2 Dead In Ambulance, Semi Crash

From KCCI:

A Carroll County nurse with significant injuries fought to save her patient and an ambulance driver on Thursday following a crash in Boone County.

Rescue crews arriving on the scene said the woman told them her co-worker in the back of the ambulance was dead. She then continued to move back and forth treating the patient in the back of the ambulance as well as the driver.

Officials said the ambulance ran into the back of the semi tractor-trailer as the vehicles rolled down Highway 30 near the town of Beaver. The roadway was closed in both directions as multiple rescue crews worked to move the victims to hospitals.

Left AMA from the (Peds) ED

From Pediatric Emergency Care:

Objective: Previous literature suggests that process-related factors (eg, time of day, patient volume) and patient-related factors (eg, acuity, socioeconomic status) are associated with premature departure from emergency departments. We sought to evaluate the relationship of these and other factors with premature departure in a large, unselected cohort of pediatric emergency department patients.

Conclusions: Process-related factors and individual patient acuity have the strongest influence on premature departure from the pediatric emergency department. Health care organizations concerned with premature departure should focus efforts on improving pediatric emergency process flow.

Health Law Guarantees Protections For Emergency Room Visits

From the Kaiser Health News:

Under the new health law, insurance companies must extend several new protections to patients who receive emergency care. One of the biggest guarantees: Patients who need emergency treatment will have their costs covered at the same rate, regardless of whether they are treated at “in-network” or “out-of-network” hospitals.

The law also bars health plans from requiring prior authorization for emergency services. And it mandates that plans follow the “prudent layperson” rule. For example, if a person goes to the ER with chest pain, but ends up being diagnosed with indigestion, the claim has to be covered because going to the hospital under those circumstances made sense.

The provisions go into effect for every health plan issued after Sept. 23 – six months after the law was enacted — that offers emergency coverage.

Interrupted ED Docs

From CNN:

Interruptions in the emergency room may exact an unhealthy toll on patient care, a group of Australian researchers reported Thursday.

The researchers, from the University of Sydney and the University of New South Wales, found that interruptions led emergency department doctors to spend less time on the tasks they were working on and, in nearly a fifth of cases, to give up on the task altogether.

“Average Wait Time 35 Hrs” vs. “See the Doc in 15 Mins or It’s Free”

From L.A. NOW:

Complaint alleges long delays and privacy violations at County-USC emergency room

Los Angeles County health officials launched an investigation this week into allegations that the emergency room at County-USC Medical Center is so crowded, patients wait an average of 35 hours to be seen — sometimes without any vital signs being taken — and hospital workers fail to protect patient privacy.


Emergency Care Fast — Or It’s Free

Visits to one Denton County emergency room are free if you don’t see a doctor in 15 minutes or less.

The Emerus 24 Hour Emergency Room on Highway 380 in Aubrey has even put up billboards advertising the policy.

“We started that about a month ago,” said Dr. Randy Park, the facility’s director. “We recognized this as one of our goals was rapid service.”

So far, only three people have had their $1,000 visit paid for by the facility.

Ambulances Running Hot…Do Lights and Sirens Help?

From the Central Line:

Zachary F. Meisel and I just yesterday posted an article on Slate about the public health impact of speeding ambulances, focusing on the issue of lights & sirens. While I try to be a fierce advocate of emergency care and emergency personnel in general, I got the idea for this article after an ambulance, riding “hot”, nearly ran my family and me off the road.

Field intubation of cardiac arrest patients: a dying art?

From the Emergency Medicine Journal:

Ed. Emphasis added.

Introduction The most appropriate advanced airway intervention in out-of-hospital cardiac arrest (OHCA) is unproven. This study reviews prehospital advanced airway management and its complications in OHCA patients.

Methods A 4-year, observational, retrospective case review. Patients attending the Emergency Department of the Royal Infirmary of Edinburgh, Scotland, with a primary diagnosis of OHCA were identified. Patient demographics, survival to admission, airway management technique and complication rates were identified.

Results Seven hundred and ninety-four cases were identified. The aetiology of cardiac arrest was medical in 95.2%, traumatic in 3.9% and unrecorded in 0.9%. Prehospital intubation was attempted in 628 patients. Prehospital intubation was successful in 573 patients. A significant complication (multiple attempts, displaced endotracheal tube or oesophageal intubation) occurred in 55 (8.8%) patients. 165 (20.8%) patients survived to hospital admission, of whom 110 had undergone prehospital intubation. 55 patients who did not undergo prehospital tracheal intubation survived to hospital admission.

Conclusion The optimal method of maintaining an airway and ventilating an OHCA patient has yet to be established. Prehospital tracheal intubation for OHCA is associated with significant complications and may reduce survival. The use of tracheal intubation as a routine intervention should be reconsidered. Ambulance services should consider adopting alternative strategies in airway management.