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On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions
- Julia Tärnqvist, Erik Dahlén, Gabriella Norberg, Carl Magnusson, Johan Herlitz, Anneli Strömsöe, Christer Axelsson, Magnus Andersson Hagiwara
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- Journal:
- Prehospital and Disaster Medicine / Volume 32 / Issue 5 / October 2017
- Published online by Cambridge University Press:
- 08 May 2017, pp. 528-535
- Print publication:
- October 2017
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Introduction
The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group.
ProblemThere is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis.
MethodPatients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records.
ResultsIn all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years.
The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent).
Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate.
Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate.
Conclusion:Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate.
,Tärnqvist J ,Dahlén E ,Norberg G ,Magnusson C ,Herlitz J ,Strömsöe A ,Axelsson C .Andersson Hagiwara M On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions . Prehosp Disaster Med.2017 ;32 (5 ):528 –535 .
The baobab tree in Malawi
- Aida Cuni Sanchez
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Introduction. The baobab tree’s potential overexploitation has recently been reinforced by the acceptance of baobab fruit pulp in the EU and US food markets. Despite the number of recent studies on this species, Adansonia digitata, little is known from Malawi, the main exporter of baobab fruit pulp in Africa. Materials and methods. Information on distribution and density of baobab trees present in Malawi was gathered from field surveys. The Maxent software based on the maximum-entropy approach for species habitat modelling was used together with spatial environmental data and geo-referenced records of the baobab tree to analyse its ecological preferences and potential cultivation sites. Farmers were interviewed about who was using and buying baobab fruits in different areas. Fruit and leaf morphological diversity was assessed in eight study sites selected along a latitudinal gradient. Results and discussion. The baobab tree was found to be widely distributed in southern Malawi, with variable densities. Modelling results show that this species could be cultivated in most of the southern region. A large morphological diversity in both fruit and leaf characteristics was observed, which gives the opportunity to select more desirable characters for cultivation. Conclusion. Our study showed that, while some areas of high baobab tree density could be further exploited, its cultivation, however, should be recommended in areas with low density of baobab trees in southern Malawi because there is little natural regeneration. Moreover, this study suggested that there is room for selecting baobab planting material with desirable characteristics for cultivation purposes in Malawi.