Ammunition and the Firefighter

It’s about 4 years old, but I think most haven’t seen this by SAAMI, the sporting arms and ammunition manufacturer’s institute:

It’s 25 minutes but it’s informative and entertaining (though it’s a little hard to watch all that ammo being destroyed).

Yes, the VA is without doubt the model for American healthcare

Well, let’s consider their actual track record:

Shot:
The Pentagon reported Friday that 265 active-duty service members killed themselves last year, continuing a trend of unusually high suicide rates that have plagued the U.S. military for at least seven years.
http://www.usatoday.com/story/news/nation/2016/04/01/us-military-suicides-remain-stubbornly-high/82518278/

 

Chaser:

A VA suicide hotline designed to help distressed vets, at times instead sent their calls to a voicemail message, provided no immediate assistance, and did not even return some calls, according to a new report. … The crisis center was recently the focus of a HBO documentary praising the workers’ tireless efforts to help vets. The film, “Crisis Hotline: Veterans Press 1,” even won an Oscar last year.
http://www.cnn.com/2016/02/18/us/va-crisis-line-report/

A former Marine intelligence officer told the Senate Veterans’ Affairs Committee on Wednesday he waited more than a year for care, and when he finally saw a VA psychiatrist, he was prescribed a medication for depression. When he reacted poorly to the prescription, however, he was not able to make a follow-up appointment for another two months.
http://www.militarytimes.com/story/military/benefits/veterans/2015/10/28/report-vets-still-face-long-waits-mental-health-treatment/74734474/
Two former Minneapolis VA employees … say they were instructed to falsify records to make it look as if veterans were canceling or delaying appointments, a practice they allege allowed VA managers to hide long appointment delays. … Investigators have said efforts to cover up or hide delays were systemic throughout the agency’s network of nearly 1,000 hospitals and clinics.
When Anthony McCann opened a thick manila envelope from the Department of Veterans Affairs last year, he expected to find his own medical records inside. Instead, he found over 250 pages of deeply revealing personal information on another veteran’s mental health.
http://www.npr.org/sections/health-shots/2015/12/30/461400692/patient-privacy-isn-t-safeguarded-at-veterans-medical-facilities
One complaint against an employee found they accessed a veteran’s medical records—in violation of the Health Insurance Portability and Accountability Act—61 times. The employee even posted the private medical information on her Facebook page and “discussed it with her friends.” … The only punishment this employee received was a two-week suspension.
http://observer.com/2016/01/this-couldnt-have-been-a-more-scandalous-week-for-the-veterans-affairs-department/

Katherine Mitchell, a VA doctor in Phoenix, said that shortly after she complained to the Veterans Affairs inspector general about safety concerns, the department punished her, citing patient privacy.https://www.washingtonpost.com/politics/federal_government/va-uses-patient-privacy-to-go-after-whistleblowers-critics-say/2014/07/17/bafa7a02-0dcb-11e4-b8e5-d0de80767fc2_story.html

The Department of Veterans Affairs has not listened to whistleblowers or protected them, and it also has not punished employees who tried to stop or interfere with whistleblowers, according to a letter the U.S. Office of Special Counsel sent to the White House and Congress on Thursday.
http://www.cnn.com/2015/09/17/us/veterans-affairs-whistleblower-osc-findings/

Last May, a three-judge panel of the United States Court of Appeals for the Ninth Circuit accused the department of “unchecked incompetence” and ordered it to overhaul the way it provides mental health care and disability benefits.
http://www.nytimes.com/2012/03/25/us/recent-california-suicides-highlight-failures-of-veterans-support-system.html?_r=1

A study by a VA researcher found that veterans with PTSD were nearly twice as likely to be prescribed opioids as those without mental-health problems. They were more likely to get multiple opioid painkillers and to get the highest doses.
http://www.wsj.com/articles/SB10001424052702304672404579181840055583388

We gathered data from five of the states with the most veterans. We found they are dying of accidental narcotic overdoses at a 33 percent higher rate than non-veterans.
http://www.cbsnews.com/news/veterans-dying-from-overmedication/

“Veterans are now required to see a prescriber every 30 days, but at the El Paso VA, they are unable to get an appointment, so they go without, or they do something they shouldn’t — they buy them on the street.”

“The VA let them get wound up on all these drugs and now they cut them off completely. … These guys are coming into my office and they are a goddamn mess and the VA is just blowing them off.”
http://www.startribune.com/cut-off-veterans-struggle-to-live-with-va-s-new-painkiller-policy/311225761/

HT: Tig (thanks, brother).

How long do condiments last?

Some good info here:

Honey, salt, sugar: Indefinite

Tabasco sauce, pepper, vinegar: 3-4 years

Jelly in plastic tubs: 2-3 years

Olive oil, parmesan cheese, taco sauce, mustard, soy sauce: 1-2 years

Mayonnaise, relish, barbecue sauce, tartar sauce, horseradish sauce, maple syrup, nut butters, salad dressing, ketchup: 1 year

ZDogg sings about stroke

It’s good!

Follow him on twitter, @ZDoggMD or at this blog ZDoggMD.com

Pearl Harbor Day

December 7, 1941. 74 years ago.

If you meet a Pearl Harbor vet, thank ’em. They’re pretty rare (an 18 year old then would be 92 now…).

