24.08.2014

Best emergency medicine articles of 2014

He says patient reviews are skewed because they're usually only written by people who either hate or love their doctors. If you're looking for more expressions of ''woeful inadequacy" and generally disappointed if not bittersweet reflections on the human condition, buy this book. Conditions & Treatments BlogJosh Peterson riffs on today's medical findings and what they mean to you. For over 7 years, the 16 physicians on our editorial board have been dedicated to bringing you the only evidence-based, relevant, and up-to-date Pediatric Emergency Medicine publication in the industry.
Over 72 journals are examined each month by our team of more than 100 emergency physicians for the most relevant evidence-based approaches to pediatric medicine. EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) as well as AMA, ACEP, AAFP, AAP, and AOA.
Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP-SCPA) to increase regional surge capacity and emergency preparedness for healthcare facilities.
In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period.
The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies. The purpose of this article is to describe an approach to improve surge capacity, in this case for hospital and ED treatment areas.
Figure 1The South Central region of Pennsylvania consists of 8 counties (Adams, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Perry, and York), 17 acute care hospitals, emergency medical services (EMS), and county-based emergency management.
The Partnership leveraged the structure of the South Central Pennsylvania Regional Counter-Terrorism Task Force (SCTF), EMAs, and the Emergency Health System Federation (EHSF, regional EMS agency) as important and established entities with an identical geography to that of the HCFP-SCPA with which to formulate planning efforts. Also in place before the development of the Partnership was the federal Emergency System for Advance Registration of Volunteer Health Professionals Program (ESAR-VHP).
After the grant was awarded, personnel from the SCTF, the largest 7 EMS companies, and 11 hospitals within the region were provided the opportunity to participate in specific roles including planning, collaboration, development, and training activities.
Four primary teams were formed within the Partnership to establish modes, mechanisms, procedures, and evaluation techniques to fulfill the goals created for the grant. Through early Partnership discussions, a consensus was reached that surge capacity would be defined as “the number of adequately staffed beds that can be provided in addition to the normal demand within 2 hours of an incident,” which includes accounting for both inpatient and ED treatment beds. Specific, measurable, achievable, realistic, and time-framed (SMART) objectives were created from the 6 grant objectives. Inclusive and frequent communication was evaluated as essential for the Partnership to act as 1 cohesive unit. The Partnership conducted regularly scheduled discussions between regional healthcare facilities on shared needs to enhance surge capacity. These alerts were tested, improved, and practiced by using the Comprehensive Hazard and Vulnerability Analysis (HVA), the HSEEP, the pandemic influenza exercise (PanSurge07) assessment, and the PanFlu assessment. To gather effectiveness and outcomes data, brief Web-based surveys and polls, as well as larger hospital and regional exercises, were performed to quantify various outcomes and clarify roles and responsibilities. A SERV-PA administrator at each of the HCFP-SCPA hospital facilities was designated and trained. The NIMS training requirements were simplified to become more appropriate for the hospital-based participants, and training was made more accessible to all Partnership hospitals, with an online certification process.
After several months of information gathering and discussion, the Partnership evaluation and integration team identified 6 gaps in the overall progress and focused on remediating these specific gaps. Outcomes of the Partnership were targeted to be realistic, measurable, time-conscientious, and repeatable so as to be available for implementation by other hospital expanses looking to develop partnerships.
Training, policies, and procedures for working with volunteers during a surge were developed or adopted.
