Blog break

This blog is taking an extended break while I concentrate on other priorities. Blogging will resume (hopefully) at some yet-to-be-determined time in the future.

In the meantime, since influenza is in all the headlines right now, here’s a selection of past entries about flu and flu vaccine:

- We all know someone who’s been sick with the flu. But is it really influenza, or is something else? Read more here about Influenza’s identity crisis.

- Remember the H1N1 flu virus? Was it all Much ado about nothing, or was the public health community simply being prudent about a potentially serious disease threat?

- By now, many of us have heard that flu shots aren’t as effective as they could be, and it’s fueling a certain amount of skepticism over the value of annual flu shots. In defense of the flu vaccine explores some of the research on attitudes and beliefs about the flu vaccine.

- Does age have anything to do with how we view influenza? Read about what happened during the H1N1 outbreak when Generation X met the flu.

- Swine flu, avian flu, H1N1… Even when it’s a new type of influenza, the lessons are invariably the same.

- If you didn’t get a flu shot this past fall and plan to do so now, here’s a rundown of the vaccination options that may be available (ask your health provider which one is best for you).

- Finally, we could all do with a gentle reminder about the low-tech but effective practice of washing our hands.

Despite taking a break from blogging, I may not be able to resist posting new entries from time to time. Readers are invited to check for updates.

A blogiversary, and lessons learned

It dawned on me this weekend that as of Dec. 1, this blog has been around for four years.

That’s hardly a milestone occasion like a five-year or 10-year anniversary would be. But in the here-today-gone-tomorrow world of blogging, a blog that’s been around for four years is… well, relatively ancient.

I did a quickie Google search some research and came up with this tidbit about blog longevity: Worldwide, 60 to 80 percent of blogs are either abandoned or updated infrequently within a month of being created. According to the folks at Squawkbox, “This means that the average lifespan of a blog is equal to that of the common fruitfly.”

So a fourth birthday is a pretty good deal, I guess.

Four musings on the occasion, one for each year, in no particular order of importance:

Health is universal. It affects people’s lives in many ways every single day, from how they communicate with their doctor and whether they take their pills to what they eat, how well they sleep and how they cope with stress. Health is often scholarly and academic but it also intersects with popular culture. There’s never a shortage of topics to blog about, and it’s always interesting to see how the issues resonate with readers.

Blogging is demanding. Fresh content is what drives traffic to a blog and keeps readers coming back, but it’s a constant challenge to feed the beast. Most bloggers will tell you that sustaining the mental and creative energy for it, along with the time commitment, isn’t easy. I used to blog an average of three times a week; now I’m down to twice a week which seems somewhat more manageable.

Audience reach is surprising. In the beginning, most of the readers here were local. Now they come from all over, and local readers are a minority. (Hello out there, everyone!) Belonging to the Forum Communications Co.’s Area Voices online community has been a tremendous help with visibility. Most bloggers like some reassurance they’re not just talking to themselves. Area Voices has increased this blog’s exposure in ways I could never have accomplished alone.

Blogging is rewarding. When you have a passion for a topic, such as health, blogging about it isn’t work; it’s satisfying and often fun. It’s especially rewarding when readers leave comments sharing their own thoughts and insight and experiences. The conversation becomes better, both for readers and for me.

Now let’s blow out the candles and have some cake!

Linkworthy 4.0: The overdue edition

I’m way overdue for another edition of Linkworthy, my semi-occasional collection of links to interesting health-related stuff recently encountered on the web.

Besides, it’s time we all moved on from the Hatfield-McCoy post, which has accumulated several thousand hits since being published three days ago and is perhaps in need of a rest. (I’m just sayin’.)

Regional news first: The latest issue of Prairie Business Magazine includes a cover story about the use of high-tech diagnostic imaging, how the technology has evolved and how it’s being used in daily care. As a bonus, there’s also a story exploring the demand for doctors in rural health.

Did anyone catch the news earlier this week about a proposal by Michael Bloomberg, mayor of New York City, to ban extra-large soft drinks? On the surface, this might sound like a good tactic in the so-called war on obesity. Many people are questioning, however, the likelihood that a ban on large sodas will make much difference. The critics have weighed in here and here. The most colorful quote probably comes from the online commenter who opined that “we are like a bunch of lemmings headed for tyranny.”

Speaking of obesity, few people could have failed to miss the recent news about a study that discovered exercise does not in fact benefit everyone. Researchers analyzed six earlier studies and found that in about 10 percent of the participants, heart-related measures such as blood pressure, insulin level, cholesterol and triglycerides worsened with exercise.

The spinmeisters have been hard at work. Some are pointing out, and rightly so, that this was only one study – and a relatively small one, at that. Others worry that folks will use it as an excuse to avoid exercise. What this study really seems to be saying, however, is that we need to be careful about cookie-cutter assumptions that a particular intervention or lifestyle is always good for everyone, because often there are exceptions to the rule.

After blogging about three years ago on needle phobia, I heard from a couple of people who have this fear and who felt their anxiety often wasn’t taken seriously by health care providers. So I was intrigued to come across the news that MIT has developed a high-powered liquid injection device that squirts a thin stream of medicine directly into the skin.

