Emergency, Primary Care Physicians Need More Teamwork

From Medscape:

Emergency department (ED) physicians and their primary care counterparts all too often work poorly together, and that spells trouble for patient care, say researchers at the Center for Studying Health System Change (HSC) in a new study.

The researchers write that better communication and coordination among PCPs and ED physicians are more important than ever since the nation’s new healthcare reform law will extend insurance coverage to more than 30 million additional Americans, who will be more likely to visit EDs as a result.

Explosive device found on man treated in hospital emergency room

From the Kansas City Star:

Staff at Liberty Hospital called authorities this week after finding an explosive device in clothing worn by a patient admitted to the emergency room.

Liberty police responded just after 11 a.m. Thursday to the hospital, where staff members had been assisting a 19-year-old Holt, Mo., man who had been involved in a rollover car accident near Kearney.

Staff members had found marijuana, assorted pills, drug paraphernalia and an apparent explosive device in the man’s clothing. They moved the items to the ambulance bay and called police.

Welcome to the Emergency Room. Papers Please.

From Time (Swampland blog)

Arizona, which passed a controversial immigration bill last year, is again debating measures to discourage undocumented immigrants from living in the state.

Another (bill) would take the immigration battle all the way into the emergency room. If passed, the measure would require hospital personnel to verify immigration status of each person before they are admitted. If a person could not prove he or she was in the country legally, the hospital would be required to report that to federal immigration officials. If the person needed emergency care, the hospital would still be required to provide it under the rules spelled out in the Emergency Medical Treatment and Active Labor Act, which makes it illegal to deny care to anyone on the basis of his or her ability to pay.

According to the Arizona Republic, this last proposal has the state’s health care workforce worried. Doctors, nurses and hospital administrators could be on the hook legally if they did not check immigration status and report those who appeared to be undocumented. Some are also concerned that Medicaid funding – partially paid by the state – could be withheld from providers and facilities that don’t check immigration status and report offenders. This “compliance burden” could tax already swamped medical workers. There are also concerns about the threat to public health if illegal immigrants with communicable diseases stay away from emergency rooms for fear of being deported.

Many errors result of physicians not listening

From Modern Physician (free subscription required):

Great effort goes into stopping preventable errors such as wrong-site surgeries, but authors of a study on unwanted variation in elective procedures say that many more errors are taking place because physicians are not listening to their patients.

Patient fires starter pistol in Oklahoma ED

From NewsOK:

A patient fired a starter pistol loaded with blanks inside a Yukon hospital Wednesday night, hospital officials said.

The man, whose name was not released, had been detained by El Reno police on a trespassing complaint, but complained of chest pains and was taken to Integris Canadian Valley Hospital, Integris spokeswoman Brooke Cayot said.

The man was combative at the hospital and was put in a room by himself while security was notified. The starter pistol was fired once while the man was alone in the room, Cayot said.

Patient abandoned at the ED dies

From the Chicago Tribune:

Sheriff’s officials are investigating the death of a man dropped off at a hospital emergency room in Shawano, WI.

Authorities say the 21-year-old Town of Weston man was in “severe medical distress” when an individual left him at Shawano Medical Center’s ER Tuesday about 5 p.m., then left on foot.

“…you’re going on YouTube!”

From WhiteCoat’s blog on EPMonthly:

A patient’s mother completely freaked out on one of our nurses because her child wasn’t getting Demerol for her chronic back pain. So she holds her iPhone up to the nurse’s face and says …

“Smile, bitch, you’re going on YouTube!”

Jail Time for Assaults on ED Personnel

From WUSA9:

Virginia’s governor is expected to sign legislation making mandatory at least two days in jail for anyone convicted of assaulting emergency room workers.

“It brings the punishment level up to the same level that the police, law enforcement receive, other first responders, EMS personnel and school teachers.

“We feel, being first responders ourselves, emergency room physicians and emergency room nurses and those who work in the emergency department, this should, in essence, level the playing field for all of us,” said Dr. Peter Paganussi, an emergency room physician in Reston and a past president of the Virginia College of Emergency Physicians.

Prehospital Endotracheal Intubation, The Gold Standard

From JEMS:

The program, which emphasizes the clinical aspect over didactic and simulation experiences, consists of 2,150 hours of training divided into about 350 hours of lectures and 1,800 hours of hospital rotations and field time.

In the first month, students receive six hours of classroom instruction in airway management and 12 hours of intubation practice time on airway manikins from senior paramedics, emergency physicians and anesthesiologists. The training includes education on techniques and clinical indications for ETI, as well as management of the patient once they’re successfully intubated. Competency at this phase is evaluated by a practical intubation examination, and students receive a pass or fail grade. For example, paramedic students are expected to successfully intubate a manikin and verify tube placement in 15 seconds or less in order to pass.

Next, students spend 40 hours in the operating room, where they gain airway management skills, including such techniques as bag-valve-mask (BVM) ventilation, placement of oral and nasal airways, ETI, basic anesthesia induction and use of muscle relaxants and sedatives. They also learn advanced airway rescue techniques under direct supervision of an attending anesthesiologist at Harborview Medical Center.

Additionally, students spend a day in the operating room at Children’s Regional Hospital and Medical Center in Seattle to practice infant and pediatric airway management and intubation. Students are integrated into field care during the first month of training. They work in teams of two, paired with two senior paramedics. The permission for field intubations is granted by the director of paramedic training after students complete a written exam, a timed manikin intubation and at least five successful intubations in the operating room.

People Confused Over When to Call an Ambulance

From MedPage Today:

Almost all of the respondents correctly identified the need for an ambulance in three of the five scenarios — a patient having a heart attack, a drug overdose, and a motorcyclist thrown more than two meters from his bike.

However, far fewer identified the need for an ambulance for a child with symptoms of meningitis (53.3% said they wouldn’t call) or in a suspected stroke (25.2% said they wouldn’t call if an elderly patient started slurring their words without having consumed alcohol).