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12 Hospitals. 1 All-Expense Paid Trip. Register Now for EmCare's Hiring Conference!


Senior residents and experienced providers will have the opportunity to interview with up tohershey hiring conference 12 hospitals at EmCare’s inaugural “Hiring Conference.” The event will be held at The Hotel Hershey in Hershey, Pa., on Sept. 25 and 26, 2014. Hosted by EmCare’s North Division, the event kicks off with a “Meet & Greet” Reception on Thursday evening, followed on Friday by a full day of educational presentations and interviews.

The conference is geared to generate interest in a select group of Emergency Department
(ED) and Inpatient Services (IPS) practices at EmCare-affiliated facilities in New Jersey, Ohio, Pennsylvania and West Virginia. Pre-screened candidates will have the opportunity for an on-site interview with Site Medical Directors and a letter of intent to secure a contract, while enjoying complimentary travel and hotel accommodations, including a stay at the one-of-a kind, historic Hotel Hershey.  

Sites include:

  • Blue Mountain (ED and IPS) – Lehighton, Pa.
  • Community Health of Scranton (ED) – Scranton, Pa.
  • East Liverpool City Hospital (ED) – East Liverpool, Ohio
  • Heart of Lancaster (ED) – Lancaster, Pa.
  • Holy Spirit Hospital (ED) – Harrisburg, Pa.
  • Lancaster Regional Medical Center (ED) – Lancaster, Pa.
  • Meadville Medical Center (ED) – Meadville, Pa.
  • Saint Peter’s University Hospital (ED) – New Brunswick, N.J.
  • Trumbull Memorial Hospital (ED and IPS) – Warren, Ohio
  • Washington Health System (ED and IPS) – Washington, Pa.
  • Wheeling Hospital (ED) – Wheeling, W.V.
  • Williamsport Regional Medical Center (ED) – Williamsport, Pa.

Third- and fourth-year residents, as well as experienced providers for Emergency Medicine and Hospitalist positions, are especially encouraged to attend. Registrants will be pre-screened to determine their fit with EmCare, a leading national provider of healthcare practices.

“This is a great opportunity for providers to meet with this region’s Medical Directors to discuss and earn top-priority positions while evaluating the right fit for them,” said Eileen McKeogh, Physician Recruiting Manager of EmCare’s North Division. “Rarely do Medical Directors and Providers have the chance to gather face-to-face and collaborate on where their skills will be the best match.”

To learn more about EmCare’s 2014 Hiring Conference, please visit or call Amanda DiRuggieri at 215.442.5170.  For opportunities nationwide, visit or contact us directly at  

10 tactics to Reduce Violence in the Emergency Department


According to a survey by the International Association for Healthcare Security & Safety, theed violence number of violent incidents involving hospital workers jumped 37 percent in the past three years. In this 3 part series, two EmCare-affiliated Divisional Directors of Clinical Services, share the details of their first-hand experience with violence in the ED and they reveal the improvements that need to be made within ER departments to reduce acts of violence in the hospital.

By Ginger Wirth, RN and Denise Sexton, RN, BSN, Divisional Directors of Clinical Services, EmCare


