54 results on '"Vaillancourt, C"'
Search Results
2. LO20: The characteristics, clinical course and disposition of long-term care patients treated by paramedics during an emergency call: Exploring the potential impact of community paramedicine
- Author
-
Leduc, S., primary, Wells, G., additional, Thiruganasambandamoorthy, V., additional, Cantor, Z., additional, Kelly, P., additional, Rietschlin, M., additional, and Vaillancourt, C., additional
- Published
- 2020
- Full Text
- View/download PDF
3. LO15: Paramedic and allied health professional interventions at long-term care facilities to reduce emergency department visits: systematic review
- Author
-
Leduc, S., primary, Cantor, Z., additional, Kelly, P., additional, Thiruganasambandamoorthy, V., additional, Wells, G., additional, and Vaillancourt, C., additional
- Published
- 2020
- Full Text
- View/download PDF
4. LO19: AED on the fly: A drone delivery feasibility study for rural and remote out-of-hospital cardiac arrest
- Author
-
Drennan, I., primary, Cheskes, S., additional, Snobelen, P., additional, Nolan, M., additional, Chan, T., additional, McLeod, S., additional, Dainty, K., additional, Vaillancourt, C., additional, and Brooks, S., additional
- Published
- 2020
- Full Text
- View/download PDF
5. MP50: National survey of 9-1-1 ambulance communication centers’ resources related to prehospital recognition of agonal breathing and cardiac arrest
- Author
-
Vaillancourt, C., primary, Charette, M., additional, Cyr, K., additional, Hodges, S., additional, Thiruganasambandamoorthy, V., additional, Dainty, K., additional, Morrison, L., additional, Jenneson, S., additional, Tallon, J., additional, Segal, E., additional, Sibley, A., additional, Measham, J., additional, Thoma, B., additional, and Allain, D., additional
- Published
- 2019
- Full Text
- View/download PDF
6. P008: Evaluation of outcomes after implementation of a provincial prehospital bypass standard for trauma patients – an Eastern Ontario experience
- Author
-
Austin, M., primary, Sinclair, J., additional, Leduc, S., additional, Duncan, S., additional, Rouleau, J., additional, Price, P., additional, Evans, C., additional, and Vaillancourt, C., additional
- Published
- 2019
- Full Text
- View/download PDF
7. LO74: Exploring emergency physicians’ ability to predict patient admission and decrease consultation to admission time
- Author
-
Lee, E., primary, Kwok, E., additional, and Vaillancourt, C., additional
- Published
- 2019
- Full Text
- View/download PDF
8. P083: Innovative use of AED by RNs and RTs during in-hospital cardiac arrest (Phase III)
- Author
-
Vaillancourt, C., primary, Lanos, C., additional, Charette, M., additional, Dale-Tam, J., additional, Gatta, M., additional, Godbout, J., additional, Buhariwalla, H., additional, Kasaboski, A., additional, Nery, P., additional, Nemnom, M., additional, Brehaut, J., additional, Wells, G., additional, and Stiell, I., additional
- Published
- 2019
- Full Text
- View/download PDF
9. LO71: Evaluating the application of the prehospital Canadian C-Spine Rule by paramedics in sport-related injuries
- Author
-
Carmichael, H., primary, Vaillancourt, C., additional, Shrier, I., additional, Charette, M., additional, Hobden, E., additional, and Stiell, I., additional
- Published
- 2019
- Full Text
- View/download PDF
10. MP54: The prevalence and pattern of drugs detected in injured drivers in four Canadian provinces
- Author
-
Brubacher, J., primary, Chan, H., additional, Lee, J., additional, Rowe, B., additional, Koger, K., additional, Davis, P., additional, Vaillancourt, C., additional, and Wishart, I., additional
- Published
- 2019
- Full Text
- View/download PDF
11. P037: The Devil may not be in the detail - training first-responders to administer publicly available epinephrine – microskills checklists have low inter-observer reliability
- Author
-
Dunfield, R., primary, Riley, J., additional, Vaillancourt, C., additional, Fraser, J., additional, Woodland, J., additional, French, J., additional, and Atkinson, P., additional
- Published
- 2019
- Full Text
- View/download PDF
12. LO01: Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators
- Author
-
Fernando, S. M., primary, Vaillancourt, C., additional, Morrow, S., additional, and Stiell, I. G., additional
- Published
- 2018
- Full Text
- View/download PDF
13. MP34: Assessment of pain management during transport of intubated patients in a prehospital setting
- Author
-
Zia, A., primary, MacDonald, R., additional, Moore, S., additional, Ducharme, J., additional, and Vaillancourt, C., additional
- Published
- 2017
- Full Text
- View/download PDF
14. PL03: Implementation of the Canadian C-Spine Rule by paramedics: a safety evaluation
- Author
-
Vaillancourt, C., primary, Charette, M., additional, Sinclair, J.E., additional, Maloney, J., additional, Dionne, R., additional, Kelly, P., additional, Wells, G.A., additional, and Stiell, I.G., additional
- Published
- 2017
- Full Text
- View/download PDF
15. LO72: Implementation of an educational program to improve the cardiac arrest diagnostic accuracy of ambulance communication officers: a concurrent control before-after study
- Author
-
Vaillancourt, C., primary, Kasaboski, A., additional, Charette, M., additional, Calder, L., additional, Boyle, L., additional, Nakao, S., additional, Crete, D., additional, Kline, M., additional, Souchuk, R., additional, Kristensen, N., additional, Wells, G.A., additional, and Stiell, I.G., additional
- Published
- 2017
- Full Text
- View/download PDF
16. MP36: Safety and clinically important events in PCP-initiated STEMI bypass in Ottawa: a health record review
- Author
-
Mitchell, S., primary, Dionne, R., additional, Maloney, J., additional, Austin, M.A., additional, Mok, G., additional, Sinclair, J.E., additional, Cox, C., additional, Le May, M., additional, and Vaillancourt, C., additional
- Published
- 2017
- Full Text
- View/download PDF
17. P091: Evaluation of pain management in medical transfer of trauma patients by air
- Author
-
Miles, I., primary, MacDonald, R., additional, Moore, S., additional, Ducharme, J., additional, and Vaillancourt, C., additional
- Published
- 2017
- Full Text
- View/download PDF
18. LO048: Systematic review of the use of low-dose ketamine for analgesia in the emergency department
- Author
-
Ghate, G., primary, Clark, E., additional, and Vaillancourt, C., additional
- Published
- 2016
- Full Text
- View/download PDF
19. LO017: Review of prehospital naloxone use in Ontario: Is a mandatory patch point necessary?
- Author
-
Charbonneau, V., primary, Costain, N., additional, Austin, M., additional, Willmore, A., additional, Reed, A., additional, Maloney, J., additional, Lewis, J., additional, Vaillancourt, C., additional, and Dionne, R., additional
- Published
- 2016
- Full Text
- View/download PDF
20. LO099: Colchicine in acute and recurrent pericarditis: a meta-analysis
- Author
-
Costain, N., primary, Choi, S., additional, and Vaillancourt, C., additional
- Published
- 2016
- Full Text
- View/download PDF
21. LO018: The utility of ECG characteristics as prognostic markers in pulseless electrical activity arrests: a retrospective observational cohort study
- Author
-
Ho, M., primary, Gatien, M., additional, Vaillancourt, C., additional, Whitham, V., additional, and Stiell, I.G., additional
- Published
- 2016
- Full Text
- View/download PDF
22. LO002: Improving safety of patients in respiratory distress: identifying preventable adverse events related to care provided in the emergency department
- Author
-
Pretty, S., primary, Scaffidi Argentina, S., additional, Vaillancourt, C., additional, Perry, J.J., additional, Stiell, I.G., additional, Forster, A., additional, De Gorter, R., additional, and Calder, L.A., additional
- Published
- 2016
- Full Text
- View/download PDF
23. Evaluating the impact of a specialized and centralized online medical consultation system for paramedics: pilot study.
