Category Archives: Emergency Medicine

Emergency Medicine

Quebec emergency room doctors warn conditions out of control due to surge of COVID and other respiratory infections – WSWS

With the onset of winter, Quebecs emergency rooms are overflowing, endangering the health and lives of Quebecers. A major driver of the increased burden on hospitals is a surge in COVID-19 cases.

This is a repeat of the situation experienced in November and December 2022. According to the governments Index Sant website, the provinces overall emergency-room (ER) occupancy rate has exceeded 100 percent on every single day since Nov. 12. On Tuesday, the average rate across the province was 131 percent. In Laval, Quebecs third-largest city, it was 182 percent and in the nearby Lanaudire region, 171 per cent.

ER doctors wrote to Health Minister Christian Dub last Friday to warn that conditions in emergency rooms across the province are out of control. Overcrowding in the emergency department leads to daily mortality, says the letter, which was written by Dr. Marie-Maud Couture, the president of the Regroupement des Chefs dUrgence du Qubec (Association of Emergency Rooms Chiefs), and supported by the hundreds of doctors and residents who comprise the Association des spcialistes en mdecine durgence du Qubec(Quebec Association of Specialists in Emergency Medicine).

Congestion in emergency departments leads to mortality, recently estimated at one excess death for every 82 patients admitted, wrote Dr. Couture. This statistic does not take into account indirect deaths, i.e. people who present late despite having an urgent medical condition, for fear of waiting more than 24 hours in a waiting room, and sometimes even for fear of being a nuisance.

The immediate cause of the current overcrowding crisis is the triple epidemic of respiratory viruses that is hitting the province. As in 2022, influenza, COVID-19 and respiratory syncytial virus (RSV) are infecting Quebecers en masse.

According to the Institut national de sant publique du Qubec (INSPQ), some 130,000 Quebecers contract a respiratory virus every day.

COVID-19 is believed to be responsible for a third of these infections, although official figures (4,987 new cases for the week ending November 26) continue to seriously underestimate the number of cases. This is because they are based on PCR tests, which are accessible to only a small minority of people. These incomplete official figures and voluntary declarations of positive rapid tests have been steadily increasing since the end of September.

As of last week, 2,200 people were hospitalized with COVID-19, a number that exceeds what was seen in 2020 and 2021 before the arrival of the Omicron wave. This shows that the policy of mass infection adopted by the ruling class at the time has allowed the disease to take hold permanently, with a very high baseline.

COVID-19 also continues to kill. The 70 people who died between November 26 and December 2 in Quebec brought the official count of COVID deaths since 2020 to 19,084. At the end of November, Statistics Canada published its annual report on life expectancy in Canada. For the third year in a row, life expectancy in the country has fallen, from 82.3 years in 2019 to 81.3 in 2022.

The Statscan report also revealed that COVID-19 caused more deaths in the country last year than in any other year of the pandemic. With over 19,700 deaths attributable to it in 2022, COVID-19 is now the third leading cause of death in the country, responsible for around 6 percent of all deaths. In Quebec and Ontario, the two most populous provinces, mortality caused by COVID-19 increased by 38 percent in 2022 as compared to 2021.

The right-wing Coalition avenir Qubec (CAQ) government, with the complicity of the corporate-controlled media outlets and the federal Liberal government, is doing everything in its power to prevent the public from becoming aware of the immense dangers it faces. Its aim is to continue pursuing a deliberate policy of mass infection.

The COVID-19 health emergency was lifted in Quebec on June 1, 2022, and all measures, including the mandatory wearing of masks in healthcare centers, were eliminated. Even tracking the evolution of COVID-19 has become almost impossible due to the lack of data.

In the most recent example, on December 6 the INSPQ discreetly announced on its website that data on hospitalizations linked to COVID had also become imprecise with the end of the obligation for hospitals to record specific information. In particular, it will no longer be possible to know the number of COVID patients hospitalized in intensive care units.

Government and media propaganda downplaying the dangers associated with COVID has also led to a collapse in the number of Quebecers keeping their COVID vaccinations up to date. As of the middle of December, barely 900,000 people, or around 14 percent of the population, had received a booster dose designed to combat the Omicron XBB.1.5 sub-variant since the vaccination campaign began in October.

The data are just as alarming for the most vulnerable people, the only ones for whom the government and INSPQ officially recommend the vaccine. Vaccination rates are 39.1 percent for those over 60 and 45.8 percent for people aged 70-79. Of those 80 and over barely half, 50.5 percent, have received the latest booster.