I was a victim of violence in the E.D. Here's my story. Pt. 1

I was a victim of violence in the E.D. Here's my story. Pt. 2 

  1. Teach staff to recognize aggressive and escalating behaviors early.  Be able to anticipate potential violent situations or patients/families that exhibit signs of increased stress, dissatisfaction or agitation.  Remember that overcrowding of ED’s, increased wait times and the ED’s being used as primary care clinics can have significant potential on increasing stress on patients, families or visitors.
  2. It is imperative that we provide education on how to deescalate aggressive or potentially violent customers.  This has to be real time training-- hands on, not the computer- based modules that we so often see on an annual basis in healthcare.  This training needs to be shown to all staff with a focus on the Emergency Department team, and should include drills or exercises to practice putting this training into action.  I understand that in other countries this happens on a regular basis.  We have disaster drills, fire drills, code blue drills, why are we not drilling on how to protect the staff, other patients and visitors in the hospitals?
  3. We need to educate the staff that there are Federal Laws in place to protect and prosecute those that do harm against healthcare workers.  This should be a zero tolerance initiative and treated as such in healthcare.  Staff should be encouraged to report any incidents-- small or large-- to administration and those incidents should be investigated and dealt with strictly and severely.  No longer should there be a stigma or fear or retribution for reporting incidents of violence.  This will take away the power from those assailants and give it back to the staff.
  4. Signs should be clearly posted in the Emergency Departments that any acts of aggression, disrespect or violence in the ED will not be tolerated and could result in law enforcement action.  I have seen these signs in a couple ED’s and I believe that informing the patients, families and visitors right in the beginning and reinforcing that with signs could help to deter events.
  5. Hospitals need to perform a root cause analysis of any and all incidents that occur in the facility.  In healthcare, we do these on all medical events that have adverse outcomes quickly and effectively.  Any type of violence needs to be treated the same and given the same attention.  The areas for improvement will show during these events and they demonstrate to any staff involved that these are serious events, and they will be investigated and addressed as such.
  6. ED team members need to treat all patients and their family members as if they have the potential to become violent. Never drop your guard with any of them.
  7. Be sure to undress the patients, put them in a hospital gown, and search for weapons. With most states adopting open carry laws for concealed weapons, you never know who may have a gun. We’ve removed many weapons over the years from patients,  most of which have been knives or other sharp objects. Clear the room of anything that they can use to harm you or themselves.
  8. Make sure that you have a code that you can call that will bring all available personnel to the ED. There is strength in numbers. I have seen many psych patients and irate family members become more cooperative with just a show of staff.
  9. Always position yourself with a way out of a room so you cannot be cornered by the patient. Never let a patient come between you and the door. Even a small patient can become unbelievably strong when adrenaline kicks in.
  10. Administration needs to be supportive and prosecute to the fullest extent of the law on any threats to healthcare workers. I have seen many patients and family members verbally abuse staff and think that they should take it.


What tips do you have for preventing violent episodes in your ED? Tell us in the comments.



I was a victim of violence in the E.D. Here's my story. Pt. 1

I was a victim of violence in the E.D. Here's my story. Pt. 2 

Seriously Ill Patients Have Limited Facial Expression

In the emergency room setting, facial expressions may help in assessment of cardiopulmonary disease

FRIDAY, July 18, 2014 (HealthDay News) -- Decreased variability of facial expression may help identify patients with serious cardiopulmonary disease in the emergency care setting, according to research published online July 14 in the Emergency Medicine Journal.

Jeffrey A. Kline, M.D., of the Indiana University School of Medicine in Indianapolis, and colleagues conducted a prospective study of diagnostic accuracy using a convenience sample of 50 adult patients presenting with dyspnea and chest pain in an emergency department. Facial expressions, including smile, surprise, and frown, were scored in response to emotional cues (stimulus slides). The diagnosis of cardiopulmonary disease, including acute coronary syndrome, pulmonary embolism, pneumonia, aortic or esophageal disasters, or new cancer, within the next 14 days was assessed.

The researchers found that, during the first stimulus slide, the median of all Facial Action Coding System values was significantly lower for disease-positive patients (3.4; first to third quartiles, 1 to 6) than for disease-negative patients (7; first to third quartiles, 3 to 14; P = 0.019). The largest difference between disease-positive and disease-negative patients was observed for the expression of surprise.

"With a single visual stimulus, patients with serious cardiopulmonary diseases lacked facial expression variability and surprise affect," the authors write.

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FDA Approves Tough-to-Abuse Formulation of Oxycodone

Targiniq ER includes naloxone, which blocks euphoric effect if pill is crushed or broken

THURSDAY, July 24, 2014 (HealthDay News) -- Targiniq ER (oxycodone hydrochloride and naloxone hydrochloride extended release) has been approved by the U.S. Food and Drug Administration as a long-term, around-the-clock treatment for severe pain when other therapies are ineffective or unavailable.

Targiniq ER has properties that are designed to deter abuse of the drug by snorting or injection, the FDA said in a news release. It contains naloxone, designed to block the euphoric effects of oxycodone, the agency said. Targiniq ER can still be abused by taking too many pills, the FDA warned, stressing that an overdose could cause death. The drug is not meant for as-needed pain relief, the agency said, repeating its warning of the potential for abuse and addiction.

Targiniq ER was evaluated in a clinical study of 601 people with chronic lower back pain. The most common side effects were nausea and vomiting.

The agency said it is requiring the manufacturer to conduct additional post-marketing studies to assess the drug's risks of misuse, addiction, and abuse.

