ER Overcrowding at OSF

In September 2001 I wrote a letter to Keith Steffen regarding the ER at OSF. As documented in Keith’s Letter, the ER was not working well.

I was put on probation the next day by George Hevesy, the Director of the ED at OSF. Three months later I was fired from OSF by Mr. Steffen.

I believed then and believe now that not enough effort was directed to the main ER at OSF to help patients move efficiently through the system.

A recent study published in March 2007 in Annals of Emergency Medicine described the relative impact of input, throughput, and output factors on the average daily ED length of stay. Output factors examined included the number of elective surgical admissions, the number of ED admissions to the hospital, the number of critical care admissions, and hospital census. The only factors that were independently associated with increased ED length of stay were output factors. These included hospital occupancy, the number of ED admissions to the hospital, and the number of elective surgical admissions.

An editorial in Annals regarding this study indicated that “smooth functioning of the ED is highly dependent on the ability of a hospital to accept admitted patients. (This is considered “output”). Any disruption in the outflow of patients from the ED to the hospital drains resources and impairs the ED’s ability to car for new seriously ill or injured patients. Hospitals that have had the most success alleviating ED crowding are those that have recognized the hospital-wide nature of patient flow problems and designed initiatives to move admitted patient out of the ED more efficiently.”

My letter to Mr. Steffen six years ago was pleading for help for patients in the OSF ER that were not being admitted in a timely fashion. Were the number of “elective surgical admissions” at OSF, guaranteed to make money for OSF, keeping my ER patients boarded in the ER for long periods of time?

The Annals editorial continued:

“It is no longer just the key stake holders in the emergency care system who are calling for the end of inpatient boarding in the ED. The Institute of Medicine (IOM) has also recognized that boarding inpatients is the most important driver of ED crowding and has called on hospitals and the regulatory bodies that govern them to end the practice of boarding. The IOM committee didn’t leave shades of gray when it published the following recommendation:

“Hospitals should end the practices of boarding patients in the ED and ambulance diversion, except in the most extreme cases, such as a community mass casualty event. The Centers for Medicare and Medicaid Services should convene a working group that includes experts in emergency care, inpatient critical care, hospital operations management, nursing, and other relevant disciplines to develop boarding and diversion standard, as well as guidelines, measures, and incentives for implementation, monitoring, and enforcement of these standards.”
----------------

In January, 2007 Emergency Medicine News contains an article written by Dr. Peter Viccellio. Dr. Viccellio is a professor of emergency medicine and the vice chairman and clinical director of the department of emergency medicine at the State University of New York at Stony Brook.

His article was titled, “I’m as Mad as Hell, and I’m Not Going to Take This Anymore”.

Here are some interesting facts and thoughts from his article regarding the crisis of emergency departments across the United States:

1. There were 120 million people that visited emergency departments last year in the United States.

2. The patients’ needs and how long their needs take to be cared for should be enumerated in the ER. Their needs have been viewed as impossible or as a burden to be suffered alone. We (ER doctors and nurses) have been in the underbelly of the beast too long. Our view of our own world (emergency rooms) is too dysfunctional.

3. Dr. Viccellio states, “I am convinced at this point that the real under-pinning is not that we have too many patients. The real thing that drives this issue is that our hospitals as a culture are organized around the needs of the staff and not the patient. That is why we let them sit in the waiting room.”

4. The ED should be designed to save lives. It should be the front door of the medical center determined to do the same. The ED should provide a service to the individual and the community. This is an ED (and hospital) where everyone is a Very Important Person who deserves, if we can give them the chance, to continue their Very Important Life, and not to toss it away in the waiting room or ED hallway because we can only hope for an ED built on compromise and capitulation. Why demand any less?

Peoria's Airway

Annals of Emergency Medicine reported last year:

“Many researchers, emergency medical service (EMS) providers, and emergency physicians are increasingly viewing ground transport, out-of-hospital endotracheal intubation with skepticism.”

There are people on both sides of the argument. Some think that endotracheal intubation should continue for the outpatient while others think that there is not credible evidence that out-of-hospital endotracheal intubation contributes meaningfully toward the reduction of morbidity or mortality in ground transported EMS patients.

