Thirty-Minute CPR Course as Effective as a Three-Hour One

From Medpage Today:

A 30-minute, video-based cardiopulmonary resuscitation course (CPR) is as effective as a traditional 3-hour course, with possibly better retention at six months, researchers found.

A comparison of the short course with longer versions of CPR training was conducted by a team at the University of Texas Southwestern Medical Center, here, and reported in the August issue of Resuscitation.

Ahamed Idris, M.D., and colleagues randomized 294 volunteers to one of the two training programs; 270 completed the training — 151 took the short course, adopted recently by the American Heart Association, and 119 took the longer one. Volunteers were all employees of American Airlines and CPR training sessions took place at corporate headquarters in Fort Worth, Tex.

The short course consisted of a 23-minute CPR video, a three-minute discussion on recognition of choking and demonstration of the Heimlich maneuver, and a five-minute demonstration on the use of an automated external defibrillator (AED).

Students each received an inflatable mini-manikin to use during training, a device that provides real-time audio feedback on the depth and rate of chest compressions, knee pads, and alcohol wipes.

In the traditional course didactic lectures on CPR, rescue maneuvers for choking, and AED use are supplemented by videos. Students share full-size manikins, which cuts the amount of hands-on training they received, the researchers noted.

With the short course, “individuals practice while they learn, allowing more time to perform and retain the critical hands-on skills required to provide more effective CPR,” said Dr. Lynn Roppolo, assistant professor of emergency medicine and lead author of the study.

Skills evaluation was accomplished by having the student demonstrate CPR and AED use on a life-size manikin. They were videotaped and the manikin recorded compressions/ventilations. The videotapes were evaluated by reviewers blinded as to which of the courses the subjects took.

After evaluation, the researchers found no significant difference between the two groups in ability to provide the correct depth and rate of compressions, the amount of air delivered during ventilations, or other measures of competence.

However, at six months follow-up, more of the students in the short course called 911 appropriately, conducted a more rapid assessment of the victim, began CPR more rapidly, and were more likely to provide adequate ventilations compared with those enrolled in the longer training course.

Report: Average patient spends 4 hours in ED

Source: AHA News Now (
Date: June 28, 2007

The average time spent in emergency departments rose in 2006, but so did patient satisfaction, according to a new report by Press Ganey Associates. Based on the firm’s patient surveys in 1,500 hospitals, patients spent an average of 4 hours in the ED, 18 minutes more than in 2005. The more patients an ED saw over the year, the longer the average visit, which increased by 30 minutes for every additional 10,000 patients annually. Patient satisfaction dropped as time in the ED increased, with the lowest satisfaction reported from 3-11 p.m. and highest from 7 a.m.-3 p.m.

To view the report, go to:

Baghdad ER

Baghdad ER” an excellent documentary originally aired on HBO, is now posted, in its entirety, on Google Video.

Here’s a link to a site devoted to the program at

New Cervical Collar Design

From Medgadget

“LuboCollar is designed to protect the neck by restricting the movement of the head relative to the rest of the body and to maintain an open airway in a non-invasive, simple and quick to operate way. It does so by using a “jaw-thrust”-like knob to maneuver the mandibles, pushing them forward in the direction of the chin,” explains Dr. Omri Lubovsky, developer of the LuboCollar and a physician in the Department of Orthopedic Surgery at Hadassah University Hospital.

Reassurance Workup

From Movin’ Meat:

I have devised a simple, cheap and quick “reassurance work-up” for these folks which consists of: an ECG, an i-Stat, a D-dimer, and a troponin. Sometimes I add a chest x-ray if it seems helpful. (We are lucky in that most of these tests can be done in the ED’s stat lab with a turn-around-time of about 15 minutes.) Then I sit down with the patient and invest a few minutes telling him or her about all the tests we did and all the Bad Things we ruled out. I list each electrolyte separately, the normal blood sugar (we ruled out diabetes), normal blood counts (rules out anemia), ruled out heart attack, blood clots, aneurysm, etc etc. It’s interesting how well patients respond to that. The long list of things “you don’t have” seems to really be effective in reassuring patients. Then a quick laugh — I ask the question for them: “Great, doc, you told me what I don’t have, so what do I have? Well, I can’t tell you what is causing your symptoms, but there are only x number of Bad Things that can cause symptoms like yours, and you don’t have any of those Bad Things, so I know it is safe for you to go home, we will keep an eye on it, and I expect that it will go away on its own.”