- Author
-
Guo K, Austin M, De Mendonca B, Cantor Z, Wall M, Cox C, Ferguson J, and Vaillancourt C
- Abstract
Introduction: There are many limitations to utilizing on-duty emergency department (ED) physicians as Base Hospital Physicians for paramedic telephone consultations. We aimed to examine the impact of a specialized and centralized Online Medical Consultation program for paramedic consultations on system-relevant performance., Methods: This is a before-after study with concurrent control using health record review of audio recordings over a 6-month period before and after implementation of the Online Medical Consultation program. The primary outcome was the duration of paramedic consultation calls. The secondary outcomes included number of calls with orders that contradicted existing medical directives, number of calls with orders outside of paramedic scope of practice, number of calls with Base Hospital Physician requiring clarification on medical directives, and number of calls with Base Hospital Physician interrupting the paramedic during the call., Results: We included 220 consultation calls. The patients' mean age was 54.5 years. Most consultation calls (70.5%) were for mandatory consultations and 22.7% were voluntary. Most consultations were related to cardiac arrest (43.6%), combative patients (15.0%), and analgesia (13.6%). Before-after comparisons for total call duration showed that mean call duration decreased in Ottawa from 4:28 to 4:05 min (p = 0.77) and decreased in Kingston from 4:50 to 4:13 min (p = 0.49). There were no significant differences in our secondary outcomes., Conclusions: The Online Medical Consultation program was implemented and removed the responsibility of responding to online medical consultations for on-duty emergency physicians in Ottawa. The total call duration was not significantly different between groups. Additional time intervals and adherence to protocol benefits were also not statistically significant due to low baseline incidence., (© 2024. The Author(s), under exclusive licence to the Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
- Published
- 2024
- Full Text
- View/download PDF
24. Which adults aged 65 and older are at low-risk for cervical spine injuries after low-level falls?
- Author
-
McCallum J, Eagles D, Stiell I, Taljaard M, Vaillancourt C, Mercuri M, Clayton N, Mercier É, Morris J, Jeanmonod R, Varner C, Barbic D, Buchanan IM, Ali M, Kagoma YK, Shoamanesh A, Engels P, Sharma S, Worster A, McLeod SL, Émond M, Papaioannou A, Parpia S, and de Wit K
- Subjects
- Humans, Male, Female, Aged, Aged, 80 and over, Prospective Studies, Risk Factors, Glasgow Coma Scale, Emergency Service, Hospital, Risk Assessment, Prevalence, Age Factors, Accidental Falls statistics & numerical data, Cervical Vertebrae injuries, Spinal Injuries epidemiology, Spinal Injuries etiology
- Abstract
Objectives: The population is aging and falls are a common reason for emergency department visits. Appropriate imaging in this population is important. The objectives of this study were to estimate the prevalence of cervical spine injury and identify factors associated with cervical spine injuries in adults ≥ 65 years after low-level falls., Methods: This was a pre-specified sub-study of a prospective observational cohort study of intracranial bleeding in emergency patients ≥ 65 years presenting after low-level falls. The primary outcome was cervical spine injury. The risk factors of interest were Glasgow coma scale (GCS) < 15, head injury, neck pain, age, and frailty defined as Clinical Frailty Scale ≥ 5. Multivariable logistic regression was used to measure the strength of association between risk factors and cervical spine injury. A descriptive analysis of absence of significant risk factors was performed to determine patients who may not require imaging., Results: There were 4308 adults ≥ 65 who sustained low-level falls with mean age of 82.0 (standard deviation ± 8.8) years and 1538 (35.7%) were male; 23 [0.5% (95% confidence interval (CI) 0.3-0.8%)] were diagnosed with cervical spine injuries. The adjusted odds ratios and 95% CIs were 1.3 (0.5-3.2) for GCS < 15, 5.3 (1.7-26.7) for head injury, 13.0 (5.7-31.2) for new neck pain, 1.4 (1.0-1.8) for 5-year increase in age, and 1.1 (0.4-2.9) for frailty. Head injury or neck pain identified all 23 cervical spine injuries. Management was a rigid collar in 19/23 (82.6%) patients and none had surgery., Conclusions: In emergency patients ≥ 65 years presenting after a low-level fall, head injury, neck pain, and older age were associated with the diagnosis of cervical spine injury. There were no cervical spine injuries in those without head injury or neck pain. Patients with no head injury or neck pain may not require cervical spine imaging., (© 2024. The Author(s), under exclusive licence to the Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
- Published
- 2024
- Full Text
- View/download PDF
25. Predicting the critical administration threshold in bleeding trauma patients.
- Author
-
Durr K, Yadav K, Ho M, Lampron J, Tran A, Drew D, Petrosoniak A, Vaillancourt C, Nemnom MJ, Abdulaziz K, and Perry JJ
- Abstract
Introduction: Delays in promptly recognizing and appropriately managing hemorrhagic injuries contribute to preventable trauma related deaths nationwide. We sought to identify patient variables available at the time of emergency department arrival associated with meeting the critical administration threshold., Methodology: We conducted a trauma registry review from September 2016 to March 2020 of trauma team activations at The Ottawa Hospital, a Level 1 Trauma Center. Our primary outcome was the frequency of meeting the critical administration threshold. Secondary outcomes included time to critical administration threshold, 24-h all-cause mortality, and 30-day all-cause mortality. Multivariate logistic regression identified factors independently associated with meeting the critical administration threshold., Results: We assessed 762 patients, of which 78 (10.2%) met the critical administration threshold. The median time to critical administration threshold was 28.9 min. Mortality at 24 h occurred in 58 (7.6%) patients. Four variables available upon patient arrival predicted the critical administration threshold, including systolic blood pressure ≤ 90 mmHg (OR 6.6; 95% CI 3.7-12.0), Glasgow Coma Scale ≤ 8 (OR 5.9; 95% CI 3.2-10.6), heart rate ≥ 100 beats/minute (OR 4.4; 95% CI 2.4-8.1), and respiratory rate ≥ 20 breaths/min (OR 2.2; 95% CI 1.2-4.0)., Conclusion: We identified four clinical variables readily available to physicians upon patient arrival associated with meeting the critical administration threshold: systolic blood pressure ≤ 90 mmHg, Glasgow Coma Scale ≤ 8, heart rate ≥ 100 beats/minute, and respiratory rate ≥ 20 breaths/min. Patients presenting with any of these clinical parameters should prompt physicians to consider ordering blood products immediately., (© 2024. The Author(s), under exclusive licence to the Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
- Published
- 2024
- Full Text
- View/download PDF
26. Impact of age on emergency physicians' preference for overnight shifts.
- Author
-
Atkinson P, Vaillancourt C, Talbot JA, Howlett M, and Chandra K
- Subjects
- Humans, Emergency Service, Hospital, Practice Patterns, Physicians', Emergency Medicine, Physicians
- Published
- 2023
- Full Text
- View/download PDF
27. The hospital care and outcomes of long-term care patients treated by paramedics during an emergency call: exploring the potential impact of 'treat-and-refer' pathways and community paramedicine.
