Health & Wellness
Health & Wellness (8)
Wednesday, 06 October 2010 08:18
Don't get fired for Facebook
10 ways to use social media safely
How to make sure your online activities do not interfere with your job as a paramedic or EMT at your agency
We've seen several cases in recent months where EMS providers have gotten in hot water and even lost their jobs for posting what their employer believed were inappropriate images, videos, or comments. For instance, take a look at SC firefighter-paramedic fired over Facebook video post or NYC EMS lieutenant may lose job over Facebook post, prank.
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Sunday, 20 June 2010 15:29
Connection between Gingivitis and Heart Dieses
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.
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Thursday, 17 June 2010 16:22
Latest drowning statistics reveal a few interesting emerging trends
Latest drowning statistics reveal a few interesting emerging trends
One would think that, over the summer holiday season, South Africa’s coastal areas experience the greatest increase in drowning incidences. The country’s beaches are jam-packed with holidaygoers, young and old, who don’t necessarily put safety first while being in their relaxed environment. But the latest statistics from the emergency medical services provider, Netcare 911, indicate an interesting trend.
Since the beginning of December, Netcare 911 has received more calls relating to drowning and water related emergency incidents from the country’s inland provinces than it has for the coastal areas. Between
1 December and 14 December, 18 related calls were logged from the provinces of the Western Cape, Eastern Cape, Kwazulu-Natal and the Northern Cape collectively. During the same period, 23 calls were logged at the call centre for incidents happening in the inland provinces.
According to Peter Feurstein, Netcare 911’s Regional Coastal Operations Manager, many of the calls received from the coastal provinces, involving children, resulted from freshwater sources such as public and private swimming pools, rural dams and rivers. There is also a noticeable trend in terms of the age differences of the children involved in these incidences.
“There seems to be a definite distinction between inland and coastal incidents. Coastal incidents seem to be involving the age group of 10 to 18 year-olds more predominantly whilst, inland, the greatest number of incidents involve the 2 to 8 year-old age bracket,” says Feurstein.
Nick Dollman, a safety officer and spokesperson for Netcare 911’s incident management unit in Gauteng, confirms the alarming statistics being shown through this trend: “In Johannesburg alone, Netcare 911 has attended to 17 victims including fatal drowning and near drowning emergencies, since 1 December. 12 of these involved children under the age of 10, two were teenagers and three adults.”
Feurstein believes that this trend can be explained by the fact that warning campaigns about water safety are seemingly more adhered to, as well as the heightened sense of awareness, in the coastal areas. During last year’s holiday season, for instance, the Vodacom Netcare 911 Surf Rescue Service where five helicopters were made available to volunteer rescue workers from the National Sea Rescue Institute (NSRI), Lifesaving SA and Netcare 911.
Dollman agrees, especially as his team in Gauteng have picked up on the fact that most of the drowning incidences they have been called out to involved the children of people who are not used to being around swimming pools.
He explains: “These past two weeks we attended to several children of domestic workers who had drowned, or nearly drowned, at their parents’ place of work. Some of these children are from other provinces and come to visit their family for the holidays and are not familiar with swimming pools or the hazards that lie within. Interestingly, as many of the employers do not have small children themselves, their pools are not protected, which leads to avoidable tragedies.”
But swimming pools, even those where permanent lifeguards are on duty, are not the only places where children can easily drown. 90% of children who drown are under some sort of supervision at the time.
Dollman warns that a small child can easily drown in only a few hundred millimetres of water. “We have even attended to a child who had fallen into a large plastic bucket that was being used to clean nappies. Parents and childminders should be aware of all the water hazards in and around the home, including fishponds, water features, toilets, pets’ water bowls, bore holes and open drains.”
One of the scariest statistics is that, for every child that dies from drowning, five are left with permanent brain damage as a result of the prolonged lack of oxygen which occurs during a near drowning. It takes only four minutes without oxygen for irreversible brain damage to occur.
Drownings are listed as one of the top causes of unnatural death amongst children in South Africa. At the same time, these unfortunate events are very preventable. Should you find yourself in the position of having to call for help, please call Netcare 911 immediately on 082 911.
