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

Background: Measles is a highly contagious respiratory disease caused by a virus that can be serious in all age groups. However, measles complications more like to occur in children younger than five years and adult older than 20 years. Qatar is one of the Eastern Mediterranean (EMR) countries that are committed to achieving measles elimination target by 2015. However, Qatar has been experiencing a measles outbreak mainly due to a uniq Read More

Background: Ambulance Paramedics are dispatched to all calls while Critical Care Paramedic (CCP) units only attend potentially “life threatening” cases (Priority 1). Ambulance Paramedics (AP) triaged patients based on clinical judgment and experience creating a risk of Priority 1 under or over-triage. QEWS was designed to supplement priority decision-making process based on physiological values used as a trigger to identify patients with Read More

Background: The handover process is meant to ensure patient safety and maintain continuity of care through endorsement of critical patient information. This study evaluates staff's perceptions about the current patient handover process effectiveness between Ambulance Service (AS) and Emergency Department (ED) clinicians. It may help identify barriers and contributing factors to an effective patient handover. Methods: An el Read More

Background: The ambulance patient compartment is a working environment where paramedics provide care to patients at times of distress. It needs to meet a number of functional requirements under various conditions whilst being practical and safe for its occupants. Their design varies greatly internationally and often nationally. This study aims to review the current design of Qatar's ambulances to ensure the safe journey of its user Read More

Background: The introduction of electronic health record (Cerner) in Qatar's public health system aimed to bridge the disparities in documenting patient's official health record. It is essential to recognize nurses' viewpoint in using this technology. As it embarks on the two emergency walk-in-clinics, we attempted to identify its impact to ER nurses in terms of coordination of care, documentation skills and staff productivity. Methods: The st Read More

Background: Benign paroxysmal positional vertigo (BPPV) is a common medical condition. According to recent literature, it is prevalent in about 28% of the head injury patients. BPPV can be easily diagnosed in the Emergency Department (ED) by a simple bedside Dix-Hallpike test, in which patients experience vertigo and nystagmus as observed by the physician. It can be treated effectively in the ED by the Epley maneuver. In 2014, over Read More

Background: Organophosphorus poisoning is a global public health problem. Annually, approximately 200,000–300,000 individuals die worldwide from Organophosphorus poisoning with the majority of deaths occurring in developing countries. In many countries in the Middle East, legislation is inflexible and unable to cope with new challenges. Often standards are not consistent with international and national needs. Hamad General Hospital ( Read More

Background: As one of the leading causes of death and disability in the world, human trauma and injury disproportionately affects individuals in developing countries. During initial program development, senior MOHP physicians stated there was a critical need for a portable and flexible educational course on the clinical care of injured patients. To meet the need for improved trauma care in Egypt, the Sequential Trauma Emer Read More

Background: DMI itself is a benign condition unless complicated by compartment syndrome or superadded infection. However, coexistence of extensive DVT may have serious complications such as pulmonary embolism. We report 2 cases of DMI with iliac vein thrombosis presented to our ED. Case presentation: Case 1 A 40-year-old lady with diabetes, presented with a swollen and painful left leg for a day. A bedside Doppler ultrasound co Read More

The presence of undeclared pharmaceuticals, including drugs that have been withdrawn from the market, in anti-diabetic and weight-loss herbal and dietary supplements can pose a serious health risk to consumers; they also undermine confidence in legitimate products. To protect consumers from potentially harmful products that are marketed as dietary supplements, the Drug QC Laboratory, Qatar is involved in the testing of herbal an Read More

Background: The ambulance service communication center is the first access point of the public to the health care services in the state of Qatar. It's receiving between 400 and 600 emergency calls per day which are processed through a very robust and consistent workflow, for the aim to triage the emergency incidents and distinguish high and low acuity patients and send an adequate response. Within these emergency calls there are ca Read More

Background: Although Emergency Medicine has existed as a recognized specialty in Alexandria University since 1970 a recent shining as a highly competitive specialty since 2003 through an Egyptian Fellowship Training program granting a professional and not an academic degree. Emergency Medicine is still in its development phase as a practice. Five public universities are offering postgraduate degrees in Emergency Medicine. The Read More

Objective: Since 1998 seasonal epidemic meningitis has been a recurrent problem in Sudan with a variation in the severity between seasons. Mass vaccination campaign with conjugated vaccine (MenAfriVac) for Neisseria meningitidis A was implemented in Sudan since October 2012, since then case base surveillance of meningitis was implemented. The target age group was 1–30 years. Measuring of meningitis trends in three years pre an Read More