Quebec Public Health Director Dr. Luc Boileau has warned of a cocktail of COVID-19 and flu for Christmas, even while downplaying the dangers. He is urging those over 70 to get vaccinated, and recommends that those with symptoms wash their hands and wear a mask. Quebec Premier Franois Legault appointed Boileau as the provinces interim public health director in Jan. 2022, as the government was moving to eliminate all mitigation measures amid the Omicron wave, and later made his posting permanent, precisely because of Boileaus readiness to implement the governments murderous profits-before-lives pandemic policy.

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According to Dr. Boileau, cases of influenzawhose main strain this year is H1N1, which is particularly dangerous for childrenare also rising sharply in Quebec. The test positivity rate has risen from 3.9 percent to almost 7.3 percent in the space of a week, and several adults with influenza are hospitalized in intensive care. Authorities fear that the situation will evolve in the same way as in Alberta, where the test positivity rate has risen from 3 percent to 33 percent in the space of a month.

The deeper causes of the ongoing crisis in emergency departments and, more generally, in the healthcare system, are also well known. They include the savage cuts made for decades by successive Parti Qubcois and Quebec Liberal Party governments, and the intensification of capitalist austerity by the CAQ, which announced in its March budget an increase in healthcare spending below inflation when non-recurring, COVID-19-related expenses are deducted.

Meanwhile, Dubs solutions to the ER crisis are collapsing miserably one after the other. At the end of November, the only two full-time nurses in the first Specialized Nurse Practitioner (SNP) clinic resigned, citing issues impacting the quality and safety of care, including a lack of equipment.

The clinic was opened with great fanfare at the suggestion of the crisis unit set up by Dub in December 2022, when emergency departments were in acute crisis. It was intended to relieve emergency departments and hospitals by treating less urgent cases.

Similarly, the Info-Sant line (811), where sick people are supposed to be able to talk to a professional and be directed to an alternative to ER care if their case is not too serious, is itself overwhelmed. People sometimes have to wait several hours to talk to someone.

In the first week of December, 42.3 percent of 811 callers hung up before getting any advice. Despite this, Dub reiterated on Tuesday that people should avoid the ER if at all possible, encouraging sick people to self-diagnose the severity of their illness and decide if they have the right to seek ER treatment.

The crisis in the healthcare system and the indifference of the ruling class are a serious threat to the lives of Quebecers. Recently, the media revealed that two people died in the emergency room of the Anna-Laberge hospital in Chteauguay, near Montreal, on November 29 and 30.

Although the authorities have refused to give details of these tragic incidents on the pretext that administrative investigations are underway, it appears that one person died after waiting 12 hours, although he was supposed to see a doctor within 30 minutes of arrival according to the preliminary examination carried out in triage. The stretcher occupancy rate at Anna-Laberge Hospital was 184 percent.

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Quebec emergency room doctors warn conditions out of control due to surge of COVID and other respiratory infections - WSWS

Emergency Medicine

Study pinpoints ideal locations for public bleeding control kits in shopping centers – News-Medical.Net

Where should bleeding control equipment be located to save as many lives as possible? Researchers at Linkping University in Sweden, in collaboration with US researchers, have found the answer to this through computer simulations of a bomb exploding in a shopping center. One of the most important conclusions: bleeding control kits should not be located at entrances.

In the event of an accident or an attack, members of the public can save lives by performing first aid measures until the arrival of emergency medical services. But it is not enough that people see themselves as life-saving immediate responders, prepared and able to act.

There must also be certain equipment available to manage major bleeding. The question then is where this equipment should be placed, so that people who want to help can quickly access bleeding control kits."

Carl-Oscar Jonson, adjunct senior associate professor at the Department of Biomedical and Clinical Sciences at Linkping University and head of research at the Center for Disaster Medicine and Traumatology in Linkping

Until now, there have been no guidelines for where such bleeding control kits should be located to ensure maximal utility. The current study, published in the journal Disaster Medicine and Public Health Preparedness, now contributes research-based recommendations.

"We found that the largest number of lives saved correlated with bleeding control kits being placed in two or more locations on the premises, but most importantly they shouldn't be placed at entrances. We also concluded that the equipment must be accessible within 90 seconds' walking distance," says Anna-Maria Grnbck, doctoral student at the Department of Science and Technology at Linkping University, who was involved in developing the simulation.

This means that bleeding control kits should not be placed at entrances, which is often the case with automated external defibrillators (AEDs). The reason for this is that they may be difficult to reach in a situation where many people have to be evacuated at once, such as in the case of attack or major accident. According to attack statistics, roughly 20 injured people will need first aid including a bleeding control kit each. It may be helpful to locate bleeding control kits in the same places as clearly marked AEDs, as long as not located at the entrances.

