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The Hospitalized Officer

The Hospitalized Officer. Protect Your Investment. Sarah Mildred Gamble, DO Police Surgeon / Greenwich Police Department / Greenwich / CT Clinical Instructor- Columbia University College of Physicians and Surgeons, NY, NY. Me. Board Certified Internal Medicine Physician

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The Hospitalized Officer

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  1. The HospitalizedOfficer Protect Your Investment Sarah Mildred Gamble, DO Police Surgeon / Greenwich Police Department / Greenwich / CT Clinical Instructor- Columbia University College of Physicians and Surgeons, NY, NY

  2. Me • Board Certified Internal Medicine Physician • Police Surgeon- Greenwich, CT • Exclusive hospitalized patient care • Clinical Instructor for Internal Medicine- Columbia University College of Physicians and Surgeons- NY, NY Wife of S.W.A.T/S.R.U Officer

  3. Disclosures None

  4. Objectives • HIPAA Review • US Hospitals = Danger Zones • Why LEO’s get Hospitalized • Top 3 Hospital Dangers • Officer/Family Support Liaison • Chief Prevention Strategies

  5. HIPPA • Health Insurance Portability & Accountability Act • Privacy • Security

  6. Office of Civil Rights • Enforce HIPAA Privacy • Protects individually identifiable health information • Security Rule • National standard for electronic health information • Confidentiality Provisions Patient Safety Rule • Protect identifiable information • Analyze patient safety events 

  7. HIPAA Privacy • Electronic / Written / Oral Information • 12 national priority purposes allowing disclosure of medical information  

  8. Oops, My Bad… HIPAA applies to: Doctors Health Insurance Companies Health Care Clearing House

  9. Doc to Brass… • Serious Threat to Health or Safety • Prevent/lessen serious and imminent threat to a person/public • Made to someone they believe can prevent/lessen the threat (Brass)

  10. Doc to Brass… • Judicial & Administrative Proceedings • Order from court / administrative tribunal • Subpoena • To protect the health and safety of inmates

  11. But if I Know… • Cocaine/heroin/PCP • Contagious • Multiple (vs. 1st) DUI’s • Homicidal • Uncontrolled medical issue: • diabetes • seizures • bleeding/clotting disorder

  12. Just the Facts Ma’am • Minimum Necessary • To accomplish the intended purpose of the use/disclosure/request • Not the whole record

  13. GINA • Genetic Information Nondiscrimination Act • Acquisition of employee genetic information • Unlawful • If you already have it • Keep it separate • Not in regular accessible employee file

  14. Health is Wealth • Open the discussion • This is first generation to DIE before parents

  15. Extrapolate This…

  16. LEO’s have Significantly Higher… • Stress Levels • PTSD / Depression • Suicide Rates • Divorce On the Job Injury & Chronic Disease

  17. How Was GPD Last Year? • Muscle/Bone (sprains/strains): • 54% • 90% while on the job • Trauma: • 36% • 93% while on the job • Atherosclerotic Disease: • 10% • 50% while on the job

  18. Cold Hard Facts • Your LEO’s get INJURED • Your LEO’s are OBESE • Your LEO’s get CHRONICDISEASE

  19. Physical Deconditioning Hurts! • Pursuit Issues • Effecting Arrest • Sprains and Strains

  20. Obesity Hurts! • #1 Cause: back injury / all cause injury • Degenerative Joint Disease / Arthritis

  21. Chronic Disease Hurts! • Incidence is on the rise 50% • Using up • Medical benefits • Sick time / personal day / vacation time • Short term disability claims • Long term disability claims • Early retirement • Early pension

  22. Chronic Disease • CAD • Diabetes Type II • High Blood Pressure • High Cholesterol • COPD / Asthma

  23. 1/3 of All Cause Mortality Tobacco Abuse Physical Inactivity Poor Eating Habits Obesity Alcohol Abuse Stress

