Monday, October 31, 2005

ER's Swamped After Wilma


PLANTATION, Florida (AP) -- A week after Hurricane Wilma, more than 1 million Florida homes are still without power and many doctors' offices remain closed, leaving hospitals swamped as the only source of medical care in some communities.

"You can't get any regular doctors on the phone. You can't get anything filled," said Tim Swett, 41. He waited five hours at one emergency room and finally left without help for a back problem he had aggravated while cleaning up his mother's yard.

Doctors, Cadavers and America's First Riot

From Medgadget:

On this Halloween, we present a story that starts as a tale of the macabre, and evolves into star-studded massacre.

It's the tale of the first riot in the young United States, a riot not about taxes or whiskey but cadavers, and the inappropriate procurement of them.

Sunday, October 30, 2005

2nd Airlift Northwest Crash in One Month

From KOMO News:

OLYMPIA - Federal investigators were at Providence-St. Peter Hospital early Saturday, examining debris from the second Airlift Northwest medical-evacuation helicopter crash in a month.

None of the four people on board was seriously injured in the accident, which occurred on takeoff from the hospital roof late Friday. The previous crash, Sept. 29 near Edmonds, killed all three crew members.

One of the three crew members from Friday's accident was hospitalized overnight but expected to be released Saturday, hospital spokeswoman Deborah Shawyer said.

The fourth person in the aircraft was a patient who had been brought to Olympia from Grays Harbor County by ambulance for helicopter evacuation to Seattle's Harborview Medical Center.

Saturday, October 29, 2005

Conflict in Washington State

Trouble's brewing in Belfair, WA. From (registration required):

Fire District 2 Chief Mike Greene is in the middle of a controversy he didn't foresee when he sought election to the Mason County public hospital board.
In what Greene calls an "attack ad," six Mason General Hospital emergency room doctors say they have "no confidence in Mike Greene as a paramedic." Greene believes the ad stems primarily from a disagreement over rules for transporting patients with brain hemorrhages, especially those caused by a medical condition rather than "trauma."

In a written statement, the fire chief said the policy "endangers the lives of people in my community" and he has asked the state Department of Health to get involved. A DOH complaint against Greene also is being investigated.

At a Belfair candidates' forum last week, Greene told the audience the ad is "disgusting and despicable." His opponent, Don Wilson, answered, "I don't know if this is the proper format to bring that up."

The same ad has been in the county's weekly newspaper twice and in The Kitsap Sun once. In both papers, a line at the top urged voters to re-elect Wilson. The long statement ends, "He (Greene) is not trusted for his medical decision making and administrative motivations by those of us who know him best, and should not be elected to this position." Emergency staff work under the direction of ER physicians, the ad says, and "Mike Greene has a long history of attempts to subvert that control."

Greene placed a lengthy rebuttal in an ad in the weekly Belfair Herald last Thursday. In it, he wrote, "I challenge my opponent to address the emergency medical issues resulting from the DOH investigation."

He said he'd resign from the hospital board if proven wrong and asked Wilson to make the same pledge or "fix the problem."

Kelley McIntosh, chairman of the fire district's board of commissioners, said the five-member board stands firmly behind Greene. He's been District 2 chief since 1993 and a paramedic for 25 years.

"There have never been any questions in regard to his capabilities," she said. "There has never been any criticism, never been anything from the medical program director or any other place of employment."

But it was the county's medical program director, Joe Hoffman, who took the lead in writing the ad. He defends it as a statement of "different and collective opinions" based on the doctors' experiences, some spanning a decade or more. The ad wasn't politically motivated, Hoffman said.

"There are not any fallacies in there." He said he couldn't discuss specifics because of patient confidentiality.

Friday, October 28, 2005

Emergency Room Rap

From GruntDoc

Very amusing....

I'm a big fan of ER Nurses, but not of rap music. Why do I mention those two interesting things in one sentence?

Because the University of Alabama (Birmingham) ED nurses have the best Emergency Nurse rap video I've seen! For the record, I've seen exactly one, but it's terrific!

Disclaimers: It's a Windows Media file (.wmv), it's 3MB big, and I didn't create it. Also, I have no idea who made it ("the Internet is you Daddy"), so if it's yours, let me know.

Emergency room guarantees fast service


BRISTOL, Tenn. – Twenty-six minutes of your time could be worth $25.

