Category Archives: Emergency Medicine

Emergency Medicine

Sporting Clays Tournament to Benefit Garnet Health Medical Center Emergency Department – Sullivan County Democrat

MIDDLETOWN Garnet Health Foundation invites all to its highly popular annual Sporting Clays Tournament, benefiting the Every Minute Counts campaign to renovate and expand Garnet Health Medical Centers emergency department.

Everyone from beginner to advanced is welcome to join in the excitement and fun taking place Friday, June 28, at Mid-Hudson Sporting Clays, 411 North Ohioville Road, New Paltz. Registration opens at 9:00 a.m., and the tournament begins at 10:00 a.m. The cost is $250 per shooter and includes 100 clays, a golf cart, shells, safety training and lunch. Gun rentals and sponsorship opportunities are also available.

Garnet Health Medical Center leads the region in access to state-of-the-art emergency care. The planned renovation will more than double the size of the emergency departmentfrom 45 treatment spaces to 100. It will also improve efficiencies while enhancing the patient experience. The expansion will increase capacity to 85,000 patient visits annually.

This fundraiser is fast becoming one of our most anticipated events of the year, and we once again thank Mid-Hudson Sporting Clays for hosting the tournament at their beautiful Hudson Valley location, said William Dauster, CFRE, Garnet Health Foundations president and chief philanthropy officer. Every 20 minutes, someone needs care in the emergency department. With our Every Minute Counts campaign, we will expand and enhance Garnet Health Medical Centers emergency department, all while confirming our promise to bring the very best in emergency medicine to the Hudson Valley region.

Those interested in participating in or sponsoring the Sporting Clays Tournament should reserve their space as soon as possible. For more information, visit garnethealth.org/sportingclays or call the foundation office at (845) 333-2333. Learn more about the foundation at garnethealth.org/foundation.

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Sporting Clays Tournament to Benefit Garnet Health Medical Center Emergency Department - Sullivan County Democrat

Emergency Medicine

Quick thinking leads to miraculous recovery of a stroke patient at VCU Health – VCU Health

By Leigh Farmer

Imagine watching your close friend and EMS surround you. Your eyes and ears take it all in, but you cannot move or speak.

This type of paralysis is called locked-in syndrome. It can happen when someone experiences a stroke.

I will never forget the paramedic. I kept going out and I remember he kept saying Chwanda look at me!, Chwanda Johnson recalled. She remembers everything from start to finish.

Sitting down with Chwanda, youll notice how she always has a smile on her face. It takes mere moments from the start of a conversation to see why she calls herself a jokester, others just start laughing right along with her. She even smiles when telling you about the scariest day of her life. November 7, 2023.

It was just like any other normal morning. I didnt feel anything different, the 49-year-old said, describing her early morning routine.

Chwanda usually hits the road at 6:30 a.m. to head to her job as a medical technician at a local senior living facility, where she has worked for more than 22 years. Usually, shes enthusiastic about getting a jump start on her day. But on that November morning, Chwanda stumbled to the car.

I got closer to the car, and it got worse. And I was like oh my God what is going on? she recalled.

When she got to the car, Chwanda called her friend Calvin on the phone who was still inside the house. As soon as she pressed send, her body gave out. She couldnt talk and her hands curled up into fists.

I wasnt able to say 9-1-1. I just said ugh, ugh, ugh.

Calvin ran out of the house and immediately knew Chwanda was having a stroke, so he dialed 911.

According to doctors, Calvins quick thinking saved his friends life. EMS was there in minutes and knew exactly where to take Chwanda.

Once I saw the VCU sign I was at ease because I knew I was in the right place. I didnt want to go anywhere else, Chwanda said.

About two million brain cells could be lost every minute a stroke goes untreated, according to VCU Health stroke specialists. A stroke happens when something blocks the blood supply to part of the brain or when a blood vessel in the brain bursts, rapidly decreasing the flow of oxygen to the brain. The more time that elapses, the worse the brain damage. After experiencing a stroke, an individual can have lasting brain damage, long-term disability or die.

Being prepared to react swiftly and appropriately, as Calvin did, can save a life. That is why it is important to recognize the symptoms.

I think if he hadnt called 911 when he did, I wouldnt be here, Chwanda recalled, her face changing quickly from a smile to a somber gaze.

