EMS has gotten swept up in the evidence-based medicine craze in recent years. This is not at all a bad thing; on the contrary, it is probably the clearest path forward for a field that is continually locked in a struggle to carve out and maintain an identity within the healthcare community. There lurks danger, though, in becoming too dependent on only one mode of analysis and progressive impetus. This danger is primarily one of methodology and not of substance, but EMS leaders would nevertheless be wise to understand the limitations of evidence-based medicine. Like any other tool at the EMS provider's disposal, its capabilities must be exploited without losing sight of its shortcomings.
Years ago, a paramedic coworker loudly declared, "There has never been a single study that demonstrated any benefit to taking people to the hospital." This individual was particularly fond of loud declarations, but in this case he was spot on. It stands to reason that you should go to the hospital if you get sick or injured. but can you use statistics to demonstrate its superiority? That is, after all, the essence of evidence-based medical practice.
A popular anecdote among EMS providers is the 1998 study that tracked the outcomes of two groups of patients, one in New Mexico and one in Malaysia, who were transported after suffering spinal injuries. The patients in New Mexico were all placed in cervical collars and secured to backboards by EMS whereas the Malaysian group was not given the benefit of such "advanced" treatment. Guess which group had a lower incidence of permanent neurological deficits?
The spinal immobilization study is very much a success story for evidence-based medicine; selective spinal immobilization protocols have since been developed and promulgated widely. In my view, and that of more than a few training officers and medical directors, this is a huge step forward for EMS providers and the patients we treat. Score one for research.
But let's get back to the fact that we transport people to the hospital at all. There will never be a study that proves the benefit of transporting patients to the hospital because there will never be a study that even considers whether or not we should transport patients. Who would volunteer for the control group? "Well, Mrs. Smith, it appears you're suffering from acute pulmonary edema secondary to a CHF exacerbation. Unfortunately, you've been placed in the 'control group,' so we're not going to take you to the hospital today. Just keep gurgling away when you inhale and maybe some air will get in there. Have a nice day!" Common sense dictates that we transport patients to the hospital, and we will continue to do so--at least for high-acuity patients--as long as there is such a thing as EMS.
So does that mean that we should rely on reason and intuition to guide treatment protocols? Of course not. Just look at the evolution of cardiac arrest protocols: I've been in EMS for the better part of a decade now, and I've already seen several sea changes in the way cardiac arrests are managed (the changes in compression-to-ventilation ratios and the introduction of prehospital therapeutically-induced hypothermia leap to mind). There are providers out there with four times my level of experience who could describe countless more steps in the evolution of cardiac arrest management. The point is that as research sheds additional light on the pathophysiology of cardiac arrest, our treatment protocols are updated to match current understanding. And rinse and repeat. There is simply no other way to advance our understanding and treatment of that condition or many others.
How do we resolve the tension between letting research guide us forward while not getting paralyzed by the obsessive need to gather research to prove the unprovable? Fortunately the answer is simple: This is not a tension that needs resolving. Use research to gather as much information about as many pathologies and treatments as possible. Embrace whatever benefit can be gleaned from such study. But don't forget a liberal application of common sense to know what can and cannot be improved through scientific research. If we get too caught up in worshiping at the altar of evidence-based medicine, we lose sight of the fact that research is supposed to serve us, not the other way around.
About Me
- Robert
- I'm a 2009 graduate of Dartmouth College who loves Jesus, my wife and all things Northeast.
Showing posts with label EMS. Show all posts
Showing posts with label EMS. Show all posts
Saturday, March 9, 2013
Thursday, September 20, 2012
News from the CPR front
I couldn't help but notice when The New York Times picked up a story two weeks ago about a change in thinking about the benefits of prolonged CPR (putting "CPR" in the headline of anything pretty much guarantees I'll read it). The article detailed new research recently published in British medical journal The Lancet suggesting that patients who go into cardiac arrest while inpatients (and excluding patients in the operating room) may be viable much longer than originally thought.
I have to admit, my interest started to wane when I read that the research was only directed toward in-hospital arrests (I may someday find myself working in the hospital and/or clinic environment, but EMS was explicitly excluded from the new recommendations). Nevertheless, medicine is an extremely adaptable field, and what is found to improve patient outcomes in one setting or environment may start popping up in others.
I'll be curious to see how the American Heart Association receives the news and if they will make any changes when they issue the next set of Emergency Cardiac Care guidelines. There are a number of differences between the in-hospital and pre-hospital environments when it comes to attempting resuscitation; hospitals have more available manpower, better environmental conditions, and an easier time getting the patient optimally positioned than do EMS crews. So it's possible that these new findings may not reverberate outside hospital walls, but in any event, it's good to know that new ground is being broken in this all-important field.
I have to admit, my interest started to wane when I read that the research was only directed toward in-hospital arrests (I may someday find myself working in the hospital and/or clinic environment, but EMS was explicitly excluded from the new recommendations). Nevertheless, medicine is an extremely adaptable field, and what is found to improve patient outcomes in one setting or environment may start popping up in others.
I'll be curious to see how the American Heart Association receives the news and if they will make any changes when they issue the next set of Emergency Cardiac Care guidelines. There are a number of differences between the in-hospital and pre-hospital environments when it comes to attempting resuscitation; hospitals have more available manpower, better environmental conditions, and an easier time getting the patient optimally positioned than do EMS crews. So it's possible that these new findings may not reverberate outside hospital walls, but in any event, it's good to know that new ground is being broken in this all-important field.
Sunday, June 17, 2012
A problematic benefaction
Medical and humanitarian organizations routinely collect recently expired medications from U.S. hospitals, doctors' offices, and ambulance services for distribution in impoverished nations. Proponents of this practice assert that the medication is still safe and largely effective, and it would have just gone to waste otherwise. This way people can have access to drugs that would have otherwise remained beyond their reach. Still, I can't shake the nagging doubt: Is this an ethical thing to do? A condescending one? Or is it noble and praiseworthy?
Reduced to its simplest form, the argument against sending expired medication to Third World countries goes something like this: These drugs aren't good enough for Americans to take themselves, but they're good enough for people in poorer nations? Who do we think we are?
I've never been involved in this practice myself, but I suspect that many supporters would reframe the question not as one of drugs being good enough for some and not for others but as one of regulatory reasonableness. Not all expiration dates refer to the medicine's point of last effectiveness/safety. Some, for example, refer to the guaranteed sterility of the packaging. And then there are some drugs which really don't "expire" per se. "D50," which is used to correct hypoglycemic emergencies, is a prime example: It's sugar and water. That's it.
One could make a further case against the regulatory standards that have been imposed on pharmaceutical companies, saying that many expiration dates have been artificially or arbitrarily contrived. I know little about pharmaceutical regulations, so I can't speak to this point. I am not persuaded by it, however, since I have a hard time believing that the oversight agencies knowingly impose false or incorrect standards.
I find the humanitarian argument most compelling and also most troublesome. I recognize that this may be one of the only ways that large numbers of people can obtain medicine they sorely need, and I in no way oppose that objective. But declaring medicine unfit for patient consumption in the United States and then turning around and sending it to patients abroad just doesn't seem right.
