The Observation Deck

Brian Essi wrote:

james fitzgibbons wrote:

Brian Essi wrote:The building in which the emergency room of Belle Avenue is operated is no longer a "hospital"

It is no longer a "hospital emergency room"

Thank You Brian Essi for speaking for us at the special meeting last night you were great! The way council and the mayor handle business is disgusting. They were just leading us on and wasting our time.

Thanks James,

I was honored to have been asked to speak and field questions on behalf of the petitioners and the 2,868 signers of the petition (who represent 40% of the votes needed to overturn the bad deal). I'm afraid that it was a hopeless and unproductive exercise due to the the misinformation on a few that dominates the group think dynamic at City Hall.

You are welcome, it seems like mayor and council want a no compete on their decision to close the hospital just as CCF wants a no compete on letting the people of Lakewood have a full service hospital with a full service emergency room. We have to keep working to receive justice. It will be an uphill battle.

Lori you were emailed back by the law department
You made a request for run repost from 12/1 to 12/29 to the law department that I responded back to on 1/7
You revised your request on 1/15 at 330 pm the reports you requested were delivered to the law department on 1/20 keep in mind city hall was closed on 1/18
No one altered any run times they are entered by dispatch and the times are recorded.
As for the time is tissue I worked in the field a a paramedic for 30 years I am well aware of that phrase that is why we start treatment in the field and notify the hospital of the patients condition. The truth is that our patients that need cardiac cath have seen a reduction in the time it takes to have the procedure done even when you add in the extra drive time.
As for the medics shown in the video they were asked to make a video on the ACA. They were not involved in any time or impact reviews of the closure of the in patient beds at Lakewood hospital. And yes they all still work for Lakewood FD I talk with them almost every week

M. Gilman,

Can you tell me how many stroke patients, your EMS transported in 2015, 2014? Do you know how many Lakewood resident stroke patients were transported by any EMS, including Lakewood's in 2015, 2014? How many did you bring to Lakewood Hospital ER? Do I need to make a formal request for this information?

I am interested in knowing how 1 mobile stroke unit can service Cleveland & the suburbs they have or will extend the service to. I believe there are over 5600 strokes patients hospitalized a year in Cuyahoga County (per CCF). I do not know how many of these were transported by an EMS. What is your estimate of the true impact of CCF's Mobile Stroke Unit will have on saving Stroke patients' lives and enhancing their prognosis' for fuller recovery fir Lakewood Residents. I am concerned about the range of territory 1 unit can cover effectively especially taking traffic & weather issues into account. When one of SLH members, Judy Gillespie stated a while back that what would you do if the stroke unit was on the other side of Lakewood while you were having a stroke, I thought it was a good point. I did NOT know that there is ONLY ONE mobile stroke unit operational for the Cleveland Clinic.

Because a REAL ER with a hospital attached is so vital to stroke patients, I do not see how 1 Mobile Stroke Unit for Cleveland & CCF designated suburbs can effectively reduce one's risk of death & severe stroke damage.

Since our proposed ER will not be a level 1 with in house trauma surgeon specialists on the spot or an operating room, the best it can be is a level 2 with specialties on an on-call basis...usually available within 60 minutes. (Yikes!)ER MD's will care for you until a specialist arrives. No in hospital resources available without extra time & money to transport the patient t o a hospital.

I am not even sure our proposed ER w be a level 2. I think the definition of a level 3 is what we are getting: Treatment by EM doctors. Not all specialties available to come to ER to help. Patient will be stabilized and transported to an appropriate care facility. Trauma patients will be transferred to another (hospital) that is equipped to handle trauma. (Kathleen Handal, MD) A FAR cry from what we have had in Lakewood, Ohio for many, many years.

Please advise.

Respectfully,

pam wetula

Pam:
I do not have those numbers with me but will get them for you by Tuesday. It is important to note that when we are dispatched for a stroke it is often some other type of medical emergency. Not all of the patients that are listed as strokes actually were stroke patients. We do not always get follow up from the hospital with the final diagnosis.
As for stroke treatment that varies once the type of stroke and the onset of symptoms has been determined. The stroke care for a stroke from clot does not differ if you are at the Lakewood ER or at Fairview, both ER's can administer TPA if indicated and at this time if further intervention is indicated the patients would need to be transferred from both ER's.
It is true that there is only one Mobile Stroke Unit (MSU) in service. A second one is on order I am unsure of when that will go into service. As for the number of stroke patients in cuyahoga county not every community is involved with having a response from the MSU. I do not know how many communities other then Cleveland have an agreement for the MSU response. If there were multiple stroke calls in the city the patients would be treated as they have been since LFD took over EMS in 1999.
As for trauma response Lakewood Hospital was never designated as a Level 1 trauma center. Lakewood and Huron Road were Level 2 trauma centers but have not operated as such since 2010. With the trauma system in place there are currently 2 level 2 and 2 level 1 trauma centers.
Since the reduction in the number of trauma centers from 5 to 3 there has been a 26% decrease in trauma mortality. These figures are on the state of Ohio EMS web site. Cuyahoga County was the only county in the state to see this type of reduction in mortality.
The LFD trauma care will not change we will take the patient to the most appropriate trauma center based on the patients condition and our protocols.
Hope I addressed all your questions
Scott

When is an emergency room NOT an emergency room?

