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EMTs bring the emergency room to the patient – EMS1.com

EMTs, ambulance crews trained to respond quickly to medical emergencies, trauma situations and accidents, are a critical but often overshadowed component of public safety

By Susan Spencer Telegram & Gazette, Worcester, Mass.

WORCESTER They’ve pulled injured people out of burning buildings, performed ice rescues, delivered babies while on the road, started IVs and intubations in the back of a truck, and revived far too many people who have overdosed on opioids with their ever-present supply of Narcan.

Emergency medical technicians, ambulance crews trained to respond quickly to medical emergencies, trauma situations and accidents, are a critical but often overshadowed component of public safety.

They’ll be found working in what one EMT called “a well-choreographed dance” with firefighters and police officers anytime a 911 call comes in. But often the role of emergency medical services as health care providers gets lost from public view in the tidy news summary that a patient was rushed to the hospital.

May 21-27 is the 43rd annual National EMS Week, in which the National Association of EMTs, in partnership with the American College of Emergency Physicians, seeks to recognize the vital contribution of EMTs to community health and safety.

A Telegram & Gazette reporter and photographer rode along with Worcester Emergency Medical Services paramedics this week, getting a view from the road of calamities large and small. On these days, it was mainly the everyday stuff of age, illness and disability — perhaps not dramatic, but the conditions and events that ultimately take their toll on most people.

Worcester EMS is a clinical department of UMass Memorial Medical Center. With approximately 90 paramedics, EMTs who have the highest level of training, Worcester EMS contracts with Worcester and Shrewsbury to provide around-the-clock coverage.

Seven ambulances drive all day in Worcester and four handle the nights. Shrewsbury has one ambulance assigned during the day and one at night, but Worcester will cover for Shrewsbury if needed.

In addition to the ambulances, supervisors, who are also paramedics, ride the streets in two Chevrolet Tahoes or a Suburban, outfitted with communications equipment and medical supply bags, to direct emergency response, coordinate with police and fire departments, or provide backup.

Serious situations or not, Worcester EMS gets 40,000 calls per year between the two communities, averaging 90 to 115 a day, according to Capt. Mark Wilson, one of four captains in charge of the department.

Capt. Wilson has worked with EMS since 1980 when it was operated out of Worcester City Hospital. It moved in 1991 to what was then UMass Medical Center.

“The whole city has changed. Every intersection is different from when I started,” he said.

What used to be eight hospitals receiving emergency patients is now three. The population has increased too, as has the proportion of people who call EMS.

Capt. Wilson said, “People are using the emergency system more as primary care. It’s a lot more busy.”

Emergency 911 calls go to the Worcester Emergency Communications Center, which dispatches to the appropriate agency — fire, police or EMS. Most calls now come in by cellphone, however, and those first get routed to Massachusetts State Police in Weston and then to the local community.

Worcester Regional Transit Authority buses can also radio EMS.

According to Capt. Wilson, the EMS system is moving in the next year to have cellphone calls go to the closest EMS department. Text messages and FaceTime video calls are also on the horizon.

“You can get 15 calls in 45 minutes,” Capt. Wilson said. And although some people call an ambulance so they don’t have to pay for a cab to the hospital, “We’re required to respond, by the commonwealth. We cannot make that judgment over the phone.”

The high volume and variety of calls Worcester EMS handles have made it one of the most active departments in the state and a place where even paramedics from Boston come to sharpen their skills.

Christian Grant, 25, is one of those who started his career with Worcester EMS, then got a full-time job with Boston MedFlight air ambulance. But he still works 30 to 40 hours a week as a per diem paramedic in Worcester.

Waiting for a call at the former Providence Street fire station, one of three ambulance hubs in the city, he said, “One of the bigger things here is you deal with everything. You are on all the calls.”

Violence, drugs, Mr. Grant has worked on it. “This is a very addicting place to work,” he said.

Worcester EMS crews are stationed at garages at 23 Wells St. and UMass Memorial’s University Campus on Lake Avenue, in addition to Providence Street, to get to calls throughout the city as quickly as possible. In Shrewsbury, the ambulance is based at the Harrington Street fire station.

Driving through Worcester’s narrow streets, including unpaved residential neighborhoods, is a constant challenge. The DCU area downtown “is a nightmare,” Capt. Wilson said, especially in the afternoon and evening when school buses and commuters are on the road.

“Drivers have gotten better (about letting EMS through),” he said. “But the biggest thing is they don’t come to a stop.” And while bicycles haven’t been much of an obstacle, pedestrians who aren’t in crosswalks and aren’t paying attention present another hazard.

The radio crackled as Capt. Wilson drove around the city in the SUV on a recent weekday afternoon. An iPad on the console showed the location of the ambulances.

A call came in from 67 Belmont St., a medical office building at UMass Memorial’s Memorial Campus. An elderly woman had fallen when coming in from the parking lot, suffering a cut over her eye.

Capt. Wilson turned on the siren in bursts, which has been shown to be more effective in gaining drivers’ attention than a continuous siren, and arrived first on the scene. He jumped out of the SUV, medical bag in hand, and started checking the patient’s condition.

Soon police, firefighters and an ambulance arrived, with paramedics Evan Kirby and Eric Laighton, who took over care of the patient. Although the injury didn’t appear life-threatening, the paramedics placed the woman on a stretcher and took her to St. Vincent Hospital.

The scene was quickly repeated with a call to East Mountain Street, where a man in his 40s was suspected of having a stroke.

In addition to police and firefighters, Worcester EMS paramedics Darren Brock and Andrew Person were on the scene, assisting the patient.

