From the McCook (NE) Daily Gazette:

A new service, called “teletrauma,” is now available at Tri Valley Health System in Cambridge to allow instant consultation on trauma cases.

In a front page article, the Indianola News reports that the new video conferencing equipment has been installed and is ready for use whenever needed. A special camera has been set up in Tri-Valley’s rural trauma room to send images to the emergency room at Good Samaritan Hospital in Kearney.

Through that connection, and a hands-free microphone worn by the attending physician, decisions can be made concerning treatment and transport.

This is another example of the dramatic changes taking place in health care. As a result, residents of rural areas are gaining more direct access to the latest technology in the medical field

Concerns About Length of Stay


A Kentucky man who was reportedly frustrated with slow service at a hospital now faces multiple charges after police say he opened fire in the emergency room. It happened Wednesday afternoon at a hospital in Hazard.

Kentucky State Police say Eddie Grubbs was taken by ambulance to the Hazard ARH Medical Center emergency room. KSP says he then pulled out a gun and fired two shots. No one was hurt.

Grubbs was reportedly upset about how long he had to wait to be treated. One account quotes him as saying, “I just wanted to get their attention.”

Robotics Use in Mexican Medical School

From Medgadget:

Faced with a growing number of medical students and few training hospitals, this Mexican university is turning to robotic patients to better train future doctors.

The robots are dummies complete with mechanical organs, synthetic blood and mechanical breathing systems.

“The country’s rapid increase of medical students has not kept up with the number of medical facilities,” said Joaquin Lopez Barcena, an associate dean at the university’s medical school. “This a very a good learning opportunity for our students.”
The $1.3 million facility has 24 robotic patients and a computer software program that can simulate illnesses ranging from diabetes to a heart attack.

For Paola Mendoza Cortez, a first-year medical student, the robotic patients offer peace of mind.

“I would feel nervous if this was (a) real patient,” said Mendoza after drawing blood from a plastic arm. “With this (dummy patient) I can practice many times.”
With close to 15,000 enrolled students, UNAM has one of the largest medical school in Latin America. There are about 70,000 medical students enrolled in Mexico, according to the Mexican association of medical schools.

Bill proposes funding to promote apologies to patients

A new bill would create a voluntary federal program to help hospitals negotiate fair compensation with patients harmed by medical errors as an alternative to lawsuits.

The bill, introduced by Sens. Hillary Clinton (D-N.Y.) and Barack Obama (D-Ill.), is modeled on an initiative called “Sorry Works!” in which hospitals own up to errors and apologize to the patients affected.

There is no companion bill in the House. Apologies can reduce malpractice lawsuits against providers and lower the compensation sought by patients, the senators said at a news conference.

Under the bill, federal grants would be available to help hospitals set up negotiation programs, hire patient-safety experts and track patient-safety trends. At deadline, the cost of the bill had not been estimated.

Participating hospitals and malpractice insurers would be required to use part of any savings to reduce physicians’ malpractice premiums. In addition, the bill would create a national medical-errors database and set up an Office of Patient Safety and Health Care Quality within HHS.

A new law signed this summer already authorized HHS to establish a medical-errors reporting system and a national network of databases. At deadline, it was unclear how the database provisions of the Clinton-Obama bill relate to the new law.

Iowa Doctors March In D.C. Over Emergency Care

From the Iowa Channel:

Iowa emergency room physicians Tuesday joined doctors and nurses from around the country to march on the nation’s capitol.

The group’s goal is to improve the emergency medical care that it gives to patients.

An ambulance rushed to Mercy Medical Center with a trauma patient. It’s part of a busy day’s work for the doctors and nurses.

“We take care of the people. That’s our first priority,” said Dr. Rob Hatchitt, of Mercy Medical Center.

Hatchitt has seen the challenges grow in emergency medical care. He said challenges include overcrowding and a growing number of uninsured people seeking care.

“A lot of people don’t have primary doctors. They come here. When you have 30 people waiting, that can lead to problems,” he said.

Hatchitt also said Iowa hospitals face among the lowest re-imbursements in Medicare cases. Doctors also said many physicians no longer practice medicine because of high malpractice insurance costs, which also adds to the burden for hospitals.

Those issues brought thousands of doctors and nurses to march on Washington, D.C, to ask Congress to ask members to pass the Public Access to Emergency Medical Care Act.

The Emergency Medical Services Act would extend liability protection to emergency room physicians.

Dr. David Stilley, of Mercy, led the state delegation.

“It was pretty exciting to see all these people in white coats — asking for support of all Americans,” Stilley said.

Among other things, the measure would provide supplemental funding for emergency departments and financial incentives for hospitals that can reduce the time patients remain in the emergency room.

“We’re saying something needs to be done before things get worse,” Hatchitt said.

Mo. settles antitrust probe of two ambulance companies

From Modern Physician

Missouri signed its second antitrust settlement with an ambulance company in the past two weeks, recovering $2 million from Medical Transportation Management, St. Louis, for alleged overbilling and $400,000 for costs of the investigation.

MTM also agreed not to collect $17.4 million already billed to the state Medicaid program. The company, which provides services in 12 states, did not admit wrongdoing and said it settled to avoid prolonged litigation.

Attorney General Jay Nixon was investigating whether MTM and a rival company, LogistiCare, College Park, Ga., rigged a state Medicaid contract for nonemergency medical transportation. LogistiCare won the state contract in 2004, but Missouri canceled the agreement only a few months later.

MTM, which had held all the previous state contracts since 1997, was the only bidder for the next contract and subcontracted a portion to LogistiCare. The companies had planned to merge at the time the contract was awarded, but their letter of intent expired without a merger in June.

