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Emergency room crews learn to spot elder abuse – LA Daily News

Abuse often leads to depression and medical problems in older patients even death within a year of an abusive incident.

Yet, those subjected to emotional, physical or financial abuse too often remain silent. Identifying victims and intervening poses challenges for doctors and nurses.

Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.

The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.

The VEPT program initially funded by a small grant from The John A. Hartford Foundation (a Kaiser Health News funder) and now fully funded by the Fan Fox and Leslie R. Samuels Foundation includes Presbyterian Hospital emergency physicians Tony Rosen, Mary Mulcare and Michael Stern. These three doctors and two social workers take turns being on call to respond to signs of elder abuse. Also available when needed are psychiatrists, legal and ethical advisers, radiologists, geriatricians and security and patient-services personnel.

We work at making awareness of elder abuse part of the culture in our emergency room by training the entire staff in how to recognize it, said Rosen. Its easy for the ER staff to alert the VEPT team and begin an investigation, he said.

A doctor interviews the patient and conducts a head-to-toe physical exam looking for bruises, lacerations, abrasions, areas of pain and tenderness. Additional testing is ordered if the doctor suspects abuse.

Unlike with child abuse victims, where there is a standard protocol in place for screening, there is no equivalent for the elderly, but we have designed and are evaluating one, said Rosen.

The team looks for specific injuries. For example, radiographic images show old and new fractures, which suggest a pattern of multiple traumatic events. Specific types of fractures may indicate abuse, such as midshaft fractures in the ulna, a forearm bone that can break when an older adult holds his arm in front of his face to protect himself.

When signs of abuse are found but the elder is not interested in cooperating with finding a safe place or getting help, a psychiatrist is asked to determine if that elder has decision-making capacity. The team offers resources but can do little more if the patient isnt interested. They would have to allow the patient to return to the potentially unsafe situation.


Patients who are in immediate danger and want help or are found not to have capacity may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found. Unlike with children and Child Protective Services, Adult Protective Services wont become involved until a patient has been discharged, so hospitalization can play an important role in keeping older adults safe.

During the first three months of the program, more than 35 elders showed signs of abuse, and a large percentage of them were later confirmed to be victims. Changes in housing or living situations were made for several of them.

Its difficult to identify and measure appropriate outcomes for elder abuse victims, because each patient may have different care goals, said Rosen, but we are working on making a case that detection of elder abuse and intervention in the ER will improve the patients lives. We also hope to show that it will save money, because when an elder is in a safe place, expensive, frequent trips to the ER may no longer be needed.

The teams ultimate goal is to optimize acute care for these vulnerable victims and ensure their safety. They plan to work at continually tweaking VEPT to improve the program and to connect to emergency medical, law enforcement and criminal justice services. Eventually, they hope to help other emergency departments set up similar programs.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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Emergency room crews learn to spot elder abuse – LA Daily News


ER doc resting at home when car plowed into 7 people – Standard Speaker

RICE TWP. Still in her pajamas and sipping coffee after a long overnight shift in the emergency room, Dr. Annette Mann bolted from her house Friday afternoon upon hearing a thunderous crash outside.

She didnt even pause to put on shoes.

Mann, a trauma doctor for 20 years, spotted a man she recognized from the neighborhood wounded in the street outside her Aleksander Boulevard home.

He grabbed my ankles and said to me, My babies. Where are my babies? I turned my head and I realized there were children all over the lawn. I just went in automatic emergency medicine mode, Mann recalled.

Bryan Herbst, his wife, Nina, the couples four small children and a niece had been hit by an out-of-control car during a walk and lay critically wounded.

Mann, 51, started a triage process to assess the victims and treat them in order of injury severity.

Tessa, the couples beloved 10-month-old daughter, was in the worst shape. She wasnt breathing.

I went to the baby first because I saw the carriage was mangled. My neighbor Becky (Mendrzycki) did so great. We got her airway open and I had Becky hold her airway open so she could breathe better. I was on the phone at the same time, Mann said.