According to the developers, it’s so fast and precise that it can barely be felt. But it’s a little premature to hope the device could be coming soon to a health facility near you. The injector device is still in the prototype stage and hasn’t yet been tested on humans. There’s also the not-insignificant matter of cost. Nevertheless, it’ll be interesting to see whether this Star-Trekkian concept catches on.

Most of us have probably heard about Munchausen’s disease, or Munchausen by proxy, in which people go to great lengths to fake illness in themselves or someone close to them. Now it seems there may be a new version of this behavior: Munchausen by Internet.

A rather chilling story from the BBC News Magazine details the behavior – and impact – of individuals who go online and convincingly pretend to be sick or to have someone in their family who is sick. Some of these hoaxes can be incredibly elaborate – for example, a woman in the U.S. who faked having cancer, HIV, anorexia and heart problems, and went so far as to post online pictures of herself in a hospital bed with an oxygen mask and feeding tube.

Many fakers seem to crave attention, and the Internet is the ideal medium for their manipulations, the article notes. “It gives the perpetrator a quick hit of attention, a feeling of being valued, but without really having done anything to deserve it. Just as online fraudsters dream of easy money, these people crave easy attention. And it is, perhaps, just another form of fraud – emotional, rather than financial fraud.”

Consider setting aside a chunk of time for the final piece in today’s series of links, an in-depth look at the huge global business of tobacco smuggling. Cigarettes are the most widely smuggled legal substance in the world, generating multibillion-dollar profits, fueling organized crime and corruption, and diverting much-needed tax revenue from governments.

Since 1999, a team of reporters with the International Consortium of Investigative Journalists has been examining this issue. They’ve just published a new series of reports, assembled by journalists from 15 countries, that takes a look at the influence of organized crime and terrorists groups as well as “the continued complicity of distributors, wholesalers, and tobacco companies themselves” in the illicit tobacco trade.

Most people are likely unaware of the impact of tobacco smuggling, its ties to crime and its impact on developing nations where cigarettes increasingly are being introduced and sold on the black market. This ambitious news project explains what’s happening and, more importantly, why it matters.

Blog break

New entries here will be rather sparse for the next two weeks while the blogger takes a long- overdue break. More frequent posting will resume at Halloween or thereabouts.

Readers are invited in the meantime to check out the archives and browse through some of the older posts. To get you started, here’s a selection of some that have been the most popular over the past three years.

- Readers seem to respond to blogs that are about food. “Deep-fried everything on a stick” was a blockbuster when it was published back in August, just in time for the Minnesota State Fair and its menu of deep-fried cheese curds, candy bars and cookie dough. There’s still hardly a day that goes by when I don’t get at least half a dozen site visits because of this entry.

- Anything to do with pets is popular too. I was a little late in stumbling across a study about the health hazards of sleeping with the family cat or dog (the study came out in January 2011 and I didn’t blog about it until a month later) but the topic was too good to pass up. Here it is: “Sleeping with the dog? Bad human!”

- One of the all-time most read posts on this blog explored the issue of marriage and its impact on health. “Wedding ring = better health?” You be the judge.

- I’m a little surprised at how often people continue to read “When the patient is a no-show.” This post was published in March 2010; well over a year later, it’s still generating site visits. I’ve even received a couple of emails (one of them from Finland) from people who are researching the topic of no-show patients and are looking for sources of more information.

- I had fun writing “That twin thing.” Part psychology, part popular culture and part personal experience, it was one of those posts that just wrote itself. (My twin sister enjoyed it too.)

- Speaking of popular culture, “Reality bites,” another ancient post from two years ago, still turns up quite frequently among my stats. Who knew five minutes of watching “Wipeout” would provide something to blog about?

- And to wrap this up, a couple more posts that have turned into the blog equivalent of frequent fliers: “Farmville, Angry Birds and other online compulsions” and a medical trivia quiz (the answers are posted here).

LInkworthy 3.3: Dog days

Had enough of the hot weather? Ancient Romans called these the dog days, named after Sirius, the brightest star in the Canis Major constellation, which was ascendant in late July and early August and was believed to turn the weather hot and sultry. Find an air-conditioned place away from the heat, thunderstorms and mosquitoes to peruse this latest edition of Linkworthy, a roundup of reading material recently encountered on the Web.

- Why are so many medical practices and hospitals lagging when it comes to implementing electronic medical records? The reasons are explored in an in-depth article recently published by the Center for Public Integrity, which takes a look at the experiences of individual clinicians as well as the overall policy issues surrounding health technology.

As the article makes clear, it’s more than simply installing a computer in every doctor’s office and at every hospital bedside. Here’s one of many reasons why it’s complicated:

The decision to purchase one of these systems is complicated because they do much more than picture a paper record on a computer screen. They handle more than a thousand details, including a patient’s medical history, current diagnoses and prescriptions. They also have the kind of interactive “real time” features that work almost like computer games: when certain information is entered, the computer talks back with questions, alerts (such as an abnormal lab result), reminders, new screens or choices that demand a response.

Patients might consider all of this the next time they see their doctor or nurse using an electronic medical record – or a paper chart, for that matter.

