Emergency medicine

Objective: To examine the effect of an education campaign based around a gold coin fine on ordering of C-reactive protein (CRP) tests.Design and setting: A retrospective analysis of CRP test ordering before and after the intervention in the emergency department (ED) of a tertiary referral hospital in metropolitan Sydney that sees about 60 000 patients per annum. The date of the intervention — 2 August 2013 — ...

James L Mallows MB BS, FACEM

To the Editor: We are concerned that recent media reports about a 17-year-old Sydney boy who died after allegedly consuming 25B- or 25I-NBOMe might lead to an increase in the incidence of NBOMe toxicity among patients presenting to emergency departments. NBOMe was reported to be available online for as little as $1.50 per tab.1 The subsequent media interest is likely to have increased public awareness of ...

David G E Caldicott · Stephen J Bright · Monica J Barratt

Using a new assay method on an old set of samples reveals that the role of high-sensitivity troponin in the real world still requires clarification

Daniel M Fatovich · Michael R Phillips · Kelley M Hubble · Samuel D Vasikaran

Trauma registry data on patients admitted to Sydney hospitals following bicycle or motorcycle accidents reveal the protective effect of wearing a helmet.

Michael M Dinh · Kate Curtis · Rebecca Ivers

To the Editor: Surfboard riding is an iconic pastime in Australia. Injuries to the head and face constitute a considerable proportion of surfing injuries;1-5 26% of acute surfing injuries are to the head and face, and these make up 42% of emergency department presentations by surfers.3 We conducted a retrospective review at our tertiary referral hospital of patients who underwent medical imaging for injuries sustained to ...

Simon J Dimmick · Patrick V Sheehan · Mark Gillett · Suzanne E Anderson

To the Editor: Cyclones, floods and bushfires are experienced in Australia every year, and Australia’s management of natural disasters centres on prevention, preparedness, response and recovery.1 Although access to safe food is a basic human need, during the 2010–2011 Queensland floods there was minimal information available to guide household food preparedness and food supply to communities.2 To ensure that Queensland is better prepared for future natural ...

Elizabeth J Good · Amanda J Lee · Fiona L McKenzie Lewis

To the Editor: It is pleasing to see Curtis and colleagues report injury trends and mortality across New South Wales,1 but the data are old and precede major changes to the NSW trauma system. We are concerned that the conclusions of this study will be misapplied by policymakers, leading to unnecessary out-of-area transport of injured patients. The authors concluded that there is a survival benefit when ...

Stuart G Stapleton · Rod O Bishop · James L Mallows

In reply: In our study,1 we allocated the numbers and type of trauma centres according to New South Wales Department of Health terminology and the Royal Australasian College of Surgeons Trauma Verification Committee model resource criteria. The latter reflected the resource availability of 24-hour, 7-day per week specialty services such as plastic surgery, cardiothoracic surgery and neurosurgery at those centres during the study period,2,3 as ...

Kate A Curtis*

Australia must continue to support learning in emergency medicine through sufficient resourcing for emergency departments — the most appropriate setting for such training — and via robust accreditation standards.

Andrew D Gosbell · Rob D Mitchell · Victoria A Brazil · Alana M Killen

Do the CSL snake venom detection kit dose recommendations need updating?

Alan Paul

In reply: A low-volume, polyvalent antivenom for brown and tiger snake envenoming would make treatment simpler and safer. Since 2001, when information cited by Paul was published, there have been over 15 peer-reviewed research publications addressing the issue of antivenom dosing.1-3 There is now consistent evidence that one vial is equivalent to larger doses, and there have been no cases of active venom being present after one ...

Geoffrey K Isbister · Nicholas A Buckley · Simon GA Brown

A study designed to measure the effect of introducing a new electronic medical record system in a public hospital emergency department reveals deterioration in a number of key performance indicators following the introduction of the new system.

Murugabalaji K Mohan MB BS · Rod O Bishop MB BS, MPH(Hons), FACEM · James L Mallows MB BS, FACEM

First and foremost, do no harm. Second, do some goodOne of the key issues for high-volume, high-risk workplaces like hospital emergency departments (EDs) is the struggle of conflicting aims. While hospital managers need information systems for data collection and storage, clinicians need efficient clinical documentation, data retrieval and order-entry systems that save time rather than steal it from the patient. The work of clinicians is ...

Jon D Patrick PhD, MSc, BSc · Susan Ieraci MB BS, FACEM

A 3-year whole-of-hospital clinical service redesign program in a tertiary paediatric hospital in Western Australia finds that the introduction of a 4-hour-rule program for discharge or admission from the emergency department improves timeliness of care for patients throughout the hospital, with no adverse impact on the quality and safety of clinical care.

Liana Maumill RN, BN, PGDip(Paed Nsg) · Mia Zic BHlthSc, MIPH · Amanda A Esson BHlthSc · Gary C Geelhoed MB BS, FRACP, FACEM · Meredith M Borland MB BS, FACEM · Christopher Johnson MB BS, ANZCA · Philip Aylward BBA · Andrew C Martin MB BS, FRACP, MD