There has to be a better way to meet the needs of the medically underserved. Whether it be new international aid initiatives, pharmaceutical grant programs, or something else, this is a problem that has to have a solution. And I want to emphasize that I admire medical and humanitarian groups for the selflessness and dedication they practice day in and day out; it is only this one component of their work that I have doubts about.
I recognize the elements of truth in many of the arguments for and against doing this. Ultimately, though, if I have to remove a vial of medication from my ambulance because it is no longer appropriate to give to a patient, then I simply can't condone it being sent off for use on a patient.
Agree? Disagree? Leave a comment and let's discuss.
Thursday, January 5, 2012
Taxes and ambulance billing
First of all, happy New Year! May your 2012 be happy, peaceful, and safe.
The Journal of Emergency Medical Services ran a feature on their website today detailing the Derry, NH Fire Department's proposal to raise the rates for their ambulance service. Derry FD is asking for "an approximately 10 percent increase in its ambulance fees," according to the article. This request has precipitated, predictably, a whirlwind of support and opposition. And that's a good thing. The debate over how to fund / pay for EMS is an important one to have, and it will hopefully lead to better public understanding over what EMS is and how it fits into the civic and social fabric in the United States.
One popular objection, which Derry Councilor Janet Fairbanks raises here, is that since Derry FD is a municipal department, it is funded by tax dollars and charging residents for ambulance service is "double-dipping." This is an understandable, but flawed, position. The fact is that tax dollars provide only that an ambulance and a properly trained and equipped crew will show up at your door. Tax dollars do not cover service you receive once the EMS crew enters your home (Chuck Hemeon, the Emergency Services Director for Derry, makes a similar point in the article).
The analogy of utilities is helpful here. The residents of Derry--or any town--all pay the same rate for their electricity. This is a flat fee, universally levied, that provides them with the availability of a service. But each household pays a different amount each year on their electric bill based on how much, or how little, they used that service. In the context of municipal departments, EMS is the same way. Your tax dollars mean there will be an ambulance available if you need one, but that does not automatically translate to free healthcare.
The Journal of Emergency Medical Services ran a feature on their website today detailing the Derry, NH Fire Department's proposal to raise the rates for their ambulance service. Derry FD is asking for "an approximately 10 percent increase in its ambulance fees," according to the article. This request has precipitated, predictably, a whirlwind of support and opposition. And that's a good thing. The debate over how to fund / pay for EMS is an important one to have, and it will hopefully lead to better public understanding over what EMS is and how it fits into the civic and social fabric in the United States.
One popular objection, which Derry Councilor Janet Fairbanks raises here, is that since Derry FD is a municipal department, it is funded by tax dollars and charging residents for ambulance service is "double-dipping." This is an understandable, but flawed, position. The fact is that tax dollars provide only that an ambulance and a properly trained and equipped crew will show up at your door. Tax dollars do not cover service you receive once the EMS crew enters your home (Chuck Hemeon, the Emergency Services Director for Derry, makes a similar point in the article).
The analogy of utilities is helpful here. The residents of Derry--or any town--all pay the same rate for their electricity. This is a flat fee, universally levied, that provides them with the availability of a service. But each household pays a different amount each year on their electric bill based on how much, or how little, they used that service. In the context of municipal departments, EMS is the same way. Your tax dollars mean there will be an ambulance available if you need one, but that does not automatically translate to free healthcare.
Tuesday, November 15, 2011
Whistleblowers and anonymity
The title of the article in last Friday's New York Times summed it up: "Ombudsmen Gave Whistle-Blowers' Names to State Agency." Evidently, employees who care for developmentally disabled patients have long been promised anonymity for reporting potential cases of abuse and neglect, but they have not actually been receiving it. The identities of employees who make such reports have been routinely forwarded to the Office for People with Developmental Disabilities, which is in ultimate charge of many of these patients.
While the reports themselves must obviously be forwarded in order for the situations to be investigated and, if necessary, rectified, including the names of the employees filing the reports seems counterproductive at best and malicious at worst. Including the "whistle-blower's" name does nothing to aid the state in its inquiry. What it does do, however, is raise the specter of reprisals, which in turn disincentivizes employees from making reports.
Reporting cases of suspected abuse and neglect is not confined to employees of mental health institutions. In several states, EMS providers are "mandated reporters." As the name suggests, this means that if we encounter an instance of abuse or neglect--for both the pediatric and geriatric populations---we are required to file a report with the appropriate state office. To my knowledge, there is no assumption of anonymity that goes along with a mandated report. That's not a big deal, at least in my eyes, because we're told up front what to expect.
Whether or not there should be anonymity for whistleblowers is a different, though not entirely unrelated, question. It seems to me that there should be some sort of protection for those who speak up on behalf of those who can't be their own advocates. I'm not sure if complaints submitted entirely anonymously are the best way to go, but the ombudsmen know who came forward with which report. It's the facility administrators who are kept in the dark, which seems wise. The temptation to discourage reporting by wielding the threat of reprisals would be too great for some unscrupulous management teams to resist. Not all, maybe, but even one is too many. And as a measure of protection for the facilities themselves, the ombudsmen are well-equipped to do a little investigating of their own if a pattern of obviously specious complaints emerges.
Ultimately, New York's bait-and-switch with regard to whistleblower anonymity comes at the cost of the patients' welfare. And whenever it's the patient who loses in the end, something needs to be fixed.
While the reports themselves must obviously be forwarded in order for the situations to be investigated and, if necessary, rectified, including the names of the employees filing the reports seems counterproductive at best and malicious at worst. Including the "whistle-blower's" name does nothing to aid the state in its inquiry. What it does do, however, is raise the specter of reprisals, which in turn disincentivizes employees from making reports.
Reporting cases of suspected abuse and neglect is not confined to employees of mental health institutions. In several states, EMS providers are "mandated reporters." As the name suggests, this means that if we encounter an instance of abuse or neglect--for both the pediatric and geriatric populations---we are required to file a report with the appropriate state office. To my knowledge, there is no assumption of anonymity that goes along with a mandated report. That's not a big deal, at least in my eyes, because we're told up front what to expect.
Whether or not there should be anonymity for whistleblowers is a different, though not entirely unrelated, question. It seems to me that there should be some sort of protection for those who speak up on behalf of those who can't be their own advocates. I'm not sure if complaints submitted entirely anonymously are the best way to go, but the ombudsmen know who came forward with which report. It's the facility administrators who are kept in the dark, which seems wise. The temptation to discourage reporting by wielding the threat of reprisals would be too great for some unscrupulous management teams to resist. Not all, maybe, but even one is too many. And as a measure of protection for the facilities themselves, the ombudsmen are well-equipped to do a little investigating of their own if a pattern of obviously specious complaints emerges.
Ultimately, New York's bait-and-switch with regard to whistleblower anonymity comes at the cost of the patients' welfare. And whenever it's the patient who loses in the end, something needs to be fixed.
