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CDC: In U.S., Half Million C. Difficile Infections in 2011

Posted on Mon, Mar 02, 2015
CDC: In U.S., Half Million C. Difficile Infections in 2011

29,000 died within a month of diagnosis

THURSDAY, Feb. 26, 2015 (HealthDay News) -- Almost half a million Americans were infected with the bacteriaClostridium difficile in 2011, and 29,000 died within a month of diagnosis, U.S. health officials say. The report is published in the Feb. 26 issue of the New England Journal of Medicine.

For the report, researchers collected data on C. difficileinfections in 10 areas of the United States in 2011. They wanted to know how many infections were related to health care facilities, such as hospitals and nursing homes, and how many were contracted in the community at large.

Two-thirds of C. difficile infections occurred in hospitals and nursing homes, the investigators found. However, 150,000 infections were community-associated, meaning they happened among those who had not been inpatients in a health care facility. The researchers estimated that there were 453,000 C. difficile infections in the United States that year. They calculated that women, whites, and those aged 65 and older were most likely to be infected. Moreover, the study authors estimated that 83,000 people experienced a first recurrence of C. difficile infection, and that 29,300 people died from the bacteria in 2011.

"Infections with C. difficile have become increasingly common over the last few decades, and are seen in patients in health care facilities as well as people in their communities," Michael Bell, M.D., said at a U.S. Centers for Disease Control and Prevention press conference Wednesday.

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With a Little Help from My Friends: How EmCare and Its Sister Companies Tackled Ebola

Posted on Thu, Dec 11, 2014
With a Little Help from My Friends: How EmCare and Its Sister Companies Tackled Ebola


Three months ago, Ebola was another exotic disease in some far away land. Then on Sept. 30, the Centers for Disease Control and Prevention (CDC) announced that the first Ebola patient had been identified in the United States. That distant shore became our front door.

Watching the news, you would have thought Ebola was about to run rampant through the streets of every city, county and state. The challenge for public health officials became two-fold: get ready to deal with the possibility of Ebola and calm public fears.

Envision Healthcare’s clinical leadership team understood those challenges and began to address concerns unique to each company. EmCare has two sister companies under the Envision Healthcare parent: Evolution Health, a physician-led company specializing in the management of complex patients in the home and alternate settings; and AMR, the country’s largest emergency medical services provider.

As the nation’s largest physician services company, EmCare was in the spotlight. Dighton Packard, M.D., Envision Healthcare’s Chief Medical Officer, communicated regularly with clinicians as well as partner hospitals and developed web-based informational resources.

“The key to stopping this disease is to quickly identify and isolate potential carriers,” said Dr. Packard.

“Our goal was to provide the latest CDC recommendations as well as helpful clinical resources that addressed concerns unique to our various practice environments.”

Al Sacchetti, M.D., a Medical Director for EmCare, created instructional videos for EmCare clinicians. The videos were sent to EmCare-managed locations across the country.

“The highest probability is that an Ebola patient who enters the U.S. will find his way to an emergency department,” said Dr. Sacchetti. “As a leader in the field of emergency medicine, EmCare is making sure all our affiliated clinicians have the best tools to deal with the situation. We want them to be able to recognize Ebola patients, and respond appropriately and quickly.”

RELATED: Managing Ebola, Enterovirus and Other Infectious Diseases

The videos Dr. Sacchetti created focus on the correct ways to don and doff personal protection equipment (PPE). They were quickly reshot several times as the CDC changed its recommendations.

“Things change,” said Dr. Sacchetti. “When we made the first videos, we had the associates putting on goggles. A few days later, the CDC recommended against goggles because people kept adjusting them and touching their faces. Now we have hoods.”

EmCare also developed a special website for updates, educational resources and messages from Dr. Packard. The site, is still active and will be updated as needed.

Not too long before the first patient was identified in Dallas, AMR had worked with the CDC to transport a known Ebola patient. The transport wasn’t publicized, but AMR leaders realized there was a very good chance more Ebola transports were imminent.

They were right.

“From the very beginning, our primary consideration was the health and safety of our caregivers, our patients and the communities we serve,” said Ed Racht, M.D., AMR’s Chief Medical Officer. “Ebola is a concern for emergency medical services (EMS) because the out-of-hospital setting is unpredictable and identifying potential cases is challenging.”

