Did you hear about the blonde couple that were found frozen to death in their car at a drive-in movie theater?

They went to see ”Closed for the Winter”.

But I digress……

Just to keep you on top of things:  There is a new investigational botulism antitoxin that will be replacing the regular stuff.  It’s a new heptavalent botulinum antitoxin (HBAT, Cangene Corporation) through a CDC-sponsored Food and Drug Administration (FDA) Investigational New Drug (IND) protocol. HBAT replaces a licensed bivalent botulinum antitoxin AB and an investigational monovalent botulinum antitoxin E (BAT-AB and BAT-E, Sanofi Pasteur) with expiration of these products on March 12, 2010. As of March 13, 2010, HBAT became the only botulinum antitoxin available in the United States for naturally occurring noninfant botulism.

http://omniphysicians.com/2010/03/19/hbat/

The U.S. Food and Drug Administration today warned patients and healthcare providers about the potential for increased risk of muscle injury from the cholesterol-lowering medication Zocor (simvastatin) 80 mg. Although muscle injury (called myopathy) is a known side effect with all statins, today’s warning highlights the greater risk of developing muscle injury, including rhabdomyolysis, for patients when they are prescribed and use higher doses of this drug. Rhabdomyolysis is the most serious form of myopathy and can lead to severe kidney damage, kidney failure, and sometimes death.

Simvastatin is sold as a single-ingredient generic medication and as the brand-name Zocor. It also is sold in combination with ezetimibe as Vytorin, and in combination with niacin as Simcor.

For more information, please visit: Zocor

The Illinois Supreme Court says Champaign-based Provena Covenant Medical Center didn’t provide enough charity services to be exempt from property taxes.

The Supreme Court on Thursday upheld a lower court ruling that supported the Illinois Department of Revenue’s claim that the medical center couldn’t avoid property taxes as a charitable institution.

http://omniphysicians.com/2010/03/19/how-to-give-hospital-ceos-heartburn/

Paul R

Link:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5910a4.htm?s_cid=mm5910a4_e

Investigational Heptavalent Botulinum Antitoxin (HBAT) to

Replace Licensed Botulinum Antitoxin AB and Investigational

Botulinum Antitoxin E

March 19, 2010 / 59(10);299

CDC announces the availability of a new heptavalent botulinum antitoxin (HBAT, Cangene Corporation) through a CDC-sponsored Food and Drug Administration (FDA) Investigational New Drug (IND) protocol. HBAT replaces a licensed bivalent botulinum antitoxin AB and an investigational monovalent botulinum antitoxin E (BAT-AB and BAT-E, Sanofi Pasteur) with expiration of these products on March 12, 2010. As of March 13, 2010, HBAT became the only botulinum antitoxin available in the United States for naturally occurring noninfant botulism.

Botulinum antitoxin for treatment of naturally occurring noninfant botulism is available only from CDC. The transition to HBAT ensures uninterrupted availability of antitoxin. BabyBIG (botulism immune globulin) remains available for infant botulism through the California Infant Botulism Treatment and Prevention Program (1). BabyBIG is an orphan drug that consists of human-derived botulism antitoxin antibodies and is approved by FDA for the treatment of infant botulism types A and B.

HBAT contains equine-derived antibody to the seven known botulinum toxin types (A–G) with the following nominal potency values: 7,500 U anti-A; 5,500 U anti-B; 5,000 U anti-C; 1,000 U anti-D; 8,500 U anti-E; 5,000 U anti-F; and 1,000 U anti-G. HBAT is composed of <2% intact immunoglobulin G (IgG) and ≥90% Fab and F(ab’)2 immunoglobulin fragments; these fragments are created by the enzymatic cleavage and removal of Fc immunoglobulin components in a process sometimes referred to as despeciation. Fab and F(ab’)2 fragments are cleared from circulation more rapidly than intact IgG (2), and repeat HBAT dosing might be indicated for some wound or intestinal colonization patients if in situ botulinum toxin production continues after clearance of antitoxin.

