Archives for April 2008

Never Distract Your Barber

I’m learning things as I mature. Such is the experience of a remarkably close haircut.

You’d not be surprised to learn that, like the rest of my life, my hair style is no nonsense and low maintenance. The usual cut involves the electric clipper with guards of a couple of single-digit sizes, and it doesn’t take long.

Most recently I was settling in to get my usual trim, and, also as usual was making small talk with my barber of several years. I watched her attach the guard, and usually she starts with the sides. This time, the top was the starting place, and big chunks of hair started falling. It was too late at that point to do anything other than wait for the realization to come.

She was very apologetic. I got a nice, very short, haircut. I look a touch like a graying tennis ball, and I learned a lesson: don’t distract people when they’re thinking.

Many thanks, Logan Plaster of EP Monthly

A belated thanks to Logan Plaster for guest-blogging here this past weekend (and if you didn’t read his entries, they’re below). He’s quite a good writer, take a good photo, and of course I won’t be having him back.

Kidding. Logan’s always welcome back here, and thanks for reading!

MedBlogs Grand Rounds – Vol. 4, No. 29

Dr. Wes: Welcome to Grand Rounds – Vol. 4, No. 29
Welcome to the Medical Blog-o-sphere’s weekly edition of Grand Rounds! Today we’ll take a decidedly (well, what else?) cardiovascular bent. I appreciate all who contributed their talents to this week’s edition.

Have a heart, and read it.

National Review Online on My Favorite Charity

The Corner on National Review Online
It’s a great charity — they provide scholarships, emergency medical care, emergency loans, all kinds of good things — and there’s a reason why it’s considered one of the best in the country: all contributions, one hundred percent, go directly to the recipients. Nothing taken out for overhead or salaries.

They speak, of course, about the Navy/Marine Corps Relief Society.  Doing good work for our Marines, Sailors, and their dependents.

An MCI “just won’t happen to me”

How can we practice for a mass casualty incident (MCI) if we believe “it couldn’t happen to me”?

While in San Francisco I had the chance to speak with Dr. Jacob Or, the president of the Israeli Association of Emergency Medicine, on a couple of occasions. He also happens to be an emergency physician at the largest trauma center in the Middle East. During a presentation he gave on the state of emergency medicine in Israel, Dr. Or couldn’t help but comment on how excellently well-prepared his men and women were for a mass casualty incident. Their surge capacity, apparently, is the stuff of legend, and it’s all been tested and proven. There was an upspoken current that the U.S. had a lot to learn from this small nation in this regard. Undoubtedly.

But I had a question, so I met up with Dr. Or after the talk over a beer. What about the docs in Iowa? In Peoria? What about the docs who want to improve surge capacity and disaster preparedness, but for whom an MCI simply isn’t a daily reality? How can we make disaster preparedness a reality for the EPs in the States who don’t see an impending threat of any kind?

“That’s the million dollar question” another doc chimed in.

The response I heard from Dr. Or and others was this: Focus on legitimate regional threats. If your town is near an oil refinery, base your mass casualty drill on a disaster at the plant, not a bomb at the mall. If you practice in Florida, your MCI should involve a hurricane rather than a terrorist attack.

Makes sense and it’s good logic, but it only partially satisfied me, so I want to know what people think. Have you experienced a mass casualty drill that was either particularly effective or ineffective? In your experience, what efforts were taken to get participants mentally invested in the drill? How can we make mass casualty drills more meaningful, and more effective in the long term?

-Logan Plaster

Emergency Physicians Monthly



If you could build an EM system from scratch…

…what would you do differently? 

