Dec 24, 2009

Twas' the Night Before Christmas - Nurse Style

Twas the Night Before Christmas -A Nursing Version

Twas the night before Christmas, and all through the floor
Lasix was given, filling foleys galore.
Stockings were worn to prevent emboli,
they came in two sizes, knee and thigh high.

The patients were nestled half-@$$ed in their beds,
while visions of stool softeners danced in their heads.
We in our scrubs, and they in their gowns,
Fashion created to hide extra pounds.

When down in the ER it became such a zoo,
they called with admissions for me and you.
They're coming, they're going, and they're all looking the same.
My patience for patients is starting to wane.

Now call lights are ringing, the patient 400 pounds,
says "Didnt get my pericare, send my nurse now".
And now delegation seems the best plan,
We try to send others, for the needs of this man.

When what to my wondering eyes should appear,
But Santa himself and 8 tiny reindeer.
Hey says he comes from Central Supply.
To bring us LR, NS, & D5.

The doctors then scribbled what no one could read.
Orders on patients, to measure their pee.
We try to decipher illegible words,
orders for patients, to guaiac their turds.

The new shift arriving, our day is now through,
How did stool & emesis get in my shoe?
We give them report and pass on the facts,
and tell them of duoderm lining the cracks.

And the nurses exclaim as they limp out of sight,
"Ativan to all, and to all a good night".

Dec 22, 2009

Nurses' Perks For Working on Christmas

There truly are advantages to working on Christmas and other holidays.  If you are scheduled to work a holiday, don't despair!  Look at the bright side.

OVERTIME PAY:  This is one perk that most nurses appreciate when working a holiday like Christmas.  The extra money can help with holiday expenses.  If you are really on the ball, you can start paying off your bills quicker – get a jump on your New Year's resolution.  If your loved ones are upset that you are not going to be there part of the day on Christmas, plan something special with them later in the week!  Let them know in advance what you will be doing.

YOU DON'T HAVE TO COOK:  Health care facilities go full scale on Christmas to make a fantastic meal for patients and family members.  Staff members working Christmas reap the benefit of a great holiday meal without the cooking and clean-up!

YOU GET TO WITNESS SPECIAL MOMENTS BETWEEN PATIENTS AND FAMILY MEMBERS:  You get a front row seat to those special holiday moments shared between patients and their family members.  You see the hugs from grandkids, the gifts exchanged, and hear the resolutions and hopes for the New Year.  This is a gift you can't and won't want to exchange!

YOU ARE REMINDED HOW LUCKY YOU ARE:  By seeing those special moments, you are reminded of how lucky you are and all of the great gifts in your own life.  After all, you get to leave the health care facility after your shift – conversely the patients have to stay!

YOU ARE NOT WORKING THE ENTIRE 24 HOUR PERIOD:  You still have about 12 hours of the day to spare.  Make plans to do something special on the holiday before or after your shift.  Create a unique and new tradition for your holiday this year!

Credit for this essay goes to Sue Heacock, RN

Dec 4, 2009

Some Pearls for EMS/ER to live by...

Credit for this goes to Thom Dick as publised in his JEMS article...

Following is a list of 30 Pearls for EMS/ER practice.... 
  1. People don’t change. 
  2. Some of the most beautiful people in the world come wrapped in the plainest packages .
  3. You can stir up as much trouble as you need to. Just make sure you do it only to make things better, your care is always top-notch and your certs are always up to date.
  4. You may be a medical genius. But sometimes it’s your job to just take people to the hospital.
  5. Never plan anything until after noon on the day after a 24-hour shift.
  6. People make stuff up, sometimes.
  7. This is medicine we’re doing here.
  8. There are two kinds of leaders in EMS: good ones, and those who spend just enough time in the field to realize they hate it—then presume that qualifies them to lead those who don’t.
  9. It’s not enough to be nice. You have to be competent and nice. 
  10. There’s a very good reason why you’ve never met a dual-role surgeon. 
  11. The genius who first presumed that one person could do two full-time jobs at once was an administrator who meant some other person.
  12. Liars lie—that’s why we call ’em liars.
  13. A whole lot of stuff is funnier than you think.
  14. Paramedics/ER Nurses get lied to for a living. There’s only one thing dumber (sic) than lying to one, and that’s lying to a whole room full of them at once.
  15. Anybody can be a former Paramedic/ER Nurse. All you have to do is quit.
  16. Never do anything you know is stupid (especially if the person who tells you to do it is stupid).
  17. You can break bad rules, especially if you’re funny.
  18. Your life insurance company wants you to be in perfect health, because that means you can keep on paying premiums. They don’t care if you’re happy.
  19. The concept of fear is not discussed in any EMS/Nursing text. That’s too bad, because fear is a component of all suffering.
  20. What’s right is not always popular; what’s popular is not always right.
  21. People who cut corners eventually find themselves running around in circles.
  22. If most people were smart, we would be unemployed.
  23. Be nice to people on your way up. You may meet them again on your way back down.
  24. If the patient tells you they’re about to die, they’re probably right.
  25. Nothing in the EMS/Nursing curriculum makes us judges.
  26. We should probably listen about twice as much as we talk.
  27. People don’t care how much you know until they know how much you care.
  28. If you’re tired of taking care of poor, old, dirty, naked sick people, take a rest. Do something else.
  29. Your ambulance is a machine that can either earn you a living or kill you on any day of your career. It probably deserves your respect.
  30. A partner who tells you not to worry about their driving because they "can handle it" most likely isn’t so sure. Maybe you’d better take the keys.

Nov 13, 2009

US Panflu Update - 11/12/09 "Are we in the clear yet???"

US Pandemic Situation Report- Nov 12th

The overall national trend is now one of declining impact. Reporting nationwide continues to be highly variable from location to location. Some locations are reporting decreases in case loads while others are reporting dramatic surge. The below information pertains to those locations within the US reporting challenges related to pH1N1.

School Absenteeism

Student absenteeism rate (elementary and high school): 10-40% (10-20% usual range reported)
Teacher absenteeism rate (elementary and high school): not specified but still documented

Local Medical Infrastructure

EDs and outpatient clinics continue to be overwhelmed by anxious well and truly ill patients.

EMS and first responders report no appreciable impairment in operations reported.

Hospital ward level inundations have been reported. Excession of capacity was not noted since last report. Healthcare worker absenteeism has contributed to strain.

ICU capacity has been reported to approach near- to at-capacity. Demand for ECMO or HFOV continues to be observed.

San Joaquin County, California declared a local state of emergency due to broad medical infrastructure strain.

Mortuary services have not reported strain.

Fewer people are donating blood in the United States due to the pandemic. In addition, some blood centers nationwide have had to throw out blood donations after learning that the donor had influenza-like symptoms. Although the centers claim that they have sufficient blood supplies now, a further decrease in blood donations, particularly during the Christmas season, is a concern.

General Infrastructure Strain

Main sectors affected this week include primarily education, public health, and medical care. Government and corporate sectors have not reported strain since last report.

