Wednesday, August 31, 2005

DIY Narcan

From the Chicago Tribune, emphasis added:

"Heroin addicts get overdose remedy
Training helps put treatment on streets"

Street lore holds that in case of a heroin overdose, the victim should be made to walk, placed in a cold shower or shot up with everything from salt water to milk.

But on Tuesday, a Chicago health organization tried to spread the word about the remedy that works best: a drug called naloxone.

It's a clear liquid that reverses the potentially fatal effects of opiate drugs. The Chicago Recovery Alliance, which has trained 5,000 people in how to use naloxone, says the instruction has saved at least 336 lives over the last four years.

"As a physician, this is some of the most rewarding work I've ever done," said Dr. Sarz Maxwell, the alliance's medical director.

She was leading a workshop for six outreach workers who, in turn, are supposed to pass their knowledge to heroin addicts. Once trained, drug users can get bottles of naloxone and syringes from Maxwell.
Heroin kills by depressing breathing. Naloxone reverses that effect, which for decades has made it the standard emergency room method of reviving overdose victims.

The alliance, formed in 1992, operates needle exchanges--providing sterile needles in exchange for used ones--around the city and suburbs. Alliance officials believe that heroin addicts can save fellow users with naloxone. Most won't call 911 if a friend gets in trouble for fear of the police, Maxwell said.

Naloxone "wakes people up enough that they can walk to the car and go to the hospital," she said. "That might be a better idea [to users] than inviting the cops up to your apartment where all your dope is laying out."

Dr. Richard Feldman, head of the emergency department at Advocate Illinois Masonic Medical Center in Lakeview, said he saw little downside to the training.

"It's an extremely rapid-acting, effective and safe drug," he said. "I would be very supportive of [the training program], because there are a lot of heroin addicts who die without ever getting to the hospital."

But in the view of Dr. Andrea Barthwell, a public health consultant and former official with the White House Office of National Drug Control Policy, distributing naloxone helps support drug habits and makes addicts harder to reach.

"If you engage in strategies that delay confrontation of the disease and application of curative strategies, you actually do more harm than good," she said.

But those who took the training said their main concern is to help in a moment of crisis. Ana Arias, an HIV case manager at Howard Brown Health Center in Lakeview, said that some of her clients use heroin, and that naloxone could keep them and their peers around until they're ready for help.

"If you know for sure this person isn't going to stop, you're not enabling them, you're helping to save their life," she said.

Hurricane Katrina - One Hospital's Experience in Mississippi

From the Hattiesburg American:

Forrest General Hospital is running short of water, is rationing food and has closed its doors to everyone but staff, patients and their families.

Hospital President William Oliver said one of the biggest problems the hospital has is a shortage of water, which he said is critical because “it is used for personal hygiene, cooking, cleaning, sterilizing equipment and for dialysis patients.”

Oliver said Forrest General is working with volunteer fire departments and various vendors to make sure there is enough water to maintain the bare necessities. Even though the hospital has enough food to last a few days, he said, it’s still being rationed.

At Wesley Medical Center, Catherine Pittman, director of customer service, said the hospital is open today for anyone in need of medical care.

“We will be open, but we will not be doing surgeries,” she said. “People who are sick can visit our emergency room.”

Pittman said the medical staff at Wesley put the needs of the patients above everything else during Hurricane Katrina.

“They were great troopers through this whole thing,” she said. “A lot of our employees stayed overnight to make sure our patients were cared for.”

Oliver said Forrest General has had a problem with people trying to use the hospital as a shelter. He said people needing shelter are being redirected to the James Lynn Cartlidge Forrest County Multi Purpose Center.

Oliver said the hospital has about 250 patients, and two generators are maintaining enough power for emergency situations. He said another generator is on the way.

“Facilities are very limited,” he said. “Once we get the resources, once some patients are discharged and we have water to clean, we should be able to accept patients. Without air conditioning, surgery has to be very limited.”

“This building did amazingly well,” he said. “We were very fortunate. Staff, doctors and employees stepped up to the plate to take care of patients during the storm.”

Tuesday, August 30, 2005

Rapid Response Team in Mercy Sioux City

Excerpted from the Sioux City Journal:

Mercy Medical Center -- Sioux City will begin using a Rapid Response Team this Thursday.

A Rapid Response Team can be called into action to assess a hospitalized patient who has had a significant change in clinical condition while on a non-ICU medical or surgical floor in the hospital.

"The team can be called by the floor nurse or the attending physician," explained Diane Prieksat, Mercy's Quality Services director. "The goal is to intervene as soon as possible when a patient becomes unstable in order to avoid cardiac or pulmonary arrest."

"Several national studies indicate that patients often exhibit signs and symptoms of physiological instability for some period of time prior to cardiac arrest," Prieksat said. "Our Rapid Response Team which will be comprised of a Mercy Air Care flight nurse, an ICU nurse, a respiratory therapist and a laboratory medical technologist will take action whenever a patient first starts to show any of those signs or symptoms that suggest his or her condition is deteriorating."

Redwood Falls ER Partnerships

From the Redwood Falls Gazette, word about the collaborative relationships of one of our affiliated facilities:

Staff at the Redwood Area Hospital pride themselves on providing the right care at the right time and in the right place.

That care, however, might not always be within the walls of the local hospital.

"When patients come to the hospital here, our primary goal is that they get the best possible outcome," Redwood Area Hospital Administrator Jim Schulte said. "We work in partnership with a number of different providers to reach that outcome."

Monday, August 29, 2005

State funding supports 24-hour ER at Hawaii hospital

RE: Rural Hawaii, From Modern Physician:

Waianae (Hawaii) Coast Comprehensive Health Center received $1 million in state funding to maintain its emergency room 24 hours a day year-round. Without the grant, the not-for-profit facility would have been forced to eliminate services between midnight and 8 a.m., officials said. Established in 1972, Waianae Coast is the largest community-owned health center in the state, serving 23,000 patients annually, and is the only facility equipped to handle emergency medical care in the 50,000-resident Waianae area, located on the west side of the island of Oahu. The nearest emergency room is located 16 miles -- or about 30 to 40 minutes -- away at 102-bed St. Francis Medical Center-West, Ewa Beach.

Chest Pain Center

From the Milwaukee Journal Sentinel

Every day, thousands of people drive past an I-94 billboard telling them that Elmbrook Memorial Hospital is Waukesha County's first accredited chest pain center.

A billboard on I-94 for Elmbrook Memorial Hospital does not say that although the hospital can perform other treatments, it lacks a cardiac catheterization lab to treat heart attack patients.

But if their chest pain is caused by a heart attack, they could be sorely mistaken in thinking that the hospital will fully treat the emergency.

Recently, the small, community hospital placed an ad on a billboard along I-94 near the Waukesha-Milwaukee county line, just a few miles from its doors. The billboard tells westbound motorists about the hospital's recent chest pain accreditation.

What the ad does not say is that while the hospital has an emergency department that can diagnose a heart attack, it does not have a cardiac catheterization lab. That means it is not capable of opening a blocked coronary artery with balloon angioplasty, the preferred method for treating a heart attack.

The billboard also does not say that nearly all the heart attack patients who go to Elmbrook have to be transferred by ambulance to other hospitals with catheterization labs, a process that can take as long as an additional half-hour.

Sunday, August 28, 2005

Organ Donation: "Presumed Consent"

From the LA Times

Most Americans volunteer to become organ donors by affixing a sticker to their driver's license. But that method isn't producing enough donors to meet the nation's profound need. More than 89,000 Americans are awaiting organ transplants — surgeries that have become highly successful at prolonging the lives of people who might otherwise die — but only about 20,000 organs became available last year.

Even when an individual's driver's license indicates a willingness to donate, some families override those wishes at the time of death.

That's why some people suggest it's time for the United States to do what more than a dozen other countries do: assume people want to donate unless they specify otherwise, by adding their names to a government-operated registry.