Worcester EMS paramedics started an intravenous line in the patient and transported him to UMass Memorial’s University Campus emergency department.

From the second they arrive at the hospital, EMTs have 20 minutes to check the patient in, bring the patient to the treatment room, give the resource nurse all the necessary medical information, and then clean and prepare their ambulance for the next patient. It’s a precision operation, requiring an ability to focus calmly while multitasking.

Another call came in for a combative patient in an altered state, whom paramedics Patrick Ring and Eddie Murphy interviewed and took to UMass Memorial for an emergency mental health referral.

Capt. Wilson said the number of people in police custody has increased over the years, whether they’re intoxicated or having a mental health crisis.

“It’s important to use your persuasion skills and to listen,” he said. Some communities include social workers with EMTs to help with these calls.

Most of the time, though, Capt. Wilson said, “You see a lot of medical issues. With the baby boomer population, there’s an influx of heart, aging, diabetic, respiratory issues. Everyone who’s young thinks it isn’t going to happen to them, until it happens to them.”

And then there are the motor vehicle crashes, such as the next call. A “rollover with entrapment” was on Acton Street. The driver, a woman who was alone in the car, had been wearing her seat belt and was uninjured as she stood up in the car, which was resting on its driver’s side. Firefighters needed to stabilize the car before they could get her out.

Once she was safely extricated, EMTs sat the woman on a stretcher and assessed her condition, but she declined further treatment.

Capt. Wilson said improved safety features and more people wearing seat belts have cut down on serious vehicle-related injuries. “The biggest thing is, you don’t get ejected from the vehicle if you wear a seat belt,” he said. Injuries suffered in the vehicle are usually minor.

On another afternoon, EMS supervisor Bill Humphrey drove around during an unusually quiet spell, after a nonstop morning. A few calls came in, one for an elderly man with a fever and shortness of breath, and another for a middle-aged woman with suspected seizure who was described as “in an altered state.”

Paramedics, firefighters and police officers efficiently did their jobs, with compassion and attentiveness to each patient. Vital signs were checked and IVs were started.

“It’s a version of the emergency room coming to the patient,” Mr. Humphrey said.

Efforts to professionalize emergency medical services took off in 1976, with the passage of a federal law outlining training and equipment standards. The field has been building research to improve pre-hospital emergency care, which means EMTs must keep training and gaining experience. Among the updated practices, for instance, studies found that backboards generally aren’t as important as a cervical collar to stabilize the spine, for patients under age 65.

EMTs have to be recertified by the state Department of Public Health’s Office of Emergency Medical Services every two years, which requires 60 hours of continuing education.

The wage for new paramedics starts around $16 an hour, according to Mr. Humphrey, and it goes up slowly to around $22 an hour.

“EMS is in its infancy,” he said. “It’s still working on itself.” ___ (c)2017 Telegram & Gazette, Worcester, Mass.

McClatchy-Tribune News Service

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Manchester bombing: We treated kids whose names we didn’t know, doctor says – USA TODAY

Queen Elizabeth II on Thursday visited in hospital some of the children injured in the Manchester terror attack which killed 22 people. Video provided by AFP Newslook

Staff at the Royal Manchester Children’s Hospital stand next to donations made to a charity connected to the facility on May 25. The donations are for the families and victims of the Manchester attack as well as for the doctors and nurses treating them.(Photo: Kim Hjelmgaard/USA TODAY)

MANCHESTER, England Doctor Steve Jones didn’t have a lot of information. He didn’t know why there was an explosion. He didn’t know much about singer Ariana Grande. He didn’t know the children who came into his emergency room, bloodied and crying.

But there was one thing he did know: It was time for him to try and save lives. Even if he didn’t know their names.

“The anonymity of it was also hard,” said Jones, a surgeon at Central Manchester University Hospital NHS Foundation Trust. “Some of the kidswere separated from their families for a time. We were treating children and we just didn’t know who they were.”

The horror of Monday night’s bombing in Manchester, which left 22 dead and over 100injured, is particularly difficult for doctors and emergency personnel. Many of Ariana Grande’s fans are young people, and many of the concert-goers were teenagers or even younger, accompanied by their moms, sisters and brothers.

Related:

Manchester bombing: Ariana Grande’s stage manager recalls explosion, pandemonium

It made the tragedy even more palpable for Jones and his fellow doctors and nurses, who struggled with some of the most difficult injuries to treat: Blast wounds. In children, no less.

Jones wouldn’t reveal specific details about the injuries, thought to include amputations, damage to major organs and serious head injuries, but he did offer some observations about what it was like to respond to Britain’s worst terrorist-relatedatrocity ina decade.

“The kid thing is particularly tricky,” he said. “As a doctor, it’s easy to be in the moment, you can do things, but the real difficulty that we’ve all felt with this incident is that it’s not just one child, and the ‘you can go off and have a cup of tea and have a chat with a friend’ it was the volume and severity of it.”

Joneswas roused from a deep sleep at home just before 11 p.m. on that night. The hospital was asking if he had heard the news.

He hadn’t. He was also not familiar with Grande’s music. His first thought was that the injured would probably be adults. He wasn’t sure how long he would be neededand or ifhe would need to rest in between. He took along a sleeping bag just in case.

When he arrived at the ER, part of a campus of medical facilities that includesthe Royal Manchester Children’s Hospital, he was surprised to see so many families and kids.

Many of the 116 people who sustained injuries in Monday’s attack atManchester Arena were treated in the emergency rooms that Jones presides over. Seventy-five people are still receiving careacross eight Manchester hospitals. Eight children remain in a critical condition. At least six children were killed in the blast.The youngest,Saffie Rose Roussos, was 8. All thevictims of the attackhave now been identified.