Bristol Regional Medical Center now promises patients they will begin to receive treatment within 25 minutes or receive a $25 gift card to a local store or vendor.

The whole visit should last no more than 70 minutes, hospital officials promise.

Having to wait stands as the No. 1 complaint among patients visiting the emergency room at Bristol Regional, said Bart Hove, the hospital’s administrator.

"As the ER volume has grown over the years and we continue to survey our patients, one of the biggest dissatisfiers is the length of time it took to get the patients through the process because of the trauma center out here," he said.

"Mixing (minor problems) with the auto accidents and heart attacks, they always got put to the end of the line as we took care of our emergent need."

By dividing the emergency room into two sections – patients requiring immediate care and those requiring care for minor ailments and illnesses – both groups can receive treatment more quickly and efficiently, Hove said.

Patients with minor injuries or illnesses go to the "quick care" section of the ER.

Man in hospital hit by woman with crowbar

Insult after injury...
From Sign On San Diego:

COLLEGE AREA – A man in the Alvarado Hospital emergency room awaiting care after getting into a fight was attacked by a woman with a crowbar and seriously injured Wednesday night, police said.

The victim, who is in his 60s, was taken to the hospital to be treated for minor injuries after getting into a fight with a relative at a City Heights home on Van Dyke Avenue near Wightman Street about 10:30 p.m., police said.

While he was waiting, a woman walked in and hit him in the head several times with a crowbar, police said. She then got into a gray Saturn sedan and drove away.

No arrests have been made.

Tuesday, October 25, 2005

Technique For Starting a Large Bore IV

From Medgadget:

In September's issue of Anesthesiology, Dr. Jonathan I. Stein of York Hospital (York, PA) describes a nifty technique for placing a large-bore IV in patients with suboptimal veins. The idea is based on the Bier block, a commonly performed intravenous block for extremities.

So here is the way to do it. A small-bore (20- to 24-gauge) hand or wrist IV started after applying a continuous-pressure tourniquet to the upper extremity. Without deflating the tourniquet, through the new IV, a crystalloid solution is given (usually 60 mls, according to Dr. Stein), to distend all veins of the upper extremity. Voila! Now you can place a monster catheter into the vein that wasn't even there five minutes ago. According to Dr. Stein, this technique is especially useful when one wants to have strong access but to avoid a central line, for example in patients for an elective c-section with placenta previa or accreta.

The Next Step for STEMI: Field Dx and Decision?

From Biotech Intelligence:

New Treatment Protocol Delivers Four-Fold Reduction in Mortality Among Higher Risk Heart Attack Victims

The hearts of patients experiencing chest pains caused by blocked arteries typically exhibit a particular type of ECG waveform called a STEMI (ST-Elevation Myocardial Infarction). The UOHI team trained paramedics to recognize the STEMI waveform and initiate a protocol designed to deliver the fastest, most effective treatment by bypassing normal emergency room procedures and routing the patient directly to a specialized treatment lab. To clear blocked arteries, the team used a mechanical method known as percutaneous coronary intervention (PCI) wherein a balloon is inserted into the artery to eliminate obstructions, a procedure known as angioplasty.

Urgent Care at Wal-Mart


Solantic, an urgent care company based in Jacksonville, Fla., has struck a deal with the world's largest retailer to locate walk-in clinics in two of its stores in Florida.

Each center has a board-certified physician on duty and is open on weekends, holidays and weekends -- the same as Wal-Mart.

Solantic said the flexible hours will make it easier for people who rarely see a doctor to do so without going to an emergency room.

In addition, the days of cooling your heels in a waiting room are over. Solantic says after you check in, you can go out and shop in the store and you'll be paged or called on your cell phone when it's time for your appointment.

Solantic said if the Florida experiment is successful, the concept could be taken nationwide.

Car Crashes Into ER

From In-Forum. This actually happened at a hospital where I worked - a substance abuse / paranoid patient tried to construct a drive through.

BISMARCK, N.D. - A car crashed through the glass wall of a waiting room at Medcenter One hospital, sending six women, including the 87-year-old driver, to the emergency room.

"It was total chaos," Bismarck Police Officer Dave Horner said. "There were so many people there that we didn't know who had been hit and injured, or who the witnesses were."

