Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II

As opposed to what I wrote about in Part I, there is a more thoughtful, more thorough approach to disaster planning covered on both Mitigation Journal and the MedicCast.

Cecil County (Maryland) Director of Emergency Services Richard Brooks is interviewed.

This is a podcast that is very important to listen to.

There are many important topics that people do not understand. For example, if there is the possibility of a disaster, how much preparation is appropriate? When the disaster does not happen, there will be many critics, so some places avoid preparation.

Better not spend too much. That will look bad, if the storm is not as bad as forecast. If the worst happens, we can just blame the medics.

That is an important contrast between Pittsburgh and Cecil County. It is true that Pittsburgh has a lot of financial problems that other places do not have, but this should have encouraged them to call for help earlier. The National Guard has 4 wheel drive vehicles. Pittsburgh needed 4 wheel drive vehicles. The National guard has snow plows. Pittsburgh needed snow plows. The decision to call early should have been easy.

When 911 calls are put on hold for 10 hours, you might want to consider that you are dealing with a disaster. Maybe avoiding dealing with a disaster is their style.

When you have 911 calls on hold for 10 hours, you need to admit that you are overwhelmed. You need to use your brains, rather than having crews wandering around in the snow, doing things that should be done by equipment. The Luddite approach leads to deaths.

Public Safety Director Michael Huss clearly does not believe in using critical judgment. His response was for the medics to tie themselves up on one call for hours by getting out of the truck and walking to the patient. Then possibly endangering the patient by having 2 people try to drag him through the snow and ice. Mayor Ravenstahl seems to be defending his buddy.[1]

We all had ample time to prepare.

– Cecil County Director of Emergency Services Richard Brooks.

In the interview, Richard Brooks describes using critical judgment and encouraging his people to use critical judgment. He describes it as thinking outside the box. I do not like the phrase for a bunch of reasons. One is that it has become overused by so many people. Richard Brooks uses it appropriately.

Michael Huss doesn’t seem to want medics to appropriately use equipment. He seems to want them to just use their legs. If they do that, he seems to think that the lack of preparedness will not be noticed.


He knows what happened, so he thinks that he knows how to avoid it in the cheapest way possible. He is wrong. Monday morning quarterbacks usually are.

Public Safety Director Michael Huss encourages us to think as Luddites. Technology is evil. Destroy all tools. And blame the medics.

We’re successful because our business, be it fire department, EMS, combination, career, volunteer, emergency management, emergency operation, or in my case emergency services – We have got to be flexible, forward thinking, out of the box type people. That’s when we’ll do the best job.

When people come at you with something that you did not predict, and you can sit back for a few minutes and go, “There’s a way we can deal with this,” and make it work, then refine it for the next time. That’s how we’re going to have success.

– Cecil County Director of Emergency Services Richard Brooks.

That is not the bureaucratic response. The bureaucratic response is to sacrifice low ranking personnel to protect the jobs of their bosses (the ones who really caused the problem).

Cecil County will not have to deal with explaining a preventable death to the media, because they will be prepared for disasters. When their preparation does not lead to an easy solution, they will start trying other things.

How much thought is required to decide to send a 4 wheel drive truck to pick up a patient, rather than have the medics re-enact the Iditarod? If we use the right tools, we are able to help more people. If we use critical judgment, we are able to help more people. If we use the Luddite solution, we endanger everyone.

I am very critical of people who discourage the use of critical judgment.

I think that the only way that the statements of Public Safety Director Michael Huss make sense, is if we abandon the use of critical judgment. We would need to engage in a willing suspension of disbelief.[2]

Reasonable people only engage in a willing suspension of disbelief to enjoy fiction. Fiction, that otherwise would be seen as unbelievable.

Public Safety Director Michael Huss does not even provide good unbelievable fiction.

The official report from the medical director is not fiction.[3]

There is more in Part III

Podcasting on the death of Curtis Mitchell:

From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

From the EMS Garage

Up to My Pips: EMS Garage Episode 75 – 03/02/10

Writing on the death of Curtis Mitchell:

From Too Old To Work, Too Young To Retire

Trouble Right Here In Three River City – 02/19/10

Comment From Someone In Pittsburgh – 02/20/10

More From Pittsburgh – 02/23/10

Update On The Pittsburgh Story – 02/28/10

And Then I Realized… – 03/01/10

Fertilizer – 03/22/10

Human Sacrifice – 3/24/10

The Tapes Don’t Lie, But People Do – 3/29/10

The Drama Continues In Pittsburgh – 5/12/10

Let The Scapegoating Begin – 01/06/11

Common Sense Prevails – 02/15/11

From David Konig

EMS Blog Rounds Edition 32 – 03/09/10

Why You Need A Social Media Presence: The Case Of Pittsburgh EMS – 02/22/10

Yes Mary, It Is A Transportation System – 02/19/10

From 9-ECHO-1

Pittsburgh…my take on it – 02/23/10

Still Don’t Make It Right… – 03/20/10

From A Day In The Life Of An Ambulance Driver

As usual the truth is somewhere between the extremes – 02/20/10

From Pittsburgh Legal Back Talk

The Power of Saying “I’m Sorry”. – 02/21/10

Medic’s Perspective on Mitchell Case. – 02/22/10

The Need for Evidence Before Assessing Guilt. – 02/23/10

The View from Foggy Goggle. – 02/25/10

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.


[1] Investigation Clears EMS Workers In Snowstorm Death – Mayor Says City Has ‘Higher Standards’
Posted: 4:58 am EDT March 19, 2010
Updated: 5:34 pm EDT March 20, 2010

[2] Suspension of disbelief

[3] Medical Call Review for 5161 Chaplain Way 2/6/2010
Ron Roth, MD Final 2/15/10
Medical Director, City of Pittsburgh, Department of Public Safety
Medical Director, Allegheny County Emergency Operations Center
Free Full Text


Anonymous Comments on the Death of Curtis Mitchell

In one comment to City may discipline EMS workers – Public Safety Director Michael Huss and in 3 comments to Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? there is a trend. One of the comments is repeated, but maybe the authors of these comments are incapable of interpreting material rationally. Maybe they are attempting to protect themselves from criticism for their failure to prepare for this snow storm.

In any case, I will address the lies presented in the whining.

First is an anonymous comment signed as Jack E. Davis, Sr. Actually, first and second, since he/she provided the same comment on both posts.

