Emergency Medicine

July 3, 2019

Suffering of rural poor a reminder of how much health policy debates matter

Twenty Democrats who are campaigning for president took to network television for four hours and two nights last week to put health care as a central issue of their campaigns.

The format of this initial candidate “debate,” including hand-raised answers to complex issues, failed to allow the presidential aspirants to delve much into the details of their proposals. But tons of news coverage followed on — and likely will keep doing so up until Americans enter the voting booth — about Medicare, the government health coverage for seniors, and how it might be expanded to benefit tens of millions more. Those interested may wish to check out this podcast primer on the issue.

These future-looking discussions also already have tended to eclipse a key part of the existing Affordable Care Act, the Obama Administration initiative that remains a subject of hot dispute a decade after its passage: The expansion of Medicaid, the federal program to assist the poor and working poor with health coverage.

June 26, 2019

Concerns rise over costly emergency intervention — a ‘bridge to nowhere?’

by Patrick A. Malone

Medical ethicists and patient advocates are raising concerns about a big, costly, and often unsuccessful procedure that “pumps blood out of the body, oxygenates it, and returns it to the body, keeping a person alive for days, weeks or months, even when their heart or lungs don’t work,” the Kaiser Health News Service reported.

Extracorporeal membrane oxygenation or ECMO (eck-moe) is considered an appropriate treatment for some patients on death’s door.

But hospitals, to maintain their competitive business standing, are battling to get the equipment and staff to provide this therapy, which costs on average half a million dollars per patient. The number of hospitals that can do ECMO has increased from 108 in 2008 to 264 now, with the number of ECMO procedures tripling since 2008 to almost 7,000 in the last count in 2014.

June 14, 2019

As temperatures rise, so can dangers to kids and pets locked in hot cars

by Patrick A. Malone

As the weather turns toasty, it’s worth remembering that common sense and a bit of caution can save the lives of children and pets: Please don’t forget they are in your vehicle’s back seats, and don’t lock them in there with the windows rolled up — even for the briefest moment.

The New York Times reported this, in a timely news article:

As the summer months heat up across America, advocates are hoping to draw attention to the issue [of children dying in locked vehicles] as well as their push for legislation to help address the problem. Dozens of children die of heatstroke each year in cars whose temperatures, even on relatively mild days, can quickly soar past 100 degrees. Many of those children were left behind by a distracted caregiver.

March 27, 2019

Clinicians are facing up to the preventable harms that ICU’s inflict on many patients in the process of saving lives

by Patrick A. Malone

Doctors and hospitals finally are owning up to and treating mental and physical damages inflicted on some of the sickest and most vulnerable individuals in their care—the 5 million or so patients who get helped in intensive care units, published research shows.

Although ICU patients may get dramatic emergency care that saves them from deadly infections, major disease, and significant accident or injury, experts only recently have begun to recognize and assist them with a condition associated with their stays: post-intensive care syndrome (PICS). A readable new study in the medical journal JAMA says that ICU patients may suffer a “constellation of symptoms” with PICS that hinders their recovery to their pre-hospitalization well-being, including: “muscle weakness, cognitive impairment, depression, anxiety, and post-traumatic stress disorder (PTSD).”

January 22, 2019

Diabetes is serious. So why aren’t patients getting more treatment help?

by Patrick A. Malone

Doctors, hospitals, health officials, and disease advocacy groups race to warn about diabetes’ risks, harms, and increasing prevalence. But why, then, doesn’t modern medicine also do much more to help diabetics with the skyrocketing costs of their care, whether with insulin at excessive prices or with expensive medical aids?

Ted Alcorn of the New York Times drilled down on one slice of diabetes care to capture how medical profiteering distorts what ought to be a more direct, simple, and less pricey treatment for a disease that afflicts as many as 100 million Americans in varying degree.

He reported on the “strange marketplace” for the chemical-imbued plastic strips diabetics use to test their blood sugar, inserting them into specialized meters for glucose readings. Before diabetics adjust their diet or take insulin, they may test themselves with strips and meters as many as 10 times a day. The costs add up. Diabetics can pay thousands of dollars annually to get test strips over the counter.

January 1, 2019

‘Bleed Out’ details how daunting the pursuit of justice can be for harmed patients

by Patrick A. Malone

When doctors, hospitals, insurers, and their captive lawmakers howl about how unfair malpractice lawsuits allegedly can be for modern medicine, patients who have suffered harms while seeking medical services should require loved ones, friends, and members of their community to view Bleed Out.