He said it was fortunate that so many doctors and nurses were nearby.

Horner said the car driven by Ruth Otto, of Mandan, "sideswiped the building, then sideswiped a car and then went into the building.

It happened at about 11 a.m., Monday, the officer said. Otto told police that she had an appointment at the hospital.

Medcenter One spokesman Chuck Bartholomay said two women were listed in serious condition and one was listed as stable. He said three women, including a coffee stand worker, were treated and released.

Bartholomay said the car crashed through three panes of glass and came to a stop after hitting another wall. It wiped out a good part of the coffee corner in the hospital lobby, he said.

"The six women were taken to the emergency room immediately," Bartholomay said.

Sunday, October 23, 2005

AED Success in MO

From Kansas City InfoZine:

Automatic External Defibrillator Used to Save Smithville Lake Patron

Smithville, Mo. - Clay County park patron Jack Morgan, 81, Independence, learned recently that having a heart attack at Smithville Lake makes him a lucky man. When Morgan started having symptoms of a heart attack after shooting skeet October 1, he asked for an ambulance.

Clay County Park Ranger Vince Wonderlich and Missouri Water Patrol Officer Kim Davis also responded and saved Morgan with an automatic external defibrillator (AED) after Morgan collapsed at the Kansas City Trapshooters Association lodge. Off-duty Missouri State Highway Patrolman Cpl. B.W. Vernon also assisted. The officers delivered three shocks before detecting a pulse in Morgan.

Morgan was transported by ambulance to Liberty Hospital and was able to speak and walk when he arrived. The emergency room doctor commended Davis and Wonderlich for their response to Morgan's condition.

Clay County started its AED program over two years ago and received five AED units from St. Luke's Mid America Heart Institute. Dr. Robert Leich, a board member with the institute and the Spellman Foundation, provides medical authorization for the county program which also includes county facilities in Liberty, Kearney and Kansas City.

Taser Fire

From the Raleigh News & Observer

FAYETTEVILLE -- A man covered with gasoline suffered burns over 70 percent of his body when a deputy shot him with a Taser gun, Cumberland County officials said.

Richard Nuejean McKinnon, 52, of St. Pauls was in critical condition Thursday after the shooting, which occurred after a chase with police late Wednesday night, said Debbie Tanna, spokeswoman for the Cumberland County Sheriff's Office.

The chase began when sheriff's Cpl. Bradley Dean noticed a van that was missing a taillight. Dean stopped the van, but it then drove off, Tanna said. Dean, who was patrolling an area where several thefts had occurred at construction sites, also noticed that the van was sitting low to the ground.

At some point, a fuel container in the van came open and sprayed throughout the vehicle, Tanna said.

The pursuit ended when the driver drove his van into a yard and hit a mailbox, she said.

The driver crawled from a window, and Dean drew his gun but put it away when he realized the suspect wasn't armed, Tanna said. Instead, Dean shot suspect with the Taser when he refused orders to stop, she said.

The suspect's shirt caught fire, and Dean threw him to the ground, Tanna said. The fire was extinguished when the men rolled into a creek.

Friday, October 21, 2005

Domestic Violence

From the

Domestic violence was responsible for 16 percent of emergency room assault visits during 2002 in Oklahoma, including 35 percent of visits by women and 3 percent by men, according to a federal report released Friday.

In addition, a survey conducted between 2001 and 2003 revealed that 5.9 percent of women aged 18-44 reported a domestic violence injury during the previous year, according to the findings of researchers in Oklahoma that are outlined in a U.S. Department of Health and Human Services publication.

The findings demonstrate the need for public services for victims of domestic violence in the state, including law enforcement and programs that help women get out of dangerous situations, according to Sheryll Brown, an epidemiologist at the Oklahoma Department of Health who spearheaded the domestic violence survey.

Thursday, October 20, 2005

Antibacterial Soaps Ineffective?


Antibacterial soaps and body washes in the household aren't any more effective in reducing illness than regular soap, and could potentially contribute to bacterial resistance to antibiotics, experts told a government advisory panel Thursday.

The independent panel, the Nonprescription Drugs Advisory Committee, advises the Food and Drug Administration. Panelists were to vote later Thursday whether they believed such soaps provided any benefits above regular soap for people outside of health care.

