Archives for October 2003

Military Wildfire Firefighting

This has nothing to do with military firefighting as a profession, which is a military specialty. This has to do with the “send in the troops” solution which waxes and wanes with the severity and destruction of the current SoCal wildfires.

I was fortunate enough to provide medical planning and support for a Battalion of Marines going to Oregon in 199(7?). The Tower fire is how the Forest Service designated the effort. (When I write Marines, I mean Marines and Sailors, as the Marines don’t go places without their Corpsmen. Or their RP’s, for those who know what I’m talking about).

First, we need to understand what military wildfire support is, and what it isn’t. It is freeing up professional, trained firefighters to attack active fires by doing the backbreaking drudge work of cleaning up hot spots, raking embers, and that sort of thing. Therefore, it’s not the Marine with a chainsaw taking down a flaming tree, it’s a Marine with a rake stirring up ash and dust. It’s very useful, and it’s very hard work, so the contribution isn’t to be minimized, just everyone needs to know what they do.

The military really bends over backwards to avoid any appearance that they’re “cheap labor” or, worse, cutting civilians out of these jobs. The Forest Service has the same concerns (and a very small well of goodwill to draw from), so they don’t ask until the last minute.

Training for this sort of deployment is minimal, but is mostly safety-related. Being Marines, most units break out the unit chainsaws and train some sawyers to clear snags and that sort of thing. The safety training is taken very seriously: real, professional firefighters get killed doing this (I believe at least one was killed this week), so the danger is never minimized.

The upside is that the arrival of 400+ (a Battalion that’s in the rebuilding stages following a deployment) very fit and rested hard workers can significantly contribute to the manpower. There are potential downsides, which we took care of by isolating the troops in their own camp, with plenty of everything. You’ve never eaten so well in the wilderness as at a Forest Service fire. Tons of chow, and the FS spends a lot of money putting down gravel for walkways, plywood or bark chips in the tent floors, etc.

So, if and when they send in the Marines (and Sailors), understand what their role is, and isn’t.

SoCal Fire Map

Rapid Response Fire Maps
The .jpeg image looks nice, and shows there are several fires, not just one. I don’t know why, but from my cursory reading I thought there was only one fire.

An easy way to keep up with the fires.

I Rave

According to the author, I rave. I’m OK with that.

Sorry posting has been slow, but I’ve contracted some benign but achy viral illness. More raving soon. I promise.

Puberty Gene Discovered – Scientists identify puberty gene

Three sets of researchers in the United States, France and England identified the gene simultaneously.

There’s a joke in here about finding a gene that locks itself in the bathroom for hours at a time, but I can’t put it together.

Insured a big drain on emergency rooms ?!?

Medpundit commented on this, and it seemed too good to be true. The original article seems to have been written from an alternate dimension: | Business | Insured a big drain on emergency rooms

People with insurance are increasingly using emergency rooms, even for non-urgent care, a new study found — perplexing experts who believed the uninsured were the chief reason for emergency room overcrowding.

Emergency room visits jumped to an average total of 107.7 million in 2001 and 2000, up 16.3 percent from 1996 and 1997. Most of the increase came from insured patients, according to the Center for Studying Health System Change, a Washington-based think tank.

Privately insured patients’ use of the emergency room rose 24.3 percent to 43.3 million visits over that six-year period. People covered by Medicare, the government insurance for the elderly, visited the ER 16 million times, a 10 percent increase. Visits by uninsured patients rose 10.3 percent to 18 million, while those by patients covered by Medicaid, the government program for the poor, were flat at 18.4 million.

Now, on what planet are patients with Insurance a “drain”? My ED actively works to get that exact demographic (people with insurance) to come to us for care.

I don’t think people come to any ED for the ‘glamor’, even the nicest I’ve been in wasn’t a place I’d spend time voluntarily.

The reason people come to ED’s is because we’re too good for our own good. We work in an embarrasingly resource-rich environment, able to get the vast majority of common tests done within a few hours, and come up with an answer, or at least exclude life threats.

It’s a convenience issue, all right. I wonder when CLIA (Clinical Laboratory Improvement Act) kicked in, and docs were basically put out of the office-lab business. (Read that page and see if you’d have a lab in your office. Docs aren’t kidding when they scream about excessive regulation).

Senate has a plan

via CNN today:
Gonna need the extra cash on vacation!

Looks like the plan is coming together for them!

Schoolboys took Viagra at lunch – Schoolboys took Viagra at lunch

LONDON, England (Reuters) — Six British schoolboys were rushed to the hospital after taking the erection-enhancing drug Viagra at lunchtime for a dare, the school said Thursday.

The Sun newspaper quoted a source at the school as saying: "By the time the afternoon lessons began, there was no hiding what they had done."

Paramedics took the six squirming boys to the nearby Royal Berkshire Hospital, where they were monitored until the effects wore off.

