Archives for October 2008

Newsflash: Transportation is Dangerous

It’s been in the news (at least, in the medical worlds’ news) that there are a lot of EMS helo crashes this year: 

The Associated PressThe five-member National Transportation Safety Board in January 2006 urged the Federal Aviation Administration to take a series of steps to improve the safety of EMS helicopter flights.

At a meeting Tuesday, the safety board acknowledged that the FAA is working on the proposals, but not quickly enough. Over the past 11 months, nine emergency medical helicopters have crashed, killing 35 people.

Interestingly, the NYTimes is on point today with an article about the untimely deaths of politicians, musicians, etc, with the common denominator being that they’re ‘unscheduled’ (charter) flights. 

New York TimesThey fly to the next gig or the next game, to the next political rally or the next board meeting — another day, another town, and another ride in a corporate jet, chartered plane, helicopter or whatever other conveyance seems convenient, sometimes regardless of risk.

When their planes crash, the headlines name another musician, politician or athlete killed in an aviation accident: Will Rogers, Knute Rockne, Otis Redding, Hale Boggs, Rocky Marciano, Thurman Munson, Rick Nelson and John G. Tower, to name just a few. The song "American Pie" memorializes the crash in February 1959 that killed Buddy Holly, Ritchie Valens and J. P. (The Big Bopper) Richardson.

Because they are busy and prosperous, prominent people often fly in planes not operated by major airlines. By doing so, accident statistics show, they increase their chances of crashing.

(Wikipedia listing of deaths by aircraft of the rich and powerful here).

Airlines have their outstanding safety record because they work terrifically hard (and well) at doing the same thing the same way every time, managing risk, and by avoiding anything that’s been historically risky.  That doesn’t mean they’re perfect, or that accidents don’t happen, but when you’re looking for a safe transportation baseline the scheduled airlines are where to start.

EMS helos are, by definition unscheduled.  They are, with a few exceptions, expected to be available every minute of every day.  They also don’t have the luxury of flying into well lit, organized airports, they’re landing in areas with trees, wires, etc.  There are a lot of things the NTSB has recommended, and hopefully they’ll help.

So, you’ll avoid an accident if you take the ground ambulance, instead, right?  Umm, no.  EMS crashes happen as well.  Per the CDC:

MMWREMS personnel in the United States have an estimated fatality rate of 12.7 per 100,000 workers, more than twice the national average (1). This report documents 27 ambulance crash-related fatalities among EMS workers over a 10-year period.

(Before you point out that 27 isn’t a big number, read the limitations section of the paper).  Here’s a somewhat less scientific but much more inclusive list of EMS crashes, from the EMS Network.

The WSJ Health Blog points out a real concern: if a helicopter is always available, it’ll get used, sometimes when it shouldn’t be:

Medical helicopters have been under scrutiny for a while now. In 2005, the WSJ reported that air ambulances are often used to transport patients who are “minimally injured,” and who could make it to a hospital faster and more safely via ground transport.

Helos on the ground don’t pay for themselves, so there’s a bias to fly.  I understand it, but we all need to understand there are risks to everyone.

None of us like helos falling out of the sky, and it’s always going to be risky.  Steps should continue to be taken to mitigate risks in all transportation, but remember that all unscheduled travel is risky.

MedGadget’s SciFi Writing Contest Starts Today.

We are excited to announce the third annual Medgadget Sci-Fi Writing Contest! The competition is designed to present to the public talented writers, among our readers and beyond, who imagine the future of medicine through fictional stories.


Go there to read all about it.  I’ll be a judge again, and look forward to reading your excellent prose.

Great moments in bad customer service: DirecTV Style

Life’s been good to me, and today I wanted to upgrade two of my regular DirecTV boxes to HD boxes.  So, a call to customer service to get a couple.

(I had tried to do this online, but stopped when it wanted to charge me for an HD installation, which I already had: that should have told me the legendary DirecTV customer service was slipping).

