Global Health

Comments on “Emergency Medicine Resident Rotations Abroad: Current Status and Next Steps”

Gabrielle A. Jacquet, MD, MPH, et al.

Morris and Schroeder have highlighted the need for a uniform and comprehensive national education program for emergency medicine residents doing international rotations. As faculty for a newly released course, The Practitioner’s Guide to Global Health, we wanted to call your attention to this innovative resource for preparing resident physicians, medical students, and other trainees to participate in safe and sustainable global health rotations.

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Emergency Medicine Resident Rotations Abroad: Current Status and Next Steps

Volume 17, Issue 1, January 2016.
Stephen C. Morris, MD, MPH, et al.

Introduction: International rotations for residents are increasingly popular, but there is a dearth of
evidence to demonstrate that these rotations are safe and that residents have appropriate training
and support to conduct them.
Methods: A survey was sent to all U.S. emergency medicine (EM) residencies with publicly
available e-mail addresses. The survey documents and examines the training and support that
emergency medicine residents are offered for international rotations and the frequency of adverse
safety events.
Results: 72.5% of program director responded that their residents are participating in rotations
abroad. However, only 15.4% of programs reported offering training specific to working abroad. The
results point to an increased need for specific training and insurance coverage.
Conclusion: Oversight of international rotations should be improved to guarantee safety and
education benefit.

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Emergency Department of a Rural Hospital in Ecuador

Volume 17, Issue 1, January 2016.
Tara Johnson, MD, MPH, et al.

Introduction: There is a paucity of data studying patients and complaints presenting to emergency
departments (EDs) in low- and middle-income countries. The town of Pedro Vicente Maldonado
(PVM) is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM) is a rural teaching
hospital providing family medicine residency training. These physicians provide around-the-clock
acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin
America by reviewing one year of ED visits to HPVM.
Methods: All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed,
totaling 1,239 patient visits. Data were collected from their electronic medical record and exported
into a de-identified Excel® database where it was sorted and categorized. Variables included age,
gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint,
laboratory and imaging requests, and disposition. We performed descriptive statistics, and where
possible, comparisons using Student’s T or chi-square, as appropriate.
Results: Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were
ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security
insurance. The top three chief complaints were abdominal pain (25.5%), fever (15.1%) and trauma
(10.8%). Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The
most frequently requested imaging studies were chest radiograph (14.9%), upper extremity
radiograph (9.4%), and electrocardiogram (9.0%). There was no seasonal or day-of-week
variability to number of ED patients. The chief complaint of human or animal bite made it more
likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely
the patient would be transferred.
Conclusion: Analysis of patients presenting to a rural ED in Ecuador contributes to the global study
of acute care in the developing world and also provides a self-analysis identifying disease patterns
of the area, training topics for residents, areas for introducing protocols, and information to help
planning for rural EDs in low- and middle-income countries.

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Crossing Borders

Volume 17, Issue 1, January 2016.
Erik D. Barton, MD, MS, MBA

As emergency physicians, we are privileged to be
in a field that crosses more boundaries than any other
medical specialty. It is a calling. Our skills are portable
and transferable across cultural and geographic disparities.
For these reasons, many of us are drawn to sharing our
knowledge and training across the globe – towards treating
patients in underserved and austere environments abroad. The
rapid growth of international and global health educational
initiatives across our U.S. residency training programs is a
direct result of those undeniable forces. Additionally, inclusion
of such rotations becomes a powerful resident recruitment
tool as more and more of our trainees are looking for these
opportunities during their formative years.

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Medication Overdoses at a Public Emergency Department in Santiago, Chile

Volume 17, Issue 1, January 2016.
Pablo Aguilera, MD, et al.

Introduction: While a nationwide poison control registry exists in Chile, reporting to the center is
sporadic and happens at the discretion of the treating physician or by patients’ self-report. Moreover,
individual hospitals do not monitor accidental or intentional poisoning in a systematic manner. The
goal of this study was to identify all cases of intentional medication overdose (MO) that occurred
over two years at a large public hospital in Santiago, Chile, and examine its epidemiologic profile.
Methods: This study is a retrospective, explicit chart review conducted at Hospital Sótero del Rio
from July 2008 until June 2010. We included all cases of identified intentional MO. Alcohol and
recreational drugs were included only when they were ingested with other medications.
Results: We identified 1,557 cases of intentional MO and analyzed a total of 1,197 cases,
corresponding to 0.51% of all emergency department (ED) presentations between July 2008 and
June 2010. The median patient age was 25 years. The majority was female (67.6%). Two peaks
were identified, corresponding to the spring of each year sampled. The rate of hospital admission
was 22.2%. Benzodiazepines, selective serotonin reuptake inhibitors, and tricyclic antidepressants
(TCA) were the causative agents most commonly found, comprising 1,044 (87.2%) of all analyzed
cases. Acetaminophen was involved in 81 (6.8%) cases. More than one active substance was
involved in 35% of cases. In 7.3% there was ethanol co-ingestion and in 1.0% co-ingestion of some
other recreational drug (primarily cocaine). Of 1,557 cases, six (0.39%) patients died. TCA were
involved in two of these deaths.
Conclusion: Similar to other developed and developing nations, intentional MO accounts for a
significant number of ED presentations in Chile. Chile is unique in the region, however, in that
its spectrum of intentional overdoses includes an excess burden of tricyclic antidepressant and
benzodiazepine overdoses, a relatively low rate of alcohol and recreational drug co-ingestion, and a
relatively low rate of acetaminophen ingestion.

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Contact Information

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Phone: 1-714-456-6389

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.