Small hospitals’ finances improved in 2005

From Modern Physician:

Median financial ratios for small, not-for-profit hospitals improved in the past year, buoyed by a favorable operating environment and higher reimbursements from insurers and the federal government, according to Standard & Poor’s. S&P said rating trends were “generally stable” in 2004 and 2005 for small hospitals — those with net patient revenue of $75 million or less. Overall, improved medians were most evident at higher-rated hospitals, S&P said. Small hospitals rated A+ to A- had a median profit margin of 6.6% and median operating margins of 4.7% in 2005, up from 2.3% and -0.5%, respectively, in 2003. Larger hospitals had a median profit margin of 5.1% and a median operating margin of 3.1% in 2005.

More on the 2005 ECC Guidelines

The Winter issue of the American Heart Association publication Currents is available online and contains a comprehensive overview of the 2005 Guidelines.

“This special edition of Currents presents the new material most relevant to instructors, compares it with the former guidelines, and gives you the scientific reasoning behind the change in compact and reader-friendly form.

The issue also includes links to the full guidelines document with all the references as well as an article on the evidence evaluation process, both available to you free online.”

Milestone for German Air Medical Team

From (gave me an excuse to post a picture of a helicopter):

The DRF (Deutsche Rettungsflugwacht e.V./German Air Rescue) has been saving lives on its air rescue missions, both with helicopters and ambulance aircraft for over 30 years. On November 17th, the non-profit air rescue organization flew its 325,000th mission.

The emergency dispatching center in Suhl alerted the DRF rescue helicopter for an emergency in the region of Sonneberg. A woman had fallen down the stairs sustaining serious head injuries. ”Christoph 60“ started at 7:22 a.m. and landed shortly after at the scene of the accident some 45 km away. After providing for the patient’s needs, the crew flew the patient to Meiningen. At Meiningen hospital, the DRF emergency physician and the paramedic handed the patient over to neurosurgeons.

2005 ECC Guidelines Published Today

The 2005 Emergency Cardiovascular Care (ECC) Guidelines were published today and are accessible (as sections of Circulation) on the web.

The American Heart Association (AHA) has also posted three webcasts (BLS, PALS and ACLS) that provide a concise summary of the changes.

The Winter edition of Currents will be published tomorrow and will include a summary of the changes as well.

Here’s an excerpt from the AHA press release:

The 2005 guidelines emphasize that high-quality CPR, particularly effective chest compressions, contributes significantly to the successful resuscitation of cardiac arrest patients. Studies show that effective chest compressions create more blood flow through the heart to the rest of the body, buying a few minutes until defibrillation can be attempted or the heart can pump blood on its own. The guidelines recommend that rescuers minimize interruptions to chest compressions and suggest that rescuers “push hard and push fast” when giving chest compressions.

“The 2005 guidelines take a ‘back to basics’ approach to resuscitation,” said Robert Hickey, M.D., chair of the American Heart Association’s Emergency Cardiovascular Care programs. “Since the 2000 guidelines, research has strengthened our emphasis on effective CPR as a critically important step in helping save lives. CPR is easy to learn and do, and the association believes the new guidelines will contribute to more people doing CPR effectively.”

The most significant change to CPR is to the ratio of chest compressions to rescue breaths – from 15 compressions for every two rescue breaths in the 2000 guidelines to 30 compressions for every two rescue breaths in the 2005 guidelines. The 30-to-two ratio is the same for CPR that a single lay rescuer provides to adults, children and infants (excluding newborns). The change resulted from studies showing that blood circulation increases with each chest compression in a series and must be built back up after interruptions. The only exception to the new ratio is when two healthcare providers give CPR to a child or infant (except newborns), in which case they should provide 15 compressions for every two rescue breaths.

Another guidelines change emphasizing the importance of CPR is the sequence of rhythm analysis and CPR when using AEDs. Previously, when AED pads were applied to the chest, the device analyzed the heart rhythm, delivered a shock if necessary, and analyzed the heart rhythm again to determine whether the shock successfully stopped the abnormal rhythm. The cycle of analysis, shock and re-analysis could be repeated three times before CPR was recommended, resulting in delays of 37 seconds or more. Now, after one shock, the new guidelines recommend that rescuers provide about two minutes of CPR, beginning with chest compressions, before activating the AED to re- analyze the heart rhythm and attempt another shock.

Annals Launches New Web Site

From the American College of Emergency Physicians:

Annals of Emergency Medicine has launched a new Web site at The new design includes streamlined features, personalization options such as saved searches and e-mail alerts, and free PDA functionality.

Additionally, all articles that have been published dating back to the journal’s inception as the Journal of the American College of Emergency Medicine in 1972 are now available in online archives on the new site.

New features of the site include:
Images in Emergency Medicine – Front-page viewing of a featured image, with a click-through to our entire databank of images and diagnoses.

Customized e-mail alerts such as saved searches.

Tracking the impact of articles (and other saved articles of interest) via e-mail citation alerts.

Linking to abstracts and full text in other participating Elsevier journals via cited references.

Searching across 400 journals and Medline.

PDA downloads and updates via PocketConsult with free registration.

Chilling film aims lesson at ‘cool’ kids

From the Anchorage Daily News:

It may be the world’s first frostbite movie featuring snowboard dudes — plus a goofy flannel-clad narrator named “Dr. O” and an upbeat musical score.

But most Anchorage parents and teachers will shiver in recognition at the scenes involving “cool” teens.

