DIY Narcan

From the Chicago Tribune, emphasis added:

“Heroin addicts get overdose remedy
Training helps put treatment on streets”

Street lore holds that in case of a heroin overdose, the victim should be made to walk, placed in a cold shower or shot up with everything from salt water to milk.

But on Tuesday, a Chicago health organization tried to spread the word about the remedy that works best: a drug called naloxone.

It’s a clear liquid that reverses the potentially fatal effects of opiate drugs. The Chicago Recovery Alliance, which has trained 5,000 people in how to use naloxone, says the instruction has saved at least 336 lives over the last four years.

“As a physician, this is some of the most rewarding work I’ve ever done,” said Dr. Sarz Maxwell, the alliance’s medical director.

She was leading a workshop for six outreach workers who, in turn, are supposed to pass their knowledge to heroin addicts. Once trained, drug users can get bottles of naloxone and syringes from Maxwell.
Heroin kills by depressing breathing. Naloxone reverses that effect, which for decades has made it the standard emergency room method of reviving overdose victims.

The alliance, formed in 1992, operates needle exchanges–providing sterile needles in exchange for used ones–around the city and suburbs. Alliance officials believe that heroin addicts can save fellow users with naloxone. Most won’t call 911 if a friend gets in trouble for fear of the police, Maxwell said.

Naloxone “wakes people up enough that they can walk to the car and go to the hospital,” she said. “That might be a better idea [to users] than inviting the cops up to your apartment where all your dope is laying out.”

Dr. Richard Feldman, head of the emergency department at Advocate Illinois Masonic Medical Center in Lakeview, said he saw little downside to the training.

“It’s an extremely rapid-acting, effective and safe drug,” he said. “I would be very supportive of [the training program], because there are a lot of heroin addicts who die without ever getting to the hospital.”

But in the view of Dr. Andrea Barthwell, a public health consultant and former official with the White House Office of National Drug Control Policy, distributing naloxone helps support drug habits and makes addicts harder to reach.

“If you engage in strategies that delay confrontation of the disease and application of curative strategies, you actually do more harm than good,” she said.

But those who took the training said their main concern is to help in a moment of crisis. Ana Arias, an HIV case manager at Howard Brown Health Center in Lakeview, said that some of her clients use heroin, and that naloxone could keep them and their peers around until they’re ready for help.

“If you know for sure this person isn’t going to stop, you’re not enabling them, you’re helping to save their life,” she said.

Hurricane Katrina – One Hospital’s Experience in Mississippi

From the Hattiesburg American:

Forrest General Hospital is running short of water, is rationing food and has closed its doors to everyone but staff, patients and their families.

Hospital President William Oliver said one of the biggest problems the hospital has is a shortage of water, which he said is critical because “it is used for personal hygiene, cooking, cleaning, sterilizing equipment and for dialysis patients.”

Oliver said Forrest General is working with volunteer fire departments and various vendors to make sure there is enough water to maintain the bare necessities. Even though the hospital has enough food to last a few days, he said, it’s still being rationed.

At Wesley Medical Center, Catherine Pittman, director of customer service, said the hospital is open today for anyone in need of medical care.

“We will be open, but we will not be doing surgeries,” she said. “People who are sick can visit our emergency room.”

Pittman said the medical staff at Wesley put the needs of the patients above everything else during Hurricane Katrina.

“They were great troopers through this whole thing,” she said. “A lot of our employees stayed overnight to make sure our patients were cared for.”

Oliver said Forrest General has had a problem with people trying to use the hospital as a shelter. He said people needing shelter are being redirected to the James Lynn Cartlidge Forrest County Multi Purpose Center.

Oliver said the hospital has about 250 patients, and two generators are maintaining enough power for emergency situations. He said another generator is on the way.

“Facilities are very limited,” he said. “Once we get the resources, once some patients are discharged and we have water to clean, we should be able to accept patients. Without air conditioning, surgery has to be very limited.”

“This building did amazingly well,” he said. “We were very fortunate. Staff, doctors and employees stepped up to the plate to take care of patients during the storm.”

Rapid Response Team in Mercy Sioux City

Excerpted from the Sioux City Journal:

Mercy Medical Center — Sioux City will begin using a Rapid Response Team this Thursday.

A Rapid Response Team can be called into action to assess a hospitalized patient who has had a significant change in clinical condition while on a non-ICU medical or surgical floor in the hospital.

“The team can be called by the floor nurse or the attending physician,” explained Diane Prieksat, Mercy’s Quality Services director. “The goal is to intervene as soon as possible when a patient becomes unstable in order to avoid cardiac or pulmonary arrest.”

