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                <text>International Emergency Nursing Vol. 54 January 2021&#13;
Characteristics, management and outcome of critically ill general medical&#13;
patients in the Emergency Department: An observational study</text>
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                <text>Background: Critically ill general medical patients are an increasing group in the Emergency Department (ED). This register-based cohort study aimed to examine these patients’ characteristics, ED management and outcome, and investigate factors associated with ICU admission.&#13;
Methods: The study comprised all adult medical triage 1 patients treated by a specialized multidisciplinary team in 2015 and 2016. Univariate and multivariate analysis were used.&#13;
Results: 1294 patients were included. Mean age was 59 years, 56% (n = 725) were male, mean National Early Warning Score 2 (NEWS2) was 7, intensive care unit (ICU) admission was 56.8% (n = 735) and mortality rate was 16.8% (n = 217). Median ED length of stay (LOS) was 1.6 h, 1.2 h if admitted to ICU. The most frequent discharge diagnosis was acute poisoning (24.0%, n = 308). Younger age, male gender, arriving at nighttime weekdays, higher NEWS2 at arrival, critical care interventions or medications in the ED was associated with ICU admission.&#13;
Conclusion: More than half of the patients were admitted to ICU, and the mortality rate was 16.8%. A large proportion was diagnosed with acute poisoning. Younger age, higher NEWS and critical care in ED were asso-&#13;
ciated with ICU admission. The short ED LOS suggests that management by a multidisciplinary team is beneficial. </text>
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                <text>Sri Wahyuni</text>
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                <text>International Emergency Nursing Vol. 54 January 2021&#13;
COVID-19, the family unfriendly virus: Is the family’s experience of the ED relevant within the confines of a pandemic? (Editorial)</text>
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                <text>The COVID-19 pandemic spread quickly in 2020, leaving in its wake a trail of economic burden with large financial losses, psychological consequences, enforced changed patterns of social interaction and&#13;
concomitant changes in healthcare delivery [1]. The pandemic has&#13;
severely affected our working lives, with special note in the emergency&#13;
care environment. In light of the aforementioned, one might ask about&#13;
the relevance of such an editorial; why it might be important to focus on&#13;
family engagement in the emergency department (ED)? Surely there are&#13;
other more important matters during this time? Why indeed should this&#13;
be considered a focal point of concern almost a year into the pandemic?&#13;
Reading through the plethora of COVID-19 literature, there is an&#13;
emergence of the adverse mental health impact of working as healthcare&#13;
workers on the COVID-19 frontline, of note is the moral injury when&#13;
exposed to emotional trauma for which we were not prepared, such as&#13;
facilitating network connections to enable family goodbyes [2]. Indeed,&#13;
it has been reported that COVID-19 may cause many psychological&#13;
problems that could potentially be even more detrimental in the long&#13;
run than the virus itself [3].</text>
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                <text>International Emergency Nursing Vol. 54 January 2021&#13;
Editorial Board</text>
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                <text>International Emergency Nursing Vol. 54 January 2021&#13;
Emergency preparedness for heat illness in China: A cross-sectional observational study</text>
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                <text>Heat illness, Heat stroke, Heat exhaustion, emergency nursing, Ambulance, Emergency preparedness, disaster planning, Climate change&#13;
Global warming, Questionnaire survey</text>
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                <text>Background: The morbidity and mortality rates from heat illness have increased due to a higher number of heatwaves. Effective urgent care of heat illness is crucial for optimizing patient outcomes. However, few studies have examined the emergency preparedness measures required for treating such patients.&#13;
Methods: From December 23, 2019, to January 23, 2020, a content-validated instrument containing the Perceived Emergency Preparedness Scale for heat illness (heatPEPS) was administered to emergency nurses in China through WeChat. Some of these nurses were retested two weeks later. SPSS 26, IRTPRO 4.2, and NVivo 12 Plus were used for data analysis. &#13;
Results: In total, 46.4% (200/431) of the participants returned valid responses. With dichotomous scoring, a high score for heatPEPS (mean 7.29; SD 1.667) was elicited. The reduced 9-item heatPEPS had a perfect fit with the 2PL model (M2 = 27.24, p &gt; 0.05; RMSEA = 0.01) and acceptable internal (α = 0.68) and test-rest reliability (intraclass correlation = 0.56). Many participants (74%) were dissatisfied with their heat illness-related knowledge and skills, suggesting an area that could be improved for better emergency preparedness.&#13;