Annals continues:

“In the spirit of seeking system-level improvements, one cannot ignore the question, Should we intubate at all? For apneic or near-apneic patients, alternate airways such as the Combitube (esophageal-tracheal twin-lumen airway device; Kendall, Inc., Mansfield, MA) and laryngeal mask airway (LMA North America, San Diego, CA) have appealing characteristics and are supported by some data. These devices are conceptually simpler than endotracheal intubation, easier to insert than endotracheal tubes, require less training, and are less subject to skill delay. These devices have been extensively used as primary and secondary airway management devices. There is wide experience with the use of these devices by nonphysicians and even basic-level rescuers. Combitubes and laryngeal mask airways offer ventilation and oxygenation comparable with endotracheal intubation in controlled and field settings. Current advanced cardiac life support guidelines recommend the use of these devices when rescuers have only limited endotracheal intubation experience.”

In Peoria, the Peoria Fire Department (PFD) can oxygenate and ventilate the patient with the bag-valve-mask (BVM). The PFD cannot endotracheally intubate the patient regardless of the literature in support of this technique. Also, the PFD does not use the alternate airway techniques described above. With the blessing of the local Project Medical Director, employed by OSF-SFMC, Advanced Medical Transport (AMT) can use the BVM or select to endotracheally intubate the patient at the determination of the AMT paramedic on scene.

It has been a serious mistake not to educate the PFD in airway control that could supercede the BVM that they use now. The Combitube and the laryngeal mask airway (LMA) are two alternate airways that could and should have been used by the PFD for many patients in respiratory distress.

The local Peoria Project Medical Director, the three Peoria hospitals that influence decision making in the city, Advanced Medical Transport, PAEMS, and the City Council all need to support and encourage the PFD to develop these skills.

Resuscitation in Peoria

In Emergency Medicine News, September 2006, the following was written:

"Three years ago, the physician director of the Houston EMS system with investigators at Baylor College of Medicine, the Houston Medical School at the University of Texas, and Ohio State University looked at cardiac arrest survival as a function of ambulance deployment strategy. Though limited to a single geographic area, this study showed definiteively that outcomes for cadiac arrest patents improve when they are cared for by paramedics than by basic EMT's. (Resuscitation 2003;59:97.)

"What was the difference? The busy urban area used paramedics, and a suburb used EMT's (Basic).

"The authors said the study demonstrated better response times and better skills proficency by the "targeted response" team in the urban core, or as they call it, the TR paramedics."

In Peoria, the Peoria Fire Department (PFD) is Basic. The PFD has paramedics that cannot use their skills to resuscitate patients. This unfortunate decision has been made by multiple individuals. The majority of the Peoria public is not aware that the PFD cannot resuscitate them with advanced life support when the public calls 911.

The medical literature also states that having too many paramedics trained in an area may not be ideal for patient care because an individual paramedic may not be able to keep up his/her skills with competition for procedeures by other paramedics.

Thus, the literature is begging these questions:

1. Should the PFD petition the State of Illinois and the Peoria Area EMS (PAEMS) to allow their paramedics to give advanced life support at the scene of a medical emergency? When the PFD arrives before Advanced Medical Transport (AMT) and the paramedic firemen cannot do anything but provide Basic service, that seems suboptimal if one reads and believes the medical literature regarding patients who suffer from cardiac arrest.

2. Should AMT cut their staff of paramedics so as not to dilute the skills of their own paramedics? And if the PFD paramedics were allowed to function as paramedics, less AMT paramedics may be desirable.

Peoria's City Council and PAEMS have to decide what is more important--the business and money generated by AMT or quality of pre hospital patient care in central Illinois.

A Byte Out Of Poverty

Peoria Journal Star
Tuesday, June 19, 2007

"Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity. Whether through democracy, strong public education, quality health care, or broad economic opportunity, reducing inequity is the highest human achievement."

That's a pretty powerful quote. And this altruistic appeal originates not from a preacher or presidential candidate but from a software engineer named William Henry Gates III - better known as "Bill."

The Microsoft mogul recently addressed the graduating class of Harvard, the Ivy League school he famously quit to pursue his passion for computers. After accepting an honorary degree, Gates joked he was glad to finally get his diploma. But jokes aside, this commencement address transcended the usual fodder college grads hear. It was revelatory, honest, a humanitarian call to arms.

The 52-year-old Gates admitted he left campus in the mid-1970s "with no real awareness of the awful inequities in the world - the appalling disparities of health, and wealth, and opportunity that condemn millions of people to lives of despair." It took him "decades to find out" that others, especially in developing nations, were getting substandard schooling, enduring hunger or dying of treatable illnesses like malaria and measles - not of their own fault, but because both private and public sectors had failed them.