“Several national studies indicate that patients often exhibit signs and symptoms of physiological instability for some period of time prior to cardiac arrest,” Prieksat said. “Our Rapid Response Team which will be comprised of a Mercy Air Care flight nurse, an ICU nurse, a respiratory therapist and a laboratory medical technologist will take action whenever a patient first starts to show any of those signs or symptoms that suggest his or her condition is deteriorating.”

Redwood Falls ER Partnerships

From the Redwood Falls Gazette, word about the collaborative relationships of one of our affiliated facilities:

Staff at the Redwood Area Hospital pride themselves on providing the right care at the right time and in the right place.

That care, however, might not always be within the walls of the local hospital.

“When patients come to the hospital here, our primary goal is that they get the best possible outcome,” Redwood Area Hospital Administrator Jim Schulte said. “We work in partnership with a number of different providers to reach that outcome.”

State funding supports 24-hour ER at Hawaii hospital

RE: Rural Hawaii, From Modern Physician:

Waianae (Hawaii) Coast Comprehensive Health Center received $1 million in state funding to maintain its emergency room 24 hours a day year-round. Without the grant, the not-for-profit facility would have been forced to eliminate services between midnight and 8 a.m., officials said. Established in 1972, Waianae Coast is the largest community-owned health center in the state, serving 23,000 patients annually, and is the only facility equipped to handle emergency medical care in the 50,000-resident Waianae area, located on the west side of the island of Oahu. The nearest emergency room is located 16 miles — or about 30 to 40 minutes — away at 102-bed St. Francis Medical Center-West, Ewa Beach.

Chest Pain Center

From the Milwaukee Journal Sentinel

Every day, thousands of people drive past an I-94 billboard telling them that Elmbrook Memorial Hospital is Waukesha County’s first accredited chest pain center.

A billboard on I-94 for Elmbrook Memorial Hospital does not say that although the hospital can perform other treatments, it lacks a cardiac catheterization lab to treat heart attack patients.

But if their chest pain is caused by a heart attack, they could be sorely mistaken in thinking that the hospital will fully treat the emergency.

Recently, the small, community hospital placed an ad on a billboard along I-94 near the Waukesha-Milwaukee county line, just a few miles from its doors. The billboard tells westbound motorists about the hospital’s recent chest pain accreditation.

What the ad does not say is that while the hospital has an emergency department that can diagnose a heart attack, it does not have a cardiac catheterization lab. That means it is not capable of opening a blocked coronary artery with balloon angioplasty, the preferred method for treating a heart attack.

The billboard also does not say that nearly all the heart attack patients who go to Elmbrook have to be transferred by ambulance to other hospitals with catheterization labs, a process that can take as long as an additional half-hour.

Organ Donation: "Presumed Consent"

From the LA Times

Most Americans volunteer to become organ donors by affixing a sticker to their driver’s license. But that method isn’t producing enough donors to meet the nation’s profound need. More than 89,000 Americans are awaiting organ transplants — surgeries that have become highly successful at prolonging the lives of people who might otherwise die — but only about 20,000 organs became available last year.

Even when an individual’s driver’s license indicates a willingness to donate, some families override those wishes at the time of death.

That’s why some people suggest it’s time for the United States to do what more than a dozen other countries do: assume people want to donate unless they specify otherwise, by adding their names to a government-operated registry.

Known as presumed consent, some ethicists and organ transplant activists are advocating for the concept even though they acknowledge it’s controversial. It’s uncertain whether such a system would ever be endorsed in this country, as it has in many European countries.

“The driving factor behind presumed consent is the fact that the waiting list continues to rise at a rapid rate,” said Richard Darling, a Palm Desert dentist and three-time liver transplant recipient who is active in transplantation issues. “As we get close to 100,000 people awaiting donation, that’s going to open people’s eyes.”

In June, the American Medical Assn. adopted a policy on organ donation that encourages pilot studies investigating the effectiveness of presumed consent. The California Medical Assn.’s ethics committee will also discuss presumed consent later this year.

The Advisory Committee on Organ Transplantation, a federal government panel, and the United Network for Organ Sharing, the agency that oversees organ procurement and distribution nationwide, are also discussing the idea of presumed consent.

“It’s one additional avenue to consider,” said Margaret Allee, chairman of the Organ Procurement and Transplantation Network-UNOS ethics committee.

Presumed consent is among several ideas that have been proposed for increasing organ donation. Other suggestions include some form of financial compensation to families, such as payment for funeral expenses or monetary rewards to families who donate.

