So today we did some airway, for the most part we focused on combitubes. The past days we did NPA and OPA, Some people in my class where unable to use the combitube, ( they where not even able to inflate the cuffs or even put it down the dummies airway)to me it seamed really easy, but so has most the stuff we have covered. (anyone here have the same thing happen to them in class, maybe its not to hard for me because we are not into the harder stuff) The class I am in is at my high school. So hopefully the people who are not grasping even the most simple of ideas in the class will not become emts. I would not trust my life with 1/2 of my class.
I leave you with this tree.........
I dont normally dwell on the death of my pts but in this case I just have to say RIP Phylis.
She was a remarkable pt. She never once complained about her treatments and when ever I had to deal with her she always had a smile and a thank-you in the end. You know you have the best pt in the world when you go into visit and the nurses are huddled together with straws to see who was going to get her that shift.
This lady always had a sense of humor no matter what was going on. She coined the new medical condition of "Tit Lash" and for those who are trying to figure that out it goes like this. Phylis what do you think the pain is in your chest? She states she has Tit Lash. Ok Phylis can you explain that to me. Well you know my daughter Laura drives way to fast and I was in the car with her one day, we were going around the corner so fast that my body went left and my tits went right. Now you have to undstand that this comming out of the mouth of a 73 yr old woman is very unexpected. I couldn't stop laughing with her, I had tears down my face and I had to put my glasses on top of my head. Minutes later as Im trying to compose myself I started to look for my glasses. Phylis asks what I'm looking for and I replied my glasses. She's says come here, so I do and she gently takes them off of my head and hands them to me saying "dont worry dear we all loose our glasses there" I now have an idiot string on my glasses.
Phylis passed away peacefully from lung ca on wed with her 8 children, and multiple grand and great grand children
I suppose I should just be happy to be alive and above ground. I never thought it would bother me... but one day you wake up and BAM! You're old
My dear ole Grandaddy used to say, "One day you'll look at the obits and say wow... look at all those old people dying. Then one day you look at em' and think... Wow... look at all the young people dying.
Never mind the fact that over the past few years gray hair began springing up. In fact, never mind that hair now grows in places that it shouldn't on an upright walking mammal. I didn't see it coming.
So I walk in to a a local fast food dive. I place my order and frankly, it was bad. Double bacon cheese burgers with a side order of fries should be something I left behind long ago, but what can I say? Anyway, the girl behind the counter looked up at me and said,
"Now we're money! We banging!"
I honest to God had/have no idea what that means. Now when I was growing up in my formative years (1985-1995), "banging" had a context that I sadly never found appropriate on the counter of a fast food joint... Or any fine dining establishment for that matter. Yet here I am, in the middle of a half full restaurant, apparently "banging in the money" with someone still in highschool!
I felt like Hank Hill at a rave. "Uhhh... that's nice. Could I please get my order and some ketchup"?
Yes. It was at that point I realized it. I am officially old. There is an entire new world and language I don't understand. I hate to say it, but admitting it is the first step in the program... I have become my dad.
Now I'm going to go lay in a fetal position and cry for awhile.
Employment for EMTs and paramedics is expected to grow by 19 percent between 2006 and 2016, faster than the average for all occupations, according to the Bureau of Labor Statistics. To help the increasing number of emergency services professionals, or those considering entering the field, learn more about first responder training, advanced cardiac life support (ACLS) certification, pediatric advanced life support (PALS) certification, and career opportunities, Health Education Solutions, the leading provider of continuing education solutions for healthcare professionals, today released a new First Responder Special Section. This series of articles, infographics, vignettes and important facts about first responder certification is available in Health Education Solutions’ online research library.
“As growing numbers of people join the ranks of this lifesaving profession, training and continuing education will become increasingly important,” said Melissa Marks, president of Health Education Solutions. “Whether you’re just entering the emergency care field or looking to update your professional skills, Health Education Solutions’ research library and online healthcare certification courses can help you stay equipped and informed.”
The special section is free for first responders, healthcare providers and individuals who simply want to be prepared to provide emergency care. Highlights include:
• Employment Outlook for Paramedics and EMTs
• Five Things You Should Know About Emergency First Response
• CECBEMS Approval Identifies Legitimate Learning Opportunities
• Solutions to Automated External Defibrillator Challenges
Health Education Solutions offers PALS, ACLS and basic life support (BLS) training for first responders and healthcare professionals, as well as first aid courses and CPR and automated external defibrillator (AED) training for individuals seeking to learn lifesaving skills. PALS and ACLS online courses were developed in partnership with Union College.
For more information, please visit www.healthedsolutions.com.
just stopping by saying hello to all i see the legal mongers are uppon us. really??? well not throwing in my .02 cents in but oh well. texas was a lesson learned, costly but learned things. now back an enjoying things. hope to chat with new and past members.
Yea, School, work, clinicals, and on call has me on very little sleep. I have sure learned the value of coffee and mtn dew. School is going very well though. I am in my last year of medic. I will be graduating in May and HOPEFULLY passing registry. It sure has been a long journey but fully worth it!!
