Electronic Devices Shouldn’t be Used as Comforters (for Frightened Children)

The Dangers of Summer

This was my most recent column in the Daily Yonder.  Unfortunately, the Yonder website is down or I’d give you a hot link.

It’s Spring now and all across the land things are bursting with life. Flowers are in bloom, yards are bright with new grass and the sun is high in the sky. My car was, for a while, covered in a thick, green coat of pollen. Carpenter bees are still turning my log-house into Swiss Cheese. It’s pretty out, the sky is blue and the days are warm. Blah, blah, blah. I for one don’t really like this time of year. And it’s mainly because warm weather brings me patients with all kinds of injuries; some of them pretty nasty.

In rural America, there are dangers that seldom occur to people in more populous, metropolitan areas. Ironically, though, rural folks often assume that life in the city is more dangerous. And indeed, murder rates are higher.

However, according to the CDC, deaths from unintentional injuries are 50% higher in rural than urban areas; https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html. These differences in death are due to several causes; rural citizens are further from necessary health care and are closer to large lakes and rivers, use dangerous equipment and firearms. Doubtless there are many factors involved in the difference.

Of course, some of the perils of rural life are just the result of living in close proximity to nature and all her deadly charms. In Spring and Summer, we encounter creatures that bite and sting. Just last year, while mowing our lawn, we must have run over yellow-jacket nests at least half a dozen times. By the end of the summer I just let the grass grow. ‘You win!’ I screamed to the little jerks, hiding in their holes. Whether it’s scorpions, hornets, wasps, centipedes, spiders or some other tiny monster, we simply encounter such creatures more in the warm months. And their various stings and bites, while rarely fatal, can cause dangerous allergic reactions. And make your spouse want to leave the area and move to a condo.

Fortunately, deaths from allergic reactions of all sorts are rare, and around 99 deaths per year in the US. https://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/death-anaphylaxis. Still, If you or your loved-ones are afflicted with such allergies, please talk to your physician about what to keep on hand; hopefully epinephrine injectors will get cheaper. And there are some other brands besides the ‘Epi-Pen’ that should be less costly. They just hurt a lot (the Black Widow) or make ugly wounds (the Brown Recluse).

Poisonous reptiles (Copperhead, Rattlesnake, Cottonmouth and Coral snakes) are also a feature of rural life in many areas. Those who ‘ooh and aww’ in city zoo reptile houses rarely have the singular delight of encountering these wonders in their own yards or whilst walking through the woods. But these creatures, while important to the eco-system, can deliver nasty wounds and in rare cases can be lethal. They’re certainly dangerous to your finances given the cost of anti-venin to treat the bites. So be aware as you go about working and playing in places where snakes are also enjoying the summer sun, or cool evenings.

Remember also that at least in the US, many snake bites occur because people are 1) intoxicated and 2) trying to mess with the snakes. And yes, ladies, this is a peculiar affliction of men that starts with ‘hey, betcha’ I can catch him!’ Actually, I have it on good authority that snakes don’t even like the taste of drunk people and would like to be left alone, thank you very much.

Now, other dangers of rural life have to do with the necessity of power-tools. In my own life, the chain-saw, weed-trimmer and lawn-mower are absolutely essential to keeping nature from simply over-running our house. But as the dear reader knows, these are things to be treated with great respect. Please use appropriate protective gear, like safety glasses, gloves, appropriate clothes and heavy shoes. Of course, those who work on highways or farms use much bigger types of tools and heavy equipment and have to be ever watchful. This is probably more true in Spring and Summer because that’s when farms are busy, roads need to be fixed, bridges repaired, pipes laid, power-lines connected, houses constructed and all the rest. God bless all those folks who make our lives better by doing hard, dangerous work on the hottest of days.

