Spatial Epidemiology

I was always interested in disease.  And mapping.  I never knew there was an entire world wrapped up in the study of disease transmission, the meaning of vector analysis, the spread of disease over the surface of the earth.
I loved all those "bad disaster movies" like Outbreak, And The Band Played On, etc.  I read books, tracked disease outbreaks like Lassa Fever and Ebola.  When I worked in East Africa I got interested in malaria and yellow fever.  Just a hobby, really.

So somehow (in my infinite wisdom) I have ended up with EMS and Mapping/Data Analysis as co-careers.  I wish I could say it was the plan all along, but I guess our lives take us down the roads we choose.  It makes me think that I should be doing more important work with my skill set, somehow pushing the boundaries of spatial epidemiology. 

So the fact that Ebola Virus Disease (EVD) is growing and moving is of no surprise.  As Jurassic Park taught us, there is no way to contain nature.  The bugs will eventually win, always.

Here are a couple of New York Times pieces about the current EVD crisis that I thought were interesting:

An overview of the outbreak, where we are:
http://www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html

We don't have it so bad.  Really.  A Liberian ambulance nurse is taking one for the team:
http://www.nytimes.com/2014/10/17/world/africa/because-of-ebola-ambulance-work-in-liberia-is-a-busy-and-lonely-business.html?_r=0

EMS Roundup - August 2014

Transcranial Ultrasound to diagnose stroke (prehospital)
http://www.neuroems.com/2014/08/03/prehospital-transcranial-ultrasound-to-diagnose-stroke/

Study resources (yup, NREMT is coming for me!):
http://medictests.com/how-to-memorize-the-national-registry-medical-assessment/
http://www.jems.com/article/administration-and-leadership/reference-notes-can-aid-you-en-route-and


OK, oxygen generating is cool:
http://www.ogsi.com/index.php?src=directory&view=Products&srctype=detail&refno=46&category=products

Supply and Logistics (my current nemesis) a podcast for your listening pleasure:
http://www.jems.com/webinar/successfully-doing-more-less-supply-and

Amb Man W (we just got one, I will write a review later):
http://www.ambu.com/corp/products/emergency_care/product/cpr_software-prod294.aspx#downloads

Added to blogroll:
http://transportjockey.com/
http://surviveemtp.blogspot.com/

EMS Roundup - September 2014

Still busy, folks.  Trying to cram in as much work as possible.  Trying to figure out what happened to the month of August.


I'm scheduled to take my NREMT tests.  Flying to Las Vegas for the practical.  Then the written a couple days later.  Wish me luck!


Ah, well, here's the best of the month.


Five things that can save your EMS career.  Scary, and true.
http://www.ems1.com/careers-1/articles/1383153-5-answers-that-could-save-your-EMS-career/


LOVE these "photographs"
http://www.dansunphotos.com/


Throwback article - drunk or diabetic?
http://www.ems1.com/medical-clinical/articles/1081443-Drunk-versus-diabetes-How-can-you-tell/


EMSWorld has these nice CE articles...Childbirth what fun!  I will check out some of the others.
http://www.emsworld.com/article/11152064/prehospital-childbirth


I've fought this battle with the medical director..."Why are you getting a 12 lead before doing MONA/FONA?  Guess this is one argument.
http://www.ems1.com/cardiac-care/articles/1237577-Why-we-capture-a-12-lead-ECG-with-the-first-set-of-vital-signs/


http://www.jems.com/article/major-incidents/evolution-civilian-high-threat-medical-g

EMS Roundup - July edition

Yes, I have been very busy.  No, that is no excuse for neglecting you so long, gentle reader.
My sincere apologies.
It's been quite a tough summer.  A few ups, too many downs, and trying to get all my paperwork in before I "time out" of my paramedic.  You see, I had a year from graduation to complete my clinicals.  With the nightmare of trying to secure my sites, delays, and general Bravo Sierra from the varying entities involved, it came down to this:
I finished my field internship 11 days before I timed out.
Now I'm studying for written, and trying to find a practical exam.