A pork producer from Clinton, North Carolina filed for bankruptcy after owing about USD three million to various vendors. The company, Coharie Farms, blames the loss on an increase in grain prices, a decrease in hog prices, and pandemic (H1N1) 2009 "fears". The owner of Coharie Farms plans to liquidate the company and "some" of the 170 employees will be laid off. The company lost about 17 million dollars this year. Coharie Farms is the largest independent pork supplier to Smithfield Foods Company. North Carolina has the second largest pork industry in the United States.

Social Anxiety

Frustration and anxiety associated with failure of meeting expected public access to pandemic vaccine and public perception of uneven distribution of vaccine to priority groups has become the primary focus for public anxiety. This relates to public outcry due to a perception of politicians and other non medical-risk groups observed to be vaccinated ahead of those groups identified and publicized by CDC for vaccine priority.

Worried well influx to emergency departments and parents keeping well children home from school continues to be documented. Limited instances of parents refusing vaccination after reports of adverse vaccine reactions (regardless of credible proof the vaccine was the cause of the reaction) continue to be documented.

The current focus for social tension revolves around vaccine availability and uneven distribution.

In addition to strain and anxiety, medical staff are dealing with threats, insults, and bribes from patients. Doctors are compelled to reassure patients that they are waiting their turns for the vaccine and not prescribing Tamiflu for themselves or their families unless necessary. Two vaccine clinics in New York were canceled after parents began to threaten nurses. According to staff members, one parent stated that he would "hunt down" the nurse if anything happened to his child while another parent threatened to sue a nurse if something happened to his child.

Primary triggers for social outcry and anxiety behavior continue to be 1) the death of children or 2) pregnant mothers in a community. Publicly perceived violation of expectation regarding availability (and now) distribution of pandemic vaccine has become a prominent driver of social anxiety.

Environmental Conditions

Environmental conditions are currently moderately optimized for transmission throughout the majority of the US and are projected to optimize fully within the next 3 months.

Expected Progression

While national epidemiological statistics indicate a past peak and decline in cases, high variability in local experience is still observed. Overall national impact is declining.

Pandemic H1N1 is expected to continue to strain local medical capacity, however now at lower levels. Variables in local transmission include herd immunity levels achieved through prior community exposure to the virus, public and healthcare worker uptake of pandemic vaccine, and virus genetic stability.

Veratect's West and East Coast Operations Centers remain vigilant for possible resurgence following mass mixing events such as Thanksgiving and especially the Christmas / New Year's holiday seasons. It is unclear to what degree the pandemic will impact social functioning when environmental conditions are maximally optimized in January-February. Veratect remains vigilant for reporting of virus drift or recombination.

 James M. Wilson V, MD
Chief Technical Officer and Chief Scientist
Veratect Corporation
Kirkland, Washington
jim@veratect. com

Oct 23, 2009

CAMTS Accreditation - Blessing or Curse?

NOTE: This is my commentary/response to the original article which appears at:

VerticleOnline and published Oct 21, 2009


CAMTS accreditation has become double edged sword.

On one hand your HEMS program may not be able to live without it (either by regulatory requirement of your state, OR by lost revenue via third party insurers who require accreditation), but on the other it may be hard to live WITH it too! -recurring site visits, 3 year applications for reverification, continually updating standards etc.

One of the big problems with CAMTS accreditation is that in some circles it is legislatively mandated (see the 8 states that require it) and by definition, accreditation conflicts with "mandatory" -- so which is it? Mandatory or voluntary???

Personally I believe the original intent of CAMTS was good for the following reasons:

1) It's not governmental: for those of us who dislike big brother running everything. (This is a HUGE plus in my book)

2) Technically, it's still voluntary (debatable)

3) Nursing/carregivers: involvement with heavy focus on requirements for the medical crews, in my opinion, is good. I believe the industry is moving towards recognizing the medical crews as AIRCREWS. I think there will be needed discussion when/if this happens (I hope it does) because then there is more FAA oversight in that aspect.

4) CAMTS uses widespread representation. Argue if you like about how the pilots are not as strongly represented, but there are a few other "non-specific" seats on the CAMTS board of directors which could be occupied by qualified pilots as well.
---->NOTE: if the HEMS pilots do not feel they are represented adequately by CAMTS, then they should lobby their professional organizations to develop some type of accreditation program as well, OR, get their representative body to work more collaboratively and intertwined with CAMTS
5) In my personal opinion, in what I have read and researched over the years, I feel CAMTS strives to stay "ahead of the curve" in as much as incorporating or leaning towards industry leading "best practices" as well as those practices which may be recommendations by federal investigative/review committees. I have always felt that CAMTS was dynamic and responsive to the HEMS community.

I realize there are more problems and concerns with CAMTS which I have not listed here; I will look for part two of this article to help stimulate more discussion.

My bottom line however, is directed towards the skeptics and nay-sayers.. and I say to those that are (1) unhappy, (2) dis-enfranchised or (3) mis-represented by CAMTS - "sorry", CAMTS has ONLY become so influential and powerful by the VOLUNTARY submission to it's program requirements and accreditation processes by programs across the US... The more programs that seek the CAMTS "Merit Badge", give the CAMTS machine more influence, power and presence....

Oct 12, 2009

National Emergency Nurses Week Oct 11-17, 2009

Emergency Nurses "Prepared for the Unexpected"

Emergency nurses across the US will be celebrating Emergency Nurses Week, Oct. 11-17, and Emergency Nurses Day on Oct. 14. This year’s theme is "Prepared for the Unexpected," a perfect theme as every day brings the unexpected. There is no "usual" or "typical" day in an emergency department.

Emergency patients are just that — emergencies requiring acute, episodic care. We care for patients across the lifespan, with a vast range of problems. It is not uncommon to care for a two-year-old boy with a fever, a 75-year-old woman with a fractured hip and a 22-year-old man involved in a car crash, all in the same hour.

We are frontline health care providers, often a person’s first and only interaction with the health care system. Every day, we interact with other disciplines — including physicians, paramedics, respiratory therapists and police officers. We do not work alone, but as part of the health care team, relying on each other’s skill and expertise. Each day, we touch people’s lives, from providing CPR, to explaining the signs of infection to a mother whose child just received stitches for the first time. We are there for our patients and families during happy and sad times — we are also there for each other.

We need to acknowledge the great work done by all our emergency nurses across the US. We are truly a unique specialty, caring for a multitude of diseases and injuries from infancy to adulthood. Every day, we are faced with increased demands, from violent patients, short staffing to overcrowding, but we do our best to provide safe and competent care.

Since 1989, the Emergency Nurses Association has celebrated the second Wednesday in October as Emergency Nurses Day, a day set aside to honor emergency nurses for their commitment to patient care. Starting in 2001, ENA expanded the celebration to devote an entire week to honoring emergency nurses, because it was felt that one day was not enough to recognize all contributions made my emergency nurses.