Medicaid Changes in Kentucky

From the Louisville Courier-Journal:

Medicaid patients who use emergency rooms for non-emergencies may have to pay the bill themselves, Kentucky officials said yesterday.

The state is considering such a measure as a way of controlling the cost of non-emergency visits, estimated at as much as $50 million a year, officials said.

The proposal also comes after state officials said they determined that a small number of Medicaid patients are the worst abusers of emergency rooms and may be using them to feed prescription-pill addictions.

State officials only recently learned that they can refuse payment for non-emergency visits to emergency rooms, said Mark D. Birdwhistell, state undersecretary for health.

If Medicaid won't pay the bill, patients would have to do so themselves -- or the hospital would take the loss.

Asked about the likelihood of imposing such an option for Medicaid, Birdwhistell said in an interview, "Stay tuned.''

Medicaid officials said last week that they expect to announce cost-saving measures in the next few weeks, particularly addressing emergency-room and prescription-drug costs.

Kentucky's Medicaid plan for the poor and disabled is struggling to reduce a projected $425 million budget shortfall this year. Officials hope to avoid cuts like those during the administration of Gov. Paul Patton that forced thousands of people to lose nursing home or other health services.

Birdwhistell and Medicaid Commissioner Shannon Turner told lawmakers yesterday that recent data show 49 Medicaid members are the heaviest users of costly emergency rooms.

They often walk away with prescription painkillers.

Those 49 visited emergency rooms at least 50 times each in the past year, most frequently citing headaches or back pain.

"Is this a drug-seeking population or a population in chronic pain?" Turner asked while appearing before the joint House-Senate Health and Welfare Committee meeting in Louisville.

The state recently added a $3 co-pay for emergency room visits, but people can't be turned away if they don't have it.

Dr. Rick Voakes, a Bowling Green pediatrician who treats many Medicaid patients, said he thinks refusing to pay for non-emergency visits is a good idea.

"I think that's very reasonable," said Voakes, who was not at the hearing.

He said he's frustrated to learn his patients often use the emergency room, potentially costing hundreds of dollars instead of visiting his office, which costs Medicaid about $27.

"They just go straight to the emergency room because they know they can go any time they want to for free," he said.

Tuesday, October 18, 2005

Sioux City Mercy Sends Supplies to Lousiana

From the Sioux City Journal:

Mercy Medical Center-Sioux City Friday sent needed medical supplies to the federal Disaster Medical Assistance Team supporting Christus St. Patrick Hospital in Sioux City's sister city, Lake Charles, La.

The shipment of several thousand syringes, suture staplers and other supplies came at the request of Mercy emergency physician Dr. Thomas Benzoni who is working with other members of the DMAT to provide medical care to the victims of Hurricane Rita and evacuees from areas devastated by Hurricane Katrina.

"Christus St. Patrick Hospital has seen its patient volumes increase by 250 percent," Benzoni said Thursday from Lake Charles. "While the hospital is doing an excellent job meeting patients' needs under such extenuating circumstances, it became apparent that additional medical supplies would be very helpful."

Since Monday, Benzoni has been working with other federal DMAT members who have been triaging and treating patients at Christus St. Patrick. Their frontline triage center was intended to serve as a kind of cordon around the hospital in order to preserve the emergency room's staff and resources for more serious injuries or illnesses.

Saturday, October 15, 2005

Prehospital EKG Transmission via Cell Phone

Feasibility of early emergency room notification to improve door-to-balloon times for patients with acute ST segment elevation myocardial infarction.

An algorithm to lower time from first contact in the field by EMS personnel to in-hospital mechanical reperfusion is described. ECG tracings were telemetered via cellular phone to an emergency room physician, who then activated the cardiac catheterization call team to bypass usual delays seen during ER triage. Seventy-one ECGs were sent to the ER in the time interval from October 2003 to October 2004. Five ECGs (7.0%) failed to transmit due to failure of the cellular phone to receive an adequate signal. Sixty-six patients (93.0%) had an adequate ECG transmitted to the ER and six patients with ST elevation myocardial infarction were identified. Door-to-balloon times were lowered to 44 +/- 17.4 min, a substantial decrease over historical norms that range from 120 min (25th percentile) to 289 min (75th percentile).

