describe war-like effort to save lives following terrorist attacks
A group of Paris doctors have offered a chilling account of how their
medical teams responded in the wake of the deadly attacks broke out across
Paris on Nov.13.
Published Tuesday in The Lancet, the report described “the civil
application of war medicine” as doctors focused on maintaining blood
pressure, ensuring consciousness, and treating victims with medication and
Paris’ public health system, the Assistance Publique-Hôpitaux de Paris (APHP),
mobilized 40 hospitals, nearly 100,000 staff members and 200 operating rooms
within minutes of the first attack.
Beginning just before 9:30 p.m. Paris time, three suicide bombers struck
near the Stade de France in Saint-Denis, followed by suicide bombings and
mass shootings at cafés and restaurants, and a hostage taking at the Bataclan
“Never before had such a number of victims been reached and so many wounded
been operated on urgently,” one of the author’s wrote.
The attackers killed 130 people, including 89 at the Bataclan theatre. More
than 360 people were injured, including more than 90 who were seriously
injured. Seven of the terrorists also died, and authorities continue to
search for a remaining fugitive believe to be in Brussels.
The accounts are written from the anonymous perspective of an emergency
physician, an anesthesiologist, and a trauma surgeon and detail how 45
medical teams were deployed to the six attack sites.
“15 were kept in reserve, since we did not know how and when this nightmare
would end,” the author wrote. Medical teams focused on treating patients at
the scene and controlling the “damage” as much as possible as most of the
injuries were bullet related. The need for tourniquets was so high that
medical teams came back without their belts, according to the report.
The report also noted the Paris public hospital system had been bracing for
a terrorist attack since January, when gunmen killed 12 people at the
offices of the satirical newspaper Charlie Hebdo.
The anesthesiologist said following the attacks that the number of patients
admitted to hospital was “far beyond” what any of the staff imagined they
Medical teams worked continuously through the night on the injured, and by
Nov. 15, the hospital’s usual services resumed.
A review by staff on Nov.16 found one common observation was that all but
one of the victims admitted to hospital were less than 40 years old and all
patients suffered from “high-energy ballistic trauma.”
“What happened strengthens our belief that size can be combined with speed
and excellence,” the authors said. “As terrorism becomes more lethal and
violent, nothing will prevent the medical community from understanding,
learning, and sharing knowledge to become more effective in saving lives.”
Visit Global News for the story.
How data can help
with hand hygiene compliance
In a 2012 study, Gojo measured the rate of hand washing at John Peter Smith
Hospital in Fort Worth, TX by pairing traffic-monitoring activity counters
with sensor-laden soap and sanitizer dispensers. These sensors were
installed in medical, surgery, and infectious disease units throughout the
hospital. The company later crunched the results via Microsoft Azure, the
company’s cloud computing service. The results were revealed last week at a
Microsoft event in New York City.
At the beginning of the study, the system collected baseline figures over 10
days, tabulating a hand washing compliance rate of 16.5%. That’s the
percentage of times that healthcare workers sanitized themselves versus how
many opportunities they had to do so.
Then, over the next 80 days, workers, patients, and even hospital visitors
were informed of the study, in the hopes that people would consciously
choose to scrub up as much as possible. Over that period, compliance rates
jumped to 31.7%. Over the final 50 days, a post-study assessment tracked how
much people cleaned up, even though they were no longer being reminded. It
seems the lesson stuck, because the compliance rate wound up at 25.8%.
The system was able to detect 90,000 handwashing opportunities, a number
that human auditors would have a hard time matching. Applied across more
hospitals, this could have a huge impact on sanitization in hospitals,
potentially reducing the number of infections. But even just in this one
instance, hand washing soared 92% during the study period. In human terms,
that means fewer infections — and quite possibly some lives saved.
Visit Time for the article.
releases compendium to help hospitals with alarm management goal
The AAMI Foundation has synthesized the knowledge, experience, and advice of
leading practitioners into a toolkit designed to help healthcare
organizations meet The Joint Commission’s National Patient Safety Goal on
Starting Jan.1, The Joint Commission will expect hospitals to establish and
implement policies and procedures for managing clinical alarms, as this is
when surveyors will start documenting noncompliance to the second phase of
“Noncompliance will be a direct finding, and the organization will have to
submit a plan for corrective actions. Noncompliance also will be posted on
Quality Check,” said Ronald Wyatt, MD, medical director of healthcare
improvement for The Joint Commission. The Quality Check website provides
detailed information about an organization’s performance and accreditation.