In revisiting his naivete, Gates urged not only graduates but also Harvard as an institution to "make market forces work better for the poor" and use "creative capitalism . . . so that more people can make a profit, or at least make a living." In addition, citizens should "press governments around the world to spend taxpayer money in ways that better reflect the values of the people who pay the taxes."

Gates should know something about values. The man who tops Forbes' billionaires list has, along with wife Melinda, thrown himself into philanthropy. His foundation, with an endowment of $33 billion, has given millions in grants to fund the kind of "teach a man to fish" initiatives he referenced in his speech: college scholarships, public school curriculum support, access to vaccines and, of course, money to bridge the digital divide. Like Warren Buffett, another billionaire benefactor, Gates seems to have realized money is only as good as the man who makes it, and that wealth and position can motivate others - politicians, businesses, the media - to pay attention to those less fortunate.

In his late middle age, the world's richest man has dedicated his time to the world's poorest people. Ironic, yes, but nicely so. Would that those of us mere mortals with more modest means but equally generous spirit follow suit.



--------------------------------------------------------------------------------
My comment:

The PJS editorial states, “…Gates seems to have realized that money is only as good as the man who makes it, and that wealth and position can motivate others—politicians, businesses, the media—to pay attention to those less fortunate.”

Why isn’t the Journal Star “paying attention” to those less fortunate that have lived right here in Peoria? I wonder what the Journal Star thinks of OSF’s refusal to take care of Haitian Hearts patients that have been treated at OSF in the past and now need further heart surgery to stay alive.

Haitians kids are dying because of OSF’s refusal to care for their patients. Gates’ cry for reducing inequity as the “highest human achievement” generates no action in Peoria for Haitians, only written words.

The Cuban Experience

“It is increasingly rare for many of us to believe that people can be poor, but honest; poor, but deserving of respect. Poverty is no longer blamed on anyone but the poor themselves. Contempt for the poor has become virtue.”

John Cardinal O’Connor
Archbishop of New York

After working a fair number of years in Haiti, I think that Haiti’s medical problems are solvable. All problems in Haiti are solvable, but this post regards how adopting certain aspects of Cuba's health system could help Haiti and, quite possibly, improve the lives of certain poor populations in the United States.

The International Journal of Epidemiology published an article in August, 2006: “Health in Cuba”. It is written by Richard Cooper, Joan Kennelly, and Pedro Ordunez-Garcia.

The authors write that no matter what one believes about the politics of Cuba, there is a lesson to be learned regarding Cuba’s health care system. And with just a little water separating Cuba from Haiti, my very small mind asks, why can’t Haiti adopt some of Cuba’s life saving public health measures?

The article reports that the word needs to disseminate that Cuba has done something very worthwhile regarding health care.

The abstract of the paper states:

“The poorer countries of the world continue to struggle with an enormous health burden from diseases that we have long had the capacity to eliminate. Similarly, the health systems of some countries, rich and poor alike, are fragmented and inefficient, leaving many population groups underserved and often without health care access entirely.

"Cuba represents an important alternative example where modest infrastructure investments combined with a well developed public health strategy have generated health status measures comparable with those of industrialized countries. Areas of success include control of infectious diseases, reduction in infant mortality, establishment of a research and biotechnology industry, and progress in control of chronic diseases, among others.

"If the Cuban experience were generalized to other poor and middle income countries, human health would be transformed. Given current political alignments, however, the major public health advances in Cuba, and the underlying strategy that has guided its health gains, have been systematically ignored.”

The authors are saying that the biomedical literature in English has been almost entirely silent on the Cuban health experience and Cuban health revolution since 1959. They think that an open discussion should take place on the potential lessons to be learned from the Cuban medical experience because the “raison d’etre of the health sciences is the discovery of new knowledge and the use of that knowledge to improve health”.

In 1991 the Soviet Union withdrew economic support for Cuba. The authors refer to this as an “abrupt economic disruption”. However, they noted, “The impact on health indices was relatively modest and short-lived, however, further demonstrating that economic measures alone are poor predictors of physical well-being within a society. One potential explanation of this anomalous pattern may be the relative absence of extreme poverty, which is the most powerful economic correlate of ill health and can confound the effect of average Gross National Product (GNP). Cuba has a high degree of income equality and lacks the marginalized slum populations of most of Latin America, although the growing dependence of the tourist economy and, to a lesser extent, foreign remittances has widened the income distribution”.

Regarding the infant mortality rate, the article reports, “Since 2002 Cuba has had the second lowest infant mortality in the Americas, 20% below the US rate for all ethnic groups and just below the rate for US whites... Thirty-five per cent of the Cuban population is black or mulatto, yet the infant mortality rate are less than half of what is observed in the US black.”