The phone call started fine, through the phone tree that has very good voice recognition, and within a few minutes I was talking to a nice rep who knew her stuff.  She was unfailingly polite and professional throughout; this isn’t about an individuals’ poor service, it’s about a company that’s setting policies designed to drive away customers.

me: I’d like to upgrade two of my DirecTV receivers to HD, please
dtv: I’d be glad to help you with that.  Oh, I see you ordered an HD receiver last December, so I can only give you one.
me: Why’s that?
dtv: You can only order 2 in a year.
me: Why would that be?  I’ve never heard of a company that didn’t want business…odd.
dtv: It’s just the policy.  (appropriately business-polite expression of sorrow).
dtv: I can have an installer come out (second week of November) to do an installation.
me: Installation?  We’re swapping boxes.  I’m going to unplug one and plug in the replacement.  I really don’t need an installation.
dtv: It’s a no-charge installation.
me: It’s not about the charge, it about waiting two weeks for someone to swap a set-top box.
dtv: Your account isn’t able to have a drop-ship.  (Apologies again).
me: Well, let’s cancel this order while I decide whether to keep this service.
dtv: (in that ‘let me see if I can fix this’ voice’) Hang on just a second.
me: Ok
three minutes on hold here…
me: What are we waiting on?
dtv: I’m canceling your order.
me: You need me to stay on the phone to cancel my order?
dtv: Yes.  If you hang up your account information goes off my screen.
me: You’re kidding?
dtv: No sir.

I’d like to reiterate this isn’t the phone-persons’ doing (unless she really really misunderstands several policies, which I doubt), it’s about a company that has made some really bad choices about equipment, and set up some terrible customer service interaction software for their personnel.

I’ve got an email out the the good people at Weaknees for the same boxes (whom I should have turned to first anyway), so we’ll see.

Update: Weaknees sold me two, and assures me by email (after hours) that they’ll be activated without a problem. I suspect that’s the case. (They hadn’t heard of a limit on receiver numbers, either).

Who’s the most-kissed woman of all time?

Resusci Annie.  Hadn’t thought of that.

S. Weasel did, and her tale of the face of Annie is fascinating.  Enjoy it.

Gentlemen: Start Your Grand Rounds! // Emergiblog

Gentlemen: Start Your Grand Rounds! // Emergiblog
Welcome to the Emergiblog Speedway, where the Grand Rounds 500 is about to get underway! No chance of a rain delay – our bloggers are ready to roll!

Thirty-nine bloggers have shown up for the event. All entries have qualified; no posts were sent back to the garage.

Nascar analogy, from the Bay Area.  Heh.

GruntDoc readers deliver

Remember this, a couple of days ago? We needed some connections to get a SSGT with a family and a terribly shortened lifespan to have a special dinner with his girls at DisneyWorld.

You (err, one of you) delivered. Just now by email:

Great news Doc!

A woman called our Post’s answering machine and said, “I read about the SSG on GRUNTDOC which is a blog my husband reads. I have called my daughter at Marriott in Orlando, and she will get the family into a Complimentary Princess Character Dining. Her Name is (Sweetheart) and you can call her at xxx-xxx-xxx to set up a reservation.”

I called the number and spoke with (Sweetheart); and the girls will eat with some Princesses…

How cool is that? GRUNTDOC Rocks!!!

No, the readers (err, reader) rocks, but it could have been any of you nine, so thanks to all of you. I hope we’ll get an update about how it went. Even if we don’t, life is good.

Thanks, reader, whoever you are!

Happy First Anniversary, Lauren & Jeff



And best wishes for many, many more.

Why you need an ED Pharmacist


And yes, our intrepid ED Pharmacist was able to identify them.  Strong work! – Round The Clock Medical News Aggregator

If you’re like me, there’s never enough to read on the internet.

There’s now a cure, for the medical world at least: – Round The Clock Medical News Aggregator.

As introduced by Dr. Subrahmanyam Karuturi::

Medical Cavity is a one stop website for medical news worldwide. It is a
single web page which wraps up the latest headlines from the trusted
medical news sources worldwide. It gives you a quick glance on what’s
happening in the medical world. Medical Cavity is the starting point for
Doctors to navigate the world of medicine.

