Emergency Medicine

The blood-pressure-lowering drugs known as ACE inhibitors are a mainstay of treatment for many diseases. But with growing use of these heart-helping medications, more and more patients are winding up in emergency rooms with a rare side effect that most have not been warned about: swelling around the face and neck. In the worst cases, the patient's tongue and throat become hugely bloated, closing the airway. No medications can slow or reverse this swelling, called angioedema.

A stray bullet fired in a drive-by shooting killed a young boy who just hours earlier was sitting in an elementary classroom. Paul E. Gourley, an emergency-room physician, remembers the sounds of the boy's mother crying as he entered the waiting room to deliver the news. Experiences like that one, he said, persuaded him to become medical director of the Youth Violence Prevention Program for Albert Einstein Medical Center. "Until you've had a parent fall into your arms, collapse on the floor after you tell them their child was killed, you don't understand the impact of violence," Gourley said.

Dr. Robert B. Laucks, 70, whose career at Graduate Hospital spanned four decades, from his internship in 1951 to chairmanship of the department of emergency medicine from 1982 to 1988, died Wednesday at his home in Shamong Township, N.J. "He was a master surgeon - a blend of outstanding techniques, judgment and innovation," said Moreye Nusbaum, chief of surgery at Presbyterian Medical Center, who had been a colleague of Dr. Laucks' at Graduate for...

For years, hospitals have responded to crowded emergency rooms and longer waits for beds by building ever-bigger buildings and spending vast sums - up to $2 million per bed. But expansion hasn't solved the problem, and the costs are becoming unsustainable. So some hospitals are trying a new tactic: Working more efficiently around the clock. This month, the New Jersey Hospital Association received a $7 million grant, in part to hire a former Soviet industrial engineer whose forte is smoothing out the flow of hospital patients so they can be treated more efficiently.

So far, three Delaware County hospitals have met the state's criteria for medical command facilities - a designation that ensures that paramedics at an emergency scene will be able to communicate by phone with a physician at that hospital trained in emergency medicine. At such a facility, a physician certified in emergency medicine will be available 24 hours a day for when an emergency call comes in. Such assurance has not always been the case. There once was no guarantee that the physician in a hospital emergency room would be trained in emergency medicine, or even be familiar with what procedures a paramedic or emergency medical technician could do in the field.

From the soles of his black Reebok sneakers to the top of his fashionably cut hair, John Foster represents a new breed of doctor - the emergency medicine specialist. "Eight or nine years ago we would have had trouble staffing an emergency department with qualified people," said Franklin Kelton, chairman of the department of emergency medicine at Chester County Hospital. "Now I get several calls a week from qualified physicians. " Last Sunday, members of the community were invited to an open house to inspect Chester County Hospital's new emergency room, in the hospital's North Pavilion.

A bomb threat has forced the American Board of Emergency Medicine to abruptly cancel examinations for certification and recertification only a few days before 2,000 physicians were scheduled to take them at nine sites around the country. Physicians learned of the board's decision Thursday morning when they received a cryptic Mailgram, which gave only this explanation for the cancellation: "This decision was based upon the possibility of direct harm to individuals related to the examination and concerns for security at all examination sites.

Billy Mills 3d lies on a table in a hospital trauma room, head pillowed on his arms, ankles crossed, attitude bravado. His brown eyes, however, are wide and frightened. The 5-year-old fell at his Barnsboro home and opened a jagged cut above his right elbow. His father has brought him to the emergency department at Kennedy Memorial Hospitals/Washington Township Division, the hurt arm swaddled in a blue bath towel. Dr. Robert A. Supplee explains what he is about to do and asks the boy if he understands.

Dr. Jack W.P. Love, 61, longtime chairman of Underwood-Memorial Hospital's emergency medicine department, died of cancer Saturday at the hospital in Woodbury. Born in Johnson City, Tenn., he had been a Mantua Township resident since 1969. Dr. Love served a four-year term on the Underwood-Memorial board of trustees that ended last December. He practiced emergency medicine at the hospital since 1971 and chaired the department since 1974. He also directed the hospital's paramedic programs for Gloucester, Salem and Cumberland Counties and served as president of the hospital's medical dental staff in 1993 and 1994.

John S. Foster, 51, an outdoorsman and a physician who advocated the use of alternative therapies as well as conventional drugs to treat patients, died of pancreatic cancer Monday at his home in Charlestown Township, Chester County. Dr. Foster was cochairman of the department of emergency medicine for more than 15 years at Chester County Hospital. He became associate director of the Center for Integrative Medicine at Thomas Jefferson University Medical School in 2001. In addition to using conventional therapies, the center treats patients with nutritional, herbal, homeopathic and other types of natural therapy, such as acupuncture and meditation.