Known as presumed consent, some ethicists and organ transplant activists are advocating for the concept even though they acknowledge it's controversial. It's uncertain whether such a system would ever be endorsed in this country, as it has in many European countries.

"The driving factor behind presumed consent is the fact that the waiting list continues to rise at a rapid rate," said Richard Darling, a Palm Desert dentist and three-time liver transplant recipient who is active in transplantation issues. "As we get close to 100,000 people awaiting donation, that's going to open people's eyes."

In June, the American Medical Assn. adopted a policy on organ donation that encourages pilot studies investigating the effectiveness of presumed consent. The California Medical Assn.'s ethics committee will also discuss presumed consent later this year.

The Advisory Committee on Organ Transplantation, a federal government panel, and the United Network for Organ Sharing, the agency that oversees organ procurement and distribution nationwide, are also discussing the idea of presumed consent.

"It's one additional avenue to consider," said Margaret Allee, chairman of the Organ Procurement and Transplantation Network-UNOS ethics committee.

Presumed consent is among several ideas that have been proposed for increasing organ donation. Other suggestions include some form of financial compensation to families, such as payment for funeral expenses or monetary rewards to families who donate.

The Rise of TB in Africa

A bit of a stretch, given the theme of the blog, but I thought it particularly interesting given the fact the movie "The Constant Gardener" opens this week. The film, based on the excellent le Carre' novel, deals with a pharmaceutical scandel involving TB in Kenya. Excerpted from the Independent:

The World Health Organisation is ready to announce a regional emergency over levels of tuberculosis throughout Africa. African health ministers and WHO officials met in Mozambique this week to discuss how to halt the spread of HIV, malaria and tuberculosis in Africa.

By declaring the rising rates of TB infection to be an emergency, it is hoped to unlock extra money from the G8 nations and the Global Fund, which helps developing countries fight disease.

Rates of tuberculosis are rising alarmingly in Africa, where it is linked to the spread of HIV/Aids. HIV weakens the immune system and makes sufferers more susceptible to infectious diseases such as tuberculosis and pneumonia, which they cannot afford to treat.

Tuberculosis is now believed to be the single biggest killer of adults and young people in the world and accounts for a third of Aids-related deaths. In Africa, it kills more than 500,000 people a year

Saturday, August 27, 2005

Court says police may enter emergency room without warrant

An interesting development in Vermont, as reported in the Boston Globe:

Law enforcement officers may enter a hospital emergency room without a warrant when they suspect a patient was a drunken driver, the Supreme Court ruled on Friday.

The court rejected an appeal by Adam Rheaume, who was charged with drunken driving after an accident in Highgate on May 19, 2002.

Justice Marilyn Skoglund, writing for a unanimous court, said that patients cannot expect full privacy in the emergency ward of a hospital. Such wards, she said, are open to emergency workers, medical staff and other hospital workers not involved in direct patient care, families and other patients, extinguishing any claim to privacy.

Besides, Skoglund said, Rheaume did not take any steps to protect any privacy he may have wished.

"Once the officer entered the trauma room, defendant did not ask him to leave or suggest the room was private or inaccessible in any way," she said. "Defendant did not attempt to leave or limit contact with the officer."

Rheaume was taken to Northwestern Medical Center in St. Albans for treatment of injuries after the accident in Highgate. State Trooper Jeffrey Smith went to the hospital to investigate the crash after he was told by rescue workers that they believed Rheaume was drunk.

The Supreme Court said nurses gave him permission to see Rheaume and he walked into a trauma room whose door was open. Rheaume had cuts to his lip and tongue and his bleeding hands were wrapped.

Smith told Rheaume of his rights and asked if he would agree to be interviewed. Rheaume refused, saying he was in too much pain. Smith advised Rheaume of his rights under state law and asked whether he would agree to provide a blood sample to determine his drunkenness. Rheaume refused and Smith then cited him for drunken driving.

Skoglund wrote that before Rheaume was taken from the room for X-rays, he yelled out that he knew the trooper was there to charge him with drunken driving and "he would not have been drinking and driving were it not for a fight at a party he attended before the accident."

Rheaume asked District Court Judge Michael Kupersmith to suppress those statements, but the judge refused. So Rheaume agreed to a plea agreement that preserved his right to appeal to the Supreme Court.

The high court determined Friday that Kupersmith's ruling was appropriate and dismissed Rheaume's appeal.

Car Seat Efficacy

I imagine this will be rather controversial in the safety community. An excerpt from a New York Times article posted to the Freakonomics website (which supports the best selling book of the same name):

Perhaps the single most compelling statistic about car seats in the NHTSA manual was this one: ''They are 54 percent effective in reducing deaths for children ages 1 to 4 in passenger cars.''

But 54 percent effective compared with what? The answer, it turns out, is this: Compared with a child's riding completely unrestrained. There is another mode of restraint, meanwhile, that doesn't cost $200 or require a four-day course to master: seat belts.

For children younger than roughly 24 months, seat belts plainly won't do. For them, a car seat represents the best practical way to ride securely, and it is certainly an improvement over the days of riding shotgun on mom's lap. But what about older children? Is it possible that seat belts might afford them the same protection as car seats? The answer can be found in a trove of government data called the Fatality Analysis Reporting System (FARS), which compiles police reports on all fatal crashes in the U.S. since 1975. These data include every imaginable variable in a crash, including whether the occupants were restrained and how.

Even a quick look at the FARS data reveals a striking result: among children 2 and older, the death rate is no lower for those traveling in any kind of car seat than for those wearing seat belts. There are many reasons, of course, that this raw data might be misleading. Perhaps kids in car seats are, on average, in worse wrecks. Or maybe their parents drive smaller cars, which might provide less protection.

Friday, August 26, 2005

IL Governor Signs Med Mal Law

From Modern Physician

Illinois Gov. Rod Blagojevich has signed a medical malpractice law that caps noneconomic damages at $500,000 in cases against physicians and increases regulatory oversight of medical liability insurers in the state. The legislation includes a $1 million cap for hospitals, and allows physicians to apologize for errors without such statements being used against them in court.

The medical establishment, which has sought the changes for years, said the law will reduce the cost of liability insurance and stop the migration of doctors who may be leaving the state because of high costs. "Every patient and physician in Illinois should be happy to know that positive change is on the way," said Craig Backs, president of the Illinois State Medical Society.

Previous attempts to impose a cap have been declared unconstitutional by the state Supreme Court, and lawyers are already mounting an effort to have the legislation overturned, saying it strictly limits the rights of plaintiffs in cases where doctors have made errors.

"No Wait" ER's

I love the title on this one, excerpted from The Journal News.

"Hospitals figure patients don't like to wait"

Hudson Valley is hoping that yesterday's opening of its new "no-wait" emergency room will attract patients who dread waiting a long time to be treated in other crowded facilities.

The hospital's emergency room overhaul is the first in a wave of emergency room expansions coming to Westchester that are designed to cope with a growing patient load and, if not actually eliminate emergency room waits, then at least reduce them and make them less stressful.

Among its improvements, the million-dollar redesign at Hudson Valley doubled the number of patient rooms and eliminated the need for patients to stop at a registration desk by introducing bedside registration on a wireless computer.

"Our patients have told us what they would appreciate most is eliminating the whole waiting period," said John Federspiel, the hospital's president.

Thursday, August 25, 2005

State's Malpractice Cap Applies to Award in Civil EMTALA Action

From BNA’s Health Care Daily (Volume 10 Number 164, Thursday, August 25, 2005, ISSN 1091-4021)

6th Circuit Says State's Malpractice Cap Applies to Award in Civil EMTALA Action

Noneconomic damages awarded in a failure-to-stabilize claim brought under the Emergency Medical Treatment and Labor Act must be reduced in accordance with Michigan's limitation on malpractice awards because the federal statute incorporates state law and the claim would be considered a medical malpractice action under state law, a federal court of appeals held Aug. 18 (Smith v. Botsford General Hospital, 6th Cir., No. 04-1436, 8/18/05).

