ACEP Magazine for Patients

The American College of Emergency Physicians (ACEP) is exploring the possibility of publishing a free, quarterly magazine for patients in emergency department waiting rooms. The magazine would include healthcare-related information, injury and illness prevention tips, profiles of emergency physicians and emergency departments, relevant celebrity profiles and additional patient-focused information.

EMS "Virtual Museum"

Link: EMS Virtual Museum

Welcome to the formal opening of the National EMS Museum Foundation's Virtual Museum! We have been working diligently for some months now, gathering material, researching, and (hopefully) presenting it in a format that is easy to navigate and enjoyable to see. Please.... take your time and look around. Let us know what you think!

Navigation is simple! The main entrance is a large star with points - or "wings" - modeled after the points on the original "Star of Life" Individual "wings" are represented by small stars and their points will take you to the "stacks". Once in a stack or wing, you will also find you can switch to a different location by using the right side menu. Once viewing a display, any pictures may be enlarged by clicking on them. They open in a new window, so simply close this browser window when done. Finally, at all times you will be able to return to the Virtual Museum Home Page by simply clicking on the link found on each page.

EMS Week

The American College of Emergency Physicians (ACEP) today announced that the 34th annual Emergency Medical Services (EMS) Week will be celebrated throughout the nation May 20-26, 2007. The event brings together local communities and medical personnel to publicize safety and honor the dedication of those who provide the day-to-day lifesaving services on the medical "front line."

National EMS Week will feature hundreds of grassroots activities coast-to-coast that will be planned around this year's theme, "Extraordinary People, Extraordinary Service," which exemplifies the excellent services provided every day, under any circumstances by the 750,000 EMS providers who serve their communities.

"As this year's theme emphasizes, EMS providers are dedicated to saving lives, even putting their own lives on hold as they respond to medical emergencies," said Dr. Brian Keaton, president of ACEP. "They do this every day without special recognition, which is why we are recognizing EMS providers this year as extraordinary."

The weeklong series of events will include national and local activities to honor EMS providers (paramedics, emergency medical technicians, first responders, fire fighters, and police), and to raise public awareness about health and safety issues, including how to prevent injuries and what to do in a medical emergency.

EM Leaders Meet with Joint Commission About First Dose review

From ACEP.
May 23, 2007

On April 6, 2007, the Joint Commission notified hospital administrators that effective immediately the interim rule delaying the standard requiring first dose prospective pharmacy review had been reversed. ACEP, working with ENA and AAEM, sent a letter of protest. In addition, the three organizations requested a face-to-face meeting with the Joint Commission to underscore the problems the standard presents.

On May 17, representatives of ACEP, ENA and AAEM met with the Dr. Robert Wise, Vice President, Division of Standards and Survey Methods, and other key staff from the Joint Commission. During the 90-minute meeting, the three organizations presented their concerns and asked that the Joint Commission address the problems presented by this standard.

Dr. Wise indicated that the standards division will be making recommendations to the Joint Commission leadership based on the concerns expressed during the meeting and will be publishing interpretive guidelines for the medication standard within the next 3 to 4 weeks.

USA Today: "Does where you live determine if you'll live?"

From USA Today:

Hospital death rates are among the best-kept secrets in American medicine. The Internet may be crowded with consumer information, from school report cards to airline safety records, but death rates for most hospitals are still as closely guarded as the formulas for Kentucky Fried Chicken and Coke.

That will begin to change in June, when the Centers for Medicare and Medicaid Services (CMS) plans to post the first broad comparison of the death rates for heart attack and heart failure on its website, Hospital Compare (hospitalcompare.hhs.gov).

The federal initiative marks a bold departure for an agency that has long been the repository of private information on Medicare patients. More than a dozen top hospitals provided USA TODAY with an exclusive look at the government's initiative by sharing their confidential Medicare death-rate report cards. The reports are drawn from death rates of heart attack and heart failure patients who died between July 2005 and June 2006, of any cause, within a month of entering the hospital.

The analysis reveals just 17 of 4,477 hospitals had heart attack death rates that were better than the national rate. Thirty-eight of 4,804 hospitals had heart failure death rates that were better than the national rate.

