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Fulltext Emergency traffic adaptive MAC protocol for wireless body area networks based on prioritization

Masud F, Abdullah AH, Abdul-Salaam G

PLoS One, 2019;14(12):e0225518.
PMID: 31790457 DOI: 10.1371/journal.pone.0225518

This paper proposes an emergency Traffic Adaptive MAC (eTA-MAC) protocol for WBANs based on Prioritization. The main advantage of the protocol is to provide traffic ranking through a Traffic Class Prioritization-based slotted-Carrier Sense Multiple Access/Collision Avoidance (TCP-CSMA/CA) scheme. The emergency traffic is handled through Emergency Traffic Class Provisioning-based slotted-CSMA/CA (ETCP-CSMA/CA) scheme. The emergency-based traffic adaptivity is provided through Emergency-based Traffic Adaptive slotted-CSMA/CA (ETA-CSMA/CA) scheme. The TCP-CSMA/CA scheme assigns a distinct, minimized and prioritized backoff period range to each traffic class in every backoff during channel access in Contention Access Period (CAP). The ETCP-CSMA/CA scheme delivers the sporadic emergency traffic that occurs at a single or multiple BMSN(s) instantaneously, with minimum delay and packet loss. It does this while being aware of normal traffic in the CAP. Then, the ETA-CSMA/CA scheme creates a balance between throughput and energy in the sporadic emergency situation with energy preservation of normal traffic BMSNs. The proposed protocol is evaluated using NS-2 simulator. The results indicate that the proposed protocol is better than the existing Medium Access Control (MAC) protocols by 86% decrease in packet delivery delay, 61% increase in throughput, and a 76% decrease in energy consumption.

Matched MeSH terms: Emergency Service, Hospital
Fulltext What constitutes a good medical emergency drill report

Jefferelli, S.B., Sunthar, R., Trauth B., Bauder, K.

Journal of Occupational Safety and Health, 2019;16(2):57-59.
MyJurnal

Good reporting of medical drill is important to optimise learning and benefit from the activity. This article shares our opinion on what constitutes a good medical emergency drill report. A good medical emergency medical drill report should include medical drill background, observation, remarks on observation and details of observers and reporter.

Matched MeSH terms: Emergency Service, Hospital
Fulltext Knowledge of Good Blood Culture Sampling Practice among Healthcare Staffs in An Emergency Department - Are We Getting It Right?

Chew KS, Mohd Hashairi F, Jusoh AF, Aziz AA, Nik Hisamuddin NAR, Siti Asma H

Med J Malaysia, 2013 Aug;68(4):323-5.
PMID: 24145260 MyJurnal

Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice.

Matched MeSH terms: Emergency Service, Hospital*
Fulltext The pattern of death related to trauma cases presented to the emergency department of a tertiary university hospital

Nik Ab Rahman NH, Mohd Hussain H

Med J Malaysia, 2013 Apr;68(2):148-52.
PMID: 23629562 MyJurnal

Trauma is an ever increasing problem and it is the leading cause of morbidity and mortality in the under 40s age group. The main purpose of this study is to determine the pattern of death related to trauma cases presenting to the emergency department (ED) of a university hospital. This was a retrospective analysis of 75 consecutive trauma case records at a university hospital for a one year period. The most common cause of deaths is motor vehicle crashes. The mean score for the injury severity score (ISS) and revised trauma score (RTS) on arrival to the ED among the succumbed patients were 27.8 (s.d 8.6) and 5.7 (s.d 1.1) respectively. 58.7% of deaths occurred within 48 hours after the admission. Less than 50% of studied patients were still alive beyond 45 hours post admission and less than 10% still alive beyond 11 days. Our analysis also showed that 28% (n=21) and 56% (n=41) of the studied sample had a probability of survival between 50% to 75% and more than 75% respectively upon arrival based on the initial vital signs in the ED and the trauma and injury severity score (TRISS) methodology. Overall, we observed similar injury mechanisms, demographics and causes of death compare to other studies. The figures from this study, mandate further exploration of preventive issues and management improvements that should be applied not only to the current trauma system, but also to the health care system in general.