In an issue of first impression for the U.S. Court of Appeals for the Sixth Circuit, Judge Deborah L. Cook reduced the $5 million district court jury award to less than $400,000, ruling that Michigan's malpractice cap on noneconomic damages applied to Andrea Smith's EMTALA claim.

Smith sued Botsford General Hospital under EMTALA's civil enforcement provision, alleging the hospital failed to stabilize her husband, Kelly Smith, before transferring him to another hospital better equipped to deal with a man of his size. Kelly Smith, a 600 pound man whose suffered a broken left femur that pierced the skin of his thigh in an automobile accident, died from extensive blood loss while being transferred, according to Cook.

Cook affirmed the jury verdict in favor of Smith, but reduced the award pursuant to Michigan's malpractice law.

EMTALA Incorporates State Law

EMTALA's civil enforcement provision allows individuals harmed as a result of a hospital's violation of the federal statute to recover personal injury damages "under the law of the State in which the hospital is located," according to Cook, quoting 42 U.S.C. §1395dd(2)(A). The plain language of the statute therefore incorporates state law, Cook said.

The next step, Cook said, is to determine whether Smith's claim would constitute a medical malpractice action under Michigan law. A claim sounds in malpractice if it relates to an action that occurred during the course of a professional relationship and involves a question of "medical judgment beyond the realm of common knowledge and experience," Cook said, highlighting the test the Michigan Supreme Court set forth in Bryant v. Oakpointe Villa Nursing Center, 684 N.W. 2d 864 (Mich. 2004).

Smith's claim met the definition on both counts, Cook said. There was no dispute that Botsford's treatment and transfer of Smith occurred within the course of a professional medical relationship. Further, Cook concluded that Smith's claim necessarily involved questions of medical judgment, even though an EMTALA action does not require a breach of the professional standard of care.

The statute's stabilization requirement demands a medical judgment to determine "within a reasonable medical probability" whether a patient can be transferred without risking a deterioration in his or her condition, Cook said.

Cook also addressed Smith's challenge that Michigan's cap on damages violated the Seventh Amendment and her right to equal protection under the constitution.

Concluding there was no Seventh Amendment violation, Cook noted that the role of jury is to determine the extent of a plaintiff's injuries, not the legal consequences of its factual findings. As to equal protection, Cook said Michigan's choice to limit the amount of a plaintiff's recovery did not violate a fundamental right and served the legitimate state interest in controlling health care costs.

Full text of the decision is available at

Wasp Stings in Wisconsin

Excerpted from the Milwaukee Journal- Sentinel

"Rash of wasp attacks stings area "

Medical and emergency response officials from Milwaukee-area counties confirmed Wednesday that wasp and bee stings are on the rise and expressed concern about the severity.

"Over the last three weeks, we've had a tremendous increase in incidents of bee stings, and occasionally some are becoming infected," said Bill Haselow, an emergency medicine physician at Columbia St Mary's, Ozaukee Campus in Mequon.

On some shifts, as many as seven patients have sought treatment for stings, he said.

"It's definitely more than I've ever seen," said Thomas Dietrich, an emergency medicine physician at St. Joseph's Hospital near West Bend.

Wednesday, August 24, 2005

Woman Offended by Doctor's Obesity Advice

From AOL News, excerpted below:

As doctors warn more patients that they should lose weight, the advice has backfired on one doctor with a woman filing a complaint with the state saying he was hurtful, not helpful.

Dr. Terry Bennett says he tells obese patients their weight is bad for their health and their love lives, but the lecture drove one patient to complain to the state.

"I told a fat woman she was obese," Bennett says. "I tried to get her attention. I told her, 'You need to get on a program, join a group of like-minded people and peel off the weight that is going to kill you.' "

He says he wrote a letter of apology to the woman when he found out she was offended.

Her complaint, filed about a year ago, was initially investigated by a board subcommittee, which recommended that Bennett be sent a confidential letter of concern. The board rejected the suggestion in December and asked the attorney general's office to investigate.

Bennett rejected that office's proposal that he attend a medical education course and acknowledge that he made a mistake.

Top Ten Medical Devices We Miss

From Medgadget, excerpted from "Top Ten Medical Devices We Miss"

1. The Precordial Thump

It couldn't be simpler, or more satisfying: take your fist and whack an unresponsive patient's breastbone. And before people knew about cardiac contusions or commotio cordis, it was done quite a bit. The thump isn't entirely gone -- it's still allowed by ACLS guidelines for witnessed arrest in the absence of a defibrillator. There's some evidence that the energy of the strike can sometimes convert a ventricular tachycardia to a normal rhythm, and in the case of witnessed arrest, it's worth the risk. Otherwise, it's an artifact of a lively past.

Monday, August 22, 2005

New Efforts Begin to Improve CPR Effectiveness

Excerpted from Associated Press / AOL News

"New Efforts Begin to Improve CPR Effectiveness
Guidelines, New Machines Designed to Help People Do it Right"

Old-fashioned CPR is getting a makeover. Cardiopulmonary resuscitation is crucial when people collapse with cardiac arrest, but it's hard to perform correctly.

Now major efforts are under way to improve how doctors, paramedics and average bystanders do the job: New CPR guidelines are due this fall, and high-tech machines that promise to help are already showing up in ambulances and offices.

Not yet proven is whether using technology - like a chest-squeezing gadget or sensors that coax rescuers to pound harder - to spice up the 40-year-old resuscitation technique really will save lives.

Emergency-care specialists agree that CPR today doesn't save as many lives as it could.

"We've got our work cut out for us to make sure CPR is done better,'' says Mary Fran Hazinski of the American Heart Association, which is finalizing new recommendations designed to do just that.

More than 300,000 Americans each year die of cardiac arrest, where the heart's electrical system goes haywire and the heart abruptly stops beating.

Portable defibrillators can increase survival, delivering a jolt of electricity that stuns the heart, ending the abnormal rhythm and giving it a chance to resume a normal beat.

But the heart-zappers alone aren't enough. Virtually all cardiac-arrest victims need CPR, too. It buys time until a defibrillator arrives. Often, it's needed immediately after zapping, as the heart struggles to resume circulation.

Also, studies show that doing CPR first makes defibrillation more likely to work if cardiac arrest has lasted longer than three minutes. The longer someone goes without oxygen, the more their abnormal heart rhythm degrades until it's unshockable.

But "it has to be good CPR. We don't want to delay defibrillation for crummy CPR,'' warns Dr. Lance Becker of the University of Chicago, co-author of one of a pair of surprising studies earlier this year that found even the best-trained rescuers - doctors, nurses and paramedics - too frequently give inadequate CPR.

The studies found long pauses in CPR; that rescuers often didn't pound hard or fast enough on victims' chests; and that they pumped too much air into the lungs (a mistake more prone to professionals using hand-held air bags instead of mouth-to-mouth breathing.)

Why? Good CPR is tough - you must compress the chest 1 1/2 to 2 inches deep - and rescuers tire or may pause to prepare the defibrillator or perform other tasks.

More on Rapid Response Teams

From Modern Physician

"Hospitals embrace rapid response teams to prevent deaths"

The number of Australian-theme Outback Steakhouse restaurants has grown to 898 from zero in 17 years. In healthcare, another inspiration from Down Under -- hospital rapid response teams -- has shown even more explosive growth, to roughly 1,400 U.S. hospitals today from no more than 50 two years ago, according to the Institute for Healthcare Improvement in Boston.

Australians are credited with developing the rapid response team concept, which focuses on identifying hospitalized patients as their conditions just start to decline and providing immediate, aggressive treatment. The typical team consists of a critical-care nurse, a respiratory therapist, and other support staff and physicians as needed.