- Some years ago I spent a day tagging along with the unfortunately-now-defunct Rural Health School, a program of the University of Minnesota that provided intensive, hands-on education on rural health issues for students in the health professions. Part of the day included a couple of hours with a Willmar Police Department crime prevention officer who shared statistics about violence against health care providers and how to stay safe.

It was pretty eye-opening for most of the students, who may not have realized the risks they can face. An article published this past weekend in the Los Angeles Times reinforces this vulnerability and the inadequacy of many health organizations to deal with it.

The story opens with a rather graphic example of violence in the hospital: “The patient was drunk, naked and covered in blood when he burst out of his emergency room cubicle around 2 a.m., brandishing scissors. He lunged at two nurses and began chasing them. It took two police officers and three zaps from a Taser to subdue him.”

According to a 2007 survey in California, nearly 40 percent of emergency room staff said they’d been assaulted on the job during the previous year. Another survey, conducted last year by the Emergency Nurses Association, found that more than one in 10 emergency room nurses reported being attacked at work within the previous week.

Because statistics aren’t well tracked, it’s not clear if violence against health care workers has been on the rise in recent years. The evidence seems to point in this direction, however, and the article explores many of the contributing factors: shortages of appropriate mental health care services, the public’s simmering frustration with the health care system, inadequate training for health care workers on how to recognize a potentially violent situation or how to protect themselves if things escalate, and an underlying belief that a certain amount of violence just comes along with the job.

- What would you do if you faced a $9.2 million hospital bill? The bill, for the care of a young woman who died two years ago at Tampa General Hospital in Tampa, Fla., appears to set the record for the largest hospital bill ever in the United States.

Tameka Jaqway Campbell died from a severe and progressive neurological disease. The $9 million has been billed to her estate. Her mother has refused to pay and has accused the hospital of inappropriate care.

There are at least two important issues entangled in this story: the need for health care costs to be transparent, and the state of palliative care in the United States and how we care for patients when death is the inevitable outcome. Whether Tampa General Hospital will ever collect on even a portion of this bill seems doubtful; even if discounts are applied, the total could still come to $2.25 million.

- When it comes to health care news, does the public want to know about the uncertainties and the complexities or do they want it short and simple? Based on a recent series of conversations with journalists, hosted by the Center for Advancing Health, the preference appears to be for the latter.

Journalists said they’re often encouraged to avoid ambiguity and to choose stories that readers want rather than stories they need, Jessie Gruman writes in the Prepared Patient Forum.

But in the long run, is this best for readers? We may want our health news to be simple, Gruman writes, but if consumers are to be expected to truly participate in their care, what they need is information that’s both accurate and complete.

- Finally, a medley of entries from the health blogs: Why kids often hate sports physicals; the importance for hospitals of paying attention to how the doctors communicate; and a thought-provoking reframing of the obesity-as-public-health-crisis issue.

Image: “Starry Night over the Rhone,” Vincent Van Gogh, 1888.

Linkworthy 3.2: the midsummer edition

Ah, midsummer. What’s not to like about long June days? Grab your lawn chair and laptop for this latest edition of Linkworthy, a roundup of thought-provoking and/or interesting items encountered recently online.

- What do you say to someone who has cancer (or any other serious disease, for that matter)? “You look great” and “What can I do to help?” are not on the most-recommended list for Bruce Feiler, who vented in last week’s New York Times about “‘You look great’ and other lies.”

What’s wrong with “You look great”?

“We know we’re gaunt, our hair is falling out in clumps, our colostomy bag needs emptying,” Feiler writes. “The only thing this hollow expression conveys is that you’re focusing on how we appear.”

He suggests helpful things to say instead: “I should be going now.” ”Would you like some gossip?” “I love you.”

Feiler’s essay seems to have hit a nerve. More than 160 readers responded with their own experience and insights. An especially thoughtful reaction came from Lisa Bonchek Adams, a blogger who has been on the front lines of breast cancer. The problem with lists of what not to say, she writes, is that one size doesn’t fit all – and if people become too self-conscious about saying the wrong thing, they may withdraw altogether:

In those cases you may lose people who may have been well-intentioned. Sometimes forgiveness and compassion need to go out from the person who is sick and not just flow to them.

People who’ve known me for a long time know that I had non-Hodgkin’s lymphoma several years ago. Probably my least favorite on the list of what-do-you-say was “Call me if I can do anything” because it was so vague. What if the one thing I needed most was someone to change the cat litter? Would the response have been “Sure, great!” or would it have been, “Eewww, no thanks”?

People who made non-specific offers of help invariably meant to be kind and supportive, however – and that’s what counts. It seems wiser to cultivate gratitude for people’s good intentions, even when they’re sometimes clumsily expressed, than to react with eye-rolling or annoyance. (Readers are welcome to share their own thoughts in the comment section.)

- “Give doctors a break,” implores Dr. Elaine Schattner, who blogs at Medical Lessons. Her plea is prompted by ”a heartless op-ed” by Dr. Karen Sibert, a Los Angeles anesthesiologist, who asserts medicine cannot be a part-time endeavor.

Is this yet another round in the mommy wars, or is the deeper issue one of balance between work and the rest of life?

