♪

>> ON "HEALTH MATTERS,"

TELEVISION FOR LIFE, A HIGH

SCHOOL FOOTBALL PLAYER IS

AIRLIFTED TO THE HOSPITAL AFTER

A HIT ON THE FIELD KNOCKS HIM

OUT.

>> IT COULD HAVE BEEN SO MUCH

WORSE.

>> GO INSIDE THE NEWEST CHOPPER

AT NORTHWEST MEDSTAR AND SEE HOW

TECHNOLOGY IS SAVING LIVES.

>> IT'S BEEN A VERY EXCITING

TIME IN THE DEVELOPMENT OF

EMERGENCY MEDICINE.

>> FROM URGENT CARE TO THE E.R.,

EXPERIENCE THE FAST-PACED WORLD

OF MODERN EMERGENCY MEDICINE.

RIGHT NOW ON "HEALTH MATTERS."

>> "HEALTH MATTERS" IS MADE

POSSIBLE BY VIEWERS LIKE YOU,

THE FRIENDS OF KSPS.

AND BY THE FOLLOWING:

>> WILLIAM, I REALLY LIKED THE

IDEA OF BEING PART OF

PROVIDENCE.

IF I HAVE A QUESTION AND THERE'S

SOMETHING I'M CONCERNED ABOUT, I

CAN ALWAYS CALL A SPECIALIST.

I'M DR. ANNA BARBER.

HERE I CAN HELP CHILDREN THRIVE

AND REACH THEIR HIGHEST

POTENTIAL.

>> IF YOU READ PROVIDENCE'S

MISSION STATEMENT, IT'S ALL

ABOUT DELIVERING QUALITY CARE TO

THE PATIENT AT ALL TIMES.

I'M DR. PETER RONALDI, AND I

CHOSE PROVIDENCE BECAUSE THEY

PUT THE DOCTOR-PATIENT

RELATIONSHIP FIRST.

>> FIND YOUR DOCTOR ONLINE AT

PHC.ORG.

>> GOOD EVENING AND WELCOME TO

"HEALTH MATTERS" HERE ON KSPS.

I'M YOUR HOST TERESA LUKENS.

ACCORDING TO THE CDC, EMERGENCY

DEPARTMENTS ACROSS THE COUNTRY

SEE MORE THAN 136 MILLION PEOPLE

EACH YEAR.

IT'S A SPECIALIZED CERTAINLY IN

EMERGENCY MEDICINE AND ONE THAT

A LOT OF PEOPLE ARE FASCINATED

BY.

ALSO URGENT CARE IS ANOTHER

SPECIALTY AND WE WILL BREAK DOWN

BOTH OF THOSE TODAY WITH OUR

GROUP OF PANELISTS WHO WE

ASSEMBLED TO TALK ABOUT

EMERGENCY CARE AND URGENT CARE

AND ALSO E.M.T.s.

SO WITH US TONIGHT IS

HEATHER HEALY IS THE DIRECTOR OF

NURSING AND THE DIRECTOR OF SIX

URGENT CARE CLINICS FOR ROCKWOOD

HEALTH SYSTEM.

DAN GETZ IS THE MEDICAL DIRECTOR

FOR THE PROVIDENCE SACRED HEART

EMERGENCY DEPARTMENT.

SHAUN PITTS IS AN ADVANCED

EMERGENCY MEDICAL TECHNICIAN AND

INSTRUCTOR FOR INLAND NORTHWEST

HEALTH SERVICES.

TAMARA BRINING WORKS IN THE

EMERGENCY DEPARTMENT AT VALLEY

HOSPITAL WHERE SHE IS ONE OF THE

ASSISTANT MEDICAL DIRECTORS.

THANK YOU ALL FOR BEING HERE

TONIGHT.

THIS IS A GREAT TOPIC, AND ONE

WE REALLY HAVEN'T EXPLORED, AND

IT'S VERY SPECIALIZED.

IT'S VERY DIFFERENT.

I THINK FASCINATING TO A LOT OF

PEOPLE AND OFTEN ONE THAT THEY

DON'T KNOW ABOUT UNTIL THEY HAVE

TO USE ONE OF YOUR SERVICES.

SO LET'S TALK, FIRST, ABOUT

EMERGENCY CARE, DAN.

AND WHAT WE'RE TALKING ABOUT

WHEN WE ARE TALKING ABOUT THE

EMERGENCY ROOM AND THE UNIQUE

FEATURES TO THE EMERGENCY ROOM

AND WHY WE GO THERE, AND WHAT IS

OFFERED.

>> SURE.

EMERGENCY MEDICINE IS A FAIRLY

UNIQUE SPECIALTY IN THAT WE ARE

REALLY THE FIRST LINE OF CARE

FOR LIFE THREATENING OR

POTENTIALLY IMMEDIATELY

DISABLING ILLNESS.

SO IF YOU SEE THAT AMBULANCE IS

DRIVING BY, USUALLY THEY ARE

COMING TO SEE ONE OF OUR LOCAL

E.R.s WITH PRETTY SICK PEOPLE.

AND THERE'S A LOT OF CONFUSION

ON WHAT WARRANTS AND E.D. VISIT,

BUT ANYTHING THAT'S LIFE

THREATENING OR DISABLING, WE

TEND TO GET THEM.

WE HAVE BROKEN ANKLES AND URGENT

CARES WHERE A PERSON WHO

PRESENTS WITH A COMPLAINT THAT

MAY NOT BE APPROPRIATE FOR THEIR

SETTING BUT THEY WILL SEND IT TO

THE EMERGENCY DEPARTMENT.

>> THAT'S A GREAT WAY TO BRING

YOU IN, HEATHER TO TALK MORE

ABOUT THE URGENT CARE

FACILITIES.

WE ARE SEEING A LOT OF THEM NOW

IN SPOKANE, WHICH IS A GOOD

THING.

WHY DO WE GO TO URGENT CARE AS

OPPOSED TO MAYBE GOING TO THE

EMERGENCY ROOM?

>> IT'S A GREAT ACCESS POINT

DURING THE WEEK, DURING THE DAY

IF YOU CAN'T GET IN WITH YOUR

PRIMARY CARE AND YOU HAVE COLD,

FLU-LIKE SYMPTOMS, A CHEST COLD,

THE FLU BUG THAT'S GOING AROUND

RIGHT NOW.

IT'S -- SO IT'S NOT THE URGENT

AND IMMEDIATE, REALLY LIFE

ALTERING THAT DAN WAS TALKING

ABOUT.

SOME OF THE QUICK ILLNESSES IN

THE URGENT CARE, WE CAN DO, YOU

KNOW, ANKLES AND SPRAINS AND

STRAINS, THAT TYPE OF THING.

BUT IT'S SOME VERY QUICK, COLDS,

FLUS, AND THEN WE JUST KIND OF

ASSESS.

IF WE DO FEEL LIKE MAYBE YOU

NEEDED AN E.R., THEN WE

ABSOLUTELY SEND TO THE E.R.s

IN THE AREA, ROCKWOOD VALLEY,

AND THEN PROVIDENCE IF NEEDED.

>> AND THE IDEA BEING THAT I CAN

JUST WALK IN AND GET THAT CARE

THAT I NEED IF MY PHYSICIAN IS

NOT AVAILABLE.

YOU ARE PROBABLY FAIRLY BUSY ON

THE WEEKENDS ALSO?

>> YES, WE HAVE OUR WEEKENDS AND

SATURDAY AND SUNDAYS, THOSE ARE

TIMES WHEN PEOPLE CAN'T GET INTO

PRIMARY CARE BUT THEY ARE SICK.

THEY NEED TO GET IN.

THEY WANT TO GET HEALTHIER AND

GET BACK TO WORK.

AND SO SATURDAYS AND SUNDAYS ARE

BUSY, ESPECIALLY WITH ALL THE

SPORTS GOING ON.

WE WILL GET KIDDOS THERE.

WE HAVE SPORTS PHYSICALS.

WE CAN TAKE CARE OF THAT.

SO SOME WELLNESS THINGS TOO.

SO THAT'S GOOD.

>> MM-HMM.

>> AND SHAUN, YOUR CREWS ARE

FIRST ON THE SCENE AS THE

E.M.T.s AND SO YOU ARE THERE

TO DO THAT FIRST ASSESSMENT.

TO GET THEM TO ONE OF THE

FACILITIES.

TALK ABOUT YOUR ROLE AND THE

LARGER ROLE THAT E.M.T.s PLAY.

>> ABSOLUTELY.

SO WE -- YOU CALL 911 AND WE ARE

WHO SHOWS UP, A MIX OF E.M.

T.s AND SOME AREAS ADVANCED

E.M.T.s AND OTHERS OFFER

PARAMEDICINE.

MOST OF ALL OF THE PATIENTS WE

ARE TAKING FROM THEIR HOME TO AN

EMERGENCY DEPARTMENT FACILITY.

EVERY ONCE IN A WHILE, WE GET

SOMEONE WHO HAS AN URGENT CARE

FACILITY THAT WE ARE TAKING INTO

THE EMERGENCY DEPARTMENT,

WHETHER IT WAS SOMETHING THAT

WAS A LITTLE MORE CRITICAL THAN

THE PATIENT THOUGHT OR THE

NURSING STAFF DECIDED IT WOULD

NEED TO BE HANDLED ON THE E.D.

SIDE OF THINGS.

WE TRANSPORT THEM IN AND GET

THEM TAKEN CARE OF BY THE

DIFFERENT E.R. FACILITIES.

>> AND SOME FACILITIES INDICATOR

TO SENIORS AND CHILDREN'S

HOSPITAL WITH A TRAUMA UNIT.

SO TALK ABOUT HOW WE'RE

ADDRESSING THOSE UNIQUE NEEDS OF

THE PATIENTS AND NOT JUST KIND

OF A CATTLE CALL, SO TO SPEAK.

>> YES, THAT'S TRUE.

WE HAVE KIND OF -- EACH

DIFFERENT -- EACH INSTITUTION

THAT WE HAVE IN SPOKANE HAS A

CERTAIN, YOU KNOW, LEVEL OF

SPECIALTY, WHETHER IT BE THE

SACRED HEART CHILDREN'S

HOSPITAL.

WE FOCUS MORE ON SOME GERIATRIC

APPROACH FROM VALLEY HOSPITAL'S

STANDPOINT, BEING A GERIATRIC

FRIENDLY E.D.

URGENT CARE, YOU SEE ALL WALKS,

OF COURSE.

YOU HAVE YOUNG, OLD, DOESN'T --

ALL AGE RANGES.

THERE ARE SOME SPECIALTY E.D.s

AS WELL, EVEN OUTSIDE OF OUR

LOCAL COMMUNITY AS WELL THAT

FOCUS ON SUBSPECIALTY NEUROLOGY,

ET CETERA, THAT KIND OF THING.

I THINK WE ARE PROBABLY ALL THE

EMERGENCY DEPARTMENTS IN OUR

SURROUNDING AREA, SPOKANE

SPECIFICALLY, CAN TAILOR, YOU

KNOW, TO ANYONE WHO WALKS

THROUGH THE DOOR OR GETS BROUGHT

IN THROUGH THE AMBULANCE DOOR.

>> SO KIND OF TAKE US THROUGH

THAT PROCESS, ESPECIALLY WHERE

YOU CATER TO SENIORS.

WHY IS IT UNIQUE FOR THEM?

>> SO FOR SENIORS, SPECIFICALLY,

ONE OF THE FOCUSES THAT WE TOOK

WAS BEING ABLE TO HAVE A

COMFORTABLE, EASY ACCESS,

ACCESSIBLE ENVIRONMENT.

SO ESSENTIALLY THAT EASIER

PARKING.

SO BRINGING A PARKING SPOT

CLOSER TO THE DOOR.

BECAUSE IT'S A BIG DEAL TO GET

FROM THAT CAR TO THE FRONT DOOR

IN SOME CASES.

WE HAVE THICKER MATTRESS

STRETCHERS.

SO ESSENTIALLY WE ADDED MORE

PADDING.

SO YOU DON'T FEEL -- YOU DON'T

FEEL THE STRETCHER AS MUCH WHILE

YOU ARE SITTING THERE GETTING

YOUR CARE.

SO LITTLE THINGS THAT MAKE THE

DIFFERENCE.

>> AND DAN, WE OFTEN SAY ON THE

SHOW WITH A LOT OF OUR DOCS THAT

CHILDREN AREN'T JUST SMALL

ADULTS.

