Posted on 12/29/2003 5:41:55 AM PST by Mamzelle
High-speed access in ER
Smaller, faster machines are making a difference in hospitals. ADVERTISEMENT
By Foster Klug ASSOCIATED PRESS Monday, December 29, 2003
BALTIMORE -- It's nine o'clock on a Saturday night when a 15-year-old boy with a bullet in his leg is rolled on a gurney into the R Adams Cowley Shock Trauma Center. More than 20 minutes have passed since he was shot in a drive-by. Here at Cowley, and at other trauma centers across the nation, leaping improvements in emergency medical technology are helping doctors to save lives that a few years ago would almost certainly have been lost.
Most valuable are devices that swiftly offer detailed looks under the skin, such as portable ultrasound machines and thermometer-like oral probes that detect stomach bleeding.
Since Dr. Thomas Scalea, the hospital's chief physician, arrived at the trauma center, technology has transformed nearly every corner of the emergency room, most impressively in ultrasound and CT scan machines.
"Every patient, it's like a detective project. You've got to figure out what's wrong, and you don't have much time," Scalea says.
"When I first got here (seven years ago), I'd sometimes say, `Oh, that person's going to die.' Now, my expectation of who's going to die is very much different," Scalea says. "I used to think there was a ceiling. There is no ceiling."
With blunt-force injuries -- which occur during auto accidents and falls, and account for most trauma cases -- a patient often has minor, if any, external bleeding.
All the while, however, he or she could be bleeding to death internally.
Instead of inserting a catheter in the abdomen to blindly test for internal bleeding or using a 500-pound ultrasound machine that needs three people to maneuver and operate, now a 6-pound, brick-size portable ultrasound can detect bleeding in about 15 seconds.
It takes all of about 20 seconds for a bigger, stationary machine that travels a patient's length -- it's called a helical CT scan -- to provide doctors with a crisp, three-dimensional digital view of every part of the internal landscape, from the brain to the smallest artery.
The new "16-slice" CT machine, which looks like a large, white doughnut, rotates around a patient stretched out on a narrow table, capturing 16 images every half-second.
With the older CT scan, it often took more than an hour to see the result.
Doctors say it won't be long before they're wearing tiny ultrasound scanners around their necks, much as they now wear stethoscopes.
Even smaller trauma centers, which might not have the staff or facilities needed to perform complicated surgeries, can afford the fast-imaging machines and other new devices that are lowering emergency room mortality rates.
Some of the new ultrasounds, for instance, cost about $25,000, well within most hospital budgets.
Medical tech is also making the battlefield more survivable. Wounded soldiers in Iraq are diagnosed on portable CT machines, which are carted in semi-trucks and powered by generators. And the military uses anti-hemorrhaging bandages made from a protein-like substance found in shrimp shells that adheres to blood in a wound, stopping even severe bleeding almost immediately.
Benefits of technology
Nationally, improvements in emergency care have over the past 40 or so years helped lower the death rate for assault victims by nearly 70 percent to between 15,000 and 20,000 annually, according to a study headed by sociology professor Anthony Harris of the University of Massachusetts at Amherst that was done jointly with Harvard researchers.
The study credits a variety of medical improvements: expanded 911 service, an increase in the number of hospitals and trauma centers, and better technology for emergency medical workers in the field, Harris says.
"With advanced lifesaving techniques, they've been able to sort of freeze the deterioration of the patient and deliver him to the hospital within the `Golden Hour,' " Harris says.
The Golden Hour is a concept developed by the Baltimore trauma center's founder and namesake, R Adams Cowley. It holds that chances for survival dramatically increase when a patient is treated within an hour of injury.
New diagnostic devices alone have cut the mortality rate at the emergency units of the Methodist Medical Center in Dallas by as much as 35 percent since 1998, estimates Dr. Robert Simonson, the hospital's associate director of emergency services.
He can now do a complete internal and external diagnosis within 15 minutes; five years ago it would have taken an hour and a half.
At the Cowley center, which belongs to the University of Maryland Medical System, the mortality rate is about 3 percent -- half what it was 10 years ago -- even though the number of patients doubled to 7,000 annually, says Dr. Richard Dutton, the center's chief of anesthesia.
The Cowley center was the country's first trauma center, established in 1969. With its steady stream of severe injuries and worldwide reputation for skilled nurses and surgeons, it's where many new technologies are first tested.
