Emergency Physicians

Opioid drug overdoses, the cause of some 16,000 fatalities and  half a million emergency-department visits yearly, may have met their match: The Food and  Drug Administration on Thursday approved the sale, by prescription, of a hand-held auto-injector of the opioid-reversal drug naloxone, a "rescue pen" that caregivers or family members can use to avert a potentially fatal overdose. Delivered by syringe, naloxone has been a workhorse drug in emergency departments battling the relentless rise of opioid abuse in the last decade.

Opioid drug overdoses, the cause of some 16,000 fatalities and  half a million emergency-department visits yearly, may have met their match: The Food and  Drug Administration on Thursday approved the sale, by prescription, of a hand-held auto-injector of the opioid-reversal drug naloxone, a "rescue pen" that caregivers or family members can use to avert a potentially fatal overdose. Delivered by syringe, naloxone has been a workhorse drug in emergency departments battling the relentless rise of opioid abuse in the last decade.

QUAKE: It's a geological time bomb that experts say could kill 4,400 people and cause $60 billion damage. The catastrophic impact of a major quake on the Newport-Inglewood Fault is explained in LIFE, along with a two-page color map (N8) and a guide to making your home safe (N2). The good news: $33,000 has been raised for a unique plan by emergency physicians to stash medical gear at fire stations and schools and train doctors to react. "They want to be effective," says Dr. Robert H.

An updated national report on U.S. emergency medical care has again awarded California an F for lacking access to speedy treatment, noting that the state has the fewest hospital emergency rooms per capita - 6.7 per 1 million people - in the nation. The America's Emergency Care Environment report card, which gauges how well states support emergency care, was released Thursday by the advocacy group American College of Emergency Physicians. Tracking 136 measures from sources including the U.S. Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, the organization called overcrowding in California emergency wards a "critical problem" and urged the state to increase its healthcare workforce and beef up a variety of facilities to reduce long waits for emergency services.

Re "Recession has some hospitals on the brink," Jan. 14 Never have emergency departments been more crucial than during this economic crisis, when people are losing jobs and insurance. Yet the American College of Emergency Physicians released a national report card on the state of emergency medicine in which California earned a D+ for its lack of support for emergency medicine and ranked last in the country in patients' access to emergency care. Policymakers at state and national levels must focus on making sure lifesaving care is available to everyone.

Local anesthetics are supposed to reduce pain, but the shots themselves can be painful -- sometimes quite painful. But the pain can be reduced substantially by the simple expedient of warming the painkiller before performing the injection, researchers reported Tuesday. The painkillers are normally kept cold to preserve them. Dr. Anna Taddio of the University of Toronto and her colleagues reviewed 18 studies involving a total of 831 patients. They reported online in the Annals of Emergency Medicine that warming the injections before administering them consistently produced a "clinically meaningful reduction in pain" regardless of how the shot was administered or how large an injection was given.

It is extremely likely that your local emergency room is overcrowded and not prepared for the sudden surges in cases that are seen with an epidemic such as the flu, a natural disaster such as an earthquake or a man-made disaster such as an act of terrorism.

Before a major catastrophe hits Orange County, Dr. Robert Bade hopes, physicians throughout the county will be armed with backpacks and able to perform surgery on the spot, and fire stations will be equipped to serve as satellite hospitals. Bade co-founded the Medical Disaster Response program, which trains emergency physicians to treat victims in the field. It also establishes local fire stations as bases for emergency treatment.

Re "Emergency Doctors Found Lacking Special Training," Sept. 8: The article states that many emergency departments across the country are staffed by residents and/or physicians without adequate training to care for the many types of medical problems which confront emergency physicians. It says that only half of the nation's 25,000 jobs in emergency medicine are filled by doctors certified to provide emergency care. This picture is painted with far too broad a brush stroke.

New estimates from the U.S. Centers for Disease Control and Prevention show that emergency room visits rose nearly 10% to 136 million in 2009. The agency reported that: ER visit rates were higher for African Americans than for whites.   More than one-third of the ER patients were under 25.   More than three-quarters were prescribed medication.   Most - 85% - of ER patients had some form of insurance. Only a small number - 8% - came to the emergency room with non-urgent issues.

