Volume 14 Issue 5 Archives - The Western Journal of Emergency Medicine

Discourse in Emergency Medicine and Population Health

In Response to “Temperature and Violent Crime in Dallas, Texas: Relationships and Implications of Climate Change”

Volume 14, Issue 5, September 2013
Matt N. Williams, MA, et al.

To the editor:

We were interested to read Gamble and Hess’s study finding that the daily incidence of violent crime in Dallas increased with temperatures up to 90°F (32.2°C), but decreased above this threshold. On this basis, their abstract surprisingly concludes that “higher ambient temperatures expected with climate change…. are not likely to be accompanied by markedly higher rates of violent crime” (p.239). This conclusion contrasts with the findings of previous studies.1–3

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Ethical and Legal Issues

Medical-legal Issues in the Agitated Patient: Cases and Caveats

Volume 14, Issue 5, September 2013
Jessica Thomas, MD, et al.

More than any other area of emergency medicine, legal issues are paramount when caring for an agitated patient. It is imperative to have a clear understanding of these issues to avoid exposure to liability. These medico-legal issues can arise at the onset, during, and at discharge of care and create several duties. At the initiation of care, the doctor has a duty to evaluate for competence and the patient’s ability to consent. Once care has begun, patients may require restraint if they become combative or violent.

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Ethical and Legal Issues

When a Patient Declines Curative Care: Management of a Ruptured Aortic Aneurysm

Volume 14, Issue 5, September 2013
Sangeeta Lamba, MD, et al.

The management of major vascular emergencies in the emergency department (ED) involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case.

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Emergency Department Operations

Measuring Power in an Emergency Department to Improve Processes and Decrease the Length of Stay to their Optimum Value

Volume 14, Issue 5, September 2013
Bert A. Silich, MD, MS

Many emergency departments (EDs) compare themselves to national productivity benchmarks, such as the average patients/hour or relative value units (RVUs)/hour. Making these comparisons does not provide a tool to determine which processes need improvement, most urgently, within the ED to improve efficiency. Furthermore, there has been no clear means to determine how to set reasonable goals based on the capabilities of the particular ED under study.

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Emergency Department Operations

Perception of Noise by Emergency Department Nurses

Volume 14, Issue 5, September 2013
John Graneto, DO, MEd, et al.

Noise in the emergency department (ED) may be perceived to be high by both patients and nurses alike. This increased noise level is hypothesized to be responsible for communication interference and subsequent disruption of complex procedures and decision-making. The objective of this study is to quantify ambient noise level in an ED while obtaining coincident subjective surveys from nurses in the assessment of actual versus perceived noise.

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