Emergency_Medicine RSS : Gourt

Highlights from this issue

This month we range from Politics to philosophy, from basic science to standards of care. There is a spread of material on the resuscitation of cardiac arrest and lots of pre-hospital care; triage at ‘front’ and ‘rear’, trauma transfer times, airway care in the field and even how to improve ambulance safety. The meaning of words In this month's editorial, Hughes (see page 90) shows how easy it is to become confused with the political language of the performance culture in UK Emergency Medicine and translates some into simple terms that can be understood! On a much simpler and certainly more fundamental level, Body and Foex (see page 91) consider the philosophical difference between pain and suffering. Do we see and try to manage the disease/injury or care for the patient? Try their thought experiments to find out. Real science Tura et al (see...

A&E quality indicators

International readers may need reminding that in April 2011 a new set of clinical quality (A&E) indicators was introduced in the NHS in England to replace the previous 4 h waiting time standard, the new indicators providing a platform with which to measure the quality of care delivered in A&E departments in England. The indicators were developed by the national clinical director for urgent and emergency care, working with the College of Emergency Medicine, the Royal College of Nursing and informed patient representatives. At the beginning of October last year the government released data for May 2011, related to A&E attendances for that month and drawing on just over 1.4 million detailed records of attendances at major A&E departments, single specialty A&E departments (eg, dental), minor injury units and walk-in centres in England.1 Five indicators are reported:left department before being seen for treatment rate; re-attendance rate;...

Optimising well-being: is it the pain or the hurt that matters?

In recent years there has been a commendable focus on patient-centred medicine, with increasing attention being paid to the timely assessment and management of acute pain. 78% of patients who attend the emergency department report pain, the severity of which is often used to determine clinical priority at triage. Clinical guidelines are increasingly including the timely provision of appropriate analgesia as a clinical standard. Pain scoring has been widely adopted, causing pain to be considered as the ‘fifth vital sign’ by some. Interestingly, there remains little evidence to support the benefit of this approach for patients. The aim of this review is to explore some of the assumptions that made in defining and addressing ‘pain’, and to explore whether it is truly ‘nociception’ or ‘suffering’ that ought to be addressed. Through two thought experiments, it is demonstrated that the current approach to pain relies heavily on addressing ‘nociception’ but does little to address the ‘suffering’ that is undoubtedly they key determinant of well-being in patients. It is demonstrated that the current naturalistic approach risks neglecting many ‘non-nociceptive’ sources of suffering, including physical (eg, nausea, vertigo, dyspnoea, pruritus) and mental (anxiety, depression, fear, anger) symptoms. In the humane quest to relieve suffering, there is a clear need to examine current practice. Indeed, the philosophical enquiry presented even questions whether our culture risks overemphasising the importance of pharmacological analgesia and calls for emergency physicians to take a more holistic approach to meeting patient needs.

Comparative quality analysis of hands-off time in simulated basic and advanced life support following European Resuscitation Council 2000 and 2005 guidelines

Aim To compare hands-off time (HOT) in simulated advanced life support (ALS) following European Resuscitation Council (ERC) 2005 guidelines and ERC 2000 and to provide quantitative data on workflow. Subjects and Methods Observations with 18 professional paramedics, performing 39 megacodes (mega-code training; MCT) were videotaped during ALS re-certification. Teams were randomly assigned to train according to ERC 2000 or ERC 2005. HOT, hands-off intervals (HOI) and other variables describing interventions and workflow were analysed. Results In group ERC 2000 17±3 HOI appeared with a mean duration of 17.5±10.8 s (mean±SD). Overall HOT was 382±47 s, equivalent to a mean hands-off fraction (HOF) of 0.45±0.05. 15±5 ventilation-free intervals (VFI) were observed, with a mean duration of 21±10 s. In contrast after ERC 2005 variables resulted in 18±3 HOI with a mean duration of 10.0±4.0 s (p<0.001 vs ERC 2000), overall HOT 196±33 s (HOF 0.23±0.04; p<0.001), 24±12 VFI with a duration of 24±7 s (p<0.05). The first HOI lasted for 60.4±33.1 s in ERC 2000 and 17.6±4.3 s in ERC 2005 (p<0.001). In ERC 2000 6.1±2.6 interruptions for two bag/mask ventilations (BMV) lasted for 5.4±0.8 s, whereas in ERC 2005 9.6±3.1 interruptions for two BMV took 6.5±2.2 s (p<0.001). In both groups HOI were used thoroughly for basic life support/ALS-based interventions. Conclusion The application of ERC guidelines of 2005 markedly reduced the first HOI and mean duration of HOI at the cost of delayed secure airway management and ECG analysis in this MCT model.

Mild hypothermia treatment in patients resuscitated from non-shockable cardiac arrest

Objective Therapeutic hypothermia has proved effective in improving outcome in patients after cardiac arrest due to ventricular fibrillation (VF). The benefit in patients with non-VF cardiac arrest is still not defined. Methods This prospective observational study was conducted in a university hospital setting with historical controls. Between 2002 and 2010 387 consecutive patients have been admitted to the intensive care unit (ICU) after cardiac arrest (control n=186; hypothermia n=201). Of those, in 175 patients the initial rhythm was identified as non-shockable (asystole, pulseless electrical activity) rhythm (control n=88; hypothermia n=87). Neurological outcome was assessed at ICU discharge according to the Pittsburgh cerebral performance category (CPC). A follow-up was completed for all patients after 90 days, a Kaplan–Meier analysis and Cox regression was performed. Results Hypothermia treatment was not associated with significantly improved neurological outcome in patients resuscitated from non-VF cardiac arrest (CPC 1–2: hypothermia 27.59% vs control 18.20%, p=0.175). 90-Day Kaplan–Meier analysis revealed no significant benefit for the hypothermia group (log rank test p=0.82), and Cox regression showed no statistically significant improvement. Conclusions In this cohort patients undergoing hypothermia treatment after non-shockable cardiac arrest do not benefit significantly concerning neurological outcome. Hypothermia treatment needs to be evaluated in a large multicentre trial of cardiac arrest patients found initially to be in non-shockable rhythms to clarify whether cooling may also be beneficial for other rhythms than VF.

'Scurvy': presentation and skin manifestations of a not so uncommon condition

An 84-year-old man attended our emergency department with a 5-month history of poor oral intake since the death of his wife. He complained of lethargy, dyspnoea, epistaxis and myalgic pains. He was severely thin with purpuric skin lesions over his knuckles, elbows and shins (figures 1 and 2).1 Scurvy was suggested and confirmed by dermatology. The patient was started on ascorbic acid (400 mg/24 h) and initially improved, but died later of a nosocomial infection. Scurvy is a state of vitamin C (ascorbic acid) deficiency. Ascorbic acid is used in the synthesis of collagen, neurotransmitters and helps in dietary iron absorption. Deficiency results in poor wound healing, defective capillary walls and anaemia. The UK incidence of clinical scurvy is unknown, but the prevalence of vitamin C deficiency is estimated at 25% in men and 16% in women and is associated with low income, poor diet...