Wednesday, September 28, 2011
Medical school EMTs
Time magazine ran a fascinating article back in July about Hofstra North Shore - LIJ School of Medicine requiring their students to obtain EMT certification and spend time riding on an ambulance. The program is new this year--in fact, everything is new this year, as this is the inaugural class of medical students--but a number of the students interviewed for the article said they were excited about it. One even said it influenced his decision to attend Hofstra North Shore.
The article went on to say that the program was implemented largely in response to the demand for physicians with improved people skills; forcing medical students to operate as part of an EMS unit would help forge their teamwork and leadership abilities. This is certainly true, and I think that the program will achieve its stated goals. I predict, however, that it will also have a number of unintended, positive results.
A common lament among EMS providers is that we don't get enough respect in the medical community. There are a number of contributing factors, but one big reason is that many hospital providers don't understand what we do or the conditions under which we do it. Putting future physicians in the field will imbue them with a better sense of how EMS fits into the patient's overall care. This will, I think, allow the next generation of doctors to better appreciate, interact with and utilize EMS in a way that maximizes the system's resources and provides superior patient care from start to finish.
Furthermore, the medical students will have in their capacity as EMTs a unique opportunity to provide direct patient care long before their traditional schooling would have allowed them to do so. For example, a student at Dartmouth Medical School doesn't do his OB/GYN rotation until midway through his third year, and even then in a controlled environment under close supervision. Some of these students may not make it one month in the field before they find themselves delivering a baby in the back seat of a car, alone.
And even if the students have a relatively "vanilla" experience on the ambulance, they will still gain valuable experience in delivering care to patients in their hour of perceived greatest need. Because no matter the patient's level of clinical acuity, the situation is still an emergency in his eyes and you must treat him with compassion. And that lesson alone is worth the price of admission.
The article went on to say that the program was implemented largely in response to the demand for physicians with improved people skills; forcing medical students to operate as part of an EMS unit would help forge their teamwork and leadership abilities. This is certainly true, and I think that the program will achieve its stated goals. I predict, however, that it will also have a number of unintended, positive results.
A common lament among EMS providers is that we don't get enough respect in the medical community. There are a number of contributing factors, but one big reason is that many hospital providers don't understand what we do or the conditions under which we do it. Putting future physicians in the field will imbue them with a better sense of how EMS fits into the patient's overall care. This will, I think, allow the next generation of doctors to better appreciate, interact with and utilize EMS in a way that maximizes the system's resources and provides superior patient care from start to finish.
Furthermore, the medical students will have in their capacity as EMTs a unique opportunity to provide direct patient care long before their traditional schooling would have allowed them to do so. For example, a student at Dartmouth Medical School doesn't do his OB/GYN rotation until midway through his third year, and even then in a controlled environment under close supervision. Some of these students may not make it one month in the field before they find themselves delivering a baby in the back seat of a car, alone.
And even if the students have a relatively "vanilla" experience on the ambulance, they will still gain valuable experience in delivering care to patients in their hour of perceived greatest need. Because no matter the patient's level of clinical acuity, the situation is still an emergency in his eyes and you must treat him with compassion. And that lesson alone is worth the price of admission.
Thursday, July 21, 2011
Turning 24
I turned twenty four years old on Sunday. To celebrate, Ellen and I went down to Manchester for the New Hampshire Open chess tournament. Manchester plays host to several of New Hampshire's biggest chess tournaments throughout the year, and perhaps none is bigger than this. The tournament is open to any member of the U.S. Chess Federation, but the top-scoring New Hampshire resident in the Open section is crowned State Champion. In the final round I was paired with Black against five-time state champion FM Brad Bournival. Unfortunately, after a game filled with ups and downs, neither side could break through in the end. Our draw gave IM Joseph Fang his fifteenth (!) state title. All in all I was pleased with the way I played, and I had a great time! And it was especially nice having Ellen there with me. Maybe next time I can convince her to play!
Other than the birthday festivities, it has been pretty much business as usual around here. I am in the process of joining Enfield FAST (First Aid Stabilization Team); they are a paid-on-call transporting ambulance company serving, you guessed it, Enfield. The call volume is not high--last year they responded to 132 calls and this year is on pace to be even slower--but the equipment is fairly nice and most importantly it's a way for me to help out and give back to the community. Their biggest personnel need is daytime hours during the week, and that just happens to be when I'm home with nothing to do. I've been granted "ride-along" status currently and I'm looking forward to finishing the rest of the paperwork so I can become a full-fledged (or at least probationary) member.
Ellen is doing well; she has begun what will probably be the final year of her Ph.D. and is otherwise keeping busy training for her first marathon. I am proud of her and extremely impressed (but not in the least surprised) by all she has accomplished.
In other news, the space shuttle program officially came to an end today. I've been to Cape Canaveral, and it was an impressive site to visit. I wonder how this latest development will affect the area, tourism and all.
Other than the birthday festivities, it has been pretty much business as usual around here. I am in the process of joining Enfield FAST (First Aid Stabilization Team); they are a paid-on-call transporting ambulance company serving, you guessed it, Enfield. The call volume is not high--last year they responded to 132 calls and this year is on pace to be even slower--but the equipment is fairly nice and most importantly it's a way for me to help out and give back to the community. Their biggest personnel need is daytime hours during the week, and that just happens to be when I'm home with nothing to do. I've been granted "ride-along" status currently and I'm looking forward to finishing the rest of the paperwork so I can become a full-fledged (or at least probationary) member.
Ellen is doing well; she has begun what will probably be the final year of her Ph.D. and is otherwise keeping busy training for her first marathon. I am proud of her and extremely impressed (but not in the least surprised) by all she has accomplished.
In other news, the space shuttle program officially came to an end today. I've been to Cape Canaveral, and it was an impressive site to visit. I wonder how this latest development will affect the area, tourism and all.
Thursday, April 28, 2011
Kamsky repeats!
Grandmaster Gata Kamsky clinched his second consecutive U.S. Chess Championship title yesterday with a 1.5-0.5 victory over Yury Shulman in the finals. Kamsky is now a three-time winner, with his first title coming in 1991. The last player to win back-to-back titles was Lev Alburt in 1984-1985. The women's championship has gone to tiebreaks and will be decided today; by this time tomorrow either Tatev Abrahamyan or Anna Zatonskih will be newly coronated. Last year's champion, Irina Krush, finished in third place.
Two of my former colleagues were recently highlighted for unveiling their culminating engineering project, a combination blood pressure / atrial fibrillation monitoring system. Adam Strom '10 and Jeff Spielberg '10, good friends with whom I served for multiple years on the Dartmouth EMS officer board, completed this project while finishing their BE degrees this winter. The first patient for the device was none other than Dartmouth College President Jim Yong Kim. This is an exciting achievement that has great potential. Way to go, guys!
Speaking of Dartmouth EMS, they organized the second annual Northern New England Collegiate EMS Conference this past Saturday at Dartmouth College. Comprised of a series of training sessions and two mass-casualty incident drills, the event was attended by squads from Tufts, Mt. Holyoke, the University of Vermont, the University of Massachusetts--Lowell, Amherst, Colby and Worcester Polytechnic Institute, along with host Dartmouth. I had the privilege to participate in the event, first as a drill evaluator and later as an actor in one of the simulations. It was an impressive undertaking, and I take my hat off to them for pulling it off in fine style.
