Journal of Emergency Medicine, Trauma and Acute Care - 2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings, October 2016

Objective: Physician Associates were employed in a busy London Emergency Department to provide a new level of integrated Emergency Medical care. Background: Physician Associates have proved invaluable in the USA medical field over the past 30 years and have been identified as a possible workforce solution in the UK1,2. There are currently 19 Physician Associates (PAs) working in Emergency Departments across the UK3, with t Read More

Background: On 3rd March the local newspaper published report regarding measles outbreak in Mansehra Colony Landhi, Karachi. In response to the report the Executive District Office health Karachi constituted a three members investigating team with the objectives to investigate the outbreak and propose recommendations for control of outbreak the affected Mansehra Colony Landhi having population of 600 households. Methods: Inve Read More

Introduction: Diabetic foot is one of the most disabling complications with substantial morbidity. It remains the most common reason for hospital admission, impairs quality of life, engenders high treatment costs and is the most important risk factor for amputation. Objectives: To determine the prevalence of diabetic foot among diabetic patients and the prevalence of main related risk factors. Methods: A cross-sectional study was pe Read More

Background: It has been found that 89% of the ED staff in HGH has very low knowledge on the approach of SBAR, due to which they don't converse it accordingly with other staff especially during endorsements, face-face & critical call scenarios. Aim: To increase and standardize the usage of SBAR as a communication tool among the clinical staff in the ED of high to 100% by FEB 2016. Methods: The project was done in an iterative four-step c Read More

Background: Acute respiratory infections, including influenza, comprise a leading cause of morbidity and mortality globally. Influenza surveillance provides important information to inform policy on influenza control and vaccination. While the epidemiology of influenza has been well characterized in western countries, few data exist on influenza epidemiology in the Eastern Mediterranean Region. We describe the epidemiology of influenza Read More

Background: This study used the 2012 London Olympic Games as the empirical context to examine how interagency collaboration took place among the diverse public health and safety agencies involved in this mass gathering event. In order to develop our understanding of how collaboration among the key stakeholders in a mass event may be improved, this study aims at capturing the components that affected the ability of interagency colla Read More

Background: The aim of this study was to evaluate post-injury functional recovery over three years in patients with moderate and major trauma in Hong Kong. Methods: This is a multicentre prospective cohort study conducted in Hong Kong. The inclusion criteria were: trauma patients admitted to one of three trauma centres, with age ≥ 18 years, injury severity score (ISS) ≥ 9, meeting Trauma Registry criteria, and surviving to 48 hours. Functi Read More

Background: There is little evidence of research outcome data or studies into self-reported back pain in Middle Eastern or Gulf region countries. Within HMC there is anecdotal evidence that suggests that back pain in nurses working in critical care environments accounts for a significant percentage of all sick cause leave. This has the potential to impact on productivity, patient care and quality of life in nurses working within critical care in envir Read More

Emergency Medicine (EM) is an officially recognized medical specialty in over 60 countries, with the rate of specialty recognition accelerating in recent years. EM care delivery systems are specifically focused on managing the acute consequences of non-communicable as well as communicable disease processes, and therefore represent an important public health tool for reducing the present and future global. According to the 2006 World H Read More

Oman has committed to the goal of eliminating measles, rubella and congenital rubella syndrome (CRS) by 2015 year. Elimination is defined as the absence of endemic measles and rubella transmission in a defined geographical area for ≥ 12 months in the presence of a well-performing surveillance system and for rubella without the occurrence of CRS cases associated with endemic transmission in the presence of high-quality surveillanc Read More

Introduction: MVC accident is one of the major cause of mortality and morbidity in children. In 2010, road traffic accidents were the major cause of 228 deaths and 568 major injuries in Qatar.(4). Children in cars who are not restrained, have a great risk of being injured. Our aim from this study is to check parents' awareness of the important of using child restrain (car seat) and reasons behind preventing them from not using it. Objectives: Chec Read More

Background: Cranial computed tomography (CT) scan is a commonly performed neuroimaging prior to lumbar puncture (LP) in children with suspected meningitis to rule out intracranial hypertension or space occupying lesions. The purpose of this study was to assess the accuracy of physicians' prediction of CT abnormal cerebral findings in pediatric meningitis. Subjects and methods: A prospective observational study design was perf Read More

Endoscopic third ventriculostomy (ETV) is a common minimal-invasive neurosurgical procedure with well-documented complications. We report the case of a 6-year-old female child who underwent ETV, external ventricular drainage (EVD) catheter insertion and biopsy for a tumour arising from the pineal gland causing obstructive hydrocephalus and raised intra cranial pressure (ICP). Vital signs were stable pre-operatively and anaesthesia was Read More