Value of a rigid collar in addition to head blocks: a proof of principle study

Background All trauma patients with a cervical spinal column injury or with a mechanism of injury with the potential to cause cervical spinal injury should be immobilised until a spinal injury is excluded. Immobilisation of the entire patient with a rigid cervical collar, backboard, head blocks with tape or straps is recommended by the Advanced Trauma Life Support guidelines. However there is insufficient evidence to support these guidelines. Objective To analyse the effects on the range of motion of the addition of a rigid collar to head blocks strapped on a backboard. Method The active range of motion of the cervical spine was determined by computerised digital dual inclinometry, in 10 healthy volunteers with a rigid collar, head blocks strapped on a padded spine board and a combination of both. Maximal opening of the mouth with all types of immobiliser in place was also measured. Results The addition of a rigid collar to head blocks strapped on a spine board did not result in extra immobilisation of the cervical spine. Opening of the mouth was significantly reduced in patients with a rigid collar. Conclusion Based on this proof of principle study and other previous evidence of adverse effects of rigid collars, the addition of a rigid collar to head blocks is considered unnecessary and potentially dangerous. Therefore the use of this combination of cervical spine immobilisers must be reconsidered.

Slow infusion metoclopramide does not affect the improvement rate of nausea while reducing akathisia and sedation incidence

Objective To compare the effects of metoclopramide infusion in emergency department (ED) patients complaining of nausea to determine the changes in its therapeutic effect and prevention of side effects such as akathisia and sedation. Methods A prospective, randomised, double blind trial, from 1 March 2007 to 1 May 2008 in the ED of Pamukkale University Faculty of Medicine. Patients with moderate to severe nausea were randomised and divided into two groups: group 1 received 10 mg metoclopramide as a slow intravenous infusion over 15 min plus placebo (SIG); group 2 received 10 mg metoclopramide as an intravenous bolus infusion over 2 min plus placebo (BIG). The whole procedure was observed, and nausea scores, akathisia and vital changes were recorded. Results 140 patients suffering from moderate to severe nausea in the ED were included in the study. There was no significant difference between the groups in terms of mean nausea scores during follow-up (p=0.97). A significant difference in akathisia incidence was observed between the groups (18 (26.1%) in the BIG and 5 (7%) in the SIG) (p=0.002). There was also a significant difference in sedation incidence between the groups (19 (27.5%) in the BIG and 10 (14.5%) in the SIG) (p=0.05). Conclusion Even though slowing the rate of infusion of metoclopramide does not affect the rate of improvement in nausea, it may be an effective strategy for reducing the incidence of akathisia and sedation in patients with nausea.

Serum procalcitonin predicting mortality in exertional heatstroke

Background The aim of this study was to test if Procalcitonin PCT value at the time of admission is a predictor of mortality and/or a diagnostic marker of concomitant infection in exertional heatstroke. Methods 68 patients with exertional heatstroke admitted to the multidisciplinary intensive care unit were studied. Serum PCT was detected by means of a specific and ultrasensitive immunoluminometric assay within 2 h of admission. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was evaluated within 24 h of admission. Results There was no significant difference in PCT levels between concomitant infection and non-infection patients (p=0.712). Elevated PCT level in exertional heatstroke patients was associated with a more critical pathological state. PCT values in patients with multiple organ dysfunction syndrome (MODS) were significantly higher than those without MODS (p=0.007.). PCT values were also positively correlated with APACHE II scores (r=0.588, p=0.016). PCT values in non-survivors were higher than in survivors at univariate regression analysis (p=0.017). After adjusting for confounders, PCT concentration also remained an independent determinant of mortality (OR 2.98; 95% CI 1.02 to 4.41; p=0.039). Receiver operating characteristic curve for PCT concentration was located above the reference line, which shows an association with mortality. The area under the curve for PCT concentration (0.705; 95% CI 0.547 to 0.862) was statistical significantly (p=0.019). As a predictor of mortality, PCT value was inferior to APACHE II score. Conclusions PCT value at the time of admission is an independent predictor of mortality, but maybe not a good indicator of concomitant infection in exertional heatstroke.

Unexpected splenic injury

A 31-year-old man presented to the emergency department at 04:50 complaining of left-sided abdominal and flank pain that started from the previous afternoon. The pain had initially settled but he woke up with a recurrence of the pain. The pain settled with the administration of rectal diclofenac and an intravenous pyelogram was normal. The patient was stable and blood tests were unremarkable. He was admitted by the surgeon, reviewed by senior surgeons in the morning and discharged. After 2 days, he returned with persistent abdominal pain. Abdominal examination was unremarkable. Emergency department ultrasound showed significant intra-abdominal free fluid and a lesion in the spleen (figure 1A,B). A CT scan confirmed the presence of free fluid in the abdomen, intrasplenic laceration together with peri-splenic haematoma. The patient admitted to jet skiing the week before the pain started. He was readmitted. The pain settled over the next few days and...

Recent massive blood transfusion practice in England and Wales: view from a trauma registry

Background Few studies have characterised massive blood transfusion (MBT) practice in UK trauma. This study describes the Trauma Audit and Research Network experience of MBT over a 4-year period, and examines variables predictive of MBT and mortality following MBT. Methods Prospectively collected data between 2005 and 2009 from the Trauma Audit and Research Network database were analysed. MBT incidence was examined, and patient characteristics, blood component usage and mortality compared to non-MBT patients. Clinical and injury features predictive of massive transfusion, and risk factors predictive of death in MBT, were analysed using multivariate logistic regression. Results 157 patients (0.4%) received MBT, with a mortality rate of 40.3%. MBT patients were younger, more likely to be male and to have sustained more severe trauma (median age 39.2 years, median Injury Severity Score 27, 78% male, p<0.01). No patients received platelets and fresh frozen plasma (FFP) in 1:1 ratios with packed red cells. Multivariate analysis showed: age, admission pulse rate, systolic blood pressure, and injury type; thoracic, abdominal, pelvis, were significant predictors of MBT. Injury Severity Score and admission pulse rate were also independent predictors of death in MBT, but level of platelet and FFP use were not found to be statistically significant. Conclusion MBT is a rare event with high mortality in UK trauma. Haemostatic resuscitation is not currently practiced in the UK and the authors were unable to show that FFP and platelet use were significant predictors of survival in MBT.

