Archives for August 2005

Michael Yon : Sunday Radio Interview

If you’re available this evening: Michael Yon : Online Magazine: Click Here for Information about Sunday Radio Interview.

I will conduct a radio interview on Sunday, 14 August, at 9pm Eastern Standard Time. The interview will be live on WRKO in Boston. Listeners can call with questions toll free at 877-469-4322.

The broadcast can be heard anywhere in the world by clicking the title above to visit the WRKO web site. There is a "Listen Live" button on the top right of the home page. Anyone who has Internet can listen to the simulcast.


Michael Yon

Mosul, Iraq

I have to miss it, but hope to read a review, somewhere.  Put yours in the comments!

Update: you can listen to it here, via PunditReview.

Ethanol treatment may be instrumental in fighting IV-based infections

Unfortunately, it’s not going to be oral therapy: RELEASE: Ethanol treatment may be instrumental in fighting IV-based infections.

MADISON – Inserted through the skin and into a vein, long-term intravascular devices such as IV catheters deliver to patients a range of life-saving medications, nutrition and fluids, among other uses.

But these life-saving devices also can provide a furtive pipeline for germs from the external world to gain access to the bloodstream of patients who often already are sick, resulting in a serious infection or even death, says professor of medicine Dr. Dennis G. Maki.

More than 200 million intravascular devices are in use in hospitals, clinics and outpatient settings today. Although health care staff who insert them wear sterile gloves and swab patient skin with disinfectant, about 500,000 patients each year develop an associated bloodstream infection. Of those, up to 30,000 die as a result of the infection, says Maki, who is head of the Medical School’s infectious diseases section.

Maki’s new approach for patients with intravascular catheters is a daily "rinse cycle" with a 25- to 50-percent solution of ethyl alcohol, or medical-grade ethanol. "We fill each lumen of the catheter with the ethanol solution and then cap it off," says Maki.

"It is allowed to sit there for an hour, rapidly killing any germs that have insidiously gained access. We then simply pull it back out and reattach the IV fluids, intraveneous nutrition or intravenous medications, and the risk of later bloodstream infection caused by germs that may have gained access in the preceding 24 hours has been essentially eliminated."

So, no buzz (or very little, if it’s done right).  The trick is to inject just enough to fill the catheter volume without over or under filling.  You’d think that’s be easy, but it’s not: a lot of IV access devices are of ‘custom’ (nonstandard) lengths, and calculating their volume is nearly impossible clinically.  For instance, dialysis catheters are supposed to have exactly this same process, but with heparin, a blood thinning agent.  It’s not, unfortunately, unusual to have patients markedly anticoagulated when their catheters are overfilled.

It’s an intriguing idea, though.  I hope it works, because medical grade ethanol is super cheap (most of the cost of booze is tax, and medical alcohol isn’t taxed).

“The City of Fort Worth” moves to Arizona

I’ve had a link in the left sidebar for as long as I can recall, in support of the last B-36 Peacemaker made and the efforts to make it a new home, here, where it was born, and now it’s time to take it down: B-36 PEACEMAKER MUSEUM in FORT WORTH.

B-36J-III-10-CF 52-2827, "City of FT. WORTH" is currently being moved to its new home in Tucson, Arizona at the PIMA County Air & Space Museum.  All that remains to be moved is the wing and a few smaller parts.

We have learned the wing will be moved intact on a special articulated trailer that requires a driver in the rear, much like the ladder trucks used by some fire departments.  This is great news for the aircraft since the wing provides most of the structural strength for the entire aircraft.

Most comments we have received from our membership and other supporters about the loss of the Last B-36 from our city have been very favorable toward PIMA.

A consensus seems to be that since there is very little support for the B-36 in its home town, its survival is now assured for many years to come in the care of a dedicated group of aviation professionals in a city that openly welcomes it for the great tourist attraction it will be for them.

In keeping with our purposes and our pledge of continued support for the Last B-36, we have been in contact with PIMA’s executive director and we are jointly considering ways that B-36 Peacemaker Museum can assist PIMA with the aircraft’s reassembly and various other tasks.  Several of our Convair veterans have already decided they can travel to Tucson to help in any way they can.

What does this mean for us here in Cowtown?  Hopefully it will ease the way for the establishment of a superb aviation museum at Meacham Field.  Since we no longer need to build an environmentally controlled facility larger than a football stadium for the B-36, we have been relieved of a $20 million-dollar obstacle.  We are continuing to work with the city and the city’s aviation department to this end.

Our architect is working long hours to finish a design for the lobby display area at Meacham.  Expect to see many innovative concepts on our website as they become available.