CPR Glove

From Medgadget:

The CPRGloveTM is a significant development in cardiopulmonary resuscitation technology. It is a portable, inexpensive, and adaptive device designed to greatly improve the success rate of cardio-pulmonary resuscitation (CPR). As simple as putting on a glove, this device will jump into action in an emergency, calmly guiding you through the life-saving steps of CPR. The CPRGloveTM also includes an array of sensors that immediately provide you with important feedback. Not only will the CPRGlove improve emergency CPR, but it will also help improve both CPR training and testing. What most distinguishes CPRGloveTM from all other technologies is that every component is completely incorporated into a wearable glove, increasing device accessibility, portability and autonomy.

The CPRGloveTM has been named one of the Top Ten Inventions of the Year by Popular Science Magazine.

CMS ISSUES GUIDANCE ON HOSPITAL EMERGENCY SERVICES REQUIREMENTS

Source: Centers for Medicare & Medicaid Services (http://www.cms.hhs.gov/)

Guidance Applies to Specialty and All Other Hospitals Except Rural Critical Access Hospitals

CMS Continues to Implement the Strategic Plan for Specialty Hospitals Reported to Congress in August, 2006

The Centers for Medicare & Medicaid Services (CMS) issued guidance today clarifying the responsibility of hospitals provide emergency services if they participate in the Medicare program. The guidance makes it clear that nearly all hospitals; including specialty hospitals and others without emergency departments; must be able to evaluate persons with emergencies, provide initial treatment, and refer or ransfer these individuals when appropriate. The guidance does not apply to critical access hospitals (CAHs), which are small, rural hospitals that are subject to eparateregulation.

The guidance was issued in a Survey and Certification letter. The announcement was made at the annual meeting between CMS and the Directors of the State Agencies that contract with CMS to survey hospitals and other Medicare providers and suppliers to ensure compliance with quality of care standards.

Education Tool Entitled "tPA for Stroke - Potential Benefit, Risk, and Alternatives" Now Available

AAEM has created an Education Tool entitled tPA for Stroke - Potential Benefit, Risk, and Alternatives, which can be viewed at
http://aaem.org/education/tpaedtool-AAEM.pdf.

The document is designed to help emergency physicians inform patients and family members about the pros and cons of tPA for stroke in appropriate patients. We hope that you find this document useful and would welcome your feedback via info@aaem.org.

EMTALA

The Centers for Medicare & Medicaid Services (CMS) recently clarified two EMTALA issues for its state survey agency directors.

The first memo, dated April 26, 2007, [http://www.cms.hhs.gov/SurveyCertificationGenInfo/PMSR/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=3&sortOrder=descending&itemID=CMS1198795&intNumPerPage=10] states that all hospitals must be able to evaluate persons with emergencies, provide initial treatment, and refer or transfer these individuals when appropriate, regardless of whether the hospital has an ED. To be in compliance with the Medicare Conditions of Participation (CoPs), a hospital cannot rely on 9-1-1 services to provide appraisal or initial treatment of individuals in lieu of its own capability to do so. The guidance does not apply to critical access hospitals.

The other memo, dated April 27, 2007, [http://www.cms.hhs.gov/SurveyCertificationGenInfo/PMSR/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=3&sortOrder=descending&itemID=CMS1198926&intNumPerPage=10] relates to emergency transport services and the transfer/acceptance of patients. It specifically addresses a July 13, 2006, Survey and Certification letter concerning "parking" of individuals transported by (EMS) to hospitals.

Illinois lawmakers back damage awards for grief

ST. LOUIS POST-DISPATCH SPRINGFIELD BUREAU

Illinois lawmakers on Thursday passed a measure that lets jurors consider the grief and sorrow of survivors when deciding payouts in wrongful death lawsuits — a move that promises to reopen political wounds from the state's medical malpractice battle of two years ago.

Gov. Rod Blagojevich, a Democrat, hasn't said whether he will sign the bill, which passed the Senate Thursday 31-23.

Illinois now allows jurors to consider several factors when deciding how much to award plaintiffs who prevail in wrongful death suits. Factors include actual damages such as loss of income, as well as "noneconomic" damages such as the loss of love, comfort and other intangibles by the survivor- plaintiffs.

The new legislation would add heartache to that list of intangibles, allowing jurors to consider "damages for grief, sorrow, and mental suffering, to the surviving spouse and next of kin of such deceased person."

That language, the result of a lobbying effort by Illinois trial lawyers, reopens a fractious debate over what doctors and hospitals should have to pay when their patients are maimed or killed. In 2005, Illinois capped the amount that plaintiffs could collect for noneconomic damages in malpractice cases, to $500,000 per doctor and $1 million per hospital.