  24. Injured/Ill LEO Must Go… • Off to the Hospital • Vulnerable / Unprotected • In Danger

  25. Top 3 Hospital Dangers • Hospital Acquired Infections • Wrong Drug / Wrong Dose • No Planned Follow Up

  26. Hospital Danger #1 Hospital Acquired Infections Skin / Soft Tissue Blood Urine C. difficile Diarrhea Ventilator

  27. Hospital Danger #2 Medication Error Wrong Medication Wrong Dose

  28. Hospital Danger #3 Poor / No Discharge Plan No scheduled follow up Poor pain management Prescription compliance

  29. Break the Cycle!

  30. Officer/Family Support Liaison • Role is to standardize the process and improve care rendered • Must have some medical knowledge • PS/Occ Health/PA/NP/RN

  31. Liaison Responsibilities • Admission • Daily visits- communication • Educate LEO/Family (hand washing/meds/find a PMD) • Discharge Planning • Weekly contact LEO on sick leave/light duty • Once LEO Full Duty… Can sign off case

  32. No Liaison • 55yo LEO no PMD to follow department physical results for 20 years • Lost consciousness on patrol • Admitted: BS critical high, kidney failure, almost complete vision loss • Contracted blood infection from central line • Prolonged stay for 2 weeks • Poor discharge- no PMD, blind,3 flights of stairs, didn’t fill meds • END RESULT: Disability, dialysis, almost dead

  33. With Liaison • 26yo LEO emergency sx aggressive spinal tumor • Speak with NES / ONC day of admission • Translate to LEO and family progress/diagnosis • Tumor Board organized to discuss case • Second opinion arranged • NES no ins on follow up / assisted with billing • Narcotic management, physical therapy compliance, light duty, full duty • 1st year follow up- doing great!

  34. Liaison Leads Return to Work Program • Within 7 days of discharge • Not if contagious or open wounds • Specific light duty for recovering LEO • For Patrol (SWAT/SRU stricter guidelines) • Narcotic Use Agreement • Establish PMD / Follow Up • Medication Compliance • Physical / Occupational Therapy Compliance

  35. The Bottom Line is… • Standardize care: policy and procedure • Human capital: investment to be managed • Money for REACTIVE CARE • Barriers to health / Worsen clinical outcomes • Money for PROACTIVE CARE • Educate • Diagnose early • High quality care

  36. Chief Then Please… • Be Responsible and Educate • Direct the Health Care • Keep them out of Danger!

  37. Non Hospitalized LEO • Physically fit: appropriate physical activity • No tobacco / illicit drugs • Preventative health • Psychologically handle highly demanding job • Safe and healthy work environment • Respond positively to changes

  38. Healthy Cops Are Productive Cops!

  39. What Are You Waiting For? • Shoulder / Hip / Knee Replacement • Spinal Disc Herniation • Degenerative Joint Disease • Stroke / Heart Attack • Morbid Obesity • SUPER Morbid Obesity

  40. Summary of Main Points • LEO’s have high rates of Illness/Injury • Ill/Injured LEO’s go to the Hospital • Hospitals = DANGER • Officer/Family Support Liaison protects your investment from Danger • Simple low cost education/screening breaks the cycle

  41. Our Team • Contact # provided memo/email quarterly • Desk sergeant / dispatchers • 24 hour answering service • Email accounts- urgent vs. routine • Facebook- weekly health updates • Contact WITHIN department • Captain Hero

  42. Areas for Future Research • Department Specific Data • Unit Specific Data

  43. References • Violanti et al, BCOPS, Ann Epidemiol. Vol 16 no 2, Feb 2006 • Kunen et al, JOEM, vol 51, no 9, Sept 2009 • Stuart, COP, vol 21, no 5, Sept 2008 • Loeppke et al, JOEM, vol 51, no 4, April 2009 • Franke et al JOEM, 52(5):561-565, May 2010 • www.healthypeople.gov • www.cdc.gov • www.fbi.gov • www.leoka.org • JOEM, 51(6):700-707, June 2009. • www.businessgrouphealth.org • US Department of Labor-Bureau of Labor Statistics. Occupational Outlook Handbook, 2008-09 Edition • US Department of Labor-Bureau of Labor Statistics. Police and Detectives. Washington, DC; 2008-2009 Edition • Ramey et al, AAOHN, vol 57, no 11 nov 2009 • Franke et al, JOEM, vol 40, no 5, May 1998

  44. Contact Me • Sarah.Gamble@GreenwichCT.org • 203-962-1009 office • 11 Bruce Place / Greenwich / CT / 06830 • www.PrecinctMedicine.com

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