Sunday, April 30, 2006

Riding in Pickup Beds

We have the same concern in Iowa...
From the Honolulu Star-Bulletin:

While island motorists buckle up more than those in any other state, Hawaii is one of several states that allow passengers to ride unrestrained in the bed of pickup trucks.

Everyone from state lawmakers to national highway safety experts is questioning the rationale of having a seat belt law while people roam freely in truck beds. They say laws need to be changed before more people are killed.

"Considering every state but one has a law that requires people to be belted in vehicles, it makes no sense to me they can ride unrestrained in the back of a pickup truck that has no protection at all," said Susan Ferguson, of the Insurance Institute for Highway Safety. "There's no restraints in the rear, and it's extremely dangerous."

Thirty states have some type of restriction on riding in cargo areas, but many of those fall short of a comprehensive ban, according to the institute.

The states without any type of restriction are Alabama, Alaska, Arizona, Delaware, Idaho, Illinois, Indiana, Iowa, Kentucky, Minnesota, Mississippi, Montana, New Hampshire, North Dakota, Oklahoma, North Dakota, South Dakota, Washington, West Virginia and Wyoming.

Many states, including Hawaii, prohibit young children from riding in the back. Several states allow truck bed riding for work, like farmers, or during parades. Colorado allows it only if the cargo area is enclosed on all sides.

Friday, April 28, 2006

Adults Ambivalent About Higher Payments to High Quality Providers

A Wall Street Journal Online/Harris Interactive Health-Care Poll shows that many U.S. adults believe it is fair to assess healthcare quality, but they are ambivalent and confused about whether or not payments to doctors and hospitals should be linked to quality metrics.

Half of all adults believe there are fair and reliable ways to measure and compare the quality of care provided by different hospitals and medical groups. However, only one in five (19 percent) think it would be fair for patients to pay more to be treated by healthcare organizations that have been shown to provide better care. Furthermore, only 14 percent said they themselves would be willing to pay a significantly higher premium for such care.

Compared to individual patients, a higher percentage (33 percent) of adults favor health insurance plans paying more to hospitals and medical groups that have been shown to provide better care. However this is down from 44 percent in 2003.

Thursday, April 27, 2006

Changes in Medicare Fiscal Intermediaries

From CMS:

The Centers for Medicare & Medicaid Services (CMS) is implementing significant changes to the Medicare fee-for-service program’s administrative structure. This Medicare Contracting Reform (MCR) will:

Integrate and simplify the administration of Medicare Parts A and B with primary A/B MACs which will process both Part A and Part B claims for the fee-for-service benefit;

Make contracting dynamic, competitive and performance-based, resulting in more accurate claims payments and greater consistency in payment decisions; and

Centralize information, creating a platform for advances in the delivery of comprehensive care.

Under MCR, there will be 23 Medicare Administrative Contractors (MACs) with no national MAC. These new MACs will include:

Fifteen primary A/B MACs to serve the majority of all types of providers for
Part A and Part B;

Four specialty MACs to serve home health and hospice providers; and

Four specialty MACs to serve durable medical equipment (DME) suppliers.

Emergency Physicians Warn That Risky Drinking Can Increase Your Risk of an ER Visit

From an ACEP press release:

As part of Alcohol Awareness Month in April, the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA) have launched a campaign to educate occasional drinkers about how much is too much alcohol consumption and why it may put them at a higher risk of a trip to the emergency department.

Funded by the National Highway Traffic Safety Administration (NHTSA), the Risky Drinking Campaign hopes to keep people from driving after drinking and increase awareness about how much is too much alcohol. ACEP emergency physicians are available in 21 communities across the country to comment on the campaign and to talk about the consequences of risky drinking. Additional information about the campaign also is available at

Percentage of Uninsured Americans Rising

From Yahoo News, via Symtym:

The percentage of working-age Americans with moderate to middle incomes who lacked health insurance for at least part of the year rose to 41 percent in 2005, a dramatic increase from the 28 percent in 2001 without coverage, a study released on Wednesday found.

