Category Archives: Emergency care
On a busy night at the Stamford (CT) Hospital ER on the snowy East Coast this past holiday weekend, wait times for emergencies were just minutes thanks to a system that has a technician take vital signs within moments of patients walking through the entrance. Those metrics are passed to the medical staff to review in a room just a couple of steps from the reception area which, through a back door, opens onto several emergency suites where treatment can begin almost instantaneously. Contrast that with recent reports of hours-long waits, reduced staff and insufficient equipment at many rural hospitals, which often face budget, staff and equipment constraints.
One solution may be sharing those resources, according to a new study in Health Affairs by researchers at the University of Iowa College of Public Health. The researchers evaluated a tele-emergency service in the upper Midwest that provides 24/7 connection between an urban “hub” emergency department and 71 remote hospitals. At any time, clinical staff at the remote hospitals can press a button for an immediate audio/video connection to the tele-emergency hub Emergency Department.
A survey of the staff members at the rural hospitals found that 95 percent of those responding found that that the relationship significantly improve care for their patients in several ways:
- Improved quality of care
- Provided clinical second opinions for the rural medical staff
- Increased the use of evidence based treatment
“Tele-emergency improves patient care through integrated services that deliver the right care at the right time and the right place,” says Keith Mueller, PHD, head of the Department of Health Management and Policy and lead author of the report. “Our country’s health care system is in a massive state of change, and it’s through services such as this that we’ll be able to address patient need and assist in the financial concerns of smaller medical care units.”
Read the Health Affairs abstract.
A nine-year-old girl staying with her mother and siblings in a hotel room in Texas last month was unable to reach 911 to save her mother from an attack by the woman’s estranged husband because the child didn’t know to press “9” in the hotel room before “911” in order to reach an outside line. That death has led to a Federal Communications Commission (FCC) inquiry into how wide that problem is at U.S. hotels and is just one of many facets of the 911 response system that experts say needs updating. Other pressing issues include:
- Call 911 from a land line and responding operators can usually track your location, which is crucial if a person is being attacked or collapses before completing a call. However, most centers don’t yet have the technology to track 911 calls placed from a cell phone. Current FCC rules call for wireless phones to have the needed GPS technology to allow 911 centers to track call locations by 2018.
- While many people assume they can and do send 911 requests by text message, few 911 centers can access text messages currently and so most of those texts go unanswered. The four largest wireless telephone companies—AT&T, Sprint, T-Mobile and Verizon—have voluntarily committed to make texting to 911 available by May 15, 2014 in areas where the local 911 center is prepared to receive the texts. The FCC maintains a list of communities that can respond to 911 text messages which includes all of Iowa, Maine and Vermont, and some counties in a few other states.
“Our 911 systems today are pretty much voice-centric, last-century technology,” says Brian Fontes, CEO of the National Emergency Number Association (NENA). Fontes says that “the ability to have 911 communicate in the manner in which the public is communicating among itself today, is critically important.”
In addition, according to emergency experts new technologies would enhance the 911 response in many ways, including letting first responders see video and photos of an accident victim; demonstrate a needed emergency action, such as CPR, to responding laypersons; and even access medical records such as a victim’s medications, which could improve the response
How do you prepare for the safety and health of 27,000 runners and 500,000 spectators? And how do you prepare for the unexpected—such as a terrorist attack—so that the public health response can be as swift and effective as possible?
That was the first topic of Monday's American Public Health Association (APHA) session, "Late Breaking Developments in Public Health." Mary E. Clark, Director of Emergency Preparedness Bureau at the Massachusetts Department of Public Health, presented on "Public Health and Medical Response to the Boston Marathon Bombing."
Discussing the particular difficulties of staffing an event such as the Boston Marathon, Clark noted that the route goes through 26.2 miles, crosses through eight different communities in Massachusetts and then goes straight into the city of Boston. Along the way, there are thousands of runners and hundreds of thousands of spectators.
"This presents us with medical and health challenges, as well as security challenges," Clark explained.
"This year was the 117th running of the Boston Marathon, and each year we plan this as a planned mass casualty event," Clark said. "We have to build on the work that has gone on in the 116 years before."
To do this, Clark said, the department takes at least four months of preparedness planning, with the assumption that at least 1,000 runners or spectators will need some sort of medical care.
But how did they deal effectively with the unexpected?
"We had a remarkably quick response to bombings," Clark said. She noted that less than a minute after the bombs went off, gurneys were heading to the victims. And in just 18 minutes, they were able to remove 30 critically injured spectators off the scene into ambulances. Massachusetts General Hospital received their first patient 14 minutes after the explosions.
Since the marathon bombings, though, Clark said, they have identified further needs—particularly in the areas of mental health.
"One of the key things that's happened since the Marathon is the recognition of the need for a robust mental health response,” she said. “We have created more mental health support systems for volunteers and staff.”
