Category Archives: Disaster Preparation

Stock up on emergency supplies this weekend

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When it’s time to change your clocks because of daylight saving time, use it as a reminder to check your preparedness kit to make sure your emergency stockpile isn’t missing any items and that the food hasn’t expired. – American Public Health Association.

See the infographic: Continue reading

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Washington scores four out of 10 on key indicators related to preventing and responding to infectious disease outbreaks

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From Trust for America’s Health and the Robert Wood Johnson Foundation 

Washington scored only four out of 10 on key indicators related to preventing, detecting, diagnosing and responding to outbreaks, like Ebola, Enterovirus and antibiotic-resistant Superbugs.

Some key Washington findings include:

No. Indicator Washington Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding: Increased or maintained level of funding for public health services from FY 2012-13 to FY 2013-14. N 28
2 Preparing for Emerging Threats: State scored equal to or higher than the national average on the Incident & Information Management domain of the National Health Security Preparedness Index. Y 27 + D.C.
3 Vaccinations: Met the Healthy People 2020 target of 90 percent of children ages 19-35 months receiving recommended ≥3 doses of HBV vaccine. N 35 + D.C.
4 Vaccinations: Vaccinated at least half of their population (ages 6 months and older) for the seasonal flu for fall 2013 to spring 2014. N 14
5 Climate Change: State currently has completed climate change adaption plans – including the impact on human health. Y 15
6 Healthcare-acquired Infections: State performed better than the national standardized infection ratio (SIR) for central line-associated bloodstream infections. N 16
7 Healthcare-acquired Infections: Between 2011 and 2012, state reduced the number of central line-associated blood stream infections. N 10
8 Preparing for Emerging Threats: From July 1, 2013 to June 30, 2014, public health lab reports conducting an exercise or utilizing a real event to evaluate the time for sentinel clinical laboratories to acknowledge receipt of an urgent message from laboratory. N 47 + D.C.
9 HIV/AIDS: State requires reporting of all CD4 and HIV viral load data to their state HIV surveillance program. Y 37 + D.C.
10 Food Safety: State met the national performance target of testing 90 percent of reported Escherichia coli (E. coli) O157 cases within four days. Y 38 + D.C.
Total  4

 Read the full report here.

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Sign up to receive Flood Alerts! Or get the app!

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King County Flood Alert App

King County is offering free Flood Alerts to help keep you informed of flood conditions you can sign up for phone or text messages — or get an app.

  • Get Alerts by e-mail and/or phone (voice or text messages)
  • Select the rivers that affect you
  • Select the flood phase levels of interest to you.

 Make sure you get alerted in an emergency!

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PR over people: The Red Cross’ secret disaster

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Photo courtesy of Dell, Inc.

By Justin Elliott and Jesse Eisingerm ProPublica, and Laura Sullivan, NPR
Oct. 29, 2014, 5:00 a.m.

In 2012, two massive storms pounded the United States, leaving hundreds of thousands of people homeless, hungry or without power for days and weeks.

Americans did what they so often do after disasters. They sent hundreds of millions of dollars to the Red Cross, confident their money would ease the suffering left behind by Superstorm Sandy and Hurricane Isaac. They believed the charity was up to the job.

They were wrong.

The Red Cross botched key elements of its mission after Sandy and Isaac, leaving behind a trail of unmet needs and acrimony, according to an investigation by ProPublica and NPR. The charity’s shortcomings were detailed in confidential reports and internal emails, as well as accounts from current and former disaster relief specialists.

Sandy_Oct_25_2012_0320ZWhat’s more, Red Cross officials at national headquarters in Washington, D.C. compounded the charity’s inability to provide relief by “diverting assets for public relations purposes,” as one internal report puts it. Distribution of relief supplies, the report said, was “politically driven.”

During Isaac, Red Cross supervisors ordered dozens of trucks usually deployed to deliver aid to be driven around nearly empty instead, “just to be seen,” one of the drivers, Jim Dunham, recalls.

