ER’s Swamped After Wilma


PLANTATION, Florida (AP) — A week after Hurricane Wilma, more than 1 million Florida homes are still without power and many doctors’ offices remain closed, leaving hospitals swamped as the only source of medical care in some communities.

“You can’t get any regular doctors on the phone. You can’t get anything filled,” said Tim Swett, 41. He waited five hours at one emergency room and finally left without help for a back problem he had aggravated while cleaning up his mother’s yard.

Doctors, Cadavers and America’s First Riot

From Medgadget:

On this Halloween, we present a story that starts as a tale of the macabre, and evolves into star-studded massacre.

It’s the tale of the first riot in the young United States, a riot not about taxes or whiskey but cadavers, and the inappropriate procurement of them.

2nd Airlift Northwest Crash in One Month

From KOMO News:

OLYMPIA – Federal investigators were at Providence-St. Peter Hospital early Saturday, examining debris from the second Airlift Northwest medical-evacuation helicopter crash in a month.

None of the four people on board was seriously injured in the accident, which occurred on takeoff from the hospital roof late Friday. The previous crash, Sept. 29 near Edmonds, killed all three crew members.

One of the three crew members from Friday’s accident was hospitalized overnight but expected to be released Saturday, hospital spokeswoman Deborah Shawyer said.

The fourth person in the aircraft was a patient who had been brought to Olympia from Grays Harbor County by ambulance for helicopter evacuation to Seattle’s Harborview Medical Center.

Conflict in Washington State

Trouble’s brewing in Belfair, WA. From (registration required):

Fire District 2 Chief Mike Greene is in the middle of a controversy he didn’t foresee when he sought election to the Mason County public hospital board.
In what Greene calls an “attack ad,” six Mason General Hospital emergency room doctors say they have “no confidence in Mike Greene as a paramedic.” Greene believes the ad stems primarily from a disagreement over rules for transporting patients with brain hemorrhages, especially those caused by a medical condition rather than “trauma.”

In a written statement, the fire chief said the policy “endangers the lives of people in my community” and he has asked the state Department of Health to get involved. A DOH complaint against Greene also is being investigated.

At a Belfair candidates’ forum last week, Greene told the audience the ad is “disgusting and despicable.” His opponent, Don Wilson, answered, “I don’t know if this is the proper format to bring that up.”

The same ad has been in the county’s weekly newspaper twice and in The Kitsap Sun once. In both papers, a line at the top urged voters to re-elect Wilson. The long statement ends, “He (Greene) is not trusted for his medical decision making and administrative motivations by those of us who know him best, and should not be elected to this position.” Emergency staff work under the direction of ER physicians, the ad says, and “Mike Greene has a long history of attempts to subvert that control.”

Greene placed a lengthy rebuttal in an ad in the weekly Belfair Herald last Thursday. In it, he wrote, “I challenge my opponent to address the emergency medical issues resulting from the DOH investigation.”

He said he’d resign from the hospital board if proven wrong and asked Wilson to make the same pledge or “fix the problem.”

Kelley McIntosh, chairman of the fire district’s board of commissioners, said the five-member board stands firmly behind Greene. He’s been District 2 chief since 1993 and a paramedic for 25 years.

“There have never been any questions in regard to his capabilities,” she said. “There has never been any criticism, never been anything from the medical program director or any other place of employment.”

But it was the county’s medical program director, Joe Hoffman, who took the lead in writing the ad. He defends it as a statement of “different and collective opinions” based on the doctors’ experiences, some spanning a decade or more. The ad wasn’t politically motivated, Hoffman said.

“There are not any fallacies in there.” He said he couldn’t discuss specifics because of patient confidentiality.

Emergency Room Rap

From GruntDoc

Very amusing….

I’m a big fan of ER Nurses, but not of rap music. Why do I mention those two interesting things in one sentence?

Because the University of Alabama (Birmingham) ED nurses have the best Emergency Nurse rap video I’ve seen! For the record, I’ve seen exactly one, but it’s terrific!