Here's some fun reading for y'all:

Incredible Emergency Medical Artwork (by Dan Sun, "Photo Art"):
http://www.dansunphotos.com/EmergencyServices

CPAP/BiPAP preventing the need for intubation:
http://www.jems.com/article/case-month/noninvasive-positive-pressure-ventilatio

AHA does it for prehospital providers -- BLS for Prehospital Providers:
http://www.jems.com/article/news/aha-launches-new-custom-training-solution


SURPRISE!  The US ranks last in healthcare study:
http://www.ems1.com/international/articles/1930050-Report-U-S-health-care-among-worst-in-world/

Hybrid ambulance/fire truck
http://www.3news.co.nz/Hybrid-ambulance-fire-trucks-unveiled/tabid/423/articleID/349450/Default.aspx?utm_content=buffer43542&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

Spotlighting the Code Green Campaign and the reality of not just toughing it out alone:
http://codegreencampaign.org/2014/06/story-14-38/
http://codegreencampaign.org/2014/06/story-14-35/
http://dt4ems.com/?p=2835
http://www.rescuingprovidence.com/2014/06/23/do-you-have-a-plan/
http://www.ems1.com/ems-education/articles/1464623-The-Art-of-EMS-Creating-a-balanced-EMS-life/

Laugh, cry, whatever:
http://www.tickld.com/x/15-dumbest-patients-ever

Paramedic Chief - EMS Leadership Newsletter
http://www.ems1.com/newsletters/ParamedicChiefNL-July-30-2014/

http://www.rescuingprovidence.com/2014/08/01/the-ten-other-commandments/
http://www.swattourniquet.com/orange/

STEMI stuff:
http://ambofoam.wordpress.com/2014/06/22/so-you-think-you-can-spot-a-stemi/
The STEMI song:
https://www.youtube.com/watch?v=PmWtAnlgDrs


http://www.ems12lead.com/2014/06/23/the-most-awesome-stemi-test-on-the-internet/
 
http://www.ems12lead.com/2014/06/20/pit-crew-cpr-the-explicit-details/

http://www.ems1.com/als/articles/1932766-Can-less-ALS-mean-better-BLS/

http://www.emlitofnote.com/2014/06/should-paramedics-intubate-out-of.html

Weekly EMS roundup - 06/21/2014

Plenty to read this week:

Triage:
http://www.ems1.com/health-and-wellness/articles/1930916-An-open-letter-to-a-medic-who-hesitated/?utm_source=newsletter&utm_medium=email&utm_campaign=exclusiveBlock1&nlid=1930376

What are we, anyway?
http://www.ems1.com/ems-advocacy/articles/1930010-Why-are-paramedics-not-given-the-same-recognition-as-firefighters-and-police/

Yet another EMS service says "No" to spinal restriction via long board - When will the rest of us catch up?
http://www.ems1.com/ems-products/patient-handling/articles/1929551-Mo-policy-eliminates-long-spine-board-mandate/
http://www.jems.com/article/administration-and-leadership/flush-away-your-support-always-backboard

More on drug shortages...it's become my big worry of late
http://www.ems1.com/columnists/art-hsieh/articles/1922306-How-to-manage-drug-shortages-and-expired-pharmaceuticals/?utm_source=newsletter&utm_medium=email&utm_campaign=exclusiveBlock4&nlid=1927645

I've tried to educate myself about the whole vaccine/autism connection.  And the evidence has convinced me.  VACCINATE YOUR KIDS, PLEASE!
http://www.iflscience.com/health-and-medicine/dear-parents-you-are-being-lied
How the immune system works:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010386/
How to evaluate information
http://www.immunizationinfo.org/parents/evaluating-information-web
How to read a scientific paper
http://violentmetaphors.com/2013/08/25/how-to-read-and-understand-a-scientific-paper-2/

I went to medic school with a guy from Hatzalah and joked that I could do a ride-along (they are all male, folks) now the Hasidic ladies have their own corps:
http://www.ems1.com/ems/articles/1931043-All-woman-EMT-corps-to-hit-NYC-streets/

Telemedicine - so those big-city doctors can give their opinion without us actually having to be in the same room with them:
http://www.ems1.com/rural-ems/articles/1925602-Rural-clinics-increasingly-turn-to-telemedicine/
http://www.jems.com/article/news/rural-clinics-turn-telemedicine


Learning and teaching - doing better
http://www.ems1.com/ems-products/education/testing/articles/1669531-5-things-to-know-when-buying-EMS-education-products/
http://www.emsworld.com/article/11444706/promoting-a-culture-of-learning-in-ems


Inspiring story, makes me feel like a putz for complaining...
http://www.ems1.com/amputate/articles/1929568-Video-Double-amputee-completes-EMT-training/


Sad news from Nebraska
http://www.jems.com/article/news/tornadoes-tear-through-nebraska-town

Neato EMS tools
(haven't tried this one - anyone?)
http://www.511tactical.com/double-duty-responder-knife.html
Leatherman Raptor...because my old happy shears were dulling and retail therapy is a good thing:
https://www.leatherman.com/831741.html
(and yes, it's AWESOME!)