The recommendations are based on conclusions reached by the research team by developing a computer-based simulation of an explosion in a large shopping centre with thousands of simultaneous visitors. In their simulation, the researchers have looked at what happens right after an explosion. The majority of the simulated people try to get out of the premises and move towards the exits. Simulated people close to the blast suffer varying degrees of injury and start bleeding. In the simulation, some individuals help those injured by applying direct pressure to reduce bleeding, or by trying to find equipment. It is a race against time. Depending on how long it takes to get the equipment, the simulated injured people may die from blood loss.

To find the best strategy for the placement of bleeding control kits, the researchers tested four different scenarios in their simulation. They weighed together the outcomes of the many simulated courses of events for each scenario and compared them to understand which placement of equipment saved the largest number of lives.

The current study is a collaboration project between the Center for Disaster Medicine and Traumatology in Linkping, the Department of Computer and Information Science and the Department of Science and Technology at Linkping University and American experts affiliated with the National Center for Disaster Medicine and Public Health. While the placement of bleeding control kits in sports arenas and similar has become increasingly common in the US, it is so far a rarity in Sweden.

"I hope policymakers and public venues can use this study to guide plans and decisions about where to locate public-access bleeding control supplies. For example, our study suggests that supplies co-located with AEDs would be more beneficial than those located near exits. In an emergency when minutes matter, having equipment readily accessible might mean the difference between life and death," says Craig Goolsby, Professor of Clinical Emergency Medicine at the David Geffen School of Medicine at UCLA and Chair of the Department of Emergency Medicine at Harbor-UCLA Medical Center, USA.

The project was funded by the Swedish Civil Contingencies Agency (MSB), the Department of Homeland Security Science and Technology Directorate in the USA, and Linkping University. The Center for Disaster Medicine and Traumatology in Linkping is a national knowledge centre located at Region stergtland and Linkping University.

Some of the researchers behind the study have patents related to bleeding control kits.

Source:

Journal reference:

Steins, K., et al. (2023). Recommendations for Placement of Bleeding Control Kits in Public Spaces a Simulation Study. Disaster Medicine and Public Health Preparedness. doi.org/10.1017/dmp.2023.190.

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Study pinpoints ideal locations for public bleeding control kits in shopping centers - News-Medical.Net

Emergency Medicine

Lisa Lincoln, M.D., Awarded Unsung Hero by New York American College of Emergency Physicians – URMC

Lisa Lincoln, M.D., Attending Physician in the Department of Emergency Medicine at Highland Hospital and Associate Professor, Department of Clinical Emergency Medicine, University of Rochester School of Medicine & Dentistry has been named a New York State Emergency Medicine Unsung Hero. This designation is awarded to physicians for their work ethic, compassion, and collegiality.

A New York State Emergency Medicine Unsung Hero goes beyond simply being the embodiment of what it means to be an emergency physician. They are a stalwart of the Emergency Department, who is deeply committed to the mission of the emergency department, their colleagues, co-workers and patients.

Emergency Medicine encompasses planning, oversight and medical direction for community emergency medical response, medical control and disaster preparedness. Emergency physicians possess a unique body of knowledge including the initial evaluation, diagnosis, treatment, coordination of care among multiple providers and disposition of patients requiring expeditious medical, surgical or psychiatric care.

"It is no secret that the current clinical practice environment in Emergency Medicine can be challenging just about every Emergency Department has issues with boarding and resources, said Timothy Lum, M.D., FACEP, Chief of Emergency Medicine for Highland Hospital. It is these challenges that allow physicians like Dr. Lincoln to demonstrate just how exceptional they are. Dr. Lincoln is a role model within our department when it comes to patient care. She possesses integrity, truly cares about patients and is unwaveringly kind, compassionate and dedicated to the provision of excellent patient care. She does this all with an unparalleled humility."

Dr. Lincoln is a Rochester native. After attending SUNY Geneseo for her undergraduate degree, Dr. Lincoln received her medical degree from the University of Rochester School of Medicine and Dentistry in 2009. She completed her Emergency Medicine residency training at the University of Rochester and was elected to be one of the Chief Residents by her peers and the Emergency Medicine faculty.

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Lisa Lincoln, M.D., Awarded Unsung Hero by New York American College of Emergency Physicians - URMC

Emergency Medicine

ER Physician Paul Mucciolo Files for Conklin’s School Board Seat, Citing Need for ‘Healthy Dose of Professionalism’ – FlaglerLive.com

Dr. Paul Mucciolo. ( FlaglerLive)

Last Updated: 6:44 p.m.