The HBAT FDA IND treatment protocol includes specific, detailed instructions for intravenous administration of antitoxin and return of required paperwork to CDC. Health-care providers should report suspected botulism cases immediately to their state health department; all states maintain 24-hour telephone services for reporting of botulism and other public health emergencies. Additional emergency consultation is available from the CDC botulism duty officer via the CDC Emergency Operations Center, telephone, 770-488-7100 (3). Additional information regarding CDC’s botulism treatment program is available at http://www.bt.cdc.gov/agent/botulism.

References

1. Arnon SS, Schechter R, Maslanka SE, Jewell NP, Hatheway CL. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med 2006;354:462–71.
2. Sevcik C, Salazar V, Diaz P, D’Suze G. Initial volume of a drug before it reaches the volume of distribution: pharmacokinetics of F(ab’)2 antivenoms and other drugs. Toxicon 2007;50:653–65.
3. CDC. New telephone number to report botulism cases and request antitoxin. MMWR 2003;52:774.

Link:  http://www.jpeds.com/article/S0022-3476(09)01215-3/abstract

J Pediatr, 2/15/10

Study design

The study involved a medical chart review to assess the association of peanut allergy with asthma morbidity in children beyond age 3 years. Peanut allergy was assessed by specific and validated criteria. A Poisson regression model was used to compare the frequency of systemic steroid use and of hospitalization for asthma beyond age 3 years in children with asthma with and without peanut allergy.

Results

Children with peanut allergy had a 2.32-times greater rate of hospitalization (P = .03) and a 1.59-times greater rate of systemic steroid use (P <.001) after controlling for covariates.

Conclusions

Peanut allergy serves as an early marker for asthma morbidity. Early prevention and intervention can improve quality of care.

By JASON ROBERSON / The Dallas Morning News
jroberson@dallasnews.com

 http://www.dallasnews.com/sharedcontent/dws/bus/stories/DN-ERwait_19bus.ART.State.Edition1.3ceac55.html

A long-held notion among hospital administrators says the emergency room is a money-loser. But a Texas company aims to disprove that idea by running emergency departments more efficiently.As a testament to its confidence, it’s promising patients no longer than a 15-minute wait to see a doctor or the medical care is free.

“When we started our company, everybody thought we were crazy,” said Dr. Hemant Vankawala, medical director of 24 Hour Emergency Room at The Hospital at Craig Ranch in McKinney.

Critics say the company’s 15-minute promotion is meaningless if after seeing a doctor a patient still must wait for hours on test results or procedural paperwork. Vankawala, however, said he’s confident he knows what patients want when they come into an emergency room.

Wait times have become a bigger issue as the number of emergency rooms has decreased. From 1996 through 2006, the number of hospital emergency departments decreased from 4,019 to 3,833, according to the U.S. Department of Health and Human Services.

As a result, emergency departments are under increasing pressure to care for more patients. Crowding’s an issue. Emergency patients already seen by a doctor still must wait hours for a bed to open up. Across the country, ambulances are passing up emergency rooms in search of hospitals with more space, according to the department of health.

The Woodlands-based 24 Hour Emergency Room, in business for five years, operates four stand-alone locations in Texas, three in the Houston area and one in Aubrey in Denton County.

Its fifth location is in The Hospital at Craig Ranch in McKinney.

To be sure, the company is designed with insured patients in mind.

“Our business model doesn’t allow us to take on high volumes of uninsured patients who are also unable to pay with cash because of the expense involved with running our facilities,” Vankawala said.

The company doesn’t accept Medicaid, the government insurance for the poor, but it does take Medicare, the government insurance for the elderly and disabled.

“We think that emergency medicine is a very specialized delivery of health care,” Vankawala said. Large hospitals, with their multiple services and focuses, cannot be as efficient at emergency care as his company, he said.

Vankawala said the business problem with most emergency departments of large hospitals is they do not get to claim the revenue they generate. Large hospitals are heavily departmentalized, and revenue-generating functions, such as the use of X-rays and digital imaging machines, are credited to the departments responsible for them.

“In our facility, the emergency room department governs the whole hospital,” Vankawala said. “The majority of our function is emergency room services.”