- Author
-
Leduc S, Wells G, Thiruganasambandamoorthy V, Cantor Z, Kelly P, Rietschlin M, and Vaillancourt C
- Subjects
- Adult, Humans, Paramedics, Long-Term Care, Paramedicine, Canada, Emergency Service, Hospital, Hospitals, Emergency Medical Technicians, Emergency Medical Services
- Abstract
Introduction: Adults living in long-term care (LTC) are at increased risk of harm when transferred to the emergency department (ED), and programs targeting treatment on-site are increasing. We examined characteristics, clinical course, and disposition of LTC patients transported to the ED to examine the potential impact of alternative models of paramedic care for LTC patients., Methods: We conducted a health records review of paramedic and ED records between April 1, 2016, and March 31, 2017. We included emergency calls originating from LTC centers and patients transported to either ED campus of The Ottawa Hospital. We excluded scheduled or deferrable transfers, and patients with Canadian Triage and Acuity Scale of 1. We categorized patients into groups based on care they received in the ED. We calculated standardized differences to examine differences between groups., Results: We identified four groups: (1) patients requiring no treatment or diagnostics in the ED (7.9%); (2) patients receiving ED treatment within current paramedic directives and no diagnostics (3.2%); (3) patients requiring diagnostics or ED care outside current paramedic directives (54.9%); and (4) patients requiring admission (34.1%)., Conclusion: This study found 7.9% of LTC patients transported to the ED did not receive diagnostics, medications, or treatment, and overall 11.1% of patients could have been treated by paramedics within current medical directives using 'treat-and-refer' pathways. This group could potentially expand utilizing community paramedics with expanded scopes of practice., (© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
- Published
- 2023
- Full Text
- View/download PDF
28. Just the Facts: Management of return of spontaneous circulation after out-of-hospital cardiac arrest.
- Author
-
Kareemi H, Hendin A, and Vaillancourt C
- Subjects
- Humans, Return of Spontaneous Circulation, Body Temperature, Retrospective Studies, Out-of-Hospital Cardiac Arrest therapy, Hypothermia, Induced, Cardiopulmonary Resuscitation
- Published
- 2023
- Full Text
- View/download PDF
29. Alternative care models for paramedic patients from long-term care centers: a national survey of Canadian paramedic services.
- Author
-
Leduc S, Wells G, Thiruganasambandamoorthy V, Kelly P, and Vaillancourt C
- Subjects
- Humans, Long-Term Care, Paramedics, Allied Health Personnel, Cross-Sectional Studies, Canada, Emergency Medical Services, Emergency Medical Technicians
- Abstract
Introduction: Long-term care (LTC) patients do poorly when transported to emergency departments (ED). Community paramedic programs deliver enhanced care in their place of residence, yet few programs are reported in the literature. We conducted a national cross-sectional survey of land ambulance services to understand if such programs exist in Canada, and what the perceived needs and priorities are for future programs., Methods: We emailed a 46 question survey to paramedic services across Canada. We asked about service characteristics, current ED diversion programs, existing diversion programs specific to LTC patients, priorities for future programs, the potential impact of such programs, and what the feasibility and barriers are to implementing programs that treat LTC patients on-site, avoiding an ED visit., Results: We received responses from 50 sites across Canada, providing services to 73.5% of the total population. Almost a third (30.0%) had existing treat-and-refer programs, and 65.5% of services transported to destinations other than an ED. Almost all respondents (98.0%) felt the need for programs to treat LTC patients on-site, and 36.0% had existing programs. The top priorities for future programs were support for patients being discharged (30.6%), extended care paramedics (24.5%), and respiratory illness treat-in-place programs (20.4%). The highest potential impact was expected from support for patients being discharged (62.0%) and respiratory illness treat-in-place programs (54.0%). Required changes in legislation (36.0%) and required changes to the system of medical oversight (34.0%) were identified as top barriers to implementing such programs., Conclusion: There is a significant mismatch between the perceived need for community paramedic programs treating LTC patients on-site, and the number of programs in place. Programs could benefit from standardized outcome measurement and the publication of peer-reviewed evidence to guide future programs. Changes in legislation and medical oversight are needed to address the identified barriers to program implementation., (© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
- Published
- 2023
- Full Text
- View/download PDF
30. Optimizing collaborative relationships in emergency medicine research.
- Author
-
Perry JJ, Vaillancourt C, Hohl CM, Thiruganasambandamoorthy V, Morris J, Emond M, Lee J, and Stiell IG
- Subjects
- Canada, Emergencies, Emergency Service, Hospital, Humans, Emergency Medicine, Societies, Medical
- Abstract
Objective: The objective of the Canadian Association of Emergency Physicians (CAEP) 2020 Academic Symposium Panel was to present recommendations for collaboration on (1) writing a grant application; (2) conducting a study; (3) writing an abstract; and (4) writing a manuscript., Methods: We assembled an expert panel of eight experienced emergency medicine clinician scientists from across Canada. Panel members performed literature searches for each of the four topics. Draft recommendations were developed and refined in an iterative fashion by panel members. We solicited external feedback on the draft recommendations online from identified researchers known to CAEP and in person at the Network of Canadian Emergency Researchers meeting in February 2020. We obtained additional feedback during an online symposium presentation on October 15th, 2020, open to all members of the Canadian Association of Emergency Physicians., Results: Four sets of recommendations were established for each component including: 14 for writing a grant application including relevant timelines; 23 for conducting a study; 13 for writing an abstract; and 18 for writing a manuscript. Forming a strong team, including patients, appropriate methodologists, content experts and a mix of senior and junior investigators, establishing and following clear timelines, and proactive communications were common themes., Conclusions: We offer recommendations for research collaboration for (1) writing a grant, (2) conducting a study, (3) writing an abstract, and (4) writing a manuscript. We believe these recommendations will help to improve the science, improve grant success, and improve the impact of the abstracts and manuscripts.