During the initial HAN alert system exercise, 76% of the hospitals confirmed receipt of HAN alerts and 45% of the personnel within the hospital received the alert. At baseline, an average of 38% of healthcare facilities responded to scheduled weekly alerts on the FRED and 800-MHz systems. Surge capacity was analyzed by a contemporaneous phone survey of cooperating hospitals of the region. During initial review, it was clear that many improvements to the emergency response system were needed in the region. During the granting period, we observed and demonstrated the importance of testing emergency response, not only as a single healthcare entity but also as a regional healthcare system. The members of the partnership were asked to disclose information to the HCFP-SCPA, and much of the data were reliant on this self-reporting. The Partnership successfully increased preparedness and surge capacity through a coalition of regional healthcare facilities and emergency response agencies. We would like to thank the members of the Healthcare Facilities Partnership of South Central Pennsylvania and their representatives: Hanover Hospital (Joshua Hale), Gettysburg Hospital (Ron Sterchak), Chambersburg Hospital (Vickie Negley), Waynesboro Hospital (Dan Farner), The New Carlisle Regional Medical Center (Georgeann Laughman), Holy Spirit Hospital (Jason Brown), Pinnacle Health (Christie Muza), Penn State Milton S.
9. US Department of Health and Human Services Assistant Secretary for Preparedness and Response. Emergency medical technician (EMT) courses are designed to prepare students for service at emergency scenes, which may include procedures necessary for saving lives. The National Association of Emergency Medical Technicians (NAEMT) supports students at top EMT schools through scholarships. The National Highway Traffic Safety Administration (NHTSA) supports research in the field of emergency services, such as a project at the University of North Carolina's Highway Safety Research Center. Basic EMT training typically includes treatment of wounds, fractures, bleeding and other conditions often encountered in emergencies.
Emergency medical technician schools and colleges teach a progression of courses with increasing levels of expertise and responsibility. Online EMT schools may not offer classes in all subjects; for example, schools may target practicing EMTs seeking online refresher coursework or test preparation. If you are interested in learning more about online EMT schools, please search our website and contact individual schools for information on their programs. X pulmonary embolism (pe) with intracardiac thrombus which entrapped ina patent foramen ovale is a extremely rare condition. The new england journal of medicine (nejm) is a weekly general medical journal that publishes new medical research and review articles, and editorial opinion on a. Importance previous assessments of readiness of emergency departments (eds) have not been comprehensive and have shown relatively poor pediatric readiness, with a. Importance previous assessments readiness emergency departments (eds) comprehensive shown poor pediatric readiness, .
Open journal medical imaging (ojmi) international journal dedicated latest advancement medical imaging. The american journal emergency medicine volume 34, issue 8, pages a1-a12, 1331-1742 (august 2016).
Professional scientific articles healthy aging program authors – view bibliographies year.
Copyright © 2015 Caroldoey, All trademarks are the property of the respective trademark owners. Mailed directly to you, each issue contains a review of more than 200 emergency medical articles and journals and comes complete with access to 4 approved CME credits (with 150+ additional credits available!).


Further, each issue includes over 100 references and must pass four rounds of peer review before publication. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. The coalition focused on 6 objectives: (1) increase awareness of capabilities and assets, (2) develop and pilot test advanced planning and exercising of plans in the region, (3) augment written medical mutual aid agreements, (4) develop and strengthen partnership relationships, (5) ensure National Incident Management System compliance, and (6) develop and test a plan for effective utilization of volunteer healthcare professionals. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents.
Furthermore, national-level exercises such as “Dark Winter” and the Homeland Security Exercise and Evaluation Program (HSEEP) have repeatedly exposed areas where the need for improvement in response is clear.3–7 For political leaders, health officials, hospital leaders, and emergency management officials, upholding public confidence in their respective institutions before, during, and after a catastrophic event is crucial. The timely availability of these treatment areas is crucial for all seriously ill and injured patients, and for the public’s health, when a mass casualty incident (MCI) occurs.
The region is composed of both rural and micro and metro urban areas, and has a hospital capacity and capability that ordinarily serves the needs of these communities (Figure 1). The SCTF’s mission is to deliver a comprehensive and sustainable regional “all-hazards” emergency preparedness program that addresses planning, prevention, response, and recovery for events in South Central Pennsylvania that exceed local capabilities. It consists of more than 200 quick response services, basic life support services, and advanced life support services.