THEY HAVE SPECIAL NEEDS AND

THAT'S WHERE CHILDREN'S

HOSPITAL, SACRED HEART

CHILDREN'S HOSPITAL COMES INTO

MAY WITH THE ONLY AREA TRAUMA

UNIT FOR KIDS.

>> YES, IT'S -- THE WAY WE SET

UP OUR PEDIATRIC EMERGENCY

DEPARTMENT, IT'S FOR THE MOST

PART STAFFED BY EMERGENCY

MEDICINE PHYSICIANS, FELLOWSHIP

TRAINING AND PEDIATRIC CARE.

IT'S DEFINITELY A VERY DIFFERENT

SPECIALTY FROM GENERAL EMERGENCY

MEDICINE AND A VERY UNIQUE

PRACTICE.

THEY DO A VERY GOOD JOB

PROVIDING CARE TO VERY, VERY

SICK CHILDREN.

THAT'S ONE OF THE CHALLENGES

WHEN YOU HAVE A CHILDREN'S

HOSPITAL, YOU DEAL WITH THE

PEDIATRIC POPULATION WITH SOME

VERY SERIOUS ILLNESSES AND WE

HAVE CHILDREN COMING FROM THE

SEATTLE AREA TO RECEIVE CARE IN

SPOKANE.

>> MM-HMM.

SO ALL OF THE EQUIPMENT IS

GEARED TOWARDS CHILDREN.

IT'S CHILD-SIZED SO TO SPEAK?

>> YES, EVEN THE WAY YOU WALK IN

THERE, THERE'S A TREMENDOUSLY

BIG FISH TANK AND VIDEO GAMES

AND WE TRY TO MAKE IT AS

COMFORTABLE AS WE CAN FOR THE

CHILDREN, AS WELL AS THE

FAMILIES.

IT'S AN ENTIRELY DIFFERENT

WAITING ROOM FROM OUR ADULT

WAITING ROOM.

THANKS TO A LARGE DONATION,

THERE WAS A NEW PEDIATRIC

EMERGENCY DEPARTMENT THAT'S

BEAUTIFUL AND COMFORTABLE FOR

CHILDREN AND THEIR FAMILIES.

>> SHAUN, IS THAT AN AUTOMATIC

FOR THE E.M.T.s TO KNOW WHICH

FACILITY TO USE?

I'M FASCINATED BY THAT PROCESS?

>> ABSOLUTELY.

WE ALL HAVE POLICIES AND

PROCEDURES THAT WE DETERMINE ON

THE SCENE IF IT'S A PEDIATRIC

PATIENT, THEN WE WILL BE HEADED

DOWN TO SEE PEOPLE AT SACRED

HEART.

DIFFERENT LEVELS OF CARE, WHICH

IT'S A CARDIAC PATIENT, AND WHAT

HOSPITAL THEY ARE SUPPOSED TO GO

TO OR A STROKE PATIENT,

UTILIZING THOSE.

AND SPOKANE COUNTY AND OTHER

AGENCIES LIKE THEM HAVE

PROTOCOLS SET UP THAT WE CAN USE

AS GUIDELINES OF WHERE TO GO AND

ONE THING THAT WE HAVE ALWAYS

UTILIZED IS AN ONLINE MEDICAL

DIRECTION, WHERE WE CAN PICK UP

OUR CELL PHONES OR RADIOS AND

CONTACT AN E.R. PHYSICIANS,

THESE ARE OUR PATIENT'S

SYMPTOMS, WOULD YOU LIKE THEM TO

BE SEEN AT YOUR FACILITY OR

ANOTHER FACILITY.

MOST OF THE TIME, MOST OF OUR

PATIENTS, ONE OF OUR FIRST

QUESTIONS IS WHAT HOSPITAL WOULD

YOU LIKE TO BE SEEN AT?

AND THOSE PATIENTS DETERMINE

WHERE THEY ARE GOING TO GO.

AND WE TRY TO FOLLOW THOSE

WISHES UNTIL THERE'S SOMETHING

THAT'S SPECIALIZED AND

ABSOLUTELY NEEDED.

>> WHEN SOMEONE PICKS UP THE

PHONE TO CALL 911 AND THEY NEED

ASSISTANCE, WHEN DOES AN

AMBULANCE ARRIVE AND WHEN DOES A

FIRE AID CAR ARRIVES?

HOW IS THAT DETERMINED?

>> IF THIS AREA IF YOU CALL 911

AND YOU ARE REQUESTING A MEDICAL

NEED, THE FIRE DEPARTMENT AROUND

HERE IS STAFFED WITH E.M.T.s

AND PARAMEDICS AND SO YOU WILL

GET A FIRE RESPONSE, WHETHER

IT'S AN ENGINE OR SOMETHING

ALONG THOSE LINES, AND THEN AN

AMBULANCE RESPONDS.

AND SO MOST PLACES ESPECIALLY IN

THE CITY OF SPOKANE AND THE

SPOKANE COUNTY AREA, YOU GET

BOTH THE FIRE DEPARTMENT AND THE

AMBULANCE AREA.

WE ARE ALL PRETTY USED TO

WORKING TOGETHER, AND, AGAIN,

JUST DEPENDS WHERE YOU LIVE

WHETHER THE FIRE DEPARTMENT HAS

A PARAMEDICS OR JUST A PARAMEDIC

ON AN AMBULANCE.

THAT PARAMEDIC LEVEL IS WHAT WE

STRIVE TO GET TO OUR COMMUNITY,

AS QUICK AS POSSIBLE, BECAUSE OF

THEIR SCOPE OF PRACTICE.

>> MM-HMM.

AND HEATHER, MORE PEOPLE ARE

USING URGENT CARE WHICH IS A

GOOD THING AND WITH THE HEALTH

INSURANCE CHANGES YOU ARE SEEING

MORE PATIENTS AT YOUR CLINICS.

WHAT WOULD YOU LIKE THOSE PEOPLE

TO KNOW THAT MAYBE HAVEN'T SET

FOOT IN AN URGENT CARE FACILITY

BEFORE THEY ARRIVE.

WHAT DO THEY NEED TO KNOW, FOR

INSTANCE, ABOUT THEIR INSURANCE

OR WHAT THEY NEED TO BRING AND

THE TYPE OF DOCTOR AND NURSES

THAT THEY ARE GOING TO SEE?

>> SO IN OUR URGENT CARES, WE

ARE STAFFED BY PHYSICIANS, NURSE

PRACTITIONERS, PHYSICIAN'S

ASSISTANTS AND SO THEY COULD SEE

ALL THREE OF THE PROVIDER TYPE.

WE HAVE R.N.s AND MEDICAL

ASSISTANTS AND SO THEY SEE THE

WHOLE GAMUT.

ONE REALLY, REALLY, REALLY

IMPORTANT THING IS THEIR

MEDICATION LIST.

BECAUSE IF THEY HAVE COME TO

URGENT CARE FOR THE VERY FIRST

TIME, EITHER THEY ARE ROCKWOOD

PATIENTS OR THEY ARE PROVIDENCE

PATIENTS OR THEY ARE JUST MOVING

THROUGH, BECAUSE THEY ARE

VISITING FAMILY FOR A FUNCTION

OR WHATEVER, WE DON'T HAVE ANY

OF THEIR HEALTH RECORDS ON FILE.

AND SO WE NEED TO KNOW WHAT

MEDICATIONS THEY ARE TAKING SO

THAT WE CAN TREAT THEM PROPERLY,

PREVENT MORE ILLNESS BECAUSE WE

USE MEDS THAT DIDN'T MATCH OR

ALLERGIES.

SO IF THEY HAD A MED LIST, IF

THEY HAD A LIST OF SOME OF THEIR

CHRONIC CONDITIONS, THAT'S

HELPFUL SO THAT WE CAN KIND OF

NARROW IT DOWN AND SPEED UP

THEIR CARE.

WE WOULD LIKE TO GET THEM IN AND

OUT QUICKLY.

>> I CAN SEE HOW THAT WOULD BE A

CHALLENGE BECAUSE ESSENTIALLY

YOU ARE SEEING THIS DOCTOR

PROBABLY FOR FIRST TIME.

>> YES.

>> IF I HAVE BEEN TO AN URGENT

CARE, AND I NEED TO GO BACK AT

SOME POINT, IS IT IMPORTANT TO

GO TO THE SAME ONE?

>> IN OUR SYSTEM, ALL SIX ARE

CONNECTED.

SO HELPS WITH THE CONNECTION

WITH THE COMPUTER SYSTEMS AND

THE MEDICAL RECORD.

IF YOU WENT TO ONE ROCKWOOD IN

OUR OR BEGAN FACILITY OR

ROCKWOOD AT LIBERTY LAKE, THOSE

MEDICAL RECORDS WOULD BE

CONNECTED.

SO IT DOESN'T MATTER WHICH

URGENT CARE YOU GO TO, WE WOULD

HAVE THAT DATA.

>> I'M HEARING A LOT ABOUT

CUSTOMER SERVICE AND THE FACT

THAT THERE AS A LOT -- A LOT OF

THOUGHT BE PUT INTO MAKING SURE

THE PATIENT IS COMFORTABLE,

MAKING SURE YOU SEE THEM

COMFORTABLE.

YOU HAVE A 30 MINUTE OR LESS

POLICY.

>> WE HAVE A PLAQUE ABOUT THAT.

>> YEAH.

>> SO ESSENTIALLY WE PLEDGE TO

SEE THE PATIENT WITHIN 30

MINUTES UPON ARRIVAL IN THE

DEPARTMENT.

NOW, WHEN YOU FIRST COME, IN YOU

ARE GREETED BY A GREETER,

OBVIOUSLY.

IF YOU NEED SOMETHING

EMERGENTLY, IT HAPPENS

EMERGENTLY.

BUT AS A PROVIDER WE STAFF NURSE

PRACTITIONERS AT THE FRONT OF

THE DEPARTMENT.

SO WE CAN GET A LOOK AT THEM

WITHIN THAT 30-MINUTE TIME FRAME

TO DECIDE WHAT DO WE HAVE TO DO?

DO WE NEED TO EXPEDITE THE CARE

AND FIGURE OUT WHAT WE NEED TO

DO FOR THEIR STAY AT THE

EMERGENCY DEPARTMENT AND FIGURE

OUT THE BEST WAY TO GET THEM

THROUGH AND WHAT THEY NEED.

IT HELPS US TO EXPEDITE THEIR

CARE OVERALL.

>> TYPICALLY HOW MANY STAFF ARE

ON?

IS THERE A BUSY TIME?

DO YOU HAVE MORE PEOPLE

OVERNIGHT OR ON WEEKENDS OR IN

THE SUMMER MONTHS WHEN WE TEND

TO SEE MORE INJURIES?

>> SOME OF OUR BUSIEST MONTHS

WITH TRAUMA SEASONS, WITH THE

WAY SPOKANE HAS GROWN, THERE'S

REALLY NO SLOW TIME IN THE

EMERGENCY DEPARTMENT.

WE FINISHED LAST YEAR SEEING

82,000 PATIENTS IN THE EMERGENCY

DEPARTMENT OF THE SACRED HEART

AND WE ARE ON PACE TO SEE CLOSE

TO 100,000 THIS YEAR.

SO IT REALLY -- YOU REALLY BUILD

FROM PROBABLY 2 P.M. TO 1 A.M.

AND THEN IT SLOWS DOWN A LITTLE

BIT, BUT IT'S -- IT'S VERY BUSY

THE WHOLE TIME.

WE HAVE A SIMILAR APPROACH WHERE

WE USE NURSE PRACTITIONERS AND

PHYSICIAN ASSISTANTS IN TRIAGE,

WE CALL IT A PROVIDER IN TRIAGE

PROGRAM TO GET THE PATIENTS SEEN

MORE EXPEDIENTLY ON THE VERY

HIGH VOLUME DAYS WHICH IS

SATURDAY, SUNDAY AND MONDAY AND

WE WILL EXPAND THAT PROBABLY TO

EVERY DAY OF THE WEEK BECAUSE WE

ARE RUNNING OUT OF REAL ESTATE

WHEN WE ARE DEALING WITH THE

PATIENT VOLUMES BUT THE CUSTOMER

SATISFACTION AND OUR PATIENTS

ARE OUR CUSTOMERS ARE COMING TO

THE FOREFRONT OF EMERGENCY

MEDICINE.