Two of my former colleagues were recently highlighted for unveiling their culminating engineering project, a combination blood pressure / atrial fibrillation monitoring system. Adam Strom '10 and Jeff Spielberg '10, good friends with whom I served for multiple years on the Dartmouth EMS officer board, completed this project while finishing their BE degrees this winter. The first patient for the device was none other than Dartmouth College President Jim Yong Kim. This is an exciting achievement that has great potential. Way to go, guys!
Speaking of Dartmouth EMS, they organized the second annual Northern New England Collegiate EMS Conference this past Saturday at Dartmouth College. Comprised of a series of training sessions and two mass-casualty incident drills, the event was attended by squads from Tufts, Mt. Holyoke, the University of Vermont, the University of Massachusetts--Lowell, Amherst, Colby and Worcester Polytechnic Institute, along with host Dartmouth. I had the privilege to participate in the event, first as a drill evaluator and later as an actor in one of the simulations. It was an impressive undertaking, and I take my hat off to them for pulling it off in fine style.
Tuesday, February 22, 2011
Back to work
I started a new job a couple weeks ago. It has been a lot of fun so far, and I'm really enjoying working on my own as a paramedic. I also have a great schedule, even if I did spend all of Valentine's Day at work. Two twenty-four hour shifts a week is demanding, but having five days off is a definite upshot! Ellen and I are both pleased with the way things have turned out.
Looking at the bigger picture, taking my first solo call as a medic two weeks ago was the culmination of something that began all the way back in August of 2009. What a great testament to God's faithfulness that He saw Ellen and me through the entire paramedic school and National Registry certification process, strengthening and enriching our relationship in the process. (No "paramedic school divorce" for us ... just the opposite, in fact!)
Speaking of Ellen, she and I finally brought our car hunt to a close. We purchased a 2004 Pontiac Vibe last weekend, which was extremely exciting for both of us (and especially for Ellen, since she gets to drive it every day!). But as soon as I (resume and) finish learning how to drive stick, I will enthusiastically take a turn in the driver's seat. It's a very nice car!
Dartmouth's 100th Anniversary Winter Carnival was Valentine's Day weekend; Ellen and I got to spend a fair amount of time enjoying the festivities. The snow sculpture was more respectable than in recent years (which isn't saying much), but considering the amount of snow that fell this winter, the sculpture was a bit lackluster. There was enough snow to support a sculpture twice as big. Presumably the limiting factor is manpower, which is unfortunate. Have Dartmouth students forgotten that a Winter Carnival snow sculpture once held the world record for tallest free-standing snow sculpture? Whither that gung-ho spirit?
Dartmouth undergrads do get credit for showing up in force to the men's ice hockey game against Princeton (which Dartmouth won 4-1). And they get credit for launching an impressive barrage of tennis balls at the Princeton goalie following Dartmouth's first goal, as is the custom. Sadly, things took a turn for the disappointing as the crowd continued to pelt the goalie with tennis balls following each of Dartmouth's subsequent goals, which is not only a delay-of-game penalty but is also altogether not in keeping with the tradition.
In other news, the U.S. Amateur Team East, the largest team chess tournament in the country, concluded yesterday. "West Orange Krush," headlined by International Masters Mikhail Zlotnikov and Irina Krush, took top honors. I have never played in this event, and I had hoped to change that this year, but in the end the timing just wasn't right. Maybe next year!
Looking at the bigger picture, taking my first solo call as a medic two weeks ago was the culmination of something that began all the way back in August of 2009. What a great testament to God's faithfulness that He saw Ellen and me through the entire paramedic school and National Registry certification process, strengthening and enriching our relationship in the process. (No "paramedic school divorce" for us ... just the opposite, in fact!)
Speaking of Ellen, she and I finally brought our car hunt to a close. We purchased a 2004 Pontiac Vibe last weekend, which was extremely exciting for both of us (and especially for Ellen, since she gets to drive it every day!). But as soon as I (resume and) finish learning how to drive stick, I will enthusiastically take a turn in the driver's seat. It's a very nice car!
Dartmouth's 100th Anniversary Winter Carnival was Valentine's Day weekend; Ellen and I got to spend a fair amount of time enjoying the festivities. The snow sculpture was more respectable than in recent years (which isn't saying much), but considering the amount of snow that fell this winter, the sculpture was a bit lackluster. There was enough snow to support a sculpture twice as big. Presumably the limiting factor is manpower, which is unfortunate. Have Dartmouth students forgotten that a Winter Carnival snow sculpture once held the world record for tallest free-standing snow sculpture? Whither that gung-ho spirit?
Dartmouth undergrads do get credit for showing up in force to the men's ice hockey game against Princeton (which Dartmouth won 4-1). And they get credit for launching an impressive barrage of tennis balls at the Princeton goalie following Dartmouth's first goal, as is the custom. Sadly, things took a turn for the disappointing as the crowd continued to pelt the goalie with tennis balls following each of Dartmouth's subsequent goals, which is not only a delay-of-game penalty but is also altogether not in keeping with the tradition.
In other news, the U.S. Amateur Team East, the largest team chess tournament in the country, concluded yesterday. "West Orange Krush," headlined by International Masters Mikhail Zlotnikov and Irina Krush, took top honors. I have never played in this event, and I had hoped to change that this year, but in the end the timing just wasn't right. Maybe next year!
Thursday, January 20, 2011
Nationally registered
I passed my final practical exam station on Sunday, meaning I am finally a Nationally Registered Paramedic. As I have mentioned previously, both Vermont and New Hampshire require providers to be nationally registered and neither state offers reciprocity to New York certifications. As much of a pain as it has been to go through this process, I am pleased to now have this certification under my belt. Between this and my New York card, I should have little difficulty obtaining a license to practice in whatever state we move to next for Ellen's post-doctoral studies. She and I are both elated and relieved!
I enjoyed watching the Jets-Patriots football game last weekend, and I was especially pleased with the result. As much as has been said about the result--and there has been a lot--I was surprised by one nuance that seems to have been largely overlooked. At the end of the game, with the ball on the New England 16-yard line, Jets running back Shonn Greene took a handoff and scampered into the end zone for what proved to be the decisive score. My question is, why didn't he just stop, a la Brian Westbrook in 2007?
Here's the situation: If Greene gets past the 10-yard line, New York earns a first down. New England has to burn their last time-out to stop the clock, meaning the Jets have first-and-goal with 1:43 or so on the clock. Seeing as it's a forty-second play clock, all the Jets have to do is kneel down three times and the game is over. New England can't stop the clock again and they never get another chance to touch the ball. I'm no NFL coach, but I'd take a guaranteed win over a two-score lead with Tom Brady getting the ball back with 1:41 on the clock any day. In any event, next up are the Pittsburgh Steelers. I'm hoping for a great game.
I enjoyed watching the Jets-Patriots football game last weekend, and I was especially pleased with the result. As much as has been said about the result--and there has been a lot--I was surprised by one nuance that seems to have been largely overlooked. At the end of the game, with the ball on the New England 16-yard line, Jets running back Shonn Greene took a handoff and scampered into the end zone for what proved to be the decisive score. My question is, why didn't he just stop, a la Brian Westbrook in 2007?
