Small hospitals' finances improved in 2005

From Modern Physician:

Median financial ratios for small, not-for-profit hospitals improved in the past year, buoyed by a favorable operating environment and higher reimbursements from insurers and the federal government, according to Standard & Poor's. S&P said rating trends were "generally stable" in 2004 and 2005 for small hospitals -- those with net patient revenue of $75 million or less. Overall, improved medians were most evident at higher-rated hospitals, S&P said. Small hospitals rated A+ to A- had a median profit margin of 6.6% and median operating margins of 4.7% in 2005, up from 2.3% and -0.5%, respectively, in 2003. Larger hospitals had a median profit margin of 5.1% and a median operating margin of 3.1% in 2005.

More on the 2005 ECC Guidelines

The Winter issue of the American Heart Association publication Currents is available online and contains a comprehensive overview of the 2005 Guidelines.

"This special edition of Currents presents the new material most relevant to instructors, compares it with the former guidelines, and gives you the scientific reasoning behind the change in compact and reader-friendly form.

The issue also includes links to the full guidelines document with all the references as well as an article on the evidence evaluation process, both available to you free online."

Milestone for German Air Medical Team

From RotorHub.com (gave me an excuse to post a picture of a helicopter):

The DRF (Deutsche Rettungsflugwacht e.V./German Air Rescue) has been saving lives on its air rescue missions, both with helicopters and ambulance aircraft for over 30 years. On November 17th, the non-profit air rescue organization flew its 325,000th mission.

The emergency dispatching center in Suhl alerted the DRF rescue helicopter for an emergency in the region of Sonneberg. A woman had fallen down the stairs sustaining serious head injuries. ”Christoph 60“ started at 7:22 a.m. and landed shortly after at the scene of the accident some 45 km away. After providing for the patient’s needs, the crew flew the patient to Meiningen. At Meiningen hospital, the DRF emergency physician and the paramedic handed the patient over to neurosurgeons.

2005 ECC Guidelines Published Today

The 2005 Emergency Cardiovascular Care (ECC) Guidelines were published today and are accessible (as sections of Circulation) on the web.

The American Heart Association (AHA) has also posted three webcasts (BLS, PALS and ACLS) that provide a concise summary of the changes.

The Winter edition of Currents will be published tomorrow and will include a summary of the changes as well.

Here's an excerpt from the AHA press release:

The 2005 guidelines emphasize that high-quality CPR, particularly effective chest compressions, contributes significantly to the successful resuscitation of cardiac arrest patients. Studies show that effective chest compressions create more blood flow through the heart to the rest of the body, buying a few minutes until defibrillation can be attempted or the heart can pump blood on its own. The guidelines recommend that rescuers minimize interruptions to chest compressions and suggest that rescuers “push hard and push fast” when giving chest compressions.

“The 2005 guidelines take a ‘back to basics’ approach to resuscitation,” said Robert Hickey, M.D., chair of the American Heart Association’s Emergency Cardiovascular Care programs. “Since the 2000 guidelines, research has strengthened our emphasis on effective CPR as a critically important step in helping save lives. CPR is easy to learn and do, and the association believes the new guidelines will contribute to more people doing CPR effectively.”

The most significant change to CPR is to the ratio of chest compressions to rescue breaths – from 15 compressions for every two rescue breaths in the 2000 guidelines to 30 compressions for every two rescue breaths in the 2005 guidelines. The 30-to-two ratio is the same for CPR that a single lay rescuer provides to adults, children and infants (excluding newborns). The change resulted from studies showing that blood circulation increases with each chest compression in a series and must be built back up after interruptions. The only exception to the new ratio is when two healthcare providers give CPR to a child or infant (except newborns), in which case they should provide 15 compressions for every two rescue breaths.

Another guidelines change emphasizing the importance of CPR is the sequence of rhythm analysis and CPR when using AEDs. Previously, when AED pads were applied to the chest, the device analyzed the heart rhythm, delivered a shock if necessary, and analyzed the heart rhythm again to determine whether the shock successfully stopped the abnormal rhythm. The cycle of analysis, shock and re-analysis could be repeated three times before CPR was recommended, resulting in delays of 37 seconds or more. Now, after one shock, the new guidelines recommend that rescuers provide about two minutes of CPR, beginning with chest compressions, before activating the AED to re- analyze the heart rhythm and attempt another shock.

Annals Launches New Web Site

From the American College of Emergency Physicians:

Annals of Emergency Medicine has launched a new Web site at www.annemergmed.com. The new design includes streamlined features, personalization options such as saved searches and e-mail alerts, and free PDA functionality.

Additionally, all articles that have been published dating back to the journal’s inception as the Journal of the American College of Emergency Medicine in 1972 are now available in online archives on the new site.

New features of the site include:
Images in Emergency Medicine - Front-page viewing of a featured image, with a click-through to our entire databank of images and diagnoses.

Customized e-mail alerts such as saved searches.

Tracking the impact of articles (and other saved articles of interest) via e-mail citation alerts.

Linking to abstracts and full text in other participating Elsevier journals via cited references.

Searching across 400 journals and Medline.

PDA downloads and updates via PocketConsult with free registration.

Chilling film aims lesson at 'cool' kids

From the Anchorage Daily News:

It may be the world's first frostbite movie featuring snowboard dudes -- plus a goofy flannel-clad narrator named "Dr. O" and an upbeat musical score.

But most Anchorage parents and teachers will shiver in recognition at the scenes involving "cool" teens.

One freezing adolescent boy hops foot to foot at a school bus stop in a T-shirt and shorts, a chilling contrast to the serene girl standing beside him in a kuspuk. Two girls, minus jackets and hats, get stranded along the Seward Highway in a blizzard with their car in the ditch. A child is rushed to the emergency room, where his frozen hands get soothed in a warm-water bath.

The new video "Frostbite and Hypothermia" is now being distributed free to every Alaska school district -- along with a packet of classroom activities for fifth- through eighth-grade students.

But don't think of those old cautionary film strips from health class. In this video, when one cold snowboarder is taunted with "don't be a wuss," an older snowboarder wearing shades intervenes:

"You know, man, it's really not worth it. You should go in if you're cold."

And the message carries the jolt of real damaged flesh: blistered skin, blackened fingers and amputated limbs from Anchorage patients.

"The mistake I made was not stopping immediately and building a fire," says one unnamed victim, as the camera lingers on the stumps below his ankles.

The project was produced largely by three brothers from a longtime Anchorage family -- surgeon Dr. James O'Malley, kindergarten teacher Tom O'Malley and video editor Robert O'Malley, who now lives in Seattle. They plugged away on it in their spare time for about 10 years, pushing it through multiple versions and a few false starts.

Disrupted plans common theme for on-call docs

An article more or less sympathetic to pay for on call, from the Charlotte (WV) Gazette-Mail:

Most people leave work at work. On-call doctors cannot leave work at all.

For their private patients or the emergency room, many doctors usually have to be ready at a moment’s notice: That means little travel, no wine with dinner and rarely uninterrupted dinners.

