Tag Archives: emergency response

Simulating an emergency room response #ahcj14

Hoag Levins

About Hoag Levins

Hoag Levins is managing editor for digital publications at the Leonard Davis Institute of Health Economics (LDI), a center within The Wharton School at the University of Pennsylvania.

Photo by Hoag Levins

Photo by Hoag Levins

Thursday’s field trip to the University of Colorado Anschutz Medical Campus included a visit to the School of Medicine’s health simulation facility, the Center for Advancing Professional Excellence. As part of that visit, AHCJ members were selected to try their hand at treating a computer-controlled dummy patient. This photo shows three of them in the simulation “emergency room” with a dummy industrial-accident patient. They are:

In the hard hat, Rachel Roubein, a health reporter at the Carroll County Times in Westminster, Md., is playing the role of “friend or family member” who delivered the patient to the ER and then became obnoxious, creating an added stress level under which medical personnel had to work.

Joey Failma, in the green scrubs, is a CAPE staffer playing the role of ER doctor.

Marijke Vroomen-Durning, in the middle, is – in real life –  a registered nurse and an independent journalist from Montreal, Quebec, playing the part of an ER nurse.

Margarita Cambest, in the white coat, is a staff reporter at the Kentucky New Era in Hopkinsville, Ky. She is acting as a nurse’ aide keeping pressure on a severely cut leg.

With control room computers changing the patient’s condition to dire, and the monitors showing his rapidly declining biometrics, the scene was a frantic, but educational, one. In the end the patient died and the AHCJ members left with a much better sense of both the importance of clinical simulators in the medical education process as well as the kind of often-excruciating stress ER clinicians must work in.

Joplin hospital staff took action during disaster

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

If you haven’t already, take 90 seconds to read Tulsa World reporter Michael Overall’s brief, powerful account of how emergency preparedness translated to emergency action at the hospital caught in the center of the May tornado in Joplin, Mo.

joplin-hospital

Photo by Red Cross: Carl Manning GKCARC via Flickr

The staff had practiced severe weather drills and evacuations hundreds of times but, as one administrator told Oklahoma colleagues, “There’s no way you can plan for an F-5 tornado.” Nevertheless, Overall writes, the well-drilled staff of St. John’s hospital “evacuated all 183 patients in just 90 minutes with no major injuries,” a sentence you won’t appreciate until you read Overall’s narrative based on a hospital administrator’s talk at a conference for regional emergency workers.

For those of you looking for story ideas, you might look into local hospitals’ disaster plans. Have they really planned for every contingency? Certainly there are things no one can plan for, but it’s worth reading the story from this hospital and evaluating disaster plans with those events in mind.

For more, read AHCJ’s roundup and review of Joplin tornado coverage.

Giffords’ surgeon credits system, multidisciplinary approach

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

With the news that U.S. Rep. Gabrielle Giffords, who was shot in the head in Tucson in January, will travel to Florida to watch the final launch of the space shuttle Endeavor, which will be commanded by her husband, there may be renewed interest in her medical history and treatment.

Lemole speaks at Health Journalism 2011 in Philadelphia on April 16.

Lemole speaks at Health Journalism 2011 in Philadelphia on April 16.

Attendees of Health Journalism 2011 heard her neurosurgeon, Dr. Michael Lemole, describe his response, and that of the whole team at his hospital, in the minutes, hours and days after Giffords’ injury. In the speech, he credited the hospital’s multidisciplinary approach as well as the fact that the system worked as it was intended to on that day. He gave details about Giffords’ treatment and brain injuries in general that health journalists might find useful as Giffords re-emerges in the news.

If you weren’t able to make it to the conference, now you can watch Lemole’s keynote speech online.

Some articles about the talk:

Why Detroit’s emergency services are lagging

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Detroit News‘ Charlie LeDuff tried to figure out his city’s abysmal ambulance response times, and had a tough time finding excuses for why they are so far behind the national average, though staffing cuts and budget shortages certainly played a role. He wears his frustration on his sleeve and the article’s brutally incisive as a result. I’ll do my best to summarize, but it’s certainly worth a read.