ACTUALLY IN 2016O EARLY 2017,

THEY ARE GOING TO BE ROLLING OUT

E.D. CAPS WHICH IS HOSPITALS

WILL BE REIMBURSED AND PART OF

THE MEDICARE D.R.G. MONEY BASED

ON PATIENT SATISFACTION SURVEYS.

SO IT'S REALLY ONE OF THOSE

THINGS WHERE IT USED TO BE, YOU

COME INTO AN EMERGENCY

DEPARTMENT WHO KNOWS HOW YOUR

EXPERIENCE WAS.

YOU WILL GET A TREMENDOUSLY

LARGE BILL, AND THANKS, HAVE A

NICE DAY.

WELL, NOW PATIENTS HAVE A CHANCE

TO CONTRIBUTE BACK, AND IF THEY

HAD A BAD EXPERIENCE, WE NEED TO

KNOW ABOUT IT.

>> HMM.

WHAT ARE SOME OF THE CHALLENGES

THAT YOU ARE FACING?

>> WELL, I THINK EXPECTATIONS

AND THIS IS, I THINK, A HUGE

QUESTION IN THE MINDS OF PEOPLE

WHEN THEY COME INTO THE

EMERGENCY DEPARTMENT.

I ALMOST WISH WE COULD NAME IT

WHAT IT AIN'T DEPARTMENT.

I HAVE A PATIENT COME IN AND

THEY WILL BE IN THE EMERGENCY

DEPARTMENT FOR THREE AND A HALF

HOURS AND ORDER A BATTERY OF

TESTS AND THEY WILL COME WITH

ABDOMINAL PAIN AND I WILL TELL

THEM I DON'T KNOW WHAT THE

ABDOMINAL PAIN IS.

IT'S NOT LIFE THREATENING OR

APPENDITIS, BUT I TELL THEM THAT

NO NEWS IS GOOD NEWS FROM THE

EMERGENCY DEPARTMENT.

SO IF WE CAN SELL THEM SOME

REASSURANCE AND REALIZE THAT YOU

DON'T HAVE A LIFE THREATENING OR

POTENTIALLY DISABLING CONDITION

AND YOU ARE STABLE TO FOLLOW UP

WITH YOUR PRIMARY CARE CONDITION

FOR FURTHER TESTING, THAT'S THE

VALUE OF THE EMERGENCY

DEPARTMENT.

BUT IF WE DO FIND SOMETHING, WE

ARE EQUIPPED TO HANDLE THAT BUT

WE ARE SET TO LOOK FOR A VERY

SMALL SPECTRUM OF ILLNESS THAT

CAN POTENTIALLY KILL YOU.

IF WE DON'T FIND THAT, THAT'S A

GOOD THING FOR PEOPLE.

>> IS THAT SOME OF THE

CHALLENGES THAT YOU FACE WITH

URGENT CARE?

>> WE DO THAT.

I THINK PEOPLE WILL SEE A HEALTH

SYSTEM NAME AND THEN THEY WILL

GO THIS NO MATTER WHAT.

AND SO WE'LL HAVE PEOPLE COME

INTO THE URGENT CARE THAT HAVE

HAD, YOU KNOW, THE CLASSIC CHEST

PAIN SIGNS, YOU KNOW, PRESSURE,

RADIATING UP MY JAW AND DOWN MY

ARM, AND THEY JUST SEE ROCKWOOD

OR THEY SEE PROVIDENCE AND

THAT'S WHERE THEY GO, AND THAT'S

REALLY NOT THE BEST CARE FOR

THEM, BECAUSE WE CAN'T GET TO

THE -- THOSE ARE THE ONES THAT

MIGHT CAUSE A DEATH.

SO WE NEED TO GET THEM TO THE EX

E.R. AS FAST AS WE CAN.

WE CALL OUR E.M.S. TEAM AND THEY

GET THEM THERE QUICK.

THE PATIENTS ARE SCARED IN AN

EMERGENCY AND ALL THAT THEY KNOW

IS I GO TO ROCKWOOD OR I GO TO

PROVIDENCE AND I WANT TO SEE MY

DOC, BUT I CAN'T.

SO I'M GOING TO GO TO THE NEXT

BEST THING.

AND SO THEY SEE THE NAME AND

THEY GO RIGHT IN.

SO WE HAVE HIGHLY TRAINED STAFF

THAT CAN TRIAGE THAT PATIENT AND

FIGURE OUT IS THIS THE RIGHT

PLACE?

OR IS THE E.R. THE RIGHT PLACE?

AND SOMETIMES E.R.s WILL DO

THE REVERSE AND THEY WILL FIGURE

OUT, YOU ARE A LEVEL FIVE OR A

LEVEL ONE AND THEN THEY HELP TO

TRIAGE AND GET THE RIGHT CARE

FOR THE RIGHT THING.

>> THAT'S WHAT'S FRUSTRATING FOR

PATIENTS TOO.

WHEN THEY WALK INTO A BUSY

WAITING ROOM AND THEY SEE 20

PATIENTS AND THEY KEEP SEEING

PEOPLE COMING PAST THEM INTO THE

EMERGENCY DEPARTMENT.

THEY GET FRUSTRATED.

I HAVE BEEN HERE TWO HOURS AND

THAT PATIENT JUST WALKED IN.

BUT WHAT SHE ALLUDED TO WAS THE

TRIAGE CRITERIA.

IF SOMEONE POTENTIALS WITH

POTENTIALLY MORE SERIOUS

COMPLAINT WE EXPEDITE THEM BACK

AS QUICKLY AS POSSIBLE.

I DON'T THINK PEOPLE ALWAYS

REALLYIZE THAT THE AMBULANCE IS

COMING THROUGH THE BACK DOOR AT

A STEADY CLIP.

LAST I SAW STATISTICALLY ABOUT

80% OF ALL AMBULANCE TRAFFIC

GOES TO SACRED HEART.

SO WE HAVE A STEADY STREAM OF

AMBULANCES.

SOMETIMES 60 AMBULANCES A DAY

WHICH COMES THROUGH THE BACK

DOOR, WHICH MAKES IT HARDER FOR

PEOPLE TO COME THROUGH THE FRONT

DOOR.

>> I THINK THAT'S WHY IT'S

ESSENTIAL THAT WE NOW HAVE THE

PROVIDERS IN KIND OF THE FRONT

OF THE DEPARTMENT AS WELL,

BECAUSE, YOU KNOW WHEN YOU ARE

LOOKING AT PRIME REAL ESTATE FOR

SICK, SICK PATIENTS IF YOU CAN

SEE SOMEONE QUICKLY, THAT

DOESN'T REQUIRE A BED, THAT CAN

STAY UPRIGHT AND GET THEIR

TREATMENT QUICKLY, THEN I THINK

THAT'S WORTH ITS WEIGHT IN GOLD,

BECAUSE THEN, YOU KNOW, THEY

DON'T HAVE TO STAY FOR

PROLONGED, YOU KNOW, WORKUP.

AND THE PATIENT THAT NEEDS THE

BED CAN GET TO THE BED FASTER,

AND GET WHAT THEY NEED.

SO I THINK THAT'S A BIG -- I

THINK THAT'S A BIG DRIVE WITH

SOME OF THE PROGRAMS THAT WE

HAVE INSTITUTES, AT BOTH OF OUR

E.D.s.

>> A LOT OF IN-PRO PROCESS

WAITING.

THAT'S THE NAME OF THE GAME.

AND WHEN YOU WALK THROUGH THE

FRONT DOOR.

WHEN YOU WALK INTO OUR LOBBY,

EVEN IF WE CAN'T GET A BED BACK

FOR YOU, IF WE CAN GET IN FRONT

OF A PROVIDER AND START CARE AND

GET YOUR WORKUP ARE GOING THAT

MAYBE POTENTIALLY HOUR AND A

HALF THAT YOU WAITED IS GETTING

AN HOUR AND A HALF AND

DISPOSITION HOME, AND THAT'S

WHERE THE VALUE ADD IS FOR THE

PATIENT.

>> WE HAVE A CALLER COMING IN

FROM SPOKANE.

THIS IS KATHY.

>> Caller: GOOD EVENING.

>> THANK YOU SO MUCH FOR

CALLING.

DO YOU HAVE A QUESTION FOR OUR

PANEL?

>> Caller: YES, I JUST WANT TO

KNOW, LIKE, WHEN YOU GO -- I

RECENTLY WENT TO AN URGENT CARE,

AND -- BECAUSE I HAD FALLEN, AND

THERE WAS A DOCTOR THAT, YOU

KNOW, TALKED TO ME, AND I GOT

X-RAYS AND STUFF.

AND THEN THIS WAS A DIFFERENT

DOCTOR THAT READ THE X-RAYS.

SO I WANTED TO KNOW -- AND THAT

DOCTOR WAS NOT A PROVIDER IN MY

INSURANCE.

SO I WANTED TO KNOW, LIKE, AS A

PATIENT COMING IN, WHAT

QUESTIONS DO WE HAVE TO ASK?

DO WE HAVE TO ASK, LIKE, IF THE

DOCTOR THAT'S GOING TO BE SEEING

US IS IN OUR NETWORK AND THE

DOCTOR THAT READS THE X-RAYS IS

THAT A DIFFERENT NETWORK?

DOES THIS MAKE SENSE?

>> YES, I THINK IT, DOES KATHY,

AND HEATHER, CAN YOU TAKE THAT?

>> YES, I THINK IT'S AN

EXCELLENT QUESTION, AND ONE OF

THE TOPICS WE HAVEN'T REALLY

TOUCHED ON IS HOW INSURANCE

DICTATES WHERE YOU GO TO WHAT

URGENT CARE YOU GO TO WHAT

EMERGENCY ROOM YOU GO TO.

AND IN TERMS OF THE RADIOLOGIST.

SO IN THE ROCKWOOD URGENT CARE

SYSTEM, WE DO TAKE THE RADIOLOGY

LOGICAL FILMS AND THEN A

RADIOLOGIST DOES THE

CONFIRMATION FILM, WHICH WOULD

BE THE SAME IN THE EMERGENCY

ROOMS, AND THAT RADIOLOGIST IS

PARTNERED WITH ROCKWOOD, AND SO

IF THE INSURANCE WORKED FOR

ROCKWOOD, YOU KNOW, WE'RE NOT --

WE DON'T ALWAYS KNOW THAT THE

RADIOLOGIST WILL BE THE

INSURANCE CARRIER.

SO WE DO CHECK ON THE INSURANCE

FOR THE EMERGENCY ROOM VISIT OR

THE URGENT CARE VISIT, BUT SOME

OF THE ANCILLARY SERVICES, IT'S

NOT ALWAYS 100% THAT WE KNOW ALL

OF YOUR PARTS AND PIECES TO THE

INSURANCE.

AND I THINK WHAT'S REALLY

CHALLENGING IS THERE'S SO MANY

DIVISIONS WITH THE DIFFERENT

INSURANCE COMPANIES AND SO THEY

WILL COVER THIS OR THEY WILL PAY

FOR THIS, BUT THEY WON'T PAY FOR

THAT.

AND THAT'S INSURANCE A.

AND INSURANCE B IS GOING TO DO

IT A LITTLE BIT DIFFERENT.

INSURANCE C DOES IT A LITTLE BIT

DIFFERENT.

AND SO ON OUR END, THAT IS HARD

SOMETIMES FOR OUR RECEPTION

STAFF AND FOR OUR MEDICAL STAFF.

SO WHAT WE DO, OUR PRIMARY

OBJECTIVE IS WE WANT TO GET YOU

IN.

WE WANT TO GET YOU TAKEN CARE OF

AND WE WANT TO GET THE

MEDICATIONS AND THINGS THAT YOU

NEED.

AND THEN THAT OTHER FINANCIAL

PART IS THAT BACK END.

SO FOR THE CALLER'S QUESTION,

IT'S GREAT TO LOOK THROUGH YOUR

BENEFIT PACKAGE AND FIGURE IT

OUT, WHICH HOSPITAL DO THEY WANT

YOU TO GO TO, WHICH EMERGENCY

ROOM DO THEY WANT YOU TO GO TO,

WHICH URGENT CARE DO THEY WANT

YOU TO GO TO AND THEN DO THEY

REALLY PLACE IT OUT SPECIFICALLY

ON WHICH LAB, WHICH RADIOLOGY?

AND THAT CAN HELP, BUT THAT'S

DATA THAT THE PATIENT NEEDS TO

COME IN WITH THEM FOR US.

