Emergency Rooms: The Canary in the Health Care Coal Mine

From the Atlantic (quoting the Star):

“There is no question; the ER is the canary in the coal mine. When something isn’t being properly being managed anywhere in the health system, the problems then show up in the emergency department,” Matthews said, adding that is why the Liberals are expanding homecare initiatives.

Trajectories of End-of-Life Care in the Emergency Department

From Annals of Emergency Medicine:

The emergency department (ED) is the gateway to the hospital setting. Despite the intentions from the end-of-life care strategy in the UK to improve care provision, the ED has increasingly become the access site for end-of-life support. Little attention has been given to this aspect of the work of the ED, even as the quality of end-of-life care in hospitals has become the subject of increasing concerns. We explore end-of-life care in the ED and provide an understanding of how care is delivered to the dying, deceased and bereaved in the emergency setting.

Methods: Observation was carried out in a large urban ED during 12 months. This was complemented by detailed interviews with emergency staff, patients diagnosed with a terminal condition, who had visited the ED in the previous 6 months, and their relatives. Data were analyzed thematically, following the normal conventions of ethnographic research.

Results: Two distinct trajectories of end-of-life care were identified in the ED; the spectacular and the subtacular. Patients and family members experiencing end-of-life care in the ED have distinctly different care because of the nature of these 2 trajectories, frequently resulting in dissatisfaction for staff and distress and frustration for patients and their relatives.

Conclusion: The ED is priority driven, focused on resuscitation and the prolongation of life. As a result of the consuming nature of the spectacular death, a reluctance to build relationships with the dying, and a lack of educational support, the care needs of patients in the subtacular trajectory are somewhat neglected. These trajectories can be used to identify the shortfalls in end-of-life care in the ED and raise serious concerns for policy in regard to staffing, resources, and professional development.

Anesthesiologist dressed as Elvis resuscitates woman at burger bar


It wasn’t blue suede shoes but a pair of sneakers that led a San Francisco doctor dressed as Elvis Presley to a woman who passed out at a Las Vegas restaurant after a marathon.

Commotio Cordis?

From CNN:

16-year-old catcher collapses, dies after pitch hits chest protector

Authorities were examining the chest protector and awaiting the autopsy results Wednesday of a 16-year-old baseball catcher who collapsed and died last week after being hit in the chest by a pitch during an after-school practice in Paterson, New Jersey, police said.

Major incident tabletop exercises: a high tech, low cost evolution

From Injury Extra:

Traditional tabletop exercises, that facilitate major incident (MI) planning and education, use paper plans and models. We describe a low-cost, electronic whiteboard that explores how interactive software can advance this educational scenario. The authors intend to demonstrate this technology.

The infra-red tracking device within the Nintendo Wii handset is the key to this setup’s functionality. When connected to a computer and projector it provides an ad hoc interactive whiteboard, operated with infra-red pens, comparable to proprietary wall-mounted solutions yet easily transportable. Capturing a team’s work, by enabling print-outs at principal stages of exercises, is additionally advantageous.

Utilising this technology we ran an exercise to determine our new Paediatric Emergency Department Unit’s MI Plan. The software was purpose-built so the incident played out on the departmental floor plan, allowing scrutiny of patient flow within our own physical environment. Questionnaires employing 1–5 Likert scales (where 1 and 5 indicated strong disagreement and agreement, respectively), were retrospectively completed by participants. Median values and interquartile ranges (IQR) were calculated.

Although from a small sample size (n = 10), the results from this ‘mini-trial’ were very encouraging. The response rate was 100%. A high level of positive concordance was maintained across the feedback received. The main outcome was whether the setup facilitated MI Plan development. The median response found unilateral strong agreement for this and none of the users found the setup distracting. Additionally, novice contributors found the equipment easy to use (median = 4; IQR = 4.0–4.75).

By combining new, affordable technology and bespoke software, this novel set up demonstrates a new approach to updating the current tabletop exercises used in MI training and practise. We were able to positively apply the feedback generated to develop the new Paediatric Unit’s MI Plan. Future work with this innovation will include adapting our MI Plan for a new Emergency Department currently under-construction.

Sadly, Another “Violence in the ED” Day

From Cincinnati.com:

Police: Man punched ER doctor

A 37-year-old man is accused of punching a Christ Hospital emergency room doctor several times in the face, according to Cincinnati police.

According to a police incident report, Kemplin came to the hospital’s emergency room for treatment and punched the doctor when she began talking to him. She suffered a swollen nose and left eye.


From the Wall Street Journal Health Blog:

Which Health-Care Workers Are Most Likely to Be Assaulted?

They looked at government stats and found that while shootings in health-care workplaces are pretty rare, the rate of assaults is relatively high — 8 per 10,000 workers vs. 2 per 10,000 for all private-sector industries. Nursing staff in nursing homes or long-term care facilities, ICUs, psych units and emergency departments are at higher risk, the paper says.