Because Chwanda Johnsons close friend Calvin knew the signs of stroke, he immediately called 911. (Contributed photo)

When Henrico Division of Fire answered the call, medical personnel knew exactly what to do get Chwanda to the most equipped stroke care team in the area. They alerted VCU Medical Center. Thanks to this communication, emergency medicine physicians, nurses and a vascular neurologist were waiting at the door for Chwanda to arrive.

Our personnel are accustomed to the immediate availability of a multi-disciplinary team of specialists in emergency medicine, radiology, and neurology to care for these patients as well as the Direct to CT pathway that minimizes patient time to diagnosis and treatment, said Jeff Ferguson, M.D., medical director of Henrico Fire. Ferguson is also an emergency medicine physician at VCU Medical Center and associate professor in VCU School of Medicines Department of Emergency Medicine.

VCU Healths Comprehensive Stroke Center is one of only three centers of its kind in the region. Upon arrival, a patient suspected of having a stroke receives CT scans, labs, neurology assessments in one place. If surgery is needed, no time is wasted. They are waiting in a dedicated operating room that allows for the complete care of a stroke patient.

A quick CT scan at the hospital revealed a blood clot at the base of Chwandas brain. John Reavy-Cantwell, M.D., Chwandas neurosurgeon, removed that clot through a procedure called a mechanical thrombectomy less than an hour after Chwanda tripped in her driveway. The minimally invasive procedure is one of a few highly effective treatment options available when a patient is brought to the hospital soon after suffering from a stroke. If it takes longer for them to been seen by a medical team, the patient may be ineligible for the surgery.

Thats why its so critical for stroke patients to get medical treatment as soon as possible more options are available to prevent long-term health problems.

Recovery from a stroke is different for every person. Sometimes recovery can take weeks, months or even years. While some people fully recover, others live with lifelong disabilities such as problems with memory, speech or mobility. Rehabilitation can involve a variety of different therapists and support groups that help stroke survivors live with their new normal.

For Chwanda, it was a matter of hours before she was sitting up and laughing, back to her old self.

I could hear voices saying, move your feet, lift your leg. And anything they told me to do I did. And I heard them say Oh, call the doctor! Call the doctor! They were so surprised, said Chwanda. She describes it like she was performing a magic trick.

Reavey-Cantwell couldnt believe his own eyes when he went to check up on Chwanda several hours after removing the blood clot from her brain.

I thought that I had walked into the wrong patient's room because she was awake and talking and moving everything, he said. I was turning around to leave and then said, oh, no, this is her. Oh my gosh!

Her daughter and two granddaughters were by her side. Reavey-Cantwell believes Chwandas remarkable recovery is part miracle and part perfect execution of emergency stroke protocol.

She was probably as close to death as one can really come and then came back and made an incredible recovery, in my opinion, Reavey-Cantwell said.

Since Chwanda Johnson had a stroke, her 9-year-old granddaughter keeps stroke educational information with her so she can help if theres an emergency. (Contributed photo)

While the month of May is Stroke Awareness Month, VCU Healths Comprehensive Stroke Center is dedicated to raising awareness all year long.

The center works with the academic health system, VCU, and the Richmond community to educate residents, students, faculty, and medical professionals alike on the signs, symptoms, and latest methods for treating stroke patients. This outreach includes an annual conference as well as the city-wide initiative Stroke Smart Richmond, which educates people on stroke symptoms to reduce treatment delays.

The co-leaders of the project, VCU Health stroke program manager Stacie Stevens, Ph.D., D.N.P., R.N., and emergency room physician Ramana Feeser, M.D., are driving home one important message: When you spot a stroke, call 911.

The majority of patients with a confirmed diagnosis of stroke do not arrive by EMS, Feeser said. On top of this, most stroke patients arrive too late to be eligible for effective medication for a stroke. There is hope, if you come to us fast. We need everyone possible to spot a stroke and stop a stroke by calling 911.

You never know who will take it to heart.

Chwandas littlest advocate, her 9-year-old granddaughter, carries stroke information everywhere she goes.

She keeps it in her purse just in case she is here with me and needs to know what to do, said Chwanda with tears running down her face and a heart bursting with gratitude.

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Quick thinking leads to miraculous recovery of a stroke patient at VCU Health - VCU Health

Emergency Medicine

CPR and AED save life of man at the gym with help from UAB physician – University of Alabama at Birmingham

Knowing the basics of CPR, even low-quality CPR from a bystander, can be a lifesaving action for a person in need.

