Suicide is the 10th leading cause of death in the United States, with firearms reported as the cause of death in up to 50% of these cases. Our goal was to evaluate the feasibility of the Counseling on Access to Lethal Means intervention in the Emergency Department (CALM-ED) by non-physician personnel.
The Sandy Hook Elementary School mass shooting on December 14, 2012, killed 26 people including 20 young children ages six to seven. The Sandy Hook shooter fired 154 bullets in less than four minutes, or about 38 bullets per minute from a semiautomatic rifle.
When the bullet leaves a Bushmaster rifle, it travels over 2000 feet per second. This velocity gives this bullet its devastating wounding potential. As this rifle bullet penetrates a human body, the energy of the bullet tears and shreds through tissue and bone, resulting in fractures, ruptured livers, and swollen brains, leading to hemorrhage, shock, and death. As an emergency physician, I have cared for hundreds of patients injured by bullets. I have had to tell parents that their teenager has died. Even those who survive are forever maimed and suffering. As a physician, I am interested in better understanding this pathogen of gun violence: the bullet and the guns that carry them.1
Current screening techniques include history and physical exam (H and P), with or without an electrocardiogram (ECG). Adding point of care cardiac ultrasound has demonstrated benefits, but there is limited data about implementing this technology. We evaluated the feasibility of adding ultrasound to preparticipation screening for collegiate athletes.
Suicide is the 10th leading cause of death in the United States. An estimated 50% of these deaths are due to firearms. Suicidal ideation (SI) is a common complaint presenting to the emergency department (ED). Despite these facts, provider documentation on access to lethal means is lacking. Our primary aim was to quantify documentation of access to firearms in patients presenting to the ED with a chief complaint of SI.
The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy.
The incidence and causes of iatrogenic hypoglycemia are not known. We aim to describe how often the cause of ED hypoglycemia is iatrogenic and to identify its specific causes.
Since hoverboards became available in 2015, 2.5 million have been sold in the US. An increasing number of injuries related to their use have been reported, with limited data on associated injury patterns. We describe a case series of emergency department (ED) visits for hoverboard-related injuries.
Medical and public health societies advocate that healthcare providers (HCPs) counsel at-risk patients to reduce firearm injury risk. Anonymous online media comments often contain extreme viewpoints and may therefore help in understanding challenges of firearm safety counseling. To help inform injury prevention efforts, we sought to examine commenters’ stated opinions regarding firearm safety counseling HCPs.
Deaths and injuries from all-terrain vehicle (ATV) crashes result in approximately 700 deaths each year and more than 100,000 emergency department (ED) visits. The purpose of this study was to determine ATV crash patterns within a state, and to compare and contrast characteristics of these crashes as a function of crash-site rurality.
Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia.
Our primary objective in this study was to evaluate the feasibility of a screening survey to identify adult victims of sex trafficking in the ED. We also compared the sensitivity of emergency physician concern and a screening survey for identifying sex trafficking victims in the ED and determined the most effective question(s) for identifying adult victims of sex trafficking.
Survey data regarding the prevalence of risky substance use in the emergency department (ED) is not consistent. The objective of this study was to identify the prevalence of risky substance use among injured ED patients based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.0).
Horizontal violence (HV) is malicious behavior perpetrated by healthcare workers against each other. These include bullying, verbal or physical threats, purposeful disruptive behavior, and other malicious behaviors. This pilot study investigates the prevalence of HV among emergency department (ED) attending physicians, residents, and mid-level providers (MLPs).
Volume 17, Issue 1, January 2016.
Carol W. Runyan, MPH, PhD, et al.
Introduction: A youth’s emergency department (ED) visit for suicidal behaviors or ideation
provides an opportunity to counsel families about securing medications and firearms (i.e., lethal
means counseling).
Methods: In this quality improvement project drawing on the Counseling on Access to Lethal Means
(CALM) model, we trained 16 psychiatric emergency clinicians to provide lethal means counseling
with parents of patients under age 18 receiving care for suicidality and discharged home from a
large children’s hospital. Through chart reviews and follow-up interviews of parents who received
the counseling, we examined what parents recalled, their reactions to the counseling session, and
actions taken after discharge.
Results: Between March and July 2014, staff counseled 209 of the 236 (89%) parents of eligible
patients. We conducted follow-up interviews with 114 parents, or 55% of those receiving the
intervention; 48% of those eligible. Parents had favorable impressions of the counseling and
good recall of the main messages. Among the parents contacted at follow up, 76% reported all
medications in the home were locked as compared to fewer than 10% at the time of the visit. All who
had indicated there were guns in the home at the time of the visit reported at follow up that all were
currently locked, compared to 67% reporting this at the time of the visit.
Conclusion: Though a small project in just one hospital, our findings demonstrate the feasibility
of adding a counseling protocol to the discharge process within a pediatric psychiatric emergency
service. Our positive findings suggest that further study, including a randomized control trial in more
facilities, is warranted.
Volume 16, Issue 7, December 2015.
Christopher A. Kahn, MD, MPH, et al.
For years, public health experts have been concerned about the effect of cell phone use on motor
vehicle collisions, part of a phenomenon known as “distracted driving.” The Morbidity and Mortality
Weekly Report (MMWR) article “Mobile Device Use While Driving – United States and Seven European
Countries 2011” highlights the international nature of these concerns. Recent (2011) estimates from
the National Highway Traffic Safety Administration are that 10% of fatal crashes and 17% of injury
crashes were reported as distraction-affected. Of 3,331 people killed in 2011 on roadways in the U.S.
as a result of driver distraction, 385 died in a crash where at least one driver was using a cell phone.
For drivers 15-19 years old involved in a fatal crash, 21% of the distracted drivers were distracted by
the use of cell phones. Efforts to reduce cell phone use while driving could reduce the prevalence of
automobile crashes related to distracted driving. The MMWR report shows that there is much ground to
cover with distracted driving. Emergency physicians frequently see the devastating effects of distracted
driving on a daily basis and should take a more active role on sharing the information with patients,
administrators, legislators, friends and family.
Volume 16, Issue 7, December 2015.
Jill M. Huded, MD, et al.
Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3
million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for
identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT),
a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and
prompt interventions through a geriatric nurse liaison (GNL) model.
Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of
ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk
screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical
therapy (PT), social work or home health as determined by the GNL.
Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13
and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those
screened with the TUGT, 368 patients experienced a positive result. Interventions for positive
results included ED-based PT (n=63, 17.1%), outpatient PT referrals (n=56, 12.2%) and social work
consultation (n=162, 44%).
Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk.
Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and
place appropriate referrals based on assessment results. Identifying and intervening on high fall
risk patients who visit the ED has the potential to improve the trajectory of functional decline in our
elderly population.