Website :

I salute Dr. Karturi, and will be visiting frequently.

The Happy Hospitalist: What Kind Of Patient Are You?

The Happy Hospitalist: What Kind Of Patient Are You?
So I ask the question, what type of patient are you? Are you contributing to the demise of the third party model so ingrained in our current culture. A third party model whose cost structure has risen exponentially due to rapidly rising costs on the few. A third party model who must pass on to others the costs of a few. The following is my breakdown of America’s patients, as seen from the door of the hospital room. What kind of patient are you?

Happy’s on a roll. Excellent summation.

Movin’ Meat: I was due

Movin’ Meat: I was due

Nothing good ever comes via certified mail, and it was with a sense of dread that I took the envelope, noting the return address from a law firm. I opened it and was hit in the gut by the block type at the top reading “NOTICE OF INTENT TO SUE,” with my name underneath.

Bummer. You’ll live through it, but it still stinks.

Anyone with DisneyWorld Connections?

Sounds like a good cause:

Hey Doc…

Can you help us? American Legion Post #1460, Machias, NY wants to get SSGT Robert Toland a Princess Tea Party with his wife and 3 daughters (all under 5).
He has Colon Cancer and expects to die before Easter.

We are sending him to Disney in Florida from November 3rd through the 8th (they’re doing an ‘Extreme Home Makeover’ of their own -GD). This will be the last vacation the girls have with their Daddy.

We want to get his family a Tea Party or Dinner with Cinderella. The cost is nearly $700.00 for the 5 of them, and unless someone pulls some strings…reservations are nearly impossible.
But, your blog has many readers…surely one of your subscribers can help.

Please do what you can…

For God and Country,

Kevin Haynes, Service Officer
American Legion, Post #1460
Machias, New York

In an email exchange, he tells me it’s not the money, it’s the arrangements with Disney for the Tea Party they need help with, and turned here because of our vast social network.

If you can help, drop me an email.

(Updated to spell the SSGT’s name right).

We’re All Dead … « WhiteCoat Rants

We’re All Dead … « WhiteCoat Rants
If you believe Michael Cannon’s article “Universal Coverage Kills” at the National Review Online.

It amuses me when people possessing little knowledge of the inner workings of the practice of medicine write articles as if they are “in the know.” Mr. Cannon’s article is one such work.

Nice rant, on point and on target.

iPhone Emergency Apps

From The Unofficial Apple Weblog:

Save a life with your iPhone or iPod touch

by Steven Sande on Oct 20th 2008 at 12:00PM

If you came upon someone who was injured or had suffered a medical emergency, would you know how to react? In the midst of a crisis situation, even citizens who have been trained in first aid sometimes forget what they need to do to help save a life.
Several iPhone apps are now available to give you a hand. PhoneAid, First Aid, and 1st Reponse: Emergency Kit are all designed to be at your fingertips in the event of an emergency. Although it might be difficult or impossible to read an iPhone screen and perform CPR at the same time, the apps can help you or someone else give instructions in a panic situation.

I’ve downloaded the three they mentioned, and will be giving a short review of them over the next few days.

Askimet: A bloggers’ best friend

Bloggers are afflicted with a lot of comment and trackback spam.  How much, you ask, thrilled at the concentrated navel-gazing necessary to care about such matters?


Thanks to the latest Askimet update, I can show you, in graphic form:



Yes, the pink part is spam, the blue part is ‘ham’. as they amusingly term actual, wanted comments. Additionally, they have this amusing explanation of the ‘ham’ thing:

What the heck is ham doing on my blog? I’m a vegetarian.

Spam most people know as the unwanted commercial comments on their blog, its counterpart we call ham to indicate legitimate comments. On the Akismet mistakes side, missed spam is pretty self-explanitory, but a false positive is what it’s called when we incorrectly identify a legitimate comment as spam. (Which hopefully happens exceedingly rarely.) Also, we’re sorry about the vegetarian thing.

Thanks, Askimet, from bloggers everywhere.  And a pox upon spammers.