Evaluating the Quality of Cardiopulmonary Resuscitation in the Emergency Department by Real-Time Video Recording System

From PLoS:


To compare cardiopulmonary resuscitation (CPR) quality between manual CPR and miniaturized chest compressor (MCC) CPR. To improve CPR quality through evaluating the quality of our clinical work of resuscitation by real-time video recording system.


The study was a retrospective observational study of adult patients who experienced CPR at the emergency department of Shanghai Tenth People’s Hospital from March 2013 to August 2014. All the performance of CPR were checked back by the record of “digital real-time video recording system”. Average chest compression rate, actual chest compression rate, the percentage of hands-off period, time lag from patient arrival to chest compression, time lag from patient arrival to manual ventilation, time lag from patient arrival to first IV establish were compared. Causes of chest compression hands-off time were also studied.


112 cases of resuscitation attempts were obtained. Average chest compression rate was over 100 compression per minute (cpm) in the majority of cases. However, indicators such as percentage of hands-off periods, time lag from patient arrival to the first manual ventilation and time lag from patient arrival to the first IV establish seemed to be worse in the manual CPR group compared to MCC CPR group. The saving of operators change time seemed to counteract the time spent on MCC equipment. Indicators such as percentage of hands-off periods, time lag between patient arrival to the first chest compression, time lag between patient arrival to the first manual ventilation and time lag from patient arrival to the first IV establish may influence the survival.


Our CPR quality remained to be improved. MCC may have a potentially positive role in CPR.

“Emergency Physicians Are Not To Blame for the Opiate Crisis”

From Emergency Physicians Monthly:

Until the government stops treating emergency physicians as the scapegoat for opiate addiction, we won’t be able to address the real issues facing this challenging patient population.

Texas hospital discontinues obstetric service

From the Leader:

Last week, the Graham hospital’s board of directors passed a new policy that outlines how the facility will deal with emergency baby deliveries and patients in labor, now that it has closed its obstetrics department. But experts say the policy still needs work.

The Graham Regional Medical Center board of directors unanimously passed the policy at their Sept. 24 meeting, but Dr. Donald Behr, director and GRMC’s medical chief of staff, voiced some concerns regarding the transport of women in labor, how the policy fails to address that issue and some fears from the clinical staff.

“It’s complicated. The EMTs are scared about it. The emergency room doctors are scared about it, at least some of them. I’m not sure the emergency room nurses are thrilled about it, except for the ones that are actually OB nurses,” Behr said. “We are likely to have to bring this back with some changes in the near future.”

Behr reported that on the weekend of Sept. 19 alone, three patients came into the Graham hospital to be transferred while in labor.

Reducing aeromedical transport for traumas saved money and lives

Press Release:

Changes to the trauma triage protocol in Maryland resulted in decreased use of helicopter transport for trauma patients and improved patient outcomes, saving lives and money. The results of a 11-year study of the impact of statewide field triage changes to Maryland’s helicopter emergency medical services (HEMS) were published online Wednesday in Annals of Emergency Medicine (“Maryland’s Helicopter Emergency Medicine Services Experience from 2001-2011: System Improvements and Patients’ Outcomes“).

“Purported benefits of HEMS are derived from enhanced crew expertise and decreased time to deliver seriously injured patients to trauma centers,” said lead study author Jon Mark Hirshon, MD, FACEP, of the University of Maryland School of Medicine in Baltimore, Md. “However, by shifting to a new protocol that increased ground transports and decreased air transport for less critical patients, we improved patient outcomes while saving the state considerable money. Those are wins all around.”

Over the study period, overall EMS transport of trauma patients increased by 21 percent. However, helicopter transport of trauma patients decreased by 49 percent and ground transport of trauma patients increased by 33 percent. During the study period, HEMS patient acuity increased though expected mortality did not.

Researchers studied records for all patients in Maryland’s Trauma Registry recorded as directly admitted to the hospital from the scene or transferred to trauma centers between July 1, 2000 and June 30, 2011. They focused in particular on what happened after significant field triage changes were instituted in July 2004, July 2007 and October 2008. Those changes first recommended then later required that patients within a 30-minute drive of a trauma center be transported by ground rather than helicopter and that a physician authorize aeromedical transport for patients in certain trauma categories, regardless of the distance to a trauma center.

“Aeromedical transport costs five to 15 times what ground transportation costs and can also be very dangerous,” said Dr. Hirshon. “After nine fatal helicopter EMS crashes killed 35 people in 2008, the NTSB took action and the state of Maryland did, too. New field triage protocols were associated with fewer flights but better expected outcomes, despite having more seriously injured patients. Future research is required to confirm our findings and determine when helicopter EMS can offer the most benefit.”


Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical 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. For more information, visit http://www.acep.org.

Will the soon-to-close Independence, KS hospital be transformed into an ED?