Tele-Ambulance, Part 2

I blogged about this previously, but here's a bit more detail (remote controlled cameras on the exterior!) from the Arizona Daily Star:

The days of doctors making house calls are long gone.

Virtual visits in ambulances, however, are the wave of the future, city officials said of a new system that could be operational in about six months.

Beginning next summer, video cameras mounted on top of and installed inside of Tucson Fire Department ambulances will allow University Medical Center emergency-room doctors to see live images of accident scenes and patients before they are taken to the hospital, officials said.

The set-up will be similar to a video conference call, Leyva said. Emergency room doctors will have control of the cameras with the ability to zoom in on the patient's injuries. They will also be able to speak directly to the paramedics.

In addition, UMC will be better prepared for incoming patients because doctors will have a better idea of what resources will be needed to give the best treatment possible, Capt. McDonough said.

New Rewarming Technology

From the San Jose / Silicon Valley Buiness Journal, based on a post at Medgadget:

The new chief executive and president of Fremont's Dynatherm Medical Inc. is making the rounds on Sand Hill Road to pitch the idea of a high tech mitt that warms hypothermic patients through a combination of heat and air. He's seeking to launch the mitt as the company's first product and tap a $1 billion-plus market.

Based on a patent developed at Stanford University, VitalHeat is deceptively simple and extremely effective, he says. A patient's hand, placed in a sealed mitt, is subjected to heat and vacuum pressure. This rapidly channels blood to a patient's vital organs, or core, spiking the body temperature by several degrees within minutes.

Mr. Christensen, a medical device veteran who was appointed in May, says the product, cleared by the FDA in the fourth quarter of 2004, is needed in frosty environs like operating rooms because the threat of hypothermia in patients undergoing anesthesia or suffering from trauma is a constant challenge for health care providers. It is not unusual for a patient's core temperature to drop several degrees during surgery, medical experts say, raising the risk of longer recovery times and other complications. Treatments to counteract the effects of hypothermia can cost hospitals up to $7,000 per patient, according to Dynatherm.

Conventional thermal technologies, meanwhile, fail to heat up patients as quickly and easily, Mr. Christensen says. Blankets made by competitors like Arizant Inc. of Eden Prairie, Minn., for instance, which blow hot air over a patient's supine body, take up to two hours and are obtrusive for doctors, he says, while treatments that involve warming patient fluids via catheters are invasive and more risky.

For Dr. Jim Watkins, forced air blankets have been the treatment of choice for combating hypothermia. But the Fresno anesthesiologist says there are certain cases, such as heart surgeries or vein harvests, where a bulky blanket isn't practical.

When Dynatherm showed Dr. Watkins its product to see if he would test it for the company, "I laughed at it," he says. "It was hard to convince me that warming a small area of the body -- 2 to 3 percent of a body' total surface -- would work."

His skepticism disappeared after a dozen trial runs. "It worked beautifully," he says. "I've chatted with several people at the hospital about [buying] the system."

Adding hospitality to the hospital stay

From the Kansas City Star:

When you go to the hospital, you probably don’t expect to enjoy the hospitality.

But AVP Inc., an Overland Park company, is working to change that notion by bringing upscale customer attention — valet parking, concierge service, room service and bell staff — to hospitals and other health-care facilities.

“The health-care institutions are fighting for the baby boom generation. We’re providing services that help them compete,” said Jeff Perry, part owner and a division president of AVP.

The company serves more than 100 hospitals in 34 states. In the Kansas City area, facilities include Lee’s Summit Hospita l, Menorah Medical Center, Overland Park Regional Medical Center, Research Medical Center and Shawnee Mission Medical Center.

It’s Perry’s contention that patients want to be treated better during hospital visits.

“We want to improve the hospital stay,” Perry said. “We’re trying to dress up the front end and when they (patients) depart the hospital.”

Iraqi Suicide Bombing; Hospital / ED

From the London News-Telegraph:

A suicide car bomber killed dozens of people in an Iraqi town yesterday when he rammed his vehicle into American and Iraqi soldiers as they handed out toys and sweets to children outside a hospital.

But instead of inflicting mass casualties among the soldiers, the bomber's victims were mostly children, medics and patients, killed when the brunt of the blast was taken by the hospital's emergency room, which was wrecked by the explosion.

The attack in Mahmoudiyah, south of Baghdad, claimed at least 30 lives and was followed by a second blast last night in a shopping district in Hilla, also south of the Iraqi capital, where up to 11 people were reported to have died

Prehospital Stroke Care Initiative in Illinois

From the (Champaign-Urbana) News-Gazette:

All too often, precious time is lost because people don't recognize the signs of a stroke and don't go to the hospital, according to Dr. James Ellis, medical director of the emergency department at Provena Covenant Medical Center, Urbana.

That's why Covenant and its sister hospital in Danville, Provena United Samaritans Medical Center, have launched a new stroke assessment and treatment program that starts at the first possible moment, right in the ambulance.

Now, Provena officials say, when an ambulance is called for a possible stroke victim, emergency medical crews serving those two hospitals begin an assessment in the ambulance to determine if the patient is suffering an ischemic stroke and meets the strict criteria for a controversial, clot-busting drug treatment best-known by its acronym, tPA.

The ambulance crew also now starts the patient's IV, gets blood for lab tests and begins documenting findings on a treatment form that is continued by nurses upon arrival at the hospital.

And, to save time, the patient is taken directly to a CT scan at the hospital to confirm that an ischemic stroke has occurred, instead of being taken first to the emergency room, Ellis said.

The two Provena hospitals have set a goal of administering tPA, or tissue plasminogen activator, to patients who meet the criteria for the drug treatment within 30 minutes of arriving at the hospital.

Cigarette Tax in California: Pay for ER Care?

From the San Mateo County Times:

The battle over next year's ballot initiatives is already beginning, with health-care groups feuding over two different measures that would impose new taxes on tobacco.

On one side, the California Hospital Association is now seeking voter signatures to put an initiative on the June primary ballot that would impose a $1.50 tax on cigarettes to offset hospitals' costs for providing emergency-room care.

On the other side are anti-smoking groups such as the American Lung Association and the American Cancer Society, which are hoping to put their own $1.50 tobacco-tax measure on the November ballot. Their initiative, also supported by children's advocates and the California Nurses Association — the hospitals' frequent nemesis — would use the money to provide health insurance for all uninsured children in California and pay for tobacco-control programs.

Doctor tips off cabbie to illness

From the Pioneer Press

Dr. Victor Tschida had an unusual tip for a cabdriver at the end of his ride Sunday night: Get to the emergency room; your heart is failing.

The St. Paul cardiologist was riding from the airport to United Hospital and noticed the driver was breathing rapidly and coughing. The cabbie, Mamo Assefa, 47, dismissed his ailment, but Tschida grew more concerned during the eight-mile drive as he asked Assefa about his health.

"I offered to drive the cab, but he chose not to let me do that," Tschida said. He asked Assefa to stay off the interstate, then persuaded him to pull up to the United emergency room.

The Columbia Heights man was diagnosed with pulmonary edema, a severe form of heart failure. He was treated with medication and is recovering at United.