Theme: Suicide and suicidal behaviours

Question 1 Which of the following are true regarding suicidal intent and suicide? A previous suicide attempt is the best predictor of a future suicide attempt. 10–15% of those attempting suicide succeed, but 60–70% of successful suicides have no prior history of attempts. Patients who attempt suicide have low CSF serotonin levels. Borderline personality disorder is the Axis II diagnosis most closely associated with suicide. Question 2 Which of the following are true regarding assessment of potentially suicidal patients? A ‘SAD PERSONS’ score of <6 has a negative predictive value (NPV) of >95%. No single psychological test can accurately predict suicidal attempts. Scoring systems might help in determining the need for hospitalisation. Suicide is often provoked by a treatable or reversible short-term crisis. Question 3 Which of the following are true regarding treatment of suicidality? Suicidal patients frequently...

Is computer-assisted telephone triage safe? A prospective surveillance study in walk-in patients with non-life-threatening medical conditions

Background Patients often establish initial contact with healthcare institutions by telephone. During this process they are frequently medically triaged. Purpose To investigate the safety of computer-assisted telephone triage for walk-in patients with non-life-threatening medical conditions at an emergency unit of a Swiss university hospital. Methods This prospective surveillance study compared the urgency assessments of three different types of personnel (call centre nurses, hospital physicians, primary care physicians) who were involved in the patients' care process. Based on the urgency recommendations of the hospital and primary care physicians, cases which could potentially have resulted in an avoidable hazardous situation (AHS) were identified. Subsequently, the records of patients with a potential AHS were assessed for risk to health or life by an expert panel. Results 208 patients were enrolled in the study, of whom 153 were assessed by all three types of personnel. Congruence between the three assessments was low. The weighted values were 0.115 (95% CI 0.038 to 0.192) (hospital physicians vs call centre), 0.159 (95% CI 0.073 to 0.242) (primary care physicians vs call centre) and 0.377 (95% CI 0.279 to 0.480) (hospital vs primary care physicians). Seven of 153 cases (4.57%; 95% CI 1.85% to 9.20%) were classified as a potentially AHS. A risk to health or life was adjudged in one case (0.65%; 95% CI 0.02% to 3.58%). Conclusion Medical telephone counselling is a demanding task requiring competent specialists with dedicated training in communication supported by suitable computer technology. Provided these conditions are in place, computer-assisted telephone triage can be considered to be a safe method of assessing the potential clinical risks of patients' medical conditions.

Cardiovascular collapse after return of spontaneous circulation in human out-of-hospital cardiopulmonary arrest

Objective Animal studies describe cardiovascular collapse (CVC; hypotension or reoccurrence of cardiac arrest) after return of spontaneous circulation (ROSC) from cardiopulmonary arrest. Few studies describe CVC in humans. This study aimed to determine the occurrence of CVC in human out-of-hospital cardiopulmonary arrest (OHCA). Methods Using observational data from a site of the Resuscitation Outcomes Consortium, the study analysed treated, non-traumatic OHCA achieving initial ROSC. CVC was defined as post-ROSC hypotension (systolic blood pressure ≤80 mm Hg), post-ROSC administration of epinephrine, vasopressin or dopamine, or post-ROSC recurrent cardiac arrest. The time period from initial ROSC to emergency department (ED) arrival was measured. The prevalence of and elapsed time to post-ROSC CVC was determined, censoring cases at the point of ED arrival and comparing clinical characteristics between CVC and non-CVC cases. Results Of 1081 treated OHCA, ROSC occurred in 58 (5%; 95% CI 4% to 7%). CVC occurred in three cases of 58 ROSC (5%; 95% CI 1% to 14%), all due to recurrent cardiac arrest. The median ROSC to ED arrival time was 6 min (IQR 3–13 min). ROSC to CVC times were 1, 2 and 8 min. Patient sex, age, initial ECG rhythm, endotracheal intubation, bystander cardiopulmonary resuscitation and bystander automated external defibrillation were similar between CVC and non-CVC cases (p=0.11–1.00). Conclusions In this series of treated OHCA, only a small fraction of patients experienced CVC after ROSC.

Effect of an onboard event recorder and a formal review process on ambulance driving behaviour

Background Onboard event recorders in vehicles record external and internal video before and after when preset g-force limits are exceeded. The use of these recorders in a fleet of ambulances, along with formal review, may decrease the number of unsafe driving events. The aim of this study was to evaluate the number of driving events since the inception of DriveCam technology in a fleet. Methods 54 vehicles were outfitted with DriveCam event recorders in 2003. Events were captured and assigned a categorical severity score of 1–4 (1 being the lowest severity) when the vehicle exceeded preset g-force limits. An event was assigned a score of ‘good’ if the review determined that the driver demonstrated good judgement. A review and feedback process was implemented in August 2006 and analysed through June 2008. Results During the study period, 2 979 891 miles were driven for 115 019 ambulance responses, with 6009 events captured. Events were categorised as follows: 2008 (33.4%) level 1; 3726 (62.0%) level 2; 175 (2.9%) level 3; 3 (0.05%) level 4; and 97 (1.6%) good events. The proportion of all events per mile and all events per response decreased over time with use of the recorder and review and feedback. Conclusions The institution of video event recorder technology along with formal review and feedback resulted in a change in driving behaviour. Given that call volumes increased and driving events decreased, these measures may serve as surrogates for improvements in safety and maintenance costs. Economic analysis is necessary for conclusions on fiscal impact.

Prehospital anaesthesia: a survey of current practice in the UK

Aim To establish the national picture of prehospital anaesthesia in the UK and to reference practice against the Association of prior to Anaesthetists of Great Britain and Ireland safety guideline on prehospital anaesthesia. Methods Lead clinicians were identified for all prehospital services in the UK that could potentially be performing prehospital anaesthesia and invited to complete a detailed online survey. The survey requested details on team structure, the process for prehospital anaesthesia, drugs and equipment used and training and governance arrangements. Results 55 responses were received from 63 invitations sent (87.3%) yielding usable data for 47 services. 31 of the 47 services (70%) responded that they performed prehospital anaesthesia. All services performing prehospital anaesthesia utilised a doctor but only 18 services (58%) always utilised a trained assistant. 28 services (90%) maintained a database and over half of services (55%) performed less than 20 prehospital anaesthetics annually. 23 services (74%) had a designated lead clinician for prehospital anaesthesia and 25 (81%) had a written difficult airway plan. 19 services (61%) had mandatory continual training requirements. Conclusions The majority of services are currently complying with the recommendations in the Association of prior to Anaesthetists of Great Britain and Ireland safety guideline. There are still areas of concern, particularly with regard to ongoing training and the high numbers of services that do not use a trained assistant for the process of prehospital anaesthesia.