Matched MeSH terms: Emergency Service, Hospital*
Potential problems with interventions that restrict access to patients who present inappropriately to Emergency Departments

Ting JY

Med J Malaysia, 2005 Aug;60(3):392-3.
PMID: 16379203
Matched MeSH terms: Emergency Service, Hospital/utilization*
Real-Time Impact Analysis and Response using a New Disaster Metrics: 2018 Sulawesi (Indonesia) Earthquake and Tsunami

Yew Y, Arcos González P, Castro Delgado R

Prehosp Disaster Med, 2020 Feb;35(1):76-82.
PMID: 31928556 DOI: 10.1017/S1049023X19005247

INTRODUCTION: The Richter Scale measures the magnitude of the seismic activity for an earthquake; however, it does not quantify the humanitarian need at the point of impact. This poses a challenge for humanitarian stakeholders in decision and policy making, especially in risk reduction, response, recovery, and reconstruction. The new disaster metrics tool titled "The YEW Disaster Severity Index" (DSI) was developed and presented at the 2017 World Congress of Disaster and Emergency Medicine, May 2017, Toronto, Canada. It uses a median score of three for vulnerability and exposure indicators, a median score percentage of 100%, and medium YEW DSI scoring of four to five as baseline, indicating the ability to cope within local capacity. Therefore, scoring more than baseline coping capacity indicates that external assistance is needed. This special real-time report was presented at the 2nd National Pre-Hospital Care Conference and Championship, October 2018, Malaysia.
REPORT: The aim of this analysis is to present the real-time humanitarian impact and response to the 2018 earthquake and tsunami at Donggala and Palu, Sulawesi in Indonesia using the new disaster metrics YEW DSI. Based on the earthquake (measuring 7.7 on the Richter Scale) and tsunami at Donggala, the humanitarian impact calculated on September 29, 2018 scored 7.4 High in the YEW DSI with 11 of the total 17 indicators scoring more than the baseline coping capacity. The same YEW DSI score of 7.4 was scored on the earthquake and tsunami at Palu, with 13 of the total 17 indicators scoring more than baseline ability to cope within local capacity. Impact analysis reports were sent to relevant authorities on September 30, 2018.
DISCUSSION & CONCLUSION: A State of Emergency was declared for a national response, which indicated an inability to cope within the local capacity, shown by the YEW DSI. The strong correlation between the earthquake magnitude, intensities, and the humanitarian impact at Donggala and Palu reported could be added into the science of knowledge in prehospital care and disaster medicine research and practice. As a conclusion, the real-time disaster response was found to be almost an exact fit with the YEW DSI indicators, demonstrating the inability to cope within the local capacity.

Matched MeSH terms: Emergency Service, Hospital/standards*
Fulltext Comparison of adaptive neuro-fuzzy inference system and artificial neutral networks model to categorize patients in the emergency department

Azeez D, Ali MA, Gan KB, Saiboon I

Springerplus, 2013;2:416.
PMID: 24052927 DOI: 10.1186/2193-1801-2-416

Unexpected disease outbreaks and disasters are becoming primary issues facing our world. The first points of contact either at the disaster scenes or emergency department exposed the frontline workers and medical physicians to the risk of infections. Therefore, there is a persuasive demand for the integration and exploitation of heterogeneous biomedical information to improve clinical practice, medical research and point of care. In this paper, a primary triage model was designed using two different methods: an adaptive neuro-fuzzy inference system (ANFIS) and artificial neural network (ANN).When the patient is presented at the triage counter, the system will capture their vital signs and chief complains beside physiology stat and general appearance of the patient. This data will be managed and analyzed in the data server and the patient's emergency status will be reported immediately. The proposed method will help to reduce the queue time at the triage counter and the emergency physician's burden especially duringdisease outbreak and serious disaster. The models have been built with 2223 data set extracted from the Emergency Department of the Universiti Kebangsaan Malaysia Medical Centre to predict the primary triage category. Multilayer feed forward with one hidden layer having 12 neurons has been used for the ANN architecture. Fuzzy subtractive clustering has been used to find the fuzzy rules for the ANFIS model. The results showed that the RMSE, %RME and the accuracy which evaluated by measuring specificity and sensitivity for binary classificationof the training data were 0.14, 5.7 and 99 respectively for the ANN model and 0.85, 32.00 and 96.00 respectively for the ANFIS model. As for unseen data the root mean square error, percentage the root mean square error and the accuracy for ANN is 0.18, 7.16 and 96.7 respectively, 1.30, 49.84 and 94 respectively for ANFIS model. The ANN model was performed better for both training and unseen data than ANFIS model in term of generalization. It was therefore chosen as the technique to develop the primary triage prediction model. This primary triage model will be combined with the secondary triage prediction model to produce the final triage category as a tool to assist the medical officer in the emergency department.