Nurses are asked to call the team if they have a "gut feeling" a patient is in trouble or when physiological measures, such as sharp changes in blood pressure or heart rate, indicate there may be trouble.

Two factors influenced the rise of rapid response teams in the U.S., experts said. First, the federal Agency for Healthcare Research and Quality began using "failure to rescue" deaths -- hospital patients who die of medical complications -- as a quality measure. And the IHI began promoting rapid response teams in its "100,000 Lives" campaign.

The nearly year-old campaign seeks to avert 100,000 preventable patient deaths by encouraging hospitals to adopt rapid response teams, evidence-based care for heart attacks and various interventions to prevent adverse drug events, ventilator-associated pneumonia, and central-line and surgical-site infections.

The impact of the campaign on the growth of rapid response teams has been "absolutely huge," said Terri Simmonds, a nurse who is an IHI faculty member and director.

So far, Centura Health in Denver has deployed rapid response teams at 10 hospitals and will expand to one more in December, said Terry O'Rourke, M.D., the system's chief medical officer.

"We were talking about (rapid response teams), but our decision to participate in the IHI campaign certainly added some emphasis," O'Rourke said. "Our projections show we have the potential to save 50 to 100 lives (systemwide) annually, and our experiences so far could support that kind of an outcome -- or even better."

O'Rourke said it's too early for definitive data, but rapid response teams have been getting 10 to 15 calls a month in Centura's larger hospitals and three to five a month in smaller facilities. The result, he said, has been fewer cardiac arrests.

Sunday, August 21, 2005

Picture Archiving Communications System (PACS)

An interesting article about digital radiography, from the Gainsville Times, excerpted below:

"Film is a thing of the past at hospital"

The lighted box that doctors use to view X-rays fast is becoming a museum piece.

A growing number of hospitals are ditching film and converting to a computerized system for storing images.

Northeast Georgia Medical Center made the switch this spring, spending more than $11 million to implement its Picture Archiving Communications System (PACS).

The new technology, which includes X-ray, MRI, CT scans and cardiac imaging, was introduced at the Lanier Park campus in March, followed by the Imaging Center in April and the main campus in May.

David Kimball, chief of radiology at the hospital, said he and his colleagues are enthusiastic about the change.

"A lot of us used this type of system when we were in training, but it's still found mostly at the academic hospitals," he said. "This technology can improve the accuracy of diagnosis, because you can manipulate the image any way you want.

"And reading off a computer makes things so much faster," he said. "You always have quick access to images. You don't have to go hunting for them."

Bulky film images created two major problems: getting them from one place to another and finding someplace to put them.

Saturday, August 20, 2005

Rural Hospital Information Technology

From Iowa Senator Chuck Grassley, as published in the Iowa Hospital Association Friday Mailing "Newstand" supplement, excerpted below.

Information technology holds the promise of reducing health care disparities for those living in rural communities. We can measure our success in building an IT infrastructure by the provision of quality care in these communities challenged by long distances and scarce medical resources.

The Institute of Medicine (IOM), National Committee on Vital and Health Statistics, and numerous experts recommend information technology as a powerful tool for iincreasing quality and improving efficiency in health care. One of the best ways we can leverage IT is in the creation of a national health information infrastructure that supports improved decision-making and public health initiatives. I believe, however, that to develop a comprehensive IT infrastructure we must focus on rural America, which truly needs assistance in the adoption and use of health IT. Until information technology is integrated within health care delivery systems in Iowa, Montana, Alaska and other rural and frontier areas, the transition to an interoperable health IT system that links all providers nationwide is not possible.

Friday, August 19, 2005

New triage program can reduce ER wait times

From Modern Physician

New triage program can reduce ER wait times: study

A new program to streamline registration and expedite care can cut emergency room wait times by nearly a half hour, reducing the number of patients who risk further health problems by leaving without treatment, according to a new study.

Researchers said an urban emergency department was able to decrease patients' wait times by an average of 24 minutes and average length of stay in the department by 31 minutes by implementing a program called ED REACT, or Rapid Entry and Accelerated Care at Triage. The program streamlines the registration process, improves triage and begins tests and interventions before patients are placed in ER beds.

Long wait times, a common complaint about emergency departments, often prompt patients to leave without seeing a physician. Surveys have shown that as many as 7% of the nation's emergency departments have "leave-without-being-seen" rates higher than 5%, with some reporting rates as high as 15%, the study shows.

"Patients who leave emergency departments before they are seen by a physician represent a failure in the healthcare safety net," said Theodore Chan, M.D., an emergency medicine physician at the San Diego Medical Center and lead author of the study published online today by the Annals of Emergency Medicine.

He said patients who leave the ER before being seen by medical personnel are "most likely to return to the emergency department later and in worse condition."

Thursday, August 18, 2005

Rapid Response Teams

We've been researching the 100K Lives "Rapid Response Team Concept". This sound like the same thing.

Response Team Rushes Relief in Medical Crises

In an effort to speed care at the first sign of change in patient condition, Methodist Healthcare has formed Medical Response Teams at each of its hospitals. A Medical Response Team (MRT) may be summoned at any time by anyone in the hospital to assist in the care of a patient who appears acutely ill.

"The Medical Response Team is an important improvement in patient care," said Dr. Francis J. Fenaughty, medical director of emergency services, Methodist Le Bonheur Germantown Hospital.

"Research has shown that there are certain cues long before patients become critically ill or suffer a cardiopulmonary arrest. The team welcomes calls and assists the patient's nurse in the care of the patient. The emergency physician on duty assists in the care of the patient, as needed," Fenaughty said.

The purpose of the Medical Response Team is to provide appropriate responses to health-status instability in order to improve clinical care, minimize Intensive Care Unit admissions, and improve patient outcomes.

If at any time, a nurse or other caregiver feels uncomfortable about a patient's condition, the MRT can be called to assess the patient. The MRT will act as a consultant and will assist the staff nurse with assessment and management of the patient. The team is available to any nurse 24 hours a day to answer questions or respond to any situation.

The National Institute of Health (NIH) has set guidelines that track specific diagnoses throughout the hospital.

The MRT at Germantown tracks such quality initiatives by identifying patients - in collaboration with the bedside nurses and case managers - who fall into the NIH guidelines.

The MRT at Germantown is comprised of a critical care nurse and a respiratory therapist during the weekdays (7 a.m.-7 p.m.) and an advance practice nurse and a respiratory therapist on weeknights (7 p.m.-7 a.m.) and weekends.

Nurse Practitioner Clinics at Osco

Excerpted from Zwire

"Nurse practitioners coming to Osco"

Six Osco stores in the Kansas City area will soon have more than a pharmacy and the usual drugstore offerings.

Albertsons is partnering with Take Care Health Systems to open in-store health centers, staffed by nurse practitioners, in six Greater Kansas City Osco stores by Nov. 1. This means that patients ages 24 months and over will have another option if they have a common family illness, need immunizations such as hepatitis B or tetanus, or would like to undergo certain diagnostic health screenings. Patients can visit the Take Care Health Centers without an appointment seven days a week.

"We're not an emergency room and we're not a primary care office," said Sandra Ryan, CPNP, national director of nurse practitioners for Take Care Health Systems, based in Conshohocken, Pa.

In the centers, nurse practitioners will be working alone while they are there. After patients check themselves in at a computerized kiosk, the nurse practitioner will call the patients back to one of two examination rooms.

But the nurse practitioners will have support from electronic medical records and information systems that will help to guide them through a diagnosis after they input symptoms. In addition, a network of physicians will be available in the Kansas City area for the nurse practitioners to consult with.

"Even though they are functioning independently in the centers, they have built-in support systems through the electronic medical records system and network of providers," Ryan said.