Emergency Medicine Physician Paul Mucciolo Files to Run for Conklins School Board Seat

Dr. Paul Mucciolo, an emergency-medicine physician at AdventHealth Palm Coast, picked up his two children from Indian Trails Middle School this afternoon, headed to the Supervisor of Elections office in Bunnell and declared his candidacy for the District 3 seat on the Flagler County School Board to bring back a healthy dose of professionalism to the board, he said, and to return the school district to an A-rated organization.

Mucciolo is running for the seat Colleen Conklin has held since 2000, as he did three years ago. Conklin has elected not to run again in 2024, as has Cheryl Massaro, though Massaro may not have entirely closed the door on another run.

Their departure will leave the board with the least combined elected-office experience it has had in memory, with three other board membersSally Hunt, Will Furry and Christy Chongeach having only two years on the board by then, assuming all three complete their first term.

The school districtstop administrative staff has also lost experienced hands and is led by first-year Superintendent LaShakia Moore, with additional administrative losses ahead. Moore expects to have a deputy superintendent by early next year. That would not necessarily be a problem in an organization moored to a functioning board. But that has not been the case, as a member of the public put it to the board this afternoon at the beginning of a workshop.

Ive been coming to these meetings a long time. But for the past year, which coincides probably with three new members of the board, what I dont seem to see or understand or perceive is that the board has spent any time in the last year thinking about kids, Mike Cocchiola told the board before enumerating the boards various firings and going after anything with a rainbow on it, for your own personal convictions. It seems to me that youre spending more time and more taxpayer money attacking cultural issues, and not once that I hear, especially the new members, say lets do something for the kids.

Mucciolo hadnt heard the commentit was delivered around the same time that the doctor was leaving the supervisors office, three floors up from where he wasbut seemed to echo it. Im trying to get Flagler schools and mainly the school board back on track to try to get the students and parents first, then the staff, then the support staff, and then the the board actually last, he said. The board should be there to serve, to serve the students and to give them the best possible education that they can get.

He does not want the operations of the school board to control so much of the agenda, as it has for the past few years, often at the detriment of other priorities. Flagler should be back to an A school [district], it should never lost the designation, he said. We have to look at why its not an A school and make sure that we dedicate the resources to bring whatever area needs attention up to par in order to earn that designation. He added: I would like there to be more of a business like attitude, a healthy dose of professionalism, and what I would like to really see happen is to open the doors more to our community. That is what is going to benefit our children, benefit our businesses, benefit our district in generalby having a closer relationship with the educational opportunities and businesses in the community.

Mucciolo carries a heavy workload. He practices emergency medicine full time, serves as the medical director at AdventHealth Palm Coast and AdventHealth Palm Coast Parkway (both the north and south campuses of the hospital), and at the International Speedway, where AdventHealth is the exclusive healthcare provider. My demands are many but the flexibility in my scheduling affords me the ability to attend meetings, to take phone calls, to meet with people. So, while I do have a heavy load, I can adjust it in order to accommodate additional demands, Mucciolo said.

He and his wife Christy moved to Palm Coast in 2008. He was in emergency medicine with Halifax Health before switching to AdventHealth in 2015. Why emergency medicine? The variety of the job. I get to see it all, he said. And its a privilege to be able to care for people who are at their worst. Its their worst moment, and its an honor to help people put their trust in you to try to help them. The current school board may not be such a leap from the emergency room.

He is now one of two candidates for the District 3 seat. Nicole Durenberger, a relatively new arrival in Flagler County, initially filed for a Palm Coast City Council seat, withdrew, then filed for School Board. (Like County Commission candidates, School Board candidates are elected according to districts. The candidates must live in the district they represent. But voters from across the county cast ballots for candidates regardless of district. The races are ostensibly non-partisan, but in todays ideologically polarized campaigns, most voters pay attention to a candidates registration and the local political parties overtly politicize non-partisan races.)

Mucciolo has been following the school board since before his first campaign. He ran against Conklin three years ago. Conklin won in a three-way race (she took 52 percent of the vote to Mucciolos 35, with a third candidate taking the balance of the votes) Mucciolo, a Republican, and Conklin, a Democrat, then essentially became colleagues as Mucciolo appeared on a virtual town hall Conklin organized during the Covid pandemic to counter the effects of unscientific information and tamp down some o the hysteria surrounding recommended safety measures at the time, in school and elsewhere.

Paul and I had an opportunity to work together during Covid, Conklin said this evening, after a boar workshop. I relied on his expertise and it was clear to me that he was greatly focused on the success of all students. I believe hes disassociated himself from those who thought they may have been able to influence him. He is very much his own man.

