agreed;88% felt thev were calm and collected, l2Zo disagreed.We conclude from our ii-it"A gro"p-ifr", -"r,-f"_ilies of sudden death patients were reneralli- r"tirfi.a-"ritl"thJir no experience, impactiig tnuor"tty ."it.'i,rrri"ii"n of lj:t:T-.bly rng process. specific procedural and emotionar their griev_ stiiis ie.a rmprovement.
!9jf -fn"_Lirera_rureof Emersency ilediciner A j 6ipart,i6nt. Gitation Analysis aw smitn orcrirical
Medicine,SUNy Ujstate [redrcat Center, :.9j^"-"ld uyracuse,fferqgncy New york .The development of emergency medicine as a scientific discipline is demonstrated in part'by ifr.-p"Uii"rri."-of several prima_ ry iournals. On the othe; hana, "-irg.""y *;icine remains a multi-disciplinary, specialty, *itit t.re"?"t lr irt*.r, ro emergency physicianspublished in a variety of medicai specialty ;oum1b.
p-::,|9f jT:rf jli1,l*r 3 citation;"ry;i;;I;; source ioumars, Anna6ol Emergencv Medicine, Ameficanlournalof riersiiii
Medicine, lourna! o1 E^"rgency Medicine, Critical Care Medi_ cine, and lournal of Ttauma, *", performJ nfi "i,ril", Ui thesefive journalsduring l98i w"r" i;il;-tA ,rra cited foumals y_._t:1i+.d,by freque-ncy of citation Uy tf,LG [.r-rt.. To com_ pensatetor the size of the iournals,an impact factor was calcu_ latedbydividing the frequency;i;ffi;6ii,i'r,,r_u". of cita_ ble articlesduring 1983i-a t6ei, il;iljil;als wereranked by impactfactor.-To"o-p.rrr"i.'foi ,iil'"iJ "r ,'ioumal, recent citationsof th_e-ioumals weretabulateJ"rrt "" i_i".ai"Jy i"-J"* wascalculatedbv dividing-th"""-U Jr"J.ri^citatiorrs ly tt. numberof citabli articleJdurin! t983aii'ffi;;ira ,t. iournals wererankedby immediacyjndei.The t"p f*" il"-"ls rankedby immediacyindexareAnl EryergM"d, ir;; i;;;Ir";,i Tyr;;;,
Med,Circstock,_fr p"si lm I .Emery "r fu"i,-e"Lrtn A"olsCi, io\owl.Emery M9d, A Ci;:;;;;.". rheselists *,':!!:'frf mrght serve to make decisions
about what ;oumals to incrude in an emergencymedicine library about what'loumals ;-;;;t;;
;filXfl;l;:,and
whatiournals"".;;A;;
piysi"i,,, _ight
Compurer.Assisred ED Charr Audit Dr 132 rtgn./_Departmenr or emergen-y utedi";;;, Witi;, Beaumont !,ve Hospital,
RoyalOak, Michrgan . Computer technology offers.the potential to increase produc_ tivity of quality "ssrri"n"e .rtortr.'!1i.-pt!reit^a'merhod for a micro-computer assistedemergency dlpartment chart audit which numerically and gaphicat"t dei,i"rr?J r"*marizes data. Charts are audited daili aird ""Jpiiir". .itir"#criteria is as_ sessed.Results are tabulated ;;tht ;'" "oirpu,., ^i-tz-a" ,,spreadsheet" using an IBM-pCo "o*prrt.i Lj i*", software. Results are tgbulated according t. gp""ifi" a".ficlncy on the y_ axis, and individual nhvsician"on tff i;;:-T;,"fi.rg ,fr. J"L along the -Y-axissummarizes the performance of the entire department for each criterion. Totaling ;h" ;;t; iiorrg tlr. X_"*i, summarizes the.overall performancJof each physician. Thus a quantitative profile (averige deficiencies p.i "fr'"if i. maintained lor eachphysician and thJentire a.p"rt"i*l iI.'roft**. "o__ bines monthly spreadsheets.to yield'yeaitolJ"*'i",r, and gener_ ates a variety.of gr-ap_hics, allowing uiJ""t ,.pi"rl"t"tion oi p-erformance. Specific deficiencies or irends, "i[t "i-lv i"aividual or cepartment, are thus easily,seen.W-ehave fo,lrrd iire-r,r.eof graptr_ ic peer compalrson.feedbaik luisurrffi-p-"irig iir-. qr.r,, ji1"1iu" pertormanceof each ohvsician to his/her peers on a nionthly arrj
