Category Archives: Emergency Medicine

Emergency Medicine

TTUHSC Emergency Medicine professional shares hiking tips – KLBK | KAMC | EverythingLubbock.com

LUBBOCK, Texas Texas Tech University Health Science Center Assistant professor of Emergency Medicine, Brian Kendall, MD., shared tips on how to be prepared before a hiking trip, according to a press release.

According to the press release, Dr. Kendall emphasized that even on short hikes, that means having what you need to prevent and handle a variety of medical issues on the trail.

I think having some basic knowledge before you go and then taking some of the supplies that you would needcan cover a wide range of medical issues day-hikers might experience. said Dr. Kendall.

Dr. Kendall said in the press release that he has a first aid kit that has a lot of different things in it like gauze, bandages and ace wrap and medicine.

While blisters are an inconvenience for hikers, Dr. Kendall has preventative measures to protect the area of the foot that is more prone to sweat and friction.

Duct tape or moleskin are recommended depending on if youre hiking in wet or dry conditions, said the release.

It is also important to stay hydrated before and during the hike.

Dr. Kendall recommended carrying electrolyte tablets to add to water on longer trips.

Thats what helps your body function at its peak performance. If youre dehydrated, your brain isnt going to be able to function as well Thats going to decrease your physical performance on the hike, Dr. Kendall said in the release.

Dr. Kendall also reminds when hiking to go with a partner in case of an emergency and pack your essentials to carry in your backpack.

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TTUHSC Emergency Medicine professional shares hiking tips - KLBK | KAMC | EverythingLubbock.com

Emergency Medicine

Return of 3-Day Rule Will Stress Crowded Hospitals Further – Medpage Today

Emergency physicians are concerned about the return of Medicare's 3-day rule when a waiver that suspended it expires with the COVID Public Health Emergency (PHE) on May 11, warning it will make hospital overcrowding much worse.

The waiver has allowed hospitals to bypass a requirement that traditional Medicare beneficiaries must have 3 full days of an acute stay in order for Medicare to cover their skilled nursing facility (SNF) care when they are discharged.

At the moment, these patients can be discharged directly to a nursing home -- even from the emergency department if appropriate and they have been stabilized -- and still get Medicare coverage for their SNF stay.

When the original policy goes back into effect, patients not hospitalized for that duration will have to pay out-of-pocket for SNF care. Additionally, many skilled nursing facilities won't accept beneficiaries who didn't fulfill the requirement.

That means hospitalists will be under more pressure to keep these patients in acute care beds for the required 3 days, even if they don't really need to be there, emergency physicians said.

"Patients need to meet criteria in order to be admitted in the first place," Jeffrey Davis, director of regulatory and external affairs for the American College of Emergency Physicians (ACEP), told MedPage Today. "But sometimes when a patient needs only 1 or 2 days, they're going to try to keep them there for 3 days so they qualify if they need SNF coverage."

He gave an example of a patient who has a knee operation and there's a surgical complication that takes him to the emergency department. "If he needed rehab treatment, he could probably go safely and directly to a skilled nursing facility. But instead, you have to be an inpatient for 3 days. It doesn't make any sense."

The domino effect means inpatient units will fill up faster, beds will be occupied for longer periods, and more patients will be boarded in the emergency department, taxing emergency department staff even more, Davis said.

The ACEP website has a section devoted to what Davis called "horrific" stories of boarding in hospital emergency rooms, where patients are receiving what he called "hallway medicine."

"Our worry is if they reinstate this, it will make matters even worse, because when the inpatient beds are full, this backs up and locks up whole lines of patients," he said.

Davis noted that most Medicare Advantage enrollees and beneficiaries cared for under certain experimental models such as acute care organizations (ACOs) are not bound by the rule.

Hospital Overcrowding 'Already the Worst in My Career'

A combination of factors in the current "peri-pandemic" period are contributing to hospital overcrowding, said Abhi Mehrotra, MD, an emergency physician and vice chair of emergency medicine at the University of North Carolina Hospitals.

Right now, for example, 60% to 70% of his hospitals' emergency room beds last week were occupied by patients "waiting to go someplace else, either into the hospital for a medical reason, or into a state psychiatric facility, or other kind of hospitalization for behavioral health purposes," said Mehrotra, who is also the past president of ACEP's North Carolina chapter.

"We are definitely over capacity and crowded on the inpatient side, and that has led to emergency department boarding and ED overcrowding," he said.

Workforce issues play a role as well. Mehrotra said his hospital has "had times when beds within the hospital had to be shut down because we didn't have nurse staffing for those beds. I've heard of facilities that have shut down operating rooms because they don't have the staff to run them."

Some of the beds are filled with patients receiving long-delayed but necessary elective care. But much more glaring and difficult, he said, is that "the patients have changed."

"We didn't use to have patients brought into the emergency room because their families weren't able to care for them," he said. Patients have behavioral or cognitive issues, and "they need other resources and placement but there's no medical diagnosis to admit them."

Sometimes the nursing homes themselves can't take care of a patient whose status has changed, and send them to the hospital as well.

Scripps Health in San Diego has been keeping track of "avoidable bed days," or ABDs -- days in which patients were medically stable enough to be discharged but remained in acute care because there was no safe, appropriate setting for them to move to.

From Oct. 16, 2022 to April 15, 2023, its five hospitals and behavioral health unit counted 18,301 avoidable bed days affecting 1,958 unique patients, or an average of 101 ABDs per day.

Scripps Health president and CEO Chris Van Gorder said most of his system and that of others in his region are at capacity.

"Because of low state and federal reimbursement for their patients, SNFs, long-term care, and behavioral health facilities are not taking these low-pay and sometimes, complex patients and we are ending up with beds that are tied up for months and longer," he said.

