In case of a disaster, tip your servers

I was a local health department’s emergency operations center today, and I got to listen to a lot of different opinions on what to do in the event of an emergency or a disaster. The best comment from that discussion came from someone in the US Army. She said that, in the event of an intentional release of anthrax, she would give antibiotics to the people that make sure “clean water goes into my house and the dirty water is taken away.” I giggled for half a second and then it dawned on me that, yes, she was absolutely correct.

Think about it. If some biological weapon is released that is going to hurt and/or kill people — or if a pandemic comes around — is it really a good idea to start giving out medication or vaccines to “the top” of the social pyramid? Sure, you need a President, Congress, and the Supreme Court to operate, but the whole thing falls apart if no one is there to pick up the trash, wash the dishes, and fix the toilets. (It’s been my experience that politicians like to “crap things up,” not clean up crap.) Continue reading

Governor Larry Hogan of Maryland speaks of addressing heroin epidemic, but will he act?

Maryland Governor Larry Hogan presented his plan to address heroin addiction in Maryland yesterday. Unlike some of his more conservative counterparts, Gov. Hogan clearly stated that heroin addiction — like all addiction — is a disease, and that people with the disease need to be helped:

“”This used to be considered an urban problem, but it’s not anymore,” he said. All over the state, he said, local officials told him heroin had become their No. 1 problem. The governor said he felt a personal connection because a cousin died of an overdose a couple of years ago.

“I know the kind of devastation it can cause for families and communities, but still I was shocked by how widespread this problem had become,” he said.

Hogan said heroin was both a law enforcement problem and a health issue. “This is a disease, and we will not be able to just arrest our way out of that crisis,” he said.”

Continue reading

In case of emergency, check your ego

My wife and I were taking a vacation day in between two talks she’s giving, and we decided to stop at a local restaurant to have some food. We were eating the food, relaxing and having a good time. It was a warm, summer day, and we didn’t have a care in the world. Suddenly, one of the restaurant employees ran out and called for someone. That someone ended up being a young man whose aunt was in some sort of trouble. “Do I need to respond?” my wife asked. I told her I’d go check.

I got up and walked across the area where you order food and get your drinks to another area where people were eating. There was a group of people around a woman who was laying on a set of chairs, surrounded by people. I turned around, walked back to our table, and called my wife’s name. She bolted from her chair, handed me her bag, and went to the aid of the woman on the chairs. The woman had apparently passed out, lost control of her bladder, and was now vomiting and profusely disoriented. My wife, a physician assistant with tons of experience in urgent care and family practice, stepped in to help, but another woman there quickly announced to the entire room that she was a nurse and that she would be taking care of the woman.

I’m not going to second-guess the nurse’s actions. I’m not an expert. But I will tell you that my wife was not impressed. The nurse refused to let us put the woman on the floor. Instead, three people had to hold the woman on the narrow chair seats. Had the woman fallen to the ground, we’d have a whole other set of problems. Next, the nurse kept saying that the woman probably had a seizure. We asked the nephew if there was anything medically wrong with his aunt. He said that she had been complaining of vertigo because of the heat. Upon hearing this, I grabbed a dinner tray and started fanning the woman as hard as I could. With everyone around holding her, the air wasn’t circulating very well, and she probably had heat exhaustion or even heat stroke. Maybe she was diabetic and didn’t account for drinking fluids on a hot day when taking her medication. Finally, when the fire department arrived, the nurse called for an oxygen mask “at full blast.” Even without any emergency medicine experience, I looked at my wife in horror. Have you ever seen anyone puke into an oxygen mask?

It can get “soupy.”

The best part was that the fire department first responders, who arrived in a pick-up truck with lights and sirens and a medical go-bag, had no glucometer with them. No blood pressure cuff. No stethoscope. The paramedics arrived five minutes later, and we hoisted the woman onto a stretcher… Then we went back to eat after washing our hands. I could tell my wife was not happy. She told me that the nurse handled things in a mistaken way. I agreed with her that holding the lady on the chairs by four people in a hot room was crazy. And I agreed that the oxygen mask “at full blast” (how many liters per minute is that?) could have caused the woman to aspirate vomit if she had vomited into it.