The adulteration of herbal/dietary supplements with erectile dysfunction (ED) drugs and their analogues is reported worldwide and is an increasing problem. The sale of so-called 100%, ’all-natural’ products has become a highly profitable business for online pharmacies, however these products can pose a serious threat to consumers owing to the undisclosed presence of approved/prescription drugs or the unknown safety and toxicity pro Read More

The consumption of dietary supplements is widely spread and on the rise in Qatar market. Toxic metals like mercury, lead, cadmium and arsenic can be naturally present in dietary supplements and can pose harmful effects on human health. Pharmacy and Drug Control Department; SCH has been involved in proper counselling of these products before they are marketed to Qatar. In this study Two hundred and thirty five different dietary Read More

Background: Dengue Fever constitutes a major international public health concern due to rapid expansion of geographic distribution of the virus and the mosquito vector of the disease. In this paper we aim to review the risk of Dengue Fever introduction to Qatar. Methods: Review of the Literature for the factors responsible for the worldwide spread of dengue fever and assess these factors in Qatar. Results: Internationally, the Global Climate C Read More

Introduction: Brain abscess is caused by inflammation and collection of infected material, coming from local or remote infectious sources, within the brain tissue. The infection may also be introduced via a breach in the skull following head trauma or surgical procedures. Brain abscess may also be associated with congenital heart disease in the young children. Here we would like to describe a case of brain abscess secondary to seemingl Read More

Background: Primary achalasia is a disease of unknown etiology in which there is a loss of peristalsis in the distal esophagus and a failure of lower esophageal sphincter to relax with swallowing. Typical Clinical manifestations including dysphagia for solids (91%) and liquids (85%) and regurgitation food (76 to 91%) are the most frequent symptoms in patients with achalasia. Regurgitation may also result in aspiration (8%). However, atypi Read More

Background: One of the most common reasons why patients visit the Emergency Department is with the complaints of pain. The compliance rate of pain assessment and reassessment by the nurses in ED is far from expectation. This results in delayed disposition, increased re admission and poor patient satisfaction. As pain is exclusively a subjective experience, accurate documentation of patient pain assessment is critical in the management Read More

Background: Clinical governance requires having a process for adverse incident review and management to ensure the organisation ‘learns from its mistakes’ to prevent repetition. How leadership implements this system may enhance learning and patient safety, or have the unintended consequence of raising alarm, possible demotivation, and staff becoming risk-averse. The impact of the existing Ambulance Service incident management Read More

Background: There are cases of ED visits with chief complaints of Shortness of Breath which are managed as a Case of Bronchial Asthma, URTI or Cardiac Origin with the total number of 13047 ED visits in Female Urgent Area in December 2014, random sample of 180 patients with complaints of SOB and diagnosed as BA, 90% were given nebulization therapy without measuring PEFR. There is 0% compliance of PEFR measurement of t Read More

Critically ill shock patients presenting to the Emergency Department (ED) in Hamad General Hospital (HGH), Doha Qatar often needs central line when fluid resuscitation fails to improve their blood pressure (BP). Triple lumen central lines are used when vasopressor or inotropic support becomes necessary. In some of these patients, a double lumen dialysis line is later inserted (often in the femoral vein), when it becomes clearer that th Read More

MERS-COV is an emerging zoonotic disease primarily originated in Arabian Peninsula, where camel industry and trade are part of the local culture and economy. Camels were proposed to be the possible reservoir. A convenient sample of 78 camel owners were interviewed through a structured questionnaire to assess their risk perception and practices. All were males, mean age of 42.5 ± 12.7 years. Most of camel owners were Qata Read More

Despite substantial progress emergency public health and medicine, there is no doubt that recent European Union (EU) migration crisis has provide a new dimension and complexity in public health and lives of millions are in peril, while international aid organizations are unable to effectively deal with associated emergencies. Health risks related to migration process associated with emergency or crises situations are not fully studied despit Read More

Background: Each hospital in the UK has a hospital trauma team which includes a multi-disciplinary team. However, the use of such team for minor trauma can lead to inappropriate use of healthcare resources. Thus, an “Emergency Department (ED) trauma team” including only ED staff was developed. The 2 teams together form the 2-tiered trauma system. Each team has its own activation criteria. Its effectiveness in the UK still r Read More