- Published
- 2021
- Full Text
- View/download PDF
31. Evaluating the paramedic application of the prehospital Canadian C-Spine Rule in sport-related injuries.
- Author
-
Carmichael H, Vaillancourt C, Shrier I, Charette M, Hobden E, and Stiell IG
- Subjects
- Adult, Allied Health Personnel, Canada epidemiology, Female, Humans, Male, Prospective Studies, Cervical Vertebrae, Emergency Medical Services
- Abstract
Objectives: We sought to compare the ability of the prehospital Canadian C-Spine Rule to selectively recommend immobilization in sport-related versus non-sport-related injuries and describe sport-related mechanisms of injury., Methods: We reviewed data from the prospective paramedic Canadian C-Spine Rule validation and implementation studies in 7 Canadian cities. A trained reviewer further categorized sport-related mechanisms of injury collaboratively with a sport medicine physician using a pilot-tested standardized form. We compared the Canadian C-Spine Rule's recommendation to immobilize sport-related versus non-sport-related patients using Chi-square and relative risk statistics with 95% confidence intervals., Results: There were 201 sport-related patients among the 5,978 included. Sport-related injured patients were younger (mean age 36.2 vs. 42.4) and more predominantly male (60.5% vs. 46.8%) than non-sport-related patients. Paramedics did not miss any C-Spine injury when using the Canadian C-Spine Rule. C-Spine injury rates were similar between sport (2/201; 1.0%) and non-sport-injured patients (47/5,777; 0.8%). The Canadian C-Spine Rule recommended immobilization equally between groups (46.4% vs. 42.5%; RR 1.09 95%CI 0.93-1.28), most commonly resulting from a dangerous mechanism among sport-injured (68.7% vs. 54.5%; RR 1.26 95%CI 1.08-1.47). The most common dangerous mechanism responsible for immobilization in sport was axial load., Conclusion: Although equal proportions of sport and non-sport-related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the Canadian C-Spine Rule to evaluate collegiate or pro athletes assessed by sport medicine physicians. It does support using the Canadian C-Spine Rule as a tool in sport-injured patients assessed by paramedics.
- Published
- 2021
- Full Text
- View/download PDF
32. CO-aVoID: coronavirus outbreak affecting variability of presentations to a local emergency department.
- Author
-
Cole V, Atkinson P, Hanlon R, Dutton DJ, Liu T, Fraser J, Lewis D, Brunt KR, Wiemer H, Dahn T, Fok PT, and Vaillancourt C
- Subjects
- COVID-19 therapy, Cross-Sectional Studies, Follow-Up Studies, Humans, Incidence, New Brunswick epidemiology, Retrospective Studies, SARS-CoV-2, COVID-19 epidemiology, Emergencies, Emergency Service, Hospital statistics & numerical data, Hospitalization statistics & numerical data, Pandemics
- Abstract
Background: The impact of the COVID-19 pandemic on public health, specifically on patients presenting to the emergency department (ED) with non-COVID-related diseases, remains largely undocumented., Objective: This study explored how overall rates of presentations to the emergency department were impacted immediately after the declaration of the COVID-19 pandemic, and specifically how key presenting symptoms representing emergency, standard and low-acuity conditions were impacted., Methods: A sequential modified Delphi survey and cross-sectional analysis of administrative census data from a tertiary care center in New Brunswick, Canada, were performed. Details of ED presentations for emergency, standard and low-acuity conditions from February 1 to April 30, 2020, were compared to data from previous years., Results: There was a significant decrease in the number of patients visiting the ED with emergency, standard and low-acuity complaints immediately after March 13, 2020, compared to 2019. The proportion of females and males remained similar, with a median age of 48 years in 2020 and 44 years in 2019. Total presentation patterns to the ED (registrations, admissions to hospital and left without being seen numbers) decreased, compared to previous years., Conclusions: We report a predictable decrease in patient visits to the ED with minor, non-life-threatening conditions during a pandemic. However, we also report a decrease in presentations for emergency and standard conditions. Improved messaging highlighting the need to seek help for "true" emergencies, while providing non-ED options for minor, non-life-threatening conditions, may be helpful under normal circumstances and during future pandemics.
- Published
- 2021
- Full Text
- View/download PDF
33. Can a screening tool safely identify low risk cardiac patients to be transported with primary care flight paramedics?
- Author
-
Godbout J, Moore SW, Sawadsky B, Pan A, and Vaillancourt C
- Subjects
- Aged, Allied Health Personnel, Emergency Medical Technicians, Female, Humans, Male, Ontario, Retrospective Studies, Emergency Medical Services, Primary Health Care, Transportation of Patients
- Abstract
Objectives: We aimed to determine the rate of adverse events during interfacility transport of cardiac patients identified as low risk by a consensus-derived screening tool and transported by primary care flight paramedics (PCP(f))., Methods: We conducted a health records review of adult patients diagnosed with a cardiac condition who were identified as low risk by the screening tool and transported by PCP(f). We excluded patients transported by an advanced care crew, those accompanied by a clinical escort from hospital, and those transported from a scene call, by rotary wing or ground vehicle. We recorded patient and transportation parameters using a piloted-standardized collection tool. We defined adverse events during transport a priori. We report descriptive statistics using mean (standard deviation), [range], (percentage)., Results: We included 400 patients: mean age 66.9 years old, 66.5% male. Mean transport duration was 136.2 (74.9) minutes. Most common comorbidities were hypertension (50.3%) and coronary artery disease (39.5%). Most transports originated out of Northern Ontario and were for cardiac catheterization (61.8%) or coronary artery bypass grafting (26.8%). Overall, the adverse event rate was low (0.3%), with no serious event such as cardiac arrest, death, or airway intervention., Conclusions: A screening tool can identify cardiac patients at low risk for clinical deterioration during air-medical transport. We believe patients screened with this tool can be transported safely by a PCP(f) crew, leading to potentially significant resource savings.
- Published
- 2020
- Full Text
- View/download PDF
34. Just the Facts: Protected code blue - Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic.
- Author
-
McIsaac S, Wax RS, Long B, Hicks C, Vaillancourt C, Ohle R, and Atkinson P
- Subjects
- Betacoronavirus, COVID-19, Humans, Pandemics, Patient Care Team organization & administration, Personal Protective Equipment, Risk Factors, SARS-CoV-2, Cardiopulmonary Resuscitation, Coronavirus Infections complications, Emergency Service, Hospital organization & administration, Infection Control organization & administration, Infectious Disease Transmission, Patient-to-Professional prevention & control, Out-of-Hospital Cardiac Arrest therapy, Pneumonia, Viral complications
- Abstract
Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?
- Published
- 2020
- Full Text
- View/download PDF
35. Evaluating the impact of point-of-care ultrasonography on patients with suspected acute heart failure or chronic obstructive pulmonary disease exacerbation in the emergency department: A prospective observational study.