Here's the abstract in PubMed

"Ouchless" ED

From (yep, happy news)

At St. Louis Children's Hospital, two pediatric emergency medicine specialists have helped foster a treatment culture in which reduction of pain and anxiety is an essential aspect of a growing number of common procedures such as fracture reduction, suturing and IV starts.

"It became clear to me that the care we provided was causing a lot of kids to cry and become upset, whether we were reducing fractures, debriding burns, drawing blood or starting IVs," says Robert "Bo" Kennedy, MD, pediatric emergency medicine physician at St. Louis Children's Hospital and associate professor of pediatrics at Washington University School of Medicine (WUSM). "The decibel level was the telling measure of the department's activity level."

Dr. Kennedy and colleague Jan Luhmann, MD, emergency medicine physician and WUSM assistant professor of pediatrics, have helped advance the increased use of pharmacologic and non-pharmacologic modalities in a pediatric ED setting - including nitrous oxide, buffered lidocaine, early oral oxycodone, and "positions of comfort" - to lessen anxiety and pain during procedures.

Friday, October 14, 2005

Mexican Immigrants and ER's


Fewer than 10% of recent Mexican immigrants -- whether they came in legally or not -- reported using an emergency room in 2000, according to the study, based on an analysis of the U.S. National Health Interview Survey conducted in 2000 by a unit of the U.S. Department of Health and Human Services.

Recent immigrants were defined as people who had been in the United States for fewer than 10 years.

In contrast, 20% of U.S.-born whites and Mexican Americans used an emergency room during the same time period.

"The study breaks a lot of the myths.... There are assumptions that immigrants are breaking the economy by using emergency rooms," said Xochitl Castaneda, director of the California-Mexico Health Initiative, an arm of the California Policy Research Center based at the UC Office of the President.

Polio in MN

From MedPage Today:

Four cases of polio virus infection have been identified in children living in a small Amish community in central Minnesota. None of the children had been immunized against polio, state health officials here reported.

"The general public is not at risk," said Minnesota Health Commissioner Dianne Mandernach.

The only people at risk for contracting polio, Mandernach said, are those who have not been immunized against polio and who come into direct contact with an infected person.

The infections occurred in three children from one family and in an infant from an unrelated family with whom they had direct contact. The source of the infection may have been a fifth person who recently received an oral form of the vaccine containing live attenuated virus. The viral strain isolated in the infections appears to be a variant of a strain used in oral vaccines overseas, the health authorities said.

Thursday, October 13, 2005

CPR Anytime

The American Heart Association created a simple, affordable way for people to learn CPR in less than 25 minutes, for under $30--CPR Anytime™ for Family and Friends. Everything needed to complete this self-directed CPR training comes in one kit, which can be used in the convenience of the living room or family room. A single kit allows an entire family to learn CPR. The kit includes a one-of-a-kind CPR manikin, 22-minute DVD and resource booklet.

The CPR Anytime manikin is an inflatable version of the traditional CPR manikin, designed exclusively for CPR Anytime for Family and Friends by Laerdal Medical Corporation. An instructional DVD walks users through each step of the training, from inflating the manikin, to doing chest compressions and rescue breathing. The CPR Anytime for Family and Friends program allows users to keep the kit, so it can be used in a variety of training settings--from community group meetings with multiple trainees to families and individuals at home. The American Heart Association's goal is for each person who receives a kit to take it home and share it with other family members, increasing the number of potential rescuers. The kit also allows families to refresh their skills whenever they can.

Tuesday, October 11, 2005

Sleep Guidelines For Infants

From the Detroit Free Press:

Infants should sleep alone in their own cribs or approved beds in the first year of life, without blankets and stuffed animals, according to new national guidelines likely to have an impact on millions of U.S. households and child care providers.

The guidelines, released today by an American Academy of Pediatrics task force, are an attempt to reduce hundreds of preventable deaths of infants in adult beds and other unsafe sleep environments.

The guidelines will impact generations of future caregivers, as well as gift-givers at baby showers. The better gift now is a portable mesh crib or a sleeper or sleep sack, not a stuffed animal or blanket and never the crib bumpers that have been associated with infant deaths.

In another change likely to stir discussion, the academy recommends that babies should be put to bed with pacifiers, because their use is associated with fewer SIDS deaths, and they don't impair the development of teeth or ability to breast-feed.