The huge investment in a medical education confers some responsibility to use that education to benefit patients, Dr. Schattner writes. But what if a physician truly needs to cut back her hours or stop seeing patients altogether? Macho attitudes about medicine can put tremendous and ultimately harmful pressure on doctors, she writes. “A flexible, more realistic system would allow doctors, in whom the system has invested so much, and who have invested so much of themselves, to take time off when they need it, and flexibility in their schedules, so they can continue in their careers after prolonged illness.”

Other reactions to Dr. Sibert’s op-ed can be found here and here.

- Good news for those of us who can’t imagine life without a companion animal: A new study published in the Clinical and Experimental Allergy journal has found that the presence of a dog or cat in the household doesn’t increase children’s risk of developing allergies.

Researchers followed a cohort of children from birth to adulthood, checking in periodically to collect information about their exposure to dogs and cats. At age 18, 565 of the study participants gave blood samples that were analyzed for the presence of antibodies to dog and cat allergens.

Interestingly, the results suggested that being exposed to an animal during the first year of life seemed to be critical – and that for some people, this early exposure may actually be protective.

The men in the study who lived with an indoor dog during the first year of life had about half the risk of becoming sensitized to dogs as those whose families didn’t have a dog. Both men and women were about half as likely to become sensitized to cats if they lived with a cat during the first year of life.

- How much do you think it costs for adult children to be caregivers for their aging parents – $10,000? $50,000? $100,000?

A new study by MetLife calculates the total: a collective $3 trillion in lost wages, pension and Social Security benefits for those who take time off work to care for their parents. On average, women lose $324,044; for men, it’s $283,716.

The researchers analyzed data from the National Health and Retirement Study to assess how much caregiving is provided by baby boomer adults for their older parents, its impact on their careers and the amount of potential lost wages and retirement benefits.

Among other findings from this study: Adult children 50 and older who both work and provide care for an older parent are more likely to report their health as fair or poor than those who don’t combine work and caregiving. The percentage of adult children providing personal care and/or financial assistance to their parents has more than tripled over the past 15 years and currently represents 25 percent of adult children, primarily baby boomers.

A key conclusion of the report is that workplaces need to become more flexible and adopt policies that support working caregivers. The report also points to a need for more resources to help middle-aged caregivers with retirement planning and stress management.

- Other worthwhile reading: GeriPal, the geriatrics and palliative care blog, reflects on “Lessons I Learned by Examining Miracles.” A compelling story from CNN examines miscarriages and when they become something that requires deeper medical investigation. The latest issue of Proto, the magazine of Massachusetts General Hospital, contains several intriguing in-depth articles. If you have time to read just one, check out “Foreign Bodies,” a fascinating and creepy look at the strange things people swallow and the early-20th-century laryngologist from Pennsylvania who amassed a collection of swallowed objects. The article includes an online photo gallery that will make you think anew about the hazards of swallowing foreign objects.

Photo: Wikimedia Commons

An invitation to Grand Rounds

Grand Rounds, n. A formal conference in which an expert presents a lecture concerning a clinical issue intended to be educational for the listeners. In some settings, grand rounds may be formal teaching rounds conducted by an expert at the bedside of selected patients. – Mosby’s Medical Dictionary

Each Tuesday the health care blogging community holds Grand Rounds, a weekly collection of the best of the blogosphere. This week’s edition is hosted by the Center for Advancing Health of Washington, D.C., and includes a post that recently appeared in this blog.

Grab yourself a cup of coffee and head over there for a few hours of excellent reading from a diversity of writers/bloggers. And be sure to browse through the CFAH site itself to learn more about the Prepared Patient Forum, the Good Behavior! series, the Health Behavior News Service and other tools and information found on the site.

Photo: Wikimedia Commons

Everyday heroes

When you’re a member of an ambulance crew, you never quite know what your day will bring. These are medicine’s everyday heroes – the emergency medical technicians and paramedics whose work is stressful, demanding, exacting, skilled, professional and rewarding.

What is it like to spend a day in their shoes? To mark National Emergency Medical Services Week, we’re taking readers behind the scenes today with live guest-blogging by the Willmar Ambulance Service at Rice Memorial Hospital. Follow us from 7 a.m. to 7 p.m. and see how the day unfolds as entries are live-blogged continuously throughout the day. Readers are invited to ask questions or provide feedback via the comment section below; the paramedics will try to answer as many of your questions as possible. Be sure to check out the links posted above to learn more – and visit us often during the day for live updates.

7:03 a.m.: Good morning, everyone, this is Brad Hanson, the operations manager for the Willmar Ambulance Service. I will be blogging with you today as we respond to calls and bring you up to speed on a day in the life of a Willmar paramedic.

I am just heading into the office after helping my wife get the kids up for the day and off to school and day care. As the manager, I have a take-home paramedic vehicle so I can always be available if there is a major incident or have to cover call in town due to our crews being busy on other calls.

Our service responded to over 2,600 calls last year, so we have some very busy days where all five of our ambulances are being utilized. You may have seen one of our big blue ambulances in the community!

I am looking forward to giving you an inside look today, so let me know if you have any questions!

