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  1. Freestanding EDs Offer Alternative Patient Destinations - Journal of Emergency Medical Services

    Subscribe | Newsletters | Advertise | Contact Us             Journal Supplements Subscribe Jobs Featured Jobs Search Jobs Post A Job Products Buyer's Guide Product Reviews Hot Products Hot Products Submissions Product Announcements Product Videos Webcasts White Papers Videos Ask the Expert Education & Training EMS 10 Interviews EMS Today Fitness JEMS Games Product Spotlight Home About Us Advertise Contact Us Our Team Authors Community Submit A Press Release News Patient Care Airway & Respiratory Cardiac & Resuscitation Trauma Administration & Leadership Communications & Dispatch Documentation & Patient Care Reporting Training Operations Ambulance & Vehicle Ops Equipment & Gear Rescue & Vehicle Extrication Major Incidents Mass Casualty Incidents Terrorism & Active Shooter Mobile Integrated Healthcare   Home About Us Advertise Contact Us Our Team Authors Community Submit A Press Release News Patient Care Airway & Respiratory Cardiac & Resuscitation Trauma Administration & Leadership Communications & Dispatch Documentation & Patient Care Reporting Training Operations Ambulance & Vehicle Ops Equipment & Gear Rescue & Vehicle Extrication Major Incidents Mass Casualty Incidents Terrorism & Active Shooter Mobile Integrated Healthcare Home Administration & Leadership Freestanding EDs Offer Alternative Patient Destinations Freestanding EDs Offer Alternative Patient Destinations Providers are increasingly recognizing freestanding EDs as approved transport destinations Mon, Nov 23, 2015 By Mark E.A. Escott, MD, MPH, FACEP Freestanding EDs (FSEDs) have entered the emergency healthcare arena in many states. With the development of these community-based EDs have come questions regarding their appropriate use by EMS providers in regards to routine use, community surge capacity and disaster preparedness. While initially shunned by hospitals and EMS services due to concerns regarding decreased revenue for hospitals and potential lack of reimbursement for transport, we’re starting to see increasing numbers of providers recognizing FSEDs as approved transport locations . STRIP MALL ED? After returning to the Houston area after working in Pennsylvania, I noticed an “emergency room” neon sign in a local shopping center. Of course, as a “real” ED doctor at the regional trauma center, I had a few choice words and thoughts about the concept. I was quite vocal about this one day with a colleague and said things about “doc in the box” and “fake EDs,” and then he kindly let me know he was also working at that shopping center ED by my house. Oops! He also told me about its CT scanner, X-rays, labs and board-certified emergency medicine physicians, and suggested I drop by to check it out. I was seduced! The doctors and nurses working there were the same ones working in the big EDs. The equipment was nice, facilities were clean and people were happy. I was so impressed that I started working at one as a side job because it was close to my house. Three years later, I still work in FSEDs. [Native Advertisement] QUESTIONS OF QUALITY You may wonder what the allure is. Is it the nice artwork or free coffee? I think it has more to do with the fact that in a very busy world, you don’t need an appointment; there’s rarely any time spent in a waiting room; you see a specialist; get your labs, scans, meds and diagnosis; and still make it home in time to catch the game. It’s a consumer-driven industry that recognizes in a busy world, high quality and efficiency are a powerful combination. The problem, of course, is the quality question. There are varying requirements across the states with these facilities regarding the staffing, facility requirements and equipment. There may be some FSEDs that exceed the minimum requirements and have physicians who are board certified in emergency medicine or with decades of experience working in EDs. These higher-level FSEDs sometimes also have video laryngoscopy capabilities, a tissue plasminogen activator, LUCAS 2 devices, and other equipment that’s indicative of a high-functioning ED. Other facilities meet the bare minimum requirements, which in Texas include one year of experience working in an ED setting for physicians. Therefore, an allergist who works occasionally in an ED could be the only physician on duty when a critical patient is rolled in the door. The solution is to know the details about the FSEDs in your territory and make an informed decision about their role in your system. Some have proposed “leveling” of FSEDs so that state or regional agencies can develop standards to help patients and EMS providers identify high-functioning FSEDs. These levels should not only be indicative of capabilities, but, like the leveling of trauma centers, should be based upon outcomes as well. A system I recently worked for was evaluating EMS transport to FSEDs after long turnaround times for ambulances at the hospitals and call surges resulted in low numbers of ambulances in service. It doesn’t make sense for us to continue to ignore the importance of FSEDs, particularly as it relates to surge capacity. We may find some FSEDs are utilized regularly to receive ambulance traffic due to patient request or limited resources. Other areas may utilize them only in times of call surge, hospital ED overcrowding or only in disaster planning for untapped surge capacity. CONCLUSION Regardless of how people feel about FSEDs, EMS servicers must make an informed decision about how to utilize these facilities in their routine and surge response planning. We have to appreciate that patients like these facilities because of the personal service they provide. When the 9-1-1 system ignores these facilities, patients choose to drive themselves to the FSED rather than take the ambulance to the hospital. I’ve taken care of patients with tension pneumothorax, ST elevation myocardial infarctions, strokes and other major traumas who’ve delivered themselves to the FSED either because they were close or because the ambulance refused to take them there. It’s time to create engaged partnerships so that our patients can benefit from the rapid response of 9-1-1 but also be free to go to a facility of their choice, including FSED More Leadership & Professionalism from JEMS.com. By Mark E.A. Escott, MD, MPH, FACEP Mark E.A. Escott, MD, MPH, FACEP, is the medical director/founder of Rice University EMS. He’s the founder/director of the Baylor College of Medicine EMS Collaborative Research Group, where he’s also the director of the Division of EMS and Disaster Medicine and an assistant professor in the Section of Emergency Medicine. He’s Montgomery County’s public health authority and is board certified in emergency medicine and subspecialty board certified in EMS. Sponsored Content is made possible by our sponsor; it does not necessarily reflect the views of our editorial staff. Journal Archives Prev 2016 2015 2014 2013 2012 2011 Next Feb 2016 Volume 41 Issue 2 Jan 2016 Volume 41 Issue 1 Prev 2016 2015 2014 2013 2012 2011 Next Copyright © 2016: PennWell Corporation, Tulsa, OK. All Rights Reserved. UTILITY Home About Us Contact Us Terms of Use Subscribe Advertise Submit a Press Release RSS Feeds Privacy Policy Topics News Patient Care Leadership Training Major Incidents Mobile Integrated Healthcare Operations Sections Authors Columns Community Jobs Journal Products Supplements Webcasts