No, Mr. Huss, it isn’t rocket science and the wheel doesn’t need to be reinvented. The EMTs are there for a reason, to save lives, if possible, and to carry out their duties as they were “HIRED” to do!

This person seems to think that sending the medics on foot to calls in the snow will help to create jobs in Pittsburgh. We don’t need to waste money on snow plows or 4 wheel drive trucks. We will just have the medics carry everyone. Then we can sit around and do some Monday morning whining and stoning. We aren’t good at anything else.

If the medics decide not to call for help, then the city will need many more medics to transport patients. How many patients would they actually have reached? How many patients with similar medical conditions, or more serious medical conditions (according to their dispatch criteria), would have been waiting for EMS for a much longer time?

The medics did not refuse to transport anyone.

The medics were dispatched 3 times.

The medics were canceled 3 times.

The investigation by the medical director did not find fault with the medics.[1]

Maybe this person is posting anonymously because of the embarrassing ignorance displayed in these comments.

Hot coffee and Krispy Kremes sound much better than a cold, wet trudge through the snow; let’s go back to the station, this guy will be alright, he’s probably just having a bad reaction to some drugs anyway.

Why presume that the medics were able to go back to the station? Because this person appears to have an overly active imagination. When it wants to make something up to suit its prejudices, it will. Why let the facts get in the way of reality?

The medics were transporting patients all day in the snow. They were digging themselves out of the snow every time they became stuck in the snow.

We know where the medics were and what they were doing.

The medics were working.

We do not know what this anonymous liar was doing.

Interesting that this abdominal pain call is presumed to be due to drugs. Where does this come from? Is this from personal experience? Is this from information that was reported after the fact? If the medics knew how the inaccurately reported story would be written, they could have told dispatch. You can’t cancel us. We know this guy is going to die. We are refusing to treat or transport anyone else, until we transport this guy, because we know he is going to die. Isn’t everyone psychic?

Prosecution for dereliction of duty sounds like the proper and justified course of action and a STERN message needs to be sent. If you’re a “public servant” and you’re not fully dedicated to the complete and proper discharge of your duties; C H A N G E J O B S !!!

Oh, the contradictions. Follow imaginary rules, but disobey actual rules.

This writer wants anarchy in Pittsburgh.

Ignore dispatch, when dispatch cancels you.

Ignore dispatch, when dispatch sends you to treat and transport patients.

Medics only need to use their psychic powers to predict which patient will die, respond only to that patient’s residence, transport only that patient, and ignore the rest of the patients.

In any case, the anonymous person posting as Jack E. Davis, Sr. is more than willing to give false testimony and cast the first stone. I don’t know what I am writing about, but I am willing to punish people because of the way I imagine things. And what an imagination it has.

Let’s not rely on facts. Let’s demand that the main stream media make all of our decisions for us. This person provides an example of what happens when our schools fail to educate. If only critical judgment were taught, we should not see so many people forfeiting their decision making to the media.

This lowest common denominator hates America and the rights that our Founding Fathers sacrificed so much for. This person just wants to lynch people. Especially the innocent. This is an example of the true American Taliban. Intolerance combined with ignorance.

Next, Melvin writes this comment.

I can not understand how we travel around the world to dig people out of destroyed rubble and assist with devestaing earthquakes, and all types of disasters, but whatever the reason our public service can not transport a man to the hospital regardless of the bad weather conditons.

3 different ambulances were dispatched. They became stuck in the snow/ice. They called for help getting to the patient.

All 3 of those ambulances were canceled. All of the help they called for was canceled, too.

The medics did not refuse to treat or transport Curtis Mitchell.

This is what they train for to be able to respond in the worst of conditions.

You would have to bring that up with Public Safety Director Michael Huss. Public Safety does not appear to have any plan to deal with these storms that happen every decade, or two. I agree that they should have some preparation for this. However, that failure is not a failure on the part of the medics.

Anyone can respond in nice summer day. My 95 year old grandmother on a wheelchair can respond.

Some modestly amusing hyperbole.

How does your 95 year old grandmother get the patients onto the stretcher?

How does your 95 year old grandmother get the patients into the ambulance?

What kind of treatment does your 95 year old grandmother provide to unstable patients?

You clearly do not know what is involved in treating and transporting patients.

Arriving at the side of the patient and transporting the patient are not even close to being the same thing. Not that your 95 year old grandmother would be able to get to the side of the patient without a wheelchair ramp and somebody to push her up the ramp.

What a shame and embarssment to not have been able to save this mans life.

I agree, Melvin. The medics were canceled each time they responded, so this is not the fault of the medics.

These EMT should be disciplined and or fired.

I think I have already established that you do not understand what you are commenting about.

The medical director reviewed this call.

The medical director found a lot of problems with the way the 911 calls were handled.

The medical director did not blame the medics for these problems.

Unlike these comments, there is a more reasonable comment. Sandra writes the following comment.

I, cannot believe that this man have lost his life after making all these calls for help and then with so many days that it took.

The medics did call for help. Each time they were stuck. Each time they were canceled. If they had not been canceled, Curtis Mitchel would have been transported. This may have required the Public Safety Director to divert a snow plow, or a supervisor, to transport the patient in a 4 wheel drive truck, but Curtis Mitchell would have arrived at the hospital.

I, also agree with Mr. Melvin it is a shame that Mr. Curtis could not get the help that he needed and these people need to be disciplined and a lawsuit needs to be filed.

I also agree that those at fault need to be held accountable. You use the term, these people. I think that the people you need to look at are those trying to blame the medics.

The medical director’s report makes it clear that the medics are not at fault.

My heart goes out to his girlfriend Sharon Edge. I, hope that this do not get swept under the table.

I agree.

Curtis Mitchell should not have died. I do not know what the cause of death was. I am assuming that the cause of death was something that would have been successfully treated in the hospital.

Sharon Edge should not have had to deal with his death.

People are trying to sweep this under the rug by blaming the medics.

The medics are the only people who have been cleared by any investigation.

Public Safety Director Michael Huss had the results of that investigation, but still made his ridiculous claim that this was all the fault of the medics. Why is Public Safety Director Michael Huss providing false information?