ENA is the only professional nursing association dedicated to defining the future of emergency nursing and emergency care through advocacy, expertise, innovation, and leadership. Founded in 1970, ENA serves as the voice of more than 36,000 members and their patients through research, publications, professional development, injury prevention and patient education.

Oct 8, 2009

ENA General Assembly Day #1 - Town Hall Report

Day #1 of the ENA General Assembly (GA) finished up with a Town Hall style meeting. This is an activity which has been done at the last several ENA GAs and has continued since. It is an opportunity for members to meet in a collegial and informal setting and ask quetions and engage in an "open forum" with the ENA leadership. This provides an opportunity for members to directly ask questions or discuss ideas with the leaders in a setting in which they might not otherwise be able to so easily. Each town hall meeting has several ENA leaders and members of the board present.

The town hall meeting Wednesday evening went quite well. Participation was good and there were approximately 40-50 members present to share.

Some of the topics/items shared are presented here...

One member brought up discussion that they were having a hard time getting "buy in" on TNCC education at her small community hospital because they aren't a "trauma" center and apparently the adminstration felt that they didn't need "trauma" education.

The presenter aknowledged that TNCC was an outstanding course that taught good ED nursing skills as far as patient assessment. Members of the ENA board and those involved with TNCC development responded. They said they understood the point and suggested that this person try to promote TNCC education from the standpoint that a lot of trauma doens't come into the ED by EMS/prehospital, but also by private vehicle or "walk in". As such, it seems that "trauma" education even in the non-trauma centers is definitely of benefit. There was no indication that the naming of the TNCC product was going to be changed, but that maybe a strategy for marketing it differently to address the broader needs of all EDs.

Another question was presented regarding the newest BCEN certification, the CPEN (Certified Pediatric Emergency Nurse). It was pointed out that the CPEN is the only BCEN credential which includes a clinical practice requirement in order to sit for the exam. Currently the other BCEN credentials do not have this (CEN, CTRN, CFRN). The question was asked as to why this practice requirement was made and if in the future, the other credentials would move to include a clinical requirement also.

The response was that the CPEN was developed in conjunction with the Pediatric Nursing Certification Board (PNCB). The joint venture was necessary to establish core content and competencies and as such necessitated the CPEN mirror the pre-existing clinical practice requirement of the PNCB.

So basically the CPEN is a "joint-certification" and shares similarity with PNCB. The other BCEN credentials (CEN, CFRN, CTRN) are unique to BCEN and share no joint development with other certifying boards.

Finally a member from California ENA brought up for discussion that in her state they were having a new mandate from their state legislation. AB 911 mandates that the EDs use a matematical formula to calculate how "full" or "busy" they are with high acuity patients. The presenter discussed how they are not sure how these numbers are going to be used but they are having to dedicate resources to fulfilling this obligation. There was also concern that this mandated a certain softward package or method to do this. Another speaker, also from California, stated that she felt it was a useful tool because part of the calculation was taking into account some patient/system acuity beyond just the ED as it includes numbers of ventilators available etc.

The ENA town hall board responded that they were not as familiar with this recent legislative madate, but would keep their eyes on it in the future. It was stressed to the attendees that this was an example of needing to keep active on the legisltative forefront via our ENA's support structure.

The town hall meeting ran up until the end of time and probably would have gone on longer if there was not a time constraint.

This author has attended the GA Town Hall meeting for th past 4 GAs. I have always appreciated the venue and felt that it was beneficial. It's a nice forum to get a "direct line" to the people with answers or to get referred to those who may be able to help more. It has always been open, informal and a good use of time.

I'm going to suggest to the ENA conference committe that we continue this forum, maybe even to have it repeated on one of the days of the "reguular" conference too, or to extend the time to 90 minutes or so because there has always seemed to be more topics pending that people wanted to discuss.

Oct 7, 2009

ENA Conference/General Assembly Opening in Baltimore

Wednesday October 7.

ENA president Bill Briggs called the General Assembly to order for 2010 here in Baltimore MD.
Many new and interesting things were on tap for starters.

One of the first "improvements" was the installation of a new method for registering keypads for the delegates to vote with. Previous years had seen difficulties with delegate registration, missing keypads, DUPLICATE keypads, keypads being "swapped" etc. So it was with a bit of trepidation that we installed a new vendor/service for this and a new process for registering keypads. Overall it seems to be like a good system and some inefficiencies since last year have been improved upon... so far. ...we'll see!

The second part of the morning session saw some emotional debate and speaking regarding one of the new proposed bylaws which is going to effectively "cap" the number of delegates to the general assembly.

This had been proposed by ENA leadership for several reasons, one of which was a financial concern in that larger and larger delegate assemblies was becoming a logistical chore, as well as expenses to the organization were increasing as well. The ENA leadership had proposed a fixed number of delegates and each state would be awarded a respective percentage based upon their annual membership.

Good --- Bad???

Much discourse was had throughout the assembly, many people voiced their opinions both for and against. Some of the larger states voiced concerns that their representation might be diluted by the smaller states getting their "guaranteed" delegates based on small ENA member rolls. Other speakers voiced concerns about the principles of "grassroots", "membership driven" as their speaking points and they advocated for the current method using arbitrary ratios, such as is the current case.

The discussion went on and nearly ran into lunch time and discussion had to be halted temporarily.

As for this author, I am not completely convinced on my own stance on this. I understand the need to limit some of the expenses and the ever increasing logistical burden, however I also understand that, as a "pure" representative organization that is growing, a stable delegate:member ratio, despite increasing numbers, has it's benefits also.

Will be interesting to see how this one pans out.

Sep 18, 2009

Seasonal Flu Myths

In the spirit of the upcoming flu season I decided to share with my followers this list of common misunderstandings and misperceptions of the seasonal flu vaccine. An alarming 50% of healthcare workers do not get the flu vaccine annually and some of these myths are the reasons I've heard of before...

Flu Myth #1: The seasonal flu vaccine protects against swine flu. Unfortunately, it doesn’t. The swine flu virus that first appeared in Mexico during April 2009 is a different strain of influenza virus. There is no vaccine for it. So even if you got a flu vaccine earlier this season, it won’t offer any protection against swine influenza.

Flu Myth #2: The seasonal flu is annoying but harmless. There has been a lot of focus on swine flu, but it’s important to remember that the run-of-the-mill seasonal flu can be a serious condition itself. “A lot of people just think of the flu as a very bad cold,” says Curtis Allen, a spokesman for the CDC in Atlanta. But it’s much worse than that. For one, you usually feel terrible. In addition to the congest ion and cough, you’re apt to have nasty body aches and fever, which are less likely with a garden-variety cold. “When you get the flu, you know it,” says Christine Hay, MD, assistant professor at the University of Rochester Medical Center. “You feel like you’ve been hit by a Mack truck.” Aside from the short-term misery and lost workdays, flu can have more serious implications. Sure, most people who get the seasonal flu recover just fine. But the seasonal flu also hospitalizes 200,000 people in the U.S. each year. It kills about 36,000. That’s close to the number of women killed by breast cancer each year, and more than twice the number of people killed by AIDS.