Moreover, more than half of the uninsured adults said they were having problems paying their medical bills or had incurred debt to cover their expenses, according to a report by the Commonwealth Fund, a New York-based private, health care policy foundation. The study of 4,350 adults also found that people without insurance were more likely to forgo recommended health screenings such as mammograms than those with coverage, and were less likely to have a regular doctor than their insured counterparts.

Tuesday, April 25, 2006

Drive-in Option Not Available

From the Marshalltown (IA) Times-Republican:

A Marshalltown man was arrested Monday after running into doors at the Marshalltown Medical & Surgical Center, then leading police on a chase through part of the city and county.

Nathaniel James Kopel, 22, of 403 N. Second Ave., ran his car into doors at both the OB-GYN center on the east side of the building and the emergency room doors on the west side of the building, according to police. MMSC spokesman John Cahill said the OB-GYN doors were hit first, followed by the emergency room side.

Change the lights from red to green...

We had these on the ambulances, fire trucks and police cars in Ames, Iowa. From

A man who said he bought a device that allowed him to change stop lights from red to green received a $50 ticket for suspicion of interfering with a traffic signal.

Jason Niccum of Longmont, Colorado, said the device, which he bought on eBay for $100, helped him cut his time driving to work.

"I guess in the two years I had it, that thing paid for itself," he told the Daily Times-Call on Wednesday.

Niccum was issued a citation March 29 after police said they found him using a strobe-like device to change traffic signals. Police confiscated the device.

"I'm always running late," police quoted Niccum as saying in an incident report.

The device, called an Opticon, is similar to what firefighters use to change lights when they respond to emergencies. It emits an infrared pulse that receivers on the traffic lights pick up.

Monday, April 24, 2006

Air Medical Scam

From JEMS:

OREM, Utah — If a stranger calls wanting your credit card number in exchange for the dispatch of a medical helicopter to help a loved one in distress — be skeptical.

Orem police are warning residents about a scam by individuals posing as operators of Life Flight, Intermountain Healthcare's medevac unit.

According to police and hospital officials, a person will call and identify themselves as an IHC employee. The caller will then say that they are calling to inform them that one of their family members has been in an accident.

The caller will then say that a credit card number is needed before the helicopter will transport the injured party to a hospital for medical treatment, said Orem Police Lt. Doug Edwards.

However, the scammers have nothing to do with IHC, said Janet Frank, a company spokeswoman.

"When (Life Flight) picks up a patient, they have nothing to do with money," Frank said. "When they're called, they pick the person up."

Sunday, April 23, 2006

12 Nails to the Head: Picture

Blogged yesterday, picture today, courtesy of the Mumbai Times:

Docs seek access to Rx tracking

From the Boston Herald:

Pill-hungry “doctor shoppers” who gin the system to score multiple narcotics prescriptions are being tracked by regulators via mapping technology, but frustrated physicians and pharmacists on the front lines of the addiction battle say they are being pointlessly denied the vital information.

“I would like to know exactly who it is who is going doctor shopping,” said Dr. Srdjan Nedeljkovic, director of Pain Fellowship Education at Brigham and Women’s. “Sometimes you wonder about a patient. I wonder if I’m doing the right thing. How do you know?”

The $20,000 mapping software is used to pinpoint where patients are filling prescriptions for drugs such as OxyContin or Percocet. The new system uses data already collected by the state’s Prescription Monitoring Program.

The overall goal is to halt people from using scripts from numerous doctors to buy up large amounts of addictive painkillers for personal use or resale.

The program tracks patients’ prescription-filling trends through information given at the pharmacy counter, such as driver’s licenses.

While there is a proposal to notify doctors and pharmacists about patients who receive questionable prescriptions from multiple locations, for now only law enforcement, the DPH and regulators are allowed the data.The Public Health Council is likely to decide whether to let doctors and pharmacists access the data this summer. But that’s not soon enough for many of them.