Take a look at the ER Lakewood is left with right now, that's when.

scott gilman wrote:Pam:
I do not have those numbers with me but will get them for you by Tuesday. It is important to note that when we are dispatched for a stroke it is often some other type of medical emergency. Not all of the patients that are listed as strokes actually were stroke patients. We do not always get follow up from the hospital with the final diagnosis.
As for stroke treatment that varies once the type of stroke and the onset of symptoms has been determined. The stroke care for a stroke from clot does not differ if you are at the Lakewood ER or at Fairview, both ER's can administer TPA if indicated and at this time if further intervention is indicated the patients would need to be transferred from both ER's.
It is true that there is only one Mobile Stroke Unit (MSU) in service. A second one is on order I am unsure of when that will go into service. As for the number of stroke patients in cuyahoga county not every community is involved with having a response from the MSU. I do not know how many communities other then Cleveland have an agreement for the MSU response. If there were multiple stroke calls in the city the patients would be treated as they have been since LFD took over EMS in 1999.
As for trauma response Lakewood Hospital was never designated as a Level 1 trauma center. Lakewood and Huron Road were Level 2 trauma centers but have not operated as such since 2010. With the trauma system in place there are currently 2 level 2 and 2 level 1 trauma centers.
Since the reduction in the number of trauma centers from 5 to 3 there has been a 26% decrease in trauma mortality. These figures are on the state of Ohio EMS web site. Cuyahoga County was the only county in the state to see this type of reduction in mortality.
The LFD trauma care will not change we will take the patient to the most appropriate trauma center based on the patients condition and our protocols.
Hope I addressed all your questions
Scott

Chief Gilman,

Thank you for the fine work that you and your professional team performs for the citizens of Lakewood and others.

Would the existence of an interventional cardiac cath lab at an ER affect your team's decision making on whether to take certain patients with time sensitive needs to that ER?

As we all know, about this time last year Lakewood Hospital closed its the higher end cath services and the Master Agreement only requires CCF's new ER to maintain the level of service offered by the Lakewood ER as of 12/21/2015, i.e. without those time sensitive life saving cath services.

Can you articulate for the public exactly what level of service existed at the Lakewood Hospital ER as of 12/21/2015? (If not, no worries as I know that you were not in control of the rather vague language agreed to in that document) Perhaps there is some regulatory report that establishes this baseline?

Are you aware of any effort by anyone at the City of Lakewood to document the exact level of service that existed at the Lakewood ER as of 12/21/2015 so that the City can monitor CCF's compliance with maintaining that level of service?

I am told that the ODH has now implemented its new rule that will allow a freestanding ER like the new CCF FHC to have the higher level of cath services as long as they are within 30 minutes of a hospital (that were eliminated last year).

Do you believe that having those higher end cath services at the new FHC would be beneficial to Lakewood? Would those services help you and your team or add another level of complexity and make decision making more difficult?

Is it even realistic to think that CCF would take the cath lab equipment in Lakewood Hospital that it got for free and install it in the new FHC?

I don't mean to put you on the spot here on the Deck if any of my questions are inappropriate in this forum, that's fine.

I really do appreciate your participation on the Deck.

I am surprised that an SLH member has to post on the Deck to ask the Fire Chief for statistics. As I told Tom Monahan weeks ago, and was screamed at for, SLH attorneys should have been investigating issues with the EMS runs, etc., a long time ago. I have no problem with the treatment that patients get from these fine folks. However, I believe this is an area that should have been looked into. Perhaps part of the problem is that the SLH group tends to trust everybody. How did that work out? Just saying sleeping with the enemy is not a good strategy.

Brian when I am at my computer I will do my best to answer your questions
To Pam in 2015 LFD stats indicate 70 stroke responses. I don't have the stats for 2014 until I get back to work
The strokes on our report are not all confirmed as strokes and some do not get a final diagnosis of stroke. I don't get reports back on all patients that were listed as possibly having a stroke
Scott

Chief Gilman,

Thank you for the fine work that you and your professional team performs for the citizens of Lakewood and others.

Would the existence of an interventional cardiac cath lab at an ER affect your team's decision making on whether to take certain patients with time sensitive needs to that ER?

If there were a cath lab we would transport to the closest most appropriate facility.

Of the 281 chest pain calls LFD responded to in 2015 less than 10% required that type of intervention. The average time to complete the procedure since the change with the cath lab at Lakewood has been reduced by 18 minutes.