Turned out Assefa had forgotten medication he takes for high blood pressure during a recent trip to visit relatives. Tschida said the lack of medication for a week probably contributed to the man's heart failure.

Reducing Laboratory Turnaround Time Outliers Can Reduce Emergency Department Patient Length of Stay

From Medscape:

Poor core laboratory performance that causes delays in diagnosis and treatment is an impediment to optimal patient care, particularly in high-volume patient care areas such as the emergency department (ED). To evaluate the impact of laboratory performance on patient care outcomes, we obtained data from 11 hospitals related to laboratory test turnaround time (TAT) parameters and ED patient throughput.

We observed that the average length of stay (LOS) in the ED correlated significantly with the percentage of total laboratory outliers (R2 = 0.75; P < .01) and to a lesser extent the TAT means (R2 = 0.66; P < .01). Furthermore, improvements in laboratory performance during the study were associated with concurrent decreases in ED LOS.

Although in the past, laboratories have focused on TAT means for performance assessment, our observations suggest that a more appropriate method of benchmarking might be to aggressively set clinically driven TAT targets and assess performance as the percentage of results achieving this goal.

Medical Records on a Portable USB Flash Drive

From Medgadget:

The AP is reporting on the US Senate's encouragement of electronic medical record keeping, in the form of a USB-style key chain.

People could carry their medical records around their necks or on key chains through technology being encouraged in a bill passed Friday by the Senate.
"When they go to the doctor's office they won't have to take that little clipboard and figure out whatever it is that they can remember about their health," said Sen. Mike Enzi, R-Wyo.

The Wired for Health Care Quality Act encourages the Health and Human Services Department to form a public-private partnership to identify ways to streamline the health care system's information technology. Hospitals and other health care providers could apply for grants to help them implement new technologies.

Automated Defibrillator Used to Treat NHL Player

From CNN SI:

DETROIT (AP) -- Detroit Red Wings defenseman Jiri Fischer was hospitalized in good condition early Tuesday after he collapsed on the bench and his heart stopped late in the first period of a game against the Nashville Predators.

Red Wings coach Mike Babcock said Fischer's heart was restarted before he was taken from the arena.

"They hooked up the auto defibrillator and shocked him," Babcock said.

Fischer was also given CPR at the bench by team physician Dr. Tony Colucci before the 25-year-old native of the Czech Republic was removed on a stretcher.

"How to survive in the ER"

A tip from Gruntdoc, excerpted from CNN Money:

So when my 84-year-old stepfather Jim quietly slumped out of his chair late last year, my mother and I were stunned.

Ten years of helping him manage Parkinson's disease hadn't prepared us for this. Barely conscious and unresponsive, Jim needed an emergency room—like, stat. You know the image: overcrowded halls filled with doctors who don't know you, overwhelmed with people unable to afford care elsewhere.

Panic.

We called 911, scrambled desperately for Jim's Medicare card, grabbed his many medications and told the paramedics as much as we could recall. A white-knuckled 30 minutes later, Jim became one of the 114 million E.R. visits last year.

The emergency department (it's not a "room" anymore) is a weirdly democratic institution. It's a place where crisis rules the day and sets the pace.

It doesn't matter how rich or well insured you are -- if you bleed, you lead.

To help you prepare for the unexpected, MONEY spoke with doctors, nurses, patient advocates and other experts to develop this user's guide to the E.R. Here's hoping you never need it.

Specialists On Call in the ED

From MSNBC, based on the briefing referenced in the previous post:

Many hospitals, including a few in the Dayton area, are finding it difficult to get specialist doctors to respond to emergency room calls.

Some specialist physicians, such as neurosurgeons and plastic surgeons, are resisting being on call for emergency rooms, where many of the patients have less ability to pay the doctors for their services than the patients specialists treat through referrals from primary care doctors.

Losing those kinds of services can leave emergency room patients and hospitals in a lurch. It also has the potential to compromise access to care at emergency rooms and raise health care costs if hospitals pay specialists to respond, according to a new study from the Center for Studying Health System Change, a Washington, D.C.-based nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

Increase in Nonemergency Visits to ED's

From Modern Physician:

Hospital emergency rooms are being strained by an increase in nonemergency visits, a growing number of patients with serious mental illnesses and a lack of specialists willing to accept on-call duty, according to the Center for Studying Health System Change.

If not addressed, the problems will compromise access to hospital care and contribute to higher healthcare costs, the center said in an issue brief.

Specialists' reluctance to provide on-call services reflects fear of malpractice litigation, lack of reimbursement for uninsured patients and more opportunities in outpatient facilities and specialty hospitals.

The number of patients using ERs for nonemergency care rose steadily between 1997 and 2003, with the largest growth in the rate of nonemergency visits occurring among Medicare patients, the center said.

Here's a link to the brief.

Smoking Ban Challenges

One of the Iowa Hospital Associations goals for 2006: Smoke-free campuses. Enforcement" Check out this excerpt from the Daily Iowan:

Come rain, bitter wind, or a new UI Hospitals and Clinics policy - some smokers outside the hospital refuse to move inside designated shelters.

"What are they going to do, write a ticket?" said UIHC visitor Ricky Booher, taking a puff outside the emergency-room entrance. "Here, I'll light it up with my cigarette, and you can have it back."

The enforcement of the new ban - which prohibits smoking aside from five designated smoking areas on the UIHC grounds - has several hospital employees up in arms about the specifics and overall fairness of the policy.

But as long as smokers stand around the designated shelters, they were complying with the ban, said Ann Rice, the UIHC's associate director.

"There isn't a hard and fast rule at this point in time, because people are still getting used to the policy," she said.

But UI law Professor Marc Linder said he was dismayed by the laxity with which UIHC officials have enforced the ban, which went into effect Nov. 1.

Plagued by the "gauntlet of smoke" that encircles the hospital grounds, Linder said his repeated pleas to UIHC officials to better enforce the policy have gone unheard.

"This is the most important hospital in Iowa," he said. "Why doesn't the state and the university have the right, the power, the duty to protect its citizens?"

EM Physician is the Next "Batchelor"

Love the title of the article, from the New York Daily News:

'Bachelor' pages a Dr. & Mr. Stork delivers

Dr. Travis Stork is a 33-year-old physician from Nashville.

Marry a doctor. It's an old cliché. But it's one that producers of "The Bachelor" have been trying to capture since the reality series began.
"For 10 [cycles], we looked for a doctor," said executive producer Mike Fleiss. "But we never found him."

Until now.

The good doctor is Travis Stork, a 33-year-old emergency-room physician on hiatus from a residency at Vanderbilt Medical Center in Nashville.

"He's so good-looking and so personable," said Fleiss. "He's not what you expect from a guy who wears a stethoscope around his neck."

2005 ECC Guidelines

Breaking news...

ECC Guidelines Publication Date Change

As many of you know, the AHA ECC Guidelines originally were scheduled for publication on December 13. This date would have followed two weeks after the publication of the International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations (CoSTR).

