Archives for September 2005

Use of Former (?Shuttered?) Hospitals to Expand Surge Capacity

via MedPundit, the Government (Motto: "We’re Here to Help") has released some guidance for re-opening shuttered hospitals in the even of a disaster, here.

I spent some time looking these guidelines over, and they look pretty good.  This document also points out an incorrect statement I made recently: actually there are empty hospitals waiting for patients.  Nearly every major city has one or two closed hospitals sitting empty, but they’re empty of everything: beds, medicines, but mostly the skilled people who make them run.

The guidance gives several hints for who should staff these places, like DMAT’s, which make sense, especially if it’s a local DMAT and the credentialling is already in place.  The planners state the best way to handle this would be for the ‘surge capacity’ hospital to be considered a satellite of an existing hospital, which makes sense from an organizational standpoint.

Overlawyered: New Orleans Letter and EMTALA

From Overlawyered:

Longtime reader C.G. Moore, a 3L at Tulane Law who lives in St. Tammany
Parish outside New Orleans, writes in to say:

My wife, 4 mo. old son, and I survived [Hurricane Katrina] (we live
in St. Tammany parish, about 10 miles from lake Pontchartrain). I noticed you
had a link to WWL
television’s plea for medical personnel
to assist the victims. I was in a
unique position during the storm and afterward: my wife is an ER doctor, and we
sheltered at the hospital where she works.

The doctors and nurses were
incredible. They worked non-stop, under incredibly stressful conditions. Many
didn’t know where their loved ones were, or whether they had survived, and there
was no way to contact the outside world. Many lost everything to the flood
waters, tornadoes, and fallen trees. And still, they worked 12-hour shifts
(sometimes longer).

But one of the first hurdles they had to contend
with was the effects of EMTALA in a disaster situation. [EMTALA is a federal law under
which hospitals can be sued if they turn away patients needing emergency medical
— ed.] Under EMTALA, ER physicians are cautious to the point of
absurdity. But as the hospital quickly filled to capacity with seriously ill and
injured patients, the ER was able to attend to life-or-death situations only.
Strict triage procedures were needed to separate the "worried well" from the
dying. Medical care really was a limited commodity. Although the magnitude of
the catastrophe was clear to all, some patients and their families couldn’t
understand that minor boo-boos didn’t merit immediate care (much less admission
to the hospital, where it was air-conditioned and they could get a hot meal).

So, my concern is this: once the rubble is cleared and the power
restored, the plaintiffs’ lawyers will ooze back into the scene — that this was
a disaster situation won’t matter one iota — and they’ll use EMTALA to file
lawsuit after lawsuit.

I really hope I’m wrong. But only time will tell.

I wouldn’t bet against it.

Tarrant County Medical Society Swings into Action for Katrina

This just in:

Message from TCMS President Gary W. Floyd,


Donate Sample Medications for Hurricane Katrina

Fort Worth, Arlington, Tarrant County and other local
emergency organizations are partnering to provide sheltering assistance to
refugees. Both the City of Fort Worth and Tarrant County have declared a local
state of emergency to allow local authorities to provide any and all assistance

At this point, several shelters have been established in Tarrant
County and there will be a great need for medications of all kind.

Tarrant Count Public Health Department is collecting sample medications to
distribute to refugees.

Physicians’ office can drop off sample
medications to:

Tarrant County Public Health Department
1101 S. Main
Fort Worth, TX 76104
(at the corner of Rosedale & Main)

That’s a good idea, but will be a drop in the bucket of what’s needed.  However, this is probably a very good short-term solution.  Since I work in an ED, I don’t have any samples. – Evacuations resume at flooded hospital – Sep 2, 2005

They’re still evacuating hospitals in New Orleans, and many hope to get the staff out today.  I don’t know how they’ll be able to go back without a massive cleanup operation. – Evacuations resume at flooded hospital – Sep 2, 2005.

TMA: No docs being sent into Louisiana

Just got this from the Texas Medical Association This color is my emphasis:

Deployment Status:   TMA has not received an
official notice to deploy volunteers to Louisiana.
We appreciate your
willingness to help and ask for your patience at this time. If you have
contacted TMA to volunteer, you are in our volunteer database. You will be
contacted as soon as we are notified. (See Next Steps.)

Overwhelming Response:   Wednesday, Aug. 31,
Gov. Rick Perry asked the Texas Medical Association to solicit 200 physician
volunteers to assist Louisiana with their medical needs. As a result of that
request, TMA has received more than 1,500 responses from physicians, residents,
and medical student volunteers. And more calls are coming in by the minute.

Our initial announcement requesting volunteers was stated
exactly as provided to us by the Governor’s Division of Emergency Management.
That notice listed only six specific specialties. However, TMA sent a notice to
all specialties in our e-mail database. We anticipated additional skills and
expertise would be needed. The response from our physician members has been
overwhelming and heartwarming. The rescue shelters established in Texas? major
cities are in desperate need of primary care physicians.

Next Steps:   The State Operations Center has
been told that additional physicians (except for mental health professionals)
are not needed in Louisiana.
Hospitals in New Orleans have been evacuated.
Physicians displaced from New Orleans are being dispersed throughout the state
and are helping with immediate relief efforts. State and federal officials will
not deploy any volunteers into Louisiana until your safety can be guaranteed…

From what I’ve seen on TV this makes the most sense: with no infrastructure there’s no need to add to the disaster.  Let’s evacuate everyone out of the area and fix the problems out of the disaster zone.