Cautionary Tale

From the LA Times

In the emergency room at Martin Luther King Jr.-Harbor Hospital, Edith Isabel Rodriguez was seen as a complainer.

"Thanks a lot, officers," an emergency room nurse told Los Angeles County police who brought in Rodriguez early May 9 after finding her in front of the Willowbrook hospital yelling for help. "This is her third time here."

The 43-year-old mother of three had been released from the emergency room hours earlier, her third visit in three days for abdominal pain. She'd been given prescription medication and a doctor's appointment.

Turning to Rodriguez, the nurse said, "You have already been seen, and there is nothing we can do," according to a report by the county office of public safety, which provides security at the hospital.

Parked in the emergency room lobby in a wheelchair after police left, she fell to the floor. She lay on the linoleum, writhing in pain, for 45 minutes, as staffers worked at their desks and numerous patients looked on.

Aside from one patient who briefly checked on her condition, no one helped her. A janitor cleaned the floor around her as if she were a piece of furniture. A closed-circuit camera captured everyone's apparent indifference.

Arriving to find Rodriguez on the floor, her boyfriend unsuccessfully tried to enlist help from the medical staff and county police — even a 911 dispatcher, who balked at sending rescuers to a hospital.

Alerted to the "disturbance" in the lobby, police stepped in — by running Rodriguez's record. They found an outstanding warrant and prepared to take her to jail. She died before she could be put into a squad car.

Analysis: Are ERs really 'overused'?

From UPI

Healthcare reformers say the United States can save a lot of money by reducing unnecessary emergency room visits, but number crunchers are not so sure.
"The concept of 'inappropriate' visits is naive," said Robert Lowe, a researcher at the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University.

Two studies released this week found that it is difficult to define what an "unnecessary" or "avoidable" ER visit is, and reducing those visits may not actually save a lot of money.

The conventional healthcare reform wisdom is that people who lack access to primary care put off treatment, develop more expensive conditions, then get expensive treatment in the emergency room. Others go to the emergency room to treat non-emergency conditions like bladder infections or earaches.

As a result, many health reform proposals argue the cost of covering the uninsured will be offset by a reduction in spending on emergency room visits.

But research is mixed on how many emergency room visits are unnecessary, and how many could actually be avoided by increased access to primary care.

One of the studies released this week found that it is even difficult to define what an unnecessary or avoidable visit is.

Helmet saves man when truck runs over his head

From CNN.com

Ryan Lipscomb lived to tell how it felt to have a truck run over his head. "Really strange," he said.

Lipscomb, 26 of Seattle, suffered a concussion but was otherwise unhurt. He was shaken up, especially after he saw his mangled helmet.

Lipscomb, a graduate student in medical physics at the University of Wisconsin-Madison, was riding down a bike path in Madison on Friday afternoon. As he approached an intersection, he said, he noticed the oncoming delivery truck preparing to make a right turn in front of him.

The truck wasn't going to stop, Lipscomb said, so he slammed on his brakes, flipping his bike and landing in the street.

A moment later the truck rolled over his head.

"I didn't see it coming, but I sure felt it roll over my head," he told The Capital Times newspaper. "It feels really strange to have a truck run over your head."

His black helmet was flattened, tread marks visible on the cracked frame.

Lipscomb was taken to a hospital and released about three hours later.

Newsweek Series on ER Crisis

Code Blue in the ER

First Article: On Life Support
http://www.msnbc.msn.com/id/18579368/site/newsweek/
It's a familiar story: America's emergency rooms are in crisis. But it's far worse than you think. How does the ER prepare for a terrorist attack when its medics can barely cope with the routine flow of mayhem on a Saturday night? A worried doctor traveled to Washington to sound the alarms.

Second Article: 'We're At Our Breaking Point'
http://www.msnbc.msn.com/id/18598633/site/newsweek/
Gunshot wounds. Blood and brain matter. Exhausted nurses, endless wait times—and no end in sight. The only thing scarier than an average Saturday evening in the ER: What if it was forced to close? One night in Atlanta.

Third Article: How to Stop the Bleeding
http://www.msnbc.msn.com/id/18615533/site/newsweek/
Emergency-room health care is in a state of emergency. What the best minds in the medical community prescribe to begin to treat the crisis.