“In terms of child survival, a ‘continuum of care’ that provides for the pre-conceptional health of women, prenatal care, skilled birth attendants, and a comprehensive well-baby program can quickly reduce infant mortality to levels approaching the biological minimum. Many observers will regard these propositions as reasonable, yet hopelessly too ambitious for the poorer nations of the world, It must be recognized, however, that these principles have been successfully implemented in Cuba at a cost well within the reach of most middle-income countries.”

I have had a number of young mothers in Haiti bring in their newborns that they delivered alone at home lying on their dirt floor. One mother told me that when her newborn cried immediately after delivery, the neighbor man next door heard the baby’s cry, and rushed over and cut the baby’s cord. This neighbor man could be considered a concerned person, but hardly a “skilled birth attendant”, which almost all Cuban mothers have during labor. This scenario in Haiti is absurd and wrong and could and should be fixed.

I think the real problem is fear. How much will the gran mange in Haiti have to give up for the vast poor underclass in Haiti can live like humans? How much will the well-to-do in the United States have to give up for our poor health care statistics to improve? Probably very little. And all social classes in Haiti and the United States would live stronger and more productive lives if the slightest amount of compassion, energy, and action were directed for the benefit of the poor.

The Cuban story regarding improving the health of its population needs to get out and be implemented in resource rich and resource poor countries whose people suffer from health care inequalities.

Luke--Part 2

Luke underwent his tests yesterday at OSF in Peoria.

The tests reveal that he has a large kidney stone in his right kidney that will need to be removed so that it does not obstruct and further injure his kidney.

The stone probably formed due his severe malnutrition several years ago in Haiti with infection possibly playing a role.

The medical care that he received yesterday from the nurses and physicians was excellent.

Luke spent approximately 30-40 minutes in the operating room where the procedure and xrays were obtained. No surgery was performed. He entered the operating room at about 9 AM and was discharged to home at 11:10 AM.

OSF's charges for the above are $9,500. The physicians charges are not included.

I asked OSF for an itemized bill so we can see how this breaks down. Will post the bill when I receive it.

Haitian Has Heart Surgery At Provena St. Joseph

Marie Amazan, a 24 year old Haitian Hearts patient, received two new heart valves at Provena St. Joseph Medical Center in Joliet, Illinois. See Press Release. Provena St. Joseph provided their medical center pro bono as they did for four previous Haitian Hearts patients.

Dr. Bryan Foy performed the delicate heart surgery and Dr. Kinder placed a permanent pacemaker. All physicians involved in Marie's care provided their services at no charge.

Marie is from Carefour Feuilles in Port-au-Prince. She lives in a crowded two room house on the side of a steep hill. Many family members live with her. She has six older sisters and no brothers. Her father is dead.

Her family does not eat everyday due to the poverty of Haiti and her neighborhood can be dangerous with the gang and political violence that plagues much of Port-au-Prince.

Marie has been unable to do much for many years due to congestive heart failure. She could mop the floor and make her bed, but that was about it.

This week, Marie was discharged from the hospital and is improving everyday. A Cardiovascular Intensive Care nurse, Anita, has been supervising Marie's outpatient medical care and transportation since discharge from the hospital.

Marie was given a chance by Provena St. Joseph and its physicians and nursing staff. Haitian Hearts cannot thank all of you enough.
-----------------

See more about Marie's recovery as reported in Chicago at ABC News.

Luke

My wife and I adopted a Haitian boy last year. We named him Luke and we think he is about four years old. We brought him to the United States in February, 2007.

This post will be added to as the days and weeks roll by regarding Luke's medical saga at OSF in Peoria.

Several months ago Luke developed a medical problem. He has gross hematuria which means he is passing blood in his urine.

We did some blood tests at a local lab that is run by a lady named Joyce Harmon. After Joyce would take Luke's blood, she would kiss him, to help melt away his pain and trauma that he felt he did not deserve. Joyce charges very little for her blood tests and her lab is more a labor of love than a way for her to make any real money.

Other than the blood in his urine, Luke's blood tests were normal.

At that point, we decided to do a sonogram of Luke's kidneys. The sonogram was done at OSF in Peoria and OSF charged us $700.00 dollars for this test. The radiology group read his sono for no fee.

The sono revealed that Luke has kidney stones in his right kidney with an obstruction somewhere in his collecting system.

Several weeks later, Luke had his appointment with a pediatric urologist in Peoria who is very competent and we trust.