Targiniq ER is manufactured by Purdue Pharma, based in Stamford, Conn.

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In Case You Missed It: Week of Aug. 15, 2014


“In Case You Missed It” is a weekly roundup of popular healthcare headlines.

I was a victim of violence in the E.D. Here's my story. According to a survey by theemergency department violence International Association for Healthcare Security & Safety, the number of violent incidents involving hospital workers jumped 37 percent in the past three years... continue >>

Are hospitals responsible for preventing workplace violence? Despite the rise in workplace violence, many hospitals don't know how to prevent assaults... continue to >>

5 Signs You Need a New Physician Recruiter. After spending six years as a physician recruiter, I’ve seen it all—the good, the bad and the ugly behavior physician recruiters engage in to fill positions. Here’s my list of five... continue >>

If Ebola Arrives In The U.S., Stopping It May Rely On Controversial Tools. Given the scope of the Ebola outbreak unfolding in Western Africa, it seems possible that a case will eventually ... continue to>>

Medical lessons from Robin Williams. The death of Robin Williams has opened much dialogue about depression. Here's one physician's take on the issue. Click here to read entire post at

WEBINAR. How Integrated Clinical Services and Technologies are Making Healthcare Work Better. Register now for this webinar presented by Dr. Kirk B. Jensen and Mark Hamm, to discover the benefits of hospital-wide integration. Wednesday, September 17, 2014 | 1:00 PM - 2:00 PM CDT. Register at now!

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Recruiters Behaving Badly: 5 Signs You Need a New Physician Recruiter


Megan FieldsBy Megan Fields

After spending six years as a physician recruiter, I’ve seen it all—the good, the bad and the ugly behavior physician recruiters engage in to fill positions. Here’s my list of five ways to spot a bad physician recruiter and what to do if you happen to get stuck with one.

  1. You don’t feel like they’re listening. The recruiter physicianPoor Listener relationship is just that, a relationship. And in any relationship, listening is key. A bad recruiter doesn’t view recruiting as a relationship business; they view it as a numbers game, so they may not take the time to listen to you and understand what you want. A good recruiter knows that every clinician is unique and takes time to listen to what makes each clinician’s situation special, so that they can wow you with positions that are tailored to you.
  2. They just don’t get you... or what you do. In some industries, it’s easy to hide a lack of understanding, but in healthcare, and particularly in healthcare recruiting, when a recruiter doesn’t understand the unique concerns of an emergency physician or a hospitalist, it becomes apparent very quickly. How can you trust a recruiter to place you in the proper environment if they haven’t educated themselves on your industry? A good recruiter knows that part of their job is developing a deep understanding of your specific field because it will help save them, and you, time when it comes to finding your ideal facility.
  3. You caught them in a lie. What do bad physician recruiters have inDishonest common with Run-DMC? They’re both known for being “Tricky.” A bad recruiter may use deception or embellish when describing facilities and other details about a position. If you suspect the recruiter is being dishonest, visit the site in question, or do some research online by checking out the facility’s website, the local CVB site and by reaching out to current docs who practice there through LinkedIn and Twitter.
  4. They’re hard to find. Your recruiter should not be the proverbial needle in the haystack. Physicians don’t work 9-5 M-F and neither do recruiters. A good recruiter knows that there are always issues that may arise that require attention – you may need to change your availability or you may need to change facilities—and they’re available to work with you as the need arises, not just during their office hours.
  5. They’re too pushy. A bad recruiter doesn’t take “no” for an answer when you express reservations about a position. A physician recruiter’s goal should be to ensure you are 100% satisfied and have no doubts or surprises when it comes to signing on for a new position.

The One Tip You Need to Fix a Bad Physician Recruiter Relationship

To ensure the recruiter gives you the best possible guidance when it comes to finding a new facility, create a list with the following columns prior to communicating with them to explain exactly what items are non-negotiable for you:

1. Must-have

2. Nice to have

3. Deal breaker

It’s important that this list is in writing so that there’s no room for miscommunication.

Remember: A physician recruiter’s job does not solely consist of filling positions. Signing on with a new facility is a big commitment with many variables including location, compensation, talented team, and other items that are simply important to each individual clinician and a recruiter’s priority is to ensure that each clinician’s unique needs are met. If all else fails, and you and your current physician recruiter just can’t get on the same page, contact a recruiting manager; their information can usually be found on the company’s website.