One example of someone who might use one of these centers is a mother who picks up her child from school and finds out that the child has an earache. It's too late to make an appointment at their primary care physician that day, and it's not serious enough to visit an emergency room.

"This is an extension of care. We are not to take the place of primary care providers," Ryan said. "...It will take the burden off emergency rooms having health care centers like this available."

Patients also will have paperwork they can take back to their primary care physician regarding their visit to the Take Care Health Center.

Tuesday, August 16, 2005

No assault weapons means a good day at the office

From the Bangor Daily News, excerpted below..

None of my patients showed up at the office today with an assault rifle, and none showed up dead. Unless I missed something none of them had any body parts blown off, and none carried a virulent, infectious pestilence dangerous to all around. For some doctors around the world that would qualify as a great day. Once in a while those of us who love to whine about health care in the United States need to remember just how much it can suck (that's a medical term meaning to really stink) to be a patient or a health care professional in most of the rest of the world.

Three medical colleagues returning from tours of duty in Afghanistan and Iraq reminded me of this fact recently, by their stories and by the looks of changed men.

One spoke of practicing in a clinic in Afghanistan where the main entrance (actually, that's too grand - the entrance was just a wooden door) had a sign forbidding assault weapons inside the premises. Another spoke of the piece of shrapnel in his neck, blown there by a suicide bomb in Iraq that killed 20 of his comrades. The third said nothing of his experience, but his eyes spoke of a man who was still trying to figure out all he had seen in his work on an evac helicopter for wounded American soldiers.

By comparison, if you had asked me about my day in the office today I would have spoken about the frustrations of the piles of paper awaiting me after two weeks on vacation. By comparison, some of the world of health care outside my pristine office, and outside this wealth nation, is a world of want and medical mayhem most of us cannot imagine; a day in it would have most of us reaching for our Prozac, a luxury itself in a world where the only medicine for depression might be tomorrow.

‘Employees Did Not Do Job,' Administrator Says In Response to ER Treatment Complaint

From the Ashley County Ledger (Arkansas), excerpted below:

‘Employees Did Not Do Job,' Sword Says In Response to ER Treatment Complaint

"What happened was that my employees did not do their job," Ashley County Medical Center administrator Russ Sword responded after hearing a complaint by a county citizen in regard to service in the emergency room of the county hospital the weekend of July 9. "There is absolutely no excuse, and I will offer none," he said.

His comments came after James C. Mills addressed the members of the quorum court in regard to his wife's visit to the emergency room. Mills said that his wife woke up about 2 a.m. with an itch and swelling which he said threatened to close her throat and cut off her breathing. He gave her Benadryl to help with the swelling and then took her to the emergency room at the hospital.

When they arrived at the emergency room, he said that they filled out the paperwork, "and no one came to take her vital signs". He said he was told that the emergency room was waiting on an ambulance with a gunshot victim, and they were there 15 to 20 minutes before the ambulance arrived, with no treatment. "There were two doctors at the hospital," he said, "and she couldn't be seen."

Monday, August 15, 2005

ER doctor at JFK's assassination tells his story

From the Casper Star Tribune, excerpted below...

Only a small number of eyewitnesses to the JFK assassination are alive today, and even fewer of the team of ER doctors on staff at Parkland Hospital that day are able to tell their stories.

Saturday at the Trigeminal Neuralgia Association Conference at the Holiday Inn in Casper, neurosurgeon Dr. Phil Williams, M.D., spoke of his experiences on Friday, Nov. 22, 1963, in Dallas.

"Even though it was 40 years ago, it is still a part of our lives," said Williams, who was on staff at Parkland Hospital that day. A few hands raised when Williams asked who in the crowd of neurosurgeons could remember the exact place they stood when Kennedy was shot.

"The next thing we remember like that in our history is 9/11," Williams said.

In September of 1963, Williams was put in charge of the emergency room at Parkland Hospital in Dallas, where only two months later, President Kennedy would be brought to die. Williams had just graduated from Tulane University in New Orleans, returning to his hometown of Dallas for his internship. On Fridays around noon, Williams said he usually went to the ER to tend to the patients, but on that particular Friday, he was at a conference on the third floor above the ER.

A little after noon, Williams and his colleagues heard pages for some of the most important doctors at Parkland, but shrugged them off. A few minutes later, another intern stuck his head through the conference room door and said that President Kennedy and then Gov. John Connally were in the ER with gunshot wounds.

Sunday, August 14, 2005

ED Co-Pay for Poor Patients

From the Clarion-Ledger

"Co-pay of $30 for poor looms"

University of Mississippi Medical Center officials are considering charging poor patients a $30 co-pay before receiving care, a move UMC said is necessary because of declining financial support from the state.

"It's a very difficult decision on many levels. It's personally difficult for me," said UMC Vice Chancellor Dr. Dan Jones, who earlier this year told lawmakers about the hospital's funding concerns. "That's simply the financial reality we face."

Whether the proposal would comply with federal law is under discussion, Jones said. A 1986 federal law requires hospitals receiving Medicaid and Medicare funding to treat patients in the emergency room "regardless of (their) ability to pay."

"A co-pay in our system is more complicated," Jones said. "We're still working through the policy decisions."

The plan could be in place this fall, though UMC could not provide an estimate of how much money the plan would generate — or save.

Jones said patients with medical emergencies still would receive treatment. The $30 would help the hospital offset rising health-care costs and encourage those with non-emergencies to seek care from county health clinics and not the emergency room, he said.

"Our emergency room will remain open to anyone who has an emergency," Jones said. "No one is trying to evade responsibility to provide care."

Bone Injector Gun (Intraosseous)

Tipped off by MedGadget, I checked out this artticle on Israel21c, about the Israeli Army's use of this intraosseous device, excerpted below..

Whether on the battlefield or in the emergency room, when first responders arrive to treat a critically injured patient, they sometimes cannot administer vitally needed intravenous fluid.

Either the veins have collapsed or in the cases when blood pressure is low, such as heart attacks or unconsciousness, veins contract and are hard to find.

American emergency personnel serving in Iraq and Afghanistan know this as well as anyone, which is why they've come to rely on a novel Israeli-made device - WaisMed's Bone Injection Gun (BIG) which enables a medic to bypass the veins and penetrate the tibia within seconds to inject saline or medications into the marrow.

The BIG is the world's first automatic intraosseous (IO) infusion device, and was invented by Dr. Marc Waisman - an orthopedic surgeon. Not quite a needle, the device is described by WaisMed's CEO Mickey Flint as "a simple tube with a trigger that is released."

This "simple tube" is saving lives around the world. It is being used throughout the American military - not only by many units in Iraq and Afghanistan - but also by the CIA, the Department of Homeland Security and the Department of Health and Human Services. Other customers include American hospitals, emergency medical service providers and fire departments.

Saturday, August 13, 2005

Critical Perception Gaps About Emergency Care

From Medical News Today, excerpted below...
(Includes a pitch for Dermabond, but is otherwise worthwhile)

"Critical Perception Gaps About Emergency Care As Annual Emergency Room Visits Hit Record Highs"

Many US Adults Feel Uninformed About Treatment Alternatives and Disempowered to Make Affirmative Treatment Decisions in the Emergency Room -

New national survey results released today indicate that while the vast majority of U.S. adults feel confident that they know when a cut is serious enough to require emergency care, there is a considerable disconnect after actually reaching the emergency room. The survey, commissioned by ETHICON, INC., and conducted by Harris Interactive®, found that more than one-third of U.S. adults feel only somewhat or not at all confident that they would know the right questions to ask if they had to go to the emergency room for a serious cut or laceration. Even more astoundingly, more than two in five adults believe they do not have a choice in the type of care they receive once they are at the emergency room.

This news is significant considering that, according to a recent report from the Centers for Disease Control and Prevention, annual emergency room visits have reached a record level of 114 million annually, a 26 percent increase from 1993.

