Emergency Medicine

August 5, 2018

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

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.

June 10, 2018

It’s not just celebrities; CDC warns of public health crisis in suicides

by Patrick A. Malone

Uncle Sam’s sobering new report about suicide rates rising in all but one state between 1999 and 2016, with fatal increases across age, gender, race and ethnicity, became even more somber and urgent with the shock and grief expressed widely over the self-inflicted deaths of chef-raconteur Anthony Bourdain in France and fashion designer-entrepreneur Kate Spade in Manhattan.

Suicide no longer should be viewed solely as a personal mental health problem but also now as a public health crisis, the federal Centers for Disease Control and Prevention warned. Anne Schuchat, the CDC’s principal deputy director, told the Washington Post: “The data are disturbing. The widespread nature of the [suicide rate] increase, in every state but one, really suggests that this is a national problem hitting most communities.”

The suicides of Bourdain, 61, and Spade, 55, hit many hard, as was reflected in the extensive media coverage and social media reactions. Both Bourdain and Spade rose from modest circumstances, with abundant hard work, talent, personality, and ambition, to lead lives in the spotlight, and with an economic comfort that others would envy and consider glamorous. They were “successes.”

June 8, 2018

Is there a doctor aboard? While flying this summer, you may hope so

by Patrick A. Malone

With tens of millions hopping on jets to get to summer vacation destinations, it’s worth noting that medical emergencies aloft aren’t as rare as many travelers might imagine — and it may be beneficial if a doctor happens to be aboard when the need arises.

The nation’s top doctor, U.S. Surgeon General Jerome Adams, of course, may have spotlighted sky-high medical care, when he answered flight attendants’ emergency page to all those aboard a Delta flight from Fort Lauderdale to Atlanta. Details are a bit sketchy. But a passenger on the early May trip apparently passed out, and worried crew needed medical assistance and an evaluation of potential next steps.

Adams said he was pleased to step up and assist the crew as the flight, which was on the tarmac, returned to the airport gate, where a crew member took the ailing passenger off for care, while the Delta plane resumed its planned trip.

June 7, 2018

Stigma inflicts harsh toll on mentally ill, but society pays too

by Patrick A. Malone

Although Americans keep making progress toward ending the stigma associated with mental disorders, including trying to put public funding for the diseases’ treatment on a more even footing, patients with serious mental illness suffer unfairly and harshly still due to their conditions.

Dhruv Khullar, a doctor at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written a painful piece for the “Upshot,” an evidence-based column for the New York Times. His article, “The Largest Health Disparity We Don’t Talk About,” reports that:

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younge r than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century [for most in this country] have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

June 5, 2018

With more legal pot and a raging opioid crisis, deadly drugged driving spikes

by Patrick A. Malone

There’s been a deadly side to the nation’s opioid drug abuse crisis and increasing number of states’ legalization of marijuana: A leading safety group says the number of drugged drivers killed in car crashes is rising dramatically.

The Governors Highway Safety Association reported that 44 percent of fatally injured drivers tested for drugs had positive results in 2016, which is up more than 50 percent compared with a decade ago, according to a blog post by the nonprofit, nonpartisan Pew Trusts, which added that, “more than half the drivers tested positive for marijuana, opioids or a combination of the two.”

As Pew reported, the District of Columbia and nine states “allow marijuana to be sold for recreational and medical use, and 21 others allow it to be sold for medical use. Opioid addiction and overdoses have become a national crisis, with an estimated 115 deaths a day. States are struggling to get a handle on drugged driving. Traffic safety experts say that while it’s easy for police to test drivers for alcohol impairment using a breathalyzer, it’s much harder to detect and screen them for drug impairment. There is no nationally accepted method for testing drivers, and the number of drugs to test for is large. Different drugs also have different effects on drivers. And there is no definitive data linking drugged driving to crashes.”

May 25, 2018

Experts issue new cautions as hospitals and ERs treat a spike in teen suicides

by Patrick A. Malone

Moms, dads, grandparents, teachers, and coaches all may need to increase even more the attention and concern they devote to teen-agers, especially young women, as hospitals and emergency rooms report dramatic increases in their treatment of youthful suicides.

Multiple news organizations reported that, as the New York Times noted, “the proportion of emergency room and hospital encounters for … suicide-related diagnoses almost tripled, from 0.66 percent in 2008 to 1.82 percent in 2015. And the rate of increase was highest among adolescent girls.”

NPR reported: “Children ages 5 to 17 visited children’s hospitals for suicidal thoughts or attempts about twice as often in 2015 as in 2008.”

May 8, 2018

Cities battle opioid carnage that now includes lethal fentanyl mixtures

by Patrick A. Malone

Ss the nation’s opioid crisis spirals into ever-more risky territory where synthetic painkillers get mixed with illegal drugs with fatal results, reporters are digging deeper into how drug companies got the country into this mess and cities now are stepping up with different approaches to curb deadly overdoses.

Vox, an online news and information site, reported that experts aren’t sure why, but they’re seeing an ugly trend in users and dealers mixing fentanyl, a synthetic opioid and sometimes legally prescribed painkiller, and other illicit narcotics, notably cocaine and heroin.

Vox reporter German Lopez, in interviews with drug experts, finds they are divided: Some think the deadly mixtures are occurring on purpose, with users seeking even greater intoxication or dealers promoting this to them. It may be that the mixtures are occurring unintentionally, as fentanyl, even in the tiniest amount as a residue, packs a wallop. Or it may be that authorities, as they try to get a better handle on the opioid crisis, have developed sharper data on drug abuses.

April 25, 2018

District tests an alternative answer to what really ails too many 911 callers

by Patrick A. Malone

Residents of the nation’s capital will participate in a public health test every time they pick up the phone to dial 911 for help. How their calls get answered says a lot about common sense, as well as the availability and affordability of medical services in Washington and the nation.

National Public Radio reported that a bunch of new faces now will join dispatchers in DC’s already hectic and often overloaded 911 center. They will be registered nurses specializing in urgent triage. And when 911 callers want what they claim is emergency medical help, dispatchers will hook in the nurses who will try to determine what kind of fast assistance might be appropriate.

This might raise hackles: Why can’t 911 dispatchers just get on with it and send ambulances with lights flashing whenever a caller reports an “emergency”? Here’s the problem, as NPR reported: