Harbor-UCLA ED Newsletter
May 18, 2026
Major Takeaways This Month
TL;DR
Operations & Workflow
  • Arterial lines remain limited to Trauma/Resus areas
  • "ED Trauma" pages trigger StatRad priority reads
  • IR emergent consults must be communicated as REDLINES
  • MAT consult service unavailable May 18–29 (possibly through June 5)
Safety & Quality
  • Arrow kits with lidocaine affected by national recall
  • Avoid verbal medication orders without Cerner follow-up
  • Repeat lactates within 3 hours — don't wait for IVF completion
  • Avoid "r/o infection" language in XR orders
Infectious Disease Alerts
  • Brucella outbreak linked to unpasteurized dairy
  • Andes virus hantavirus advisory related to cruise exposure
Department Updates
  • EMS Week recognition and award winners
  • Social EM Journal Club June 2
  • Dr. Jen Roh beginning maternity leave June 8th
Operations Updates
Operations Updates
New clinical and operational reminders for all ED staff.

OOP Sensitive Services
For OOP OB/GYN referrals involving pregnancy termination, STI treatment/testing, HIV counseling/testing, sexual assault services, or family planning:
➡ Add "Sensitive Services" to special instructions
Arterial Line Placement
  • Restricted to Resuscitation/Trauma area
  • Trauma nurses currently trained for setup/monitoring
  • Coordinate with Charge RN if needed elsewhere
ED Trauma Pages
  • Automatically prioritize imaging for StatRad interpretation
  • Please reserve for critically ill trauma patients
ED Operations
ED Throughput + Trauma Bay Utilization
In efforts to better optimize our Trauma (Resus) Bay and Trauma RN capacity – you may see lower acuity patients assigned to your physician teams (*when the Trauma bays are not full). Please be mindful to see these patients in a timely manner as well.
*Peds ED Team can also help see low acuity adult patients in the Trauma bays. Communicate with the Adult Teams to coordinate staffing if the Peds ED Attending cannot see adults.

If you notice many low acuity patients being assigned to your team and you have a question, please call the RME charge and see if there are actually FT providers to see the lower acuity patients (*oftentimes it’s because triage is backed up or there were call-offs and we don’t have anyone to see FT patients in RME)
ED Supplies
GlideGo’s

All GlideGo’s (adult and peds) are now updated to the Quick Connect versions (all blades near the airway bag should all be quick connects).
The trauma Glidscopes are still a mix of HDMI and Quick connect (*always check the connection). We will use the HDMI connections until we run out of the HDMI blade supplies.
Operations Pearls
IR Redline Reminder

Emergent IR cases must be labeled REDLINE. IR page system still requires manual paging to contact provider directly.
Law Enforcement Recording Policy
  • Recording patient interviews — allowed
  • Recording physician-patient encounters — NOT allowed
  • Review WikEM guidance for escalation pathways
MAT Coverage Gap

No MAT consult coverage: May 18–29 (also possibly June 1–5)
Backup Resources — Providers
  • DHS MAT Line: 213-288-9090
  • UCSF NCCC: 844-275-6222
Backup Resources — Patients
  • LA MAT resources
  • Recover LA
  • Substance Abuse Helpline
Operations Workflow Reminders
From prior newsletters
IR Outpatient Requests
Use: .harir
Endoscopy Pathways
  • Emergent → ICU or OR Redline
  • Urgent → Admit for GI scheduling
Rancho Admissions
Remember Rancho-specific admission workflows for appropriate patient routing.
ESI Scores
  • Do NOT change after triage
  • Escalate concerns to Charge RN
RME "Round 2" Workflow Reminder

Goal
Improve throughput and order completion for Fast Track/Surge patients without assigned nurses.
Workflow Steps
1
Enter all orders in FirstNet
2
Complete RME task form
3
Place form in "2nd Round Orders" bin
4
Place patient in RME chairs if available
Workflow Reminder
Administrative Update
Dr. Jen Roh — Maternity Leave
June 8, 2026
During Leave
  • Coverage details will be included in OOO email
  • Contact AOD for urgent same-day operational issues