New Orleans Patients arrive in Fort Worth

I worked an afternoon shift in my ED today, and the buzz was all about the New Orleans transfers we’d received, and continued to receive.

Our joint got about 12 that I’m aware of, with a very high percentage being dialysis patients and in need of that service.  It was entirely appropriate that they were sent to us, as we’re one of a few hospitals in the area with inpatient dialysis services available.  Our nephrologists didn’t bat an eye, and worked hard to get them taken care of.

The patients were flown into the JRC Fort Worth (used to be Carswell AFB), and then a team from the county hospital and the county EMS director started divvying them up.

The patients I cared for showed what you’d expect in a debilitated, chronically ill person with no adequate sanitation for 3 days.  All but one showed up with their inpatient hospital chart (in the binder), and one had not just that but prior charts dating back several years!

The staff, who would gripe even if struck with a new stick, were quite remarkably compassionate and there were no harsh statements made about the sending facilities’ care.

Another flight was due in this evening, but I left before that batch of patients arrived. 

A moment of levity in all this: one patient, evacuated with just a gown and a chart arrived with a bottle in hand: a bottle of Tabasco sauce.  When asked, yes, it was the patients’ just to make sure it was available for meals.

That should prove interesting for the hospital dietitians.

And now: where in the world are all these cities and hospitals going to put these new patients with chronic illnesses?  My place routinely holds admitted patients in the ED hallways.  There are no empty hospitals waiting for new patients.

TCU – Learning to Change the World

If you’re from the DFW area and were set to attend college in NoLA: TCU – Learning to Change the World.

Wednesday, August 31, 2005

Message to TCU from Chancellor Victor J. Boschini Jr.  

Dear TCU Community,

Devastation caused by Hurricane Katrina in Louisiana, Mississippi and
Alabama has left thousands homeless, businesses destroyed and
livelihoods uncertain. Universities in the area, including Tulane,
Xavier, Loyola, and Dillard, all located in New Orleans, have sustained
major damage and there is great uncertainty as to when they might
re-open. To that end, TCU is offering admission until Tuesday,
September 6 to Metroplex undergraduate students previously admitted to
a university severely damaged by Hurricane Katrina.
I am asking that
each member of the TCU community be flexible in accommodating these
late arriving students and help them feel welcome. Although we are at
our maximum for this year’s freshman class, we feel a great sense of
duty to offer this gesture of goodwill to these college students.

In addition to these efforts, TCU’s Student Affairs division (Community
Outreach/Service Learning and University Ministries) is coordinating an
additional response to the disaster. A full accounting of their efforts
follows below.


Victor J. Boschini, Jr.

Marooned doctors plead ‘Please help us’

This is completely unacceptable, and those responsible need to be dealt with harshly.  And I’m not advocating handcuffs, or jail time.

Dr. McSwain, quoted in the article, is one of the dieties of early trauma research.

Unruly crowds disrupt, prevent hospital evacuations

(AP) — Doctors at two desperately
crippled hospitals in New Orleans called The Associated Press Thursday
morning pleading for rescue, saying they were nearly out of food and
power and had been forced to move patients to higher floors to escape

"We have been trying to call the mayor’s office, we
have been trying to call the governor’s office … we have tried to use
any inside pressure we can. We are turning to you. Please help us,"
said Dr. Norman McSwain, chief of trauma surgery at Charity Hospital,
the largest of two public hospitals.

Charity is across the street
from Tulane University Medical Center, a private facility that has
almost completed evacuating more than 1,000 patients and family
members, he said.

No such public resources are available for
Charity, which has about 250 patients, or University Hospital several
blocks away, which has about 110 patients.

"We need coordinated help from the government," McSwain said.

He described horrific conditions. (Watch a report on the scenes of death and despair on the streets of New Orleans — 4:36)

is no food in Charity Hospital. They’re eating fruit bowl punch and
that’s all they’ve got to eat. There’s minimal water," McSwain said.

of their power is out. Much of the hospital is dark. The ICU (intensive
care unit) is on the 12th floor, so the physicians and nurses are
having to walk up floors to see the patients."

[Read more…]

Dr. Charles announces his book

DrcharlesbookAnd now, presenting Legends of the Examining Room, a collection of the best writing this little weblog has had to offer over the past year.

Read about
the hidden poetry, the hilarity, and the heroic resilience of ordinary
people as they filter through this otherwise unremarkable examining

I’m writing under the pseudonym Aidan Charles. Both names
have a special significance for me, and were chosen mostly on
sentimental grounds. Now you can call me whatever you like, but I
feared that if I didntt get myself a first name that I was on the fast
track to a Dr. Phil-style reputation.


I will be donating a percentage of any sales to charities such as Doctors Without Borders. For now, Imm going to give 25% to The Red Cross for their efforts in Hurricane Katrina relief (this is assuming that proceeds total more than a 37 cent stamp).

He’s selling these through an independent publisher, here:

Legends of the Examining Room

Now, who’s doing the book review?

New Orleans Satellite Photos

Remember those before and after satellite photos from the tsunami?  Now they’re out for New Orleans.