The national average wait time to see a physician for emergent patients – those patients who should be seen in less than 15 minutes – was 37 minutes in 2006, more than twice as long as recommended for their level of urgency, according to the U.S. Government Accountability Office.

At 24 Hour Emergency Room, the 15-minute countdown starts after patients fill out paperwork. The clock stops when they see an emergency medicine physician. Should the wait take longer than 15 minutes, only the medical care received in the emergency room is free, meaning referrals to other providers or prescriptions would not be covered.

Dr. Jay Kaplan, a director with the American College of Emergency Physicians and a practicing emergency physician in the San Francisco Bay area, is skeptical of the company’s promotion.

The 15-minute wait time marketing concept first started in the late 1990s in New Jersey, Kaplan said. At the time, area hospitals also were giving out movie tickets to lure patients.

“A significant number of hospitals that initiated this program abandoned it,” he said. “It led to a focus of getting the patient seen upfront, but not enough on the middle process.”

The promise to be seen quickly does not necessarily correlate with an overall shorter time in the emergency room process. Often there’s a lag in waiting for results from blood tests or X-rays.

“Wait time is a serious issue to our patients,” Kaplan said. “Besides money, the most precious thing to people is their time. People don’t like waiting.”

Vankawala said that not only does 24 Hour Emergency Room aim to get patients in front of a doctor in 15 minutes, it also concentrates on a streamlined workflow, so that blood tests and X-rays come back quicker.

Across the nation, hospitals are trumpeting shortened wait times in hopes of attracting more patients.

In Arizona, Scottsdale Healthcare System advertises emergency room wait times for its four hospitals online and on a flat screen in each hospital’s emergency waiting room.

Edward Hospital in Naperville, Ill., sends text messages back to prospective patients with its wait times.

Some Healthcare Corp. of America hospitals in west Florida post wait times on billboards, according to reports from the St. Petersburg Times.

“Accidents happen fast. Emergency care should, too,” reads one electronic billboard, which also lists wait times.

Other hospitals are testing a service where patients register online and pay a fee to hold their spot while they wait at home, according to the Press of Atlantic City in New Jersey.

The Hospital of Central Connecticut has an iPhone application listing wait times and directions to the hospital.

But for the busiest emergency department in North Texas, those strategies aren’t necessary, said Jennifer Sharpe, director of emergency services at Parkland Memorial Hospital.

“Typically, those hospitals are trying to drive up volume,” Sharpe said. “They’re trying to increase their business and gain market share.”

Parkland’s emergency department, which treated 109,000 people last year, is hardly trying to drum up market share.

But it has had an alarming problem with wait times.

In 2008, the average wait at Parkland was 4 hours and 41 minutes. That year also included the death of 58-year-old Michael Herrera, who died after waiting 19 hours in Parkland’s emergency room.

After implementing a strategy of pairing several small groups of doctors into work stations, the hospital improved patient flow. Today, the average wait time is 70 minutes.

Instead of billboards, iPhone apps and text messages, Parkland issues a monthly report of average wait times on its Web site.

Sharpe said though Parkland is not trying to attract more patients to the hospital, officials don’t want needy patients to be turned off by a long wait. That can compromise patient care and lead to more life-threatening and costly problems if they return.

An estimated 2.4 million people in 2006, or 2 percent of all emergency patients, left without ever seeing a doctor, according to the most recent analysis from the U.S. Centers for Disease Control and Prevention.

Modern Healthcare (3/18, Carlson) reported, “A new federal survey of US nurses finds the country’s 3.1 million registered nurses are more educated and ethnically diverse than ever, but the group’s average age continues to approach 50, even as the number of nurses has grown.” In fact, according to the Health Resources and Services Administration’s Bureau of Health Professions’ quadrennial survey of the US nursing population, “in 2008, nearly 45% of all nurses were aged 50 or older,” whereas “in 1980, the first year of the first survey, only 25% of registered nurses were.” Notably, the “report was drawn from survey results from 33,549 nurses.”

