Western Journal of Emergency Medicine最新文献

{"title":"Developing Machine-Learning Models to Predict Bacteremia in Febrile Adults Presenting to the Emergency Department: A Retrospective Cohort Study from a Large Center.","authors":"Chia-Ming Fu, Ike Ngo, Pak Sheung Lau, Yaroslav Ivanchuk, Fan-Ya Chou, Chih-Hung Wang, Chien-Yu Lin, Chu-Lin Tsai, Shey-Ying Chen, Tsung-Chien Lu, Hung-Yu Wei","doi":"10.5811/westjem.35866","DOIUrl":"10.5811/westjem.35866","url":null,"abstract":"<p><strong>Introduction: </strong>Bacteremia, a common disease but difficult to diagnose early, may result in significant morbidity and mortality without prompt treatment. We aimed to develop machine-learning (ML) algorithms to predict patients with bacteremia from febrile patients presenting to the emergency department (ED) using data that is readily available at the triage.</p><p><strong>Methods: </strong>We included all adult patients (≥18 years of age) who presented to the emergency department (ED) of National Taiwan University Hospital (NTUH), a tertiary teaching hospital in Taiwan, with the chief complaint of fever or measured body temperature more than 38°C, and who received at least one blood culture during the ED encounter. We extracted data from the Integrated Medical Database of NTUH from 2009-2018.The dataset included patient demographics, triage details, symptoms, and medical history. The positive blood culture result of at least one potential pathogen was defined as bacteremia and used as the binary classification label. We split the dataset into training/validation and testing sets (60-to-40 ratio) and trained five supervised ML models using K-fold cross-validation. The model performance was evaluated using the area under the receiver operating characteristic curve (AUC) in the testing set.</p><p><strong>Results: </strong>We included 80,201 cases in this study. Of them, 48120 cases were assigned to the training/validation set and 32,081 to the testing set. Bacteremia was identified in 5,831 (12.1%) and 3,824 (11.9%) cases of the training/validation set and test set, respectively. All ML models performed well, with CatBoost achieving the highest AUC (.844, 95% confidence interval [CI] .837-.850), followed by extreme gradient boosting (.843, 95% CI .836-.849), gradient boosting (.842, 95% CI .836-.849), light gradient boosting machine (.841, 95% CI .834-.847), and random forest (.828, 95% CI .821-.834).</p><p><strong>Conclusion: </strong>Our machine-learning model has shown excellent discriminatory performance to predict bacteremia based only on clinical features at ED triage. It has the potential to improve care quality and save more lives if successfully implemented in the ED.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"617-626"},"PeriodicalIF":1.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Efficiency: Considering the Benefits of Residents in the Emergency Department.","authors":"Rachel Elizabeth Armstrong","doi":"10.5811/westjem.38598","DOIUrl":"10.5811/westjem.38598","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"761"},"PeriodicalIF":1.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Efficiency: Considering the Benefits of Residents in the Emergency Department.","authors":"Jake Valentine, Johnathan Poulson","doi":"10.5811/westjem.41505","DOIUrl":"10.5811/westjem.41505","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"762"},"PeriodicalIF":1.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Prehospital Time Among Pediatric Poisoning Patients in Rural and Urban Settings.","authors":"Aaron T Phillips, Michael Denning, Em Long-Mills, Dmitry Tumin, Jennifer Parker-Cote, Kathleen Bryant","doi":"10.5811/westjem.33507","DOIUrl":"10.5811/westjem.33507","url":null,"abstract":"<p><strong>Objectives: </strong>Barriers to healthcare in rural areas can delay treatment in pediatric patients who have experienced poisoning. We compared emergency medical services (EMS) response times and EMS-reported delays in responding to pediatric poisoning incidents between rural and urban settings using the 2021 National Emergency Medical Services Information System (NEMSIS).</p><p><strong>Methods: </strong>The NEMESIS defines rural areas as locations with a population of <50,000, not part of metropolitan areas, while all other locations are classified as urban (metropolitan) areas. In this study we included 11,911 patients (12% rural) <18 years of age who were transported by EMS with a first-responder primary impression of poisoning. We compared study variables using rank-sum tests and chi-square tests. Multivariable analysis of outcomes included quantile regression and logistic regression for continuous data and categorical data, respectively.