♪
>> 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.