Podcasting on the death of Curtis Mitchell:

From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

From the EMS Garage

Up to My Pips: EMS Garage Episode 75 – 03/02/10

Writing on the death of Curtis Mitchell:

From Too Old To Work, Too Young To Retire

Trouble Right Here In Three River City – 02/19/10

Comment From Someone In Pittsburgh – 02/20/10

More From Pittsburgh – 02/23/10

Update On The Pittsburgh Story – 02/28/10

And Then I Realized… – 03/01/10

Fertilizer – 03/22/10

Human Sacrifice – 3/24/10

The Tapes Don’t Lie, But People Do – 3/29/10

The Drama Continues In Pittsburgh – 5/12/10

Let The Scapegoating Begin – 01/06/11

Common Sense Prevails – 02/15/11

From David Konig

EMS Blog Rounds Edition 32 – 03/09/10

Why You Need A Social Media Presence: The Case Of Pittsburgh EMS – 02/22/10

Yes Mary, It Is A Transportation System – 02/19/10

From 9-ECHO-1

Pittsburgh…my take on it – 02/23/10

Still Don’t Make It Right… – 03/20/10

From A Day In The Life Of An Ambulance Driver

As usual the truth is somewhere between the extremes – 02/20/10

From Pittsburgh Legal Back Talk

The Power of Saying “I’m Sorry”. – 02/21/10

Medic’s Perspective on Mitchell Case. – 02/22/10

The Need for Evidence Before Assessing Guilt. – 02/23/10

The View from Foggy Goggle. – 02/25/10

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.


[1] Medical Call Review for 5161 Chaplain Way 2/6/2010
Ron Roth, MD Final 2/15/10
Medical Director, City of Pittsburgh, Department of Public Safety
Medical Director, Allegheny County Emergency Operations Center
Free Full Text


President Obama’s Speech on Health Care

The part of the President’s speech that relates to health care are copied from White Coat’s Call Room.

For that same reason, we must also address the crushing cost of health care.

This is a cost that now causes a bankruptcy in America every thirty seconds.

Isn’t this supposed to be the President, who makes us forget about all of the verbal blunders of the past 8 years? When nobody understands statistics, will any intelligent decisions be made?

On average the statement may be true, but that is not what he said. You would have to believe that there is some official timer making sure that each bankruptcy happens at just the right time. Those 3 AM bankruptcies are probably the most difficult. You’ll just have to wait your turn. The people in front of you still have 17 seconds before they become bankrupt.

The same thing is done in misrepresenting rapes, deaths of babies, becoming a millionaire, . . . . If this is all so controllable, I think I would choose to become a millionaire, rather than to become a dead baby, or to get raped. I’m odd that way.

This is not some minor point. The people in charge do not understand statistics. The people in charge are using statistics to make decisions. Slasher movies are less scary than this.

Look at what has been done with the economy. The bankers have misrepresented the risks they were taking. This is probably because they did not understand those risks. These same bankers are still considered to be an essential part of the solution. The only problem the administration seems to be worried about is capping salaries and bonuses. The real problem is the bankers and the regulators. The people who continually encouraged the reckless risk taking that they claimed was not risky.

The solution seems to be to keep the guilty in positions where they can continue to cause harm and pass the buck. They are passing out bucks like crazy. that is the right word for it. Crazy. Bernanke, Paulson, the heads of the banks, . . . . Why get rid of the problem, when you can throw money at it – and end up with more control over the banks?

By the end of the year, it could cause 1.5 million Americans to lose their homes. In the last eight years, premiums have grown four times faster than wages.

Health care costs are rising for many reasons. One is the attempt to do everything for everybody. When people feels entitled to concierge level care, then who will turn down having everything done, just in case? Not many do. Then, if everything is not perfect, some of these pampered idiots will sue. There are many things that might help, but hardly a consensus on what will work.

Perhaps the best start would be to eliminate JCAHO/TJC and Press Ganey. JCAHO/TJC is the Joint Commission for Accrediting Healthcare Organizations – now trying to give the appearance of impressive new management with a new name – The Joint Commission. Their motto is, There is no such thing as a health care Mafia. That is just a myth to discredit our valiant efforts to prove that the clipboard is mightier than the physician.

Press Ganey is the empowerment organization for malingerers with inconveniences or addictions. Scum who demand to be treated ahead of those with life threatening conditions – true emergencies. The Press Ganey motto is, We will help you make those know-it-all doctors jump through hoops, just to please you. Remember, you’re worth it!

And in each of these years, one million more Americans have lost their health insurance. It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas. And it’s one of the largest and fastest-growing parts of our budget.

Pay no attention to the slight problem of printing money faster than we can throw it at people, people who have demonstrated gross incompetence in money management.

Given these facts, we can no longer afford to put health care reform on hold.

Given the facts of printing money like a counterfeiter on methamphetamines, keeping the dangerous people in charge, and completely misunderstanding the problems, why put anything on hold? Do it all now. Wave a magic wand of change and it will all get better. Really.

Already, we have done more to advance the cause of health care reform in the last thirty days than we have in the last decade.

But is it good reform?

Is the cause health care reform for the sake of health care reform, or health care reform for the sake of patients?

When it was days old, this Congress passed a law to provide and protect health insurance for eleven million American children whose parents work full-time.

Parents will no longer have to pay for health insurance directly. The government will pay for it. Which just means that parents pay for it indirectly. Not seeing the cost of health care choices is part of the problem. The solution to the problem is more of the same.

Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.

It is a good thing that President Obama learned from the mistakes of President Bush. Don’t declare victory too soon.

When none of these things happen, will President Obama apologize to America.

Ensure privacy? Since that is impossible, we are obviously dealing with someone, who does not understand the problems.

It will launch a new effort to conquer a disease that has touched the life of nearly every American by seeking a cure for cancer in our time.

JFK did a slightly better job of getting people interested in going to the moon. This cancer comment fell flat. Did Bobby Voodoo Jindal write this for him?

And it makes the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.

Since preventive care means to keep our people healthy, he might as well be saying that cancer treatments are the best way to treat cancer.

President Obama seems to think that the best way to reform financial problems is by giving money to those who caused the banking problem. What could possibly go wrong with this approach?

This budget builds on these reforms. It includes an historic commitment to comprehensive health care reform – a down-payment on the principle that we must have quality, affordable health care for every American. It’s a commitment that’s paid for in part by efficiencies in our system that are long overdue. And it’s a step we must take if we hope to bring down our deficit in the years to come.

