Background and objectivesInternational and national health policies advocate greater integration of emergency and community care. The Physician Response Unit (PRU) responds to 999 calls ‘taking the Emergency Department to the patient’. Operational since 2001, the service was reconfigured in September 2017. This article presents service activity data and implications for the local health economy from the first year since remodelling.MethodsA retrospective descriptive analysis of a prospectively maintained database was undertaken. Data collected included dispatch information, diagnostics and treatments undertaken, diagnosis and disposition. Treating clinical teams recorded judgments whether patients managed in the community would have been (1) conveyed to an emergency department (ED)and (2) admitted to hospital, in the absence of the PRU. Hospital Episode Statistics data and NHS referencing costs were used to estimate the monetary value of PRU activity.Results1924 patients were attended, averaging 5.3 per day. 1289 (67.0%) patients were managed in the community. Based on the opinion of the treating team, 945 (73.3%) would otherwise have been conveyed to hospital, and 126 (9.7%) would subsequently have been admitted. The service was estimated to deliver a reduction of 868 inpatient bed days and generate a net economic benefit of £530 107.ConclusionsThe PRU model provides community emergency medical care and early patient contact with a senior clinical decision-maker. It engages with community providers in order to manage 67.0% of patients in the community. We believe the PRU offers an effective model of community emergency medicine and helps to integrate local emergency and community providers.

Healthcare is one of the basic needs for human beings. Unfortunately, a densely populated country like Bangladesh has always struggled to provide adequate healthcare to all of its people, especially to the rural population. To handle with huge amount of data and coordination between the doctors and patients, electronic health record system (EHR) has become a necessity. During this Covid-19 pandemic, face to face consultation between frontline workers like doctors, and nurse and patients has become difficult. As a result, many patients are having difficulty in getting treatment from doctors. In Bangladesh’s perspective at this moment, a cost effective, energy efficient and portable device system is needed to build up a customized Electronic health record system. The proposed system can reduce medical errors about patient identification and treatment, increase effectiveness and timeliness of doctors and overall improve the health care of people of the rural area. Therefore, an easy to use, affordable, user-friendly E customized EHR system design is proposed in this paper by utilizing recent wireless communication techniques that will give the rural people better health service.

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

Increase in the number of participants who are interested in Off-Roading Trips has contributed to the growth of the local tourism economy of the hill areas of Kerala, but it was found that Off-Roading without any control, would create serious repercussions to the natural environment in the areas. The study focused on the popularity and the significance of Off-Roading Trips in the Hill Areas of Kottayam, Idukki, Pathanamthitta and Wayanad and suggests strategies to be adopted so as to improve sustainable Off-Roading practices in the regions.