News update:   A student  injured in a physical education class at Franklin Regional High school in Murrysville , Pa Medics called for https://experience.tripster.ru/experience/Moscow/17149-na-korablike/ helicopter transport as a precaution.  This will be an interesting case to follow.  No further information at this time.  Sometime back, I asked the question:  Are medics in the field trained to a level to make accurate assessments?    Reportedly, the student was playing volley ball.  Wow!  Didn’t think  this game could create life threatening injuries.  I have read that sometimes medics do call for a helicopter in order to keep their ambulance in the field.  Do follow this story and give comment.   Share and Retweet

Thursday, July 17, 2014

WASHINGTON, July 17 – Preventable medical errors in hospitals are the third leading cause of death in the United States, a Senate panel was told today. Only heart disease and cancer kill more Americans.

“Medical harm is a major cause of suffering, disability, and death – as well as a huge financial cost to our nation,” Sen. Bernie Sanders (I-Vt.) said at the outset of the hearing by the Senate Subcommittee on Primary Health and Aging.  “This is a problem that has not received anywhere near the attention that it deserves and today I hope that we can focus a spotlight on this matter of such grave consequence,” added Sanders, the panel’s chairman.

The Journal of Patient Safety recently published a study which concluded that as many as 440,000 people die each year from preventable medical errors in hospitals. Tens of thousands also die from preventable mistakes outside hospitals, such as deaths from missed diagnoses or because of injuries from medications.

The new research followed up on a landmark study, To Err is Human, conducted by the Institute of Medicine 15 years ago, when researchers reported that as many as 98,000 people die in hospitals each year due to preventable medical errors. Experts now say that figure was too low and hospitals have been too slow to make improvements.

There has been some progress, Dr. Peter Pronovost of Johns Hopkins University testified. Yet thousands of patients still are dying unnecessarily from infections, preventable blood clots, adverse drug events, falls, over exposure to medical radiation and diagnostic errors. “We need to declare right now that preventable harm is unacceptable and work to prevent all types of harm,” Pronovost said.

Compared to the rest of the world, the United States is about average. “While average is OK, given that we spend more on health care than any other country we should be a lot better. Our high spending is not buying us particularly safe care,” said Dr. Ashish Jha of the Harvard School of Public Health.

Other reports have examined the impact of medical mistakes on segments of America’s patient population. A Department of Health and Human Services report in 2010 said 180,000 Medicare patients die each year from preventable adverse events in the hospital. The Centers for Disease Control and Prevention in 2011 said 1-in-25 hospital patients get an infection from being in the hospital; 700,000 of them get sick as a result and 75,000 die.

In addition to deaths and injuries, medical errors also cost billions of dollars. One 2011 study put the figure at $17 billion a year. Counting indirect costs like lost productivity due to missed work days, medical errors may cost nearly $1 trillion each year, according to a 2012 report in the Journal of Health Care Finance. Lisa McGiffert of Consumers Union spoke about the everyday impact on individuals and families. “People who are harmed lose their jobs, their homes, their insurance. Many go bankrupt trying to pay the medical bills that they would not have had if they had not been harmed by a health care provider,” she said.

 

 

EMS pilots can be on the job for 70 plus hours a week with only 10 hours of flying.  Long periods of nothing in particular to do, but wait for a call can be stressful.  There is the boredom of having many hours, without stimulation or challenge, and most likely having one’s mind on outside activities. While it may not be uncommon for corporate executives to spend as many hours involved with their jobs, there is on important difference:  Executives are for the most part, actively engaged in constructive activity and receiving    constant stimulation.  The pilot, on the other hand, must make a swift transition from inactivity to the jarring experience of responding to the critical needs of a victim.  Pilots can be tensed up enough that sleep is not really restful; this kind of anticipation has been likened to sleeping with one eye open.

Many new programs have not been too concerned with the issue of understaffing.  In these times of inflation, it is easy to take the position:   ‘If you’re not able to handle the job, we’ll find someone who can.’  Pilots need their jobs to take care of care of their families and meet financial obligations.  This leaves them in a subservient position with essentially no bargaining power, and in the position of flying regardless of weather conditions.  Most EMS pilots are contracted out to hospitals by a helicopter company.  Many are in new air ambulance programs trying to prove themselves.  These programs want to show their communities that they can save lives; this can put incredible pressures on the pilot to perform when a call comes in.  Emotions and tension can run high with the pilot having little apparent authority to decline to fly, even if in his best judgment, conditions do not permit.

What’s it like in your world?

 

While just about everything in the medevac industry seems controversial, it is not surprising that some who argue that there is not much validity in establishing regional trauma centers.  Any attempt to evaluate the impact of a regional trauma center is uniquely complex due to the large number of variables that must be taken into account.  It was the intent of the 1985, Trunkey study to demonstrate that preventable death could be used to evaluate the impact of regional trauma programs in reducing mortality.  Salmi, Williams, Guibert et.al. from Montreal, Quebec and Germany has challenged the validity of United States studies on preventable death rates.  They profess that “preventable death rate” studies have major flaws.

By thorough review of design and research strategies, selection of subjects these researchers have come to the conclusion that “unless results from two or more studies are based on comparable data, the comparisons may reflect systematic information biases.”  They cite the following basic flaws in preventable death studies:  1) Time trends in trauma severity unrelated to care are not taken into account.  2)  Selection bias occurs when there is a restriction of cases by region hospital, type or cause of injury, time of death, or other variables.  3)  Other problems arise if clinical and post mortem data are drawn inconsistently from varying sources.  4) Also, the choice of criteria for consensus about preventability could by itself explain observed differences in preventable death rates.”  They also point out a more serious flaw of not accounting for those patients who would have died, but actually survived because of adequate care.

A trauma system can only be as effective as the services provided to designated communities.  Effectiveness is dependent upon quickly identifying the victims and dispatching EMS services; immediate and accurate diagnosis of severe injury; compliance of ambulance services, emergency rooms, hospital specialists and providing all victims with the highest standard of treatment through all stages of care.  Further consumer awareness, acceptance, and use of services plays an important role.  There is also the possibility that the quality of care may be related to differences in circumstances completely unrelated to care.

Death at the scene may or may not be preventable.  However, delays in response can result in “preventable deaths.”  Failure to provide basic or Advanced Life Supports at the scene or in transit may contribute to DOA (Death on Arrival).