Category Archives: Emergency Medicine

News about emergency services and medicine.

Surprise! Here’s another bill for that ‘paramedic response’

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Katie Gurzi, 85, at her apartment in Long Beach, Calif. on Thursday, January 21, 2016. Gurzi received a bill from the City of La Habra for the $260 after an emergency ambulance ride. “I was quite sure I’d be covered,” she said. “What I didn’t know is [the city] charges above and beyond.” (Heidi de Marco/KHN)

Katie Gurzi, 85, at her apartment in Long Beach, Calif. on Thursday, January 21, 2016. Gurzi received a bill from the City of La Habra for the $260 after an emergency ambulance ride. “I was quite sure I’d be covered,” she said. “What I didn’t know is [the city] charges above and beyond.” (Heidi de Marco/KHN)

By Anna Gorman
KHN

After Katie Gurzi woke in the middle of the night with excruciating chest pains, paramedics rushed her to the hospital.

Gurzi was rebuffed nearly every step of the way, as she contacted more than a dozen people from city bill collectors to her congressman. Some didn’t return her calls. Others refused to help. A few were just plain rude.

That part went smoothly: Gurzi, 85, was pleased with the care she received. And doctors determined she wasn’t having a heart attack, just a spasm in her esophagus.

But then, in January of 2015, the city of La Habra, California sent her a $260 bill for “paramedic response” — after her insurers had already been billed for the November ambulance ride. That made Gurzi mad.

It wasn’t just that she believed the city was trying to reach into her purse for money it couldn’t get from health insurers. It was that she was rebuffed nearly every step of the way, as she contacted more than a dozen people from city bill collectors to her congressman. Some didn’t return her calls. Others refused to help. A few were just plain rude. Continue reading

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Inslee calls for public health approach to gun violence

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GunFrom the Office of the Governor

Gov. Jay Inslee today signed an executive order that launches a statewide public health initiative to reduce and prevent gun-related fatalities and injuries.

The order uses the same data-driven public health approach that has significantly reduced motor vehicle deaths over the past two decades.

The initiative will help the state understand the people and places most at risk of gun violence or suicide, determine the best approaches to reducing gun violence and work with its partners to develop strategies and actions to prevent gun violence.

“This will be a data-driven approach that helps us identify the people and places most susceptible to gun crime and suicide,” Inslee said. “Gun crime is a scourge that has scarred thousands of families in every corner of our state. It’s a scourge we can, should and will help prevent.”

Between 2012 and 2014, 665 people died in Washington state from firearm injuries, compared to 497 deaths from automobile accidents. Approximately 80 percent of the firearm deaths were suicides.

Inslee’s order requires the Department of Health and the Department of Social and Health Services, in collaboration with the University of Washington and other state and local agencies to collect, review and disseminate data on deaths and injury hospitalizations related to firearms, as well as recommend strategies to reduce firearm-related fatalities and serious injuries.

Inslee said he also wants to further strengthen the background check law approved by Washingtonians in 2014. He is directing the state Office of Financial Management to analyze the effectiveness of information sharing between state agencies, the courts, local jurisdictions, law enforcement and other entities to determine if there are ways to improve the effectiveness of the system.

He is also requesting the Attorney General’s office to analyze current enforcement practices to make sure those attempting to purchase a firearm illegally are held accountable.

He is also asking them to update a 2007 white paper regarding access to firearms for those with mental illness. The white paper included recommendations that have yet to be implemented such as a centralized background check system.

Inslee is directing agencies to submit recommendations by October of 2016. Continue reading

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Create an emergency preparedness kit – from stuff you have!

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From Island Health:

You likely already have most of the items you need to create a personal emergency preparedness kit.  Now you just need to organize them and ensure your kit is stored in an easy to access area in your home.

Island Health provides health care to more than 765,000 people on Vancouver Island, the islands of the Georgia Strait, and in the mainland communities north of Powell River and south of Rivers Inlet. View a map
➨ Visit their website at: http://www.viha.ca/
➨ Like Island Health on Facebook: https://www.facebook.com/VanIslandHealth
➨ Follow Island Health on Twitter: https://twitter.com/VanIslandHealth

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Many hospitals neglect practices to combat ER overcrowding, study

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Sign for an emergency room.By Michelle Andrews
KHN

Crowded emergency departments have been vexing patients and hospital staff for years as consumers have increasingly sought care there.

But a new study finds that many of the busiest facilities have yet to adopt several well regarded measures to reduce the wait and minimize delays.

The study, published in the journal Health Affairs this week, measured crowding based on patients’ length of stay in the emergency department and then divided hospitals into quartiles from least to most crowded.

Overcrowding in the emergency department can lead to worse outcomes for patients, including more complications and higher mortality rates.

