First EDition: News for and about the practice of Emergency Medicine

More bicyclists, more fatalities

BY RICHARD FRANKI
FROM MORBIDITY AND MORTALITY WEEKLY REPORT

The annual rate for bicyclist deaths associated with motor vehicles dropped 44% from 1975 to 2012, but the downward trend has slowed in recent years, the Centers for Disease Control and Prevention reported.

Annual mortality among cyclists for all motor vehicle-related deaths was 0.23 per 100,000 in 2012, a decline of 44% since 1975 when the rate was 0.41 per 100,000. But the rate is up from just under 0.20 per 100,000 in 2010. In 2012, the rate topped the Healthy People 2020 goal of 0.22 for the first time since 2008, according to Jason Vargo, PhD, of the University of Wisconsin, Madison, and his associates.¹

Similarly, the proportion of cyclist deaths among all motor vehicle-related deaths was 2.25% in 1975, and dropped to a low of 1.46% in 2003. Since then, however, the rate has risen steadily and in 2012 stood at 2.15%, the highest rate since 1975.

The explanation may be that the number of bicyclists has been steadily rising. “The share of total household trips taken by bicycle has doubled over the last 35 years,” with the largest share of that increase occurring in recent years. From 2000 to 2012, for example, “the number of US workers who traveled to work by bicycle increased 61%,” the researchers wrote.

The report was based on data from the Fatality Analysis Reporting System, which limits fatalities to those involving a motor vehicle on a public road.²

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Surgical bolt cutters quickly cut titanium ring

BY AMY KARON
FROM EMERGENCY MEDICINE JOURNAL 

A pair of large surgical bolt cutters were used to safely and quickly cut a titanium ring from a patient’s swollen finger, according to a letter published online in the Emergency Medicine Journal.

“Our method used simple equipment that is readily available in most hospitals at all times, took less than 30 seconds to perform, and could be performed by a sole operator without damage to the underlying finger,” wrote Dr Andrej Salibi and Dr Andrew Morritt at Sheffield (England) Teaching Hospital NHS Foundation.¹

Ring constriction is a fairly common problem that can cause necrosis and loss of the digit if the ring is not removed. Basic ring cutters can sever gold and silver, but not titanium, which has become popular for rings because it is hypoallergenic, durable, lightweight, and strong—so strong that diamond-tipped saws or drills can take up to 15 minutes to cut these rings. Many facilities also lack access to such equipment, and it generates enough heat that an assistant must irrigate the surrounding skin to prevent burns.

The case report described a patient who bathed in warm water at a spa and developed a painful, swollen finger that was constricted by a titanium wedding band. Elevation and lubrication at the ED failed to remove the ring, as did finger binding, and use of a manual ring cutter.

“The fire service was called and attempted removal using specialized cutting equipment, which also failed,” the surgeons wrote. “The patient was then admitted under the plastic surgery service for hand elevation, and further attempts 8 hours later blunted two manual ring cutters.” At this point, the surgeons borrowed a large pair of bolt cutters from the operating room, and quickly severed the ring without harming the finger. Then they applied lateral traction with a pair of paper clips and removed the split ring.

The authors declared no funding sources or conflicts of interest.

---

Federal plan emphasizes heroin/opioid treatment over incarceration

BY WHITNEY MCKNIGHT
Frontline Medical News 

WASHINGTON—The Obama administration has announced that it will spend an additional $13.4 million fighting opioid and heroin abuse, emphasizing treatment over law enforcement.

The increased emphasis will center on geographic areas where heroin and opioid abuse are rampant, specifically: Appalachia; New England; Philadelphia/Camden, New Jersey; metropolitan New York City, particularly northern New Jersey; and the Washington/Baltimore metropolitan region. Public safety officers and first responders will be trained in how to administer naloxone and provide other medical attention for those in the midst of a heroin or opioid overdose. 

The 15 states in the targeted areas will share and leverage data to determine regional patterns of heroin and prescription painkiller-related overdose. These data are expected to delineate where the narcotics—especially those laced with other, more dangerous drugs—are being produced and distributed so that heroin response teams can disrupt the production and distribution of illegal drugs, and respond pre-emptively by expanding resources to communities hardest hit.

In a statement, Michael Botticelli, director of the White House Office of National Drug Control Policy, said the administration’s emphasis on “the national drug challenge as both a public health and public safety issue” is based on viewing drug addiction as “a chronic disease of the brain that can be successfully prevented and treated, and from which one can recover.” 

 

The initiative also will provide additional funding for similar efforts to address opioid abuse and methamphetamine abuse in the Southwest and along the United States/Mexico border.