The blood-pressure-lowering drugs known as ACE inhibitors are a mainstay of treatment for many diseases. But with growing use of these heart-helping medications, more and more patients are winding up in emergency rooms with a rare side effect that most have not been warned about: swelling around the face and neck. In the worst cases, the patient's tongue and throat become hugely bloated, closing the airway. No medications can slow or reverse this swelling, called angioedema.

For years, hospitals have responded to crowded emergency rooms and longer waits for beds by building ever-bigger buildings and spending vast sums - up to $2 million per bed. But expansion hasn't solved the problem, and the costs are becoming unsustainable. So some hospitals are trying a new tactic: Working more efficiently around the clock. This month, the New Jersey Hospital Association received a $7 million grant, in part to hire a former Soviet industrial engineer whose forte is smoothing out the flow of hospital patients so they can be treated more efficiently.

AlliedBarton Security Services L.P. , a provider of security personnel, said Charles P. Pizzi had been appointed to the board of directors of the company's parent, Allied Security Holdings L.L.C. Pizzi was president and chief executive officer of Tasty Baking Co. from 2002 until its recent merger with Flowers Foods Inc. ARC of Philadelphia , a nonprofit advocacy and vocational-training organization, has elected Mimi Rose to its board. She is the former chief of the child-abuse-prosecution unit and the family-violence-prosecution unit in the Philadelphia District Attorney's Office.

St. Christopher's Hospital for Children has appointed Evan J. Weiner emergency department director of operations at the Philadelphia hospital, overseeing the day-to-day operations. Weiner is an attending physician, director of pediatric emergency medicine medical education, assistant professor of pediatrics and emergency medicine, Drexel University College of Medicine, and clinical assistant professor of pediatrics, Temple University School of Medicine. RES Software, Philadelphia, has appointed Gene Bonacci vice president of channels and strategic alliances.

ERNEST SIMPSON knew all the best players in Pittsburgh. He played with them, had success against them. He knew Kenny Durrett, hung out with Connie Hawkins when the "Hawk" played for Pittsburgh's ABA team, remembers the hardest hit of his life from Maurice Lucas. He was sure he had a chance to be a serious player. Then, he blew out his knee and never sought treatment at a time before orthopedic surgery was very advanced. So, he chose a different path, studied emergency medicine, moved to New Jersey in 1970 where he eventually became chief paramedic at the old New Jersey Medical Center.

What are the chances of being hit with gastroenteritis, also known as Norwalk flu, on a cruise - and how qualified and equipped are ship doctors to help you? Good questions, considering that in recent years, some vessels have reported outbreaks of the disease. Actually, the chance of getting the Norwalk virus, which typically causes vomiting and diarrhea over a period of one to three days, may not be any greater than contracting it at any crowded and enclosed environment. It's not found only on cruise ships.

Hurricane Katrina A sampling of letters about the storm and some questions it raises. Kenneth Myers of Elkins Park We are losing an important part of our homeland, the city of New Orleans, to the waters of the Gulf of Mexico. Each day the damage grows. Preventing a total loss will require immense forces and energy. The President should immediately bring home our Army from Iraq and put it to work fighting to secure the levees and then to drain, dry and repair New Orleans.

One thing's certain about the group of Medical College of Pennsylvania Hospital doctors who just clinched a deal to save their storied Philadelphia hospital: They sure know emergency medicine. The 150-year-old facility was put on life support months ago by its owner, Tenet Healthcare Corp. MCP was losing $5 million a month - an amount the for-profit chain described as "unsustainable. " Of even greater concern, Tenet said the losses threatened to weaken its five other local hospitals.

Gretchen Worden has some advice if you need to go to the emergency room: Pack a change of underwear. Worden, 56, got a splinter in her foot while gardening, developed a dangerous infection, and was seen quickly when she showed up at Hahnemann University Hospital's ER last month. But she waited more than 16 hours for a bed, spending a mostly sleepless night on a gurney in a busy urban emergency room. "They couldn't even find me a pillow. They had to fold up a sheet," said Worden, who nonetheless praised the quality of her care.

John S. Foster, 51, an outdoorsman and a physician who advocated the use of alternative therapies as well as conventional drugs to treat patients, died of pancreatic cancer Monday at his home in Charlestown Township, Chester County. Dr. Foster was cochairman of the department of emergency medicine for more than 15 years at Chester County Hospital. He became associate director of the Center for Integrative Medicine at Thomas Jefferson University Medical School in 2001. In addition to using conventional therapies, the center treats patients with nutritional, herbal, homeopathic and other types of natural therapy, such as acupuncture and meditation.