Infant safe sleep recommendations include:

•No bed sharing. Infants in the first year of life should sleep in a crib or playpen.

•Infants always should sleep on their backs.

•Use a firm crib mattress, covered by a sheet.

•Keep soft objects and loose bedding such as pillows, comforters and stuffed toys, out of the crib.

•Keep infants away from smoke.

•Offer a pacifier when the infant is laid down for a nap or at bedtime. Don't reinsert it once the infant falls asleep.

•Avoid letting the baby get too hot. The infant should be lightly clothed for sleep, and the bedroom temperature should be warm enough for a lightly clothed adult.

•Avoid devices marketed to reduce the risk of SIDS, for instance, by maintaining a healthy sleep position. None has been tested sufficiently for safety. There is no evidence that use of home monitors decreases the risk of SIDS.

•Have others caring for the infant follow these recommendations.

Monday, October 10, 2005

MHA speaks out against DHS interpretation of new law on ER use

From the Minnesota Hospital Association's "The Advocate" publication:

Concerned about the state's interpretation of new legislation aimed at curbing Medicaid emergency room payments for "convenience" level care, MHA staff and several MHA members have been speaking to Department of Human Services (DHS) officials about delaying and changing how it proposes to implement the law. The legislation was prepared to save the state approximately $3 million over the biennium. (With the loss of federal matching dollars, hospital payments are expected to be reduced by nearly $6 million.)

On Sept. 16, DHS shared a draft provider bulletin that first raised concerns about how the department was planning to implement the new law, effective Oct. 1. Rather than focusing exclusively on the issue of convenience care - which was what was addressed in legislation - the bulletin also delved into urgent-vs.-emergency care.

Speaking on Sept. 16 with Chris Reisdorf, DHS' manager of benefit policy, MHA staff and several finance, billing and coding representatives from member hospitals shared two major areas of concern. First, EMTALA requires that anyone presenting in the emergency room must be treated as an emergency; and second, hospitals would have difficulty classifying treatment delivered as "emergency" or "non-emergency" retrospectively through billing codes. Members encouraged DHS staff to discuss EMTALA requirements with the Joint Commission on Accreditation of Healthcare Organizations, to analyze their claims database to quantify the problem and clarify usage of the new triage code.

New ED Construction

From an MSNBC article about new ED construction in the Triad:

"Hospital ER investments boost overall financial health"

Hospitals point to emergency rooms as linchpins in their community service mission. The ER is typically one of the most expensive places to receive care, and most Triad hospitals say they've seen an increase in the number of uninsured patients in the last few years, who often can't afford to pay all of their bills.

Nonetheless, it turns out that hospital emergency departments are not necessarily big sources of red ink. In some cases they may even be profitable, and they drive business to the rest of the hospital.

Hospitals' front door

Even if a hospital loses money in its emergency room, administrators may still view a bigger ER as a good investment. That's because the emergency department is a major source of hospital admissions.

"The emergency room is important to the hospital because it's kind of considered the front door for a lot of patients to come in," said Richard Gundling, vice president of the Healthcare Financial Management Association, a large professional group for people who work in health care financing.

"We don't generally evaluate the emergency department in isolation," said Lynn Pitman, director of strategic planning at Wake Forest University Baptist Medical Center. "It impacts the whole house."

Sunday, October 09, 2005

Paramedic Shortage?

From the Indianapolis Star:

Emergency medical services agencies nationwide, from hospitals to fire departments to private ambulance companies, are reporting problems in finding enough qualified paramedics. And EMTs such as Nash are taking advantage of the organizations' offers of free training to help fill the void.

Experts blame the shortage on low pay for high-stress work, time- consuming training and a new medical environment that spreads the available paramedics too thin.

Saturday, October 08, 2005

Traumatic Brain Injuries in MN

From In-Forum:

The rolling hills and forests of rural Minnesota can often be just as dangerous as the state's metropolitan areas when it comes to severe head injuries, according to a new study based on data from the state's emergency rooms.

Researchers have good guesses about why people get hurt where they do, but they don't know for sure. But they say the number of traumatic brain injuries is going up, and that's a good reason to sound the alarm.

In the metro area, Washington County has the highest rate of head injuries treated in emergency rooms without needing hospitalization. Dakota County is second. Some counties has several times as many injuries as others.