>> AGAIN, GOOD INFORMATION TO

HAVE ALONG WITH THAT MEDICATION

LIST.

THESE ARE THINGS THAT YOU SHOULD

BE PREPARING BEFORE YOU HAVE THE

EMERGENCY AND BEFORE YOU BECOME

SICK.

>> YES, IT'S GREAT TO HAVE IN

YOUR WALLET OR YOUR PURSE.

>> THAT'S GREAT.

I WANT TO BRING IN ANOTHER PIECE

OF THE PUZZLE WHEN IT COMES TO

EMERGENCY CARE.

WE HAVE SEEN SPOKANE'S EMERGENCY

ROOMS AND URGENT CARE ARE READY

AT A MOMENT'S

NOTICE TO PROVIDE LIFE-SAVING

MEDICAL ASSISTANCE.

ONE KEY TO THAT SUCCESS IS

NORTHWEST MEDSTAR WHICH USES

HELICOPTERS TO TRANSPORT

PATIENTS.

WITH A SERVICE AREA THAT REACHES

INTO FOUR STATES, NORTHWEST

MEDSTAR COVERS A LOT OF GROUND

AND TRANSPORTS A LOT OF

PATIENTS.

>> HUNDREDS EVERY YEAR.

>> BUT DR. JAMES NANIA, MEDICAL

DIRECTOR FOR MEDSTAR, IS QUICK

TO POINT OUT, IT'S NOT ABOUT THE

NUMBERS.

IT'S ABOUT THE PEOPLE.

>> YOU JUST HAVE TO MEET ONE

PERSON THAT WASN'T GOING TO BE

THERE NEXT CHRISTMAS, WASN'T

GONNA MAKE THEIR BIRTHDAY,

WASN'T GONNA SEE THEIR FIRST KID

BORN, AND SEE THAT THEY ARE

ALIVE BY VIRTUE OF WHAT IS BEING

DONE HERE, AND THAT'S WHY I AM A

FAN.

IT IS MIRACLES.

>> THOSE MIRACLES HAPPEN HIGH IN

THE SKY AT SPEEDS OF 140 MILES

AN HOUR AND IN SOME PRETTY TIGHT

QUARTERS.

HERE EMS PERSONNEL HAVE ACCESS

TO TOOLS ONCE RESERVED FOR

HOSPITAL STAFF.

>> THE MONITORS ARE MUCH MORE

SOPHISTICATED.

MAYBE ONLY 20 YEARS AGO, YOU

COULDN'T DO AN EKG TO LOOK FOR

A HEART ATTACK TILL THEY GOT TO

THE HOSPITAL.

>> THE ADDED TECHNOLOGY AND

TRAINING MEAN DR. NANIA'S TEAM

CANNOT ONLY TREAT, BUT PREVENT

SOME COMMON KILLERS.

>> WE ARE ABLE NOW TO STOP

STROKES SOMETIMES.

WE ARE ABLE TO STOP HEART

ATTACKS SOMETIMES.

>> IT'S THAT COMBINATION OF

SPEED AND EXPERTISE THAT GIVE

PATIENTS A FIGHTING CHANCE.

PATIENTS LIKE MAXWELL MIELKE.

>> I WAS PLAYING A FOOTBALL GAME

AT LAKESIDE HIGH SCHOOL, RUNNING

THE FOOTBALL, AND I ENDED UP

GETTING HELMET-TO-HELMET CONTACT

AND ENDED UP GOING IN AND OUT OF

CONSCIOUSNESS, ENDED UP A HAVING

A FRACTURE OF THE SKULL AND

BLEEDING OF THE BRAIN.

>> MAXWELL WAS AIRLIFTED BY

NORTHWEST MEDSTAR.

THE MEDICAL TREATMENT HE

RECEIVED EN ROUTE AND AT THE

HOSPITAL MADE ALL THE

DIFFERENCE.

>> IT COULD HAVE BEEN SO MUCH

WORSE.

THANKS TO THEM, I'M PRETTY MUCH

A NORMAL HUMAN BEING.

>> MEDSTAR OPERATES FROM SIX

SITES IN EASTERN WASHINGTON AND

MONTANA.

READY TO GO 24/7.

AN INVESTMENT IN CRITICAL CARE

THAT IS PAYING OFF ONE CALL AT

TIME.

>> IT'S THE BEST.

>> AND DAN, TALK ABOUT THIS

MEDSTAR UNIT.

THESE ARE INCREDIBLE FLYING MINI

HOSPITALS IN ESSENCE.

>> YEAH, THEY ARE AMAZING.

THEY ARE FLYING I.C.U.s AND

THE STAFF THAT WORK ON THEM ARE

INCREDIBLE.

THEY ARE TAKING PATIENTS FROM

THE MIDDLE OF NOWHERE OUT ON THE

HIGHWAYS AND SCOOPING THEM UP

AND PROTECTING THEIR AIRWAY AND

GUARDING THEIR CERVICAL SPINE

AND STABILIZING THEM EN ROUTE TO

GET THEM IN A HOSPITAL SETTING.

IT'S AN AMAZING TECHNOLOGY AND

SOMETHING THAT'S ADVANCED THE

EMERGENCY MEDICINE OVER THE PAST

20 YEARS.

HISTORICALLY IF YOU WERE OUT IN

THE MIDDLE OF NOWHERE, YOU WOULD

GO TO A CRITICAL ACCESS HOSPITAL

THAT WOULD NOT BE EQUIPPED TO

DEAL WITH THE LEVEL OF INJURIES

YOU HAVE.

AND NOW WE CAN GET YOU TO A

TRAUMA CENTER AND FROM A TRAUMA

SURGEON AND EMERGENCY MEDICINE

SPECIALIST.

IT'S PRETTY AMAZING.

>> WE LIVE IN AN AREA WHERE YOU

ARE 20 MINUTES FROM BEING IN A

RURAL AREA.

WE HAVE LOTS OF SMALL TOWNS, AND

NOW THEY ALSO EVEN OFFER THAT

YEARLY PAYMENT SERVICE, WHICH WE

HAVE SEEN A LOT OF PEOPLE END UP

USING OTHERWISE THAT CAN BE A

PRETTY EXPENSIVE RIDE TO THE

HOSPITAL.

>> IT CAN BE.

>> ABSOLUTELY, BUT WELL WORTH IT

ALSO.

TALK ABOUT THE TECHNOLOGY THAT'S

INSIDE MEDSTAR.

>> SURE.

WELL, THE MOBILE I.C.U. UNITS

WHETHER THEY ARE GOING BY AIR OR

GROUND, THEY HAVE PRETTY MUCH

EVERYTHING YOU WOULD IN AN

I.C.U., THEY HAVE ADVANCED PUMPS

AND THINGS TO DELIVER LIFE

SAVING MEDICATIONS IF THEY NEED

IT.

THEY HAVE ADVANCED AIRWAY

SUPPLIES IF THEY NEED TO

INTUBATE YOU OR PROTECT YOUR

AIRWAY.

THEY HAVE PRETTY MUCH EVERYTHING

IN THE I.C.U., PRETTY NICE

AMOUNT OF MEDICATIONS IF YOUR

HEART NEEDS SOME MEDICATIONS.

>> ARE THESE PHYSICIANS ON

BOARD.

>> FOR THE MOST PART, NO, THEY

ARE NOT, THEY ARE R.N., FORMER

I.C.U. R.N.s THAT ARE TRAINED

FOR TRANSPORT.

THERE ARE SOME PLACES WHERE THEY

WILL HAVE PHYSICIANS ON E.M.S.

TEAMS BUT I DON'T BELIEVE

SPOKANE IS USING THAT.

>> PRETTY AMAZING THAT WE HAVE

THAT HERE AT OUR DISPOSAL,

AGAIN.

JUST KIND OF GOES TO WHAT

SPOKANE HAS TO OFFER IN MODE

SIN, AND -- MEDICINE AND, AGAIN,

TAKING YOU INSIDE THE EMERGENCY

ROOMS AND THE URGENT CARE

FACILITIES HERE ON "HEALTH

MATTERS" TONIGHT.

SHAUN, LET'S TALK ABOUT CPR.

THERE WAS JUST A STORY OUT OF

EVERETT, WHERE TWO TEENAGED

GIRLS JUST COMPLETED THEIR CPR

CLASS AT HIGH SCHOOL.

THEY WERE AT A RESTAURANT AND A

GENTLEMAN WAS HAVING AN

INCIDENT.

AND THOSE TWO GIRLS WHO HAD JUST

COMPLETED THAT CPR CLASS PULLED

HIM OUT OF HIS PICKUP AND

PERFORMED CPR AND MOST LIKELY

SAVED HIS LIFE.

PRETTY AMAZING STUFF.

BUT A LOT OF PEOPLE ARE STILL

HESITANT TO LEARN CPR OR TO USE

IT.

>> YES, ABSOLUTELY.

AND ONE OF THE THINGS THAT WE

ARE DOING AROUND THIS AREA IS

WORKING ON TEACHING WHAT'S

CALLED HANDS ONLY CPR WHICH

TAKES OUT THE MOUTH-TO-MOUTH

PIECE.

>> IS THAT WHY PEOPLE WERE

HESITANT?

>> I THINK THAT WAS THE BIGGEST

PROBLEM.

THEY WERE CONCERNED ABOUT

WHETHER IT WAS DISEASE

PREVENTION OR TRANSFER OF

DISEASES OR NOT KNOWING, MAYBE

NOT DOING IT CORRECTLY.

THERE'S A COUPLE OF DIFFERENT

AGENCIES AROUND HERE THAT DO DO

HANDS ONLY CPR CLASSES.

THERE'S A COUPLE OF GROUPS, I

KNOW, ONE OF THE DOCTORS FROM

PROVIDENCE DOES A GROUP FOR THE

HIGH SCHOOLS AND THE MEADS

SCHOOL DISTRICT AND DISTRICT 81,

WHERE THE SENIORS ARE GETTING

TAUGHT CPR, WHICH IS PRETTY

IMPRESSIVE.

WE ALWAYS GET THE PHONE CALLS OF

HOW YOUNG CAN I HAVE MY SON OR

DAUGHTER LEARN TO DO CPR.

WE ARE BASICALLY TELL PEOPLE IF

THEY ARE STRONG ENOUGH TO PUSH

ON SOMEONE'S CHEST, WE CAN TEACH

THEM HOW TO DO CPR.

WE DON'T HAVE TO TEACH THE

MOUTH-TO-MOUTH PIECE OR THE

PULSE CHECK PIECE.

IF THE PERSON DOESN'T LOOK LIKE

THEY HAVE SIGNS OF LIFE AND THEN

TEACHING THEM HOW TO DO CHEST

COMPRESSION.

ONE THE BIG NEW THINGS HERE IN

THE SPOKANE AREA IS THE PULSE

POINT APP.

IT'S AN APP THAT GOES ON YOUR

PHONE THAT NOTIFIES YOU AS A

PUBLIC SERVICE PERSON ANYBODY

CAN DOWNLOAD IT.

IT NOTIFIES OF YOU A CARDIAC

ARREST NEARBY IN A PUBLIC VENUE

AND RECENTLY HERE IN SPOKANE,

THEY DID HAVE THE FIRST

CONFIRMED SAVE -- THE APP IS

BASED OUT OF CALIFORNIA AND THE

FIRST CONFIRMED SAVE WAS HERE IN

SPOKANE, WASHINGTON.

THAT INDIVIDUAL WAS -- HIS STORY

WAS SENT ALL AROUND THE NATION,

AND TALKED ABOUT THAT STORY, BUT

ANYBODY CAN DOWNLOAD IT AND IT'S

JUST GETTING CPR BY BYSTANDERS

QUICKER.

ONE OF THE BIGGEST THINGS WE

DEAL WITH IN THE AMBULANCE THAT

WE CAN'T CONTROL IS THE AMOUNT

OF TIME IT TAKES US TO GET TO

THE RURAL AREA.

THE AMBULANCE COMPANY THAT I

WORK FOR, BEST CASE SCENARIO,

INSIDE TOWN, WE CAN BE THERE IN

10 TO 15 MINUTES.

WORST CASE SCENARIO WE COVER 720

SQUARE MILES AND SO IT COULD BE

45 MINUTES TO 50 MINUTES BEFORE

YOU GET AN AMBULANCE.