Introduction: Proteinuria in burn patients is common, and it could be associated with acute kidney injury (AKI) with bad outcomes. We evaluated the incidences, outcomes, characteristics and determinants of proteinuria as a biomarker and its influence on AKI and outcomes in burn patients. Methods: This retrospective study was carried out on a group of patients with burn injuries admitted though Emergency Department to burn unit of Ha Read More

Background: Ambulance services in Saudi Arabia are organised through the Red Crescent, the organisation that is responsible for ensuring adequate ambulance service for all communities in Riyadh. Paramedics are the first responders among the healthcare providers responsible for saving patients' live outside hospital settings. Work-related stress is a serious problem that affects the health and well-being of employees as well as the prod Read More

Background/aims: Prognosis for patients with cirrhosis admitted to medical intensive care unit (MICU) is poor. The objective of this study was to assess the predictors for hospital mortality and admission of cirrhotic patients to MICU in Qatar. Materials and methods: We conducted a retrospective cohort study of consecutive adult cirrhotic medical-ICU patients whom hospitalized from 2007 through 2012 to Hamad General Hospital-Qatar. We c Read More

Introduction: Use of ECMO has been shown to be an acceptable intervention for patients with respiratory failure refractory to optimal ventilator management. As experience with ECMO grows the indications for its use are also expanding. Case: Our patient is a 20-year-old female who was found lying on the roadside after being hit by a moving vehicle. She was rushed into the trauma room where she was intubated for low Glasgow co Read More

Background: Anticipating falls in the Emergency Department is a very challenging task as it's often the most unpredictable setting. Fall risk assessment tools used in inpatient units do not adequately capture the risk factors present in patients presenting to the Emergency Department. The MORSE scale is implemented only at a latter phase of patient admission to the inpatient unit. The purpose of this study is to develop and implement a simple, Read More

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging infection that causes severe illness in patients, particularly those with comorbidities; and has a high mortality rate. Healthcare associated outbreaks have been reported across the Gulf region and the Republic of Korea. While there have been cases of MERS-CoV in Qatar, no healthcare associated outbreaks have been reported. The aim of this paper is to give Read More

Introduction: Despite the potential benefits of EMR systems to improve patient care, many attempts at implementing them have failed or met with high levels of user resistance, Implementations that failed have often been those with which the users were dissatisfied with the system. Aim: The aim of this study is to assess the satisfaction of both the physicians and nurses with the newly introduced EMR system at the Emergency Department of Read More

Background: Non-adherence to antimicrobial guidelines is a major factor leading to emergence of antimicrobial drug resistance. Objective: This study was carried out to investigate the adherence to local antimicrobial guidelines in the Emergency Department (ED) at Al Wakra Hospital in the state of Qatar. Materials and methods: This cross-sectional, retrospective study was carried out in the Emergency Department of Al Wakra Hospital in Read More

Hospitals' track-and-trigger systems to identify and respond efficiently to patient's deterioration became an evidence base tool for patient safety and medical management worldwide. A prospective study about the Impact of Rapid Response Team Implementation in the Cuban Hospital was developed since September 2014 up to September 2015. The patients admitted in medical and surgical wards were screened upon admission and rescr Read More

Background: In 2011, HMCAS designed new Evidence-Based CPG. The previous protocols were not fit for purpose and not best practice. The service had multiple tiers of clinical practice among staff without standardization of care. CPG development is a knowledge management process to ensure standardization of care and a safer patient experience. This research sets out learning from two rounds of CPG development over 4 years. M Read More

Background: Hip fractures are very common in UK population (excluding Scotland) accounting for 64102 hospital admissions in 2014. FCIB is part of a best practice tariff and a quality indicator audited annually by the National Hip Fracture Database in UK, as part of NICE clinical guidelines. The ED protocol for fracture neck of femur (NOF) includes fascia Iliaca compartment block (FICB), which is a new service development as part of tre Read More

Background: Spontaneous rupture of the renal pelvis is very rare and hence diagnosis may be delayed. Diagnosis of the rupture is best evaluated by CT and treatment is primarily removal of the underlying cause, followed by conservative management. Presentation: An otherwise healthy 31-year-old male suffered abdominal pains and vomiting. His pain was at the right iliac fossa and suprapubic areas, which he rated as 7/10(NRS). He also repor Read More