In order to avoid confusion about the differences between the consensus document and Guidelines, the decision was made to "fast track" the Guidelines publication to November 28, the same day CoSTR is published. The CoSTR document will be published at 9:00 a.m. EST, and ECC Guidelines will be posted approximately 30 minutes after CoSTR.

Although the electronic version of the ECC Guidelines will be available beginning November 28, the print version still will be published in Circulation on December 13.

11 students pass out during meth talk

From the Pioneer Press:

A class discussion on the dangers of methamphetamine may have been a bit too much for some students at Hutchinson High School.

Eleven students passed out during a graphic presentation by former meth addict David Parnell, who spoke about his struggle, attempted suicide and recovery. The presentation included videos, Hutchinson police Lt. Dave Erlandson said.

Four ambulances, three police officers and the school nurse were called in to help.

Nine of the students were treated at the scene and one was taken to a hospital emergency room. Another student was released to a parent and then taken to the hospital.

There were no serious injuries.

Erlandson said some of the students indicated the temperature in the room and the fact that they skipped breakfast may have contributed to the fainting.

Stroke care comes to local hospitals

From TownOnline.com (Harvard Post):

A collaborative effort among UMass Memorial Medical Center, Brain Saving Technologies of Wellesley Hills and five community hospitals is bringing the highest level of stroke care to emergency room patients without them having to travel far from home. Clinton Hospital is one of five hospitals now designated as primary stroke services centers by the Massachusetts Department of Public Health. This designation is made possible by the sharing of physicians and technology via an advanced digital video medicine service coordinated by BST.

The video monitoring system, also called a telemedicine system, enables on-call neurologists with expertise in stroke diagnosis and management at UMass Memorial and BST to examine and talk to an emergency patient or his family as well as the doctor in real time at the community hospital. A mobile unit in the community hospital's emergency department is wheeled bedside so that the doctors can see the patient and make a diagnosis.

Both the emergency room physician and neurologist also can view CT and MRI scans, enabling them to work collaboratively throughout the patient care process. Once a diagnosis is made, the doctors decide on the most effective treatment plan hoping to lessen the symptoms and outcomes of the stroke, quickly. UMass Memorial doctors assist in assessment, diagnosis and treatment recommendations.

"Ambulances are dangerous places"

From Slate magazine, as excerpted and commented upon by Medlaw.com:

By Zachary Meisel MD from SLATE Magaine
Posted Wednesday, November 9, 2005

Not long ago in Western Pennsylvania, an ambulance was dispatched to help an elderly woman whose heart was beating irregularly. Although the patient was awake and her blood pressure was normal, the paramedics on the scene detected a worrisome cardiac rhythm on their monitor: The heart was beating too fast, and each beat appeared widened on the screen. The patient's condition was consistent with a serious and sometimes fatal heart rhythm called ventricular tachycardia. One of the paramedics called a local hospital, and a doctor there told him to administer intravenously 100 milligrams of a potent anti-arrhythmic drug, intravenous lidocaine hydrochloride. In the cramped ambulance, the medic grabbed a 2-gram syringe of lidocaine in concentrated form, which must be diluted in a bag of saline and dripped into the vein slowly. Thinking he had a different vial, the paramedic quickly injected the entire syringe into the patient. The woman went into cardiac arrest and died.

In 1999, the Institute of Medicine published its report To Err Is Human, which estimated that up to 98,000 patients may die each year because of the mistakes of doctors, nurses, and other hospital workers. But few published studies have tried to quantify or even characterize the injuries to patients that take place before they reach the hospital. How frequent and how serious are the mistakes that take place in ambulances—and are there simple changes that could help prevent them?

Mandatory Influenza Vaccination for Healthcare Workers with Direct Patient Contact?

From Modern Physician:

The Association for Professionals in Infection Control and Epidemiology's board unanimously endorsed mandatory influenza vaccination for healthcare workers with direct patient contact.

The Centers for Disease Control and Prevention has been recommending vaccinations for all healthcare workers since 1981.

APIC President Sue Sebazco said that with a 36% vaccination rate for healthcare workers, voluntary programs are falling short. The APIC has no authority to enforce a recommendation.

Bad News for AutoPulse

From the Seattle Post-Intelligencer:

COLUMBUS, Ohio -- Researchers have produced data supporting their decision to halt a study of automated CPR machines after preliminary results showed a lower survival rate for patients treated with the devices.

The study - led by Dr. Michael Sayre, an emergency physician at the Ohio State University Medical Center - tested the AutoPulse in ambulances in five cities, including Seattle. Researchers expected the machines, which fit over the chest and deliver a steady pulse, would outperform medical staff who can become inconsistent or exhausted when delivering CPR.

"It was just the opposite of what we would anticipate happening," Sayre said.

The study began in June 2004, and researchers intended to examine 1,850 patients - half using the AutoPulse and half using manual resuscitation.

But researchers halted the study when they found that only 6 percent of the 394 patients treated with the device survived. About 10 percent of the 373 patients manually treated survived.

Dogs ease anxiety, improve health status of hospitalized heart failure patients

From the American Heart Association (tipped off my MedGadget):

Researchers discovered that a 12-minute visit with man’s best friend helped heart and lung function by lowering pressures, diminishing release of harmful hormones and decreasing anxiety among hospitalized heart failure patients. Benefits exceeded those that resulted from a visit with a human volunteer or from being left alone.

Animal-assisted therapy (AAT) has been shown to reduce blood pressure in healthy and hypertensive patients. It reduces anxiety in hospitalized patients, too.

Video and Patient Telemetry: Ambulance to ER

From a press release:

Wireless Facilities, Inc.(WFI) (Nasdaq: WFII), a global leader in the design, deployment, and management of wireless communication networks, technology networks and security systems, announced today that it has been selected to provide network design and deployment services for the City of Tucson, Arizona's proposed wireless mesh network. The network project, called Emergency Room Link (ER-LINK), is initially planned to provide video and patient telemetry services between ambulances and the University Medical Trauma Center, with options to expand the network to include other area hospitals and advanced life support (ALS) paramedic vehicles. In collaboration with two other technology partners, WFI will design and deploy the network in phases throughout the Tucson area. The project is expected to begin in early 2006 and is anticipated to be completed by the second quarter of 2006.

Doctor accused of taking drugs from hospital

From the Princeton Daily Clarion:

PRINCETON-A former emergency room physician faces a theft and drug possession charge in Gibson Circuit Court.

Michael T. Rogan, 37, Evansville, was arrested early Sunday morning by Princeton police at Gibson General Hospital , and appeared in court Monday.

Rogan entered a not guilty plea to charges of stealing controlled substances and syringes from the hospital, and to possession of a controlled substance.

Judge Walter Palmer appointed Neta Schleter as his attorney and set bond at $7,500 surety or $750 cash before scheduling a pre-trial hearing for 9 a.m. Dec. 12.

According to an affidavit for probable cause filed by Princeton Police Sgt. Stan McNeece, the arrest came after police got a 2 a.m. call from Gibson General emergency room staff, reporting Rogan walked through the ER with a large duffel bag, heading toward the surgery suite.