The ESAR-VHP (a product of HHS in response to volunteer-related complications on September 11, 2001) is a registration program of healthcare professionals who will potentially volunteer their efforts in the event of a mass casualty event. The project contracted with additional key partners to provide both technical assistance and outcomes measurements. These teams were (1) education and development, (2) technology and simulation, (3) evaluation and integration, and (4) surge enhancement. The Healthcare Facilities Partnership of South Central Pennsylvania is composed of personnel from 17 hospitals, emergency medical service (EMS), and emergency management agencies (EMA) in the region. Two specific tools were implemented to enhance contact during meetings and to immediately collaborate on data and information: a desktop-sharing tool and a toll-free number. Emphasis was based on frequent development, reduced dependency on face-to-face meetings, and growth of mutual understanding of hospital-based procedures. These systems were the Facility Resource Emergency Database (FRED) system, an 800-MHz radio system, and the Health Alert Network (HAN) system. The Partnership also established triggers for activating those systems and created an “ideal communication” flow chart for the South Central Pennsylvania region.
On the secured access portion of the portal, members of the Partnership are able to share information about the surge capability of their particular hospital. To develop a library of low-cost repeatable training exercises, 3 computer simulations were created: a pandemic influenza outbreak (gradual and persistent surge simulation), mass casualty blast incident (sudden surge simulation), and a hospital evacuation scenario (“reverse” surge simulation).
All participating healthcare facilities reviewed, enhanced, and agreed upon updated MMAAs that now included the availability of volunteers (SERV-PA). The administrators were given responsibility and oversight for volunteer alerts and organization of volunteers during an actual event. The gaps were identified as requirement for (1) increased capacity through staffing and alternative care sites, (2) improved efficiency through preparedness standardization, (3) decompression of hospitals by working with alternative care sites, (4) development of command and control and NIMS compliance, (5) development of improved transportation planning, and (6) enhanced surge capacity through broader participation. Progress was evaluated by the completion of the 59 SMART objectives (Table) and tested through implementation of 17 brief regional exercises.
The 3 computer-based simulations were created and used throughout the region as an education tool.
Seventeen regional data gathering and assessment exercises were conducted during the time period of the grant.
Fifteen of 17 hospitals appointed SERV-PA managers and all were sufficiently trained by the end of the granting period.
This should lead to a greater ability for hospitals to meaningfully participate in disaster response. In all, 50% of hospitals were responding to the 800-MHz alert system, and 62% of hospitals were using the FRED alert system (31% used both systems). This was performed by using the Health Alert Network and Web portal communications as an alerting activity, followed by a teleconference documenting capacity for surge at 0700 and 1500 hours at each facility. Many systems that were expected to respond to MCI and other surge emergencies, such as NIMS, MMAAs, and ESAR-VHP, were in existence but not functioning optimally.
In particular, it is important for key jurisdictions within a healthcare region to practice communication in order for a flow of information to go from the initial dispatch to all of the key jurisdictions that need to respond, including hospitals. Although the South Central Pennsylvania region has many communities, hospital facilities, and demographics that are similar to other regions, no 2 points across the country are the same. Furthermore, we rely on the partners to uphold preparedness and surge quality after the end of the grant period. At baseline, the healthcare facilities in our region of Pennsylvania had the ability to accommodate 10 critically ill patients. Hershey Medical Center (Scott Freeden), Good Samaritan Health System (Kim Crosson), Heart of Lancaster Regional Medical Center (Scott Marks), Ephrata Community Hospital (Gloria Jean Maser Fluck), Lancaster Regional Medical Center (Walter Roth), Lancaster General Hospital (Jeffery Manning), York Memorial Hospital (Lisa Ziegler), and York Hospital (Kevin Arthur). Homeland security exercise and evaluation program, volume I: HSEEP overview and exercise program management. EMT classes may cover topics like medical terminology, basic health care techniques and life support. Students traditionally learn how and when to use stretchers, oxygen systems, backboards and other equipment. Some hybrid programs blend online coursework with in-person skills training and hands-on clinical practice. Wachter warns that going solely on patient ratings may not be the most scientific way to go about deciding on a doctor. However, these factors may not be optimally functioning to generate an effective and efficient surge response. This can be done by increasing preparedness for public health emergencies, largely those that require the ability to treat a large influx of patients (surge capacity).