AND SO GETTING BYSTANDERS THERE

QUICKER THAT CAN DO CPR IS A

PRETTY IMPORTANT PIECE.

>> AND THE HANDS ONLY PIECE IS

JUST AS EFFECTIVE AS THE OLD CPR

THAT SOME OF US LEARNED MANY

YEARS AGO.

>> ABSOLUTELY.

THE AMERICAN HEART ASSOCIATION

SAYS THAT THE CIRCULATION IS THE

MOST IMPORTANT PART.

CIRCULATING THAT TO YOUR HEART

AND VITAL ORGANS.

>> SO HOW YOUNG CAN YOU BE TO

LEARN THIS TECHNIQUE.

>> WE HAVE SEEN KIDS AS YOUNG AS

11 OR 12 THAT CAN PUSH DOWN ON

THE CHEST AND WE ARE GLAD TO

TEACH THEM CPR AND GET THEM OUT

THERE.

IN THE UNIQUE CIRCUMSTANCES THEY

CAN DO IT EFFECTIVELY.

>> ARE YOU SEEING MORE FAMILY

MEMBERS THAT BRING IN PATIENTS

INTO THE EMERGENCY ROOM THAT

HAVE PERFORMED CPR AND SAVED

LIVES.

>> WE HAD A FEW.

THAT'S WHAT SAVED THEM.

>> THAT'S PRETTY EXCITING.

AND THE HANDS ONLY?

>> HANDS ONLY.

MM-HMM.

BECAUSE THEY WEREN'T ACTUALLY

TRAINED, THE FEW CASES THAT WE

HAD WHEN I WAS ON SHIFT.

>> I KNOW THERE USED TO BE A

FEAR THAT YOU COULD HURT

SOMEBODY WITH CPR.

>> WELL, PROBABLY A LITTLE BIT,

BUT FOR THE GOOD OF THEM.

>> FOR THE GOOD.

YEAH, YOU HAVE TO PRESS THEM

PRETTY HARD AND I THINK THE

BENEFIT ALSO OF TAKING THESE

TYPE OF CLASSES, THEY TRAIN YOU

ON THE USE OF THE AUTOMATED

EXTERNAL DEFIBRILLATORS AND THEY

SAVE LIVES AND TEACHING THE

PUBLIC HOW TO UTILIZE THOSE.

IT'S MAKING A HUGE IMPACT ON

PEOPLE THAT HAVE WITNESSED

CARDIAC ARREST.

>> AND I THINK THE THING FOR THE

PUBLIC TO REMEMBER AND THIS

MIGHT SOUND CRASS, BUT THEY ARE

DEAD.

SO YOU CAN'T HURT THEM.

YOU CAN ONLY SAVE THEM.

>> I HAVE NEVER HEARD IT QUITE

THAT WAY AND I THINK YOU MAKE AN

EXCELLENT POINT.

>> LET'S TAKE ANOTHER PHONE

CALL.

WE HAVE TINA FROM SPOKANE.

GOOD EVENING, TINA.

>> Caller: HI, THIS IS TINA.

I HAVE A COUPLE OF QUESTIONS

ABOUT EMERGENCY SERVICES HERE IN

SPOKANE.

>> SURE.

>> Caller: I HAVE BEEN AN R.N.

FOR 44 YEARS AND I HAVE WORKED

HERE AT A LOCAL E.R. AND ALSO AT

AN LOCAL AMBULATORY CARE OFFICE,

AND I HAVE CONCERNS ABOUT E.R.

ACCESSIBILITY.

I HAD A KNEE REPLACEMENT ABOUT

FOUR YEARS AGO, AND I HAD

ABSOLUTE EXCELLENT CARE.

THE FOLLOWING YEAR, MY HUSBAND

HAD SOME ISSUES THAT REQUIRED A

CAT SCAN AND THEY DISCOVERED

THAT HE HAD A TUMOR IN HIS

PANCREAS.

AND HE WAS TREATED ABSOLUTELY

WITH EXCELLENCE AT CANCER CARE

NORTHWEST WITH THE SCANS AND THE

WHIFFLE PROCEDURE BUT AFTERWARDS

HE WAS IN THE HOSPITAL FOR A

MONTH.

HE HAD MAJOR COMPLICATIONS.

HIS -- HIS ONCOLOGIST SURGEON

CALLED SACRED HEART AND SAID

THIS IS -- THIS GUY IS COMING

IN.

THIS IS WHAT'S GOING ON.

HE NEEDS TO BE SEEN.

AND WE LITERALLY SAT IN THE E.R.

FOR FIVE HOURS.

I WENT UP TO THEM AND ASKED IS

THERE A PLACE HE CAN ACTUALLY

LAY DOWN?

HE WAS PROPPED IN A CHAIR WITH

HIS FEET ON ANOTHER CHAIR,

BARELY ABLE TO DO ANYTHING.

AND HAVING E.R. EXPERIENCE IN

THE PAST, WHICH ISN'T THAT

UPDATED NOW, I WAS VERY, VERY

FRUSTRATED WITH THE WAY HE WAS

TREATED, THE LACK OF RESPONSE TO

GETTING HIM IN A ROOM, AND THE

FACT THAT THE ONCOLOGY PHYSICIAN

HAD CALLED IN AND SAID, THIS

NEEDS TO BE DEALT WITH.

AND I JUST DON'T FEEL WE WERE

ADEQUATELY ADDRESSED.

I THINK WE WERE PUT OFF, AND HE

WAS OUT IN THE WAITING AREA FOR

A MINIMUM OF FOUR TO FIVE HOURS

WITHOUT -- YOU KNOW, WITH ALL OF

THAT OTHER CONTAGIOUS STUFF

GOING ON.

>> ALL RIGHT.

THANK YOU, TINA.

WOULD ANYONE LIKE TO ADDRESS --

IT WAS OBVIOUSLY, SHE WAS VERY

FRUSTRATED BY THAT PROCESS.

>> SURE.

WE HATE TO HAVE PEOPLE WAIT.

AND, YOU KNOW, A COUPLE OF

THINGS THAT MAYBE WOULD HAVE

PREVENTED THAT WAIT IS THAT ON

KOHLISTS COULD HAVE ALWAYS --

ONCOLOGISTS COULD HAVE DIRECTLY

ADMITTED HIM TO THE HOSPITAL IF

THEY THOUGHT HE NEEDED TO BE

HOSPITALIZED.

MAYBE HE DIDN'T NEED TO GO TO

THE E.R. IN THE FIRST PLACE AND

JUST HAVE ONE OF THE MEDICAL

PHYSICIANS UPSTAIRS CARE FOR

HIM.

SECONDLY, WE DON'T KEEP PEOPLE

OUT THERE ON PURPOSE.

WE HAVE HIGH ACUITY.

WE HAVE TO DEAL WITH THE ILL

PEOPLE THAT WE HAVE.

FIVE HOURS IS AN EXTENSIVE WAIT

AND I HATE TO HEAR NUMBERS LIKE

THAT.

THAT'S BY NO MEANS THE NORM AND

THERE'S NO LOBBY THAT IS A

COMFORTABLE SETTING FOR SOMEBODY

THAT'S HURTING.

YOU KNOW, IT'S AN UNFORTUNATE

EXPERIENCE WHEN PEOPLE DO GO TO

THE EMERGENCY DEPARTMENTS.

DEPARTMENTS

THERE'S THE POTENTIAL THAT WE

WILL BE WAITING A FAIR AMOUNT OF

TIME IF THEY DON'T REQUIRE

AGGRESSIVE CARE IMMEDIATELY.

WE WILL TAKE CARE OF THOSE

PEOPLE AHEAD OF THEM THAT DO.

>> IS THERE ANYTHING SHE COULD

HAVE MAYBE DONE DIFFERENTLY IN

THAT SITUATION NOT KNOWING THE

FULL STOREY?

>> IT'S REALLY TOUGH, AND THAT'S

ONE THING AS AN EMERGENCY

DEPARTMENT WE ARE STRIVING TO

IMPROVE.

AND WHAT DAN SPEAKS OF WITH

REGARDS TO COMMUNICATING WITH

YOUR PHYSICIAN OR YOUR

ONCOLOGIST, OR SOMEONE TO

ADVOCATE ON YOUR BEHALF.

IT MAY SAVE YOU A TRIP INTO THE

EMERGENCY DEPARTMENT, NOT TO

TURN BUSINESS AWAY BUT AT THE

SAME TIME TO GET HIM THE CARE

THAT HE NEEDS MORE

EXPEDITIOUSLY.

IT MIGHT BE IN HIS BEST TO HAVE

YOUR PROVIDER SPEAK ON YOUR

BEHALF.

BUT OTHER THAN THAT, NO, I DON'T

THINK THERE'S ANYTHING HE OR SHE

COULD HAVE DONE DIFFERENTLY.

IT'S JUST THE WAY THAT THE

CURRENT SYSTEM WORKS WITH WHEN

YOU HAVE SOMEONE WHO YOU ARE

ACTIVELY RESUSCITATING IN THE

BACK OR AN AMBULANCE THAT, YOU

KNOW, YOU BROUGHT IN SOMEBODY

THAT YOU ARE RESUSCITATING THERE

AND YOU CAN'T PHYSICALLY GET OUT

TO THE SEE THE PATIENT OR GET

THEM BACK INTO A BED.

I THINK THAT'S WHY WE ARE

CONSTANTLY TRYING TO MAKE SMALL

IMPROVEMENTS EVERY DAY TO

EXPEDITE AND KIND OF PREVENT

THAT FROM HAPPENING THOSE

FIVE-HOUR WAITS.

>> THAT'S THE RATIONALE BEHIND

THE URGENT CARE OPENING.

WE ARE TRYING TO DRIVE THOSE WHO

DON'T REQUIRE EMERGENCY CARE TO

URGENT CARE.

PEOPLE WHO REQUIRE ADVANCED CARE

HAVE AN EASIER TIME GETTING

ACCESS TO THAT.

>> IT IS PRETTY AMAZING THE

LEVELS OF CARE WE HAVE STARTING

WITH THE FIRST RESPONDERS AND

THEN HAVING ACCESS NOW TO URGENT

CARE AND EMERGENCY ROOM OR YOUR

OWN PHYSICIANS.

SO WE REALLY DO HAVE THE

DIFFERENT LEVELS, SO TO SPEAK,

THAT YOU JUST NEED TO TARGET AND

SNOW WHAT'S BEST FOR YOUR

SITUATION OR HAVE THE DOCTORS

ASSESS THAT AND LET YOU KNOW

WHAT IS BEST FOR THAT SITUATION.

SO WE ARE FORTUNATE.

>> PROVIDENCE IS ROLLING OUT

TELEMEDICINE NOW TO THE AREA.

SO IF YOU HAVE PINK EYE OR IF

YOU HAVE A COUGH, YOU CAN TAKE A

PICTURE OF WHAT IS BOTHERING YOU

AND FOR $35, THEY WILL TAKE CARE

OF THAT VIA A TELECONSULT.

SO YOU DON'T HAVE TO LEAVE YOUR

OWN HOME.

I THINK WHAT YOU WILL SEE NOW

WITH COUGH, THE LANDSCAPE OF

MEDICINE IS REALLY SHIFTING

TOWARDS MORE ACCESSIBLE MEDICINE

THAT STILL HAS GOOD QUALITY BUT

FOR CHEAPER.

AND IF WE CAN KEEP PEOPLE IN

THEIR OWN HOME, THEY DON'T NEED

TO GET IN THEIR CAR AND DRIVE TO

AN URGENT CARE, THAT WILL SAVE

MONEY FOR THE SYSTEM AND THEY

SHOULD STILL HAVE PRETTY QUALITY

CARE.

>> HOW MUCH NETWORKING IS GOING

ON BETWEEN THE FACILITIES AND

THESE DIFFERENT LEVELS OF CARE?

ARE THERE -- ARE THERE WAYS YOU

GET TOGETHER AND PUT YOUR HEADS

TOGETHER TO TRY AND ADDRESS

THOSE CUSTOMER ISSUES?

>> I THINK QUITE A BIT.

I KNOW FOR US, WE MEET WITH THE

MANAGEMENT FOR OUR EMERGENCY

ROOMS AND OUR SYSTEM EVERY

QUARTER.

AND THEN WE HAVE THE PHYSICIANS

THAT COMMUNITY BACK AND FORTH.