Link:  http://www.suntimes.com/news/metro/2110216,provena-champaign-hospital-tax-031810.article

CHICAGO — The Illinois Supreme Court says Champaign-based Provena Covenant Medical Center didn’t provide enough charity services to be exempt from property taxes.

The Supreme Court on Thursday upheld a lower court ruling that supported the Illinois Department of Revenue’s claim that the medical center couldn’t avoid property taxes as a charitable institution.

The high court says Provena did provide some charitable services to the surrounding community but described them as minimal.

The decision was closely watched by other hospitals that have charity exemptions.

 3/19/10

The U.S. Food and Drug Administration today warned patients and healthcare providers about the potential for increased risk of muscle injury from the cholesterol-lowering medication Zocor (simvastatin) 80 mg. Although muscle injury (called myopathy) is a known side effect with all statins, today’s warning highlights the greater risk of developing muscle injury, including rhabdomyolysis, for patients when they are prescribed and use higher doses of this drug. Rhabdomyolysis is the most serious form of myopathy and can lead to severe kidney damage, kidney failure, and sometimes death.

Simvastatin is sold as a single-ingredient generic medication and as the brand-name Zocor. It also is sold in combination with ezetimibe as Vytorin, and in combination with niacin as Simcor.

For more information, please visit: Zocor

Link:  http://ajcp.ascpjournals.org/content/133/3/380.abstract

Pathologic Findings in Novel Influenza A (H1N1) Virus (“Swine Flu”) Infection

Contrasting Clinical Manifestations and Lung Pathology in Two Fatal Cases

AJCP 2010 133:380-387

Although novel influenza A (H1N1) virus infection has assumed pandemic proportions, there are few reports of the pathologic findings. Herein we describe the pathologic findings of novel influenza A (H1N1) infection based on findings in 2 autopsy cases. The first patient, a 36-year-old man, had flu-like symptoms; oseltamivir (Tamiflu) therapy was started 8 days after onset of symptoms, and he died on day 15 of his illness. At autopsy, the main finding was diffuse alveolar damage with extensive fresh intra-alveolar hemorrhage. The second patient, a 46-year-old woman with alcoholism, was found unresponsive in a basement and brought to the hospital intoxicated and confused. Her condition deteriorated rapidly, and she died 4 days after admission. The main autopsy finding was acute bronchopneumonia with gram-positive cocci, intermixed with diffuse alveolar damage. The pathologic findings in these contrasting cases of novel influenza A (H1N1) infection are similar to those previously described for seasonal influenza. The main pathologic abnormality in fatal cases is diffuse alveolar damage, but it may be overshadowed by an acute bacterial bronchopneumonia.

Link:  http://www.acha.org/ILI_Project/ILI_LatestWeek.cfm

Link:  http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/mar1710hcws.html

Mar 17, 2010 (CIDRAP News) – Requiring healthcare workers to get vaccinated against influenza is one effective way to boost their vaccination rates, and another may be to target immunization messages to workers who are relatively isolated from coworkers, according to reports being presented this week at a conference on healthcare-associated infections.

Flu vaccination has long been recommended for health workers as a way to protect themselves and their patients and coworkers, but immunization rates have hovered in the 40% range for years. …..

Mandated vaccine
Hospital Corporation of America (HCA), a leading healthcare chain, reported that it raised its employees’ flu immunization rate to nearly 97% by requiring vaccination for the 2009-10 season.

Jonathan Perlin, MD, PhD, HCA’s chief medical officer, said flu vaccination is important for health workers because a person can transmit the virus for 24 hours before having any symptoms. Speaking at a press conference held last week in advance of the Decennial meeting, Perlin also cited a study suggesting that 50% of flu-infected health workers have no symptoms.

HCA’s policy required all employees to be vaccinated. Those who could not be immunized because of an egg allergy or history of Guillain-Barre syndrome or refused for nonmedical reasons were reassigned to non-patient contact roles or required to wear surgical masks, according to a press release.