"To be honest," Van Gorder said, "while the end of the PHE will make things a bit worse, they are already the worst I've seen in my healthcare career."

'Antiquated' Rule

Vincent Mor, PhD, of the Brown University School of Public Health in Rhode Island, and author of an invited commentary on the 3-day rule's history in JAMA Internal Medicine, agreed that the waiver's demise could lead to additional patients taking up hospital beds.

Depending on the size of the hospital, he said, on any day "you could have as many as 10 or 15 extra bed days waiting for that third day to finish."

"If the emergency doctors are concerned about it, it's because they're admitting people who they may not need to admit," he said.

Many others interviewed said it's time for the 3-day rule -- which is as old as Medicare itself, going back to 1965 -- to be abolished.

Leading Age, an advocacy organization for long-term and other senior care providers, has petitioned HHS Secretary Xavier Becerra to permanently extend the waiver.

Although the rule's original intention of preventing hospitals from inappropriately discharging certain patients was noble, recent Medicare audits showed the waiver had no negative impact on patient outcomes, according to Leading Age.

In a statement, the group called the 3-day rule "antiquated" and said it's "onerous for patients and providers and reimplementing it will create hardships for older adults and families who need access to care."

Cheryl Clark has been a medical & science journalist for more than three decades.

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Return of 3-Day Rule Will Stress Crowded Hospitals Further - Medpage Today

Emergency Medicine

Fresno emergency doctor helps save honoree at Top Dog event – The Business Journal

Dr. Danielle Campagne currently serves as the Interim Chief of Emergency Medicine at UCSF Fresno. Photo contributed

Fresno States Top Dog awards took a turn Saturday when one honoree helped save the life of a fellow honoree.

Scott Barnes, a former Fresno State Basketball standout and current athletic director at Oregon State University, attended the ceremony to receive the Outstanding Alumni Award for the Department of Athletics.

Toward the start of the ceremony, witnesses feared Barnes was experiencing a medical emergency. Thats when Dr. Danielle Campagne stepped in and administered aid to the athletic director along with other medical personnel in attendance with her.

My colleagues and I are honored to have been there to provide emergency medical care. This is what we do as emergency medicine physicians. Right now, our thoughts and prayers are with him and his family, said Campagne in a statement.

Campagne currently serves as the interim chief of emergency medicine at UCSF Fresno, and was the Distinguished Alumna honoree, the highest honor given by the Fresno State Alumni Association.

After Campagne took lifesaving measures, Barnes was transported to Saint Agnes Medical Center where he was showing signs of improvement and communicating with family members Sunday.

Dr. Campagne earned her medical degree at University of Southern Californias Keck School of Medicine before completing residency at University of California, San Francisco, Fresno, where she served as a chief resident.

Part of her job at UCSF Fresno is supervising medical students and residents in the emergency department at Community Regional Medical Center.

A former Sanger resident, she earned a bachelors degree in biology from Fresno State in 2000 where she was a member of the honors college and played on the tennis team.

Barnes received both a bachelors degree in 1986 and a masters degree in 1993 from Fresno State. During his time at the university, Barnes was a basketball letterman and helped the Bulldogs advance to the NCAA Tournament and NIT. As a senior, he was second team all-conference player before playing professionally in Germany.

In a statement on Sunday following the incident, the Pac-12 expressed support for Barnes and his family during this difficult time.

Scott Barnes is a dear friend, trusted colleague and incredibly loved man across the Oregon State and Pac-12 families and the entire college sports community. Our thoughts are with Scott and his family at this time, said Pac-12.

Fresno County Supervisor Sal Quintero said Tuesday he was in attendance at the event when he saw Barnes face grow blank while addressing the audience. Then he heard a thud when Barnes apparently lost consciousness.

Quintero said Campagne and her colleagues saved Barnes life.

I told her afterward you should have worn a cape or something,' Quintero said.

The Associated Press contributed to this report.

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Fresno emergency doctor helps save honoree at Top Dog event - The Business Journal

Emergency Medicine

Nation’s No. 1 Veterinary School to Open New ER/ICU – University of California, Davis

Veterinary appointments have been a challenge to obtain in the past two years, with long wait times even in emergency situations, as the industry struggles to keep up with demand. To combat this issue, the University of California, Davis, School of Veterinary Medicines teaching hospital has expanded its clinical space, including the opening of a new emergency room and intensive care unit on Wednesday, May 3.

Admittances to the ER have more than doubled since immediately before the pandemic. Historically, the ER caseload has increased tenfold since 2013, seeing an average of more than 900 cases per month in 2022, with some months seeing more than 1,200 patients.

The veterinary school, recently ranked No. 1 in the nation by U.S. News and World Report for a third straight four-year period, is celebrating its 75th year. It remains committed to growing the profession through an improved campus to train future veterinarians and meet the needs of animals needing emergency and complex care.

The new ER/ICU occupies the old space and incorporates adjacent space, for a total of approximately 1,600 square feet, nearly double the 900 square feet of the old ER/ICU, according to Mark Stetter, dean of the School of Veterinary Medicine. While the level of emergency care has improved over the decades, the physical space of the ER/ICU has remained the same since the building opened in 1970. With the expanded space, the new facility will optimize patient care and increase student training opportunities.

The expansion will also make way for more training opportunities for visiting veterinarians wanting to learn about emergency medicine and residents training to become critical care specialists. The number of ER/ICU residents will expand from seven to eight over the next year.

Our ERs caseload has increased tremendously since the pandemic, said Stetter. This new space and expanded care teams will better allow us to meet our patients needs, as well as the professions need for more specialists. Well be able to see that all animals are treated in a timely and compassionate manner.