Inappropriate 999 calls: an online pilot survey

Background Abuse of ambulance services is high, and there is concern among healthcare professionals that misuse of ambulances places stress on services, which may jeopardise patient care. This study aims to determine the proportion of people who correctly identify appropriate situations to call for an ambulance, and determine the characteristics of those most likely to call inappropriately. Methods An online questionnaire presented 12 common scenarios that may require medical attention and required participants to identify when they would request an ambulance. Proportions correctly responding to each scenario were calculated and each respondent was given a total score. t-Tests compared mean scores between groups (with and without first aid (FA) training), and 2 tests compared between-group proportions of correct answers for scenarios. Backwards stepwise logistic regression analyses determined the characteristics of those most likely to call inappropriately. Results 150 respondents completed the questionnaire. 5.2–47.8% responded with an inappropriate answer, depending on the scenario. Almost all participants identified the need for an ambulance in 3/5 scenarios when it was required; however, fewer (74.8%) respondents identified the need for an ambulance to a suspected stroke. The majority correctly identified an ambulance was not required in only 2/7 scenarios. Those with FA training were less likely to call inappropriately in all scenarios (significant in three situations). However, no participant characteristics were predictive of calling an ambulance inappropriately once confounders were taken into account. Conclusions The majority would call for an ambulance appropriately when a real emergency occurred, and most inappropriate classification occurs when an ambulance is not required.

Management of acute allergic reactions by dispatching physicians in a Medical Emergency Dispatch Centre

Background Acute allergic reactions often occur in out-of-hospital settings, and some of these reactions may cause death in the short term. However, initial diagnosis, management and processing of acute allergic reactions by Medical Emergency Dispatch Centres are not documented. The aim of the present study was to describe acute allergic reactions and their management by a Medical Emergency Dispatch Centre. Methods A prospective study was conducted from 20 August 2006 to 5 November 2006 on incoming calls for acute allergic reactions to the Medical Emergency Dispatch Centre for the Hauts de Seine (Paris West suburb, France). The agreement between initial diagnosis (made by dispatching physician) and final diagnosis (made by the physician who later examined the patient), and between initial and final severity, were evaluated using Cohen's weighted coefficient. Results 210 calls were included. The diagnoses made by the dispatching physician were: in 58.1% of cases urticaria, in 23.8% angioedema, in 13.3% laryngeal oedema, and in 1.9% anaphylactic shock. The agreement between initial and final diagnoses was evaluated by a coefficient at 0.44 (95% CI 0.26 to 0.61) and the agreement between initial and final severity was evaluated using a coefficient at 0.37 (95% CI 0.24 to 0.50). Conclusions Only moderate agreement is highlighted between the initial severity assessed by the dispatching physician and the final severity assessed by the physician later examining the patient. This demonstrates the need to develop a tool for assessing severity of acute allergic reactions for dispatching physicians in Medical Emergency Dispatch Centres.

Paramedics and the effects of shift work on sleep: a literature review

Introduction This paper investigates the literature regarding the impact of shift work on prehospital emergency providers. While the issue of shift work has been thoroughly investigated in other health disciplines, this is not the case for the paramedic discipline, particularly in the Australian context. Objective To identify the literature available on prehospital providers regarding the effects of shift work on sleep. Method Electronic databases used were the Cochrane Database of Systematic Reviews, Ovid MEDLINE, Proquest, AMED and CINAHL. The following MeSH terms and keywords with truncation were used in the search strategy: ‘shift work’; ‘sleep disorder’; ‘sleep deprivation’; ‘circadian rhythm’; ‘fatigue’; ‘occupational stress’. Results The electronic databases cited 226 articles, of which nine met the inclusion criteria with another three articles sourced from references in the retrieved papers. There is a lack of literature describing the effect of shift work on sleep in the prehospital arena, with only one paper exploring paramedics in the Australian setting. These findings suggest that further work is required to examine shift hours and workforce health and safety in the prehospital setting. Conclusions Shift work can affect health and well-being on a variety of levels, both physiologically and psychologically, affecting aspects of work and personal life. Further research is warranted to prevent the issues of patient safety, work-related fatigue and the cumulative effects of shift work.

Is direct transport to a trauma centre best for patients with severe traumatic brain injury? A study in south-central Taiwan

Objective This study attempted to identify any differences between the outcomes of patients with severe traumatic brain injury (TBI) who were directly transported to Chang Gung Memorial Hospital and those who were stabilised initially at other hospitals in south-central Taiwan. Methods A retrospective review of the records of 254 patients with isolated severe TBI who visited this hospital's emergency department from July 2003 to June 2008, of whom 167 were referred from other hospitals. Logistic regression was used to assess the effects of transfer and its components on mortality. Results Transfer from another hospital was not significantly correlated with mortality in this study (OR 0.513, 95% CI 0.240 to 1.097). Moreover, neither intubation (OR 1.356, 95% CI 0.445 to 4.133) nor transfer time over 4 h (OR 0.549, 95% CI 0.119 to 1.744) had a significant effect on mortality. Conclusion No differences in outcome were found between patients with isolated severe TBI who were directly transported and those transferred to this hospital's emergency room.

Using 'reverse triage' to create hospital surge capacity: Royal Darwin Hospital's response to the Ashmore Reef disaster

This report analyses the impact of reverse triage, as described by Kelen, to rapidly assess the need for continuing inpatient care and to expedite patient discharge to create surge capacity for disaster victims. The Royal Darwin Hospital was asked to take up to 30 casualties suffering from blast injuries from a boat carrying asylum seekers that had exploded 840 km west of Darwin. The hospital was full, with a backlog of cases awaiting admission in the emergency department. The Disaster Response Team convened at 10:00 to develop the surge capacity to admit up to 30 casualties. By 14:00, 56 beds (16% of capacity) were predicted to be available by 18:00. The special circumstances of a disaster enabled staff to suspend their usual activities and place a priority on triaging inpatients' suitability for discharge. The External Disaster Plan was activated and response protocols were followed. Normal elective activity was suspended. Multidisciplinary teams immediately assessed patients and completed the necessary clinical and administrative requirements to discharge them quickly. As per the Plan there was increased use of community care options: respite nursing home beds and community nursing services. Through a combination of cancellation of all planned admissions, discharging 19 patients at least 1 day earlier than planned and discharging all patients earlier in the day surge capacity was made available in Royal Darwin Hospital to accommodate blast victims. Notably, reverse triage resulted in no increase in clinical risk with only one patient who was discharged early returning for further treatment.

Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary

Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four stages that have been described elsewhere.2 The BETs shown here together with those published previously and those currently under construction can be...

BET 1: Does the 'Seatbelt Sign' predict intra-abdominal injury after motor vehicle trauma in children?