Photography: Jennifer Alsabrook-TurnerFor Floyd Lawson, it started off as a normal weekend workout at his local YMCA branch. A veteran, husband, grandfather and gym regular, Lawson usually spends two hours or so at the gym doing cardio, stretching, lifting weights and then a visit to the steam room. To say he is active and in good health is an understatement.

However, on that Saturday in the spring of 2024, Lawson sat up after doing a round of crunches and felt the blood drain from his body.

I thought wow, let me compose myself, Lawson recalled. And that is the last thing I remember. That is until I saw my guardian angel, Dr. Andy.

On that same Saturday at the same YMCA by pure chance, Andrew Edwards, M.D., emergency medicine physician at the University of Alabama at Birmingham, was working out with his son. He saw a group of people gathered around a man on the floor and immediately ran over to help.

I realized what was happening a man had collapsed and was suffering from what appeared to be cardiac arrest so I jumped in to help a medical student and nurse who were already performing CPR on the man, Edwards said. We realized how dire the mans situation was and that it was imperative that early onset and effective CPR and defibrillation were needed.

After CPR was performed for nearly two minutes followed by advised shock via an AED, Lawsons pulse went out again and Edwards did another round of CPR and defibrillation. Once Lawson woke up after nearly 10 minutes, Edwards was immediately able to route EMS to UAB Hospital and give a heads up to the attending in UABs University Emergency Department that Lawson was on the way.

It felt like I was really put in the right place at the right time, Edwards said. Ive been doing this long enough that I went into automation mode; I can help restart someones heart this is my fastball. But outcomes can be variable if bystander CPR isnt administered quickly and effectively. Im really glad we were able to get him to UAB fast, too.

Edwards stresses that every person should know the basics of CPR, as even low-quality CPR from a bystander can be a lifesaving action for a person in need.

Cardiac arrest occurs when the heart stops beating unexpectedly and results in no blood flow to the entire body. Like Lawson, theindividualwill beunresponsive, witheither no signsof breathingor very abnormalbreathing, and no detectable pulse.

Ryan Coute, D.O., assistant professor in the UAB Department of Emergency Medicine, outlines what a person should do if they find themselves in a position to administer CPR to a person in need:

Photography: Jennifer Alsabrook-TurnerIt is OK to not provide rescue breaths if you are uncomfortable doing so. Instead, focus on providing chestcompressions until 9-1-1personnel arrive. If providingrescue breaths, givetwo breaths after every 30 chest compressions and repeat until 9-1-1personnel arrive.

If available, use an automated external defibrillator, or AED, and follow its instructions as soon as possible.

CPR is highly effective and can double thelikelihoodof survival for those in cardiac arrest, Coute said. It is very important to begin CPR as soon as possible because survival will decrease byaround10 percent for every minute without CPR.If in the moment you are uncertain of what to do, call 9-1-1 and the medical dispatcher can provide youinstructions over the telephone to helpidentifycardiac arrest and begin the steps for CPR.

At the YMCA that day, Edwards and others performed hundreds of chest compressions. Their quick action undoubtedly saved Lawsons life, and bystanders watching and seeing how quick and simple CPR can be undoubtedly will save others, Lawson thinks.

When I got to UAB, it was clear that I had had a heart attack, Lawson said. I was perfectly healthy, and for this to happen at the gym of all places I was just in the right place at the right time. I truly feel like Dr. Andy is my guardian angel and that God put him there to save my life that day. If I had collapsed anywhere else, I may not be here today.

Since Lawsons heart attack at the YMCA that day, he and Edwards have struck up a friendship. They have much in common, including their faith, and even plan to meet up at the YMCA one day soon for a joint workout when Lawson is back to full health.

I never thought in my life that I would be saved by a complete stranger performing CPR, which is why its so important that everyone knows the basics of CPR I cannot stress that enough, Lawson said. I dont know what I can ever say to Dr. Andy for saving me. Thank you for not giving up on me.