Additional notes on preventing drownings:
Prevention is better than cure. Be vigilant and keep a watchful eye on the children around water, keep pool gates locked or cover your pool with a certified pool net. A basic course in first aid and CPR can make a dramatic difference in the outcome should the skills be applied timeously.
For further information on the courses available, please contact the Netcare 911 School of Emergency and Critical Care on 011 695 9600, visit the Netcare 911 website or consult your local yellow pages under the "first aid" heading for a comprehensive list of training facilities. Ensure that you use an accredited facility and receive a certificate of competence.
In any emergency situation the most important thing to do is immediately contact the correct emergency number for the relevant authority. Try and memorise the number for emergency services in your area and keep the number saved on your cell phone or close to your landline telephone. In many cases, during the panic of a medical emergency, people cannot remember the correct number or cannot find where they have written it down. Otherwise contact Netcare 911 on their national number: 082 911
In the event of a drowning, the following assistance interventions are recommended:
Having multiple layers of safety around pool and spa areas or other open bodies of water (such as a safety net, a closed fence, a childminder and a surface alarm) can prevent tragic accidents.
Get the victim out of the water as soon as possible, but do not become a victim yourself. Make sure it is safe for you to enter the water first.
Handle the victim with care. Many submersion incidents are associated with neck injuries, so keep movement to the back and neck to a minimum.
Assess to see if the victim is awake or not.
Check for breathing. If the victim is not breathing, administer two slow rescue breaths, ensuring that the victim’s chest JUST starts to rise.
If the victim shows no response to the rescue breaths, start CPR.
CPR is vital, even if it is an amateur administering it. Keep on doing it until someone who is trained in advanced life support arrives and can take over. All parents should learn how to administer child CPR as it does differ from adult CPR. There has also recently been a worldwide revision in the CPR technique and it is vital that even current first aiders be retrained according to the new protocols.
Call, or have someone call, a recognised ambulance service as early as possible during this sequence. Whoever calls for the ambulance must give the dispatcher an accurate location of the incident and a contact number at the scene. Never hang up on the operator and always return to the rescuer to inform them that you have called for help
One would think that, over the summer holiday season, South Africa’s coastal areas experience the greatest increase in drowning incidences. The country’s beaches are jam-packed with holidaygoers, young and old, who don’t necessarily put safety first while being in their relaxed environment. But the latest statistics from the emergency medical services provider, Netcare 911, indicate an interesting trend.
Wednesday, 14 October 2009 16:46
Clarifying HIPAA and Disclosure of Disease Information
Case 1: It’s 3 a.m. on a Saturday night and you’re en route with a patient in the back of the ambulance. When the patient becomes combative, you’re not able to trigger the safety device and are stuck with a contaminated needle. Your designated officer for infection control reports the exposure to the medical facility and requests source patient testing. The designated officer is told the results can’t be released because of HIPAA.
Case 2:
The Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-191, directed the U.S. Department of Health and Human Services (HHS) to issue privacy regulations that set standards to govern individually identifiable health information. The Privacy Rule developed by HHS went into effect for most entities subject to the law (i.e., “covered entities”) on April 14, 2003. Following implementation of the Privacy Rule, a great deal confusion has persisted within medical facilities regarding the sharing of source patient test results following an exposure event. Some medical facilities have refused to provide the test results of source patients involved in exposures because they believe such disclosure would violate HIPAA. Such refusals on the part of medical facilities are inappropriate and represent a misinterpretation of the Privacy Rule.
The Privacy Rule protects all “individually identifiable health information” held or transmitted by a covered entity. This information is referred to as “protected health information” (PHI). It includes information regarding the individual’s health condition, the provision of health care to the individual, or payment for the provision of health care to the individual if the information identifies the individual or there’s a reasonable basis to believe it can be used to identify the individual. The individual’s written authorization is required for any use or disclosure of PHI that is not for treatment, payment, or healthcare operations or otherwise permitted or required by the Privacy Rule . 
