2 masks better than one, some experts say

From Becker’s:

Some physicians say doubling up on masks offers better protection against COVID-19, CBS Denver reports. 

“Specifically, what we’re saying is that two masks may actually equal the protection you would get from N-95 masks, which is considered the best mask there is short of a complete respirator-type unit,” said Dave Knida, MD, the station’s medical editor and a family and emergency physician. 

A good option is to wear a surgical mask with a cloth mask over it, Dr. Knida said, adding the recommendation is based on research. 

Protecting the protectors: what vaccination means for a rural, volunteer ambulance service

From WQAD:

The crew is comprised of nine EMTs, one paramedic, and three first responders, who all volunteer all of their time and skills. And most of them are over 60 years old. 

They’ve stayed busy throughout the pandemic, and responded to 30 calls in October alone. Since March, the crew has transported eight known cases of Covid-19 to the hospital, and say working in close quarters with other people, often responding to calls that could be Covid-related, has been stressful – especially as they fall in one of the most vulnerable age groups. 

“It’s been pretty stressful,” said Anne Switzer, ambulance service president. “We’ve had one of our EMTs that did get the Covid. We try to make sure our stretchers are wiped down, our blood pressure cuffs and everything we use is wiped down, I think we’ve took just about every precaution we could take.” 

Switzer has been a volunteer with the crew for the past 41 years, and says she’s been doing everything she can to keep her crew safe throughout this pandemic. 

But now, a ray of good news, as the crew completed their second dose of the vaccine on Thursday, Dec. 7. Some got the Pfizer shot and some had the Moderna jab. 

With few pharmacies, Wisconsin’s rural counties are forced to get creative to administer COVID vaccines

From The Examiner:

“We have good working relationships with pharmacies and they’re a strong force in providing vaccines in any given year, particularly with flu,” said Dr. Stephanie Schauer, Wisconsin Department of Health Services Division of Public Health Immunization Program Manager. “Taking advantage of all that pharmacies offer is important,” she adds. She acknowledges that there are underserved areas of the state where pharmacies are sparse. “But for many parts of the state pharmacies are a vital part of the vaccination effort.”

While there are lots of places to get vaccinated, including “in hospitals, in local and tribal health departments, in medical clinics, in federally qualified health centers, in pharmacies, in long term care facilities, in home care agencies and more,” according to DHS Deputy Secretary Julie Willems Van Dijk, not having access to a pharmacy means local health officials need to be more creative with resources. 

That creativity will be required in counties across the state as the state health department cedes much of the actual administration of vaccine distribution to county health departments. Florence County is the only county without a single retail pharmacy capable of providing immunization, according to the brief, but Adams, Buffalo, Lafayette, Iron and Menominee counties all have just one pharmacy able to vaccinate. 

Hospital housekeepers are the unsung heroes of the pandemic

From WRBL:

Hospital housekeepers’ roles have greatly expanded during the pandemic, and not only in terms of the very deep cleaning they give patient rooms day after day. They’re also filling in as something patients need more than ever – visitors. 

Cristine Perry of SSM Health St. Louis University Hospital is a shining example.    

“I love what I do,” Perry said.  

Her hands clean just about every inch of 24 rooms every day. Perry wipes everything down with virus-killing cleaners and, just as importantly to her, a touch of love. 

Perry has been infected with COVID herself but said that made her more committed to her job, not less. She recovered, got through her quarantine, and went right back to work as housekeeper and hero. 

Implementing a Pandemic Roster in a Specialty Emergency Department – Challenges & Benefits

From DocWireNews:

OBJECTIVE: To create a roster which eliminated unnecessary cross staff exposure to ensure the hospital had sufficient staff to run the Emergency Department in the event that a group of staff are affected by COVID-19. This roster was aimed at providing staff with ‘manageable shift lengths, down-time between shifts, regular breaks and access to refreshments’ as dictated by the Victorian Department of Health and Human Services.

METHODS: Creating 6 fixed teams in our Emergency Department. Teams work blocks of 3 consecutive days of 12 hour shifts, each block alternates between day and night shifts.

RESULTS: We managed to completely eliminate unnecessary cross over of staff thus reducing risk of having a large part of our workforce incapacitated should any member be affected by COVID.

CONCLUSIONS: A pandemic roster plan to minimize staff exposure from other colleagues during a pandemic was possible. This helps to ensure an adequate workforce in the unfortunate event a staff contracts the disease leading to other close contact staff requiring isolation or succumbing to the same illness.

Simulation Training for Community Emergency Preparedness

From Pediatric Annals:

Most infants and children who are ill and injured are cared for in community-based settings across the emergency continuum. These settings are often less prepared for pediatric patients than dedicated pediatric settings such as academic medical centers. Disparities in health outcomes exist and are associated with gaps in community emergency preparedness. Simulation is an effective technique to enhance emergency preparedness to ensure the highest quality of care is provided to all pediatric patients. In this article, we summarize the pediatric emergency care provided across the emergency continuum and outline the key features of simulation used to measure and improve pediatric preparedness in community settings. First, we discuss the use of simulation as a training tool and as an investigative methodology to enhance emergency preparedness across the continuum. Next, we present two examples of successful simulation-based programs that have led to improved emergency preparedness

Study summarizes effectiveness of cloth masks in protecting clinicians from COVID-19

From News Medical:

A rapid, evidence-based review summarizes the effectiveness of cloth masks in protecting health care clinicians from respiratory viral infections, such as COVID-19. Nine studies were included in the review, and all but one were conducted prior to the COVID-19 pandemic.

