Category Archives: Emergency Medicine

News about emergency services and medicine.

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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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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Training young men to change their lives by saving others

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In Oakland, California, a program called EMS Corps trains young men to become certified emergency medical technicians. Students with disadvantaged backgrounds get an intensive five-month course, as well as a powerful, new outlook on what they can do in life and for their neighborhoods. Sarah Varney of Kaiser Health News reports in collaboration with the NewsHour.

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Harborview as busy as ever, even with more people insured | Local News | The Seattle Times

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HarborviewWith more people obtaining health insurance under the Affordable Care Act, places like Harborview Medical Center are providing much less “charity” (uncompensated) care. The Emergency Department there is as busy as ever, though.

via Harborview as busy as ever, even with more people insured | Local News | The Seattle Times.

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Vicodin, some other pain meds will be harder to get – DEA

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Patients who use drugs containing hydrocodone as a pain reliever or cough suppressant are going to have to jump through more hoops to get them starting next month.

The Drug Enforcement Administration is reclassifying so-called “hydrocodone combination products” (HCP) from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access. Vicodin, for example, is an HCP because it has hydrocodone and acetaminophen.

The final regulation, which takes effect Oct. 6, will mean that patients generally must present a written prescription to receive the drug, and doctors will no longer be able to call in a prescription to the pharmacy in most instances.

Many patients with painful chronic diseases, including cancer, take hydrocodone combination products

.The regulation is a response to the widespread misuse of prescription pain killers.

In an emergency, doctors will still be able to call in a prescription, according to the new rule. And although prescription refills are prohibited, a doctor can, at his discretion, issue multiple prescriptions that would provide up to a 90-day supply.

These measures don’t satisfy consumer advocates or pharmacists who are opposed to the new rule. Continue reading

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States Seek to Protect Student Athletes from Concussions, Heat Stroke

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A Wet Bulb Globe Temperature calculator in use last week during a football practice of the Oconee County High School in Watkinsville, Georgia. The device, which measures temperature, humidity and radiant temperature is used to govern sports activities at all Georgia high schools. Photo © Stateline

By Michael Ollove
Stateline

Athens, Georgia—When Georgia public high schools were asked several years ago to devise a policy to govern sports activities during periods of high heat and humidity, one school’s proposal stood out: It pledged to scale back workouts when the heat index reached 140.

Those who understood the heat index, the combined effects of air temperature and humidity, weren’t sure whether to be appalled or amused. “If you hit a heat index of 140,” said Bud Cooper, a sports medicine researcher at the University of Georgia who examined all the proposed policies, “you’d basically be sitting in the Sahara Desert.”

The policy reflected an old-school, “no pain, no gain” philosophy, a view that athletes need to be pushed to their physical limits—or beyond them—if they and their teams are to realize their full potential.

In some places, state, school and sports officials are recognizing that the zeal of coaches, players, and parents for athletic accomplishment must be subordinated to safety. Increasingly, they are adopting measures to protect student athletes from serious, even catastrophic injuries or illnesses that can be the consequence of a blinkered focus on competitiveness. Continue reading

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Replacing an ambulance with a station wagon

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Eric Bleeker and a partner respond to 911 calls in this vehicle. (Photo by Eric Whitney for KHN).

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

CENTENNIAL, COLO. — When they get a call for medical help, most fire departments scramble both an ambulance and a fully-staffed fire truck.

But that’s way more than many people really need, says Rick Lewis, chief of emergency medical services at South Metro Fire Rescue Authority in the Denver suburbs.

“It’s not the prairie and the old West anymore, where you have to be missing a limb to go to the hospital. Now it’s a sore throat, or one day of cold or flu season sometimes, and that can be frustrating for people, I know it is.”

It’s kind of like an urgent-care clinic on wheels.

It’s frustrating for both ambulance crews and patients. Somebody who’s been running a fever for a couple of days needs help, but not necessarily an ambulance ride to the ER.

Ambulance crews aren’t required to transport everyone who calls, but Lewis says crews fear lawsuits if they were to leave and a patient got worse. Also, ambulance companies typically don’t get paid unless they take somebody to the hospital.

So Lewis teamed up with Mark Prather, an emergency room doctor, to come up with a better way. Continue reading

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Beware higher charges if you go to an out-of-network ER

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Sign for an emergency room.By Michelle Andrews
KHN

When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you.

That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care.

Beware, you could be left on the hook for substantially higher charges than you might expect.

The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network.  (Plans that are grandfathered under the law don’t have to abide by these provisions.)

That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect. Continue reading

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The latest in medical convenience: ER appointments

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 This story also ran in .

Scott Paul knew he needed to head to the emergency room on a recent Sunday after his foot became so painful he couldn’t walk.

The one thing that gave him pause was the thought of having to wait several hours next to a bunch of sick people.

But his wife, Jeannette, remembered she’d seen Dignity Health television commercials featuring a woman sitting in a hospital waiting room and then cutting to the same woman sitting on her living room couch as words come up on the screen: “Wait for the ER from home.”

“I’ve been in emergency rooms before, so I thought I’d see if this worked out,” she said, and went online to book an appointment for her husband at Dignity’s St. Mary’s Medical Center in San Francisco. Continue reading

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