ER Informative Podcasts-Series
In this panel discussion Dr. Kachhi and Jacquelyn Horton, RN share when someone should go to the ER, what the ER Staff does to be prepared for emergencies as well as important training needed while working in the ER.
Transcription:
ER Informative Podcasts-Series
Melanie Cole (Host): The emergency department at Temecula Valley Hospital is open 24 hours a day, seven days a week to provide area residents with the emergency and urgent medical care they need when they need it. Today, we’re talking about emergency services at Temecula Valley Hospital. This panel discussion, we have Dr. Pranav Kachhi. He’s the chief of staff and the medical director of the emergency department at Temecula Valley Hospital, and Jacquelyn Horton. She’s a registered nurse and the director of emergency services at Temecula Valley Hospital. Thank you both for joining us today. Dr. Kachhi, I’d like to start with you. Please tell us about your ER staff, and how they are specially trained for emergencies.
Pranav Kachhi, MD (Guest): Thank you for the introduction. Our staff comprises of advanced cardiac life support trained nursing staff, which they’re all RNs. We have a mixture of EMTs that are emergency medical technicians. We also have unit secretaries and monitor techs that help watch monitors, help with our daily workflow, phone calls, et cetera. We also have physicians that are board certified in emergency medicine. Back in the 60’s and the 70’s, [the] emergency department was actually staffed with general practitioners, but over the last 30 to 40 years, we have now have our own specialty in emergency medicine. It’s actually a three to four-year residency program outside of medical school. So, all of our physicians are board certified in emergency medicine. They also have the assistance of PAs and nurse practitioners. So, you can see that we are very highly trained to work in a setting that can take care of a multitude of complaints and issues.
Melanie: Well, thank you for that answer, doctor, and Jacquelyn if something is an emergency, like a stroke, why is it important to call 911? What do your ER staff, doctors, nurses do to be prepared for emergencies with communication from the EMS teams? Tell us how that works.
Jacquelyn: Well, when EMS calls us and lets us know that they have a suspected stroke patient coming in, we immediately call overhead alerting everyone that a stroke patient is on their way in. That allows our pharmacy to mix and bring appropriate medications to the bedside so that we can give them quickly. We have a lab technician that comes so that they’re available to draw blood, and we have the radiology staff make sure that the CT scan machine is ready and turned on, and staff is there awaiting that patient to actually come to the ER and get the patient immediately when they arrive so that we can provide the fastest treatment.
Melanie: Well, that’s so important and really comprehensive. So, let’s talk about some conditions that would warrant going to the emergency room versus calling their primary care provider or going to an urgent care. So, Dr. Kachhi, when patients need to go to the ER, what do you feel are the most important things that they should know—stroke symptoms, heart attack signs, burns, severe burns? What would you like them to know that those are the times you call 911? Don’t even try and drive yourself to the hospital.
Dr. Kachhi: So, I mean, I think you’ve said a lot of the conditions already there in itself, but, you know, I always talk to patients when they come in, and they ask me, you know, right from the get go, “Hey, should I have called 911 or should I have gone to an urgent care?” and sometimes patients aren’t sure. So, this is a very good question. My answer to them first and foremost is, “How do you feel?” When you’re feeling horrible, and you feel like something is really stressful, or you in yourself feel like something’s an emergency, regardless of whether it’s chest pain, abdominal pain, headache. If you feel like something is really, really wrong, I would say pick up the phone, call 911, and ask for help. That’s the first and foremost thing. You know, we see people come in by 911 that could have come in by car, and we’ve likewise—the opposite. We see people that drove into the hospital and should have called 911. So, I always leave it up to the family or the patient, first of all, what they feel is an emergency. Now, like you said earlier, obviously cases of bad trauma or a fall or an injury or a chemical exposure, those are all things that should warrant a 911 response or, yet, immediately driving to the ER. Chest pain, headache, any type of paralysis or neurologic symptoms that you’re having, any type of fever or cough that’s, you know, that doesn’t seem like the regular flu to you, those are all things that you should come to the ER for. You know, there’s things like people that have abdominal pain and the elderly population. There’s not a lot that’s going to be done at an urgent care in terms of radiographic studies or labs and so, when they have something that’s abdominal pain, where there, you know, you could present with 10 different things and 10 different illnesses, that’s something that should warrant a visit to the ER. I hope that kind of explains your question.