As I have been thinking about where I want to go in my life, I have decided that I am going to go on to graduate school after I get my bachelors degree. For what you may ask? Well, I am going to go into clinical and research psychology. Yes, I will still work as a Paramedic after I am a therapist. There is no law saying I can't practice both. I am actually very happy with my decision. It seems like now that I have direction in life, I am focused once again.
Well I just wanted to update you all. Until next time, take care and stay safe.
ASH
I am currently working on a book that will feature stories from all over the US submitted by any emergency services worker (paid or volunteer) the book will carry the stories from scenes that have touched each of us in some way whether it be that it made you smile,made you mad,made you happy or sad or just left you trying to figure out WHAT just happened.it's ok if more than one person submits a story about the same scene because it touches each of us in different ways and the scene is viewed in different perspectives form each person on scene. I am looking for stories that in some way touched you, please include as much detail as possible but omit Names and actual identifiable information. all stories will be considered for publication, stories will be ran in their entirety and strictly in the submitters own words. please no profanity,racist,or political comments,for more info on where to submit stories contact me. all submitters will be notified at time of publishing.
Ten of the 20 fastest-growing occupations in the U.S. are healthcare related, underscoring the vital need for training and resources to support this expanding industry. To improve the educational experience for this critical population, Health Education Solutions, the leading provider of continuing education solutions for healthcare professionals, today released a new Careers in Healthcare Special Section. This series of articles, vignettes and important facts about careers in healthcare and continuing healthcare education is available in Health Education Solutions’ online research library. The 10-article special section is free for healthcare providers, first responders and individuals who simply want to be prepared to provide emergency care.
“In the healthcare industry, proper certification is vital to securing employment, and continuing education is integral to career growth,” said Melissa Marks, Director of Health Education Solutions. “Whether you're seeking to update your professional skills, or just want to be prepared for a medical emergency, Health Education Solutions’ research library and online courses make vital information easily accessible.”
The special section includes information about careers in healthcare, as well as information about healthcare certification, stories, how-tos and more. Here are some highlights:
• Thinking About EMT Training? How About a Career as an EMT?
• Traveling Nurses Can Keep Career Options Open with Online Certification
• Today’s Healthcare Profession – Job Trends and Opportunities
• Careers in the Fitness Industry: Interview with the International Health, Racquet and Sportsclub Association
Health Education Solutions offers online certification and recertification for advanced cardiac life support (ACLS) and pediatric advanced life support (PALS). ACLS and PALS courses follow the American Heart Association guidelines and were developed in partnership with Union College.
For more information or to access the online research library, please visit www.healthedsolutions.com.
Every year, about 785,000 Americans have a first heart attack and another 470,000 have a recurrent one. Healthcare professionals certified in advanced cardiac life support (ACLS) save many of their lives. Health Education Solutions, the leading provider of continuing education solutions for healthcare professionals, today released a new ACLS Special Section, a series of articles, vignettes and important facts about ACLS and ACLS certification, available in its online research library. The 10-article special section is free for healthcare providers and others who want to learn more about this important life-saving skill set.
"Now more than ever, busy healthcare professionals need easy access to training and resources that will help them respond to medical emergencies," said David King, president of Health Education Solutions. "Whether you're seeking to update your professional skills, need continuing medical education credits or require certification or recertification in ACLS, it's easy to get the vital information you need through Health Education Solutions' research library and online courses."
The special section includes information about the ACLS course, as well as stories, how-tos and more. Here are some highlights:
• Four Important Things to Know About ACLS Certification
• Your ACLS Study Guide: Three Keys to Success
• AED Training: Challenges to AED Use
• F.A.S.T. Stroke Assessment
• Heart Attack Symptoms Differ with Gender and Ethnicity
Health Education Solutions offers a variety of ways for healthcare professionals and others who want to be prepared for a medical emergency to master the skills they need. For example, the online Advanced Cardiac Life Support (ACLS) recertification and initial certification courses provide training in the key skills necessary to intervene when someone experiences a heart attack or other medical emergency.
Initial certification requires completion of an in-person skills test, whereas recertification is 100 percent online. Students have access to the course materials for 12 months after purchase regardless of when they take their exam.
Using a blended approach to learning, the ACLS course offers the convenience of self-paced study as students work toward certification and continuing medical education credits. Health Education Solutions also offers online certification and recertification for pediatric advanced life support (PALS). ACLS and PALS courses follow the American Heart Association guidelines and were developed in partnership with Union College.
For more information or to access the online research library, please visit www.healthedsolutions.com.
About nine percent of children who suffer from cardiac arrest outside a hospital and 27 percent of those who experience cardiac arrest in a hospital setting will survive—most of them thanks to a healthcare professional certified in pediatric advanced life support (PALS). Health Education Solutions, the leading provider of continuing education solutions for healthcare professionals, today released a new PALS Special Section, a series of articles, vignettes and important facts about PALS and PALS certification, available in its online research library. The 10-article special section is free for healthcare providers and others who want to learn more about this important life-saving set of skills.
“Pediatric emergency care requires a unique set of skills, as well as a strong understanding of the differences between caring for an adult versus a child or infant,” said David King, president of Health Education Solutions. “Whether you're seeking to update your professional skills, need continuing medical education credits or require certification or recertification in PALS, it’s easy to get the vital information you need through Health Education Solutions’ research library and online courses.”
