More on the Bellvue, IA Parade MCI

From the AP, via Google:

BELLEVUE, Iowa — A pair of runaway horses in harness crashed into a Fourth of July parade float and collapsed, ending a rampage that injured nearly two dozen people and killed one, people at the parade said Monday.

The injured were sent by ambulance and medical helicopter to hospitals in Dubuque, Maquoketa and Iowa City. Most were treated and released, but at least four people remained in critical condition early Monday, hospital officials said.

Staffing of the ED by non–emergency medicine-trained personnel: the VA experience

From The American Journal of Emergency Medicine:

Study objective: VA (Veteran’s Affairs) emergency departments (EDs) are generally staffed with physicians trained in internal medicine (IM), although recently, a movement has begun toward hiring emergency medicine (EM)-trained staff. At our institution, the ED is staffed by physicians of both specialties. This study examines the frequency of unscheduled return visits to the ED in an effort to compare the quality of emergency care given by physicians trained in IM and EM.

Methods: The record of all visits to a VA hospital ED during a 90-day period were examined, and all those visits resulting in a return ED visit within the 30 subsequent days were noted.

Results: The charts of 2891 consecutive ED patients were examined. The rate of revisits was significantly higher for the IM than for the EM-trained physicians (8.9% vs 5.5%, respectively; P < .001). The IM-trained physicians had a significantly higher rate of admissions upon revisit within 30 days than did the EM-trained physicians (3.5% vs 1.9%, respectively; P = .014). The IM-trained staff had lower initial hospitalization rates than the EM physicians (20% vs 43%, respectively; P < .0001).

Conclusions: The IM-trained physicians were less likely to hospitalize patients, although this can be partially explained by the lower acuity of patients during the hours that they covered. The IM-trained physicians were significantly more likely to have a patient return after discharge and also more likely to have a patient return in need of hospitalization. This may reflect a difference in training for the rapid diagnosis and risk stratification of ED patients.

Mass Casuality Incident at Iowa 7/4 Parade: Runaway Horse and Wagon

From CNN:

An Independence Day parade in Iowa descended into chaos when when two horses went out of control and took their wagon with them, running into crowds of celebrants and leaving more than 20 people injured, according to authorities.

A woman injured in the incident died Sunday evening, police said.

It happened at the Bellevue Heritage Day Celebration Parade in Bellevue, Iowa, on the state’s eastern border with Illinois.

A total of 24 people were taken to hospitals in the area. The injuries ranged from abrasions to fractures to collapsed lungs. Five people were in critical condition and five were in severe condition, while 14 people had injuries considered minor, Rowling said.