That study reported wide-ranging confidence intervals when comparing groups, but overall, they conclude that cloth mask use was associated with significantly higher viral infections than the exclusive use of medical masks.

Zocdoc offers COVID-19 vaccine scheduler to health care organizations

From The Verge:

Medical appointment company Zocdoc is offering to handle COVID-19 vaccine scheduling logistics for hospitals and health systems, many of which have spent the early days of the vaccine rollout struggling to handle the crush of demand for doses. Mount Sinai Health System in New York has been using the company’s tool to handle vaccine appointments since mid-December, and has scheduled over 100,000 appointments since.

“It’s for anyone who’s in the front lines of administering COVID-19 vaccinations, to streamline their work. That’s our contribution to the public health effort,” Oliver Kharraz, CEO and founder of Zocdoc, told The Verge. The scheduler is free for any group offering vaccines, even if they aren’t Zocdoc clients.

Drop in ED Visits for Cardiac Conditions Tied to Later Cardiac Deaths

From Health Day:

Reduced emergency department visits for suspected cardiac disease during the COVID-19 pandemic peak in England are associated with a time-lagged increase in cardiac mortality, according to a research letter published online Dec. 20 in Circulation: Cardiovascular Quality and Outcomes.

The researchers found that during the COVID-19 pandemic period (March 12 to April 15, 2020), there was a decline of 2,750 emergency department visits per week for suspected cardiac disease (~35 percent decrease) compared with the average weekly admission before the pandemic in 2020. Every 100 nonattendances at emergency departments for suspected cardiac disease were associated with 3.1 to 8.4 excess cardiac deaths, corresponding to the estimated mortality lag times of zero and 18 days, respectively. During the pandemic period, weekly excess cardiac mortality due to nonattendance at emergency departments was 84 to 232 deaths, corresponding to an 18 percent increase in weekly non-COVID-19 cardiac mortality versus the previous five years. This finding suggests that one cardiac death could have been prevented or delayed for every 12 emergency department visits with suspected cardiac disease.

ACEP Applauds Removal of X-waiver, Expanding Medication-assisted Treatment for Opioid Use Disorder

Press Release:

The American College of Emergency Physicians (ACEP) applauds the U.S. Department of Health and Human Services’ (HHS) decision to effectively remove the “X-waiver” requirement for physicians, expanding their ability to utilize medication-assisted treatment (MAT) for patients struggling with opioid use disorder (OUD).

“As emergency physicians, we see every day the devastating effects that the opioid crisis has had on the communities we serve—a crisis that has unfortunately only worsened during the COVID-19 pandemic,” said Mark Rosenberg, DO, MBA, FACEP, president of ACEP. “Buprenorphine is the most important medication in our arsenal for treating opioid use disorder, which is currently one of the most lethal diseases for Americans.”

In the decision announced on January 14, HHS issued an exemption to the X-waiver requirement for physicians registered with the Drug Enforcement Administration (DEA) who wish to prescribe buprenorphine and other MAT. While the new guidelines pertain to physicians who treat no more than 30 patients with buprenorphine for opioid use disorder at any one time, ACEP appreciates that the Department recognized the unique nature of emergency medicine and decided not to apply this limitation to hospital-based physicians, including emergency physicians.

The X-waiver presents a major obstacle to “legitimate” patient access to buprenorphine and other MAT. Before today’s announcement, physicians wishing to prescribe buprenorphine outside of opioid treatment programs had to take an eight-hour course and often waited 60 to 90 days to receive the waiver once the course is completed and the license application is submitted. The presence of this X-waiver requirement has also led to misperception about MAT and has increased negative pre-conceived notions about OUD and the treatment of this disease. As a result, some clinicians are hesitant to pursue this DEA license or even engage in treatment of patients with OUD.

Removing the X-waiver and reducing stigma to treating OUD in the emergency department has been a major priority for ACEP. In January 2020, the College hosted the Summit Addressing the Opioid Stigma in the Emergency Department—an event funded by the federal Substance Abuse and Mental Health Services Administration as part of its Opioid Response Network in which stakeholders identified strategies and behaviors to reduce practices that perpetuate stigma in the emergency department. ACEP also sent a letter to HHS to illustrate the challenges of the X-waiver and supported H.R. 2482, the “Mainstreaming Addiction Treatment Act of 2019,” which would eliminate the waiver requirement.

Added Dr. Rosenberg, “This is a great day for our patients. The X-waiver was an outdated and cumbersome barrier to treatment, and it exacerbated stigma for those struggling with opioid use disorder. Now, more than ever, we need compassion and action in treating patients with addiction.”

The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million Americans they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org