“We were sent way down on the Gulf with nothing to give,” Dunham says. The Red Cross’ relief effort was “worse than the storm.”

During Sandy, emergency vehicles were taken away from relief work and assigned to serve as backdrops for press conferences, angering disaster responders on the ground.

After both storms, the charity’s problems left some victims in dire circumstances or vulnerable to harm, the organization’s internal assessments acknowledge. Handicapped victims “slept in their wheelchairs for days” because the charity had not secured proper cots. In one shelter, sex offenders were “all over including playing in children’s area” because Red Cross staff “didn’t know/follow procedures.”

ER red cross iconAccording to interviews and documents, the Red Cross lacked basic supplies like food, blankets and batteries to distribute to victims in the days just after the storms. Sometimes, even when supplies were plentiful, they went to waste. In one case, the Red Cross had to throw out tens of thousands of meals because it couldn’t find the people who needed them.

The Red Cross marshalled an army of volunteers, but many were misdirected by the charity’s managers. Some were ordered to stay in Tampa long after it became clear that Isaac would bypass the city. After Sandy, volunteers wandered the streets of New York in search of stricken neighborhoods, lost because they had not been given GPS equipment to guide them.

The problems stand in stark contrast to the Red Cross’ standing in the realm of disaster relief. President Obama, who is the charity’s honorary chairman, vouched for the group after Sandy, telling Americans to donate. “The Red Cross knows what they’re doing,” he said.

Two weeks after Sandy hit, Red Cross Chief Executive Gail McGovern declared that the group’s relief efforts had been “near flawless.”

The group’s self-assessments, drawn together just weeks later, were far less congratulatory. Continue reading

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ER docs give Washington a D+

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The American College of Emergency Physicians has given Washington state a “near failing D+” in the its annual state-by-state report card assessing the nation’s emergency services.

Overall the state ranked 35th in the nation, down from its ranking of 19 in the College’s 2009 report, which that year gave Washington a C.

Screen Shot 2014-01-16 at 15.21.58 Continue reading

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Don’t use grills or gas generators in enclosed areas – Department of Health warns

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From the Washington State Department of Health

Power outages may raise risk of carbon monoxide poisoning

Charcoal grillDon’t use grills or gas generators in enclosed areas

January 10, 2014 — Barbecue grills and gas generators may seem like they could double as an indoor furnace during a power outage, but that can be downright dangerous.

Neither should be used inside to heat homes, as families could get sick and even die from carbon monoxide poisoning.

Carbon monoxide, or CO, is a poisonous gas that can’t be seen or smelled and can kill a person in minutes. Carbon monoxide is produced whenever any fuel such as gas, oil, kerosene, wood, or charcoal is burned. It can quickly build up to unsafe levels in enclosed or semi-enclosed areas.  Continue reading

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In case of tornado, electronic health records can be just the prescription

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Radar debris signature from the Moore tornado.

Radar debris signature from the Moore tornado – National Weather Service

By Jenny Gold

Everyone expects a hospital to be ready to jump into action when disaster strikes. But what about when the disaster devastates the hospital itself?

Turns out, it helps a lot to have an electronic medical record system in place.

At least that was the case at Moore Medical Center in Oklahoma, a small hospital right in thepath of the tornado that ripped through the suburbs of Oklahoma City on Monday.

Three-hundred people — staff, patients and community members — hunkered down in the cafeteria, stairwells and chapel as 200-miles-per-hour winds demolished the building around them.

One patient in labor stayed on the second floor with two nurses, where they could continue to monitor the fetal heartbeat.

Amazingly, everyone survived. Within an hour, 30 patients had been transferred to the two other hospitals that are part of the Norman Regional Health System. And every one of them arrived with their medical histories fully intact. The woman in labor even delivered a healthy baby later that evening.

“The transfer was totally seamless,” says John Meharg, director of health information technology at Norman, which has had an electronic health record system for the past five years. “We’re very fortunate that we’re a little ahead of the game,” he said.