We wish to sincerely thank all our members and other supporters for working with us through the past few months as we worked to keep the Last B-36 at home.  Now is the time to accept the outcome and to continue to support not only the B-36, but the industry that has kept North Texas alive and prosperous for so many years – aviation.

I’ve been to the Pima Air Museum, and it is a terrific collection with a dedicated staff.  I made the mistake of visiting in late June one year, which is a prescription for heat injury.  This isn’t the worst ending for the old girl, and the respect for the painstakingly refurbished wing being transported as one piece is more than a little solace to those who have labored for years to refurbish her and make a permanent home here in Consolidated / Vultee land.  Alas, it never came together here, and Pima will give The City of Fort Worth a good home.

My connection to the B-36 is familial: dad was a ‘right scanner’ (lower right aft gunner) on one during his AF tour, and I grew up with a model of the B-36 atop the TV (until I could reach it, then it was toast, I’m told).  Dad has a new model, and his memories, and we’ll get out to Pima together someday.

The Fort Worth group has done terrific work,  saving it from the chopping block when Meacham Field was closed, then arranging for the refurbishment.  Ultimately, to our collective shame, Fort Worth wasn’t able to find a suitable home, so it’s off to sunny Arizona for the city’s namesake.

I’ll keep the sidebar link for a while, then I’ll let it go, like we let a bit of our own history go.  Here is the Cockpit section, leaving us for good:


I don’t know the AF phrase, but in the Navy it’s Fair Winds and Following Seas, City of Fort Worth!

NEJM features on the London Bombing Medical Effort

This week’s New England Journal of Medicine has four free (no subscription needed) articles featuring British commentary on the emergency medical response to the London terror bombings of July 7th, 2005.  On the NEJM front page they’re under "Perspective" (toward the bottom of the page).

Each of these is worth reading, but I’m going to abstract a little here from my favorite:

Peter J.P. Holden, M.B., Ch.B., F.I.M.C.R.C.S.Ed.

Thursday, July 7, 2005. A hot, humid day for London, and all the windows on the third floor of the British Medical Association (BMA) building are open. A last-minute change of plans at 9 A.M. leaves me working at BMA House, preparing for a meeting. This is to prove fateful. 

9:20 A.M. Colleagues begin arriving. There is more than the usual commotion from emergency-services vehicles. Ten minutes later, an emergency medical helicopter from the Royal London Hospital is hovering overhead. Newsflashes on our computer screens report power surges and incidents on the London Underground. We turn on the television: clearly, a major incident is unfolding. A chill runs down my spine. I sat in the same place watching the events of 9/11.

Suddenly, around 9:50, everything momentarily appears pale pink. There is an enormous bang. Some of my colleagues have looks of terror on their faces. We can see white smoke and debris raining down in the square. The fire alarms are sounding. 

Although staff members leave, the doctors stay, and we lower the blinds to give a modicum of protection from flying glass from any further explosion. After several minutes, we gingerly make our way to the front of the building and look down onto the stricken bus. 

Within a second, I recognize that we are dealing with multiple blast injuries. I grab some surgical gloves and my ambulance service physician identity card ? without it, we will be ignored by the London Ambulance Service. 

On arrival downstairs, I meet the deputy chairman of the BMA Council, who is coordinating the first aid response. Knowing of my prehospital emergency care experience, he asks me to take over the direction of clinical operations while he requisitions and gathers resources. My assets are a building offering protection from all but a direct hit and 14 doctors, most of them experienced general practitioners with some training in emergency medicine. But we have no equipment, no communications, and no personal protective clothing. Armed with nothing, we set about maximizing the victims’ chances of survival. 

I have trained for such a situation for 20 years ? but on the assumption that I would be part of a rescue team, properly dressed, properly equipped, and moving with semimilitary precision. Instead, I am in shirtsleeves and a pinstripe suit, with no pen and no paper, and I am technically an uninjured victim. All I have is my ID card, surgical gloves, and my colleagues’ expectation that I will lead them though this crisis.

Read them all, but it’s an interesting look into their event, and at the flexibility of individuals under stress.

Oh, and in one article "…penetration with biologicals…" is a nice way to say bones and bits from one victim blown into another.  Nice bit of understatement, that.

Doctors push St. Luke’s to forgo $25 million gift

In the "I cannot believe they’d even consider it" category: – Doctors push St. Luke’s to forgo $25 million gift.

St. Luke’s Episcopal Hospital’s famed medical tower will soon be renamed for a Houston lawyer who has made millions taking the health care industry to trial.