Jones said the injuries his staff treated that night are fairly typical of blast trauma, or, as he puts it, the “consequences of lots of things flying around.”

He said that the team of doctors he manages performed so well that he was able to spend most of the night comforting families. “I say ‘thank you’ a lot in this job,” he said, referring to how proud he was of his team’s clinical response to the attack. “On this particular occasion, ‘thank you’ just doesn’t seem enough.”

Surgeon Steve Jones in Manchester on May 25.(Photo: Kim Hjelmgaard/USA TODAY)

Investigators believe that the explosive materialsused in the bomb detonated by22-year-old Salman Abedi were the sameas those used in terrorist attacks in Brussels and Paris, and in the 2005 bombings in London. The bomb was packed with nuts and bolts to cause maximum damage.

When Queen Elizabeth visited the Royal Manchester Children’s Hospital on Thursday to meet patients and praise the hospital’s staff, she described Monday’s incident as a”wicked” act. “The awful thing was that everyone was so young. The age of them,” she said.

During the visit, Grant Barlowtold the queen how when his daughter Amy, 12, suffered injuries to her legs outside the concert hall a man selling T-shirtsripped them up to help stem the bleeding. “He used the T-shirts as bandages,” Barlow told her.

When USA TODAY visited a charity that is connected to Royal Manchester Children’s Hospital, there were piles of donations stacked up against a wall. Mostly small bags and containers ofpotato chips, cookies and sweets, but also toiletries, bottles of water and other consumables.

Sarah Naismith, the charity’s director, explained that many people from around Britain have been eager to help. “Firemen, students, companies, they’ve all been calling up saying ‘whatever you need, it’s yours.'”

Britain’s Queen Elizabeth II speaks to Amy Barlow who was injured in the Manchester Arena terrorist attack along with her mother Kathy during a visit to the Royal Manchester Children’s Hospital.(Photo: Peter Byrne, AFP/Getty Images)

“Everyone’s felt that they needed to do something. It’s been an emotional roller-coaster,” she said.But Naismithfought back tears when asked how she was doing.

“I have three children and to think of the horror that people saw, you can’t fathom it.” she said.

Soon afterNaismith finished speaking, Manchester resident Simeon Gunningstopped by to donate some cases of soup and other goods.

“I thought it would be helpful,” he said. “Me and a couple of friends put a little money together and just tried to do what we could, to help the families.”

Gunning said that “as a (regular) person” he felt a little powerless in the face of all thecarnage.

“You can’t really do anything to help fix their injuries, so what can you do besides put your hand in your pocket and try to do something that way?” he said. Then he added, “Manchester Strong,” anecho of the “Boston Strong slogan that popped up in reaction to the Boston Marathon bombing in April 2013.

For Dr. Jones, there was recognition that Manchester, its victims and its healers, would be dealing withthe consequences of the attack for some time.

“This is not an ‘on’ and ‘off’thing,” Jones said.

As for the sleeping bag that he brought to the hospital Monday night? By the time he left the next morning at 10 a.m., he hadn’t used it.

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Can Comfort Care At The ER Help Older People Live Longer And … – NPR

As baby boomers age, more older Americans are visiting the emergency room, which can be an overcrowded, disorienting and even traumatic place. Heidi de Marco/Kaiser Health News hide caption

As baby boomers age, more older Americans are visiting the emergency room, which can be an overcrowded, disorienting and even traumatic place.

A man sobbed in a New York emergency room. His elderly wife, who suffered from advanced dementia, had just had a breathing tube stuck down her throat. He knew she never would have wanted that. Now he had to decide whether to reverse the life-sustaining treatment that medics had begun.

When Dr. Kei Ouchi faced this family as a young resident at Long Island Jewish Medical Center, he had no idea what to say. The husband, who had cared for his wife for the past 10 years, knew her condition had declined so much that she wouldn’t want to be rescued. But when Ouchi offered to take out the tube, the man cried more: “She’s breathing. How can we stop that?”

Ouchi had pursued emergency medicine to rescue victims of gunshot wounds and car crashes. He was unprepared, he says, for what he encountered: a stream of older patients with serious illnesses like dementia, cancer and heart disease patients for whom the life-saving techniques he was trained to perform often only prolonged the suffering.

As baby boomers age, more of them are visiting the emergency room, which can be an overcrowded, disorienting and even traumatic place. Adults 65 and older made 20.8 million emergency room visits in 2013, up from 16.2 million in 2000, according to the most recent hospital survey by the Centers for Disease Control and Prevention. The survey found 1 in 6 visits to the ER were made by an older patient, a proportion that’s expected to rise.

Half of adults in this age group visit the ER in their last month of life, according to a study in the journal Health Affairs. Of those, half die in the hospital, even though most people say they’d prefer to die at home.

Some states on board

The influx is prompting more clinicians to rethink what happens in the fast-paced emergency room, where the default is to do everything possible to extend life. Hospitals across the country including in Ohio, Texas, Virginia and New Jersey are bringing palliative care, which focuses on improving quality of life for patients with advanced illness, into the emergency department.

Interest is growing among doctors: 149 emergency physicians have become certified in palliative care since that option became available just over a decade ago, and others are working closely with palliative care teams. But efforts to transform the ER face significant challenges, including a lack of time, staffing and expertise, not to mention a culture clash.