If the hospital system had still been using paper, Norman explains, “the first thing we would have had to do was find their records. And with all of the hustle and bustle of a disaster, they can easily get lost.”

As for any records left behind in files, he continues, “if the tornado doesn’t get them, the subsequent rain would ruin them. The roof’s gone, the walls are gone, and the windows are gone.”

Instead, physicians at the two transfer hospitals were able to pick up care for the Moore patients where their home physicians left off.

Even if the patients had been taken to hospitals outside of the Norman system, their records would still have gone along with them.

That’s because Oklahoma City has a regional health information exchange that allows the various hospital systems in the area to access all patient records, says Meharg.

“I’m very happy,” he adds, breathing a sigh of relief. “The systems never missed a beat. It would really have been a mess if we weren’t electronic.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Snohomish emergency preparedness event seeks to engage diverse communities

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Photo by Ada Be

Photo by Ada Be

Snohomish County will sponsor an emergency preparedness event next week that will focus on engaging the county’s diverse communities.

The EMPOWER emergency preparedness fair will seek to break down the barriers between emergency responders and minority communities through a day of presentations, information sharing, resource tables, and demonstrations, from 8 a.m. to 2 p.m., Sat., April 20 at Everett Station, 3201 Smith Ave., Everett.

The event is free and open to the public, and includes complimentary continental breakfast and lunch. Walk-ins are welcome or you can register at Brown Paper Tickets.

The day will have two educational tracks: One for community residents to learn more about being prepared for emergencies, and another for emergency responders to learn ways to respond more effectively to a diverse community.

“This fair is for people who want to learn more about getting prepared for earthquakes, storms, and other disasters,” said Therese Quinn, event organizer and Medical Reserve Corps coordinator. “It is also for emergency responders and planners who want to learn more about working with vulnerable populations.”

Morning presentations follow a welcome by Snohomish County Sheriff John Lovick.

The emergency responder track will hear a hands-on diversity panel discuss “What you need to know when you respond in my community.” Panelists will include individuals from the Iraqi and Latino communities, and lesbian, gay, bisexual, and transgender community.

The panel discussion will be followed by speaker Conrad Kuehn from the Northwest ADA Center, presenting “Disability Language and Etiquette.”

The community education track includes a presentation on how to prepare for an emergency and make an emergency kit. Following the kit demonstration, a panel will discuss the mission of emergency responders as public safety — and not immigration enforcement.

Panelists include Dave Alcorta, Red Cross; Sgt. Manny Garcia, Everett Police Department; and John Pennington, Snohomish County Department of Emergency Management.

The lunchtime keynote speaker will be National Fire Academy Instructor Leslie Olson, who will talk about the importance of cross-cultural communication.

All presentations and the lunch keynote speech will be interpreted into Spanish and translated by Communication Access Realtime Translation (CART) for the deaf and hard of hearing.

The event is the result of community partnership among Snohomish Health District, Tulalip Tribes, Fire District 1, Starbucks, Communities of Color Coalition, Snohomish County Emergency Management, Medical Reserve Corps, Puget Sound Energy, City of Everett, and South Everett

Photo courtesy Ada Be via Flickr

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Four NYC hospitals still closed by hurricane Sandy

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Generators sit outside the NYU Medical Center after the Sandy superstorm on Oct. 31 (Photo by Matt Kane via Flickr).

By Fred Mogul, WNYC

Three weeks after Hurricane Sandy, four New York City hospitals remain closed for inpatients, leaving thousands of patients scrambling to find other medical centers to treat everything from broken bones to brain cancer.

The closures of NYU Langone Medical Center, Bellevue Hospital Center, the Manhattan VA Medical Center, and Coney Island Hospital have meant more business for some nearby hospitals and an unwelcome extra burden for others.

St. Luke’s-Roosevelt Hospital is in the former group. When the hospital, near Columbus Circle in Manhattan,  opened a $21 million cardiac electrophysiology center in September, officials figured it would take months to build up enough patients to reach full capacity.