And of course, warm weather brings assorted recreational dangers. Hiking and camping are delights, but someone always manages to fall off of a waterfall or cliff-edge, break an ankle, sustain a laceration or encounter said biting and stinging creatures.
Bicyclists and motorcyclists look forward to warm months so that they can enjoy the open, dry road. But helmets really are important as is appropriate protective clothing, reflective material and good education. I’ve seen patients who left their tanned skin on 50 yards of asphalt. Nobody enjoys that.

Lakes and rivers are warm, and filled with persons who typically want to be dragged at high speed behind a power-boat while skiing, clinging to a large inflatable item for dear life, or kneeling on a wake-board. Likewise, fishermen head to their favorite spots (either in tournaments or alone for peace and quiet) and other aquatic persons kayak, canoe and raft the rivers that draw so many to rural America for vacations. All of which is fantastic! But remember to learn to swim, always wear life-jackets and follow local laws when doing all of the above.

Obviously there’s always the danger of heat exhaustion, heat stroke, dehydration and sunburn. We all have to remember to be careful to stay hydrated and remember that beer and caffeinated sodas don’t help. Also be reasonable about sun exposure and wear sunscreen to hep protect against skin cancers.

And if the gentle reader wishes to avoid painful foreign bodies and sutures, here’s another bit of advice. Wear shoes all; all the time. Simple and to the point.

Spring and Summer are glorious in rural America. But the dangers are many; I’ve only skimmed the surface here. Please remember to be safe, think before doing, follow the laws, don’t drink and boat, drive, ride, ski, pick up snakes, work with power-tools or do just about anything else. If you’re going to drink, find a chair and sit in it. That bit of advice would keep many an ER quiet all night long. Also remember that everything I said you shouldn’t do when drinking is something you shouldn’t do while taking narcotic pain medications.

I hope everyone has a great summer, free of emergencies. And that you can still be around when that first breath of cool air dips down from Canada and a proper season comes back once more.

Just please, please, be careful out there, OK?

(If you’re interested, here’s another link to a nice discussion of the unique injuries common in rural America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448517/)

Welcome new physicians! Watch where you step…

Today is the day that new resident physicians begin their training all across the United States.  Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.  Anxiety-filled and debt-ridden, they will embark on four to seven (or even more) years of training to make them knowledgeable, technically proficient physicians.

I will occasionally wax poetic and philosophical for their benefit.  But not today.  Today there are practical matters.  Today I want to give them a few pointers, to ease their transition into the maelstrom of post-graduate medical training.

1)  Any flat surface that holds still, is free of gross body fluids and not used as a walk-way or cook-top will serve for a quick nap.  Practice sleeping in odd positions:  sitting upright, reclining at various angles, lying sideways or with your head cradled in your hands.

2)  In my day (always wanted to say that!) we filled our fresh, white lab-coat pockets with review books, algorithms, reference manuals, scissors and calculators.  And candy bars.  You, doubtless, have a smart-phone of some incarnation, which contains all that we had, as well as the Web.  Which means, where we had to play video games in the lounge and find answers in giant, antiquated things called attending physicians and books, you can look up fun facts on hyponatremia and instantly play Angry Birds, whether you’re on rounds, in the cafeteria or hiding in the call-room, pretending you didn’t hear ‘code blue.’

3)  Eventually, you may decide the lab-coat isn’t worth it.  Don’t be surprised.  Your kids will eventually wear it for Halloween.

4)  If you keep the lab coat, what with the extra space in your pockets, carry extra candy bars.  Or protein bars, or whatever it is you crazy kids snack on these days.

5)  Watch where you step.  Trauma patients and cardiac arrests are exciting!    But there’s almost always some body fluid on the floor when the shouting is over.  Try not to get too covered in blood early in your call night.  It’s sticky and gross.

6)  You know so much.  You don’t know anything.  Keep those two ideas in constant tension.  Odds are, your command of modern evidence-based medical research is extremely impressive.  Eighteen years after residency, I can still leave you in the dust when it comes to making decisions and knowing who is sick and who isn’t.