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CPR and AED save life of man at the gym with help from UAB physician - University of Alabama at Birmingham

Emergency Medicine

Visby Medical Sexual Health Test Results in More Appropriate Antibiotic Treatment and Shorter Emergency … – PR Newswire

Point-of-Care test significantly shortens time from ED arrival to test results, treatment and discharge significant improvements are seen in the use of antibiotics for the treatment of chlamydia and gonococcal infections in women

Nationwide increases in sexually transmitted diseases and antibiotic resistance create the need for a paradigm shift from traditional lab-based molecular testing

SAN JOSE, Calif., May 30, 2024 /PRNewswire/ -- Visby Medical and the Johns Hopkins Medicine Department of Emergency Medicine announced findings froma study evaluating a new approach to management of the three most common non-viral sexually transmitted infections (STI) in women. The study found that use of the Visby Medical Sexual Health Test, a point-of-care (POC) polymerase chain reaction (PCR) test, shortened time from specimen collection to STI result to only 47 minutes per patient, compared to an average of 25 hours for the standard of care (SOC) lab-processed molecular send-out tests. The Visby Medical test also resulted in significantly higher rates of appropriate treatment and lower rates of over-treatment with antibiotics for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections, compared to SOCi.Full data were presented on May 17 at the 2024 annual meeting of the Society for Academic Emergency Medicine (SAEM).

The Visby Medical Sexual Health Test is the only "instrument-free" POC test available in the U.S. that provides PCR results in under 30 minutes. In March 2023, the Visby Medical test received 510(k) clearance and was granted a CLIA waiver from the U.S. Food and Drug Administration for its second-generation POC test.

An STI surveillance report published in 2024 by the U.S. Centers for Disease Control (CDC) found more than 2.5 million cases in 2022ii. At the same time, the rate of inappropriate use of antibiotics to treat STIs has contributed to antimicrobial resistant strains of NG, prompting the World Health Organization (WHO) to release new guidance to improve diagnosis of STIs, including POC tests, with special emphasis on reducing antimicrobial resistanceiii.

"The rise in STIs has created a crisis for the nation's hospital emergency departments because the conventional send out tests do not provide results fast enough to inform treatment decisions during the patient visit. Rather than lose a potentially infected patient, clinicians must decide whether to treat before they have definitive results, which isn't ideal for anyone and contributes to antibiotic resistance," explained Gary Schoolnik, MD, an infectious disease expert, Chief Medical Officer at Visby Medical, and Professor of Medicine at Stanford University. "The dramatic improvements seen with the Visby Sexual Health test in testing time, ED visit duration, and in the use of antibiotics point the way toward a new best practice for STI testing. Implementation of a new rapid point-of-care testing standard of care would greatly benefit our hospitals, urgent care centers and, most importantly, women who seek treatment for this condition."

The study, Management of Sexually Transmitted Infections in the Emergency Department: Evaluation of a Point-of-care Test, compared two approaches to testing female patients presenting to the Johns Hopkins Emergency Department in Baltimore, MD with potential STIs during two separate four-month study periods in 2022 and 2023. The first approach, SOC central laboratory testing with batched nucleic acid amplification testing (NAAT) (n=517 patients), and the second approach, the POC PCR Visby Medical Sexual Health Test (n=304 patients), were compared for rates of STIs identified, median time-to-result intervals between the two phases, and rates of appropriate treatment (including over and under treatment) based on CDC recommended guidelines.

For patients testing positive (4.8% for CT, 2.7% for NG, 8.0% for trichomoniasis [TV], and 1.9% with co-infections), proportions of appropriate treatment were significantly higher among the POC group for CT (92.7% vs 75.1% p<0.001) and NG (87.1% vs 74.3% p<0.001). Proportions of over-treatment were significantly lower among the POC group for CT-negative (7.0% vs 25.2% p<0.001) and NG-negative (13.0% vs 25.5% p<0.001) patients. No significant differences between the two testing groups were seen for TV. Median time intervals were significantly lower for the POC group, including time from specimen collection to STI results (47.0 minutes vs 25 hours p<0.001), time from ED arrival to STI results (5.7 hours vs 33.9 hours p<0.001), and time from ED arrival to discharge (9.1 hours vs 11.9 hours p<0.001)iv.

The study was conducted by researchers at Johns Hopkins Universitywith support fromVisby Medical.

About Visby Medical Visby Medical is transforming the order of diagnosis and treatment for infectious diseases so clinicians can test, talk with, and treat the patient in a single visit. The Company developed a proprietary technology platform that is the world's first instrument-free, single-use PCR platform that fits in the palm of your hand and rapidly tests for serious infections.

The Visby Medical Sexual Health Test for women is the first step in a robust pipeline that is accelerating the delivery of fast and accurate, palm-sized PCR diagnostics to the point of care, and eventually for use at home. For more information, visitwww.visbymedical.com. Follow Visby Medical onLinkedIn.