Fentanyl Analog, Abuse and Overdose

From the Northwest (Chicago) Herald:

As far back as the early 1980s, a powerful narcotic painkiller called fentanyl began to be used illicitly. Subsequently, a legal loophole was found by developing an analog to the drug, a slight alteration of the compound that does not change its effect, but essentially makes it unregulated. These unregulated versions of fentanyl were called China White and sometimes "new heroin." These compounds caused a number of overdose deaths on the West coast in the late 1980s and early 1990s.

Since the introduction of the fentanyl analogs and the use of fentanyl as a substitute for heroin, fentanyl-related overdose deaths have been on the increase, sometimes dramatically. According to emergency room statistics in the U.S., from 1994 to 2002, fentanyl overdose deaths have increased from 28 to 1,506. Pockets of overdose deaths have popped up in places from Salt Lake City to Philadelphia, from Los Angeles County, California, to Aiken County, South Carolina.

On Aug.15, NBC News reported police said fentanyl disguised as heroin had caused multiple overdoses on the west side of Chicago and had been given away by members of a street gang to acquire new customers. There was a rash of overdose deaths in Chicago in February, that according to the Chicago Sun Times, was initially suspected to have been caused by a bad batch of heroin. Upon further investigation, autopsy results showed the presence of fentanyl.

Fentanyl is available from drug companies in the form of a patch called Duragesic or a flavored lozenge with a handle called Actiq, known on the street as a "Percopop."

Most of the illegal fentanyl on the street has been extracted from the patches. Even legal users of the long-acting patches have suffered mishaps and even fatalities when the patch accidentally releases its contents too quickly. Obviously fentanyl is an extremely hazardous drug and needs to be more closely monitored by the FDA. In the interim, however, let those who use heroin or other opiates or synthetics beware and be warned that an exceptionally dangerous heroin substitute is currently on the market.

Friday, April 21, 2006

Oregon man survives 12 nails to the head

An AP wire story as posted in the Duluth News Tribune:

PORTLAND, Ore. - An Oregon man who went to a hospital complaining of a headache was found to have 12 nails embedded in his skull from a suicide attempt with a nail gun, doctors say.

Surgeons removed the nails with needle-nosed pliers and a drill, and the man survived with no serious lasting effects, according to a report on the medical oddity in the current issue of the Journal of Neurosurgery.

The unidentified 33-year-old man was suicidal and high on methamphetamine last year when he fired the nails - up to 2 inches in length - into his head one by one.

The nails were not visible when doctors first examined the man in the emergency room of an unidentified Oregon hospital a day later. Doctors were surprised when X-rays revealed six nails clustered between his right eye and ear, two below his right ear and four on the left side of his head.

Wednesday, April 19, 2006

More on the OB (Delivery) Simulator

From Medgadget:

Take a deep breath. The Associated Press is announcing the arrival of NOELLE, a birthing simulator conceived by Florida-based Gaumard Scientific Company. This medical simulator system, the product of long and difficult labor, is a "pregnant robot used in increasing numbers of medical schools and hospital maternity wards." Supplied with four umbilical cords, four dilating cervices, two umbilical clamps and three vulva for postpartum suturing (no less!), the device's S560 model really delivers.

Tuesday, April 18, 2006

Safety: In the Emergency Room, Seat Belts Matter, Too

Grom the NY Times

Of people who survive car wrecks, those who weren't wearing seat belts are three times as likely to die in an emergency room as those who were, researchers say.

The findings, which appear in the current issue of Academic Emergency Medicine, are based on a review of what happened to more than 23,000 people in car wrecks in Wisconsin in 2002.

Emergency room doctors treating the victims routinely want to know if a patient was wearing a seat belt, so they know what kind of injuries to look for.