7:34 a.m.: Well, looking back over the night shift we have already been a bit busy. As I was saying earlier, I am on call pretty much 24/7. As I was making breakfast for my wife with my 8-year-old daughter this morning (we decided we were going to serve breakfast to her in bed since today is our 14th wedding anniversary), my wife Michelle was awakened by my cell phone ringing. One of the crews called regarding a transfer to St. Cloud, as they were just finishing up an intercept call to Atwater. I will explain intercepts more later. S0 much for the perfect surprise breakfast in bed…

Oh well, we had a good breakfast, and in reviewing the night I remember hearing several pages for the crews since 11 p.m. I counted five with the transfer. It makes for a long night and morning for the crew that started last evening at 7 p.m. Looks like it’s going to be a 16-hour shift for Jim and Keith. This also leaves us a bit short in town so only one crew now until 9 a.m., then back to two. Let’s see how the rest of this day goes.

7:59 a.m.: Checked in with the new 0700 crew, Lonnie and Jim B., today, having a bite of breakfast, then on to rig checks.

Our mornings start out fairly typical with equipment checks to make sure everything is on board and ready and the narcotics are counted and signed off. We are also going to be getting ready for our open house tomorrow as it is National Emergency Medical Services Week, so if you get a chance, say thanks to anyone in public safety that does medical work, from 911 dispatchers, First Responders, EMTs, paramedics, emergency room physicians and nurses.

8:36 a.m.: Sure is nice to see the sun, it can get to be a HUGE downer to do ambulance calls when the weather is nasty. I can remember many calls over the years where I was sure glad I had extra winter gloves and hats in my vehicle to hand out to crews on accident calls when it was below zero. Brrrr!

Having nice days just makes you even more excited about how you can help. It’s kind of like an unknown adventure, waiting for the pager to start blaring about an emergency. Are we going to be going to a major accident, transporting a pleasant elderly lady from a nursing home to the hospital, or something else?…  It seems some days you can just sense that it’s going to be busy and some days you wonder if you’re ever going to get a call.

I mentioned intercepts in a previous blog. Since Willmar Ambulance is an Advanced Life Support Ambulance Service, or ALS, we provide advanced care services to all the Basic Life Support Services around Willmar. In Kandiyohi County there are a total of five ambulance services: New London, Atwater, Raymond, Lake Lillian and Willmar. We also work with services outside of our county like Kerkhoven, Clara City, Brooten, Cosmos and others.

We are automatically sent out on calls anywhere in our county if the 911 call is for things like chest pain, major trauma or someone that is considered unconscious or unresponsive. We have a great working relationship with all our surrounding services and always look forward to working with them to help take care of their patients.

9:30 a.m.: We are back to full crews in town. We have two crews on street duty during the day Monday through Friday, with another crew on call either from home if they live in Willmar or at our ambulance quarters located within the Kandiyohi County Rescue Squad building just north of the E. Highway 12 Burger King on Lakeland Drive (very nice facility).

Our two duty crews have assigned tasks to keep them busy during their shifts, like getting the garage ready today for our open house, or working on any number of assigned tasks like data reports, CPR training or just making sure the trucks are looking good. I always remind our staff that we live in a fishbowl and we are driving large blue billboards, so we always need to look and be professional as we are serving the public 24/7!

10:22 a.m.: With our crews today is Jesse. He is a new casual paramedic hired recently by Willmar Ambulance and is doing his field training today. When we hire new staff, we look for candidates that will fit well within our organization and that are already trained to the National Registry EMT standards.

The Willmar Ambulance field training program trains new members how to be an EMT or paramedic on our service. Field training is done by our seasoned Field Training Officers, or FTO staff. Depending on any previous experience in EMS, this training can last up to 30 days. In this time, we schedule the new hire with FTOs for a number of shifts. They spend the day working with the duty crews going through the equipment on the trucks, checking off on a number of different competency tasks during their FTO time.

As they go on calls with us, they initially start by just watching and getting used to our process, paperwork and how we handle calls, as well as learning our medical protocols and working on mapping of the city. As time goes on and runs are accomplished, they move to being the care provider while the FTO watches their care. After each event and the end of every shift, they are evaluated on the day to see where they are at and asked how they are feeling about the position.

Quality assurance is a large part of our work and we always evaluate and make sure our protocols are being followed and reviewing our runs to maintain the best care possible!

12:09 p.m.: Hello, my name is Shar. I have been an EMT with Willmar Ambulance Service for just over eight years. Also a member of Kandiyohi County Rescue for the past 10 years. I got into this profession a little later than most of my co-workers.

At the time I decided to become an EMT I was looking at doing something different with my life, needed a career change and this was something I had wanted to do but didn’t have the opportunity, due to having small children at home.

Yes, we all start out as adrenaline junkies and get a little excited when the pagers start to go off and we hear the sirens, see flashing lights, just like little kids do whenever they see us.

A typical day for myself and my medic partner Carrie is Mon.-Fri. 9-5. We start our day with rig checks, making sure all equipment is stocked and everything is in full working condition.