Flu Myth #3: Swine flu is transmitted by pork products. Lots of people have reacted to the swine flu outbreaks by swearing off bacon – just as some countries reacted by banning pork or slaughtering pigs. But experts say that despite the name, there’s no reason to worry about pork products spreading swine flu. Though the virus did originate in pigs, it’s now jumped to people. Since then, the spread has been from person to person, not from pork to person.

Flu Myth #4: The flu vaccine can give you the flu.
This is the flu myth most likely to drive experts bonkers. “There is simply no way that the flu vaccine can give you the flu,” says Hay. “It’s impossible.” Why? For one, injected flu vaccines only contain de
ad virus, and a dead virus is, well, dead: it can’t infect you. There is one type of live virus flu vaccine, the nasal vaccine, FluMist. But in this case, the virus is specially engineered to remove the parts of the virus that make people sick.

Flu Myth #5: There is no treatment for the flu. I
f you can get to the doctor quickly -- within 48 hours of having flu symptoms-- there are antiviral medications that can help. These drugs, such as Tamiflu and Relenza, won’t cure the flu. But they can reduce the amount of time you’re sick by one or two days and make you less contagious to others. These drugs work with both the typical strains of seasonal flu as well as swine flu.

Flu Myth #6: Antibiotics can fight the flu.
Antibiotics only fight bacterial infections. Flu – whether it’s seasonal flu or swine flu -- is not caused by bacteria, but by a virus. So antibiotics have absolutely no effect on any kind of flu. But this message just won’t sink in for some people.
“We still have oodles of patients coming into the doctors, or bringing their children to the doctors, who want antibiotics for influenza,” says Schaffner.

Flu Myth #7: The flu is only dangerous for the elderly.
It’s true that the people most likely to become seriously ill or die from the seasonal flu are over age 65. But flu can become risky for anyone, even healthy young adults. Some of the most susceptible people to seasonal influenza are young children. Experts don’t have enough evidence yet to say whether young children are at increased risk from swine flu. However, based on pa
st experience with the seasonal flu and previous flu pandemics, it’s possible. “Children under 2 years have some of the highest rates of hospitalization from [seasonal] flu,” says Hay. Children under 6 months are at the most risk from the seasonal flu because they’re too young to get the vaccine.

Flu Myth #8: “Stomach flu” is a form of influenza. The word “flu” is so overused that it’s lost much of its actual meaning. Gastrointestinal viruses are called the “stomach flu,” but they have no connection to the actual influenza virus. If you suffer vomiting and diarrhea, but no fever or body ache, you probably do not have the flu.

Flu Myth #9: If you get the flu, you can’t get it again during that flu seaso
n. Many people assume that if they’ve had the flu recently, they can’t get it again -- and thus don’t need to get the vaccine, Perl says. That’s not the case because the flu isn’t a single virus. “In any flu season, there’s usually both Type A and Type B influenza in circulation,” Perl tells WebMD. Both can cause the flu. It’s quite possible that you could get infected with one type and then the other.

Flu Myth #10: If you’re young and healthy, you don’t need to worry about getting the vaccine. First of all, we should all get the seasonal flu vaccine. Sure, if you’re in good health, you’ll probably recover from the seasonal flu just fine. But why suffer through the flu if you can avoid it? Second, protecting yourself isn’t the only reason to get vaccinated. “Healthy adults forget that while they themselves might be at low risk for getting serious flu complications, other people in their family might not,” says Hay. If you have a small child at home, or an older parent, your failure to get yourself vaccinated could endanger them. And that’s true on a larger, societal level. People with the weakest defenses, like children under 6 months, can’t get the flu vaccine. Their safety depends on the rest of us getting immunized.

Flu Myth #11: You can skip years between flu vaccinations.
Experts say that some of us don’t understand that we need a new seasonal flu vaccine every year. “It’s confusing, since the flu vaccine is different from most vaccines, which offer longer-lasting protection,” says Schaffner. “With the measles vaccine, you get two injections and then you don’t have to worry about it for the rest of your life.” The flu vaccine isn’t like that.

Flu Myth #12: Vaccines are dangerous.
In recent years, there’s be
en growing mistrust of vaccines, including the flu vaccine. Some believe that there could be a link between vaccines -- specifically the ingredient thimerosal -- and developmental disorders in children, like autism. However, there is no evidence that vaccines cause autism, and experts say that we’re losing sight of how important vaccines are. “Vaccines are, arguably, the greatest medical advance in history,” says Perl. They’ve prevented more illness and death than any treatment.

Flu Myth #13: Cold weather causes the flu.
No matter what your grandmother may have said, going outside in the winter hatless does not increase your risk of flu. While there might seem to be a connection -- since flu season coincides with colder months in the U.S. -- there isn’t. After all, flu season is the same throughout the whole country: even if it’s frigid in Minnesota, it’s still warm in Florida. The rise and fall of flu season each year has more to do with the natural cycle of the virus, although experts aren’t exactly sure
how it works.

Flu Myth #14: If you haven’t gotten the seasonal flu vaccine by November, there’s no point getting vaccinated.
While supplies of vaccine used to run out by November, that’s not the case anymore, says Allen. Nowadays, there should be enough vaccine for anyone who wants it, and you should be able to get it as late as December or January. Besides, the flu often doesn’t hit its peak until February or sometimes as late as March.

(Original source article:

Sep 15, 2009

"A 98.8% passing rate...?"

While promoting and publishing my own CEN review course and CEN Review Manual, I have been keeping abreast of what others are doing out there.

One "competitior" company is Med-Ed. On their website they boldy proclaim a "98.8%" passing rate.
While they do not specific which exam that refers to, they do print it on their flyer for their CEN classes.

I found this passing rate pretty high and had some questions as to how they calculated it so on 9/12 I called them. I called their office in Charlotte and spoke with the lady who answered the phone. She was nice and pleasant. I introduced myself and stated that I was wondering about their quoted passing rate. I asked her how they knew who did and did not pass the exam. (I do not have her permission to use her name publicly, so I will honor that).

She politely told me that they know the pass rate based on the number of people who have requested a refund based on not passing their exam.

Okay, I can buy that, I guess. But, what if someone doesn't even take the exam? I asked her this, and she said, "well, why wouldn't they take it?".

So I clarified by saying to her that she was telling me that they calculate their pass rate based on how many attendees request a refund for not passing; she said "Yes"....

Seems to me this isn't very scientific at all.
Just because someone doesn't pass the exam, does NOT mean they will contact Med-Ed for a refund.

I can think of several scenarios where someone would NOT be contacting them for a refund....

1) If the attendee is taking the class merely for CEU (continuing education) purposes and they are already certified as a CEN - they have NO NEED to take the exam! (I've had a few of these people in my own classes)

2) If the attendee does not take their exam within the 60 day window, then they do not qualify for a refund; there is the potential for many delays in this 60 day time frame. It takes at LEAST 3-4 weeks to get the "permission to test" letter from the BCEN, then you still have to make an appointment to take the exam. Some exam centers have very limited openings.

