Providers Fear Immigration Proposals May Cause Some Patients to Nix Care.

With high-profile travel bans and well-publicized Immigration and Customs Enforcement (ICE) activities, frontline providers have noticed changes in the behavior of immigrant patients. Some emergency providers report there is more fear and a reluctance to share key information. Also, providers are concerned that worries about deportation will cause immigrant patients to refrain from accessing needed care. Investigators note that such concerns are valid, considering how heightened ICE activities previously have affected immigrant health. •Emergency providers who see a high number of immigrant patients report patients are very guarded about providing identifying information and recent travel history. They are concerned that medical staff will report them to ICE authorities. •Some emergency providers are wearing "safety pin" symbols to try to let patients know that they are safe in their care. Others are thinking about posting signs in multiple languages to inform immigrant patients that information about travel history only will be used for medical purposes. •Experts worry that restrictions on foreign-born physicians and medical students only will exacerbate anticipated shortages, particularly in rural areas. •In a previous period of increased immigration enforcement, researchers found that more than 40% of frontline providers reported that ICE activities produced negative health effects on their immigrant patients, including stress, anxiety, and avoidance of the healthcare system.

Acquired Bleeding Disorders.

Emergency medicine practitioners treat bleeding patients on a regular basis. Disorders of hemostasis are an additional challenge in these patients but can be assessed and managed in a systematic fashion. Of particular importance to the emergency clinician are the iatrogenic causes of abnormal hemostasis. Other acquired causes of abnormal hemostasis include renal disease, immune thrombocytopenia, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, acquired coagulation factor inhibitors, acute traumatic coagulopathy, liver disease, and disseminated intravascular coagulopathy.

Acquired bleeding disorders.

Emergency medicine practitioners treat bleeding patients on a regular basis. Disorders of hemostasis are an additional challenge in these patients but can be assessed and managed in a systematic fashion. Of particular importance to the emergency clinician are the iatrogenic causes of abnormal hemostasis. Other acquired causes of abnormal hemostasis include renal disease, immune thrombocytopenia, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, acquired coagulation factor inhibitors, acute traumatic coagulopathy, liver disease, and disseminated intravascular coagulopathy.