Blog Posts


Second Severe Allergic Reaction Within Hours Isn't Uncommon

Posted on Mon, Jul 20, 2015
Second Severe Allergic Reaction Within Hours Isn't Uncommon

Researchers find about one in seven children have repeat episode

(HealthDay News) -- About 15 percent of children who have a severe allergic reaction can have a second one within a few hours, according to a new study published online June 22 in the Annals of Allergy, Asthma & Immunology.

The study team looked at the medical records of 484 children seen in an emergency department for severe allergic reactions. The researchers sought to determine whether the children had a second, follow-up reaction.

About one in seven childen had a second reaction, the researchers found. "We found that 75 percent of the secondary reactions occurred within six hours of the first," lead author Waleed Alqurashi, M.D., from the University of Ottawa in Canada, said in an American College of Allergy, Asthma & Immunology news release.

"A more severe first reaction was associated with a stronger possibility of a second reaction. Children aged 6 to 9, children who needed more than one dose of epinephrine, and children who did not get immediate epinephrine treatment were among the most likely to develop secondary reactions," Alqurashi said. At least half of the second allergic reactions were considered serious and had to be treated with epinephrine.

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Get to Know October’s Clinician of the Month: Denise Sexton

Posted on Tue, Oct 07, 2014
Get to Know October’s Clinician of the Month: Denise Sexton

EmCare has more than 10,000 clinicians serving communities across the country and we want to share their stories with you. Get to know these hard-working, difference-makers right here with our monthly “Clinician of the Month” blog post. This month's clinician of the month is celebrated in tandem with Emergency Nurses Week and features one of EmCare's many talented emergency nurses. Do you know a clinician who should be featured? Email!

Denise Sexton has 20 years of healthcare experience to EmCare partner hospitals, and over 15 years specifically in the emergency department and in leadership roles.

As a Divisional Director of Clinical Services for EmCare, Denise’s strength in leadership and diverse clinical skills provides a solid foundation for improving hospital operations, not only in the E.D, but also with services including hospitalist programs, observation units, operating rooms and critical care units. Denise uses her education and experience to o­ffer expertise and broad perspectives for E.D. and inpatient managers.

When she is not busy helping EmCare partner hospitals achieve their goals, Denise enjoys spending time with family, gardening and being outdoors.


Get to know Denise!


How do you fight burnout? If you love what you do then the risk of burnout is low. I truly love my job and enjoy every day of it. When I get stressed out, I go outside and work. I spend as much time as possible working in the garden and around the farm. I find that is my best stress reliever.

The one piece of healthcare advice I wish everyone would follow is ___. Take care of yourself. As healthcare providers we spend all of our time taking care of everyone else and forget that we need care too.

What’s been your proudest moment during your career? One busy night in the ED I took care of a patient who was going to die in a short period of time. His family was 6 hours away and was attempting to get there to be with him. I sat with him as much as I could and talked to him. As I kept in contact with the family I would go and talk with him to let him know that they were coming in hopes that he could hang on until they got there. They shared personal information about him with me so I could talk to him. Unfortunately he passed before they could arrive at the hospital. The family came after I got off shift but we had an area that they could sit with him until they were ready to leave. They sent the kindest letter to me afterwards about how much it meant to them that he did not die alone and that the updates and talking to him meant a lot to them. I still have the letter that they sent me.

I hope my patients remember me as ___.  I hope that the facilities I work with remember me as helpful and a great resource person to turn to when they need assistance.


Facility Spotlight: 11 Reasons You'll Love Cypress Fairbanks Medical Center

Posted on Tue, Sep 16, 2014

Each month, EmCare features a client hospital to highlight the quality care available throughout the EmCare portfolio. To learn more about career opportunities at all EmCare-affiliated facilities, click here.