7)  See above.  Learn, as quickly as you can, who is sick and who isn’t.  Hopefully medical school helped; but don’t count on it.  If you know this simple thing, you will know when to go for help, when to panic (or not) and what to tell your upper level residents and attending physicians on rounds.  And you will become that greatest of commodities:  useful.

8)  Look professional, develop your own style.  Be comfortable.  My friend Sherri used to wear pearls on call, with her green scrubs.  They always made her appear elegant, no matter how much pediatric vomit had been hurled her direction.

9)  Patients can be frightening.  But remember what they told you at camp, about bears, raccoons and snakes.   ‘Don’t worry, they’re just as afraid of you.’  This is kind of true.  Except patients really aren’t afraid to ask for pain medicine or call attorneys, whereas you are afraid to do anything since you can’t believe you know anything yet.

10)  You may be more frightened of physicians than patients.  But remember, the people assigned to train you are smart, capable and experienced.  And they put their tentacles in their pants just like everyone else.  Ask them questions, listen and watch.  And remember what I said above:  be useful.  My surgery resident was fond of saying, ‘Help me, don’t hurt me!’

11)  You will soon have a thing called a paycheck.  It will have a stub that shows how much the government is taking from you.  Do not be surprised.  This happens to everyone.  It’s just that you owe a lot more money than most people.   Cheer up!  Everyone expects you to be rich someday, so they can complain about the fact that your rich.  (Whether you will be or not remains to be seen.)  Remember that no matter how little or much you make, never tell a contractor or car-dealer you’re a physician.  Tell them you work in customer satisfaction, or something nebulous like that.

12)  Crazy people, even really crazy people, are sometimes terribly ill.  Pay attention.

13)  Ill people, really ill people, are sometimes very crazy.  Pay attention.

14)  Medicine is inexact.  I promise you will make mistakes. Don’t live in fear, and don’t let error define you.  No one in medicine, or law, is capable of perfection.  Except for being perfectly insufferable, of course.

15)  If you poke things that look like they are filled with blood or pus, they will explode into your face; if you tend to hold your mouth open when you focus, well you know what will happen.

16)  Scalpels really are sharp.  Pneumonia and HIV and TB and Hepatitis really are communicable.  Psychotic patients really will try to choke you.  Medicine is dangerous.  Be careful out there!

17)  Human beings are really frail, vulnerable and hurting.  Be gentle and kind whenever possible.

18)  Have fun!  Don’t think of it as residency, think of it as a chance to spend most of your waking and many of your sleeping hours in a huge, cold-building where people are dying!

19)  Everyone is proud of you.

20)  Pay attention to what the nurses say.  They aren’t always right.  But for quite a while, they’ll be right more than you are.

21)  Only three to seven years to go!  Hang in there.  Remember, it’s no different from Boot Camp.  It just lasts much, much longer.

The Canine Pain Verification Team

We’re all familiar with the dogs used by the blind, and more recently with dogs used to comfort those with PTSD. There are even dogs that identify low blood sugar in diabetics!

What I want is a ‘pain scale dog.’  Physicians who treat pain in the emergency department and elsewhere are often confused and frustrated by the pain scale, by its inherent subjectivity and by the abuse to which it is subject.

That’s why I want the Pain Verification Dog.  Let me illustrate.

21 year-old-patient presents to emergency department ambulatory.  He is healthy appearing but grimaces, saying ‘I pulled it at work.’

Me:  ‘What’s your pain scale, sir, if zero is no pain and ten is the worst pain in the world?’

‘It’s a twelve!  No kidding, maybe a 15!’

Me:  ‘Nurse, call the Canine Pain Verification Team!’ Dog enters room.  ‘I repeat sir, what’s your pain scale?’

‘Now it’s a 20!  I have to have some, what is it, it starts with a D and it’s all that ever helps!’

Me:  ‘Sir, that’s Axon. He’s highly trained and very sensitive to pain scales and he feels that you may be overestimating!’