</p><p><strong>Results: </strong>The median total prehospital time by EMS was 40 minutes (interquartile range 29-57), and the most common type of delay was scene delay (6%). On multivariable quantile regression, patients transported by rural EMS agencies experienced 6.6 minutes (95% confidence interval 5-8, P<0.001) longer prehospital time than those transported by urban agencies. There were no differences between rural and urban EMS agencies in the occurrence of dispatch, response, scene, and transportation delays.</p><p><strong>Conclusion: </strong>These results elucidate the need for equitable allocation of resources and training to enhance rural EMS responders. The additional nearly seven minutes translates into greater risk for the human body to remain physiologically unstable and not be optimally treated. Therefore, by integrating targeted interventions to rural pediatric populations, better care can be achieved across all geographic regions. Further research must be conducted to ascertain the specific factors, aside from delays, that result in the disparity between rural and urban prehospital response time.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"650-656"},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive Monitor of Effective Chest Compressions with Carotid and Femoral Artery Ultrasound in the Emergency Department.","authors":"Feihong Yang, Hao Zou, Jiaohong Gan, Xia Zhao, Xiaopeng Tu, Cheng Jiang, Jian Xia","doi":"10.5811/westjem.36710","DOIUrl":"10.5811/westjem.36710","url":null,"abstract":"<p><strong>Background: </strong>End-tidal carbon dioxide (EtCO₂) has been regarded as the gold standard for assessing the effectiveness of cardiopulmonary resuscitation (CPR). However, the clinically observed limitations of EtCO₂ influenced by ventilation during CPR suggest the need to implement a new, non-invasive hemodynamic monitoring method to evaluate and optimize CPR effectiveness in real time.</p><p><strong>Methods: </strong>For this prospective study we enrolled 31 cardiac arrest (CA) patients who presented to the emergency department (ED) and 13 healthy volunteers as point-of-care ultrasound (POCUS) controls. Two physicians not involved in the resuscitation team performed POCUS of the bilateral carotid and femoral arteries during chest compression within the first 10 minutes of CPR. The clinical data and presumed CA cause were recorded. We observed the arterial pulse and measured the peak systolic velocity (PSV). The EtCO₂ values during POCUS were also recorded. We explored the correlation between arterial PSV and EtCO₂.</p><p><strong>Results: </strong>The mean age of the patients was 69 ± 2 years, and 22 were male. Of 25 patients who experienced out-of-hospital cardiac arrest, 18 had an average no/low-flow time >30 minutes before ED arrival. Five patients achieved return of spontaneous circulation (ROSC). We found no significant difference in arterial PSV between ROSC and non-ROSC patients. The PSV of the left femoral artery was most consistently and positively correlated with EtCO₂ in CA patients (R² 0.35, P=0.003).</p><p><strong>Conclusion: </strong>Detection of arterial peak systolic velocity by point-of-care ultrasound, especially of the left femoral artery, might be a feasible method for non-invasive, real-time monitoring of chest compression effectiveness during CPR.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"491-499"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time Ultrasound-guided Lumbar Puncture: A Comparison of Two Techniques Using Simulation.","authors":"Kara Samsel, David Wasiak, Elaine Situ-LaCasse, Srikar Adhikari, Josie Acuña","doi":"10.5811/westjem.21163","DOIUrl":"10.5811/westjem.21163","url":null,"abstract":"<p><strong>Introduction: </strong>The current literature on the use of real-time ultrasound-guidance for lumbar punctures (LP) is limited. Two techniques have been described: the paramedian sagittal oblique (PSO); and the transverse interlaminar (TL) approach. Our objectives in this study were to compare the procedure outcomes between these two techniques and assess the ability of emergency physicians to perform ultrasound-guided LPs.</p><p><strong>Methods: </strong>This was a prospective study whose participants included emergency physicians. Participants were randomized into either Group P (PSO technique) or Group T (TL technique). After a didactic session, participants then performed an ultrasound-guided LP on a training manikin, during which we collected procedure data. A survey was administered after completion of the procedure.