"If you're not wearing a seat belt, that's an important piece of information," said Dr. Stephen Hargarten, a co-author of the study and the chairman of emergency medicine at the Medical College of Wisconsin. The research was led by Shane Allen, a student there.

The study also found that victims not wearing seat belts were more likely to suffer moderate to severe injuries to the head, face, chest and spine.

Those patients also cost about 25 percent more to treat in the E.R., but the expenses did not stop there. Patients who had not worn seat belts were more than twice as likely to need hospitalization as those who had. Only about a fifth were discharged from the emergency room, the study found.

"Unbelted occupants create a significant burden on the health care system," the authors wrote.

New York Veto

From Capitol News 9:

Last week, Governor Pataki vetoed more than $1 billion in state healthcare funding and an increase to the state's Medicaid emergency room reimbursement rate -- and that's got healthcare professionals talking.

Healthcare professionals said Medicaid patients cost hospital ERs $400 per visit. Currently, hospitals are reimbursed $95. It's been that way since 1991, but this year the legislative budget proposed raising that reimbursement to $150. It would still leave hospitals $200 in the red per visit, but hospital managers said every little bit helps.

Monday, April 17, 2006

Simulator: Pregnant robot tests medical talents


Noelle's given birth in Afghanistan, California and dozens of points in between. She's a lifelike, pregnant robot used in increasing numbers of medical schools and hospital maternity wards.

The full-sized, blond, pale mannequin is in demand because medicine is rapidly abandoning centuries-old training methods that use patients as guinea pigs, turning instead to high-tech simulations. It's better to make a mistake on a $20,000 robot than a live patient.

Noelle, from Miami-based Gaumard Scientific Co. Inc., is used in most of Kaiser's 30 hospitals nationwide, and other hospitals are putting in orders. The Northwest Physicians Insurance Co. is sponsoring similar training programs in 22 hospitals in Oregon and Idaho, rolling out Noelle initially at five of themNoelle models range from a $3,200 basic version to a $20,000 computerized Noelle that best approximates a live birth.

She can be programmed for a variety of complications and for cervix dilation. She can labor for hours and produce a breach baby or unexpectedly give birth in a matter of minutes.

She ultimately delivers a plastic doll that can change colors, from a healthy pink glow to the deadly blue of oxygen deficiency. The baby mannequin is wired to flash vital signs when hooked up to monitors.

Saturday, April 15, 2006

More Doctors Shunning Cumbersome Casts

From the AP Wire, as posted to

Once almost a childhood rite of passage, plaster or fiberglass casts were the method of choice for fixing broken bones. But now, doctors around the world are increasingly shunning cumbersome casts in favor of more cutting-edge options for both kids and adults: splints, special boots, metal plates, rods and screws.

For Ben Crotty's broken wrist, it was a removable splint.

The trend is most common among adults, who often develop swelling and pain and sometimes permanent stiffness. "We often refer to this as 'cast disease.' I say, 'Good riddance!'" said Dr. John Fernandez, an orthopedic surgeon at Rush University Medical Center in Chicago.

Support for the modern technique on kids was bolstered by a Canadian study last month in the journal Pediatrics. It showed that in children aged 6 to 15 with wrist fractures like Ben's, those who wore removable splints for three weeks had better physical function during treatment and afterward than those treated with plaster casts.

Friday, April 14, 2006

AZ House OKs bill to stop frivolous ER lawsuits

From the Arizona Republic:

The (Arizona) state House of Representatives unanimously passed a bill Thursday aimed at curbing frivolous lawsuits against emergency-room workers.

But the chamberwide support belies the deep divisions and controversy behind the measure, which was amended in a bipartisan showdown in the House on Wednesday. The House amendment significantly watered down the bill, with supporters of tort reform claiming it stripped the measure of any significant impact.

The Senate bill would raise the standard of proof needed to win a lawsuit against emergency-room personnel to "clear and convincing" from the current standard of "preponderance of evidence." The House version does not raise the burden of proof but instructs judges and juries to consider the unique situations in emergency-room care, such as the lack of patient records, when making their determination in malpractice cases.