‘Dude!  Get that dog off me!  I’m serious!  OK, OK!  It’s, it’s a ten!’

Me:  ‘Sir, I appreciate your situation; but Neuron disagrees.  What do you think?  Is it really a ten?’

‘I’m serious, I’m scared of dogs!  My back hurts and this is making it spasm!  OK, OK, it’s, it’s maybe a three, OK?  A three!  Can I get a Tylenol or something!’

Me:  ‘Sir, the pain scale dog team leader, Decem, says “good boy!”  Here’s a list of exercises and an Aleve.’

Now those are useful service dogs!

 

Emergency Medicine: a Model for Unity

This is my April EM News column.  I hope you enjoy it!

http://journals.lww.com/em-news/Fulltext/2017/04000/Life_in_Emergistan__A_Model_for_Unity_and.12.aspx

How do you define yourself? How do you describe yourself? In the past, I have tried to avoid immediately categorizing myself by my profession. I always agreed with The Little Prince:

“Grown-ups love figures…When you tell them you’ve made a new friend they never ask you any questions about essential matters. They never say to you ‘What does his voice sound like? What games does he love best? Does he collect butterflies?’ Instead they demand ‘How old is he? How much does he weigh? How much money does his father make?’ Only from these figures do they think they have learned anything about him.”
-Antoine de Saint-Exupery, The Little Prince.
Taken from https://www.goodreads.com/work/quotes/2180358-le-petit-prince

And yet, we do this constantly. Physicians especially love to divide ourselves into groups. Each group has its own characteristics. Most of those reading this (but not all) are EM docs (ER docs if you’re older), also known sometimes as ‘pit docs.’ There are internists, or fleas. Surgeons, or cutters. Anesthesiologists, or gas passers. Pediatricians, or pediatrons. Radiologists, or shadow doctors. Orthopedists, or carpenters. (I kid!) This is a natural division as our specialties are our big, nerdy fraternities and sororities. They are the places we learn to make our living, establish habits of thought and behavior, create world-views and life-long friendships.
Unfortunately, it goes much further than specialty. We are divided between rural and urban, and there are significant problems in that chasm, as physicians in urban teaching centers sometimes have little knowledge of the stark limitations of the rural setting when we call for help or transfers. ‘You don’t have a surgeon? You don’t have an ICU?’ Likewise, rural physicians often forget that even ‘the big house,’ eventually reaches capacity and can’t take transfers; and the presence of the large center (or a helicopter) is no excuse for sloppy care on the outside.
We are also demarcated by into ‘community vs academic.’ In my medical wanderings over the past few years, I have found that this is a point of contention with many community physicians. Research, treatment pathways, algorithms, check-lists and new imperatives seem to constantly emanate from academic centers and flow to the community hospital and its citizens. Community physicians, many of whom have lived through countless swings of the medical pendulum and associated policy changes, are often reasonably skeptical of the latest study, the latest rule about pain medications or sepsis protocols. They feel cut-off from what they perceive is a connection between academics and policy-makers, and they feel particularly excluded if, later in life, they have an interest in entering academia, which seems like a closed club.
Physicians are also increasingly divided by gender and sexuality, as we see various physician advocacy groups pop-up. That’s fine, I suppose, so long as it doesn’t split us further apart but serves as a source of encouragement and connection for the members of those groups. (It becomes toxic when it is used as an exclusionary tool. I was told once that my opinion in a debate was less relevant because I was a ‘straight white male.’)
However, our divisions seem to be at their worst when it comes to politics. And it’s a pity, really, because we have such potential to be models for the rest of the world. I have seen physicians argue politics in person and online. I have been part of some of those debates, and it can be very, very ugly. I have recently withdrawn from most political dialog because it wastes time, causes anger and accomplishes nothing.
But I will give this ‘opinion’ and stand by it. I’ve worked with physicians who were Christian like me, Muslim, Hindu and atheist. I have worked beside ardent progressives and hard-core conservatives who make me look like a socialist (and that’s tough to do). I have worked with physicians who were gay and straight, rural and urban, academic and purely clinical. I’ve laughed and cried with them, eaten with them, encouraged and been encouraged by them. And I’d do it all over again. Because when it comes to our job, our real job of treating the sick, easing suffering and saving the dying, all of our differences evaporate into vapor.
So identify yourself by whatever category you wish. But never forget that we can serve as a model for unity, a model for the greatness of all free people, when we do our jobs well, and do them together for the good of others.
Now, what’s your favorite food? What’s your hobby? Tell me about your wife, husband and children. Because those categories interest me more than all the rest.