How Stuff Works: Emergency Room

I happened upon this site by accident and found it to be of interest. Ton's of ads, but a nice overview. Perhaps of use in developing instructions and explanations for your community.

How Stuff Works: How Emergency Rooms Work

In this article, Dr. Carl Bianco leads you through a complete behind-the-scenes tour of a typical emergency room. You will learn about the normal flow of traffic in an emergency room, the people involved and the special techniques used to respond to life-or-death situations. If you yourself find the need to visit an emergency room, this article will make it less stressful by revealing what will happen and why things happen the way they do in an emergency department.

Friday, August 12, 2005


From Modern Physician

Three hospitals settle EMTALA allegations

Three hospitals paid a total of nearly $60,000 in July to settle 'patient-dumping' allegations made by HHS' inspector general's office, Modern Healthcare has learned.

Dominican Hospital, Santa Cruz, Calif., agreed to pay $33,000 to resolve allegations that it violated the Emergency Medical Treatment and Active Labor Act (EMTALA) when it failed to perform an adequate medical screening on one patient and stabilize another. Dominican is a 276-bed facility owned by San Francisco-based Catholic Healthcare West.

Lakeside Hospital, a 75-bed facility in Metairie, La., owned by Nashville-based HCA, agreed to pay $20,000 to settle two incidents of alleged patient-dumping in which the government said the hospital's emergency staff failed to assess the conditions of two patients. In both cases, the ER staff allegedly told the patients to go to other facilities without screening them first, as required by EMTALA.

Hickman Community Hospital, a 25-bed critical-access hospital in Centerville, Tenn., owned by St. Louis-based Ascension Health, agreed to pay $5,000 to resolve two allegations that the hospital failed to conduct medical screenings and raised questions about insurance that could have deterred patients from seeking treatment there.

Wisconsin Medical Malpractice

From Modern Physician

Wis. med mal task force appointed in wake of state's high court ruling

Speaker of the Wisconsin State Assembly Rep. John Gard (R-Peshtigo) has appointed a task force to study the state's medical malpractice laws and options for heading off any problems stemming from the state's Supreme Court's ruling last month declaring Wisconsin's caps on noneconomic damages unconstitutional. The panel will comprise five legislative members and five public members, including two lawyers, a physician and two healthcare executives.

"Wisconsin was a nationwide model for medical malpractice reform," Gard said in a press release. "That law made us a destination state for good doctors. We will work hard to regain that title."

Wisconsin Medical Society spokesman Steve Busalacchi said his organization's preference would be to bring back a cap that passes the court's constitutionality test. Until then, he said Wisconsin's medical community would be marked by uncertainty.

"It's too early to say what the effects of the court's ruling will be," he said. "But, right now, we have a lot of scared doctors who are concerned about what could happen."

He added that double-digit percentage increases in medical liability insurance premiums are expected in January.



Plaintiffs Score Win in Hospital 'Patient Dumping' Case

In a significant win for plaintiffs bringing claims under the federal Emergency Medical Treatment and Assisted Labor Act -- a law designed to prohibit hospitals from engaging in a practice known as "patient dumping" -- a federal judge has ruled that such a plaintiff need not show that she was indigent or uninsured to invoke the law.

The 22-page opinion in Love v. Rancocas Hospital by U.S. District Judge Joseph E. Irenas of the District of New Jersey marks the first time that any judge within the courts of the 3rd U.S. Circuit Court of Appeals has addressed EMTALA's requirements.

ACEP Statement on Procedural Sedation

From the American College of Emergency Physicians (ACEP)

"Delivery of Agents for Procedural Sedation and Analgesia by Emergency Nurses"

Approved by the ACEP Board of Directors April 2005 and the Emergency Nurses Association (ENA) Board March 2005

Published simultaneously, October 2005, in Journal of Emergency Nursing and Annals of Emergency Medicine
(Policy #400347, Approved April 2005)

The Emergency Nurses Association (ENA) and the American College of Emergency Physicians (ACEP) support the delivery of medications used for procedural sedation and analgesia by credentialed emergency nurses working under the direct supervision of an emergency physician. These agents include but are not limited to etomidate, propofol, ketamine, fentanyl, and midazolam.

Ottumwa, Iowa EMTALA Update

From the Ottumwa Courier

Medicare will continue payments to Ottumwa Regional Health Center, rescinding a threat to cut off the hospital for flawed patient care procedures.
ORHC received a notice from Medicare on July 26 that payments would end as of Aug. 11. That decision was based on a series of inspections that showed flaws in patient care in the hospital's mental health unit. A public notice from Medicare was printed in The Courier the next day.

Medicare rescinded the hospital's termination on Wednesday.

Thomas Lenz, an associate regional director with the Centers for Medicare and Medicaid Services, told The Ottumwa Courier that Ottumwa Regional's plan of correction has been accepted and that the hospital passed a new inspection by the state department of inspections and appeals.

"They have confirmed that the hospital has implemented appropriate corrective actions," Lenz said. "We fully expect that the hospital will maintain that standard of care."

Hospital CEO Lynn Olson said Wednesday that the hospital has made changes based on the incidents Medicare cited. It accepted Medicare's position that the hospital violated the specifics of patient care law.

"We have never denied the incidents that were cited in the original investigation," Olson said.

The hospital did contend that an incident July 1, in which Medicare accused the hospital of discharging an unstable patient, was not a violation.

"The only thing that we said was not a violation was the July [incident], was the result of the July 13 inspection where we said we felt that the patient was discharged in a stable condition," Olson said. "Our position on that hasn't changed. We don't believe that the hospital discharged the patient in unstable condition.
What we said then and what we say now is that the documentation of that was [flawed]."

Lenz said the complaints were valid and were indeed violations.

"We believe there was reason to investigate the complaint. That complaint was investigated and substantiated," he said, adding there could still be civil penalties against the hospital. "Because the complaint was valid and substantiated, the hospital may be subject to monetary penalties."

Lenz said those penalties could involve fines for civil rights violations. Medicare is not involved in that decision.

"That's a separate track," Lenz said.

Olson confirmed that civil penalties remain possible for the hospital.

"That's always a possibility in these," Olson said. "Generally they refer it to the Office of the Inspector General and then that office conducts its own investigation."
Neither Lenz nor Olson were sure if the inspector general had initiated such proceedings.

Additional details emerged Wednesday about just how the entire investigation began. Officials previously said the hospital failed an investigation in April and a follow-up investigation in July. It turns out that concerns were raised even before the April investigation.

Lenz said Medicare became concerned about Ottumwa Regional as a result of an inspection at an entirely different hospital. An inspection of that hospital's records raised questions about ORHC and led to the April inspection.

"We were reviewing a complaint at another hospital and identified ... this situation at Ottumwa. It's kind of convoluted, but that's what happened," Lenz said.

Complaints come from four basic sources. Lenz said hospitals are expected to self-report violations, that receiving hospitals can file a complaint if they have concerns about a patient's prior care, patients themselves may file reports, or complaints may arise out of professional reviews.

Medicare considers the complaints about the mental health issue as one continuous issue as opposed to a series of incidents.

"CMS looks at this not as one incident. They look at it as all the incidents. They view this as one continuous process, so when they come back for re-visits, it's not what they find at that visit, it's the whole picture. And they reminded us of that," Olson said.

There will be changes within the emergency room. Olson said the hospital will have social workers with training in psychiatric counseling on call to assist the emergency room doctors. The hospital may expand that to bring in psychiatric nurses for the same purpose.

"It's having someone with specific psych experience available to help the ER doctor fill out an evaluation of that patient," Olson said. "They can still determine if they need a psychiatric consult on top of that. This is an attempt to give them a resource that we haven't had before."
The future remains unclear for the mental health unit itself. The unit had two of the three psychiatric positions filled at the time of the complaints, but both psychiatrists have since submitted their resignations. A statement from Ottumwa Regional said the psychiatrists will leave the hospital in October and November, respectively.

