My $.02

It’s really nice when medical professionals ask for patients’ input.  GruntDoc asks what the ideal emergency department would look like, and wants input from a variety of people, including patients.  What do you think?  Here’s my two cents:

Privacy

One important issue to address is restricting access to patients.  A few years ago I was in a car crash and was taken to the hospital on a back board.  The paramedics unloaded me, and a million people descended.  Included in all those people asking questions was one person who assured me, “Don’t worry about how to pay for this; I can get the responsible person to pay,” as he tucked a brochure for his law firm under my blanket.  Ambulance-chasers aren’t a figment of Hollywood’s imagination.  The emergency department should be designed to keep them out.

I have to admit that I have very little idea about my most recent trip to the ER.  As my husband and I walked through the door, the person at the triage desk quickly swapped my bucket for an emesis bag and sat me down in a wheelchair.  I answered a few questions, then was wheeled out into the middle of the waiting room, right in front of a lady with two little kids who were bouncing off the walls.  They stopped bouncing to stage whisper, “Mommy, that lady’s throwing up.”  Surprisingly, I was not bothered by a waiting room full of people watching me heave.  I felt too horrible to care.  When the kid made his comment, I thought, “It’s a hospital; you’re gonna see sick people here.”  Although I was too sick to care, the others in the waiting room might have wished that I had a little privacy.

Testing Convenience

Both of those hospitals mentioned above have the emergency department right beside the imaging department (or maybe they have their own dedicated x-ray and CT equipment).  It’s nice to not be wheeled half-way across the hospital for those tests.  Likewise, it’s nice when the lab is located nearby.  Those are features that would be good to incorporate into any ED.

Education

Odds are that patients who have rheumatoid arthritis will have tender joints.  This includes the joints in their fingers.  Everyone working in a hospital should keep that in mind if the pulse oximeter will be used.  Gently placing something on the fingertip is fine.  Taping the pulse-ox finger sensor onto painful fingers – using the tape as a tourniquet around one of the DIPs – is a very bad idea.

This is also true for people who have lupus, Stills, mixed connective tissue disease, juvenile arthritis, psoriatic arthritis, ankylosing spondylitis or any other form of spondyloarthropathy.  Our joints already hurt, and we don’t want them assaulted by people who are supposed to be helping us.  Use the gentle clip.

Entertainment

Televisions in the waiting room – just say no.  The noise is annoying to people who are truly sick.  Perhaps if there wasn’t free entertainment in the waiting room, people who aren’t sick would be less inclined to spend hours hanging out there.

The same thing goes for the little kids’ play area.  It’s a cute idea, but ill-thought-out.  If kids are sick enough that it’s an emergency, they don’t feel up to playing.  If they’re not that sick, but still contagious, then they’re getting germs all over the toys.  If they’re not sick at all, but accompanying a parent who couldn’t get emergency childcare, then they’re getting germs off all those toys.  Now from this, you might think that I’m some ogre who hates kids.  Not so.  I love kids – and when they behave, I even like them.  I have five children of my own, and wouldn’t dream to teaching them that the ED is a fun place to hang out.  I’d rather teach them (and have others teach their children) that we only go to the hospital if it’s an emergency.  No play area; no toys.

Food

Food is another issue to address in the emergency department.  When I was released from the ED after my accident, the nurse offered me a sandwich.  Really?   I knew from looking at the clock that I’d missed supper, but the last thing I wanted to do was eat.  I just wanted to go home and go to bed.  Since then I’ve noticed a number of medblogs bemoaning patients who show up demanding food.  Whose fault is that?  Who taught people they could get free food just by going to the emergency room?  Why  are financially strapped hospitals giving  food away?

Not everyone agrees with me.  I recently read something by somebody who was complaining that the food she was given in the ER wasn’t vegetarian-friendly.  She believes that needs to be addressed.  I agree, but I’d address it very differently than she would.

