ACEP continues to opt out of “Choose Wisely”; offers alternative strategy

From The Central Line:

After considerable debate, the ACEP Council voted this month to refrain from participation in the national “Choosing Wisely” campaign in large part due to the other efforts being taken by ACEP to achieve the same and even larger goals.

“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources, according to its website. As part of the campaign, specialty organizations identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.

ACEP had considered joining this campaign three distinct times since its launch in December 2011. Three different workgroups of various ACEP members, committees and Board members looked at the campaign and decided that while the concept is positive, the scope of listing tests, especially for emergency physicians, was too narrow.

Despite this extensive review by ACEP members, a resolution was submitted by the New York Chapter asking the ACEP Council to decide if ACEP should join the “Choosing Wisely” campaign.

The issue generated strong feeling on both sides and the majority of the Council ultimately decided to refrain from participation.

Trauma Medical Kits for deputies’ cars

From Wood TV: (Ed. The links to the kit and course are my best guesses, not links from the article)

Kalamazoo County Sheriff Richard Fuller announced Tuesday his office has been awarded a $9,630 grant from the National Emergency Medicine Association to purchase fully equipped Tactical Trauma Law Enforcement Medical Kits for his deputies’ patrol vehicles.

The Tactical Kits are intended to equip officers with the implements needed to immediately treat life-threatening emergencies in the first few moments after a critical incident or when medical response is delayed into a scene for safety reasons.

In keeping with these efforts, Kalamazoo County has trained this month four patrol staff members to be instructors in Officer Down Response and Medical Assessment to enhance the officers’ response to critical emergency situations.

Cause of Death

Hat Tip: Jeff Oliver.

Congruence of Disposition After Emergency Department Intubation in the National Hospital Ambulatory Medical Care Survey

From the Annals of Emergency Medicine:

The National Hospital Ambulatory Medical Care Survey (NHAMCS) includes a large nationally representative sample of emergency department (ED) visits that is widely used for research. This study investigates the frequency of apparent NHAMCS disposition discrepancies for visits with intubation.

Methods

Using 10 years’ worth of NHAMCS data composed of 348,367 ED visits, those recorded as including intubation were evaluated for congruence of disposition, which was expected to be either death or admission to a critical care unit.

Results

Of the 875 ED patients recorded as having intubation performed, 27% had incompatible dispositions: 81 (9%) were recorded as discharged and 153 (17%) as admitted to a non–critical care unit. Cross-reference with free text chief complaint descriptions and International Classification of Diseases, Ninth Revision diagnoses codes indicated errors in recording both intubation and admission.

Conclusion

One fourth of NHAMCS ED visits with intubation have an ED disposition incompatible with this procedure.

Predictive Factors of Successful Telephone-assisted Cardiopulmonary Resuscitation

From the Journal of Emergency Medicine:

Our emergency medical service developed a telephone (phone)-assisted cardiopulmonary resuscitation (PACPR) procedure. Objectives: To describe this procedure and study the factors modulating its implementation.

Methods

We conducted a single-center prospective study of telephone calls to our emergency medical communication center for cardiac arrest, for which PACPR was initiated.

Results

Thirty-eight patients were included in the study. In six cases, cardiopulmonary resuscitation (CPR) had been started before the call. When PACPR was initiated, CPR was performed until the rescue team arrived in 27 cases. One-third (n = 9) of the bystanders in these cases knew first-aid interventions, and all of these bystanders continued CPR until the rescue team arrived. The absence of a familial relationship between bystander and patient facilitated the continuation of CPR (100% vs. 37% with family ties, p = 0.01). CPR was continued more often if the bystander immediately agreed to PACPR than when he or she did not agree at first (88% vs. 45%, respectively, p = 0.01). When an obstacle to performing CPR was encountered, CPR was then performed in 57% of cases vs. 100% of cases with no obstacle (p = 0.003). These obstacles were associated with either the bystander (panic, apprehension, feelings of inadequacy, physical inability, indirect witness, tiredness) or the victim (morphotype, physical position). The presence of an obstacle, compared to no obstacle, associated with the bystander lowered the CPR performance rate (58% vs. 94%, respectively, p = 0.01). The presence of an obstacle, compared to no obstacle, associated with the victim also lowered CPR performance rate (50% vs. 85%, respectively, p = 0.04).

Conclusion

Our study demonstrates the feasibility of PACPR. The results may lead to a better understanding of facilitating factors and obstacles to telephone-assisted CPR, with the goal of improving its implementation. Good command of communication tools, identification of an appropriate bystander, and appropriate victim positioning are three fundamental factors of success.

Push for ‘Ouchless’ Emergency Rooms for Kids

From ABC:

Parents, your next trip to the hospital emergency room may be a little less painful, thanks to a new report by the American Academy of Pediatrics.

The report authors reviewed nearly 250 medical studies to provide guidance on how to reduce pain and stress for babies and kids in the emergency room.

“We’ve gotten a lot better at managing kids’ pain,” said author Dr. Joel Fein, an emergency room doctor at the Children’s Hospital of Philadelphia and professor of pediatrics and emergency medicine at the University of Pennsylvania School of Medicine. “We need to do everything we can.”

See also: MedPage Today and NBC.

Chronic 911 callers to get aid from ‘community paramedics’

From the Star Advertizer:

In hopes of giving better care and saving money, the Honolulu Emergency Services Department will begin deploying “community paramedics” to help people who call 911 so often that they are on a first-name basis with the dispatchers.

“The top 50 callers to 911 are on track to make 1,600 calls this year,” said Dr. James Ireland, director of emergency services. “If you’re calling 911 and going to the emergency room every couple of days, obviously something’s wrong.”

Rather than reacting to 911 calls, the community paramedics will take the initiative, reaching out to these frequent callers in person in hopes of uncovering the source of their problems. The plan for the pilot program is to visit the top 50 callers once a week, whether they are at home, at a shelter or in a park, and guide them to the social and medical support they need.