Olson said he is not sure at this time what the impact of the first departure will have.

"It depends on if we recruit another psychiatrist or if we get some temporary help. Just don't know that yet," Olson said. Asked if ORHC is considering contracts with local psychiatrists who are not currently affiliated with the hospital, Olson said that that is an option. "We're looking at all options, including that."
A statement issued by the hospital said the mental health unit will be forced to close if new psychiatrists are not found. The unit is certified for up to 23 patients.

Monday, August 08, 2005

Washington Post Editorial: ER Disaster Readiness

From the Washington Post

Still Not Ready in The ER

By Arthur Kellerman

One of the fundamental responsibilities of government is to coolly and dispassionately assess health threats against the populace and take decisive action to counter these threats.

Faced with the twin specters of mass casualties from international terrorism and emerging biological threats, our government has failed to take effective action on either front.

International terrorism's weapon of choice is explosives -- improvised and otherwise. The London attacks and the devastating Madrid bombings are only some of the more recent examples. Over the past decade terrorist bombings have caused many civilian deaths and injuries in Israel, Russia, Bali, Colombia, Iraq, Spain, Egypt, Yemen, Kenya, Tanzania, Argentina, Afghanistan, the Philippines and other places, including two U.S. embassies in Africa.

But unfortunately, rather than strengthen our nation's beleaguered emergency and trauma care system to meet this threat, the federal government has turned a blind eye to the problem. Across the United States, underfunded emergency rooms and trauma centers lack sufficient beds to meet their daily mission, much less absorb large numbers of victims from a terrorist attack. Few ambulance personnel know how to assess a blast scene or properly evaluate multiple casualties from a bombing. The tiny amount of federal funding ($3.5 million) devoted to trauma systems planning and development is being targeted for elimination by the House.

Pay for On Call

From the Arizona Daily Sun

Local baby doctors and Flagstaff Medical Center are in a dispute over caring for walk-in patients without being paid to be on call.
Depending on how the issue is resolved, it could wind up costing FMC up to $1 million a year or mean less local care for pregnant women.

In 2003, according to its tax returns, FMC had total revenues of more than $235 million.

The OB-GYN department at FMC has voted 7-4 that, without a daily on-call payment, it would not agree to be placed on the hospital's rotating call list to take patients who are admitted to the emergency room or show up at FMC without a private physician.

The department has given FMC officials until Aug. 20 to put a "cogent and decent" offer on the table for negotiation.

The doctors contend that other medical specialties in Flagstaff are paid hundreds of thousands of dollars a year to be on call, and they deserve the same consideration, especially because many of the pregnant women who come to FMC have not had adequate prenatal care and are high-risk patients.

Carlson said some specialists are compensated for call -- neurosurgeons, orthopedic surgeons, general surgeons and psychiatrists -- but that's because FMC is required by federal law and, in the case of the psychiatrists, by state law, to cover the emergency room "commensurate with its capabilities."

FMC is one of only seven trauma centers in the state and the only one north of Bell Road in Phoenix, said Carlson, and it sees about 1,600 trauma cases a year.

According to the FMC's 2003 tax return, it paid Northern Arizona Orthopaedics and Neurosurgery $526,483 and Forest Country Anesthesia $477,731.

"We have to compensate them for that additional demand," Carlson said, adding that obstetrics is not considered "trauma care" according to industry standards

Sunday, August 07, 2005

ACEP: Emergency Physicians Offer Advice on Decreasing Teen Motor Vehicle Fatalities

Excerpted from the American College of Emergency Physicians (ACEP)

"Crashes Among Teen Drivers Peak in Summer Months"

Teen drivers average 44 percent more hours behind the wheel each week during the summer. Of the 6,434 youth (ages 15 to 20) motor vehicle fatalities in 2000, July saw more deaths (644) than any other month, followed by June (600), September (590) and August (587), according to the National Highway Traffic Safety Administration.

Based on the latest injury prevention research, emergency physicians offer the following advice to parents on how to decrease their teen's risk of a fatal crash.

Limit Passengers
Teenage passengers significantly increase the risk of a fatal crash for 16- and 17-year-old drivers and the risk increases with the number of passengers. In fact, the majority of deaths that occur in crashes involving young drivers are to other people, particularly their own passengers. Parents of teenagers may want to limit their child's exposure to teenage drivers, even if it means driving their child themselves.

Limit Night-time Driving
Setting a 9 p.m. driving restriction for novice drivers could save their lives. In 2003, 32-percent of the crashes that killed 16- and 17-year-old drivers occurred between 9 p.m. and 5 a.m.

Choose a Safe Vehicle
Traffic safety experts believe that some vehicles are riskier for teen drivers. Sports cars can incite novice drivers to dangerous behavior, placing them and their passengers in jeopardy. Older vehicles may lack safety features of newer models, increasing occupants' risk of serious injury in a crash. The higher center of gravity in light trucks, including pickups and Sport Utility Vehicles (SUVs) may combine with novice mistakes and lead to an increased risk of rolling over.

Buckle Up
Parents and peers of teen drivers can have a major influence over safety belt use. This is important because of the teens killed as occupants in motor vehicles in 2003, only 33 percent (37 percent of drivers and 25 percent of passengers) were wearing safety belts at the time of the crash. One of the biggest factors affecting whether teenage drivers and passengers involved in fatal crashes were wearing a safety belt was whether or not the state where they were driving had a primary safety belt law - one that allows a police officer to pull the vehicle over simply for having occupants who are unbelted.

Zero Tolerance for Alcohol Use
Alcohol use increases the crash risk for all drivers. However, alcohol's contribution to heightened crash risk for drivers under 21 is markedly greater at lower blood alcohol concentrations, and increases more sharply at all levels of alcohol use.

For this reason, all states and territories in the U.S. have zero tolerance legislation, which means the legal limit of alcohol in a driver under 21 is zero (or 0.02, the limit of the test). However, relatively few teens know this (ranging from 32 percent to 71 percent).

Saturday, August 06, 2005

AED's in Churches

From the (Baton Rouge, LA) Advocate

Members of Shiloh Missionary Baptist Church hope they never need it, but they have it. First Presbyterian Church also has one, but more congregations have yet to talk about it.

The item in question is an automated external defibrillator, a medical device capable of shocking the heart and restoring its rhythm after a sudden cardiac arrest.

Mary Dudley, health-care committee chairperson at Shiloh, said her church bought a defibrillator just over two years ago in order to be proactive.

"I'm a cardiac care nurse, and we have a lot of people with emergency backgrounds on the committee. We looked at the cost and we advised Rev. (Charles) Smith (the church's senior pastor). He said 'Go for it.' "

The church is no stranger to such medical emergencies. Years ago, a member in his 30s directing the church choir had a cardiac arrest. He survived, but the incident lingered with members of the committee, Dudley said.

While an Emergency Medical Services unit is within blocks of the church, she said, the committee felt that when looking at the concept of "emergency, that time is muscle."

Since having the device, the church has trained members who serve as emergency responders, making certain Sunday services are covered, and plans are in the works to train church, day-care and administrative personnel.

Friday, August 05, 2005

BP Checks Under EMTALA

Howard Eikenberry, Assistant Administrator at Boone County Hospital in Boone, IA, discovered this in the Interpretive Guidelines, and I believe that constructing the policy and support documents could solve one of the more frustrating aspects of EMTALA compliance, dealing with requests for blood pressure checks.