I cant fill her seat, Mucciolo said of Conklin. With that depth and length of experience and the breadth of experience, Im coming in new. It has some disadvantages because I have to uncover a lot of things and look behind the doors that we dont see now, because Im not active on the board. But it has an advantage of bringing some fresh perspectives. And the thing to do is to carry on the good work. She has worked tirelessly for the students and the teachers. And what Ive noticed from her is that shes very open to listening. And I think thats where its most importantthat we listen to our students. We listen to the teachers, and we listened to the community, and I would like to carry forth that quality more than anything, and the dedication to making sure that everyones needs are met when there are difficult times like Covid or an economic downturn.

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ER Physician Paul Mucciolo Files for Conklin's School Board Seat, Citing Need for 'Healthy Dose of Professionalism' - FlaglerLive.com

Emergency Medicine

Are First-Year Emergency Medicine Residents Still Behind on Level 1 Care-Based Milestones? – Cureus

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Are First-Year Emergency Medicine Residents Still Behind on Level 1 Care-Based Milestones? - Cureus

Emergency Medicine

UAB researchers awarded $1 million to study ways to reduce emergency department overcrowding – University of Alabama at Birmingham

The research teams goal is to create a customizable solution that can be applied across various health care settings to reduce overcrowding in emergency departments.

Abdulaziz Ahmed, Ph.D. and Bunyamin Ozaydin, Ph.D.A group of University of Alabama at Birmingham researchers have been awarded $1 million to develop and implement solutions to reduce emergency department overcrowding.

This is definitely a significant topic and an important societal problem, said Abdulaziz Ahmed, Ph.D., associate professor in the UAB School of Health Professions and associate scientist in the Center for Clinical and Translational Science. We are all excited to be tackling something that can be so impactful for so many people.

The research will use artificial intelligence, machine learning and health information technology to analyze the full capacity protocol in managing patient flow in the ED and beyond. The FCP consists of multiple levels, each triggered by specific criteria. When a level is activated, various interventions can be implemented to address ED crowding.

Currently, most hospitals adopt a reactive approach, waiting until the ED is crowded before deploying resources to mitigate the issue. In contrast, this project aims to leverage AI and machine learning to transform the FCP into a proactive protocol that anticipates crowding using different AI models.

This is a problem facing every health system around the world. There is not one universal protocol, Ahmed said. Plus, not every hospital even has an FCP.

Bunyamin Ozaydin, Ph.D., who has extensive system development experience in the UAB Marnix E. Heersink School of Medicine Department of Anesthesiology, emphasizes that ED overcrowding is not solely an ED problem but rather a hospital wide issue affecting patient flow.

After leaving the operating room, surgical patients go into post-op or ICU, then some go to inpatient units, and those are the same destinations for admitted ER patients, Ozaydin said. That is why were looking at this more holistically and looking at more of the overall hospital patient flow.

Shortly after joining the HSA department, Ahmed gave a presentation at the CCTS, where he discussed the research he conducted, predicting ED admission disposition at the time of triage. His work was to be a possible solution to reduce boarding time and consequently reduce overcrowding.

Ahmed connected with James Booth, M.D., associate vice chairman of the UAB Department of Emergency Medicine and interim chief medical information officer of the UAB Health System, about the impracticality of focusing solely on anticipating patient outcomes without considering the use or lack of use of an FCP. After extensive discussion, they agreed to collaborate and proposed shifting from reactive strategies to proactive solutions.

In the simplest terms, we decided to use AI and machine learning to leverage reactive FCP and make it proactive, Ahmed said. We plan to use a deep learning model to predict different patient flow measures across the hospital and then package all these models to feed data automatically into a decision support system, which is a dashboard that can be integrated with the set of tools the patient flow management team utilizes.

The team will focus on the conceptualization and development of the process and procedures in the first two years of the grant. During this time, the UAB team will study the effectiveness and feasibility of proactive FCP that is supported by AI.

The models are the engine of the car, but an engine alone doesnt get you there you have to build a car that is actually drivable, said Ozaydin, who holds a masters degree in electrical engineering and a doctoral degree in computer engineering. For that, we need a substantial system with input interfaces, output interfaces, user requirements, user interfaces and more built around the models.

The proactive FCP simulation will compare the system prediction model outcomes with the reactive outcomes to evaluate the effectiveness of the proactive FCP before its full implementation. Once the models reach a certain maturity level, they will be launched live.