WE ACTUALLY JUST MET WITH SOME

OF THE COMMUNITY BOARDSES WITH

IT, AND WANTING TO MAKE SURE

THAT WE DIDN'T JUST LOOK AT THE

EMERGENCY ROOM FOR DISASTER

PLANNING BUT LOOKED AT THE

URGENT CARES AS WELL.

WE ARE STARTING TO DO A LOT MORE

COMMUNITY AWARENESS, COMMUNITY

BENEFIT, COMMUNITY RELATIONSHIPS

TO MAKE SURE THAT WE ARE MEETING

THE NEED OF THE AREA.

SO BEING NEW IN TOWN, I FEEL

LIKE WE ARE DOING QUITE A BIT TO

START TO BUILD THOSE

RELATIONSHIPS AND COMMUNITY WITH

ALL -- COMMUNICATE WITH ALL THE

DIFFERENT ENTITIES.

IT STARTS WITH E.

M.S. AND THEN THEY GO TO THE

E.R. OR IT START STARTS WITH THE

URGENT CARE AND THEN E.M.S. TO

GET THEM TO THE HOSPITAL.

>> ALL THE PIECES HAVE TO FIT

TOGETHER.

>> WE CAN'T DO IT ALONE.

WE CAN'T DO IT IN A SILO.

FOR THE BEST PATIENT CARE AND TO

MAKE THE TIME SMALLER FOR HIKE

THE CALLER WHO HAD THE LONG

WAIT, WE ARE TRYING TO REALLY

STREAMLINE IT AND LIKE DAN SAID,

HAVE THE PATIENTS GO TO THE

RIGHT LEVEL OF CARE, TO GET IT

INTO FASTER.

>> MM-HMM AND ALSO BE PREPARED

IF WE WERE TO HAVE SOME SORT OF

LARGE-SCALE DISASTER.

I KNOW THERE'S A LOT OF

READINESS DRILLS THAT SPOKANE

DOES, ALONG WITH FIRE AND THE

FACILITIES THAT WE PROVIDE, AND

TO BE READY FOR A SITUATION

SHOULD SOMETHING COME UP.

>> MM-HMM.

HOW OFTEN DO YOU DO THOSE?

>> WITH THE EBOLA SCARE, WE HAD

THEM PRETTY REGULARLY.

YEAH.

THAT WAS PROBABLY THE MOST

RECENT WITH THE INFLUENZA SEASON

THAT WE HAD.

WE HAD SOME DRILLING THERE.

BUT DISASTER PREPAREDNESS

COURSES ARE PRETTY ROUTINE

THROUGH EMERGENCY DEPARTMENTS.

WE WORK CLOSELY WITH THE E.M.S.

COMMUNITY, ORGANIZING THOSE

DRILLS AS WELL, BECAUSE YOU ARE

KIND OF IT.

YOU HAVE SOMEONE THAT COMES IN

AND THEY HAVE BEEN EXPOSED TO A

CHEMICAL OR THEY HAVE AN

INFECTIOUS EXPOSURE, THAT'S

WHERE THEY ARE GOING THROUGH IS

THE EMERGENCY DEPARTMENT AND

TRYING TO MAKE SURE THAT

PEOPLE THAT THEY ARE NOT WALKING

THROUGH A WAITING ROOM FULL OF

FOLKS.

>> YOU HAVE TO BE READY FOR JUST

ABOUT ANYTHING.

>> DECONTAMINATION ROOMS AND A

SPECIAL WAY TO TRIAGE.

YES, WE DO THAT QUITE REGULARLY.

>> LET'S TAKE ANOTHER PHONE

CALL.

WE HAVE DAN.

GOOD EVENING, DAN.

>> Caller: GOOD EVENING.

THANK YOU FOR TAKING MY CALL.

>> WELL, THANK YOU FOR WAITING.

>> Caller: I HAVE A QUESTION

ABOUT THE CONSISTENT CARE

PROGRAM AND HOW THE EMERGENCY

ROOMS IN THE STATE OF WASHINGTON

JUST ABOUT ALL OF THEM, ARE

GOING TO THE CONSISTENT CARE

PROGRAM.

HOW DO THEY GET AWAY WITH THE

LIFETIME OF PROFILING THE SICK

AND THE DISABLED, A LIFETIME

SENSE THAT CAN NEVER BE REMOVED,

AND THAT DISCRIMINATES AGAINST

THE DISABLED THAT HAVE CHRONIC

PROBLEMS AND NEED THE EMERGENCY

ROOM ON A REGULAR BASIS.

I WANT TO KNOW WHAT YOUR

FEELINGS ARE ABOUT THAT AND HOW

I GO ABOUT GETTING MYSELF OFF

THE CONSISTENT CARE LIST.

>> I'M NOT FAMILIAR WITH THE

PROGRAM.

>> I CAN -- I'M VERY FAMILIAR

WITH IT.

SO THE CONSISTENT CARE PROGRAM,

WHEN WE LOOK AT THE AMOUNT OF

MONEY WE HAVE TO DELIVER

HEALTHCARE ACROSS THE COUNTRY,

IT'S NOT GETTING ANY BIGGER AND

WE HAVE MORE PATIENTS AND

EXPANDING WAX WE HAVE DONE IS WE

HAVE IDENTIFIED PEOPLE WHO ARE

FREQUENT UTILIZERS OF EMERGENCY

SERVICES, AND WHEN WE IDENTIFY

THOSE PEOPLE, WE GO THROUGH

THEIR VISITS, DO A CASE REVIEW

WITH TWO PHYSICIANS.

USUALLY THE PRIMARY CARE

PHYSICIAN OF THAT PATIENT AND

SEE IF THEY ARE APPROPRIATE USES

OF EMERGENCY DEPARTMENT.

THE AVERAGE BILL IS $1,200.

SO EVERY TIME, A $1,200 BILL IS

ENGENDERED.

IT'S NOT DESIGNED TO KEEP THOSE

PEOPLE OUT OF THE EMERGENCY

DEPARTMENT.

IF THEY HAVE AN ISSUE THAT WE

FEEL REQUIRES EMERGENCY ROOM.

THE CONSISTENT CARE HAS CREATED

A RESOURCE FOR PATIENTS THAT ARE

IDENTIFIED AS HIGH UTILIZERS TO

GET CARE THROUGH THEIR PRIMARY

CARE PHYSICIANS.

A LOT OF IT WAS DONE TO CRACK

DOWN ON NARCOTIC PRESCRIPTIONS

ACROSS THE STREET.

SPOKANE COUNTY HAS ONE OF THE

HIGHEST DEATH RATES SECONDARY TO

OVERDOSE FROM PRESCRIPTION

NARCOTICS ANYWHERE IN THE

COUNTRY.

AND SO WHAT WE FOUND IS THAT

PEOPLE WE ARE GOING TO E.R.s

TO OBTAIN THESE PRESCRIPTIONS,

SELLING THEM ON THE STREET, AND

THIS PROGRAM STARTED DARIN

NEVEN, WORKING WITH SOME PEOPLE

IN OLYMPIA AND GOT THIS PROGRAM

UP AND RUNNING.

WE IDENTIFIED PEOPLE WHO WERE

USING THE EMERGENCY DEPARTMENT

60 TIMES A YEAR.

DO THE MATH, 60 TIMES A YEAR AT

$1,200 FOR THE MINIMAL COST.

IT WASN'T FAIR TO THE SYSTEM.

WHEN WE GET THE CONSISTENT CARE,

WE GET THEM ENROLLED.

FOR THE GENTLEMAN'S QUESTION, I

FEEL TERRIBLE THAT HE FEELS LIKE

HE WAS DISCRIMINATED AGAINST BUT

WE WANT YOU TO HAVE ACCESS TO

THE CARE THAT YOU NEED THAT IS,

ONE, COST EFFECTIVE AND TWO,

VERY HIGH QUALITY CARE AND IF

YOU DO HAVE AN EMERGENT

COMPLAINT.

COME TO THE E.R.

IF WE FEEL IT DOESN'T FEEL LIKE

YOU REQUIRE EMERGENT CARE, WE

WILL GET YOU SEEN AT 8:00 IN THE

MORNING.

WE HAVE SOCIAL WORKERS THAT HELP

OUT WITH THESE FOLKS.

THAT'S A DRIFT OF MEDICINE IN

GENERAL AND WE HAVE SO MANY

DIFFERENT ISSUES THAT WE DEAL

WITH IN OUR COMMUNITY THAT

FUNNEL INTO THE EMERGENCY

DEPARTMENT BECAUSE IT'S THE ONLY

PLACE OPEN AT 3 A.M.

SO WE HAVE BEEN CREATING

ALLIANCES WITH THE COMMUNITY

DETOX AND MENTAL HEALTH

FACILITIES SO WE CAN EXPEDITE

PEOPLE WHO HAVE MENTAL HEALTH

CARE.

AND THAT'S THE GAME OF MEDICINE

UNFORTUNATELY AND THIS

GENTLEMEN'S ISSUE THAT WE ARE

TRYING TO BE CREATIVE IN HOW DO

WE PROVIDE HIGH QUALITY CARE

THAT IS MORE ON PAR WITH WHAT

THE REST OF THE WORLD IS

SPENDING.

>> CAN HE GET OFF THE LIST ONCE

HE'S BEEN PUT ON THE LIST?

>> YES, YOU CAN.

>> DO YOU ASK TO BE TAKEN OFF A

LIST?

HOW DOES THAT --

>> WHAT IS THE PROCEDURE?

>> IT TAKES ALMOST AS MUCH TIME

AND COMMUNICATION WITH THE

PHYSICIAN, AND THE HOSPITAL.

IT IS A VERY EXTENSIVE PROCESS.

IT INVOLVES CASE MANAGEMENT.

WE HAVE CASE MANAGERS AT OUR

HOSPITAL AS WELL AS I'M SURE

PROVIDENCE, THAT WORK ON THAT

WITH US, WITH ALL THE PATIENTS

THAT ARE ON THIS PROGRAM.

BECAUSE IT IS SO EXTENSIVE.

BECAUSE IT'S TAKEN VERY

SERIOUSLY.

IT'S SOMETHING THAT'S NOT TAKEN

LIGHTLY.

IT'S NOT SOMETHING THAT SOMEONE

COMES IN FIVE TIMES AND IT GETS

TURNED ON.

IT DOESN'T HAPPEN THAT EASILY.

YOU CAN GET OFF THE LIST.

IT JUST TAKES WORK.

IT TAKES A LITTLE EFFORT.

>> AND THE STATE TRACKS IT.

SO THERE'S A -- THE E.D., THE

EMERGENCY DEPARTMENT INFORMATION

EXCHANGE WILL TRACK VISITS

THROUGHOUT THE STATE.

SO WHEN I HAVE A PATIENT THAT

SHOWS UP, I GET A FAX FROM E.D.

THAT SAYS THIS PATIENT HAS BEEN

SEEN IN NINE DIFFERENT E.R.s

ACROSS THE STATE IN THE LAST

THREE MONTHS AND WHAT WE ARE

LINKING RIGHT NOW TO THESE E.D.

FAXES ARE ACCESS TO THE

WASHINGTON STATE PRESCRIPTION

MONITORING PROGRAM.

WE WILL KNOW IN A PATIENT HAS

BEEN PRESCRIBED NARCOTICS IN

OLYMPIA OR KENNEWICK, AND SO THE

CONSISTENT CARE PROGRAM, IT

SHOULDN'T HAVE A DEROGATORY

CONNOTATION.

IT'S A GOOD PROGRAM FOR PATIENTS

WOULD REQUIRE HIGHER LEVEL OR

MORE FREQUENT LEVELS OF CARE.

I DON'T KNOW IF THERE'S TRULY A

WAY TO GET OUT OF IT.

IT'S NOT DESIGNED TO

DISCRIMINATE.

IT'S TO CREATE AN EXTRA LEVEL OF

NETWORK FOR THAT PATIENT TO GET

CARE EXPEDITED.

IF THEY DON'T NEED IT AT 2 A.M.,

THEN WE WILL GET IT FOR THEM

LATER THAT DAY.

>> I THINK ONE OF THE THINGS WE

TALKED SO MUCH TODAY ABOUT THE

RIGHT CARE AT THE RIGHT

LOCATION.

AND THIS IS JUST BEFORE THAT.

SO THIS IS THE RIGHT CARE IN

PRIMARY CARE.