Supporters of the Senate version say that raising the burden of proof is needed to address the shortage of doctors willing to work in emergency rooms.

Mumps in Southern IL

From the Southern Illinoisian:

Southern Illinois University Carbondale officials say they’ve sent home three students this week with the mumps, the first cases the campus has seen in more than 20 years.

Medical personnel with SIUC Student Health Programs said they have had one confirmed and two probable cases since Monday. The confirmed mumps case involved a student living off campus, but the latter two resided in campus residence halls, Mae Smith and Allen.

Meanwhile, the Jackson County Health Department reports there are currently seven possible local mumps cases, part of the 46 total cases said to be in Illinois, according to state health officials.

Thursday, April 13, 2006

ResQPod Success in MN

From ABC Newspapers:

In December 2005, Allina Medical Transportation chose the Coon Rapids Fire Department to be the first emergency medical first responder in its service area to be trained in the use of a new piece of cardiopulmonary resuscitation (CPR) equipment - the ResQPOD - as well as new CPR techniques.

Since the first of the year, the ResQPOD has been used in five medical emergencies - and in three cases the victims survived.

With the old CPR equipment and procedures, the survival rate was under 10 percent, according to Jim Ktytor, Coon Rapids fire inspector.

“Now with the ResQPOD we are up to 60 percent,” Ktytor said.
“In two of the cases, the person walked out of the hospital fully recovered a few days later.

“It definitely makes a difference. There are so many more positives.”

Wednesday, April 12, 2006

UW Family Practice Residency Singled Out as Top Program

Congratulations to the University of Wisconsin Family Practice Residency program! They've been honored as one of the top four programs in the country by US News and World Report.

Redheads may need extra anesthesia

From Consumer Reports

People with naturally red hair may need extra anesthesia to ensure that they don’t feel pain during surgery or wake up before it’s over, suggests a report in the Canadian Journal of Anesthesia. The January 2004 study of 39 men and women found that redheads experienced significantly less sedation when given the common anesthetic midazolam (Versed) than the other volunteers did. The researchers theorize that certain genes linked with red hair may activate a feedback system in the brain that confers resistance to sedation. So if you’re a redhead, you may want to mention those findings to your anesthesiologist--especially if you’ve dyed your hair blond or brunet.

"Frequent Fliers" Have Insurance

From an ACEP press release:

A recent report promotes the use of urgent care centers as a solution to emergency department overcrowding, although the gridlock in emergency departments is related to the lack of inpatient bed capacity, not patients with nonurgent medical conditions, according to the American College of Emergency Physicians (ACEP).   .   

“Urgent care centers may appear to be a reasonable safety valve for overcrowded emergency departments, and educating people about when to seek emergency care is beneficial to the public, but offering the wrong solutions to overcrowding might actually threaten patient safety,” said Dr. Rick Blum, president of ACEP.  “Hospitals across the country have serious shortages of resources, physicians and nurses that have led to an increasing number of holes that are jeopardizing the nation’s emergency medical system.  Solving these problems is critical for responding effectively to the day-to-day emergencies and to disasters and acts of terrorism.”  

Dr. Blum said only 13 percent of emergency visits are classified as nonurgent, according to the latest statistics from the Centers for Disease Control and Prevention.  The report released by the National Association of Community Health Centers uses an older statistic of one-third.  Research shows the real gridlock in emergency department crowding is a “throughput” problem, caused by the lack of inpatient bed capacity in hospitals, not by too many nonurgent patients.  The General Accountability Office (GAO 03-460) reported in 2003 that “boarding” of critically ill patients causes overcrowding, tying up staff and resources, making them unable to treat any more patients from the waiting room or from an ambulance.   