McNeece said hospital staff reported Rogan hadn't worked at the hospital for approximately two years, and while he told GGH staff that he was going to clean out his locker, there was no plausible reason for him to be in the hospital at that hour. McNeece said he walked into the surgery suite and saw Rogan standing in the physician break room, with four sealed syringes sticking out of his back pocket.

The police officer said Rogan was “acting very nervous and was standing beside the duffel bag.” McNeece said Rogan gave permission for him to search the bag for any weapons.

“I opened the duffel bag and located three red ‘sharps' containers, each containing numerous drug vials and syringes,” he wrote in the affidavit.

McNeece said he also removed the syringes from Rogan's back pocket.

The police officer wrote that Rogan told him he took the sharps containers and syringes from the surgery rooms.

In the report McNeece noted, “given his former position as a physician, he knows that unused schedule drugs can be obtained from these sharps containers. I asked ER staff to look into the containers to see if any unused controlled substances could be seen in the containers. Several were identified by looking into the top of the container.”

McNeece said he contacted the hospital administrator, who asked police to take appropriate action. Rogan was arrested for the theft and drug possession charges.

At the hospital, police and staff inventoried the contents of the containers. McNeece said several substances, including two vials of Midazolam, two vials of Duramorph, several vials of Demerol and a syringe full of Fentanyl were identified.

Rogan was charged with possession of the Duramorph and Fentanyl, two narcotic analgesics.

EMTALA Settlement in Illinois

From Modern Physician

Pekin (Ill.) Hospital agreed to pay $35,000 to resolve allegations that it twice violated the Emergency Medical Treatment and Active Labor Act in 2000.

The 107-bed hospital, managed by Quorum Health Resources, allegedly transferred a pregnant woman who arrived in its ER to a nearby hospital without screening her.

The hospital also allegedly sent a 16-year-old boy who arrived at its ER seeking help for drug addiction to a nearby hospital, also without a screening.

Emergency Neurosurgery in Montana

From the Grand Forks Herald:

SIDNEY, Mont. - What little boy hasn't bonked his head on a coffee table or a staircase or a kitchen chair? Kids roughhouse. They get bruised. They bounce back.

Carter Engstrom is no different. At home in Sidney, the boisterous 4-year-old plays hard with his little brother, Grant, and five cousins, all boys.

When Carter conked his ear on the corner of the television stand three weeks ago, his parents weren't worried.

"He said, `Look at my ear, Mommy. I got an ouchie!'" said his mother, Annie Engstrom. "It was not a big deal at all."

Within 15 hours, though, Carter lay unconscious in an operating room at the Sidney Health Center. A blood clot was pressing dangerously against his brain.

There are no neurosurgeons in eastern Montana, but there is Dr. Ed Bergin, who has been Sidney's general surgeon for the past 25 years.

"It was either do it or lose him," said Bergin, who drilled a series of holes in Carter's skull to relieve pressure and drain away blood. "You just have to grab the bull by the horns. You step out of the box and out of your comfort zone and do it."

By all accounts, Bergin saved the boy's life, although he is reluctant to acknowledge it.

"All of this publicity is a little embarrassing for me," he said. "I'm just the average general surgeon. I'm no superstar I go home and take the garbage out like everyone else."

Tool to Determine Suitability for Discharging Chest Pain Patients

From ACEP:

Washington, DC—Canadian researchers have developed the "Vancouver Chest Pain Rule," which can be used to identify and safely discharge emergency patients with chest pain from the emergency department, following evaluation.

According to the study authors, this finding is important to relieving emergency department crowding and will improve the cost-effectiveness for certain coronary diagnostic tests, as well as reduce patient inconvenience. This study is included as an early online release from Annals of Emergency Medicine (A Clinical Prediction Rule for Early Discharge of Patients with Chest Pain).

"Patients who go to the emergency department with chest pain fall into three categories," explains lead study author James M. Christenson, MD, FRCPC, clinical professor, department of surgery, University of British Columbia and research director, St. Paul’s Hospital Department of Emergency Medicine. "There are those who have serious symptoms and need admission and treatment, those whose pain is not related to heart problems, and those who require testing and diagnosis to rule out acute or life-threatening conditions."

According to the findings, patients with normal cardiograms and negative blood tests (used to diagnose heart attacks) are considered at low risk for serious heart conditions and can be safely discharged without prolonged emergency department observation, expensive rule-out protocols or testing.

The Vancouver Chest Pain Rule uses age, medical history, diagnostic tests for heart disease, and pain characteristics to identify patients with chest pain but who do not have an acute heart condition. About one-third of patients screened this way are found, with minimal error, to be at very low-risk of heart problems. The Vancouver Rule reduced the number of patients who had undetected acute cardiac conditions and were discharged from 5 percent to only 1 percent in Canada.

ACEP Will Hold Scientific Symposium in New Orleans

The American College of Emergency Physicians has announced that Scientific Assembly 2006 will be held in New Orleans, Louisiana, October 15-18, 2006.

New Orleans was scheduled as the host city for Scientific Assembly 2006 seven years ago. After Hurricanes Katrina and Rita, the ACEP Board and staff questioned whether the city would still be able to play host to more than 4,000 emergency medicine professionals and exhibitors. After a recent tour of the city and convention facilities by staff, the answer came back a resounding “Yes.”

"The emergency physicians providing care during Hurricane Katrina were among the very last people to leave the city,” said ACEP President Frederick C. Blum, MD. “It's appropriate that we are now one of the first to return.”

WI: Medical Malpractice Legislation Heads to Governor’s Desk

From the Wisconsin Hospital Association

After clearing the Assembly two weeks ago, this week the Senate passed legislation reinstating caps for non-economic damages (pain and suffering) awarded in medical malpractice cases. AB 766 reinstates caps on non-economic damages at $450,000 for adults and $550,000 for children (18 and under). The legislation is in response to the Wisconsin Supreme Court striking down Wisconsin’s cap on non-economic damages in July.

In making the case for reinstating the cap, Senator Scott Fitzgerald (R-Juneau) was quick to point out to his colleagues that, unlike some other states that limit both economic and non-economic damages, Wisconsin currently has no cap on economic damages and there is no effort to change that.

Sen. Fitzgerald said the legislation is designed to address Supreme Court Justice Crooks’ concerns about the lack of rationale behind the previous cap, when he indicated that the number seemed to be "plucked out of the sky." Fitzgerald described to his colleagues the thoughtful process that was undertaken in crafting this legislation. "The numbers were arrived at by claims’ experience, comparison to other states and a study by Pinnacle Actuarial Resources that indicates these numbers are very close to where we need to be."

The bill also establishes a biennial review process (every odd numbered year) for determining whether the amount of the caps is still appropriate or whether it needs to be adjusted. While six Democrats in the Assembly joined all of their Republican counterparts in voting for the bill, the vote in the Senate was strictly along party lines. However, Senator Mark Miller (D-Madison) offered an amendment to reinstate a cap at $1 million. Though the $1 million cap was not supported by WHA, and failed, it was a strong, bipartisan signal of a desire to address the issue.

