🏥 Harbor-UCLA ED Newsletter
April 30, 2026 · Emergency Department · Harbor-UCLA Medical Center
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🚨 TL;DR — Quick Hits
Everything you need to know from this month's ED newsletter, at a glance.
💊 Droperidol is HERE 🎉
Rapid-onset D2 antagonist for acute agitation. Faster than haloperidol, shorter duration. Monitor QT risk, sedation, EPS.
✋ Hand Surgery Coverage
No full-time attending, but coverage remains. Continue standard consult workflow.
📟 Cardiology Pager Fix
C-team autopager unreliable. Use Main Paging System (x6534).
🧠 Psych Transfers
Arrival → "Continue hold." Discharge → "Discontinue hold → continued at different service area."
⚠️ ED Extubations = Rare
Use DHS orderset + Harbor checklist only.
🚑 Trauma & Transfers
Activate appropriately (TTA1/TTA2/TC). Use trauma orderset. ❌ No inpatient → ED transfers.
🏛️ Joint Commission
Keep triage clean, compliant, and uncluttered.
🚨 New Drug Alert
Medetomidine contamination → prolonged sedation + withdrawal.
🧸 Peds Updates
Separate urine cultures <2 yrs. 3-view joint X-rays (except hip).
💻 IT Update (May 5)
New DVPRS pain scale going live.
⚖️ Social EM Policy 8337
Expanded rights for ICE/CBP patients. Escalate to leadership — do NOT enforce directly.
👏 Shoutout
Congrats to Ryan Pedigo — 2026 Dadone Clinical Teaching Award recipient!

🗓 EMS Day: May 14 | 8am–12pm · Lundquist Auditorium
⚙️ Operations Updates
Consults – Hand Surgery
Interim coverage remains despite the loss of a full-time attending. The standard consult workflow continues to apply.
Confirm Resident Coverage
Ensure resident is staffed with an attending before proceeding with consult.
Escalate Early
If concerns arise, escalate promptly rather than waiting for issues to compound.
Transfer Pathways (if needed)
1
Emergent
MAC → LAG
2
No Capacity
UM → Outside Facilities
3
Non-Emergent
DHS vs. In-Network Transfer
📟 Cardiology Pager Update
The C-team autopager has been found to be unreliable and should not be used as the primary contact method.
Effective immediately, use the Main Harbor Paging System to reach cardiology (x6534)

Do NOT use the C-team autopager — it is currently unreliable and may result in missed consults.
🧠 Psych Transfers (Exodus)
Proper documentation of psychiatric hold status during Exodus transfers is critical for continuity of care and legal compliance.
On Arrival
Select "Continue hold" in the system to maintain the existing psychiatric hold status upon patient arrival.
On Discharge
Select "Discontinue hold" followed by "Hold continued at different service area" to properly document the transfer of hold status.

Accurate documentation ensures legal protection for staff and continuity of psychiatric care for patients across service areas.
Order:
Cancellation:
💊 ED Pharmacy Update: Droperidol
Droperidol is now available in the Harbor-UCLA ED — a significant addition to our acute agitation and antiemetic toolkit.
Why It Matters
Faster Onset
5 min vs. 20 min for haloperidol
Shorter Half-Life
2.3 hrs vs. 14 hrs for haloperidol
Indications
  • Acute agitation
  • Refractory nausea/vomiting
Dosing
  • 5–10 mg IM/IV (repeat q10–15 min)
  • Lower doses in elderly patients
  • Peds: 0.1 mg/kg
Safety Monitoring
QT Risk
Low at ED doses — monitor high-risk patients
Sedation
Monitor level of consciousness
EPS
Watch for extrapyramidal symptoms
Electrolytes
Check K+ and Mg2+ in at-risk patients
Clinical Pearls
  • Often sufficient as a single agent for agitation
  • Less respiratory depression compared to benzodiazepines
🧠 ORCHID + Clinical Ops
ED Extubation Protocol

⚠️ ED extubations are VERY RARE and should only be performed under specific, well-defined circumstances using approved protocols.
Required Tools
  • DHS Orderset — must be used for all ED extubations
  • Harbor Checklist — complete prior to extubation
Appropriate Cases
  • Intoxicated trauma patient with resolved intoxication
  • Simple procedural airway with clear indication for extubation
If in doubt, consult with the attending and document your clinical reasoning thoroughly before proceeding.
🚑 Trauma Reminders
Consistent use of trauma protocols ensures patient safety and team coordination during high-acuity cases.
1
Call Acute Charge RN
For all incoming trauma transfers, notify the Acute Charge RN immediately upon receiving the call. Early notification allows the team to prepare appropriately.
2
Use Trauma Orderset for ALL Imaging
Every trauma patient requiring imaging must have orders placed through the trauma orderset — no exceptions. This ensures standardized workup and documentation.
3
Activate Appropriately
Use the correct activation level: TTA1, TTA2, or TC based on mechanism and clinical presentation. Avoid over- or under-activation.