Melanie: Well, it certainly does. So, Jacquelyn, as a parent myself and when my kids were little, I know I went through this every time they complained of a stomachache. What would you like parents to know about really when—because they worry every time a kid has a pain, it’s appendicitis or something horrible? That’s what parents do. What would you like parents to know about when you do feel it’s important, they do bring their child in, and what should they bring with them? How can they be prepared to be good advocates in the emergency room? Do you want them in the room with the kids? Do you want them to stand back a little? What would you like from the parents?
Jacquelyn: Well, you know, as a parent myself, even as a nurse, I still question things. You know, if this was an emergency or not with my own children, and what I can say from what I’ve seen in the emergency room, it’s always better to err on the side of caution. Children are difficult to treat sometimes because we don’t know exactly what’s going on with them, and we’re always happy to see children, you know, even if maybe it wasn’t absolutely necessary that they come to the ER, but the parent didn’t have any way of knowing about that, and we would rather be safe than sorry. So, we’re always happy to see children in the emergency department. Mothers, you know, or fathers or parents, they tend to know when something’s not right with their child, and they’ll bring them in and just say,
“You know, something just isn’t right.” They’re maybe way too sleepy than, you know, than they’re supposed to be or, you know, even a vague complaint where they just have a gut feeling something’s not right. We absolutely want, you know, want them to call their pediatrician, but if they have—if they’re not getting the help that they need, or they’re concerned, then we absolutely want them to come in, and we like to involve families with the care of their child. It helps the child feel more comfortable. Obviously, there might be times when we need to do a procedure and, you know, we need space to work in, and we would ask a parent maybe to step aside, but I know at Temecula Valley
Emergency Department, we really encourage participation with the family and the parents. We like to keep them as informed as possible, keep them in the room as much as possible—where we see it as a benefit to the patient when the family is involved.
Dr. Kachhi: Yeah, I would like to add, also. I completely agree with what Jacquelyn just said, but you know, parents know best. They know their kid better than any other doctor or nurse and so, the first thing I always do is listen to the parents. You know, I grew up with a mother that wasn’t a physician, but somehow, she always knew when something was really, really wrong, and so—and the last thing I ever want to do is question a parent. Even when we find that there’s really nothing wrong, and all the tests are normal or no tests are needed, I even have a conversation with the parents because, you know, day one of any illness can flip like the stomach flu can look like, you know, something minor and day two can change. So, part of the first visit is also emphasizing that if anything changes or worsens or anything at all, they’re welcome to come back and don’t hesitate just because the first day, everything was okay doesn’t mean the next day that it’s going to continue to be the same. So, that reassurance and that opportunity for them to come back is something that I always give them.
Melanie: Well, it certainly is so important, and before we wrap up, Jacquelyn, tell us about your staff, as Dr. Kachhi already has spoken about, a little bit about how they’re trained and the doctors, tell us about the nurses in the emergency department and the other staff that are involved and how you all work together as this cohesive team to take on really some pretty scary emergencies.
Jacquelyn: Yes. So, and as Dr. Kachhi mentioned, you know, we have different specialties within the department. We have emergency technicians who are there quickly providing things like EKGs on patients who have chest pain. We have very good times for things like that that we know that we act on those urgently and emergently when they come in. We also have nurses who are trained in so many things in the emergency department because you’re going to see so many different disease processes and every age of person. So, they have to have a lot of training. They have to know, you know, about the stages of infancy and what we expect with those patients, as well as elderly patients and what special conditions they need to know in order to treat those patients and what the risks are, you know, involved in that. So, they do a lot of training. We do training, you know, several times a year in the department with all the special equipment that we need to know about in the emergency room. It’s really one of those places where you always have to be learning, and you know, as medicine develops and you know, new technologies come around, we have to make sure that we are experts on those things as well. So, it’s definitely a place where you are always growing and learning, and we have, you know, a culture of being okay with change and development, and it’s probably one of the more challenges places, I think, to work, but also very rewarding for anybody who, you know, loves to work in that type of fast, challenging environment where you really have to have a very big skill set.