</p><p><strong>Results: </strong>A total of 31 participants were included, 16 in Group P and 15 in Group T. Most participants (90.3%) successfully performed the procedure, without a statistical difference between Group P and Group T (15/16 vs 13/15, P = 0.95). Group T required a longer average time to complete the procedure (176.7 ± 140.4 seconds [s] vs 311.2 ± 202.3 s, P = 0.04). There was no statistically significant difference between Group P and Group T with regard to average time needed to obtain the required ultrasound view (18.3 ± 14.6 s vs 35.1 ± 32.9 s, P = 0.09); number of needle redirections; total number of needle passes; first puncture success; number of participants who advanced the needle without visualization of the tip (13/16 vs 14/15, P = 0.64); penetration of the anterior dura; and needle contact with bone. The Likert-style questionnaire responses (reported on a 1-10 scale) revealed no difference between Group P and Group T as to perceived difficulty of finding the required ultrasound view (3 [interquartile range (IQR) 2-5) vs 5 (IQR 3-6.5), P = 0.10), perceived difficulty of needle tracking, or rating of the needle view when entering the intrathecal space. However, Group T reported a higher overall perceived level of difficulty (4 [IQR 3-5] vs 6 (IQR 5.5-7.5), P= 0.01).</p><p><strong>Conclusion: </strong>This study suggests emergency physicians can be trained to use ultrasound-guidance for lumbar puncture in the simulation setting without significantly prohibitive training. Both techniques were performed with high success rates. There may be a preference for implementing the paramedian sagittal oblique approach over the transverse interlaminar.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"737-742"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Artery Bypass Grafting Is Rarely Done in the Acute Care of ST-elevation Myocardial Infarction Patients Treated by Emergency Medical Services.","authors":"Jake Toy, Caroline Lauer, Amy H Kaji, Joseph L Thomas, Nichelle Megowan, Nichole Bosson, Marianne Gausche-Hill, Puneet Dhawan, Robert A Kloner, Sara Rasnake, William French, Shira Schlesinger","doi":"10.5811/westjem.35271","DOIUrl":"10.5811/westjem.35271","url":null,"abstract":"<p><strong>Introduction: </strong>The use of coronary artery bypass grafting (CABG) for primary revascularization during the acute care of ST-elevation myocardial infarction (STEMI) patients has declined significantly in the past decade; but there is little data to determine whether there has been a change in the use of CABG for STEMI patients treated by emergency medical services (EMS). In this study we described the incidence of urgent or emergent CABG for STEMI patients treated in a large, regionalized cardiac care system.</p><p><strong>Methods: </strong>We obtained data obtained for patients transported by EMS between January 2011-December 2022 who were diagnosed with acute STEMI on prehospital or emergency department (ED) electrocardiogram and taken for primary diagnostic catheterization. All STEMI patients were transported by EMS to one of 34 STEMI receiving centers (SRC) in a regionalized cardiac care system, all of which are required to maintain onsite cardiac surgery as a condition of their SRC designation. Patients were considered to have undergone urgent or emergent CABG if it was performed within 72 hours of the primary diagnostic cardiac catheterization. We excluded patients if no diagnostic catheterization was performed or if CABG was performed >72 hours after diagnostic catheterization. The primary outcome was the incidence of urgent or emergent CABG. Patients were further stratified by time between diagnostic catheterization and CABG (<24 hours, 24-48 hours, 48-72 hours).</p><p><strong>Results: </strong>A total of 28,349 patients were transported by EMS and diagnosed with an acute STEMI during the study period. Only 384 (1.35%) patients underwent CABG within 72 hours of diagnostic catheterization: 268 (0.95%) underwent CABG in <24 hours; 71 (0.25%) in 24-48 hours, and 45 (0.16%) in 48-72 hours. The median age of patients undergoing CABG was 64 years (interquartile range 58-72). Twenty-eight (7.3%) experienced prehospital cardiac arrest, and eight (2.1%) required vasopressors. Prior to undergoing CABG, 137 patients (36%) underwent primary percutaneous coronary intervention. The proportion of patients undergoing CABG within 72 hours remained relatively stable between 2011-2022 at 1.19% and 1.96%, respectively.</p><p><strong>Conclusion: </strong>Urgent or emergent CABG remained infrequently performed for acute STEMI patients after primary diagnostic catheterization. There was little change in the percentage of STEMI patients who received CABG within 72 hours of diagnostic catheterization over the past decade. These findings suggest that regional or local policies requiring on-site cardiac surgery at SRCs may be reconsidered.