AND SO IF YOU HAVE PULMONARY

DISEASE OR HEART DISEASE OR

DIABETES, YOU KNOW, 9 -- THE

E.R. OR THE URGENT CARE, YOU

KNOW, THEIR PURPOSE IS FOR THOSE

LIFE THREATENING DISEASES OR

LIFE THREATENING ISSUES, AND WE

WANT YOUR CHRONIC ILLNESS, YOUR

ASTHMA, PULMONARY ISSUES, HEART

FAILURE, WE WANT THEM DONE IN

THE PRIMARY CARE FOR YOUR DOC

AND YOUR TEAM TO KNOW WHAT YOUR

MEDICINES ARE, WHAT DID WE DO

LAST.

IT DIDN'T WORK.

SO LET'S TRY THIS.

IF WE -- IF WE E.R. SHOP, THEN

WE DON'T HAVE THAT HISTORY.

AND SO THE BEST THING FOR THE

PATIENT IS TO HAVE THAT PRIMARY

CARE PROVIDER AND ACROSS THE

COUNTRY, THEY HAVE THE PATIENT

CENTERED MEDICAL HOME AND THE

IDEA IS THAT YOU HAVE A MEDICAL

HOME AND THEN YOU GO TO THE

RIGHT CARE AT THE RIGHT TIME FOR

THE RIGHT THING.

AND SO I THINK THAT'S A LITTLE

BIT OF WHAT WE ARE TALKING AND

THAT'S WHAT THAT PROGRAM DOES.

IT SAYS, THE RIGHT PLACE FOR THE

RIGHT CARE AT THE RIGHT TIME.

>> VERY WELL SAID.

LET'S TAKE ANOTHER PHONE CALL.

DON FROM CALGARY, GOOD EVENING,

DON.

>> Caller: GOOD EVENING.

THANK YOU FOR TAKING MY CALL.

I JUST HAVE A GENERAL QUESTION

FOR YOUR PANEL.

I WONDERED WHAT THEY THOUGHT OF

THE CONCEPT OF PATIENTS OF A

CERTAIN AGE GROUP GOING TO BABY

ASPIRIN IN THEIR POCKET AND IF

THEY HAVE CHEST PAIN TO TAKE IT.

IT MIGHT SAVE THEIR LIFE.

>> ALL RIGHT.

THANK YOU, DON.

>> ABSOLUTELY.

SO ONE OF THE THINGS THAT WE DO

HERE IN SPOKANE IS OUR 911

DISPATCHERS ARE TRAINED TO GIVE

SOME OVER-THE-PHONE INSTRUCTIONS

AND THAT'S ONE OF THE THINGS

THAT'S BEING DONE IS THE

POSSIBILITY OF ASKING THE RIGHT

QUESTIONS WHEN THE CALLER

REPORTS THAT SO AND SO IS HAVING

CHEST PAIN OR WHATEVER THEIR

COMPLAINT MIGHT BE.

WHAT THEY THEN DO IS ASK A

SERIES OF QUESTIONS AND THEN IF

THEY DO HAVE THAT ASPIRIN

AVAILABLE IN THEIR HOME, GIVING

THEM THE ASPIRIN.

THEY TEACH CPR GUIDELINES OVER

THE PHONE.

THERE'S WAYS OF, YOU KNOW IS

THERE EPINEPHRINE IN THE

HOUSE/DO THEY HAVE KNOWN

ALLERGIES?

SO OUR DISPATCHERS ARE

ADDRESSING THAT TO HOPEFULLY

PROVIDE FOR SOME BETTER CARE

BEFORE IT TAKES US TIME TO GET

THERE.

AND SO, I KNOW ONE OF THE THINGS

THE AMERICAN HEART ASSOCIATION

IS PUSHING IS FOR THE USE OF

ASPIRIN WHEN IT COMES TO

CARBACK.

CARDIACS.

YOU SEE THE COMMERCIALS AND THE

BEAR.

I THINK IT IS A GOOD TOOL, AS

LONG AS THERE'S DEFINITELY SOME

INSTANCES WHERE YOU WOULDN'T

WANT TO GIVE THAT ASPIRIN.

FOR THE MOST PART, I THINK IF

IT'S DEEMED UNDER THOSE

CIRCUMSTANCES THAT'S ABSOLUTELY

A GOOD IDEA.

>> THAT'S SO FASCINATING.

WHAT OTHER TYPES OF MAYBE BASIC

FIRST AID DO YOU ADVISE PEOPLE

TO KNOW ABOUT, SAY, AND WE ARE

COMING UP ON THE SUMMER MONTHS.

WE TALKED A LITTLE BIT ABOUT

THIS BEFORE THE SHOW STARTED

TONIGHT, BUT, FOR INSTANCE, HOW

DO I KNOW IF MY CHILD HAS A

FRACTURE?

AND YOU KNOW, SOME OF THOSE

THINGS, BEE STINGS ARE GOING TO

BECOME PROMINENT.

TICK BITES, THOSE SORTS OF

THINGS.

WHAT CAN WE ARM OURSELVES WITH

BEFORE WE MAKE THE PHONE CALL OR

WHILE WE ARE MAKING THE PHONE

CALL AND BEFORE EMERGENCY TEAMS

GET THERE?

>> I THINK THE BEST THING IS

MOST OF THOSE FIRST AID KITS

THAT YOU WOULD GET AT WALMART,

YOU KNOW, IT'S ONE OF THOSE YOU

GET WHAT YOU PAY FOR SO IF IT'S

A $5 OR $6 FIRST AID KIT, IT

WILL HAVE BAND-AID AND GAUZE.

THE MORE YOU SPEND ON THE FIRST

AID, YOU WILL GET SOME DIFFERENT

SPLINTS OR A BEE STING KIT AND

SOME OF THOSE THINGS.

ONE OF THE BIG THINGS WE PUSH

FOR IS JUST THE EDUCATION SIDE.

INHS TEACHES FIRST AID AND CPR

THAT COMBINES THE TWO CLASSES

AND TEACHES VERY, VERY BASIC

FIRST AID MANEUVERS WHETHER IT'S

USING A MAGAZINE TO SPLINT A

POSSIBLE BROKEN ARM OR LEG.

WE TALK ABOUT TOURNIQUET USE

THAT'S BIG IN EMERGENCY MEDICINE

WHEN IT COMES TO STOPPING

BLEEDING, ESPECIALLY IF YOU ARE

OUT IN THE RURAL AREA AND A

CHAIN SAW INCIDENT OR SOME SORT

OF LACERATION THAT CAUSES LIFE

THREATENING BLEEDING.

ONE OF THE THINGS WE ARE

TEACHING IS THE USE OF

TOURNIQUETS.

FIRST AID KITS THAT HAVE BEE

STING KITS AND THINGS ALONG

THOSE LINES ARE GOOD.

YOU KNOW, THE ONLY DOWNFALL IF

IT'S A KNOWN ALLERGY AND YOU

DON'T HAVE THAT EPINEPHRINE PEN,

YOU WON'T FIND AN EPI PEN INSIDE

ONE OF THOSE KITS.

THAT NEEDS TO BE PRESCRIBED TO

YOU FROM A FACILITY.

I THINK THE EDUCATION SIDE IS

THE BIGGEST PIECE OF GETTING OUT

THERE AND THEY ARE USUALLY

PRETTY LOW COST PROGRAMS THAT WE

TEACH IT IN THE AREA AND THEY

CAN COME TO US AND HELP WITH

THAT THINKING OUTSIDE THE BOX

WHEN IT COMES TO TREATING SOME

PRETTY SERIOUS INJURIES.

>> DO YOU ADVISE AT ALL GOING TO

THE INTERNET FOR ANY OF THAT?

ARE THERE ANY WEBSITES THAT CAN

HELP OR WOULD YOU RATHER SEE

THEM TAKE ONE OF THE CLASSES?

>> I DEFINITELY WOULD ALWAYS

RECOMMEND A CREDIBLE SOURCE.

THE INTERNET IS FILLED WITH

CREDIBLE SOURCES AND

NON-CREDIBLE SOURCES.

YOU KNOW, ONE OF THE THINGS WE

SEE ON THE AMBULANCE IS IF

SOMEONE LOOKS UP THEIR SYMPTOM

ON SOME SORT OF WEB-BASED

DIAGNOSTIC AND IT'S EITHER

CANCER OR RUNNY NOSE.

IT RANGES IN SEVERITY.

AMERICAN HEART ASSOCIATION IS

ALWAYS A GOOD TOOL.

THEY DO FIRST AID THINGS ALONG

THOSE LINES BUT I THINK

EDUCATION FROM A CREDIBLE

SOURCE, I THINK COULD DEFINITELY

BE RECOMMENDED.

>> OKAY.

VERY GOOD.

LET'S TAKE ANOTHER PHONE CALL.

DIANE, GOOD EVENING.

>> Caller: HELLO.

>> HELLO.

DO YOU HAVE A QUESTION FOR OUR

PANEL?

>> Caller: YES, I DO.

AND THANK YOU ALL SO MUCH FOR

SPENDING THE TIME WITH US.

I WAS WONDERING HISTORICALLY

EMERGENCY ROOMS HAVE BEEN USED

FOR THE HOMELESS PEOPLE AS THEIR

FIRST BASE OF CARE, AND THE

UNDER EMPLOYED WHERE THEY DON'T

HAVE ANY INSURANCE, AND THIS IS

THE FIRST PLACE THEY COME TO IS

THE EMERGENCY ROOM.

IS THAT SEEING ANY KIND OF

LESSENING EFFECT NOW THAT WE

HAVE THE A.C.A. AND MORE PEOPLE

HOPEFULLY BEING INSURED?

HOW IS THAT GOING AS FAR AS THE

EMERGENCY ROOMS?

>> THAT'S AN INTERESTING POINT.

>> I WOULD SAY, YES.

I THINK WE ARE STARTING TO SEE

SOME IMPROVEMENTS WITH REGARDS

TO PEOPLE HAVING COVERAGE.

WE ALSO HAVE MORE PROGRAMS

WITHIN OUR HOSPITAL TO GET

PEOPLE ENROLLED IN COVERAGE AND

I'M SURE PROVIDENCE DOES AND SO

DOES ROCKWOOD.

IT REALLY HELPS THE PATIENT GET

ON TO A PROGRAM, AND I THINK WE

HAVE SEEN AN INCREASE IN COVERED

FOLKS THAT COME IN THROUGH THE

DOOR, BUT ALSO THOSE THAT

AREN'T, THEY ARE GETTING ACCESS

TO CARE.

AND ACCESS TO COVERAGE FOR THE

CARE THAT THEY HAVE BEEN GIVEN.

SO I THINK THERE HAS BEEN A

POSITIVE.

>> MM-HMM.

>> IT'S GOING TO BE AN UPHILL

BATTLE.

>> I MEAN, THE APPLE CARE IS

GREAT AND WE HAVE AN EXPANDED

INSURED PATIENT POPULATION.

THE PROBLEM THAT WE HAVE IS

THERE'S A LARGE LACK OF PRIMARY

CARE PROVIDERS IN THE AREA.

THAT'S ONE OF THE BIG PUSHES TO

HAVE THESE MEDICAL SCHOOLS OPEN

IN SPOKANE AND HEAVILY RECRUIT

PRIMARY CARE DOCTORS.

IF YOU ARE UNDER INSURED OR

UNINSURED THE EMERGENCY

DEPARTMENT IS REALLY YOUR ONLY

OPTION.

IT'S AN EXPENSIVE OPTION.

SO JUST LIKE ROCKWOOD IS DOING,

PROVIDENCE HAS BEEN VERY

AGGRESSIVE AT FINDING EXPANDED

WAYS OF KEEPING PEOPLE IN OUR

COMMUNITY IN THE RIGHT DIRECTION

FOR PRIMARY CARE AND HOPEFULLY

IT GETS BETTER AS WE GET MORE

PRIMARY CARE PHYSICIANS IN THE

AREA.

THE LAST STATISTIC, THERE'S A

SHORTAGE OF 35,000 PRIMARY CARE

PHYSICIANS ACROSS THE UNITED

STATES, AND IF YOU LOOK AT HOW

LONG IT TAKES TO MAKE A PRIMARY

CARE DOCTOR, IT'S GOING TO BE A

WHILE TO FILL THAT.

I THINK THAT'S WHY NURSE

PRACTITIONERS AND PHYSICIAN

ASSISTANTS EXTEND THAT AND YOU

CAN HAVE THEM RUNNING THEIR OWN

CLINIC AND PROVIDING GOOD

PRIMARY CARE AND FILLING THAT

GAP.