A short cut review was carried out to establish whether the seat belt sign was a significant predictor of intra-abdominal injury in children involved in motor vehicle collisions. 51 papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that seatbelt sign appears to be associated with an increased risk of intra-abdominal injuries, especially gastrointestinal and pancreatic injuries.

BET 2: Should capnography be routinely used during procedural sedation in the Emergency Department?

A short cut review was carried out to establish whether capnography should be routinely used during procedural sedation in Emergency Departments. 206 papers were found using the reported searches, of which nine presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is that capnography may provide early warning of ventilatory changes that could result in hypoxia.

BET 3: Can pregabalin effectively diminish acute herpetic pain and reduce the incidence of post-herpetic neuralgia?

A short cut review was carried out to establish whether pregabalin can reduce acute herpetic pain and reduce post herpetic neuralgia. 48 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. It is concluded that pregabalin does not seem to decrease the intensity of pain related to acute herpes zoster. Moreover, it does not decrease the incidence of post herpetic neuralgia. More research is.

Massive transfusion: a complex issue

I must comment on the article by Milligan et al regarding massive transfusion in trauma.1 The authors state that ‘standardizing blood transfusion in major trauma to include automatic delivery of appropriate blood products at particular points in resuscitation may be of benefit’. They base this on their survey of 32 emergency medicine doctors to whom they asked questions apparently relating to the definition of massive transfusion (MT), ‘target’ laboratory values and blood product components. The definition of MT is a retrospective one and therefore not of value to the emergency physician faced with a bleeding patient. The ‘target’ laboratory values may be of academic interest but are not the primary relevant point we should be interested in—the authors quite rightly allude to the delay associated with treatment reactionary to laboratory values. A recent data analysis by Brown et al2 noted that, in patients who had...

Short answer question case series: diagnosis and management of glaucoma

Case vignette A 40-year-old woman with history of hypertension and migraines presents with a complaint of headache. Two days prior to presentation she began to experience a left-sided, throbbing headache that radiated to the right and was accompanied by blurring of left eye vision and nausea. The blurred vision and headache were exacerbated by bright light, consistent with prior migraine attacks. She took her usual dose of naproxen with resolution of her nausea but still had a mild headache and blurred left eye vision. Two hours prior to presentation she walked outside and experienced worsening of her headache upon exposure to the sunlight, but without concomitant change in her vision or nausea. Aleve did not improve her symptoms, so she decided to present to the emergency department. Her vital signs were normal. Key questions Which features are consistent with migraine in this patient? What other important...

Highlights from the literature

Prehospital intraosseous access Intraosseous (IO) needles are commonly used to obtain vascular access in children rapidly. Recent studies have shown that IO needles can also be used as a rapid method for obtaining vascular access in adults. A randomised controlled trial attempted to establish whether there was a difference in the frequency of first attempt success between humeral IO, tibial IO and peripheral intravenous access in adult patients experiencing non-traumatic out-of-hospital cardiac arrest. The study found that tibial IO needles had the highest first attempt success and the most rapid time to vascular access. Perhaps IO access should be adopted more widely in the adult population (Annals of Emerg Med 2011;58:509–16). Pigtails for chest trauma There is an increasing trend towards using pigtail catheters (rather than traditional large bore drains) in patients who are found to have a traumatic pneumothorax. A retrospective study from the USA found that...

US Army: Brigadier general has died in Afghanistan

Natural causes. FORT HOOD, Texas (AP) – A 49-year-old brigadier general who died Friday in Afghanistan of apparent natural causes is likely the highest-ranking military officer to die in that conflict, according to military records. via US Army: Brigadier general has died in Afghanistan. At 49. Wow. Condolences to his family. Related posts: Army [...] Related posts: Army seeking troops bitten by stray animals following rabies death – Army – Stripes Wow, that is awful beyond belief. Army seeking troops bitten... Truman CO dies after collapsing – Navy News | News from Afghanistan & Iraq – Navy Times Carrier Command. On the path to Stars. Died at age... Wish comes true for cancer-stricken 10-year-old inducted into Army – Yahoo! News Most kids might hope to get an Xbox or an... Related posts brought to you by Yet Another Related Posts Plugin.

Worker Trapped Under Boeing 787 Tires

EVERETT, Wash. – Officials say emergency crews have rescued a worker who was temporarily trapped beneath the tires of a Boeing 787 jetliner at an Everett, Wash., airfield. via Worker Trapped Under Boeing 787 Tires Is Rescued. Yikes. Best wishes. via Drudge. Related posts: Boeing Providing Facebook Fan With the ‘Opportunity of a Lifetime’ [...] Related posts: Boeing Providing Facebook Fan With the ‘Opportunity of a Lifetime’ — CHICAGO, Feb. 9, 2011 /PRNewswire/ – This weekend, Dr. Jeremy Hampton, an aviation enthusiast and amateur... Related posts brought to you by Yet Another Related Posts Plugin.

The Best Super Bowl ad you won’t see

It’s only on in Canada (eh). It’s good. Yeah, it’s a Budwiser ad, but since they paid for the stunt (I guess), so they get a lot of credit from me. via SFGate Related posts: Volkswagen rolls out full Super Bowl ad – Autoweek Volkswagen rolls out full Super Bowl ad – Autoweek. ... Announcing [...] Related posts: Volkswagen rolls out full Super Bowl ad – Autoweek Volkswagen rolls out full Super Bowl ad – Autoweek. ... Announcing Guess-a-Nobel 2011 MedGadget has an interesting contest going on: Six days from... Related posts brought to you by Yet Another Related Posts Plugin.

Not dead yet

All, Sitemeter tells me people still visit this site. Probably from a sense of nostalgia, and I thank all of you for checking in here from time to time. I’m working a lot of shifts, going to a lot of meetings, and still trying to have a semblance of a life. This leaves no time [...] No related posts. Related posts brought to you by Yet Another Related Posts Plugin.

Volkswagen rolls out full Super Bowl ad – Autoweek

Volkswagen rolls out full Super Bowl ad – Autoweek. No related posts. Related posts brought to you by Yet Another Related Posts Plugin. No related posts. Related posts brought to you by Yet Another Related Posts Plugin.

American Airlines, this is a problem

Dear AA, I appreciate all the good to great service over the years, so this is why, in the spirit of improving our relationship, I offer this constructive criticism: For those unfamiliar with DFW, the gates are always related to the terminal. So the terminal being B and the gate starting with D, that’s a [...] Related posts: My first medical checklist Laugh if you want, this helps my life, at least... Royal wedding’s lone American will guard Queen on horseback – CNN.com Good for him. London (CNN) — Growing up on the... Related posts brought to you by Yet Another Related Posts Plugin.