3) Another person who would not qualify for a refund is an attendee who has had their registration paid for by the hosting institution in a "flat fee" pricing structure.

There are other permutations of similar scenarios here but I believe the point is clear, there is ABSOLUTELY no sure way to know who has not passed their CEN exam.

The opposite is true however, you can find out who HAS passed their exam by checking the BCEN website and looking at the names of those who have passed their CEN. However, that still would not account for those who have NOT taken it yet.

I'll be doing my own research and study from an upcoming Med-Ed CEN review class and seeing just who is and who isn't passing their exam and running my own numbers.

In the meantime, feel free to check out MY CEN revivew book which is 10% off through the end of September!

10% OFF Thru September 30, 2009

Use code "LULUBOOK" at checkout.

(Click on the Book to Preview or Purchase!)

Sep 14, 2009

ER Wait Times....

While reviewing some of the Emergency/EMS blogs I read, I came across Paul Bond's "Emergency Nursing Today Show" latest post... Public Tracking of ED wait times. This made me think of a site I had seen a while back that was doing sometihng similar....

North Florida ER Wait Times

Middelsex Hospital Wait Times

These are just two examples and apparently there are several more out there.

I find this interesting because my mind looks at this in several different ways.

1) If you are having a "real-emergency" why would wait times mater? If it's life or death, you go straight back and your wait time is essentially non existent. So obviously this marketing of "wait times" is for the non-urgent population and for customers to consider where they could go to be seen quicker.

2) If we are marketing ED wait times to the public, does that mean that inappropriate use of the ED is being encouraged?

3) Shouldn't we be spending more money on injury/accident prevention and community education to help de-emphasize the need to for non-urgent patients to come to the ED?

4) Finally, does it really matter? Is there some patient satisfaction quality trend that is associated with this? As of THIS MOMENT the times on the Middelsex website are: 22min, 0 min, and 9 min for each of their facilities. So I guess the potential customer would want to go to the one that is ZERO minutes so they could be seen immediately (??); but I ask is 22 minutes really that much?

These ongoing trends in Emergency Services towards "customer service" and increased satisfaction are of themselves, okay. It does help the system to strive for excellence, but sometimes I feel that the emphasis is being placed on the wrong areas and right now, much more spending on these websites to "track ER wait times" seems to be not the most appropriate focus for today.

Sep 11, 2009

Remembrance 9-11-01

No words necessary for today's post
However you choose to honor and give respect today - make sure you do and NEVER FORGET!

Jul 17, 2009

Primary Care in the ER?

Original article at: See my points/comments in bold/blue

A Critical Situation For Area
Primary-Care Needs Spill Over Into ERs
This title is inaccurate: it implies patients are seeking "primary care" in the ED. This is false. Primary care (pap smears/breast exams, colonoscopies, diabetes managment etc) is not done in the ED, rather it's people who no longer have a PCP coming to the ED for their acute problems that would otherwise have gone to their PCP's office.
By Yamiche Alcindor

Washington Post Staff Writer Monday, July 13, 2009

Hospital emergency departments across the region are overflowing with patients who have been battered by the recession and are increasingly using hospitals as their primary source of health care, according to local and national health officials.

What national officals? This article mentions none.
At the District's Providence Hospital, emergency room visits increased by 13 percent in the past year. In Montgomery County, the number of patients seeking free care at community clinics designed to divert people from emergency rooms rose by 43 percent, many of them referred by hospitals.

The community clinics are not focused on providing ACUTE care, they are there for chronic, preventative and primary care purposes. They provide a different service line than the ED. That 43% increase are the people that have no PCP and are going there for their ongoing, primary medical services.
... A national debate is underway about how to reduce health-care costs and provide medical coverage to everyone. Diverting people from emergency rooms -- which are an inefficient and expensive way of delivering basic health care -- is a central issue, said Larry Gage, president of the National Association of Public Hospitals and Health Systems.

Don't forget dwindling reimbursements for emergency care are also to blame. Trauma funding is often inadequate as well. Lack of on call specialists, lack of qualified attending MD's and Nurses as well. Also patient "boarding" and psychiatric/mental health patient "holds" ....ALL these things are contributing in addition to people merely lacking a primary MD.
"The absolute number of people using emergency rooms has gone up as much as 20 to 30 percent in the last six to eight months due to the recession and people losing their jobs," he said. "The only option in their minds is going to the hospital."

...also, it's the only thing they KNOW. In my personal experience, quite a few of the folks I've had to refer to community clinics or free clinics had no idea they even existed. (Now here's an opportunity for public education!)

Last year, Providence and the D.C. Primary Care Association launched the ED Diversion Project, which places community health workers in waiting areas to help patients obtain primary-care doctors and sign up for Medicaid and Medicare coverage.
Now this is a GREAT idea! However, don't the hospitals have social workers and medicare/medicaid workers already? Can't the ED care team give these people the information to make a phone call the next day or give them directions to these people's offices? Why do the taxpayers (again!) have to fund this "diversion project" when we already have health care workers who can make the referrals?
Zoila Alvarez, who arrived in the United States three years ago from El Salvador, has been a patient at Mary's Center for a year. Before she found the clinic, she sought prenatal care and treatment for depression at hospital emergency rooms, she said.
Interesting, here is a lady (I'll assume a legal immigrant) who comes to the US (no mention of husband or family) to have her baby who "becomes" a US citizen upon birth....
...Albertha Boone, 55, of Southeast Washington, can relate. Her last visit to a primary-care doctor was in 1989, she said, even though she has asthma and high blood pressure and needs to have major knee surgery.

She said she has a monthly income of $1,400: $1,000 from a disability check and $400 from a part-time job as a clerical assistant. After she pays rent -- $800 -- she uses the remaining $600 to pay for utilities and buy groceries. She said that she has Medicare coverage but that it won't pay for regular doctor visits or for the knee surgery a doctor has told her she should have. So when she needs care, she will continue to go to an emergency room for treatment.

WHAT????? Medicare not paying for doctor visits? I don't believe this statement. However, if you tell me that she can't find a PCP who will TAKE medicare, then I can swallow that a bit more. We need more information here because this doesn't make sense to me.

"Moving forward, we need to do more so that people are aware of clinics in their neighborhoods," said Pierre Vigilance, director of the D.C. Department of Health. "We have to make sure that these clinics are available to people when they need them."
I agree, get the word out, run a campaign or a public education incentive. However, I postulate that the root cause of a lot of this (economy aside) from the provider's standpoint is the whole EMTALA ( issue. Those of you in the "biz" you know what I'm talking about...the whole legislated principle of ED's not "turning" people away as well as ED's doing WAY MORE than they were designed to do beyond providing the legally mandated "Emergency Medical Screening" assessment/exam.

Jun 29, 2009

Tasers in the ER...