Dr. Racht’s clinical team began by developing EMS Ebola screening criteria. The document was sent to every operation and the 44 AMR communications centers that answer 911 calls and dispatch ambulances. It was also added to MEDS, AMR’s electronic patient care record, and within six weeks more than 117,000 AMR patients had been screened for Ebola. Eighty-six met the criteria to be considered a potential Ebola patient and were transported accordingly.

AMR also launched an Ebola resource website at that has generated more than 63,000 hits and become a valuable resource for hospitals, fire departments and other EMS providers around the country.

RELATED: Nina Pham, Amber Vinson and other ‘Ebola Fighters’ named Time’s Person of the Year

AMR’s clinical team then worked with the logistics and supply departments to identify and order upgraded personal protective equipment for paramedics and EMTs.

“We looked at the CDC recommendations and felt we needed equipment that in some instances exceeded those standards,” said Ron Thackery, AMR’s Senior Vice President of Professional Services. “The CDC was focused on managing hospitalized Ebola patients. We knew transporting patients would be more challenging, so we developed guidelines that took every possible scenario into consideration.”
The team also set up a hotline at Evolution Health’s Williams Medical Command Center in Dallas (MCC) where nurse practitioners and members of the AMR medical leadership team provided clinical and operational support. Most of the questions regarded the transport of suspected Ebola patients. That changed when the CDC requested AMR’s assistance in transporting two known Ebola patients.

On Oct. 15 and 16, AMR’s preparations were put to the test when Ebola-stricken nurses Nina Pham and Amber Vinson were transported from Texas Health Presbyterian Hospital to Dallas Love Field Airport.

Both transports were broadcast live nationally.

“From wrapping the interior of the ambulance to donning and doffing the PPE, the entire process worked just as we had planned,” said Dr. Racht. “I couldn’t have been prouder of the crew members who participated in these transports. It was a shining moment for the entire organization.”

Starting the next day, the MCC provided monitoring services for the AMR paramedics who were in the ambulances that transported the nurses.

“This is another example of how we came together as an organization to support each other,” said Dr. Racht.

The emphasis on Ebola has slowed for now, but its effect on the healthcare system and emergency medical services has been profound.

“Our experience with Ebola has shown that we must remain vigilant and always prepared for new and evolving infectious diseases,” said Dr. Racht. “The new role for EMS moving forward will be to identify, respond and contain new outbreaks as they occur.”

While the role of emergency medical services may have changed, emergency medicine was once again front and center at this critical time.

“Emergency physicians have been, and will continue to be, on the front lines of America’s healthcare system,” said Dr. Packard. “Whether it’s Ebola, H1N1 or any other infectious disease, we will continue to keep our communities safe.”


Ebola Workshop Scheduled for Nov. 3 in Washington, D.C.

Posted on Sun, Oct 26, 2014
Ebola Workshop Scheduled for Nov. 3 in Washington, D.C.

Experts and policymakers will discuss the public health response to Ebola virus disease in the U.S.

THURSDAY, Oct. 16, 2014 (HealthDay News) -- At the request of the U.S. Department of Health and Human Services, the Institute of Medicine and the National Research Council will host a workshop to discuss research needed to prepare for handling the occurrence of Ebola virus disease in the United States, according to a press release from the National Academies.

Health care experts and policymakers will convene at a one-day workshop, to be held on Nov. 3, 2014, at the National Academy of Sciences building in Washington, D.C., to discuss basic science research and public health concerns regarding the response to Ebola. Advance registration is required to attend in person; plenary sessions and discussions will be available via live video webcast.

The researchers will discuss various topics on Ebola, including routes of viral transmission; persistence of the virus on surface areas and transfer of the virus; methods for viral inactivation and disinfection; and protective strategies for at-risk responders, providers, and the general public, including the use of personal protective equipment. Experts and policymakers will identify key areas of biomedical and public health research that should be conducted to protect the public and prevent the spread of Ebola.

"Our goal for this workshop is to provide a forum for key experts and decision makers to discuss what research is needed and can be performed now to assist the public health response to the occurrence of Ebola in the United States," Victor J. Dzau, M.D., the president of the Institute of Medicine, said in a statement.