Media Contact: Harry Wade [emailprotected] 917-482-9057

iKendall N. Maliszewski BS, Management of Sexually Transmitted Infections in the Emergency Department: Evaluation of a Point-of-care Test. Paper presented at the 2024 annual meeting of the Society for Academic Emergency Medicine, May 14-17 2024, Phoenix, AZ. iiCDC, CDC's 2022 STI Surveillance Report underscores that STIs must be a public health priority. Available here: https://www.cdc.gov/std/statistics/2022/default.htm. iii WHO Announcement: WHO releases new guidance to improve testing and diagnosis of sexually transmitted infections, 24 July 2023. Available here: https://www.who.int/news/item/24-07-2023-who-releases-new-guidance-to-improve-testing-and-diagnosis-of-sexually-transmitted-infections. ivKendall, Management of Sexually Transmitted Infections.

SOURCE Visby Medical

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Visby Medical Sexual Health Test Results in More Appropriate Antibiotic Treatment and Shorter Emergency ... - PR Newswire

Emergency Medicine

St. Luke’s EMS Physician Response Team Partners with Bethlehem Ambulance Crews – The Valley Ledger

The blue, gold and white Ford Expedition with the St. Lukes logo on its doors rushed along Schoenersville Road in Bethlehem on route to assist an ambulance crew caring for a patient with an unusual, life-threatening medical emergency.

This specialized vehicle is a key component of a new partnership between St. Lukes Emergency Medicine Department and Northampton County, aimed at saving more lives at on-scene accidents and incidents in Bethlehem.

Bryan Wilson, MD, St. Lukes EMS Fellowship Director and Director the EMS Response program, explained: This new collaboration with Northampton County and our first-responder partners puts our fellowship-trained emergency medical services faculty physicians and fellows in the field in a mobile manner to supplement and support the medically complex care provided by emergency medical technicians (EMT) and paramedics in the community.

St. Lukes mobile EMS Response Team is the first one of its kind in the Lehigh Valley area, currently serving ambulance units from the City of Bethlehem EMS, Suburban EMS and Bethlehem Township Volunteer Fire Company and expecting to add other units in the future.

The grant-funded $250,000 vehicle, like a mini-ER on wheels, is equipped with state-of-the-art heart monitor/defibrillator, integrated CPR and ventilation feedback devices, life-saving medications, advanced airway management supplies and a hand-held ultrasound machine. Plans are underway to carry emergency blood for on-scene transfusions when there is major blood loss.

Dr. Wilson was behind the wheel of the Ford that day, responding to a request for assistance from the EMS crew. Together, he and the EMS crew worked with staff from a cardiologists office to save the patients life after his pacemaker malfunctioned. The team was able to safely deliver the living patient to a nearby hospital for follow-up care.

Based at St. Lukes Anderson Campus, the EMS Response Team receives requests from an ambulance crew through Northampton Countys 911 Center. The Response Team also provides continuing hands-on emergency medicine education to first responders in the county. These services help show EMS clinicians how much we value their expertise and possibly address recruitment and retention issues faced by EMS services professionals across the region, added Dr. Wilson.

What the EMS Response Team brings to that on-scene setting are extra hands and an advanced understanding of the patients pathophysiology (disease processes), so we can better the direct the care of the patient, in partnership with the on-scene EMTs and paramedics, thinking outside of the box, when necessary, to save lives.

Photo caption: Bryan Wilson, MD, St. Lukes EMS Fellowship Director and Director the EMS Response program.

About St. Lukes

Founded in 1872,St. Lukes University Health Network(SLUHN) is a fully integrated, regional, non-profit network of more than 20,000 employees providing services at 15 campuses and 350+ outpatient sites. With annual net revenue of $3.4 billion, the Networks service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Lukes hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Lukes Childrens Hospital.

Dedicated to advancing medical education, St. Lukes is the preeminent teaching hospital in central-eastern Pennsylvania. In partnership with Temple University, the Network established the Lehigh Valleys first and only four-year medical school campus. It also operates the nations oldest School of Nursing, established in 1884, and 52 fully accredited graduate medical educational programs with more than 500 residents and fellows. In 2022, St. Lukes, a member of the Childrens Hospital Association, opened the Lehigh Valleys first and only free-standing facility dedicated entirely to kids.