Both companies are eligible to bid for a new Medicaid contract, which the state expects to award shortly. LogistiCare settled its part of the investigation earlier this month by agreeing to pay $150,000 and drop a suit against the state over the contract cancellation.

LogistiCare President and Chief Executive Officer John Shermyen said the company viewed the settlement as a “vindication” of its conduct because the state said it could bid on the new contract and took no action against the company.

College Students, Health Care Insurance, and ED’s

Not exactly non-urban, but it caught my eye as it was published in the Iowa State Daily (ISU’s student newspaper):

Avoiding trips to the emergency room – or avoiding health insurance altogether – could lower students’ healthcare costs as insurance rates rise across the nation.

Health insurance premium rates are up 73 percent since 2000, far outpacing the rate of inflation and wage growth, which grew 3.5 percent and 2.7 percent respectively, according to the 2005 Annual Employer Health Benefits Survey.

Todd Holcomb, ISU associate vice president for student affairs, said some students are opting not to have insurance because they think they’re young, invincible and the odds are with them.

“This is a great opportunity for students to understand policy decisions on the national level and how it affects them as individuals paying taxes,” he said. “Students don’t fully understand health costs, health insurance and how voting, or not voting, plays out in their individual lives.”

There are other reasons costs have increased.

Some of the factors driving costs up are the increasing cost of delivering health care as well as prescription drugs, new technology and the number of times people use the emergency room.

Ashley said if people never use the emergency room, the cost to use one will go down.

“Try not to go to the emergency room because it costs far less to go to the doctor,” Feig said.

“I wouldn’t go to the emergency room if you get home from work and just can’t stand your ear ache.”

MP3 First Aid Tips

From Medgadget:

St. John Ambulance from the United Kingdom introduced iFIRSTAID, a website from which you can download first aid tips onto MP3 players, phones and CDs. Guidance available for people when they need it, where they need it, in the format they need it.

The charity said it was prompted by the 25% increase in inquiries about first aid courses it received immediately after the July bombings in London.

“Now that MP3 players are so popular our iFIRSTAID downloads will make first aid guidance available for people when they need it, where they need it, in the format they need it,” said Andrew New, senior training officer at St John Ambulance.
Users can access information about identifying and treating burns, bleeding, shock and fractures, giving rescue breaths and chest compressions and putting someone in the recovery position.

The charity plans to develop the scheme to offer advice for further scenarios, first aid podcasts and seasonal first aid advice.

St John Ambulance stressed that the information was no substitute for first aid training, but was useful as a quick reminder to give people confidence and reinforce their knowledge.

Earthquake Preparations in Montana

From the Helena Independent Record:

As the country watches the Gulf Coast recover from hurricanes Katrina and Rita, are we ready for our own disaster?

Planners: We’re ready Disaster and emergency officials certainly hope so.

“When I started my job 25 years ago, I would have said, ‘No, we probably aren’t,’ ” says Paul Spengler, Lewis and Clark County disaster and emergency services coordinator. He’s responsible for beating the drum of earthquake preparedness. “(But) we have raised a couple generations of schoolkids…(on) how to take protective cover in an earthquake,” he says. “People are far more aware of the earthquake hazard.” Many have criticized the response to Hurricane Katrina and what emergency personnel did and didn’t do. Depending on the size and scope, here’s how local officials hope a local disaster would play out:

The Emergency Operations Center — a plain basement next to the County Courthouse — would become a hive of activity, with elected officials, department heads and others figuring out what’s left standing. Hospitals, nursing homes, and the Law Enforcement Center would be top priorities.

Once they dig out and check on their own families, up to 50 police officers would patrol streets, secure sites, look for looters and direct traffic.

The city’s 36 firefighters would likely be tied up fighting one large building fire, or searching for victims. The first 48 hours after a disaster are the “golden hours” to find trapped victims.

The area’s four ambulances would quickly become overwhelmed. As in most big disasters, victims would stagger to the emergency room the best they could.

Dams fail incrementally, so evacuation warnings could be broadcast for Missouri River-side dwellers. Sheriff’s deputies would race downstream and warn people to head for higher ground. A siren would sound in Wolf Creek. Great Falls residents would have 10 hours to clear out.

The Red Cross would establish emergency shelters.

The City Public Works Department would assess damage to buildings and services, with the help of a dozen local architects.

Assuming all sent well, work crews would soon clear streets, restore water, sewer, gas and power in a matter of days.

237,000 tons of debris would need to be hauled away.

It’s Tough Being A Rural Hospital These Days…

From Planet Jackson Hole:

Insiders and longtime observers of St. John’s Medical Center ­ such as SJMC Chief of Staff Dr. Robert “Buz” Bricca, 23-year veteran Jackson physician Dr. Brent Blue, and former Board of Trustee Jonathan Schechter ­ describe the hospital as something resembling Hamlet caught in a Catch-22. Hamlet, for those too busy to remember, had trouble figuring out what he wanted to be. Throughout much of Shakespeare’s play, he wanders around saying noble things while remaining paralyzed by circumstance and inaction and constantly being upstaged by Fortinbras’ easy success in accomplishing whatever he desires.

Medical excellence, charitable good works, and nobility of purpose aside, St. John’s Medical Center, by virtue of operating in America’s ritziest zip code, is obligated to decide what kind of hospital it wants to be, lest it remain upstaged by Idaho’s and Utah’s bigger more successful ‘Fortinbras hospitals’, a half day’s ride away.

Does SJMC want to be a good rural hospital, or a regional referral hospital with an expanded menu of quality specialties?

That, for many, is the question.