Emergency services specialize in the initial treatment and acute care of patients who present a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. Most emergency departments operate 24 hours a day. Every year, the nation’s emergency rooms treat 117 million patients, and the average patient spends approximately three hours in the ER. Because patients can present at any time, without notice, and with any complaint, emergency services prioritize cases based on clinical need. Some of the most common critical conditions handled in emergency rooms include heart attack, cardiac arrest, trauma, asthma and COPD. Acute care facilities often operate under an integrated and comprehensive network to ensure that critically injured patients are seamlessly transferred to the appropriate facility by the most efficient means.
The South Texas Medical Center has the largest ER in San Antonio located in University Hospital, also home to the leading Level 1 Trauma Center in the South/Central Texas region. An average of 70,000 patients are treated each year.
Emergency departments at the South Texas Medical Center are equipped and prepared to treat almost any kind of emergency situation. Cardiac arrests and major trauma are relatively common in emergency departments, so defibrillators, automatic ventilation and CPR machines are readily available. Emergency departments also have their own diagnostic equipment such as X-Rays, CT Scanners and ultrasounds to avoid waiting for equipment from elsewhere.
Fast decisions on life-and-death cases are critical in hospital emergency rooms. Doctors at the South Texas Medical Center have the expertise, the resources and the support they need to assess and treat patients 24/7. All emergency medicine physicians at the South Texas Medical Center are board certified and work across all departments and subspecialties to provide quality care to patients in need.
Weekday heart attacks still getting quicker treatment at hospitals
By Kathryn Doyle
NEW YORK (Reuters Health) - People who arrive at the hospital with a heart attack during business hours are more likely to survive than those who show up on weeknights, weekends or holidays, according to a new study.
Rates of death in the hospital are very low overall, at just over 4 percent, the researchers found. But some life-saving treatments can take longer to get to patients during off hours, which makes care less than optimal, they write.
It was actually surprising how similar quality of care seemed to be for working hours and after hours in the hospital, and even for balloon angioplasty, there was only a difference of 16 minutes, said study author Dr. Jorge F. Saucedo of the NorthShore University Health System in Evanston, Illinois.
In the most severe heart attacks, a blood vessel in the heart is completely blocked. Using a catheter to thread a balloon into the blocked artery can immediately restore blood flow.
In the new study, which included more than 50,000 severe heart attacks between 2007 and 2010 in the U.S., patients who arrived at the hospital during work hours took an average of 56 minutes to have angioplasty, the balloon procedure. For those who arrived on nights or weekends, the average wait time was 72 minutes.
Both times fall within the American Heart Association's recommendation of no more than 90 minutes wait for angioplasty. The time to patients getting imaging or medication was the same for both groups, according to the results in Circulation: Cardiovascular Quality and Outcomes.
When the researchers adjusted for a variety of patient characteristics, they found those who arrived at the hospital during off hours were about 13 percent more likely to die from any cause.
The proportion of patients who had angioplasty within the recommended 90 minutes was 89 percent during the weekdays and 79 percent during off hours.
All in all, the numbers are better than in past studies, the authors note in their report, and in most categories there were no differences in treatment based on when patients arrived at the hospital.
Management of these severe heart attacks seems to have improved greatly over the past several years, said Dr. Rodrigo Estévez-Loureiro of the interventional cardiology unit at Complejo Asistencial Universitario de León in Spain.
"Differences observed in (door to balloon) times, although statistically significant, are not clinically relevant between off and on-hours," Estévez-Loureiro, who was not involved in the new study, told Reuters Health by email.
A 16-minute delay likely will not influence overall mortality from the heart attacks he said.
"Also surprising was the very low in- hospital mortality for both groups," Saucedo told Reuters Health.
The hospital catheterization laboratory, where angioplasties are performed, is fully staffed during the day but most hospitals in the U.S. do not staff the lab after hours, he said. When a heart attack patient arrives on a night or weekend, staff members are paged and have to drive to the hospital from their homes.
To make angioplasty wait times equal day and night, catheterization labs would have to be fully staffed 24-hours per day, but currently the financial and logistical costs would be too high to recommend that, Saucedo said by email.
Patients may have waited longer to come to the hospital with heart attack symptoms in the middle of the night, which might have contributed to the increased risk of death, he noted. All things considered, the management and outcomes for people with severe heart attacks after hours was very good.
One takeaway message for patients, he said, is to come to the hospital as soon as you have symptoms of a heart attack, including tightness of the chest, excess sweating, weakness and light-headedness.
Estévez-Loureiro recommended calling an ambulance to get to the hospital, since medical personnel may be able to verify if you are having a heart attack on the way and start administering treatment and call the catheterization lab en route.
SOURCE: http://bit.ly/XaY6j7 Circulation: Cardiovascular Quality and Outcomes, online July 29, 2014.
Tools for planning end of life care are varied, untested: study
By Kathryn Doyle
NEW YORK (Reuters Health) - Many tools exist to help introduce people to the subject of advanced care planning, but they vary widely in what they offer and how accessible they are, according to a new research review.
The authors found the tools that are most readily available often have not been vetted by formal studies, and the ones that have are often not accessible to the public or are specific to certain diseases.
"Decision aids" have proliferated in many areas of medicine but have yet to really take off in the area of advanced directives, though they have a lot of potential to help doctors and patients, said Dr. Benjamin H. Levi of Penn State College of Medicine in Hershey, Pennsylvania.
Levi was not one of the authors of the new paper in the Annals of Internal Medicine, but he did review it for the journal.
Advance care planning helps seriously ill patients think through their treatment goals and informs care choices for the future in case they cannot express their wishes.
Less than half of severely or terminally ill patients have an advance directive in their medical record, according to the study authors, and past research has found doctors are only correct 65 percent of the time in predicting what intensive care a patient would want.
Some patients prioritize living longer, whereas others may not wish to be kept alive when meaningful recovery or a particular quality of life is no longer possible, write the authors, led by Mary Butler of the Minnesota Evidence-based Practice Center at the University of Minnesota School of Public Health in Minneapolis.
One common "advanced directive" is a do not resuscitate order, but the directives can be much more nuanced than that, taking into account religion, spirituality and philosophical outlook, they note.
It can take more than an hour to have that kind of conversation with your doctor, Levi said, time many doctors can't devote to one patient.
"For something like advanced care planning it's way outside the experience of most people, they don't know how to word their preferences," Levi said. "The decision aid can be very useful as a stand-alone or as springboard to that conversation with your doctor."
Decision aids, some of which actually function as legally binding final directives, should not be a substitute for talking to your doctor, though, he told Reuters Health.
As the study notes, those aids that exist can be printed leaflets, videos or interactive sites, some of which work to introduce any person, healthy or sick, to the idea of an advance directive. Others are tailored specifically to certain long-term illnesses.
The existing studies on these aids have not been uniform and there has not been a side-by-side comparison of the different types to see which are best, Levi said. The new research review did not attempt to do that either, rather it just accumulates the existing studies in one place, Butler and her coauthors write.
"You can't use this article to choose one," Levi said.
Dr. Linda L. Emanuel, director of the Buehler Center on Aging, Health & Society at Northwestern University Feinberg School of Medicine in Chicago, agreed.
"We have no idea how to assess what's a good decision aid," Emanuel told Reuters Health by phone.
"First of all, these decisions are assessed as good bad or indifferent in real time, and 'maybe I regret my decision but I don't know how another decision would make me feel.'"
But there are certain criteria anyone can use to assess whether an aid might be useful, she said. It should be understandable and accessible for patients and should communicate with their healthcare teams in a useful way.
Patients should remember that they have a federally protected right to have their preferences honored no matter how they communicate them, even verbally, she said.
"I think there's really only one product out there that I think is good and I would recommend, it has a website that people can go to and have an interactive experience," she said, referring to PREPARE, an interactive website for families navigating medical decision making, run by the University of California.
Emanuel also recommended The Conversation Project as "a good resource for familiarizing yourself with advanced care planning and seeing what people are talking about in the area."
The experts agreed that advanced care planning is important and the best advice right now is to do a little exploring, try a few different decision aids and see what works for you.
"I believe strongly that these decision tools can be helpful for folks and that they should try one or more different ones to see what works," said Dr. Michael Green of Penn State College of Medicine in Hershey. He and Levi helped develop "Making Your Wishes Known," one of the interactive web tools included in the review.
"I think everybody should explore this, not just sick people," Green told Reuters Health. "If someone is sick and comes to the hospital, the default position is to do everything."
"In many cases that's the right call, but in some cases it's not and what a shame and a waste and a tragedy if people undergo unnecessary unwanted treatment because there is no directive," Levi said.
SOURCE: http://bit.ly/UzEcfY Annals of Internal Medicine, online July 29, 2014.
Dozens of ill Keith Urban fans treated at concert near Boston
By Reuters Staff
BOSTON (Reuters) - Forty-six music fans were treated for mostly alcohol-related medical problems at Australian country singer Keith Urban's concert outside Boston on Saturday night, local officials said.
Fire and emergency medical personnel dealt with dozens of ill fans during the show at an outdoor arena in Mansfield, Massachusetts, about 25 miles south of Boston, the town's police and fire departments said in a joint statement on Sunday.