Conclusion: Emergency departments appear to be well-prepared; however, this is subject to social desirability bias. The 9-item heatPEPS is a reliable and valid tool to measure emergency preparedness for heat illness. </text>
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                <text>Lijuan Zhao, Xingfeng Lin, Yuli Zang </text>
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                <text>Sri Wahyuni</text>
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                <text>International Emergency Nursing Vol. 54 January 2021</text>
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Situational awareness during a full-scale exercise in an underground mine:&#13;
A qualitative single-case study of the ambulance incident commander</text>
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                <text>Introduction: Underground environments present challenges for providing and managing effective emergency care. Situational awareness (SA) has been suggested as a critical process to the management of care.&#13;
Aim: This study aims to explore the process of SA in the tasks of an ambulance incident commander (AIC) during a fullscale underground mine exercise.&#13;
Methods: Data consisted of video recordings, audiotapes and fieldnotes; these were subjected to content analysis based on the categories from the Busby Theory of Situational Awareness in Multi-casualty Incidents.&#13;
Results: The results show that the underground mining environment presented the AIC with specific challenges for the SA process with respect to aspects such as situational information about the scene and the victims, as well as with making decisions for ambulance personnel so they could perform their work safely, and having a structured manner to counteract information overload. Both technical and non-technical aspects influenced the process.&#13;
Conclusion: The AIC’s situational awareness was largely built through coordinated communications and actions with collaborating actors. The results of this study can be used for further exploration of how to train and support people in medical leadership roles on aspects of SA in emergency care, as well as on how to evaluate educational outcomes through exercises. </text>
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                <text>Annika Eklund, Britt-Inger Saveman, Lina Gyllencreutz</text>
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                <text>Sri Wahyuni</text>
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                <text>1755-599X</text>
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                <text>International Emergency Nursing Vol. 54 January 2021</text>
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                  <text>International Emergency Nursing Vol. 54 January 2021</text>
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                <text>International Emergency Nursing Vol. 54 January 2021&#13;
The experience of non-conveyance following emergency medical service&#13;
triage from the perspective of patients and their relatives: A qualitative study</text>
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                <text>Background: As many as 25% of all Dutch ambulance emergency service assignments result in non-conveyance of the patient to the hospital. Little is known about how patients and their relatives experience being left at home by an ambulance nurse after an acute request for medical help.&#13;
Aim: To gain insight into the experience of patients and their relatives with a high urgency request for ambulance assistance that results in non-conveyance, with the ultimate goal of offering adequate follow-up.&#13;
Method: A qualitative design based on semi-structured interviews with fifteen patients and seven relatives, conducted between September and November 2018. &#13;
Results: Four themes emerged from the thematic analysis: Fear as the prominent emotion, four components of confidence in decision-making, different consequences and coping between patient and relative(s) over time and the perceived need for evaluation afterwards.&#13;
Conclusion: The experience after non-conveyance has several phases in which fear, reassurance, confirmation (for relatives) and shame (for patients) follow each other throughout the care process. Complex interpersonal skills of ambulance nurses congruent with the concept of person-centred care can modulate this impact. These findings offer starting points for the optimisation of training programmes within the ambulance care sector. </text>
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                <text>Silvie C.M. van Doorn, RN, MSc, Ruud C. Verhalle, RN, MSc, Remco H.A. Ebben, RN, PhD, Donna M. Frost, RN, PhD, Lilian C.M. Vloet, RN, PhD, Carin P.M. de Brouwer, PhD</text>
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                <text>Sri Wahyuni</text>
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                <text>1755-599X</text>
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                <text>International Emergency Nursing Vol. 54 January 2021</text>
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