(This blog refers to a post by "" which can be found here)
Dr Donald Dawes, from the University of Louisville, Kentucky, reported that
Tasers were used 27 times at one Minneapolis medical center over a one year
period and found the number of injuries to both patients and medical staff were
reduced with the introduction of Tasers to the hospital.
(For more information on Taser devices:

It is an interesting sign of the times when we even have to be discussing use of Tasers in the E.D. However, it is a sign of today's times indeed. I can speak from my personal reference including my personal observations and viewings of Taser use in the ED.

A local ED is staffed by at least 2-3 "off duty" local law enforcement officers 24/7, they carry the usual fare of lethal as well as non-lethal force weapons (Tasers). I have seen them 'displayed' to a perp twice and seen them used to drop a pt. twice. I have "heard" them out of eye sight being used 3-4 times.

While not considered "firearms", Tasers do present a new venue of consideration which requires application of standards, codes and interpretation of the law and consequences.

There are even safety claims as to the liability for Taser weapons to cause permanent and or fatal damage. This is an ongoing debate and struggle to get these tools accepted more widely.

However, when I consider all the times I've seen the Taser "deployed", it was situations, which, in my opinion, had it not been deployed, it would have escalated into a situation in which deadly force would have been likely to have been used and/or warranted.


Jun 28, 2009

Stimulus Checks to fund EMS????

Over at there is an article, "Stimulus to pay for emergency vehicles" which originally was printed in the Chattanooga Times Free Press (May 19).

In said article, it explains how Tennesses will get approx $4.5 MILLION for fire, police and rescue vehicles courtesey of the "Stimulus Package".....WHAT??

I for one, did not envision the Stimulus Package, errrrr, the American Reinvestment and Recovery Act to be used for this kind of spending. Never mind that I'm already highly irritated that my tax money is having to go to save corporate CEO's and middle/upper managers from loosing their jobs and a general re-organization of corporate USA for the "benefit" of all....AKA my "bailout" of America at MY I'm funding the public sector in ANOTHER state?

This whole thing reeks of shades of the misappropriate and irresponsible spending of Homeland Security funds status post 9/11. See this article from 2005 that talks about amongst other things: New Jersey buying air-conditioned garbage trucks and Nebraska buying cattle prods and chutes...?????

Prime examples of wasteful government spending, often not directly related to the original intent of the grant.


May 20, 2009

CEN Review Questions 5/19/09

Sorry for the delay folks!
Here's some more CEN Exam Review Questions for practice/review...

Here's some sample CEN like review questions. Try to answer them and write out a rationale. Try to justify why the answer you choose is correct and why the others are wrong.....

The link to the answers is at the Bottom of this page...

Category: Psychiatric/Mental Health
(1) When caring for a delusional patient, the ED RN knows that it is important to:

A) Allow the patient to freely verbalize his thoughts.
B) Provide distraction activities for this patient.
C) Acknowledge the thought disorder and orient the patient to reality.
D) Place the patient on a suicide precautions.

Category: Cardiac

(2) Which of the following is an INAPPROPRIATE route to give epinephrine by:

A) Intravenous
B) Endotracheal
C) Intraosseous
D) Epidural

Category: OB/GYN
(3) At what point during pregnancy is the fetus at most risk of injury due to trauma?

A) In the first week of pregnancy
B) In the second trimester
C) In the third trimester
D) In the first trimester

Category: Professional/Legal
(4) Which of the following sources of evidence is the BEST to establish the standard of care in a legal case?

A) The defendant's testimony
B) Nurse Practice Act
C) The plaintiff's attorney
D) An expert witness

Category: Professional/Legal
(5) A prior ED patient is suing after having complications from an IV access while in the ED previously. During that visit the pt became agitated and ripped the IV out. This went unnoticed for 3 hours as the primary RN did not do any assessment or documentation of the IV site. Based on this information, which principle of negligence is being described.?

A) Duty
B) Breach of duty
C) Causation
D) Damages

May 18, 2009

Too Many Cooks in the Kitchen?

A recent discussion over at was started in which the original poster (OP) threw out the question about what drives EMS staffing, Cardiac Arrests (ALS) or Medical Care, and what the mix of EMT's to EMT-P's should be utilized. (

An interesting discussion ensued with many people voicing their opinions and experiences. After reading through a majority of the posts I could pick up on a couple of themes which seem to predominate...

One of the strongest themes is that if we are basing our EMS staffing on ALS calls, then increased EMT-P's are needed, sometimes even dual EMT-P crews. This is further facilitated by the growing use of and demand for EMT-P qualified "first responders" as part of the fire service and a responding engine or rescue company. Unfortunately, with this increased use of EMT-P's by the fire service, it has mandated or "encouarged" many who would not otherwise consider going to EMT-P school to go to get the increased education and medical credentials. Many men/women entering the fire service are now being called up on to change/alter their career paths to incorporate this EMS training to meet the demands/desires of their municipality public safety administrators.

So the thought process goes that we need more medics (EMT-P's) to be able to effectively cover more ALS calls, more readily.

While this sounds good in principle the numbers don't pan out as well.

Having more medics on duty means each medic gets less calls. Huh you say? What's that got to do with the price of diesel?

Of those ALS calls that require medic level skills (IE: non-BLS), each medic will have less opportunities to "play" and get the ongoing job/real-life experiences which add to and build upon their experience repertoire'. When one considers critical ALS skills, like, er, uh, lets say "INTUBATION", you see where lack of "practice" can lead to lack of success.

Ultimately this leads to an EMS/Fire Service with lots of medics who each SELDOM get intubations on live (er, uh, "barely alive") patients. So when it REALLY counts, they lack the field experience and have to base their skill set on those manikins and OR rotations for recalling the psychomotor skills.

Add to this the current recommendations by the American Heart Association and the EMS/Pre-hospital system as a whole; to forego intubation if BVM will suffice. So now you have even less opportunities for intubations amongst and increasing number of medics.

It's not uncommon to read about medics in some systems these days who are lucky to get even just ONE opportunity to intubate annually - that's OPPORTUNITY, we're not even talking successful intubation yet!

So now to explore this we respectfully have to look at the other side of the equation or assume the other possible outcome - to DECREASE the number of employed medics and increase the number of EMT's (basics) out there.

Well, up front the numbers would support this. Overall, a majority of all EMS calls are BLS in nature and don't require ALS skills at all. So it would make sense to have an EMS system that is heavy on the EMT-B side of providers. This would, however, beg the question: what to do with all those medics?

Some proponents have suggested staffing with medics where they are needed, or centralized or via the QRV scheme.

Looking at demographics, transport times, distances, a service could strategically look at where to maximally staff their medics. Maybe they would put them in areas that were longer transport, higher acuity traumas or more rural where experienced providers were limited in availability.

One could conceive of even putting more EMT-B's in some of the urban areas where even with a "trauma" a load-n-go might only be 2-3 minutes from a trauma center.