If the cafeteria is near the ED, people who need food could easily slip into the cafeteria to buy their meal (or snack).  This would solve many problems:  patients get the food they need, and can choose their own menu; doctors and nurses are freed up to focus on providing medical care instead of serving as waitstaff; the hospital makes a little bit of money off of the food, instead of giving it away.  The hospital might even make more money (or not lose as much by providing free, expensive care) if those looking for a handout discovered that there ain’t no such thing as a free lunch.

Refine Focus

Along those same lines, I’d address the entertainment issue not with television and germy toys, but with a gift shop conveniently located just outside the emergency department, right beside the cafeteria.  The gift shop should be staffed at all times, and have plenty of newspapers, magazines, decks of playing cards, and small, quiet games for children.

People who show up in the emergency department for trivial issues take resources away from people who have real emergencies.  Part of this problem could be addressed by requiring everyone to pay out-of-pocket for their food and entertainment.  The ED should be designed to focus on providing high quality emergency care.

Click on through to GruntDoc’s blog and give him your ideas, too.

Disaster Prep

We finally heard from our friends in Japan.  They fired up the generator long enough to send out email with pix, but didn’t expect to do it again.  One, because they have to focus on survival.  Two, because they were nearly out of fuel; last week they’d waited in line at the gas station for five hours, only to discover that there was no gas available.

The earthquake made a mess of everything, but their entire family survived.  Fortunately, our friends live on a hill, so their house wasn’t flooded/carried away by the tsunami.  Many in their city weren’t so fortunate.

Now everyone is trying to stay warm  – quite a challenge with snow covering everything.  I’m not going to go on about Japan – the situation has just got me to thinking about what my family would do in an emergency.  A few years ago my older kids made emergency kits for a scouting merit, but the younger kids never did that activity (nor did the adults).  I’ve talked about a family kit, and have some of the supplies, but never actually put them all together in one location where we could access them easily in an emergency.

Water  is the reason I’ve never pulled everything together before now.  The recommendation is always at least one gallon per person for a minimum of three days.  I think about that and ask, “Where would I possibly keep twenty-one gallons of water?”  Then, since I don’t have a water supply (very basic to survival), I sigh and don’t do anything.

Now I look at Japan’s situation and think that I probably ought to figure out a place to store water and a whole lot of other things.  In the past week, I’ve pulled out our lists and have been doing the shopping needed so that we can assemble/update our disaster-preparedness kits.  The list of things for our disaster prep kits, based on space available and what various agencies recommend:

  • emergency radio (this isn’t the one I have, but it’s close – nice to be able to charge the cell phone with it)
  • flashlight (separate from the radio – we have a few hand-crank flashlights, plus a few headlamps+extra batteries)
  • first aid kit
  • toilet paper
  • hand sanitizer
  • seat (Ours has no cartoon characters, and is left over from potty-training days when I carried it in the diaper bag.  This looks more comfortable for adults, but not particularly portable.)
  • unscented baby wipes (better than washcloths when water is limited)
  • blanket
  • emergency blanket (those foil things that take up very little space and can double as a rain-collector)
  • toiletries – comb, toothbrush & toothpaste, soap, etc.
  • walking shoes – not in our packs; hopefully we’d have time to grab shoes
  • complete change of clothes (undies, socks, sweats)
  • clothes for cold weather (long underwear, wool socks, gloves, hat, wool sweater, wool pants, warm windbreaker)
  • clothes for hot weather (lightweight pants, lightweight cotton shirt, cap for shade, sunscreen)
  • compass
  • signal mirror
  • whistle
  • dust masks
  • work gloves
  • water purification tablets
  • bottled water
  • food (zone & trio bars – I’ll add some dried fruit, and am considering something like these meals)
  • mess kit (everyone has their own little plate, small pans, and silverware)
  • fire starting supplies
  • multi-tool
  • camping shovel & saw
  • large plastic garbage bag
  • tarp
  • Emergency Financial First Aid Kit
  • one-month supply prescription medicines
  • Frio – for keeping refrigerated meds cold; note that the product is only rated for 60-72 degrees F, so this technically might not work

The toilet paper and all our clothes are vacuum sealed (separate pouches).  First, to keep them dry.  Second, because they take up significantly less space that way.