Some 22 people were transported to area hospitals, mostly for alcohol-related illness, and more than 50 people were taken into protective custody by police, who noted that the large number of people needing treatment prompted authorities to call in ambulances from five nearby communities.
"Last evening's Keith Urban concert was not anticipated to present with the volume of issues handled," officials said in the statement.
The incident came a month after dozens of people were taken to hospitals for drug and alcohol-related illnesses at a house music concert at Boston's TD Garden.
Urban, a Grammy winner who is married to Oscar-winning actress Nicole Kidman, was tapped last month to return as a judge on Fox's television singing competition "American Idol."
U.N. warns of alarming malnutrition rates in Somali capital
By Reuters Staff
MOGADISHU (Reuters) - The United Nations has reported alarming rates of malnutrition in the Somali capital where aid agencies cannot meet the needs of 350,000 people due to insufficient funds, drought and conflict.
The U.N. Office for the Coordination of Humanitarian Affairs (OCHA) said the Somali government had compared the situation to the run-up to a 2011 famine that killed 260,000 people.
The United Nations has sought to improve its early warning mechanisms after its failure to spot indications of crisis in 2010 was blamed for the scale of the famine that followed in a nation torn apart by years of conflict.
"Alarming rates of malnutrition have been observed among displaced communities in Mogadishu," OCHA said in a report released over the weekend, citing a study by a unit of the U.N. Food and Agricultural Organization.
It said aid agencies were unable to meet the needs of 350,000 people who had fled to Mogadishu, saying the aid organizations faced a shortage of funds and violence in the capital that could restrict deliveries.
Al Shabaab rebels, seeking to topple the Western-backed government and impose their own strict interpretation of Islam, have staged a series of attacks in Mogadishu during the Muslim fasting month of Ramadan, which ends this week.
"The humanitarian community is mobilizing resources to address the serious situation, but the significant shortfall in funding for humanitarian activities has undermined the capacity to respond," OCHA said of the challenges in Mogadishu.
Because of drought and continued conflict, it said food shortages were expected to worsen in areas mainly in the south and southeast of Somalia.
Earlier this year, African Union forces launched a new drive to push al Shabaab militants out of other towns and cities. Many people fled their homes in the fighting. Officials have said aid convoys sometimes struggled to reach newly retaken towns.
A U.N. emergency fund had allocated more than $21 million to support humanitarian work in Somalia, including funding a campaign to combat an outbreak of measles, OCHA said.
Overall, OCHA said it had raised less than a third of the $933 million required for its relief work in 2014, which ranges from food provision to health work and basic education.
India battles to contain "brain fever" as deaths reach almost 570
By Nita Bhalla
NEW DELHI (Thomson Reuters Foundation) - Almost 570 people in India have died after contracting encephalitis, commonly known as "brain fever", health authorities said on Friday, warning the death toll may rise with more people still at risk.
Outbreaks of Acute Encephalitis Syndrome and Japanese Encephalitis are common every year in India, especially during the monsoon season, and claim hundreds of lives.
But this year, major outbreaks - usually most prevalent in the northern states of Uttar Pradesh and Bihar - have spread to regions such as West Bengal and Assam further east and north, killing 568 people.
In West Bengal, where at least 111 people have died from both strains, a senior health official said authorities were taking emergency steps to contain the outbreak.
"We have sounded an alert in seven districts and canceled the leave of all health department officials," West Bengal's Health Services Director B.R. Satpathy told the Thomson Reuters Foundation.
The health department has set up clinics across affected areas and is trying to prevent breeding of mosquitoes by fogging, especially around pig farms, where there is a high risk of contracting the virus.
Encephalitis is an inflammation of the brain, caused by any one of a number of viruses, says the World Health Organization. Symptoms include high fever, vomiting and, in severe cases, seizures, paralysis and coma. Infants and elderly people are particularly vulnerable.
It is most often caused by eating or drinking contaminated food or water, from mosquito or other insect bites or through breathing in respiratory droplets from an infected person.
Outbreaks of the virus tend to occur in poor, flood-hit areas, where monsoons have left pools of stagnant water, allowing mosquitoes to breed and infect villagers.
Floods also lead to the contamination of clean water sources such as wells, leaving many people with no option but to use the same dirty water for both drinking and sanitation.
Health Minister Harsh Vardhan said last month that he was distressed at the "runaway conquest of encephalitis" and ordered the vaccination of all children in vulnerable states and the provision of dedicated hospital beds.
In 2012, the government launched a national program to prevent and control the virus, including expanded vaccinations, strengthened surveillance and improved access to safe drinking water and sanitation.
There were 1,273 deaths due to encephalitis in 2013 compared to 440 deaths from malaria and 193 from dengue, according to government statistics.