At White Coat’s Call Room, this is debunked very nicely.

Now, there will be many different opinions and ideas about how to achieve reform, and that is why I’m bringing together businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue next week.

Gosh, there is not yet a plan, but there are already results.

I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.

Non sequiturs rule!

Note to Bobby Jindal. American astronauts did land on the moon. This is science, and nobody would expect you to be aware of science. You managed to major in biology, yet still think Intelligent Design should be taught as science. So what if they did not return with cheese?


Blogging and Privacy and Competition for Dr. Deborah Peel

J Gen Intern Med. 2008 Jul 23. [Epub ahead of print]Click here to read Links
Content of Weblogs Written by Health Professionals.
They make it seem as if you get the free full text, but you don’t. On the other hand, you are not really missing anything.

The research cited in this article is pretty poor. They start by assuming that they can identify most of the bloggers, but do not demonstrate that. Here is their big chart of proof:

Blogs n (%)

Reviewer agreement kappa

Blog author identification

First name

139 (51.3)


Last name

95 (35.1)



117 (43.2)


Identifiable photo

60 (22.1)



197 (72.7)


Patient privacy

Patient images

3 (1.1)


Patient radiographs

8 (3.0)


Patient laboratory studies

0 (0.0)


Other privacy information

1 (0.4)


Patient depictions

Any comments about patients

114 (42.1)


Negative comments about patients

48 (17.7)


Positive comments about patients

43 (15.9)


Commentary on health profession/heath care system

Comments about the health care system

137 (50.6)


Positive comments about health care profession

108 (39.9)


Negative comments about health care profession

86 (31.7)


Product endorsement

Blog posts promote health care products

31 (11.4)


What do they agree on the least? “Positive comments about health care profession.”

They make a lot of unreasonable assumptions about being able to identify the person writing the blog, based on the initial assumption, they look at the information presented about the “patients” mentioned in the blogs, presuming all of the information to be correct, they jump to the conclusion that there are HIPAA violations.

Over half of the 271 blogs had identifiable authors; 89 (32.8%) authors provided both first and last name and 43 (15.9%) gave enough information about their name, subspecialty, or location to be identifiable. A recognizable photo was displayed by 22% of authors. Of sampled blogs, 206 (76.0%) were written by physicians, including 23 interns and residents, and 59 had nurse authors (21.8%). The remaining six blogs (1.8%) were written by groups of health professionals including both doctors and nurses.

The fixation on HIPAA also ignores the patient’s right to privacy. Patient privacy did not begin with HIPAA. Dr. Deborah Peel and these clueless researchers do nothing to improve patient privacy. Claiming that you are accomplishing something and actually doing it are not at all connected.

There is much good that may come out of blogs. That is one of the reasons I read and write blogs. I can’t guarantee that no medical blogger is inappropriate with privacy information in a blog, in a book, in a radio interview, or at a cocktail party. Condemning medical blogs will not change any of that.

These researchers looked at only 19% of the medical blogs that they found. They cherry picked the ones they thought most likely to have violations of privacy issues. Out of those 19%, they found 17% that they claim had privacy issues.

This is only 3% of the medical blogs they found. But wait, where do they identify any actual patients based on the information in the blogs?

They do not. They mention the case of a doctor sued for malpractice, who blogged about the experience. The lawyer for the plaintiff recognized the information as being about his client and apparently used that to get a large settlement. This is not somebody with no knowledge of the patient, but someone intimately aware of the medical details of the patient’s medical records. Then you add the unusual identifier of the details of the malpractice case and it is not at all surprising that the lawyer was able to recognize the patient. This is the only case, of a patient being identified, that they mention. They draw some conclusions below, but do not demonstrate that they were actually able to identify anyone.

Forty-five blogs (16.6%) that described interactions with individual patients also included significant identifying information about the blog author. Three blogs showed recognizable photographic images of patients, and one provided an extensive description and links to pictures of a patient. Eight blogs showed patient radiographs without further identifiable information.

Yeah, that X ray, that looks about the same as every other X ray of that part of the body – that one is mine؟

They do not mention if these patients gave permission for their information to be used on these blogs. This is something that is relevant to the topic. Is this information able to be used to identify a patient? If so, did the patient give permission?

RM – Mr. Rectal Bleed, I’m going to make you a star.

Mr. RB – A star! Wow, wait until I tell the little hemorrhoids. What do I have to do?

RM – Just sign this standard disclosure form and smile for the camera. I’ll try to get your good side.

Mr. RB – Who would have thought that anything good would have come out of my sphincter?

There is also some concern that a patient might recognize him/herself in the description of a patient encounter posted on a blog. This is possible. The patient may be the person most familiar with their medical history. The patients described on blogs may be described with the permission of the patient, may be composites, or may be completely fictitious – used to demonstrate a particular concept (ethical, economic, political, educational, . . .).

A patient may read a blog and conclude that he/she is the patient described in a blog. What if the patient knows that the blog is by their doctor and they have a rare disease that is not the doctor’s specialty? Then it is likely that the patient has found information about their particular case. The doctor should have received some permission to write about the patient, first. What about the doctor who specializes in rare diseases? It is not unlikely that a doctor, specializing in some rare disease, has more than one patient with a similar presentation.

What if a patient believes that they have located personal information about themselves on a blog?

The person probably needs the services of a psychiatrist, rather than a lawyer.

Why do they believe that this is about them and not some of the hundreds, or thousands, of similar patients?

Why do they believe that the information presented is not a composite of several, or even dozens, of patients?

It’s not all about you!

Unless you are reading EE’s blog and call 911 for any one of many extremely stupid reasons. Then you need to contact me, because I certainly cannot identify you from the information she puts in her blog, you moron, and I will attempt to engage in some behavior modification for all of the system abuse you are guilty of. Of course, these are people who are having their stupidity violated – if you can ever identify them. This has nothing to do with medical privacy.

Another thing that they criticize is doctors making negative comments about patients, other doctors, or the profession of medicine. It is unprofessional in their opinion. Apparently all problems should be addressed with a false smile and more respect for social graces than for improving health care. Augh!