Thank you to everyone for your teamwork, flexibility, and dedication to patient care.
Clinical Corner
With Dr. Ilene Claudius
Incidental Findings Reminder
When incidental findings are discovered, please ensure the following steps are completed:
Inform patients
Communicate findings clearly and compassionately.
Notify PCP/admitting teams
Ensure continuity of care with appropriate handoff.
Add findings into ORCHID diagnoses list
Document accurately for follow-up tracking.
ORCHID Workflow
Use the following sections within ORCHID to document properly:
  • RVF section
  • PMH section
  • Diagnosis List updates
Medication Safety
Important medication safety reminders for all clinical staff.
Alarming Pumps
  • Do NOT manipulate pumps directly
  • Contact assigned RN
Verbal Orders
  • Minimize verbal medication orders
  • Enter Cerner orders ASAP after emergent situations
Recent Safety Concerns
  • Ketamine drips
  • Insulin drips
  • Medication discontinuation without formal order follow-up
National Recall ⚠️
Arrow Kits containing lidocaine are currently under a national recall. Do not use affected kits.

Arrow Kits with lidocaine are affected by a national recall. Signs are up in all pertinent areas.
Bedside Patient Safety
Paracentesis Safety
Use Doppler Guidance for Paras
Please use Doppler guidance before placing paracentesis catheters.
Why This Matters
Abdominal wall vessels are frequently closer than expected. Doppler guidance significantly reduces the risk of inadvertent vascular injury during the procedure.
Sepsis Pearls
SEP-1 Reminders
Lactate Timing
  • Repeat within 3 hours
  • Do NOT wait until IVF completion
Imaging Order Language
Avoid the following phrases in XR orders:
  • "r/o osteo"
  • "r/o PNA"
  • "rule out infection"
Why It Matters
Using "rule out infection" language may unintentionally trigger the SEP-1 infection suspicion clock, affecting compliance metrics and patient care pathways.
LAHAN Alert — Brucella melitensis Cluster
Infectious Disease
Exposure Risk
Linked to unpasteurized dairy products:
  • Goat milk
  • Cow milk
  • Raw cheese
Symptoms
  • Fever
  • Night sweats
  • Arthralgias
  • Fatigue
  • Meningitis
  • Endocarditis
Critical Safety Steps

Aerosolizable organism — handle with extreme caution
01
Notify lab before specimen handling
02
Avoid tube system for transport
03
Use full PPE
04
Contact ID + Public Health immediately
Infectious Disease Alert
Hantavirus Advisory — Andes Virus
Key Difference from Sin Nombre Virus
Person-to-Person Spread
Unlike Sin Nombre virus, Andes virus CAN spread person-to-person. This distinction is critical for isolation and contact precaution decisions.

