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  1. Article: Emergency Department Hallway Care From the Millennium to the Pandemic: A Clear and Present Danger.

    Richards, John R / Derlet, Robert W

    The Journal of emergency medicine

    2022  Volume 63, Issue 4, Page(s) 565–568

    Abstract: Background: Emergency department (ED) crowding and hallway care has been a serious problem for the past three decades in the United States and abroad. Myriad articles highlighting this problem and proposing solutions have had little impact on its ... ...

    Abstract Background: Emergency department (ED) crowding and hallway care has been a serious problem for the past three decades in the United States and abroad. Myriad articles highlighting this problem and proposing solutions have had little impact on its progression.
    Objectives: To discuss reasons for ED crowding leading to hallway care, the impact of the coronavirus disease (COVID-19) pandemic, potential solutions, and why little has changed despite widespread awareness.
    Discussion: ED crowding has been a public health issue for the past three decades, leading to patient care and boarding of admitted patients in ED hallways with limited resources. This care is often substandard and precarious. The COVID-19 pandemic placed further strain on the ED safety net, especially in certain urban areas. Despite recognition of the problem, publication of studies, and proposals offering many solutions, this problem continues to worsen. Corporate and hospital leadership must be made aware of the financial and legal ramifications for failure to address potential solutions, such as inpatient hallway boarding, provision of flexible expansion care areas, smoothing of elective admissions/surgeries, and efficient inpatient discharge flow. State and federal legislation may also be required to motivate this process.
    Conclusions: ED crowding and hallway care will continue to worsen unless hospital leadership is willing to listen to ED staff concerns and address the problem on all levels of the hospital using previously proposed solutions. Emergency physicians should not fear termination for discussing this issue and its potential for poor clinical outcomes and ED staff morale.
    MeSH term(s) Humans ; United States/epidemiology ; Patient Admission ; Pandemics ; COVID-19 ; Crowding ; Emergency Service, Hospital
    Language English
    Publishing date 2022-09-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2022.07.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Wilderness Medical Society Clinical Practice Guidelines on Water Treatment for Wilderness, International Travel, and Austere Situations: 2024 Update.

    Backer, Howard D / Derlet, Robert W / Hill, Vincent R

    Wilderness & environmental medicine

    2023  Volume 35, Issue 1_suppl, Page(s) 45S–66S

    Abstract: To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not ... ...

    Abstract To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not assured, including wilderness and international travel, areas impacted by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiological contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence base includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians.
    MeSH term(s) Humans ; Disasters ; Societies, Medical ; Wilderness Medicine
    Language English
    Publishing date 2023-12-27
    Publishing country United States
    Document type Journal Article ; Practice Guideline
    ZDB-ID 1238909-2
    ISSN 1545-1534 ; 1080-6032
    ISSN (online) 1545-1534
    ISSN 1080-6032
    DOI 10.1177/10806032231218722
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: The Founding of a Journal.

    Derlet, Robert W

    The California journal of emergency medicine

    2017  Volume 3, Issue 3, Page(s) 35

    Language English
    Publishing date 2017-04-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2589126-1
    ISSN 1948-3392 ; 1948-3384
    ISSN (online) 1948-3392
    ISSN 1948-3384
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Introducing the New Editor-In-Chief.

    Derlet, Robert W

    The California journal of emergency medicine

    2017  Volume 3, Issue 3, Page(s) 36

    Language English
    Publishing date 2017-05-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2589126-1
    ISSN 1948-3392 ; 1948-3384
    ISSN (online) 1948-3392
    ISSN 1948-3384
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Corporate Control of Emergency Departments: Dangers from the Growing Monster.

    Derlet, Robert W / McNamara, Robert M / Tomaszewski, Christian

    The Journal of emergency medicine

    2022  Volume 62, Issue 5, Page(s) 675–684

    Abstract: Background: Corporate control in emergency departments (EDs) has increased during the past 20 years through hospital consolidation and the growth of ED contract management groups.: Objectives: To describe the growing corporate influence in the ... ...

    Abstract Background: Corporate control in emergency departments (EDs) has increased during the past 20 years through hospital consolidation and the growth of ED contract management groups.
    Objectives: To describe the growing corporate influence in the practice of emergency medicine and associated dangers to the public's safety and well-being.
    Discussion: Hospital systems through mergers and acquisitions have created regional monopolies providing them the power to charge high fees, which can lead to economic hardship for patients. Hospitals have also increasingly employed physicians and can exert influence over their practice to further increase profits. ED contract management groups (CMGs) obtain the exclusive contract for emergency services and gain control over the livelihood of emergency physicians, decreasing their autonomy and inserting the business interest into the physician-patient relationship, and this may result in harm to patients. Safety issues identified by emergency physicians may not be articulated for fear of being fired, and protocols may direct physicians to order unneeded testing and encourage unnecessary hospital admissions to make higher profits. Of additional concern, some CMGs are involved in graduate emergency medicine education, exposing physicians in training to corporate influence during their formative years.
    Conclusions: Given the potential harm to patients due to corporate influence, there must be serious consideration for legislative or regulatory solutions regarding the increasing corporate control of emergency medicine in the United States.
    MeSH term(s) Education, Medical, Graduate ; Emergency Medical Services ; Emergency Medicine/education ; Emergency Service, Hospital ; Humans ; Physicians ; United States
    Language English
    Publishing date 2022-04-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2022.01.026
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Another dogma dispelled? Antipsychotic treatment of sympathomimetic toxicity.

