DCHAS-L Archives, Apr 12 2012 - Re: [DCHAS-L] Academic Medical Policy Question

All,

There is always a cost to SOMEBODY when EMS/ED services are requested and used. The question is "to whom?" On some campuses, students may opt to have health insurance coverage through the campus. Some my have their own private insurance, etc. The College/University may pick up the tab. The local taxpayers may pick up the tab. There's always that part of Murphy's Law that says: "Whatever they're talkiing about; they're talking about money."

What an old ED physician will tell you is that under COBRA law, any patient presenting to any emergency department must be screened to see if there is a true emergency (including impending childbirth) present and that no patient can be turned away without that screening. Now it just plain makes medical and ethical sense that if it's something you can treat there, you just go ahead and do it and let the bloody billing department figure it out (and eat the cost if it isn't paid). Naturally, there's a limit to that and that's way certain facilites have closed their doors.

Maybe academic facilities might think about this beforehand and let their risk management and whoever departments make suitable arrangements with the nearby healthcare facilites so that the best student/patient outcomes can be assurred? Nobody would be hurt by rational planning and forethought. Students would obviously benefit if we can't generate the Academic Safety Culture we all wish for.

Alan
Alan H. Hall, M.D.
Medical Toxicologist
20 years Board-Certified Emergency Physician
ahalltoxic**At_Symbol_Here**msn.com

Date: Thu, 12 Apr 2012 17:41:59 -0400
From: r.calhoun**At_Symbol_Here**MOREHEADSTATE.EDU
Subject: Re: [DCHAS-L] Academic Medical Policy Question
To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU

One thing I noticed was that Heather said there was no cost to the student if they go to the ER or see a doctor. I don't think that is the case here. Is this the case at other Universities and Colleges? Does the school pick up the tab for an ambulance and ER visit?

Kay

From: DCHAS-L Discussion List [mailto:dchas-l**At_Symbol_Here**MED.CORNELL.EDU] On Behalf Of Heather McCollor
Sent: Thursday, April 12, 2012 3:01 PM
To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU
Subject: Re: [DCHAS-L] Academic Medical Policy Question

On our campus we have a very small health center that is only for students (not staff) and does not have doctors on staff. It mostly deals with STDs and minor health issues as well as mental health. The staff there is booked solid and do not have time to leave their office or even to squeeze somebody in if they were walked over there.

We do have some staff trained in first response in the athletic department as well as security. Our policy is to call 911 and security. Any chemical exposure should have an MSDS sent with the victim in the ambulance (sirens or not). We are fortunate enough to have a Trauma I hospital and a toxicology department within 10 miles of us. Always call the hospital ER to alert them that a chemical exposure case will be arriving so they can summon the proper staff (toxicologist on call) and equipment. They will also need to know if decontamination (clothing) is necessary or if radiation is involved.

Do not let anybody transport the victim in a personal car. What if the victim passes out, gets into a panic, starts screaming? What if the driver gets in a car accident? It is best to call 911 and let the EMTs transport (even if it embarrasses the victim). My philosophy is I would rather embarrass the victim than to embarrass myself and employer by not responding with appropriate follow-up care. I cannot afford to lose my job or be the topic of bad press either.

Do not do what the student wants you to do (write it off as a minor incident) but do what that student's mother expects you to do...get it checked out and OK'ed by a doctor immediately, not tomorrow or the week after it becomes a serious health issue.

The incident report must be filed within 24 hours and would look awful if there were no follow up because the student was too embarrassed to get things checked by a professional at no cost to them. How can we claim we have a safety culture and then let the student decide whether they want to go see a doctor or not. Logic should rule, not emotion.

Heather
--
Heather McCollor
Laboratory Materials Supervisor
Macalester College
1600 Grand Ave
St Paul, MN 55105
651-696-6484

NAOSMM president July 2011-July 2013

On Thu, Apr 12, 2012 at 11:34 AM, Humphrey, Karalyn J. <Karalyn_Humphrey**At_Symbol_Here**baylor.edu> wrote:

Hello,

My university is currently involved in discussions concerning how to medically respond to chemical exposures. Our health center is currently only for routine illness and injury among students. On one hand we have the opinion that the best course of action is to do what we can (remove and rinse if appropriate) and call the EMTs. On the other hand, we have the opinion that the health center should become more robust or that we should either hire trained emergency personnel or train all our personnel to be emergency personnel.

I wanted to poll the academic members and see (1) what role does your campus health center play; (2) what role do your lab personnel play; and (3) who are your emergency responders?

What I have been able to find online all seems to point to a policy of lab people rendering basic first aid and calling the EMTs.

Right now our policy has become to bypass the student health center, since they are not equipped to handle chemical exposures, and call the EMTs. This is raising concern among our lab personnel, who consistently have the question of what is minor that we can deal with ourselves and what is major enough to call an ambulance. The university stance is "when in doubt, call", but the personnel seem to want more guidance. The problem is that every chemical exposure is different because every chemical is different, so we really can't provide hard and fast guidelines.

Thanks in advance,

Dr. Karalyn (Karen) Humphrey

Laboratory Coordinator, Department Safety Officer & Part-Time Lecturer

Baylor University Department of Chemistry & Biochemistry

Office: BSB E.111

Phone: 254-710-2002

"Vast worlds lie within the hollows of each atom, multifarious as the motes in a sunbeam." ~Yoga Vasishtha

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