Longer version: I got there yesterday, early enough to spend a couple of hours with a good friend, and completely accidentally ran into two of my residency buddies.

It’s an interesting phenomenon, and this was just like when I bumped into another at ACEP: it’s like talking to someone you last saw two days ago. It was nice to catch up with one, and I had a brief chat with the other (working a shift). I’ve known a lot of people, but it’s these residency colleagues that I have that really comfortable vibe with. I need to see them more than every 9 years. They’re good people.

Then a dinner with the faculty who trained me (and one new faculty who’s very cool), catching up on their families, the changes in the residency, just small talk. I haven’t enjoyed small talk that much in a long time. While it’s a different connection with the staff, we still have three years in common as they did their best to teach me something.

Then a fitful nights’ sleep after the obligatory final fiddling with the slides. An easy drive to the new (to me) beautiful campus for UCSF-Fresno, which is a giant improvement over the old one in the VMC/UMC building I trained in. (After I left they closed it, maybe in my honor, maybe not).

The talk: I talked about charting ER patients (for docs) in EPIC, which I know fairly well, a general overview of Scribes, then how we do things in my ED. I used the new Prezi presenter, and it worked very well, I like it and will use if from now on over Powerpoint. That said, I have to remember to write my talk in a really poor monitor resolution. My EPIC screenshot slides looked perfect on my monitor, but when turned down to something the projector would deal with they were mush. Very dissatisfying. (Not Prezi’s fault, mine). Did I mention I like Prezi?

The audience was roughly 30 people, mostly residents with some staff and some ER nurses to hear what I had to say about Scribes and how we do things. I had an hour and a half to talk, and about 30 minutes worth of slides. Fortunately there were a lot of questions, so I wasn’t left with a lot of time to kill.

When I talk about how we do things (from the doc perspective) in our ER it always gets attention, mostly because we have a system that flows well, is mutually supportive, and it works to the time and flow advantage of the patients and the docs. All of what we do depends on excellent nursing and hospital staff support, so this isn’t a doc only thing… I think there are parts of what we do that would be adaptable to a residency program ED, and some that aren’t.

I gave my unsolicited advice to the upcoming graduates (lease or rent for a year, don’t buy), and my talk ended well. Nobody booed.

Then a nice tour of the ED, a meeting with some honchos about scribes, and it was time to come home. Fun for me, very ego-flattering to be asked to go back to your residency and talk, and I enjoyed it.

Maybe in another 10 years…

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1. Fresno Trip I’m off to Fresno tomorrow, to give a chat about...

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Injuries sustained while riding Segway transporters are significant and on the rise, according to a study of emergency department visits published online in Annals of Emergency Medicine.

“The Segway may seem cool, but there’s nothing cool about a head injury,” said Mary Pat McKay, MD, MPH, FACEP, of George Washington University in Washington, D.C. “One-quarter of the patients who came to our emergency department with Segway injuries were admitted to the hospital. Forty percent of the admitted patients were admitted to the ICU because they had traumatic brain injuries.”

via Segway Scooter Injuries On the Rise; ER Docs Recommend Helmets.

Wow, sobering data.

I have enjoyed riding Segways, and if I had any use, any at all, I’d have one.  And a helmet, which I’d wear.

Segways are pricey, good helmets aren’t cheap, but the ER visit is going to bill out for about 15-30 really nice helmets, so get one, and wear it.

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There’s lots of ways to be an impaired driver: physical or mental fatigue, chemicals (legal and not), emotional extremes, etc. (this is not an exhaustive list).  What I want to focus on here today is a very controllable risk factor, divided attention.

A quick internet search turned up some original research from Car and Driver on the subject of texting while driving compared with actual alcohol impaired driving, and the results are shockingly worse than I would have thought.  From their (admittedly limited but well done) study, texting is way worse than being at the legal alcohol limit, both reading and writing.

How bad?  This bad (please read the article; it’s short, well written and will fill you with any leftover dread you don’t get from looking at their illustration):

I, like C&D, would like to point out that this doesn’t make driving under the influence okay, it doesn’t.  What it does do is put into perspective the astonishing diminution of skill with divided attention between driving and texting.  It’s 100 times worse when you consider that they knew they were being tested, and still had these results. None of us get into a car and say ‘my reaction times will be severely tested today, I must be hypervigilant’.

Apparently we should, and just drive with this in mind: everybody’s drunk, or worse.  (And pull over, park safely, then text – we’ll all be glad that you did)

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I’ve been fortunate enough to travel in and out of DFW several times recently.  I fly American most of the time, because I like to see just how small a seat I can get into, and guessing which terminal I’ll return to is unpredictable, which is what every traveler wants at the end of a journey.  Win win.