As we all know, about this time last year Lakewood Hospital closed its the higher end cath services and the Master Agreement only requires CCF's new ER to maintain the level of service offered by the Lakewood ER as of 12/21/2015, i.e. without those time sensitive life saving cath services.

Can you articulate for the public exactly what level of service existed at the Lakewood Hospital ER as of 12/21/2015? (If not, no worries as I know that you were not in control of the rather vague language agreed to in that document) Perhaps there is some regulatory report that establishes this baseline?

I am not aware of a regulatory requirement that establishes the baseline.

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


Are you aware of any effort by anyone at the City of Lakewood to document the exact level of service that existed at the Lakewood ER as of 12/21/2015 so that the City can monitor CCF's compliance with maintaining that level of service?

I am not aware of any monitoring, however I have been in contact with the ER director and we will be monitoring transports taken to the ER to make sure that the patients needs are being met.

I am told that the ODH has now implemented its new rule that will allow a freestanding ER like the new CCF FHC to have the higher level of cath services as long as they are within 30 minutes of a hospital (that were eliminated last year).

Do you believe that having those higher end cath services at the new FHC would be beneficial to Lakewood? Would those services help you and your team or add another level of complexity and make decision making more difficult? I don’t think it would add to the complexity of making a decision.

I think the system that is currently in place works well and can be improved and become even more efficient. The treatment of the patient starts before we leave for the hospital.

Is it even realistic to think that CCF would take the cath lab equipment in Lakewood Hospital that it got for free and install it in the new FHC?

I have no knowledge of who purchased the cath lab equipment at Lakewood Hospital. The extent of my involvement with the cath labs was to do the fire safety inspections of the fire protection equipment in those areas.

I don't mean to put you on the spot here on the Deck if any of my questions are inappropriate in this forum, that's fine.

I really do appreciate your participation on the Deck.

People have a misunderstanding about what happens in a hospital emergency room. It's not like on what you see on TV.

The people working in the emergency room are not skilled in heart surgery, brain surgery, plastic surgery or specialists in exotic diseases. They are skilled nurses and physicians who stabilize the patient until the specialist or surgeon can get to the emergency room. Lakewood's emergency room does not have those types of doctors on staff. The new emergency room planned for Lakewood will have not have those doctors on staff. They will be in Avon or Fairview and will not hop in the car to race to Lakewood. The patient will have to be loaded into an ambulance and transferred to Avon or elsewhere. Assuming they have beds available.

Are we risking lives by calling a minute Clinic an emergency room?

Are we getting an emergency room or a minute clinic with emergency room prices?

Bill,
This is exactly what I have talked about previously in several different threads. We all know this already. Instead of being reactive on the Deck we need to be proactive out with the public. Repeating the same info over and over does not help the cause.

Bill you are completely wrong. The Lakewood emergency room will have board Certified Emergency Room doctors that can stabilize the patient and see that the patient is transported to the closest most appropriate facility. This model has worked in Cuyahoga County for over 30 years and has worked in Summit, Medina and Lorain Counties. If someone has a medical emergency the best thing to do is to call 9-1-1 and the paramedics will assess and make sure the patient is transported to the closest most appropriate medical facility. As for walk in patients the system has already worked for a patient with a work in gunshot wound with falling blood pressure. The patient was stabilized and transferred for surgery and will have a good outcome.

Good luck if you need immediate surgery. What if you walk in with a blood clot that lets lose, an abdominal aneurysm, A severed limb, unknown poisoning? I am talking walk ins that don't have time to be transported elsewhere. We all know, as I believe Dr. Kilroy said, time is tissue. We have over 51,000 people here in Lakewood, a lot of them elderly. Avon has about 20,000 residents. So, what makes their lives so much more important than ours? Summers can send all his buddies on here and spew crap. We know this was a bad, and possible illegal deal with OUR hospital. Those that appear to be going along with this deal should know that aiding and abetting is a crime. Mr. Summers, it is time for you to come on the Deck and let us all know why there was no open bidding process on the hospital. It is the law. Lakewood Hospital was good enough for you when you needed it.

Chief Gilman and Mr. Call,

I don't see either of you saying much different than ---patients will be transferred from the existing ER to a hospital outside of Lakewood.

There is no dispute that the hospital is currently closed and cannot handle the types of patient needs that Chief Gilman has outlined above.

The quality of the individual professionals in the ER are beside the point---for the seriously ill who actually end up there it will operate as a transfer station to another hospital.

The current ER still qualifies as an "ED/ER" under EMTALA--the federal guidelines--but not all ER/EDs are the same under those guidelines.

Thanks to City Hall's failure to protect us, we are at the mercy of CCF as to what level of service it chooses to provide in the transfer station.

Brian,
Please read what I posted right above your post. I believe this explains it all. No need to beat a dead horse!