As far as product endorsement is concerned, they highlighted one blog entry. A response by the author of Medicine and Man, a seemingly respectable and not controversial blog, who points out that he was misrepresented and only wrote about an article in the New England Journal of Medicine. His response is On “Content of weblogs written by health professionals”. According to them I would be endorsing a lot of products, since I have written about many products described in peer reviewed journals. The post in Medicine and Man was not an entirely positive post, so their claim that it was advertising, rather than a literature review, is quite a bit exaggerated.

In the discussion they are a bit more balanced, but there are so many conclusions drawn from so little data – data that has been intentionally made misleading – that we should ignore the scary headline numbers completely. The discussion was only hinted at in the article. There are some people, who have probably been a bit careless with patient identifying information. I think that it is unlikely that they will avoid getting pointers from other bloggers about appropriate posting of patient interactions. Making this out to be more than that is just being silly.

Maybe Dr. Deborah Peel is using a pseudonym to publish her HIPAA hysteria.

Below is what I posted in the comments to the LA Times article. Imagine, limiting me to 650 characters. The nerve.

17% blogs included enough information to identify patients. They located 1,434 medical blogs, but narrowed it down to 271 “journal style” blogs. This cherry picking means that 17% of medical blogs is inaccurate. They only looked at 19% of the medical blogs they located, but selected the ones they felt would be most likely to be indiscreet. If they were good at cherry picking: 3%. They do not mention being able to identify any patients. They mention one case reported in the news. 1 case out of over 1,000 blogs! If only actual doctors, taking care of real patients, had such a good record. Rogue Medic http://roguemedic.blogspot.com/
Submitted by: rogue medic
10:55 PM PDT, August 5, 2008

This is also written about at On medical blogging codes on
DB’s Medical Rants.


Governor Jindal Arranges for Hurricane DI to hit Louisiana in September

In a continuation of my criticism of dangerous people misrepresenting science to the detriment of others, the Governor of Louisiana has decided that the local school districts are overfunded and need to pay for expensive First Amendment violations out of their own pockets. If you live in Louisiana and like the Governor, see if he can take some of the state money and redirect it to the local school boards to pay for his stupidity. Even though he is well trained in biology, the DI (Discovery Institute) has convinced him to sign a bill that will result in the science classrooms becoming a place of religious debate. Then they will become the focus of expensive and futile judicial debates.

How does the DI do this?

Is there any science being supported by this decision?


Is there any genuine scientific inquiry being encouraged by this?

No. This is designed to discourage scientific inquiry and encourage teaching religion in science classes.

It is the same old creationism argument that has no basis in science and is supported by fundamentalist religions. As if we don’t have enough problems with fundamentalist religions trying to drag us back into the dark ages.

But it’s not creationism, it becomes ID (Intelligent Design), after ID is ruled unconstitutional it becomes – Scientific Inquiry New and Improved. They gave it some fake boobs, did some liposuction, and squirted Botox all over the place. There is nothing natural about this creation. Let’s put the red light out front and see if we can hustle some business.

Here are the relevant parts of the bill. The link allows you to see the changes that were made along the way. They talk about good things, but they don’t really support any of the good things they mention. George Orwell’s New Speak has been adopted. “Ignorance is Strength.”

B.(1) The State Board of Elementary and Secondary Education, upon request of a city, parish, or other local public school board, shall allow and assist teachers, principals, and other school administrators to create and foster an environment within public elementary and secondary schools that promotes critical thinking skills, logical analysis, and open and objective discussion of scientific theories being studied including, but not limited to, evolution, the origins of life, global warming, and human cloning.

(2) Such assistance shall include support and guidance for teachers regarding effective ways to help students understand, analyze, critique, and objectively review scientific theories being studied, including those enumerated in Paragraph (1) of this Subsection.

C. A teacher shall teach the material presented in the standard textbook supplied by the school system and thereafter may use supplemental textbooks and other instructional materials to help students understand, analyze, critique, and review scientific theories in an objective manner, as permitted by the city, parish, or other local public school board unless otherwise prohibited by the State Board of Elementary and Secondary Education.

D. This Section shall not be construed to promote any religious doctrine, promote discrimination for or against a particular set of religious beliefs, or promote discrimination for or against religion or nonreligion.

“promotes critical thinking skills, logical analysis, and open and objective discussion of scientific theories being studied including, but not limited to, evolution, the origins of life, global warming, and human cloning.”

The Newspeak version of this is that their claim to promote critical thinking skills, actually discourages critical thinking skills. But keep on saying it and people will believe. Logical analysis – ditto. Open and objective discussion – taking time away from teaching science, to preach religion, is not open or objective or discussion.

These ignorantists are similar to the islanders of the problems solving questions. One group will always tell the truth. One group will sometimes tell the truth and sometimes lie. And the other group, the DI, will always lie. How can you tell that the DI are telling lies? Sorry, old joke.

If we all say the same thing, maybe chant in rhymes, and stick together, they will have to give in. But why give in to ignorance?

Most of this post is about the connection between evolution and the origin of life. Global warming is another area of science that is politically driven and supported by an arrogant confidence in the computer programs used to predict the weather, not just next decade, but next century. One way to determine the worth of a theory is by its predictive value. In this, both evolution and global warming have problems. But evolution does not pretend to predict the direction of the random changes of evolution. It describes them.

Global warming attempts to predict what will happen in 10, 100, 1,000 years. How do we evaluate this? Well if the worth of this theory can be determined by its predictive value, what is the predictive value? That is how far out in the future has it been shown to be able to make consistently accurate predictions that are not likely to be the result of chance. Well they have these wonderful supercomputers that have been around for a decade or two. How far into the future have they been able to predict accurately? From the time the prediction was made, to the time it could be confirmed (which cannot be farther ahead than the present), how accurate have they been? Weren’t we more concerned about global cooling at the end of the last century? The history of the planet has been fluctuation. Our attempts to control climate change on a planetary level will probably be embarrassingly futile.

Should we attempt to cut down on pollution? Absolutely.

Should we conserve energy? Again, there is no sane reason for profligacy.

Well, there will be ice ages and global warming, but there really is not a lot to show that our attempts to control this will make things better. Since the DI believe that dinosaurs and humans lived at the same time, maybe the DI should oppose the use of petroleum products, since these products could be the remains of humans that lived with the dinosaurs.