ACEP Comment on CDC Data

ED Visits Jump to Record 115 Million

Visits to emergency departments increased to an all-time high of 115 million in 2005, 5 million more than in 2004, according to a [new report from the Centers for Disease Control and Prevention. ACEP leaders said the increase in visits combined with closures of emergency departments threaten the safety of patients and will further endanger an already fragile system.

“With 315,000 people visiting emergency departments every day, the alarm bells are sounding and policymakers should heed the alert and respond,” said ACEP President Brian Keaton, MD.

ACEP supports legislation, the Access to Emergency Medical Services Act (H.R. 882 and S.1003), that calls for the creation of a national bipartisan commission on access to emergency medical services that will examine factors that affect and may impede the delivery of care in U.S. emergency departments.

CMS Proposes Big Cuts for 2008 Medicare Payments

From ACEP:

The now yearly controversy over cuts to Medicare payments has started again, and without congressional action, emergency physicians could see a 12% decrease in Medicare payments starting in 2008. The 2007 Medicare Trustees report predicts total cuts of approximately 40% for all physician payments by 2016.

Key policy makers on Capitol Hill expressed concern about the cuts and are working with ACEP, the AMA, and others in the physician community to develop a legislative solution for the next several years. The temporary fix would also allow Congress time to develop a comprehensive plan to change the sustainable growth rate (SGR) formula, the flawed metric used to set payment rates.

The legislation could reach the floor of the House before the August recess or sometime in September. Rural legislators are also considering extensions of physician payment bonuses that expire at the end of this year.

National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary

Available as a PDF on the CDC website

Here’s one graph (courtesy of GruntDoc)

Pay for Specialist Coverage for the ED

From the American Hospital Association

More than one-third of hospitals now pay for some physician specialty emergency department call coverage, according to results from AHA’s survey of hospital leaders. The 2007 State of America’s Hospitals – Taking the Pulse also found 55% of hospitals experienced gaps in physician specialty coverage with coverage issues most prevalent in orthopedics and neurosurgery. In addition, nearly half of EDs are “at” or “over” capacity, with a majority of urban hospitals experiencing time on diversion. Hospital leaders cited a lack of staffed critical care beds as the most common reason for diversion. The survey also found that hospital workforce shortages, including an estimated 116,000 registered nurse vacancies as of December 2006, are affecting patient care. Regarding disaster readiness, hospitals are taking a variety of actions to bolster preparedness, including participating in large scale drills, establishing back-up communication plans and developing resource plans with other hospitals. The survey, which had a 17% response rate, was sent to about 5,000 ommunity hospital CEOs in late February 2007 via fax and email.

Physicain Drain in (Rural) Upstate New York

It’s similar in other rural areas, I’d wager…

From The New York Times

While newly licensed doctors flock to New York City, Long Island and Westchester County, where there is already a glut, far fewer choose to practice in the vast upstate region. For instance, during the years the study was conducted, Essex County in the Adirondacks lost 22 percent of its doctors, while there was a 19 percent increase in Nassau County, on Long Island.

And as doctors upstate retire — one-third of the physicians in Binghamton are 55 or older — recruiting replacements is becoming more difficult. “I worry that new physicians may not see certain areas in the state as viable or attractive,” Ms. Moore said.

There is little question why, since statistics show a steady exodus of jobs and a decline in prosperity in upstate New York. In the last three decades, the population drain has contributed to New York’s loss of Congressional seats, to 29 today from 39, and state figures show that the number of 20- to 34-year-olds in the region decreased by 22 percent in the 1990s.