“Urgent care centers are linking themselves with the overcrowding issue,” said Dr. Blum.  “However, the link is not really appropriate, especially when they don’t have a federal mandate, like emergency departments, to treat patients, regardless of their ability to pay.”  

A large number of patients in a waiting room is a symptom of a deeper problem in the emergency department itself.  Patients with nonurgent medical conditions can usually be treated quickly and released.   Emergency departments use a triage process to sort patients, which means the most critically ill patients are cared for first.  Even if some patients in a waiting room went to urgent care centers instead, the patients who remained would still wait until critically ill patients were cared for.

Emergency Physicians and Charity Care

From an ACEP press release:

A new study of physician charity care found U.S. physicians overall to be providing less charity care.  However, emergency physicians provide the highest percentages of charity care, and as other physicians decline to provide this care and close their practices to new Medicare patients, emergency physicians will provide even more, according to the American College of Emergency Physicians (ACEP).  

Dr. Rick Blum, president of ACEP, said the findings of the Centers for Health System Change study is a warning that the nation must act now to protect everyone’s access to lifesaving emergency care.

“The growing lack of resources in emergency departments affects everyone’s access to emergency care,” said Dr. Rick Blum, president of ACEP.  “As other physicians decline to provide charity care, more patients will come to emergency departments for medical care, which means less resources for everyone.  Emergency patients already are suffering, lacking timely access to emergency care and to medical specialists and waiting days for hospital beds.  We are asking the public to send messages to their representatives in Congress to support legislation to help reduce the dangerous trends that are limiting their ability to receive high-quality, lifesaving medical care.”  

More than 95 percent of emergency physicians provided care to the uninsured, compared with 31 percent of all other physicians, according to the American Medical Association (AMA) in 2003.  Reasons for this include the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals with emergency departments to provide emergency medical care to everyone who needs it, regardless of ability to pay or insurance status.

Uninsured patients cost ERs billions

From the Columbus (OH) Dispatch:

Nonemergency care in ERs will cost about $18 billion this year, according to a recent study by the National Association of Community Health Centers. In Ohio, it will cost nearly $1 billion.

Why? Because many of these patients who use emergency rooms for minor issues are uninsured. In Ohio, about 1 million people lack health insurance.

"In the last several years, the uninsured rate has skyrocketed, so the emergency rooms are the only place left for people," said Shawn Frick, executive director of the Ohio Association of Community Health Centers.

The national study used 2004 data and based the cost on the industry belief that 35 percent of emergency-room visits are avoidable. The group multiplied that number by the average cost of an ER visit by region, subtracted the average cost of a health center visit and used 2006 dollars to get $18 billion.

Tuesday, April 11, 2006

Family Presence in ER's

From the Union-Tribune (San Diego)

In the April 3 edition of The New Yorker, Dr. Jerome Groopman, the brilliant author of “The Measure of Our Days” and other books about illness and death, examines the evolution of family presence, the catchphrase for allowing family members into the emergency room.

The trend, Groopman reports, has been championed by hospital chaplains and nurses, often in opposition to physicians opposed to adding more stress to an already chaotic situation.

If there is a patron saint of family presence, it is the Rev. Hank Post, a chaplain who persuaded a Michigan hospital to allow families to observe resuscitations of loved ones. Post's 1985 survey of 70 families revealed that the vast majority believed the experience, though harrowing, helped them move through their grief.

Thirteen years ago, the national Emergency Nurses Association endorsed open access, concluding that family members benefit from the first-hand knowledge that everything that could be done was done. Accompanied by a staff member, family can become part of the rescue team. Family members can provide information, for example. They can help decide when it is time to stop.

Still, families should not expect an automatic pass into the emergency room. That's typically a judgment call by the emergency team, which can be divided.

Advanced Simulator Lab

From the Philadelphia Inquirer:

You wouldn't want to be Dee, Fritz or Eric.

Last week, Dee was having a heart attack. Fritz was getting a tube snaked down his throat. And Eric, with no pulse or blood pressure, had been left for dead.