There’s some blather about a strict drug policy and punishing these boys, but really…what punsihment is going to be greater than the humiliation they’re going to suffer at the hands of their mates?

Liberian Marine Malaria Results

In an article that has the facts right, but the headline exactly wrong: Malaria Outbreak Blamed On Troops.

Looks like my original rant was correct, this was a leadership failure, notwithstanding the blame-the-victim headline.

October 20, 2003

WASHINGTON – The large outbreak of malaria among Marines who spent time ashore in the West African nation of Liberia in the summer was apparently caused by a nearly wholesale failure of the troops to follow protective measures, and in particular not taking a once a week malaria preventing drug.
Blood samples taken from the 26th Marine Expeditionary Unit right after malaria was diagnosed in several troops in early September showed that only 5 percent had been regularly taking the recommended drug, mefloquine. Only 12 percent wore uniforms properly treated with the insecticide permethrin. Only 27 percent reported using the time-released insect repellant issued to them. And none slept under insecticide-treated mosquito nets.

The findings were presented last week in closed briefings to the House and Senate Armed Services committees. (emphasis mine)

I said it then, and Ill say it now, this was a leadership failure. If the command gets it, the troops get it. But, when force protection, in this case malaria, isn’t pushed, hard, from the top down, it will not get done.

In a classic statement that blames the individual but not the system:

“It is difficult to get these young Marines, who are willing to charge a machine gun nest, to be worried about a mosquito,” said … a Navy physician involved in the investigation. “It is much more difficult than we believe it should be.”
Later, the investigators specifically said they don’t think observed / forced compliance is the answer ‘more education’ is.

As several commenters to the recent posts have pointed out, it’s not all that hard to get compliance on this issue: observe your people taking their meds. No excuses, no wimpouts, just take it. Education is great; 100% compliance with the goal of having a force that’s combat capable is better.

Read the source article for the astonishing stats (a 44% attack rate for a 2 week deployment ashore), then be very glad that all have recovered.

Malaria isn’t a mystery illness, and it’s mostly preventable, if you just try. They (the commanders) knew going in that Liberia is 1,000 times more malarious than the Persian Gulf or Afghanistan, and they did essentially nothing to prevent this parasitic ambush. This force was basically combat ineffective by the time they were withdrawn to the ships, it’s a good thing we didn’t need to fight there.

Now, back to my original answer: a career or two need to come to a screeching halt over this, the ultimate career officer motivator.

Many thanks to Tony for the link!

General reading:
Malaria, from the CDC
Virtual Naval Hospital, NavMed Malaria Prevention

GE MedPro Drops Texas EP’s

At the end of the following article – Doctors hope law boosts patient care is a paragraph which is, now, ironic.

One carrier, Texas Medical Liability Trust, announced before the Sept. 13 vote it would cut rates by 12 percent on Jan. 1. Two others, GE Medical Protective of Fort Wayne, Ind., and The Doctors Co. of Napa, Calif., are considering similar cuts.

Our ED group started getting registered letters Saturday notifying them that MedPro will not be renewing any of their policies, “to decrease the number of Emergency physicians” they cover. There’s a cut!

90% of the docs in our group are covered by MedPro, and now my colleagues are going to have to apply for new coverage, in a uncertain market, many now having outstanding suits from the flurry of filings just before the new tort laws went into effect. (I’m with another company, and praying I’m with them in the future).

So much for tort reform fixing our medmal problems. Next: Insurance Reform.

West Nile Graphics update

In my prior post several states’ West Nile data wasn’t represented, as they weren’t sharing data with the CDC. I still don’t know why they weren’t sending in data, but they weren’t. If you know why, write or comment.

Now they are, as evidenced by the new CDC map; But, once again, the USGS has more detailed information (that’s how we know the one California case was in Riverside County).

A big thanks to Beth for the information! (And thanks for reading).

Stanford sets new policy for med students

Stanford Med discovers their students are occasionally sleeping, and comes up with a solution: – Stanford sets new policy for med students –

…Stanford announced last month it would become the first U.S. university to require new medical students to pick “scholarly concentrations” — similar in spirit to undergraduate majors –…

apparently missing the point that medical school is a graduate program, with well -defined goals, and a fairly well-defined way of getting smart but untrained kids to become educated, trained doctors.

Attracting specialized, career-focused students is one reason Stanford University Medical Center overhauled its curriculum and required students to pick a concentration by the end of their first year. Officials say the policy puts Stanford at the forefront of medical education.

Sometimes, being at the forefront means the train hits you first. I read this to mean that they weren’t attracting enough pale, lab-rat masochists, but that’s just me.

…”Students in medical school turn into cookie cutters, all learning the same, huge amount of data, and by the end the idealists are gone,” said Dr. Julie Parsonnet, Stanford’s senior associate dean for medical education. “We’re saying, ‘We know you’re all different from each other and you have individual reasons for going to school.’ We want to foster that passion and still produce great doctors.”