Matched MeSH terms: Emergency Service, Hospital
A perspective on emergency medicine in the developing world

Morton TD

J Emerg Med, 1992 7 11;10(4):485-8.
PMID: 1430987

The author spent 6 months as director of a major university hospital accident and emergency department in Kuala Lumpur, Malaysia. A brief summary of this experience is provided, followed by a series of recommendations based on the experience that may provide some guidance in future efforts to establish emergency medicine in developing areas of the world.

Matched MeSH terms: Emergency Service, Hospital
Fulltext Factors associated with discharge against medical advice from emergency department, Universiti Kebangsaan Malaysia Medical Centre

Ismail, A.K., Mohamad Ali, S., Che' Man, Z.

Medicine & Health, 2016;11(1):29-37.
MyJurnal

Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09-15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.

Matched MeSH terms: Emergency Service, Hospital
Fulltext Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation

Ahmad Khaldun, I., Mohd Fyzal, B., Soo, C. I., Yeap, B. T., Mohamed Faisal, A. H.

Medicine & Health, 2017;12(2):357-362.
MyJurnal

The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious patient. Many reported cases of locked-in syndrome following neurotoxic snake-bite mimics brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming. His condition deteriorated, and was intubated and ventilated in the emergency department. He received a total of 33 vials of the Ophiophagus hannah monospecific antivenom and subsequently recovered well with no neurological deficit. Retrospectively, he was able to recall the events and while he was lying paralysed and intubated under minimal sedation in the intensive care unit. He described it as a terrifying and painful experience. This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming lock-in syndrome from brain dead. Patients are unable to respond to physical pain and require adequate analgesia. A patient suffering this highly distressing experience may require psychological support.
Keywords: emergency, envenoming, neurotoxicity, snakebite

Matched MeSH terms: Emergency Service, Hospital
Fulltext Diagnosing pediatric intussusception through bedside ultrasound by novice emergency department sonographers: a case report

Farah, N. A., Ismail, M. S.

Medicine & Health, 2017;12(2):321-328.
MyJurnal

Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.
Keywords: diagnosis, Emergency Department, intussusception, paediatric, ultrasound

Matched MeSH terms: Emergency Service, Hospital
Fulltext Experiences of the public on the services in emergency department: a qualitative study

Aung,Khin Thandar, Fatin Izzati Saiful Bahri

International Journal of Care Scholars, 2018;1(2):1-4.
MyJurnal

Objective: The purpose of this study was to explore the experiences of the public on the services provided in the Emergency Department (ED) of Hospital Tengku Ampuan Afzan (HTAA). Methods: An exploratory, descriptive design was used to understand public experiences on the services in the ED. Ten respondents who fit the inclusion criteria were selected using purposive sampling method during their visit to the ED. They were interviewed for 30 to 45 minutes and were audio-recorded with the permission of the participants. The general meaning and the tone conveyed by the respondents were determined through coding, descriptions, and the themes that emerged. Results: Four major themes emerged from the study including waiting time, ED staff, information regarding the ED, and expectation on the ED services. Conclusion: As a result, there is a need to improve the practices in the ED and a need for an awareness program on the real functions and services of the ED

Matched MeSH terms: Emergency Service, Hospital
Fulltext Development and validation of the knowledge and clinical reasoning of acute asthma management in emergency department (K-CRAMED)

