The simultaneous fires that swept through LA County in the last few weeks have left ash, dust and debris that can cause health concerns in the near future and in the long term. Dr. Nader Kamangar, a Pulmonary Critical Care Specialist at Olive View-UCLA Medical Center was recently interviewed by the Associated Press (AP) for his perspective on respiratory illnesses and risk factors that can have real consequences for our community members affected by the fires.

He noted that most doctors are concerned about the very fine particles that can carry toxic substances deep into the lungs and bloodstream, potentially causing heart and lung problems.

At the time of the interview, he recommended that people wear N-95 respirators outdoors. He also recommended that people with asthma or other respiratory problems keep medicine and emergency inhalers with them.

The full article can be viewed here:  In Los Angeles, people snap up air filters and wear masks against smoke pollution   

In January, the Los Angeles County Emergency Medical Services (EMS) Agency released a new protocol application called RAPID LA County Medic, bringing Los Angeles County EMS treatment protocols, clinical decision support tools, policies and “Just-In Time” training videos to the hands of the EMTs, paramedics, and hospital personnel that serve our communities. This application allows for critical information used to make patient care decisions to be available in real-time, accessible at one’s fingertips.

The project was supported by the California Office of Traffic Safety (OTS) grant program, which receives funding from the federal National Highway Traffic Safety Administration (NHTSA). California OTS grants are awarded on a competitive basis to governmental agencies for projects that can enhance road safety and post-crash trauma care. Over the last 40 years, the EMS Agency has developed a robust Trauma System capable of timely response and transport to specialized trauma centers, optimizing survival for patients that experience injury in Los Angeles County. In fact, the timely arrival of well-trained EMS personnel is a major factor ensuring an injured person receives the medical care they need to survive a crash or other injury.

Despite tremendous progress in trauma care over several decades, one critical need recognized by the EMS Agency was implementing current technology to promote rapid access to tools and policies that would improve clinical decision making in time-critical situations. RAPID LA County Medic includes several features to meet this need:

• “Rapid Access Treatment Protocols (RATPs)” that summarize clinical steps for managing critically ill and injured patients.
• “Quick Reference Guidelines (QRGs),” which include decision tools to initiate time-sensitive treatments for patients in the field and to get them to the correct specialty hospital for their condition.
• “Just-In-Time Videos (JITs)” that provide refresher training on highly critical, low-frequency medical procedures, optimizing field care delivery.
• All EMS policies, protocols, and medical care guidelines are readily accessible via the RAPID LA County Medic application for reference.

The 11th Annual DHS Diabetes Day occurred on December 5, 2024. This was the first year it was held in conjunction with New York City Health+Hospitals (NYC H+H), led by Mitchell Katz, MD, the former Director of LA Health Services. Dr. Friedman envisioned a bi-coastal event so that both systems could share best practices about caring for patients with diabetes.

Attendance at the 11th Annual DHS Diabetes Day exceeded expectations with over 650 participants either live in Los Angeles, live in NYC or on Zoom. 

Dr. Friedman welcomed participants and provided an overview about diabetes care in both systems and a short background on New York City H+H. Michelle McMacken, MD, was the guest speaker who gave an inspiring talk on lifestyle medicine and diabetes. NYC H+H has set up their lifestyle medicine program in seven of their clinics to treat thousands of people with diabetes and other chronic conditions.

A leadership panel followed, comprised of: Evan Raff, MD, Director of Specialty Services at LA Health, and Chris Brown, MD, Director of Primary Care Services at LA Health, Mitch Katz, MD, President/CEO of NYC H+H, and Andrew Wallach, MD, NYC H+H Ambulatory Care Chief Medical Officer. All of them talked about their visions for diabetes care, including using available resources to take better care of patients who have diabetes in both primary care and specialty care.

There were four afternoon break-out sessions. The first one about "Lifestyle Medicine for Diabetes” was the most widely attended. Our second afternoon session was about continuous glucose monitors, an important new technology for patients with diabetes on insulin. The third session was on case-based learning led by Gyanesh Agrawal, MD, who went over the various steps involved in escalating therapy, including how to treat those with renal insufficiency. Another discussion was on diabetes care in the medical home including the ideal diabetes visit, motivating and treating patients with low adherence, and comparing the systems in NYC H+H and LA Health Services in caring for patients with diabetes. 

The 12th Annual DHS Diabetes Day is scheduled for November 10, 2025. There will also be a patient education Diabetes Day on July 18, 2025. Dr. Friedman looks forward to inspiring and teaching more providers who take care of patients with diabetes to optimally care for their patients in both Los Angeles and New York City.

The sponsors of DHS Diabetes Day especially want to thank the Good Hope Foundation and the UCLA Catalyst Award for generous donations to allow Diabetes Day to occur. All the talks and slides for Diabetes Day are posted on the DHS Diabetes SharePoint, the New York City H+H SharePoint, and Dr. Friedman's Dropbox where the people who either missed sessions or want to hear sessions again can listen to them.