The center’s state-of-the-art equipment helps doctors recalibrate faulty electrical impulses in the heart that cause arrhythmia. Before Sandy, there were about a dozen procedures a week, but now that displaced NYU doctors and patients are coming to St. Luke’s-Roosevelt, there are about 18 a week.

Dr. Emad Aziz says that’s a big jump in a short amount of time, particularly for a complicated and expensive procedure that can take up to eight hours.

This story is part of a reporting partnership that includes WNYCNPR and Kaiser Health News.

“We really wanted to accommodate them,” Aziz said. “And it turned out to be really nice. It’s a great opportunity on a personal level, to assist them in a time when they have that big damage.”

Of course, the closures have been a big problem for many patients and hospitals, too.

Eileen Wal, of Atlanta, is a breast cancer patient who planned to fly to New York next month for reconstructive surgery at NYU. After Sandy, her surgeon, Dr. Robert Allen, has nowhere else to operate locally.

He also practices at Manhattan’s Eye and Ear Infirmary, but that hospital has been filled to capacity, thanks to the cascading effects of Sandy.

“They have no O.R. time available,” Wal said. “Now some may pop up, but if it does it would only be very last-minute. So the only people who could take advantage of it would be someone who’s local to New York.”

Fortunately for Wal, her surgeon spends half his time working and teaching at Ochsner Baptist Medical Center in New Orleans, so she can go there for the operation. But she’s not looking forward to spending time in The Big Easy.

“The surgery in New York was far easier for me logistically,” Wal said. “One, it has public transport, and, two, you walk out of your door of where you are, and you have food. You don’t have to deal with anything. It’s all very simple. New Orleans, basically, there’s nothing there. [The hospital] in the middle of nowhere.”

When it’s up and running, NYU performs about 2,700 inpatient procedures a month. Officials haven’t estimated how long Tisch Hospital, the core facility, will remain closed, but other medical centers are bracing for it to be months.

Lenox Hill Hospital, on the Upper East Side, was operating well under capacity before Sandy. It has about 600 beds, and daily occupancy was running “in the mid-400s,” according to Dr. Arthur Klein, regional executive director for North Shore-Long Island Jewish, Lenox Hill’s parent system.

Since Sandy, there are about 100 additional inpatients a day, and the operating rooms stay booked well into the evening and on weekends. Lenox Hill, which has struggled financially, has fast-tracked admitting credentials to about 300 NYU doctors and is additionally employing close to 500 NYU nurses.

Nearby New York-Presbyterian/Weill Cornell Medical Center is not so eager to take on more patients and isn’t credentialing NYU doctors. The CEO, Dr. Steven Corwin, says his hospital can barely keep pace with the increased number of people coming into the emergency room. And he’s concerned about what might happen in the event of a big public health crisis.

“If we were to have a significant flu season over the winter time, that would further hamper our ability to respond,” Corwin said.

Of the four closed hospitals, only NYU lacks a network and sister institutions to place patients. The Manhattan VA has transferred most of its inpatients to the Brooklyn VA.

Bellevue, the largest shuttered facility, and Coney Island are part of the city’s Health and Hospitals Corporation, with nine other hospitals.

Coney Island Hospital has recently reopened for 24-hour urgent care, specialty clinics and primary care clinics but its inpatient operation is still closed.

Bellevue is planning to reopen “limited primary care outpatient services” on Monday, according to its website.

By all indications, the placement of NYU patients to other institutions has been piecemeal.

“I would’ve thought in this sort of situation that maybe FEMA or the [NYC Office of Emergency Management] would go straight in and look at the hospitals that are closed, grid out the patients, look at the potential services in a reasonable surrounding area, and put out suggestions based on that,” said Mike McCarry, head of perioperative services for Mt. Sinai Medical Center. “Maybe that’s happening, but if it is, it isn’t visible.”

