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Monday

Protecting At-Risk Populations

Protecting At-Risk Populations: Here is a great story...perhaps the best way to better hold off the spread of  H1N1 or any other disease. CNN is reporting on a crew of volunteers going out to the streets to vaccinate homeless persons against H1N1. Taking the vaccine to the streets, along with any type of treatments, will almost certainly keep the infection rates down and may prevent spread of the disease.

Lets remember that the homeless population includes many who have issues with addiction or mental illness in addition to co-existing medical conditions. This situation clearly makes the homeless population at greater risk.

Friday

Air Terror Attack

I've suspected something of this nature would be happening and have been following events the mainstream media has not been covering. Tonight, 12/25/09 we have striking developments from Detroit...
MSNBC is reporting that a Nigerian man attempted to detonate or ignite a powdery material on a Northwest airlines flight today.

At the same time, CNN is reporting that this incident took place at the end of the flight from the Netherlands to Detroit and involved fireworks or fire crackers of some type.

While the latest Reuters report out of Washington and being carried locally here in Rochester, NY,  has the White House confirming a more serious event...calling it an act of terrorism.

Interestingly, we've been talking about several instances occurring on commercial airliners in the last few weeks. These events seemed to involve threatening or hostile-like actions on the part of passengers appearing of Middle-Eastern dissent. I've called them "probing" events - those events used to test our response to and actions during an event and just talked about them in MJ#140 on the podcast. They have received scant media coverage and what has been covered has received a glossy political correct finish. While supposed eye-witness accounts and the "official" airline accounts differ in degree of severity, its important to note that seemingly everything that can be done to discredit those concerned (civilians) who bring this issue up.  The National Terror Alert is linking to an article published by the American Thinker that you should read. They do a nice job of piecing the commonalities together.

While all the details are yet to be known, we have to ask what type of explosive or device could get past TSA? We'll be increasing our security for sure. More to follow.

Wednesday

Cardiac Arrest Survival: Thirty Years of Change without any Changes

Cardiac Arrest Survival: Thirty Years of Change without any Changes...Yes, you guessed it. I going to take yet another shot at the American Heart Association. UPI is reporting on a study by the University of Michigan that states cardiac arrest survival rates have not changed in thirty-years. This despite all the CPR and ACLS cards issued to and paid for by emergency service responders.

The study concluded the chance of surviving an out-of-hospital cardiac arrest has not improved since the 1950s. As quoted from the original UPI article:
"Increasing bystander CPR rates, increasing the awareness and use of devices to shock the heart and keeping paramedics on scene until they restore a person's pulse needs to occur if we are ever going to change our dismal survival rate," Dr. Comilla Sasson, the study's lead author, said in a statement.
Now lets take a look back...how many CPR changes have we seen...all with a new book ($$) and another class (more $$)...and can someone tell me why we have to PAY for CPR training? How about all the "research" that causes us to change the procedures we do (advanced airway, for example) or the medication changes we have to endure. High dose Epi, Vasopressin, Amiodarone, Verapamil, bicarb or not, Lido or not...in what order...and don't forget...the research (sarcasm) will tell you that everything you know and have been doing will be totally wrong and deadly tomorrow! So run out and take another class and buy another book. Because you can see the results of all the cardiac arrests we saving.

Too many systems still gauge effectiveness based on cardiac resuscitation rates. Nothing could set us up for failure more than this unrealistic expectation. Why do we expect responders to show up and correct decades or a lifetime of disease that caused the cardiac arrest? We'll work on a cardiac arrest victim for a while with limited resources in the field and then turn them over to the ED. Yet, if they don't walk out of the hospital...we didn't "save" them. How can this make any sense?  A majority of what Paramedics carry in terms of medications and equipment is aimed at the cardiac arrest patient.

And despite what we know and do, we're not making much of a difference.

Monday

Air Medical. At What Cost?

I have the deepest respect for my colleagues who work in the air medical arena. I also have little doubt that air medical transport with helicopter and fixed-wing aircraft have saved untold numbers of lives throughout the Country. In general I support air medical, albeit with some reservation on the use of helicopters.

I've written about the potentials of landing a helicopter at your emergency scene or on the roof of a hospital (a totally bad idea as far as I'm concerned) and you can read my comments in Mitigation Journal http://mitigationjournal.blogspot.com/2008/05/helicopters-and-hospitals.html one persons opinion may be that helicopters and operating with lights and siren are the two biggest contributors to EMS LODD...maybe they should be avoided...and at all costs, keep your helicopters off of and away from your hospitals!


Todays posting is going to look at another, less deadly impact of air medical transport...cost. MSNBC is running an article with focus on the cost of emergency helicopter transport and the health care system. According to MSNBC, the cost of this service can be anywhere from $12,000 to $25,000 and that cost may not be covered by insurance. Sure, we can't put a price on a life...and I would certainly pay that amount and more for any of my family...gladly. I think what is at issue here is the fact that these flights are not always deemed appropriate. Even in the setting of trauma other alternatives to air medical transport my have provided the same outcome at a fraction of the cost.

Another issue is choice. Victims of trauma who are in serious condition may not have the capacity to provide informed consent for air transport. The public is trusting the emergency responders to make the best choice for their care. Transport mode should be a decision, like any other, made carefully and with the patients best interest in mind. In these cases the "customer" has little choice. And on that note, please remember we treat patients...not customers. Read my comments on the word "customer".

So let this one sink in a while. When is air medical helicopter really needed? How can this service be put to best use...when should it be avoided? Patient condition, injury severity, distance to definitive care, and weather conditions are just some of the points to ponder. Now we have to add in cost...or better stated; cost effectiveness. Will air medical transport make a difference in relation to the non-covered cost in relation to ground transport alternatives.  More to follow on this...and I welcome your opinion.