AED's in Schools

From the Dr. Wes blog

Just in time for the back-to-school season comes this report on the epidemiology of cardiac arrest in our schools.

The report adds much to our knowledge of the epidemiology of sudden death in schools from two large counties near Seattle, WA, USA. Of 3773 episodes of cardiac arrest in a public domain over 16 years, 97 arrests occurred in 671 schools but only 12 of these occurred in children.

The incidence of sudden death among (adult) school staff was 25-fold greater than that among students. Given the additional contribution of other adults not employed by the school, greater than 90% of cardiac arrests in schools occurred among adults. The finding supports the assertion that school-based CPR and AED programs would benefit faculty and staff members, as well as visitors to the school who, because of their age, are at greater risk of cardiac arrest than the students.

These data, in my view, make a compelling case for the wide availability of public access defibrillation. It is survival to discharge from a hospital that matters, and there is nothing that will improve survival in that setting better than a beating heart. The chest thumping of CPR, while helpful temporarily, only mildly improves the chance of survival following cardiac arrest until the coordinated contraction of the heart can be restored with defibrillation.

47 Million Uninsured

In a front-page article, the New York Times reports, "The nation's median household income grew modestly in 2006, the Census Bureau reported yesterday, even as the percentage of people without health insurance hit a high." Officials from the Census Bureau "attributed the rise in the uninsured -- to 47 million from 44.8 million in 2005 -- mostly to people losing employer-provided or privately purchased health insurance. The percentage of people who received health benefits through an employer declined to 59.7 percent in 2006, from 60.2 percent in 2005." In addition, "The percentage of people with government-provided health insurance...dropped, to 27 percent from 27.3 percent." The Times continues, "And the new data on the rise in the number of those uninsured prompted advocates for the poor to step up their call for Congress to reauthorize the State Children's Health Insurance Program (SCHIP), which provides subsidized insurance to children of the working poor."

The relationship between distance to hospital and patient mortality in emergencies: an observational study

From the Emergency Medicine Journal

ABSTRACT
Objectives: Reconfiguration of emergency services could lead to patients with life-threatening conditions travelling longer distances to hospital. Concerns have been raised that this could increase the risk of death. We aimed to determine whether distance to hospital was associated with mortality in patients with life-threatening emergencies.

Methods: We undertook an observational cohort study of 10 315 cases transported with a potentially life-threatening condition (excluding cardiac arrests) by four English ambulance services to associated acute hospitals, to determine whether distance to hospital was associated with mortality, after adjustment for age, sex, clinical category and illness severity.

Results: Straight-line ambulance journey distances ranged from 0 to 58 km with a median of 5 km, and 644 patients died (6.2%). Increased distance was associated with increased risk of death (odds ratio 1.02 per kilometre; 95% CI 1.01 to 1.03; p<0.001). This association was not changed by adjustment for confounding by age, sex, clinical category or illness severity. Patients with respiratory emergencies showed the greatest association between distance and mortality.

Conclusion: Increased journey distance to hospital appears to be associated with increased risk of mortality. Our data suggest that a 10-km increase in straight-line distance is associated with around a 1% absolute increase in mortality.

Capnometry in the prehospital setting: are we using its potential?

From the Emergency Medicine Journal:

Capnometry is a non-invasive monitoring technique which allows fast and reliable insight into ventilation, circulation, and metabolism. In the prehospital setting it is mainly used to confirm correct tracheal tube placement. In addition it is a useful indicator of efficient ongoing cardiopulmonary resuscitation due to its correlation with cardiac output, and successful resuscitation. It helps to confirm the diagnosis of pulmonary thromboembolism and to sustain adequate ventilation in mechanically ventilated patients. In patients with haemorrhage, capnometry provides improved continuous haemodynamic monitoring, insight into adequacy of tissue perfusion, optimisation within current hypotensive fluid resuscitation strategy, and prevention of shock progression through controlled fluid administration.

Medical Statistics Made Simple

From Medical Economics

Medical Studies: What You Need to Know

Americans are bombarded with news of medical breakthroughs every day. How can you judge which deserve your attention? The most meaningful studies are well-designed, include hundreds of patients similar to you (in age, sex, race, and stage of disease), and have clear, dramatic results.

Consider these results with your doctor, along with your own values and concerns. Tell your physician why you want a specific test or treatment, and share what you consider important in your healthcare, whether it’s quality of life, costs, or risks vs benefits.

Fast Relief, and Simple

From Surgeon's Blog:

...the subject was a simple procedure bringing rapid and dramatic relief, commenters have mentioned other similar interventions. Seems like a fun topic. Here's a list I can think of (a couple of which are those mentioned in the comments, by readers.) Anyone want to chime in with others?

Giving "Narcan" to an overdose patient: within seconds a moribund and blue, pin-point-pupilled addict is transformed to a yelling and screaming maniac.

Similarly: Dextrose IV for hypoglycemia rapidly raises from unconsciousness to lucidity.

Pain medicine use has nearly doubled

From Yahoo News:

The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during the most recent year represented in the data. That total is enough to give more than 300 milligrams of painkillers to every person in the country.

Medicare to Stop Pay for Hospital Errors

From AOL News:

In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

Special Ambulance for Morbidly Obese Patients

From JEMS

SAVANNAH, Ga. - Southside Fire and EMS has added a special-order ambulance meant for very obese patients to its fleet of emergency vehicles.

It's getting great business.

Southside is using the bariatric ambulance for anyone larger than 400 pounds. It has been used more than once a day since it was delivered in late June. The largest patient transported thus far weighed 730 pounds.

It's also being used to transport normal-weight patients, but special features, including a cot that can hold a 1,600-pound patient, are easing transport problems with larger patients.