The special section includes information about the PALS online course, as well as stories, how-tos and more. Here are some highlights:
• The Need for Pediatric Emergency Assessment
• Signs and Symptoms of Shock in Children and Infants
• The Three Most Common Causes of Pediatric Cardiac Arrest
• Not-So-Fun in the Sun: Summertime Months Bring Heightened Incidence of Pediatric Injury
• The What, When, Who, Where and Why of PALS
Health Education Solutions offers a variety of ways for healthcare professionals and others to learn the skills they need to be prepared for a medical emergency. For example, the online Pediatric Advanced Life Support (PALS) recertification and initial certification courses provide training in the key skills necessary to help a child experiencing a heart attack or other medical emergency.
Initial certification requires completion of an in-person skills test, whereas recertification is 100 percent online. Students have access to the course materials for 12 months after purchase regardless of when they take their exam.
Utilizing a blended approach to learning, the PALS course offers the convenience of self-paced study as students work toward certification and continuing medical education credits. Health Education Solutions also offers online certification and recertification for Advanced Cardiac Life Support (ACLS). ACLS and PALS courses follow the American Heart Association guidelines and were developed in partnership with Union College.
Through participation in the American Heart Association Enterprise Program, Health Education Solutions additionally offers Basic Life Support (BLS) for Healthcare Providers Online Part 1, Heartsaver® and stroke courses.
For more information or to access the online research library, please visit http://www.healthedsolutions.com.
Patient Assessment Practice Scenarios, American Academy of Orthopaedic Surgeons (AAOS), Les Hawthorne, EMT-P, Jones & Bartlett, 2010
And Essentials of Emergency Care: Refresher for EMT-B / Edition 3
by Daniel Limmer, Michael F. O'Keefe, Bob Elling, Edward T. Dickinson (Editor) with the cd
If you are selling either of these please let me know, my email is andy915@mycricket.blackberry.com I am trying to get a refresher for my basic and get better with patient assessment thanks
A sudden cardiac arrest victim's chance of survival falls seven to 10 percent for every minute of delay until defibrillation if CPR (cardiopulmonary resuscitation) is not provided, underscoring the need for training in this lifesaving skill set. Health Education Solutions, the leading provider of continuing education solutions for healthcare professionals and the general public, today released a new Heartsaver® Special Section, a series of articles, vignettes and important facts about the American Heart Association's Heartsaver® courses, including CPR and Automated External Defibrillator (AED), First Aid and Bloodborne Pathogens certifications.
The 10-article special section is now available in Health Education Solutions' online research library. It is free for healthcare providers, first responders and individuals who simply want to be prepared to provide emergency care.
"CPR and AED are important skills for not only healthcare workers and first responders, but also for child care workers, fitness and recreation professionals, and even moms and dads or anyone else who interacts with people on a day-to-day basis," said David King, president of Health Education Solutions. "Whether you're seeking to update your professional skills, or just want to be prepared for a medical emergency, Health Education Solutions' research library and online courses make vital information easily accessible."
The special section includes information and stories about first aid certification and other related topics. Here are some highlights:
• Eight Things NOT to Do When Performing CPR
• Heartsaver® First Aid and CPR at Home
• What Are Bloodborne Pathogens and How Do They Spread?
• First Aid at Work: Best Practices and Fundamentals
Through participation in the American Heart Association Enterprise Program, Health Education Solutions provides the cognitive portions of the Heartsaver® courses entirely online. The courses' web-based, self-paced modules offer a flexible training option for anyone seeking to learn lifesaving skills. Following the online course, students are required to meet with an American Heart Association instructor to complete a hands-on skills practice session and test.
Heartsaver® training for CPR, first aid courses and other American Heart Association certification options include Heartsaver® First Aid Online Part 1, Heartsaver® CPR and AED Online Part 1, Heartsaver® First Aid Online with CPR & AED Part 1 and Heartsaver® Bloodborne Pathogens Online. Other courses offered through the American Heart Association Enterprise Program include Stroke and BLS for Healthcare Providers Online Part 1.
Health Education Solutions also offers online certification and recertification for advanced cardiac life support (ACLS) and pediatric advanced life support (PALS). ACLS and PALS courses follow the American Heart Association guidelines and were developed in partnership with Union College.
For more information or to access the online research library, please visit www.healthedsolutions.com.
This isn't something I have ever really entertained no do I have in the least any respect for someone that cheats on their life partner, yet it seems to become pretty common practice these days to have a "romp on the side".
This conversation became the topic of discussion today after a friend seemed pretty upset. He explained that years ago his father had an office affair, although very fleeting, that his mother found out about. I must admit, his father would be the last person I would have thought to have an affair. He's the ultimate family man working hard so his family never has anything they need. In fact, they are the hardest people in this world to buy gifts for cause they have everything their hearts desire and then some.