Several of the hospitals taking in Sandy evacuees initially reported losing millions of dollars – with much of the shortfall the result of taking in Medicaid and uninsured patients from Bellevue and, in some cases, displaced nursing home residents.

But in the months ahead, those hospitals that take on NYU patients needing high-end inpatient procedures are likely to see a temporary surge in profits – and possibly win new long-term patients. And they could see millions of dollars a month they would not get, if NYU were open.

This story is part of a reporting partnership that includes WNYC, NPR and Kaiser Health News.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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RedCross App

Red Cross releases free First Aid app for iPhone and Android

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The American Red Cross has created a free “First Aid” app that provides instant access to the information you need to know to handle the most common first aid emergencies.

“With videos, interactive quizzes and simple step-by-step advice it’s never been easier to know first aid,” says the Red Cross.

Features:

  • Picture of the Red Cross First Aid app for burn treatmentSimple step-by-step instructions guide you through everyday first aid scenarios.
  • Fully integrated with 911 so you can call EMS from the app at any time.
  • Videos and animations make learning first aid fun and easy.
  • Safety tips for everything, from severe winter weather to hurricanes, earthquakes and tornadoes help you prepare for emergencies.
  • Preloaded content means you have instant access to all safety information at anytime, even without reception or an Internet connection.
  • Interactive quizzes allow you to earn badges that you can share with your friends and show off your lifesaving knowledge.

The app is available for both iPhone and Android devices.

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MakeIt

Disaster preparation expo at Northgate this Saturday

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Catastrophes can happen at any time. Preparing for three days will help you make it through many of the disasters you’ll face in the Puget Sound region—including major storms and even small earthquakes.

However, to make it through a major catastrophe—like Hurricane Katrina or the earthquake and tsunami in Japan—you’ll need to be prepared for longer—at least 7 to 10 days.

Local agencies across Puget Sound are teaming up to share information and encourage residents to prepare for catastrophic events with a regional campaign: What to do to make it through.

You know you need an emer­gency pre­pared­ness plan; it is on your to-do list.

But where do you start?

How do you talk to your chil­dren about the pos­si­bil­ity of dis­as­ter and how it will affect your fam­ily?

Is your busi­ness pre­pared?

To learn answers to these questions, go to  North­gate Mall on Sat­ur­day, June 9th for the What If Expo.

At the Expo you’ll be able to:

  • Attend edu­ca­tional and fam­ily friendly seminars
  • Meet experts in emer­gency planning
  • Pur­chase what you need to help sur­vive an emergency

WHEN:

Sat­ur­day, June 9th, 10am – 5pm

WHERE:

North­gate Mall | North Court

401 NE North­gate Way

Seat­tle, WA 98125

To learn more:

 

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Public Health Reserve Corps looking for volunteers to serve south King County

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The King County Public Health Reserve Corps is holding information session on June 6 for people interested in volunteering in the event of a public health emergency in south King County.

PHRC volunteers assisting with the set-up of a flu-vaccine clinic in Des Moines in 2010.

The PHRC currently has more than 300 volunteers countywide but is actively seeking additional volunteers from south King County.

Recently, PHRC volunteers helped provide medical support in a Red Cross shelter in Federal Way during this year’s winter storms, staffed a flu shot clinic in Tukwila, and are currently helping the fight the county’s whooping cough epidemic.

Volunteers do not need a medical background to join the PHRC.

To learn more about the PHRC:

  • Go to an information session on Wednesday, June 6 at 6 p.m. at the Kent Senior Activity Center (600 E. Smith St., Kent)
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Sign for an emergency room.

ERs demanding payment upfront from patients with routine problems

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Sign for an emergency room.By Phil Galewitz
KHN Staff Writer

This story was produced in collaboration with wapo

Next time you go to an emergency room, be prepared for this: If your problem isn’t urgent, you may have to pay upfront.

Last year, about 80,000 emergency-room patients at hospitals owned by HCA, the nation’s largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency.

