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| Emergency Medicine:
Successfully Responding to Crisis Situations |
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Under the leadership of Dr. John Coffey, Chairman, Bronx-Lebanon’s Emergency Department has become one of the er the leadership of Dr. John Coffey, Chairman, Bronx-Lebanon’s Emergency Department has become one of the best and busiest in the New York metropolitan area, with 130,000 patient visits annually.
The ER’s success is clearly demonstrated by the rapidly rising number of patients that depend on it for treatment. This number has almost doubled, from 4,000 patients treated per month in 2002, to more than 7,000 per month in 2008. |
“Our highly experienced ER physicians, nurses, and support staff are experts in successfully responding to and treating all adult, pediatric, and geriatric conditions, as well as mental health problems.”
DR. JOHN COFFEY, CHAIRMAN, EMERGENCY MEDICINE |
In addition to higher patient volume, Bronx-Lebanon’s ER is also experiencing significant increases in the severity of illnesses treated, including more patients in the advanced stages of com-plicated conditions such as heart disease, hypertension, asthma, and diabetes. These patients often require extensive medical work-ups, admission (frequently to the intensive care unit), as well as close follow-up when discharged home. |
Many patients in critical condition are brought to Bronx-Lebanon’s ER by ambulance. Such emergency situations might involve para-medics rushing in a pedestrian struck by a vehicle, someone in cardiac arrest or having a possible stroke, an asthmatic who cannot breathe, or even a victim of multiple gunshot wounds. “You have to expect anything, which means you have to be on deck and ready to respond at a moment’s notice. That’s the nature of our ER and that’s why we are successful,” stated Tina Burnham, Patient Care Technician.
Critically ill patients with life threatening conditions are immediately moved to Bronx-Lebanon’s state-of-the-art code and trauma rooms. There the staff performs cardiac monitoring and pacing, defibrillation, intubation and mechanical ventilation, as well as administers intravenous medications. The ER staff is also providing life saving interventions for heart attack and acute stroke victims, working with physicians from the Department of Medicine to expedite the admission process for these critically ill patients.
Bronx-Lebanon’s 911 designation as a Stroke Center by the New York State Department of Health is also helping patients suffering from a possible stroke obtain immediate care in the ER, and receive the vital medications necessary. In addition, the staff of its dedicated adult and pediatric asthma rooms are addressing the high incidence of this disease in the Bronx and helping patients manage this frightening and often life threatening condition. “Our patients receive the best possible emergency care because Bronx-Lebanon’s ER physicians are board certified emergency medicine specialists with vast experience and compassion for their patients,” stated Dr. Alexandra Meis, Attending, ER.
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“We have a strong working relationship with the FDNY and NYPD. They depend on us and have total confidence in our ability to respond to any kind of trauma.”
Dr. Charles Martinez, Medical Director, EMS. |
In 2006, 14 firefighters, seriously injured in a tragic building fire and floor collapse, were taken to Bronx-Lebanon. Many lives were saved. “Our team immediately responded to this crisis, saving lives and helping the families of the firemen cope with this traumatic situation,” stated Dr. Thomas Boyd, Assistant Medical Director, ER.
“Bronx-Lebanon was there for us in our time of need, and we thank them for their heroic efforts,” stated Lieutenant Steve Wall, Engine Company 42. “We are proud of our life-saving efforts, successful patient out-comes, and the high quality emergency care we deliver to our community. We are grateful for the recognition and trust that our community and EMS have placed in us,” added Dr Coffey. |
| Bronx-Lebanon, in addition to receiving ER cases through the Fire Department of New York’s 911 system, also operates five ambulances, including three basic life support and two advanced life support vehicles. These ambulances provide vital assistance to the community in emergency related situations. |
In the pediatric area, Dr. Roy M. Vega, Director of the Pediatric Emergency Department and his team are diagnosing and treating all types of conditions in children.
“Families in the Bronx can take comfort in knowing that we will provide their chil-dren with superior pediatric emergency care,” stated Dr. Vega.
For those individuals or families with mental health emergencies, Bronx-Lebanon’s Comprehensive Psychiatric Emergency Program (CPEP) is responding to the challenge. Its staff, in¬cluding a special Mobile Crisis team, is stabilizing and resolving emotional crisis situations.
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Triaging is a vital part of the ER process. It involves screening patients on arrival to expedite patient flow and determine whether immediate medical treatment is necessary. The Rapid Intake Program is assuring that patients receive the care they need without delay. “We have been extremely successful in addressing high volume situations, clearly a great challenge to an ER as busy as Bronx-Lebanon’s,” stated Sakeena Shaw, RN, Director of Patient Care Services, Emergency Medicine.
“The nursing staff continually responds to the challenge by providing pivotal assistance in helping patients overcome all types of emergency situations,” added Tony Ramgahan, RN, Patient Care Manager, ER. |
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A unique “meeter-greeter” program, in which an ER staff member initially talks to patients regarding their condition upon arrival, has also been implemented.
As a result, patients with acute condi¬tions are identified, at an early stage, and then moved directly to triage, thereby reducing waiting time for them.
Patients that have non-life threatening health problems are directed to the FastTrack area, adjacent to the ER. Its staff treats low acuity con¬ditions, such as colds, sore throats, and minor cuts and bruises.
When ER patients are treated and discharged, referrals are made to the hospital’s BronxCare outpatient network for appropri¬ate medical follow-up. |
“As busy as the ER can become, the staff makes every effort to attend to the individual needs of our adult and pediatric patients,” stated Dr. Stacy Nunberg, Associate Medical Director, ER.
“Continuity of care is our priority and we do everything possible to ensure that health care does not end when a patient leaves the ER, including providing our patients with scheduled follow-up appointments,” added Dr. Elizabeth Tillem, Emergency Management Medical Director.
When patients require admission, the ER team works closely with the medical staff and the hospital’s support services, including Patient Access and Patient Transportation to expedite the process.
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A special Emergency Department Inpatient Program (EDIP) initiative has been put into place to help decompress the overcapacity situations that often occur in the ER. It provides the continuing medical attention and support needed by patients awaiting an inpatient bed.
ER patients also have available to them state-of-the-art radiology services, including magnetic resonance imaging, PET, and CT scans.
Consulting physicians from other specialty areas at Bronx-Lebanon are often called in to provide the most comprehensive care.
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Dental emergency services are also avail-able. Additionally, the ER is fully computerized, an important benefit in monitoring and tracking patients through the course of their Emergency Department stay.
It is as a direct result of the continuing demand by the community for emergency services that Bronx-Lebanon will be increasing its ER capacity.
A major ER expansion project is now moving forward and will be completed by the end of 2009. |
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Anesthesiology
Dr. Roy M. Vega, Director, Pediatric Emergency Department,
Dr. Elizabeth Tillem, Emergency Management Medical Director, and patient, Deborah Merritt.