But her biggest takeaway from the tragedy and the response? "Lessons learned were the benefit of preparedness activities," Clark said.
"People did what they were trained to do and they did it very well."
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
The National Institutes of Health’s Office of Emergency Care Research (OECR), established in 2012, will now be under the leadership of Jeremy Brown, MD. Brown was recently appointed as the first permanent director of OECR, which is housed in NIH’s National Institute of General Medical Sciences.
Before joining NIH, Brown was an associate professor of emergency medicine and chief of the clinical research section in the Department of Emergency Medicine at The George Washington University. Additionally, he served as an attending physician in the emergency department of the Washington, D.C., VA Medical Center. According to the acting director of the National Institute of General Medical Sciences, Judith H. Greenberg, PhD, “Brown brings an impressive mix of clinical expertise, research experience, management abilities and communication skills to this important new position.”
Part of Brown’s research includes how to introduce routine HIV screening—a public health intervention—in hospital emergency departments. Previous studies have found these screenings to be cost-effective and frequently welcomed by patients. This is just one of the many ways in which steps could be taken in the emergency room setting to help improve the data available to assist public health efforts across the country. By using emergency departments as sites for collecting data on the status of the public’s health, more targeted efforts for prevention can be implemented.
NewPublicHealth spoke with Dr. Brown on the evidence that shows support for the collaboration between emergency departments and efforts to improve public health, as well as his new role and what he sees for the future of emergency departments.
NewPublicHealth: How is the transition into this new position going so far and how are you pulling from previous experiences to help with new challenges in this position?
Jeremy Brown: This is the beginning of my fourth week here; it is a new program and a new project really for both me as its first permanent director and for the NIH as well. They’ve never had an office that has addressed this particular part of our nation’s health and I think it’s going to be a learning experience on both sides.
So far, I’ve been really struck by the extremely warm reception that I’ve had from people within institutes and centers with whom I’ve had meetings. Currently, my agenda is really to meet with as many people as possible within NIH whose work touches on emergency medicine and other time sensitive medical issues.
In terms of the latter, I started a brand new HIV screening project from scratch at GW, it hadn’t been done there previously and it really had only been done in a couple of places in the U.S. before. That required the marshaling of a lot of different aspects of both the hospital, the nursing staff, and emergency physicians to get that up and running.
NPH: What other public health initiatives do you think emergency departments can take the lead on to improve public health?
About 40 million U.S. workers don’t receive even a single paid sick day and millions of others can’t utilize sick leave to take care of a sick child. The result is sick kids in school—where they make others sick—and a dramatically increased likelihood of ending up in an emergency room rather than a doctor’s office.
About $1.1 billion in emergency department costs could be saved each year if every U.S. worker had access to paid sick days, according to Vicki Shabo, the Director of Work and Family Programs at the National Partnership for Women & Families. Shabo recently spoke with Grassroots Change about the importance of paid sick leave and the on-the-ground efforts to enact the essential public health initiative at the local level—while also battling government preemption efforts that would take away local ability to improve sick leave policies.
“Unfortunately, we’re seeing a trend,” she said. “It’s sobering and undeniable. There are preemption bills this year that have been introduced in 13 or so states, and several of them have passed. Last year we saw Louisiana pass preemption, and until we alerted some of the local groups on the ground, no one was paying attention to it.”
This and other examples illustrate the critical importance of grassroots efforts to combat preemption and promote improved sick leave policies, which Shabo says benefits workers and their families while having no negative economic impact. With the number of these grassroots advocates growing every day, the next step is improving training and providing more resources to improve policies statewide.
“The takeaway message is that progress is possible, it’s happening, and local grassroots activity is instrumental in the progress that’s been made. As we work federally, grassroots activity will continue to play a central role in future progress. We know that this is not something that we can do from Washington—it has to come from the ground up.”
May is Stroke Awareness Month, a good time to bump up the percentage of Americans who recognize the most common symptoms of a stroke from only 38 percent, according to a Centers for Disease Control and Prevention (CDC) survey. Speedily identifying stroke symptoms and calling for an ambulance is essential because people who get to an emergency room for treatment within three hours are healthier three months later than people for whom stroke care was delayed, according to the CDC.
New this year to help increase symptom awareness is a free smartphone app from the American Heart Association/American Stroke Association called F.A.S.T. The acronym stands for common stroke symptoms and a critical call to action: Face drooping; Arm weakness; Speech difficulty; and Time to call 9-1-1. The app also includes a link to additional symptoms that bystanders and caregivers can access and a 9-1-1 button to call an ambulance. Using the 9-1-1 button saves time by not having to back out of the app to dial the number manually. And using the button also generates an automatic time stamp, which gives emergency room staff a good indication of when symptoms began. Some treatments can only be given within a specific time window.