One new digital X-ray system is based on a technology developed to search South African miners for stolen diamonds. Doctors can scan a patient's entire body in 13 seconds, as opposed to the 45 minutes a conventional X-ray takes, enabling doctors to trace a bullet's trajectory through the body, for example.
Emergency workers in helicopters and ambulances will soon be using the capnometer, a thermometer-like device placed under the tongue that senses gastric carbon dioxide levels. Higher levels sometimes indicate a patient might be bleeding in the stomach.
And the Cowley center is testing the portable, 1-pound Brain Acoustic Monitoring system, which lets emergency workers quickly assess brain injuries using a small forehead sensor. The system analyzes cerebral blood flow to see whether a patient is unconscious from trauma or another cause, such as drugs or alcohol.
Other new inventions are allowing doctors to better marshal information in the emergency room.
The Cowley center has four Computers on Wheels, flat-screen computers set on height-adjustable rolling carts with a tiny brass-color bell tied to the front of each COW so even staffers in the heat of an emergency can hear them coming.
Instead of walking from department to department, doctors and nurses can pause during a procedure and search the COWs for every piece of information stored on every patient in the Cowley center: digital X-rays, CT scans, pharmacological information. They can even access surgical techniques listed on Web pages at medical schools.
Dr. Amy Sisley, a surgeon, is already looking forward to the benefits of advances in wireless communications.
"Pretty soon," she says, "I'll be able to pull up a patient's information, from CT scans to pharmacology, all on my pager."
Throwing modern technology at mortality is Sisyphusian. How can you not save grandma with a little more technology? Yet when you have "saved" her, you must then reckon on her getting even older--and becoming an even more difficult medical case to deal with in the future. Including, too often, Alzheimers . . .Basically, medicine illustrates the fact that economic scarcity cannot be transcended.
When HMOs first came into being, there was some discussion on how the $5 office visits were going to "save money in the long run" for people who wouldn't blink at spending $50 bucks for a first-rate hairdo or 100 bucks to have a good plumber do a housecall.
That created a whole generation of people who expect an office visit for free, when the office visit at $70 is the cheapest link on the chain of medical care.
It's not the doc in the office, or even the surgeon at the hospital that is the problem. Everyone focuses on "doctor's bills"--but the docs are simply beside the point in this problem.
It is the infrastracture of hospitalization. And that infrastructure is drop-dead fabulous.
And, I've come to realize, we cannot afford it. Something has to collapse soon.
what would you do...In the year 2003.. On the flip side if I do everything that I can do and he dies you still sue my a## for $1,000,000.00 and I get to bill you a couple of hundred dollars. tops.... and you or others don't even pay the bill.
The infrastructure is what keeps folks alive... it's just a matter of priorities... do you want to live long or have cable tv, cell phones, vacations to Vegas or pay for health insurance.
That's really what the "choice" that most folks make... they expect "free" medical care... Nothing is free.
Heavens, I was just bragging about how fabulous it all is. How every day, more lives are saved and more people are helped.
And it is stressed to the max. I'm telling you there is a problem to be faced--there are ways to keep it affordable but there is no will to take the action. Docs are now throwing up their hands and saying--"Bring on socialized medicine. I can't fight this battle anymore. We're outnumbered by lawyers a hundred to one. Every day is a new Catch22 --"
I'd rather not be hamstrung by regulation whilst being throttled by lawyers.
I'd rather have people pay out of pocket for office visits, be required to maintain an MSA and set up a system for catastrophic care.
I'd rather allow hospitals to make at least some decisions for economic reasons, to build into the system some protected discretion for choosing what is "almost as good" when it is considerably cheaper. At present, the hospitals have no choice in whether they can buy a Ferrari or a Honda. They MUST buy the Ferrari, even when the Honda will still get them where they want to go. If they buy the less expensive, they will get sued for not practicing "standard of care."
I'd rather the public appreciate the wonderful system they have and work to shepherd it, but I fear that they would "rather" equalize a low-quality alternative through no reason except their own resentment of the better off...
.
Perhaps you'd prefer to give up the technology if it is one of you or yours.
Jerk.
But don't misunderstand either, that the threat of Alzheimers' increases with age--and if grandma gets it you could come to wonder if you did anyone a favor. Find a cure or preventative for Alzheimers, and the equation shifts dramatically--assuming always that the cost of the cure is finite.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.