Melanie: You have to be trained both for infants and elderly. So, it really is across all of the spectrums and Dr. Kachhi, wrap it up for us—what you would like listeners to know about the emergency department at Temecula Valley Hospital, and how as I said in my intro, you are there to provide area residents with the emergency and urgent medical cares that they need when they need it.
Dr. Kachhi: I think one of the biggest things, I think, for everyone to know is that we can take care of a variety of conditions. When I first started at the hospital here six years ago, we didn’t have all the services. Now, we basically do. We are aiming towards becoming a thrombectomy capable center. So, we’re going to be a comprehensive stroke center, if you will. We have multiple cath labs where we can do angiograms. We’re doing open-heart surgery. We’re doing vascular procedures that are done through a non-invasive approach and so, it’s just an amazing place to work because of the level of specialists that we have, the resources that we have, the spaces in terms of operative suites and cath labs that we have, we are not transferring as many patients as we were six years ago. We’re keeping everyone here. The community’s very, very happy with this. They like to stay in the area. They finally have a hospital where they can go to where they can get a complete circle of all the services and so, I’m just really proud of everyone that works here and really proud to be a doctor at this hospital, and I’m really, really proud to be a member of this community. So, thank you.
Host: What a great testament from both of you for the value that the residents are getting from all of your hard work at Temecula Valley Hospital in the emergency department. Thank you again for joining us. That wraps up this episode of TVH Health Chat with Temecula Valley Hospital. Please visit our website at temeculavalleyhospital.com/services/emergency-services for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Temecula Valley podcasts. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.
ER Informative Podcasts-Series
Melanie Cole (Host): The emergency department at Temecula Valley Hospital is open 24 hours a day, seven days a week to provide area residents with the emergency and urgent medical care they need when they need it. Today, we’re talking about emergency services at Temecula Valley Hospital. This panel discussion, we have Dr. Pranav Kachhi. He’s the chief of staff and the medical director of the emergency department at Temecula Valley Hospital, and Jacquelyn Horton. She’s a registered nurse and the director of emergency services at Temecula Valley Hospital. Thank you both for joining us today. Dr. Kachhi, I’d like to start with you. Please tell us about your ER staff, and how they are specially trained for emergencies.
Pranav Kachhi, MD (Guest): Thank you for the introduction. Our staff comprises of advanced cardiac life support trained nursing staff, which they’re all RNs. We have a mixture of EMTs that are emergency medical technicians. We also have unit secretaries and monitor techs that help watch monitors, help with our daily workflow, phone calls, et cetera. We also have physicians that are board certified in emergency medicine. Back in the 60’s and the 70’s, [the] emergency department was actually staffed with general practitioners, but over the last 30 to 40 years, we have now have our own specialty in emergency medicine. It’s actually a three to four-year residency program outside of medical school. So, all of our physicians are board certified in emergency medicine. They also have the assistance of PAs and nurse practitioners. So, you can see that we are very highly trained to work in a setting that can take care of a multitude of complaints and issues.
Melanie: Well, thank you for that answer, doctor, and Jacquelyn if something is an emergency, like a stroke, why is it important to call 911? What do your ER staff, doctors, nurses do to be prepared for emergencies with communication from the EMS teams? Tell us how that works.