To assist in developing the necessary policies and procedures, the AAMI
Foundation’s complimentary Clinical Alarm Management Compendium provides
specific tips and outlines practices already being used by leading
In addition to outlining ways to implement these ideas, the compendium
provides a set of default alarm parameters that could be used to benchmark
alarm system settings. These parameters were developed from information
reported in a survey conducted by the AAMI Foundation, and they represent
responses from 17 of the 25 hospitals and healthcare system members of the
National Coalition for Alarm Management Safety.
To learn more about the best practices and comprehensive initiatives of
healthcare systems and hospitals featured in the compendium,
New CDC estimates
underscore the need to increase awareness of a daily pill that can prevent
A new Vital Signs report estimates that 25 percent of sexually active gay
and bisexual adult men, nearly 20 percent of adults who inject drugs, and
less than 1 percent of heterosexually active adults are at substantial risk
for HIV infection and should be counseled about PrEP, a daily pill for HIV
PrEP for HIV prevention was approved by the Food and Drug Administration in
2012. When taken daily, it can reduce the risk of sexually acquired HIV by
more than 90 percent. Daily PrEP can also reduce the risk of HIV infection
among people who inject drugs by more than 70 percent.
However, according to recent studies, some primary healthcare providers have
never heard of PrEP. Increasing awareness of PrEP and counseling for those
at substantial risk for HIV infection is critical to realizing the full
prevention potential of PrEP.
While PrEP can fill a critical gap in America’s prevention efforts, all
available HIV prevention strategies must be used to have the greatest impact
on the epidemic. These include treatment to suppress the virus among people
living with HIV; correct and consistent use of condoms; reducing risk
behaviors; and ensuring people who inject drugs have access to sterile
injection equipment from a reliable source.
PrEP is one of four focus areas in the July 2015 Update to the National
HIV/AIDS Prevention Strategy. Other key elements of the Strategy and CDC’s
high-impact prevention approach are:
Widespread HIV testing and linkage to care that enables early treatment;
Broad support for people living with HIV to remain engaged in comprehensive
care, including support for treatment adherence;
And universal viral suppression
CDC has published resources to educate and advise providers – including 2014
clinical guidelines, step-by-step PrEP checklists and interview guides – and
supports a hotline to answer providers’ questions about when and how to
Visit CDC for more information.
prescribing generic drugs often enough? This group says no
Doctors should more diligently prescribe generic medicines whenever
possible, both to help contain rising prescription drug costs and to improve
the chances that patients will adhere to their therapies, a top physicians
group said Monday.
Generic drugs now account for roughly 88 percent of prescriptions in the
United States, even though they amount to less than a third of the more than
$325 billion Americans spend each year on prescription drugs. But the
American College of Physicians says doctors should be using generics even
more often than they already do.
"While the use of generic drugs has increased over time, clinicians often
prescribe more expensive brand-name drugs when equally effective, well
proven and less expensive generic versions are available," Wayne J. Riley,
president of the American College of Physicians, said in a statement.
Researchers detailed several reasons in a paper published Monday in the
group's journal, Annals of Internal Medicine.
One key hurdle is that some patients -- and even some doctors -- perceive
lower-cost generic drugs as inferior and associate them with lower
effectiveness, despite evidence that most work just as well as their
brand-name counterparts. In addition, the report found many physicians still
refer to drugs by their original brand name, even long after generic
versions become available, which can result in them inadvertently
prescribing of more expensive drugs.
Some doctors also reported prescribing brand-name drugs rather than existing
generics because a patient requested it. "The likelihood of this behavior
was significantly higher for physicians who also reported that they received
industry-provided food and samples or who met with [brand name]
representatives," wrote the authors, who studied years of past research on
They said the consequence of such practices likely amounts to billions in
lost savings. For instance, they cited a study of Medicare beneficiaries
with diabetes, which found that 23 percent to 45 percent of prescriptions,
depending on drug class, involved brand-name drugs for which identical
generics existed. That rate was far higher than for similar patients treated
by the Veterans Affairs system, which has a centrally managed formulary that
encourages greater generic-drug use.
