Hazards of Hospitals

If you think a hospital is a fairly safe place to be, especially when you are sick, you might want to think again. It is well-known that the risk of certain types of infections are greater in a hospital setting than many other places. And as we discussed yesterday regarding the reading of mammograms, there are perils involved with hospitalization simply due to poorly trained, over-worked, and incompetent staff. Throw in the dangers of surgery, medications, and other procedures, and you have an environment that is risky enough to give anyone a good dose of anxiety.

Now studies are confirming that even emergencies such as cardiac arrest may be better handled outside of a hospital setting. Your chances of surviving such an event in a public place like an airport or a casino are better than if your heart malfunctions in a hospital. It really makes you think twice about submitting to a hospital stay, especially as budget cuts typically result in under-staffing and long work hours, often with little sleep between shifts. The number of mistakes made in hospitals that lead to fatalities is on the rise, another indicator of the overall failure of the health care system here in America.


Hospitals have their limits
Study finds more people survive heart rhythm problems in airports, casinos
By Thomas H. Maugh II
Los Angeles Times
January 6, 2008

People who suffer a life-threatening alteration in heart rhythms are more likely to survive if they are in a casino or airport than if they are in a hospital, researchers have reported.

Doctors already knew that more than half of those who suffer such attacks in airports and casinos survive. But a new study in hospitals shows that only a third of victims there survive, primarily because patients do not receive life-saving defibrillation within the recommended two minutes.

Nearly 40 percent of hospitalized patients who received defibrillation within two minutes survived to leave the hospital, compared with only 22 percent of those for whom the response took longer, researchers reported in the New England Journal of Medicine.

As many as 750,000 people suffer such attacks in hospitals every year in the United States, and another quarter-million have them outside hospitals.

"It is probably fair to say that most patients assume -- unfortunately, incorrectly -- that a hospital would be the best place to survive a cardiac arrest," University of Southern California cardiologist Dr. Leslie Saxon wrote in an editorial accompanying the report.

People who suffer a heart attack in the middle of a crowded airport or casino, where defibrillators are widely available, are typically noticed immediately, whereas a lone patient suffering an attack in a hospital room may not be noticed for much of the crucial window of opportunity during which defibrillation is most effective.

The odds of survival are even lower in small hospitals with fewer than 250 beds, and on nights and weekends, according to the study by Dr. Paul S. Chan of St. Luke's Mid-America Heart Institute in Kansas City, Mo., and Dr. Brahmajee K. Nallamothu of the University of Michigan.

At least part of the apparent discrepancy arises because hospitalized patients are sicker to begin with, while those who suffer attacks in airports and casinos generally don't have underlying medical illnesses or symptoms, said University of California-Los Angeles cardiologist Dr. Gregg C. Fonarow, who was not involved in the study.

Still, he said, hospitals can do more to shorten the time needed to administer defibrillation.

Defibrillation is used when patients suffer either ventricular fibrillation or ventricular tachycardia. In the first case, the heart beats abnormally or intermittently, while in the second it beats extremely rapidly. In both cases, the result is the same: an inability to pump blood through the body effectively.

Applying a shock to the heart often restores normal heart rhythms. The devices found in public places, called automated external defibrillators, can be used by trained laymen to treat the condition rapidly.

Guidelines developed by major heart organizations call for administration of defibrillation within two minutes after the onset of an attack, but there is little hard data to support the need for a rapid response, the authors wrote.

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