A $2.1 million gift from an anonymous donor supported the expansion. It is part of the UC Davis Veterinary Medical Center campaign to transform the current teaching hospital into the foremost veterinary facility in the world. The ER/ICU is one of two projects that will bookend the schools anniversary year. The All Species Imaging Center is also projected to be complete as the school wraps up its 75th anniversary celebration in 2024.

In addition to the new ER/ICU and imaging center, UC Davis is also creating the Dentistry, Oral and Maxillofacial Surgery Center, as well as the outpatient Center for Advanced Veterinary Surgery to diminish wait times of nonemergent orthopedic surgeries.

Other Veterinary Medical Center endeavors include the already completed Feline Treatment and Housing Suite, and Cardiology Service suite. Still to come are the Equine Performance and Rehabilitation Center, the Livestock and Field Service Center and an entirely new Small Animal Hospital, all of which will develop later in the decade.

The opening of the new ER/ICU kicks off the schools 75th anniversary celebrations, which run from April 2023 through May 2024. Later this week, the school will hold its Alumni Reunion Weekend (April 28-30) and include celebrations throughout the year, culminating with a gala event in April 2024.

And as the school celebrates its 75th anniversary year, it is launching the largest fundraising campaign in its history, with a goal of $75 million by the end of the 2023-24 academic year.

Its my great honor to lead the veterinary school during such a vibrant, celebratory era, Stetter said. I look forward to the expansion of our first-class veterinary instruction, research, and clinical care, as we continue to position UC Davis at the top of veterinary education.

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Nation's No. 1 Veterinary School to Open New ER/ICU - University of California, Davis

Emergency Medicine

Local news briefs for the Watertown area. – Watertown Public Opinion

Watertown Volunteer Center suspends operations

The Watertown Volunteer Center announces the suspension of the organization effective on Friday, April 28.

The decision to suspend the Watertown Volunteer Center was made after careful consideration of the organizations long-term goals and financial sustainability. It came to fruition as a response to the flood of 1997 and was intended to house and place volunteers for the needs of the community during this time. From there, it evolved into a non-profit organization that helped other organizations find and place volunteers.

The Watertown Volunteer Center has fulfilled thousands of volunteer opportunities and hours over the years. However, in recent years, there has been a drastic decrease in requests and registration of volunteers.

Officials want to express their sincere gratitude to all of the volunteers, partner organizations and community members who have supported the Center over the years and are committed to working with partners and stakeholders to ensure a smooth transition.

Although the Watertown Volunteer Center may be halting operations, officials are confident that the spirit of volunteerism and community service will continue to thrive in Watertown. Everyone is encouraged to continue supporting local organizations in their pursuit of making a positive impact in our community.

If you or your organization are interested in continuing the Watertown Volunteer Center's work, please call (605)753-0282.

Prairie Lakes welcomes new physician to Emergency Services

The Prairie Lakes Healthcare System welcomes Niel Burns, MD to the ER staff at the Prairie Lakes Emergency Department.

Dr. Burns joins Dr. Erickson, Dr. Filler and Dr. Singh in triaging and treating patients with urgent and emergency medical needs and conditions.

Dr. Burns is a board-certified family physician and has nine years of experience in the emergency medicine setting. He earned his medical degree from the University of South Dakota Sanford School of Medicine in Vermillion nd completed his residency in family medicine at Siouxland Medical Education Foundation-Family Medicine Center in Sioux City, IA.

Dr. Burns currently resides in Pierre with his wife Heidi and stepdaughter Ava. Dr. Burns is very active in his spare time and enjoys archery/bowhunting, fishing, golfing, distance running, cooking, kayaking, playing piano and reading.

I look forward to serving the Watertown community, said Dr. Burns. The Emergency Department is fast paced, challenging, and very rewarding. Its where I feel passionate about helping, treating, and caring for patients.

Prairie Lakes Healthcare Systems Emergency Services are dedicated to serving the Watertown community and surrounding region with highly skilled, 24/7 emergency care.

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Local news briefs for the Watertown area. - Watertown Public Opinion

Emergency Medicine

Tyler Jorgensen: Easing End-of-Life Care With Nostalgia & Music … – Dell Medical School

Many forms of recorded music have been shown to lower pain scores, decrease anxiety and depression, and promote loved ones well-being. However, we feel that vinyl records in particular in contrast to more readily available electronic modalities of music provide a more unique and multisensory experience.

Records providetactile, visual and auditory stimulation, while often evoking nostalgia and drawing on positive shared memories. We specifically chose a wide-ranging library of records to represent music from across diverse cultural backgrounds, allowing for a customizable, patient- and family-centered experience. We have found that the record player and records are like a time machine for our patients, transforming them back to a happier time in their lives.

We are still studying the impact, but a recent survey of residents, nurses and advanced practice providers reveals uniformly positive experiences with the record player.Anecdotally, our patients and families (and our staff) have reported a significant boost in their well-being after using ATX-VINyL. A recent patient and his family stated that using ATX-VINyL was the first time they had felt fully human again after many weeks in the hospital.

As physicians, we need to deliver our care in a way that respects and honors the humanity and dignity of each patient we care for. This includes tailoring our therapeutic strategies toward patient-centered goals of care. But caring for our patients personhood can also include the incorporation of some human elements as we treat their illnesses and injuries music, art, poetry, stories, laughter. Educational efforts highlighting research that supports the use of these therapies can help providers and institutions understand the value of non-pharmacologic interventions.

Ideally, hospitals in Austin, across Texas, and around the world will grow to value complementary therapies and devote resources toward music and art therapy experts and toward artistic resources that can be shared with patients.