Pandora’s Pill Bottle. (A poem about the narcotic epidemic)

Pandora’s Pill Bottle

‘Patients who suffer from painful conditions
Should always be treated by caring physicians,
Who never forget to give good medications
For problems from fractures to awful menstruation.’

‘The fifth vital sign is your bright guiding light
The pain scale will lead you to do what is right,
So doctor remember to show some compassion
Since giving narcotics is now quite the fashion!’

Thus we were told for a decade or two
As patients stopped breathing and turned rather blue.
But hospitals loved their new high survey scores
And doctors were turned into pill-writing whores.

Yet things are now changing across the whole nation.
There’s blame all around and new drug regulations.
‘What were you thinking? What were you doing?’
‘How could this happen? Someone will start suing!’

In ER’s and clinics and every location
We docs shake our heads with increasing frustration.
We did what they told us despite all our fears
And Pandora’s Pill Bottle spilled out for years.

The pain scale betrayed us and caused too much trouble
The fifth vital sign is a big popping bubble.
The statistics we’re reading have left us quite nauseous.
So we’re trying new things to save lives and be cautious.

Dear doctors it’s you that must make these decisions!
Push back against administrative derision!
And when those ‘above us’ make policy errors
Stand in for the truth to prevent further terrors.

Rural Suicide and Mental Health; my column today at Politico.com.

Here’s a column of mine, published today at Politico.com.  Everyone wants to make these issues into right/left battles.  I was asked to write this, and it concerns mental health, which is a topic very important to anyone in emergency medicine.  I have written for publications of various political orientation and I’ve tried not to let the liberal/conservative division limit me too much.

http://www.politico.com/agenda/story/2017/04/suicide-er-rural-hospitals-000398

Thanks!

Edwin

 

Grandmothers as an ER Preventative Measure

This is my column in the latest edition of the Daily Yonder.  Enjoy and share as you see fit. Link followed by text.

Life & Limb: Grandmothers — An Ounce of Prevention for a Pound of ‘Freak Out’

 
I have a theory that engaged, wise grandmothers could save families a lot of money by helping avoid hospital visits. Personally, my grandmothers were very important to my well-being as a child. Not only did they feed and dote on me, they kept me healthy and safe. I remember the time I made a spear out of a sharpened stick. (OK, one of the times.) I was running with it, and as I drew back my arm to fling it across the field I must have stumbled. It ended up going through the top of my shoe and between two toes, scraping them on the way to the ground.
I limped to the big white house under the maples where Grandma Leap helped me take off my blood-soaked shoe, cleaned the wound, probably applied Merthiolate (didn’t we all spend our summers painted orange?), and said ‘don’t tell your grandpa, he worries!’ Maybe she knew he’d take my now cool, blood-stained spear away. I was none the worse for the wear.
I have seen injuries like this time and time again in the emergency room. Relatively minor affairs; scrapes, bumps, bruises, stings, nevertheless brought to the hospital by anxious mothers and fathers, new to parenthood or simply far more worried than necessary.
I also remember the smell of Vicks Vaporub, slathered across my coughing, wheezing chest. I remember cool cloths applied during fevers. My grandmothers had those simple skills down pat. Honestly, I don’t ever remember coming to the hospital for a fever as a child. And yet, fever is one of the most common complaints for which parents bring kids to the hospital.

