Chief Gilman Clarifies Change In Protocol In Transport to Lakewood's Freestanding ER

[Brian Essi]

Below is LFD Protocol of transport to freestanding ER’s
Transport to Free Standing E.D.

General Considerations:

1. Trauma patients shall be triaged following the NOTS Trauma Triage Protocol. Those patients with minor single extremity injuries (excluding Femur fractures) that are not likely to require operative care or admission may be transported. Otherwise, trauma patients should NOT be transported to these facilities. Patients with Femur fractures shall be transported to Metro.

2. General medical patients can be transported per the judgment of the paramedics. However, the
following patients should not be transported to a free standing ED:

a. Patients who are unstable or have unstable vital signs (unless it is necessary to transport for
stabilization of patient, i.e. the delay in transferring to a hospital based ED would negatively
impact patient care).

b. Patients with unstable chest pain either secondary to EKG changes (STEMI), or clinical
appearance. All patients with chest pain that are transported must have an EKG transmitted
ahead to ensure non-transport of STEMI patients to free standing ED.

c. Any patient requiring immediate surgical intervention (acute abdomen, signs of aortic
catastrophe, etc.).

d. Any patient with respiratory distress that may require emergency airway interventions (severe
COPD, CHF such that they require CPAP or intubation) - * again, unless it is necessary to
transport for stabilization of the patient.

e. Any patient requiring 2 or more IV medications.

f. Any patient who is more than 20 weeks pregnant.

3. Medical Control should be contacted for a decision on any case where the paramedic needs
clarification or requests advice.
Specific Incidents
Free Standing ER In Patient Facility
Abdominal pain (no fever or signs of bleeding) Burns
Airway Obstruction Cardiac Symptoms
Allergic reaction Chest Pain
Altered Level of Consciousness Cough with Blood
Anxiety Dyspnea - SOB
Apnea GI Bleed
Asthma Symptoms Hemorrhage (Severe)
Back Pain (No Trauma) Hyperthermia
Behavioral Disorders Hypothermia
CVA/Stroke Monitoring Required
Carbon Monoxide Poisoning Newborn
Cardiac Arrest OB/Gun complications
Dehydration symptoms Post Op Complications
Depression Pulmonary Edema
Diabetic Symptoms Respiratory Failure
Dizziness Shock
Elevated temperature/Fever Trauma Injury
Eye Symptoms (No Trauma) Vomiting Blood
Flu Symptoms
GI Constipation
GI Diarrhea
Headache (No Trauma)
Hyperventilation
Medical Reaction
Migraine
Nausea
Nose Bleed
OB/GYN less than 20 weeks
Poisoning
Pneumonia Symptoms
Psychiatric Emergencies
Respiratory Arrest
Seizure (No trauma)
Sore Throat
Syncope Fainting
Unconscious (Consult with Med Control)
Urinary Bleeding
Urination Problem
Vomiting
Weakness

Chief Gilman,

Thank you for your response from an earlier post setting forth LFD's protocol (above) for transporting to a freestanding ER.

I have taken the liberty of cutting and pasting just the protocol in this post in the hopes that folks on both sides of the issue can continue a completely fact based discussion concern just the existing ER and new ER how things are different since 12/21/2015.

My points in this post are twofold:

1. To make sure the public understands what is different for their own health and safety--which might help the LFD
2. To circumscribe the ongoing debate away from the misinformed on both sides.

Please check me if I have misinterpreted the practical effect of the protocol in relation to the existing and planned ER, but things are clearly different from the way they were before.

1. The subset of the serious medical matters (listed above) for which LFD will not take patients to the existing or new Lakewood ER is significant in terms of saving the lives of those patients in this category.
2. At the same time, statistically, the total number of patients in that category will be in the hundreds each year but is a relatively small subset of the total number of patients LFD will transport in any given year.

Can you clarify by giving a couple of practical examples of patient scenarios in which LFD would transport to the Lakewood ER for stabilization, i.e. where the
"unless it is necessary to transport for stabilization of patient, i.e. the delay in transferring to a hospital based ED would negatively
impact patient care."? Implied in that language is that there is a subset of scenarios in which "delay in transferring" affects patient outcomes.