“This program demonstrates the importance of linking health to criminal justice in collaboration rather than seeing better, new drug policy as a choice between health and law enforcement,” Dr Robert L. DuPont, former director of the National Institute on Drug Abuse (NIDA) and president of the Institute for Behavior and Health, said in an interview.

---

Online resource is aid for preventing patient falls

BY MIKE BOCK
Frontline Medical News

An online resource guide offers 21 targeted solutions for reducing the rate of falls in hospitals and urgent care settings,1 The Joint Commission Center for Transforming Healthcare announced in a statement.

Developed in collaboration with seven hospitals and five health care organizations, the fall prevention methodology of the Targeted Solutions Tool could potentially reduce the number of patients injured from a fall from 117 to 45 in a typical 200-bed hospital, avoiding approximately $1 million in costs annually, the agency claims.

Some of the recommendations for reducing in-hospital falls include:

•  Creating awareness among staff
•  Using a validated fall risk assessment tool
•  Engaging patients and their families in the fall safety program
•  Hourly rounding with scheduled restroom use for patients
•  Engaging all hospital staff and patients to ensure no patient walks without  assistance

“Hundreds of thousands of patients fall in hospitals every year; and many of these falls result in moderate to severe injuries that can prolong hospital stays and require the patient to undergo additional treatment,” Dr Erin DuPree, vice president and chief medical officer of the Joint Commission Center for Transforming Healthcare, said in a statement.

The Joint Commission Center for Transforming Healthcare was created in 2008 as a nonprofit affiliate of The Joint Commission.

---

Dr Lappin is an assistant professor and an attending physician, department of emergency medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York.

More bicyclists, more fatalities

BY RICHARD FRANKI
FROM MORBIDITY AND MORTALITY WEEKLY REPORT

The annual rate for bicyclist deaths associated with motor vehicles dropped 44% from 1975 to 2012, but the downward trend has slowed in recent years, the Centers for Disease Control and Prevention reported.

Annual mortality among cyclists for all motor vehicle-related deaths was 0.23 per 100,000 in 2012, a decline of 44% since 1975 when the rate was 0.41 per 100,000. But the rate is up from just under 0.20 per 100,000 in 2010. In 2012, the rate topped the Healthy People 2020 goal of 0.22 for the first time since 2008, according to Jason Vargo, PhD, of the University of Wisconsin, Madison, and his associates.¹

Similarly, the proportion of cyclist deaths among all motor vehicle-related deaths was 2.25% in 1975, and dropped to a low of 1.46% in 2003. Since then, however, the rate has risen steadily and in 2012 stood at 2.15%, the highest rate since 1975.

The explanation may be that the number of bicyclists has been steadily rising. “The share of total household trips taken by bicycle has doubled over the last 35 years,” with the largest share of that increase occurring in recent years. From 2000 to 2012, for example, “the number of US workers who traveled to work by bicycle increased 61%,” the researchers wrote.

The report was based on data from the Fatality Analysis Reporting System, which limits fatalities to those involving a motor vehicle on a public road.²

---

Surgical bolt cutters quickly cut titanium ring

BY AMY KARON
FROM EMERGENCY MEDICINE JOURNAL 

A pair of large surgical bolt cutters were used to safely and quickly cut a titanium ring from a patient’s swollen finger, according to a letter published online in the Emergency Medicine Journal.

“Our method used simple equipment that is readily available in most hospitals at all times, took less than 30 seconds to perform, and could be performed by a sole operator without damage to the underlying finger,” wrote Dr Andrej Salibi and Dr Andrew Morritt at Sheffield (England) Teaching Hospital NHS Foundation.¹

Ring constriction is a fairly common problem that can cause necrosis and loss of the digit if the ring is not removed. Basic ring cutters can sever gold and silver, but not titanium, which has become popular for rings because it is hypoallergenic, durable, lightweight, and strong—so strong that diamond-tipped saws or drills can take up to 15 minutes to cut these rings. Many facilities also lack access to such equipment, and it generates enough heat that an assistant must irrigate the surrounding skin to prevent burns.

The case report described a patient who bathed in warm water at a spa and developed a painful, swollen finger that was constricted by a titanium wedding band. Elevation and lubrication at the ED failed to remove the ring, as did finger binding, and use of a manual ring cutter.

“The fire service was called and attempted removal using specialized cutting equipment, which also failed,” the surgeons wrote. “The patient was then admitted under the plastic surgery service for hand elevation, and further attempts 8 hours later blunted two manual ring cutters.” At this point, the surgeons borrowed a large pair of bolt cutters from the operating room, and quickly severed the ring without harming the finger. Then they applied lateral traction with a pair of paper clips and removed the split ring.