“Nearly 97% of our healthcare workers have been vaccinated, and the remaining 3% are wearing masks, supporting our goal of 100% safety,” said Perlin. “The response from our employees has been overwhelmingly positive; they appreciate knowing they’re protected from being infected by a sick coworker or patients.”

Workers vaccinated under the mandate numbered about 150,000, HCA reported. The chain has 163 hospitals, 112 outpatient clinics, and nearly 400 practices.

HCA previously used a combination of education, conveniently offered immunizations, and declination forms to induce workers to get their flu shot. These tactics yielded modest improvements but were inadequate for complete patient safety, the press release said.

The mandatory policy was developed by representatives of many disciplines. It was accompanied by prevention efforts such as promoting cough etiquette, proper hand hygiene, sick-visitor guidelines, and environmental cleaning, HCA reported.

“We believe that programs such as ours will become standard of care,” Perlin said.

Not-quite-mandatory vaccine
At Children’s Mercy Hospital and Clinics in Kansas City, a less coercive approach—requiring employees either to be vaccinated or to decline in writing—boosted vaccination coverage to 90.5%, according to Robyn Livingston, MD, the hospital’s director of infection control and prevention.

The hospital’s immunization rate in 2004 was 63%. The system introduced the vaccination/declination policy in 2008, which increased coverage to 85% that year, according to a press release.

For the 2009-10 season, officials stiffened the policy by adding consequences, including a forced leave of absence, for those who didn’t take the vaccine or formally decline. As a result, the vaccination rate rose to 90.5%, and 98.8% of workers complied with the policy.

“Even though this program has exceeded our expectations, we recognize there is still room for improvement,” Livingston said in the press release. “We are considering a fully mandatory influenza vaccination policy to begin next fall.”

Vaccinated-coworker approach
In another study featured at the meeting, researchers from University of Iowa Health Care in Iowa City said they determined that health workers were more likely to be vaccinated if their near coworkers were vaccinated.

Donald Curtis, a graduate student in the university’s Computational Epidemiology Research Group, used data from the university’s electronic medical record system to assess employees’ level of interactions with coworkers and determine their vaccination status. The data were stripped of personal details but included login times, locations, and vaccination status.

“We found a significant association between vaccination rates and healthcare workers who worked closely with other vaccinated workers,” Philip Polgreen, MD, an assistant professor at University of Iowa Health Care, said at the press conference.

Employees “were more likely to be vaccinated if their closest coworkers were vaccinated,” he said. “We think our results may be able to help inform hospital vaccination campaign strategies.”

Polgreen cautioned that the social patterns inferred from the data are only a proxy for actual social interactions, since the strength of relationships was estimated from the frequency of being in the same part of the hospital at the same time.

He said the research team gathered data on employees’ job classification and type and whether or not they were in patient care, but didn’t assess the effects of other possibly relevant variables, such as age.

Link:  http://content.nejm.org/cgi/content/full/362/11/e40?query=TOC

NEJM Volume 362:e40

A 46-year-old woman presented with a history of 3 days of pruritus in the anal area and 1 day of excretion of tapelike materials. During the year before presentation, she had reported intermittent colicky abdominal pain and loose stool, which had been attributed to irritable bowel syndrome. Laboratory evaluation was unremarkable, with no evidence of anemia. Colonoscopy revealed a long, moving tapeworm, Diphyllobothrium latum, located in the terminal ileum and extending to the sigmoid colon. D. latum is a fish tapeworm that can infect humans after they consume infected undercooked or raw fish. The patient had a history of eating raw fish and recalled eating raw trout most recently 2 months before presentation. She was treated with a single dose of praziquantel. After administration, the abdominal pain resolved, but she continued to have intermittent loose stool.

Link:  http://content.nejm.org/cgi/content/short/362/11/994?query=TOC

NEJM Volume 362:994-1004

Background It is unclear whether dissemination of automated external defibrillators (AEDs) in public places can improve the rate of survival among patients who have had an out-of-hospital cardiac arrest.