Researchers who interviewed emergency room staff at two Boston hospitals, for instance, found resistance to palliative care. ER doctors questioned how they could handle delicate end-of-life conversations for patients they barely knew. Others argued that the ER, with its “cold, simple rooms” and drunken patients screaming, is not an appropriate place to provide palliative care, which tends to physical, psychological and spiritual needs.

Ouchi saw some of these challenges during his residency in New York, when he visited the homes of older patients who frequently visited the emergency room. He saw how obstacles like transportation, frailty and poor vision made it difficult for them to leave the house to see a doctor.

“So what do they do?” Ouchi asks. “They call 911.”

When these patients arrive at the emergency room, doctors treat their acute symptoms, but not their underlying needs, Ouchi says. In more severe cases, when the patient can’t talk and doesn’t have an advanced directive or a medical decision-maker available, doctors pursue the most aggressive care possible to keep them alive: CPR, intravenous fluids, breathing tubes.

“Our default in the ER is pedal to the metal,” says Dr. Corita Grudzen, an emergency physician at NYU Langone Medical Center who studies palliative care in the ER. But when doctors learn after the fact that the patient would not have wanted that, the emergency rescue forces families to choose whether to remove life support.

When older adults are very ill if they need an IV drip to maintain blood pressure, a ventilator to breathe, or medication to restart the heart they are most likely to end up in an intensive care unit, where the risk of developing hospital-acquired infections and delirium is increased, Grudzen says. Meanwhile, it’s not clear whether these aggressive interventions really extend their lives, she adds.

Some have sought to address these problems by creating separate, quieter emergency rooms for older patients. Others say bringing palliative care consultations into regular emergency rooms could reduce hospitalization, drive down costs and even extend life.

There’s no hard evidence that this approach will live up to its promise. The only major randomized controlled trial, which Grudzen led at Mount Sinai Hospital in New York City, found that palliative care consultations in the emergency room improved quality of life for cancer patients. It did not find statistically significant evidence that the consultations improved rates of survival, depression, ICU admission or discharge to hospice.

Trying to avert suffering

But frontline doctors say they’re seeing how palliative care in the ER can avert suffering. For instance, Ouchi recalls one patient a man, in his late 60s who showed up at the emergency room for the fifth time in six months with fever and back pain. Previous visits hadn’t addressed the underlying problem: The man was dying of cancer.

This time, a nurse and social worker called in a palliative care team, who talked to the patient about his goals.

“All he wanted was to be comfortable at home,” Ouchi says. The man enrolled in hospice, a form of palliative care for terminally ill patients. He died about six months later, at home.

Now Ouchi and others are trying to come up with systematic ways to identify which patients could benefit from palliative care.

One such screening tool, dubbed P-CaRES, developed at Brown University in Providence, R.I., gives ER doctors a list of questions. Does the patient have life-limiting conditions such as advanced dementia or sepsis? How often does the patient visit the ER? Would the doctor be surprised if the patient died within 12 months?

Doctors are using the tool to refer patients at the University of California-San Francisco Medical Center at Parnassus to palliative care doctors, says Dr. Kalie Dove-Maguire, a clinical instructor there. The questions pop up automatically on the electronic medical record for every ER patient who is about to be admitted to the hospital.

Dove-Maguire says UCSF hasn’t published results, but the tool has helped individual patients, including a middle-aged man with widespread cancer who showed up at the ER with low blood pressure. The man “would have been admitted to the ICU with lines and tubes and invasive procedures,” she says, but staff talked to his family, learned his wishes and sent him to home hospice.

“Having that conversation in the ER, which is the entry point to the hospital, is vital,” Dove-Maguire says.

Measured in minutes

But time is scarce in ERs. Doctors’ performance is measured in minutes, Grudzen notes, and the longer they stop to make calls to refer one patient to hospice, the more patients line up waiting for a bed.

Finding someone to have conversations about a patient’s goals of care can be difficult, too. Ouchi enlisted ER doctors to use the screening tool for 207 older ER patients at Brigham and Women’s Hospital in Boston, where he now works as an emergency physician. They found a third of the patients would have benefited from a palliative care consultation. But there aren’t nearly enough palliative care doctors to provide that level of care, Ouchi says.

“The workforce for specialty palliative care is tiny, and the need is growing,” says Grudzen.

Palliative care is a relatively new specialty, and there’s a national shortfall of as many as 18,000 palliative care doctors, according to one estimate.

“We’ve got to teach cardiologists, intensivists, emergency physicians, how to do palliative care,” she said. “We really have to teach ourselves the skills.”

Kaiser Health News is an editorially independent part of the Kaiser Family Foundation.

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Can Comfort Care At The ER Help Older People Live Longer And … – NPR

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Spike in opioid visits at ECMC pushes ER doctors to front lines of epidemic – Buffalo News

Opioid-related emergency room visits at Erie County Medical Center more than doubled from 2009 to 2016, a startling rise reflective of the addiction epidemic in Western New York and across the country.

The growth mirrors an increase in opioid deaths and, like the fatalities tied to drug abuse, the patients come from every corner of the region urban, suburban and rural.

An examination of nearly 17,000 opioid-related patient visits at one of Buffalo’s busiest hospitals offers a snapshot of the epidemic, and suggests current estimates of hospital visits connected to opioid use in the region are underestimated.

Data from ECMC also reveal the central role emergency departments have come to play in the wake of the extraordinary expansion in the use of narcotic pain relievers in the United States and the growing abuse of heroin.

Among the results:

In recent years, as the opioid epidemic swept the nation, emergency room doctors have been pressured to reduce their prescribing of addictive painkillers for chronic pain.But now, so many patients arrive in emergency rooms with a history of opioid use that emergency rooms are coming to be seen as a potentially ideal place to start addiction treatment.

