altA 21-year-old, right-hand dominant male without significant past medical history, presents to your emergency department after a pallet of bricks fell on his left, ring finger, while at work just prior to arrival.  His vaccinations are up to date.  On exam, he has amputated his ring finger just distal to the DIP joint, and bone is exposed  at the site of injury.You’re in small town U.S.A.  No orthopedic service around. What do you do?

altIn recent years, the growth of emergency medicine around the globe has been exponential, with nearly 70 countries now granting some form of formal recognition to the field. At the same time, interest in Global Emergency Medicine (GEM) as a unique subspecialty of emergency medicine has also grown rapidly over the past decade.

altThe CDC reports that 123.8 million patients visited an emergency department last year. That’s 41.4 visits per 100 population. That number has risen every year despite numerous, concerted efforts by the government and the insurance industry to stem the rising tide. Could it be that patients see what the politicians and planners seem to be missing, that the model of emergency care by qualified specialists, when and only when you need it, is a good model for health care delivery?

altImagine you are the CEO of St. Elsewhere Hospital, which is a suburban hospital with a 35,000 yearly visit emergency department (ED). The ED is a mess: average door-to-doctor times of 110 minutes, a left-without-being seen (LWBS) rate of 7%, and poor Press Ganey scores. Most everyone in the hospital, including the patients, refer to it as “That ER.”

An emergency physician recently contacted me to tell me a story. It all started when her local hospital emergency department received notice that they were on an award list published by a well-known health care grading company. “Terrific!” she said.

A patient is suffering from two life threatening events. Treatment for one condition may exacerbate the other condition. The standard of care is based upon a “reasonable person” standard, so I asked my friend what a reasonable doctor would do in the same or similar circumstances. He wasn’t sure.

Many EMS providers use devices like the King Laryngeal Tube or Sheridan Combitube as primary or rescue airways (if tracheal intubation fails). The pharyngeal balloons on the King LT or Combitube make them very secure to dislodgement. They are also blindly inserted and require relatively little training.

Each year at the Scientific Assembly of the American College of Emergency Physicians over 300 Council members convene to consider, debate, and vote on a slate of resolutions put forth from the membership through their various state chapters. Many members of ACEP – even after years of membership – know little of these resolutions.

Building a team is one of the most important components of a medical director’s job, and it starts with finding the right people. Many factors come into play in this process, but in many ways it starts with timing.

Dr. Adam Levine, an assistant professor at Brown University Medical School, traveled to Libya with International Medical Corps (IMC) during August, just as rebels were beginning to overthrow the Gaddafi regime. The following are excerpts from his travel blog, which first appeared on www.epijournal.com .

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