Here's the situation: If Greene gets past the 10-yard line, New York earns a first down. New England has to burn their last time-out to stop the clock, meaning the Jets have first-and-goal with 1:43 or so on the clock. Seeing as it's a forty-second play clock, all the Jets have to do is kneel down three times and the game is over. New England can't stop the clock again and they never get another chance to touch the ball. I'm no NFL coach, but I'd take a guaranteed win over a two-score lead with Tom Brady getting the ball back with 1:41 on the clock any day. In any event, next up are the Pittsburgh Steelers. I'm hoping for a great game.
Thursday, January 6, 2011
The axe falls
The New York Times reported today that John Peruggia, the EMS chief for New York City's fire department, has been demoted due to his agency's performance during the Christmas weekend blizzard. He will be replaced by Abdo Nahmood, who was previously in charge of overseeing emergency medical dispatch for the department. An unnamed source added that Chief Peruggia has also received scrutiny from the city Conflicts of Interest board, which may have contributed to his reassignment.
If Chief Peruggia has indeed violated conflict of interest regulations, then that's a completely different matter that needs to be dealt with, but I disagree with demoting him because of the disruption in service during the blizzard. As the president of the union pointed out in the article, Chief Peruggia is being punished for things he couldn't control. It seems the city felt it needed a scapegoat, and perhaps the risk of being put on the chopping block like this comes with the territory when you are in a leadership position like Chief Peruggia's. Still, the whole thing leaves a bad taste in my mouth.
On a more positive note, the following article appeared on NewCastleNow.org, a community-interest news site covering my hometown. In addition to serving as an adjunct to the volunteer ambulance corps's fund-raising drive, it also highlights the numerous members who have used their experience as a jumping-off point for further medical endeavors. I must point out that I never served in the Youth Corps there--I joined as an adult member following high school--but otherwise it's a nicely done piece.
If Chief Peruggia has indeed violated conflict of interest regulations, then that's a completely different matter that needs to be dealt with, but I disagree with demoting him because of the disruption in service during the blizzard. As the president of the union pointed out in the article, Chief Peruggia is being punished for things he couldn't control. It seems the city felt it needed a scapegoat, and perhaps the risk of being put on the chopping block like this comes with the territory when you are in a leadership position like Chief Peruggia's. Still, the whole thing leaves a bad taste in my mouth.
On a more positive note, the following article appeared on NewCastleNow.org, a community-interest news site covering my hometown. In addition to serving as an adjunct to the volunteer ambulance corps's fund-raising drive, it also highlights the numerous members who have used their experience as a jumping-off point for further medical endeavors. I must point out that I never served in the Youth Corps there--I joined as an adult member following high school--but otherwise it's a nicely done piece.
Wednesday, January 5, 2011
"Move Over Act" takes effect
New York State's "Move Over Act" took effect on January 1. The law, which was signed last summer by former Gov. David Paterson, requires motorists to slow down any time they encounter an emergency vehicle parked on the side of the road. If it's a highway, drivers will also be required to move over a lane, assuming traffic conditions permit this to be done safely. Failure to comply will be punishable by a fine and two points on your driver license.
The impetus for the law was the deaths of two New York State Troopers, Robert Ambrose and Glenn Searles, who were killed while investigating accident scenes on the highway. While police officers are the primary beneficiaries of the new law, fire and EMS workers also stand to benefit from the law. Roadways are extremely dangerous places to respond for emergencies, and this will hopefully reduce the too-high number of roadside fatalities among public safety workers (more than 160 police officers alone have been killed in the past decade).
Staying on public safety, The Dartmouth ran an article today on the Dartmouth College administration's new alcohol-harm reduction initiatives. The article reported that President Jim Yong-Kim drew a distinction between the personal safety and public safety spheres with respect to student drinking. "The Hanover Police are public safety officers. But this is really not a public safety issue ... I am very concerned at the current situation, that by misunderstanding fundamentally the alcohol problem at Dartmouth as a public safety issue, the arrests and the prosecutions are making personal safety in grave danger."
President Kim's distinction between public safety and personal safety is an interesting one, and I agree with him to an extent. He seems, however, to be equating public safety with situations that only involve individuals and property not associated with the College. This relegates to the realm of "personal safety" legal infractions that do not directly affect the aforementioned "public" entities, and this definition is better suited for the term "victimless crime" than "personal safety issue." Though safety is certainly an issue in many instances of underage drinking, each alcohol-related emergency starts with a crime (often multiple crimes, since underage drinking and providing alcohol to a minor tend to go hand in hand).
President Kim may be correct that "The arrests and the prosecutions are making personal safety in grave danger," although I doubt it. But even if this is so, criticizing the police department for enforcing the law is not going to make things better. Greater personal responsibility and accountability on the part of the student body, on the other hand, is the way to go. Or if that is too much to ask--which I reject as a conclusion--then pursuing legislative reform by way of lowering the drinking age or lessening the (already lenient) penalties for underage drinking might be satisfactory. But what police department could ever agree to stop enforcing the law?
The impetus for the law was the deaths of two New York State Troopers, Robert Ambrose and Glenn Searles, who were killed while investigating accident scenes on the highway. While police officers are the primary beneficiaries of the new law, fire and EMS workers also stand to benefit from the law. Roadways are extremely dangerous places to respond for emergencies, and this will hopefully reduce the too-high number of roadside fatalities among public safety workers (more than 160 police officers alone have been killed in the past decade).
Staying on public safety, The Dartmouth ran an article today on the Dartmouth College administration's new alcohol-harm reduction initiatives. The article reported that President Jim Yong-Kim drew a distinction between the personal safety and public safety spheres with respect to student drinking. "The Hanover Police are public safety officers. But this is really not a public safety issue ... I am very concerned at the current situation, that by misunderstanding fundamentally the alcohol problem at Dartmouth as a public safety issue, the arrests and the prosecutions are making personal safety in grave danger."
President Kim's distinction between public safety and personal safety is an interesting one, and I agree with him to an extent. He seems, however, to be equating public safety with situations that only involve individuals and property not associated with the College. This relegates to the realm of "personal safety" legal infractions that do not directly affect the aforementioned "public" entities, and this definition is better suited for the term "victimless crime" than "personal safety issue." Though safety is certainly an issue in many instances of underage drinking, each alcohol-related emergency starts with a crime (often multiple crimes, since underage drinking and providing alcohol to a minor tend to go hand in hand).
President Kim may be correct that "The arrests and the prosecutions are making personal safety in grave danger," although I doubt it. But even if this is so, criticizing the police department for enforcing the law is not going to make things better. Greater personal responsibility and accountability on the part of the student body, on the other hand, is the way to go. Or if that is too much to ask--which I reject as a conclusion--then pursuing legislative reform by way of lowering the drinking age or lessening the (already lenient) penalties for underage drinking might be satisfactory. But what police department could ever agree to stop enforcing the law?
Tuesday, January 4, 2011
Planning ahead?