I find it very interesting that childrens hospitals seem to understand the need for these sorts of things intuitively they are filled with art, music, and interactive play and therapies but our adult hospitals often are not. Patients still need these things even after they turn 18-years-old.

I have dedicated significant time this year to studying existing research on music interventions for terminally and critically ill patients. I have also met with researchers from around the country and internationally to discuss and workshop our latest music intervention strategies.

I practiced emergency medicine for over a decade before pursuing training in palliative medicine and I had a front row seat to the distress, fear, pain and anxiety that acute medical illnesses and traumatic injuries can cause. Now in palliative medicine, I have truly enjoyed being able to focus more on the human experiencing the illness than the illness itself.I stress to our residents and medical students that one of our main jobs is to learn to connect with the human inside each patient. Then we will know how to best care for them.

This news feature is part of Dell MedsVoices, a series of profiles that highlight the people of Dell Med as they work to improve health with a unique focus on our community.

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Tyler Jorgensen: Easing End-of-Life Care With Nostalgia & Music ... - Dell Medical School

Emergency Medicine

Unique program at Miriam Hospital combines palliative and emergency care – WJAR

Providence Fire Rescue ambulances. (WJAR){}

A new unique partnership is already proving to be a difference-maker in a local emergency room.

This is for patients with serious, chronic illnesses who are rushed to the Miriam Hospital in Providence.

It combines palliative and emergency care.

"This is a pretty new field," said Dr. Leah McDonald with HopeHealth Hospice & Palliative Care. "I'm trained in emergency medicine and palliative care, so I am in the ED five days a week working as part of the ED team to see patients down there."

And please, she says, don't mix up hospice and palliative care --they're different.

"Palliative care is a medical specialty that provides an additional layer of support for patients with chronic and life-limiting illnesses," said McDonald. "A typical patient may be an elderly patient with heart failure; one whose been in and out of the hospital frequently over the past year."

Currently, many hospitals in Rhode Island and across the country offer palliative care to patients who are admitted.

This one starts from the point of entry.

"The goal with this is really to start patient-centered care from the minute they get here," said McDonald. "Research has shown that embedding a physician within the ED really increases consults to the palliative care services."

"If we can potentially target treatment outside of the hospital and alleviate some of the symptoms that lead to hospitalization the goal would then be to keep them home," she added.

They're now six months into this pilot program and Miriam and Hope Health says patients love it and it is making a difference.

The hope is that this spreads to other hospitals.

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Unique program at Miriam Hospital combines palliative and emergency care - WJAR

Emergency Medicine

Ending Affirmative Action Would Be Bad for Our Health – Progressive.org

Harvard and the University of North Carolina at Chapel Hill are among the higher ed institutions involved in a U.S. Supreme Court battle over affirmative action that is expected to be decided this spring or summer. As a former appellate defender in the Gratz v. Bollinger affirmative action case in 1993, as well as an emergency medicine physician serving under-insured patients, I know firsthand how affirmative action can affect health equity and social justice.

White women are affirmative actions largest beneficiaries, and have been since the 1960s when conservatives attempted to change the affirmative action narrative. Even after President Lyndon Johnson passed Executive Order 11246 to improve equal employment opportunity, white women remain the top beneficiaries of affirmative actionand its greatest opposition.

Affirmative action remains a hot button issue, despite the fact that Black and Latino students at the nations top universities are more underrepresented today than they were thirty-five years ago. At Harvard, for example, 43 percent of white students are legacies, athletes or related to donors or employees.

Centuries of racism in this country have resulted in unequal access to education, a social determinant of health. Yet private and public colleges and universities are still under scrutiny for using race as one of the many complex variables in the college admissions process. Education opens doors to employment for many fields, but especially highly specialized ones in medicine and healthcare. Diversity amongst physicians and healthcare professionals leads to improved care and financial outcomes across the board. In effect, outlawing affirmative action threatens the health of all Americans.

For too many patients, a diverse healthcare system may mean the difference between life and death. Without more diversity, patients may be on the receiving end of bias, such as when doctors mislabel some pain patients as drug seekers, or brush off a womans chest pain as anxiety.

Diversity is about far more than offering soul food in the college cafeteria for Black History Month. Higher education institutions and medical organizations should make meaningful investments into outreach, recruitment and mentoring programs for students and faculty who are underrepresented in medicine. Criterion for board promotions, especially in majority-white boardrooms should also be reassessed from a lens of diversity, equity and inclusion. This is of particular importance as states such as Florida and Iowa are cracking down on diversity, equity, and inclusion initiatives in education.

Private and public institutions job is to ensure that it remains a tool for expanding access to education and healthcare. People of all races thrive in diverse healthcare environments and improved health for marginalized patients benefits everyone. This is how affirmative action lays the foundation for health equity and social justice in medicine.

This column was produced for The Progressive magazine and distributed by Tribune News Service.

Katrina Gipson is an assistant professor of emergency medicine at Emory University School of Medicine. She is the founding program director of the health policy fellowship at Emory and a public voices fellow of The OpEd Project and AcademyHealth.

April 26, 2023

12:29 PM

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Ending Affirmative Action Would Be Bad for Our Health - Progressive.org

Emergency Medicine

Opinion | Public Health: Lack of Trust, Loss of Workers – Medpage Today

The following is a transcript of an Instagram Live event where Jeremy Faust, MD, editor-in-chief of MedPage Today, and Megan Ranney, MD, MPH, incoming dean of the Yale School of Public Health in New Haven, Connecticut, discuss professional issues in public health, including how the sector has changed after the COVID-19 pandemic (note that errors in the transcript are possible).

Faust: We're talking about public health today: the field, the good, the bad, where we're headed, where we've been. Who better to join us than my good friend Megan Ranney?

