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

Weekly Roundup - 05/02/2014

Forever fun with my love of ambulances:
http://www.emsworld.com/video/11313705/how-our-ambulances-are-built-the-richmond-ambulance-authority-experience

OK Medictests.com - I am going to give you a try!
http://medictests.com/

Wow...really?
http://www.ems1.com/education/articles/1895189-Instructor-sets-off-grenade-in-drill-blows-ear-drum-of-EMT-student/

Yup, love EMS1
http://www.ems1.com/top-5/articles/1894831-Top-5-EMS-videos-of-April-2014/

Neuro exams/trauma, continued
part 2
http://www.emsworld.com/article/11282199/neurologic-exams-and-selective-spinal-immobilization
part 3
http://www.emsworld.com/article/11296299/dermatomes-and-spinal-cord-injuries

Ambulance Wars (sounds like another bad reality TV series...)
http://www.jems.com/video/news/differing-views-las-vegas-response-times

Diagnosis - a good argument
http://www.jems.com/article/patient-care/ems-doesn-t-diagnose-or-do-we

Weekly Roundup - Tax Week 4/18/2014

My apologies to you, gentle reader, (I'm sure there is at least one person who reads this blog, surely?) and I apologize for the "Weekly Roundup" being the only thing you hear from the Ambulance Ranger these days.  More content to come, I promise.
The short update?
Lots of calls, then none.
Still plodding through Paramedic internship.
Still studying.
Still working.
yep, that's pretty much it.  Hope you enjoy this week's finds:

I think I will link to the NEW Ferno iNX stretcher every week.  Forever.  Or until we get a grant to buy them for our service.  Then I will post videos of us using them.  Or at least a picture of me sleeping on one.
http://www.jemseditorblog.com/2014/04/17/ferno-introduces-revolutionary-patient-transport-loading-system-at-the-fdic-conference-in-indianapolis/

Teaching tips - that awful moment when you realize everyone's asleep...
http://www.ems1.com/education/articles/1878798-6-training-tips-to-reach-unengaged-EMTs/?utm_source=newsletter&utm_medium=email&utm_campaign=exclusiveBlock1&nlid=1881013

Blood pressure - how to do it the right way
http://www.ems1.com/blood-pressure/articles/1882581-5-errors-that-are-giving-you-incorrect-blood-pressure-readings/?utm_source=newsletter&utm_medium=email&utm_campaign=exclusiveBlock4&nlid=1882308

I know a couple people who would be great at motorcycle medicine...
http://www.emsworld.com/article/11393194/motorcycle-paramedics-provide-faster-ems-response-at-special-events

Strokes, under-diagnosed:
"Analyzing federal health care data, a team of researchers led by a Johns Hopkins specialist concluded that doctors overlook or discount the early signs of potentially disabling strokes in tens of thousands of American each year, a large number of them visitors to emergency rooms complaining of dizziness or headaches."
http://www.emsworld.com/news/11398693/stroke-assessment

Furosemide - No, No, and No
http://www.emlitofnote.com/2014/04/pre-hospital-furosemide-no-no-also-no.html

Specifically targeting abdominal pain, another sacred cow gets slain:
"In this era of iPods and digital media, EMS pain management seems stuck in the days of boom boxes and cassette tapes. It’s time we tossed the old attitudes about pain management, like those old boom boxes, into the dustbin of history."
http://www.emsworld.com/article/10862823/ems-relief-of-abdominal-pain

$40 that might save your life, via Kelly Grayson - LET RESPONDERS FIND YOU!
The porch lights flashing switch is very cool, and something I had not seen:
http://www.ambulancedriverfiles.com/2014/04/16/when-you-need-the-good-guys-can-they-reach-you/

Kelly has been busy this week!  Great podcast discussion with Chris Cebollero on hot topics, clinical issues, and operational leadership lessons:
http://www.ems1.com/fire-ems/articles/1882760-Inside-EMS-Podcast-Reducing-spine-board-usage-EMS-leadership-styles/

And finally, a shout-out to our awesome dispatchers (you know who they are, the ones when you hear their voice on the line you KNOW you will be taken care of for your shift)
http://psc.apcointl.org/2013/03/21/so-you-want-to-be-a-dispatcher/

Weekly Roundup 4/11/2014

Important, for many reasons.  Not a "how-to" but more of a "how we got here"
http://www.jems.com/article/history-ems/how-heal-after-responding-tough-call

Active shooter EMS -- Discussion
"During an active shooter/active killing response, the first-arriving Fire/EMS responders, not special operations or tactical medical teams, must accept the responsibility for life rescue and medical operations and must work with first-responding law enforcement assets to rapidly deploy into the areas that have been cleared but not secured (warm/indirect threat zones) to initiate treatment and rescue injured victims."
http://www.jems.com/article/supporting-paradigm-change-ems-operation