More tests were ordered.

On June 7, 2007 we received a letter from OSF-SFMC that stated, "As a service to you we have verified your insurance coverage; however, verification of benefits is not a guarantee of payment by your insurance company that all services rendered will be covered. Based upon this verification, your estimate/deposit for this visit will be $875.00 due upon registratiion. Your payment options are credit card, cash, or personal check."

What the above means, is that OSF-SFMC wants their money as soon as possible. The $875.00 is for a lasix radionuclide scan of Luke's kidney. Like the kidney sonography bill of $700.00, these bills are not covered by our insurance and do not come off our deductible.

So I spoke with the pediatric urology office and we cancelled the lasix radionuclide scan.

On Friday, June 15, Luke is scheduled to have a cystoscopy with retrograde pyelograms performed under a general anesthesia as an outpatient at OSF.

Patient Accounts at OSF called my wife today and stated that OSF charges for the cystoscopy will be $4,598.00 and the charges for the retrograde pyelogram (squirting some dye up the ureters during the cystoscopy), will be $4,903.00. These tests should take between 30-45 minutes in the operating room.

The pediatric urology fees and anesthesiology fees are unknown at this time.

After we meet our deductible of $2,500.00 and add $1,000.00 more, Blue Cross/Blue Shield will cover the rest...we think. OSF advised my wife today to bring $1,600.00 cash on Friday morning at 7 AM to get things started off on the right foot for OSF, the Catholic medical center with a "commitment to life".

OSF's Commitment to Life?

My wife was being cared for by an OSF health care provider last fall. E-mails between the OSF provider and my wife were blocked. They could not communicate with each other over medical issues while we were in Haiti.

The OSF provider was stunned to realize this especially when we did a “test run” to see if we received each other’s e mails. No e-mails were received by either party when sent through the OSF account.

What can this OSF provider do? Nothing if this individual wants to keep her job.

It seems that both my wife’s account and my account to OSF and from OSF employees to us have been blocked by OSF. Dr. Gerry McShane indicated this as I posted in the past. Dr. McShane told me last spring that he was not receiving my e-mails.

I have sent e-mails to OSF Corporate and to OSF's Administrative team and legal counsel pleading for the lives of Haitian Heart's children to allow them to return to OSF for further care.

I do not believe that Dr. McShane and others want other members of Corporate or any OSF employee seeing the content of my electronic communication.

Our four year old son will soon have surgery at OSF. Will the e-mails continue to be blocked by OSF regarding my son’s medical care too? The physician who will operate our son works out of OSF-Children’s Hospital of Illinois.

The Value Statements at OSF are being ignored. Statement number four, “Collaboration with each other, with physicians, and with other providers to deliver comprehensive, integrated and quality health care. Statement number seven, “Open and honest communication to foster trust relationships among ourselves and with those we serve.”

OSF’s hypocrisy regarding its Value Statements is not ethical and could indeed be dangerous.

Milestone for Generosity?

A Milestone for Generosity
Friday, June 8, 2007

OSF Saint Francis Medical Center's plan to improve care for its youngest patients seems to have touched the community. Donations are pouring in by the millions.
First came CEFCU, which in February pledged $1 million toward a new pediatric emergency department for the Children's Hospital of Illinois.

In April came $500,000 from Lynn and Susan McPheeters to help fund construction of the hospital's neonatal intensive care unit. Lynn McPheeters, whose daughters were born at St. Francis, is a former president of the hospital's foundation council.

Then RLI Corp. founder Jerry Stephens and his wife, Helen, donated $5 million for the neonatal ICU. Stephens told reporters he had long admired the standard of care at St. Francis. He also revealed that his only brother had died from spinal meningitis and he hoped to spare other families such grief.

All of this generosity is remarkable, especially since OSF isn't running a public campaign for its "Milestone Project" - a $234 million, eight-story building going up at its Downtown campus. In addition to the Children's Hospital, that building will have ground-floor space for Peoria's St. Jude cancer clinic affiliate, to be named after longtime St. Jude crusader and former Peoria Mayor Jim Maloof.

Perhaps local folks just have a soft spot for children, whom nobody wants to see suffer from treatable diseases.

Perhaps it's because Peorians feel that OSF's project, along with a $350 million makeover of Methodist Medical Center, will solidify the city's reputation as downstate's premier medical community. Or perhaps it's simply because people recognize that extraordinary beneficence has a way of paying its own, intangible rewards.