- Author
-
Nakao S, Vaillancourt C, Taljaard M, Nemnom MJ, Woo MY, and Stiell IG
- Subjects
- Cohort Studies, Emergency Service, Hospital, Humans, Middle Aged, Point-of-Care Systems, Ultrasonography, Heart Failure, Pulmonary Disease, Chronic Obstructive
- Abstract
Objectives: Acute heart failure and chronic obstructive pulmonary disease (COPD) are sometimes difficult to differentiate in the emergency department (ED). We sought to determine the clinical impact of point-of-care ultrasonography (POCUS) in ED patients with suspected acute heart failure or COPD., Methods: We conducted a prospectively collected cohort study with health records review with frequency matching at The Ottawa Hospital between March and September 2017. We included patients aged 50 and older with shortness of breath or cough from suspected acute heart failure or COPD. Our primary outcome was ED length of stay. Secondary outcomes were time to disposition decision, time to appropriate treatment, and the incidence of adverse events. We analyzed time-to-event outcomes using Kaplan-Meier analysis and Cox regression analysis with POCUS analyzed as a time-dependent variable, and the incidence of adverse events using logistic regression analyses., Results: There were 81 patients evaluated with lung POCUS and 243 matched patients who were not. Lung POCUS was not significantly associated with ED length of stay and time to disposition decision; however, patients evaluated with lung POCUS received disease-specific treatment faster compared with the non-POCUS group (adjusted hazard ratio, 1.50 [95% confidence interval, 1.05-2.15], a median time difference of 31 minutes). We found no significant differences in the incidence of adverse events., Conclusions: In this study, use of lung POCUS resulted in no difference in ED length of stay and time to disposition decision, but was associated with faster administration of disease-specific treatments for elderly patients with suspected acute heart failure or COPD.
- Published
- 2020
- Full Text
- View/download PDF
36. Evaluation of pain management in medical transfer of trauma patients by air.
- Author
-
Miles IH, MacDonald RD, Moore SW, Ducharme J, and Vaillancourt C
- Subjects
- Adolescent, Adult, Ambulances statistics & numerical data, Analgesia methods, Canada, Cross-Sectional Studies, Databases, Factual, Electronic Health Records, Female, Glasgow Coma Scale, Humans, Male, Middle Aged, Pain Measurement drug effects, Trauma Centers, Wounds and Injuries diagnosis, Young Adult, Analgesics, Opioid administration & dosage, Emergency Medical Services organization & administration, Pain Management methods, Treatment Outcome, Wounds and Injuries therapy
- Abstract
Objectives: With regionalized trauma care, medical transport times can be prolonged, requiring paramedics to manage patient care and symptoms. Our objective was to evaluate pain management during air transport of trauma patients., Methods: We conducted a 12-month review of electronic paramedic records from a provincial critical care transport agency. Patients were included if they were ≥18 years old and underwent air transport to a trauma centre, and excluded if they were Glasgow Coma Scale score <14, intubated, or accompanied by a physician or nurse. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment via 11-point numerical rating scale, patterns of analgesia administration, and analgesia-related adverse events. Results were reported as mean ± standard deviation, [range], (percentage)., Results: We included 372 patients: 47.0 years old; 262 males; 361 blunt injuries. Transport duration was 82.4 ± 46.3 minutes. In 232 (62.4%) patients who received analgesia, baseline numerical rating scale was 5.9 ± 2.5. Fentanyl was most commonly administered at 44.3 [25-60] mcg. Numerical rating scale after first analgesia dose decreased by 1.1 [-2-7]. Thereafter, 171 (73.7%) patients received 2.4 [1-18] additional doses. While 44 (23.4%) patients had no change in numerical rating scale after first analgesia dose, subsequent doses resulted in no change in numerical rating scale in over 65% of patients. There were 43 adverse events recorded, with nausea the most commonly reported (39.5%)., Conclusions: Initial and subsequent dose(s) of analgesic had minimal effect on pain as assessed via numerical rating scale, likely due in part to inadequate dosing. Future research is required to determine and address the barriers to proper analgesia.
- Published
- 2019
- Full Text
- View/download PDF
37. Adverse events associated with nonsteroidal anti-inflammatory drug use among patients taking oral anticoagulants.
- Author
-
Reardon PM and Vaillancourt C
- Subjects
- Anti-Inflammatory Agents, Non-Steroidal, Anticoagulants, Humans, Atrial Fibrillation
- Published
- 2019
- Full Text
- View/download PDF
38. Multiple shocks or early transfer for shock refractory ventricular fibrillation?
- Author
-
Cheskes S and Vaillancourt C
- Subjects
- Humans, Prognosis, Ventricular Fibrillation, Cardiopulmonary Resuscitation, Emergency Medical Services, Out-of-Hospital Cardiac Arrest
- Published
- 2019
- Full Text
- View/download PDF
39. Safety and clinically important events in PCP-initiated STEMI bypass in Ottawa.
- Author
-
Mitchell S, Dionne R, Maloney J, Austin M, Mok G, Sinclair J, Cox C, Le May M, and Vaillancourt C
- Subjects
- Adult, Aged, Aged, 80 and over, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Ontario epidemiology, Retrospective Studies, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction mortality, Survival Rate trends, Time Factors, Young Adult, Emergency Medical Services methods, Emergency Medical Technicians standards, Emergency Service, Hospital standards, Patient Safety standards, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction therapy, Transportation of Patients standards
- Abstract
Objective: The aim of this study was to determine what clinically important events occur in ST-elevation myocardial infarction (STEMI) patients transported for primary percutaneous coronary intervention (PCI) via a primary care paramedic (PCP) crew, and what proportion of such events could only be treated by advanced care paramedic (ACP) protocols., Methods: We conducted a health record review of STEMI transports by PCP-only crews and those transferred from PCP to ACP crews (ACP-intercept) from 2011 to 2015. A piloted data collection form was used to extract clinically important events, interventions during transport, and mortality., Results: We identified 214 STEMI bypass cases (118 PCP-only and 96 ACP-intercept). Characteristics were mean age 61.4 years; 44.4% inferior infarcts; mean response time 6 minutes, 19 seconds; total paramedic contact time 29 minutes, 40 seconds; and, in cases of ACP-intercept, 7 minutes, 46 seconds of PCP-only contact time. A clinically important event occurred in 127 (59.3%) of cases: SBP < 90 mm Hg (26.2%), HR < 60 (30.4%), HR > 100 (20.6%), arrhythmias 7.5%, altered mental status 6.5%, airway intervention 2.3%. Two patients (0.9%) arrested, both survived. Of the events identified, 42.5% could be addressed differently by ACP protocols. The majority related to fluid boluses for hypotension (34.6%). In the ACP-intercept group, ACPs acted on 51.6% of events. There were six (2.8%) in-hospital deaths., Conclusions: Although clinically important events are common in STEMI bypass patients, a smaller proportion of events would be addressed differently by ACP compared with PCP protocols. The majority of clinically important events were transient and of limited clinical significance. PCP-only crews can safely transport STEMI patients directly to primary PCI.