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"729-736"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a Methodology to Investigate Care Inequities for Transgender Patients.","authors":"Kellyn Engstrom, Fernanda Bellolio, Molly Moore Jeffery, Sara C Sutherland, Kayla P Carpenter, Gia Jackson, Kristin Cole, Victor Chedid, Caroline J Davidge-Pitts, Kharmene L Sunga, Cesar Gonzalez, Caitlin S Brown","doi":"10.5811/westjem.21279","DOIUrl":"10.5811/westjem.21279","url":null,"abstract":"<p><strong>Introduction: </strong>Pain is a common chief complaint in the emergency department (ED), and there are known disparities in the management of pain among racial/ethnic minorities, women, and older adults. Transgender and gender diverse (TGD) individuals comprise another under-represented patient population in emergency medicine and are also at risk of disparities in care. To measure and evaluate the magnitude of care inequities among TGD individuals, first we need to be able to accurately identify the right cohort and comparison groups. The primary objective of this study was to establish an accurate and generalizable process for identifying TGD patients through the electronic health record (EHR). Secondary objectives included creating and validating a method for matching and comparing of TGD patients to cisgender patients.</p><p><strong>Methods: </strong>This was a retrospective, observational cohort study that included patients presenting to Mayo Clinic EDs with a chief complaint of abdominal pain across four states (MN, WI, AZ, FL) between July 1, 2018-November 15, 2022. Patients ≥12 years of age were included. Patients' sex assigned at birth and gender identity was extracted from the EHR via patient-provided registration fields. Two independent investigators independently reviewed each medical record of the identified TGD patient to validate the accuracy of pulled gender identity. Discrepancies were resolved by a third reviewer. Each transgender patient was matched to cisgender GBQ males (gay, bisexual, queer), cisgender LBQ (lesbian, bisexual, queer) females, cisgender heterosexual males, and cisgender heterosexual females using propensity score (PS) matching. We calculated the PS values using a multivariable logistic regression model where being transgender was the outcome, and covariates in the model included age, site, mental health history, and gastrointestinal history.</p><p><strong>Results: </strong>We initially identified 300 patients as TGD based on electronic data pull. An additional 1,000 patients were also included in the cohort for matching purposes. The agreement between electronic and manual review was 99.9%, and the kappa was 0.998 (95% confidence interval 0.994-1.000). We were able to match patients except for GBQ males due to low numbers. There is a significant difference in age between groups (P <0.001) with GBQ males being older than other groups.</p><p><strong>Conclusion: </strong>The methodology for identifying transgender and gender diverse patients in the EHR was accurate compared to manual review of gender identity. The TGD patients were able to be well matched, except to GBQ males. This provides a validated method to identify TGD patients in the EHR and further study disparities they may receive in care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"425-430"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Heat Index and Patient Presentation Rate at a Stadium.","authors":"Jennifer Wolin, Daniel Wolf, John Su, Eric Quinn, David Eng, Humaira Ali, David Lobel, Matt Friedman","doi":"10.5811/westjem.21222","DOIUrl":"10.5811/westjem.21222","url":null,"abstract":"<p><strong>Introduction: </strong>A mass gathering is defined as an event that has the potential to strain the resources of the local health system. An onsite physician for mass gatherings can mitigate the strain on the local health infrastructure. One factor affecting onsite medical usage and patient presentation rates is the heat index, which is a calculated value of perceived heat exposure that combines air temperature and relative humidity. In this study we asked whether there was a positive association between heat index and patient presentation rates for onsite medical care at a bounded (large event in an enclosed location) professional stadium sporting event. We hypothesized that a positive correlation exists between these two variables and assess whether it might surpass current onsite resources.</p><p><strong>Methods: </strong>We performed a prospective observational study with patients seeking medical care at a baseball stadium in a large northeastern city in the United States. The onsite physician collected information on patients who presented during games held at the stadium. Data on game attendance, temperature in degrees Fahrenheit (F), humidity, and heat index were collected using government and professional organization websites. We assessed the correlation between heat index and patient presentation rate with the Pearson product-moment correlation (PPMC) per 100,000 attendees at the game.