Led by the Nashville-based HCA, a growing number of hospitals have implemented the pay-first policy in an effort to divert patients with routine illnesses from the ER after they undergo a federally required screening.

At least half of all hospitals nationwide now charge upfront ER fees, said Rick Gundling, vice president of the Healthcare Financial Management Association, which represents health-care finance executives.

“It has been a successful part of helping to reduce crowding in emergency rooms and to encourage appropriate use of scarce resources,” HCA spokesman Ed Fishbough said.

But emergency-room doctors and patient advocates blast the policy as potentially harmful to patients, and they say those with mild illnesses such as sore throats and ear infections do little to clog ERs and do not require CT scans or other pricey technologies.

Kim Bailey, research director for the consumer group Families USA, said the tactic lets hospitals turn away uninsured patients who often fail to pay their bills and are a drag on profits. While the uninsured pay upfront fees as high as $350, depending on the hospital, those with insurance pay their normal co-payment and deductible upfront.

“This is certainly a concern to us,” Bailey said.

‘A Real Problem’

Physicians worry that sick people will forgo treatment. There is no data on how many who leave the ER without treatment follow up with visits to doctors’ offices or clinics.

“This is a real problem,” said Dr. David Seaberg, president of the American College of Emergency Physicians, who estimated that 2 to 7 percent of patients screened in ERs and found not to have serious problems are admitted to hospitals within 24 hours.

A 2010 study found that 27 percent of those visiting ERs could be treated more cost-effectively at doctors’ offices or clinics.

“After you’ve done the medical screening, it makes little sense to not go ahead and write a patient a prescription,” said Dr. Michael Zappa, a Boca Raton, Fla., hospital consultant and former president of the Florida College of Emergency Physicians.

Patient advocates say the strategy could discourage patients from going to the ER for true emergencies.

“It seems the point of the policy is to put a financial barrier between the patient and care,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

The U.S. Centers for Disease Control and Prevention says that about 8 percent of ER visits are for non-urgent problems that could be treated less expensively in a doctor’s office or clinic; others put the number of non-emergency visits much higher. A 2010 Health Affairs study found that 27 percent of those visiting ERs could be treated more cost-effectively at doctors’ offices or clinics.

Reducing Bad Debt

Washington state cut Medicaid reimbursements for those visiting ERs for specified non-urgent conditions, such as sore throats or warts.

Hospital officials say the upfront payments are a response to mounting bad debt caused by the surge in uninsured and underinsured patients and to reduced reimbursements by some private and government insurers for patients who use the ER for routine care.

In the past year, for instance, Iowa, Tennessee and Washington state reduced or eliminated Medicaid reimbursements for those visiting ERs for specified non-urgent conditions, such as sore throats or warts.

In an annual report filed last year with the Securities and Exchange Commission, HCA officials wrote that “we are taking proactive measures to reduce our provision for doubtful accounts by, among other things, screening all patients, including the uninsured, through our emergency screening protocol, to determine the appropriate care setting in light of their condition, while reducing the potential for bad debt.”

HCA says it complies with federal requirements to screen and stabilize anyone with an emergency. Of more than 6 million ER visits to HCA hospitals last year, 314,000, or about 5 percent, were determined not to be emergencies, Fishbough said. About 230,000 of those patients paid and remained in the emergency room for treatment. The other 80,000 or so left.

The HCA payment policy excludes children 5 and younger, pregnant women and those 65 and older.

“This helps ensure that the sickest patients get treated quickly and those who do not have an emergency have access to more efficient, less costly care settings,” Fishbough said.

HCA officials declined to say which of its hospitals use the practice, but the company owns more than 160 hospitals in 20 states, including Virginia, California, Alaska, Georgia, Missouri, Kentucky, Idaho and South Carolina.

Following HCA’s lead

Other large chains that have followed HCA’s example include Naples, Fla.-based Health Management Associates and Franklin, Tenn.-based Community Health Systems.