However, the Privacy Rule does not prohibit disclosure of PHI in all circumstances. Recognized exceptions include the issue of a medical facility disclosing source patient testing. A covered entity (e.g., a medical facility) is permitted to disclose PHI without an individual’s authorization to the extent that such use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law [45 CFR Section 164.512 (a)]. One of the “required by law” categories in the Privacy Rule is “Uses and Disclosures for Public Health Activities.” The following use and disclosure is specifically authorized:
“A covered entity may disclose protected health information for the public health activities and purposes described in this paragraph to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition, if the covered entity or public health authority is authorized by law to notify such person as necessary in the conduct of a public health intervention or investigation.” [45 CFR 164.512 (b)(1)(iv).]
Medical facilities clearly are required by law to provide source patient test results in exposure incidents. The Ryan White Law, a federal law (PL 101-381), mandates that source patient test results be provided to the designated infection control officer (DICO) of the emergency response employee involved in an exposure incident. The medical facility to which the source patient involved in the exposure was transported has the legal obligation under this law to provide source patient test results following notification of the exposure by the DICO. The DICO then has the obligation to inform the exposed employee of the source patient test results.
In addition, the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030), also a federal law, provides that the employer of an employee involved in an exposure incident must obtain the results of the source individual’s testing and make this information available to the exposed employee.
It’s clear, therefore, that in the event of a bona fide exposure, medical facilities are authorized under HIPAA to disclose source patient test results pursuant to the Ryan White Law and the OSHA Bloodborne Pathogens Standard. Such disclosures are no different than disclosures made to state public health officials pursuant to state notifiable disease laws. In the opening scenario, the DICO should give a copy of this information to the emergency department staff. It’s clear that source patient test results are to be released to the DICO.
Confusion has also persisted regarding the role of medical facilities in the sharing of tuberculosis diagnosis information. This issue is important to clarify because the practice of standard precautions does not include the routine procedure of masking the patient for transport with a surgical mask. The rules for bloodborne disease and airborne disease are very different. In November 2005, the Centers for Disease Control and Prevention (CDC) published a document entitled “Controlling Tuberculosis in the United States” that included the following statement:
“HIPAA also recognizes the legitimate need for public health authorities and others responsible for ensuring the public's health and safety to have access to personal health information to conduct their missions and the importance of public health disease reporting by health-care providers. HIPAA permits disclosure of personal health information to public health authorities legally authorized to collect and receive the information for specified public health purposes. Such information may be disclosed without written authorization from the patient. Disclosures required by state and local public health or other laws are also permitted. Thus, HIPAA should not be a barrier to the reporting of suspected and verified TB cases by health-care providers, including health-care institutions.”
In addition, the CDC published updated TB guidelines in December 2005, which OSHA is enforcing. In the guidelines, medical facilities are reminded that “EMS personnel should be included in the follow up contact investigations of patients with infectious TB disease. The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381) mandates notification of EMS personnel after they have been exposed to a patient with suspected or confirmed infectious TB disease.” Here, it’s clear that it’s the responsibility of the medical facility to notify the DICO directly if there has been an exposure.
Medical facilities refusing to provide this information may not be aware of the Ryan White Law and the exception to providing this information contained in the HIPAA law. The DICO and a member of administration from your department should schedule a meeting with the medical facilities risk manager, head of the emergency department and the infection control practitioner to review this issue. Minutes of the meeting should be taken to document the discussion and the agreed to results. If non-compliance continues or is not agreed to, then OSHA may be called to report this violation and, for exposures involving emergency responders, to Dr. Gomma, who is in charge of the administrative aspects of the Ryan White Law. Dr. Gomma can be reached at 513/841-4337.
Resources
- Centers for Disease Control and Prevention: “The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule.” April 2, 2001.
- IV. Final Regulatory Impact Analysis, 5U.SC.804(2)- Public Law 104-21.
- Occupational Safety and Health Administration: “CPL 2-2.69, Compliance Directive, Occupational Exposure to Bloodborne Pathogens.” November 27, 2001.
- Centers for Disease Control and Prevention, Department of Health and Human Services: “Ryan White Comprehensive AIDS
- Resources Emergency Act; Emergency Response Employees; Notice.” Federal Register. March 21, 1994.
- Centers for Disease Control and Prevention: “Controlling tuberculosis in the United States.” MMWR. 54(RR12):1-81, 2005.