This new HBO documentary details the decade-long quest by comedian Steve Burrows and his family for justice for his mother, Judie. She was an energetic, retired teacher when she fell from her bike and needed emergency hip surgery. Before she had recovered, she fell again and needed a second operation. But this time, something went wrong: She lost more than half her blood, fell into a coma, and suffered irreversible brain damage that meant that she would spend the rest of her life in institutional care in rural Wisconsin.

December 31, 2018

Launch 2019 safe and healthy: Don’t drive while distracted or under the influence

by Patrick A. Malone

Don’t be tempted over the next few days of new year’s revelry to drive while distracted or intoxicated — whether under the influence of alcohol, marijuana, or prescription drugs.

It’s a myth that the start of the year is the deadliest time for motorists across the country. But Jan. 1, statistically and without great explanation, has been most lethal for pedestrians nationwide. Pedestrians also are in greater harm’s way than they should be here in Washington, D.C.

Drunk driving poses significant problems in the nation’s capital, where alcohol-related fatalities increased 33 percent in 2017. Officials in the District of Columbia need to crack down even more on an issue that puts motorists, pedestrians, and cyclists alike in peril.

November 6, 2018

Gun violence takes terrible toll on kids too

by Patrick A. Malone

As the nation struggles with grief from the latest mass shooting at a Pittsburgh synagogue, new research shows how grievous the mayhem that guns cause for the young, with weapons injuries over nine years sending 75,000 children and teen-agers to emergency rooms at a cost of almost $3 billion.

The Associated Press reported that researchers at Johns Hopkins found in their published study that:

[M]ore than one-third of the wounded children were hospitalized, and 6 percent died. Injuries declined during most of the 2006-14 study, but there was an upswing in the final year. … 11 of every 100,000 children and teens treated in U.S. emergency rooms have gun-related injuries. That amounts to about 8,300 kids each year. The scope of the problem is broader though; the study doesn’t include kids killed or injured by gunshots who never made it to the hospital, nor does it count costs for gunshot patients after they’re sent home.

October 19, 2018

Officials around the globe take steps to battle public health menace of suicide

by Patrick A. Malone

They may seem small and may be symbolic, but Britain and Japan both are taking steps to deal with suicide, a public health menace by which 45,000 Americans age 10 or older took their lives by their own hand in 2016 alone.

In Britain, the New York Times reported that Prime Minister Theresa May appointed health minister Jackie Doyle-Price to lead “government efforts to cut the number of suicides and overcome the stigma that prevents people with mental health problems from seeking help. While suicide rates have dropped in recent years, about 4,500 people take their own lives each year in England. It remains the leading cause of death for men under age 45.”

Britain, like the United States, has struggled to provide adequate and appropriate mental health care to its people, even though it has a national health service. And Britons, like their friends across the ocean, are reluctant to seek mental health care for multiple reasons, including stigmatization.

October 17, 2018

Hurricane Michael shows extreme planning may be key to protect medical care

by Patrick A. Malone

As Florida, Georgia, and the Carolinas struggle with Hurricane Michael’s devastation and slow-rising death toll, hospitals, nursing homes, and other caregiving facilities across the country may need to reexamine their disaster planning, paying heightened attention to extreme and worst-case scenarios.

Although doctors, nurses, and other medical personnel deserve great credit, as always, for their courage and fortitude in helping the sick and injured, the New York Times reported that, even with disaster plans in place, care-giving facilities got caught short by the latest powerful hurricane:

As Michael bore down and then passed, some hospitals in the region closed entirely, and others evacuated their patients, but kept staff in place to run overwhelmed emergency rooms. In Florida, four hospitals and 11 nursing facilities were closed, according to the Federal Emergency Management Agency. Panama City has five hospitals, according to the Florida Health Association. Bay Medical, with 323 beds, and Gulf Coast Regional Medical Center, with 238, are the biggest. Florida officials also said food and supplies were being dropped in by air to the state’s mental hospital in Chattahoochee, which is cut off by land. The mental hospital has a section that houses the criminally insane, but the facility itself has not been breached, officials said. Gov. Nathan Deal of Georgia said 35 hospitals or nursing homes in that state were without electricity and operating with generators. Federal health officials said they were moving approximately 400 medical and public health responders into affected areas, including six disaster teams that can set up medical operations outdoors. Some were heading to an overwhelmed emergency department in Tallahassee. Other federal medical personnel were being assigned to search-and-rescue teams to triage people who were rescued. University of Florida Health Shands Hospital sent ambulances and four helicopters to assist in rescue efforts, transporting patients out of Panhandle hospitals.