Thanks again for engaging with us on the Deck.

[Lori Allen _]

Do any of you REALLY believe what the city tells you? I sincerely hope not!

[tom monahan]

Brian:

I believe that you know Cleveland's EMS squads cannot use the new ER (and the present ER) because there is no hospital attached to it. That means, according to Cleveland EMS folks that the 2,500 or so annual squad runs that used to come to Lakewood's ER must go to other hospitals, probably Fairview and that means more overloading at that facility.

The list is pretty scary, if you think about it. It means more of us will be transported to other hospitals. I am told that more and more folks are transferring out of the Clinic system in favor of Metro, St. John's, St.Vincent Charity. I am not sure how the squad runs for EMS breaks down so far because it is early on.

And speaking of the so-called ER to be built inside the Medical Office Building across from the present hospital will eat up about 25% of the space. And despite the Clinic claims, there will be no specialists there after hours and on weekends.

Also, there is no guarantee that Clinic won't shut that part of the MOB (Medical Office Building) down when it starts losing money. Kevin Butler and Mike Summers and the other council folks need to show the residents of this city where that guarantee is the so-called Master Agreement.

These people just shilled for the Clinic and gave away our great hospital for pennies on the dollar.The myth-makers at the East Side campus also wont tell you that Lakewood Hospital got A =-ratings in Safety. while the East Side Main campus received a C rating in 2015.
They also won't tell you that there is no downtown campus. I know, because I drove around for hours looking for it. The only hospital I could find downtown was St. Vincent Charity Hospital, which just celebrated its 150th anniversary in providing care to all people.

[Lori Allen _]

Does anyone know if the SLH attorney's have asked for an emergency stay order yet? I heard the bulldozers are coming in this April. As the deal continues, there won't be much left to fight for.

[james fitzgibbons]

Does anyone know if the SLH attorney's have asked for an emergency stay order yet? I heard the bulldozers are coming in this April. As the deal continues, there won't be much left to fight for.

What about the Emergency Room?

[Lori Allen _]

If a stay is requested and granted, I don't believe this would bring back a full-service emergency room. I imagine we will still be stuck with the urgi-care we have now.

[cameron karslake]

Lori Allen wrote:
"Does anyone know if the SLH attorney's have asked for an emergency stay order yet? I heard the bulldozers are coming in this April. As the deal continues, there won't be much left to fight for."

From what I understand, no demolition on the hospital campus can begin until the FHC with 24/7/365 "ER" is built and up and running (June 2018). The bulldozers you mention may be for the MOB and parking garage, and their subsequent demolitions this spring/summer.

But what I really want to know is with all the ailments that the new "state-of-the-art" etc. "ER" cannot treat, what ailments can it handle? A definitive list should be distributed to every home in the city (water bill anyone?) to let people know how to proceed in an emergency. It's the right thing to do, but will the city, the LFD, or the Clinic step up to the plate and submit a list?

[Jim O'Bryan]

But what I really want to know is with all the ailments that the new "state-of-the-art" etc. "ER" cannot treat, what ailments can it handle? A definitive list should be distributed to every home in the city (water bill anyone?) to let people know how to proceed in an emergency. It's the right thing to do, but will the city, the LFD, or the Clinic step up to the plate and submit a list?

Cameron

To state the obvious. In case of an emergency dial 911. Calmly let them know what is going on with health, fire, crime, whatever.

Let the professionals decide.

I have driven myself to a hospital, checked my self in to the hospital emergency room, waited, as there was no blood, and nearly died.

I have called an ambulance, and from the moment the paramedics had me hooked up I felt safer, quicker. By the time they got me to the hospital, in this case it was Metro.

The doctors had my charts, knew my ailments, my thoughts and the thoughts of professionals, in much less time than walking in.

One of the reasons we were so high on stopping side effects from strokes, is our paramedics and ambulances, that have received special training.