Thanks to our Pearl Harbor vets.

Happy Birthday, Marines!

SemperFi

I post this every year, and I still enjoy it…
original poster from: stores.ebay.com/WONDERFULART

Happy Birthday to our youngest, latest in a series (and an Aunt!)

Happy Birthday, sweetheart! We wish you all the best.

Here’s a nice throwback birthday post:

We love you a lot! Your life has progressed in the last seven years (see the following post), we’ve been happy to have raised you (so far), and we wish you the best. First year out of the teens. Congrats. Still can’t drink.

Looking at the blog I found this trip down memory lane turned up this ‘gem’ from several years ago:

Today’s the first day of teendom for my littlest girl. She still talks to me, and that’s encouraging, but usually only about horses, or how much she loves horses, or how I should get her a horse.

Tonight we were eating TCBY, and I commented how tall something was. “It’s about 13 hands” was her reply. Horse crazy.

However, no horse this year, and she’s OK with it (though secretly resentful, in the way I still am that I didn’t get either an airplane or a motorcycle for my 13th birthday).

Happy Birthday, sweetheart

Happy Birthday, honey, from all of us. You are loved more than you can know.
[Read more…]

How ER docs actually process what we do

A remarkably good blog post from Seth Treuger ( @MDaware on twitter).

The classic model of history, physical, testing, diagnosis & treatment does not apply to us. I think we do 3 things in emergency medicine:

  1. Resuscitation
  2. Risk stratification
  3. Care coordination

Resus is the fun sexy stuff that we stay up late at night having twitter arguments about. As much as I love ketamine, I can go a number of shifts without using it, and very little of what we do is resus. Most of what we do is risk stratification and care coordination.

Read it. It’s good.

 

When healthcare is literally legislated

Hint: it’s not good. A terrific article from Weingart and Faust.


If the drafted CMS measure goes into effect, we are hosed. Because data will be collected retrospectively, hundreds of patients will be deemed severe sepsis who were never actually sick.

Government organizations do not invent this stuff. Behind every measure there is, somewhere, a group of physicians that made it happen. Just as medical malpractice would not exist without plaintiff witnesses, these measures would not exist without us. Let’s fight back before it is too late.

Hint: it’s too late. Enjoy the people who wrote the tax code legislating your care.

 

Dragonfly

I’m not a book reviewer but when I read one I want to share I’ll tell you about it. 

This is one for a small audience, those who are space junkies who don’t know a ton about the U.S. Mir space missions. It’s very well written and well sourced, the author having gotten a lot of access to NASA and Mir astronauts  and the myriad people who support them. 

I’m told by a friend who’s briefly mentioned in the book that the author began as a rah-rah angle but soured on NASA and that probably explains the more than warts and all presentation.  It’s not a hatchet job but it’s not a recruiting too either. It reads quickly, and the quirks of astronauts of both countries are very interestingly laid out. 

Oh, did I mention they had both a fire and a rapid decompression while NASA was aboard?

Well written, reads well. Recommended. 

  

Nursing Homes are restarting the ‘don’t send the MAR’ game

For a primer, from 2007, here.

Another patient, another absent MAR (if you don’t know that acronym, you didn’t read the lead in article!). Usually they send when we call, but not recently. Here’s an amalgamation of some cases:

Calls are made by the nurses at my behest. The MAR Will Not be Sent.

Per nursing, whom I work with daily and trust implicitly, here are the objections proffered:

1) It’s illegal to send our signatures
Really? No, it’s not.

2) It’s our policy not to send MAR’s
Good luck with that policy. It’s going to get you in trouble.

3) You don’t need that.
As it’s a patient who has a) gotten meds from you and b) that timing is a question and c) we don’t know what the timing is, yeah, we and the patient you sent to us need that.

4) We sent you a med list
Yes, you did. That’s a List of Meds, but we don’t know what’s scheduled, PRN, given, held, parameters, etc. That’s a dodge.

Allow me to quote me:

This is outrageous. A chronically ill patient is sent to a higher level of care for an acute problem, and without a complete information base; but not just that, information crucial to the care of the patient that’s being intentionally withheld.

It is a situation that makes me, frankly, nuts. When did intentionally withholding critical patient care information become acceptable? Seriously, have these people not learned from history? The coverup is always, always worse than the crime, and is looked upon less favorably and punished more severely that any original offense. You could ask Nixon, but he’s dead.

Send me all the info you have, and our patient will live or die based on their problem(s); withhold information I need, and it’s on you, Nursing Home nurses.

– See more at: http://gruntdoc.com/2007/06/nursing-home-mars-sent-to-the-ed-with-all-times-removed-a-new-and-horrible-trend.html#sthash.k1mXnxiK.W4zJDG1c.dpuf

And if you’re from the Texas NH Regulatory agency that emailed me after the first posting, please recontact. I’m ready to send you some facility names going forward.

How teleconferences really go

This is way too true.

 

America’s Emergency Physicians

Really good video!

VP Biden’s best speech

Joe Biden isn’t my cuppa tea.

Yet, his talk to TAPPS is the best contemporaneous speech by a Pol to military families who lost family members in combat. I now like him much more.

Happy Birthday Dad!

Thanks for not killing me all those years ago.

m&d