This represents a fundamental change for a hospital service focused on stabilizing patients with immediate medical concerns and referring them elsewhere for follow-up care.

“Emergency departments can be a real-time source of information on public health problems like this one. They can also be a foot in the door to getting people addicted to drugs the care they need,” said Dr. Ronald Moscati, an emergency room physician and co-leader of a seven-year study of opioid-related visits at the medical center. “It’s a horrible disease and very difficult to treat.”

More visits from outside the city

The review by Moscati and his colleagues attempted a truer accountingof the ways opioid use ispushing people into hospitals. Most hospitals track opioid-related visitsby looking at counts of addicted patients who arrive in emergency rooms seeking detoxification, suffering from withdrawal symptoms or having overdosed. But in many other cases such as patients who injure themselves or feel ill for other reasons opioids turn out to be a contributing factor.

ECMC sought to track allthe reasons opioid users land in the emergency room.

Of the462,983 patient visits to the ECMC emergency departmentfrom June 2009 through June 2016, 3.6 percent, or16,712,had anopioid connection, particularly patients who overdosed on drugs or requested detoxification treatment.

As the years went on,a greater share of theopioid-related visits came from outside the City of Buffalo, jumping from 42 percent in 2009 to a high of 62 percent in 2014.

Whites represented 59 percent of the patients in 2009 but, otherwise, accounted for about 82 percent of opioid-related cases each year afterward. Most of the patients 63 percent on average were male.The median age grew from 28 to 31.

The statistics include patients who may have visited the emergency room multiple times. But the researchers say the trends at ECMC represent those in the larger community because the emergency department receives a majority of the opioid overdose patients in the region, and is the only emergency department to offer specialized services for trauma, psychiatric emergencies and acute substance abuse detoxification.

Opioid-related emergency room visits at Erie County Medical Center more than doubled from 2009 to 2016. (Derek Gee/Buffalo News file photo)

“There is no mystery to what we found,” Moscati said. “We’ve confirmed in an objective way what was an impression of what is happening, and that gives us better insight for targeting education and treatment.”

The chart review, which was organized by the University at Buffalo emergency medicine department, suggests a way to improve regional surveillance of opioid trends, much like the flu and other communicable diseases are tracked. It also argues for greater involvement in addiction care by emergency medicine doctors.

“We see this as a potential way to see the changes in the overall picture over time,” said Heather Lindstrom, research director of UB Emergency Medicine and a co-author of the study.

Starting addiction treatment in the ER

Addicts looking for help confront a health system with a shortage of treatment options, especially access to buprenorphine, a medication also known as Suboxone that is used to reduce cravings. In 2015, fewer than 20 percent of people in the United States who needed addiction treatment received it, according to the National Survey on Drug Use and Health sponsored by the Department of Health and Human Services.

Emergency room doctors focus on evaluating and stabilizing seriously ill and injured patients. But as physicians, advocates and public health officials grapple with the challenges of how to deal with a mounting number of opioid addictions and overdoses, they are looking at the emergency department as a place to start addiction treatment.

“Historically, in the emergency department, we’ve given people with addiction problems a list of phone numbers for treatment at discharge after their immediate concerns have been taken care of. But too many of them leave, use again and overdose again,” said Dr. Joshua Lynch, an emergency room doctor at ECMC and Kaleida Health involved in an initiative in Erie County to establish medication-assisted addiction treatment in emergency rooms.

Opioids include the illegal drug heroin, as well as powerful pain relievers available by prescription, such as oxycodone, hydrocodone and fentanyl. Experts say an explosion in the use of prescription opioids in the past few decades led to increased use of heroin.

“There is no overnight fix. Policies have to change. The stigma of addiction has to change. Doctors need to be trained,” he said. “But we should be treating addiction like any other medical problem.”

The idea of starting treatment in the emergency room got a big boost from a 2015 Yale University study thatfound that individuals with opioid addiction who were treated with the medication buprenorphine in the emergency room were more likely to stick with treatment beyond the emergency room by a large margin 78 percent compared to 37 percent of patients who were seen in the emergency department and given a referral for care elsewhere.

Dr. Joshua Lynch in the emergency room at Millard Fillmore Suburban Hospital. (Mark Mulville/Buffalo News)

Lynch, who also chairs the hospital group in the Erie County Opiate Epidemic Task Force, said the project here will take that idea a step further with formal links between emergency departments and addiction treatment services, such as Evergreen Health and others in Buffalo. For most opioid-users, the goal is to screen potential candidates, and ensure they leave the hospital with a treatment plan and a definitive link to a place to get treated. A smaller portion who need medication would receive short-term supplies of buprenorphine or other medications, and linkage to addiction services.

None of this will be easy.

Overcoming health system challenges

Doctors must be trained and certified to prescribe buprenorphine, which is also an opioid. Currently, there are only about four emergency doctors in the area with such training, and addiction patients can be difficult to treat in a busy emergency room. To get physician buy-in, referring treatment services must be reliably available at all hours. To truly succeed, more primary care doctors must be certified in buprenorphine prescribing and willing to follow opioid-addicted patients once they have completed addiction treatment.

There are more than 900,000 doctors in the U.S. who can prescribe addictive painkillers, but only 37,000 who can prescribe buprenorphine.

“This is not just an emergency room or addiction doctor issue. The entire medical community needs to step up,” said Lynch, who anticipates starting addiction treatment at ECMC and Millard Fillmore Suburban Hospital later this year once about a dozen emergency doctors receive training to prescribe buprenorphine.