But I have to admire my wife for stepping aside and letting the nurse do her own thing. It wasn’t a moment to start having pissing contests, but my wife was ready to step in and intervene if the nurse crossed any lines.

They say that the first rule of handling an emergency is not to panic. I think the second rule should be to know your own limitations. Then the third rule should be to be ready to step aside and let the adults handle the situation. And the fourth rule should be to get a good picture to post on Twitter. (Don’t judge me. I was just a human air fan at that point.)

Cardiopulmonary Resuscitation

You just never know when something is going to happen that will require you to act to save a life. You really don’t. I thought of CPR and First Aid as abstract concepts when I was in high school and was trained in them as part of a “magnet school” program for those of us interested in medical and scientific fields. We got to practice with dummies, but it was just that, practice. We mostly joked and laughed our way through the training, and I can honestly say that I learned nothing but how to dial 911 to get help.


What does “911” spell, anyway?
[do action=”credit”]Photo credit: zen / Foter.com / CC BY-NC-SA[/do]

My first real exposure to a situation requiring CPR came when I was in college and I was on my laboratory practicum rotations at a hospital. I went to draw blood from someone in the emergency department, and there were about 20 people working on a lady who was blue. The amount of organized chaos was impressive to me, so much so that I almost forgot to draw blood on the person a few beds down because I just stood there and watched the physicians, nurses, and techs try to save that woman’s life. What I remember the most was the forcefulness of the chest compressions being given by a tech and sounds of air going in and out of her.

Over the years, as I went from college to actually working at a hospital lab, I was more and more exposed to people in situations requiring CPR, but I didn’t do any of the CPR-ing myself. I was always the lab tech who took blood and ran off to analyze them. The chest compressions, breathing assistance, and drug delivery was left to others. Even my training then was laughable. We just stood around, did one or two rounds of CPR on a dummy, took a written exam, and then we were certified… All to meet the hospital’s requirements, but never really intended for any of us in the lab to do something with it. Saving dummies in dire straits was easy.

afterlife-1_l
Putting them together is a whole other thing.[do action=”credit”]Photo credit: bez uma / Foter.com / CC BY-NC-ND[/do]

And so it went for several years until I decided to pay attention to what I was doing with regards to CPR. I don’t know why. It just dawned on me that I would come upon a situation where someone would need my assistance, and it would be extremely embarrassing (not to mention dangerous to the victim) if I didn’t know my stuff. So I paid attention to the instructional videos, put a little more effort at the re-certification hands-on exercises, and ran the scenarios in my head over and over whenever I could.

(I’m not going to write about it right now, but all this came in very handy back at the end of April. That’s all I’m going to write about that, for now.)

Last night, I went to get re-certified in CPR, and, let me tell you, I was hurting this morning. It was a good feeling, though, because it meant that the practice rounds of the instruction were physically demanding, just like CPR is in real life. We went at it for three and a half hours, pumping the chests of those dummies and going through all the motions of actual CPR. We also didn’t put the dummies up on a table like all my previous classes. The dummies were on the floor, making it more akin to an actual situation. I had a hard time kneeling for that long a time and bending all the way down to deliver rescue breaths with a mask.

Not only was the training environment more real, the instructor was phenomenal. He had wide experience in the fields of public safety and emergency medical services, and it showed. It was his idea that we go through all the motions of CPR on the ground and in real time, which is why it took us over three hours to get the whole thing done… And why I’m hurting. I really appreciated that, especially in light of my recent experiences with medical emergencies. I really do feel that I’m more prepared now.

I am a strong proponent of First Aid and CPR training for all parents with children in the household, homeowners with swimming pools on their properties, and for people who care for people with special needs. I highly recommend it for everyone else as well. If you are interested in learning these valuable techniques, I recommend contacting the American Heart Association, the Red Cross, or checking with your employer to see if they have a way of facilitating your training. You never know if you’ll need it, but it’s better to know what to do and not have to than to have to do something and be lost in ignorance.