“These policies are beneficial because they help patients understand their financial responsibilities and make informed decisions about where to utilize services,” said Tomi Galin, a spokeswoman for Community Health Systems. “These practices help reduce costs for both the patient and the hospital.”

John Merriweather, vice president at Health Management Associates, said the 66-hospital system has seen a decline in wait times since it implemented upfront payments.

“We think this is appropriate, given that some people use the ER in a way it was not intended: as a source for routine care,” he said.

The upfront payments for non-urgent ER visits are also used by nonprofit hospitals.

In May, Halifax Health in Daytona Beach, Fla., began asking adult patients to pay their co-payment or $350 before treatment for a non-emergency in its ER, spokesman Byron Cogdell said. Like other hospitals, Halifax applies that fee to the patient’s bill.

Paying To Get Prescriptions

“More people now know our ER is not a walk-in clinic or a primary care office.”

In December, Skaggs Regional Medical Center in Branson, Mo., began asking ER patients to pay $40 or their insurance co-payment before receiving a prescription.

“If they don’t pay . . . they won’t be given their prescription,” hospital spokeswoman Michelle Leroux said.

The strategy is designed to help the hospital deal with spiraling, unpaid ER bills. About a third of the 120 patients treated daily in the hospital’s ER are uninsured. The change was implemented after the ER reported $1.3 million in bad debt for August.

“This amount of bad debt is unsustainable for our operation,” Skaggs chief executive William Mahoney said.

Midland Memorial Hospital in Midland, Tex., implemented a $150 upfront ER fee in 2009 as part of a cost control effort. In 2008 the nonprofit hospital lost $14 million, partly because of millions of dollars in unpaid bills from ER patients.

Since the change, the 320-bed hospital has seen a 10 percent drop in people visiting the ER with non-emergencies and a big drop in bad debt, said Stephen Bowerman, Midland’s chief financial officer.

In conjunction with the new ER policy, Midland set up a 24-hour telephone nurse triage system so people in the community can call a nurse to help decide whether to go to the ER or a nearby clinic.

Bowerman said the policy is helping to change behavior. He estimated that about 75 percent of patients with non-emergencies left the facility instead of paying the upfront fee.

“More people now know our ER is not a walk-in clinic or a primary care office,” he said.

We want to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Keeping food safe during power outages

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During power outages, food can go bad. Even food that smells and tastes fine can harbor bacteria that can make you and your family ill. To help you avoid such food-borne illnesses, the Washington State Department of Health has prepared the following food-safety tips:

Uncooked turkey in a pot

Spoiled food can make you sick; handle, store food safely when power is out

Keep cold food cold to prevent bacteria from growing: if in doubt, throw it out

When the power is out it’s important to protect your food supply. Keeping foods cold or making sure they’re fully cooked can protect you from foodborne illness. That can be difficult without power.

If you think power might be out for a long time, use food that can spoil fast before food that keeps longer. It’s most important to keep meat, seafood, and dairy products cold.

Refrigerator doors should be kept closed as much as possible to keep cold air inside. Freezers that are part of a refrigerator-freezer combination will keep food frozen for up to a day.

A free-standing chest or upright freezer will keep food frozen solid for two days if it is fully loaded. The more it is opened, the quicker it will thaw.

An ice chest packed with ice or snow is a good temporary solution. However, storing food outside is not recommended. Outside temperatures change often and the sun can thaw frozen foods or warm cold foods so that bacteria can grow. Animals can also contaminate food left outside.

“If in doubt, throw it out.” 

Bags of ice or block ice from the store can be placed in the refrigerator to keep food cold. Also, many items that people often keep in their refrigerator can temporarily be stored on a countertop or in a cool place like a garage. Some examples include fresh uncut fruits and vegetables, butter and margarine, ketchup, mustard, pickles, relish and similar condiments.

When it comes to food safety, the general rule is, “If in doubt, throw it out.” Never taste suspicious food. It may look and smell fine, but bacteria that cause foodborne illness may be present and could make you sick.