  1. Cypress Fairbanks Medical Center is located in Houston, TX—ranked #4 on the Forbes 2014 List of America’s Coolest Cities.
  2. Cy-Fair’s freestanding ER facility provides the same high quality care patients receive at facilities throughout the Cy-Fair Regional Health Network.
  3. Efficiency is paramount: Patients can check-in to Cy-Fair ER online which creates an efficient ER process for patients and staff.
  4. Cypress Fairbanks Medical Center Hospital was recently recognized for achievement in Mission: Lifeline®, a program created by the American Heart Association to help ensure prompt, evidence-based care for heart attack patients.
  5. Ranked among the top 10 Best Hospitals in the Houston metro area by US News & World Reports in 2011
  6. American Heart Association Get with the Guidelines Gold Performance Achievement Award for Heart Failure
  7. American Stroke Association Get with the Guidelines Silver Plus Performance Achievement Award for Stroke
  8. 2012 HealthGrades Coronary Intervention Excellence Award
  9. 2010 and 2011 HealthGrades Emergency Medicine Excellence Awards
  10. 2008/2009, 2009/2010, 2010/2011, 2011 and 2012 HealthGrades Maternity Care Excellence Awards
  11. Bariatric Surgery Center of Excellence from the American Society for Metabolic and Bariatric Surgery
To submit your CV for this exciting opportunity, click here!

Watch this video to learn more about Cypress Fairbanks Medical Center.


10 tactics to Reduce Violence in the Emergency Department

Posted on Tue, Aug 19, 2014
10 tactics to Reduce Violence in the Emergency Department

According to a survey by the International Association for Healthcare Security & Safety, the number of violent incidents involving hospital workers jumped 37 percent in the past three years. In this 3 part series, two EmCare-affiliated Divisional Directors of Clinical Services, share the details of their first-hand experience with violence in the ED and they reveal the improvements that need to be made within ER departments to reduce acts of violence in the hospital.

By Ginger Wirth, RN and Denise Sexton, RN, BSN, Divisional Directors of Clinical Services, EmCare


I was a victim of violence in the E.D. Here's my story. Pt. 1

I was a victim of violence in the E.D. Here's my story. Pt. 2 

  1. Teach staff to recognize aggressive and escalating behaviors early.  Be able to anticipate potential violent situations or patients/families that exhibit signs of increased stress, dissatisfaction or agitation.  Remember that overcrowding of ED’s, increased wait times and the ED’s being used as primary care clinics can have significant potential on increasing stress on patients, families or visitors.
  2. It is imperative that we provide education on how to deescalate aggressive or potentially violent customers.  This has to be real time training-- hands on, not the computer- based modules that we so often see on an annual basis in healthcare.  This training needs to be shown to all staff with a focus on the Emergency Department team, and should include drills or exercises to practice putting this training into action.  I understand that in other countries this happens on a regular basis.  We have disaster drills, fire drills, code blue drills, why are we not drilling on how to protect the staff, other patients and visitors in the hospitals?
  3. We need to educate the staff that there are Federal Laws in place to protect and prosecute those that do harm against healthcare workers.  This should be a zero tolerance initiative and treated as such in healthcare.  Staff should be encouraged to report any incidents-- small or large-- to administration and those incidents should be investigated and dealt with strictly and severely.  No longer should there be a stigma or fear or retribution for reporting incidents of violence.  This will take away the power from those assailants and give it back to the staff.
  4. Signs should be clearly posted in the Emergency Departments that any acts of aggression, disrespect or violence in the ED will not be tolerated and could result in law enforcement action.  I have seen these signs in a couple ED’s and I believe that informing the patients, families and visitors right in the beginning and reinforcing that with signs could help to deter events.
  5. Hospitals need to perform a root cause analysis of any and all incidents that occur in the facility.  In healthcare, we do these on all medical events that have adverse outcomes quickly and effectively.  Any type of violence needs to be treated the same and given the same attention.  The areas for improvement will show during these events and they demonstrate to any staff involved that these are serious events, and they will be investigated and addressed as such.
  6. ED team members need to treat all patients and their family members as if they have the potential to become violent. Never drop your guard with any of them.
  7. Be sure to undress the patients, put them in a hospital gown, and search for weapons. With most states adopting open carry laws for concealed weapons, you never know who may have a gun. We’ve removed many weapons over the years from patients,  most of which have been knives or other sharp objects. Clear the room of anything that they can use to harm you or themselves.
  8. Make sure that you have a code that you can call that will bring all available personnel to the ED. There is strength in numbers. I have seen many psych patients and irate family members become more cooperative with just a show of staff.
  9. Always position yourself with a way out of a room so you cannot be cornered by the patient. Never let a patient come between you and the door. Even a small patient can become unbelievably strong when adrenaline kicks in.
  10. Administration needs to be supportive and prosecute to the fullest extent of the law on any threats to healthcare workers. I have seen many patients and family members verbally abuse staff and think that they should take it.
What tips do you have for preventing violent episodes in your ED? Tell us in the comments. 