    Richards, John R / Derlet, Robert W

    The American journal of emergency medicine

    2019  Volume 37, Issue 12, Page(s) 2256–2257

    MeSH term(s) Antipsychotic Agents ; Autonomic Nervous System Diseases ; Humans ; Sympathomimetics
    Chemical Substances Antipsychotic Agents ; Sympathomimetics
    Language English
    Publishing date 2019-05-06
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2019.05.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Wilderness Medical Society Clinical Practice Guidelines for Water Disinfection for Wilderness, International Travel, and Austere Situations.

    Backer, Howard D / Derlet, Robert W / Hill, Vincent R

    Wilderness & environmental medicine

    2019  Volume 30, Issue 4S, Page(s) S100–S120

    Abstract: To provide guidance to clinicians, the Wilderness Medical Society convened experts to develop evidence-based guidelines for water disinfection in situations where the potability of available water is not ensured, including wilderness and international ... ...

    Abstract To provide guidance to clinicians, the Wilderness Medical Society convened experts to develop evidence-based guidelines for water disinfection in situations where the potability of available water is not ensured, including wilderness and international travel, areas affected by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiologic contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence evaluation includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks or burdens, according to the criteria published by the American College of Chest Physicians.
    MeSH term(s) Disasters ; Disinfection/methods ; Humans ; Practice Patterns, Physicians' ; Societies, Medical ; Travel-Related Illness ; Water Microbiology ; Water Purification/methods ; Wilderness Medicine/methods ; Wilderness Medicine/standards
    Language English
    Publishing date 2019-10-23
    Publishing country United States
    Document type Journal Article ; Practice Guideline
    ZDB-ID 1238909-2
    ISSN 1545-1534 ; 1080-6032
    ISSN (online) 1545-1534
    ISSN 1080-6032
    DOI 10.1016/j.wem.2019.06.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Overcrowding in U.S. EDS: A Critical Condition.

    Derlet, Robert W

    The California journal of emergency medicine

    2010  Volume 3, Issue 2, Page(s) 24–26

    Language English
    Publishing date 2010-09-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2589126-1
    ISSN 1948-3392 ; 1948-3384
    ISSN (online) 1948-3392
    ISSN 1948-3384
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Triage and ED Overcrowding: Two Cases of Unexpected Outcome.

    Derlet, Robert W

    The California journal of emergency medicine

    2010  Volume 3, Issue 1, Page(s) 8–9

    Language English
    Publishing date 2010-09-07
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2589126-1
    ISSN 1948-3392 ; 1948-3384
    ISSN (online) 1948-3392
    ISSN 1948-3384
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Backpacking in Yosemite and Kings Canyon National Parks and neighboring wilderness areas: how safe is the water to drink?

    Derlet, Robert W

    Journal of travel medicine

    2008  Volume 15, Issue 4, Page(s) 209–215

    Abstract: Objective: The objective of this study was to determine the risk of acquiring disease from popular Sierra Nevada wilderness area lakes and streams. This study examines the relative risk factors for harmful waterborne microorganisms using coliforms as an ...

    Abstract Objective: The objective of this study was to determine the risk of acquiring disease from popular Sierra Nevada wilderness area lakes and streams. This study examines the relative risk factors for harmful waterborne microorganisms using coliforms as an indicator.
    Methods: Water was collected in the backcountry Yosemite and Kings Canyon National Parks and neighboring wilderness areas. A total of 72 sites from lakes or streams were selected to statistically differentiate the risk categories: (1) natural areas rarely visited by humans or domestic animals; (2) human day use-only areas; (3) high use by backpackers; (4) high use by pack animals; and (5) cattle- and sheep-grazing tracts. Water was collected in sterile test tubes and Millipore coliform samplers during the summer of 2006. Water was analyzed at the university microbiology lab, where bacteria were harvested and then subjected to analysis using standardized techniques. Statistical analysis to compare site categories was performed using Fisher's exact test.
    Results: Coliforms were found in none of the 13 wild sites, none of the 12 day hike sites, and only 3 of 18 backpacker sites (17%). In contrast, 14 of 20 sites (70%) with pack animal traffic yielded coliforms, and all 9 sites (100%) below the cattle-grazing areas grew coliforms. Differences between backpacker versus cattle or pack areas were significant, p <or= 0.05. All samples grew normal aquatic bacteria. Sites below cattle grazing and pack animal use tended to have more total heterotrophic bacteria.<br />Conclusions: Alpine wilderness water below cattle areas used by pack animals is at risk for containing coliform organisms. Water from wild, day hike, or backpack areas showed far less risk for coliforms.
    MeSH term(s) Animal Husbandry ; Animals ; Animals, Domestic ; Animals, Wild ; Enterobacteriaceae/growth & development ; Enterobacteriaceae/isolation & purification ; Environmental Monitoring/methods ; Fresh Water/microbiology ; Humans ; Leisure Activities ; Mountaineering ; Nevada ; Risk Assessment ; Water Microbiology ; Water Pollution/analysis
    Language English
    Publishing date 2008-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 1212504-0
    ISSN 1708-8305 ; 1195-1982
    ISSN (online) 1708-8305
    ISSN 1195-1982
    DOI 10.1111/j.1708-8305.2008.00201.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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