The bill also mentions human cloning. I have no idea what they plan on saying. If human organs can be cloned, not harming people, but helping people, where is the ethical problem. If it can be demonstrated, where is the scientific problem, which would be the important consideration in a science class. If human beings can be shown to be cloned successfully (something that would need to be defined), the science would not really be in question. Ethics is important, but belongs in a different class. So far, all claims of human cloning have been unconvincing, at best. The science does not seem to be open for debate. Well done science invites attempts to disprove it, includes attempts to disprove it, and is not done in secret.

Back to the evolution part of the law.

They are encouraging the teaching of religion, but not promoting any religious doctrine, such as creationism?

Will these be reputable scientific texts being used or is the DI going to be selling the schools a ton of pseudoscientific ideas from “scientists” who would not be able to get a paper published in a peer review journal?

Why are they not able to get articles published?

Not prejudice against them by other scientists, but their own incompetence.

How much money is DI likely to make?

Who knows, but they don’t have anything to lose.

Is that offensive? Only if the DI people gave any impression of honesty or integrity or any of the other things you might expect from the devout, which they clearly are not. Read on, ye of little cynicism.

Well, at least the DI will help pay for the legal expenses they are encouraging.

Not a chance. These brainless cowards walk in, pick a fight, and then leave.

Here is a bit from a story, titled Patsy Jindal, from The Corner, the blog of National Review.

Helping to defend creationist school boards in federal courts is not the Discovery Institute’s game. Their game is to (a) make money from those spurious “textbooks” they put out, and (b) keep creationism in the news so that they don’t run out of lecture gigs and wealthy funders. So far as those legal bills are concerned, Discovery Institute policy is: Let the dumb rubes fund their own stupid lawsuits.

Or, as the Discovery Institute’s John West put it in an interview with a New Orleans news service:

“This bill is not a license to propagandize against something they don’t like in science,” West said. “Someone who uses materials to inject religion into the classroom is not only violating the Constitution, they are violating the bill.”

See, the Discovery Instutute does not want any Louisiana school boards bringing religious instruction into science lessons. Heaven forbid! They would never encourage that. Absolutely not! Why, that would be wrong.

In other words, Governor Jindal will be the Patsy to the DI’s Iago.

Apparently, the reputation of the DI for demagoguery, deception, and destruction was ignored by the Governor. If he becomes Vice President, maybe he will have learned his lesson. If not the DI may get him to push a bill to inflict the same punishment on students and school boards nationally. Not that the federal government should have a say in this according to the Constitution. What Constitution? Since when have the occupants of the executive branch shown any respect for that document, or what it defends?

He could call it the Support for Foreign Medical Graduates Act.

Maybe the Export American Jobs Act.

The Do You Want Fries With That Act.

While he is not the VP candidate, and the VP is a largely ceremonial role, it is disturbing that a well educated man is willing to do so much damage to his constituents.

An article in New Scientist gives more information on this New legal threat to teaching evolution in the US.

“They believe that scientific data related to creationism should be discussed when dealing with Darwin’s theory,” Nevers told the Hammond Daily Star in April. The bill was later amended and renamed the Louisiana Science Education Act. Its final version includes a statement that the law should not be taken as promoting religion.

That way, those who wish to challenge Darwinian evolution have “plausible deniability” that this is intended to teach something unconstitutional, says Eric Rothschild of the Philadelphia-based law firm Pepper Hamilton, which represented the parents at the Dover trial. “They are better camouflaged now.”

Using the same plausible deniability ruse, a drug pusher could put a label on his product that says, “this should not be viewed as promoting drug use.”

But what about the science?

Ooops, I forgot. The science to support the creationists does not exist. They just claim that you can’t call evolution a theory and teach it as any more likely than any other theory. If they understood English, they would realize that there are many words that have more than one meaning, depending on the context in which the word is used. Theory means – why don’t we go to the reference that I have listed on the side bar. Dictionary.com links to several other dictionary sites.

WordNetCite This SourceShare This theory

noun: a belief that can guide behavior (“The architect has a theory that more is less”)
noun: a well-substantiated explanation of some aspect of the natural world; an organized system of accepted knowledge that applies in a variety of circumstances to explain a specific set of phenomena (“True in fact and theory”)
noun: a tentative theory about the natural world; a concept that is not yet verified but that if true would explain certain facts or phenomena (“A scientific hypothesis that survives experimental testing becomes a scientific theory”)

American Heritage New Dictionary of Cultural Literacy, Third EditionCite This SourceShare This theory

In science, an explanation or model that covers a substantial group of occurrences in nature and has been confirmed by a substantial number of experiments and observations. A theory is more general and better verified than a hypothesis. (See Big Bang theory, evolution, and relativity.)

Interesting distinction in the second source – “more general and better verified than a hypothesis.” Yet the creationists claim that it is nothing more than a “What if?” Maybe we should pass a law requiring people to understand English in order to be able to preach in the class room. Oh, did I write preach, that wasn’t supposed to slip out. These preachers are supposed to be pretending to be as neutral as possible on science, while they demonstrate their lack of understanding of science.

From Slate Magazine comes an example of evidence for evolution that is not overly complex, but makes sense with evolution, but not with creationism. Losing Sight of Progress. How blind salamanders make nonsense of creationists’ claims.

Another article is from Discover Magazine, a bit more technical, but it is the use of English that seems to be out of the reach of the DI people. Missing The Wrist.

As long as it is just evolution, a concept that many people are uncomfortable with, regardless of the science, some people do not feel that science is threatened. But it isn’t just evolution. If the world is just ten, or so, thousand years old, geology can no longer pay attention to things that are older – at least not without making up some story to change the actual age of the material or the event. Physics, which includes astronomy, not astrology, has a similar problem with having to make time shrink to a ridiculously small period of time to match up with “Begat Math.” You add up the ages, or an estimate, of all of the people mentioned in the Bible and you have the age of the world. The universe cannot be older than the world, because of creationism, so you have the age of the universe. Apparently, when it comes to the Bible and creationists, the same rules of medical charting apply. If it wasn’t documented, it didn’t happen.

So, we have to take these other, well proven sciences, and twist their facts to see how many events can dance on the head of a pin. All this to allow creationists to preach in public schools.

How is this not religion?

Joe Stalin also had problems with facts. He had a similar solution. “I will tell you what the truth is. You will make the facts fit.” This is the biggest reason for the failure of the Soviet Union, in my opinion. You can’t make the facts fit your beliefs. That is not science. Adjusting your beliefs to fit the facts is science. Discarding disproved beliefs is science.