Doc Fix Just Got More Expensive

Sustainable. They keep using that word. I do not think it means what they think it means… Permanent repeal of the flawed Medicare payment formula known as the Sustainable Growth Rate just got a lot more expensive…. via Doc Fix Just Got More Expensive – Margot Sanger-Katz – NationalJournal.com. Related posts: Medical Apps? There’s a [...] Related posts: Medical Apps? There’s a Doc for That When emergency physician Harvey Castro asked a nurse to start... With explanatory graphics! The Sources of the SGR “Hole” — NEJM This article and its graph (from the NEJM), and its... Related posts brought to you by Yet Another Related Posts Plugin.

Official 2012 Honda CR-V Game Day Commercial – “Matthew’s Day Off” Extended Version – YouTube

Laugh, and enjoy! Official 2012 Honda CR-V Game Day Commercial – “Matthew’s Day Off” Extended Version – YouTube. Related posts: The Canada Party Okay, it’s got an Fword in it, so if you’re... Doctors decry poor ER conditions via YouTube – FierceHealthcare Doctors at LaSalle Hospital in Montreal have turned the cameras... Compression Only [...] Related posts: The Canada Party Okay, it’s got an Fword in it, so if you’re... Doctors decry poor ER conditions via YouTube – FierceHealthcare Doctors at LaSalle Hospital in Montreal have turned the cameras... Compression Only CPR video Okay, it’s kind of amusing, and I hope it induces... Related posts brought to you by Yet Another Related Posts Plugin.

Save 50% at XYScrubs.com

I recommend these. They’re terrific. Get ‘em while they last. XY Scrubs, a premier provider of men’s scrubs and medical work apparel is having a 50% Off Sale on all Men’s Scrubs. Providing eco-friendly, anti- microbial, durable and fashion forward scrubs for Men, XY Scrubs (XYScrubs.com) has established itself as the New Leader in Men’s [...] Related posts: XY SCRUBS | Mens Scrubs – XY SCRUBS XY SCRUBS | Mens Scrubs – XY SCRUBS. A... Colorectal Surgeon’s Song It’s from 2006, but new to me. Enjoy.... Related posts brought to you by Yet Another Related Posts Plugin.

Crime Time: Juror arrested for trying to enter Fort Worth courthouse with loaded gun

This isn’t the part that made me roll my eyes: FORT WORTH — A juror was arrested Tuesday morning as she attempted to enter a courthouse with a loaded handgun and after deputies saw the weapon during a screening, a Tarrant County official said.The incident occurred about 8:30 a.m. at the south entrance to the [...] Related posts: In Fort Worth, MedStar’s Community Health Program cutting costs, improving patients’ well-being … Kudos to MedStar (our Fort Worth EMS provider) for their... Extra Credit: Fort Worth teen wins first Google Global Science Fair Fort Worth teen wins first Google Global Science Fair Shree... Texas budget crunch could delay M.D. program in Fort Worth | Texas Legislature | News fr… AUSTIN — A proposal to add an M.D. program to... Related posts brought to you by Yet Another Related Posts Plugin.

Emergency jobs

All Emergency jobs for Sun Feb 5 2012

Emergency jobs in "Various Cities in SC and the Mid Atlantic Region" - SC

Job Description: Expanding Emergency Group hiring for multiple Emergency Medicine Physician openings in SC. We have open positions all over PA and the NE. If you

Emergency jobs in "Dallas/Ft. Worth, Austin and Houston" - TX

Join an emergency medicine practice management company with locations throughout Texas including Dallas/ Ft. Worth, Houston and Austin. If you are Board Eligible/ Board Certified Emergency Medicine,

Emergency jobs in "Eugene, Lane County & Oregon Coast" - OR

Great Emergency Medicine group with excellent sites in the Northwest including Oregon, Washington and Alaska. For more details, send CV to: ds@emergencyphysiciansgroup.com

Emergency jobs in "Numerous positions throughout OH" - OH

Join an Emergency Department Management Company with locations throughout Ohio. If you are Board Eligible/ Board Certified Emergency Medicine, apply today! Our group offers a highly

Emergency jobs in "Portland and Coastal Cities" - WA

Great Emergency Medicine group with excellent sites in the Northwest including Oregon, Washington and Alaska. For more details, send CV to: ds@emergencyphysiciansgroup.com

Emergency jobs in "Various cities all over FL" - FL

Job Description: Expanding Emergency Group hiring for multiple Emergency Medicine Physician openings all over FL. We have open positions in Tampa, Orlando, SE Florida, Naples, Jacksonville,

Emergency jobs in "Throughout the DC area" - DC

Great Emergency Medicine group with excellent sites in and around the Washington, DC Metro Area. For more details, send CV to: ds@emergencyphysiciansgroup.com

Emergency jobs in "Positions all over CO" - CO

Job Description: Expanding Emergency Group hiring for multiple Emergency Medicine Physician openings all over the southern US. If you are Board Eligible/ Board Certified Emergency Medicine,

Emergency jobs in "Positions all over CA" - CA

Job Description: Expanding Emergency Group hiring for multiple Emergency Medicine Physician openings all over the southern US. If you are Board Eligible/ Board Certified Emergency Medicine,

Emergency jobs in "Call for location" - PA

Immediate locums opportunity near Williamsport, PA. Four-week assignment with the possibility of extensions. You can be considered for permanent positions while you work as a locums. Give me a call at

Emergency jobs in "Call for location" - TX

New Location south of Dallas, TX and about an hour east of Waco. Outpatient, flexible hours, weekdays only, on call rotation very light. We are looking for physicians who want work/life balance and

Emergency jobs in "Call for location" - KS

OPPORTUNITIES AVAILABLE in Kansas for Primary Care Physicians. Full-time locums with possibility for conversion to permanent. The current hot opening is full-time outpatient medicine in Norton, Kansas.

Emergency jobs in "Call for location" - TX

ANY STATE LICENSE MDA has Emergency Medicine positions at William Beaumont Army Medical Center, El Paso, TX. Physician must be ABEM Certified with current BLS, ACLS, PALS and ATLS preferred. The facility

Emergency jobs in "Call for location" - AL

Primary Care Physicians Needed. Immediate vacancies near Hamilton, Huntsville, and Montgomery. You can work month-to-month as a locums and you can be considered for the permanent position, if there

Emergency jobs in "Call for location" - PA

Primary Care Physician Needed Near Pittsburgh, PA. Four-week assignment with the possibility of extensions. The location is an hour and a half drive from Pittsburgh. You can be considered for permanent

Emergency jobs in "Call for location" - MS

OPPORTUNITY AVAILABLE near Natchez, Mississippi for a full-time primary care physician. Needed to provide coverage for out-patient clinic on an ongoing basis. Will consider locums, or locums with transition

Emergency jobs in "Call for location" - VA

Full-time Acting Medical Director Position available near Norfolk, Virginia. Monday through Friday 8 am to 5 pm in an outpatient setting. Out patient medicine only with light call and no hospital duties.