This blue sky question is part of the reason that more than a thousand emergency physicians gathered in San Francisco this week. Every country is at a different stage of EM development, but some have a relatively clean slate to work with. Take Dr. Jim Holliman for instance, the man in charge of EM development in the entire country of Afghanistan. Not only does Dr. Holliman have the chance to help a country start fresh with their EM strategy, he’s here at ICEM hearing lessons-learned from more than 60 country delegates. In theory, someone like Holliman should be able to pick and choose the best elements of every system. Of course, that’s putting it way too simply (particularly considering the physical danger inherent in many regions), but it brings up an interesting question that I’d like to pose to the blogosphere: If you were designing an EM system from the ground up, what are some specific elements from the American system that you would keep and what would you toss out like old garbage? And remember, we’re talking about a clean slate. The sky’s the limit.  

-Logan Plaster

Emergency Physicians Monthly

UK’s four-hour wait limit

Long waits have become so typical in the ED that it seems cliche to even mention them. But it’s still a serious problem. The average for a patient in the U.S. is something abysmal, but I don’t even want to ask about the maximum wait. I’m guessing you’d measure it in days, not hours. And until today, I assumed that any solution to this problem would have to be a bottom-up approach, not mandated from on high. However, I had the chance to have a few words with Dr. Edward Glucksman, the emergency physician in charge of international emergency medicine in the United Kingdom, and what he told me shed new light on the issue. 

According to Dr. Glucksman, a few years ago, Tony Blair’s government made a bold, seemingly over-reaching claim. They stated to the public that after a finite period of reforms initiated by the government, no one in the ED would wait more than 4 hours to be in a bed or sent home. Ever. This statement set off a series of extensive studies into what exactly caused wait times in the UK and how hospitals could attempt to meet this goal. According to Glucksman, the mandate actually put heat on hospitals and administrators in a way that physicians had been unable, and progress started to be made. Now, a few years out, 98% of all ED patients in the UK are in a bed or out the door in under 4 hours. That’s the max, mind you, not the mean. Now don’t get me wrong, I don’t want the federal government micromanaging the ED any more than the next guy, but this certainly got me thinking outside the box…   

-Logan Plaster

Emergency Physicians Monthly

EM in India over Irish eggs benedict

This morning I had the privilege of sitting down for breakfast with Dr. Kumar Alagappan, one of the key voices (some would say THE key voice) in the movement to get emergency medicine officially recognized in India. Dr. Alagappan, an EP currently practicing in New York City, is a generous, down-to-earth doc who has travelled extensively on his own dime to help make this amazing movement in India a reality. More on this interview soon…

-Logan Plaster

t should take care of it.Nurse Ratched’s Place: Change of Shift with Nurse Chapel

Change of shift is up.

Nurse Ratched’s Place: Change of Shift with Nurse Chapel
Greetings from the U.S.S. Enterprise. I’m Nurse Chapel, and welcome to Change of Shift.

Spocks’ secret girlfriend is in charge.



The few, the proud

Apparently, international emergency medicine isn’t for the faint of heart. And I’m not talking about CHF. You’ve gotta have guts. I found it interesting to learn that the greatest risk in practicing international emergency medicine is not that one might catch a communicable disease, but that one might die of physical violence. This according to Dr. Hilarie Cranmer, Clinical Instructor, Division of International Health and Humanitarian Programs at Brigham and Women’s Hospital in Boston. In fact, physical violence against humanitarian workers is on the rise, and it is increasingly targeted and intentional. The red cross, which was once a symbol of protection, has become, for many, a target.

“We all want to save the world,” said Cranmer, “but you’re at great risk for doing so.”

Then again, emergency medicine isn’t a specialty for the risk-averse. I look around and see a lot of men and women ready and equipped for the challenge.

-Logan Plaster

Emergency Physicians Monthly

ICEM, Part I: Bat out of hell

First of all, a special thanks to GruntDoc for allowing me to host the blog this week while I attend the ICEM conference in San Francisco. A short travel story, without which any conference coverage would be incomplete. My wife and I arrived in the Bay Area last night after an uneventful flight and then promptly hopped into the cab from hell. Our driver looked sweet enough as we climbed in the car, but then we discovered that his right foot was made entirely of lead. He hurled through highway traffic at 90 mph. I kid you not. 90. In traffic. Let’s just say I’ll have to leave my scenic viewing of the Golden Gate Bridge to another ride.