Tell us:  What do you look for in a good physician recruiter?

Megan Fields headshotMegan Fields in a recruiter for EmCare’s West Division. Follow her on Twitter at


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AUGS/IUGA: Pelvic Floor Disorder Common in Female Triathletes

About one in three report symptoms of PFD; many screen positive for Triad components

FRIDAY, July 25, 2014 (HealthDay News) -- Female triathletes frequently have pelvic floor disorders (PFDs) and screen positive for at least one component of the female athlete triad (Triad), according to a study presented at the American Urogynecologic Society and the International Urogynecological Association 2014 Scientific Meeting, held from July 22 to 26 in Washington, D.C.

Johnny Yi, M.D., from the Loyola University Health System in Chicago, and colleagues conducted a nationwide web-based survey of female triathletes aged older than 18 years. There were 311 respondents from seven regions of the United States. Validated questionnaires were used to estimate the prevalence of PFDs, pelvic girdle pain (PGP), and the Triad.

The researchers found that 16 and 37.4 percent of respondents experienced urgency urinary incontinence and stress urinary incontinence, respectively, while 5 percent experienced pelvic organ prolapse and 37 percent anal incontinence. Eighteen percent of respondents had PGP, with higher levels for those with stress urinary incontinence, urgency urinary incontinence, and anal incontinence. Twenty-two percent of the respondents who completed the Triad questionnaire screened positive for low energy availability; 24 percent for menstrual irregularities; and 29 percent for abnormal bone strength. Overall, 24 percent screened positive for one component of the Triad. No significant association was seen for PFDs and the Triad.

"Doctors should be aware of how common these conditions are in this group of athletes and treat patients appropriately to avoid long-term health consequences," Yi said in a statement.

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I was a victim of violence in the E.D. Here's my story. Pt. 2


According to a survey by the International Association for Healthcare Security & Safety, theWirth number of violent incidents involving hospital workers jumped 37 percent in the past three years. In this 3 part series, two EmCare-affiliated Divisional Directors of Clinical Services, share the details of their first-hand experience with violence in the ED and they reveal the improvements that need to be made within ER departments to reduce acts of violence in the hospital.

By Ginger Wirth, RN, Divisional Director of Clinical Services, South Division


I was a victim of violence in the E.D. Here's my story. Pt. 1

10 tactics to Reduce Violence in the Emergency Department

I have actually been a “victim” twice in my career while in the ED.  Both involved patients who had some mental/psychiatric etiology.  The first time was in 1990 while my team was providing a female patient with discharge instructions and calling her significant other for a ride home, she became agitated and punched me in the face.  This resulted in some pretty substantial bruising and some neck strain after I hit the floor. The facility fully supported me and charges were brought against the patient. She was found guilty of assault and received probation. 

The other time was also by a psych patient who became combative when he was told that he was going to be committed.  He began screaming and yelling at the staff and cornered me in the room and punched and kicked while trying to elope.

I don’t think there’s a lack of support from hospital administration, as I have had great support in both incidences.  I think the problem stems from the growing lack of treatment options throughout the country for mental health patients. Consequently, they are being dumped in the emergency departments.  No longer will the correctional system keep patients that have mental illnesses without medical clearance, causing these patients to clog and remain in the ED’s.  If police apprehend a person with any hint of a history of mental illness, they come to the ED for evaluation.  When they arrive in most ED’s, the providers are not comfortable initiating treatment for the mental illness even if there is a long history. 

For example, if a patient goes off their regular medications for depression and is picked up by law enforcement they are brought to the ED for clearance.  The ED providers may not be willing to shoulder the responsibility of restarting medications or discharging the patient without a psychiatric evaluation.  So, these patients remain in the ED until they can be stabilized.  Getting them into the mental health system can take days, weeks or sometimes months.  Also of note: many of these patients are self-pay and have a lack of resources to begin with, which hampers their entry into the overcrowded mental health system of many states. 

There has been some relief and “light at the end of the tunnel” for some areas with the increased usage of telemedicine.  In South Carolina, there is a fairly robust use of telepsychiatry; however, this has quickly succumbed to overuse and capacity issues.  The limited number of inpatient beds is a problem for patients with insurance, as well as the uninsured.  We have an opportunity to continue with training in our EDs to recognize aggressive situations, provide support for our ED providers in the care of the mental health patients in the community and what resources are available and how to access these resources easily and timely. 

