Canadian Journal of Emergency Medicine joins the Cambridge Journals list

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A new partnership between Cambridge University Press and the Canadian Association of Emergency Physicians (CAEP).

From January 2015 the Canadian Journal of Emergency Medicine (CJEM) will join the Cambridge Journals list.

CJEM is a scholarly, peer-reviewed journal, produced specifically for emergency medicine care providers in rural, urban, community, and academic settings. The journal focuses on emergency medicine content relevant to clinical practice, emergency medical services, research, medical education, administration, and continuing professional development and knowledge exchange.

A key development will be the move to an online-only format, and CJEM’s readers and authors will benefit from the additional features available on Cambridge’s electronic platform, Cambridge Journals Online. These include increased usability via mobile and web-optimized sites and state-of-the-art functionality. CJEM will be available in a wide range of different article formats for devices including pdf, html, Kindle, and epub to enhance and optimise article usage. These developments will enhance CJEM’s discoverability, whilst CJEM will continue to adhere to the same high level of peer review and editorial excellence.

Speaking about the decision to partner with Cambridge University Press, Vera Klein, Executive Director, Canadian Association of Emergency Physicians, said “CAEP is very excited to be partnering with Cambridge University Press. It will help take CJEM to new heights as a completely digital publication, but it will also allow the journal to continue its focus on Canadian emergency medicine.”


Katy Christomanou, Publishing Director for STM Journals, Cambridge University Press, commented, “There is a strong fit between the CAEP’s aims and our strength in emergency medicine within both our books and journals programmes. Our focus will be on expanding the journal’s reach and impact across the community, realising the journal’s potential to attract a worldwide audience.”


View the new journal homepage here.



DMPHP Special Issue on Ebola

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Accurate knowledge regarding Ebola is critical and pertinent for practicing physicians and clinicians given the current risk of hazardous global outbreak and epidemic. Disaster Medicine and Public Health Preparedness has launched a special issue, Ebola Virus and Public Health, to surround the public, medical professionals and media with necessary knowledge in this critical societal moment.

As part of this special issue, the journal has published A Primer on Ebola for Clinicians. The primer was prepared by Dr. Eric Toner, internist and emergency physician, as well as Amesh A. Adalja and Thomas V. Inglesby (all of the University of Pittsburgh Medical Center). The primer discusses the history, epidemiology, microbiology, clinical manifestations, biosafety, prevention, treatment and experimental vaccines to offer an informative and inclusive background on the Ebola virus for clinicians.

The scale of the uncontrolled outbreak in Western Africa makes further exportation to other parts of the world an unfortunate possibility (as citizens across the globe have already witnessed, with cases appearing in Europe and the United States). Those who serve at the frontlines of emergency medicine, critical care, infectious diseases and infection control are in high need and demand, and in some cases, high risk. The primer provided by the UPMC professionals offers clear and concise information on the fundamentals of the virus, including its diagnosis, treatment and control. The public and media are especially apt to benefit from the clear and accurate information provided by the primer, as the popularity of social media makes misinformation about Ebola easily (and rapidly) sharable, believed and misattributed.

The DMPHP Special Edition on Ebola has been designed from the outset to be a conduit for operational and policy level information that will improve outcomes and decision making, and to ensure that this information is available to all practitioners.

As such, published contributions will go online immediately after appropriate review and placed chronologically to ensure a ready historical track for future review and debate. The Special Edition will be made available to everyone in the field as well as at the policy level decision makers worldwide.

View the special issue contents here free of charge. More articles will be added as soon as they become available online.

The SDMPH have released press releases on some of these papers- you can view these by using the links below:

Volunteer guidelines for clinicians in the ebola epidemic
A Primer on Ebola for Clinicians
Special issue on Ebola



Football focus: A study into preparedness of the health sector in Brazil for the 2014 FIFA World Cup

brazil world cup

This post is taken from the abstract of the paper “Hospital Preparedness in Advance of the 2014 FIFA World Cup in Brazil” published in Prehospital and Disaster Medicine.

Regardless of the capacity of the health care system of the host nation, mass gatherings require special planning and preparedness efforts within the health system. Brazil will host the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympics. This paper represents the first results from Project ‘‘Prepara Brasil,’’ which is investigating the preparedness of the health sector and pharmaceutical services for these events.

This study was designed to identify the efforts taken to prepare the health sector in Brazil for the FIFA World Cup 2014 event, as well as the 2016 Summer Olympics.