Contact Public Health immediately for any suspected cases.
(*but no known cases in LA County at this time)
Current Situation
  • Cruise ship-associated cases identified
  • No known LA County cases currently
  • 2 California travelers from the cruise under evaluation in Nebraska, 1 from the cruise in CA, 1 who had contact ( both not in LA County)
The Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH) have issued Health Alert Network (HAN) advisories to inform clinicians and health departments about a new cluster of hantavirus disease cases caused by infection with Andes virus. Hantavirus disease can cause severe illness and can be fatal. The risk of broad spread to the United States is considered extremely unlikely at this time.
LA County Department of Public Health is not aware of any cruise ship passengers or close contacts of confirmed or suspected cases that will be returning to LA County.
As of May 9, CDPH has been notified of three California residents who were passengers on the cruise ship. One has returned to California, and two are currently at a facility in Nebraska for evaluation. A fourth traveler had contact with a known case while overseas and has returned to California. None of these individuals are from LA County.
Andes virus is a hantavirus species that is endemic to South America. It is different than the Sin Nombre virus, which is a hantavirus native to California and North America. Sin Nombre virus infections are rare in Los Angeles County with only nine cases detected in Los Angeles County since 2000. Among these, approximately half were fatal cases. Sin Nombre hantavirus is spread through contact with infected rodents, particularly deer mice (Peromyscus maniculatus), which are found in many parts of California.
Providers should contact Public Health immediately if a patient is identified with/suspected of having Hantavirus.
Los Angeles County DPH Acute Communicable Disease Control:
  • Weekdays 8:30am–5pm: call 213-240-7941.
  • After-hours: call 213-974-1234 and ask for the physician on call
Long Beach Health and Human Services:
  • Weekdays 8am-5pm: call 562-570-4302.
  • After hours: call 562-500-5537 and ask for the duty officer.
Pasadena Public Health Department:
  • Weekdays 8am-5pm: call 626-744-6089.
  • After hours: call 626-744-6043.
Read the CDPH Advisory
Public Health Contacts
Use these contacts immediately for any reportable disease or public health emergency.
LA County DPH
  • Weekdays: 213-240-7941
  • After Hours: 213-974-1234
Long Beach Health
  • Weekdays: 562-570-4302
  • After Hours: 562-500-5537
Pasadena Public Health
  • Weekdays: 626-744-6089
  • After Hours: 626-744-6043
Joint Commission Readiness
Administrative Expectations
  • Complete TalentWorks modules
  • Review TeamSTEPPS
  • Sign charts promptly
  • Enter verbal orders ASAP
Medication Safety

Label ALL syringes appropriately — no exceptions.
Core Competencies
All staff should be able to demonstrate understanding of:
  • EMTALA
  • Infection control
  • Restraints
  • Fire safety
  • PHI/privacy
  • Equitable triage
  • ED code response
Infection Control Reminder
Ultrasound Machines
Keep Surfaces Clear

Please do NOT store supplies on ultrasound machines.
Why This Matters
Infection Control
Supplies stored on machines create contamination risks and complicate cleaning protocols.
Expired Supply Risks
Items stored improperly may be used past expiration, creating patient safety hazards.
EMS Week 2026
EMS Day Celebration
Hosted by the Harbor-UCLA Office of Prehospital Care and Department of Emergency Medicine.
"Improving Outcomes, Together"
EMS Collaboration
Celebrating EMS collaboration across LA County and the partnerships that save lives every day.
Peer Support Resources
Highlighting mental health and peer support programs available to EMS personnel.
Canine Program
Showcasing the canine program and its role in prehospital and community care.
Prehospital Ultrasound
Updates on prehospital ultrasound capabilities and training advancements.
EMS Award Winners 2026
Congratulations!
MICN of the Year
Laura Avila
Base Physician of the Year
Sahar Rammaha, MD
EMT of the Year
Madison Gallegos
Paramedic of the Year
Jerome Woodcock, FFPM LAFD
EMS Excellence Award
Captain Jay Walker, LAFD
Peds ED Update
SDU Admission Reminder
For PED patients who are:
  • Made NPO
  • On HFNC
  • Admitted for respiratory distress

➡ Please place IV access before transfer upstairs
Exceptions
Limited cases may be exempt, such as:
  • BRUE observation admissions
Wellness & Resident Shout Outs
Resident Recognition
Celebrating outstanding clinical performance and dedication from our residents this month.
Pao
Excellent MICU airway management on an unstable GI bleed patient.
Tiffany
Outstanding teaching case identifying LV thrombus on POCUS.
Shimran Kumar
Exceptional ultrasound productivity recognized by LAG US leadership.
Mai Vu
Independent HD line placement on a renal failure patient.
Social EM Journal Club
Upcoming Event
Event Details
June 2
Tuesday, 6:00 PM
  • Dinner provided
  • RSVP by May 26
Topic
  • Homelessness
  • Street psychiatry
  • Caring for unhoused patients
Special Guests
LA County DMH Street Psych Team

Don't miss this important discussion on social emergency medicine and community care.
Thank You for Everything You Do
Your teamwork, resilience, adaptability, and compassion continue to make Harbor-UCLA ED exceptional.
Have updates, patient stories, or reflections? Please email: [email protected]
Have a fantastic rest of the month!