Emergency Medicine

November 6, 2018

Gun violence takes terrible toll on kids too

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.

October 9, 2018

Congress approves 650-page bill to attack opioid crisis, as doubts abound

by Patrick A. Malone

Congress has approved a major new push to deal with the opioid crisis that kills tens of thousands of Americans annually. Voters can expect President Trump to sign the big bill, passed easily and with rare bipartisan support in the House and Senate, just in time for politicians in the mid-term elections to campaign on their drug-fighting initiatives. But critics say it won’t be enough.

The opioids legislation covers 650 pages, and, in brief, the Washington Post reported, would:

Require the U.S. Postal Service to screen packages for fentanyl shipped from overseas, mainly China. Synthetic opioids that are difficult to detect are increasingly being found in pills and heroin and are responsible for an increase in overdose deaths.

October 2, 2018

Battle is on to bring down sky-high costs of emergency medical transport

by Patrick A. Malone

Even as District of Columbia officials gave a cautious, interim report on their push to reduce with nurses’ help the expensive misuses of the 911 emergency system, a news organization’s story on a sky-high medical transport bill has underscored why regulators and lawmakers need to fix a pricey part of the health care system: Why can’t sick and injured patients get to treatment, quickly but without breaking the bank?

In the nation’s capital, it will take special nurses more time to settle in, overcome excess caution, and better help emergency dispatchers decide: When can they avoid sending expensive EMS vehicles and teams and when can patients with less urgent medical complaints be helped to get to care with cheaper commercial options, like app-based ride-sharing services Uber and Lyft, D.C. Fire Chief Gregory Dean has said.

The data from the first 90 days of the $1-million “Right care, right now” program to tap nurses’ expertise to divert non-emergency medical care out of the 911 system may offer modest cause for optimism, as the Washington Post reported:

September 23, 2018

Hospitals slammed for ventures that exploit patients and violate their privacy

by Patrick A. Malone

Big hospitals can’t exploit patients and violate their privacy by throwing open their facilities to Hollywood for television shows that plump institutions’ reputations. And academic medical centers need to think twice before letting their leaders strike cozy deals to enrich a choice few insiders by hawking important diagnostic information collected with best intentions by medical staff from patients for decades.

The roster of hospitals dealing with black-eyes from recent negative news stories about their activities includes well-regarded institutions in Boston and New York — Boston Medical Center, Brigham and Women’s Hospital, Massachusetts General Hospital, and Memorial Sloan-Kettering Cancer Center.

Federal regulators busted the Boston hospitals with fines settled for just under $1 million for “inviting film crews on premises to film an ABC television network documentary series, without first obtaining authorization from patients,” reported the U.S. Health and Human Services’ department’s Office of Civil Rights.

August 21, 2018

Maryland tragedy underscores need for tough safeguards for players’ health

by Patrick A. Malone

In College Park, Md., new cooling tents have sprouted on the University of Maryland’s football practice field, where the training staff also is taking pains now to provide adequate cold drinks and breaks to players. Observers say the pre-season regimens, however, are not only marked by greater attentiveness to the young athletes’ needs, they’re also eerily quiet and somber.

That’s because top Terps leaders have apologized and conceded the school shares blame for the tragic and preventable heat stroke death of Jordan McNair, 19, a Maryland offensive lineman. Coaches forced the young man to run and over-exert himself during a May 29 practice. More importantly, they failed to diagnose the severity of his condition, neglecting to so much as take his pulse and blood pressure, and, in a disputed account, not noticing that he was suffering seizures, or acting fast to drop his body temperature with ice and cooling baths.

Published reports suggest he showed heatstroke signs before 5 that afternoon, though trainers did not call for emergency help and an ambulance until nearly 6, when his body temperature may have hit 106 degrees. He was admitted to a hospital, where nurses and doctors immersed him in a cooling bath and reduced his temperature to 102 degrees — 90 minutes or so after he apparently got into distress.

August 5, 2018

Medical valor is on finest display as wind-whipped wildfires roar in California

by Patrick A. Malone

When a raging wildfire — feeding off blowing winds and weeks of desiccating heat, also whipped up a freak, blazing tornado-like vortex with 140-mile-an-hour gusts and a 500-yard diameter — common sense might have dictated that affected Northern Californians should flee as fast and as far as possible.

While many did, correctly heeding authorities’ emergency evacuation pleas, some courageous residents of Redding, Calif., pop. 91,000, decided to stay.

No, they were neither daring nor foolish. They were doctors, nurses, and medical personnel, who — along with first responders like police, fire fighters, and civil defense personnel — put the care and safety of others’ lives ahead of their own.

July 17, 2018

ER intervention may be a key way to avert patients’ repeat suicide attempts

by Patrick A. Malone

As the nation deals with record numbers of suicides, hospital emergency rooms, with a relatively simple intervention and diligent follow-up, may be able to reduce by half the high risk that patients they treat will try to take their own lives again.

National Public Radio reported on a newly published Veterans Affairs study of more than 1,600 patients at five sites across the country treated in ERs for suicide attempts, following up on their care for six months.

Researchers found that ER doctors, nurses, and social workers — even with little training — can help prevent the “ticking time bomb” of patients’ potential repeat suicide attempts by helping them with a Safety Planning Intervention.

July 9, 2018

Blame drug makers for ER shortfalls in caring for patients in ‘trauma season’

by Patrick A. Malone

As the nation struggles through the “100 deadliest days,” the summer season of medical traumas, hospitals are warning anew that they’re not faring well in their constant battles to stock drugs that patients need for their care, notably in emergency rooms.

The New York Times reported that ERs across the country can’t find and keep sufficient supplies of vital medications, ranging from “morphine, which is used to ease the pain of injuries like broken bones [to] diltiazem, a heart drug.” And said the newspaper story:

Hospitals small and large have been scrambling to come up with alternatives to these standbys, with doctors and nurses dismayed to find that some patients must suffer through pain, or risk unusual reactions to alternative drugs that aren’t the best option.