"All 33 senators, Democrat and Republican, voted for a cap on Tuesday (November 8), because they recognize that Wisconsin needs damage limits to maintain access to high quality physicians and hospital care," said WHA’s Senior Vice President Eric Borgerding. "While the cap amounts differed, I think these votes sent a very strong message, and am hopeful that a cap will eventually be reinstated in Wisconsin."

The disagreement that remains seems to be over determining what the amount of the cap should be. Wisconsin’s Governor, Jim Doyle, in early media reports has indicated he will veto the bill. However, WHA will be working with members and the public by running radio ads asking people to contact Governor Doyle urging him to sign AB 766.

WHA’s Vice President of Government Affairs Jodi Bloch added, "We need only look to our neighbors in Illinois to witness the devastating consequences that having no caps on non-economic damages can do to health care access. We have to fight to maintain this access that up until now Wisconsinites have taken for granted."

For Profit, Home-based EKG Telemetry Service

From Medgadget:

When a customer signs up for EKGuard, the company sends a handheld EKG monitor. They also take a customer's medical history, contact his or her doctor and cardiologist, and explain how they should take a baseline EKG, for reference by cardiac specialists.



The portable monitor has three wires; placed in the right spots on the body, they record data from 12 different leads, like a standard hospital or ambulance EKG. When collected, the data build a picture of how efficiently electrical impulses are traveling through the heart. To transmit the EKG readings to the call center, the device translates the information into sound and plays it over a phone line to a computerized receiving station, where it is reconfigured into an EKG chart that can be analyzed for irregularities...

Now that the company is up and running stateside, Lichtenstein says, they plan to refine the technology. The next step: adding Bluetooth wireless capabilities to the device, so that it can communicate with a cell phone or a PDA...

Companies like EKGuard are already operating in Israel, England, Switzerland, Germany, Italy, and the Netherlands. More than 120,000 people in Israel alone are using a similar service, according to Lichtenstein, and a study by one company found that the technology helped its customers cut emergency-room visits by 30 percent. Even more telling, the average time it took for heart attack victims to call for help after their first symptoms appeared dropped from four hours to around 40 minutes.

Apparel for doctors and nurses no longer limited to just white

From Taiwan Headlines

Recently, several hospital supply stores have imported Italian made medical wear, which comes in a wide variety of colors and styles. With a bit of tailoring, the outfits are really quite fashionable. Some doctors said that they would not think twice about wearing the jackets out of the hospital and onto the street.

"Did you know that Matsushima Nanako, who stars in the Japanese series "The Female Doctor in the Emergency Room" wore this exact purple jacket? I had to search and search before finding one exactly like it," said a dentist, Yang Po-ya, who works at the Talung Dental Clinic. This clinic is one of a small number in Taipei that has already begun purchasing the trendy medical outfits.

One can see jackets of all colors hanging in the clinic's changing room. In addition there are many styles of jackets worn by the doctors as well as uniforms worn by nurses. All of the workers at the clinic are allowed to wear the style or color of uniform or jacket that suits them that day.

"Since everyone is wearing something different, it is no longer like wearing a uniform," said Yang.

"Cuts signal ambulance wreck"

From San Jose Business Journal

Ambulance companies in Silicon Valley are bracing for a new round of Medicare reimbursement cuts next year that some predict will bring further consolidation to the industry.

In January, a new government policy will take effect that phases out payments for disposable supplies and oxygen that ambulances routinely use when transporting patients, the industry says. In addition, ambulance companies are expecting cuts in their mileage reimbursement rates at a time of record gasoline prices and a reduction in payments for transporting Medicare patients, which typically make up half their customers.

Statewide, the new fee schedule could mean a 23 percent cut, or $110 million less, in Medicare payments for California's 280 ambulance companies, according to David Nevins, president of the California Ambulance Association, which is pushing for a freeze in next year's rates. "We project in 2006 that we could see nine to 10 businesses in California go under."

Ambulance companies say they cannot afford another decrease in government payments because Medicare reimbursement rates already fail to cover their costs. In 2002, the industry was shifted to a national fee schedule which bases reimbursements on national averages rather than on an individual company's customary charges. The new policy, which is being phased in over five years, has meant that companies in California, which have some of the highest operating costs in the nation, saw a loss on Medicare patients of $29 million in 2005, Mr. Nevins says.

New "long term care acute hospitals" in Iowa

From the Des Moines Register:

Out-of-state medical corporations want to build up to four new hospitals in the Des Moines and Iowa City areas.

The hospitals, which would cost more than $10 million each, would focus on critically ill, elderly people who would need to stay for weeks at a time.

Select Medical Corp. of Mechanicsburg, Pa., wants to build a pair of $16 million, 50-bed hospitals in Polk and Johnson counties, according to initial documents filed with state regulators. Regency Hospital Co. of Alpharetta, Ga., wants to build an $11.4 million, 60-bed hospital in Des Moines and a $10.4 million, 44-bed hospital in Iowa City.

The facilities would be "long-term acute care hospitals," a special class that has become increasingly common across the country. Backers say they focus on caring for patients who are too sick for nursing homes but who need longer-term care than do most hospital patients.

Select Medical, which runs 98 such hospitals nationwide, is setting up Iowa's first one in Davenport. That facility, called Select Specialty Hospital-Quad Cities , is expected to open in March. Regency Hospital Co., which runs 15 hospitals in nine states, is a newcomer to Iowa. Both companies are for-profit operations, unlike the operators of all other Iowa hospitals, which are set up as tax-exempt charities. A Select Medical Corp. lawyer said his company probably would choose sites near larger hospitals in downtown Des Moines and Iowa City.

Legislators may let docs say sorry, but won't limit malpractice damages

From the Des Moines Register:

"Sorry" seems to be the hardest word — at least for doctors who might get sued if they say it.

Legislators wrestling with malpractice issues said Monday that they likely would not be able to cap damages in malpractice lawsuits next year but they might be able to do smaller things, such as let doctors apologize for mistakes without it being grounds for a lawsuit.

A panel of lawmakers charged with making recommendations to the 2006 General Assembly offered ideas mostly aimed at reducing the cost of litigation. The rising expense of malpractice insurance to protect doctors against lawsuits is often blamed for the high costs of medical care.

One proposal would require medical experts to certify the validity of a malpractice claim earlier in the litigation process. Other ideas would be to provide state incentives to help specialty physicians pay for malpractice insurance and to require doctors and hospitals to publicly report errors.

The ideas were not without critics. A lobbyist for the Iowa State Bar Association said the state already has a quick judicial process. An official with the Iowa Hospital Association cautioned that error data can be unfairly manipulated and distorted.

The "I'm sorry" proposal is new to Iowa. The Iowa Medical Society said 16 other states have enacted some form of the law that excludes such statements as proof of liability.

Karla Fultz McHenry of the medical society told lawmakers that studies show such provisions have reduced the number of lawsuits brought against doctors.

"Patients feel better if their physician talks to them about what happened, rather than just finding out that there was an adverse event where something went wrong and not understanding why," McHenry said.