Emergency jobs in "Call for location" - KY

Outpatient Medicine Opportunity for Primary Care Physician near Lexington, KY. Primary Care outpatient only with Light Call. Full-time regular sick call. Full-time long-term locums. Permanent placement

Emergency jobs in "Call for location" - MO

OPPORTUNITY AVAILABLE in Missouri for Primary Care Physician. Full-time locums with possibility for conversion to permanent. Current hot opening near Kansas City. Available hours are Monday through Friday

Emergency jobs in "Call for location" - MO

OPPORTUNITY AVAILABLE in Missouri for Primary Care Physician. Full-time locums with possibility for conversion to permanent. Current hot opening near Columbia. Available hours are Monday through Friday

Emergency jobs in "Call for location" - AL

OPPORTUNITY AVAILABLE in Alabama for a Primary Care Physician. Full-time locums. Current hot opening is near Montgomery. Available hours are Monday through Friday from 8 to 5. Extensions month-to-month

Emergency jobs in "Call for location" - NM

Primary Care Physician needed FT in Hobbs, NM. Outpatient medicine only, with light call and no hospital duties. Board eligible or board certified FPs or IMs. Locums with transition to permanent, if there

Emergency jobs in "Call for location" - TN

OPPORTUNITY AVAILABLE in Tennessee for Primary Care Physician. Full-time locums with possibility for conversion to permanent. Current hot opening near Dyersburg. Available hours are Monday through Friday

Emergency jobs in "Call for location" - LA

Permanent full-time position for physicians in Central Louisiana. Looking for experience in internal medicine, family practice, urgent care or emergency medicine. The position is 40 hours per week,

Emergency jobs in "Call for location" - GA

Permanent full-time position for physicians in Southern and Eastern Georgia. Looking for experience in internal medicine, family practice, urgent care or emergency medicine. The position is 40 hours

Emergency jobs in "Greater Syracuse" - NY

Our client in the Greater Syracuse area of NY is currently looking for a qualified BC/BE Emergency Medicine Physician to bring on board Board Certified is preferred but

Emergency jobs in "Fox Valley Area" - WI

Expanding Emergency Group hiring for multiple Emergency Medicine Physician openings in Milwaukee, WI. If you are Board Eligible/ Board Certified Emergency Medicine, apply today for more details.

Emergency jobs in "North Carolina" - NC

New opportunity with an established emergency medicine team in a beautiful mountain community of North Carolina! Due to growth, this long-standing team of experienced emergency physicians is looking

Emergency jobs in "Greater Albany" - NY

We have a great opportunity for you to come join a very well-established group in the Greater Albany area of NY as a Emergency Medicine Physician. Board Certified is preferred

Emergency jobs in "Chesapeake Bay" - MD

We have an outstanding on-going locums opportunity in the Chesapeake Bay area of MD for an Emergency Medicine Physician. Board Certified is preferred but Board

Emergency jobs in "Not Disclosed" - MA

Our client in SW Massachusetts is seeking a permanent (may consider locum to perm) Emergency Medicine physician. Coverage is needed beginning in July of 2012, but the client is willing to start the candidate

Emergency jobs in "West Virginia" - WV

Come enjoy the beautiful northern region of West Virginia!The emergency department is looking to hire a couple of full time EM, FP, or IM physicians. They see a midlevel volume and lower trauma. Competative

Emergency jobs in "West Virginia" - WV

no web descrip Email: emjobs@haymandaugherty.com Web: http://www.haymandaugherty.com

Emergency jobs in "Massachusetts" - MA

Enjoy the beautiful coast of Massachusetts! Great hospital looking for one ABEM physician to join their team full time. Making $300-400,000 a year + full benefits, low trauma, good coverage and working

Emergency jobs in "Not Disclosed" - PA

Our client in Pittsburgh, PA seeks to hire Emergency Medicine physicians. Candidates must have a completed Emergency Medicine residency and be ABEM. Doctors will work 12 hour shifts at the level II and

Emergency jobs in "Not Disclosed" - MI

A group in southwest Michigan seeks to hire a permanent Emergency Medicine physician. Preferred candidates will have an active Michigan medical license and be Board Certified in Emergency Medicine. Candidates

Emergency jobs in "Not Disclosed" - LA

A facility about 1.5 hours from Lafayette, Louisiana is need of a permanent Emergency Medicine physician. There is a 28% admission rate and obstetrics is not required. The physician must be open to day

Emergency jobs in "Pennsylvania" - PA

Beautiful hospital in central Pennsylvania looking for another ABEM/AOBEM physician to join their group! Make a competative base salary + full benefits + loan repayment + a generous sign-on bonus!! Also

Emergency jobs in "Pennsylvania" - PA

NEW PARTNERSHIP OPPORTUNITY IN SOUTHWESTERN PENNSYLVANIA!This established group has seen no turnover in years but is now looking for one new future partner to join the team. This is a busy community ED

Emergency jobs in "Pennsylvania" - PA

Central Pennsylvania emergency department is seeking Three full-time (minimum 36 hrs/wk) physicians ,not a trauma center. Must be ER trained and boarded, OR other boards with ER experience. The ED has

Emergency jobs in "Northeastern" - ME

We have an excellent facility located in the Northeastern part of Maine seeking a Locums or Permanent BC/BE Emergency Room Physician. The ideal candidate will receive a competitive

Emergency jobs in North Carolina

All Emergency jobs in North Carolina for Sun Feb 5 2012

Emergency jobs in "Northern IL" - IL

Expanding Emergency Group hiring for multiple Emergency Medicine Physician openings in Northern IL. Excellent benefits package. If you are Board Eligible/ Board Certified Emergency Medicine,

Emergency jobs in "Mississippi" - MS

UNBEATABLE OPPORTUNITY NEAR THE GULF COAST! This is a diverse & experienced emergency medicine group that is very open and democratic. They have been around for many years providing quality care in a

Emergency jobs in "South/East" - AL

An excellent opportunity exists in the Southeastern area of AL for a BC/BE Emergency Medicine Physician to join a well-established facility. Board Certified is preferred but Board Eligible

Emergency jobs in "South/East" - AL

An excellent opportunity exists in the Southeastern area of AL for a BC/BE Emergency Medicine Physician to join a well-established facility. Board Certified is preferred but Board Eligible

Emergency jobs in "New Mexico" - NM

Great private group in northern New Mexico looking to add a BC/BE emergency medicine physician to join their team!! Level III trauma, and based on an RVU production model. VERY competative salary + full