A little something for the firefighters:
http://www.nytimes.com/interactive/2014/06/22/nyregion/rookie-new-york-firefighter-faces-first-test.html?smid=fb-share&_r=0

And it will be interesting to see how this one turns out - sounds like a lawsuit in the making:
http://www.ems1.com/politics/articles/1928690-Mass-medic-loses-job-for-not-becoming-firefighter/

Weekly EMS Roundup - 06/13/2014 Triskaidekaphobiacs need not apply

Full Moon, Friday the 13th, what could happen, really?

Stroke diagnosis - more than just Cincinnati
http://www.neuroems.com/2014/06/04/heart-attack-has-the-ekg-stroke-has-the-physical-exam/

NAEMT Code of Ethics - changes (didn't know there was a Code of Ethics?  There's an Oath, too...Read on)
http://www.jems.com/article/administration-and-leadership/review-updated-naemt-code-ethics
http://www.naemt.org/about_us/emtoath.aspx

Code Green - tough story to read:
http://codegreencampaign.org/2014/06/story-14-34/

EMS Masters Case #02 - the conclusion
http://www.ems12lead.com/2014/05/23/masters-case-02/
http://www.ems12lead.com/2014/06/11/conclusion-to-masters-case-02/

Fun with Dopamine:
http://paramedicine101.blogspot.com/2009/10/dopamine-nice-packaging.html

And more fun with drug calculations:
http://ww4.mgh.org/emt/Paramedic%20Student%20Library/IV.Drug.Calculations.pdf
http://www.americannursetoday.com/assets/0/434/436/440/6182/6184/6190/6208/0d39b2a0e79043daa93d29d73cf4681a.pdf

(non-EMS) What emotions erupt with your font choice?
http://www.fastcodesign.com/3031622/evidence/the-science-of-comic-sans

Weekly roundup -- 06/06/2014 (Holey smokes, it's June already!)

Firstly, I need to send a shout-out to some of my favorite podcasts, NOW AVAILABLE ON ITUNES!!!!  Yay.  No more weird 3rd party only when there's wireless listening!

Inside EMS -- Kelly Grayson and Chris Cebellero
https://itunes.apple.com/us/podcast/fr1-and-ems1-podcasts/id884385830?mt=2

New podcast on my radar -- EMS Leadership (more info on why this is a THING for me later, promise):
http://www.emsleadership.com/

Video: NHS gets their new ambulances -- love those Sprinters!
http://www.emsworld.com/video/11502389/from-workshop-to-first-patient-the-journey-of-a-new-ambulance

FALTER mnemonic for calling a helicopter.  I know quite a few people who hit the "F" button:
http://www.ems1.com/air-medical-transport/articles/1589630-Why-we-F-A-L-T-E-R-on-helicopter-response

Interesting, non-EMS, but on brainstorming and idea generation:
http://www.entrepreneur.com/article/234238

Zoll Summit 2014 - Community Paramedicine, Out-of-hospital Care, whatever you want to call it:
http://www.ems1.com/newsletters/ZOLL-Coverage-EMS1-May-2014

Just bought the ePub edition -- useful for explaining issues in the ambo?  Maybe.  Will review:
http://ecg-interpretation.blogspot.com/2014/06/ecg-blog-90-basic-concepts-3.html

I would say a mobile stroke unit is cool, but it is so far beyond that:
http://www.emsworld.com/news/11502649/first-patient-successfully-transported-by-first-us-mobile-stroke-unit

Trusting your spidey-senses (well said):
http://www.ems1.com/ems-education/articles/1326663-How-to-start-trusting-your-gut/

another great article on teaching - how to answer the question "can we leave early..."
http://www.ems1.com/education/articles/1921613-3-ways-to-nip-the-Will-we-finish-early-question-in-the-bud/

Motorcycle accidents, not just another MVA:
http://www.emsworld.com/article/10706462/ems-training-for-motorcycle-trauma
http://roadguardians.org/

Weekly Roundup -- 5/30/2014

Get the 12-Lead...but make sure other stuff is cared for!
http://www.ems1.com/cardiac-care/articles/1237577-Why-we-capture-a-12-lead-ECG-with-the-first-set-of-vital-signs/

Regrets
http://topinfopost.com/2014/05/12/top-5-regrets-people-make-on-their-deathbed