(Emphasis added)

Interpretive Guidelines – Responsibilities of Medicare Participating Hospitals In Emergency Cases

Interpretive Guidelines §489.24(c)

Any individual with a medical condition that presents to a hospital’s ED must receive an MSE that is appropriate for their medical condition. The objective of the MSE is to determine whether or not an emergency medical condition exists. This does not mean that all EMTALA screenings must be equally extensive. If the nature of the individual’s request makes clear that the medical condition is not of an emergency nature, the MSE is reflective of the individual presenting complaints or symptoms. A hospital may, if it chooses, have protocols that permit a QMP (e.g., registered nurse) to conduct specific MSE(s) if the nature of the individual’s request for examination and treatment is within the scope of practice of the QMP (e.g., a request for a blood pressure check and that check reveals that the patient’s blood pressure is within normal range). Once the individual is screened and it is determined the individual has only presented to the ED for a non-emergency purpose, the hospital’s EMTALA obligation ends for that individual at the completion of the MSE. Hospitals are not obligated under EMTALA to provide screening services beyond those needed to determine that there is no EMC.


From Forbes

Qwest and Public Safety Officials Encourage ''ICE'' (in Case of Emergency) Entry on Wireless Phones

Qwest Communications International Inc. (NYSE:Q) today announced it is encouraging customers to enter the number of an emergency contact in their wireless devices under the title "ICE" (in case of emergency.) The growing practice of entering an ICE number has been encouraged by emergency responders as an easy, simple-to-implement tool in rapidly identifying and assisting those needing emergency care.

"Every wireless phone should have an ICE number entered," said Fire Chief Daniel Qualman, president of the Colorado State Fire Chiefs Association. "It helps first responders -- paramedics, fire personnel and police -- provide aid should a person not be able to speak for themselves in an emergency situation."

For teenagers and children, entering an ICE number to contact parents or guardians can deliver additional peace of mind. According to news reports, in 2003 close to 900,000 emergency victims in the United States were unable to provide contact information to emergency room personnel.

The idea originated in England by paramedics frustrated at the valuable lost time, and routinely needed to identify emergency victims carrying only a cell phone. The idea has gained momentum in Europe and the United States as emergency responders and wireless device owners understand the potential life-saving simplicity of the idea.

A single entry, or multiple ICE entries, can be created: -0- *T ICE - Dad ICE - Spouse 444-123-4567 555-123-4567 *T

"I can't tell you how many times our personnel have come to an accident scene where we need to render aid and the only clue we have about who the person is and what they might need is the cell phone. An ICE entry into the address book will save us time and help us deliver better care," said Qualman.

"We hope all wireless users will create an ICE entry today," said Rex Fisher, Qwest president for Nebraska. "Public safety is key to us as a provider of wireless services and Qwest will continue working with local emergency responders to heighten awareness of this simple tool."

Thursday, August 04, 2005

CPR Instructions Should Focus On Continuous Chest Compressions, UT Southwestern Physicians Recommend

From Science Daily, an excerpt:

Cardiopulmonary resuscitation (CPR) instructions given over the phone by emergency dispatchers to lay rescuers should focus primarily on continuous chest compressions instead of the traditional ABC's - "airway, breathing, circulation," according to Dr. Paul Pepe, chairman of emergency medicine at UT Southwestern Medical Center.

Dr. Pepe, along with international colleagues from the Council of Standards for the National Academies of Emergency Dispatch (NAED), made the recommendation in the May issue of the journal Resuscitation.

The council had been asked to update and modify protocols for emergency dispatchers who may need to give rapid telephone instructions on how to perform CPR. The council's recommendations were based largely on experimental data and a supportive clinical trial that found improved survival with a "compressions-only" approach. The council's recommendations were also based on the notion that simplifying the guidelines would increase the chances that CPR will be performed since some people may be reluctant to perform mouth-to-mouth resuscitation.

New, Simpler Treatment Guidelines Could Save Heart Attack Patients

From Science Daily

A University of Cincinnati (UC) physician is the lead author of new, simplified guidelines designed to help physicians treat and prevent heart attacks.

The original guidelines, issued by the American College of Cardiology (ACC) and the American Heart Association (AHA), tell emergency department physicians how to recognize early symptoms of heart attack, and what to do next.

The problem, said Brian Gibler, MD, chairman of UC's Department of Emergency Medicine, is that navigating the daunting 95 pages of the complete ACC/AHA guidelines probably leaves them underused.

Now, in the August edition of the Annals of Emergency Medicine, Dr. Gibler and other national emergency medicine and cardiology experts provide a distilled review of the ACC/AHA guidelines.

"It's critical that physicians know how to determine whether an emergency patient with chest pain is at high or low risk of a heart attack," Dr. Gibler said. "If used, the review will help physicians diagnose acute coronary events quicker, and provide faster treatment that may even prevent a heart attack or damage to the heart before it happens."

Each year, more than 5.3 million patients are treated in hospital emergency departments for chest pains. The challenge, Dr. Gibler points out, is for doctors to quickly identify those who are at highest risk for a heart attack.

Wednesday, August 03, 2005

CA Hospital May Close Its ED

From the Mercury News

Downey Regional Medical Center may have to close its emergency room because of the exorbitant costs of treating uninsured patients, hospital officials said.

Nine other emergency rooms in the county have shut down since 2003. Downey's, which served 46,307 patients last year, would be the largest recent closure and would force crowded hospitals in Whittier and Bellflower to absorb its patients, county officials said.

"It's going to be horrible," said Carol Meyer, the county's head of emergency services. "Our emergency system is falling apart."

On Tuesday, the private nonprofit hospital asked the county Board of Supervisors to help pay for treating poor patients by approving a plan that would have entailed a tax hike. Supervisors rejected that appeal, arguing that helping Downey could prompt other hospitals to come calling for aid.

The county's Department of Health Services is staring at a $1 billion shortfall over the next three years.

"I don't know how you could ask us to subsidize a private nonprofit," Supervisor Gloria Molina said. "Every single hospital would line up, because they have the same situation as you do."

Monday, August 01, 2005

An Interesting Set of Photos

From Medgadget...

Grad student from Rutgers, David LaPuma is status post craniotomy for benign meningioma removal. He has documented the perioperative experience via a set of pics at Flickr.

Decrease in Automobile Fatalities

Good news from

The death rate in auto crashes went down again last year, according to data released Monday by the National Highway Traffic Safety Administration. But there were some exceptions to that trend.

Overall, 42,636 people died in car crashes in the U.S. last year. That's fewer than the 42,884 who died in 2003.

It also means that slightly fewer people died for every 100 million vehicle miles driven in the U.S. last year.

In 2004, 1.46 people died for every 100 million miles driven in this country. In 2003, that number was 1.48. In 1966, 5.5 people died for every 100 million vehicle miles driven, according to NHTSA, and the death rate has been steadily improving since then.

Motorcycle deaths continued to increase, rising 8 percent from 2003, marking the seventh consecutive annual increase in motorcycle deaths. Last year, 4,008 people died in motorcycle crashes, up from 3,714 in 2003. The increase was lower than last year's however, when there was a 12 percent increase in motorcycle deaths between 2002 and 2003.

Gift Idea from Amazon CEO

In a "10 Questions for Jeff Bezos" article in the August 1st issue of
TIME, the Amazon CEO is asked:

What do you think will be Amazon's biggest gift item this holiday

His response: "One of our top gift items is the Philips HeartStart
defibrillator. Defibrillators will continue to get cheaper and end up
us a very common piece of household equipment, much like a fire

EMS Licensure

From the Milwaukee Journal Sentinel

While sorting out his wife's death in the collision of her car and an ambulance, Gregg Theune came across a single sentence he can't forget and wants to change.

"The ambulance shall be driven by an individual with a valid driver's license."

In a chapter of the Wisconsin Administrative Code, between the sections governing all-terrain vehicles and amusement rides, are the laws concerning ambulance service in the state. The part covering drivers vexes Theune because he thinks the single sentence is too simple.

"I was shocked to learn that no specialized training or certification is required to drive an ambulance," Theune explained. "Only a valid driver's license is needed.

"It's no different than someone who delivers pizzas."