Stalinism was their religion. It was also a significant part of their downfall, even after Khrushchov’s Destalinization. They tried to make Marxism the true religion.

I attended religious schools while I was growing up. This was before ID was created. We learned about evolution, not creationism, in science classes. We learned about Genesis in religion classes, but not as a golden calf to worship. We learned about metaphor in English classes, in part to better appreciate the Bible.

It appears that they want the government to sponsor their religion, at the expense of other religions, preaching the government sponsored religion in the government funded schools.

It appears that scientific achievement, in medicine, in agriculture, in engineering, in physics, . . . will be abandoned in the devotion to the Politically Correct religious doctrine.

JFK gave a speech, September 12, 1962 at Rice University, that included the following important section:

We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.

Could we do that today? In a decade, would we be able to develop to the point where we put a person on Mars and bring him back safely?

With the proposed dumbing down of education? Only if we get people from other countries to do that thinking stuff for us.

To suggest that we are going to do something that is hard scares people. To tell people that it will be done by the government causes the fear to be replaced by laughter. This is just one of the examples for laughter, the government teaching religion in science class. The real reaction should be even greater fear.

Critical judgment?


We don’t do that in America anymore.

We are doomed.


The Happy Hospitalist: Happy’s Gone Lost His Mind

The Happy Hospitalist: Happy’s Gone Lost His Mind: “What do we have. Currently, we have a health care system that costs over 2 trillion dollars a year to operate. It is 15% of our economy. Half of that is government gravy train money. Some would argue, we need expensive health care to keep our economy from collapsing. That 2 trillion dollars funds millions and millions of Americana’s retirement, college savings, mortgages, SUVs and t-bone steaks. Removing a significant chunk would collapse the economy. The only problem is, that money is being spent in all the wrong ways. And we are printing money to support a system that is collapsing on its own weight.”

The most obvious recent examples of this were:

Enron. If only everybody had kept buying the stock and ignored the problems, the stock price would have stayed up. Of course, since the problems were fraud and criminals should not be allowed to continue their swindles, this should not have been allowed to continue. Happy makes a great case for Medicare being the same kind of fraud. We discourage thinking, but encourage thoughtless action. Probably not even the second best plan available to us.

The NASDAQ bubble. It was over 5,000 in March, 2000. It is less than half of that now, but its low point was at 1,140 in October, 2002 – losing almost 4/5 of its value. In the housing market this would be a quarter million dollar house dropping to $50,000. The housing market hasn’t seen really bad. NASDAQ was receiving a lot of money to prepare for Y2K. An idea that would have been ridiculed anywhere sensible people debated things, but all of this money drove the NASDAQ to obscene height. When the money ran out, the buying pressure did, too. Without buyers, there is nothing to support prices. Y2K is another example of paranoiacs bringing about great destruction in their devotion to the lie “You can’t be too safe.”

Housing. We are now trying to get the government to help out people who spent too much for their homes. Apparently, making a profit on housing is a right. If only the oil companies made houses their profits would be safe. When oil comes back down, and it will. The oil companies may be right back to depending on government hand outs to survive. A big part of the support for oil prices is the construction going on in China in preparation for the Olympics. Once the Olympics are over, will there be as much growth? I don’t think so. Is this an appropriate analogy to the Y2K fiasco? I don’t know. Food costs have been climbing too.

There is an interesting comparison between China in 2007 and the NASDAQ in 2000. The article was right, just early. They predicted that the Chinese market was at its peak, when it hadn’t even hit 4,500, yet. Later in 2007 it got above 6,000. Since then it has not resembled the missile launch that excited everyone. Now it looks more like a drunk on roller skates. It isn’t a question of if he will fall, just how bad it will be before he stops. It is under 3,000 – less than half of what it was at its peak.

Excesses need to be corrected. When they form a bubble, as these did, the correction is much more painful than it would be otherwise. If the government doesn’t straighten out the Medicare mess and the other monetary misadventures they are leading us on, we will have much bigger problems than mortgage and fuel payments.

His solution reminds me of Utopia by Thomas More. It was never meant to be a real place, so the title came from the Greek for nowhere. Is Happy’s solution more practical? I don’t know, but does anyone in government relinquish the power of the purse voluntarily?

How much do we have to lose by ignoring the problem, or just continuing to patch the more obvious holes? Too much.

Health care is a mess. People have no idea of what the costs really are, so they have no incentive to control costs. Maybe this would help. We need to stop worrying about disrupting the status quo.

Maintaining the status quo will kill us. The only status quo people are corpses. For them, things can’t get any worse.


Drinking Problem? Try SBI.

In I’LL Give You A Comment, White Coat Rants writes about a new counterproductive, and probably lethal, policy.

Well, if you have a drinking problem, or if you have a family member who has a drinking problem, or if you make money treating people who have drinking problems, then the latest JCAHO mandate to impair ED (Emergency Department) treatment is your kind of drug. Of course, that is assuming that the SBI (Screening and Brief Intervention)[1] becomes a mandate. Screen everyone for alcohol abuse, then provide a 15 minute intervention to stop the problem drinking. Ooops, most of them call this SBIRT, the RT for Referral to Treatment. That is where the counselors will make their money. Then there are the rest of the JCAHO screenings. Then you may receive a medical assessment for the emergency that resulted in your trip to the ED.

Looking at the web site for this, it seems to be guaranteed. I counted about a dozen people posting opposing views on this topic. Some of them were only “not completely thrilled.” They only seem to be concerned about where their money will come from. If they get their cut, that only leaves about half a dozen opposing voices. One is clearly a crackpot, linking this to a rebirth of Nazi style government, but the rest stay on topic. In favor of this are about 200 posts. Reading them is like reading the positive comments about Big Brother from the government officials in 1984,[2] so maybe the crackpot isn’t so crazy. How can so many be oblivious to the harm?

The trauma personnel in favor of this mandate deal with a situation that is different from what the ED faces. You are not presented with a triage nurse asking all of these screening questions and then performing a brief intervention before you are seen. Trauma centers tend to be much better at keeping social workers on staff (available to trauma), so they can respond with the rest of the trauma team and ask the screening barrage after the patient has been stabilized.