Earlier in the day, it was even worse. They had been treated for injuries caused by a small nuclear explosion.

Strapped to gurneys in a virtual emergency room at Burlington County College's Mount Laurel campus, Dee, Fritz and Eric are human patient simulators - computerized mannequins that appear to breathe, bleed, blink and urinate.

The mannequins, which cost from $20,000 to $300,000 each, can be programmed to appear to be suffering from any of more than 100 afflictions or injuries.

The college's Simulation Center has 14 of them, more than any institution outside the military, said Charles Grayson, the center's manager.

The center is only a small part of the college's Center for Public Health Preparedness, which is funded by the federal Centers for Disease Control and Prevention and has become a regional draw for hands-on emergency instruction.

Since the center opened in September, more than 2,000 nurses, firefighters, and other emergency personnel have trained there.

The mannequins can be programmed to be drug addicts, burn victims, or casualties of a nerve-gas attack. Their bowels rumble. They can be made to speak. They have a pulse just where you'd expect to find one.

Their faces bear an uncanny resemblance to the old Resusci Annes used for CPR training. But the similarity ends there. Compared with these mannequins, Anne is an old windbag. These fellows - they all resemble middle-age white men - have more in common with the humanoid robot Data from Star Trek: The Next Generation. Inside each is a tangle of wires, computer chips, hydraulics and pneumatics.

Saturday, April 08, 2006

Gym told to pay $619,650 in man's death because it didn't have a defibrillator

From JEMS:

Health-club chain LA Fitness must pay $619,650 to the family of a Fort Lauderdale man who died of sudden cardiac arrest while working out at an Oakland Park gym, a Broward Circuit Court jury ordered Wednesday.

The jury needed only two hours of deliberations to find that LA Fitness' negligence contributed to Alessio Tringali's death. No one attempted to perform CPR on the dying 49-year-old man and the club didn't have an automated external defibrillator that could have saved his life, argued Russell Adler, the attorney for Tringali's family.

The case is believed to be one of the first in the country where a health club has been held liable for failing to have a defibrillator on site, Adler said.

Full Story

Instructors learn new CPR basics

From the Casper (WY) Start Tribune:

Emergency responders and hospital workers must fundamentally change the way they perform basic CPR in order to save more lives, a retired Casper firefighter told an audience of medical technicians Friday.

"We're not saving as many lives as we could," David Woodworth said during a seminar Friday in Casper. The Basic Life Support class aimed to educate CPR instructors around the state on new guidelines from the American Heart Association.

Woodworth, who works in the laboratory at the Wyoming Medical Center, said approximately 350,000 people die from out-of-hospital cardiac arrest each year in North America.

The new focus is on increasing the number chest compressions and making sure those repetitions are at a proper depth, speed and that the compression recoil allows the heart to refill with blood.

The guidelines call for a compression/ventilation ratio of 30 to 2, with 30 chest compressions followed by two quick breaths. This new technique applies to infants, children and adults.

Before this change, emergency workers were trained to give 15 chest compressions, followed by two breaths. This provided ample oxygen, but didn't keep the heart pumping enough.

Friday, April 07, 2006

Minnesota, Wisconsin and Iowa Rank 1,2, 3 in Patient Safety

Iowa hospitals and those in other upper Midwest states were ranked among the best for patient safety by Health Grades, the Colorado-based company that sells hospital information to the public and offers marketing to hospitals using its quality and patient safety data.  The study was based on 13 patient safety indicators developed by the Agency for Healthcare Research and Quality (AHRQ), and applied to the most recent MedPar file of Medicare admissions at nearly 5,000 hospitals during 2002, 2003, and 2004.  

The study resulted in Minnesota, Wisconsin, and Iowa being ranked as the top three states for overall patient safety.  South Dakota and North Dakota also landed in the top 10.  New Jersey, New York, and Nevada were at the bottom of the rankings.