Things that make you go...huh?
https://wausaunews.wordpress.com/2014/01/18/big-hospital-finally-telling-the-truth-about-cancer-johns-hopkins/

Change is good?  Really?
http://www.ems1.com/education/articles/1920697-Lack-of-change-not-increased-training-is-causing-volunteer-shortage/

Back off!  We are in charge...
http://www.ems1.com/ems-advocacy/articles/1476128-Police-and-EMS-Who-s-the-boss/

EKG Masters case #02
http://www.ems12lead.com/2014/05/23/masters-case-02/

REALLY would like something like this in our area (similar issues...)
http://www.emsworld.com/article/11490678/ems-simulation

Kelly, thank you:
http://www.ems1.com/ems-jobs/articles/444853-top-ten-questions-you-re-better-off-not-asking/''how/

Just one more reason to avoid the bumper sticker graffiti
http://1079ishot.com/police-stick-family-decals/?trackback=fbshare_top

Weekly Roundup 5/23/2014 Enjoy your long weekend after EMS WEEK!

...I will be standing by for calls!

Funny EMS un-words from Kelly Grayson:
http://www.ems1.com/ems-humor/articles/882033-Top-ten-words-that-should-be-in-the-EMS-dictionary-but-aren't
(Kelly is on a roll this week)
http://www.ems1.com/ems-oddities/articles/1174328-Top-10-signs-your-dispatcher-hates-you/
http://www.ems1.com/ems-products/consulting-management-and-legal-services/articles/401728-Top-Ten-Signs-It-s-EMS-Week/

Video - "The Build Behind the Ambulance"
http://www.emsworld.com/video/11471904/the-build-behind-the-ambulance

Closed hospitals in rural areas turned into stand-alone ED's...not a bad idea?
http://www.ems1.com/ems/articles/1916028-Ga-turns-failing-hospitals-into-stand-alone-ERs-to-keep-EMS/

Is it a stroke, or Bell's Palsy, or what?
http://www.jems.com/article/patient-care/differentiating-facial-weakness-caused-b

A worthy cause:
http://www.emsworld.com/article/11459375/burkina-faso-ambulance-donation
http://uwwstudentoptimist.blogspot.com/

I STILL have not taken the time to see this, but need/want to!
http://www.emsworld.com/video/11122860/paramdico-a-trip-around-the-world-of-ems

The double-edged sword of naloxone:
http://www.emsworld.com/article/11389502/emt-and-law-enforcement-use-of-naloxone

Moving patients -- bad habits we should all break:
http://www.ems1.com/ems-products/patient-handling/articles/1429125-Welcome-to-my-bad-habits-Moving-patients-in-EMS/

I just had this patient (minus torsades)!
http://www.ems1.com/cardiac-care/articles/1445135-ECG-Challenge-Get-to-the-point/
http://www.ems1.com/ems-products/Patient-Monitoring/articles/1447901-ECG-Solution-Get-to-the-point/

Preserving the crime scene at an MCI:
http://www.jems.com/article/patient-care/preserving-crime-scene-evidence-when-tre

Pupils.  I've been interested in pupils this week:
http://theemtspot.com/2009/04/23/rapid-diagnosis-pinpoint-pupils/

This site looks AWESOME for review:
http://www.paramedicine.com/pmc/General_Paramedic_Physical_Exam.html

Dog imitates ambulance siren.  You know you have to watch:
http://paramedictv.ems1.com/videos/1647809-golden-retriever-imitates-ambulance-siren/

Stand aside Doctor House, CrowdMed will solve the case:
http://www.emsworld.com/news/11477150/with-crowdmed-anyone-can-play-doctor

DANGIT!!! This was my idea!  Well, mine was to put them in fitness centers...
http://www.jems.com/article/news/airport-cpr-kiosk-ditching-backboards-an

EMS Supervision...not for everyone
http://www.ems1.com/ems-management/articles/1752228-5-things-great-EMS-supervisors-do-differently/

Weekly Roundup 5/16/2014

Not much this week - but all interesting!

