Depressing Question: Could You Handle a Shooter in Your Hospital?
An urgent public emergency probably isn’t on your radar screen…until it lands in your hospital. No one knows that better than the medical and administrative staff of Boston hospitals. A new special report, “It Takes a Team—The 2013 Boston Marathon: Preparing For and Recovering From a Mass-Casualty Event, ” is pointing the way forward for hospitals everywhere. Lloyd Resnick, developmental editor at the Journal of Bone and Joint Surgery (JBJS), was intimately involved in the preparation of this report, a collaboration between JBJS & the Journal of Orthopaedic & Sports Physical Therapy (JOSPT). Resnick tells OTW, “The 2013 Boston bombing galvanized a lot of people, especially the multiple disciplines involved in emergency preparedness. In talking to numerous emergency preparedness people this theme rang throughout: hospitals must regularly drill for mass casualty events, despite how challenging it is to create time, space, and resources to do that. A large level one trauma center like Mass General runs three to five full scale exercises per year involving actors and mannequins, plus five to ten tabletop exercises. The front line people we spoke with also drove home the point that it is critical to get senior executives at these hospitals on board.”
“Another recommendation in the report—to practice low-frequency, high-impact scenarios such as an active shooter—arose from an interview with Meg Femino, Director of Emergency Management at Beth Israel Deaconess Medical Center. In the report, Femino also emphasizes the need to ‘drill deep into your hospital’s system; an occasional decontamination drill in the ED isn’t enough.’”
Resnick added, “Brigham and Women’s Hospital in Boston has produced a training video for its 16, 000 employees on how to handle a scenario where there is an active shooter in the hospital.”
And note that doing just the minimum isn’t sufficient, says Resnick. “One of the people I interviewed said that if her hospital had done only what the Joint Commission mandates for emergency preparedness, they would not have been ready for April 15, 2013.”
“On the communication front during a disaster, aim to be clear, thorough, and quick. Clear communication is greatly facilitated if you cultivate relationships with people in the emergency preparedness community. Have their phone numbers programmed into your phone, and keep having these conversations so that in the event of a disaster you know whom to call. There is no such thing as being too prepared.”
XLIF for Degenerative Scoliosis: It’s a Definitive ‘Go’
To XLIF naysayers out there, Frank Phillips, M.D., an orthopedic surgeon with Midwest Orthopaedics at Rush, has published what is the largest prospective series of degenerative scoliosis (DS) treated with minimally invasive fusion techniques. In the study, published in Spine, Dr. Phillips reported that using the XLIF in the treatment of degenerative scoliosis leads to good outcomes, and lower complication rates than with traditional open surgery.
Dr. Phillips, Professor of Orthopaedic Surgery and Director of Minimally Invasive Spine Surgery at Rush University Medical Center, tells OTW, “Many of my colleagues had questioned the role of XLIF in the treatment of DS. Early on in the XLIF experience, I felt that this procedure was a natural fit in the treatment of DS addressing a real clinical need where traditional surgeries were associated with high major complication rates and long recovery periods. We presented the first report of XLIF specifically in DS with two-year follow-up in 2005 at the IMAST [International Meeting on Advanced Spine Techniques] meeting and I was met with skepticism. We decided to put the jury to rest, however, and recruited 107 patients to be involved in the largest prospective, multicenter study to quantify outcomes after XLIF in this patient population. We found rapid and statistically significant improvement in all outcome measures—Oswestry Disability Index, visual analogue scale for back pain and leg pain, and 36-Item Short Form Health Survey mental and physical component summaries. In addition, the procedure was able to address the spinal deformity”
“We are continuing studies to determine when stand-alone lateral interbody fusion is adequate, when we need supplemental instrumentation and direct decompression, and when the patient needs a more extensive surgery to completely correct the deformity. In recent years, larger and larger surgeries are being performed more frequently to address spinal deformity. As we pay more attention to spinal balance and pelvic parameters, the role of less morbid surgeries to address these issues are receiving more attention.”
“It is gratifying to see surgeons adopting the XLIF in the treatment of scoliosis with good patient outcomes. When we first discussed this application almost 10 years ago we were met by a lot of skepticism. Now, lateral techniques have become part of the surgeon’s armamentarium in treating DS. More recently we have continued to extend the use of XLIF for the treatment of complex spinal deformity. Many surgeons that ignored this technique for years are now on a marketing tear. As long as we continue to study these procedures thoughtfully and validate outcomes, we will be helping out our patients.”
Study: You CAN Operate on Obese Patients
When an obese patient is lining up for surgery, many orthopedic surgeons put on the brakes. Now there is evidence that this may not be necessary. Alan Hilibrand, M.D. is a professor of Orthopaedic Surgery and Neurosurgery at the Rothman Institute in Philadelphia. He is also Director of Medical Education for the Department of Orthopaedic Surgery at the Rothman Institute and Jefferson Medical College. He tells OTW, “In the SPORT study, looking at patients with a BMI [body mass index] over 30 we showed that discectomy surgery did not involve a higher risk of complications. (That might be a different story with those whose BMI was higher than 40, however.) We found a significant treatment effect among the other group of patients who underwent surgery for spinal stenosis; patients taking the nonoperative route did poorly.”
“There has been quite a controversy surrounding this issue because in the joint replacement arena we have evidence that obesity negatively affects outcomes. In some places—like the UK—surgeons won’t let someone over a certain BMI have a knee replacement. And aside from the clinical issues, one has to wonder if such spine surgeries are an important use of healthcare dollars.”
“I was a bit surprised by the results in that I thought there would be a smaller treatment effect for surgery on obese patients. Going forward I would like to investigate these issues on those patients who have 40 or higher BMI. Based on our data there is a threshold beyond which the complication risk goes up…and maybe the clinical benefits go down.”
Freddie Fu, M.D. Named Lifetime Member of ESSKA
Freddie Fu, M.D., the renowned chair of the department of orthopedic surgery at the University of Pittsburgh, is being honored by the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). Dr. Fu has been named a Life/Honorary Member of ESSKA, the greatest honor bestowed by this organization. The eight-member ESSKA board voted unanimously to bestow Honorary Membership upon Dr. Fu. The ceremony will be in Amsterdam during the General Assembly during the ESSKA Congress. Dr. Fu will be the third such honoree from the U.S. and the first from Pennsylvania.
Freddie H. Fu is the David Silver Professor of Orthopaedic Surgery and Chairman of the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center. Previously, he was the department’s executive vice chairman. Dr. Fu has also been the head team physician for the University of Pittsburgh Department of Athletics since 1986 and holds secondary appointments at the university as professor of physical therapy and health physical and recreational education.
Dr. Fu received his undergraduate and post-graduate degrees at Dartmouth College and Dartmouth Medical School before earning his medical degree at the University of Pittsburgh in 1977. Continuing his training at Pitt, he then completed a residency in orthopedic surgery and a fellowship in orthopedic research. Dr. Fu also fulfilled an internship in general surgery at Brown University and an international fellowship at the Hanover Trauma Center in Germany. Dr. Fu is internationally recognized for his pioneering surgical techniques to treat sports-related injuries to the knee and shoulder. He is also an extremely well regarded scientific and clinical researcher.