</p><p><strong>Results: </strong>A total of 81 baseball games occurred at the studied stadium from April-September 2023, with eight games excluded due to incomplete data. The heat index ranged from 46°F to 91°F, with a mean (± SD) of 70.8°F (± 10.4°F). The number of patients varied from 0-5 per game, with a mean of 1.92 (± 1.13), and stadium attendance ranged from 25,007 to 47,295, with a mean of 40,824. The patient presentation rate per 100,000 in attendance was 5.04 (± 2.13). The PPMC was calculated to be 0.37 (P < .01), indicating a positive correlation between heat index and patient presentation rates. The most common reasons for seeking medical care were lightheadedness and musculoskeletal complaints.</p><p><strong>Conclusion: </strong>In this study we found that the heat index was moderately associated with higher patient presentation rates at bounded mass gathering baseball events. No additional resources were needed, but this correlation could aid future event medical planning efforts as the climate continues to evolve.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"667-673"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Civil Monetary Penalties from Violations of the Emergency Medical Treatment and Labor Act for Patients Arriving or Leaving with Law Enforcement.","authors":"Sameer Ahmed, Zach Reichert, Genevieve Santillanes, Carmen Toomer, Sandra Tyler-Mills, Neha Vontela, Jasmine Hsia, Sarah Axeen, Saman Kashani, Joe Nakagawa, Michael Menchine, Sophie Terp","doi":"10.5811/westjem.39677","DOIUrl":"10.5811/westjem.39677","url":null,"abstract":"<p><strong>Introduction: </strong>The Emergency Medical Treatment and Labor Act (EMTALA), a federal law enacted in 1986, is intended to prevent inadequate, delayed, or denied treatment of emergency medical or emergency psychiatric conditions by Medicare-participating hospitals when individuals present to dedicated emergency departments (EDs). EMTALA requires all patients seeking evaluation for an emergency medical condition (EMC) at a dedicated ED to have an appropriate medical screening exam (MSE), stabilization of identified EMCs, and an appropriate transfer if specialized services are needed for stabilization.</p><p><strong>Methods: </strong>We obtained summaries of all EMTALA-related civil monetary penalties (CMPs) between 2002-2023 from the Office of the Inspector General (OIG) and reviewed them for instances where patients arrived or departed with law enforcement officers (LEOs). In this article, we describe the characteristics of these CMPs.</p><p><strong>Results: </strong>Of 260 EMTALA-related CMPs, 15 (5.8%) were identified as having involved patients arriving to or departing from an ED with LEOs. Among these, nine (60%) involved patients arriving to the ED with LEOs, of whom five (55.6%) were transported to alternate facilities by LEOs at the direction of ED staff without receipt of an appropriate MSE. Overall, eight (88.9%) of nine patients arriving with LEOs involved psychiatric concerns. Four cases were identified as having involved patients discharged from but not arriving to the ED with LEOs. Of these, two involved patients brought to the ED for evaluation of psychiatric conditions and discharged to jail without appropriate MSE after becoming disruptive. Two involved patients with psychiatric issues sent to jail without appropriate MSE/stabilization, some due to hospital policies pertaining to alcohol intoxication. Two involved patients without noted psychiatric concerns escorted from the ED with the assistance of LEOs after reported to be \"resistant\" or \"aggressive.\" One returned to the ED in cardiac arrest, and another was subsequently diagnosed with bacterial meningitis.</p><p><strong>Conclusion: </strong>Overall, 5.8% of EMTALA-related CMPs involved patients arriving to or departing from the ED with LEOs; most of these involved patients with psychiatric emergencies. In many cases, LEOs were advised to either transport patients to an alternate medical facility without an appropriate MSE, or disruptive or intoxicated patients with noted psychiatric concerns were discharged to jail without adequate MSE or stabilization. Findings indicate a need for education surrounding EMTALA requirements to provide MSEs and, if needed, stabilizing treatment prior to discharge or transfer for all patients presenting to the ED, regardless of LEO involvement.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"712-719"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}