Dr. Ranney is a practicing emergency physician currently serving as the Warren Alpert Endowed Professor in the Department of Emergency Medicine at Rhode Island Hospital and Alpert Medical School at Brown University. But she's also departing that role, where she was also academic dean at the School of Public Health, to become the dean of the School of Public Health at Yale University as that school bridges out from its past as part of the Medical School at Yale and now becomes its own separate entity. It's sort of a reboot.

You have a background in gun safety research and have been a rational voice to not just me, but to millions of Americans. So, Dr. Ranney, thanks for joining us today.

Ranney: It's a total pleasure, Jeremy. It's an honor to be here.

Faust: I'm always very formal with my guest -- Dr. This and That -- we'll go back and forth a little bit. I'm very conscious about making sure that I use the word doctor equally to everyone who has that title. You and I are such good friends, it'll be a little weird not to go back and forth. So Megan, thanks for coming on the show.

Let's talk about where we've been. It's 2023. Public health wasn't really on people's radars in 2020, would you say so? What do you think the through line of that has been? What do you think the average American thinks when they think of public health?

Ranney: You're exactly right. Prior to COVID, when I told people that I had a deputy dean position at the School of Public Health, or that I was a public health professional, they kind of said, what's that? Nevermind if I talk about epidemiology or biostatistics. It's like I was speaking a foreign language.

Now, I think there are few Americans, few people worldwide, who don't at least know of the concept of public health. But I think there's still a lot of confusion about what we do and the scope of our work, the impact of it, and the ways in which we work with communities, with educators, with for-profit and not-for-profit businesses. I think folks' view of what public health is is a little skewed by thinking it's all about COVID.

Faust: Yeah. This is a question that I have, maybe not for the audience, but you teach in both medical school and a school of public health, which are very, very different disciplines. One's really about patient care and one's about understanding the system in which healthcare is delivered and all the challenges that a society may face.

Do you think that people who don't practice medicine who are in a school of public health or have a career in the health professions are kind of missing something by not seeing what we see, which is that this is what it's like on paper, but in real life it's a different story?

Ranney: I would say the same in the opposite direction, that many healthcare providers are missing the view of people who practice public health every day.

I think of the two disciplines as being kind of an overlapping Venn diagram. So, two circles that share a lot, and which can both be enhanced by talking to each other and by having some shared training, but they're not completely overlapping. Not all things in healthcare are public health, and not all things in public health are healthcare.

In fact, you and I would both say there's a lot that we do in the healthcare system that unfortunately is not informed by those basic principles of public health.

Faust: That's fair. My soapbox on this is that -- I don't have an MPH, that's a master's in public health -- but I also feel like medical students who are applying to residency and want to be competitive often take a research year, which is very prestigious, and then you can go down into a field that's competitive.

Stopping to get a master's in public health, people do it, but it's not necessarily held in the same kind of prestige ... I kind of wish that was different, because I think it's a skillset that is far more applicable and long-lasting than 9 or 10 months in a lab where maybe the project worked or didn't work.

Ranney: I completely agree with that, and I think that the MPH deserves to be elevated overall.

We had a good discussion yesterday with some folks at a Department of Health training the public health workforce and about how we really need to use that MPH to not just teach people the basics of sensitivity and specificity and how to program and how to understand basic environmental determinants of long-term health, but also to use it as a chance to teach people how to be leaders within the field of public health.

And I do think it's an essential skill set for physicians to understand the ways in which society, the environment, climate, the design of streets, the design of houses, economic systems, how all of that impacts health, and understand, on the other hand, how to use data, what good data sources look like, what they don't, and how do you analyze them.

One of my colleagues here at Brown works with some folks at Yale and they teach a class on napkin math. So, how do you start from an incomplete data set and do your best to get reliable and reproducible answers? Those are essential skill sets for healthcare providers, or at least for healthcare leaders, to have.

But I agree. We do have a ways to go in terms of elevating the perceptions of the rigor and the leadership value of that Master's. It's something I look forward to taking on in my new role at Yale.

Faust: What are some of the things that someone getting an MPH would learn?

Ranney: You learn about basic statistics, biostatistics, epidemiology. You learn how to track disease risk factors, preventive factors, how to create data sets, how to analyze those data sets. You learn about the basics of the healthcare system, both globally and nationally, how it's funded, how it's structured.

You learn about environmental health; everything from toxins -- in that disaster in East Palestine with the train overturning, there were public health professionals that were part of that response team that were thinking about the long-term effects.

Then you learn about communication, leadership, policy -- all the things that go into creating a functioning public health system, which of course is about more than a governmental public health system. It's about setting up the structure to keep society healthy, both physically and socially and emotionally.

Faust: I think that, from the perspective of an emergency epidemiology perspective, which is the perspective that I bring, we've never been in a better place than we are now in terms of who knows what. The workforce is amazing.

I suspect that the same is true with the MPH with who's coming in and what kind of work is being done. I mention that because the title of this conversation is a little doom and gloom -- loss of trust, lack of trust -- things are bad. But do you sense a difference in students that are coming out of public health schools in this country today?

Ranney: We've certainly seen a huge rise in the number of applications to schools of public health over the past couple of years as people have been so personally affected through the COVID pandemic, through mental health problems, through gun violence, through the effects of structural racism.

So yes, in some ways. But I will also say that I hear a lot from my colleagues in public health a little bit of the doom and gloom that is the title of this conversation, which are the same things that we have paid attention to in the healthcare workforce over the past 3 years. The burnout, the effect of misinformation, the effect of workplace violence, the stressors of declining funding -- those are present for public health as well.

