Seven-day unplanned re-attendance rate for patients seen in the ED by advanced clinical practitioners: a service evaluation.

Advanced clinical practitioners (ACPs) have become an established part of the emergency medicine workforce in the UK. However, despite increasing numbers of ACPs working in emergency medicine, there is little evidence regarding their impact on care in this area and a lack of metrics available to assess their performance. To inform national benchmarking and comparisons between organisations, the authors of this article calculated the seven-day unplanned re-attendance rate for patients seen by ACPs at two emergency departments (EDs) in the UK and compared it with the rate for patients seen locally by all other clinicians and with the overall rate in England.

Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study.

Background: Physically trapped patients following motor vehicle collisions are at high risk of time-critical injuries and poor outcomes. Despite this, there is limited consensus on which injuries should be prioritised and which early interventions are both necessary and feasible in the prehospital setting. This study aims to develop expert consensus on injury categorisation and the delivery of early care interventions to guide clinical and operational decision-making at the scene.

Optimising the care of the trapped patient following a motor vehicle collision: A UK-Based Delphi consensus study.

Background: Motor vehicle collisions (MVCs) are a leading cause of injury and death worldwide. Up to 40% of casualties may become trapped and entrapment is associated with delayed care and worse outcomes. There is little national or international consensus guiding the care of physically trapped patients who cannot self-extricate.

Emergency Department overnight deflection of low acuity patients: A 6-month evaluation of a quality improvement project.

Background And Problem Statement: Emergency care services in the United Kingdom (UK) are currently under unprecedented pressure which has resulted in long patient delays. Alternative approaches are therefore required to improve patient experience.

Project Aims: Deflection is the process where patients with low acuity presentations are offered the option of returning to an appointment.

Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh.

Background: Road traffic injury is the leading cause of death among young people globally, with motor vehicle collisions often resulting in severe injuries and entrapment. Traditional extrication techniques focus on limiting movement to prevent spinal cord injuries, but recent findings from the EXIT project challenge this approach. This paper presents updated recommendations from the Faculty of Pre-Hospital Care (FPHC) that reflect the latest evidence on extrication practices.

A biomechanical study to compare spinal movement in a healthy volunteer during extrication between 'chain cabling' and 'roof off' methods of extrication.

Introduction: Following a motor vehicle collision some patients will remain trapped. Traditional extrication methods are time consuming and focus on movement minimisation and mitigation. 'Chain cabling' is an alternative method of extrication used in some countries.

Advanced clinical practitioners' inter-shift need for recovery: a cross-sectional survey in emergency medicine.

Background: Healthcare settings are high-risk environments for fatigue and staff burnout. The Need For Recovery (NFR) scale quantifies inter-shift recovery, which contributes to cumulative fatigue and may precede occupational burnout. Advanced clinical practitioners (ACPs) are an established feature of the emergency medicine workforce in the UK, however, little is known about factors affecting their inter-shift recovery, fatigue or how NFR correlates with formal burnout inventories.

A Delphi study of rescue and clinical subject matter experts on the extrication of patients following a motor vehicle collision.

Background: Approximately 1.3 million people die each year globally as a direct result of motor vehicle collisions (MVCs). Following an MVC some patients will remain trapped in their vehicle; these patients have worse outcomes and may require extrication.

Sex-disaggregated analysis of the injury patterns, outcome data and trapped status of major trauma patients injured in motor vehicle collisions: a prespecified analysis of the UK trauma registry (TARN).

Objectives: To identify the differences between women and men in the probability of entrapment, frequency of injury and outcomes following a motor vehicle collision. Publishing sex-disaggregated data, understanding differential patterns and exploring the reasons for these will assist with ensuring equity of outcomes especially in respect to triage, rescue and treatment of all patients.

Design: We examined data from the Trauma Audit and Research Network (TARN) registry to explore sex differences in entrapment, injuries and outcomes.

Do entrapment, injuries, outcomes and potential for self-extrication vary with age? A pre-specified analysis of the UK trauma registry (TARN).

Background: Motor vehicle collisions (MVCs), particularly those associated with entrapment, are a common cause of major trauma. Current extrication methods are focused on spinal movement minimisation and mitigation, but for many patients self-extrication may be an appropriate alternative. Older drivers and passengers are increasingly injured in MVCs and may be at an increased risk of entrapment and its deleterious effects.

Assessing spinal movement during four extrication methods: a biomechanical study using healthy volunteers.

Background: Motor vehicle collisions are a common cause of death and serious injury. Many casualties will remain in their vehicle following a collision. Trapped patients have more injuries and are more likely to die than their untrapped counterparts.

