"Ambulances are dangerous places"

From Slate magazine, as excerpted and commented upon by Medlaw.com:

By Zachary Meisel MD from SLATE Magaine
Posted Wednesday, November 9, 2005

Not long ago in Western Pennsylvania, an ambulance was dispatched to help an elderly woman whose heart was beating irregularly. Although the patient was awake and her blood pressure was normal, the paramedics on the scene detected a worrisome cardiac rhythm on their monitor: The heart was beating too fast, and each beat appeared widened on the screen. The patient’s condition was consistent with a serious and sometimes fatal heart rhythm called ventricular tachycardia. One of the paramedics called a local hospital, and a doctor there told him to administer intravenously 100 milligrams of a potent anti-arrhythmic drug, intravenous lidocaine hydrochloride. In the cramped ambulance, the medic grabbed a 2-gram syringe of lidocaine in concentrated form, which must be diluted in a bag of saline and dripped into the vein slowly. Thinking he had a different vial, the paramedic quickly injected the entire syringe into the patient. The woman went into cardiac arrest and died.

In 1999, the Institute of Medicine published its report To Err Is Human, which estimated that up to 98,000 patients may die each year because of the mistakes of doctors, nurses, and other hospital workers. But few published studies have tried to quantify or even characterize the injuries to patients that take place before they reach the hospital. How frequent and how serious are the mistakes that take place in ambulances—and are there simple changes that could help prevent them?

Mandatory Influenza Vaccination for Healthcare Workers with Direct Patient Contact?

From Modern Physician:

The Association for Professionals in Infection Control and Epidemiology’s board unanimously endorsed mandatory influenza vaccination for healthcare workers with direct patient contact.

The Centers for Disease Control and Prevention has been recommending vaccinations for all healthcare workers since 1981.

APIC President Sue Sebazco said that with a 36% vaccination rate for healthcare workers, voluntary programs are falling short. The APIC has no authority to enforce a recommendation.

Bad News for AutoPulse

From the Seattle Post-Intelligencer:

COLUMBUS, Ohio — Researchers have produced data supporting their decision to halt a study of automated CPR machines after preliminary results showed a lower survival rate for patients treated with the devices.

The study – led by Dr. Michael Sayre, an emergency physician at the Ohio State University Medical Center – tested the AutoPulse in ambulances in five cities, including Seattle. Researchers expected the machines, which fit over the chest and deliver a steady pulse, would outperform medical staff who can become inconsistent or exhausted when delivering CPR.

“It was just the opposite of what we would anticipate happening,” Sayre said.

The study began in June 2004, and researchers intended to examine 1,850 patients – half using the AutoPulse and half using manual resuscitation.

But researchers halted the study when they found that only 6 percent of the 394 patients treated with the device survived. About 10 percent of the 373 patients manually treated survived.

Dogs ease anxiety, improve health status of hospitalized heart failure patients

From the American Heart Association (tipped off my MedGadget):

Researchers discovered that a 12-minute visit with man’s best friend helped heart and lung function by lowering pressures, diminishing release of harmful hormones and decreasing anxiety among hospitalized heart failure patients. Benefits exceeded those that resulted from a visit with a human volunteer or from being left alone.

Animal-assisted therapy (AAT) has been shown to reduce blood pressure in healthy and hypertensive patients. It reduces anxiety in hospitalized patients, too.