Jon Roesler, a state Health Department epidemiologist, said the high numbers of injuries in wealthy areas like Woodbury in Washington County could be the result of the "expensive toys effect."

For the wealthy, "It's skiing, snowboarding, whatever the higher income group can afford. Sports and rec are one of the three leading causes of emergency room treatment" for traumatic brain injuries.

Binge Drinking in Teens

From the Pioneer Press

It's Friday. You're in college. Time to head to the liquor store. Students everywhere follow the same ritual. Many know their limits. But Minnesota hospitals say a rising number do not.

Underage drinking is one thing, but teens drinking themselves into the emergency room is quite another.

New information from Minnesota hospitals suggests more teens than ever are drinking so excessively that they need medical treatment. The number of teens discharged from emergency rooms for alcohol-related conditions increased 45 percent from 2000 to 2004, according to hospital data obtained by the Pioneer Press.

The hospital figures contradict Minnesota's routine surveys of teenage behavior, which have shown steady or declining rates of teen drinking. But they aren't surprising to the ER doctors working nights and weekends.

"There's always one in every crowd that is convinced he can drink more than everybody else," said Dr. David Hale, medical director for the Woodwinds Health Campus emergency room in Woodbury. "That's usually the one that ends up coming in."

Binge drinking was recently spotlighted after the death of a Minnesota State University-Moorhead student. The body of Patrick Kycia, 19, of Stillwater was found Sept. 27 in the Red River. He was last seen reportedly drinking heavily at a fraternity house five days earlier.

The Minnesota Hospital Association data is, in many ways, a record of close calls. Many teens entering the ER for alcohol exposure simply need to be monitored and given intravenous fluids. Others may have been injured in traffic accidents, and their alcohol use is listed as a secondary reason for their emergency medical care.

But all the ER doctors interviewed reported rising numbers of teens with blood-alcohol levels of 0.25 to 0.35 percent, which are well above the legal driving limit of 0.08 percent

Thursday, October 06, 2005

Oregon: Statewide Decline in ED Visits

From the Medford (OR) News:

Cutbacks in the Oregon Health Plan (OHP) including establishment of a $50 co-payment for Emergency Department (ED) visits led to a 14 percent drop in ED use among OHP Standard enrollees, according to Oregon Health & Science University (OHSU) study results presented this week in Washington, D.C., at the American College of Emergency Physicians Research Forum.

"Our first reaction to the results was excitement at the cost savings from reduced ED use, but when we put these findings in context, the news was not so good," said lead investigator Robert A. Lowe, M.D., M.P.H., director of the OHSU Center for Policy and Research in Emergency Medicine and associate professor of Emergency Medicine in the OHSU School of Medicine. "Absent improved safety net access outside the ED, it is likely that these patients did without care, rather than getting less expensive care."

The study found that enrollees in OHP Standard used the ED 14 percent less after they became subject to the co-payments in March 2003, while enrollees in OHP Plus, who were not affected by the co-payments and other cutbacks, demonstrated no change in ED use.

"ED use is often a barometer of the status of our health care system," said Lowe. "Identifying ED trends helps us to understand when health care access issues may be facing a crisis point."

"This study's results raise timely questions," said Charles A. Gallia, Ph.D., evaluation research coordinator for OMAP, and study co-author. "For instance, did the benefit reduction and increased co-pays have the unintended consequence of suppressing use of some preventive health care services, even those that would best be treated in an ED setting, thereby making the long-term costs even higher?"

Tuesday, October 04, 2005

CT's for Suspected Cervical Spine Injuries

An excerpt from the American College of Emergency Physicians' website:

A new study indicates that patients sustaining a cervical spinal injury (CSI) may harbor additional spinal damage that is not visible on regular x-rays. In fact, more than 36 percent of patients with low-risk injuries actually have additional occult damage that may include significant fractures with the potential to produce serious spinal problems if not detected and treated properly. This study will be published as an early online release by Annals of Emergency Medicine (Injuries Missed by Limited Computed Tomographic Imaging of Patients with Cervical Spine Injuries).

This study stands in the face of previous medical thinking in which patients with certain forms of spinal injury were considered at very low risk of having additional such injuries. Because of that low risk, physicians were urged to use plain x-rays and avoid computed tomography (CT) in evaluating these cases.