He explained that his mother occasionally broaches this subject with it becoming more intense as the years have come and gone. Now it seems she's doing this with outsiders being in their company. Now I have worked in the Oil and Gas industry for the last 8odd years and know for a fact that very few of those guys are faithful to their partners. It's something I hate with a passion and loose all my respect for those that have affairs. Surely, and I might be old fashioned here, if you declare your love to a person in sight of God and the witnesses present you do everything in your power to keep that love alive?
While I know the blame isn't to be laid at the door of the cheating party alone, since a marriage or relationship is a two way street and I believe there's a reason the person goes out and looks for "new" meat. It still in my mind does not excuse the act of cheating. Surely if you are not "getting it all" in the bedroom you discuss this with your partner and find a solution that suits the both of you?
Now siding with either of the two people involved here will make or create one massive argument with my friend and being a lover not fighter I tend to avoid confrontation as much as possible. For years he "sided" with his mother wondering what she must have been going thought over the last years. Now it seems he's "siding" with his father. Saying and I quote "He's human, humans make mistakes. The man has worked his ass off to provide my mother with everything she wants in life. How long must he suffer for what he's done?" I suppose this would be one way of looking at, but I'm not completely convinced by his statement.
In my mind the ultimate betrayal of trust is cheating on your husband or wife. you place your future, your life, in the hands of the person only for them to basically throw it back in your face. in a sense it shows you that "you are not worth it" when it comes to doing what you can to safe your happiness and love. Personally I am more vengeful than I should probably be. I will not stand for anything like that. Had I had the proof and knowledge that my wife is or has been cheating on me, that will be the end of the relationship. Sure this goes against the "do everything you can to save the relationship" that I mentioned earlier mainly because I believe that once it's reached the stage of cheating, it's to late.
I will not go to any extremes though, I am not that type of person. I will simply collect my stuff and walk out. Maybe I am being naive in believing that the promise made to "love and to hold" should be a lifelong commitment that requires lots of work and even more communication. Either way, there's no excuse in this world to justify cheating on your partner. People don't simply fall in and out of love as it pleases them. To me, a person that cheats on their partner are lower than snake shit on the sea bed.
ok, I love barbeque. I love it. Can never have too much barbeque if it's done right.
I went to Sonny's bbq today during lunch. All was superb except the mild sauce, not my taste preference. The sauce just didn't tickle my taste buds.
What happened after lunch is what pissed me off.
I put 10.00 for a 7.82 meal. I tip good if the service is good.
I walk out, get in my car and the waiter runs out to my car saying I hadn't paid.
I told him I had and that I left a 10.00 bill on the tray with the receipt.
He said I didn't and asked me to come back inside.
I did. I showed him where I put the money and the tray was empty.
I argued the point that I had paid. The manager disputed it.
I said I'm not going to put any more money down. I said that either the waiter wasn't honest which I believe him to be honest or one of the scum sucking patrons that sat in the next booth took the money.
I said this loud enough for those aholes to hear me and none of them spoke up. I used that as evidence that one of them had taken it plus they were laughing.
I told the manager to call the cops as the 10 dollar bill had a specific marking on it.
The police arrive, the management would not allow any of the patrons near the table I sat at leave the restaurant.
Well needless to say, one of those dumbtards fessed up that his friend took the money. The officer did a frisk of the offending dumbtard and guess what - he got arrested for theft.
Now I have a court date in 6 weeks or whatever to be a witness. There's no guarantee that I will still be in this city or will be in another city at a different client.
The restaurant did give me the meal for free. I got my money back. I did give the waiter 3 in a tip.
for it wasn't his fault this happened.
Kudos for the local police to take this seriously, kudos for the restaurant manager for being a standup guy.
Screw you to the shithead who tried to make off with an extra 10 bucks.
Even though I don't like the sauce, I'm returning to that restaurant and using a credit card next time.
I have been doing some reflecting and thinking and if bathroom talk offends you then stop reading.
There is this one bathroom near the office that I work in in Lakeland Florida
It's a relatively busy office and hallway.
It's the only bathroom in the entire hallway and nearby area.
Why can I go to the bathroom and go pee every single time and nobody will come into the bathroom while I'm peeing. But when I'm trying to take a crap in private because nobody likes to hear someone in a public bathroom farting or making disgusting noises when the poop comes out. Why when I'm taking a crap does this bathroom suddenly become grand central station?
Take yesterday for example, Being a diabetic I go pee a lot what with the medications I take and then the amount of fluids (soda and water) I take in makes me go pee a lot. I pee'd over 10 times yesterday and not once did anyone come in the bathroom.
Well Metformin makes my stools quite loose sometimes and yesterday was just one of those days. Each time I went to go poop the freaking bathroom became a area of multiple arrivals. At one time there were 3 others waiting for the urinal and who knows who was waiting for the toilet. I don't understand it.
Does this mean anything in the grand scheme of things, nope but I can't help but wonder if there isn't a segment of society that has to go to the bathroom when they see me walk in the bathroom?