>> OKAY.

WE HAVE ANOTHER PHONE CALL

COMING IN FROM RON HERE IN

SPOKANE.

GOOD EVENING, RON.

>> Caller: GOOD EVENING.

I WANTED TO CALL IN AND SAY THAT

DR. GOETZ WOULD NOT REMEMBER ME,

BUT I REMEMBER HIM.

I WAS OPERATED ON IN PHOENIX IN

EARLY FEBRUARY, AND I GOT HOME

HERE, AND WHAT HAD A HAPPENED

WAS THEY HAD TO DRILL A HOLE IN

MY SKULL, THE SIZE OF A 50-CENT

PIECE.

>> I REMEMBER YOU!

>> AND IT GOT QUITE INFECTED.

>> OH, BOY.

>> IT WAS REALLY QUITE A

PROBLEM.

I FOUND OUT LATER, IT WAS SPINAL

FLUID COMING OUT OF THE HOLE

AND, YOU GOT ME IN AND

DR. CARLSON DID A GREAT JOB.

HAD TO TAKE ALL THE HARDWARE OUT

OF MY HEAD, BUT I'M DOING GREAT.

>> THAT'S WONDERFUL TO HEAR.

>> RON, THANK YOU SO MUCH FOR

YOUR CALL.

THAT'S VERY NICE OF YOU TO CALL

IN AND I'M SURE THAT TOUCHED

DR. GETZ TONIGHT ALSO.

THANK YOU.

AND WE'RE GLAD THAT YOU ARE

DOING BETTER.

>> SAY HI TO YOUR WIFE.

>> YOU PROBABLY GET THAT QUITE

OFTEN.

>> THAT'S WHY WE DO THIS.

IT'S PHENOMENALLY REWARDING.

I GET COOKIES BAKED, YOU KNOW,

DROPPED OFF AND I DO EAT THEM.

IT'S A GOOD IDEA.

AND LOTS OF THANK YOU CARDS AND

THAT'S THE REWARDING PART.

HEY, YOU DID MAKE A BIG

IFFERENCE AND I THINK PEP PEOPLE

HISTORICALLY THINK THAT

EMERGENCY PEOPLE DON'T DO

ANYTHING.

BUT FOR THE SMALL GROUP, WE DO A

LOT.

>> IT'S A SPECIAL TYPE OF BREED.

IT'S A SPECIAL TYPE OF DOCTOR TO

DO WHAT YOU DO AND SEE THE

PATIENTS THAT ALL OF YOU SEE ON

A DAILY BASIS.

YOU KNOW, WHY DID YOU CHOOSE

EMERGENCY MEDICINE?

>> WELL, I THINK IT WAS A MIX I

LOVE THE PACE OF IT, AND I LIKE

THAT SENSE OF NEVER KNOWING WHAT

COMES THROUGH THE DOOR.

I THINK THAT'S -- WE TEND TO BE

A LITTLE BIT FRENETIC IN OUR

PACE WHEN WE APPROACH THINGS.

I COME IN FOR A 9 OR 10 HOUR

SHIFT AND I BLINK AND IT'S OVER.

I MIGHT HAVE HAD A CUP OF

COFFEE, AND NO LUNCH AND USED

THE BATHROOM ONCE BUT IT'S

WONDERFUL.

WE USE SCRIBES IN OUR EMERGENCY

DEPARTMENT WOULD ACTUALLY DO ALL

OF THE NOTE TAKING.

I DON'T HAVE TO CARRY A PEN IN

ANY LONGER.

AND THESE ARE ALL GIFTED COLLEGE

STUDENTS AND THE FIRST EMERGENCY

SHIFT THEY WORK.

AND THEIR FEET WORK AND THEY ARE

HUNGRY.

AND WHEN THEY SEE WHAT COMES

THROUGH THE DOORS AND THEY SAY I

WANT TO BE AN EMERGENCY ROOM

DOCTOR.

I HAVE BEEN DOING IT ALMOST TEN

YEARS, POST RESIDENCY AND EVERY

DAY I GO TO WORK, I ENJOY DOING

IT.

>> I BET THE SAME CAN BE FED FOR

ALL OF YOU -- STEAD FOR ALL OF.

>> YOU I THINK EMERGENCY

MEDICINE CHOSE IN A SENSE WHEN I

ROTATED THROUGH THE DEPARTMENT.

SOMETHING SPOKE TO ME.

IT'S NEVER A DULL MOMENT AND

IT'S GRATIFYING AT THE END OF

THE DAY.

YOU FEEL LIKE YOU HAVE DONE A

GOOD JOB FOR YOUR COMMUNITY AND

LIKE PEOPLE CALLING IN AND, YOU

KNOW, LETTING YOU KNOW OR SEEING

THAT PERSON IN THE GROCERY STORE

WOULD WASN'T ABLE TO WALK TWO

MONTHS EARLIER WHO IS NOW UP AND

AROUND BUYING THEIR APPLES.

>> OR MAYBE RECOGNIZES YOU OR --

>> OR VICE VERSA.

>> YOU SEE A LOT OF PATIENTS.

>> YOU MIGHT RECOGNIZE THEM.

THERE ARE A LOT OF REWARDS.

>> EVEN FOR ME, I DO MOSTLY

ADMINISTRATION, BUT I STAY

CLINICAL AS A NURSE PRACTITIONER

IN THE URGENT CARES BECAUSE YOU

CAN'T STEP AWAY FROM THAT

PATIENT ALL THE TIME.

YOU STILL NEED THAT PATIENT

FOCUS AND THAT PATIENT CARE AND

IT KEEPS YOU KIND OF CENTERED

AND GROUNDED.

SO ABSOLUTELY.

>> AND SHAUN, WHAT DO YOU SAY TO

THOSE MAYBE TEENAGERS THAT ARE

CONSIDERING E.M.S., BECOMING

ANE.M.T.

WHAT DO YOU TELL THEM ABOUT YOUR

PATIENT FOR THIS SIDE OF

MEDICINE.

>> MY DEFINITE SIDE IS THE

PEOPLE.

I LOVE INTERACING WITH THE

PEOPLE.

IT'S LIKE -- DR. GETZ SAID, IT'S

NEVER THE SAME TWO DAYS IN A

ROW.

YOU CAN SEE THE SAME PATIENT TWO

DAYS IN A ROW AND IT WILL BE

DIFFERENT.

IT'S BY FAR THE MOST REWARDING

JOB I EVER HAD.

IT DEFINITELY DOES SOMETHING TO

YOU.

THERE'S DEFINITELY THE LOSSES

THAT AFFECT YOU IN A CERTAIN

WAY, BUT WE SEE A LOT KIND OF

LIKE DR. GETZ WAS SAYING WHERE

WE SEE TRANSPORT A PATIENT AND

WE DON'T GET A LOT OF AFTER NEWS

ABOUT THEM.

WE DROP THEM OFF AT A HOSPITAL

AND WE PASS THE CARE OFF TO THEM

BUT WE DON'T HEAR HOW THEY DO

T IS A PRETTY AS MANYING AMAZING

WHERE THEY STOP BACK BY AND THEY

BRING COOKIES AN DOUGHNUTS AND

CAKES AND PIES AND ALL KINDS OF

THINGS AND THANK YOU CARDS.

WE HAVE A WALL UP IN DEER PARK

WITH ALL THE THANK YOU CARDS AND

THAT'S BY FAR THE MOST

REWARDING.

THAT BEATS ANYTHING ABOUT THIS

JOB.

AND THAT'S MY DRIVE TOWARDS IT

AND I THINK THAT'S WHAT WE TRY

TO PASS ON TO OTHER PEOPLE, ALL

THE STUDENTS WHO GO THROUGH OUR

PROGRAM.

THERE'S DAYS WHERE YOU ARE WOKEN

UP, YOU ARE TRYING TO SLEEP OR

TRYING TO HAVE DINNER AND IT

PAYS OFF AT THE END OF IT.

>> I'M HEARING TOO, WE ARE DOWN

TO JUST A FEW MINUTES LEFT IN

THE SHOW.

BUT I'M HEARING A LOT OF WITH

THE APPS THAT YOU TALKED ABOUT,

SHAUN, AND THE TECHNOLOGY THAT'S

COMING INTO PLACE WITH PEOPLE

BEING ABLE TO SEND PICTURES AND

PHOTOS IN AND DO THAT THROUGH

THE COMPUTER, WHAT'S ON THE

HORIZON FOR EMERGENCY MEDICINE?

WHAT ARE WE LOOKING AT?

BECAUSE IT'S EVER CHANGING.

ALWAYS SOMETHING DIFFERENT.

WHAT ARE WE GOING TO SEE IN THE

NEAR FUTURE WHEN IT COMES TO

EMERGENCY MEDICINE.

>> I THINK YOU TOUCHED ON IT

WITH THE TELEMEDICINE.

THAT'S THE TALK AS OF LATE WITH

REGARDS TO KIND OF NEXT LEVEL OF

PATIENT CARE WITHOUT HAVING TO

ACTUALLY LEAVE YOUR HOME.

>> MM-HMM.

FOR SOME OF THOSE THINGS THAT

CAN BE MANAGED THAT WAY.

I THINK THAT'S DEFINITELY ON THE

HORIZON.

>> I THINK CONSOLIDATED CARE

NETWORKS IS GOING TO BE THE BIG

THING.

I THINK THE DAYS OF HAVING THE

PRIMARY CARE DOCTOR WITH THE

SHOP ON THE CORNER.

WE ARE LOOKING AT WAYS TO

DELIVER CENTRALIZED CARE TO MAKE

IT EASY FOR PATIENTS AND AVOID

EXCESS VISITS THAT WERE NOT

REQUIRED.

PROVIDENCE HAS BEEN VERY

AGGRESSIVE WITH THAT IN TRYING

TO FIND WAYS TO DELIVER,

CONSOLIDATED CARE TO CUT DOWN ON

OVER TREATMENT OR OVER

UTILIZATION OF RESOURCES THAT

AREN'T NEEDED AND I THINK THAT'S

WHY WE HAVE MOVED TOWARDS

ELECTRONIC MEDICATION RECORDS

AND THAT I CAN PULL UP THE

MEDICAL RECORD OF A PROVIDENCE

PATIENT WHO WAS SEEN BY THEIR

PRIMARY CARE PATIENT TWO DAYS

AGO.

AND I'M NOT FLYING BLIND.

I'M NOT ORDERING A $1,200 TEST

THAT WAS ORDERED TWO DAYS AGO.

I THINK CONSOLIDATED CARE IS

PART OF THE FUTURE.

>> IT WAS A WONDERFUL

DISCUSSION.

THANK YOU SO MUCH FOR SHARING

YOUR THOUGHTS AND YOUR WISDOM

AND KNOWLEDGE WITH US THIS

EVENING.

THAT WILL DO IT FOR "HEALTH

MATTERS."

I THANK EVERYONE WHO CALLED IN

WITH A YES.

-- WITH A QUESTION.

WE HOPE YOU'LL JOIN US ON MAY

21ST WHEN OUR TOPIC WILL BE

RURAL MEDICINE.

UNTIL THEN, THANKS, FOR

WATCHING.

I'M TERESA LUKENS.

GOOD NIGHT.

CLOSED CAPTION PRODUCTIONS
ccproductions.com
602-456-0977

>> "HEALTH MATTERS" IS MADE

POSSIBLE BY VIEWERS LIKE YOU,

THE FRIENDS OF KSPS.

AND BY THE FOLLOWING:

>> I REALLY LIKED THE IDEA OF

BEING PART OF PROVIDENCE, WHERE

IF I HAVE A QUESTION, IF THERE'S

SOMETHING THAT I'M CONCERNED

ABOUT, I CAN ALWAYS CALL A

SPECIALIST.

I'M DR. ANNA BARBER, AND I CHOSE

PROVIDENCE BECAUSE HERE, I CAN

HELP CHILDREN THRIVE AND REACH

THEIR HIGHEST POTENTIAL.

>> IF YOU READ PROVIDENCE'S

MISSION STATEMENT, IT'S ALL

ABOUT DELIVERING QUALITY CARE TO

THE PATIENT AT ALL TIMES.

I'M DR. PETER RONALDI, AND I

CHOSE PROVIDENCE BECAUSE THEY

PUT THE DOCTOR-PATIENT

RELATIONSHIP FIRST.

>> FIND YOUR DOCTOR ONLINE AT

PHC.ORG.