The plan to rename the edifice after John O’Quinn in recognition of a $25 million donation by his foundation has infuriated many St. Luke’s doctors, who last week began circulating a petition against it and Monday night convened an emergency meeting of the medical executive committee.

"Perhaps you are unaware of the intensity of feelings held by many physicians about Mr. John O’Quinn," says the petition, which is addressed to the Rev. Don Wimberly, bishop of the Episcopal Diocese of Texas and chairman of the St. Luke’s Episcopal Health System board of directors. "The primary source of his financial success has been representing plaintiffs in medical liability and products liability cases, many of them groundless."

But Lee Hogan, executive chairman of the St. Luke’s System board, said after the medical executive committee met Monday that the matter is closed. He said the board already had considered the sort of concerns the medical staff is raising and "isn’t inclined to reconsider."

Hogan said the focus should be on two things: "the generosity of the gift," the largest in St. Luke’s 50-year history; and what the money will be able to do for St. Luke’s, such as upgrade and increase the size of its emergency room, operating rooms, intensive care unit and private patient rooms.

So, Mr. Hogan, how much would, say, Dr. Kevorkian, or the American Nazi Party have to pony up to get this tower named after them?  If it’s really just about the bucks, you have no principles, period.  Well, none outside the almighty dollar.

And at least one lawyer agrees the shouldn’t be sold, so it’s not just docs against it.

Cover-up claim on ‘environment of chaos’

So, it not just the US with these problems: The Courier-Mail: Cover-up claim on ‘environment of chaos’ [10aug05].

HOSPITAL emergency departments across Queensland are in meltdown as patients queue on trolleys for beds and staff flee intolerable working conditions.

In a scathing submission to the health inquiry, eight emergency department directors and specialists from major hospitals claim the chronic problems are being deliberately concealed from the public.

The 11-page Australasian College for Emergency Medicine submission accuses Queensland Health and politicians of having "lied to the public with either fabricated figures on the number of beds" or for making claims that there was no intensive care crisis.

The college tells the health inquiry this is "complete rubbish" and emergency departments have become dumping grounds for the failures of the health system.

A lack of beds and a failure to attract staff to emergency departments fuelled the crisis in emergency departments, the college writes.

And patients were not being treated with dignity and respect.

Instead, they were being squeezed into emergency department corridors, examined in public and some were being forced to wait a day, sometimes more, on a trolley for an available inpatient bed.

"It is an environment of chaos, pressure and the ever-occurring requirement to cut corners using only your experience in a resource-poor environment," the college submission said.

I still don’t understand why it’s acceptable to put any patient in a hallway, when there are literally hundreds of offices in the hospital that could be put to that use.  Perhaps if the administration had to work in the hallway ED expansion and efficiency would be a higher priority.

Grand Rounds, 46th Edition

.PARALLEL UNIVERSES.: Grand Rounds, 46th Edition.

‘Simply overloaded. We’re packed to the brim this week, ladies and gentlemen.

Welcome to the 46th edition of the Grand Rounds, coming to you live from Manila, Philippines! It is my honor to host (for the second time) and bring to you this prestigious weekly gathering of the choicest medical and health posts from all over the world. For this week’s GR, I received more than 40 exceptional entries which I think will give you all the sensory overload, intellectual jolt, and emotional rollercoaster ride you’ll ever wish for. Let’s get the ball rolling, grab a chair, and let’s begin….

Delivery of Agents for Procedural Sedation and Analgesia by Emergency Nurses

Here’s an ACEP statement I can appreciate: Delivery of Agents for Procedural Sedation and Analgesia by Emergency Nurses.

Approved by the ACEP Board of Directors April 2005 and the Emergency Nurses Association (ENA) Board March 2005
(Policy #400347, Approved April 2005)

The Emergency Nurses Association (ENA) and the American College of Emergency Physicians (ACEP) support the delivery of medications used for procedural sedation and analgesia by credentialed emergency nurses working under the direct supervision of an emergency physician. These agents include but are not limited to etomidate, propofol, ketamine, fentanyl, and midazolam.

The best war reporting going

If you’re not reading Michael Yon’s Online Magazine you’re missing out.  I don’t know enough about Ernie Pyle’s writing to compare the two, but he is following in Pyle’s footsteps, actually going with the troops as they do their jobs.

His writing is gripping, and he pulls no punches; when we screw up, he writes about that, too.  He’s a daily read for me.

Get ’em in now…MedBlogs Grand Rounds

From Dr. Emer:

I’m hosting the 46th (how far we’ve gone!) GR this Tuesday.
Can you submit choice posts to on or before 8pm, EST Monday, August 8?