Iowa Mumps Epidemic

From MedPage:

The number of mumps cases in Iowa has climbed to 365 cases, but schools and daycare centers have been spared, state health officials reported today.

Moreover, epidemiologist Meghan Harris, M.P.H., said the laboratory tests "confirm that we are still finding mumps virus, so this outbreak is still very active." Two hundred and ninety-six of 359 cases with completed serology are IgM-positive, she said.

Harris speculated that there are no reported outbreaks in schools and daycare centers because there have not yet been enough exposures or that children's recent vaccinations are protecting them. Most children receive their first mumps-measles-rubella (MMR) vaccination around age one and a second around age four. Children younger than one are still protected by immunity from their mothers."

Harris declined to estimate when the outbreak would peak, but she said that in the days "when mumps was endemic in Iowa, outbreaks were seasonal and tended to fade by late spring or early summer."

Thursday, April 06, 2006

2005 Guidelines: FAQ's

The Iowa Emergency Cardiovascular Care (ECC) has posted a list of Frquently Asked Questions (FAQ's) about the 2005 Guidelines at their website:

"Telestroke" Centers

From the Boston Globe, via Symtym:

Massachusetts is among the first states where neurologists have begun to treat stroke patients without seeing them in person. Fourteen community hospitals have signed contracts with Mass. General's ''telestroke" service, and the hospital is considering expanding into New Hampshire and Vermont.

Meanwhile, a neurologist at South Shore Hospital in Weymouth, Dr. Colin McDonald, and four partners convinced investors to part with $5 million to start Brain Saving Technologies, a for-profit company that competes with the Mass. General service and so far has signed up nine hospitals in Massachusetts and New Jersey. Hospitals in San Diego, Georgia, and Utah have also set up telestroke services.

Doctors at large hospitals routinely use ''telemedicine" to treat thousands of patients in rural locations across the United States, diagnosing skin conditions, monitoring irregular heartbeats, and conducting therapy sessions. But diagnosing and treating patients in the middle of a potentially fatal or disabling emergency is a new frontier. Doctors on both ends of the monitor are concerned about who is liable if a mistake is made treating a patient. And in many states, including Massachusetts, health insurers and the federal Medicare program usually refuse to pay ''remote" doctors for their services.

House Passes Medicare Fee Schedule Freeze for 2006

A little after 5:00pm eastern on Wednesday, February 1, 2006, the U.S. House of Representatives approved the Senate-passed Deficit Reduction Act of 2005 (aka budget reconciliation bill) containing a freeze of the Medicare Physician Fee Schedule for 2006 at 2005 rates.  As a result, Medicare fees to physicians will not be cut by more than 4 percent during the current year.  The legislation passed narrowly by at vote of 216-214 with 3 members not voting.  The measure is expected to be signed into law by the President. 

Monday, April 03, 2006

ACEP Medical News

The American College of Emergency Physicians presents Medical News:

In a partnership with Elsevier Global Medical News, ACEP is happy to offer its members “Up to the Minute Medical News,” an exclusive, timely news service presenting the latest information relevant to your emergency medicine practice.

Mumps Spread Beyond Iowa

From MedPage:

The mumps outbreak that started in Iowa has spread to Illinois, Minnesota, Nebraska, South Dakota, and Wisconsin, an epidemiologist with the Iowa Department of Public Health said today.

Meghan Harris, M.P.H., said all states bordering Iowa -- with the exception of Missouri -- have reported cases of mumps. Moreover, said Harris, the end is no where in site.

"You can expect the numbers that we report tomorrow to be up [from cases reported March 30] and the numbers that will be reported Thursday are likely to be higher again," she said in an interview.

The Iowa Department of Public Health said will update mumps information tomorrow and again on Thursday.

The 245 confirmed, probable, or suspected cases of mumps reported to the Iowa Department of Public Health already represent the nation's largest mumps outbreak in 17 years.