Plasma in the field
http://wtvr.com/2014/05/13/richmond-ambulances-to-carry-plasma-a-first-for-the-nation/

"Externally cross-clamp the abdominal aorta and vena cava"  Works on axillae and groin area as well, and CPR adjunct? -- WOW -- this may be a game-changer..
http://www.emsworld.com/video/11458324/application-of-an-abdominal-aortic-and-junctional-tourniquet

Good idea -- maybe some of these people will let us intubate in their hospitals?
http://www.emsworld.com/article/11386677/emt-training-for-medical-students

Inventory Management - always fun
http://www.ems1.com/ems-products/ems-data-management/articles/1876952-4-ways-to-better-manage-EMS-inventory/

http://www.ems1.com/ems-products/ems-data-management/articles/1876955-Big-or-small-manage-EMS-inventory-by-thinking-lean/

Blast from the past - SLC Fire Paramedic program intro video - ca. 1970
http://www.youtube.com/watch?v=0AR0-rEZ9dc&feature=youtu.be

Chris & Kelly podcasting again - community paramedicine (or whatever we're calling it today), helmet cams in EMS, and more - always entertaining and informative!
http://www.ems1.com/camera/articles/1899007-Inside-EMS-Podcast-Community-paramedicine-helmet-cam-usage-in-EMS/

Weekly Roundup - 05/09/2014

Kelly Grayson -- My Hero:
http://www.ems1.com/community-awareness/articles/1899153-True-confessions-of-a-clinically-depressed-medic/

Kelly & Chris' most recent podcast:
http://www.ems1.com/ems-education/articles/1895959-Inside-EMS-Podcast-Dogma-in-EMS-how-to-escape-violent-encounters/

Joules & Amps and that whole electricity thing I just cannot wrap my mitts around:
http://broomedocs.com/2014/05/reader-question/

Polio - it was never gone, and it's coming back:
http://www.jems.com/article/news/world-health-organization-declares-polio

Is your equipment neonate-friendly?  A baby with WPW, I would have needed a uniform change:
http://www.jems.com/article/case-month/infant-girl-s-struggle-breathe-isn-t-res

To nitro, or not -- EKG fun:
http://www.ems1.com/ems-products/Patient-Monitoring/articles/1405197-ECG-Solution-Nitroglycerin-right/

UAV's (aka "drones") used for safety.  Get used to it.
http://washington.cbslocal.com/2014/05/05/montgomery-county-fire-department-using-drones/
(I work with a remote sensing committee and this field is changing by the day...)

Bag of chips, Hershey bar, and an IV setup, please!  Modified vending machine for supply tracking:
http://www.emsworld.com/product/11436430/vendtek-wholesale-equipment-medic-machine

Concussion or not?  App quantifies balance measurements for potential brain injury:
http://www.youtube.com/watch?v=ZMaSZz2Ycdo&feature=youtu.be
http://swaymedical.com/

Wow.  And you think you work in a tough system?
http://www.vice.com/read/riding-shotgun-with-guatemala-citys-overworked-volunteer-paramedics
http://www.gilesnclarke.com/

Very powerful - Israeli Medic working to save the fallout in Syria:
http://www.jems.com/video/news/profile-israeli-medic-syrian-border

Reality TV (my not-so-secret favorite genre) NY Med:
http://www.emsworld.com/press_release/11447251/hit-tv-show-ny-med-returns-to-newyork-presbyterian-hospital

Assume you are on camera:
http://www.emsworld.com/article/11386393/video-recording-cardiac-arrest-resuscitation-scenes

Nasal Cannula Pre-Oxygenation, putting the science to what Mr. Medic always taught us:
http://www.medscape.com/viewarticle/823961?nlid=56604_1521%3Fsrc%3Dstfb

Sadness and Loss

There's sadness and loss in our professions.  We see it every day and we deal with it.  Some better than others.

Then there's personal sadness.  The loss that wrenches at your heart and catches in your throat when you dare to let your memories picture the person, the grief, the tears.

I grew up lucky.  Total tomboy, I would much rather be out playing in the dirt, riding bikes, playing legos than inside with the "ladies" being domestic.  I had a best friend, had the term been coined then I would have called him my "brother from another mother" because we did absolutely everything together.  His family took me on vacation with them, and they sculpted my life in ways I cannot even understand.  They are the reason I learned German, met the love of my life, moved to Germany, and to some extent they are why I am going down this road to Paramedicine.  His grandmother was my grandmother.  We grew up together.  Jay will always be my friend.

Jay and Gretchen married right out of high school and had two lovely daughters.  Both love soccer as much as their dad they are beautiful children.

Gracie Snider, 10, was killed on Saturday in a car accident on I-90 in Washington State, returning from a soccer match. 

Her 10-year old friend is in the ICU.

I haven't talked to Jay.  I don't know what to say.
So, for now, I am posting this at his sister's request.  Please help if you can.

http://www.gofundme.com/8wd7q4