SLUHN is the only Lehigh Valley-based health care system to earn Medicaresfive-starratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and HealthgradesTop Hospitaland a Newsweek WorldsBest Hospital. The Networks flagship University Hospital has earned the100 Top Major Teaching Hospitaldesignation from Fortune/PINC AI 10 years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY. In 2021, St. Lukes was identified as one of the15 Top Health Systemsnationally. Utilizing the Epic electronic medical record (EMR) system for both inpatient and outpatient services, the Network is a multi-year recipient of theMost Wiredaward recognizing the breadth of the SLUHNs information technology applications such as telehealth, online scheduling and online pricing information. The Network is also recognized as one of the states lowest-cost providers.

Information and image provided to TVL by: Sam Kennedy

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St. Luke's EMS Physician Response Team Partners with Bethlehem Ambulance Crews - The Valley Ledger

Emergency Medicine

Extreme Heat: What ER Doctors Want You to Know – The New York Times

The heat index hit 112 degrees in Miami this week. Monkeys have been dropping dead amid scorching heat in Mexico. India is experiencing its latest heat crisis.

With warmer temperatures comes a greater potential for heat-related illnesses. Rates of emergency room visits for conditions related to heat rose substantially in many parts of the United States last summer, according to the Centers for Disease Control and Prevention. And weather experts are again predicting above-normal temperatures in much of the country this summer.

We asked emergency room doctors around the country what the public should know about extreme heat.

Mild heat illnesses include heat rash; swelling in the hands and feet; muscle cramps; and heat syncope, or a fainting episode after standing too long or getting up suddenly. People with heat exhaustion have more severe symptoms, which could include headache, nausea, vomiting and dizziness.

Dr. Hany Atallah, an emergency medicine physician and the chief medical officer of Jackson Memorial Hospital in Miami, said heat exhaustion is the most common heat-related illness he sees in the E.R. Doctors can usually help patients cool down and hydrate properly and, within a few hours, discharge them, he said.

Heat stroke, which can be caused by exposure to extreme heat or strenuous exertion in high temperatures, is less common but much more dangerous. The hallmark signs are a core body temperature above 104 degrees; and confusion, seizures or other mental status changes in the context of extreme heat exposure.

The bodys ability to cool itself is impaired, Dr. Atallah said. The condition can lead to brain damage, muscle breakdown and kidney failure.

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Extreme Heat: What ER Doctors Want You to Know - The New York Times

Emergency Medicine

Emergency departments prove fertile ground for smoking cessation success – News-Medical.Net

In a recent study published in the Emergency Medicine Journal, researchers discuss the outcomes of the Cessation of Smoking Trial in the Emergency Department (COSTED) study, which aimed to understand the optimal intervention and long-term outcomes of emergency department (ED)-based smoking cessation interventions.

Study:Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre, randomized controlled trial.Image Credit: rangizzz / Shutterstock.com

Tobacco consumption, which is generally in the form of smoking, is responsible for about eight million deaths each year and, as a result, is the leading cause of human mortality worldwide. Research in the United Kingdom has revealed that 22% of its 6.4 million smoking citizens belong to the routine and manual occupations segment, whereas 8.3% belong to the managerial and professional occupational cohort.

Reducing the global dependency on tobacco and tobacco products is one of the highlights of modern medicine, with addiction treatment presenting a potent intervention against premature death, oversaturation of the healthcare system, and health inequalities. EDs present a viable and untapped setting for implementing anti-tobacco interventions, as these departments see large numbers of individuals, many of whom smoke and experience complex health inequalities.

Previously, smoking cessation interventions have been tested in ED settings with generally favorable outcomes. However, current challenges to the widespread implementation of these methodologies are due to these trials having only evaluated behavioral support or a combination of behavioral support and nicotine replacement therapy (NRT), particularly in populations already motivated to quit smoking.

Recent research and anecdotal evidence suggest that e-cigarettes are more potent anti-tobacco addiction tools than NRTs; however, their effectiveness has never been formally tested. Thus, understanding the real-world and long-term effectiveness of smoking cessation interventions carried out in ED settings and involving e-cigarette use may help millions of people worldwide reduce the prevalence of tobacco smoking in the future.

The present study aims to evaluate the long-term effectiveness of an ED-based smoking cessation intervention as compared to usual care. The effectiveness of e-cigarette starter kits in reducing smoking as compared to their absence was also investigated.