An updated national report on U.S. emergency medical care has again awarded California an “F” for lacking access to speedy treatment, noting that the state has the lowest number of hospital emergency rooms per capita - 6.7 per 1 million people - in the nation. The America's Emergency Care Environment report card, which gauges how well states support emergency care, was released Thursday by the American College of Emergency Physicians, an advocacy group. Tracking 136 measures from sources including the U.S. Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, the organization called overcrowding in California emergency wards a “critical problem” and urged the state to increase its healthcare workforce and beef up a variety of facilities to reduce high wait-times for emergency services.

BOSTON - As 3 o'clock neared Monday afternoon, officials at Brigham and Women's Hospital, one of Boston's premier medical centers, expected this year's marathon would be a nonevent. "We were winding down," said Barry Wante, the hospital's emergency management director. The slow pace was welcome after last year, when unseasonably warm weather led to a rash of heat injuries among runners, inundating the city's hospitals. Full coverage: Explosions at the Boston Marathon But on Monday, the hospital's radios suddenly crackled with reports from the finish line.

New estimates from the U.S. Centers for Disease Control and Prevention show that emergency room visits rose nearly 10% to 136 million in 2009. The agency reported that: ER visit rates were higher for African Americans than for whites.   More than one-third of the ER patients were under 25.   More than three-quarters were prescribed medication.   Most - 85% - of ER patients had some form of insurance. Only a small number - 8% - came to the emergency room with non-urgent issues.

Local anesthetics are supposed to reduce pain, but the shots themselves can be painful -- sometimes quite painful. But the pain can be reduced substantially by the simple expedient of warming the painkiller before performing the injection, researchers reported Tuesday. The painkillers are normally kept cold to preserve them. Dr. Anna Taddio of the University of Toronto and her colleagues reviewed 18 studies involving a total of 831 patients. They reported online in the Annals of Emergency Medicine that warming the injections before administering them consistently produced a "clinically meaningful reduction in pain" regardless of how the shot was administered or how large an injection was given.

Melissa Genove has dreamed of becoming a physician since childhood. To help her prepare, she spends as many as 35 hours each week shadowing emergency room doctors at Loma Linda University Medical Center. The 23-year-old listens intently as they examine patients, records their treatment plans in a laptop computer, and follows up on prescriptions, lab tests, consultations with specialists and anything else the doctors order. Genove is not an intern, or even a medical student. She is the chief medical scribe in the hospital's emergency department — and one of several thousand young people pioneering a new healthcare field.

Re "Recession has some hospitals on the brink," Jan. 14 Never have emergency departments been more crucial than during this economic crisis, when people are losing jobs and insurance. Yet the American College of Emergency Physicians released a national report card on the state of emergency medicine in which California earned a D+ for its lack of support for emergency medicine and ranked last in the country in patients' access to emergency care. Policymakers at state and national levels must focus on making sure lifesaving care is available to everyone.

An updated national report on U.S. emergency medical care has again awarded California an “F” for lacking access to speedy treatment, noting that the state has the lowest number of hospital emergency rooms per capita - 6.7 per 1 million people - in the nation. The America's Emergency Care Environment report card, which gauges how well states support emergency care, was released Thursday by the American College of Emergency Physicians, an advocacy group. Tracking 136 measures from sources including the U.S. Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, the organization called overcrowding in California emergency wards a “critical problem” and urged the state to increase its healthcare workforce and beef up a variety of facilities to reduce high wait-times for emergency services.

Stories have appeared in the press recently about patients in California being denied medical care. In the most recent example, The Times reported on how some on-call medical specialists refused to respond when called to the emergency room to treat inadequately insured patients. We adamantly believe that physicians should never refuse to provide emergency care to a patient, regardless of the circumstances. It is the fundamental responsibility of every physician to treat patients in need. Period.

I pushed the button to open the emergency room's automatic doors and made my way past the central workstation to the doctor's office. This night, the usually energetic and boisterous staff was subdued. Changing for my shift, I figured we'd had a "bad outcome case." Many cases that show up in the emergency room evolve around profound changes and sometimes unexpected goodbyes for patients and their families. Such goodbyes are difficult and painful.

It is extremely likely that your local emergency room is overcrowded and not prepared for the sudden surges in cases that are seen with an epidemic such as the flu, a natural disaster such as an earthquake or a man-made disaster such as an act of terrorism.