Within this region, a total of 17 acute care hospitals became members of the Partnership, which was supported by a federal grant from September 1, 2007, to August 8, 2009, inclusive of 2 no-cost extensions to the initial award.
The SCTF, supported primarily by grants from the Department of Homeland Security, is organized into approximately 10 functional groups and committees.
ESAR-VHP expedites the volunteer’s verification of identity, licenses, credentials, and accreditations.
Each of the 59 SMART objectives created by the Partnership included a description of how to measure or document the objective, and the person or persons who took the lead to implement each, and provided a deadline for completion. The desktop–sharing program (Webinar, Web-based seminar) was fully interactive, which allowed all attendees to present, respond to, and discuss information in real time.
FRED is an Internet-based system that alerts facilities in the event of a crisis or situation that may warrant a coordinated response. These flat-screen, computer-based simulations incorporated the HVA, PanSurge07, and PanFlu assessment results for at-risk medical populations. The HCFP-SCPA carried out a week-long recruiting event to encourage volunteers to register at each regional facility.
Along with this, the Partnership launched a Web-based portal with a public and secure access to facilitate communication between partners and with the public.
Incident scene operations may require emergency operations center (EOC) support for MCIs of significant magnitude.


After each was performed, the partnership evaluated and reviewed the results to identify limitations in the region as a whole and within each Partnership facility. More than 500 SERV-PA volunteers had been added within the region since the start of the project. At baseline in 2007, it was determined that total regional surge capacity for critical adult patients was 10 or less and for critical pediatric patients, 2 or less. It was clear to the Partnership that without significant practice and troubleshooting, the path of communication did not move rapidly from the initial dispatch to all of the event catchment hospitals.
Simulation training with the regional facilities is a priority and is crucial to sustain regional disaster preparedness. Each region has individual requirements, restrictions, and resources, which may differ from ours. Although we believe that our partners are dedicated to emergency preparedness and increasing surge capacity, the incident of fraudulence is possible. At the conclusion of the study, the Partnership has practiced a regional response to a large surge event and has found an increase in capacity that exceeds 100 patients. We would also like to thank Osteopathic Hospital, The Lebanon Veterans Affairs Medical Center, The University Physicians Group-Fishburn, the University Physicians Group-Middletown, and The South Central Pennsylvania Regional Counter-Terrorism Task Force. Related subjects include emergency scene assessment, hazardous materials, disaster response and more.
EMT students may also learn to relay information by radio to hospitals and doctors, to receive medical care instructions from doctors, and to monitor patients during transit. Each state requires EMTs and paramedics to obtain a license and meet certain qualifications, the BLS reports.
Students interested in online EMT schools should check state regulations regarding online education and licensure for EMTs.
It consists of representatives from 16 hospitals, the Office of Public Health Preparedness, 8 county EMAs, and other critical entities required for public health and safety for a population of about 2 million people. The EHSF also works to improve preparedness and recruitment and provides regional resources that can be deployed in the event of a required response.
In the state of Pennsylvania, ESAR-VHP is known as The State Emergency Registry of Volunteers in Pennsylvania (SERV-PA). Teams met regularly to discuss current developments and to further the goals as set forth by the HCFP as a whole. It provides information about the emergency and enables facilities to report about available resources.
The portal also kept a central repository for information regarding availability of equipment, similar to that of the National Hospital Available Beds for Emergencies and Disasters System developed by the Agency for Healthcare Research and Quality. The SERV-PA program was advertised on the Partnership Web site and at several of the hospitals in the region to further encourage volunteer enrollment.
A regional “ideal communication flow chart” (Figure 3) was created and trigger points for surge response were identified and agreed upon to further strengthen communication. The EMAs are then responsible for producing a Pennsylvania Emergency Incident Reporting System (PEIRS) report. This compares favorably with the 600 volunteers that were available statewide at the beginning of the Partnership. 2, 100% of the hospitals confirmed receipt of the alert and 47% of the personal within the hosptials confirmed receipt.