Wake County EMS Evacuation pre-plan (outline) and A.J. Heightman's freaky night in a hotel:
http://www.jemseditorblog.com/2014/04/08/twas-the-night-before-mci-class/

Simple thoracostomy - a case for incision rather than needle decompression
(will be interesting to see what the study yields)
"To avoid the complications associated with needle decompression, a number of services in Europe have adopted simple thoracostomy as an option for chest decompression. Simple thoracostomy is a technique similar to the placement of a chest tube, traditionally done in the ED. It utilizes an incision with a scalpel and penetration directly into the thoracic cavity with forceps and a gloved finger to relieve the tension pneumothorax. The only major difference is that the chest tube isn’t inserted."
http://www.jems.com/article/patient-care/simple-thoracostomy-moving-beyond-needle

Ferno's new cot.  If it works, it's a game-changer for EMS:
http://www.fernoems.com/inx/
VERY similar to one we played with at EMS World, but this is all auto and will load into our tall 4wd ambulances.  I might be in love.

AND A little video crazed this week

How an EMT gets ready for work:
https://www.youtube.com/watch?v=ahCuA6DsSGE#t=155

Forget the egg in a skillet "this is your brain on drugs" commercial.
Just show this to the kids, and they will stay away.
https://www.youtube.com/watch?v=UePInKAKgTA

It's so funny, because it's true...
https://www.youtube.com/watch?v=V9G5CfrQN4w#t=55

Weekly Roundup 4/4/2014

CHECK!  Checklists to reduce deaths...quite the concept.
http://www.jems.com/article/administration-and-leadership/ems-checklists

Because we're all nerds
http://www.ijreview.com/2014/04/126134-girl-asked-wil-wheaton-respond-bullies-call-nerd-perfect-answer/

Ambulance safety and design, one of my geeky passions:
http://www.emsworld.com/article/11325292/ambulance-safety

Emergency Medicine (as in MD) Literature of Note - University of TX, Houston
http://www.emlitofnote.com/

NeuroEMS -- Strokes and Hearts, what can we learn?
http://www.neuroems.com/2014/03/24/12-lead-ecg-and-stroke-pt-1-overview-lit-review/
http://www.neuroems.com/2014/03/29/12-lead-ecg-stroke-pt-2-culprits-in-the-brain/
http://www.neuroems.com/2014/03/31/12-lead-ecg-stroke-pt-3-case-studies-conclusion/

more, because I'm falling in love with NeuroEMS...
http://www.neuroems.com/2014/03/15/blood-flow-through-the-brain-pt-1-overview/

Trauma Triad of Death - more understanding
http://www.emsworld.com/article/10565011/hypothermia-acidosis-coagulopathy

Weekly Roundup 3/28/2014 (sorry it's late)

YESYESYESYESYESYESYES
I will be reading this, printing it, and re-using it:
http://theemtspot.com/2014/03/22/101-things-we-should-teach-every-new-emt/


Simulation -- not just for EMS
http://www.emsworld.com/news/11359882/la-doctors-practice-speeding-up-trauma-care

Funny, because it's too true:
http://www.savortheessenceoflife.com/2014/03/23/30-things-nurses-almost-say-but-then-dont/
I had the, um, privilege of working with some DC Fire/EMS folk a couple years ago.  They are getting focused, for sure, with bad press.  But you don't get smoke without...
http://www.jems.com/video/news/dc-woman-leaves-ambulance-while-crew-arg

Field Microscopy - 50 cents each

This is a very cool item, probably one of the neatest inventions I've seen in a long time.

http://news.yahoo.com/blogs/this-could-be-big-abc-news/super-cheap-paper-microscope-could-save-millions-lives-133616732.html?vp=1

Paramedic Clinicals, Part 1 -- Getting There

I got lucky.

See, when I started this Paramedic adventure a few years ago I knew it was going to be a struggle to get it all done.  Back in 2006 when I was diagnosed with cancer, I used up all my sick and vacation time (as well as a few people who donated their time to me).  Truth is, in the 7 years since, I did not build up much of a "bank" of time.  Vacation days became more precious than work to me and I spent them with my family and friends.

Once I started this Paramedic education, however, I knew that I would be taking a ton of "vacation" days from my normal job in order to do my EMS education on the side.  So I saved up time and money.

Optimistically, I saved enough for Base Camp and EMSWorld Expo, with a few days left over for the slop, figuring I could do my clinicals every other weekend.  You see, I work 5 days then 4 days, then get a 3-day weekend.  I figured I could leave after work on a Thursday, drive 3+ hours to the hospital, work part of a night shift, sack out in the car/shower at a truck stop, work Friday night, sack out in car/shower at truck stop, work Saturday night, sack out in car/shower at truck stop, work Sunday night, drive home (nap in car along way somewhere), shower at home and work 8 hour shift at regular job Monday.  I would get every other weekend at home to recoup, and I could be finished in 14 weeks.