The county is seeking funding to operate the initiative as a study that will involve UBMD emergency medicine doctors affiliated the University at Buffalo and Columbia University, which has experience in designing research on substance abuse and counseling.

“We have the one study from Yale that looks promising. We want to see if the strategy is effective,” said Dr. Gale R. Burstein, county health commissioner. “But you first need to build capacity for medication-assisted treatment. There is no sense in screening people for possible treatment if there is no treatment.”

Meanwhile, the county continues to maintain a 24-hour addiction hotline, and is making slow but steady progress training primary carephysicians, nurse practitioners and physician assistants to use buprenorphine. That effort moves forward against a strong headwind. Primary care physicians have been reluctant to take on patients with drug addiction problems, especially with the need to perform regular drug testing and a common perception, real or not,that they may be held criminally liable if a patient dies of an opioid overdose.

Patient advocates like Debra Smith applaud the effort.

“One of the biggest situations families face is that someone goes to the emergency room to be stabilized, but they are released after the medical emergency is addressed. That’s their job. They save someone and then release them. The problem is it does not meet the needs of the addiction,” said Smith, whose 26-year-old son, Nathaniel, died in 2015 from an opioid overdose.

Smith, who also serves on the county’s opiate task force, said she’s impressed that physicians and public health officials here have taken the concern seriously and are doing something about it.

“They don’t have all the answers, but they’re trying to deal with this,” she said.

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Spike in opioid visits at ECMC pushes ER doctors to front lines of epidemic – Buffalo News

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This creature sends 100s of victims to Hilton Head’s emergency room each summer – Island Packet (blog)

This creature sends 100s of victims to Hilton Head's emergency room each summer
Island Packet (blog)
One Lowcountry creature is responsible for sending hundreds of patients to the Hilton Head Hospital E.R. every year and it isn't a jellyfish, shark, alligator or a snake. People really seem to be afraid of snakes, but we see probably 10 times the

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This creature sends 100s of victims to Hilton Head’s emergency room each summer – Island Packet (blog)

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Nurse tells Wis. lawmaker that AHCA will increase emergency room visits – Washington Post


Washington Post
Nurse tells Wis. lawmaker that AHCA will increase emergency room visits
Washington Post
May 25, 2017 2:58 PM EDT – Rep. Jim Sensenbrenner (R-Wis.) held a town hall, May 21. (Dan Wilson). May 25, 2017 2:58 PM EDT – Rep. Jim Sensenbrenner (R-Wis.) held a town hall, May 21. (Dan Wilson) …

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Nurse tells Wis. lawmaker that AHCA will increase emergency room visits – Washington Post

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EMTs bring the emergency room to the patient – Worcester Telegram

Susan Spencer Telegram & Gazette Staff @SusanSpencerTG

WORCESTER – They’ve pulled injured people out of burning buildings, performed ice rescues, delivered babies while on the road, started IVs and intubations in the back of a truck, and revived far too many people who have overdosed on opioids with their ever-present supply of Narcan.

Emergency medical technicians, ambulance crews trained to respond quickly to medical emergencies, trauma situations and accidents, are a critical but often overshadowed component of public safety.

They’ll be found working in what one EMT called “a well-choreographed dance” with firefighters and police officers anytime a 911 call comes in. But often the role of emergency medical services as health care providers gets lost from public view in the tidy news summary that a patient was rushed to the hospital.

May 21-27 is the 43rd annual National EMS Week, in which the National Association of EMTs, in partnership with the American College of Emergency Physicians, seeks to recognize the vital contribution of EMTs to community health and safety.

A Telegram & Gazette reporter and photographer rode along with Worcester Emergency Medical Services paramedics this week, getting a view from the road of calamities large and small. On these days, it was mainly the everyday stuff of age, illness and disability – perhaps not dramatic, but the conditions and events that ultimately take their toll on most people.

Worcester EMS is a clinical department of UMass Memorial Medical Center. With approximately 90 paramedics, EMTs who have the highest level of training, Worcester EMS contracts with Worcester and Shrewsbury to provide around-the-clock coverage.

Seven ambulances drive all day in Worcester and four handle the nights. Shrewsbury has one ambulance assigned during the day and one at night, but Worcester will cover for Shrewsbury if needed.

In addition to the ambulances, supervisors, who are also paramedics, ride the streets in two Chevrolet Tahoes or a Suburban, outfitted with communications equipment and medical supply bags, to direct emergency response, coordinate with police and fire departments, or provide backup.

Serious situations or not, Worcester EMS gets 40,000 calls per year between the two communities, averaging 90 to 115 a day, according to Capt. Mark Wilson, one of four captains in charge of the department.

Capt. Wilson has worked with EMS since 1980 when it was operated out of Worcester City Hospital. It moved in 1991 to what was then UMass Medical Center.

“The whole city has changed. Every intersection is different from when I started,” he said.

What used to be eight hospitals receiving emergency patients is now three. The population has increased too, as has the proportion of people who call EMS.

Capt. Wilson said, “People are using the emergency system more as primary care. It’s a lot more busy.”

Emergency 911 calls go to the Worcester Emergency Communications Center, which dispatches to the appropriate agency – fire, police or EMS. Most calls now come in by cellphone, however, and those first get routed to Massachusetts State Police in Weston and then to the local community.

Worcester Regional Transit Authority buses can also radio EMS.

According to Capt. Wilson, the EMS system is moving in the next year to have cellphone calls go to the closest EMS department. Text messages and FaceTime video calls are also on the horizon.

“You can get 15 calls in 45 minutes,” Capt. Wilson said. And although some people call an ambulance so they don’t have to pay for a cab to the hospital, “We’re required to respond, by the commonwealth. We cannot make that judgment over the phone.”