Mohd Muzammil Ozair, Kamarul Aryffin Baharuddin, Saiful Azlan Mohamed, Wafaak Esa, Muhamad Saiful Bahri Yusof

Education in Medicine Journal, 2017;9(2):1-17.
MyJurnal

Suboptimal management of asthma can lead to increase morbidity and mortality. Unfortunately, this has become global issue and approximately 40% of asthmatic patients received suboptimal management in emergency department. Therefore, this study aimed to develop a tool to assess knowledge and clinical reasoning of healthcare providers on acute asthmatic management in emergency setting.
Method: The tool was developed via three phases: (a) domain identification, (b) domain blueprinting based the Global Initiative of Asthma (GINA) and the British Thoracic Society (BTS) guidelines, and (c) item generation for each domain for assessing knowledge and clinical reasoning. Three forms of validity evidence related to content, response process and internal structure were appraised. Content validity index (CVI), face validity index (FVI), and intraclass correlation coefficient (ICC) estimate the content validity, response process and internal structure of the tool.
Results: A new tool was developed, named as Knowledge and Clinical Reasoning of Acute Asthma Management in Emergency Department (K-CRAMED), which assesses knowledge and clinical reasoning on three domains related to management of acute asthma – diagnosis, treatment and disposition. CVI values for the three domains were more than 0.83. FVI values for the three domains among doctors and paramedics were at least 0.83. The ICC between scores given by emergency specialists was 0.989 (CI 95% 0.982, 0.994, p-value < 0.001).
Conclusion: The newly developed tool, named as K-CRAMED, is a valid tool to assess knowledge and clinical reasoning of healthcare providers who manage patients with acute asthma. Further validation is required to verify its validity in other setting.

Matched MeSH terms: Emergency Service, Hospital
Fulltext Randomised controlled trial on the effectiveness of audible timed reminders for simulated serial pain score documentation in an emergency department

Ng, V.H., Ahmad Khaldun, I., Siti Sarah, M.Z., Ida Zarina, Z.

Medicine & Health, 2018;13(2):114-121.
MyJurnal

Pain is one of commonest presentations at Emergency Department (ED). Previous studies showed inadequate pain control in ED. However, few have addressed specific, practical methods of improving the timeliness and frequency of pain control in emergency setting. This study was a randomized controlled trial in a simulated environment of an actual functioning ED using a timer device to remind care personnel to assess pain and provide analgesia at set intervals versus a “standard therapy” group without visual/audio aids. The mean documentation performance scores between timer and control groups were 94.45% + 5.85 vs 72.22% + 17.57 (p

Matched MeSH terms: Emergency Service, Hospital
Analysis of pre hospital emergency management in case of head injury

Sumardino, Widodo, Poddar S

Enferm Clin, 2020 06;30 Suppl 5:228-233.
PMID: 32713577 DOI: 10.1016/j.enfcli.2019.11.061

INTRODUCTION: Cases of trauma still becomes a health problem in almost all countries causing death in few cases. In some developing countries, the insidences of head injury tend to increase. One of the reasons for the many death and disability may be due to the inavailability and inadequacy of pre-hospital first aid.
AIM: The general objective of this study is to find out the description of community first responder in providing pre-hospital first aid to head injuries.
METHODS: This study uses qualitative descriptive method.
RESULTS: Most of the respondents have variety of educational backgrounds and do not have sufficient knowledge and skills to provide first aid. The average respondents provided help by performing initial assessment, managing effective airway and controlling bleeding. Limited pre-hospital facilities become one of the reasons for respondent not getting help so the efforts provided are not maximal. Respondents prefer to send patients directly to health facilities.
CONCLUSION: Regular education and training programs for the community first responders should be initiated so that the number of death and disability can be minimized.

Matched MeSH terms: Emergency Service, Hospital
Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel 'Red Box' system

Saiboon IM, Singmamae N, Jaafar MJ, Muniandy BK, Sengmamae K, Hamzah FA, et al.

Saudi Med J, 2014 Jul;35(7):718-23.
PMID: 25028229

To evaluate the effectiveness of a new patient flow system, `The Red Box` on the quality of patient care in respect of the time taken for the care to be delivered to the patient.