One freezing adolescent boy hops foot to foot at a school bus stop in a T-shirt and shorts, a chilling contrast to the serene girl standing beside him in a kuspuk. Two girls, minus jackets and hats, get stranded along the Seward Highway in a blizzard with their car in the ditch. A child is rushed to the emergency room, where his frozen hands get soothed in a warm-water bath.

The new video “Frostbite and Hypothermia” is now being distributed free to every Alaska school district — along with a packet of classroom activities for fifth- through eighth-grade students.

But don’t think of those old cautionary film strips from health class. In this video, when one cold snowboarder is taunted with “don’t be a wuss,” an older snowboarder wearing shades intervenes:

“You know, man, it’s really not worth it. You should go in if you’re cold.”

And the message carries the jolt of real damaged flesh: blistered skin, blackened fingers and amputated limbs from Anchorage patients.

“The mistake I made was not stopping immediately and building a fire,” says one unnamed victim, as the camera lingers on the stumps below his ankles.

The project was produced largely by three brothers from a longtime Anchorage family — surgeon Dr. James O’Malley, kindergarten teacher Tom O’Malley and video editor Robert O’Malley, who now lives in Seattle. They plugged away on it in their spare time for about 10 years, pushing it through multiple versions and a few false starts.

Disrupted plans common theme for on-call docs

An article more or less sympathetic to pay for on call, from the Charlotte (WV) Gazette-Mail:

Most people leave work at work. On-call doctors cannot leave work at all.

For their private patients or the emergency room, many doctors usually have to be ready at a moment’s notice: That means little travel, no wine with dinner and rarely uninterrupted dinners.

Tele-Ambulance, Part 2

I blogged about this previously, but here’s a bit more detail (remote controlled cameras on the exterior!) from the Arizona Daily Star:

The days of doctors making house calls are long gone.

Virtual visits in ambulances, however, are the wave of the future, city officials said of a new system that could be operational in about six months.

Beginning next summer, video cameras mounted on top of and installed inside of Tucson Fire Department ambulances will allow University Medical Center emergency-room doctors to see live images of accident scenes and patients before they are taken to the hospital, officials said.

The set-up will be similar to a video conference call, Leyva said. Emergency room doctors will have control of the cameras with the ability to zoom in on the patient’s injuries. They will also be able to speak directly to the paramedics.

In addition, UMC will be better prepared for incoming patients because doctors will have a better idea of what resources will be needed to give the best treatment possible, Capt. McDonough said.

New Rewarming Technology

From the San Jose / Silicon Valley Buiness Journal, based on a post at Medgadget:

The new chief executive and president of Fremont’s Dynatherm Medical Inc. is making the rounds on Sand Hill Road to pitch the idea of a high tech mitt that warms hypothermic patients through a combination of heat and air. He’s seeking to launch the mitt as the company’s first product and tap a $1 billion-plus market.

Based on a patent developed at Stanford University, VitalHeat is deceptively simple and extremely effective, he says. A patient’s hand, placed in a sealed mitt, is subjected to heat and vacuum pressure. This rapidly channels blood to a patient’s vital organs, or core, spiking the body temperature by several degrees within minutes.

Mr. Christensen, a medical device veteran who was appointed in May, says the product, cleared by the FDA in the fourth quarter of 2004, is needed in frosty environs like operating rooms because the threat of hypothermia in patients undergoing anesthesia or suffering from trauma is a constant challenge for health care providers. It is not unusual for a patient’s core temperature to drop several degrees during surgery, medical experts say, raising the risk of longer recovery times and other complications. Treatments to counteract the effects of hypothermia can cost hospitals up to $7,000 per patient, according to Dynatherm.

Conventional thermal technologies, meanwhile, fail to heat up patients as quickly and easily, Mr. Christensen says. Blankets made by competitors like Arizant Inc. of Eden Prairie, Minn., for instance, which blow hot air over a patient’s supine body, take up to two hours and are obtrusive for doctors, he says, while treatments that involve warming patient fluids via catheters are invasive and more risky.

For Dr. Jim Watkins, forced air blankets have been the treatment of choice for combating hypothermia. But the Fresno anesthesiologist says there are certain cases, such as heart surgeries or vein harvests, where a bulky blanket isn’t practical.

When Dynatherm showed Dr. Watkins its product to see if he would test it for the company, “I laughed at it,” he says. “It was hard to convince me that warming a small area of the body — 2 to 3 percent of a body’ total surface — would work.”

His skepticism disappeared after a dozen trial runs. “It worked beautifully,” he says. “I’ve chatted with several people at the hospital about [buying] the system.”

Adding hospitality to the hospital stay

From the Kansas City Star:

When you go to the hospital, you probably don’t expect to enjoy the hospitality.

But AVP Inc., an Overland Park company, is working to change that notion by bringing upscale customer attention — valet parking, concierge service, room service and bell staff — to hospitals and other health-care facilities.

“The health-care institutions are fighting for the baby boom generation. We’re providing services that help them compete,” said Jeff Perry, part owner and a division president of AVP.

The company serves more than 100 hospitals in 34 states. In the Kansas City area, facilities include Lee’s Summit Hospita l, Menorah Medical Center, Overland Park Regional Medical Center, Research Medical Center and Shawnee Mission Medical Center.

It’s Perry’s contention that patients want to be treated better during hospital visits.

“We want to improve the hospital stay,” Perry said. “We’re trying to dress up the front end and when they (patients) depart the hospital.”