Key informant interviews were conducted with representatives of both the municipality and hospital sectors in each of the 12 host cities where matches will be played. A semi-structured key informant interview guide was developed, with sections for each type of participant. One of each municipality’s reference hospitals was identified and seven additional general hospitals were randomly selected from all of the inpatient facilities in each municipality. The interviewers were instructed to contact a reference hospital, and two of the other hospitals, in the jurisdiction for participation in the study.

Questions were asked about plans for mass-gathering events, the interaction between hospitals and government officials in preparation for the World Cup, and their perceptions of their surge capacity to meet the potential demands generated by the presence of the World Cup events in their municipalities.

In all, 11 representatives of the sampled reference hospitals, and 24 representatives of other general private and public hospitals in the municipalities, were interviewed.

Most of the hospitals had some interaction with government officials in preparation for the World Cup 2014. Approximately one-third (34%) received training activities from the government. Fifty-four percent (54%) of hospitals had no specific plans for communicating with the government or other agencies during the World Cup. Approximately half (51%) had plans for surge capacity during the event, but only 27% had any surge capacity for isolation of potentially infectious patients.

Overall, although there has been mention of a great deal of planning on the part of the government officials for the World Cup 2014, hospital surge to meet the potential increase in demand still falls short.


The full paper “Hospital Preparedness in Advance of the 2014 FIFA World Cup in Brazil” can be viewed free of charge for a limited time here.


What emergency medicine can teach emergency managers


When a tsunami hit Japan in 2011 and crippled the Fukushima Daiichi nuclear power plant, the American Ambassador called in a team of radiation, health, communications, and nuclear power plant experts to join him in Tokyo to provide Americans visiting or living in Japan with information they needed. The team used a real-time, medical decision model and now recommends that model to emergency managers as they make key decisions during an incident.

Used daily in emergency medicine, medical decision-making provides timely decisions and relies on on-site subject matter experts. Decisions are made based on the best information available at the time, and these decisions are modified the course as new information emerges.

Consider the process for treating cancer. When recommending a treatment plan, doctors look at the likelihood of the treatment’s effectiveness and risk of toxicity on the patient’s overall medical condition. They consider the properties of the tumor (not all of which will be immediately known), and current scientific data. They may consult with other experts as they identify a course of action to avoid tumor growth and dissemination. Then working closely with patients and their families, doctors develop a treatment plan, initiate it in a timely manner, monitor its effectiveness, and modify its course as appropriate.

This approach contrasts to the deliberative, multistep, and more time-consuming decision-making process that waits for a great degree of certainty when more of the outcome is known before making a decision. This deliberative approach can go on in the background and provide advice and guidance.

Like traditional approaches to disaster response, the medical decision model uses experts and committees for consultation and advice, but the medical decision model differs in that those experts are on-site, not “back at headquarters,” and decision makers are empowered to make time-critical decisions based on information, experience, and data from the on-site experts. Those decisions are made refined as new data becomes available.

Using the medical decision model, emergency response officials can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. The decisions they make are appropriately modified as the information changes. Ongoing assessment, consultation, and adaption to the changing conditions and additional information play prominently in this model.

In Japan, the decisions about the health-related consequences of the disaster encompassed more than just the potential risk from the radiation, which dominated the media and public conversation. The team also had to consider risks associated with evacuation and public relocation, the impact on physical and mental health from disruptions to normal life, economic losses, and the ongoing anxiety of living through a widespread physical and economic disaster.

Using the medical decision model requires decision makers to be open and transparent with the public about what is known and unknown and that recommended courses of action may change as they learn more data becomes available. The American ambassador embraced this concept and fostered public trust and credibility as a result.

In emergency response, the medical decision model would use the same lines of command and local control abdicated in the National Response Framework. Given the central role of health and medical issues in all disasters, the model should be considered in effective management of complex, large-scale, and large-consequence incidents.

Learn more about applying the medical decision model to emergency response (paper freely available for a limited time).


Is the ladette culture resulting in more women with broken noses?


The word “ladette”, defined by the Oxford Dictionary as “a young woman who behaves in a boisterous, assertive or crude manner and engages in heavy drinking sessions”, and the related culture of alcohol-fuelled anti-social behaviour has been quoted as being on the rise in the UK.

A retrospective study in three district hospitals has shown an 825 per cent increase in females aged 13–20 years attending for nasal fractures from 2002 to 2009.

The study supports the notion that violence amongst young women is increasing with a significant proportion of injuries being caused by non-domestic violence.

A retrospective study was performed in three district UK hospitals (Luton and Dunstable Hospital, The Lister Hospital and the Royal United Bath Hospital), serving a catchment population of approximately 1.5 million.