The recommendations come at a time when the high cost of prescription drugs
has become a topic of national interest. The Obama administration had an
all-day gathering on the topic last week, presidential candidates have
floated ideas of how to rein in high prices, and a Senate committee plans to
hold a hearing on the issue soon.
The authors of Monday's study excluded any evaluation of "biosimilars,"
which are copycat versions of complex biologic drugs. Only one biosimilar
drug has received approval in the United States -- a cancer treatment
approved earlier this year -- but the Food and Drug Administration has
received a growing number of biosimilar applications.
Visit the Washington Post for the story.
resistant to colistin discovered
Chinese scientists have reportedly identified a gene that makes
Enterobacteriaceae, a family of gram-negative bacteria, resistant to
“last-resort” drugs known as polymyxins. The polymyxins (colistin and
polymyxin B) were the last class of antibiotics in which resistance was
incapable of spreading from cell to cell. These have become known as “last
resort” antibiotics, increasingly used to treat infections that resist every
“Although now confined to China, MCR-1 is likely to emulate other resistance
genes… and spread worldwide”. This gene was found on a piece of bacterial
DNA that can be transferred between bacteria.
Should bacteria become completely resistant to treatment, it could plunge
the world into what the BBC refers to as “the antibiotic apocalypse”, a
period in which common infections could be fatal because medicine proves
ineffective, and surgeries and cancer treatments requiring antibiotic use
would be placed in jeopardy.
“These are extremely worryingly results”, said Liu Jian-Hua, a professor at
China’s Southern Agricultural University and co-author of the study. (It’s
encouraging that such a project exists.) They say they first perceived a
colistin-resistant E. coli in 2013, in a pig from an intensive farm
near Shanghai, and then noted increasing colistin resistance over several
This prompted the researchers to collect bacteria samples from pigs at
slaughterhouses across four provinces and from pork and chicken sold in 30
open markets and 27 supermarkets across Guangzhou between 2011 and 2014. On
further examination, the researchers also found mcr-1-containing plasmids in
E. coli and Klebsiella pneumoniae isolated from a small number
of patients in hospitals in Guangdong and Zhejiang provinces. The MCR-1 gene
was also found in E. coli collected from 78, or 15 percent of 523
samples of raw meat and 166 or 21 percent of 804 live animals.
Professor Laura Piddock, from the campaign group Antibiotic Action, said the
same antibiotics “should not be used in veterinary and human medicine“. So
the development of resistance to colistin may have affected the bacteria
discovered by the team in China in other ways – ways that are more harmful
to the bacteria than beneficial.
The World Health Organization (WHO) classified Colistin in 2012, as the most
broadly used polymyxin and the most important for human health.
The lower infection rate among humans suggests the resistant bacteria passed
from animals to people, the study found.
Worse still, MCR-1 enables the bacteria to spread easily from one strain or
species to another, according to the study by the researchers which was
published in the respected medical journal Lancet Infectious Diseases.
Chinese scientists identified bacteria in a position to shrug off the drug –
colistin – and livestock.
Visit Rapid News for the story.
U.S. system to
detect bioterrorism can't be counted on, government watchdog finds
The nation’s main defense against biological terrorism — a $1-billion
network of air samplers in cities across the country — cannot be counted on
to detect an attack, according to a new report by the Government
The BioWatch system, introduced with fanfare by President George W. Bush in
2003, has exasperated public health officials with numerous false alarms,
stemming from its inability to distinguish between harmless germs and the
lethal pathogens that terrorists would be likely to unleash in an attack.
Timothy M. Persons, the GAO’s chief scientist and lead author of the report,
said health and public-safety authorities "need to have assurance that when
the system indicates a possible attack, it’s not crying wolf." U.S. Homeland
Security officials cannot credibly offer that assurance, he said.
The Department of Homeland Security, which oversees BioWatch, has repeatedly
touted the system's effectiveness while seeking to upgrade it with new
The GAO report challenges the department's central claims about BioWatch. It
also illuminates the nation's vulnerability to biological terrorism at a
time of heightened concern about the reach and resourcefulness of Islamic
State and other extremist groups.
The 100-page document, scheduled for release Monday, says that Homeland
Security "lacks reliable information" about BioWatch's "technical
capabilities to detect a biological attack." The Los Angeles Times
obtained a copy of the report.