Blessed Redeemer by Casting Crowns
Up Calvary’s mountain one dreadful morn
Walked Christ my Savior, weary and worn
Facing for sinners death on the cross
That He might save them from endless loss
Blessed Redeemer, precious Redeemer
Seems now I see Him on Calvary’s tree
Wounded and bleeding, for sinners pleading
Blind and unheeding, dying for me
“Father, forgive them,” my Savior prayed
Even while His lifeblood flowed fast away
Praying for sinners while in such woe
No one but Jesus ever loved so
Dying for me
Oh how I love Him, Savior and friend
How can my praises ever find end
Through years unnumbered on Heaven’s shore
My songs shall praise Him forevermore
This song says it all. I can't imagine what Christ went through during his trek to Calvary's Tree but it had to be more than anyone that I know of or anyone out there at all could bear.
To be more like Christ, I try to be but this just humbles me.
So last night I had my second sleep study. Now I'm asking for help because I just don't know enough on this topic. Let me go ahead and spell some things out: I'm a 24 year old 200pound female. Most of that weight is in my legs. I'm athletic. I ride 6 miles everyday on bicycle, run around with my kids, run up and down the stairs at work on break because I like to, etc. I don't just sit around and eat. In fact I even pack my lunch so I don't go out to the closest fast food place. I'm not going to claim I'm an olimpian I'm far from that. Just saying I'm not a lazy slob.
Well got some results from the first sleep study I did.... Ya it was bad, In fact it was scary. It was a WTF?!? I had 30 episodes of sleep apnea an hour. Most of which were obstructive. Ok so ya it suddenly hit me that this, "unneeded cpap test" might be needed alittle more. When the place told me I had to go in again they made it sound like they were being over causous and I barely had any. I almost didn't go in again. Glad I went with the, "My insurance covers it 100% so might as well" style of thinking. Anyway I digress. My tech then tries to say that for some reason he doesn't know the computer is saying I owe a $1000 but not for taking the test. :: draw huge question mark over head now:: We're guessing it's why the corperate office tried to call me a second time on Friday but by the time I could call back they were gone and closed for the weekend. We're also guessing it would be to buy the mechine. That makes sinse right? Well because we're budget freaks we didn't pay up and I'm going to be bugging the corperate office on Monday.
Well I get home today and being the research person I am I'm trying to find out more about OSA and Cpap machines. (Any help in this would actually be nice. So I make sure I'm understanding what I'm reading. Like I said I'm a research person.) I even find the exact one I was hooked up to last night and the exact mask. The total with shipping: $608... Ok so we have almost $400 unaccountible dollars between those too prices... Um am I missing something?
Ok the rambling gypsy is done.
Alright. So, it's been a while since I wrote. Let's heavily update you on the situations that prevent me from coming around.
First and foremost, as of Janurary 2010, EMT Martin was upgraded to EMS Lieutenant 6B. I got a nice promotion by the new EMS Chief for being such a hard worker. She recognised that I not only go on just about every call...but I know what I'm doing. That's a definate.
I also caused a lot of problems at the squadhouse. How so? Well, in less than a year of being an EMT, I became a Lieutenant. :I
Not kidding. That causes people to go "HE DOESN'T KNOW WHAT HE'S DOING!!!"
Well, prove it. Not only can I quote jurisdictional protocol like it's my favourite movie/book, but I haven't found a time yet where I had someone hounding me for doing something wrong and giving a patient the wrong treatment.
With this new update in my official title, I also garnered...a new set of balls! I know, it's not polite to say that, but...I finally found my voice when I got the promotion. Before that, I would never have dared to say anything that might cross another person in the squad. I let them walk on me. Now? That's all changed. I'm tougher now, know what I'm talking about, and can successfully give someone the royal flipoff like they do to me.
Looking foward to next month. Finally going to be taking IV-Technician classes. Can't wait for it. I'm hoping adding that to my list of accomplishments might help me in the private transpourt sectour. I can cross my fingers, at least, right? We'll see what happens. Maybe...I might just finally get that lucky snap I've been looking for.
That's it for my minour updates. Thanks to you all for still checking in!
- EMS Lt. 6B
x)
I saw this on Charlie Daniels myspace page a little earlier and for those of you who arent really sure who Charlie is well he is a damn good american and a damn good musician. Anyway he has recently been publishing his thoughts on the political turmoil and in his words lack of patriotism going on in this country. The title of this blog was Wusses on the left of me and P****** on the right of me (censored if ya want the real title email me or pm me) anyway I have to say that I live in an area that is close to a Naval Base and well...most of my best friends are military and there parents were/are military and you know what those of us in America couldn't do have the shit that we do right now if it wasnt for the military. So my theory is that be you for it or against it you really should support this military of ours seeing as they are the ones who allow you to say what you say.
Now onto more parts of this blog post. I am a child who was just prior to the gray area of morals and the I grew up to "Remember the Alamo" and you know what I havent forgotten how it felt that day, and I will always remember where I was when the world stopped turning. It seems to me that some people have including our illustrious Commander in Chief.(more on that in a second). I remember the 343 that died that day and they were american heroes. I remember that first hand. I remember learning about JFK. I remember reading about the great things that FDR did including mobilizing a country for war. I remember reading about the decision that Harry Truman had to make as to wether the Atomic bomb should be used or not used. What would have happened if he had decided to not use it how would the war have changed? These are indeed heroes of our country and yet there are more before the days of Davy Crockett before the days of Abraham Lincoln. American history is littered with great decision makers. Now I will probably be called a racist for this but I am gonna bring this up anyway....not to mention this a slightly hot topic. If we have a crisis the likes of these that I have just mentioned how is Barack Obama going to cope with it, I mean with all due respect to him he is a commander in chief who has never even been in the military let alone commanded anyone. Can he handle the stresses of sending people off to war or are we going to just cower in fear. With people like Nancy Pelosi giving POTUS his marching orders I fear we may or even worse we may even bow down to them. I mean after all Obama has already bowed down and kissed the queens hand.