Far, far ahead. I received an email from the Dartmouth College Gift Planning office yesterday asking me to consider including the College in my will. You don't have to be a paramedic to know that life is unpredictable and, sometimes, tragically short, but this seems a little ridiculous. I'm barely eighteen months out of college and they're already after me for a bequest? Come on.
The Pan-American Intercollegiate chess championships wrapped up last week, with the University of Texas--Dallas taking top honors with an undefeated 6-0 match score. Second place was shared between the University of Maryland--Baltimore County and the University of Texas--Brownsville, with UMBC taking second on tiebreak. Dartmouth did not send a team this year; the Ivy League was represented by Yale University, which won the Class B prize. Brown University was also scheduled to participate, but the East Coast blizzard kept them from making it to the playing site in Wisconsin. Congratulations to all the winners!
In other news, we put our new ambulance into service at work today. It rides great, and I'm looking forward to breaking it in. Exciting times around here.
The Pan-American Intercollegiate chess championships wrapped up last week, with the University of Texas--Dallas taking top honors with an undefeated 6-0 match score. Second place was shared between the University of Maryland--Baltimore County and the University of Texas--Brownsville, with UMBC taking second on tiebreak. Dartmouth did not send a team this year; the Ivy League was represented by Yale University, which won the Class B prize. Brown University was also scheduled to participate, but the East Coast blizzard kept them from making it to the playing site in Wisconsin. Congratulations to all the winners!
In other news, we put our new ambulance into service at work today. It rides great, and I'm looking forward to breaking it in. Exciting times around here.
Monday, January 3, 2011
Rudolph the Red-Nosed Reindeer
Even though Christmas is behind us, I want to share the following item from the Dartmouth College Special Collections Library's blog. It discusses the origins of the story of Rudolph the Red-Nosed Reindeer, who was created by Robert May '26. Quite a neat story, especially the way in which May received back the copyright from the Montgomery Ward Company. You can read all about it here. Frosty the Snowman, that inveterate subversive, tellingly shares no such noble origin.
The final two days of December saw that annual Upper Valley event, the Ledyard National Bank Men's Hockey Classic. In the past I have been home for winter break during this four-team, two-round tournament, but this year I had the opportunity to attend all four games. In addition to Dartmouth and ECAC foe Colgate, Mercyhurst College and defending national champions Boston College rounded out the field. In the end, Boston College emerged victorious, defeating Mercyhurst 4-1 in the championship game. I had fun, even though Dartmouth finished in third place. And it's not every day you get to see a shootout in college hockey.
Now that January has arrived, I have tallied up my 2010 reading list. In the end I read twenty four books, not counting material for paramedic school. I finished at least one book in every month except April; July was my most prolific reading month, with six books finished, and there were six months in which I only finished a single book. It would seem my pleasure reading comes in spurts! I am already nearly a quarter of the way through Mutiny on the Bounty (which is also on the list of books made into Best Picture-winning movies), and I'm hoping to hit the ground running in 2011.
In other news, I read last week that at the worst point in Christmas weekend's blizzard, New York City dispatchers were holding 1,300 EMS calls (that is, they were backlogged by that number of requests for emergency medical service). It's difficult--and often pointless--to assign blame in such situations, but it's sad nonetheless.
The final two days of December saw that annual Upper Valley event, the Ledyard National Bank Men's Hockey Classic. In the past I have been home for winter break during this four-team, two-round tournament, but this year I had the opportunity to attend all four games. In addition to Dartmouth and ECAC foe Colgate, Mercyhurst College and defending national champions Boston College rounded out the field. In the end, Boston College emerged victorious, defeating Mercyhurst 4-1 in the championship game. I had fun, even though Dartmouth finished in third place. And it's not every day you get to see a shootout in college hockey.
Now that January has arrived, I have tallied up my 2010 reading list. In the end I read twenty four books, not counting material for paramedic school. I finished at least one book in every month except April; July was my most prolific reading month, with six books finished, and there were six months in which I only finished a single book. It would seem my pleasure reading comes in spurts! I am already nearly a quarter of the way through Mutiny on the Bounty (which is also on the list of books made into Best Picture-winning movies), and I'm hoping to hit the ground running in 2011.
In other news, I read last week that at the worst point in Christmas weekend's blizzard, New York City dispatchers were holding 1,300 EMS calls (that is, they were backlogged by that number of requests for emergency medical service). It's difficult--and often pointless--to assign blame in such situations, but it's sad nonetheless.
Tuesday, December 7, 2010
Pearl Harbor
Today is the sixty-ninth anniversary of the Japanese attack on Pearl Harbor: "A date which will live in infamy," according to President Franklin Delano Roosevelt's radio address the following day. I had the opportunity to go to Pearl Harbor in the summer of 2000; it was a moving experience. The wreckage of the USS Arizona, a battleship whose sinking claimed the lives of 1,177 sailors, was especially poignant to see. I'd like to go back and visit again someday; if my travels ever return me to Hawaii, I will make a point of doing so.
Closer to home, my thoughts and prayers go out to the two Calex Ambulance employees who were injured when their ambulance went off a bridge in Bradford, Vermont. They were returning from a call when the driver hit a patch of ice and lost control of the vehicle. Both men are in stable condition and no bystanders were injured. Talk about a close call.
Moving on to a more upbeat topic, the Women's World Chess Championship is currently underway in Hatay, Turkey. The United States is represented by two players, International Master Anna Zatonskih and Women's Grandmaster Camilla Baginskaite, although WGM Baginskaite was eliminated in the first round. IM Zatonskih is on a roll, however, breezing through her first round match and defeating GM Marie Sebag of France in the first game of their second-round match today. Keep up the good work!
In other news, James Franco and Anne Hathaway have been selected to host this year's Academy Awards. Who cares?
Closer to home, my thoughts and prayers go out to the two Calex Ambulance employees who were injured when their ambulance went off a bridge in Bradford, Vermont. They were returning from a call when the driver hit a patch of ice and lost control of the vehicle. Both men are in stable condition and no bystanders were injured. Talk about a close call.
Moving on to a more upbeat topic, the Women's World Chess Championship is currently underway in Hatay, Turkey. The United States is represented by two players, International Master Anna Zatonskih and Women's Grandmaster Camilla Baginskaite, although WGM Baginskaite was eliminated in the first round. IM Zatonskih is on a roll, however, breezing through her first round match and defeating GM Marie Sebag of France in the first game of their second-round match today. Keep up the good work!
In other news, James Franco and Anne Hathaway have been selected to host this year's Academy Awards. Who cares?
Tuesday, November 23, 2010
On abdominal pain
For EMS personnel, abdominal pain calls are notoriously difficult. As an emergency physician in Buffalo once said, "The problem with abdominal pain is it can be so many different things." In a nutshell, this sums up the dilemma faced by EMS. Without the advanced diagnostic tools and imaging technology available in the hospital setting, it is extremely challenging to arrive at an accurate field impression/differential diagnosis. There are definitely clues that can point you in one direction or another, and a skilled provider performing a detailed assessment can make headway, but sometimes you just don't have the resources to pin it down.