Some systems have already incorporated the medic QRV concept. Contemporary implementations of this usually have a shift supervisor (medic) readily available to respond to a wider area quickly to "back up" the EMT-B's on scene and bring that higher level ALS skill set when necessary. Most systems that are using this however are using their supervisors; the new evolution of this position would consider merely a street level paramedic who is unencumbered to respond as needed to scene calls and not tie up a supervisor. If no ALS needed on a particular scene, then the medic could get back "in service" and "available" for the next one.

These are only limited solutions to bigger system problems. In an era of increasing cost containment, decreasing reimbursements, increased operating costs and increased litigation risks the overall principle is COST. The costs of labor, training and effective resource utilization all add up. New and novel ways to staff and provide effective community level EMS services continues to be a challenge even for the most experienced administrations.

It is interesting however to note that we spend way too much time focusing on "the big one" when the "big one" occurs a whole less often than previously considered. But....would anyone want to tell THEIR community that they are cutting back on Advanced Life Support (IE: Paramedic) level care???? Political suicide for sure!

~"KMG-365, Clear..."

May 9, 2009

NBC TV "Trauma" - ER Replacement?

New NBC TV Series "Trauma" trailer/preview....

I'll probably watch this just for pure entertainment purposes nothing more.

Interesting - they included HEMS in this "Emergency meets Third Watch" trauma
show. Now the public will see more mis-information and mis-use of HEMS I'm

I guess that's why the guy playing the flight medic/nurse ("The rebel") is
flying cause he says "I can't die".....!!!!

May 6, 2009

"Hopelessness" and Facilitation....

Dr Ed Leap, a well respected blogger, and author that I respect, recently posted his blog on "Hopelessness". I read through it and it was quite thought provoking.

The main point I believe Dr Leap was explaining, was that no matter how much logic, observation, rationalization or coercion we use/do - there are just some aspects of human behavior that cannot be adequately explained with the traditional models we, in healthcare, use.

His conclusion was that people will continue self-destructive behaviors, not through any particular rational process, but from a state of hoplelessness; when there is no perceived better alternative, benefit of change or motivation to do same.

In the frame of reference of the people we deal with on a daily basis in the ED setting - I can testify to this; but that is because of what they come to see us for: afflictions of mind, body or psyche.

And yes, as I agree with Dr Leap, we continue to fulfill our moral, societal obligations to "counsel" and advise with learned knowledge, the need for our patients to avert their destructive pathways; and often, until blue in the face.

But let's look for a moment at an underlying stimulus which I propose facilitates this. I believe that our health care system promotes and encourages these behaviors to an extent. And sometimes, the lack of action to prevent such behaviors, can be seen as facilitating. Now I am not a fan of poor grammar, but it does remind me of that FALSE dichotomy statement, "If you're not part of the solution, you're part of the problem". But in a sense, this IS true.

Most of you reading this are probably on the patient care side of the fence. We diligently meet our calling to help, heal and restore people to their "optimal" state of wellness. But there has to be an even stronger counter-measure on the other side of the fence to effect prevention as well.

It is an economic reality that treatment costs MORE than prevention. And it is well-known that effective prevention reduces morbidity and mortality. So the obvious question, "why don't we spend more time, money and effort on prevention?" - goes unanswered.

Without prevention or "access" to prevention (note I did not say access to health care) people are forced into a situation where they cannot gain an interface with the health care system until they enter via the "EMTALA-mandated" Ivory doors to the sacred city of "OZ" (The ED). Upon being integrated into that setting the wheels are at work trying to fit a preventable problem into an acutely ill opening - the technology, resources and costs are not designed for this.

However, we see, treat and encourage our patients - they get better and they are dismissed.

Now, the next time this "need" arises again; guess where the learned behavior is going to lead the patient. They know they got better before in the ED, they still have no "healthcare home", and they are still unchanged in their unhealthy lifestyles.

I propose that the problem is multi-faceted.
Until we can:
-Encourage our system to move towards prevention,
-Re-evalute the principles, AND the necessary/contemporary changes to EMTALA,
-Take a broader recognition of the societal themes of self-entitlement, self-indulgence, self-reward and lack of self-accountability....

...We'll be fighting the same battle over and over ad nauseum.
We need thinkers and people committed to speaking up for what is right.
We don't need a government to tell us to "CHANGE", we need ourselves to recognize the need for change, both internally and in society.

-"KMG-365, Clear..."

Apr 1, 2009

Emergency Department Overuse - Austin Tx

In a recent article posted in the online version of the Austin American Statesman Newspaper, Ms. Mary Roser (a staff writer) comments on a recent release of information that shows that one ED in Austin Texas log over 2678 patient visits from just nine individual patients. These astounding numbers were released by a nonprofit group in central Texas which provides care for uninsured and low income patients.

The author goes on to discuss some specific numbers in situations which paralleled that of the current state of our EDs nationwide. The problem of ED overcrowding is not new, nor is the problem of overuse of our nations emergency departments.

In her article Ms. Roser reports that between the years 2003 in 2008 there were 9 patients who accounted for 2678 merged department visits in that time. In particular, one of these patients spent 145 days in the ED during the last year alone.

Ms.Roser further discusses in her article, some considerations for possible causes of these apparently excessive uses of the emergency department. From her article it seems that one of the main causes is that these patients have no place else to receive their health care. Which, interestingly, echoes back former Pres. George W. Bush's statement about our nation's health care. Mr. Bush, when asked about the lack of primary health care in America, stated that people do have access to health care through the emergency department.

The article also attempts to explain some things are being done to appropriately manage these recurring patients. One of the doctors interviewed for the article stated that their primary focus is to assess and stabilize any medical emergencies but the problem becomes when they must decide where and how inappropriate discharge plan would be undertaken for the patient. The problem becomes that some patients still don't have access to basic health care needs, and they find that they have nowhere to turn other than emergency departments for their care.

In particular I have seen similar problems firsthand during my times working in the ER. The problem, as Ms. Roser discusses in her article, is not unique nor inherent to any one particular region, community, or facility. That being said, the solution to this ever growing problem is not an easy one to solve. A situation such as this, would require cooperation and collaboration between the health care facility, community organizations, local, state, and federal legislators.

Several readers of this article have left their comments on the newspaper website. I would like to take a few minutes and reply to some of those comments directly on this blog.

One poster (chukalukabus): seems to have the opinion that the overuse of their ED is mostly due to a problem with illegal aliens. As we are talking about a hospital in Austin Texas, I can understand this posters position and concern. It stands to good reason that in this person's region, there are many undocumented illegals residing. These same people, again I would logically assume, do not have a third-party health-insurance, and, are for the most part unfamiliar with public or free community resources for health care needs. I also believe that this poster does not realize that the problem of ED overuse is not a regional one but of national scope. Because it is a bigger problem than just locally, more than likely there are other factors at play here than just illegal aliens using the ED for healthcare.