The COSTED study is a multicenter, parallel-group, and computer-randomized controlled trial involving six UK National Health Service (NHS) EDs. The study included adults 18 years and older who were either admitted to an NHS ED or accompanying someone who was.

Study participants were identified during routine ED screening and included those who reported daily tobacco use and excluded individuals who exhaled less than eight parts per million (ppm) of carbon monoxide (CO) or were currently using both traditional cigarettes and e-cigarettes daily. Identified individuals who provided informed consent were then enrolled in the study and computer-randomized into either the intervention or control cohort.

The intervention cohort was provided a 15-minute long smoking cessation session with a dedicated smoking cessation advisor, an e-cigarette starter kit along with detailed instructions on its use, and an electronic referral to a local smoking cessation center. Comparatively, individuals in the control group were provided with written cessation advice but no further intervention.

Study outcomes, which included self-reported and biochemically measured smoking abstinence, were measured during routine questionnaires and ED-based follow-ups conducted one, three, and six months following participant randomization. Risk estimates and differences in outcomes between cohorts were calculated using binary regression models, including fixed effects and Gaussian models with robust variances.

Individuals in the intervention cohort were significantly more likely to quit smoking and remain tobacco-free longer than those in the control group. Although the biochemically verified smoking quit rate was not as high as expected, self-reported abstinence, which was defined as six or fewer relapses over the course of the six-month-long study, was higher than expected. These results suggest that biochemical results, both from this and previous studies, are likely underestimates of the true potential contribution of EDs in smoking cessation efforts.

The ED represents an acceptable location for smoking cessation intervention and therefore offers a valuable opportunity to engage those who smoke who are not currently seeking to quit.

The study findings demonstrate the effectiveness of simple and opportunistic smoking cessation interventions provided in real-world ED settings. Self-reported daily tobacco users showed significant reductions in smoking dependency and use following a brief 15-minute-long counseling session with a dedicated smoking cessation advisor, an e-cigarette starter kit, and digital referral to a local stop-smoking service, particularly when compared to controls who only received text-based cessation advice and stop-smoking services referral.

Those attending EDs are generally from more deprived communities and more likely to smoke than the general population. Therefore, this intervention has the potential to address health inequalities that arise from disparities in smoking rates between different socioeconomic groups.

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Emergency departments prove fertile ground for smoking cessation success - News-Medical.Net

Emergency Medicine

Emergency Medicine team trains health care professionals in West Africa – UC Davis Health

(SACRAMENTO)

A team from the UC Davis Health Department of Emergency Medicine is training providers in The Gambia to deliver health care using portable ultrasound equipment.

The crucial initiative aims to enhance the diagnostic capabilities of medical professionals in The Gambia and improve access to care. The training program focuses on diagnosing heart and lung conditions.

The UC Davis team is training the providers to use Point of Care Ultrasound (POCUS), a convenient diagnostic tool that is increasingly being employed in hard-to-reach communities because of its portability.

POCUS can assess patients wherever they are located. It is a vital tool in remote settings because it enables the diagnosis and treatment of critically ill patients without having to be in a clinic or hospital.

The Gambia is a perfect environment for portable ultrasounds to make a real difference in patient care and to save lives, said Christine McBeth, assistant professor of Emergency Medicine at UC Davis Health and course director of the training program. These reliable tools provide real-time information on how to best treat patients and allow us to monitor a patients response to their treatment.

During their recent trip to The Gambia, McBeth and her team provided a week of classroom training with interactive team-based learning activities. The training was funded by the Department of Emergency Medicine, the London School of Hygiene and Tropical Medicine and the Sustainable Cardiovascular Health Equity Development Alliance (SCHEDA) and Medical Research Council Unit. SCHEDA donated four handheld ultrasound probes along with iPads.

The following week, the group from UC Davis led the local providers in hands-on simulations with real-life patient scenarios.

The goal of the training program was to teach these local health care professionals how to use the POCUS tools so they can provide care to acutely ill patients with respiratory and cardiac conditions after we leave, McBeth added.

The Gambia is one of the smallest countries in continental Africa, sharing its borders entirely with Senegal, except for its picturesque coastline along the Atlantic Ocean to the west.

While the West Africa nation has made substantial strides in health care access and delivery, it still struggles with a scarcity and unequal distribution of its health care workforce. A recent report from the World Health Organization (WHO) stated that the country's skilled health care workers stand at a modest 1.33 for 1,000 people, which is short of the WHO benchmark.