How better to foster idealism than by tacking on 200 hours of “scholarly concentration”. Also, exactly what part of that huge amount of data will you be cutting out to add in a scholarly concentration? The part about my ankle, or my MI? A lot of idealism meets reality in med school; it’s a feature, not a bug.

…Stanford’s program came after an 18-month curriculum review, when officials discovered 70 percent of students were taking five or more years to get through the four-year program.

They had to do a study to find out their students weren’t graduating on time? That’s educational malpractice.

Most spent an extra year on independent projects.

Hmmm. Students figured out a way to make getting a job take another year. Surprise! Want another answer? Spend another year, get the PhD, then you have an accomplishment, not just an extra year of student loans.

…Stanford’s newest class of 87 students must devote at least 200 hours to a project in their concentration. Officials added three weeks to the fall quarter and asked professors to spend less time in the classroom each week and more time supervising students in interactions with patients.

200 hours over 3 weeks is only 67 hrs/wk, which is a cake walk for most medical students, but there’s no way it’s put together like that. It’s too easy that way.

…”Ultimately, I think it puts us in a better career position,” (an un-named by me student) said of the curriculum change.

Ummm, no. Were I a residency director I’d be unlikely to be super-impressed that you spent 200 hours in a scholarly concentration. Oh, it’ll give you something to chat about in interviews (you’ll bring it up, trust me), but the residency director needs residents who also see patients, as well as max out board scores, so you’re not going to do so well.

And Stanford now officially shouldn’t get to complain about the high student indebtedness, after requiring more specialization of med students. Aso, they have lost any pretense to lecture about the decline of generalists, as they encourage specialization from the outset.

Update: Idealists respond. I agree that Medicine is changing, and all the med school idealists in the world aren’t going to fix it. Finish school, join us, and then join the ?whither the AMA? debate (heh).

EMS can’t help you if they can’t find you

MedicMom has the practical saftey tip of the week.

I love practical, easy to do things that increase my survival possibilities. Tomorrow, after work, mine go up.

Pro Dopes beat Anti-Dope Dopes

Sorry about that, I just get carried away sometimes.

In one of those rare instances I find myself on the same side as the ACLU, I am very glad the Bush Administration got legally stiffed over this issue. Medical pot laws survive challenge.

JUSTICES TURNED down the Bush administration?s request to consider whether the federal government can punish doctors for recommending or perhaps even talking about the benefits of the drug to sick patients. An appeals court said they cannot be punished.

Now, let’s be clear on this: I’m a horrible square (the only thing in my life more white and square than me is sliced bread), I’ve never smoked marijuana in my life, and I’m not for pot smoking. I’m aware of studies that say it helps a small subset of patients, and aware of studies that say it doesn’t help.

What I am completely against is the Government restricting my speech in a physician-patient relationship. As long as I’m not conspiring to either defraud the government or overthrow it by force, they should stay the heck out of what I tell my patients.

More on Liberia Marine Malaria

From the European Start & Stripes: Marines’ bout with malaria still puzzling

NAVAL STATION ROTA, Spain ? The first sick Marines arrived aboard the ship from Liberia with their skin riddled with mosquito bites. They became so ill that doctors planned to fly them hundreds of miles away to Germany for more care.

That night, 15 more Marines arrived on the USS Iwo Jima. Some had high fevers and high blood pressure. Many were throwing up and had severe diarrhea. By the next day, 31 Marines were seriously ill and nobody knew why.

One-third of the people sent to the West African country came down with malaria, according to the Pentagon. Eighty of the 200 Navy, Marine Corps and Department of Defense personnel developed a strain of malaria that kills 25 percent of its victims.

Something I didn’t hammer enough in my earier post on this subject was that antimalarial medications aren’t the only thing that needs to be done to keep the troops healthy. One of the commenters to that post pointed out that the mosquitoes cannot land to infect in even the slightest breezes, making fans a necessity, not a luxury.

Also, DEET, sleeves down, that sort of thing also need to be done. If your people are covered in bites, you’re not getting the job done.

Pill may cut hearing loss from noise

Pill may cut hearing loss from noise
This is a long MSNC article about an anti-oxidant medication (which will be in a liquid form, not a pill when tested). The researchers hope it will help diminish, or even prevent, noise induced hearing loss.
You need a lot of pre-arranged noise to test this sort of thing, and for statistical power you need a lot of subjects. So,

STARTING IN a few months, a group of 600 Marines at Camp Pendleton in California will face rifle training with not only foam plugs in their ears, but also a drink that tastes very much like Wild Berry Zinger herbal tea.
They?ll take it with every meal during their two weeks of the noisy training, an experience that normally erodes a bit of hearing ability from about 10 percent of trainees. And if all goes as hoped, hearing tests will show that a substance dissolved in the drink made a difference.

I want to know other things from this, like are their sick-call rates changed from cohorts?

And, does it make a difference in their marksmanship?