The ideas come after years of disagreements between Republicans and Democrats over capping awards in malpractice cases. Republicans generally support caps, saying it will lower the cost of malpractice insurance. Most Democrats say it limits a patient's right to seek damages. Leaders agreed Monday the caps debate won't likely get anywhere in 2006.

Meth protocol in Southern IL

From The Southern Illinoisan:

Already one of the first hospitals in the area to begin tracking meth-related cases that come there, Herrin Hospital's administrators and SIH are formulating a protocol for law enforcement, emergency responders and medical care professionals to follow when children are involved in a meth lab bust.

The protocol requires all children found at a meth lab to be assessed by a medical professional within two hours of being removed from the lab.

The assessment is to determine if the children are suffering ill effects from exposure to meth manufacture and use. In some cases, the protocol recommends a serum drug screen in addition to urine tests for drugs. Children in homes where meth is manufactured often test positive for meth and other drugs. The serum test helps determine the level of exposure.

The protocol also calls for follow-up treatment with special attention to developmental screening, neurological screening and tests of the respiratory system and kidney function. Follow-up is mandated at 30 days and 12 months for children who have been declared at risk.

I'll see your 30 minute guarantee and raise you 15...

From the Venice Gondolier:

Hospitals to offer faster ER service

It's no longer a race to see how fast the pizza delivery man can get to you, but how fast your local hospitals can respond when you need emergency care.

Sarasota Memorial Hospital this week introduced a new promotional campaign guaranteeing no more than a 30-minute emergency room wait before seeing a physician or a physician's assistant. The initiative begins on Nov. 20, five days after the hospital's new Emergency Care Center wing opens to patients.

Not to be outdone, Venice Regional Medical Center is responding with its Nurse First Program, which may offer a 15-minute guarantee.

"Competition is not our objective, but the need to be treated quickly is essential and we will all work in that direction," said Gwen McKenzie, chief executive officer for SMH. "Typically the ER is our front door and the right place to start.

Doctors say ERs not ready for a disaster

From the Mercury News:

In September, emergency physicians from across the country gathered in Washington to rally for additional government support. More than 3,000 physicians attended and spoke in favor of a measure that would increase Medicare payments to emergency doctors and hospitals by 10 percent.

But the bill so far has only two sponsors. Emergency physicians say they are amazed that the Bush administration is willing to spend billions to stockpile Tamiflu for a possible super-flu outbreak - even though it's not clear the medicine would be effective - while showing disinterest in aiding emergency hospitals that would have to handle flu cases.

Emergency departments are the perfect cauldrons for a dangerous strain of flu to spread through large numbers of immune-compromised people, said Kellermann, the Grady physician. Emergency centers should be expanded to have respiratory isolation areas and other services, he argued.

"We're worried about a flu pandemic and we're parking patients cheek to cheek," he said. "That's just mind-bogglingly stupid."

Millions of adolescents on road to diabetes

From the Chicago Sun Times

Nearly 2 million U.S. children ages 12 to 19 have a pre-diabetic condition linked to obesity and inactivity that puts them at risk for full-blown diabetes and cardiovascular problems, government data suggest.

Researchers from the federal Centers for Disease Control and Prevention and the National Institutes of Health examined the prevalence of abnormally high blood sugar levels after several hours without eating, a condition called impaired fasting glucose, or IFG, that is measured in a blood test.

One in 14 boys and girls in a nationally representative sample had the condition. Among the overweight adolescents, it was one in six.

Lean in Sioux Falls

From the Argus Leader:

Faced with a potential patient revolt over rising health care costs, hospitals nationwide are becoming more efficient.

In Sioux Falls, hospitals are taking cues from manufacturers such as Toyota to cut costs and improve patient care.

It's a major overhaul of daily tasks in both Avera McKennan Hospital and Sioux Valley Hospital - all with the goal of becoming "lean."

Lean is a corporate philosophy growing in popularity that means keeping fewer supplies to save expensive space, counting the number of steps it takes technicians to run basic tests and cutting wasted activity. It even means reworking the way housekeepers clean patients' rooms.Sioux Valley is now in the process of remodeling its main laboratory, blood bank and cardiac catheterization lab. The hospital plans to incorporate lean techniques in inventory and staffing in a surgical tower under construction, said Sioux Valley lean consultant Tony Vanderwolde.

Avera McKennan's initial work in its laboratory led to changes in its emergency, surgical and housekeeping departments.

The hospital has reduced the average patient's stay in the emergency room from two hours and 15 minutes to a current goal of an hour and a half, Slunecka said.

Those savings came in the form of setting up a triage area and finishing patient registration at the bedside after care has started. Now, staff bring carts equipped for certain situations -- such as a suture cart - to the patient instead of rushing to find equipment stored in a variety of areas.

But those gains created a bottleneck of patients who had to wait for rooms to be cleaned before they actually could leave the emergency room.

"Everybody in the emergency department ... believed it was a shortage of housekeeping staff," Slunecka said.

Instead, the lean team worked to decrease the time rooms were empty between patients, and looked for ways housekeepers could clean rooms more efficiently. The time has decreased from more than two hours to about 74 minutes, said Bret Corcoran, Avera McKennan's housekeeping manager.

The changes have come from changing how nurses tell housekeeping staff about empty rooms and also in standardizing the way employees empty trash bins and change shower curtains.

"So much of it is common sense," Corcoran said.

Housekeeper Kristina Simon said she likes the changes. Rooms are cleaner now, she said, and she feels like she's better at her job.

"I thought it was a great idea," Simon said. "I just feel like everybody should do things the same way."

Open House for New ED in Canton, IL

One of our affiliated hospitals. I'll be there..

The administration, staff, and physicians of Graham Hospital are pleased to announce a public open house for the new Graham Hospital Emergency Department, according to hospital spokesman Matt Ulmer.

The new Emergency Department will be accessible for viewing and guided tours on Sunday, Nov. 13, from 2 to 4 p.m.
Those attending the open house may gather in the Graham Hospital lobby. Small group tours will be leaving that area regularly for those who wish to see the new facility up close. Refreshments will be provided, and those in attendance may enter a drawing for door prizes.

The new facility was designed to streamline patient flow, and it includes a total of 10 patient rooms plus a procedure room. Some of the rooms are designed to accommodate more than one patient should the need arise. All of the new patient rooms are outfitted for general treatment, but there are rooms specially equipped for certain cases. There is a trauma bay that can accommodate two patients. There are two cardiac rooms and two isolation rooms. There is one obstetrics/gynecology examination room with a private shower, and there is the procedure room. Each patient room is equipped with a TV for the comfort of the patient and family.
The new Emergency Department boasts several other enhancements over the former emergency facility. The new construction is over 12,000 square feet while the old space was roughly 5,600 square feet. The increased square footage has made it possible to triple the storage space in comparison to the old facility. The offices of the medical director and Graham Hospital Emergency Department director are located within the new Emergency Department rather than removed from it as was the case in the old space.

The total cost of construction was around $5.2 million, and that cost is being paid through donations and prior year funds set aside for building improvements.