Anyway this is just the beginning of this series I need ot go to bed it will be continued in the days to come.....
Tyler
I am boycotting Mother’s Day this year.
This year, I have been dreading Mother’s Day more than I usually do. I see the cards, I hear the commercials “Buy something for your Mother…” “Thank your mom…”
I have always avoided church on Mother’s Day. I can’t sit through the whole “Mom’s are such a miracle…” It isn’t that I am not glad to have a mom. It isn’t that I am not proud of my sisters and friends who are moms. I just can’t face the pitying looks and the “aww, don’t you wish you had kids” crap that well-meaning people say.
Yeah, I wish I had kids. I always wanted children. I wanted a houseful of children… but due to medical issues, I was never able to have children. So, when those well-meaning people give me the “D.I.N.K” JOKE (must be nice to be double income, no kids) I don’t find it funny. I also don’t find it funny when people assume that we chose not to have children.
I think people have their heads up their ass when they give the line “oh you can adopt” – yeah? Have you tried it? Guess what – when we were young enough to adopt, our lovely adoption services here had a waiting list of 11 years – that’s right, 11 years, if you wanted a “normal” child, and 3-4 years, if you were willing to take a disabled child. Even then, that was no guarantee. We looked at private adoption, but waiting and hoping to be approved, and then paying between $10,000 and $15,000 in legal fees, just didn’t seem right. Also, in the province of Alberta, at the time we were looking, the birth mom had 6 months to change her mind, and take the child back. This happened to someone very close to me, and I saw how it ripped them apart, losing the child they had waited for for so long, and who they had opened their home and hearts to, and then to lose the child back to the crackhead birth mom at 6 months less 12 hours, just because she was the “mom” solely by being able to spawn a child.
And this year – this year is worse. My mom passed away in January. My mom, who was the best mom in the whole world, the bravest woman I have ever known, the woman who was such a role model of courage and quiet strength, is gone. My mom, who was always there for me as a child, as a rotten teen (sorry, Mom) and throughout my adult life. And what makes it worse, I was the one who had to make the decision to remove her from life support. Yeah, I know that clinically, it was the right decision, but emotionally, it was a lot harder than I thought it was going to be. I know she didn’t want to be kept alive with a ventilator and drugs and cardioversion… that isn’t living. Not for this woman. But dammit, that really sucked. And it still sucks. And I am still mad, and hurt, and feeling guilty, for making that decision, even though I know deep down it was the right one…
And dammit even more, I REALLY MISS her. I miss our daily phone calls where we talked about nothing and everything. I miss being able to tell her about my day at work, and listen to her tell me what she did that day. I miss going shopping with her, especially to the garden centre to pick out new plants each spring, and I miss going to her doctor appointments with her. I miss listening to her talk about how proud she was of all her grandchildren, and the two great-grandchildren who were of course the two cutest little girls in the world. I miss how she would always just have to say a couple words to make me believe that I could succeed, and how she would always be the cheerleader for anything we kids wanted to do, whether it was sports in high school, events in university, and applying for jobs or changing careers.
Dammit Mom, I wasn’t ready for you to be gone.. I will never be ready… and I really really miss you… and I just want to be able to say “I love you” one more time… So when I hear the jewelry commercial that says “Tell your Mom you love her….” I really really hate that commercial…
So this year, I am boycotting Mother’s Day.
Throughput and bogdowns in the Emergency department Part 1 Recently I spent some time with a good friend Kourtney Govro of SphereOne out of
Kansas City, Kansas and some members of her company discussing Emergency departments and what their biggest challenges are relating to throughput. What causes the most headache causing bogdowns and system halts? This by no means was an easy task nor did we decide we had all the answers. What we did decide is that whoever can leverage the knowledge of how to reverse or fix the bogdowns seems to have the market to themselves. We decided to focus on the top 5 throughput areas and what can be done to fix the slowdowns. Today I will focus on one of those areas and give some concrete ideas on how to begin to address the fixes. Like any ED in the country, understanding the slowdowns is one thing, putting the fixes into place, is definately another. I will focus on the area of triage as one of the biggest slowdowns in the Emergency department. First a definition of triage is in order. Triage: sorting and allocating aid on the basis of need for or likely benefit from medical treatment or food (wordnetweb.princeton.edu/perl/webwn)
The military which is the originator of the triage system as we know it today puts triage down as this: evaluation and classification of wounded for purposes of treatment and evacuation; immediate sorting of patients according to type and seriousness of injury, and likelihood of survival, establishment of priority for treatment and evacuation.