I was a victim of violence in the E.D. Here's my story. Pt. 1

I was a victim of violence in the E.D. Here's my story. Pt. 2 


I was a victim of violence in the E.D. Here's my story. Pt. 2

Posted on Tue, Aug 12, 2014
I was a victim of violence in the E.D. Here's my story. Pt. 2

According to a survey by the International Association for Healthcare Security & Safety, the number of violent incidents involving hospital workers jumped 37 percent in the past three years. In this 3 part series, two EmCare-affiliated Divisional Directors of Clinical Services, share the details of their first-hand experience with violence in the ED and they reveal the improvements that need to be made within ER departments to reduce acts of violence in the hospital.

By Ginger Wirth, RN, Divisional Director of Clinical Services, South Division

I have actually been a “victim” twice in my career while in the ED.  Both involved patients who had some mental/psychiatric etiology.  The first time was in 1990 while my team was providing a female patient with discharge instructions and calling her significant other for a ride home, she became agitated and punched me in the face.  This resulted in some pretty substantial bruising and some neck strain after I hit the floor. The facility fully supported me and charges were brought against the patient. She was found guilty of assault and received probation. 

The other time was also by a psych patient who became combative when he was told that he was going to be committed.  He began screaming and yelling at the staff and cornered me in the room and punched and kicked while trying to elope.

I don’t think there’s a lack of support from hospital administration, as I have had great support in both incidences.  I think the problem stems from the growing lack of treatment options throughout the country for mental health patients. Consequently, they are being dumped in the emergency departments.  No longer will the correctional system keep patients that have mental illnesses without medical clearance, causing these patients to clog and remain in the ED’s.  If police apprehend a person with any hint of a history of mental illness, they come to the ED for evaluation.  When they arrive in most ED’s, the providers are not comfortable initiating treatment for the mental illness even if there is a long history. 

For example, if a patient goes off their regular medications for depression and is picked up by law enforcement they are brought to the ED for clearance.  The ED providers may not be willing to shoulder the responsibility of restarting medications or discharging the patient without a psychiatric evaluation.  So, these patients remain in the ED until they can be stabilized.  Getting them into the mental health system can take days, weeks or sometimes months.  Also of note: many of these patients are self-pay and have a lack of resources to begin with, which hampers their entry into the overcrowded mental health system of many states. 

There has been some relief and “light at the end of the tunnel” for some areas with the increased usage of telemedicine.  In South Carolina, there is a fairly robust use of telepsychiatry; however, this has quickly succumbed to overuse and capacity issues.  The limited number of inpatient beds is a problem for patients with insurance, as well as the uninsured.  We have an opportunity to continue with training in our EDs to recognize aggressive situations, provide support for our ED providers in the care of the mental health patients in the community and what resources are available and how to access these resources easily and timely. 

All staff in the ED must know that violence against healthcare providers should NEVER be tolerated, expected or dismissed.  All cases should be reported to the facility administration and law enforcement when appropriate.  Abuse is just as unacceptable for someone that cares for patients, as it is for the patients themselves.


Ginger joined EmCare in 2013 as a Divisional Director of Clinical Services for the South Division with the strong belief that she could continue to make positive changes within healthcare by helping others focus on quality, excellence and the overall patient experience. Ginger Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20+ year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients. 


I was a victim of violence in the E.D. Here's my story. Pt. 1

Have you witnessed violence in your ED? What steps can staff take to protect themselves and the other patients in their care? Tell us about it in the comments. Next week: In part 3 of this 3-part series, Ginger Wirth and Denise Sexton provide tips to  reduce instances of ED violence in hospitals.  

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