Jacquelyn: Well, when EMS calls us and lets us know that they have a suspected stroke patient coming in, we immediately call overhead alerting everyone that a stroke patient is on their way in. That allows our pharmacy to mix and bring appropriate medications to the bedside so that we can give them quickly. We have a lab technician that comes so that they’re available to draw blood, and we have the radiology staff make sure that the CT scan machine is ready and turned on, and staff is there awaiting that patient to actually come to the ER and get the patient immediately when they arrive so that we can provide the fastest treatment.
Melanie: Well, that’s so important and really comprehensive. So, let’s talk about some conditions that would warrant going to the emergency room versus calling their primary care provider or going to an urgent care. So, Dr. Kachhi, when patients need to go to the ER, what do you feel are the most important things that they should know—stroke symptoms, heart attack signs, burns, severe burns? What would you like them to know that those are the times you call 911? Don’t even try and drive yourself to the hospital.
Dr. Kachhi: So, I mean, I think you’ve said a lot of the conditions already there in itself, but, you know, I always talk to patients when they come in, and they ask me, you know, right from the get go, “Hey, should I have called 911 or should I have gone to an urgent care?” and sometimes patients aren’t sure. So, this is a very good question. My answer to them first and foremost is, “How do you feel?” When you’re feeling horrible, and you feel like something is really stressful, or you in yourself feel like something’s an emergency, regardless of whether it’s chest pain, abdominal pain, headache. If you feel like something is really, really wrong, I would say pick up the phone, call 911, and ask for help. That’s the first and foremost thing. You know, we see people come in by 911 that could have come in by car, and we’ve likewise—the opposite. We see people that drove into the hospital and should have called 911. So, I always leave it up to the family or the patient, first of all, what they feel is an emergency. Now, like you said earlier, obviously cases of bad trauma or a fall or an injury or a chemical exposure, those are all things that should warrant a 911 response or, yet, immediately driving to the ER. Chest pain, headache, any type of paralysis or neurologic symptoms that you’re having, any type of fever or cough that’s, you know, that doesn’t seem like the regular flu to you, those are all things that you should come to the ER for. You know, there’s things like people that have abdominal pain and the elderly population. There’s not a lot that’s going to be done at an urgent care in terms of radiographic studies or labs and so, when they have something that’s abdominal pain, where there, you know, you could present with 10 different things and 10 different illnesses, that’s something that should warrant a visit to the ER. I hope that kind of explains your question.
Melanie: Well, it certainly does. So, Jacquelyn, as a parent myself and when my kids were little, I know I went through this every time they complained of a stomachache. What would you like parents to know about really when—because they worry every time a kid has a pain, it’s appendicitis or something horrible? That’s what parents do. What would you like parents to know about when you do feel it’s important, they do bring their child in, and what should they bring with them? How can they be prepared to be good advocates in the emergency room? Do you want them in the room with the kids? Do you want them to stand back a little? What would you like from the parents?
Jacquelyn: Well, you know, as a parent myself, even as a nurse, I still question things. You know, if this was an emergency or not with my own children, and what I can say from what I’ve seen in the emergency room, it’s always better to err on the side of caution. Children are difficult to treat sometimes because we don’t know exactly what’s going on with them, and we’re always happy to see children, you know, even if maybe it wasn’t absolutely necessary that they come to the ER, but the parent didn’t have any way of knowing about that, and we would rather be safe than sorry. So, we’re always happy to see children in the emergency department. Mothers, you know, or fathers or parents, they tend to know when something’s not right with their child, and they’ll bring them in and just say,
“You know, something just isn’t right.” They’re maybe way too sleepy than, you know, than they’re supposed to be or, you know, even a vague complaint where they just have a gut feeling something’s not right. We absolutely want, you know, want them to call their pediatrician, but if they have—if they’re not getting the help that they need, or they’re concerned, then we absolutely want them to come in, and we like to involve families with the care of their child. It helps the child feel more comfortable. Obviously, there might be times when we need to do a procedure and, you know, we need space to work in, and we would ask a parent maybe to step aside, but I know at Temecula Valley
Emergency Department, we really encourage participation with the family and the parents. We like to keep them as informed as possible, keep them in the room as much as possible—where we see it as a benefit to the patient when the family is involved.