But on to the show. ICEM is put on in coordination with the International Federation of Emergency Medicine (IFEM), a group which began as a small collection of countries with highly developed EM systems, but which has exploded in recent years. The meeting rotates through member countries, and the landmark international gathering will not take place in the United States again for at least 14 years. The conference will celebrate a year of unprecedented progress in the advancement of emergency medicine around the globe, such as in India where the specialty has finally made serious inroads thanks to the efforts of a little group of physicians called the American Association for Emergency Medicine in India (AAEMI). I have no doubt that the EM developments around the world will have far-reaching affects on the specialty in the United States.

-Logan Plaster

Emergency Physicians Monthly

Gmail: Google’s approach to email

Google makes an April Fools’ joke, and it’s pretty funny: Gmail: Google’s approach to email

That could come in handy.

Guest Host this week: Emergency Physician Monthly’s Logan Plaster

I’m very pleased to announce that Logan Plaster, Editor and Creative Director of Emergency Physicians’ Monthly will be blogging his insights and observations here during this weeks’ 12th International Conference on Emergency Medicine held in San Francisco.

I’m a big fan of EPMonthly, and enjoy reading it cover to cover every month. It’s my honor to host them here (and they have a website supporting their publication that’s terrific, check it out).

Come back often for his updates; he’s going to try to post pictures (and maybe video) in addition to the expected well-written text. I’m looking forward to it myself.

MedBlogs Grand Rounds 4:28

Welcome to MedBlogs Grand Rounds 4:28, a weekly online compendium to links of the best medical blog posts.

I’m also very happy to be the first Five time host of this little enterprise, and hope to do it again someday. Over in the left sidebar are category links, where you should be able to find a link to (nearly) all the prior Grand Rounds.

Without further ado, let’s get a look at the best posts of the medblogosphere (which is now a real word, or at least should be):

#1 Dinosaur relates his experience with an internet lurker who reached out – for a reason to not commit suicide. It’s a must read, and approaches a question I hear a lot in a unique way.

Wilderness Medicines’ Paul Auerbach writs a nice case report about a high-voltage injury. Lucky patient!

Health Business Blog write about an unintended (but happy) effect of the Wal-Mart $4 drugs. I refer a lot of patients there for their inexpensive generics.

Episcopal Chaplain at the Bedside explains HealthCare Marketing; it’s not the answer you think you’ll get. It’s very good, and has made me think more about markets in medicine.

Tech Medicine writes about medical consultants and his motivation after a seminar. (And we all know the problem is not getting good ideas, it’s the implementation).

Allergy Notes talks about Country star Trace Adkins and his efforts to publicize food allergies, a personal subject for him as his daughter has multiple food allergies.

Shadowfax discusses an ED trade secret: phototherapy and its applications. Another technique to remember for that one particular case.

NY Emergency Medicine discusses a code he probably caused, and the reactions it provoked. It took nerve to write it, and was probably cathartic.

And, this is where I ran out of, well, whatever makes you finish a Grand Rounds. I talked to Dr. Val Jones over at Revolution Health, and she’s agreed to finish up, so Go There. Sorry. I’ll have to take an Incomplete.

Update: I’m not a quitter, this April Fools’ edition of Grand Rounds was inspired (and coordinated) by Nick Genes, whose creation it was in the first place.

The rest of the conspirators, in order: Dr. Val at Revolution Health, David Williams at Health Business Blog, Nick Genes at Medgadget, Dr. Anonymous at his eponomously (anonymously eponomously?) Dr. Anonymous, Dr. Rob at Musings of a Distractible Mind, and ultimately at Kim’s Emergiblog.

It was fun to do, this doesn’t count as a hosting for me, and I hope it wasn’t too jarring.

M.D.O.D.: It’s Emergency April Fool’s Day

M.D.O.D.: It’s Emergency April Fool’s Day

What he said.