The authors declared no funding sources or conflicts of interest.

---

Federal plan emphasizes heroin/opioid treatment over incarceration

BY WHITNEY MCKNIGHT
Frontline Medical News 

WASHINGTON—The Obama administration has announced that it will spend an additional $13.4 million fighting opioid and heroin abuse, emphasizing treatment over law enforcement.

The increased emphasis will center on geographic areas where heroin and opioid abuse are rampant, specifically: Appalachia; New England; Philadelphia/Camden, New Jersey; metropolitan New York City, particularly northern New Jersey; and the Washington/Baltimore metropolitan region. Public safety officers and first responders will be trained in how to administer naloxone and provide other medical attention for those in the midst of a heroin or opioid overdose. 

The 15 states in the targeted areas will share and leverage data to determine regional patterns of heroin and prescription painkiller-related overdose. These data are expected to delineate where the narcotics—especially those laced with other, more dangerous drugs—are being produced and distributed so that heroin response teams can disrupt the production and distribution of illegal drugs, and respond pre-emptively by expanding resources to communities hardest hit.

In a statement, Michael Botticelli, director of the White House Office of National Drug Control Policy, said the administration’s emphasis on “the national drug challenge as both a public health and public safety issue” is based on viewing drug addiction as “a chronic disease of the brain that can be successfully prevented and treated, and from which one can recover.” 

 

The initiative also will provide additional funding for similar efforts to address opioid abuse and methamphetamine abuse in the Southwest and along the United States/Mexico border.

“This program demonstrates the importance of linking health to criminal justice in collaboration rather than seeing better, new drug policy as a choice between health and law enforcement,” Dr Robert L. DuPont, former director of the National Institute on Drug Abuse (NIDA) and president of the Institute for Behavior and Health, said in an interview.

---

Online resource is aid for preventing patient falls

BY MIKE BOCK
Frontline Medical News

An online resource guide offers 21 targeted solutions for reducing the rate of falls in hospitals and urgent care settings,1 The Joint Commission Center for Transforming Healthcare announced in a statement.

Developed in collaboration with seven hospitals and five health care organizations, the fall prevention methodology of the Targeted Solutions Tool could potentially reduce the number of patients injured from a fall from 117 to 45 in a typical 200-bed hospital, avoiding approximately $1 million in costs annually, the agency claims.

Some of the recommendations for reducing in-hospital falls include:

•  Creating awareness among staff
•  Using a validated fall risk assessment tool
•  Engaging patients and their families in the fall safety program
•  Hourly rounding with scheduled restroom use for patients
•  Engaging all hospital staff and patients to ensure no patient walks without  assistance

“Hundreds of thousands of patients fall in hospitals every year; and many of these falls result in moderate to severe injuries that can prolong hospital stays and require the patient to undergo additional treatment,” Dr Erin DuPree, vice president and chief medical officer of the Joint Commission Center for Transforming Healthcare, said in a statement.

The Joint Commission Center for Transforming Healthcare was created in 2008 as a nonprofit affiliate of The Joint Commission.

---

Dr Lappin is an assistant professor and an attending physician, department of emergency medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York.

More bicyclists, more fatalities

BY RICHARD FRANKI
FROM MORBIDITY AND MORTALITY WEEKLY REPORT

The annual rate for bicyclist deaths associated with motor vehicles dropped 44% from 1975 to 2012, but the downward trend has slowed in recent years, the Centers for Disease Control and Prevention reported.

Annual mortality among cyclists for all motor vehicle-related deaths was 0.23 per 100,000 in 2012, a decline of 44% since 1975 when the rate was 0.41 per 100,000. But the rate is up from just under 0.20 per 100,000 in 2010. In 2012, the rate topped the Healthy People 2020 goal of 0.22 for the first time since 2008, according to Jason Vargo, PhD, of the University of Wisconsin, Madison, and his associates.¹

Similarly, the proportion of cyclist deaths among all motor vehicle-related deaths was 2.25% in 1975, and dropped to a low of 1.46% in 2003. Since then, however, the rate has risen steadily and in 2012 stood at 2.15%, the highest rate since 1975.

The explanation may be that the number of bicyclists has been steadily rising. “The share of total household trips taken by bicycle has doubled over the last 35 years,” with the largest share of that increase occurring in recent years. From 2000 to 2012, for example, “the number of US workers who traveled to work by bicycle increased 61%,” the researchers wrote.

The report was based on data from the Fatality Analysis Reporting System, which limits fatalities to those involving a motor vehicle on a public road.²

---

Surgical bolt cutters quickly cut titanium ring

BY AMY KARON
FROM EMERGENCY MEDICINE JOURNAL 

A pair of large surgical bolt cutters were used to safely and quickly cut a titanium ring from a patient’s swollen finger, according to a letter published online in the Emergency Medicine Journal.