❌ No inpatient → ED transfers. Do not accept transfers from inpatient units to the ED under any circumstances.
❤️ E-CPR Updates
Availability
Hours
Monday – Friday, 7am – 5pm (ED only)
EMS Status
Not yet a designated EMS E-CPR center
If You Have a Candidate
  1. Call Trauma Attending via Spectra 66882
  1. Complete the ECPR PowerForm in the system
  1. Initiate standard resuscitation while awaiting ECPR team

E-CPR (Extracorporeal CPR) is a resource-intensive intervention. Early identification of candidates and prompt communication with the trauma attending is essential for optimal outcomes.
Updated Opiate Conversion Chart
Opiate conversion chart – Stephen Macaspac (adapted from the UCI chart Dr. Roh helped create)
"Ok to Book" Update
  • There is a taskforce that is trying to improve the “Ok to book” process and prevent inappropriate visits to the ED (led by Dr. Wilhelm and Dr. Parmar)
  • Please email any possibly inappropriate “Ok to book” cases to Dr. Parmar to review
🏛️ Joint Commission Readiness
The Joint Commission may conduct a survey at any time. Maintaining a clean, organized, and policy-compliant triage area is everyone's responsibility.
✅ Keep Triage:
Clean
Surfaces wiped, floors clear
Organized
Supplies in designated locations
Policy-Compliant
All workflows per current policy
❌ Avoid:
  • Clutter or "found items" left unattended
  • Tape on walls
  • Food stored in drawers
  • Unsafe or non-standard equipment setups

Surveyors pay close attention to the physical environment. A single compliance issue in triage can trigger a broader review of department practices.
🩺 Clinical Corner
With Dr. Ilene Claudius
Trauma Pearls
  • Save all FAST exam images for documentation
  • Document neurovascular exams thoroughly
  • Use trauma activation pathways correctly (TTA1/TTA2/TC)
Opioid Safety in the Elderly
  • Use lower doses in elderly patients
  • Increased risk of adverse effects including respiratory depression and falls
  • Consider non-opioid adjuncts when appropriate
EMTALA / Transfers
  • ❌ Do NOT accept inpatient → ED transfers
  • EMTALA obligations apply to all patients presenting to the ED
  • Document all transfer discussions and decisions
🚨 Emerging Drug Alert
Medetomidine Contamination
What We're Seeing
Medetomidine — an alpha-2 agonist not approved for human use — has been identified as a contaminant in illicit drug supplies.
Clinical Presentation
  • Prolonged sedation beyond what is expected from the reported substance
  • Atypical withdrawal patterns that do not respond to standard opioid withdrawal protocols
Clinical Considerations
When encountering unexplained prolonged sedation or atypical withdrawal, consider medetomidine contamination in the differential.
Treatment Options to Consider
  • Clonidine — for sympathetic withdrawal symptoms
  • Etomidate — for procedural needs in the context of altered sedation

Standard naloxone protocols may be insufficient. Maintain close monitoring and be prepared for prolonged observation periods.
🚑 EMS + Disaster
🗓 EMS Appreciation Day
May 14 | 8am – 12pm
📍 Lundquist Auditorium
Join us in celebrating our EMS partners who are essential to the care we provide every day.
📋 Family Contact Information
EMS crews should provide family contact information for all patients transported to the ED whenever possible.
📝 Submit Feedback
If family contact information is missing on arrival, submit feedback through the appropriate channel so we can address gaps in the handoff process.
🧸 Peds ED Updates
🔬 Labs
Urine Cultures
Order separate urine cultures for all patients under 2 years of age — do not rely on UA alone.
UA Interpretation
UA with 4–10 WBC does NOT automatically indicate UTI in pediatric patients. Clinical correlation required.

⚙️ Workflow
Use the PED follow-up system for all pediatric patients requiring outpatient follow-up.