The Rise of TB in Africa

A bit of a stretch, given the theme of the blog, but I thought it particularly interesting given the fact the movie “The Constant Gardener” opens this week. The film, based on the excellent le Carre’ novel, deals with a pharmaceutical scandel involving TB in Kenya. Excerpted from the Independent:

The World Health Organisation is ready to announce a regional emergency over levels of tuberculosis throughout Africa. African health ministers and WHO officials met in Mozambique this week to discuss how to halt the spread of HIV, malaria and tuberculosis in Africa.

By declaring the rising rates of TB infection to be an emergency, it is hoped to unlock extra money from the G8 nations and the Global Fund, which helps developing countries fight disease.

Rates of tuberculosis are rising alarmingly in Africa, where it is linked to the spread of HIV/Aids. HIV weakens the immune system and makes sufferers more susceptible to infectious diseases such as tuberculosis and pneumonia, which they cannot afford to treat.

Tuberculosis is now believed to be the single biggest killer of adults and young people in the world and accounts for a third of Aids-related deaths. In Africa, it kills more than 500,000 people a year

Court says police may enter emergency room without warrant

An interesting development in Vermont, as reported in the Boston Globe:

Law enforcement officers may enter a hospital emergency room without a warrant when they suspect a patient was a drunken driver, the Supreme Court ruled on Friday.

The court rejected an appeal by Adam Rheaume, who was charged with drunken driving after an accident in Highgate on May 19, 2002.

Justice Marilyn Skoglund, writing for a unanimous court, said that patients cannot expect full privacy in the emergency ward of a hospital. Such wards, she said, are open to emergency workers, medical staff and other hospital workers not involved in direct patient care, families and other patients, extinguishing any claim to privacy.

Besides, Skoglund said, Rheaume did not take any steps to protect any privacy he may have wished.

“Once the officer entered the trauma room, defendant did not ask him to leave or suggest the room was private or inaccessible in any way,” she said. “Defendant did not attempt to leave or limit contact with the officer.”

Rheaume was taken to Northwestern Medical Center in St. Albans for treatment of injuries after the accident in Highgate. State Trooper Jeffrey Smith went to the hospital to investigate the crash after he was told by rescue workers that they believed Rheaume was drunk.

The Supreme Court said nurses gave him permission to see Rheaume and he walked into a trauma room whose door was open. Rheaume had cuts to his lip and tongue and his bleeding hands were wrapped.

Smith told Rheaume of his rights and asked if he would agree to be interviewed. Rheaume refused, saying he was in too much pain. Smith advised Rheaume of his rights under state law and asked whether he would agree to provide a blood sample to determine his drunkenness. Rheaume refused and Smith then cited him for drunken driving.

Skoglund wrote that before Rheaume was taken from the room for X-rays, he yelled out that he knew the trooper was there to charge him with drunken driving and “he would not have been drinking and driving were it not for a fight at a party he attended before the accident.”

Rheaume asked District Court Judge Michael Kupersmith to suppress those statements, but the judge refused. So Rheaume agreed to a plea agreement that preserved his right to appeal to the Supreme Court.

The high court determined Friday that Kupersmith’s ruling was appropriate and dismissed Rheaume’s appeal.

Car Seat Efficacy

I imagine this will be rather controversial in the safety community. An excerpt from a New York Times article posted to the Freakonomics website (which supports the best selling book of the same name):

Perhaps the single most compelling statistic about car seats in the NHTSA manual was this one: ”They are 54 percent effective in reducing deaths for children ages 1 to 4 in passenger cars.”

But 54 percent effective compared with what? The answer, it turns out, is this: Compared with a child’s riding completely unrestrained. There is another mode of restraint, meanwhile, that doesn’t cost $200 or require a four-day course to master: seat belts.

For children younger than roughly 24 months, seat belts plainly won’t do. For them, a car seat represents the best practical way to ride securely, and it is certainly an improvement over the days of riding shotgun on mom’s lap. But what about older children? Is it possible that seat belts might afford them the same protection as car seats? The answer can be found in a trove of government data called the Fatality Analysis Reporting System (FARS), which compiles police reports on all fatal crashes in the U.S. since 1975. These data include every imaginable variable in a crash, including whether the occupants were restrained and how.

Even a quick look at the FARS data reveals a striking result: among children 2 and older, the death rate is no lower for those traveling in any kind of car seat than for those wearing seat belts. There are many reasons, of course, that this raw data might be misleading. Perhaps kids in car seats are, on average, in worse wrecks. Or maybe their parents drive smaller cars, which might provide less protection.