The high volume and variety of calls Worcester EMS handles have made it one of the most active departments in the state and a place where even paramedics from Boston come to sharpen their skills.

Christian Grant, 25, is one of those who started his career with Worcester EMS, then got a full-time job with Boston MedFlight air ambulance. But he still works 30 to 40 hours a week as a per diem paramedic in Worcester.

Waiting for a call at the former Providence Street fire station, one of three ambulance hubs in the city, he said, “One of the bigger things here is you deal with everything. You are on all the calls.”

Violence, drugs, Mr. Grant has worked on it. “This is a very addicting place to work,” he said.

Worcester EMS crews are stationed at garages at 23 Wells St. and UMass Memorial’s University Campus on Lake Avenue, in addition to Providence Street, to get to calls throughout the city as quickly as possible. In Shrewsbury, the ambulance is based at the Harrington Street fire station.

Driving through Worcester’s narrow streets, including unpaved residential neighborhoods, is a constant challenge. The DCU area downtown “is a nightmare,” Capt. Wilson said, especially in the afternoon and evening when school buses and commuters are on the road.

“Drivers have gotten better (about letting EMS through),” he said. “But the biggest thing is they don’t come to a stop.” And while bicycles haven’t been much of an obstacle, pedestrians who aren’t in crosswalks and aren’t paying attention present another hazard.

The radio crackled as Capt. Wilson drove around the city in the SUV on a recent weekday afternoon. An iPad on the console showed the location of the ambulances.

A call came in from 67 Belmont St., a medical office building at UMass Memorial’s Memorial Campus. An elderly woman had fallen when coming in from the parking lot, suffering a cut over her eye.

Capt. Wilson turned on the siren in bursts, which has been shown to be more effective in gaining drivers’ attention than a continuous siren, and arrived first on the scene.He jumped out of the SUV, medical bag in hand, and started checking the patient’s condition.

Soon police, firefighters and an ambulance arrived, with paramedics Evan Kirby and Eric Laighton, who took over care of the patient. Although the injury didn’t appear life-threatening, the paramedics placed the woman on a stretcher and took her to St. Vincent Hospital.

The scene was quickly repeated with a call to East Mountain Street, where a man in his 40s was suspected of having a stroke.

In addition to police and firefighters, Worcester EMS paramedics Darren Brock and Andrew Person were on the scene, assisting the patient.

Worcester EMS paramedics started an intravenous line in the patient and transported him to UMass Memorial’s University Campus emergency department.

From the second they arrive at the hospital, EMTs have 20 minutes to check the patient in, bring the patient to the treatment room, give the resource nurse all the necessary medical information, and then clean and prepare their ambulance for the next patient. It’s a precision operation, requiring an ability to focus calmly while multitasking.

Another call came in for a combative patient in an altered state, whom paramedics Patrick Ring and Eddie Murphy interviewed and took to UMass Memorial for an emergency mental health referral.

Capt. Wilson said the number of people in police custody has increased over the years, whether they’re intoxicated or having a mental health crisis.

“It’s important to use your persuasion skills and to listen,” he said. Some communities include social workers with EMTs to help with these calls.

Most of the time, though, Capt. Wilson said, “You see a lot of medical issues. With the baby boomer population, there’s an influx of heart, aging, diabetic, respiratory issues. Everyone who’s young thinks it isn’t going to happen to them, until it happens to them.”

And then there are the motor vehicle crashes, such as the next call. A “rollover with entrapment” was on Acton Street. The driver, a woman who was alone in the car, had been wearing her seat belt and was uninjured as she stood up in the car, which was resting on its driver’s side. Firefighters needed to stabilize the car before they could get her out.

Once she was safely extricated, EMTs sat the woman on a stretcher and assessed her condition, but she declined further treatment.

Capt. Wilson said improved safety features and more people wearing seat belts have cut down on serious vehicle-related injuries. “The biggest thing is, you don’t get ejected from the vehicle if you wear a seat belt,” he said. Injuries suffered in the vehicle are usually minor.

On another afternoon, EMS supervisor Bill Humphrey drove around during an unusually quiet spell, after a nonstop morning. A few calls came in, one for an elderly man with a fever and shortness of breath, and another for a middle-aged woman with suspected seizure who was described as “in an altered state.”

Paramedics, firefighters and police officers efficiently did their jobs, with compassion and attentiveness to each patient. Vital signs were checked and IVs were started.

“It’s a version of the emergency room coming to the patient,” Mr. Humphrey said.

Efforts to professionalize emergency medical services took off in 1976, with the passage of a federal law outlining training and equipment standards. The field has been building research to improve pre-hospital emergency care, which means EMTs must keep training and gaining experience. Among the updated practices, for instance, studies found that backboards generally aren’t as important as a cervical collar to stabilize the spine, for patients under age 65.

EMTs have to be recertified by the state Department of Public Health’s Office of Emergency Medical Services every two years, which requires 60 hours of continuing education.

The wage for new paramedics starts around $16 an hour, according to Mr. Humphrey, and it goes up slowly to around $22 an hour.

“EMS is in its infancy,” he said. “It’s still working on itself.”

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EMTs bring the emergency room to the patient – Worcester Telegram

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Getting High on Mushrooms Not Likely to Send You to the Emergency Room – Newsweek

If there was such a thing as a safe drug, then magic mushrooms would be itat least thats what a new study by the Global Drug Survey (GDS) found.