Emergency jobs in "Fort Wayne" - IN

We have an outstanding client in the Greater Fort Wayne area of Indiana that is seeking a BC/B Emergency Medicine Physician to join an established Emergency Medicine Group of over 60 Physicians

Emergency jobs in "Wisconsin" - WI

NEW PARTNERSHIP OPPORTUNITY with an expanding PRIVATE, DEMOCRATIC emergency medicine team in southern Wisconsin! Make $300,000 - $400,000 + FULL BENEFITS YOUR FIRST YEAR while practicing at a moderate

Emergency jobs in "Wisconsin" - WI

Unbeatable opportunity with a long-standing group and VERY FEW OVERNIGHT SHIFTS in a beautiful southern Wisconsin community. Earn great GUARANTEED income plus outstanding benefits while enjoying a flexible

Emergency jobs in "EM 166845" - CA

CALIFORNIA EMERGENCY MEDICINE RESIDENCY PROGRAM DIRECTOR Academic affiliation with one of the top medical programs in the United States Exciting opportunity to step into

Emergency jobs in "Southwest" - VA

There is a great opportunity available in a large facility located in the SW area of Virginia for a BC/BE Emergency Medicine Physician. Board Certified is preferred but

Emergency jobs in "Kentucky" - KY

Practice EM in a private group in a picturesque area of the mid-south. If acreage is the interest, property in this area is still priced reasonably. This is an opportunity in a high quality of life area.

Emergency jobs in "Illinois" - IL

Opportunity right outside Chicago with stable, well-established group of physicians who staff two hospitals. Position will be primarily at one of these two facilities. All physician coverage is ample

Emergency jobs in "Illinois" - IL

Earn EXCELLENT compensation, comprehensive benefits and additional perks with a very successful and stable emergency medicine team in northern Illinois! This is an extremely progressive and dedicated

Emergency jobs in "Virginia" - VA

NEW LUCRATIVE EMERGENCY MEDICINE OPPORTUNITY IN VA! This young and outgoing group of emergency physicians are looking for one sharp physician to join the team providing quality care at a large, full-service,

Emergency jobs in "Maryland" - MD

PARTNERSHIP OPPORTUNITY with a long-standing, private democratic group in a beautiful area of Maryland! Due to an unexpected event, this group has suddenly found themselves looking for one qualified

Emergency jobs in "Maryland" - MD

New emergency medicine opportunity in the suburbs of D.C.! This 55,000+ volume facility is extremely well-covered with excellent specialty back up and double/triple physician coverage. Work with a stable,

Emergency jobs in "Kentucky" - KY

New opportunity with a growing private group based in the NASHVILLE area! Openings within striking distance of Nashville are rare, especially with private physician-owned groups but due to expansion

Emergency jobs in "Illinois" - IL

This emergency department is located in a fantastic area, commutable to large cities in AL and GA! Make $175/hour and work in a high trauma center. Double coverage and partnership offered after a couple

Emergency jobs in "New York" - NY

Live and thrive in Upstate New York! Only a stones throw from Rochester, work as an employee in a progressive medical environment while receiving paid holidays, vacation, CME allowance, malpractice, full

Emergency jobs in "Michigan" - MI

New MICHIGAN EMERGENCY MEDICINE Full-Time Opportunity. This is an outstanding, new position located in the beautiful Upper Peninsula of Michigan. This position offers the security and benefits as a hospital

Emergency jobs in "Indiana" - IN

Come enjoy a great ED position with a group that allows equal pay and equal scheduling. Partnership on a 1 year track in a purely democratic opportunity! Low turn-over and long stability. Work with a

Emergency jobs in "Indiana" - IN

Full time Emergency Physician needed for low volume ED in northern Indiana, not far from Indianapolis! After 2 years become a partner, profit-sharing and bonuses included in competatice compensation package.

Emergency jobs in "Indiana" - IN

Lower volume ED in northeastern Indiana. $200,000 for 1752 hours plus bonus of up to $20,000 per year. The most beautiful and clean small town in the state! Low volume, newly remodeled ED looking for

Emergency jobs in "Indiana" - IN

Full time Emergency Physician needed for Private group with partnership track, profit-sharing and bonuses for facility in northern Indiana. Level III type trauma. Live in a major city with a short commute

Emergency jobs in "Indiana" - IN

This opportunity is located in the Ft. Wayne area. Full time Emerergency Medicine physician needed for a Private group with partner track, profit-sharing and bonuses!! Primary care certification accepted

Emergency jobs in "Indiana" - IN

Medium-high volume facility needs a full-time Emergency Physician. NO OVERNIGHTS. Earn around $145/hr. pre-partner and more than $170/hr. post-partner plus profit-sharing and bonuses. Strong established

Emergency jobs in "Wyoming" - WY

Mountainous Wyoming: beautiful setting surrounded by mountains! Skiers paradise. Lower volume ED provides quality of life with 24-hour shifts. Enjoy practicing at a moderate pace and providing quality

Emergency jobs in "Georgia" - GA

NEW PARTNERSHIP OPPORTUNITY WITH PRIVATE, DEMOCRATIC GROUP IN THE ATLANTA AREA! This long-standing team of emergency physicians has enjoyed success and seen virtually no turn-over throughout their history

Emergency jobs in "Florida" - FL

Extremely lucrative opportunity with a truly democratic, physician-owned group on FL's Gulf Coast. Guaranteed partnership after sweat-in with excellent compensation and benefits package in the meantime.

Emergency jobs in "Alabama" - AL

NEW opportunity with a private emergency medicine group in a beautiful northern Alabama community! This is a modern community emergency department treating a full range of patients and is well known

Emergency jobs in "Georgia" - GA

Attention!! Rare opening in Atlanta, GA for a brand new outpatient urgent care center! Enjoy the beautiful city located in the heart of luxury, including biking, shopping, golfing, and exciting nightlife!

Emergency jobs in "Eastern" - NC

North Carolina University of Medicine is seeking BC/BE Emergency physicians for the rank of assistant professor or above for their Department of Emergency Medicine. Highlights Include:

Emergency jobs in "Iowa" - IA

Enjoy the most beautiful town in the midwest where you can fish, hike, bike, camp, and shop. The town borders a beautiful river and has a great school system. This is the perfect place to raise a family!

Emergency jobs in "Doha" - XX

Urgently Seeking Emergency Medicine Consultants for Exciting Opportunities in Qatar We have a number of opportunities for experienced Emergency Medicine Consultants to work with a large

Emergency jobs in "Ohio" - OH

Looking for some additional lucrative part-time work? This stable private group of emergency physicians staff a lower volume community emergency department in a beautiful area of Ohio and are looking