Maximum movement and cumulative movement (travel) to inform our understanding of secondary spinal cord injury and its application to collar use in self-extrication.

Background: Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack "real world" context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury.

The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision - a biomechanical study using healthy volunteers.

Background: Motor vehicle collisions account for 1.3 million deaths and 50 million serious injuries worldwide each year. However, the majority of people involved in such incidents are uninjured or have injuries which do not prevent them exiting the vehicle.

A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped.

Background: Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation.

Productivity of Advanced Clinical Practitioners in Emergency Medicine: A 1-year dual-centre retrospective analysis.

Background: The ACP role is relatively new in Emergency Medicine (EM) nationally (RCEM, 2017). This work sought to establish the productivity of EM ACPs within our service, to enable evidence-based workforce planning and national benchmarking of this aspect of the role.

Methodology: Data from 1st January 2018-31st December 2018 was retrospectively collected from two hospitals in the United Kingdom (UK) via electronic patient records.

Rhabdomyolysis: a case-based critical reflection on its causes and diagnosis.

Rhabdomyolysis is a rare and complex condition that involves injury of the skeletal muscle fibres, resulting in the release of substances such as creatine kinase and myoglobin. It is associated with acute kidney injury and mortality. This article describes the case of a 40-year-old man who presented to the emergency department after an overdose of tramadol hydrochloride.

Full-thickness burns due to contact with gastric acid.

This article describes the case of a 33-year-old man with cerebral palsy who sustained a full-thickness burn to his thorax as a result of lying in gastric acid that had leaked from a damaged percutaneous endoscopic gastrostomy feeding tube. The patient required referral to a tertiary burns centre for specialist management. The article highlights the potential harm caused by gastric acid and why some patients may be particularly vulnerable to such injuries.

Evidence-based management of patients with Colles' fractures in emergency departments: a case-based critical reflection.

Distal forearm fractures are a common presentation in UK emergency departments (EDs). However, despite the frequency of this presentation there is considerable variation in management, which may reflect the lack of definitive evidence to support one method. This article provides a narrative review of the literature on these injuries and provides an evidence-based approach to how they can be managed by ED clinicians.

Does use of the LUCAS device improve mortality in adult patients with out-of-hospital cardiac arrest?

Out-of-hospital cardiac arrest (OHCA) is a common occurrence in the UK, with 60,000 cases reported annually. To improve outcomes among these patients it is necessary to improve links in the cardiac arrest chain of survival. Cardiopulmonary resuscitation (CPR) is one of the main elements of this chain because it reduces further ischaemic insult in the brain and heart by contributing to blood flow.

Lactate in the emergency department: a case-based critical reflection.

Serum lactate levels are frequently measured in patients with undifferentiated conditions in emergency departments. This article uses a case-based reflection to critically analyse the role of lactate measurement in these patients. It examines the rationale for testing, and the potential causes of raised levels, to remind clinicians that this diagnostic intervention must be taken in the context of patients' clinical presentations and not in isolation.

Venous and arterial blood gases in respiratory failure.

Arterial and venous blood gases are commonly performed operations in emergency departments. This case-based critical reflection examines the contemporary literature relating to the topic. An evidence-based approach to selecting the most appropriate test for each patient is discussed, aiming to minimise the need for unnecessary arterial sampling.

Management of acute heart failure in the emergency department.

Acute heart failure (AHF) is a leading cause of hospital admission in the UK and is associated with significant mortality. The National Institute for Health and Care Excellence ( 2014 ) has published guidelines for the management of AHF but, after a clinical event in which a patient's management differed from that recommended in the guidelines occurred in the author's emergency department, he conducted a critical analysis of them. This article provides a case study of the clinical event, reviews the treatment methods adopted and explores the rationale for taking a different approach from that recommended in the guidelines.

Extrication time prediction tool.

Background: Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for extrication or the factors which affect this time.

Objective: To derive a tool to predict the time taken to extricate patients from MVCs.

Major trauma training for emergency nurses.

The Midlands regional trauma network was established in March 2012 to improve and standardise the care offered to patients with major trauma. This article discusses the results of a survey of formal training in, and self-assessed knowledge of, trauma management among emergency department nurses working in the network. Less than one third of the nurses had received formal training against which standards can be benchmarked, and the article recommends that nurse education standards are reinstated as key performance indicators in the region.

Rapid sequence induction in urgent care settings.

In the management of critically ill patients in emergency departments, rapid sequence induction (RSI) of anaesthesia is often required. This article examines the elements of RSI that are necessary before before endotracheal tube placement and reviews the findings of a national audit project, conducted by Royal College of Anaesthetists and Difficult Airway Society. It also considers the role of nurses in RSI procedures.