Emergency services and trauma care in California are being
threatened. Financial pressures, infra-structure requirements and
shortages of licensed health care professionals have caused
numerous emergency department (ED) and trauma center closures or
The willingness of physician specialists to take calls in
hospital EDs has also become increasingly problematic for
At midafternoon on a recent weekday, the vast waiting area at
University of Colorado Hospital’s new emergency room is empty.
Missing are the dozens of patients who crowd a typical ER lobby,
often waiting more than an hour to see a doctor. Empty, though,
does not mean idle. Behind secured doors, a warren of treatment
rooms is packed with complaints of chest pain, dizziness and
earaches, some of the 230 patients University Hospital’s ER will
see on a given day.
That’s just the way the design team wants it. They meticulously
planned the space to employ retail magic alongside medical
miracles, putting the hospital at the forefront of a national
movement to deliver health care with industrial efficiency.
The Robert Wood Johnson Foundation (RWJF) has developed an
interactive online map that provides state-by-state injury death
rates and ranks states on injury prevention based on 10 key
indicators of steps states can take to prevent injury. The map
uses data from The Facts Hurt — a policy report RWJF
issued last year. According to the report, “millions of injuries
could be prevented annually if more states adopted additional
research-based injury prevention policies, and if programs were
fully implemented and enforced.” To view the map, visit the
The California HealthCare Foundation is working with the
Emergency Medical Services Authority and the Institute for
Population Health at the University of California, Davis, to
study how community paramedicine (CP) programs can be used to
improve access to health care in California. CP programs use
paramedics who have received additional training and work under
medical direction to fill gaps in community health care. The
project is exploring whether CP programs can be used to increase
efficiency of the Emergency Medical Services system and help
integrate it with health care systems. CHA and 34 other
organizations are participating in the project.
CHA and the California Emergency Medical Services Authority are
convening a group of key stakeholders in March to explore ways to
solve delays that occur when patients are
transferred from an ambulance by emergency
services personnel to hospital emergency department staff.
These delays, frequently referred to as ambulance “wall” or
“wait” times, prevent emergency services personnel from prompt
return to service. Most importantly, they threaten safe patient
evaluation and transfer of care. The group will examine the
problem and develop solutions that can be applied and controlled
locally, as deemed appropriate by local stakeholders.
Whether you are a sending or receiving hospital, many factors
must be considered when dealing with a potential EMTALA
situation. The patient’s medical condition, screening exams,
capacity and capability, and on-call issues are at the top of the
list. Learn how to analyze these and other complicated EMTALA
situations with confidence.
The EMTALA Manual cuts through the legalese to help you
navigate the Emergency Medical Treatment and Active Labor Act —
or “patient-dumping” law — that was enacted to ensure patients
equal access to emergency services without regard to financial or
insurance status. In a question and answer format, the manual
provides guidance to hospitals and physicians on how to comply
with the Act and clarifies situations to which EMTALA applies.
Despite warnings from the Food and Drug Administration,
manufacturers and various patient safety agencies, fentaNYL
transdermal patches continue to be prescribed inappropriately to
treat patients with acute pain who are not opioid tolerant.
CDPH has issued several Immediate Jeopardy administrative
penalties for inappropriate use of fentaNYL transdermal patches.