Methods From January 1, 2005, through December 31, 2007, we conducted a prospective, population-based, observational study involving consecutive patients across Japan who had an out-of-hospital cardiac arrest and in whom resuscitation was attempted by emergency responders. We evaluated the effect of nationwide dissemination of public-access AEDs on the rate of survival after an out-of-hospital cardiac arrest. The primary outcome measure was the 1-month rate of survival with minimal neurologic impairment. A multivariate logistic-regression analysis was performed to assess factors associated with a good neurologic outcome.

Results A total of 312,319 adults who had an out-of-hospital cardiac arrest were included in the study; 12,631 of these patients had ventricular fibrillation and had an arrest that was of cardiac origin and that was witnessed by bystanders. In 462 of these patients (3.7%), shocks were administered by laypersons with the use of public-access AEDs, and the proportion increased, from 1.2% to 6.2%, as the number of public-access AEDs increased (P<0.001 for trend). Among all patients who had a bystander-witnessed arrest of cardiac origin and who had ventricular fibrillation, 14.4% were alive at 1 month with minimal neurologic impairment; among patients who received shocks from public-access AEDs, 31.6% were alive at 1 month with minimal neurologic impairment. Early defibrillation, regardless of the type of provider (bystander or emergency-medical-services personnel), was associated with a good neurologic outcome after a cardiac arrest with ventricular fibrillation (adjusted odds ratio per 1-minute increase in the time to administration of shock, 0.91; 95% confidence interval, 0.89 to 0.92; P<0.001). The mean time to shock was reduced from 3.7 to 2.2 minutes, and the annual number of patients per 10 million population who survived with minimal neurologic impairment increased from 2.4 to 8.9 as the number of public-access AEDs increased from fewer than 1 per square kilometer of inhabited area to 4 or more.

Conclusions Nationwide dissemination of public-access AEDs in Japan resulted in earlier administration of shocks by laypersons and in an increase in the 1-month rate of survival with minimal neurologic impairment after an out-of-hospital cardiac arrest.

Link:  http://www.medicalnewstoday.com/articles/182436.php

Avoiding Visits To Emergency Departments By Dying Cancer Patients

16 Mar 2010   

Many visits by dying cancer patients to the emergency department can be avoided with effective palliative care, states an article in the Canadian Medical Association Journal (CMAJ). In Ontario, about 40% of cancer patients visit the emergency department in the last 2 weeks of life.

A study was conducted to examine how often and why people dying of cancer visit the emergency department near the end of life. These visits are an ordeal since wait times are long and uncomfortable. They are also disruptive, distressing and exhausting for patients and their families. Emergency room visits at the end of life are considered an indicator of poor quality care for cancer patients.

“Patients who are near death should have their symptoms controlled and cared for in a setting of their choice, instead of on an emergency basis,” write Dr. Lisa Barbera, Odette Cancer Centre (Toronto, Ontario) and coauthors. “While some people have unexpected urgent medical problems that need an emergency department visit, the rest of the visits are likely avoidable.”

In Ontario, 91 561 patients died of cancer between 2002 and 2005 and were included in this study. In the last six months of life, 76 759 patients had 194 017 visits to the emergency department and 31 076 patients had 36 600 visits to the emergency department in the last two weeks of life.

Abdominal pain, breathing difficulties, pneumonia, malaise and fatigue and fluid in the chest were the most common reasons for visits to the emergency department both in the last six months and two weeks of life. Lung cancer was the most common primary cancer.

“Understanding why patients visit the emergency department near the end of life offers insight into the nature of the problems they experience and provides direction for possible interventions,” write the authors. “With comprehensive and coordinated palliative care, individuals could be managed in the clinic, at home and in palliative care units or residential hospices without the need for an emergency visit. The majority of the reasons for visits are within the scope of palliative care expertise.”

Source:
Kim Barnhardt
Canadian Medical Association Journal 

Avoiding Visits To Emergency Departments By Dying Cancer Patients

16 Mar 2010   

Many visits by dying cancer patients to the emergency department can be avoided with effective palliative care, states an article in the Canadian Medical Association Journal (CMAJ). In Ontario, about 40% of cancer patients visit the emergency department in the last 2 weeks of life.