That may have worked...when I was 22, but at nearly double that age I'm just not able to swing it. 
It took 2 nights sleeping in my car to realize I needed:
1.  a bathroom. 
2.  to stand up, stretch, and do yoga
3.  a coffee pot
4.  a fridge with some real food
5.  sometimes a shower AND a bath to soak away 12 hours in the ED
6.  a decent internet connection
7.  someplace I could call "home" away from the hospital

There was no way my original plan would work.

Lo and behold, the idiocy of the Federal Government saved me.  They shut down the government for a few weeks.  I managed to score a fabulous serviceable room at the local Motel 6 for the duration, and managed to knock out 14 shifts of at least 12 hours each.  Although I hated the whole mess, the shutdown really worked in my favor.

Next time:  Paramedic Clinicals -- Day 1

NeuroEMS -- new page to me

And raises some interesting questions (along with good literature review):
http://neuroems.wordpress.com/2014/03/24/12-lead-ecg-and-stroke-pt-1-overview-lit-review/

Color me intrigued

Weekly Round-up 3/21/2014

OK, so I've decided to add a new section, for all the articles and web pages I've read this week, that might interest you, gentle reader.
So here we go:

Provider Suicide.  I've written about it a few times.  A good editorial.
http://www.lifeunderthelights.com/2014/03/14/provider-suicide-a-letter-from-someones-coworker/

Teamwork...a laudable goal:
http://www.jems.com/article/major-incidents/how-foster-teamwork-shooting-incidents

Upstroke ventilation in CPR (and ventilation in general)
http://www.jems.com/article/patient-care/using-upstroke-ventilation-optimize-coro-0

Lone Star tick bite causes some to become allergic to sugar in red meat.
http://www.outsideonline.com/fitness/bodywork/the-fit-list/Tick-Bites-Blamed-for-Red-meat-Allergies.html?utm_source=facebook&utm_medium=social&utm_campaign=facebookpost

Firsthand account of caring for your colleagues:
http://www.jems.com/article/health-and-safety/firsthand-account-stresses-caring-your-c

A good reminder on equipment checks:
http://www.emsworld.com/article/10319289/ambulance-equipment-checks

EMS Movies
http://www.emsworld.com/article/10319212/ems-movies

Mercedes/Freightliner 4x4 model to USA!!! (Ambulance Ranger REALLY wants one...)
http://www.leftlanenews.com/mercedes-sprinter-4x4-likely-headed-stateside.html#xP2f7J348WYh6wR8.01

Emergency Vehicle Safety - report shows...
http://www.emsworld.com/news/11351664/usfa-releases-updated-emergency-vehicle-safety-initiative

Vegas - "War over emergency response" in Las Vegas - Vegas fire wants to take 75% share...
http://www.jems.com/video/news/concern-grows-over-private-ambulances-ve

Distance learning...frustrated with the process

The learning part (didactic) was great.  Going to Paramedic Base Camp was great.
Trying to get someone in rural America (within driving distance) to sign on for my clinical internship took months.  Even after almost a year of pre-planning and discussion.  First choice backed out at the 11th hour, second choice did not communicate well.

Getting intubations was nearly impossible.  I'll save the gory details for later, but approximately 3 months elapsed from my last clinical shift to the week at the Big Eastern hospital OR I had to travel to in order to get my 10 tubes.

Field internship is not proving easy to navigate, either.  Had the site set up over a year ago, and just now am finding out that my school needs to be licensed in the State for me to do my field time (which they are not).

I haven't had the heart to tally my expenses so far, but for you, gentle reader, I will do it and get you an update.  Let's just say that Big Credit Card Companies are in love with me right now, and my diet is far less varied than it used to be.

I'll try to be upbeat in my next posts, but for now I'm just bummed.

Thank you for your service, officers

K9 Maros United States Department of Agriculture - Forest Service Law Enforcement and Investigations, U.S. Government End of Watch: Wednesday, March 12, 2014 Cause: Gunfire

Read more: http://www.odmp.org/officer/22038-officer-jason-crisp#ixzz2vtDob7gl

Officer Jason Crisp United States Department of Agriculture - Forest Service Law Enforcement and Investigations, U.S. Government End of Watch: Wednesday, March 12, 2014 Cause: Gunfire

Read more: http://www.odmp.org/k9/1527-k9-maros#ixzz2vtE5uh4d

On waiting...

http://jenuinereflections.wordpress.com/2013/12/18/confessions-of-an-er-nurse/

Yes.  Precisely.

So long, and thanks for all the fish!