‘He started having a fever an hour ago, so we rushed him to the hospital!’
‘Did you give him anything for the fever?’
‘Nope, we just came straight away. We freaked out and decided it was better safe than sorry!’

I hear that a lot. There was a bruise. ‘I freaked out.’ There was a tick, ‘I freaked out.’ There was a rash. ‘I freaked out.’ The baby’s nose was congested. ‘I freaked out.’ Freaking out never helps anything. And from what I can remember, it was simply something my grandmothers never did. Their job was to draw on centuries of collected cultural and family wisdom, apply personal experience, mix it all with loving attention (and food), and bring calm to all situations. Or bring switches as the situation required.
I’m not suggesting that a family member is all that’s necessary in times of medical need. And admittedly, there are plenty of grandmothers who are as ‘freaked out’ as everyone else. (I’ve met them.) Furthermore, lots of grandmothers and grandfathers are already doing this job as primary caregivers of their children’s children. God bless them.
However, it seems to me that we have an unholy confluence of problems that make people seek healthcare for things our ancestors wouldn’t, or couldn’t have. First of all, families are separated for various reasons from wise older relatives; or don’t have any. Second, people have 24/7 access to online health information that often only increases fear. Third, we have enormous numbers of young individuals and parents who never learned much about their bodies. Add that to the general increase in anxiety that mental health workers report across the land, and families are completely overwhelmed by the sorts of ailments that have afflicted mankind since well before modern medicine existed.
It seems to me that with our long history of self-sufficiency, and our deep-rooted connections to place and family, rural America should be one of those places where grandmothers could make a real difference in an era of limited medical access, coupled with enormous medical anxiety.
Maybe, in the mountains, valleys, bayous and plains that make up rural America we can be health pioneers! What we need to do first is educate young people about how to give simple medical care to themselves and others. First-responder and First-Aid/CPR courses are a great place to start. Second, those of use who are more experienced can reach out to young people and young families; neighbors, church-members, strangers at the food-bank, and offer to be there to teach them how to manage life situations. And how not to ‘freak out.’
Finally, those of us in medicine, whether nurse, physician, medic or other, can spend time educating the people we see so that they know when, and most important when not, to worry. And never to freak out.
A thing that grandmothers, in times past, taught us oh so well.

 

In an Age of Terrorism, do Something!

Here we go again.  In London three are dead and many injured thanks to the low-tech use of a car and knife in yet another act of cruelty and cowardice in the name of terrorism.  If you’ve been on a retreat, in a coma or hiking the AT, here’s a link:

http://www.bbc.com/news/live/uk-39355505

Brits rise up in unity and solidarity, etc.  Great.  We should all show unity and solidarity.  But we should all be able to DO something since the political class as a whole, around the world, seems to think the whole terrorist thing is like a teenage phase and has nothing to do with any particular belief, ideology or policy.  Witness the endless handwringing we usually see as police and officials struggle to figure out the attacker’s motivation.  ‘Gee, what could it be?’

Fortunately, the Brits have put more police on the streets.  ‘Armed and unarmed.’  It’s a great strategy really.  One of the dead was an unarmed police officer who clearly distracted the attacker and absorbed the knife so that others could use, you know, weapons to aid him in his pursuit of martyrdom.

I rant on.  But what I want to say is this.  We individuals cannot predict terroristic acts, and we certainly can’t stop them before they start. That’s the job of law enforcement and the military.  We can only do what we can, when these events happen, if we happen to be present.

So I’ve been thinking about things people should know how to do.  First of all, we should know how to PAY ATTENTION!  I have recently seen a commercial for a cellular company in which a young man streams movies and TV everywhere he goes, on the street, on the sidewalk, on the bus. The world around being, apparently, just too boring.  This is dangerous.  We should watch and learn.  Is that a suspicous package?  What does it mean that smoke is coming from under the hood of that parked car in the crowded area?  Is that a real gun the scary man pulled out?  Or is it just an oddly shaped, giant cell-phone? Why is that gentleman speeding towards me on the sidewalk?  Wait, am I on an episode of Impractical Jokers?  Paying attention to danger leads to running or fighting which leads to being the guy interviewed the next day about what happened, instead of the one remembered as ‘a really great guy who will be missed.’