- Published
- 2018
- Full Text
- View/download PDF
40. Recommendations for patient engagement in patient-oriented emergency medicine research.
- Author
-
Archambault PM, McGavin C, Dainty KN, McLeod SL, Vaillancourt C, Lee JS, Perry JJ, Gauvin FP, and Boivin A
- Subjects
- Humans, Biomedical Research standards, Emergency Medicine organization & administration, Guidelines as Topic, Patient Selection
- Abstract
Objective: To make pragmatic recommendations on best practices for the engagement of patients in emergency medicine (EM) research., Methods: We created a panel of expert Canadian EM researchers, physicians, and a patient partner to develop our recommendations. We used mixed methods consisting of 1) a literature review; 2) a survey of Canadian EM researchers; 3) qualitative interviews with key informants; and 4) feedback during the 2017 Canadian Association of Emergency Physicians (CAEP) Academic Symposium., Results: We synthesized our literature review into categories including identification and engagement, patients' roles, perceived benefits, harms, and barriers to patient engagement; 40/75 (53% response rate) invited researchers completed our survey. Among respondents, 58% had engaged patients in research, and 83% intended to engage patients in future research. However, 95% stated that they need further guidance to engage patients. Our qualitative interviews revealed barriers to patient engagement, including the need for training and patient partner recruitment.Our panel recommends 1) an overarching positive recommendation to support patient engagement in EM research; 2) seven policy-level recommendations for CAEP to support the creation of a national patient council, to develop, adopt and adapt training material, guidelines, and tools for patient engagement, and to support increased patient engagement in EM research; and 3) nine pragmatic recommendations about engaging patients in the preparatory, execution, and translational phases of EM research., Conclusion: Patient engagement can improve EM research by helping researchers select meaningful outcomes, increase social acceptability of studies, and design knowledge translation strategies that target patients' needs.
- Published
- 2018
- Full Text
- View/download PDF
41. Factors influencing the intentions of nurses and respiratory therapists to use automated external defibrillators during in-hospital cardiac arrest: a qualitative interview study.
- Author
-
Andrews J, Vaillancourt C, Jensen J, Kasaboski A, Charette M, Clement CM, Brehaut JC, Osmond MH, Wells GA, Stiell IG, and Grimshaw J
- Subjects
- Adult, Attitude of Health Personnel, Female, Humans, Male, Middle Aged, Retrospective Studies, Surveys and Questionnaires, Young Adult, Cardiopulmonary Resuscitation methods, Death, Sudden, Cardiac prevention & control, Defibrillators statistics & numerical data, Emergency Medical Services standards, Health Knowledge, Attitudes, Practice, Professional Competence, Qualitative Research
- Abstract
Objectives: Nurses and respiratory therapists are seldom allowed to use automated external defibrillators (AED) during in-hospital cardiac arrest. This can result in significant time delays before defibrillation occurs and lower survival for cardiac arrest victims. We sought to identify barriers and facilitators to AED use by nurses and respiratory therapists., Methods: We conducted semi-structured qualitative interviews with a purposeful sample of nurses and respiratory therapists. We developed the interview guide based on the constructs of the theory of planned behaviour, which elicits salient attitudes, social influences, and control beliefs potentially influencing the intent to use an AED. Interviews were recorded, transcribed verbatim, and analysed until achieving data saturation. Two independent reviewers performed inductive analyses to identify emerging categories and themes, and ranked them by frequency of the number of participants stating the topic., Results: Demographics for the 24 interviewees include mean age 40.5, 79.2% female, 87.5% performed cardiopulmonary resuscitation (CPR), 29.2% defibrillated a patient. Identified attitudes pertained to the timeliness of defibrillation, patient survival, simplicity of AED use, accuracy of rhythm recognition, and harm to self or others. Social influences consisted of physician and hospital administration support of AED use. Control beliefs included training on AED use, policy allowing AED use, familiarity with AED, and task burden during resuscitation., Conclusions: Most nurses and respiratory therapists intended to use an AED if permitted to do so by a medical directive. Successful implementation would require educational initiatives focusing on safety and efficacy of AEDs, support from physicians and hospital administrators, and additional training on AED use.
- Published
- 2018
- Full Text
- View/download PDF
42. Systematic review of the use of low-dose ketamine for analgesia in the emergency department.
- Author
-
Ghate G, Clark E, and Vaillancourt C
- Subjects
- Analgesics administration & dosage, Dose-Response Relationship, Drug, Humans, Treatment Outcome, Acute Pain drug therapy, Analgesia methods, Emergency Service, Hospital, Ketamine administration & dosage
- Abstract
Objectives: The aim of the study is to determine the performance of low-dose ketamine (LDK) as an analgesic for acute pain management in adult patients in the emergency department (ED)., Methods: We systematically reviewed electronic databases, grey literature, conference abstracts, and clinical trial registries. Two independent reviewers identified eligible studies. These selections were subsequently reviewed by one reviewer who identified the final eligible studies, using refined inclusion and exclusion criteria. Our outcome measures included the analgesic effect of LDK, need for rescue analgesia, and neuropsychological adverse events secondary to LDK use. We assessed inter-rater agreement using kappa statistics and proposed a treatment recommendation using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) software. Heterogeneity among studies precluded meta-analysis., Results: Our electronic search identified 1,408 records; 44 were selected for full evaluation (kappa=0.70), and 8 were included after the final review. All six randomized controlled trials and two observational studies were set in the ED where LDK was administered to adult patients ( >18 years old) exclusively for pain management. All studies had an overall low risk of bias. There was extensive variation in the dose and route of LDK used (0.1-0.7 mg/kg SC/IV/IM), administration protocols, and use of adjunct analgesia. Overall, most studies reported a significant analgesic effect of LDK with occasional need for rescue analgesia and mild-to-moderate adverse events (dizziness, dysphoria, and confusion)., Conclusion: There are moderate to low quality data supporting LDK as an alternative analgesic in the ED with the potential for minimal requirement of rescue analgesia and self-limited neuropsychological adverse events.
- Published
- 2018
- Full Text
- View/download PDF
43. Bystander fatigue and CPR quality by older bystanders: a randomized crossover trial comparing continuous chest compressions and 30:2 compressions to ventilations.
- Author
-
Liu S, Vaillancourt C, Kasaboski A, and Taljaard M
- Subjects
- Age Factors, Aged, Confidence Intervals, Cross-Over Studies, Fatigue physiopathology, Female, Heart Arrest mortality, Heart Massage mortality, Humans, Male, Middle Aged, Ontario, Prognosis, Respiration, Artificial methods, Risk Assessment, Survival Rate, Task Performance and Analysis, Tertiary Care Centers, Treatment Outcome, Cardiopulmonary Resuscitation methods, Fatigue epidemiology, Heart Arrest therapy, Heart Massage methods, Manikins
- Abstract
Objectives: This study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30:2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims., Methods: This randomized crossover trial took place at three tertiary care hospitals and a seniors' center. Participants were aged ≥55 years without significant physical limitations (frailty score ≤3/7). They completed two 5-minute CPR sessions (using 30:2 and CCC) on manikins; sessions were separated by a rest period. We used concealed block randomization to determine CPR method order. Metronome feedback maintained a compression rate of 100/minute. We measured heart rate (HR), mean arterial pressure (MAP), and Borg Exertion Scale. CPR quality measures included total number of compressions and number of adequate compressions (depth ≥5 cm)., Results: Sixty-three participants were enrolled: mean age 70.8 years, female 66.7%, past CPR training 60.3%. Bystander fatigue was similar between CPR methods: mean difference in HR -0.59 (95% CI -3.51-2.33), MAP 1.64 (95% CI -0.23-3.50), and Borg 0.46 (95% CI 0.07-0.84). Compared to 30:2, participants using CCC performed more chest compressions (480.0 v. 376.3, mean difference 107.7; p<0.0001) and more adequate chest compressions (381.5 v. 324.9, mean difference. 62.0; p=0.0001), although good compressions/minute declined significantly faster with the CCC method (p=0.0002)., Conclusions: CPR quality decreased significantly faster when performing CCC compared to 30:2. However, performing CCC produced more adequate compressions overall with a similar level of fatigue compared to the 30:2 method.