So although I see a lot of bright potential, I also think it would behoove us to pay attention to those warning signs, because we actually know that we're losing a lot of people -- particularly young people -- from the public health workforce.

It's the same thing that we're facing, Jeremy, in emergency medicine, right? We had 500 residency slots that didn't fill this year. We're seeing that somewhere around 50% of people who are in governmental public health in their first 5 years of that job have left due to the same confluence of factors that we're facing in healthcare.

And let's be clear, healthcare in the healthcare system cannot work if we don't have a strong public health system to partner with.

Faust: This idea of a mass exodus of public health workers -- nearly half of all public health workers in state and local agencies left their position over the last half a decade, which is from a Health Affairs report. I think that some of it might have been early retirement and some of it might have been burnout.

What's your sense of that? From the people that you know who left, do you have a sense of why?

Ranney: There's certainly an early retirement portion. The same thing as we've seen with the nursing workforce in healthcare, where we've had a lot of people that were getting towards the end of their tenure who've said, "You know what? Now's a good time to leave."

There are a lot of people who have had childcare challenges. There was the ridiculous work hour expectations, the lack of a break for the last 3 years, that has just made people burnt out and crispy. Just as those of us in emergency medicine or intensive care had to work more than before during COVID waves. Similarly, many of our public health colleagues were called to do more over the last 3 years and really have reached the end of their ropes.

There's also an element of that misinformation and workplace violence. I've talked to reporters about, I know you've had these too, stories about people who I've taken care of who were vehemently opposed to the idea that they actually had COVID as they were sitting there with an oxygen saturation of 70%. And I'm like, "No, no, you can't leave the hospital, I swear."

Public health workers have experienced that too. I've had colleagues who have left because they were tired of experiencing personal attacks on themselves, fearing for themselves, fearing for their family, and if anything, I think particularly some of our governmental public health workers have been more exposed to that.

Lastly, there's been a disturbing trend in many states of reducing the scope of practice of public health professionals. Just as with healthcare, people that go into public health do it because they care. They do it because they want to create a healthier society. Then they're working in a state that says that they can't do their job anymore, that's putting laws in place that reduce their ability to track the incidence of disease, to track risk factors, to provide interventions for substance use disorder or HIV or COVID.

That gets really dispiriting after a while when you know the thing to do, you know how to do it, and you're literally not allowed to. It has created this sense of moral injury for many.

Faust: One of my readers asked a question adjacent to this, which was: what can someone who's not in the field do to say to the CDC or their local public health agencies, "Hey, we want you to track COVID and infectious diseases. Don't shut down your website that tells us what's going on in the wastewater or a case count or hospitalizations or mortality."

You and I can write emails to people we know and various apparatuses in the healthcare structure, but what can my readers do who aren't doing this every day?

Ranney: I think that they can actually be in touch with their elected officials.

Ultimately, a lot of that ability to track and publish that data on a public-facing website depends on permission to access data and then to share it. So you need both those permissions for data access, which are being withdrawn as we speak as the public health emergency comes to an end. So reminding your legislators how important that is. There's also the funding involved in having the workforce to allow that to happen. This is a place where legislative advocacy really can make a difference.

I'll say, Jeremy, you and I have had a lot of conversations over the past few years and before about citizen science as well. I do think that this is also a place where, for better or for worse, sometimes citizens who have an interest and a skillset can partner to help create alternative data sets. We saw it for PPE [personal protective equipment], we've certainly seen it for firearm injury tracking -- the gun violence archive, which is privately funded, serves as really my best source of injury data. We saw it for COVID in those early days, the COVID tracking project, which was created by The Atlantic, served as this amazing source of data.

So I would say to your readers: do not underestimate your own power to create local change.

Faust: To add to that, the idea of long COVID really came from patients ringing the bell, saying, "Hey, we're bringing something to the attention of the medical field." I think that that's another example of how you don't have to be in the field to influence it. I think that's been a good story.

Let's talk a little bit about trust in people like you and me, doctors, healthcare professionals, people in this space. One of my readers asked a question that's adjacent to this: Trust is something that is hard to win and easy to lose. We go on TV or we write things and it can go well or not well. So for both of us, let's do this. What's something that you got right early on or during the pandemic, and what's something that you didn't get right and you take it back and say, "Oops, that was not right."

Ranney: It's a great question. I think that I called out earlier than many -- not most, but earlier than many -- the fact that COVID was likely airborne, which we now know to be true and that surface disinfection was less important. That, honestly, mask wearing made a difference, which despite a Cochrane Review that was deeply flawed, we actually know from the data around COVID that masks, particularly well-fitting masks, did make a difference at the height of those Omicron, Delta, and earlier waves.

I'm proud of calling that out relatively early and continuing to share my voice in that realm.

One thing that I did get wrong is that the early data on the vaccines strongly suggested that they stopped transmission. That they didn't just reduce severe disease and hospitalization, but that they also stopped infection and transmission. We had been so lucky to not have mutations at that point, and I did not anticipate the degree to which that was going to change.

I will say that the data changed, but I think that probably many of us, myself included, overemphasized that and created a false sense that these vaccines are magic, when really they're just regular old vaccines just like the flu vaccine, which is tremendous particularly for high-risk populations, but doesn't fully stop infection or transmission.

How about you?

Faust: Alright, very fair. Things I got right? I have to think about it, I feel like I haven't gotten much right.

Ranney: That's not true! I think you and I wrote a nice piece together once or twice.

Faust: I'll start with the thing I think I kind of got wrong early, which is that the early data sets coming out of China and elsewhere really showed that this was a disease of the elderly, and that's who we had to worry about. In fact, there were so few deaths of young people that I wasn't sure if there would really be a bump in what we call "all-cause mortality" in people who were not in a geriatric population. So I thought, "Well, we might see a few deaths, but that would probably be a statistical anomaly in younger people. We really have to worry about the older folks."