"These findings are significant because they suggest that CT imaging, which allows physicians to view the spine in much greater detail, is necessary in evaluating all patients who have radiographic evidence of cervical spine injuries," said lead study author William Mower, MD, PhD, of the UCLA Emergency Medicine Center. "What we found was that even among patients with low-risk injuries, more than one-third sustained secondary damage that was not diagnosed by plain radiography. In fact, approximately one-fourth of these secondary injuries occurred in another part of the cervical spine, which suggests that at least some of these patients may have actually sustained two separate spinal injuries. Furthermore, we believe that our finding that plain radiographs failed to detect secondary injuries in 81 of the 224 patients with identified CSIs is likely an underestimate, and the true prevalence of missed injury is probably even greater."

The authors believe that patients with any evidence of CSI, including those with CSIs previously considered to be at low risk for secondary injuries, should undergo CT imaging of the entire cervical spine. CT should be obtained both to determine whether secondary injuries are present and to identify those non-contiguous injuries that, in fact, occur in a substantial number of cases.

ACEP Rally

On September 27, at 10 a.m. more than 4,000 emergency physicians and other emergency care health professionals participated in The Rally at the US Capitol. Gathering on the Capitol’s West Lawn, these concerned citizens urged Congress to support HR 3875, the Access to Emergency Medical Services Act of 2005.

Emergency physicians across the country are concerned because Americans are losing access to emergency care due to crowding and ambulance diversion, lack of on-call physicians, the professional liability crisis, the financial consequences of EMTALA, and rising numbers of uninsured and underinsured patients.

I.D. in the ER

Of interest because of the quote from Ms. Williams in Duquoin, one of our affiliated facilities. From the Southern Illinoisan:

An unidentified cyclist was taken to Memorial Hospital of Carbondale one afternoon last week after he was sideswiped by a dump truck on U.S. 51 near Makanda.

Jackson County sheriff's deputies said the man had received a serious head injury when he was knocked from his bicycle. The collision occurred at about 12:45 p.m. Wednesday, but the man, who was unable to communicate with emergency personnel, was not carrying any identification.

He was not identified until about 7:30 a.m. Thursday.

The incident is a real-life example of the hypothetical cases marched out by law enforcement officials and medical workers for years.

Susan Williams, a registered nurse in the emergency room at Marshall Browning Hospital in Du Quoin, said emergency room workers are accustomed to dealing with unidentified patients in emergency situations. At Marshall Browning in particular, she said, patients attending events at the nearby state fairground may come in with no identification and with no known friends or relatives nearby.

"Usually we're flying by the seat of our pants in (cases where there is no way to identify the patient)," she said.

Sunday, October 02, 2005

Man Found In Stolen Ambulance With Dead Deer

From AOL Strange But True News:

JACKSONVILLE, Fla. (Sept. 29) - A man reported missing from a Florida hospital was found in North Carolina dressed like a doctor and driving a stolen ambulance with a dead deer wedged in the back, authorities said.

Leon Holliman Jr., 37, was reported missing from a River Region Human Services facility in Jacksonville last month.

The North Carolina State Highway Patrol found him driving the ambulance with the deer on Sunday.

"I don't know how the man got it up in there," said Sgt. Robert Pearson. "It was a six point buck."

It wasn't known where Holliman got the deer, which had been dead for some time, Pearson said.

Holliman was admitted to a North Carolina hospital for a psychiatric evaluation. Police said they would decide whether to charge Holliman after that evaluation is complete.

Saturday, October 01, 2005

Another Gun in the ER

From the Ukiah Daily Journal (Mendocino, CA):

Officers arrived on scene within a minute after receiving the call. Officers were flagged down outside the hospital and told that the man with the gun was still inside the ER. Officers along with sheriff's deputies, entered the emergency room and allegedly located Pedersen holding a gun to his head in one of the hospital rooms. The area around the room was immediately secured and Pedersen was contained to this one room, according to the Fort Bragg Police Department.

Also in this same room was a very ill patient with numerous medical apparatuses hooked up to him. A dialogue was established with Pedersen, and Pedersen was convinced into lowering his weapon so that the patient next to him could be moved out of the room.

When Pedersen lowered his hand gun, a Taser was deployed that immediately disabled Pedersen. Pedersen dropped his gun and he was immediately taken into custody without further incident.