At the conclusion of the grant, all hospitals had the 800-MHz radio, wired and monitored continually, and had practiced receiving the FRED alert. The computer-based simulation added additional interactive and qualitative data and measurements that exceeded previous real-time exercises, such as tabletops.
Similarly, while we feel that improvement in hospital personnel participation is a result of participation in, and actions of, the HCFP-SCPA, the possibility exists that subjects improve or modify an aspect of their behavior that is being experimentally measured in response to the fact that they are being studied.
We would also like to thank Nancy Flint, Carla Perry, Shannon Harrington, and Lee Groff for their help.
Students also need to recognize safety measures to reduce risks of exposure to diseases, violence and mentally unstable patients. He Chief of the Division of Hospital Medicine, and Chief of the Medical Service at UCSF Medical Center.
The response to this model (Figure 2) for completing the work was received favorably by members of the Partnership and this proved an efficient means of task management for its overall goals. Attendees of Webinar meetings were able to communicate verbally during sessions by calling into a phone conference. The 800-MHz radio is a system implemented by the Pennsylvania Department of Health as a means to alert and communicate in the event of failure of primary communication methods. On the public portion of the Web site, the Partnership created a way to communicate with the region’s communities about preparedness efforts and emergency situations. Following recruitment, the SERV-PA system was tested to determine how many new volunteers were generated.
Information on the PEIRS report is passed through the Pennsylvania Emergency Management Agency (PEMA), to the Pennsylvania Department of Health (DOH), to the Emergency Health Services Federation (EHSF), and then to the hospitals who will be receiving the patients. After exercises, self-reported capacity for the responding hospitals showed an average regional hospital surge capacity of 342 beds over the baseline of 3,192 beds (a 10.7% regional increase with surge capacity). We would like to thank Christopher Hatzi and Dennis Damore of Crisis Simulations International, LLC (CSI). He has published 200 articles and 6 books in the fields of quality, safety, and health policy. Using the Webinar with phone, meetings could be held and “attended” by all parties, regardless of their location within the 8 counties (approximately 13,303 km2).
HAN is a national system developed by the Center for Disease Control that alerts facilities of any health threat using Web- and satellite-based technologies, and then links organizations critical for preparedness and response to said events.
To achieve faster situational awareness for hospitals, the 911 service now directly contacts local hospitals in the event of a significant occurrence for which surge is possible.
After these surge capacity exercises, we were able to demonstrate the following increases in hospital beds: 25% increase in adult floor beds, 37% increase in critical care beds, 27% increase in ED beds, and a total regional increase of 24%. These activities were supported in part by a grant from the Department of Health and Human Services, Office of Preparedness and Emergency Operations, Division of National Healthcare Preparedness Programs, grant No. This significantly reduced travel costs and allowed partners to complete their other regular duties with less interruption to their everyday workflow. These local hospitals then contact regional hospitals capable of creating a Facility Resource Emergency Database (FRED) alert that notifies all hospitals in the region. However, no increase in pediatric capacity could be created regionally without changing the Department of Health regulations on designated use of adult and pediatric beds.
In subsequent practice sessions, verifiable alternative care expansion and personnel availability were shown to produce more than 3,600 low-acuity, staffed evaluation and treatment rooms for surge capacity enhancement within the region. These exercises asked hospital organizations to identify usable, staffed clinical areas that could be directed to care for patients needing education, immunization, and low-acuity visits but not requiring services only available within the affiliated hospital. These sessions assumed that the ESAR-VHP was used to augment staffing of available beds (ie, movement of providers assured between hospital organizations), that memorandum of understandings between hospital organizations resulted in enhanced coordination between overloaded and other hospital organizations, and that staffed beds for low-acuity patients could provide a load of 4 patients per treatment room per hour.



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