In fact, I set out to study that question thinking that we might not find anything in the younger groups. And you know what? We did find something. We found out that younger adults, people in the 25-to-44 age group, actually had a massive increase in their mortality. Even though it was just going from a little bit to a little bit more, which doesn't seem like as much, right?

So one in a thousand people usually die, and then it becomes one in 900 or something like that. That doesn't seem like much, but that's a huge, huge difference of life you're losing. Decades of life. It is a big relative difference, even though actually, the raw number of deaths certainly was highest in that older, sicker population.

I was wrong about that, and I'm actually happy that I was the one to go find that out and correct. So your priors, we call it "bias," can ask a research question. I thought it was one of those situations where I thought, "Let me be the person to ask this, because if I don't find what I'm looking for, that's okay." And we went with it. So that was a turnaround.

I think another thing that I probably got right pretty early on was not necessarily that it was airborne, I actually was late on that, but I was thinking it was airborne enough [to be] precautionary. I wasn't sure how airborne it was, and I'm still confused about how this virus transmits, because you'll have a roommate on a cruise ship not get it from somebody, and then half of a choir in Washington got it.

We have to learn about the airborne-ness of this virus. It's in the air, it's airborne, but it's not so clear that it's constant.

But I think that I was safe on that. Like, okay, it's airborne enough. Even if it isn't, which it is, putting a mask on keeps people like me from touching their face all the time, which I'm sure is how I was getting sick. I mean, I haven't had a healthier stretch of my life than 2020 because the hand hygiene was up, the hand hygiene was great, the masking kept all the junk out of my face, my allergies were better that year, it was great.

Ranney: Yes. I'm also going to call out my state, Rhode Island; we put kids back in school in September of 2020, and I think I gave a lot of leeway to folks that were not putting kids back in school, both nationally and globally. Bangladesh, for example, did not put kids back in school for another 2 years after that.

I think that it's a space where we could have advocated more strongly. We didn't have complete knowledge; we were worried appropriately about teachers and their health in the pre-vaccine era. Luckily, some of our colleagues came up with nice studies showing that masking, ventilation, et cetera, did make a difference. It's a space where I think that the public health community and the physician community could have sounded the alarm.

Many of us talked about the potential negative downstream effects of the COVID pandemic. Yes, we were healthier in some ways, but less healthy in others -- gun violence and mental health amongst them. Both are problems that existed before COVID, but certainly got exacerbated.

I was a local advocate for getting kids back to school, but I think that we could have been stronger nationally and internationally.

Faust: I'll add to this point. It's super-important because this was an area where public health officials and experts got a lot of heat. The approach that I took was that the idea is not to open schools, but to keep them open. You can keep schools open by taking a more aggressive approach on things like routine rapid testing.

So there was this weird disconnect where the people who wanted to open the schools the most were willing to do the least to achieve that. I think people like us were fighting an uphill battle to say, "No, both things are true. You can take this thing really seriously and do a lot of testing and do some masking and ventilation, and that's what's going to keep the kids in school." As opposed to some groups who were saying, "Oh my God, it's too unsafe. Kids have got to go home." They didn't think about the possible consequences of that.

So I think that even within our own field, there was this debate about how to do it, and I think we were right about it. The idea that you aggressively track it, you aggressively address it, with the aim of keeping those doors open.

Ranney: I think there's also a reality in looking back, and this is another place where I think we could have been clearer, is that the information was bound to change.

This was an emerging pandemic. We had literally nothing. We got nothing out of China, right? We had nothing when we started trying to fight it. And I think being clear about how the scientific method works, how we ask questions, the fact that we converge on truth, and that we were going to have to make choices with incomplete information, that we would do our best to make those choices accurately, but that it is inevitable in a pandemic that things change.

I mean, heck, Jeremy, you and I could probably sit here and go back and forth about things that we've done in emergency medicine over the course of our career that have changed substantially. We were all in that emergency state. I don't think there was any intentional not sharing of the fact that we were doing the best we could with the data that we had.

But I do think that that's an important part of the conversation going forwards, about making sure that everybody understands the basics of the scientific method, and that we continue to be clear that we're making our best possible recommendations, and these are the reasons why.

Having a little bit of humility, particularly in these emergency situations about how stuff may change down the road, but we're doing the best we can with what we've got.

Faust: One of my readers reminded me of something that I forgot about you, even though we're good friends, which is that you are a history of science major, so you might have a longer view on this. Do you think that the prestige of science has been worse in the past?

Ranney: Oh yeah, this is not a historical anomaly. I do think that the history of science -- I adore it. I could talk about it all day. But we look back at the plague, and you go back further to the Greeks and Romans. You look at Galileo and Copernicus, you look at the history of hand washing and belief in germ theory. You look at the history of vaccines and over and over throughout recorded history, the way in which we interpret science has been deeply influenced by the society in which we live.

There's been really good evidence that gets dismissed because of societal biases, and there have been mistakes made.

There have been periods of deep distrust in medicine. I mean, that's what the Flexner Report came out of in the early 1900s, trying to professionalize medical schools. It caused a lot of harm to particularly medical schools that were training Black physicians and women physicians, that Flexner Report, but it was created out of a fear that medicine was turning into snake oil salesmen.

So there have been many points throughout history where science and medicine and public health have been deeply distrusted.

I see this as cyclical, but it's also a space for us to lean into and to do better around creating trust. I do want to highlight, though, that we can be doom and gloom, but actually trust in public health and in public health institutions is not all that bad. People trust public health and healthcare practitioners way more than they trust a lot of other institutions in America.