- Centers for Disease Control and Prevention: “Guidelines for preventing the transmission of mycobacterium tuberculosis health-care settings, 2005.” MMWR. 54(RR17):1-141, 2005.
Wednesday, 14 October 2009 16:36
The Age of Moral Ambiguity
When was the last time you held a training session with your supervisors and employees on moral ambiguity?
Ask the average worker in your EMS organization to discuss their approach to moral ambiguity in the workplace — specifically in dealing with patients, co-workers and supervisors — and you’ll probably get a puzzled look. Ask your supervisors about their feelings on the moral ambiguities of their job and how it relates to their approach to managing employees and providing customer service and you’ll probably get a blank stare and a shrug of the shoulders.
As the EMS manager, do you have a clear picture of moral ambiguity and how it affects you, your employees and your customers?
In simple terms, “morals” are usually defined as the difference between good and bad. “Ambiguity” is the state of having more than one meaning or being open to interpretation. Put those terms together — “moral ambiguity” — and you get something that shows conflict between right and wrong.
An example of this concept is if your ambulance service mission was to care for patients but your employees mistreat patients who repeatedly call for minor problems. The mission and purpose of an ambulance responding to a call for help is good, but that “good” is at the same time “bad” for those cases when a patient may be mistreated for allegedly abusing the system.
The question for agencies today is to what degree can you be a good representative of EMS delivery against the bad examples? Do all the decisions made by your employees represent the best actions and behaviors of EMS workers in the industry? Do your organizational values demonstrate daily your commitment to doing what is right, and do you and your employee’s actions follow those values?
This is not just a question of medical ethics or setting good policies and procedures. Moral ambiguity is different for everyone. In fact, our moral character is determined prior to beginning work in EMS. We became EMTs and paramedics because we wanted to help others. We spent the time to attend classes and clinicals, and our level of commitment was increased by the time we applied for jobs. When we became employees, we were required to follow the established code of conduct of the organization. In most cases, we follow the formal and informal behaviors and actions demonstrated by senior employees and supervisors.
The number of examples of employee and supervisory misconduct in EMS is staggering. Employees who steal from their patients, hit their patients or even sexually assault their patients would probably try to justify their actions by pointing to the overall good they perform by being an EMS provider. Most employees and supervisors would clearly know the difference between good and bad in those cases.
But what about those who are having extramarital affairs, working a side job for cash and not reporting the income on their taxes, or demanding a discount at a restaurant while on duty and in uniform. Are these behaviors overlooked and thus allowed to represent your agency to the public? “Obviously not,“ you’re probably shouting in your head (or maybe out loud). But if these activities occur, what actions would you take? You probably don’t have a policy against stealing from patients, and I believe you shouldn’t have to. So how do you emphasize to your employees and supervisors what’s good and what’s bad? Isn’t everyone supposed to know what’s acceptable behavior? Do you have to attempt to cover all the anticipated indiscretions of your employees?
It shouldn’t matter if an employee or supervisor doesn’t have a policy or procedure to guide their actions or behaviors. They need to know that proper conduct is expected of them both on and off duty. In some cases, organizations mention “moral character” in either an SOP or a policy and procedure manual. Rarely, if ever, is that term explained, and the meaning is left up to interpretation by the employee and management.
So the key is to not ignore the implications of uncorrected inappropriate behavior and to ensure employees understand the importance of honest and ethical behavior. How you choose to deal with it in your organization could vary a great deal. The first step is bringing this issue to the forefront. Now consider how you would approach the idea of morals in your organization the next time they seem to be declining.
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Wednesday, 14 October 2009 15:33
The symptoms of stress
The following are symptoms of the acute “flight-or-fight” stress reaction: (Sympathetic Reaction)
- Fast beating, racing heart, often palpable
- Blood pressure soars
- Fast racing breath
- Digestion slows down
- Sweaty palms
Wednesday, 14 October 2009 15:29
Multi-drug resistant TB
Multidrug-Resistant Tuberculosis (MDR-TB) is a strain of TB bacteria that has become resistant to TB drugs.
MDR-TB is difficult and costly to treat, and can be fatal.
The current definition of MDR-TB is when a strain of TB is resistant to at least two first-line anti-TB drugs.
