total of 6,099 surveys were mailed to physicians in June 2007. The surveys included questions regarding demographics (age, gender, years of clinical practice, and practice specialty), international background (volunteer work, disaster relief), global health education interest (obtaining training, specialties desired), and course specifics (length, format, and cost).
A total of 624 surveys were returned for a 10.6% response rate. Of that group, 88.1% expressed interest in global health and 75.8% in a training course. Data analysis of this group showed that it consisted largely of physicians practicing for 15–34 years (mean = 23.8) and 45–64 years of age (mean = 55.8). Answers to course-specific questions indicated physician concerns about course time and educational interests based on differing clinical background.
Oregon physicians are interested in international healthcare education. To meet this need, a global health course has been developed at the Oregon Health and Science University (OHSU).
Current prehospital protocols for the management of patients with altered mental status include the empiric administration of hypertonic glucose, naloxone, and thiamine. The injudicious use of 50% dextrose (D50W) may result in hyperosmolarity, a worsening of hypokalemia, and unwarranted additional health-care costs for the patient. The administration of D50W also may worsen the neurological outcome of patients with local or generalized ischemia.
To evaluate the ExacTech blood glucose meter's ability to estimate blood glucose levels accurately and rapidly.
Emergency medical technicians (EMTs) from selected advanced life support (ALS) units in the Portland, Ore., metropolitan area participated in a prospective clinical trial of the ExacTech blood glucose meter. A convenience sample, was drawn from emergency medical services (EMS) patients with suspected diabetic emergencies, altered mental status, and other neurological deficits. Venous blood samples were drawn from these populations at the same time as the ExacTech readings were obtained. The venous blood was submitted to the receiving hospitals for laboratory analysis of blood glucose levels, and a comparison was made between the results of the two methods.
A total of 80 matched sets of data were obtained from 1 April 1990 through 6 May 1991. The hospital blood glucose values ranged from 8 to 1233 mg/dl. Sixteen (20%) of the patients were hypoglycemic (<60 mg/dl) and 23 (28.8%) were hyperglycemic (>180 mg/dl). The ExacTech device sensitivity and specificity for hypoglycemia using venous samples were 94.6% and 89.2%, respectively. For hyperglycemia, these same parameters were 87.5% and 97.1%. Pearson's r over the range of the instrument (40–450 mg/dl) was 0.8656 (p <.001). If the prehospital “definition” of hypoglycemia (for threshold-to-treat) is raised to 65 mg/dl, the device has 100% sensitivity in the sample population.
The device functioned accurately and consistently in the prehospital environment over a wide range of temperatures, and in the hands of many different individuals.
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