Police officer uses tourniquet to save crash victim with nearly severed hand

From the Tennessean:

A Hendersonville police officer responded to a crash Saturday morning and found a passenger leaning on a car, bleeding profusely with a nearly severed hand.

Officer Brandon Janco used his department-issued tourniquet on the passenger’s arm to control the bleeding, the Hendersonville Police Department said in a news release. Janco stayed with him until fire and emergency medical crews arrived on scene.

Information and communication in the emergency department

From International Emergency Nursing:


Effective communication between healthcare providers and patients represents an important caveat in healthcare, both nationally and internationally. Providing information to patients about their care and condition can be challenging, particularly in demanding, time-pressured environments such as the Emergency Department (ED). Understanding the process of communication and information between patients and staff in the ED is essential to ensuring patients are satisfied with their treatment and care.


This study aimed to develop a holistic understanding of the informational and communicational requirements of patients and staff in the ED.


Action Research involving patient qualitative interviews and a staff focus group were used.


Fifteen patient and family interviews identified four main themes associated with information and communication in the ED. Six ED staff participated in the focus group, which identified three emergent themes echoing some findings from the patient qualitative interviews.


Meaningful and informative interactions between patients and healthcare providers are an imperative and pragmatic component of a positive patient experience. Establishing communicative procedures that are practical, functional and reflective of the service can improve communications between and patients and staff and have implications for practice on a local, national and international level.

What Psychiatrists Need to Know: Patients in the Emergency Department

From the Psychiatric Times:

What many psychiatrists do not realize is that the majority of EDs in the US are inadequately equipped to treat psychiatric crises. As a result, many patients who seek emergency psychiatric care are mostly held for transfer to inpatient facilities. In fact, patients who present to the ED with mental health and substance abuse complaints are 2.5 times as likely to be admitted as those with purely physical problems.1

High Diagnostic Uncertainty and Inaccuracy in Adult Emergency Department Patients with Dyspnea: A National Database Analysis

From Academic Emergency Medicine:

Dyspnea is the second leading cause for visit among the twenty million annual US emergency department (ED) visits in patients aged ≥65 years old and is most commonly caused by pneumonia, acute exacerbations of chronic obstructive pulmonary disease (COPD), and heart failure in older adults. Despite its frequency and substantial associated morbidity and mortality, diagnosing the cause of dyspnea in an older adult poses substantial challenges to the emergency physician.

Report: Doctors Less Productive and Getting Paid Less, Too

From Managed Care:

…for all physicians in general, there was a decline in both compensation and RUVs. That can be underscored by looking at the numbers for the next highest compensation increase for a group. Emergency medicine doctors saw a 1% increase in median compensation while their RUVs dropped by 4.7%.

The weighted average change in median compensation in all specialties in last year was +1.2%, while the weighted average change in median RVUs was -1.5 percent.“While no definitive reason for the decline in productivity was pinpointed, the burdens imposed on doctors by EHR use, patient complexity, and administrative and compliance requirements were said to be potential factors,” Healthcare Finance News reports.

ACEP Invites the Public To Celebrate 50 Years of Emergency Care

Press Release:

Most people today understand that emergency physicians are medical specialists, according to a new survey by Morning Consult,i which was conducted as part of the 50th anniversary of the American College of Emergency Physicians (ACEP). This wasn’t true 50 years ago, before the development of specialty began.  Nearly 80 percent of those who had been patients in the past year indicated they trust emergency physicians and were satisfied with care they provided.

“One in three Americans seek emergency care each year, and ACEP is the organization that charted a path forward to create the specialty of emergency medicine, setting standards and developing the criteria for board certification,” said Paul Kivela, MD, MBA, FACEP, president of ACEP.  “Back in the 1960’s, before there were emergency departments, you were likely taken to a room in a hospital in a hearse, because that was only vehicle in which people could lie flat. We’ve come a long way, and we owe so much to our early leaders who had the foresight and wisdom to shape this specialty that people’s lives today depend on.  I think ACEP’s founders would be amazed at how progress has been made.”

Dr. Kivela said ACEP was celebrating all year with a culmination at the organization’s annual meeting in San Diego in October. ACEP has created a 50th Anniversary video and a special edition look at the history of emergency medicine, Medicine’s Front Line.  Dr. Kivela urged the public to show support by:

“Emergency physicians are the only physicians available all day, all night, all year,” said Dr. Kivela.  “For 50 years, ACEP has been the champion for emergency medicine and emergency patients, and this will continue to for next 50 years.”

The following organizations are the sponsors of ACEP’s 50th anniversary.

  • Schumacher Clinical Partners
  • TeamHealth
  • Vituity
  • Brault
  • Emergency Medicine Residents’ Association (EMRA)
  • Envision Physician Services
  • FUJIFILM SonoSite
  • Hagan Barron Intermediaries
  • Janssen Pharmaceutical Companies of Johnson & Johnson
  • MultiView, Inc.
  • Teleflex
  • United States Army Medicine

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

i Morning Consult 2018


Send a thank you: http://www.emergencycareforyou.org/thankyou/

At Your Defense: Think You Know All about EMTALA? Think Again

From Emergency Medicine News (hat tip: Dr. Menadue):

The largest EMTALA settlement in the controversial statute’s 30-year history has had a surprising effect: The number of EMTALA fines have doubled.

The Office of Inspector General (OIG) reported just nine violation settlements in 2017 but eight this year from January to May. This uptick in enforcement may be the OIG’s renewed focus on regulation because of the AnMed Health case, a $1.295 million settlement for failure to stabilize an emergency medical condition. Thirty-six patients at the Anderson, SC, hospital deemed by the emergency physician to have a psychiatric emergency were not admitted to the hospital’s inpatient psychiatry unit, but were boarded in the emergency department (one for 38 days) until transport to the county’s inpatient psychiatric facility. (OIG, June 23, 2017; http://bit.ly/2tzhN6E.)

Multiple questions arise from this settlement. Can EPs identify and stabilize a psychiatric emergency? (OIG: No.) Can a hospital policy flag only voluntary psychiatric admissions to their inpatient psychiatric unit and deflect involuntary ones for transfer to the county’s psychiatric facility? (OIG: No.) Does EMTALA require on-call psychiatrists to consult on involuntarily held psychiatric patients in the ED? (OIG: Yes.) Now consider the following cases from this year.