The government has never defined the minimum capabilities, or "performance
requirements," needed for BioWatch to alert authorities to a deliberate
release of deadly pathogens and not be fooled by similar but benign bugs
that are pervasive in the environment, according to the report.
BioWatch relies on about 600 air-collection units stationed atop buildings,
in transit stations and in other public places in more than 30 urban areas.
Mobile units are deployed at some major spectator events, such as the Super
Each of the units, about the size of a small refrigerator, sucks in air and
blows it over a disposable filter. Once every 24 hours, a technician removes
the filter and delivers it to a public health lab for analysis. Lab
personnel look for a DNA match with anthrax or any of four other pathogens
considered likely to be used in a biological attack.
BioWatch was developed by U.S. national laboratories and government-hired
contractors. Its deployment was accelerated after anthrax-laced letters were
sent through the U.S. mail in the fall of 2001, infecting more than 20
people and killing five. The letters were ultimately traced to a U.S. Army
scientist, Bruce E. Ivins, who committed suicide in 2008 as authorities
prepared to seek an indictment against him.
The GAO study was requested by members of Congress after a 2012 Los
Angeles Times investigation identified serious shortcomings in BioWatch,
including the many false alarms and doubts about whether the system could be
relied on to detect an actual attack.
Visit the Los Angeles Times for the report.
Uber delivers flu
shots in 36 cities, in one-day experiment
For four hours last week, people in Boston and 35 other cities had the
opportunity to summon a nurse to their doorstep to give them a flu shot.
This experiment in “on-demand healthcare,” which involved the use of
hundreds of Uber drivers, heralds what some consider the wave of the future:
bringing healthcare to the people, instead of waiting for them to come and
The project, dubbed UberHEALTH, was the brainchild of John S. Brownstein, a
researcher at Boston Children’s Hospital and Harvard Medical School who
develops technologies that track and promote public health.
“The concept of bringing on-demand services…bringing physicians and nurses
to people has so many opportunities,” Brownstein said. Startup companies are
enabling people to order home visits from medical professionals, he said.
For example, PediaQ, available in four Texas communities, provides an app
parents can use to summon a pediatric nurse practitioner to their homes
during evenings and weekends.
The Uber project is an outgrowth of Brownstein’s HealthMap Vaccine Finder, a
website that provides a list of recommended vaccines, tailored to the
individual, and locations nearby where the vaccine can be obtained.
But no matter how easy it gets, most healthy young adults can’t be bothered
getting a flu shot, with only 30 percent of 18- to 49-year-olds getting
The demand proved greater than the supply of vaccine, and many customers
were disappointed, Brownstein said. Still, more than 2,000 got vaccinated in
that 2014 pilot. In a survey afterward, 78 percent of respondents said
having the vaccine delivered was important to their decision to get the
Uber expanded the one-day flu-shot program to 36 cities, including
Philadelphia, Houston, Des Moines, and Los Angeles, where the service was
available from 11 a.m to 3 p.m. Thursday. It was offered only for a short
time because of limited resources and the need to gauge patient demand,
Brownstein said. Uber declined to say whether it would offer the service
“UberHEALTH” was one of the options at the bottom of the Uber app. An ad
popped up, saying, “Get one $10 wellness pack and a registered nurse will
offer free flu shots for up to 10 people.” The “wellness pack” is a bag with
trinkets such as hand sanitizer and a water bottle. When someone clicked to
order it, the driver receiving the request gave the information to a nurse,
who called to confirm the request and ask if the customer also wanted a flu
Upon arrival, the driver waited in the car, while the nurse went inside to
handle paperwork and administer the shot at no additional charge. Up to 10
people could be vaccinated at each site; workplaces were among the sites
visited. The nurses were employees of Passport Health, a national company
that specializes in running immunization clinics and providing vaccines.
Epidemico, a public health data-mining company that Brownstein helped found,
bought the vaccines and shared the operational costs with Uber.
Visit the Boston Globe for the story.
Healthcare Purchasing News
wishes you a Happy Thanksgiving!
The HPN staff wishes you all a wonderful and blessed
Thanksgiving with your own families and friends. I know my staff at HPN
has special plans with their families this Thanksgiving and I (Kristine
Russell) was blessed with a new grandson this last Sunday and will enjoy
spending time with him and my daughter and son-in-law this weekend.
I hope you all have the same opportunity to do something wonderful with the
ones you love. We will be back with the Daily Update on Monday, November 30.