scholarly journals Balancing Patient Care and Force Protection at Military Medical Treatment Facilities

2020 ◽  
Vol 185 (Supplement_1) ◽  
pp. 562-564
Author(s):  
Sean Nardi ◽  
Brian Ferguson ◽  
Sean Peck ◽  
Elliot Ross ◽  
Benjamin Walrath
Keyword(s):  
Medical Treatment ◽  
Medical Condition ◽  
Security Protocols ◽  
Unauthorized Access ◽  
Access Points ◽  
Medical Treatment Facility ◽  
Emergency Medical ◽  
Hospital Access ◽  
Treatment Facilities ◽  
Sensitive Conditions

ABSTRACT Objectives This study aimed to identify delays of care due to base access security protocols at a stateside military medical treatment facility (MTF) for patients with a time-sensitive medical condition who are seeking emergency medical care at the MTF. Methods We retrospectively analyzed emergency medical services (EMS) run reports from January 1, 2017 to November 12, 2017 to hospital access points to assess patients who were initially denied access to the MTF. Time from EMS activation until patient delivery at the emergency department, number of time-sensitive complaints, number of time-sensitive conditions, and number of unauthorized access attempts are reported. Results During the 11-month period of review, 42 delays of care related to EMS activation by the sentry at hospital access points were identified. Of the 42, 14 were associated with a time-sensitive complaint, 2 with time-sensitive conditions, and none were unauthorized access attempts. Conclusion We identify the potential for patient harm due to delays in care resulting from the security protocols at our MTF. A review of force protection requirements with consideration for their impact on patient safety, especially in cases of time-sensitive conditions, has been conducted.

scholarly journals Retrospective Assessment of the Efficacy of Modified Progressive Tinnitus Management Skills Education in a Military Medical Treatment Facility

2019 ◽  
Vol 184 (9-10) ◽  
pp. e468-e473 ◽  
Author(s):  
LaGuinn P Sherlock ◽  
Candice E Ortiz ◽  
Georgina P Blasco ◽  
Daniel I Brooks
Keyword(s):  
Medical Treatment ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Published Data ◽  
Treatment Facility ◽  
Coping Ability ◽  
Medical Treatment Facility ◽  
Treatment Facilities ◽  
Skills Education

Abstract Introduction The number-one service-connected disability is tinnitus. Tinnitus currently has no cure, but the functional impact of tinnitus has been shown to be mitigated by Progressive Tinnitus Management (PTM), a multi-level management approach. The duration of PTM Level 3 skills education (PTM-SE) and the inclusion of mental health providers have been identified as barriers to implementation of PTM-SE in Department of Defense (DOD) medical treatment facilities. The goal of this study was to determine if a version of PTM-SE modified for use in DOD medical treatment facilities resulted in positive changes in tinnitus-related outcomes. Materials and Methods A retrospective study was conducted by examining the medical records of patients who attended modified PTM-SE appointments. The study was approved by the Walter Reed National Military Medical Center Institutional Review Board. The study sample included 130 patients who completed modified PTM-SE between January 2015 and June 2016. Primary outcome measures were tinnitus awareness and tinnitus annoyance; secondary outcome measures were effect on life and self-perceived coping ability. Outcome measures were analyzed with nonparametric statistics and logistic regression. Results Modified PTM-SE resulted in clinically significant improvements in the primary outcome measures (awareness, p < 0.0001; annoyance, p < 0.0001). The proportion of patients who indicated an improvement in coping with tinnitus was similar to other published data with similar modifications to PTM-SE. Conclusions The evidence supports the assumption that PTM is a flexible program of tinnitus management that even when modified to be suitable for use in a DOD medical treatment facility provides meaningful reductions in tinnitus awareness and annoyance and improves tinnitus coping ability among military beneficiaries. These findings should encourage audiologists to modify PTM to work within their military medical treatment facility.

scholarly journals Penalties for Emergency Medical Treatment and Labor Act Violations Involving Obstetrical Emergencies

2020 ◽  
Vol 21 (2) ◽  
pp. 235-243
Author(s):  
Sophie Terp ◽  
Brandon Wang ◽  
Elizabeth Burner ◽  
Sanjay Arora ◽  
Michael Menchine
Keyword(s):  
Medical Treatment ◽  
Medical Condition ◽  
The United States ◽  
State Of Emergency ◽  
Current State ◽  
Emergency Medical ◽  
Active Labor ◽  
The Law ◽  
Title One

Introduction: The Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition – labor – specifically included in the title of the law. In light of rising maternal mortality rates in the United States, further exploration into the state of emergency obstetrical (OB) care is warranted. Understanding civil monetary penalty settlements levied by the Office of the Inspector General (OIG) related to EMTALA violations involving labor and other OB emergencies will help to inform the current state of access to and quality of OB emergency care. Methods: We reviewed descriptions of all EMTALA-related OIG civil monetary penalty settlements from 2002-2018. OB-related cases were identified using keywords in settlement descriptions. We described characteristics of settlements including the nature of the allegation and compared them with non-OB settlements. Results: Of 232 EMTALA-related OIG settlements during the study period, 39 (17%) involved active labor and other OB emergencies. Between 2002 and 2018 the proportion of settlements involving OB emergencies increased from 17% to 40%. Seven (18%) of these settlements involved a pregnant minor. Most OB cases involved failure to provide screening exam (82%) and/or stabilizing treatment (51%). Failure to arrange appropriate transfer was more common for OB (36%) compared with non-OB settlements (21%) (p = 0.041). Fifteen (38%) involved a provider specifically directing a pregnant woman to proceed to another hospital, typically by private vehicle. Conclusion: Despite inclusion of the term “labor” in the law’s title, one in six settlements related to EMTALA violations involved OB emergencies. One in five settlements involved a pregnant minor, indicating that providers may benefit from education regarding obligations to evaluate and stabilize minors absent parental consent. Failure to arrange appropriate transfer was more common among OB settlements. Findings suggesting need for providers to understand EMTALA-specific requirements for appropriate transfer and for EDs at hospitals without dedicated OB services to implement policies for evaluation of active labor and protocols for transfer when indicated.