This vagueness plays out in the treatment options available to providers. The only mention of abdominal pain in the 2009 edition of New Hampshire's patient care protocols is to instruct paramedics to withhold Nitronox, a 50% nitrous oxide-oxygen gas mixture used for pain relief, from any patient with this complaint. This is not to be cruel; if the patient turns out to have a bowel obstruction, the gas can get trapped in the folds of the obstructed bowel and potentially cause a rupture. In many cases, all you can do is assess the patient to the best of your ability, provide supportive care and rapidly transport him to the closest appropriate facility (other options for pain control exist as well).
The Health section of yesterday's New York Times had a fascinating article about abdominal pain in pediatric patients. The author, physician Perri Klass, related how as a resident she and her colleagues used to "smirk" at cases of functional abdominal pain. Functional abdominal pain, which is a term previously unfamiliar to me, is evidently a diagnosis arrived at when nothing else seems to fit. Children with persistent stomachaches that cannot be explained by the presence of any disorder are often said to have this condition.
The article discussed how functional abdominal pain had previously been a throw-away diagnosis, or as Dr. Klass puts it, "A code for a troublesome patient, dubious symptoms or an anxious family." Now, though, clinicians are recognizing it as a legitimate complaint that requires serious attention and treatment.
As difficult as abdominal pain calls can be, it's nice to know that sometimes the doctors get stumped too.
This vagueness plays out in the treatment options available to providers. The only mention of abdominal pain in the 2009 edition of New Hampshire's patient care protocols is to instruct paramedics to withhold Nitronox, a 50% nitrous oxide-oxygen gas mixture used for pain relief, from any patient with this complaint. This is not to be cruel; if the patient turns out to have a bowel obstruction, the gas can get trapped in the folds of the obstructed bowel and potentially cause a rupture. In many cases, all you can do is assess the patient to the best of your ability, provide supportive care and rapidly transport him to the closest appropriate facility (other options for pain control exist as well).
The Health section of yesterday's New York Times had a fascinating article about abdominal pain in pediatric patients. The author, physician Perri Klass, related how as a resident she and her colleagues used to "smirk" at cases of functional abdominal pain. Functional abdominal pain, which is a term previously unfamiliar to me, is evidently a diagnosis arrived at when nothing else seems to fit. Children with persistent stomachaches that cannot be explained by the presence of any disorder are often said to have this condition.
The article discussed how functional abdominal pain had previously been a throw-away diagnosis, or as Dr. Klass puts it, "A code for a troublesome patient, dubious symptoms or an anxious family." Now, though, clinicians are recognizing it as a legitimate complaint that requires serious attention and treatment.
As difficult as abdominal pain calls can be, it's nice to know that sometimes the doctors get stumped too.
Testing
I took my National Registry practical exam on Sunday in Concord, NH. The exam, which was held in a dormitory at the New Hampshire Fire Academy, consisted of eleven stations ranging from intravenous and intraosseous access and drug therapy to patient assessment, advanced airway management and cardiology. There were also two rounds of oral boards. For such a large-scale production--eighty people showed up to either retest individual stations or take the entire thing--the logistics ran like clockwork. It took me just over four hours from start to finish, and there was a minimum of downtime between stations.
The National Registry exam was different from the New York State paramedic practical exam in subtle but significant ways. Most obvious was the number and nature of the stations; both exams featured static and dynamic cardiology, IV access and bolus medications, adult airway management, patient assessment and one randomly selected "basic life support" skill. But where New York also tested IV med administration via drip and a second random BLS skill, the National Registry instead tested dual-lumen airway placement, pediatric airway management, pediatric intraosseous access and the oral boards.
More subtle were the differences when the stations overlapped between the two exams. A number of these were evident from examining the skills sheets on the National Registry website, but I also attended a "prep class" taught by an area instructor. She has been an evaluator for the National Registry for nearly twenty three years, and she has their permission to run this class the night before the exam outlining common pitfalls in the various stations. No actual exam scenarios are discussed, but she covers many of the ways in which this exam may vary from individual states' tests. It was more than worth the time and money!
Unfortunately, according to the test administrator's unofficial results, I did not pass my static cardiology station. I will have to retest that station another time (hopefully next month). It's a little disappointing, to say the least, but I'm glad to have most of the exam behind me. And since I have already passed the National Registry written exam, this is the last remaining hurdle to transferring my certification from New York to New Hampshire and Vermont.
Sunday was also our church's annual Thanksgiving Dinner, held in the town's community center. It was a great time of feasting, fellowship and, of course, thanksgiving. A lot of people spent a lot of time and energy making it the tremendous success that it was, and I know their efforts are deeply appreciated by all. (And to whoever brought the stuffing ... two enthusiastic thumbs up!)
The National Registry exam was different from the New York State paramedic practical exam in subtle but significant ways. Most obvious was the number and nature of the stations; both exams featured static and dynamic cardiology, IV access and bolus medications, adult airway management, patient assessment and one randomly selected "basic life support" skill. But where New York also tested IV med administration via drip and a second random BLS skill, the National Registry instead tested dual-lumen airway placement, pediatric airway management, pediatric intraosseous access and the oral boards.
More subtle were the differences when the stations overlapped between the two exams. A number of these were evident from examining the skills sheets on the National Registry website, but I also attended a "prep class" taught by an area instructor. She has been an evaluator for the National Registry for nearly twenty three years, and she has their permission to run this class the night before the exam outlining common pitfalls in the various stations. No actual exam scenarios are discussed, but she covers many of the ways in which this exam may vary from individual states' tests. It was more than worth the time and money!
Unfortunately, according to the test administrator's unofficial results, I did not pass my static cardiology station. I will have to retest that station another time (hopefully next month). It's a little disappointing, to say the least, but I'm glad to have most of the exam behind me. And since I have already passed the National Registry written exam, this is the last remaining hurdle to transferring my certification from New York to New Hampshire and Vermont.
Sunday was also our church's annual Thanksgiving Dinner, held in the town's community center. It was a great time of feasting, fellowship and, of course, thanksgiving. A lot of people spent a lot of time and energy making it the tremendous success that it was, and I know their efforts are deeply appreciated by all. (And to whoever brought the stuffing ... two enthusiastic thumbs up!)
Saturday, September 18, 2010
Back in the saddle
It's nice to be back in New Hampshire, but after a year in Buffalo, I've had to reacquaint myself with the realities of rural life. One jarring realization was that it's more than ten miles to the nearest store that's open past 10 pm. Additionally, you can't watch the Yankees on television unless it's a national broadcast, since New Hampshire is considered "out of market." On the plus side, though, the lake/foliage/stars are magnificent. You just can't get scenery like that in Western New York (though it certainly has pockets of great beauty). But most importantly (and on the subject of great beauty), Ellen is here, which no place else can boast!
Just before the wedding, I was rehired by the same ambulance company for which I worked following my college graduation. My New York State paramedic certification does not transfer to New Hampshire or Vermont (where the company is physically located, although it operates under New Hampshire protocols), so I am in the process of "transferring my card," as they say. Given the considerable amount of bureaucracy involved, things are actually progressing relatively quickly at this point. Hopefully the process will continue to go smoothly.