Matched MeSH terms: Emergency Service, Hospital/organization & administration*
Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia

Awang R, Al-Sohaim SI, Zyoud SH, Khan HR, Hashim S

Intern Emerg Med, 2011 Oct;6(5):441-8.
PMID: 21750875 DOI: 10.1007/s11739-011-0662-z

Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.

Matched MeSH terms: Emergency Service, Hospital*
Fulltext Audit of pain management in the emergency department

Fathil SM, Soong NS, Mustafa NM, Arith A, Ng WN, Bahrum NA, et al.

Med J Malaysia, 2011 Jun;66(2):89-91.
PMID: 22106683 MyJurnal

Pain management in Malaysian Emergency Departments has not been studied well. Convenience sampling was used to recruit 402 patients who presented with acute pain over a 2-week period. The 11-point Numerical Rating Scale was used to quantify pain. Pain relieving medications were prescribed to 178 patients (44.3%) in the Emergency Department. These patients had a median pain score of 7 on arrival. Nonsteroidal anti inflammatory drugs were the most commonly prescribed class of analgesic. Pain was found to be inadequately treated.

Matched MeSH terms: Emergency Service, Hospital*
Fulltext Outcomes of cardiopulmonary resuscitation performed in Emergency Department, Hospital Universiti Sains Malaysia

Chew KS, Idzwan ZM, Hisamuddin NA, Kamaruddin J, Wan Aasim WA

Med J Malaysia, 2008 Mar;63(1):4-8.
PMID: 18935723 MyJurnal

Despite the progresses made in the science of cardiopulmonary resuscitation, there is lack of published works on this area in the Malaysian context. This survey was done to look at the outcomes of all cardiopulmonary resuscitation performed in Emergency Department (ED), Hospital Universiti Sains Malaysia (HUSM). This is a one year cross-sectional study from March 2005-March 2006. All adult cardiac arrest cases with CPR performed in ED, HUSM were included in the survey. The end points are return of spontaneous circulation (ROSC) and survival to ward admission. Out of the total 63 cases of cardiac arrest with CPR performed, only 19 cases (30.2%) had ROSC after CPR performed on them. Eventually only six patients (9.5%) had survival to ward admission. Patients with shockable intial arrest rhythm has a significantly higher chance to achieve ROSC (60.0%) compared to non-shockable rhythms (24.5%) (p = 0.025). However, there was no different in survival to ward admission between shockable and non shockable rhythms groups. The survival after cardiac arrest is still dismally poor. Perhaps we should be more selective in initiating CPR especially for out of hospital cardiac arrest.

Matched MeSH terms: Emergency Service, Hospital*
History of the orthopaedic specialty in Singapore

Satku K, Chacha PB, Low YP

Ann Acad Med Singap, 2002 Sep;31(5):551-7.
PMID: 12395635

The Orthopaedic specialty service in Singapore began in 1952 with the appointment of J A P Cameron to the chair of Orthopaedics at the University of Malaya and the simultaneous establishment of the Department of Orthopaedic Surgery at the General Hospital, Singapore. A second department--a government department of orthopaedic surgery was established in 1959, under the headship of Mr D W C Gawne also at the General Hospital, Singapore to cater to the increasing workload. Although orthopaedic services were already available at Alexandra Hospital, Tan Tock Seng Hospital and Toa Payoh Hospital from as early as 1974, the formal establishment of a Department of Orthopaedic Surgery in these hospitals took place only in 1977. The pioneering local orthopaedic surgeons--Mr W G S Fung, Mr K H Yeoh, and Mr V K Pillay--joined the orthopaedic service in 1961. In 1967, Prof Pillay and Mr Fung took the leadership role at the University Orthopaedic Department and Government Orthopaedic Department, General Hospital, Singapore, respectively. Subspecialty services in orthopaedic surgery began in the late 1970s, and currently, at least 7 subspecialties have developed to divisional status at one or more hospitals. In 2001, there were 92 registered Orthopaedic specialists and just over a third were in private practice.

Matched MeSH terms: Emergency Service, Hospital/history

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