More Information


Managing Ebola, Enterovirus and Other Infectious Diseases

Posted on Mon, Oct 20, 2014
Managing Ebola, Enterovirus and Other Infectious Diseases

By Dr. Adam Corley

Given all of the news about Ebola and enterovirus recently, it is only natural and appropriate that there is a great deal of media attention focused on infectious diseases.  Like the rest of the world, I’m interested in and following along with both of these recent stories.  However, it is important to realize that there are other common viruses that we deal with routinely that have the potential to affect and even kill many more people than Ebola and enterovirus combined.
Between five and 20% of all Americans will come down with seasonal influenza (the flu) every year according to the CDC.  Though some flu seasons are worse than others, thousands of people die every year from influenza.  During the period from 1976 to 2006, the CDC recorded between 3000 and 49000 deaths annually.
There are simple things that we can all do to protect ourselves and our communities from routine illnesses as well as those that are more exotic, frightening, and sensational. Here are some of my top recommendations.

  • Wash your hands. Routine hand washing can dramatically reduce the spread of many viruses and bacteria that cause disease, particularly respiratory and gastrointestinal diseases. To do a proper hand wash, you should wet, lather, rinse, scrub, and dry your hands. The scrub portion should last at least 20 seconds.  Wash frequently, particularly before preparing food or eating, after using the bathroom, and when you’ve been around someone who is sick.
  • Get the flu vaccine. Yearly vaccination is one of the best ways to protect yourself from contracting influenza.  If you have questions about which flu vaccine is right for you, talk with your doctor.
  • Stay home. I love to surround myself with people who have a good work ethic. I have missed very few days of work in my life.  That said, if you are sick with a viral-type illness, stay home.  Don’t go to work, school, or other public places where you might spread your illness to others.  If you aren’t sure whether you illness is likely to be contagious, visit your doctor.
  • Cover your cough. Many respiratory illnesses are spread by droplets released when you sneeze or cough.  When you cough or sneeze, do so into the bend in your elbow, into a tissue, or into your hand. Wash your hands frequently in general and especially when you are sick.
  • Have a primary care doctor. This is good general advice but it is particularly important during cold and flu season. You need to have an established relationship with a primary care doctor in advance of getting sick.  When you feel badly, you can schedule an appointment with a doctor who knows you, your medical history, and can give you the personalized attention that you need when you’re sick.


Adam Corley, MD, FAAEM, FACEP, is a Regional Medical Director for EmCare and practices at Brazosport Regional Health Center in Houston, TX. 


In Case You Missed It: Week of Oct. 17, 2014

Posted on Fri, Oct 17, 2014
In Case You Missed It: Week of Oct. 17, 2014

“In Case You Missed It” is a weekly roundup of popular healthcare headlines.

[Ebola Update] President Obama Convenes Emergency Ebola Meeting at White House. The United States must monitor Ebola in a "much more aggressive way," President Obama said ... continue reading at  

Top Five Health Innovations of the Week. Each week, with its partner Boehringer Ingelheim brings you a snapshot of five innovative ideas that are reshaping the health care industry. Continue to >> 

[BOOK REVIEW] Here is an exclusive overview of Dr. Jensen's latest book, “The Hospital Executives Guide to Emergency Department Management." “The Hospital Executives Guide to Emergency Department Management” has its roots in my thesis for ... continue >>

[SLIDESHARE] Much has been written in the business literature about managing the waiting experience. Federal Express has noted that “waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming, and incredibly expensive.” We intuitively know this from our own experience as well as from patients. Here are some practical tips to improve your patients' ED experience. 

[From] Joan Rivers’ death: What went wrong? Several sources have reported that Dr. Korovin had not completed usual credentialing procedures at Yorkville Endoscopy ... continue at

[From Becker's Hospital Review] Design approaches to reduce patient-fall injuries. This white paper offers several design options that show promise in the fight against slip-fall injuries. Click here to access whitepaper.

Visit us at these upcoming events!

10/27: ACEP 2014 Booth 1611 

10/28: Residents-Only Happy Hour at #ACEP14

11/6: EmCare's Inaugural Cook County Crash Course (C4)

11/11: Proven Strategies to Advance your Emergency Department: 2-day Studer Group event featuring Dr. Kirk Jensen


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