One problem, according to a 2004 city audit of the Emergency Medical Services (EMS) system, is that Detroit is the only major American city that does not allow a firefighter or a police officer to aid a victim before the ambulance arrives. Another problem is substandard communication equipment. Since that report was issued, at least two hospitals have closed and the EMS system has been decimated by staffing cuts causing ambulances to drive farther.

The national standard for ambulance response is eight minutes, and some Detroit suburbs have it down around five. Nobody’s sure how long Detroit ambulances take, but it’s clear that it’s well beyond the acceptable threshold. Fire Commissioner James Mack Jr. said the departments doing the best it can to maximize resources amid budget constraints, LeDuff reports.

Mack made a claim to Fox 2 News a few weeks ago that the average response time in Detroit for an ambulance to arrive on a 911 call is 12 minutes — even while admitting that often there are no units available to get to calls.

According to that 2004 audit, the two-year average at that time was about 12 minutes. And that was before the city cut its paramedics and emergency medical technicians by nearly 40 percent.

Are emergency drivers distracted by technology?

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

“Driven to Distraction,” a New York Times series that looks at the “dangers of drivers using cellphones and other electronic devices, and efforts to deal with the problem,” turns its focus on first responders, such as police and paramedics.

ambulance

Photo by rKistian via Flickr

Reporter Matt Richtel points out that emergency drivers are often required to use technological gadgets while driving at high speeds and negotiating heavy traffic to get directions and transmit information about patients.

Data does not exist about crashes caused by police officers or medics distracted by their devices. But there are tragic anecdotes.

The New York City Fire Department says ambulance drivers are not supposed to use on-board computers while driving but “medics and E.M.T.’s in New York and elsewhere say that although they are aware of the rules, they do use their on-board computers while driving.”

6-foot rule separates San Diego paramedics, H1N1

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Voice of San Diego’s Randy Dotinga explains exactly how the fear of H1N1 has transformed every step of the health care delivery process in the Southern California city, which has been hit particularly hard by the virus. Dotinga focuses on how paramedics’ routines have changed. “To protect themselves,” Dotinga writes, “paramedics are essentially using the same precautions they would against infectious tuberculosis – something they hardly ever see.”

Dotinga says the changes become evident as soon as the paramedics arrive on the scene. Before H1N1, they’d walk right up to the patient. Not anymore.

paramedics
Photo by Fetchy via Flickr.

Now, paramedics across the county adhere to a “Six-Foot Rule” when they suspect a patient has a respiratory illness. “If you’re six feet away even without your protective equipment for a short period of time, you’re not likely to get infected,” said Haynes, the county official.

If a patient has possible flu symptoms, the paramedics put on N95 respirators. They began wearing the respirators instead of ordinary masks about a month ago. Paramedics will put on eye shields too. Many paramedics hate to wear them, and forget to put them on.

In this environment of extreme care, not even the ambulances are left to go on as usual. These days, in addition to their regular regimen of extreme sanitation, they visit a nearby fire station a few times a month. There, they are nailed with a super-powered germicidal fog that ensures no microbes, nefarious or otherwise, are going to linger for long.

Does the six-foot rule really work? What about masks?

Maybe. Your view of the effectiveness of social distancing likely depends on where you stand on a particularly contentious issue: airborne vs. droplets. If influenza is spread primarily through droplets (as the CDC says it does here, and here), then it’ll have a tough time spreading beyond three feet unless it’s smeared on a surface. In this case, then, the six-foot rule is an effective way to slow the spread of the virus, as are masks.

If, however, you believe the virus is airborne then it would be able to cross the six-foot gap and you would need, at the very least, an N95 respirator (a mask which filters out at least 95 percent of airborne particles) to protect yourself. In this case, though, it’s important to note that according to some recent research, an N95 won’t offer any more protection than a regular mask.

According to the Institute of Medicine, we haven’t yet heard the final word on influenza transmission and further research is required (PDF). In the meantime, most providers are erring on the side of caution. Check out AHCJ’s primer on controlling pandemic flu for further information.

(Hat tip to AHCJ board member Maryn McKenna for pointing us in the right direction.)