I think we've seen across the board decline in trust of government, of higher education -- you know, name an institution and it's less trusted than it was. The NIH and the CDC are trusted equivalently to the American Cancer Society. No one would say that they are political; it's just I think that we're living in a world in which folks don't trust each other right now.

I don't want to get too down on what we've done, because we've really had some tremendous successes and saved a lot of lives.

Faust: There's this poll out of the Harvard T.H. Chan School saying that 26% of people trust their state and local public health officials. We had PR for this event and in our mentions people said, "Oh, how could we trust you guys?"

But I'll tell you, the other day, when there was an emergency on the plane that I was on and they said, "Is there a doctor on board?" and I rang in, nobody said, "Don't trust that person. They're a doctor." Everyone on the plane was very glad that a doctor was on board and that I could help the person and help figure out not to land the plane, but we're going to help this person anyway.

When push comes to shove, I think people do have trust, but we know this, depending on how a question is asked and in what situation, people answer differently.

I'll just throw another thing in about the history of science and how much we've learned. You look back at landmark studies from decades ago, things that really informed our practice, and they were decent, but a lot of these even in The New England Journal of Medicine or JAMA or The Lancet -- the best journals in the world -- would never get published today. They're not nearly rigorous enough.

So I think we've made a lot of progress. And I think that anytime we overturn anything that we thought was true and now isn't, I'm always packaging it as: that is the process. We want to own those things, because that's what science is about. Science is not about an established body of knowledge; it's about an evolving body of knowledge. I think that when we have that message out front, people actually do understand that.

Ranney: I agree.

Faust: My last question for you is really about the fact that you said something about politics, which is interesting because on one hand, this should cut across all political divides. I think you have really been excellent in your work on always trying to reach both sides of the political spectrum and not being political, but at the same time, there's a saying that health and science are political. How do you thread that needle so that work gets done, because it takes politics, without alienating half of the country?

Ranney: I think it really is a both/and. Of course, health and politics are deeply intertwined because health and societal structures are deeply intertwined. There's no way to fully separate them out.

We do know that states with certain policies and laws in place have lower mortality rates -- whether it's maternal mortality, child mortality, elderly mortality, lower rates of chronic disease, lower rates of obesity -- than states without those legislative decisions. So there's a very real impact of legislation and of politics on health.

At the same time, you can respect that people's decision-making may not be informed entirely by health and/or they may be prioritizing different aspects of health. To me, part of being a great physician or a great public health professional is balancing those realities and meeting people where they are, prioritizing the things that they prioritize.

Again, this is a space where I think some states did better than others during the worst of the COVID pandemic.

I will frequently say that there is going to be 10% or 15% of society who is never going to get on board with something that creates greater health. But the vast majority of us, if you ask us, we care about our own health, about our kids' health, about our parents' health, about our community's health, but we're going to put it in the context of we also need to pay our rent, right? We need to make sure there's food on the table. We need to make sure that we're safe when we walk outdoors.

It's making people realize that that's part of health and working to advance those things that are deep priorities of every community and are not unique to a political party. It's finding ways to create bridges across supposed political divides.

I will also say, of course, that politicians need to create drama and controversy, because that's how they get attention in fundraising. Not all politicians, but many. That's not my job in public health or in medicine. I'm not about trying to create drama. I'm about trying to work with communities where they're at to meet the needs that they identify.

Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

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Opinion | Public Health: Lack of Trust, Loss of Workers - Medpage Today

Emergency Medicine

UAB: Emergency department crowding has reached a crisis point – AL.com

The University of Alabama Board of Trustees applied for an Emergency Certificate of Need from the state to temporarily expand UABs Emergency Department (ED) and resolve its extreme overcrowding earlier this month.

A Certificate of Need, or CON, is required before any health facility in Alabama can partake in major capital expenditures or expansions according to the National Conference of State Legislatures.

UAB CEO Brenda Carlisle said overcrowding in the ED had reached a crisis point in the request.

UAB requested permission from the state to temporarily lease two mobile emergency facility units and renovate parts of the hospitals waiting room to add 25 additional patient care areas as an interim solution in the letter.

These additions will cost just over $10 million which UAB plans to source from their cash on hand the letter says.

UAB is also working on a more permanent expansion plan that would add 60 additional treatment spaces at the cost of $73 million.

This plan is still awaiting full approval from the UA Board of Trustees according to UAB spokesperson Alicia Rohan.

For the more permanent expansion Gov. Kay Ivey recently proposed dedicating $50 million of the states Education Trust Fund to UAB as the Lede previously reported.

This proposal came after UAB President Dr. Ray Watts stressed the severity of their EDs overcrowding in a special meeting called by the University of Alabama System Board of Trustees in early April specifically to address the issue.

Over the last five years UAB has experienced a 20 percent increase in patients and at least 25 percent of those patients require hospital admission according to the request letter.

It adds that UAB is overburdened in part because they are the only American College of Surgeons verified Level I trauma center in the state.

This issue is only compounded by a 40% spike in UAB trauma numbers alone over the last decade which can largely be attributed to Birmingham gunshot victim numbers doubling over that time period according to a report from AL.coms Amy Yurkanin.

This combination of overcrowding and the severity of cases that come to UABs ED often leads to vulnerable patient populations receiving delayed care according to statements made in the request by Dr. Marie-Carmelle Elie, chair of the Department of Emergency Medicine at UAB.

She added that the overcrowding had also placed UAB in the top 25% of hospitals nationwide where patients leave without being seen or even leave in the middle of medical care, only to return later with worse symptoms.

The hospitals resources simply cannot meet current ED demand, said Elie.

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UAB: Emergency department crowding has reached a crisis point - AL.com