After that we head into the EMS office which is located in the emergency room where we have a lot of other assigned duties to do each day. My typical duties other than 911 and back-up calls consist of entering all ambulance billings into the computer for the business office, entering our statistics into the computer, maintaining the casual and full-time schedules for all of our staff, ordering equipment and uniforms for all of our staff, making sure we have staff to cover open shifts, fill liquid O2 tank on our truck, assist ER when needed, of course cleaning of trucks, lots of paperwork and all other duties as assigned.

The 9-5 shift is also called the power shift because we cover the hours of the day when we are usually the busiest and we handle most of the daytime transfers that are sent out to other hospitals. We also do some casual calls where you don’t have to be in the office but respond if a call comes in for a third rig.

As EMTs we do a lot of patient care with our medic partners but we also do most of the driving. We have to go through a driving program and must maintain current certification and also clean driving records. We have continued education to keep our skills and certification.

Like all jobs, we have some bad days. Sometimes you have a call that just hits home, but I wouldn’t trade this job for any other out there.

12:57 p.m.: Hi, my name is Carrie Yungerberg. I am a critical care paramedic with Willmar Ambulance.

Every day I come to work, I don’t know what to expect. I may be sitting in the office working on projects, I could be transferring a patient to another facility or responding to ambulance calls in the community. The best part of the job is that each day is different, but the same. I can respond to two chest pain calls and the symptoms for each person, the heart rhythm, and history for each are different.

I initially started college to be an ER nurse, but met a paramedic who told me to become an EMT to see if I liked that type of work. After less than a year of being a paramedic I knew that I loved EMS and would be in it for a long time. After being an EMT for nine years I went to paramedic school at South Central College in Mankato. I was fortunate to be able to continue to work with Willmar Ambulance after graduation. I have been with Willmar Ambulance now for 14 years.

Being a paramedic requires you to think on your feet. For example, when you are treating a patient and the heart rhythm changes, you need to be able to change your thinking and “go down another path” to treat the patient appropriately. Another way you have to think on your feet is to change what you think might be wrong with the patient. For example, if we respond to a car accident we need to determine if the patient had an underlying condition that might have caused the accident – for example, a heart attack or chest pain, or did the car accident cause the heart attack/chest pain.

There are days that we don’t have calls during our shift. On those days we have projects that we do in the office. Some of the projects that I work on are bike helmet safety, CPR classes, Sonshine First Aid tent volunteers, maintenance/coordination of patient care reports for the ambulance and maintaining supplies, handouts for community events as well as setting up staff to attend community events and community education such as taping a segment for the WRAC-8 show, “Willmar 911.”

The hospital has CPR classes once a month for their employees. I coordinate the instructors for teaching. Also if a business, church or community organization needs a CPR class, we work with them to set up a class. Along with CPR, I am part of the AED coalition of Kandiyohi County which helps place AEDs in the community at businesses and churches.

Sonshine Music Festival arrives in Willmar every July. Willmar Ambulance maintains the tent with volunteers from Kandiyohi County and throughout the state of Minnesota. We have over 150 volunteers who take time to help in the first aid tent. We use all types of medically trained staff, from paramedics, EMTs, RNs, LPNs and CNAs. There also are doctors and non-medically trained staff that volunteer.

All of our patient charting is now done on computers. We have a specially designed report that we use to document everything from the ambulance call. Part of my job is to make sure these reports make it to the patient medical chart at Rice Hospital. Also to make sure the reports get sent to the Emergency Services Regulatory Board.

Community education and events are also part of the job. We attend events such as National Night Out, Healthy Kids Day, and Family Fun Night and Safety Days. We give tours of the ambulance to Boy/Girl Scouts, daycare centers and preschools.

If it’s not ambulance calls keeping us busy, it’s the boss!!

1 p.m.: Just got a 911 call to a local restaurant, working with the crews right now.

1:25 p.m.: A large percentage of Willmar Ambulance calls are cardiac-related. Signs and symptoms of cardiac events can vary from males to females, but some typical clues are pain or heaviness in the chest that lasts longer than five minutes, pain radiating into arms and/or jaw. Other signs and symptoms can include unexplained shortness of breath, unexplained sweating and nausea.

Willmar Ambulance, along with the other services in Kandiyohi County, has the ability to detect significant cardiac events by being able to perform a 12-lead EKG and transmit the data directly to a physician in the emergency room. Having EMS involved early in a cardiac event has shown up to a 45-minute decrease in time when a person needs to be taken to a higher level of care like a catheterization lab in St. Cloud or the metro.

How 12-lead EKGs came to Kandiyohi County

2:18 p.m.: Our work today continues as we prepare for our open house events tomorrow. Sounds like the weather is going to be great! We hope to see a lot of families come out and enjoy the evening with us!

Oh, and since it’s going to be soooo nice, we will even cook for you!

So reminder, Wednesday 4-7 p.m. at the Willmar Ambulance garage. See more at http://www.willmarambulance.com/.

3:14 p.m.: Hello, my name is Dr. Scott Abrams, emergency physician at Rice Memorial Hospital.

For the last couple of years, I have provided medical direction for the Willmar Ambulance Service. I basically help with the medical decision-making process or “protocol” that we follow in providing care to the community.