Background: There appear to be variations in the time of presentation patients with ACS around the world. The working days and weekends differ in Qatar from the Western world. Methods: In 1846 patients admitted with ACS, 721 had Primary PCI for STEMI and 1125 had Non-ST Elevation ACS (NSTE-ACS). The days and time of onset of symptoms, Door to Balloon Time (DBT) and Out of Hospital Delay were compared in different time perio Read More

Background: Cerebrovascular Accident or stroke is a global health problem and is a leading cause of disability. It is one of the leading causes of mortality and morbidity worldwide. Materials and methods: A retrospective case-control study carried out on stroke patients admitted to the main Ministry of Health hospitals from May to November 2014. The study consisted of 110 proved cases of stroke and 110 controls (selected from patients wh Read More

Background: Ebola viral disease (EVD) outbreak 2014 in West Africa declared as Public Health Emergency of International Concern (PHEIC) according to IHR (2005), Sudanas member state committed to plan and respond to PHEIC. Sudan was in a great risk to be affected by EVD due to the previous history of EVD outbreaks in 1976, 2004 and 1979, long open borders with Limited resource and poor infrastructure, presence of united nation missio Read More

Background: As part of improving the service in ED, we conduct Pharmacist-led Pharmacy round (PLPR) led by Pharmacist to ensure best patient care is provided by pharmacist. Objective: No such experience was reported in the literature up to our knowledge so we decided to describe our experience, in the successful establishment of PLPR in ED and to identify whether implementing a pharmacy based round, provide better patients care in te Read More

Background: Heat stroke contributes considerably to cause morbidity and mortality during hot season. The main factors associated with severity and mortality of disease unclear. In Sudan heat stroke occurred mainly in Red Sea State during previous years. The purpose of this study is to assess association between heat stroke and pre-existing medical conditions in Northern State of Sudan. Study: Descriptive analysis of Heat Stroke ou Read More

A security Survey of Emergency Department Hamad General Hospital Background The problem of Emergency Department (ED) violence is a worldwide issue, and a systematic approach to mitigating the threat to our colleagues and patients is fundamental to the advancement of Emergency Medicine (EM). One of the important step to this is to assess and improve knowledge of the staff on workplace violence and how to react to it. Aim of t Read More

Background: The Syrian civil war since 2011 is one of the most complex humanitarian emergencies in history. This protracted disaster has but negative aspects, especially on living, educational and health care infrastructure and services. The goal of this study is to document the impact of four years of war on Syrian children's social, educational and health status. Methods: A cross sectional observational study was conducted in May 2015. He Read More

Background: Managing a weekly educational planner for an Emergency Residency can be a challenging task in a busy Department due to shift pattern of work, personal development and travelling issues. In this descriptive case study, we outline the challenges and solutions to facilitate this issue. We found that key interventions in the form of timely reminders to instructors and faculty, prospectively consulting them before topic allocation and tim Read More

Background: The tremendous increase in disasters in the Middle East whether natural or man-made is unforeseen in its characters and/or catastrophic effects to the communities and infrastructure, thus making public awareness is a mandate to plan, respond and mitigate the community. Methods: We run Public Awareness program targeting non-medical university students, aiming at raising their knowledge about first aid and response durin Read More

Exercise-associated hyponatraemia (EAH) is a potentially serious and occasionally fatal outcome in marathons and other long duration events. In the last 30 years, there have been more than 500 publications on hyponatraemia and exercise. Some studies, who point to the fatalities that have occurred, consider this as a major concern while others dismiss it as a rare and unimportant condition. This work critically assessed and summarized th Read More

Introduction: Pre-hospital care professionals work outside or in confined spaces. Issues like population demography, cultural diversity, geography, roads, and climate regularly challenge them. Some of these factors might be overlooked by the hospital-based mentality of other clinicians. Providing them an opportunity to accompany paramedics in their own environment may help them better understand the paramedics' role and scope of practic Read More

Background: Globalization, increasing intense urbanization and climate changes has been linked to natural and man-made evolution and curiosity resulting in multiple threats and vulnerability. The degree, nature and extent community and household preparedness and resiliency programs and activities defined the robustness and effectiveness of local, national to regional EMRO timely response policy decision maker by policy makers Read More