Thanks and hope to see you guys there!

nothing to say? Say nothing.

That’s where I am today. Lots of shifts and not much ‘other’ time, and the blog suffers.

I am in an extra-cranky mood, and am refraining from blogging about patient interactions until I’m, well, less cranky.

Marine Corps News -> Preventive medicine keeps air wing in the fight


AL ASAD, Iraq – (Aug. 6, 2005) — For the past 230 years, the Marine Corps has fought wars on foreign fronts in austere environments throughout the globe. The environmental changes experienced when deployed to a new clime and place bring unknown viruses and diseases. That, combined with less than ideal sanitary conditions can create havoc on a service members well being.

Today, the Navy has preventive health professionals who make it their mission to keep Marines and all service members free from preventable disease. Preventive medicine is giving the Marines of the forward deployed 2nd Marine Aircraft Wing the best gift they can have, the gift of health.

Preventive medicine is made up of a group of sailors from different units who work together to deal with public health issues. From checking the food is stored, cooked and served safely in the dining facilities to educating Marines on the dangers of heat injuries. This small collection of sailors helps ensure the combat readiness of the fighting forces here.

?We work to keep people healthy and reduce disease and non-battle injury rates in our fighting force,? said Cmdr. Sharon Wright, the environmental health officer for the forward deployed wing. ?We began with a healthy populous and through insect and vector control and good sanitation we have been able to keep our numbers of sick service members to a minimum.?

The sailors spend their days conducting inspections around the base. They ensure the safety and sanitation of more than 900 portable toilets, 660 shower units, 600 trash receptacles and countless living areas, food service installations and other locations around the base.

Navy Preventive Medicine, and more specifically the PM Techs (PMT’s) are the unsung heros of force protection. Prevention of Disease Non-Battle Injury (DNBI) requires attention to detail and command support, and ranges from food inspection to meds for endemic diseases (our recent disaster in Liberia illustrates what happens when it doesn’t work).

Here’s to the PMT’s!

610,000 unused flu shots now expired

This isn’t good: – 610,000 unused flu shots now expired.

CHICAGO, Illinois (AP) — Hundreds of thousands of flu shots ordered from Europe last year amid fears of a nationwide shortage now have expired and may go to waste, potentially costing taxpayers millions of dollars, officials said Wednesday.

Illinois never even received the vaccine because the Food and Drug Administration would not approve its importation. Nor has it paid for the shots, though a British wholesaler has demanded its contract with the state be fulfilled.

New Mexico and Cleveland — which have also balked at paying — were part of the deal as well, along with New York City.

The overseers of international health keeps telling us there’s a pandemic of either plain-old flu, or avian flu, or SARS just around the corner, and they’re doing a lot of planning.  However, this shows that when there was a shortage of vaccine for a known, seasonal disease the FDA not only couldn’t fix the problem, it wouldn’t let the states do so, either.

I’m hopeful things would be different if there were a true pandemic, but this gives me pause.

Garmin: Support?

If this is support, color me unimpressed: Garmin: Support.

Thank you for contacting Garmin Customer Service and for taking the time to fill out the Technical Support E-mail Form.

The information you have submitted will help us to fix any problems you have encountered.

This is a computer-generated response confirming your e-mail request has been received by Garmin. There is no need to respond to this message. All inquiries are answered in the order they are received.

Please do not send multiple e-mail messages (with the same question) before you have received a response. Doing so will delay your answer. Please allow up to 5-7 working days for an e-mail response, as our response time is longer than normal due to an overwhelming amount of seasonal phone calls and e-mails.

We appreciate your support of Garmin products and hope we can continue to serve you.

So, I’ve had their Forerunner 301 for less than 12 hours, and it’s dead.  Paperweight dead.  The pleasing "battery charging" screen is no more, it responds to no button.  It’s moved a grand total of about 8 feet, over to the window to acquire satellites, and is now defunct.  It is no more.

Fortunately, there’s a phone number to call.  Hopefully they answer in less than 5-7 working days.

Update: after only a 17 minute hold (not bad for calling during lunch time) I have an RMA number, and a promise of a 7-10 day turn around.  Hope springs eternal.

Update2: I got a nice reply email from tech support shortly after the phone call, so their response time is pretty good, really.

Matthew in Beirut: Backstroke of the West

via VodkaPundit: Matthew in Beirut: Backstroke of the West.

What Star Wars captions look like when translated through two languages.  It’s not what Lucas would have envisioned.