Medical Legal Aspects

2020 ◽  
pp. 656-658
Author(s):  
Madeline Joseph
Keyword(s):  
Emergency Department ◽  
Juvenile Justice ◽  
Medical Treatment ◽  
Children And Adolescents ◽  
Day Care ◽  
Juvenile Justice System ◽  
Medical Condition ◽  
School Personnel ◽  
Legal Aspects ◽  
Emergency Medical

Children and adolescents may present to the emergency department (ED) without a guardian for several reasons, such as emergencies occurring during school or lack of guardian availability so that relatives, family friends, or day care or school personnel must accompany children to the ED. Concern about providing evaluation and treatment without formal consent is one of the challenges that emergency physicians face when minor patients present to the ED without parents or guardians. The Emergency Medical Treatment and Labor Act mandates that all patients, including minors, presenting to the ED receive a medical screening examination to determine if an emergency medical condition exists. This chapter reviews who can provide consent for minors; cases in which minors can be treated without consent in the ED, including minors involved in the juvenile justice system; and adolescent emancipation.

Deployed ophthalmic workload in support of US and NATO operations in Afghanistan

2020 ◽  
pp. bmjmilitary-2019-001379 ◽  
Author(s):  
Richard J Blanch ◽  
M T Kerber ◽  
W G Gensheimer
Keyword(s):  
Medical Treatment ◽  
Active Duty ◽  
Treatment Facility ◽  
Aeromedical Evacuation ◽  
Medical Treatment Facility ◽  
Us Military ◽  
Active Duty Military ◽  
Ophthalmic Pathology ◽  
Treatment Facilities ◽  
Ophthalmic Disease

PurposeThe extent and types of ophthalmic disease and non-battle injury (DNBI) seen by expeditionary ophthalmologists at deployed military medical treatment facilities have not previously been reported. We aim to characterise the extent and type of ophthalmic pathology including DNBI at a US military medical treatment facility in Afghanistan.MethodsWe conducted a retrospective non-interventional cohort study of all patients seen by ophthalmologists at Craig Joint Theater Hospital at Bagram Airfield (BAF), Afghanistan, between 1 October 2018 and 31 August 2019.ResultsThere were 281 patients seen in 540 separate encounters, of which 146 patients seen were active duty military stationed at BAF with DNBI, of a population at risk of 6000 personnel. Diagnoses managed included open and closed globe injury, bacterial and herpetic keratitis and retinal detachment, with the most common being dry eye, corneal abrasion/foreign body, blepharitis, chalazion and uveitis. Thirteen patients (5%) required aeromedical evacuation out of theatre and 39 patients were aeromedically transferred within theatre for assessment. Expert consensus estimated that 89 patients (36%) would be likely to require aeromedical evacuation out of theatre without ophthalmic input.ConclusionsThe rate of ophthalmic DNBI among deployed US, UK and coalition forces at BAF was 2.65% per year, of whom 97% were returned to duty (95% of all patients). We estimate that evacuation and loss to unit would increase from 5% to 36% without an ophthalmologist present. The low number of within-theatre aeromedical transfers suggests that the local presence of an ophthalmologist at a patient’s deployed medical treatment facility affects access to deployed ophthalmic care.

scholarly journals Patient Perceptions of Drive-through Medical Treatment Facilities During the COVID-19 Pandemic

2021 ◽  
Vol 22 (5) ◽  
pp. 1032-1036
Author(s):  
Sean Stuart ◽  
Sally Mandichak ◽  
Julianne Davison ◽  
Shai Ansell ◽  
Timothy Parker
Keyword(s):  
Medical Treatment ◽  
Healthcare Delivery ◽  
The United States ◽  
Patient Comfort ◽  
Limited Data ◽  
Levels Of Care ◽  
Medical Treatment Facility ◽  
Comfort Levels ◽  
Treatment Facilities ◽  
United States Healthcare

Introduction: The cumulative burden of coronavirus disease 2019 (COVID-19) on the United States’ healthcare system is substantial. To help mitigate this burden, novel solutions including telehealth and dedicated screening facilities have been used. However, there is limited data on the efficacy of such models and none assessing patient comfort levels with these changes in healthcare delivery. The aim of our study was to evaluate patients’ perceptions of a drive-through medical treatment system in the setting of the COVID-19 pandemic. Method: Patients presenting to a drive-through COVID-19 medical treatment facility were surveyed about their experience following their visit. An anonymous questionnaire consisting of five questions, using a five-point Likert scale was distributed via electronic tablet. Results: We obtained 827 responses over two months. Three quarters of respondents believed care received was similar to that in a traditional emergency department (ED). Overall positive impression of the drive-through was 86.6%, and 95% believed that it was more convenient. Conclusion: Overall, the drive-through medical system was perceived as more convenient than the ED and was viewed as a positive experience. While representing a dramatic change in the delivery model of medical care, if such systems can provide comparable levels of care, they may be a viable option for sustained and surge healthcare delivery.

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