My meds are always in one location (the kitchen pantry), and over time I’ve managed to get an extra month’s worth of most of my prescriptions, but I need to change how I handle this.  In a real emergency, I suspect we might not have time to run to the kitchen and grab all those bottles.

Instead of storing them in the kitchen, I’ll be keeping them in my emergency kit.  Every month when I get home from the pharmacy, I’ll put my new meds in my emergency kit; then I’ll take the previous month’s meds and fill my pill boxes.  I don’t have any extra prednisone, and that’s the thing that could make the most dramatic difference if I were to run out, so I’ve added that to my list of things to discuss with my doctor.  I need to either get off the pred, or have some in my emergency kit.

Here’s hoping that you, too, have an emergency/disaster prep kit, and that it’s never needed.

Emergency Prep & Drugs

Flood, earthquake, tornado, hurricane, terrorist attack… The list of possible disasters isn’t very long.  That doesn’t mean it isn’t important to prepare.

One small line in most emergency preparation lists suggests including an extra month of prescription meds in your emergency kit.  I wondered idly how one might go about doing that, but when nobody in my family was regularly taking prescriptions it wasn’t an issue.  Now it is pertinent.

The problem isn’t with believing it’s a good idea to be prepared.  The problem is the difficulty of obtaining the extra month’s worth of meds.

1.  Insurance will not pay for early fills.  If you want to get an extra month, the cost will be entirely out-of-pocket.  That might not be a problem for one or two less expensive medications, but it’s a big deal if the cash price of your monthly trip to the pharmacy is nearly $3,000.

2.  Even if you pay cash so that you can have an extra month on hand, there’s still a problem.  Prescriptions allow a specific number of refills.  If you pay cash to get that extra month early, you run out of available refills at the pharmacy a month early.

I’ve jerry-rigged a solution.  I do not wait 30 days to refill my meds.  For a while now, I’ve refill my prescriptions every 27 days.  The first month, that got me three extra pills.  The second month, I added three more for a total of six extra pills.  The third month, I was up to nine extras, and so on.  For some weird reason, every now and then the insurance company says it’s too soon to refill and I’ve had to wait the full thirty, but this usually works.  Doing it this way, within a year, you’ll have a managed to stockpile an extra month’s worth of most prescriptions.

This doesn’t work with methotrexate, Enbrel, or anything else that’s filled for four weeks instead of one month.  Having skipped my Enbrel when I was sick, I know that when dealing with the stress of a disaster, I don’t want to be without that particular prescription.  However, since I was already well into the process of trying to accumulate an extra month’s worth for my emergency kit when I got sick, I filled the prescription at the regular time anyhow (despite not being out).

It’s a good thing I did!

Add insurance change to the list of potential emergencies

They had the audacity to send out a letter last month with instructions that we should refill prescriptions before the end of the month (on our old insurance) because it would take a while to get everyone into the new insurer’s computer system, and it probably wouldn’t be possible for the pharmacy to verify coverage for a few days.  I could picture getting laughed out of the pharmacy if I tried that, so didn’t bother.

Next the insurer said they should have everyone processed by the 10th, but we could just pay cash and then submit a request for reimbursement.  I didn’t think that would be needed, since I last filled on the 10th and would just be stretching things out to the full thirty days.  Unfortunately, the 10th came and went without new insurance cards.  My dear husband, concerned that I wouldn’t be able to get my prescriptions, was duly impressed when I said that I supposed this counted as an emergency, and explained my strategy to him as I dug into my emergency supply.

It was nice to be prepared.  It wasn’t nice to need it, but it worked out.  I had to pay cash to get my mtx last week, because there’s no extra stash on that one.  The rest of my prescriptions, though, I’ve been able to take normally, without the stress of wondering when those insurance cards are going to show up.  The tiny effort needed to be prepared was well worth it.

Do you include a month’s worth of prescriptions in your emergency kit?

___________
For more information on disaster preparedness: