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Objectives In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex‐combatants into the healthcare system. However, FARC ex‐combatants have faced significant challenges in receiving healthcare, and little is known about physicians’ abilities to address this population's healthcare needs. Methods An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians’ knowledge, attitudes, and experiences with the FARC ex‐combatant reincorporation process. Results Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two‐thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex‐combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty‐two participants (41.5%) had identified a patient as an ex‐combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex‐combatants (r = 0.356, n = 47, P = 0.014). Conclusion Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex‐combatants, and cared for these patients when they self‐identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex‐combatant healthcare reintegration.

El triaje permite la priorización de pacientes según su urgencia médica. Se propone realizar un modelo estadístico correlacionado con mortalidad para generación de alertas desde el triaje. Una cohorte prospectiva de 6438 adultos que ingresaron a urgencias del Hospital Universitario San Ignacio, del 01/03/2018 al 28/02/2019. Se dividieron aleatoriamente los datos en entrenamiento y prueba. Sobre los datos de entrenamiento se realizó una regresión logística bivariada entre triaje y mortalidad y luego una regresión logística multivariada, se redujo el modelo mediante pruebas de razón de verosimilitud. En los datos de prueba se realizaron áreas bajo la curva (AUC) para cálculo de punto de corte. Fue evaluado mediante medidas de asociación. Se realizaron áreas bajo la curva para los modelos realizados, encontrando el modelo “triage” con de AUC 0.82, “reducido” una AUC 0.90 y “Edad+sistólica” una AUC 0.87, sin diferencia significativa. Se seleccionó “reducido” con una Sensibilidad 0.869, Especificidad 0.842, VPP: 0.062, VPN: 0.998 Para seleccionar punto de corte, se realizó un árbol de decisiones teniendo en cuenta las variables significativas encontrando mayor mortalidad en pacientes triage 1-2, con TAS menor de 117mmHg y mayores de 58 años. El modelo final podría funcionar como tamización para generación de alarmas de mortalidad en triaje iguales. Palabras Clave: Medicina de Urgencias, Servicios Médicos de Urgencia, Triaje, Mortalidad, Indicadores de Salud

Context: Time from triage to patient care is usually evaluated, but time elapsed between the arrival of patient to emergency room (ER) and triage (pretriage) is not usually measured. Aims: The present study evaluates how the application of the queuing (or “waiting line”) theory in the triage process can generate effective strategies to improve patient care in the ER. Settings and Design: A “before-and-after” study was conducted in the ER of the Hospital Universitario San Ignacio, a tertiary emergency care in Bogotá, Colombia. Subjects and Methods: The pretriage time was evaluated, and queuing theory was applied to the evaluation; according to the results, the number and distribution of the necessary nursing personnel were determined. Statistical Analysis Used: The change in waiting times was compared using a paired t-test. Results: In a first 7 months evaluation period, 89,898 patient visits were considered, with an average pretriage time of 22.15 min. According to the arrival distribution by hours and days of the week and considering the results of the calculations made using queuing theory, the number of nurses needed in the service per hour was determined for each day of the week, and schedule changes were implemented without increasing staff. In a second similar evaluation period, 94,497 patient visits were considered demonstrating a reduction of the pretriage time to 7.5 min (mean difference 14.64 min, 95% confidence interval 14.42–14.85, P < 0.001). Conclusions: The use of queuing theory in the planning of the daily personnel requirements in the triage area of ER can reduce the pretriage time by 65% without incurring additional cost.

Author(s): Patino, Andres M.; Alcalde, Victor; Gutierrez, Camilo; Garcia Romero, Mauricio; Moreno Carrillo, Atilio; Vargas, Luis E.; Vallejo, Carlos E.; Zarama, Virginia; Mora Rodriguez, Jose L.; Bustos, Yury; Granada, Juliana; Aguiar, Leonar G.; Menendez, Salvador; Cohen, Jorge I.; Saavedra, Miguel A.; Rodriguez, Juan M.; Roldan, Tatiana; Arbelaez, Christian | Abstract: Introduction: Emergency medicine (EM) is in different stages of development around the world.Colombia has made significant strides in EM development in the last two decades and recognized it as amedical specialty in 2005. The country now has seven EM residency programs: three in the capital city ofBogota, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in differentstages of maturity, with the oldest founded 20 years ago and two founded in the last two years. Theobjective of this study was to characterize these seven residency programs.Methods: We conducted semi-structured interviews with faculty and residents from all the existingprograms in 2013-2016. Topics included program characteristics and curricula.Results: Colombian EM residencies are three-year programs, with the exception of one four-yearprogram. Programs accept 3-10 applicants yearly. Only one program has free tuition and the rest chargetuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% oftotal clinical time. One program does not have a pediatric rotation. The other programs require 1-2months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other commonrotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics,ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. Allprograms offer 4-6 hours of protected didactic time each week. Some programs require AdvancedCardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with someprograms providing these trainings in-house or subsidizing the cost. Most programs require one researchproject for graduation. Resident evaluations consist of written tests and oral exams several times per year.Point-of-care ultrasound training is provided in four of the seven programs.Conclusion: As emergency medicine continues to develop in Colombia, more residency programsare expected to emerge. Faculty development and sustainability of academic pursuits will be criticallyimportant. In the long term, the specialty will need to move toward certifying board exams andprofessional development through a national EM organization to promote standardization acrossprograms.

Introducción: La exposición a sustancias tóxicas es frecuente en pediatría. En Colombia, entre 2006 y 2008 se presentaron 40061 casos de intoxicaciones, de las cuales 19 723 correspondieron a menores de 14 años de edad. En 2009 se presentaron 187 muertes, lo que corresponde a una tasa de mortalidad de 0,6 casos por cada 100 000 habitantes y una tasa de letalidad de 9,48 por cada 100 000 casos de pacientes intoxicados.Objetivo: Evaluar en la literatura el papel de las medidas generales como tratamiento en el paciente pediátrico intoxicado y determinar cuáles han demostrado ser seguras y eficaces.Método: Selección de artículos (búsqueda en inglés y español en Medline, PubMed, Academic Search Complete, Science Direct y SciELO) y extracción de datos, según la aplicación de las medidas generales en el manejo de los pacientes intoxicados en el servicio de urgencias. Conclusiones: Es importante conocer el mecanismo de acción de las técnicas para disminuir la absorción o aumentar la eliminación de sustancias tóxicas y las indicaciones y contraindicaciones para su aplicación, y brindar un adecuado y efectivo tratamiento en los servicios de urgencias.

En este artículo se presenta el caso de un paciente con intoxicación crónica por plomo, cuya principal manifestación clínica fue dolor abdominal. Esta es una intoxicación que generalmente se presenta en pacientes que están en contacto laboral con este metal. En este artículo se revisan las manifestaciones clínicas más frecuentes y el manejo de esta patología, ya que de no identificarse y tratarse de forma oportuna, cursa con una alta morbimortalidad.