Doctor Says Air Ambulance’s Design Is too Risky for Patients

From JEMS:

Ed. This is an AW 139, not ORNGE’s exact ship.

ORNGE’s top doctor has checked out the medical interior of the air ambulance’s multimillion-dollar helicopters and found a disaster waiting to happen.

Dr. Bruce Sawadsky, in a report written Monday, calls the cramped interior of the brand new AW 139 helicopter a “high risk environment.”

His findings? Tough to do CPR. Hard to prop up a patient who is having difficulty breathing. Takes too long to load and unload a patient. Risky, too. Many equipment malfunctions.

Shock First or CPR First?

From Resuscitation:

A Randomized Trial of Compression First or Analyze First Strategies in Patients with Out-of-Hospital Cardiac Arrest: Results from an Asian Community

Background: It is still under debate whether a period of cardiopulmonary resuscitation should be performed prior to rhythm analysis for defibrillation for out of hospital cardiac arrests (OHCA). This study compared outcomes of OHCA treated by “compression first” (CF) versus “analyze first” (AF) strategies in an Asian community with low rates of shockable rhythms.

Methods: This randomized trial was conducted in Taipei City between February 2008 and December 2009. Dispatches of suspected OHCA that activated advanced life support teams were randomized into the CF and AF strategies. Patients assigned to CF strategy received 10 cycles of CPR prior to analysis by automatic external defibrillator. The primary outcome was sustained (> 2hours) return of spontaneous circulation (ROSC) and secondary outcome was survival to hospital discharge.

Results: We included 289 cases in the final analysis after exclusion by pre-specified criteria, 141 were allocated to CF strategy and 148 to AF strategy. Baseline characteristics were similar. Thirty-seven (26.2%) of those receiving CF strategy and 49 (33.1%) of the AF strategy achieved sustained ROSC (p=0.25). In a post-hoc analysis of patients who achieved ROSC, those that received CF strategy were more likely to be discharged alive from the hospital (16/37=43.2% vs. 11/49=22.4%, p=0.02).

Conclusion: In this study population of low rates of shockable rhythms, there was no difference in ROSC for CF or AF strategies. Considering the EMS operation situations, a period of paramedic-administered CPR for up to 10 cycles prior to rhythm analysis could be a feasible strategy in this community.

Oslo government district bombing and Utøya island shooting July 22, 2011: The immediate prehospital emergency medical service response

From the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (link is to the full text article)

Background: On July 22, 2011, a single perpetrator killed 77 people in a car bomb attack and a shooting spree incident in Norway. This article describes the emergency medical service (EMS) response elicited by the two incidents.

Methods: A retrospective and observational study was conducted based on data from the EMS systems involved and the public domain. The study was approved by the Data Protection Official and was defined as a quality improvement project.

Results: We describe the timeline and logistics of the EMS response, focusing on alarm, dispatch, initial response, triage and evacuation. The scenes in the Oslo government district and at Utøya island are described separately.

Conclusions: Many EMS units were activated and effectively used despite the occurrence of two geographically separate incidents within a short time frame. Important lessons were learned regarding triage and evacuation, patient flow and communication, the use of and need for emergency equipment and the coordination of helicopter EMS.

Local E.R. docs work to curb “doctor shopping”

From KFVS:

Doctors at one local southern Illinois emergency room say some patients are not coming looking for help, they’re looking for drugs.

It’s called “doctor shopping” and the director of the emergency department at Memorial Hospital of Carbondale says it’s become a big concern.

Dr. Joseph Haake says the fast-paced nature of an E.R. makes it a prime target for doctor shoppers, which he says could slow down service for folks who really need help in a hurry.

“They shop from one physician to the next until they get that prescription,” said Dr. Haake. “It’s a very difficult environment to determine whose behaviors are legitimate and whose aren’t.”

Massachusetts Emergency Department Visits Down For First Time Since Health Reform

From WBUR:

One of the key goals of health reform here in Massachusetts was to improve people’s health through prevention and primary care to the point that costly trips to the emergency room would decline. Until now, that hasn’t happened, according to several earlier reports.

But a just-released analysis, by the Blue Cross Blue Shield of Massachusetts Foundation found, for the first time, that ER visits (among non-elderly adults) have started to drop. Here, according to the report, which is also published in the current issue of the journal Health Affairs are the numbers: (read more by following the link above)

CT scans for dizziness in the ER: Worth the cost?

From Medical Xpress:

According to the Henry Ford study, less than 1 percent of the CT scans performed in the emergency department revealed a more serious underlying cause for dizziness – intracranial bleeding or stroke – that required intervention.

The findings suggest that it may be more cost effective for hospitals to instead implement stricter guidelines for ordering in-emergency department CT scans of the brain and head for patients experiencing dizziness.

NTSB Faults Pilots in Medical Helicopter Crashes

From JEMS:

Federal safety investigators on Friday faulted pilots who tried to outrun approaching storms in two fatal medical helicopter crashes in South Carolina and Tennessee.

The National Transportation Safety Board issued very similar findings in both crashes, saying the pilots could have made safer decisions, but risked flying into bad weather in order to return home. Two pilots and four flight nurses were killed in the 2009 and 2010 crashes.

Cedar Rapids, IA named in “America’s Top Cities for Hospital Care”

From Fierce Healthcare:

A new list from HealthGrades indicates that the best quality hospital care occurs at some smaller cities that beat out major cities, with Baltimore ranking as number one in the nation. The other cities that round out the top 10 are Phoenix-Prescott, Ariz.; Cedar Rapids, Iowa; Richmond, Va.; Cincinnati, Ohio; West Palm Beach, Fla.; Chattanooga, Tenn.; St. Louis, Mo.; Hartford-New Haven, Conn.; and Grand Rapids-Kalamazoo, Mich.; respectively.

Crash outside hospital sends four people inside to ER

From Riverhead Local:

Four people, including a small child, were sent to Peconic Bay Medical Center’s emergency room after a crash on Route 58 Tuesday morning.

They didn’t have far to travel.

The crash occurred when a Toyota sedan pulled out of the hospital’s parking lot onto Route 58, colliding with a westbound Nissan.

Police responding to the accident just before 9 a.m. called for the Riverhead Fire Department heavy rescue unit to remove the front driver’s side door of the Toyota. The heavy rescue unit arrived on the scene but did not need to use the Hurst tool because a tow truck operator from Phil’s Towing was able to release the door, allowing EMTs access to the accident victims inside the Toyota.

Discharged ER patients often miss instructions

From the CBC:

People who are discharged from emergency departments are often unable to tell what symptoms should raise alarms and make them return to the hospital, a review suggests.

Dr. Stephen Porter, head of emergency medicine at Toronto’s Hospital for Sick Children, led a review of more than 50 studies on the subject. The papers examined the content, delivery and comprehension of discharge instructions for both adults and children.

It’s important for doctors and nurses to communicate effectively with patients to deliver the best care. But in the hectic and distracting environment of an emergency department, those key instructions can be lost.