As long as we are discussion 911, you think there has been a crime, call 911, getting threats, call 911, see something suspicious, call 911.

The professionals will decide how important it is, and proceed.

Our safety forces are some of the best in the county.

All of it is part of the "Westtown" regionalism of our safety forces.


This morning Lakewood was backing up Rocky River, as they do for us in all safety matters.



FWIW

.

[scott gilman]

When the list was cut and pasted it ran together hopefully this is clear. Patients from both columns can be transported to the Lakewood ER. Patients from the right column will need to be transported out. It is the goal of LFD to make sure that the patients are transported to the correct facility the first time. Of the illness/injuries listed in the In Patient Column 8 of this have not been transported to Lakewood for a year or more.

Free Standing ER In Patient Facility
Abdominal pain (no fever or signs of bleeding) Burns
Airway Obstruction Cardiac Symptoms
Allergic reaction Chest Pain
Altered Level of Consciousness Cough with Blood
Anxiety Dyspnea - SOB
Apnea GI Bleed
Asthma Symptoms Hemorrhage (Severe)
Back Pain (No Trauma) Hyperthermia
Behavioral Disorders Hypothermia
CVA/Stroke Monitoring Required
Carbon Monoxide Poisoning Newborn
Cardiac Arrest OB/Gyn complications
Dehydration symptoms Post Op Complications
Depression Pulmonary Edema
Diabetic Symptoms Respiratory Failure
Dizziness Shock
Elevated temperature/Fever Trauma Injury
Eye Symptoms (No Trauma) Vomiting Blood
Flu Symptoms
GI Constipation
GI Diarrhea
Headache (No Trauma)
Hyperventilation
Medical Reaction
Migraine
Nausea
Nose Bleed
OB/GYN less than 20 weeks
Poisoning
Pneumonia Symptoms
Psychiatric Emergencies
Respiratory Arrest
Seizure (No trauma)
Sore Throat
Syncope Fainting
Unconscious (Consult with Med Control)
Urinary Bleeding
Urination Problem
Vomiting
Weakness

Mr. Monahan is correct in that Cleveland EMS will not transport to a free standing ER. This was also true of all of the Westshore Fire Department operating under WESHARE protocols and when the CCH and UH opened the free standing ER's the protocols changed and those departments began transporting to those emergency rooms. Cuyahoga County will see 2 more free standing ER's opening in the coming month so the model of the free standing ER is going to be an option to more communities.

To Mr. Essi we could transport patients to the freestanding Er fro both subsets. In my discussions with the Medical Directors we feel it is best to get them to the hospital that best suits the needs of the patient. This has always been the case. The Lakewood ER will be capable of handling the majority of the patients LFD encounters, Keep in mind that 1160 or 21.7% of the 5354 patients LFD encountered in 2015 were not transported to any hospital. As to your question regarding when might LFD stop at the Lakewood ER and then transport to another facility the scenario that comes to mind is a patient where we cant secure the patients airway or a complicated child birth where delivery is not going to wait to get to Fairview. As for the "delaying in transferring" negatively impacting patient outcomes in the freestanding ER, the staff knows that the patient will need an in patient bed and the transfer is made by critical care ambulance. We have already encountered such an event and the patient outcome was positive.

[Lori Allen _]

As I said on a previous thread. None of this really matters. If someone walks into the new Lakewood Urgi-care with a severed limb, an aortic or abdominal aneurysm, a blood clot that has broken lose, unknown poisoning, etc., I do not think in most cases they will make it to a real hospital. Why does Lakewood with 51,000 residents, many elderly not need an emergency room, but, Avon with 20,000 residents does? Why are the people of Avon more important than the people of Lakewood? Why doesn't Mr. Summers come on the Deck and tell us why he gave OUR hospital to CCF instead of doing it LEGALLY which is an OPEN bidding process? Lakewood Hospital was good enough for Summers when he needed it. I believe the crime is called aiding and abetting when someone goes along with something that they know is untrue and illegal. An accomplice to the crime.