--------------------------------------------------------------------------------



There are 4 comments:

John A. Carroll, MD – Peoria, Illinois
June 09, 2007 - 22:49
Subject: Peoria's Medical Mafia

The Journal Star editorial reports the millions of dollars given to OSF from people in the area. Their generosity is inspiring.

However, will the funds be put to the best possible use by OSF? Will OSF Corporate and OSF-SFMC Administration follow the founding Sisters mission philosophy?

Probably not.

Haitian Hearts donated over 1.1 million dollars to Children’s Hospital of Illinois over the years for inpatient care for Haitian children. Our patients that were operated at OSF several years ago have been rejected at OSF for repeat heart surgery with full and partial charges offered for their care. Two have died. More will die soon unless OSF follows their mission statements.

There is significant fear in the Peoria community by individuals and institutions. To criticize OSF in a public forum with one’s name attached is not what people usually want to do. An individual contributor to OSF, one that OSF has privately courted for years, implied to me that she feared for her medical safety if she was publicly critical of OSF. (She has chronic medical problems.) This individual has strong reservations about OSF’s current leadership but is afraid to say so. Her fear really says something significant about OSF and would sadden the Sisters.

Also, the Journal Star and the Catholic Post have not reported OSF’s negligence of dying Haitian children and the obscene discrimination leveled against these children. The coverage of OSF’s 500 million dollar expansion and creation of jobs for the Peoria area has been more important to these two newspapers for reasons that are apparent to anyone who lives in central Illinois.

John A. Carroll, MD

Woodford Pundit
June 08, 2007 - 17:36
Subject: All right . . .
Now that we've vented our hatred . . .

Cudos to JMD
June 08, 2007 - 09:49
Subject:
The good sisters of the third order are the crookedest bunch of "well you know what" that ever predatated in the business world.

They do NO charity. They will demand others "share the wealth" as they refer to it. If you cannot tell I know what nuns are REALLY like.

jmd
June 08, 2007 - 08:42
Subject:
If they really cared about patient care - they would drop their vastly inflated pricing schedule.

Cardiac Arrest and Peoria

In March 2007, Mickey Eisenberg, MD, PhD wrote an article “Improving Survival from Out-of-Hospital Cardiac Arrest: Back to the Basics”. It was published in Annals of Emergency Medicine.

The article states:

“A 2005 study by Rea et al summarized the cardiac arrest experience of 35 communities, representing 9% of the US population. Overall, the discharge survival rate for all cardiac arrests was 8.4%, and for ventricular fibrillation, 17.7%. Using these figures and projecting to the entire US population, the study estimated that 13,000 Americans are discharged every year after cardiac arrest. The 35 communities reported a range of discharge survival rates from ventricular fibrillation of 3.3% to 40.5%, a 12-fold difference.”

I wonder what Peoria’s “numbers” are? How does Peoria do compared to these 35 studied communities?

Several years ago, as documented on www.peoriasmedicalmafia.com, I was unable to access any statistics from the Peoria Area EMS office at OSF or from our local IDPH office. The Matrix study that looked at fire and prehospital care in Peoria (and charged the City of Peoria $79,000 for their consulting efforts) did not publish any statistics regarding how Peoria’s prehospital patients did after suffering cardiac arrest or ventricular fibrillation.

Interestingly, Dr. Eisenberg was a co-author of a paper published in Prehospital Emergency Care, October 2004. The title is “Time to Intubation and Survival in Prehospital Cardiac Arrest”.

Quoting from the article’s introduction:

“In this study, we measured the interval from collapse until intubation in cardiac arrest over a 12-year period and compared this variable with survival.

…a correlation between intubation and survival would be an additional argument that advanced life support systems employing paramedics can significantly reduce mortality over non-intubation systems, which are common. Our purpose was to examine whether shorter time from collapse until intubation is associated with greater survival in prehospital cardiac arrest.”

In Peoria, the Peoria Fire Department paramedics are not allowed to intubate a patient unless asked to do so by Advanced Medical Transport.

The results of Eisenberg’s study revealed that in the quick intubation group (intubation time <12 minutes), 46% of the patients survived; in the slow intubation group (intubation time >13 minutes), 23% of the patients survived.

The mean interval time from collapse to intubation in the “quick” intubation group was 10.0 +/- 1.7 minutes.

What would be the outcome if the intubation time could be decreased even more? Would there be more survivors? Eisenberg’s study and common sense would say yes.

But how will we know in Peoria where we don’t have access to statistics and the PFD’s hands are tied as they are unable to perform quick and possibly life saving intubation of Peoria’s prehospital cardiac arrest victims?