We should also read.  Learn, from news, books, websites and classes, how to identify concerning behaviors and situations.  What does a firearm sound like?  What does a bomb blast look-like? (Clue, TV and movies get it wrong a lot.)  It’s easy to hear or see something dangerous and immediately think it’s nothing; we want it to be nothing, after all.

One of the sites I visit is Active Response Training. They have lots of articles about self-defense, as well as reviews of mass terror events, etc.  They also have excellent classes; I’ve taken one myself many years ago.

http://www.activeresponsetraining.net

Furthermore we should stop being lazy slugs and get in shape.  Sheesh, America, there are lots of great reasons to be fit; being attractive to your mate or potential mate is a good one.  So is living long and staying away from ER doctors like me.  But another is that when you are fit, you can run and fight.  This isn’t some right-wing way of looking at things.  It’s called an ‘evolutionary advantage.’   Run, bike, lift weights, hit the punching bag.  Do it until you’re exhausted then do it some more.  Say it with me:  Fitness = Survival.  It isn’t hard.

As a child I loved the Chuck Jones cartoon production of Rudyard Kipling’s mongoose story, Rikki-Tikki-Tavi.  In the movie, Rikki the Mongoose says:  ‘A fat mongoose is a dead mongoose.’ That is, a fat mongoose can’t fight poisonous snakes.  I’ve never forgotten that lesson. Thanks Rikki!  And thanks Mr. Kipling!  (Not sure if it’s in the book, but the cartoon message really impacted this kid…)

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So what else can we do in an age of terrorism?  Emergency physicians like me understand  how to manage serious injuries, but we need to encourage citizens to learn 1) first aid with hemorrhage control and 2) CPR.  CPR classes are everywhere and typically include use of Automated External Defibrillators or AED’s.  In fact, in trauma situations like those involving terrorism, CPR and AED’s are probably not going to be very useful.  But it’s good to know for other sorts of emergencies.

DHS has a website and initiative called ‘Stop the Bleed.’  It’s worth a look as there are training videos.  Many companies also sell bleeding control kits that citizens can, and I think should, keep in their vehicles or on their persons.  A tourniquet and dressing don’t take up much space.

https://www.dhs.gov/stb-learn-how-stop-bleed

I would encourage young people to consider taking local First Responder or EMT basic classes.  It’s information you’ll never regret having, and it looks great on a resume.

We need a veritable army of first responders out there, ready to help while police and EMS are either tied up, on their way or being attacked themselves.  Physicians should be part of the effort to teach this material as well.

Last, but not least.  Those so inclined should learn to fight.  Obviously, the average person isn’t Rambo or an Army Ranger.  Most of us will never be up the the level of an MMA fighter.  But it may not take all that.  MInd you, self-defense classes can be absolute crap.  Especially the stuff they foist on nurses and physicians in order to handle attackers and dangerous patients (since security is usually told not to touch anybody…).

And self-defense skills need repetition like all motor skills.  But those people who want to learn can learn.  Learning to fight, whether boxing, wrestling, martial arts, etc., is hard, painful work.  It isn’t for everyone.

.However, sometimes, it takes just a willingness to do something, or anything. I saw a video this week in which a citizen and CWP holder shot, and killed, a man who was holding down a police officer and beating said officer badly.  Now, he was armed with a pistol, but might just as well have used the shovel I keep in my truck to hit the guy on the head.  Or might have thrown a rock.  Or picked up a stick.

In a building, a fire-extinguisher might be just enough delay and distraction.  A can of wasp and hornet spray kept in the office is mighty nasty stuff if sprayed in the face.