If food is cold to the touch, and you know it has not been above 45 degrees F for more than an hour or two, it’s probably safe to keep, use, or refreeze. Throw away all meat, seafood, dairy products, or cooked foods that don’t feel cold to the touch. Even under proper refrigeration, many raw foods should be kept only three or four days before they are cooked, frozen, or thrown away.

It is important to be very careful when trying to cook during a power outage. NEVER USE A CAMPING STOVE OR BARBEQUE INDOORS. They put off carbon monoxide, a poisonous gas that can’t be seen or smelled. It can kill a person in minutes.

To learn more:

  • The state Department of Health has several fact sheets on staying safe in bad weather (www.doh.wa.gov/Topics/weather.htm). They’re available in multiple languages.
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An illustration of a man walking on a windy day from the medieval book Tacuinum Sanitatis

Prepare for wind and rain

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An illustration of a man walking on a windy day from the medieval book Tacuinum SanitatisStrong, damaging winds will buffet the Puget Sound Region tonight through midday Tuesday, the National Weather Service warns.

Winds are expected to be 15 to 30 mph, gusting to 45 mph.

In addition, with the winds will come heavy precipitation tonight and Tuesday with a second weather system expected to bring more rain Tuesday night and Wednesday, the Weather Service said.

The heavy rain may cause some minor flooding in the most “flood-prone rivers,” the Weather Service said.

Rivers facing the greatest threat for flooding include the:

  • Newaukum
  • Chehalis
  • Puyallup, near Orting
  • Snoqualmie
  • Stillaguamish

Be Prepared for Winter Storms: Tips from the Seattle Red Cross

Wind Storms

  • Move or secure lawn furniture, outdoor decorations or ornaments, trash cans, hanging plants and anything else that can be picked up by wind and become a projectile.
  • During the storm, draw blinds and shades over windows.If windows break due to objects blown by the wind, the shades will prevent glass from shattering into your home.
  • Wind storms may lead to power outages. Prepare accordingly:
  • Assemble essential supplies, including a flashlight, batteries, portable radio, at least one gallon of water per person per day and a small supply of food. For more information about building or purchasing a disaster kit, visit www.seattleredcross.org.
  • Do not run a generator inside a home or garage. If you use a generator, connect the equipment you want to power directly to the outlets on the generator. Do not connect a generator to a home’s electrical system.
  • Never use charcoal or gas grills as an indoor heating or cooking source.
  • Only use a flashlight for emergency lighting. Due to the extreme risk of fire, do not use candles during a power outage.
  • Turn off electrical equipment you were using when the power went out. Leave one light on so you know when the power comes back on.
  • Keep refrigerator and freezer doors closed as much as possible. First use perishable food from the refrigerator. An unopened refrigerator will keep foods cold for about 4 hours.

Floods

  • Be prepared to evacuate at a moment’s notice. When a flood or flash flood warning is issued for your area, head for higher ground and stay there.
  • Eighty-percent of people who die as a result of flooding are in vehicles. If you come upon a barricade, turn around and go another way. If you come upon flood waters, do not drive through them; the road could be washed out underneath. If you are caught on a flooded road and waters are rising rapidly around you, get out of the car quickly and move to higher ground. Most cars can be swept away by less than two feet of moving water.
  • If you are driving and your car stalls, abandon your vehicle and head to higher ground.
  • Stay away from floodwaters. If you come upon a flowing stream where water is above your ankles, stop, turn around and go another way. Six inches of swiftly moving water can sweep you off of your feet.
  • Be aware of flood hazards. Floods can roll boulders, tear out trees, destroy buildings and bridges, and scour out new channels. Flood waters can reach heights of 10 to 20 feet and often carry a deadly cargo of debris. Flood-producing rains can also trigger catastrophic debris slides.

For more safety tips and information on flooding please visit www.seattleredcross.org or www.redcrosswashington.org.

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