Do NOT use the adult CCC (Comprehensive Care Clinic) system for pediatric patients — this leads to incorrect routing and follow-up failures.
Key Reminders
  • Age-appropriate dosing for all medications
  • Involve parents/guardians in all care decisions
  • Document weight in kg for all peds patients
🦴 Radiology
  1. At the request of pediatric radiology, Dr. Chawla, please order 3 views on all joints including the hand (you do not need 3 views on the hip). The quick order set will be updated to hand 3 views as now it says hand 2 views.
  1. When you order your films, radiology is requesting you put mechanism of injury and area you are concerned about. Do not put this under special instructions, but it under relevant history. This will help the radiologists significantly.
  1. If you read an xray put your read under the notes section on the film. This way the radiologist will see how you read it and if their read is significantly different, they will contact us.

Pediatric subspecialists call numbers are on Medhub. If you call a specialist through the paging system and they do not call back, try to page them through the phone. If you cannot get a hold of the specialist, please call me in real time.

To all Attendings: Please reach out to the Pediatric attending on call if you have any concerns or questions regarding a patient you want to admit. The attending is posted on Medhub and I will be posting the attendings schedules for inpatient pediatrics in the Ped Doc box starting May 1st.
💻 IT / ORCHID Update
DVPRS Pain Scale — Going Live May 5
The Defense and Veterans Pain Rating Scale (DVPRS) will replace the current pain scale in ORCHID beginning May 5. This validated tool provides a more comprehensive assessment of pain and its functional impact.
Mild Pain
Score: 1 – 4
Pain is present but manageable. Patient can perform most activities.
Moderate Pain
Score: 5 – 6
Pain interferes with some activities. Intervention likely needed.
Severe Pain
Score: 7+
Pain significantly limits function. Prompt management required.

Training materials for the DVPRS will be distributed prior to the May 5 go-live date. Reach out to the IT/ORCHID team with questions.
​​


⚖️ Social EM — Policy 8337
NEW POLICY
Policy 8337 establishes expanded rights for patients in ICE or CBP custody receiving care in our ED. All staff must be familiar with these rights and the appropriate escalation pathway.
Patient Rights in ICE/CBP Custody
Patients in immigration custody have the right to access:
  • Family — contact and communication with family members
  • Legal services — access to legal representation
  • Social work — social work consultation and support
Officer Restrictions
  • Officers must leave the room during medical care
  • Officers cannot access medical information without proper authorization
Staff Responsibilities

⚠️ Do NOT enforce immigration policy directly. This is not the role of clinical staff.
If you encounter a situation involving ICE/CBP custody:
  1. Provide standard medical care to the patient
  1. Ensure patient rights are communicated
  1. Escalate to DMR or department leadership immediately
  1. Document the encounter thoroughly
☕ Wellness Corner
🎉 New Jura Coffee Machine
Thanks to the generosity of Dr. Pedigo, the department now has a brand new Jura espresso machine in the break room.
Enjoy a quality cup of coffee during your shift — you've earned it!
Shared Space Reminders
To keep the break room a welcoming space for everyone, please remember:
  • 🍽️ Wash your dishes after use
  • 🧹 Clean out the fridge regularly
  • 🤝 Respect shared spaces — your colleagues will thank you

A clean, welcoming break room supports staff wellness and morale. Small actions make a big difference for the whole team.
🎉 Department News
Faculty Recognition
👏 Ryan Pedigo has been named the recipient of the 2026 Dadone Clinical Teaching Award — one of the most prestigious teaching honors in our department.
2026
Dadone Award
Clinical Teaching Excellence
May 12
Ceremony Date
UCLA Campus
Please join us in congratulating Dr. Pedigo on this well-deserved recognition. His dedication to teaching and mentorship has made a lasting impact on residents and students throughout the department.
🙌 Closing
Thank you for everything you do — for our patients, for each other, and for this department. Your dedication makes Harbor-UCLA ED one of the finest emergency departments in the country.
"Thanks for everything you do for our patients and each other."
📩 Submit Stories & Updates
Have a clinical pearl, department update, or shoutout to share? Send it to Dr. Jen Roh for inclusion in the next newsletter.
🗓 Coming Up
May 5 — DVPRS Pain Scale Go-Live
May 12 — Dadone Award Ceremony, UCLA
May 14 — EMS Appreciation Day, 8am–12pm
Harbor-UCLA Emergency Department · April 30, 2026