Dr. Kachhi: Yeah, I would like to add, also. I completely agree with what Jacquelyn just said, but you know, parents know best. They know their kid better than any other doctor or nurse and so, the first thing I always do is listen to the parents. You know, I grew up with a mother that wasn’t a physician, but somehow, she always knew when something was really, really wrong, and so—and the last thing I ever want to do is question a parent. Even when we find that there’s really nothing wrong, and all the tests are normal or no tests are needed, I even have a conversation with the parents because, you know, day one of any illness can flip like the stomach flu can look like, you know, something minor and day two can change. So, part of the first visit is also emphasizing that if anything changes or worsens or anything at all, they’re welcome to come back and don’t hesitate just because the first day, everything was okay doesn’t mean the next day that it’s going to continue to be the same. So, that reassurance and that opportunity for them to come back is something that I always give them.
Melanie: Well, it certainly is so important, and before we wrap up, Jacquelyn, tell us about your staff, as Dr. Kachhi already has spoken about, a little bit about how they’re trained and the doctors, tell us about the nurses in the emergency department and the other staff that are involved and how you all work together as this cohesive team to take on really some pretty scary emergencies.
Jacquelyn: Yes. So, and as Dr. Kachhi mentioned, you know, we have different specialties within the department. We have emergency technicians who are there quickly providing things like EKGs on patients who have chest pain. We have very good times for things like that that we know that we act on those urgently and emergently when they come in. We also have nurses who are trained in so many things in the emergency department because you’re going to see so many different disease processes and every age of person. So, they have to have a lot of training. They have to know, you know, about the stages of infancy and what we expect with those patients, as well as elderly patients and what special conditions they need to know in order to treat those patients and what the risks are, you know, involved in that. So, they do a lot of training. We do training, you know, several times a year in the department with all the special equipment that we need to know about in the emergency room. It’s really one of those places where you always have to be learning, and you know, as medicine develops and you know, new technologies come around, we have to make sure that we are experts on those things as well. So, it’s definitely a place where you are always growing and learning, and we have, you know, a culture of being okay with change and development, and it’s probably one of the more challenges places, I think, to work, but also very rewarding for anybody who, you know, loves to work in that type of fast, challenging environment where you really have to have a very big skill set.
Melanie: You have to be trained both for infants and elderly. So, it really is across all of the spectrums and Dr. Kachhi, wrap it up for us—what you would like listeners to know about the emergency department at Temecula Valley Hospital, and how as I said in my intro, you are there to provide area residents with the emergency and urgent medical cares that they need when they need it.
Dr. Kachhi: I think one of the biggest things, I think, for everyone to know is that we can take care of a variety of conditions. When I first started at the hospital here six years ago, we didn’t have all the services. Now, we basically do. We are aiming towards becoming a thrombectomy capable center. So, we’re going to be a comprehensive stroke center, if you will. We have multiple cath labs where we can do angiograms. We’re doing open-heart surgery. We’re doing vascular procedures that are done through a non-invasive approach and so, it’s just an amazing place to work because of the level of specialists that we have, the resources that we have, the spaces in terms of operative suites and cath labs that we have, we are not transferring as many patients as we were six years ago. We’re keeping everyone here. The community’s very, very happy with this. They like to stay in the area. They finally have a hospital where they can go to where they can get a complete circle of all the services and so, I’m just really proud of everyone that works here and really proud to be a doctor at this hospital, and I’m really, really proud to be a member of this community. So, thank you.
Host: What a great testament from both of you for the value that the residents are getting from all of your hard work at Temecula Valley Hospital in the emergency department. Thank you again for joining us. That wraps up this episode of TVH Health Chat with Temecula Valley Hospital. Please visit our website at temeculavalleyhospital.com/services/emergency-services for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Temecula Valley podcasts. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.