www.army.mil.nz/footer-links/about/glossary.htm
For the typical emergency department, triage is the way that patients are classified according to severity to facilitate the flow of those said patients through the emergency department with the least possible interruption of said care. Wordy definition which one can boil down to these simple words - allowing the sickest to be seen first. Slowdowns revolving around triage seem to fit this mold. One triage nurse for many ill patients. The bogdown occurs as follows. Patient A arrives to the ER with a complaint of an illness. That triage nurse will bring patient A into the triage area (usually a private room reserved for triage purposes) and will begin to ask all the pertinent questions. Depending upon which triage system you use the patient will be triaged to either ESI level 1 through 5 or the 5 categories of triage (Emergent, Urgent, Non-urgent, Catastrophic or None - these seem to be military based for the last two) but for sake of argument they could be classified as Emergent, Urgent and non-urgent. Assume that some departments will add a category or two such as Critical or Semi-urgent. Whatever triage system you use, you expect it to work the same way. The bogdown occurs when multiple patients come in at the same time or within a short period of time and your single triage nurse cannot keep up. So what do you do? The simple answer would be to add another triage person to lighten the load. Sounds simple but is it truly the right thing to do? Do you staff that 2nd person 24 hours a day. There may just be a few times during the day that require a second person.
What are some of the other alternatives?
Here is what some of my discussions with others in the field have told me.
1. Provide alternative patient registration models. Do you require a number of questions that have to be asked of every patient or can you streamline the questions to a certain few. Do you really need to capture in triage the last time they had a flu shot or pneumonia shot? Do you really need to capture the last time they were seen by a physician? Can these questions be better asked elsewhere in the patient treatment process. What questions are the minimum types of questions on the triage form. The minimum number of questions that should be asked on the triage evaluation will be the number that makes sense to your organization. Taking out even 1 or 2 questions could decrease the time spent on triaging each patient. By all means, do not remove questions just to remove them. The removal has to make sense.
2. Do you open a secondary department for the clinic style patients? The ones who meet ESI level 4 and 5. Can they safely be moved to a off site clinic that can better meet their needs. If your department is overwhelmed with ESI level 4 and 5 patients at certain times of the day, what is the option of opening a fast track and or minute type clinic. These patients would still have to be triaged but once the nurse determines that there are no life-threats and no injuries that would require the full focus of the emergency department then those patients could safely be moved to another style clinic or treatment area that would be better suited to take care of them. This all depends upon cost and space constraints but one suggestion put out there is to take one of your ER non-urgent rooms and make it a fast-track room. Staff with a PA or a NP and a nurse and you effectively have added a possible decrease of triage bog-downs.
3. Are there triage protocols in place? Can the patients who meet certain criteria be triaged out to their physicians office. A patient who presents with a cough or cold like symptoms having been going on for a week more than likely meets the criteria to be seen in their personal physician’s office. The caveat here is what does their personal physician say about this thought process. In the emergency departments that I’ve worked in, the patients that fit this criteria are at the emergency room because their physician cannot get them in on that day.
4. Who do you allow to perform the triage exam? Do you require a nurse only or can other staff members such as LPN’s or Paramedics. This goes directly against what some of the professional nursing groups say is a national standard but can you train your LPN’s or Paramedics to ask the same questions every time, go down the same criteria list each time and can those ancillary staff members do as good a job as nurses can. If your organization is comfortable enough to allow those types of staff members to perform triage you can effectively staff two lower level staff members for the price of one nurse. Not a popular idea in many areas but take if from the author here, it can be done, it can be done well and it can be done with minimal if no adverse effects on patients. Our facility has been using paramedics and LPN’s and even EMT’s to triage patients for years and it truly does work well.
5. Immediate Bedding. For the times that your ER is not busy, do you rely on the triage nurse to triage everyone or can that triage nurse immediately bed a patient and have the staff nurses in the ER begin the treatment. Consistently the immediate bedding has shown in patient surveys that this is a good thing. The triage nurse can quickly do the triage and initial registration or quick-reg and then return to her duties in the triage area awaiting a new patient. If the triage nurse is on break or in the bathroom or getting a drink, do your nurses in the ER go get the patient and bring them back to a bed if one is available or do they tell the patient to “Fill out the form and someone will be with you in a few minutes”? Immediate bedding of all patients is a easy way to increase patient satisfaction(the patient believes they are being seen right away), a decrease in the triage area and a decrease in the length of time that they have to wait to be seen or treated. This is a win-win situation for all.
There are many more variables which affect patient throughput throughout the emergency department.
On a future blog I will continue this discussion on the triage process and how can we improve the speed in which patients get triaged and put in a room. What are the minimal number of questions that should be asked on a triage questionnaire? What triage system should be used? Future blogs will also focus on how to help physicians increase their throughput and how to increase satisfaction of the patients by implementing certain technological advances or gadgets.
Thank you for
Reading.