While I wait, however, I am doing my junior/senior time at work. Whenever an ambulance company hires a new paramedic, he gets paired with a more experienced paramedic while he gets acquainted with the equipment, company policies and procedures, etc. It's an orientation of sorts, coupled with an informal evaluation of skills. As junior/senior time can often take a number of weeks, I'm fortunate to be able to do it now. This way, once I test out for NH/VT and my paperwork all goes through, I'll be able to go online right away.
In other news, some malls in Brooklyn are trying a new tack in the war on teenager loiterers. While there are no doubt legitimate reasons for pursuing such policies, all I can think of is the Neighborhood Watch Alliance from the film Hot Fuzz.
Just before the wedding, I was rehired by the same ambulance company for which I worked following my college graduation. My New York State paramedic certification does not transfer to New Hampshire or Vermont (where the company is physically located, although it operates under New Hampshire protocols), so I am in the process of "transferring my card," as they say. Given the considerable amount of bureaucracy involved, things are actually progressing relatively quickly at this point. Hopefully the process will continue to go smoothly.
While I wait, however, I am doing my junior/senior time at work. Whenever an ambulance company hires a new paramedic, he gets paired with a more experienced paramedic while he gets acquainted with the equipment, company policies and procedures, etc. It's an orientation of sorts, coupled with an informal evaluation of skills. As junior/senior time can often take a number of weeks, I'm fortunate to be able to do it now. This way, once I test out for NH/VT and my paperwork all goes through, I'll be able to go online right away.
In other news, some malls in Brooklyn are trying a new tack in the war on teenager loiterers. While there are no doubt legitimate reasons for pursuing such policies, all I can think of is the Neighborhood Watch Alliance from the film Hot Fuzz.
Monday, August 16, 2010
Black Eyed Peas
Part of my last-full-week-of-work duties involved a standby shift at HSBC Arena on Wednesday. I hadn't been to an Arena standby in a while--not since hockey season ended--but when the Black Eyed Peas came to town, I answered the call. All in all it was a fun concert. Even though I didn't know every song they played, it was a high-energy performance and an exuberant crowd. The concert was more of a production than the Elton John/Billy Joel show I saw in the early spring--costume changes and dancers and multimedia components--but it rarely detracted from the music itself. I hear Nickelback is coming to HSBC sometime in September ... I'm going to have to figure out a way to get on the schedule for that show.
With my departure for New Hampshire only days away, I've reluctantly begun to pack. Ordinarily, packing is pretty straightforward: I grab half a dozen trash bags and stuff all my belongings in them. Once I arrive at my new abode, I begin the arduous process of sorting through everything and weeding out items I no longer want or need. This year, I'm trying a different tack and sorting through everything before packing it up. I'm hoping to spend less time unpacking on the other end; there's certainly enough else to occupy me in the last days before the wedding!
Moving downstate, the New York City Department of Transportation just released a report analyzing more than 7,000 crashes from the middle of the decade in which at least one pedestrian suffered severe or fatal injuries. The report concluded, among other things, that left-hand turns were most likely to result in fatal collisions and jaywalkers stood a lower chance of being run down than people using crosswalks (these are not necessarily related. After all, it's hard to picture hitting a jaywalker while turning left in the middle of a block). The correlation-causation disconnect applies here, as it does to any statistical compilation, but it's nevertheless interesting to hear five years of collisions tell their tales.
In other news, football season is almost upon us. The New York Giants defeated the New York Jets in their preseason matchup Monday night. This is a great time of year to be a sports fan.
With my departure for New Hampshire only days away, I've reluctantly begun to pack. Ordinarily, packing is pretty straightforward: I grab half a dozen trash bags and stuff all my belongings in them. Once I arrive at my new abode, I begin the arduous process of sorting through everything and weeding out items I no longer want or need. This year, I'm trying a different tack and sorting through everything before packing it up. I'm hoping to spend less time unpacking on the other end; there's certainly enough else to occupy me in the last days before the wedding!
Moving downstate, the New York City Department of Transportation just released a report analyzing more than 7,000 crashes from the middle of the decade in which at least one pedestrian suffered severe or fatal injuries. The report concluded, among other things, that left-hand turns were most likely to result in fatal collisions and jaywalkers stood a lower chance of being run down than people using crosswalks (these are not necessarily related. After all, it's hard to picture hitting a jaywalker while turning left in the middle of a block). The correlation-causation disconnect applies here, as it does to any statistical compilation, but it's nevertheless interesting to hear five years of collisions tell their tales.
In other news, football season is almost upon us. The New York Giants defeated the New York Jets in their preseason matchup Monday night. This is a great time of year to be a sports fan.
Saturday, August 14, 2010
Firsts and lasts
Yesterday was the end of (hopefully!) my last full week of work as an EMT-Basic. I'm working one day next week and then taking my paramedic exam on Thursday. If all goes well, I can turn in my exam results to the Human Resources manager and switch job classifications on the spot. There's a training program at the company where new paramedics are paired with senior medics for orientation and training; this process takes roughly a month, depending on call volume and other factors. Unfortunately, I'm moving to New Hampshire four days after the exam.
It's possible to remain part-time with the company (which requires fifty two hours of work per quarter) even from afar, but as far as I can tell, no one has ever tried to do their new-medic orientation on that schedule. I'm waiting to hear back from the operations manager as to what that would look like for me. Trying to do my training in fifty-two hour spurts every three months could take a long, long time. I'm not even certain that I'll try to stay on, though I'd like to, but I'm going to wait to hear back before making a final decision.
Not all of the hospitals in Buffalo have helipads, so from time to time the helicopter is forced to rendezvous with a ground ambulance to bring a patient the rest of the way to the receiving hospital. Yesterday I got to do my first airlift-assist. The second the chopper was on the ground, we rushed out with the stretcher, speedily transferred the patient and then rushed back to the ambulance, crouching down under the rotors all the way. The whole process took maybe three minutes. It was just like a scene from a movie, only cooler because it was real life with a real patient.
In other news, the U.S. Chess League is about to get underway. The New York Knights open the season against the Boston Blitz next Monday at 7 pm. You can bet I'll be watching!
It's possible to remain part-time with the company (which requires fifty two hours of work per quarter) even from afar, but as far as I can tell, no one has ever tried to do their new-medic orientation on that schedule. I'm waiting to hear back from the operations manager as to what that would look like for me. Trying to do my training in fifty-two hour spurts every three months could take a long, long time. I'm not even certain that I'll try to stay on, though I'd like to, but I'm going to wait to hear back before making a final decision.
Not all of the hospitals in Buffalo have helipads, so from time to time the helicopter is forced to rendezvous with a ground ambulance to bring a patient the rest of the way to the receiving hospital. Yesterday I got to do my first airlift-assist. The second the chopper was on the ground, we rushed out with the stretcher, speedily transferred the patient and then rushed back to the ambulance, crouching down under the rotors all the way. The whole process took maybe three minutes. It was just like a scene from a movie, only cooler because it was real life with a real patient.
In other news, the U.S. Chess League is about to get underway. The New York Knights open the season against the Boston Blitz next Monday at 7 pm. You can bet I'll be watching!
Subscribe to:
Posts (Atom)