Background: Increasing levels of physical inactivity is associated with growing trends of childhood obesity as evidence suggests today's children physically inactive and unfit. The study aims to assess the effect of socio-demographic and lifestyle factors on mode of travel in school-aged children (10–15 years). Methods: 4,497 school-aged children were selected from wave-1 of Understanding Society database in a multi-stage random s Read More

Introduction: Simulation is almost synonymous with computerised mannequins although they are not always essential components of the learning experience as what often matters most is the facilitation process of the learning experience rather than the technology. Methods: We developed Visually Enhanced Mental Simulation (VEMS) for staff to demonstrate cognitive and decision making skills away from the practical context. Scenario p Read More

Background: “Orientation” is an important phase when joining a new institution. It is the period when someone builds an understanding of their role/responsibilities in a new setting, and for colleagues to gauge someone's level of knowledge and competence. HMCAS recruits mostly overseas nursing qualified staff with variable experience and transforms them into Ambulance Paramedics (AP) all providing the same level of care in Read More

Background: Whilst Head CT scanning carries an important role in the identification of clinically significant intracranial injuries, there are associated risks of radiation. Our initial audit of clinical notes and survey of EM physicians revealed a rate of 45% CT scans for pediatric minor head injuries with around half of requests not indicated. In 36% there were issues with documentation. The aim is to achieve a sustained compliance with Internationall Read More

Objective: The objective of this study was to collect feedback from Ambulance Paramedics (AP) with respect of their experience of using an External Chest Compression Device (ECCD) on cardiac arrest patients. Aspects of particular interest were ease of use and their perceived effectiveness of delivered CPR. Background: HMCAS crews attend to several hundreds of cardiac arrests a year. To achieve Return of Spontaneous Circulation Read More

Background: Breast cancer is the most common malignancy and leading cause of cancer mortality among females in Gaza. Most cases are diagnosed at late stage. Survival rates are persistently low in contrast to improved rates worldwide. Our study examined awareness, knowledge, attitude, practice and access to breast healthcare among both health professionals and women in Gaza. Methods: In May and June 2014, using convenience and re Read More

Background: Intraosseous (IO) access are being widely used in resuscitation of patients with difficult intra-venous (IV) access. The United Kingdom Resuscitation Council guidelines recommend the use of IO access, after two minutes of failed IV access in adult patients or two failed IV attempts in pediatric patients. There are various complications associated with IO access such as extravasation of the infusion fluid or medications, bleed Read More

Background: Vaccine preventable diseases continue to kill large numbers of young children each year UNICEF estimates that 1.2 million deaths to children under five years of age could be prevented at low cost by vaccinating children. For example, it is estimated that measles related deaths have been reduced from about 2.5 million per year in 1980 to less than one million in 1990 (2)-a decline of more than 60 percent during the decad Read More

Introduction: The mechanism for carbamate toxicity is reversible cholinesterase inhibition, which leads to accumulation of acetylcholine at the neuromuscular junction.1 The cardiac manifestations of carbamate toxicity are rare. We report a case of carbamate toxicity with atrial fibrillation as the cardiac manifestation. Case presentation: A 28-year-old patient, previously healthy, presented to the ED complaining of diplopia, dizziness, pa Read More

Backgrounds: Infection with Neisseria meningitides can produce a variety of clinical manifestations. Mortality and long-term morbidity can be very high in patients with invasive meningococcal disease if the infection is not treated appropriately. Our main objective was to evaluate mortality of all children admitted with acute meningococcal septicaemia (AMS). Methods: We conducted a retrospective study of all paediatric-cases of acute mening Read More

Background: Qatar is about to host the 2022 FIFA World Cup-WC, this can stress the public health system and resources of Qatar as hosting country. Reducing public health risks and ensuring people's safety at The Qatar 2022WC requires thorough planning and coordination. The aim is to obtain a comprehensive insight into the available practices concerning the infectious diseases preparedness and response for major Sporting events a Read More

Background: The HGH Microbiology lab indicator showed that our blood culture contamination rate has been consistently higher than the international benchmark thereby we aim to reduce it in the critical area of Emergency Department by 50% by the end of July 2015 and at least 90% by end of February 2016. Methods: A pilot area was chosen in the Emergency Department to do a study for 44 weeks after which blood culture kits (pr Read More

To assess if stratification of patients based on clinical severity, laboratory markers and radiological findings at presentation would enable better prediction for the need for a surgical intervention. Single-centre retrospective cohort study done in the in-patient pediatric wards of a tertiary care centre in the State of Qatar. Participants – 56 children (aged 6 months – 14 years) with empyema or parapneumonic effusion, from July 2009- Read More