A study was conducted to examine how often and why people dying of cancer visit the emergency department near the end of life. These visits are an ordeal since wait times are long and uncomfortable. They are also disruptive, distressing and exhausting for patients and their families. Emergency room visits at the end of life are considered an indicator of poor quality care for cancer patients.

“Patients who are near death should have their symptoms controlled and cared for in a setting of their choice, instead of on an emergency basis,” write Dr. Lisa Barbera, Odette Cancer Centre (Toronto, Ontario) and coauthors. “While some people have unexpected urgent medical problems that need an emergency department visit, the rest of the visits are likely avoidable.”

In Ontario, 91 561 patients died of cancer between 2002 and 2005 and were included in this study. In the last six months of life, 76 759 patients had 194 017 visits to the emergency department and 31 076 patients had 36 600 visits to the emergency department in the last two weeks of life.

Abdominal pain, breathing difficulties, pneumonia, malaise and fatigue and fluid in the chest were the most common reasons for visits to the emergency department both in the last six months and two weeks of life. Lung cancer was the most common primary cancer.

“Understanding why patients visit the emergency department near the end of life offers insight into the nature of the problems they experience and provides direction for possible interventions,” write the authors. “With comprehensive and coordinated palliative care, individuals could be managed in the clinic, at home and in palliative care units or residential hospices without the need for an emergency visit. The majority of the reasons for visits are within the scope of palliative care expertise.”

Source:
Kim Barnhardt
Canadian Medical Association Journal

Link:   http://www.ems1.com/technology/articles/771153-NC-adds-tourniquets-to-EMS-treatment-protocols/

PASQUOTANK COUNTY, N.C — Pasquotank County paramedic Jack Boyce slipped a manufactured tourniquet on his arm, pulled the strap tight and twisted the plastic crank until blood vessels bulged from his wrist.

The demonstration was done in seconds.

Shunned in the past, the mechanical tourniquets proved to be life savers with few side effects after the Sept. 11 attacks and in the Iraq war.

On April 1, Pasquotank and Camden counties will stock ambulances for the first time with the manufactured tourniquets.

Tourniquets will remain a last resort, but life-threatening arterial bleeding from vehicle and aircraft crashes and accidents with farm equipment or chain saws are always possible, said Jerry Newell, director of the Pasquotank-Camden Emergency Medical Service.

“We’ve got the potential around here,” he said. “If you’re putting this on somebody, it’s life or death. They’re bleeding out.”

Tourniquets are part of 58 new training and treatment protocols required by North Carolina’s Office of Emergency Medical Services to be in place by April 1.

“We wanted to standardize treatment statewide,” said Drexdal Pratt, chief of the agency.

Statewide protocols were put in place in 2000 and have been updated regularly. This is the first time tourniquets were included, Pratt said.

Few complications
New manufactured tourniquets, quick to use and easily controlled, can save lives with few or no complications — such as loss of the limb — especially with typically quick transports to the hospital, Dr. Greg Mears, North Carolina EMS medical director, said in an e-mail.

“There has been better evidence that appropriate tourniquet use is less detrimental to distal tissue than previously thought,” Mears said, “especially when used in a more controlled setting with better equipment and better tourniquet pressure control.”

Successful treatment of blast injuries after Sept. 11 and in Iraq have promoted the use of tourniquets, he said.

“It is now being taught in these preparedness courses,” Mears said.

New tourniquets purchased for local ambulances have a padded U-shaped band that fits over the appendage while a strap cinches around the other side through a clasp. A plastic half-circle can be cranked, tightening the strap until blood flow is stopped. A quick-release button eases tension immediately when needed.

“It takes about 15 seconds,” Newell said.

Currituck, Pasquotank and Camden will use also use other treatment upgrades in the protocols, including a continuous positive airway pressure machine, a device that pushes air into the lungs if the patient has quit breathing.

Another new device is the adult intraosseous, or IO, which injects an IV directly into bone marrow and is used only when a blood vessel is inaccessible.

Currituck also plans to use a protocol for aquatic bites, such as putting vinegar on jellyfish stings, typical for counties that border the ocean.