Mann, an emergency room doctor at Lehigh Valley Hospital-Hazleton for 10 years, said she was relaying information to emergency responders to prepare them for arrival. She also gave directions to neighbors and even her 17-year-old twin sons about what they could do to help the victims.

I do what I do best when I work with people who add to the team approach, she said.

After ambulances shuttled the victims to hospitals and helicopter landing zones, a bloodied and barefoot Mann stood in the middle of the street. Her feet were cut from stepping on glass debris.

I never expected in my neighborhood that this kind of thing could happen, she said.

Mann has lived on Aleksander Boulevard since moving to the area in 2004. A Philadelphia native, she became a doctor and then entered the U.S. Air Force. Following her military service, she moved to the area and worked in the emergency room of Wilkes-Barre General Hospital for several years prior to her current job in Hazleton.

Mann said instincts kicked in Friday.

I feel like I just did what I was born and trained to do. I always felt my whole life I was born to be a physician and trained to be a healer, Mann said. The only difference that is unusual with this is when you are in the ER, you are in that mind-set, you expect to see sick people. But when you are home, you dont expect that. I had to go from, Oh, Im resting to Youre an ER doctor. Go!

It was the first time her sons got to see her in action. One of them told her it was life-changing to him.

He said, Mom, I never had the thought of being a doctor until today, she recalled. That was so profound.

The night before the incident, Mann worked 7 p.m. until 7 a.m. She arrived home around 8 a.m. Friday to take a nap. She was up relaxing in her den when the crash occurred around 1 p.m.

She had Friday off, but had a full days worth of errands and tasks planned and wasnt expecting to be home much, she said.

My schedule is all over the place. Its hit or miss if Im home. When I am off, I am in and out all day, Mann said. I had a whole list of stuff I had to get done. For me to be home, it was nothing short of a miracle. It makes you wonder.

Contact the writer:; 570-821-2055; @cvbobkal

ER doc resting at home when car plowed into 7 people – Standard Speaker


PeaceHealth Emergency Department sees uptick in heat & smoke-related illnesses – KVAL

PeaceHealth Riverbend is seeing a spike in emergency room patients from heat and smoke-related illnesses. (SBG)

SPRINGFIELD, Ore. — Thanks to triple-digit temperatures and unhealthy air quality, PeaceHealth Riverbend is seeing a spike in emergency room patients.

“I went outside and tried to do a couple things, and here I am,” patient Bobby Eaton said. “Wednesday I went outside just for a little while and I came in the house. My wife says, ‘You don’t look so good,’ and I said, ‘Yeah, I’m having troubles breathing.'”

Eaton has chronic obstructive pulmonary disease (COPD), which obstructs his lungs.

“It’s never gotten this bad where I’ve had to come to the hospital. This is the worst it’s ever been for me,” he said.

Emergency Department Registered Nurse Teresa Wilson says she’s seeing a lot of patients with breathing problems this week.

“With the hot air stagnating with the increased pollen we have, as well as the smoke, it’s just a really bad kind of trifecta that’s happening to people with respiratory distress,” she said.

She’s also seeing more cases of dehydration: “The heat over the past couple days was all it took. A lot of people don’t have air conditioning, a lot of people don’t pare back their activities just because it’s 104 outside; they don’t realize their vulnerabilities.”

The Emergency Department is much busier than usual.

“It would be like when we have the flu season. You can have the flu season come and it was very very busy in January. This isn’t the flu but it is a situation where the environment is affecting someone’s health,” Wilson said. “Probably about a thirty percent increase of people coming into the ED, but more importantly, requiring admission. Whereas before they might have been able to get treated and go home.”

Just like Eaton, who’s been there for several days: “It eventually will get better but I’m just gonna have to be more cautious about what the hell is going on outside with this weather ya know.”

Wilson says everyone should pay attention to the conditions, drink water and limit time outside when it’s smokey.

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PeaceHealth Emergency Department sees uptick in heat & smoke-related illnesses – KVAL