All staff in the ED must know that violence against healthcare providers should NEVER be tolerated, expected or dismissed.  All cases should be reported to the facility administration and law enforcement when appropriate.  Abuse is just as unacceptable for someone that cares for patients, as it is for the patients themselves.


Ginger joined EmCare in 2013 as a Divisional Director of Clinical Services for the South Division with the strong belief that she could continue to make positive changes within healthcare by helping others focus on quality, excellence and the overall patient experience. Ginger Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20+ year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients. 


I was a victim of violence in the E.D. Here's my story. Pt. 1

10 tactics to Reduce Violence in the Emergency Department

Have you witnessed violence in your ED? What steps can staff take to protect themselves and the other patients in their care? Tell us about it in the comments. Next week: In part 3 of this 3-part series, Ginger Wirth and Denise Sexton provide tips to  reduce instances of ED violence in hospitals.   


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Post-Op Recovery Program Aids Community Hospital Outcomes

Improvements in colorectal outcomes independent of laparoscopy, cancer diagnosis

FRIDAY, July 25, 2014 (HealthDay News) -- Implementation of an enhanced recovery after surgery (ERAS) colorectal program is feasible in a community hospital setting and significantly improves outcomes, according to a study published online July 23 in JAMA Surgery.

Cristina B. Geltzeiler, M.D., from the Oregon Health and Science University in Portland, and colleagues assessed practice patterns and patient outcomes for all elective colon and rectal resection cases performed in 2009 (prior to ERAS implementation), 2011, and 2012. The ERAS program involves multidisciplinary efforts from anesthesia, preadmission, nursing, and surgery staff.

The researchers found that over the study period the use of laparoscopy increased from 57.4 to 88.8 percent (P < 0.001) and was accompanied by a significant decrease in length of stay (LOS; 6.7 versus 3.7 days; P < 0.001), without an increase in 30-day readmission rate (P = 0.49). There were decreases in use of patient-controlled narcotic analgesia (P < 0.001) and duration of use (P = 0.02). There was a trend toward decreased ileus (P = 0.02) and intra-abdominal infection (P = 0.24). Colorectal cancer diagnosis was not significantly associated with LOS, 30-day readmission rates, ileus, and intra-abdominal infection (all P > 0.05).

"Length of stay reductions resulted in an estimated cost savings of $3,202 per patient (2011) and $4,803 per patient (2012)," the authors write.

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Predictors Identified for Stroke Post-Cardiac Surgery

Strongest predictors include advanced age, history of stroke or TIA, peripheral vascular disease

THURSDAY, July 24, 2014 (HealthDay News) -- For patients undergoing cardiac surgery, the strongest predictors of stroke up to two years postoperatively include advanced age, history of stroke, and peripheral vascular disease, according to a study published online July 21 in CMAJ, the journal of the Canadian Medical Association.

Richard Whitlock, M.D., from the Population Health Research Institute and McMaster University in Hamilton, Canada, and colleagues examined the incidence and predictors of long-term stroke among patients who underwent cardiac surgery. The cohort included 108,711 patients who underwent cardiac surgery between 1996 and 2006 in Ontario.

The researchers found that 1.8 percent of participants had a perioperative stroke and 3.6 percent had a stroke within two years. For both early and late stroke, the strongest predictors included advanced age (≥65 years; adjusted hazard ratio [aHR] for all stroke, 1.9); history of stroke or transient ischemic attack (aHR, 2.1); peripheral vascular disease (aHR, 1.6); combined coronary bypass grafting and valve surgery (aHR, 1.7); and valve surgery alone (aHR, 1.4). Predictors of early stroke only were preoperative need for dialysis (adjusted odds ratio [aOR], 2.1) and new-onset postoperative atrial fibrillation (aOR, 1.5). The risk of stroke or death was increased with a CHADS2 (congestive heart failure, hypertension, age >75, diabetes mellitus, and prior stroke or transient ischemic attack) score of 2 or higher versus 0 or 1.

"Patients who had cardiac surgery were at highest risk of stroke in the early postoperative period and had continued risk over the ensuing two years, with similar risk factors over these periods," the authors write.

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