JCAHO (the Joint Commission for Accrediting Health Care Organization) was their old name, but they are trying for a new and improved image. Never a good sign in health care. Now they call themselves TJC (The Joint Commission). What were they thinking? Hmmm. That’s not right. What were they smoking?

Inevitably, with a bunch of bloggers who have a sense of humor, some refer to them as the Medical Marijuana Advocates. [3]

If you are unfamiliar with the topic, the Medical Marijuana Advocates are the people who the hospital calls in for prearranged inspections, so for that one week where everyone is doing everything by the book, it is because these runaways from the circus are coming to visit. They make all sorts of silly rules, as you can see from these links.[4], [5], [6]

They act as if the ED is Lake Woebegone, where all of the children are above average and giving them more and more divergent responsibilities will actually not cause competency to decrease. As if there are no lowest common denominators, who will no longer be up to that minimum standard. Now they will be more dangerous.

“Oh no! It’s Nurse X. Why do we have to work with Nurse X, nobody is worse at patient care than Nurse X.”

“Hush, Nurse X always completes the SBI thoroughly and gets such good evaluations from the patients. We are all about the Press Ganey scores, not patient care. So what if we lose a few patients, dead people don’t fill out evaluations.”

My opinion ofcross-training[7], [8], [9], [10], [11] has not changed. This is not different from the requirement that paramedics become cross-trained to satisfy somebody’s misunderstanding of medicine. The only positive I see here is that it may help others to see the problems with EMS cross-training.

Eventually, you will arrive at the ED and be asked such a ridiculous number of questions before you are treated, that most people will look for genuine alternatives. Someplace to go for real emergency care, not an emergent screening for all sorts of chronic social problems. The purpose of the ED is to keep you from immediate death or disability. Screening for smoking in the home, domestic violence, TB, suicidal ideation, alcohol consumption, . . . is not necessarily wrong. When the screening and brief intervention distract the nurse from focusing on the life and limb threats, then screening is bad. When this encourages the hiring of nurses and doctors, who are incapable of recognizing a life or limb threat, then it is very bad.

But this is just one more question, how bad can that be?

It is not one more question – it is a 15 minute intervention.

An extra quarter of an hour out of the treatment of each patient. Where are the ED nurses to find the time? If the hospitals hire more staff for this, you know that they will be the first to go when the next “belt tightening” happens.

The addiction community is lining up at the feeding trough to stuff themselves on the bacchanalia that they see as their reward for being ignored for so long. As long as nobody questions where the money or the time is supposed to come from, nobody seems to care. I see the dilution of skill, in order to include this new skill for doctors and nurses, as a bigger problem.

This is coming from you. From your wallet and from your quality of life – assuming it doesn’t kill you.

The ED cannot turn anyone away, so every “deserving” social program shall be foisted upon the ED. Eventually, the ED may have nothing to do with emergency medicine. The ED is being made to atone for the guilt of everyone else.

The ED has become the Lady MacBeth of medicine. Lady MacBeth was guilty in the death of the king. The ED has many faults, but it does not have that kind of blood on its hands – yet.

This stain will not go away.

This stain will make a mockery of emergency medicine.

No. I do not think that I am exaggerating.

Another view of the same situation is presented in the book The Victim by Saul Bellow.[12] Guilt vs. entitlement. How much do we let our guilt, or our neighbors’ guilt cause us to harm ourselves and to encourage the guilt tripper in his dissolution?

Responsibility has become a foreign concept.

No individual responsibility is to be allowed in America.

^ 1 The Joint Commission
Standards Development & Research

^ 2 From The Literature Network

^ 5 From MDOD

^ 6 From MDOD

^ 7

^ 8

^ 9

^ 10

^ 11


DC Fire and EMS – making everyone happy.

The changes at DC EMS are making at least a few people less than happy. Dave Statter at STATter 911 writes Major change in the structure of DC Fire & EMS Department. Civilian EMS workers will become sworn, uniformed members of department. He has an update today – Unity sparks disharmony.

While I do not know how things operate in DC as far as who is in the ambulances, there are some pretty nasty accusations that fly both ways in the comment section of the articles. If anyone knows how things work there I would love to learn more about it. Reading the comments does not really tell me anything, except that some people on opposite sides of the “debate” cannot make cohesive arguments.

What I do know about DC is not impressive. If there is one place that has protocols that exemplify the problems I have with OLMC (On Line Medical Command) requirements and poor physician oversight, DC is it. It appears that almost all ALS (Advanced Life Support) treatment requires a non-rebreather mask and high flow oxygen, an IV, and an ECG monitor.

This is their protocol for PVCs (Premature Ventricular Contractions) – those funny looking beats that should not generally be treated. The authors of the comments on STATter 911 are probably experiencing more than a few PVCs as they write their tirades.

Adult Cardiac Emergencies:
Premature Ventricular Ectopy (PVC’s)

All Provider Levels

1. Refer to the Patient Care Protocols.

2. Provide 100% oxygen via NRB, if respiratory effort is inadequate
assist ventilations utilizing BVM with 100% oxygen.

3. Place the patient in position of comfort. If evidence of poor
perfusion is present place the patient in shock position.

4. Initiate advanced airway management with Combi-tube if
respiratory effort is inadequate.

Note Well: EMT-I and EMT-P should use ET intubation.

5. Establish an IV of Normal Saline KVO or Saline lock.

Note Well: An ALS Unit must be en route or on scene.

II. Advanced Life Support Providers

1. Attach EKG monitor and interpret rhythm.

2. If possible, obtain 12 lead EKG.

It goes on to the typical reflexive bad reaction to PVCs – lidocaine. OK, maybe amiodarone would be more typical, but both are a bad idea for PVCs of unknown origin. Is this the normal, walking around rhythm of the patient?

Why the high flow oxygen? ACLS certainly does not encourage that.

Apparently, if it is ALS, you need at least a mask in DC.

Looking at protocols on their site kept causing my browser to freeze up. Whether it is on my end, their end, or something else, if your browser has problems there don’t be surprised.

They are hiring Paramedic/FireFighters at $48,731- $69,998/year.

I couldn’t find information on the non-fire fighter medic jobs, so I don’t know what the difference in pay is. This does appear to be a system that needs a lot of work. The outside experts have recommended fixes, but the city just seems to like to pay them to come in, make recommendations that will be ignored, and go away with a lot of city money.

Hey, DC people throwing around money – Call me!