I have come to greatly appreciate the level of care provided by Willmar’s emergency medical technicians and paramedics. They consistently provide excellent care to the community and are always working and training to become better. As medical director and as someone who calls Willmar home, I want to know that when I call 911, I’ll be getting rapid, appropriate care. I can say that we absolutely have that kind of care here in Willmar, thanks to everyone who works with the Willmar Ambulance Service.

I’ve also had the privilege of providing medical direction for several of Willmar’s surrounding communities (Sunburg, Kerkhoven, Atwater, Lake Lillian and Raymond). While Willmar has a professional or “paid” service, these communities rely on volunteers to staff their ambulance services. I have been consistently amazed by the number of people that volunteer their time and efforts to be trained and to work on their local ambulance service. It is a credit to them and to their community that these towns have such excellent services. They truly are wonderful people volunteering to do a tough job and I’ve been fortunate to work with them.

3:36 p.m.: Hi, I’m Jim Kroona and the reason the surprise breakfast wasn’t a surprise. Sorry about that, boss, and congrats on 14 years.

I’ve been an EMT with Willmar Ambulance for 13 years and on the County Rescue Squad for 16 years so the pager is always on. A shift for me is on call from 7 a.m. to 7 p.m. and on duty from 7 p.m. to 7 a.m. Twenty-four hours can go so fast and yet seem so long.

My partner Keith and I started last night with a transfer to Hutch and ended it with a transfer to St. Cloud (which went about 10 minutes before our shift was to end). We had a call where the police assisted us with a patient and did an intercept with Atwater Ambulance. So hardly time to take a lunch break. You learn early on to eat and sleep when you can because you might not have the chance if you wait.

For me it’s about giving back to my home town. Born and raised here and enjoy the sacrifice we make to help those in need.

I have had the joy/terror of delivering a baby in the front seat of a car and the sadness of extricating a relative from his truck as he died.

Please be safe in your day and with what you do. Finally off to bed!! Hope I can fall asleep.

3:51 p.m.: With over 2,600 calls per year, our crews have days of what feels like controlled chaos and some days where it feels like we are just working in the office or the garage.

It typically takes our crews one hour to respond to, transport and do the paperwork on a routine ambulance call. Our service covers 137 square miles within the county and has a response time standard of having to be enroute to calls once dispatched within 90 seconds 90 percent of the time and to be on scene within 10 minutes 90 percent of the time as well.

We use electronic patient care reports so our information about a patient is recorded and uploaded via a secure system where our records are stored and accessible to our hospital health information department as well as our quality control staff. Having the ability to do electronic reports has tremendously helped our service see and respond to our data, from staffing levels to quality assurance.

I tend to still write information on my gloves; old habits are hard to break. Oh, I still enter the data into the electronic system, but other staff members are way better at it than me.

4:33 p.m.: Being paged to a local clinic where someone has fallen, crew responding code 3 now!

4:39 p.m.: Sometimes, depending on the situation, we need to ask for a second ambulance to help on a call. This could be a need for lifting assistance, or because the patient is severely injured and extra hands are required to take care of the patient safely and without causing more harm. We are very fortunate to have backup when we need it to better take care of our patients and help prevent staff injuries when lifting or moving patients in difficult situations.

We communicate with our emergency department nurses and physicians via radio when we are on scene to give them a heads up of what we are dealing with so they can better prepare for the patient coming in. We use portable radios or mobile units within the ambulances. Cell phones are also sometimes used, but radios are simple and are quick access to medical control when needed.

Our reports are quick, with basic important information relayed to the ED about the situation, background and treatments given, as well as asking for any further questions or orders from the doctor in the ESD. We always assess our patient’s vital signs, and depending on the call, may use our cardiac monitor, oxygen, medications or other equipment as needed to make our patient as comfortable as possible and to help ease any pain they have.

4:47 p.m.: Well, as of this posting we have had six calls since midnight, with four of the calls before 7 a.m. It is typical that we have streaks where our main volume of calls comes in on the night shift and some where they come on the day shift.

Our data tells us our busiest times are M-F from 0900-1700 but calls are not always predictable, so to have 24/7 coverage is a must for a town our size.

I will keep you posted until 7 p.m. on what is yet to come. Hope you’re enjoying the weather and the day with the great crews of Willmar Ambulance.

5:41 p.m.: Hello, my name is Jim Bode and I have worked for Willmar Ambulance Service since 1998. I am currently employed as a casual paramedic and also have critical care certification.

Today was kind of a quiet day around here for an ambulance service. When we got to work at 7 a.m. we checked over all the trucks to make sure everything is stocked and ready to go for the day (and night). After truck checks it was time to get something to eat from the cafeteria. Sometimes this does not go as planned; today we got to sit down and enjoy our meal.

After breakfast we went to the garage again and started cleaning it up for the upcoming event tomorrow (come get some hot dogs and see some really cool stuff). After cleaning the garage and running errands around the hospital, we finally decided on lunch, a local pizza joint that is very understanding when we gotta run out the door.

At last we get a call, problem unknown at another restaurant in Willmar. After the run it’s time to restock supplies and clean up the truck for our next run. This usually takes about 15 minutes to get everything in order.