Another poster (dterbush): remarks that if there were more affordable primary or urgent care type clinics that the emergency departments would not be as affected as much with overuse. This is a good thought. And this may be a potential solution which we are currently watching unfold. There is a growing trend nationwide towards establishing retail health care clinics to meet some primary care needs. Some of the largest venues for these are found in places such as Wal-Mart and the CVS pharmacies. These walk-in clinics, while not a substitute for primary care, are quite capable of treating a large host of maladies which typically bring people to the ED. However, the retail health clinic system, is in its early stages of establishing itself in building its unique niche in the health care industry.

Other posters who have applied to this article have indicated that "Universal Health care" might be the answer as well. We don't know this yet, if it would be beneficial or not. Additionally, as we hear more about universal health care daily, our understanding of just what universal health care is might become different than what we perceive it to be.

I suggest that any solution for this problem is still years away, multifaceted, and will have profound political and social implications to strictly address.

You can refer to the original article here:

Mar 30, 2009

CEN Review Questions 3-30-09

(ANSWERS POSTED 4/3/09 - Scroll to bottom of this article for link)

Sorry for the delay folks!
Here's some more CEN Exam Review Questions for practice/review...

Here's some sample CEN like review questions. Try to answer them and write out a rationale. Try to justify why the answer you choose is correct and why the others are wrong.....

Category: Orthopedic/Trauma
(1) Your patient is complaining of a painful right hand. She states it got hit one day ago, and now the hand is painful and swollen. On exam, the hand and fingers are swollen and there is a wound with dried blood over the third knuckle. You anticipate an order to:

A) Perform an iodine scrub to the finger
B) Administer oral antibiotics
C) Obtain an x-ray
D) Soak in cool saline

Category: Environmental
(2) A geriatric man arrives by EMS with reports of marked lethargy. The pt has been having a steady decline for approx 4 months. The pt appears lethargic but responsive with slow speech. Skin is pale, cool and dry. Rectal temperature is 94°F, pulse 52, resp 16, BP = 82/40. IV access is accomplished. Which is the most appropriate method for gradual re-warming of this patient?

A) Heated bladder irrigation via urinary catheter
B) Passive rewarming with warm blankets
C) Warmed IV fluids
D) Peritoneal lavage with warmed fluids

Category: Psychological
(3) A female is brought by her spouse for evaluation after she made several self-inflicted lacerations on her forearm which appear to be superficial. The spouse states that the pt has been very depressed and withdrawn for over a month since the death of their only child. The spouse also indicates the patient has taken to drinking heavily and not sleeping. What is the priority intervention for this patient:

A) Ask her if she has a plan to harm herself.
B) Bandage her wrists
C) Ask her what her usual coping mechanisms have been in the past
D) Take her to the registrar so you can get a chart started

Category: Professional/Legal Issues
(4) A 52-year-old man with a subarachnoid hemorrhage is identified as a potential organ donor. The patient’s family consists of his estranged wife, geriatric parents, a 20-year-old daughter, and 40-year-old sister. Who is the legal next of kin that can give permission?

A) His daughter
B) His sister
C) His parents
D) His wife

Category: Special Populations/Pediatrics
(5) A 4-month-old female comes in with: low-grade fever, rhinorrhea, tachypnea, and poor feeding. You suspect which of the following?

A) Epiglottitis
B) Bronchiolitis
C) Croup
D) Pneumonia

I Got My EM training during 'Prime Time'....

In the article "Young Doctors Learn Bad Habits From TV Medical Dramas", in the NATIONAL POST, (Mar 23, 2009) author Tom Blackwell talks about how more and more young physicians are becoming a product of the entertainment industry rather than the medical education establishment.The original article published in the "Journal of Resuscitation" looked at data gathered by a survey in which evaluation of young MDs (YMD) ability to perform endotracheal intubation (ETI) was influenced by television medical dramas.

When YMDs were asked where they "learned" their skills (when they were noted to have performed them incorrectly) some responded by indicating that they saw it "on TV". Further information showed that the most often cited TV medical drama for this was NBC TV's "ER".

Researchers then backtracked to investigate this more and find out just how mis-leading some TV medical dramas are.

The researchers (Dr Brindley and Needham) looked at an entire season of ER episodes. They specifically looked at scenes depicting ETI; and more specifically, ones where they could clearly see the entire procedure to critique it.

Their research showed that 22 observed ETIs that met criteria, had at least one step done incorrectly.
There were 22 ETIs that met criteria, I can on
ly assume that some did not; but they do not say how many were excluded. A typical North American TV "season" averages from 22-26 episodes. This means that on the average, nearly one person received ETI each episode! Unfortunately, without data from the other seasons of ER, it's hard to compare if this particular season had more or less ETIs than their "season-average" (???)
The researchers went on to explain that "traditionally" topics such as ETI are taught in a lecture-classroom setting first, and then reinforced in the clinical (IE: hands on) setting. So when those YMDs attributed their performance failures, it is interesting to note that they recalled their more influential experience watching ETI to have come from the TV medical dramas.

So why the disparity? Why did some of the YMDs remember their ETI "training" more from the TV rather than their didactic and practical instruction? Is there something different the establishment needs to do to drive home the education and experience? Is there something to be learned from TV medical dramas?

When we look at what is "entertainment" things like: story line, special effects, continuity, contemporary issues, hi-profile actors/actresses and plot intrigue factor into play. If you look at NBC TV's successful ER drama, it is no wonder that it was successful. This was an adrenaline pumping, fast paced, on the seat of your pants show. ER was one of the innovators in using the first-person-continuous-scene filming style. This greatly enhanced the "realism" of the show. As well ER frequently dealt with issues of such impact and significance as: resuscitation, trauma, life-death -- it lends itself easily to a hi-powered drama.

All these factors that go into making ER a great show (as well as a much recognized and rewarded show), make it also form more of an impression on the viewer. You remember, more...You contemplate it more... You analyze and think about it more.

Now back to our traditional model of education; that dry, stuffy, formal lecture hall or classroom. Do you really think the classroom can lend itself to as much as an entertaining-learning experience as prime time TV?

Probably not.

Even if we step forward out of the lecture hall and into the clinica
l arena, it still fails to compare. The "real world" business of treating patients and learning by hands-on, does not compare to the pulse-pounding world of shows like ER. Although one would argue that once you apply learning to the psycho motor (IE: hands on) phase in the clinical setting, you should get higher reinforcement and retention - but apparently not.

I'm guessing that prime time medical dramas like ER, are just hard acts to follow when it comes to teaching and learning.

In the end, I think the lesson we can learn here is to look at what we (as educators) can do to make our teaching and our student's respective learning experiences more "high powered", engaging and compelling.

With our currently expanding use of life-like simulators, skills labs and technical advances - eventually we will reach a cross-roads where life meets technology. At that point we can start to see how a new "technical-altered-reality" would evolve.

I think there is something that we can take from all this, and see the future of education and how we can apply it to the learner's skill sets.

NEXT UP: Now I'm going to pick a season of ER and do my OWN study - I want to look at of all the ACLS scenarios, how they adhered to the AHA guidelines of the day!!!

"KMG-365, Clear..."