In 2010, half of patients in the least crowded quartile of emergency departments spent less than 93 minutes there, while in the most crowded quartile of EDs half of patients had a length of stay of more than 160 minutes.

Overcrowding in the emergency department can lead to worse outcomes for patients, including more complications — especially for cardiovascular patients — and higher mortality rates.

The study examined hospital implementation of 17 practices to reduce crowding in emergency departments and counted how many of them hospitals adopted from 2007 to 2010.

The data came from the National Hospital Ambulatory Medical Care Survey, an annual survey that includes approximately 36,000 hospital-based emergency department visits.

The interventions included separating patients with minor problems from those more seriously harmed to improve workflow, computer-assisted triage systems and hospital protocols to move admitted patients out of the emergency department to inpatient areas to await room assignment rather than “boarding” them in the emergency department.

During the study period, the number of measures that hospitals put in place to reduce crowding grew by 25 percent, on average. In addition, more crowded emergency departments generally adopted more interventions than did less crowded ones. But among the emergency departments in the most crowded grouping, significant numbers didn’t adopt effective interventions, the study found. Continue reading

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Surprise! That urgent care center may send you a big bill (just like the ER)

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Sign for an emergency room.By Julie Appleby
KHN

Sallyann Johnson considers herself a pretty savvy health care consumer. When she fell and injured her hands and wrists, she didn’t head for an expensive emergency room, choosing an urgent care clinic near her Milwaukee home instead.

Before seeking treatment, she asked the key question: Did the center accept her insurance? Yes, Johnson was assured, both on the phone and then again when she arrived at the clinic.

After X-rays and a visit with a physician assistant, Johnson learned her wrists were sprained, but weeks later, it was her wallet that sustained the most damage.

“I received a bill from a doctor for $356,” said Johnson, 62. “I felt I asked all the right questions. I even re-asked the questions.”

Long seen as a lower-cost alternative to hospital emergency rooms for minor illnesses or injuries, urgent care centers are increasingly popular with consumers – and their insurers.

But like doctors and hospital ERs, urgent care can also present payment headaches if they are not part of a patient’s insurance network. And consumers may need to ask specifically about network participation to find out. Continue reading

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Paramedics steer non-emergency patients away from ERs

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By Anna Gorman
KHN

SPARKS, Nev. — Paramedic Ryan Ramsdell pulled up to a single-story house not far from Reno’s towering hotels and casinos in a nondescript Ford Explorer.

No ambulance, no flashing lights. He wasn’t there to rush 68-year-old Earl Mayes to the emergency room. His job was to keep Mayes out of the ER.

Mayes, who has congestive heart failure and chronic lung disease, greeted Ramsdell and told him that his heart was fluttering more than usual. “I had an up-and-down night,” he said.

Paramedic Ryan Ramsdell checks 68-year-old Earl Mayes blood pressure during a home visit on March 26, 2015 in Sparks, Nevada. Ramsdell is part of a community health plan to help reduce avoidable emergency room visits by treating patients at home (Photo by Heidi de Marco/Kaiser Health News).

Paramedic Ryan Ramsdell checks 68-year-old Earl Mayes blood pressure during a home visit on March 26, 2015 in Sparks, Nevada. Ramsdell is part of a community health plan to help reduce avoidable emergency room visits by treating patients at home (Photo by Heidi de Marco/Kaiser Health News).

“Let’s take a look at it,” the paramedic responded, carrying a big red bag with medical supplies. “We’ll put you on the monitor.”

Since Mayes was released from the hospital a few weeks earlier, paramedics had visited him several times to monitor his heart and lungs and make sure he was following his doctor’s orders.

“With these guys coming by and checking me all the time, it makes it so much better,” Mayes said.  “When they leave, you know where you stand.” Continue reading

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Google Glass in the ER? Health care moves one step closer to Star Trek

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Photo by Antonio Zugaldia CC.

Photo by Antonio Zugaldia CC.

By Lisa Gillespie
KHN

Imagine walking into an emergency room with an awful rash and waiting hours to see a doctor until, finally, a physician who doesn’t have specific knowledge of your condition gives you an ointment and a referral to a dermatologist.

That could change if a technological device like Google Glass, which is a wearable computer that is smaller than an ink pen and includes a camera function, could be strapped to an emergency room doctor’s head or to his or her eyeglasses and used to beam a specialist in to see patients at the bedside.

Not only would a patient get a more specific initial diagnosis and treatment, but a second visit to a dermatologist might not be necessary.

Researchers did just this for a small sample of people at the emergency room of the Rhode Island Hospital in Providence.

They found during the course of the study that 93.5 percent of patients who were seen with a skin problem liked the experience, and 96.8 percent were confident in the accuracy of the video equipment and that their privacy was protected. Continue reading

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Rescue workers use apps to help save lives

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iPhone6CPRNeeded400px

PulsePoint app

By Jenni Bergal
Stateline

When 911 dispatchers get a call that someone has collapsed and stopped breathing, they quickly notify first responders. In hundreds of communities across the U.S., they now also send out a smartphone app alert summoning citizens trained in CPR.

