Archives for February 2005

Dean Wormer – John Vernon, ‘Animal House’s’ Wormer, dies – Feb 4, 2005

John Vernon, a stage-trained character actor who played cunning villains in film and TV and made his comedy mark as Dean Wormer in “National Lampoon’s Animal House,” has died. He was 72.

There’s (probably) no Double-Secret probation in Heaven. Say hi to Belushi for us.


I will never figure out the ED visit cycles. The last week of November and the first two weeks of December a lot of us had decided that our ED had fallen out of favor with the community. I mean, people weren’t coming in, and we were staring at each other wondering where we would go to get new jobs.

As with all cycles, that has definitely ended. We’ve had a ‘full’ hospital for a couple of weeks, we’re holding admitted patients in the ED (sometimes up to a third of our real beds). We’ve been on and off EMS diversion continuously, and when off diversion we’re usually ‘forced off’ by the EMS powers that be.* (Forced off diversion by the EMS powers that be: shared pain is at least fair).

Diversion is a continuous hot topic in the EM/EMS world, and there is no easy answer. It’s a problem for everyone, make no mistake. If I were to call an ambulance I’d be right ticked if I couldn’t go where I wanted to go. (As an aside, I’ve had 3 patients in 2 1/2 years here ticked because they got diverted to us; many more didn’t care. Maybe that’s my control-issue thing popping out).

Diversion is Bad because:
it over-rides choice of hospital
it keeps people out of the hospital where their docs and records are
it puts the EMS folks in the middle, where they shouldn’t be
it can erode public confidence in EMS

Diversion is Good because:
Resources are finite
The ED’s walls aren’t really rubber
Safety is compromised when pt/staff levels get big
Load sharing, therefore resourse sharing, is more efficient
It gets attention of hospital managers

That last thing cannot be overstated. As much as hospitals gripe over the (very real) monetary losses they take by having an ED, when the ED closes they aren’t happy. I’ve been astonished how beds upstairs can be magically found when the ED closes because we’re holding too many and the inn is full.

Our charge nurses are under a heck of a lot of pressure not to close until the roof caves in. This, despite no increase in resources, just ‘work harder, work faster’. No wonder the nursing burnout rate is high in EM; the same nurse can go work in the ICU and have a stable number of patients.

Our hospital is considering something that shouldn’t be a radical idea: boarding hall patients upstairs, in the ward hallways. A hall is a hall is the mantra. I hope we try it, as I think it’ll help some.


The “oops” list

The oops listHere’s a repository, albeit without thumbnails or explanations, of some real “oops” moments, mostly in aviation, though there are a few others (notably tanks).

Dr. Frist and the Tsunami

From the New England Journal of Medicine: NEJM — Recovering from the Tsunami

The media reports on the tsunami that hit South Asia the day after Christmas did little to prepare me for what I saw firsthand when I visited Sri Lanka and India. Working as a missionary, I have visited destroyed towns in war-torn Sudan and witnessed deep, grinding poverty in Uganda and Kenya. The challenges in South Asia are as daunting as any I have seen. Flying over the coastline in a helicopter, we saw an unending scene of devastation. All told, more than 150,000 people are dead and over 5 million have been left homeless.

Many of the tragedies we encountered defied simple solutions. At one overburdened hospital, I met an eight-year-old boy with infected leg abscesses. He had spent nine days in a futile search for his family (his parents and siblings had all perished) rather than seek immediate treatment for the injury he received in the initial deluge. Even those who are physically uninjured have sustained severe psychological wounds. Thousands of children will grow up without parents. And the rudiments of normal life (electricity, schools, houses of worship, and a functional economy) will take years to rebuild.

[Read more…]

The Actiongate Explanation

TCS: Tech Central Station – Toy Soldiers

19 January 2005: The Slinky betrayed us. I should have known. I never trusted him. He was an unstable character, always going back and forth, back and forth, never showing a shred of backbone. “Come, senor, I know the way to the insurgents’ headquarters,” he rasped. The fact that he was an Arab toy speaking with a stereotypical Spanish accent should have tipped me off. But hindsight is always 20/20. Literally. I can turn my head 360 degrees.

I only knew my men by their code names, but even in that short space of time we shared a bond that only six-inch plastic combatants can truly understand. They were my family, my brothers in petroleum-based products. One night we all melted the tips of our fingers and became plastic brothers.

And I led those brave action figures into the trap.

The rest is just as funny.

via ChiaTeaLatte

Medblogs Grand Rounds XIX

Capsules: Grand Rounds XIX

Glad to see so many could make it to this week’s Grand Rounds! Since we couldn’t get Richard Simmons to come in and do a quick exercise break, we’ll be following Dr. Emer’s Fidget Your Way to Better Health program to keep us slim, trim, and hopefully awake. So jiggle your feet, twiddle your thumbs, and enjoy the best of the medical blogosphere.