Researchers found that of all people who tripped on psilocybin hallucinogenic mushrooms in 2016, only 0.2 percent needed emergency medical attention, according to the annual recreational drug survey released Wednesday. Meanwhile, harder psychedelic drugs such as LSD and MDMA were almost five times more likely to send users to the emergency room in 2016.

The survey analyzed the drug use of nearly 120,000 participants in 50 countries based on questions regarding drug use patterns, effects of drug use and the various substances people use to get high. Of those surveyed, 65.1 percent said they had used illegal drugs recreationally within the last year while 79.3 percent said they used illegal substances at some point in their life.

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A fly agaric (Amanita muscaria) fungus grows in the western city of Thorigne-Fouillard on November 18, 2013. One of the most iconic and distinctive of fungi, fly agaric, with its red cap and white spots, is renowned for its toxicity and hallucinogenic properties. A Global Drug Survey released May 23, 2017, found magic mushrooms to the safest recreational drug. DAMIEN MEYER/AFP/Getty Images

About 24,000 people said they had used shrooms, as theyre commonly referred to, at some point in their lifetime while 12,000 admitted to consuming the substance derived of certain types of mushroomsusually indigenous to areas with tropical climates in South America, Mexico and the U.S.within the last 12 months.

Nearly 82 percent of people who had taken mushrooms in their lifetime said they indulged in the hallucinogenic drug in search of a moderate psychedelic experience and an enhancement of environment and social interactions.

GDS founder Adam Winstock told The Guardian Wednesday that despite its low emergency room rate, the main reason people end up in the hospital after taking psilocybin hallucinogenic mushrooms was because people were picking and eating the wrong types of mushrooms.

Magic mushrooms are one of the safest drugs in the world, he said. Death from toxicity is almost unheard of with poisoning with more dangerous fungi being a much greater risk in terms of serious harms.

Although an illegal drug, there have been studies released claiming that mushrooms have some medical benefits and could help people battling depression and anxiety, including a separate 2016 New York University study in which participants saw decreases in cancer-related demoralization and hopelessness, improved spiritual well-being and increased quality of life.

As for LSD, more than 22,000 people said they had tried the hallucinogen at some point in their lives while almost 11,500 said they had used the drug within the last year, which sent 1 percent of users to emergency rooms, compared to the 1.2 percent of MDMA usersincluding 35,500 people who had tried the party drug in their lifetime and 19,000 users within the past yearwho found themselves in the emergency room following their experience with the drug.

LSD is such a potent drug, said Winstock. Its so difficult to dose accurately when tabs you buy vary so widely. Its easy to take too much and have an experience beyond the one you were expecting.

Drugs including methamphetamine and synthetic cannabis had the highest rates of users needing emergency medical attention, with 4.8 percent and 3.2 percent of users, respectively, being hospitalized in 2016.

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Getting High on Mushrooms Not Likely to Send You to the Emergency Room – Newsweek

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Tip No. 1 For Taking Charge Of Mass. Health Care Costs: Avoid The ER – WBUR

wbur (Open Grid Scheduler / Grid Engine/Flickr)

If you’re wondering why health care costs so much in the U.S., here’s one little piece of the answer: emergency room visits.

Forty-two percent of emergency room visits in Massachusetts in 2015 were for problems that could have been treated by a primary care doctor, according to the state’s Health Policy Commission. This state agency, which is charged with driving down costs, says a 5 percent cut in avoidable emergency room trips would save $12 million a year; 10 percent fewer such visits would save $24 million.

That extra spending is passed on to all of us in the form of higher health insurance premiums. Andgoing to an emergency room for non-urgent care is often not the best move.

“If its not a true emergency, youre going to wait for hours in the emergency room, its not the best practice for coordinated care, and you run the risk of having a lot of tests that might not have been necessary if you saw your regular provider,” saidSarah Sadownik, deputy director of the research and cost trends team at the Health Policy Commission.

The commission is breaking down some of the ways we in Massachusetts could save money without doing ourselves any harm. We’ll be posting many of these tips as they are released.

What’s your guess about the most common reason your neighbors go to an emergency department (ED)? Here’s the answer, by zip code:

Statewide, the top five reasons are: sinus problems (sinusitis), stomach pain (that’s my work zip code), rashes and skin conditions, acid reflux and bronchitis.

I go to the ED on weekends or after 5 p.m. when the office of my wonderful doctor is closed. But it looks like most people go during office hours.

Sometimes we go to the emergency room because we can’t tell if our symptoms signal a common problem or something more serious.

We used to assume that most of the people who visit an emergency room were uninsured. But that doesn’t seem to have been the case before the state expanded health coverage and is likely even less true now. Here’s the most recentcomparison we could find.

I’m surprised cost is not a factor for more people. An emergency room visit is more expensive than going to see your doctoror visiting urgent care facilities, which are often open on evenings and weekends. So what’s missing from this analysis? What are your reasons for going to the Emergency Department?

If you want more juicy details about avoidable ED visits, try this. And if you’re up for a deep dive into the reasons Massachusetts has some of the highest health care costs in the country, and maybe the world here’s the HPC’s most recent cost trends report.

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Tip No. 1 For Taking Charge Of Mass. Health Care Costs: Avoid The ER – WBUR

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This Queens hospital has longest emergency room wait in NYC – New York Daily News


New York Daily News
This Queens hospital has longest emergency room wait in NYC
New York Daily News
The wait time for the emergency room at Elmhurst Hospital Center is in critical condition. The average emergency room patient at the Queens facility waited 114 minutes to be seen by a doctor in 2016, according to records obtained by the Daily News.

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This Queens hospital has longest emergency room wait in NYC – New York Daily News

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