Med student struggles to preserve her idealism

Great article from CNN.com

Learning how to practice medicine on this sort of a time-scale is stressful. But it's totally necessary in order to properly train us for a world of health care in which the average physician visit is six minutes! When our professors went to medical school, they were taught the art of healing; we are taught how to diagnose and treat patients in a limited timeframe. I can't help but think, is this what I signed up for?

Interesting Technique

From iWon News

EUGENE, Ore. (AP) - A seat belt saved a driver, police say, but not in the usual way. Steven Earp, 48, was eating a fast-food sandwich Wednesday morning, said police Sgt. Doug Mozan. Earp choked and blacked out. His 1997 Honda sedan hit a parked car.

After the wreck, Earp came to.

Mozan attributed his revival to a "seat-belt-induced Heimlich maneuver."

Lawsuit Contests Weight Rule for Helicopter Transport

From EM News:

A lawsuit alleging that a Florida car crash victim might have survived if a helicopter had been sent instead of an ambulance may be the first legal challenge of its kind in the nation.

Sharon Hanlon, the attorney representing family members of the deceased woman, Diana Lopez, said Collier County emergency personnel were lax when they allegedly declined to provide air transport because of her weight, which reportedly exceeded 300 pounds. That negligence occurred due to failure to clarify the rules/procedures regarding heavy-set patients who are trauma alert patients, she said.

Ms. Lopez was in her mid-30s, was a business owner of a trucking company, recently underwent gastric bypass surgery, and had lost 94 pounds. She was in good health and looking forward to life, Ms. Hanlon asserted.

The defense countered that the sole proximate cause of the plaintiff's damages was the decedent's own negligence and actions, or omissions, including, but not limited to, failing to wear a seatbelt. County officials appear confident that neither Collier County nor its Emergency Medical Services will be held liable. We believe that the county has many viable defenses to this action, said Assistant County Attorney William Mountford, who filed Collier County's legal reply to the wrongful death suit.

Persuasive demo

From the Daily Mail (Auckland, New Zealand):

An elderly New Zealand man who suffered a heart attack at a hardware store was revived by a salesman who just happened to be demonstrating a defibrillator to store staff.

Malpractice: To settle or fight

From Medical Economics:

Being named in a malpractice suit is bad enough. Being told by your attorney and insurance carrier that the case "just isn't defensible" is worse still.

Those discouraging words—which, when combined, usually spell "settlement"—aren't always based on medical events. Two physicians might provide the same treatment to similarly afflicted patients, resulting in the same unfortunate outcome, but one doctor goes to court and wins, while the other is forced to settle for $1 million.

Why the difference? Partly, it's the vagaries of the legal system, which relies on judges, attorneys, and juries that differ from jurisdiction to jurisdiction and case to case. Partly it's because your insurer might prefer to avoid the expense of litigation. (See "Sued? You may never get your day in court," Aug. 4, 2006.) But mostly it's because the nonmedical aspects of a malpractice case can trump the therapeutic ones. Defense attorneys, after weighing all the pertinent factors, might conclude that you're best off settling out of court because you're not likely to fare well before a judge and jury.

Defibrillators for Lacrosse

From the Baltimore Business Journal

U.S. Lacrosse said Tuesday it's teaming up with a cardiac monitoring manufacturer to get teams and leagues to have defibrillators ready on the sidelines at games.

Cardiac Science Corp. (NASDAQ: CSCX) will offer Baltimore-based U.S. Lacrosse's 250,000 national members a discounted price on the company's Powerheart automated external defibrillators.

The defibrillators use an electric shock to jolt a heart back into rhythm in the event of a sudden cardiac arrest. Since 1999, at least five players have died during live lacrosse competition as a result of sudden cardiac arrest, according to U.S. Lacrosse officials.

Bothell, Wash.-based Cardiac Science will offer the defibrillators to U.S. Lacrosse members at a price of $1,395, a 44 percent savings off the regular price of $2,495.

Automated external defibrillators are used in response to commotio cordis, which can cause sudden cardiac arrest in athletes. Commotio cordis can occur when an athlete is struck in the chest area around the heart. The impact does not have to be severe for sudden cardiac arrest to occur.

MN Level One Heart Attack Center in the WSJ

From the Wall Street Journal

Mr. Femling was treated under an initiative introduced by cardiologists at Minneapolis Heart Institute to improve heart-attack care. Since 2003, the Minneapolis cardiologists have treated more than 1,200 patients who were transferred to the city's Abbott Northwestern Hospital via ambulance or helicopter from 31 community hospitals as far as 210 miles away. The strategy is patterned after trauma centers that handle victims of car crashes and gunshot wounds.

Stroke Dx Admit from the ED: Statistics

From ACEP News (now in digital format)

Heads Up: Brain Injury in Your Practice

An estimated 75%-90% of the 1.4 million traumatic brain injury-related deaths, hospitalizations, and emergency department visits that occur each year are concussions or mild traumatic brain injuries (MTBI).

Many individuals who sustain an MTBI are not hospitalized or receive no medical care at all. An unknown proportion of those who are not hospitalized may experience long-term problems such as persistent headache, pain, fatigue, vision or hearing problems, memory problems, confusion, sleep disturbances, or mood changes. Symptoms of MTBI or concussion may appear mild, but can lead to significant, life-long impairment affecting an individual's ability to function physically, cognitively, and psychologically.

Physicians can play a key role in helping to prevent MTBI or concussion and improve a patient's health outcomes through early diagnosis, management, and appropriate referral.

In response, CDC, in collaboration with an expert work group, has recently updated and revised the "Heads Up: Brain Injury in Your Practice" tool kit. This tool kit is available free-of-charge at http://www.cdc.gov/ncipc/tbi/physicians_tool_kit.htm