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Access to acute and emergency care is essential when we are ill or injured, but the costs are significant. How can we make services more efficient and effective? This thought-provoking text provides twenty case studies detailing successful innovations to enhance value, including telehealth, observation medicine, high utilizer programs, and the use of informatics to improve clinical decision support. A detailed history of system developments over the last fifty years in the US and internationally is provided, and subjects including measurement and quality improvement, volume versus value based care, and emergency department crowding are discussed. This book is an ideal way for emergency physicians and healthcare managers to explore new ideas and enhance the quality of care in their area.
The review was conducted to evaluate if the field of mass-gathering medicine has evolved in addressing: (1) the lack of uniform standard measures; (2) the effectiveness of and needs for various interventions during a mass gathering; and (3) the various types of noncommunicable health issues (trauma and medical complaints) encountered and their severity during a gathering.
A systematic review of papers published from 2003 through 2012 was conducted using databases of MEDLINE, Ovid, CINHAL, EBSCOHost, National Library of Medicine (NLM), Agency for Healthcare Research and Quality (AHRQ), Elsevier, Scopus, and Proquest databases. Of 37,762 articles, 17 articles were included in this review, covering 18 mass-gathering events; 14 were multiple-day events.
Across all events, the patient presentation rate (PPR) ranged from 0.13 to 20.8 patients per 1,000 attendees and the transfer to hospital rate (TTHR) ranged from 0.01 to 10.2 ambulance transports per 1,000 attendees. In four out of the seven studies, having on-site providers was associated with a lower rate of ambulance transports. The highest frequencies of noncommunicable presentations were headaches, abdominal complaints, and abrasions/lacerations. Most presentations were minor. Emergent cases requiring hospitalization (such as acute myocardial infarction) were rare.
The rate of noncommunicable health issues varies across events and very serious emergencies are rare.
AlquthamiAH, PinesJM. A Systematic Review of Noncommunicable Health Issues in Mass Gatherings. Prehosp Disaster Med. 2014;29(2):1-9.