This afternoon was more prep time for tomorrow and enjoying the sunshine which has been missing for some time now. We got a call from the primary crew that they could use some help with a patient they had, so we assisted them on the scene with their requests.

At this time there is nothing more to report on, so everybody stay safe and come see us tomorrow at the ambulance garage.

6:53 p.m.: Well, everyone, not a crazy day and that’s OK! Thanks for hanging out with us and stay safe! This is Brad Hanson signing off for the day.

Thanks to Rice Memorial Hospital for agreeing to participate in a live blog; to Sandra Schlagel, communications coordinator at Rice Hospital, for facilitating this project and providing photos; and most of all to Brad Hanson and the rest of the Willmar Ambulance Service for making it all happen.

Linkworthy 3.1: Friday the 13th

A roundup of some noteworthy reading encountered on the web in recent weeks:

- I can’t believe I missed this story last month, but here it is, from the Wall Street Journal: The Battle of the Office Candy Jar. Summed up in three words: Proximity + temptation = ruination. My favorite quote from the article: “Even for a person with the greatest resolve, every time they look at a candy dish they say, ‘Do I want that Hershey’s Kiss or don’t I? At the 24th time, maybe I’m kind of hungry, and I just got this terrible email, and my boss is complaining – and gradually my resolve is worn down.”

I hope my newsroom colleague who brought in the leftover Peeps and jellybeans after Easter is reading this.

- Speaking of food, The Atlantic published an article today that takes an interesting look at supermarket design and its influence on what, and how much, we buy – and whether stores can be redesigned to help consumers make different purchasing choices. It may smack of social engineering but it seems to be backed up by some intriguing research.

- Engaging the Patient is hosting a series of guest blogs during Patient Experience Month that explores the line between rhetoric vs. action. Is health care truly becoming patient-centered, or is “patient-centered” just a buzzword?

When it comes to the things that patients care about and that deeply affect their lives, health care often seems to be missing the mark, observes Alexandra Drane, president and co-founder of Eliza, a patient engagement firm.

Dr. Davis Liu wonders: Do patients even want to become empowered? “They simply want to have convenient and personalized care, whether in office, telephone, video or email,” he writes.

Other installments in the series address the current state of patient engagement and the role of health care executives in fostering patient engagement.

- For some serious reading, check out “Neglected to Death,” a series reported in the Miami Herald that uncovers violations and abuses in Florida’s assisted living facilities. Although it focuses on the worst of the worst rather than facilities that are well-run, it’s a cautionary reminder for families to do their research before choosing an assisted living home and to remain informed and vigilant about their loved one’s care.

- Several new entries have been posted in an ongoing series at the Cost of Care blog, exploring some of the difficulties patients encounter in trying to manage the cost of their health care. The entries were submitted last year as part of a national essay contest and include the story of a knee surgery patient who ran into a brick wall while trying to get an estimate of what the procedure would cost, a student who received an unexpected bill, and a man who was both uninsured and catastrophically ill.

- HUMS, or High Utilizers of Medical Services, aren’t always well understood. Indeed, they’re often blamed and criticized for abusing the health care system. The reality, however, is that there’s more to this subgroup of patients than meets the eye. They’re often mentally ill, addicted and/or homeless, and existing public health safety nets fail them all too frequently.

Dr. R. Jan Gurley, who writes about urban health, describes an effort in San Francisco to identify these individuals and the challenges of providing care that’s less costly and more effective. It’s daunting but it’s not an issue that cities can afford to ignore, she writes: “The big question is what we all, collectively, are going to do to address their suffering and premature death – and their inefficient and costly use of safety-net services.”

- Here’s an initiative I can get behind: The Society for Participatory Medicine has embarked on a glossary project to compile the many abbreviations and acronyms used in health care and help the consumer decode them.

An example from a typical medical chart:

CC: SOB

HPI: This is a 52-year-old black female with a long history of CAD and COPD who presents wit SOB of several days’ duration. She has had some DOE but no chest pain or diaphoresis. She has had an MI in the past with CABG in 1999 of 4 occluded vessels.

Although patients are often encouraged to obtain copies of their medical record, one can’t help wondering how much good this will do if they don’t understand the alphabet soup.

The SPM has created an online form (linked above) allowing people to submit abbreviations, acronyms and an explanation of each. The information will be compiled into a glossary that can be used by patients to help decipher and better understand the technicalese in their medical record.

If this is a project you can help with, check it out and consider adding your own entry or two. This is one of those cases in which the more entries, the better.

Photo: Wikimedia Commons

Live-blogging next week!

Watch this blog next week and follow me on Twitter for a day of live guest-blogging by the everyday heroes of the Willmar Ambulance Service.

Date: Tuesday, May 17.

Time: Entries will be posted from 7 a.m. to 7 p.m., giving readers a glimpse of what it’s like to be an emergency medical technician and the role of the ambulance service in providing health care to the community.

The occasion: Emergency Medical Services Week, May 15-21.

I’ll be the blog host but the real stories will come from the ambulance crew as their day unfolds. Check back often as new entries are posted throughout the day. The EMTs would love to have many readers following this behind-the-scenes look at who they are and what they do.

West Central Tribune photo