- Published
- 2016
- Full Text
- View/download PDF
44. What is new in the 2015 American Heart Association guidelines, what is recycled from 2010, and what is relevant for emergency medicine in Canada.
- Author
-
Morrison LJ, de Caen A, Bhanji F, Bigham BL, Blanchard IE, Brooks SC, Guerguerian AM, Jensen JL, Travers AH, Vaillancourt C, Welsford M, and Woolfrey K
- Subjects
- American Heart Association, Canada, First Aid standards, Humans, United States, Cardiopulmonary Resuscitation standards, Emergency Medical Services standards, Emergency Medicine standards, Practice Guidelines as Topic
- Published
- 2016
- Full Text
- View/download PDF
45. CAEP 2014 Academic Symposium: "How to make research succeed in your department: Promoting excellence in Canadian emergency medicine resident research".
- Author
-
Calder LA, Abu-Laban RB, Artz JD, McLeod S, Blackie B, Das B, Woods R, Perry JJ, Vaillancourt C, Stiell IG, and Frank JR
- Subjects
- Canada, Humans, Clinical Competence, Congresses as Topic, Curriculum, Emergency Medicine education, Internship and Residency methods, Societies, Medical
- Abstract
Objectives: To characterize the current state of Canadian emergency medicine (EM) resident research and develop recommendations to promote excellence in this area., Methods: We performed a systematic review of MEDLINE, Embase, and ERIC using search terms relevant to EM resident research. We conducted an online survey of EM residency program directors from the Royal College of Physicians and Surgeons of Canada (RCPSC) and College of Family Physicians of Canada (CFPC). An expert panel reviewed these data, presented recommendations at the Canadian Association of Emergency Physicians 2014 Academic Symposium, and refined them based on feedback received., Results: Of 654 potentially relevant citations, 35 articles were included. These were categorized into four themes: 1) expectations and requirements, 2) training and assessment, 3) infrastructure and support, and 4) dissemination. We received 31 responses from all 31 RCPSC-EM and CFPC-EM programs. The majority of EM programs reported requiring a resident scholarly project; however, we found wide-ranging expectations for the type of resident research performed and how results were disseminated, as well as the degree of completion expected. Although 93% of RCPSC-EM programs reported providing formal training on how to conduct research, only 53% of CFPC-EM programs reported doing so. Almost all programs (94%) reported having infrastructure in place to support resident research, but the nature of support was highly variable. Finally, there was marked variability regarding the number of resident-published abstracts and manuscripts., Conclusions: Based on the literature, our national survey, and discussions with stakeholders, we offer 14 recommendations encompassing goals, expectations, training, assessment, infrastructure, and dissemination in order to improve Canadian EM resident research.
- Published
- 2015
- Full Text
- View/download PDF
46. CAEP 2014 Academic symposium: "How to make research succeed in your department: How to fund your research program".
- Author
-
Vaillancourt C, Rowe BH, Artz JD, Green R, Émond M, Thiruganasambandamoorthy V, Innes G, Perry JJ, Calder LA, and Stiell IG
- Subjects
- Canada, Humans, Biomedical Research economics, Congresses as Topic, Emergencies economics, Emergency Medicine organization & administration, Financial Management organization & administration, Societies, Medical
- Abstract
Objective: We sought to gather a comprehensive list of funding strategies and opportunities for emergency medicine (EM) centres across Canada, and make recommendations on how to successfully fund all levels of research activity, including research projects, staff salaries, infrastructure, and researcher stipends., Methods: We formed an expert panel consisting of volunteers recognized nationally for their scholarly work in EM. First, we conducted interviews with academic leaders and researchers to obtain a description of their local funding strategies using a standardized open-ended questionnaire. Panelists then identified emerging funding models. Second, we listed funding opportunities and initiatives at the provincial, national, and international levels. Finally, we used an iterative consensus-based approach to derive pragmatic recommendations after incorporating comments and suggestions from participants at an academic symposium., Results: Our review of funding strategies identified four funding models: 1) investigator dependent model, 2) practice plan, 3) generous benefactor, and 4) mixed funding. Recommendations in this document include approaches for research contributors and producers (seven recommendations), for local academic leaders (five recommendations), and for national organizations, such as the Canadian Association of Emergency Physicians (CAEP) (three recommendations)., Conclusions: Funding for research in EM varies across Canada and is largely insecure. We offer recommendations to help facilitate funding for large and small projects, for salary support, and for local and national leaders to advance EM research. We believe that these recommendations will increase funding for all levels of EM research activity, including research projects, staff salaries, infrastructure, and researcher stipends.
- Published
- 2015
- Full Text
- View/download PDF
47. Executive summary of the CAEP 2014 Academic Symposium: How to make research succeed in your department.
- Author
-
Stiell IG, Artz JD, Perry J, Vaillancourt C, and Calder L
- Subjects
- Canada, Humans, Biomedical Research, Congresses as Topic, Emergencies, Emergency Medicine organization & administration, Leadership, Societies, Medical
- Abstract
The vision of the recently created Canadian Association of Emergency Physicians (CAEP) Academic Section is to promote high-quality emergency patient care by conducting world-leading education and research in emergency medicine. The Academic Section plans to achieve this goal by enhancing academic emergency medicine primarily at Canadian medical schools and teaching hospitals. It seeks to foster and develop education, research, and academic leadership amongst Canadian emergency physicians, residents, and students. In this light, the Academic Section began in 2013 to hold the annual Academic Symposia to highlight best practices and recommendations for the three core domains of governance and leadership, education scholarship, and research. Each year, members of three panels are asked to review the literature, survey and interview experts, achieve consensus, and present their recommendations at the Symposium (2013, Education Scholarship; 2014, Research; and 2015, Governance and Funding). Research is essential to medical advancement. As a relatively young specialty, emergency medicine is rapidly evolving to adapt to new diagnostic tools, the challenges of crowding in emergency departments, and the growing needs of emergency patients. There is significant variability in the infrastructure, support, and productivity of emergency medicine research programs across Canada. All Canadians benefit from an investigation of the means to improve research infrastructure, training programs, and funding opportunities. Such an analysis is essential to identify areas for improvement, which will support the expansion of emergency medicine research. To this end, physician-scientist leaders were gathered from across Canada to develop pragmatic recommendations on the improvement of emergency medicine research through a comprehensive analysis of current best practices, systematic literature reviews, stakeholder surveys, and expert interviews.