“Our method used simple equipment that is readily available in most hospitals at all times, took less than 30 seconds to perform, and could be performed by a sole operator without damage to the underlying finger,” wrote Dr Andrej Salibi and Dr Andrew Morritt at Sheffield (England) Teaching Hospital NHS Foundation.¹

Ring constriction is a fairly common problem that can cause necrosis and loss of the digit if the ring is not removed. Basic ring cutters can sever gold and silver, but not titanium, which has become popular for rings because it is hypoallergenic, durable, lightweight, and strong—so strong that diamond-tipped saws or drills can take up to 15 minutes to cut these rings. Many facilities also lack access to such equipment, and it generates enough heat that an assistant must irrigate the surrounding skin to prevent burns.

The case report described a patient who bathed in warm water at a spa and developed a painful, swollen finger that was constricted by a titanium wedding band. Elevation and lubrication at the ED failed to remove the ring, as did finger binding, and use of a manual ring cutter.

“The fire service was called and attempted removal using specialized cutting equipment, which also failed,” the surgeons wrote. “The patient was then admitted under the plastic surgery service for hand elevation, and further attempts 8 hours later blunted two manual ring cutters.” At this point, the surgeons borrowed a large pair of bolt cutters from the operating room, and quickly severed the ring without harming the finger. Then they applied lateral traction with a pair of paper clips and removed the split ring.

The authors declared no funding sources or conflicts of interest.

---

Federal plan emphasizes heroin/opioid treatment over incarceration

BY WHITNEY MCKNIGHT
Frontline Medical News 

WASHINGTON—The Obama administration has announced that it will spend an additional $13.4 million fighting opioid and heroin abuse, emphasizing treatment over law enforcement.

The increased emphasis will center on geographic areas where heroin and opioid abuse are rampant, specifically: Appalachia; New England; Philadelphia/Camden, New Jersey; metropolitan New York City, particularly northern New Jersey; and the Washington/Baltimore metropolitan region. Public safety officers and first responders will be trained in how to administer naloxone and provide other medical attention for those in the midst of a heroin or opioid overdose. 

The 15 states in the targeted areas will share and leverage data to determine regional patterns of heroin and prescription painkiller-related overdose. These data are expected to delineate where the narcotics—especially those laced with other, more dangerous drugs—are being produced and distributed so that heroin response teams can disrupt the production and distribution of illegal drugs, and respond pre-emptively by expanding resources to communities hardest hit.

In a statement, Michael Botticelli, director of the White House Office of National Drug Control Policy, said the administration’s emphasis on “the national drug challenge as both a public health and public safety issue” is based on viewing drug addiction as “a chronic disease of the brain that can be successfully prevented and treated, and from which one can recover.” 

 

The initiative also will provide additional funding for similar efforts to address opioid abuse and methamphetamine abuse in the Southwest and along the United States/Mexico border.

“This program demonstrates the importance of linking health to criminal justice in collaboration rather than seeing better, new drug policy as a choice between health and law enforcement,” Dr Robert L. DuPont, former director of the National Institute on Drug Abuse (NIDA) and president of the Institute for Behavior and Health, said in an interview.

---

Online resource is aid for preventing patient falls

BY MIKE BOCK
Frontline Medical News

An online resource guide offers 21 targeted solutions for reducing the rate of falls in hospitals and urgent care settings,1 The Joint Commission Center for Transforming Healthcare announced in a statement.

Developed in collaboration with seven hospitals and five health care organizations, the fall prevention methodology of the Targeted Solutions Tool could potentially reduce the number of patients injured from a fall from 117 to 45 in a typical 200-bed hospital, avoiding approximately $1 million in costs annually, the agency claims.

Some of the recommendations for reducing in-hospital falls include:

•  Creating awareness among staff
•  Using a validated fall risk assessment tool
•  Engaging patients and their families in the fall safety program
•  Hourly rounding with scheduled restroom use for patients
•  Engaging all hospital staff and patients to ensure no patient walks without  assistance

“Hundreds of thousands of patients fall in hospitals every year; and many of these falls result in moderate to severe injuries that can prolong hospital stays and require the patient to undergo additional treatment,” Dr Erin DuPree, vice president and chief medical officer of the Joint Commission Center for Transforming Healthcare, said in a statement.

The Joint Commission Center for Transforming Healthcare was created in 2008 as a nonprofit affiliate of The Joint Commission.

---

Dr Lappin is an assistant professor and an attending physician, department of emergency medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York.