Mostly because I've been too busy/lazy/tired/discouraged to post anything lately:

How those of you who decide not to vaccinate are killing people:
http://www.latimes.com/business/hiltzik/la-fi-mh-antivaccination-movement-20140120,0,5576371.story#axzz2rMwGoaYf

And a cool online map of preventable disease:
http://www.cfr.org/interactives/GH_Vaccine_Map/#map



And these, just for fun
 How to survive being married to a medic: http://voices.yahoo.com/tips-survive-being-married-paramedic-3700116.html

Sirens - new EMS show, really Dennis Leary?
http://connect.jems.com/forum/topics/sirens-another-ems-television-show

Sense of entitlement = high cost healthcare

Yet another reason we need to educate the public, and EMS and ED need to have the option to refer "non-urgent" cases to other services (without being sued at every turn).

http://news.yahoo.com/study-finds-medicaid-expansion-drove-er-visits-190311748.html

Study finds Medicaid expansion drove up ER visits

SALEM, Ore. (AP) — A new study has found that people enrolled recently in Medicaid went to the emergency room 40 percent more frequently than others, often seeking help for conditions that could be treated less expensively in a doctor's office or an urgent care clinic.

The research, published Thursday by the journal Science, comes as millions of Americans gain health insurance this week under the federal health care law, many of them through Medicaid.

The findings help inform a long-running debate about the effect of expanding Medicaid and suggest that hospitals and health officials around the nation should be prepared for an increase in emergency room trips in the coming months.

The study is the third to arise from a limited expansion of Medicaid in Oregon five years ago. Demand exceeded the available funding, so the state used a lottery to randomly choose people for coverage from a waiting list. The lottery created two groups of similar people, one consisting of new Medicaid patients, the other a comparison group of people who weren't selected. It gave scientists a rare chance to evaluate the program in a randomized, controlled study — the gold-standard for scientific research.

Taken together with the earlier findings, the latest research indicates that expanding Medicaid improves mental health and leaves patients more financially stable in the first two years. But it increases spending for hospitals, primary care and prescriptions and doesn't produce significant improvements in measures of physical health like blood pressure or cholesterol.

"We've been able to eliminate some extreme views about the program," said Sarah Taubman of the National Bureau of Economic Research, the study's lead author. "In the absence of that evidence, there were some unduly pessimistic views and some unduly optimistic views" about the effects of Medicaid.

Researchers used hospital records to look at ER use over 18 months for 25,000 people in the Portland area who entered the Medicaid lottery, some who were chosen for coverage and some who were not. Patients with Medicaid made, on average, 1.43 ER visits, compared with 1.02 for those who lost the lottery, an increase of 40 percent.

The study also found that 35 percent of people who weren't selected for Medicaid made an ER visit during the research period. For those who gained coverage, however, the number was 7 points higher at 42 percent.

Men were more likely than women to have additional ER visits, but there was no racial, age or other groups that saw a statistically significant decrease in ER usage among the people selected for Medicaid.

ER visits increased both during nights and weekends and during typical business hours, when ER alternatives would generally be open. The additional visits were exclusively outpatient, and many of the Medicaid patients were diagnosed with conditions that could have been treated in a primary-care office.

The study doesn't pinpoint a reason for the increased visits. In interviews, the authors said there's no data to know for sure but it's possible that patients are quicker to have their injuries and ailments checked out if they know they won't be stuck with a large hospital bill. Some patients may be visiting the ER on the advice of a primary-care physician.

"When you lower the price of something, you're more likely to use it more. That's what we see when we look at the emergency department, hospitals, doctors offices, prescriptions," said Katherine Baicker, professor of health economics at the Harvard School of Public Health. Baicker and economist Amy Finkelstein at Massachusetts Institute of Technology are leading the long-term study into the data derived from Oregon's Medicaid lottery, including the two earlier studies.

The authors caution against concluding that ER use rose because there wasn't enough access to primary care. Their earlier research found that Medicaid patients reported more visits to doctors' offices and use of preventive care.

Oregon's expanded Medicaid population was relatively similar to the group that's gaining coverage under the federal health law, but experiences elsewhere might differ, the researchers said. Oregon opened Medicaid to a tiny share of its uninsured population, reducing the amount of strain on the health care system's capacity. Portland's low-income population is also disproportionately white compared to most other U.S. metro areas.

Alissa Robbins, a spokeswoman for Oregon's Medicaid agency, said the state is aggressively working to reduce Medicaid costs — an effort that began after the period studied. The state has created incentives for doctors, hospitals and mental health providers, and some are targeting frequent ER users.

"Increasing coverage and seeing people use more medical care isn't necessarily a bad thing," said Dr. Renee Hsia, an associate professor of emergency medicine at University of California San Francisco and a health policy researcher who wasn't involved in the study but reviewed it for Science. "The outcome that we desire is not that we don't have people going to see their doctors anymore. The outcome is that we have people who feel protected from (financial problems and) seeking care when they feel they need it."

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Follow AP writer Jonathan J. Cooper at http://twitter.com/jjcooper .