in EMS EJ Otten / Departmentof EmergencyMedicine, Universityof Cincinnati The.most neglected -areaof formal resident education is in the area of emergency medical services. r,r".ry io.-.. residents have echoedthis in requestingassistancei" sJttirrg'up or administer_ ing EMS syst.*j after iompleting ,ir'.iil.ria"""y training. In order to addressthis problern we t i'". i"rtit,rt"o a program start_ ing from day one of resident tt i"i"g-th"t-ori"-"i, tt. resident to the various components of the IME syr,"_ ta over the nexr tour years makes him/her an integral part of that system. During orientation, the first-ye.arresideit is given thiee orre-hou, lec_ tures covering basic conligurations andiyst..n. a.rigrr.. ih" r;_ dent is assigned to one oT 30-paramediJ ";i;; i" our area along with a senior resident who has t*o to ifrr". y"r., .*p.rr.rr"" rs expected ro Fal unit. During the firs.t y""r, tt. i.rij.ir, l,vitl participate in EMT training disaster exercises ,tra ".i,r"L *r* with his unit. The second-yiar ,.rid;";r;;;;"ven an eight_hour course.atthe beginningof the.yearstrerrirrg "3_munrcations and
rear resident i s respon"s i bre f", ;;;;;;;l; lj,ii*-ll :, f ,c!l{ rcremerry cans ln the emergency
department. The third-year iesi_ dent is.assignedto the rmdgenly tirr"ri.iiilrpinse Team at the beginning of the year and is an integal p"rt of?. di."rt.rlUr,_ ning in the area. Borh second_a"dtt ii+ye"i .esia.rrts "r-eie_ quired to attend flight physician ori""t"ti.r'" ""i are.e.rcorrraged to participate in the air ambulance proâ‚Źram (at least nve runs per monthf. The fourth year contains " f6""*lr.t "ourse director of prehospitai ."r. "rrJ i"J"a.rlr"i"i"g'r.qrr,r._..rt with the fo, EMTs, quality assurance-, research,efrlS fii.i"i"re, administra_ tion, financing rechnical "o*porr.rrir,- "rrJ-tJgi;t"tion with re_ f 11:"lll:^9t1r,,"tplanning-andhazardous"materiatresponse ls also covered. Throughout al] leru years weekly "o"f....""., touching on various "rf."t, of EIvIS "ri" gi"." ,"a residents par_ ticipate with EMT:A ""d EUf=p tr"i"*g i,'rfr. irr,,ue..rty ". *.ll as with their ,,own,, assigned "nit. fh'is c"iii""f"* gr;;;;: quate exposure to the EMS system and ensures that thi resident will become the complete emergency physician.
prospective Evatuation gf Inftight Medical !34 Emergencieb on commeiciir-iiriirilJ ci speizer, cJ prelol / Department ot rmerge;ctii-i,",n",HarborlTnj",.H UCLA Medical
Center,Torrance,Califoriia Over 50 billion passenger-milesare flown each year in the United_States by commercial airlines. elthl"gi ,iu.."f maior airlines.claim approximately 2-j iild*; p* i'irtiir. p.. year,the true incidence, type, and outcome or infiighi-m;aiJ"f .;;;g;;_ cres have not been studied previously Oe$ite the fr.f. the Federal Aviation Administratio" h", ,;;'.;i;'propos.d oia?tr, , ,.g_ 'ro ulation requiring commercial pf;;;;;irji;;; "rrry .r, "*_ tensive emergencymedical kit. To eximine the magnitude of the *.tl as the, pote"ti"l rppi;-;ii;r,.'"r,i pj:lt_.:^T r.q,:ir._.nt, ror â‚Źny e.mglsgncy medical kit, we have undertaken a study to evaluate inflight medical emergencies.I"nrgfrt ^.ii""f "*.ii""_ cies were evaluated among passengersarrivihg at Los Angeles International Airport (LAX) from Sctober ,f,r'o"g[ December of 1985.Evaluation *"i r".iiit"i.a ty ;h;;ilililil patients re_ quiring more than minor medicar i"r. *"t. tri"g.i to orre Emer-
(EDl.All.Eq LAx first aid st"tior,]-*a p"r"_.ai" 9::^Z records?:f. were examined. The
age, sex, chief compiaint, dluration oi inflight.symptoms, any MD ;s;is6;;; ausr.-,iG and outcome were tabulated. There were 4,400,000 at LAX ;*r;il;;;.vals
,!g.:rydyperiod.rr+
ffi;::#i',*:':L::.1,tru*t#i:*1*.li:::iex$i:
odologyin many of our ou and can easily be amended ,.i -.oi"air]i""i"""*a" emergencydepartments.
133
of various
Gurricutum lor Training Reridentr 5l
d;;;'1"p.;'-.dical
!y'l"g inflight (l:39,000f. i"ss.n!e.i com_ p,laints 5ti patieits h"J .t;;"_s tor more t h9l. Only 9 patients (8%f had infl'ill't physician llt-1i as62 patients required only iirst aid staii,ontreatment :111,": or srgnectout againstmedical advice.52-patients were triaged to the ED; ll were admitted t" the hosfiial;i;h;";;;riti"-r.*ri"i (one a delayed death from a cardiac ,rr..lr"ff.r.Jln the ground at the airport and the other a d.hyJ J;;;-?;;; intracranial bleed with a respiratorv arrest thai ;";;;;; ;Jte to the ED). Nausea and vomiting, chest pain, and loss of consciousnesswere