    Magazine Articles

    Magazine Articles

    Mon, 23 Nov 2015

  2. PCRF 2015 Clinical Abstracts - Journal of Emergency Medical Services

    Abstracts may be downloaded as a single PDF using the link below. 2015 Clinical Abstracts (PDF) 187 KB

    Article

    Article

    Tue, 6 Oct 2015

  3. Prehospital Ramifications of Butane Hash Oil Synthesis and Use - Journal of Emergency Medical Services

    Find out about this dangerous new form of marijuana that’s not only harmful to smoke, but also incredibly dangerous to synthesize.

    Magazine Articles

    Magazine Articles

    Fri, 4 Sep 2015

  4. Recognizing and Treating Injuries Caused by SCUBA Diving - Journal of Emergency Medical Services

    EMS providers may be called to assess diving-related injuries that occurred far from their service area, making it important for the provider to recognize these injuries and make the correct triage and transport decisions.

    Magazine Articles

    Magazine Articles

    Mon, 17 Aug 2015

  1. Hands On Product Reviews August 2015 - Journal of Emergency Medical Services

    Magazine Articles

    Magazine Articles

    Mon, 10 Aug 2015

  2. A Great Training Minute: Tension Pneumothorax and Needle Thoracostomy - Journal of Emergency Medical Services

    A GREAT TRAINING MINUTE - From A.J. Heightman, JEMS Editor-in-Chief & Fran Hildwine / JEMS Contributor.

    Online Articles

    Online Articles

    Tue, 7 Jul 2015

  3. FDNY Kicks of EMS Week with Annual Medical Special Ops Conference - Journal of Emergency Medical Services

    Conference will offer workshops, lectures, panel discussions, hands-on skills opportunities and a vendor area.

    Magazine Articles

    Magazine Articles

    Mon, 6 Apr 2015

  4. FDNY Kicks of EMS Week with Annual Medical Special Ops Conference - Journal of Emergency Medical Services

    In an ongoing effort to advance the knowledge and skills of emergency medical special operations personnel, the New York City Fire Department (FDNY), in partnership with the FDNY Foundation, invites first responders to attend the third annual Medical Special Operations Conference (MSOC) to kick off ...

    Online Articles

    Online Articles

    Fri, 20 Feb 2015

  5. FDNY Kicks of EMS Week with Annual Medical Special Ops Conference - Journal of Emergency Medical Services

    In an ongoing effort to advance the knowledge and skills of emergency medical special operations personnel, the New York City Fire Department (FDNY), in partnership with the FDNY Foundation, invites first responders to attend the third annual Medical Special Operations Conference (MSOC) to kick off ...

    Online Articles

    Online Articles

    Fri, 20 Feb 2015

  6. FDNY Kicks of EMS Week with Annual Medical Special Ops Conference - Journal of Emergency Medical Services

    In an ongoing effort to advance the knowledge and skills of emergency medical special operations personnel, the New York City Fire Department (FDNY), in partnership with the FDNY Foundation, invites first responders to attend the third annual Medical Special Operations Conference (MSOC) to kick off ...

    Online Articles

    Online Articles

    Fri, 20 Feb 2015

  7. Respiratory Impedance in the Hypotensive Breathing Patient - Journal of Emergency Medical Services

    Hypotension is a common clinical problem that has plagued individuals suffering from reduced central blood volume, such as hemorrhage due to trauma, cardiovascular failure, infection, dehydration and anaphylaxis. Although each process affects the cardiovascular system somewhat differently, ...

    Article

    Article

    Fri, 21 Nov 2014

  8. Respiratory Impedance in the Hypotensive Breathing Patient - Journal of Emergency Medical Services

    Hypotension is a common clinical problem that has plagued individuals suffering from reduced central blood volume, such as hemorrhage due to trauma, cardiovascular failure, infection, dehydration and anaphylaxis. Although each process affects the cardiovascular system somewhat differently, ...

    Online Articles

    Online Articles

    Fri, 21 Nov 2014

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