From the Sun:

The Labette Health Board of Trustees on Thursday agreed to have the hospital’s CEO and the trustees president begin negotiations with the city of Independence and Mercy Hospital.

The discussion would involve an agreement to supplement ambulance service for Independence and offer an emergency department when Mercy Hospital closes at 9 p.m. Oct. 9. Any agreements would be subject to approvals, including the state of Kansas and the Centers for Medicare and Medicaid Services.

Apple Watch Alert Aids Rhabdomyolysis Dx

From Read Write:

“After [football] practice I went and took a nap, my heart rate was still at 145,” he told WCVB, a local CBS news station. Houle went to get the strange readings checked out in the emergency room and was diagnosed with rhabdomyolysis, a condition which is caused by extreme exercising and pumps out toxic chemicals into the body.

Kaiser Permanente and Coalition Unions Join Forces to Protect Patients and Workers From the Flu

Press Release (hat tip: Dr. Menadue):

A coalition of unions representing Kaiser Permanente health care workers in the nation’s largest private sector talks this year have ratified a landmark agreement that includes a jointly developed flu vaccination policy for health care workers who deal directly with patients.

Workers will get a seasonal flu vaccination or wear a surgical mask during flu season while working in patient-care areas under the negotiated policy, which takes on an important issue of public health and safety by protecting more than 10 million Kaiser Permanente health plan members and patients, and the workers who provide care and service every day.

“In this landmark contract, we have reached an agreement on a national policy of frontline caregivers protecting themselves, their families and our members from the flu by receiving a flu shot,” said Dennis Dabney, senior vice president, National Labor Relations and Office of the Labor Management Partnership at Kaiser Permanente. “When managers and employees make improvements together, it’s a winning solution.”

Hal Ruddick, executive director of the Coalition of Kaiser Permanente Unions and lead negotiator for the federation of 28 union locals, said, “We’re standing up to protect patients, workers and families from the flu virus, which kills thousands of people every year.”

Ruddick said that Kaiser Permanente and the unions, which represent 105,000 Kaiser Permanente workers across the country, began negotiations early in the year with mutual commitments to patient and worker health and safety.

“We reviewed the science and consulted our values, and concluded that taking a bold step to fight flu infection was the right thing to do,” Ruddick said.

The unions and the nation’s largest integrated health plan and health care provider capped the talks with the most comprehensive contract yet in the 18-year history of their Labor Management Partnership. The three-year agreement — including the flu vaccination policy — goes into effect on October 1, 2015.

Teams of union workers and their managers have already set high standards for patient care and service by co-leading successful projects such as encouraging hand-washing and other hygienic practices, and educating employees and patients alike about the importance of preventive care. Following a tradition of convenient and accessible preventive care, Kaiser Permanente offers flu shots free of charge to employees and members and opens special seasonal clinics to reach as many people as possible.

In addition to ensuring the best care, the Coalition unions and Kaiser Permanente have negotiated an industry-leading contract that:

  • Provides competitive wages and benefits that allow the people who take care of Kaiser Permanente patients at work to also take good care of their families at home.
  • Expands the groundbreaking 2012 worker wellness program with new employee incentives to screen for cancer and for risk of diabetes, which can otherwise lead to costly and devastating complications.
  • Fosters collaborative environments, allowing each worker a voice in preparing for the future of health care.

The agreement covers Coalition-union represented workers in seven states and the District of Columbia, including nurses, medical assistants, custodial, maintenance and food service workers, lab technicians and scientists, and clerical staff. The local unions are affiliated with major internationals such as the Service Employees International Union, American Federation of State, County and Municipal Employees and United Food and Commercial Workers. The Coalition unions represent: 81,000 Kaiser Permanente workers in California; 8,500 in Oregon and Washington; 5,000 in Colorado; 5,500 in Maryland, Washington, D.C. and Northern Virginia; 1,800 in Georgia; and 800 in Hawaii.

Kaiser Permanente and the Coalition of Kaiser Permanente Unions created its Labor Management Partnership in 1997 to develop and support innovative ways of improving patient care, affordability and the work environment. Since then, the Coalition unions and Kaiser Permanente have successfully negotiated five national labor contracts in the highly competitive health care industry. The collaboration has strengthened worker engagement and participation and has helped Kaiser Permanente garner recognition for clinical quality, patient safety and member satisfaction from U.S. News and World Report, the National Committee for Quality Assurance and others.

About the Coalition of Kaiser Permanente Unions
The Coalition of Kaiser Permanente Unions, AFL-CIO, is a federation of 28 union locals from 11 international unions representing more than 105,000 Kaiser Permanente workers. The Coalition formed in 1996 to coordinate the unions’ bargaining strategies with Kaiser Permanente. With Kaiser Permanente, the Coalition has formed the largest and longest-lasting Labor Management Partnership in the United States. For more information, go to: unioncoalition.org.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 10 million members in eight states and the District of Columbia. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.


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