If so inclined, as many of us are (and far more physicians, nurses, medics, etc. than you might imagine), carry (legally) a firearm or reasonable knife.  If the attacker is bent on killing you anyway, can you do worse than fight?  You may slow him (or her…sorry). You might keep them from killing anyone after they kill or maim you.  Or, if you’re in good shape and have trained in some sort of class or fighting discipline (or just get really lucky…or have angels fighting with you), you might win!  Sure, sure, people will call you a monster.  But lives will be saved.

It’s a dangerous world, and always has been. But there are things we can do to make it less so.

Sitting back while the danger grows with our fear, apathy and inability?

Those are just bad options.

So:  Put down the phone, pay attention, read and learn, get in shape, learn to help the injured and learn (or at least consider) how to resist.  America, heck, civilization, needs this now more than ever.

 

 

Introducing Social Orbit

This is a post by the good folks at Social Orbit, an excellent new social media application. Which, by the way, has been giving away signed copies of my book ‘Life in Emergistan.’  I encourage you to check it out and sign up. There’s a banner add over to the side that will take you directly to their site to learn more.

Medicine is changing.  A lot of the comradery and connection with our physician peers has been eroded because physicians are all so busy worrying about CPOE, EMR, TJC, metrics, billing, pop-up alerts, patient satisfaction surveys…the list goes on and on.  Orbit was founded to create a community where doctors can connect with each other and reconnect with what they love about medicine.  Greg Hadden, MD FACEP (co-founder of Orbit) notes, “There is an overwhelming feeling in medicine that the physician is turning in to just another cog in the medical machine.  The providers are the heart of medicine and the center of healthcare delivery. While every other company and organization is focused on trying to make medicine more efficient, they are forgetting the individuals in healthcare that actually make it all work.” Orbit wants to focus there.

 Orbit is a unique product unlike anything else out there.  By putting together a resource that has things that doctors value and by creating a fun environment of collaboration, Orbit hopes to provide something that doctors want to contribute to and engage in. The ultimate goal is to see all physicians sharing, collaborating, and supporting each other.  The app also wants to be a one-stop-shop for doctors. Orbit can keep them up-to-date with breaking medical news, help them plan their CME travel, help explore job opportunities, do HIPAA compliant chat, and learn…all while winning some really awesome prizes that focus on helping them recharge their emotional batteries.

 The future of Orbit is bright and the developers have a lot of grand plans for the app!  “In order to get there, we need doctors to give us a shot.”  More Orbiters means a bigger community, more collaboration, more sponsorship, bigger prizes, more frequent prizes, etc.  There is incredible potential with this and the developers have a lot of fun stuff they are constantly working on adding and integrating.  In addition, Orbit has big plans for expansion into other specialties in 2017 with the ultimate goal of developing additional platforms for APPs, RNs, EMS, and international healthcare providers. However, it’s important to the developers that the rollout is measured and strategic.  Says Hadden; “We need to be confident that when we get to that stage we are still able to serve our members by protecting the integrity and privacy of the group. US-based physicians are the only group that our app currently is able to verify and validate.  We want to ensure that we are not letting in attorneys, MBA/MHA hospital administrators, recruiters, etc.  Also, I think there are a lot of physicians that want to connect in a physician-only platform.  As we build out the app, our users will be able to customize the content they see and with whom they interact.  As an example, as we progress to include APPs, if a doctor wanted to participate in a physician/APP community then they would be able to do so.  On the flip side, if an APP only wanted to connect with other APPs, then they could customize their account to exclude physicians as well.”

 ACEP16 marked Orbit’s emergence out of beta testing and its introduction to a larger audience.  The Orbit booth at ACEP16 was packed the majority of the time with most of those people coming up to find out what the tagline, “Seriously Fun Medicine”, was all about.  Hadden explains, “In Orbit, medicine is a serious business…but it can also be fun!

 

www.socialorbit.com

Apple Store link: https://itunes.apple.com/us/app/orbit-medicine/id1120695349?mt=8