Additionally, health care facilities in the country are concentrated in urban regions, which creates disparities between urban and rural communities.

We hope this training will enhance the capacity for health care providers to provide precise and timely medical interventions to patients in these rural and underserved communities, explained McBeth. It is a great starting point, and we will continue with ongoing lectures, quality assurance and follow-up education and training to ensure it is utilized in the best way possible, with patient safety always at the forefront.

The multidisciplinary team's visit to The Gambia in January was in line with UC Davis and UC Davis Healths efforts surrounding global health. Known as One Health, the interdisciplinary approach recognizes the interconnectedness of people, animals, and the environment and aims to identify and address the fundamental causes of poor health to improve the well-being of all.

Our physicians, staff and students can grow through trips like this by gaining practical experience which will reinforce medical knowledge, learning about the many social determinants of health, and gaining experience in cultural competency, explained Shakira Bandolin, director for global health at UC Davis Health. By gaining experience with different populations around the world with different cultures and belief systems global health rotations instill an appreciation for diversity and the importance of practicing among underserved and multicultural populations.

UC Davis Health recently established a new Center for Global Health. The center was created to improve collaboration, organization, financial and administrative support for all specialties and health care providers to improve health and equity for all patients across the globe. Through ongoing collaborations with domestic and international partners, the center creates opportunities for students, residents, fellows and faculty to train to be conscientious health care practitioners. The center also allows UC Davis Health providers to participate in clinical, educational and research endeavors with their global partners.

We understand that a patients health is influenced by many factors including their environment, access to health care, socioeconomic status, and other complex social determinants of health, said Nathan Kuppermann, associate dean for global health at the UC Davis School of Medicine. We are committed to high-quality care for all patients, especially the most vulnerable in our communities and abroad. We aim to collaborate on clinical care, education, research and infrastructure development with our global partners. This commitment raises the bar to care for our patients throughout our health system and across the globe.

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Emergency Medicine team trains health care professionals in West Africa - UC Davis Health

Emergency Medicine

Asking patients about flu shots in the emergency room may boost uptake – University of Minnesota Twin Cities

Simply asking patients to get the flu vaccine during emergency department (ED) visits may double vaccination ratesor raise them even higher if the request is combined with helpful video and print messages, according to a study this week inNEJM Evidence.

The study, led by researchers at the University of California-San Francisco (UCSF), compared two interventions among 767 non-critically ill adult patients seen in the ED who were not yet vaccinated against influenza. The study was conducted in San Francisco, Houston, Philadelphia, Seattle, and Durham, North Carolina, during a single flu season, from October 2022 to February 2023.

"This research arose from our desire to address the health disparities that we see every day in our emergency department, especially among homeless persons, the uninsured, and immigrant populations," said the study's first author, Robert M. Rodriguez, MD, a professor of emergency medicine at the UCSF School of Medicine, in a press release from that school.

Those groups, as well as Black and Hispanic Americans, are less likely to visit a primary care physician regularly.

Flu vaccine uptake was measured among those given no intervention, those given no messaging about flu shots but were asked about intentions to get vaccinated, and those given an influenza vaccine messaging platform consisting of a video, 1-page flyer, and scripted message of, "Would you be willing to accept the influenza vaccine?"

All printed materials were delivered in both English and Spanish.

Among the 767 adults in the study, 32% said they had no primary care provider. Forty-six percent were women, 36% were Black, 21% were Hispanic, and 12% did not have health insurance.

Thirty days after their ED visit, participants were asked if they had received a flu vaccine. Among those with no intervention, 15% had gotten vaccinated. Thirty-two percent of those who were asked about their flu vaccine intentions were vaccinated, and 41% of those who watched a video, got the flyer, and were asked about their intentions had received a vaccine.

The fact that simply mentioning vaccination had such a positive impact on future vaccination rates among our sample is incredible.

"The fact that simply mentioning vaccination had such a positive impact on future vaccination rates among our sample is incredible, and makes a strong case for incorporating vaccine messaging into emergency department workflows," said coauthor Efrat Kean, MD, an emergency medicine physician from Thomas Jefferson University, in a press release from that school.

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Asking patients about flu shots in the emergency room may boost uptake - University of Minnesota Twin Cities

Emergency Medicine

Misdiagnosis of Acute Appendicitis Cases in the Emergency Room – Cureus

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Misdiagnosis of Acute Appendicitis Cases in the Emergency Room - Cureus