I’ve taken to snapping a photo of the nearest parking lot ID post.  To their credit, no “Itchy vs Scratchy” lots at DFW, and terminal D is well marked indeed:

You’re about to say ‘how can you forget where you parked’, and congratulations on your superior memory.  Me?  I have a picture to remind me.

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Today we had a series of lectures, ranging from the mildly to hyper liberal about healthcare policy, lobbying and reform. Interesting insight, and they’re all pretty sure heath care reform will pass, in some form. (Which is really really hopeful since there’s not even a framework bill out there to start with).

All we heard from are heartened that the big players that helped torpedo HC reform in the Clinton years are currently sitting at the table. They’re well aware that if too big a chunk is taken out of any of the players they can very quickly switch from participant to opponent.

I’m learning a lot about the process, and look forward to tomorrows’ talks.

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My hotel is very nice and is obviously on the main drag to the GWU ED, meaning sirens all night long. Not a restful night.

Sunday the whole class got together for a briefing on the schedule of events and the ‘order of battle’. It was politely pointed out that this is a ‘how policy is made’ seminar, and that the people we’re here to see care not a whit what we think, we’re here to learn how and why they do what they do. Actually I like that, keeping this from devolving into unwinnable arguments and internecine warfare.

Rumor has it Senator Kennedy is to present his Health Care Plan, which has been kept under close hold and not leaked, to date.

This evening we ate at Bob’s Chili Bowl (a local landmark), saw the African American Civil War Memorial then took the Metro to the Pentagon 9/11 Memorial. Wonderful memorial, and its designer is quite a genius. Beautiful.

The sign says “These people eat free: Bill Cosby and the Obama Family”. (Underneath is hand-written ‘But he paid’)

Two things: the Pentagon Facade changes color where it was repaired, and, the monuments face toward the building for those on the plane, and away from the building for those in the Pentagon.

this is how the individual names are memorialized

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We’re told these talks are under “Chatham House Rules” (which means off the record, but I need to look up the reference see the link) so I won’t be going into detail on who said what. I do intend to share the insights I can that interest me.

Stay Tuned.

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I am a TSA Test proctor and pilot who found this intresting. I contacted
TSA/Air Marshal Dept and this is what I was told.

Thank you for your inquiry of March 25, 2009, written to the TSA Contact
Center , regarding the status of the Federal Flight Deck Officer (FFDO)
program within the Office of Law Enforcement/Federal Air Marshal Service.

In the Washington Times’ recent editorial “Guns on a Plane”, several
unfortunate and untrue statements were made regarding the Transportation
Security Administration’s (TSA) FFDO program.  Although the editorial is
merely opinion, its inaccuracies may discourage those seeking to join the
thousands of pilots who have already volunteered to become FFDOs.  In fact,
the Washington Times recently printed a retraction stating the story was
published in error.

TSA has trained thousands of dedicated volunteers to become FFDOs, and they
are an integral part of our layered approach to transportation security.
There has never been a discussion or plan to end the program as alleged in
the editorial, and there are no plans to transfer funds away from the FFDO
program.

We appreciate that you took the time to share your concerns with us and
hope this information is helpful.

Feel free to pass this on.
-(redacted)

I looked, and yes, there is an editorial at the Washington Times stating the program not only has the support of the current administration but increased funds are being sought:

The Obama administration has no plans to end a program that trains commercial airline pilots to carry guns and thwart terrorist attacks, and in fact is seeking to expand resources for oversight and training, government officials and pilots organizations say.

And, to finish the meme, from the Federal Flight Deck Officers Association:

Your voices have been clearly heard in Washington, D.C., and last week’s Op-Ed piece in The Washington Times, combined with expressing your concerns to Congress, has yielded one of the greatest showings of support (to date) from the TSA to operate a successful FFDO program. The Op-Ed retraction in The Washington Times today was a direct result of a defensive TSA responding to the pressure placed on them by Congress, and they publically went on the record.

Good news, and I’m pleased.  I hope you are as well.

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Traffic deaths last year lowest since ’61 – CNN.com
(CNN) — The number of Americans killed on U.S. highways last year was the lowest since 1961, the Department of Transportation announced Monday.
The number of fatalities on U.S. highways dropped in 2008 to its lowest level since 1961.

Last year’s death toll was put at 37,313. In 1961, the number of lives lost was 36,285. The numbers were compiled by the DOT’s National Highway Traffic Safety Administration.

There’s no information in this about whether the number of miles traveled was guesstimated, and factored into the deaths per million miles travelled. 2008 was the big gas price run-up, which (reportedly) had most drivers cutting way back on their driving, which can be assumed would cut down on accidents just through subtracting drivers and miles driven.

We’ll see when the 2009 numbers come out. If the death toll is back up we’ll know it wasn’t seatbelts (though they no doubt helped, and I’m a big fan of seatbelt use).

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Yes, that’s really what appeared.  I moved it over to get the screen cap, but that’s the only change.

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