The author, Michael N. Ruff EMT-P, MPM has over 17 years of emergency department experience with direct patient care in the emergency department for 8 of those years. Michael has also implemented the Cerner emergency department system in multiple hospitals across the country. Direct observation of these departments as well as discussions with nursing staff at those departments have allowed me to gain a insight as to what nurses and staff members want over a broad geographic area. What is remarkable is that any staff member in emergency departments across the country wants the same basic things. Nurses from Colorado Springs are not that different from nurses in Jacksonville florida nor are their needs different from nurses in New York City.
Tonight I spent some time in a Church in Lakeland Florida meeting one of my new favorite authors. He wrote a short book called “A Knights Quest” which has messages in it that are timely and forever. That’s not what I’m writing about though. I spent time in their bible study and this changed my outlook on things. This study tonight was the 2nd to last study in a series by John Maxwell, called “How to Empower Potential Leaders”.
Tonight was on empowering people and principals that Mr. Maxwell has developed over the years in his times being a pastor and inspirational speaker. Here is what I learned.
The leadership lesson learned tonight that focused me was this, Those close to me determine the level of my success. What you see in a person is what you get from the person. There are three essentials to lead people that are close to you. Evaluating people, equipping people and empowering people. Evaluate the person, find their abilities and then determine whether they match the needs of the organization, Equipping people is to provide the person with education and teaching along with the tools they need to help the organization and finally EMPOWER them by giving your influence over to them for the purpose of their personal growth as well as the growth of the organization.
So how do you empower someone? Maxwell gives 7 steps to empower others. Each step is denoted by the letters in EMPOWER.
1. Evaluate them. Do not empower people recklessly. Do it with purpose I in mind.
2. Model for them – people respond better to one who models the behaviour that you wish to instill in them.
3. Pray over them. If one who you are trying to empower says something to you that you feel deserves or needs a prayer, pray for them/with them right then. It’s amazing what a 30 second prayer can do to empower someone.
4. Open you life to them
5. Walk alongside them, walk their journey with them
6. Express your belief in them – tell them every day that you believe in them.
7. Release them – let them loose and run on their own.
A quote Maxwell gives is this “The person who knows how will always have a job… but The person who knows why will always be the leader.”
An empowered leader is a effective leader. Does your leader pass these tests? In Acts Chapter 6 verse 1-7 we find these 7 tests that Paul give us.
1. The influence test – Select from among you
2. I was unable to get this one written down
3. The Credibility Test – Are they men/woman of good character
4. The spiritual test – are they full of the Spirit
5. The administrative test – do they have the wisdom
6. The servanthood test – “whom may we put in charge of this task”
7. The attitude test – are they full of faith?
The three questions which must be asked in an empowering relationship. Do they have the knowledge to do what the is required and in addition, do they know why it should be done. Do they know how to accomplish what is required and are they accomplishing it? Do they have the motivation to get it done? If you cannot say yes to the above then is empowering being done?
Evaluate yourself as a empowering leader: Maxwell gives 10 questions to ask yourself as that empowering leader. These were put together on napkins and legal pads by Maxwell over the years. Rank yourself from 1 to 10. 1=never 10=always
1. Do I believe in people and feel that they are an organizations most appreciable asset.
2. Do I feel team leadership can accomplish more than individual leadership?
3. Do I pray for potential leaders and quickly assimilate them into the organization? I need to add something here – Maxwell said something that sticks with me. He said that God will send you the caliber of person based upon the size of your need. If your need is small (let’s say a level 2 need) God will send you someone of level 2 caliber. If your need is leadership in a Men’s ministry and your need is GREAT – then with prayer and God’s guidance – he will eventually send you what kind of leader you need. God does not waste his resources.
4. Do I desire to raise others above my own level of leadership?
5. Do I invest time developing people who have leadership potential?
6. Do I enjoy watching others get credit for what I taught them?
7. Do I allow others the freedoms of personality and process or do I have to be in control?
8. Do I give my influence publicly to potential leaders as much as possible?
9. Do I plan to have other take my present position? Am I willing to turn over the reign to another person?
10. Do I hand-off the leadership baton to a teammate and truly cheer for them?
What are the barriers to empowerment?
1. Job security – “What am I going to do next?”
2. Love for Position “I enjoy my role, perks, etc.”
3. Resistance to change – “I like it the way it is”
4. Lack of Confidence – “Who else can do the job like me”
5. Loss of Investment – “I’ve put too much into this organization to let it go”
6. Fear of Retirement – “Me, retire?”
7. Self Worth – “This role is my whole life”
So how do we empower people. We model empowerment to them.
“People do what people see”
“Empowerment is transferral and this first step in the process is visual. Empowerment is more visual than most things. Not what you say, but what you do. How you walk, how you carry yourself. People who empower have a sense of confidence.
What attributes do others see in an empowering person or leader?
1. Provide security – they feel safe with empowerers.
2. They are charismatic
3. They have passion
4. They are anointing
5. They have a sense of success
6. They have tremendous humility
What can we do to empower others. Number 1 thing is to Pray over them. You pray for the people you are working with and who you are empowering. Charles Spurgeon was asked about his success – he replied “My people pray for me”
Every empowerment program will begin with motives. Good empowerment programs begin with the right motives. Poor programs begin with the wrong motives.
Of course there was more to this message and study but this is what I gleaned from the 35 minute video tonight.