Operating theatre data for all females who attended hospital for manipulation of a nasal fracture under anaesthesia between January 2002 and December 2009 were retrieved. Case notes of all female patients attending Luton and Dunstable Hospital for assessment of a nasal fracture over a five-year period, from January 2004 to December 2009, were also reviewed, regardless of whether the patients underwent manipulation of their fracture under anaesthesia or not.

From 2002 to 2009, the collected data demonstrated an increase in the number of women presenting with nasal fractures, in all age groups. The greatest increase in incidence was seen in the 13–20 year age group. There were only 4 girls who underwent manipulation under anaesthesia across the 3 sites in 2002, whereas the respective number in 2009 had risen to 33, representing an 825 per cent increase. By comparison, the incidence in males had only risen from 47 to 102 during the same time period, a 217 per cent increase.

Accidental injury was the most common cause of nasal fracture. Falls and occupational accidents seem to play an increasing role in the epidemiology of nasal injuries in women, as they become more exposed to the respective risk factors in a society that considers them stronger and more independent compared with previous decades. Domestic accidental injuries are also frequently reported; a comment on how many of these are truthfully accidental would be purely speculative. Indeed, domestic violence continues to be under-reported by many victims, and was only cited in 2 per cent of the case notes reviewed in the present study. Sport-related injury was also a common cause of nasal trauma in the present study; an overall increase in nasal fractures amongst young women could also be related to an increased participation in sport.

In almost a quarter of cases in the Luton and Dunstable Hospital, nasal injury was the result of non-domestic violence. This type of violence stems from interpersonal conflicts, and its rates have been associated with the consumption of alcohol. Moreover, at least two UK studies from the past decade showed that alcohol consumption was closely associated with a rise in anti-social behaviour, violence and criminality in young girls. In addition, a significant correlation between cheap, readily-available alcohol and violent injury was found in a study involving 58 accident and emergency departments in 10 distinct economic regions of the UK. Therefore, the increased incidence of nasal fractures amongst young women in the present study may, at least in part, be attributed to increasingly violent behaviour amongst young women.

View the full paper “Is there a change in the epidemiology of nasal fractures in females in the UK?” free for a limited time here.

Acute heavy menstrual bleeding

Blog Post  by Malcolm G. Munro MD, FACOG, FRCS(c), Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Director of Gynecologic Services, Kaiser Permanante, Los Angeles Medical Center, Los Angeles, CA, USA

Recently a young healthy woman presented with acute heavy menstrual bleeding (HMB) and was placed on a multidose combination estrogen-progestin oral contraceptive (COC) regimen. As the bleeding stopped she developed central neurological symptoms and findings and was diagnosed with internal jugular venous thrombosis that resulted in profound neurological sequellae. Investigation identified the presence of a previously undiagnosed case of von Leiden factor deficiency. This case provides a suitable backdrop for discussion about acute heavy uterine bleeding, the role for medical therapy, and the potential consequences of high dose estrogenic interventions.

The entity of acute HMB has only recently been defined as heavy uterine flow not associated with pregnancy that is of sufficient volume to require urgent or emergent medical intervention.1  Although research evaluating the causes of this recently defined entity is necessary, it is likely that ovulatory disorders (AUB-O) are the most common cause. However, coagulopathies may also contribute (AUB-C), and, particularly in adolescents with von Willebrand disease, may augment the heavy bleeding associated with perimeharcheal anovulation (AUB-C, -O). Arteriovenous malformations are yet another but admittedly rare entity that can also cause acute HMB. Read more of this post

Treating radiation injuries in US travelers returning from Japan

March 22, 2011 — In response to the crisis in Japan, the US Centers for Disease Control and Prevention (CDC) hosted a conference call for clinicians to answer questions about treating radiation injuries in US travelers returning from Japan.

During the hour-long Clinician Outreach and Communication Activity call yesterday evening, Jeffrey Nemhauser, MD, who is a captain in the US Public Health Service and a medical officer in the CDC’s Radiation Studies Branch, answered questions from healthcare providers about radiation exposure and treatment.

Dr. Nemhauser stressed that the CDC is not aware of any US travelers returning from Japan who have been “contaminated with material at a level of concern.” If a traveler is contaminated, the CDC will recommend decontamination, collect data, and follow-up with the traveler, he said.

Customs officials routinely screen travelers (and their luggage) entering the United States for radiation contamination, he said. Because of the radiation leaks in Japan, however, the CDC is creating extra screening protocols for airports. Dr. Nemhauser said that these protocols should go into effect this week. Read more of this post

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