- Published
- 2015
- Full Text
- View/download PDF
48. CAEP 2014 Academic Symposium: "How to make research succeed in your emergency department: How to develop and train career researchers in emergency medicine".
- Author
-
Perry JJ, Snider CE, Artz JD, Stiell IG, Shaeri S, McLeod S, Le Sage N, Hohl C, Calder LA, Vaillancourt C, Holroyd B, Hollander JE, and Morrison LJ
- Subjects
- Canada, Humans, Biomedical Research organization & administration, Career Choice, Congresses as Topic, Emergency Medicine education, Societies, Medical
- Abstract
Objectives: We sought to 1) identify best practices for training and mentoring clinician researchers, 2) characterize facilitators and barriers for Canadian emergency medicine researchers, and 3) develop pragmatic recommendations to improve and standardize emergency medicine postgraduate research training programs to build research capacity., Methods: We performed a systematic review of MEDLINE and Embase using search terms relevant to emergency medicine research fellowship/graduate training. We conducted an email survey of all Canadian emergency physician researchers. The Society for Academic Emergency Medicine (SAEM) research fellowship program was analysed, and other similar international programs were sought. An expert panel reviewed these data and presented recommendations at the Canadian Association of Emergency Physicians (CAEP) 2014 Academic Symposium. We refined our recommendations based on feedback received., Results: Of 1,246 potentially relevant citations, we included 10 articles. We identified five key themes: 1) creating training opportunities; 2) ensuring adequate protected time; 3) salary support; 4) infrastructure; and 5) mentorship. Our survey achieved a 72% (67/93) response rate. From these responses, 42 (63%) consider themselves clinical researchers (i.e., spend a significant proportion of their career conducting research). The single largest constraint to conducting research was funding. Factors felt to be positive contributors to a clinical research career included salary support, research training (including an advanced graduate degree), mentorship, and infrastructure. The SAEM research fellowship was the only emergency medicine research fellowship program identified. This 2-year program requires approval of both the teaching centre and each applying fellow. This program requires training in 15 core competencies, manuscript preparation, and submission of a large grant to a national peer-review funding organization., Conclusions: We recommend that the CAEP Academic Section create a process to endorse research fellowship/graduate training programs. These programs should include two phases: Phase I: Research fellowship/graduate training would include an advanced research university degree and 15 core learning areas. Phase II: research consolidation involves a further 1-3 years with an emphasis on mentorship and scholarship production. It is anticipated that clinician scientists completing Phase I and Phase II training at a CAEP Academic Section-endorsed site(s) will be independent researchers with a higher likelihood of securing external peer-reviewed funding and be able to have a meaningful external impact in emergency medicine research.
- Published
- 2015
- Full Text
- View/download PDF
49. Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study.
- Author
-
Calder LA, Forster A, Nelson M, Leclair J, Perry J, Vaillancourt C, Hebert G, Cwinn A, Wells G, and Stiell I
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Female, Humans, Logistic Models, Male, Middle Aged, Ontario, Prospective Studies, Risk Assessment, Safety Management, Emergency Service, Hospital standards, Medical Errors classification
- Abstract
Objective: To enhance patient safety, it is important to understand the frequency and causes of adverse events (defined as unintended injuries related to health care management). We performed this study to describe the types and risk of adverse events in high-acuity areas of the emergency department (ED)., Methods: This prospective cohort study examined the outcomes of consecutive patients who received treatment at 2 tertiary care EDs. For discharged patients, we conducted a structured telephone interview 14 days after their initial visit; for admitted patients, we reviewed the inpatient charts. Three emergency physicians independently adjudicated flagged outcomes (e.g., death, return visits to the ED) to determine whether an adverse event had occurred., Results: We enrolled 503 patients; one-half (n = 254) were female and the median age was 57 (range 18-98) years. The majority of patients (n = 369, 73.3%) were discharged home. The most common presenting complaints were chest pain, generalized weakness and abdominal pain. Of the 107 patients with flagged outcomes, 43 (8.5%, 95% confidence interval 8.1%-8.9%) were considered to have had an adverse event through our peer review process, and over half of these (24, 55.8%) were considered preventable. The most common types of adverse events were as follows: management issues (n = 18, 41.9%), procedural complications (n = 13, 30.2%) and diagnostic issues (n = 10, 23.3%). The clinical consequences of these adverse events ranged from minor (urinary tract infection) to serious (delayed diagnosis of aortic dissection)., Conclusion: We detected a higher proportion of preventable adverse events compared with previous inpatient studies and suggest confirmation of these results is warranted among a wider selection of EDs.
- Published
- 2010
- Full Text
- View/download PDF
50. Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter.
- Author
-
Stiell IG, Clement CM, Perry JJ, Vaillancourt C, Symington C, Dickinson G, Birnie D, and Green MS
- Subjects
- Adult, Aged, Aged, 80 and over, Anti-Arrhythmia Agents adverse effects, Anti-Arrhythmia Agents therapeutic use, Electric Countershock adverse effects, Emergencies, Female, Humans, Length of Stay, Male, Middle Aged, Ontario, Procainamide adverse effects, Procainamide therapeutic use, Retrospective Studies, Safety, Treatment Outcome, Atrial Fibrillation therapy, Atrial Flutter therapy, Clinical Protocols
- Abstract
Objective: There is no consensus on the optimal management of recent-onset episodes of atrial fibrillation or flutter. The approach to these conditions is particularly relevant in the current era of emergency department (ED) overcrowding. We sought to examine the effectiveness and safety of the Ottawa Aggressive Protocol to perform rapid cardioversion and discharge patients with these arrhythmias., Methods: This cohort study enrolled consecutive patient visits to an adult university hospital ED for recent-onset atrial fibrillation or flutter managed with the Ottawa Aggressive Protocol. The protocol includes intravenous chemical cardioversion, electrical cardioversion if necessary and discharge home from the ED., Results: A total of 660 patient visits were included, 95.2% involving atrial fibrillation and 4.9% involving atrial flutter. The mean age of patients enrolled was 64.5 years. In total, 96.8% were discharged home and, of those, 93.3% were in sinus rhythm. All patients were initially administered intravenous procainamide, with a 58.3% conversion rate. A total of 243 patients underwent subsequent electrical cardioversion with a 91.7% success rate. Adverse events occurred in 7.6% of cases: hypotension 6.7%, bradycardia 0.3% and 7-day relapse 8.6%. There were no cases of torsades de pointes, stroke or death. The median lengths of stay in the ED were as follows: 4.9 hours overall, 3.9 hours for those undergoing conversion with procainamide and 6.5 hours for those requiring electrical conversion., Conclusion: This is the largest study to date to evaluate the Ottawa Aggressive Protocol, a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. Our data demonstrate that the Ottawa Aggressive Protocol is effective, safe and rapid, and has the potential to significantly reduce hospital admissions and expedite ED care.
- Published
- 2010
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.