Background: Approximately 1,000 U.S. citizens suffer from sudden cardiac arrest daily outside of the hospital setting. Providing cardiopulmonary resuscitation (CPR) improves survival if appropriately administered; however, many are resistant to initiate mouth to mouth. Hands only CPR (HOCPR) was developed by the American Heart Association to improve technique retention and increase the willingness to administer CPR. Methods: P Read More

Introduction: Pakistan has seen repeated outbreaks of the disease over the past decade or so. In 2011 the largest outbreak was seen in Punjab where 20,864 cases were reported. This study was conducted to estimate the disease burden and analyze epidemiological trends using data from the provincial Dengue Surveillance System, Punjab. Methods: A descriptive analysis of data from January 1 to December 31, 2013, was undertake Read More

Background: In April 2014, the South West London and Surrey Major Trauma Network entered its 4th year as an operational network, consisting of one Major Trauma Centre (MTC) and 7 acute Trauma Units (TUs) over a wide geographical area. In the year ending March 2014, 75% of the major trauma patients were taken to the MTC. However many patients with ISS >15 were admitted to TUs. Regular governance meetings are key to ensure Read More

Background: Medical missions have become a part of the Global Health Programs at many academic institutions. Commonly these programs involve annual trips to locations in the United States and around the world. The University of Toledo Medical Center (UTMC) sought to develop a sustainable mission that has educational and clinical value to both the local community and academic institution. Methods: The Department of Emergenc Read More

Introduction: Gallbladder volvulus is a rare entity, with a predilection for elderly women in their 7th or 8th decades of life. The condition results in rotation of the gallbladder on its mesentery along the axis of cystic duct and artery. Presence of redundant mesentery is a prerequisite. The disease is a frequent mimicker of acute cholecystitis, often difficult to diagnose preoperatively. Till date only about 300 cases have been reported in the lit Read More

Background/objective: Several inflammatory biomarkers of infection including procalcitonin (PCT) and C – reactive protein (CRP) have been shown to be useful in diagnosis of infection in different clinical settings. The purpose of this study was to determine the diagnostic value of serum PCT, CRP and White Blood Cells (WBC) as markers of sepsis in critically ill patients in Qatar. Materials and methods: The PCT levels and other related inflammatory Read More

Background: The last cholera epidemic in Sudan occurred in 2006/07, over 20,000 cases (4% case fatality rate) were recorded, index case was coming from South Sudan. In regard to recent outbreak in South Sudan June 2015, Sudan carried out preparedness procedures to prevent cholera spread. The uncontrollable open borders and the South Sudan refugees-over 198,000 – settled in Sudan poses a great cholera spread risk. Objective: To ill Read More

Background: Multiple trauma patients are evaluated and managed by the Emergency Department (ED) in Al Wakra. The assessment, management, and disposition of this population have become a significant workload component. The aim of this study was to evaluate the trauma service at Al Wakra ED. Methods: In our study, we aimed to collect data on the trauma patients, admitted between July 2014 and October 2015, who presented to th Read More

Background: Hepatitis C viral infection is a public health concern worldwide and a major cause of morbidity and mortality in several countries that supply the State of Qatar with many of its laborers. The objectives were to measure the prevalence of hepatitis C viral infection among single male laborers; detect the practices that may catalyze the spread of the infection; and assess the knowledge gap. Methods: A cross-sectional study was cond Read More

Background: Hamad General Hospital (HGH) Emergency Department (ED) provided 465,942 patient visits in 2014. (ED) use has increased annually resulting in overcrowding, longer wait periods for service and increased stress on health care workers. Much attention has been paid to factors contributing to this increased usage such as the return visit of an (ED) patient within 48 hours of the initial visit. 48 hours is the benchmark ti Read More

Background: Point-of-care ultrasound is an invaluable tool in the diagnosis and management of many conditions presenting to emergency departments across the world. It has also improved the success rate of invasive bedside procedures. Objectives: This study aimed to investigate the current utilization of point of care ultrasound in a large tertiary care emergency department in the Middle East and to identify barriers to its utilization. Methods Read More

Background: The rate of patients who arrive at the Emergency Department (ED) but leave before being seen (LWBS) is considered an important marker of the quality of care. Objectives: To evaluate the rate of LWBS at ED in Al Wakra Hospital (AWH) and to identify predictive factors associated with LWBS. Methods: This was a retrospective study of patients who left the Emergency Department without being seen by physicians between January 1 Read More