During the last three years of the study, they will focus on establishing a proof-of-principle by implementing their models at three hospitals. The selection of multiple sites will enable them to generalize the system as much as possible and to study configuration settings specific to a particular organization.

We will do the customization for the first site, and then we will do it at the other sites so we can understand what parameters need to be generalized, which will help us better understand how our solution can be implemented at any given hospital, Ozaydin said. There are many very complex processes in health care that could be improved. Our project further signifies the importance of AI in positively impacting everyones lives and how it can be used to tackle many problems across health care.

Their preparation for this work has already begun, and they are excited for the future. Although it will take time to see and then implement results, they firmly believe this is a strong step forward. They see their work as having the potential to help many patients soon. Even more importantly, they hope it can provide much needed insight to practitioners and other researchers for many years to come.

Ahmed, contact principal investigator; Ozaydin, multi-principal investigator; and Eta S. Berner, Ed.D., co-investigator; in the UAB Department of Health Administration, along with Booth, co-investigator in the Department of Emergency Medicine, are the investigators of a five-year grant awarded by the Agency for Healthcare Research and Quality.

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UAB researchers awarded $1 million to study ways to reduce emergency department overcrowding - University of Alabama at Birmingham

Emergency Medicine

Doctors on (video) call: Rural medics get long-distance help in treating man gored by bison – News-Medical.Net

Rural medics who rescued rancher Jim Lutter after he was gored by a bison didn't have much experience handling such severe wounds.

But the medics did have a doctor looking over their shoulders inside the ambulance as they rushed Lutter to a hospital.

The emergency medicine physician sat 140 miles away in a Sioux Falls, South Dakota, office building. She participated in the treatment via a video system recently installed in the ambulance.

"I firmly believe that Jim had the best care anyone has ever received in the back of a basic life support ambulance," said Ed Konechne, a volunteer emergency medical technician with the Kimball Ambulance District.

The ambulance service received its video system through an initiative from the South Dakota Department of Health. The project, Telemedicine in Motion, helps medics across the state, especially in rural areas.

Telehealth became commonplace in clinics and patients' homes during the covid-19 pandemic emergency, and the technology is starting to spread to ambulances. Similar programs recently launched in regions of Texas and Minnesota, but South Dakota officials say their partnership with Avel eCare a Sioux Falls-based telehealth company appears to be the nation's only statewide effort.

Lutter, 67, and his wife, Cindy, are among the 12 residents of Gann Valley, a town just east of the Missouri River in central South Dakota. They operate a hunting lodge and ranch, where they raise more than 1,000 bison.

Last December, Lutter went to check on a sick bison calf. The animal was in the same pen as Bill, a 3-year-old bull that was like a family pet.

"We raised him from a tiny little calf, and I always told everybody he thinks Im his mother. He just followed me everywhere," Lutter recalled. Lutter climbed into the pen and saw Bill calmly walk toward him.

What does Chuck Norris say? Always expect the unexpected.' Well, I didn't do that. I didn't expect the unexpected," he said.

The bison suddenly hooked Lutter with his horns, repeatedly tossed him in the air, and then gored him in the groin. Lutter thought he was going to die but somehow escaped the pen and found himself on the ground, bleeding heavily.

"The red snow was just growing," he said.

Lutter couldn't reach his cellphone to call 911. But he managed to climb into a front-end loader, similar to a tractor, and drove a few miles to the house of his brother Lloyd.

Jim Lutter's pain didn't kick in until his brother pulled him out of the loader and into a minivan. Lloyd called 911 and began driving toward the ambulance base, about 18 miles away.

Rural ambulance services like the one in Kimball are difficult to sustain because insurance reimbursements from small patient volumes often aren't enough to cover operating costs. And they're largely staffed by dwindling ranks of aging volunteers.

That's left 84% of rural counties in the U.S. with at least one "ambulance desert," where people live more than 25 minutes from an ambulance station, according to a study by the Maine Rural Health Research Center.

Konechne, the volunteer medic, was working his regular job as a hardware store manager when a dispatcher came onto his portable radio with a call for help. He hustled two blocks to the Kimball fire station and hopped into the back of an ambulance, which another medic drove toward Gann Valley.

Lloyd Lutter and the ambulance driver both pulled over on the side of the country road once they saw each other coming from opposite directions.

"I opened the side door of the van where Jim was and just saw the look on his face," Konechne said. "Its a look Ill never forget."

Rural medics often have less training and experience than their urban counterparts, Konechne said. Speaking with a more experienced provider via video gives him peace of mind, especially in uncommon situations. Konechne said the Kimball ambulance service sees only about three patients a year with injuries as bad as Jim Lutter's.