Disclaimers: It’s a Windows Media file (.wmv), it’s 3MB big, and I didn’t create it. Also, I have no idea who made it (“the Internet is you Daddy”), so if it’s yours, let me know.

Emergency room guarantees fast service


BRISTOL, Tenn. – Twenty-six minutes of your time could be worth $25.

Bristol Regional Medical Center now promises patients they will begin to receive treatment within 25 minutes or receive a $25 gift card to a local store or vendor.

The whole visit should last no more than 70 minutes, hospital officials promise.

Having to wait stands as the No. 1 complaint among patients visiting the emergency room at Bristol Regional, said Bart Hove, the hospital’s administrator.

“As the ER volume has grown over the years and we continue to survey our patients, one of the biggest dissatisfiers is the length of time it took to get the patients through the process because of the trauma center out here,” he said.

“Mixing (minor problems) with the auto accidents and heart attacks, they always got put to the end of the line as we took care of our emergent need.”

By dividing the emergency room into two sections – patients requiring immediate care and those requiring care for minor ailments and illnesses – both groups can receive treatment more quickly and efficiently, Hove said.

Patients with minor injuries or illnesses go to the “quick care” section of the ER.

Man in hospital hit by woman with crowbar

Insult after injury…
From Sign On San Diego:

COLLEGE AREA – A man in the Alvarado Hospital emergency room awaiting care after getting into a fight was attacked by a woman with a crowbar and seriously injured Wednesday night, police said.

The victim, who is in his 60s, was taken to the hospital to be treated for minor injuries after getting into a fight with a relative at a City Heights home on Van Dyke Avenue near Wightman Street about 10:30 p.m., police said.

While he was waiting, a woman walked in and hit him in the head several times with a crowbar, police said. She then got into a gray Saturn sedan and drove away.

No arrests have been made.

Technique For Starting a Large Bore IV

From Medgadget:

In September’s issue of Anesthesiology, Dr. Jonathan I. Stein of York Hospital (York, PA) describes a nifty technique for placing a large-bore IV in patients with suboptimal veins. The idea is based on the Bier block, a commonly performed intravenous block for extremities.

So here is the way to do it. A small-bore (20- to 24-gauge) hand or wrist IV started after applying a continuous-pressure tourniquet to the upper extremity. Without deflating the tourniquet, through the new IV, a crystalloid solution is given (usually 60 mls, according to Dr. Stein), to distend all veins of the upper extremity. Voila! Now you can place a monster catheter into the vein that wasn’t even there five minutes ago. According to Dr. Stein, this technique is especially useful when one wants to have strong access but to avoid a central line, for example in patients for an elective c-section with placenta previa or accreta.

The Next Step for STEMI: Field Dx and Decision?

From Biotech Intelligence:

New Treatment Protocol Delivers Four-Fold Reduction in Mortality Among Higher Risk Heart Attack Victims

The hearts of patients experiencing chest pains caused by blocked arteries typically exhibit a particular type of ECG waveform called a STEMI (ST-Elevation Myocardial Infarction). The UOHI team trained paramedics to recognize the STEMI waveform and initiate a protocol designed to deliver the fastest, most effective treatment by bypassing normal emergency room procedures and routing the patient directly to a specialized treatment lab. To clear blocked arteries, the team used a mechanical method known as percutaneous coronary intervention (PCI) wherein a balloon is inserted into the artery to eliminate obstructions, a procedure known as angioplasty.

Urgent Care at Wal-Mart


Solantic, an urgent care company based in Jacksonville, Fla., has struck a deal with the world’s largest retailer to locate walk-in clinics in two of its stores in Florida.

Each center has a board-certified physician on duty and is open on weekends, holidays and weekends — the same as Wal-Mart.

Solantic said the flexible hours will make it easier for people who rarely see a doctor to do so without going to an emergency room.

In addition, the days of cooling your heels in a waiting room are over. Solantic says after you check in, you can go out and shop in the store and you’ll be paged or called on your cell phone when it’s time for your appointment.

Solantic said if the Florida experiment is successful, the concept could be taken nationwide.