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Background: We explore the health care literature and draw on two decades of experience in the provision of medical care at mass gatherings and special events to illustrate the complementary aspects of mass gathering medical support and disaster medicine. Most communities have occasions during which large numbers of people assemble in public or private spaces for the purpose of celebrating or participating in musical, sporting, cultural, religious, political, and other events. Collectively, these events are referred to as mass gatherings. The planning, preparation, and delivery of health-related services at mass gatherings are understood to be within the discipline of emergency medicine. As well, we note that owing to international events in recent years, there has been a heightened awareness of and interest in disaster medicine and the level of community preparedness for disasters. We propose that a synergy exists between mass gathering medicine and disaster medicine. Method: Literature review and comparative analysis. Results: Many aspects of the provision of medical support for mass gathering events overlap with the skill set and expertise required to plan and implement a successful medical response to a natural disaster, terrorist incident, or other form of disaster. Conclusions: There are several practical opportunities to link the two fields in a proactive manner. These opportunities should be pursued as a way to improve the level of disaster preparedness at the municipal, provincial, and national levels. [ABSTRACT FROM AUTHOR]

Objective: Youth violence continues to trouble Canadians. Emergency department (ED) visits by youth after a violent injury may represent a "teachable moment," and thus secondary violence prevention interventions may be effective. We conducted a systematic review to identify the success rates of any interventions, the populations likely to benefit and the outcome measures used. Data source: We searched 8 databases (i.e., MEDLINE, EMBASE, PubMed, CINAHL, the Cochrane Database of Systematic Reviews, the ACP Journal Club, DARE and CENTRAL). Study selection: Studies were included if they described and evaluated an intervention, were health care-based and targeted youth who were injured by violence. Two blinded investigators selected 15 articles from 181 abstracts. After full-text review, 8 articles were excluded, leaving 7 articles from 4 intervention programs. Data extraction: All interventions used ED case management of the violently injured patient. One randomized control trial (RCT) demonstrated a significant reduction in reinjury rates (treatment group 8.1% v. control group 20.3%, p = 0.05). Another small RCT found no statistically significant reductions in repeat violence or service use. One retrospective cohort study demonstrated a lower relative risk (RR) in future criminal justice involvement (RR = 0.67, 95% confidence interval 0.45-0.99). A retrospective study of pediatric patients with violent injuries found only 1% of these youth returned with injuries as a result of repeat violence. Data synthesis: Although all 4 case management interventions that we reviewed showed promise in the United States, small sample sizes and incomplete follow-up limited their ability to demonstrate significant decreases in reinjury. Conclusion: Future research is necessary to help EDs capitalize on the opportunity to effectively reduce youth violence. [ABSTRACT FROM AUTHOR]

Introduction: Non-urgent visits comprise a significant proportion of visits to most emergency departments (EDs). Given the severe overcrowding issues faced by many EDs, the use of the Canadian Emergency Department Triage and Acuity Scale (CTAS) to identify patients who could be managed elsewhere seems to be an obvious way to reduce the pressure on the ED and ‘solve’ the overcrowding problem. Objective: To quantify the resource implications, in terms of stretcher use and waiting times, related to non-urgent patient visits and to estimate the potential impact on ED flow of redirecting these patients to alternate primary care settings. Methods: Retrospective database audit in an urban referral hospital ED. For this study, patients triaged as either CTAS Levels IV or V were considered ‘non-urgent.’ Results: Non-urgent patients comprised 30% of ED visits, but less than 5% of all those needing stretchers, along with their associated nursing resources. The longer waits consisted almost en- tirely of waits for available stretchers and would therefore have remained essentially unaffected. In spite of being labelled ‘non-urgent’ by CTAS criteria, 7.3% of all patients requiring admission came from this group. Conclusions: Non-urgent patients consume a small fraction of the ED stretchers and acute-care resources; therefore, strategies aimed at diverting non-urgent patients are unlikely to improve access for more urgent patients. Using the CTAS to identify patients for diversion away from the ED is measurably unsafe and will lead to inappropriate refusal of care for many patients requiring hospital treatment. [ABSTRACT FROM AUTHOR]

Objectives: Despite evidence-based clinical practice guidelines for the emergency management of asthma, substantial treatment variation exists. Our objective was to assess compliance with the Canadian Association of Emergency Physicians (CAEP)/Canadian Thoracic Society (CTS) Asthma Advisory Committee's ‘Guidelines for the emergency management of asthma in adults’ in the emergency department (ED) of a university-affiliated tertiary care teaching hospital. Methods: This retrospective study was conducted in a Canadian inner city adult ED. Investigators reviewed all ED records for the period from Jan. 1, 2001, to Dec. 31, 2001, and identified adult pa- tients (i.e., >18 years of age) with a primary ED diagnosis of asthma. Hospital records were then reviewed to document compliance with the CAEP/CTS asthma guidelines. Descriptive statistics, in- cluding means, standard deviations and frequencies were used to summarize information. Results: Overall compliance with the guidelines was 69.6%, (95% confidence interval, 64.7%–74.5%), but compliance ranged from 41.4% for severe asthma, 67.1% for moderate asthma, and 88.6% for mild asthma. Interobserver reliability for compliance assessment was excellent. Conclusions: Despite publication and dissemination of evidence-based guidelines for the management of acute asthma in adults, guideline compliance at a university-affiliated, inner city, tertiary care teaching hospital ED is suboptimal. [ABSTRACT FROM AUTHOR]

In a time of increased patient loads and emergency department (ED) exit block, the need for strategies to manage patient flow in the ED has become increasingly important. In March 2002 we contacted all 1282 members of the Canadian Association of Emergency Physicians and asked them to delineate strategies for enhancing ED patient flow and ED productivity without increasing stress levels, reducing care standards or compromising patient safety. Thirty physicians responded. Their suggested flow management strategies, which ranged from clinical decision-making to communication to choreography of time, space and personnel, are summarized here. [ABSTRACT FROM AUTHOR]

Examines the risks and characteristics of nuclear, biological or chemical disasters to assess the preparedness of Canadian emergency departments to respond. Availability of appropriate equipment, antidotal therapy and decontamination capability; Factors behind the significant deficiency in the ability to respond to a major biological or nuclear event; Implications on emergency medicine.

The author reflects on the issues concerning the overcrowding of emergency departments (EDs) in Canada. He mentions a literature which suggests for a more consistent approach focused on standardized indicators of events to resolve the ED overcrowding issue. He discusses the possible cons when improving overcrowding metrics erroneously, while pointing out the difference between emergency care and overcrowding measure improvements.

Comments on key issues concerning the preparedness levels of the emergency departments of hospitals in Canada. Adequate stocking of essential antidotes; Need for centralized directives to correct deficiencies in emergency departments; Implications on hospital administration.

Focuses on the development of the National Health Incident Management System (IMS) in Canada. Purpose for ensuring preparedness in emergencies; Terms and provisions underlying the implementation of the IMS; Essentials for health care providers to possess in implementing the IMS.