Katie DeJong was the emergency medicine physician at Avel eCare's telehealth center who took the ambulance crew's video call.

"What? A bison did what?" DeJong remembers thinking.

After speaking with the medics and viewing Lutter's injuries, she realized the rancher had life-threatening injuries, especially to his airway. One of Lutter's lungs had collapsed and his chest cavity was filled with air and blood.

DeJong called the emergency department at the hospital in Wessington Springs 25 miles from Gann Valley to let its staff know how to prepare. Get ready to insert a chest tube to clear the area around his lungs, she instructed. Get the X-ray machine ready. And have blood on standby in case Lutter needed a transfusion.

DeJong also arranged for a helicopter to fly Lutter from the rural hospital to a Sioux Falls medical center, where trauma specialists could treat his wounds.

Konechne said he was able to devote 100% of his time to Lutter since DeJong took care of taking notes, recording vital signs, and communicating with the hospitals.

Nurse practitioner Sara Cashman was working at the emergency department in Wessington Springs when she received the video call from DeJong.

"It was nice to have that warning so we could all mentally prepare," Cashman said. "We could have the supplies that we needed ready, versus having to assess when the patient got there."

A doctor inserted a tube into Lutter's chest to drain the blood and air around his lungs. Medics then loaded him into the helicopter, which flew him to the Sioux Falls hospital where he was rushed into surgery. Lutter had a fractured collarbone, 16 broken ribs, a partially torn-off scalp, and a 4-inch-deep hole near his groin.

The rancher stayed in the hospital for about a week and compared his painful wound-packing regimen near his groin to the process of loading an old-fashioned rifle.

"That's exactly what it was. Like packing a muzzleloader and you take a rod, let's poke that in there," Lutter said. "That was just a lot of fun."

The video technology that helped save Lutter had only recently been installed in the ambulance after Telemedicine in Motion launched in fall 2022. The program is financed with $2.7 million from state funds and federal pandemic stimulus money.

The funding pays for Avel eCare employees to provide and install video equipment and teach medics how to use it. The company also employs remote health care professionals who are available 24/7.

So far, 75 of South Dakota's 122 ambulance services have installed the technology, and an additional 18 plan to do so. The system has been used about 700 times so far.

Avel's contract ends in April, but the company hopes the state will extend Telemedicine in Motion into a third year. Once the state funding ends, ambulance services will need to decide if they want to start paying for the video service on their own. Patients wouldn't be charged extra for the video calls, said Jessica Gaikowski, a spokesperson for Avel eCare.

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF - the independent source for health policy research, polling, and journalism.

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Doctors on (video) call: Rural medics get long-distance help in treating man gored by bison - News-Medical.Net

Emergency Medicine

SPOHN RESIDENTS: Vote to determine the future of residency program – KRIS 6 News Corpus Christi

CORPUS CHRISTI, Texas The Nueces County Hospital District Board of Managers will consider a deal Friday that would keep the Christus Spohn Emergency Medicine Residency Program intact at least for the next six years.

As KRIS 6 News has previously reported, Spohn announced in October that it would be phasing out that program by 2026.

That program is a three-year learning opportunity in the hospital's emergency department for residents at the Texas A&M School of Medicine. The program allows residents to practice in any emergency care environment.

Following that announcement, doctors and community members began protesting that decision and said the termination of the program would be detrimental to healthcare in the Coastal Bend. They also said program impacts would be felt almost immediately.

READ MORE: Audio recording reveals Christus Spohn ER staff concerns post-residency cancellation READ MORE: Physicians fear community will suffer without Christus Spohn's Emergency Medicine Residency

The deal, which the board of managers will consider today, is the second to come before the Hospital District's governing body after the first was rejected.

The new agreement, which requires a vote of the board of managers, has been termed "monumental" by public officials.

As KRIS 6 News previously reported, this agreement includes payments by the Hospital District to Christus Spohn at up to $21 million over the next six years to maintain this program.

It also includes a requirement that Spohn maintain not only the program but also the support staff and materials needed for the program.

KRIS 6 News reporter Makaylah Chavez will be at this 12:30 p.m. meeting and will bring updates on this developing story.

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SPOHN RESIDENTS: Vote to determine the future of residency program - KRIS 6 News Corpus Christi

Emergency Medicine

DO Book Club: Code Gray: Death, Life and Uncertainty in the ER – The DO

Welcome back to The DO Book Club!

Very rarely, I come across a book that captures the essence of my professional experience as an emergency physician. As an avid reader and reviewer, I have read several medical memoirs that came close. They tend to be compilations of the most moving (and awful) experiences in the lives of the physicians and staff of the emergency department.