Introduction: A large number of patients present to the Emergency Department (ED) with sepsis, severe sepsis or septic shock. Septic shock is associated with 40% mortality risk and is the most common cause of death in the ICU. Moreover, survivors of septic shock are at risk of permanent organ dysfunction, prolonged hospital stay and long term institutionalization. Many of these complications can be minimized and may be avoi Read More

Background: The conventional landlines and bleeps that are commonly used in recalling physicians during major casualty incident (MCI) have shown multiple defects. Despite the remarkable advancement of handheld devices, social media and short text messaging (SMS), only a few studies on the comparison between the conventional communication and the social media have been found in the literature. This research compares (1) bl Read More

Background: Children cite needlesticks and invasive procedures as anxiety-provoking, which can have a negative impact on coping. This distress can lead to increased fear of medical settings and avoidance of care. Providing children with care that reduces the fear of pain associated with medical procedures can support positive experiences that can reduce anxiety. Thus, this will allow the child to better cope with and cooperate during Read More

Introduction: Diagnosis of patients in a pre-hospital setting is a challenging process that depends primarily on clinical evaluation. The pre-hospital environment presents particular challenges such as scanty information and limited diagnostic tools. Nonetheless, accurate diagnosis is key to activate the appropriate cascade of management, level(s) of dispatch and disposition. This study aims to compare the ambulance paramedic diagnosi Read More

Background: Despite the great success in controlling infectious disease in children, house accidents have increased, especially in developing countries, in the last years. WHO has reported that more than 20% of hospital cases involve children under 5 years of age and are caused by house accidents. Foreign body aspiration (FBA) is a preventable accident with a high risk of mortality. The objective of this study is to identify the epidemiology Read More

Background: The emergency department physicians rarely see high-pressure injection injuries (HPI) to the hand. These work-related injuries can have a devastating effect on hand function, particularly if not treated early. These injuries are usually caused by the introduction of chemicals into the wound. Chemicals under high-pressure cause local tissue damage, ischemia, and acute and chronic inflammation. The initial assessment may sugges Read More

Introduction: Renal colic is one of the common abdominal emergency presentations to an ED. The cost of imaging, health care resources and time spent in the Emergency Department (ED) is huge. There is good evidence supporting the role of ED bedside ultrasound in detecting hydronephrosis.1,2 We plan to study the role of bedside ultrasound in renal colic as a pilot audit for the QIP. Method: A convenience sample was selected prospective Read More

Background: Today, e-learning is of strategic importance to teaching and learning in Emergency Medicine (EM). We adopted an interactive e-learning platform based on the open source software called MOODLEa using a blended learning strategy to assist the implementation of a dedicated faculty development program known as the EM consolidation program. This 12-month program was designed to meet the developmental needs of 2 Read More

Background: Procedural sedation (PS) is commonly used in the Emergency Department (ED) to lessen pain, apprehension, and agony for patients during medical procedures. PS encompasses administering of sedative medications with or without the simultaneous delivery of analgesic agents. Safe and effective PS in the ED is a skill that is fundamental to practice of Emergency Medicine. Patients undergoing PS in ED should have a document Read More

Background: Delays in clinical handover can compromise a patient's care. The handover is not the sole responsibility of the ambulance personnel or the emergency departments. Reducing delays requires the working together of the entire organization, as well as designing efficient emergency and ambulance departments. Objectives: The study aims at exploring the quality of clinical handover between the emergency department person Read More

Background: This study is a quality improvement project that aimed at improving patient flow in Male Urgent Area (MUA), one of the busiest areas in the largest emergency department in the state of Qatar. Methods: The baseline process was designed by mapping and drawing a cause-and-effect diagram. Pre- and post-auditing was done after careful intervention of introducing a phlebotomy room in Male See and Treat area, the main feeder to Read More

Introduction: Sepsis is a major cause of hospitalization with a high mortality rate. Early recognition and management of sepsis have shown to improve mortality outcomes. A proactive alert system for improving the response of the interdisciplinary team may decrease the time to intervention and improve patient outcomes. Objective: The study evaluated the impact of an early alert system, “CODE SEPSIS”, on adherence to the sepsis m Read More

Background: Rhabdomyolysis, which can be defined as a CPK level greater than five times the upper limit of normal, is related to muscle breakdown and hypovolemia in heat stroke patients.1 CPK levels will likely be higher because of increased muscle breakdown in exertional heat stroke when compared with classic heat stroke. Methods: We reviewed 50 patients who came into the Emergency Department of Hamad General Hospital during the Read More