The new space was also constructed with increased security and safety in mind. All doors within the new Emergency Department are locked at all times and require special access to enter. Additionally, surveillance cameras will monitor the entrances and waiting area.

Ambulances will make use of a separate entrance to the facility as opposed to walk-ins. A decontamination bay with a shower and drainage tank has been built just off the new ambulance bay to accommodate chemical and bioterrorism exposures. Each of these factors will enhance the security and safety of patients, family, and care providers alike.

Worst 10 States for Auto-deer Collisions

Iowa didn't make the top ten

NEW YORK (CNN/Money) - Pennsylvania ranks first among the top ten worst states for vehicle-deer collisions, according to an insurance survey published Thursday.

Citing claim statistics, auto insurer State Farm said that drivers in Pennsylvania experienced more deer collisions than any other state between July 1, 2004 and June 30, 2005.

State Farm estimates that 1.5 million vehicles collide with deer every year, resulting in 150 motorists deaths and $1.1 billion in vehicle damages.

With deer migrating and mating season occurring between October and December, the auto insurer says a higher number of deer are near roads this time of year.

Coming in second and third were Michigan and Illinois, followed by Ohio and Georgia. Minnesota and Virginia ranked sixth and seventh respectively, while Indiana, Texas and Wisconsin rounded out the list at eighth, ninth and tenth.

Former Med Student Must Repay Scholarship Money

From Modern Physician

A former medical student at Creighton University, Omaha, Neb., must pay more than $410,000 for failing to follow through with his responsibilities as a participant in the National Health Service Corps Scholarship Program, which paid his tuition in exchange for a promise to practice medicine in an underserved area upon graduation.

The 8th U.S. Circuit Court of Appeals ruled Thursday in the case of Quentin Tanko, who signed up for the program when entering medical school at Creighton in 1999. Tanko accepted nearly $89,000 in scholarship funds during his first two years in medical school before quitting the program. After graduation in 2003, he entered an orthopedic surgery residency training program in Fort Wayne, Ind.

The government filed an action to collect three times what Tanko had borrowed, which is allowed in the law that created the scholarship program. The 8th Circuit upheld an earlier ruling by U.S. District Judge Richard Kopf of Lincoln that said Tanko owed more than $410,000 -- $266,000 for the scholarship and damages and $144,000 for interest.

Patients' Personal Information Mistakenly Posted Online

From Modern Physician

The personal information of about 2,800 patients who scheduled appointments at Ohio State University Medical Center in Columbus was mistakenly posted online, hospital officials said. The information included names, addresses, phone numbers, birth dates, Social Security numbers and the reason the patients were making appointments. The information posted did not include medical records.

Those affected all scheduled or changed appointments on April 19, 2004. Hospital officials said they pulled the file from the Internet immediately after someone notified them three weeks ago that he had stumbled upon it. All those affected were sent letters Wednesday telling them the university will pay for a yearlong credit-protection service.

Margaret Johnson, privacy officer for the health system, said officials have no idea how long the information was on the Internet

Stolen Ambulance in High-Speed Chase

From JEMS

Early on Sept. 25, a Danville (Va.) Police unit spotted an ambulance that was reported stolen from Davidson County Ambulance Service in Lexington, N.C., sometime before 7 a.m. that day. The unit alerted area law enforcement agencies, and the Rockingham County Sheriff's Office and the North Carolina Highway Patrol chased the suspect down various roads to the Highway 700 area.

The driver averted several spike strips that were laid to blow out the vehicle’s tires, until a sheriff's unit rammed the rear of the ambulance, knocking off the bumper, near the Rockingham\Caswell county line. The vehicle then hit a spike strip on Highway 700 at the Wolf Island Creek Bridge, forcing the ambulance over an embankment.

Deputies then pulled the suspect, Leon Perry Hollimon Jr., 37, out of the cab when he refused to exit voluntarily. Officers noticed that Hollimon had attempted to disguise himself, wearing a stethoscope and pager, and carrying two latex gloves in his back pocket. But even more unusual than his unconvincing appearance was the carcass of a deer found in the back of the ambulance, which was fully stretched out and strapped to the stretcher. Although officials were not sure how Holliman obtained the deer, it had obviously been dead for several days and was likely picked up from the side of the road.

Lt. Scott Nanney of the Lexington Police Department said Hollimon matches the description of a man arrested for public intoxication in Lexington the day prior. That man told LPD officers his name was John Lowder. Although unconfirmed as the man arrested for the intoxication charge, he was identified via fingerprint records as having extensive prior arrests, including convictions for possession of marijuana, larceny, loitering and prowling, and possession of a firearm by a felon, mostly in the Jacksonville, Fla., area.

Following the pursuit, the ambulance was towed to Hopper's Wrecker service in Eden and then returned to Davidson County on the following day. Two N.C. Highway Patrol cruisers were damaged in the pursuit, but no one was harmed.

Doctor's Assistance Leads to Mistrial

Fromt the Champaign-Urbana News-Gazette:

URBANA – In a reversal of an earlier decision, a Champaign County judge Wednesday granted a mistrial in a medical malpractice case in which a physician witness helped a juror having a medical emergency in the courtroom.

Dr. Robin Steinhorn, a Chicago neonatologist, was the first expert witness on behalf of the Shambos and was only minutes into her testimony at about 1:45 p.m. Tuesday, when a middle-aged juror indicated she wasn't feeling well.

Steinhorn, who practices at Children's Memorial Hospital in Chicago and teaches at Northwestern University in Evanston, asked the judge if she could approach the juror, who was having difficulty breathing, had broken out in a sweat, and was very pale.

Jones ordered Steinhorn to see if she could help her while emergency personnel were en route to the courthouse. The other jurors and the approximately 20 spectators, many of them University of Illinois law students, were removed from the courtroom.

Lowering the Body Temperature in Post Cardiac Arrest Patients

From the Rocky Mountain News

A Louisville company's groundbreaking device for lowering body temperatures in victims of brain traumas will be featured on Thursday's episode of the NBC medical drama ER.


"Patients have walked out of University of Colorado Hospital neurologically intact after suffering prolonged cardiac arrest that normally would have left them brain-dead," Dr. Kennon Heard, an emergency-room physician at CU Hospital, said Monday.

He was referring to the success his staff has had with Arctic Sun, a device made by Medivance of Louisville.

"We've all heard stories of someone falling through the ice of a frozen lake, going without oxygen for 15 to 20 minutes, and then when they're revived, miraculously there's no brain damage," Medivance CEO Robert Kline said.

Arctic Sun simulates that immersion into frigid water that seems to slow brain damage, but it does it in a much more controlled way, Kline said.

The device consists of four pads that contain medical electrodes, attached to the patient's torso with a common hospital adhesive, Hydrogel. Tubes connected to a mobile machine send temperature-controlled water through the energy-transfer pads.

"The water never contacts the patient, but it's as if it did," Kline said.

Heard said CU Hospital's goal is to get the patient to the ideal temperature - often about 92 degrees - within four to six hours of a cardiac arrest.