I am pleased to say that in this book, Code Gray: Death, Life and Uncertainty in the ER, author Farzon Nahvi, MD, has absolutely captured the essence of the great privilege, joy, despair and uncertainty of working in a modern urban emergency department. As an emergency physician in New York City during the early months of 2020 through the first wave of the deadly COVID-19 pandemic, Dr. Nahvi draws back the opaque curtain on what was really happening and how frontline medical staff were sharing information and trying to figure out how to treat the novel coronavirus.

Dr. Nahvis book is really two in one. The first part, entitled Prologue, was what the young doctor never expected to become part of his publication. When the epidemic of COVID-19 began, we knew hardly anything about the virus. The traditional timelines for testing evidence-based medical treatments were far too slow to be of use to the physicians, nurses and respiratory therapists faced with the first wave of afflicted patients. The author includes redacted text messages between himself and his colleagues working in the emergency departments of other cities.

In these messages, Dr. Nahvi and his colleagues describe running out of medications used to sedate before intubation, as well as shortages of personal protective equipment, IV pumps, antibiotics and ventilators. They describe the sheer ferocity and rapidity of disease progression. They discuss cases when COVID took patients before they even arrived at the hospital or intensive care unit. The author was particularly distressed over how he could accurately tell patients or their families about the terrible course and prognosis of COVID-19 that medical professionals knew so little about and were not substantially able to change.

The rapid spread of COVID-19 stressed a health care system that was already strained.

COVID-19 was not a wrecking ball, then, but a magnifying glass, wrote Dr. Nahvi. It did not break American medicine but reveal it for what it has always beenlong before the pandemic had ever hit, our experiences were challenging, strange and discomfiting. Our routine was to encounter impossible situations for which there exists no answers, and to answer them. (p. 47)

The majority of Code Gray focuses on an intense examination of one particular afternoon in the emergency department that Dr. Nahvi calls simultaneously routine and exceptional. Although he focuses on the treatment of one critically ill patient and interactions with her husband, he loops in several other patient care experiences and the difficult lessons he learned during his years of training.

One point that Dr. Nahvi explores is the universal experience that physicians have when they must deliver bad news to their patients. In painful detail, he brings in several examples from his own career and others of how physicians routinely fail in this endeavor. He notes that the softening of bad news with euphemistic language like mass instead of cancer or not doing well instead of dying only harms the patient or the family.

Ultimately, using anything but honest and frank language is not something that we do for our patients, but for ourselves, wrote Dr. Nahvi. We may believe we are softening our blows for our audience, but we know that in the end, doing so does not actually help them we do this to avoid our own discomfort. (p. 153)

COVID-19 was not a wrecking ball, then, but a magnifying glass.

Tied back to the central patient case narration, Dr. Nahvi faces the uncertainty of how to deliver the devastating news of the patients cause of death to her husband. Even exposing that one fact opens a gray area of questions and conundrums. The author presents many of the dilemmas faced by compassionate physicians and health care professionals: What can we do when the rules of the system deny treatment to some or offer no realistic care for unhoused or uninsured people in our care? How can we be honest with our patients without blaming them for their illness or injury?

When I was a medical student, many of the professors spoke about the sense of pride we would one day feel upon appreciating the awesome responsibilities that our profession entrusted us with, said Dr. Nahvi. They never once mentioned the inverse. They never mentioned the deep sense of shame we routinely feel in knowing that our profession lets so many of our patients down. (p. 175)

The professors did not know yet about the prevalence of moral injury and burnout. Dr. Nahvi knows and shares thoughtful explorations of the gray areas with his readers, not just in the abstract, but with real and relatable patient case histories from his years training in residency and as a young attending physician. For the public, much of what they read in Code Gray may be new and shocking in nature. Physicians reading the book will find themselves nodding in agreement and remembering many similar situations that they lived and worked through.

Dr. Nahvi artfully presents the trials and tribulations of the emergency department, not just the exciting narrative, but as a metaphor for life in general.

Life sometimes contains no perfect solutions and no correct courses of action, said Dr. Nahvi. We are often surrounded by unknowns, and yet we must take action. We are routinely presented with the impossible situation where there exists no right thing to do. (p. 139)

Readers will come to understand, through Dr. Nahvis detailed and lyrical prose, how uncertain the art and science of medicine actually is.

Editors note: The views expressed in this article are the authors own and do not necessarily represent the views of The DO or the AOA.

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DO Book Club: Code Gray: Death, Life and Uncertainty in the ER - The DO