Code ICE

Emory physician Greg Martin is director of Grady's medical and coronary intensive care units. Emory faculty provided $25.7 million in uncompensated care at Grady last year. When patients do have coverage, all payments for Emory services go to the Emory Medical Care Foundation, which uses every penny—$42.2 million in fiscal year 2012-2013—to support Emory's mission at Grady.
Emory physician Greg Martin is director of Grady's medical and coronary intensive care units. Emory faculty provided $25.7 million in uncompensated care at Grady last year. When patients do have coverage, all payments for Emory services go to the Emory Medical Care Foundation, which uses every penny—$42.2 million in fiscal year 2012-2013—to support Emory's mission at Grady.

 

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Life was good. Sandra Schwann had the perfect dress for the prom, she was excited about taking swimming lessons, and school was going well.

The temperature of Sandra's IV fluids was lowered. Then her chest, belly, and thighs were wrapped in high-tech cooling pads that quickly lowered her core body temperature.

Then the 16-year old collapsed in class, her heart in cardiac arrest. In the ambulance headed to Grady Hospital, electroshock restored her heart rhythms, but she was still in danger. Of the small percentage of Americans who survive cardiac arrest, many suffer brain damage from the initial lack of oxygen or from the cascade of inflammatory and other responses in the hours after restoration of blood flow.

Based on information from the emergency medical technicians, a code ICE sounded in the emergency department, bringing a special team running to meet the ambulance. Their first task was to decide if the girl was a good candidate for a new protocol in which a patient's body temperature is systematically lowered by roughly six degrees. The procedure, called therapeutic hypothermia, slows metabolism and protects the brain from damage from the restored blood flow.

Sandra was admitted by Emory physician Greg Martin, director of Grady's medical and coronary intensive care units and head of the team that developed and maintains the ICE protocol. After a rapid-fire series of tests, Sandra was found to be a perfect candidate. She was placed on a mechanical respirator and given medications to keep her comfortable and prevent seizures. The temperature of her IV fluids was lowered. Then her chest, belly, and thighs were wrapped in high-tech cooling pads that quickly lowered and carefully monitored her core body temperature. Just 24 hours later, the team began to return Sandra to her normal temperature. Waking up, she seemed groggy and confused. But the next day she was better, and better again the day after that, then better yet every day. After six days, she was sent to Children's Healthcare of Atlanta at Egleston for correction of the problem that had caused her erratic heart rhythms.

The cost of Sandra's six days at Grady exceeded $100,000. Like all Emory faculty at Grady, Martin never knows if patients have insurance coverage or whether the services he provided as her attending physician were ever reimbursed. He only knows that his new protocol returned a teenager to her normal life, starting with the prom.

       
   

Emory physicians provide 85% of the care at publically funded Grady Hospital. Grady patients receive extraordinary care, often in Emory-led programs not widely available elsewhere in the region, including centers for high-risk mothers and babies, burns, poison control, HIV/AIDS, and ground-breaking programs in stroke, cancer, diabetes, and sickle cell disease.

 

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