If those Good Samaritans arrive at the scene first, they can start resuscitation efforts until the professionals get there.

The mobile app is called PulsePoint, and it was devised to aid victims who have suffered cardiac arrest. It’s one of a number of apps that rescue workers, hospital staffers and patients themselves are using to try and improve responses to health emergencies and help save lives.

PulsePoint has helped save lives in cities such as Cleveland, where about 4,000 people have downloaded the app in the last year and 36 citizens have responded to almost three-dozen calls – including one Good Samaritan who helped save the life of a man who collapsed in traffic court.

“Apps used by citizens who want to help give them a way to be part of the structure of the emergency response program,” said Thomas Beers, emergency medical services manager at the Cleveland Clinic and coordinator for PulsePoint in the Cleveland area. Continue reading

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Many in U.S. live too far from advanced stroke care | Reuters

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Illustration of the skull and brainMany Americans would not have quick access to the best healthcare options during a stroke, even under the most ideal circumstances, according to a new computer model.

In a hypothetical model, if each state had up to 20 hospitals providing the best possible care for people having strokes – which is not the current reality – more than a third of Americans would still be more than a 60-minute ambulance ride away from one of those medical centers.

via Many in U.S. live too far from advanced stroke care | Reuters.

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New Mexico’s nurse hotline touted as a model for other states

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red-telephoneBy Christine Vestal
Stateline

If your infant has a high fever or you’re experiencing an unusual pain in your abdomen and you live in New Mexico, you may want to call the NurseAdvice line before you do anything else.

New Mexico is the only state with a 24/7 registered nurse call center that is free to all residents, whether insured or not. In operation since 2006, it has kept tens of thousands of New Mexicans out of emergency rooms and saved the state more than $68 million in health care expenses.

It has provided a basic form of health care to thousands of uninsured people who have no other access to care. It also has relieved demand on doctors and hospitals in a sparsely populated state where all but a few counties have a severe shortage of health care providers.

On top of that, the statewide call center has generated real-time public health data that has served as an early warning system during epidemics and natural disasters.

In April, the U.S. Centers for Disease Control and Prevention (CDC) will recommend New Mexico’s advice line as a national model that other states adopt during an emergency preparedness summit in Atlanta. Continue reading

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States strive to keep Medicaid patients out of ERs

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Sign for an emergency room.By Michael Ollove
Stateline

Nearly half the states use higher copayments to dissuade Medicaid recipients from unnecessary visits to emergency rooms, where care is more costly.

These states require patients to make the payments, which are as high as $30 per visit in Oklahoma, when it is later determined that they did not experience a true medical emergency.

But at least one multistate study has found that charging higher copayments does not reduce emergency department (ED) use by Medicaid recipients.

One reason might be that copays are hard to enforce, since EDs are legally obligated to examine anyone who walks through the doors, whether or not they can pay.

ED doctors and others in health policy also criticize copays as potentially dangerous, since they may lead people to think twice about seeking emergency care when they really need it.

Washington state and some Medicaid managed care plans around the country are trying a different approach. Instead of using financial disincentives, they are trying to keep frequent users out of the emergency department (practitioners prefer the name “emergency department” to “emergency room”) by enrolling them in primary care practices, scheduling appointments for them and, in some cases, making sure they get to the doctor’s office on time. The hope is that giving people comprehensive health care will make many ED trips unnecessary.

Reliable data are still sparse, but the early signs are encouraging: Washington state reported that a year after implementing its program, emergency room visits by Medicaid beneficiaries had declined by nearly 10 percent. Among frequent ED users, the drop was slightly greater. Continue reading

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Life from above? First-responder of the future could be a drone

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Developed by Delft TU (Delpht University of Technology, The Netherlands):

Each year nearly a million people in Europe suffer from a cardiac arrest. A mere 8% survives due to slow response times of emergency services. The ambulance-drone is capable of saving lives with an integrated defibrillator.

The goal is to improve existing emergency infrastructure with a network of drones. This new type of drones can go over 100 km/h and reaches its destination within 1 minute, which increases chance of survival from 8% to 80%! T

his drone folds up and becomes a toolbox for all kind of emergency supplies. Future implementations will also serve other use cases such as drowning, diabetes, respiratory issues and traumas. – From Delpht TU

Editors note: In a real case of cardiac arrest, bystanders should have started cardio-pulmonary resuscitation (CPR) immediately and looked to see if there was an automated external defibrillator (AED) in the building.

  • To learn more about CPR visit the Red Cross’ CPR pages where you can learn about classes in our area. 
  • To learn more about AEDs go to King County’s “Shockingly Simple” webpage.
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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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