Extensive Drug Resistant TB (XDR-TB also) is defined as MDR-TB that has also become resistant to three or more second-line drugs
What is multidrug-resistant TB?
Bacterial TB strains resistant to an anti-TB drug or a combination of these have emerged.
The current definition of multidrug-resistant TB (MDR-TB) is when bacteria become resistant to at least two first-line therapies - the drugs isoniazid and rifampin, considered to be the most potent against the disease.
What is XDR-TB?
XDR-TB stands for Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance). This is a newly identified TB threat: MDR-TB that has also become resistant to three or more of the six classes of reserve second-line drugs.
This description of XDR-TB was first used earlier in 2006, after a survey by the World Health Organisation (WHO) and the US Centers for Disease Control (CDC) and Prevention.
The emergence of XDR TB is cause for great concern because it is widely distributed geographically, and renders patients virtually untreatable with available drugs.
A survey conducted by the WHO and CDC found that XDR-TB has been identified in all regions of the world but is most frequent in the former Soviet Union and Asia.
The medical community considers XDR-TB to be a major public health threat associated with high mortality rates, especially in areas with high HIV rates and poor health care resources. This is the case in many parts of Africa, where drug resistance is thought to be on the rise.
What causes MDR TB?
MDR-TB is caused by poorly managed treatment of TB disease: when patients do not take all their medicines regularly for the required period because they start to feel better, when health workers prescribe the wrong drugs or the wrong combination of drugs, or when the drug supply is unreliable or of poor quality.
When patients fail to complete treatment regimens or receive incorrect treatment, they may remain infectious. Bacteria in their lungs may develop resistance to certain anti-TB drugs, which then can no longer kill the bacteria. People they infect will acquire the same drug-resistant strain. When drug treatment stops, the bacteria build up resistance to medication, reducing options for further treatment.
The end result is MDR-TB, a form of TB that doesn't respond to treatment.
Who is at risk for MDR-TB?
Drug resistance is more common in people who:
Have spent time with someone with drug-resistant TB disease
Do not take their prescribed medicine regularly
Do not take all their medicine
Develop TB disease again, after having taken TB medicine previously
Come from areas where drug-resistant TB is common (South East Asia, Latin America, Haiti and the Philippines)
Can MDR-TB be treated?
Patients with MDR-TB disease must be treated with special drugs, which are not as good as the usual anti-TB drugs and may cause more side effects. Even these drugs have little effect on XDR-TB.
Some people with MDR-TB disease must consult a TB specialist to observe their treatment to check its effectiveness. MDR-TB is at least 100 times more expensive to cure than non-resistant TB. At best, only half those infected with new strains can be cured. There is no cure affordable to developing countries for some MDR strains.
The worst scenario is that TB will become untreatable due to MDR-TB. MDR-TB usually kills its host, but only after allowing the victim years of life to spread drug-resistant bacteria to others.
Can MDR-TB be prevented?
People who have spent time with someone with MDR-TB disease can become infected with MDR-TB bacteria. If they have a positive skin test reaction, preventive therapy is important for those at high risk of developing MDR-TB disease, such as children and HIV-infected people.
Information supplied by WHO and CDC
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Wednesday, 14 October 2009 15:17
Making the best of her golden years
A Bay area woman is heading back to the classroom to train as a paramedic, but she's more than three times older than her classmates.
Seventy-two-year-old Marjorie Galvin is taking notes at Manatee Technical Institute to become a certified paramedic.
The grandmother of 20 said her children are all grown up, and her husband passed away, so she's making good use of her time.
"There's just all this stuff out there that I've never done," Galvin said.
Galvin said she plans to spend the rest of her years doing them all and in the process teaching younger people a lesson about growing old.
"We've got a preconceived notion of what it means to be old and it doesn't always hold true," Galvin said.
EMT instructor Jim Cena said Galvin had no problem fitting into the all-male class filled with students in their 20s.
"She keeps right up with them," Cena said.
In some cases Galvin takes the lead. Cena said she does so well, he'd trust her with his own life.
"If I was having a medical emergency and I looked up and saw Marge responding to help me, I would breathe a sigh of relief, that's how well she's doing," Cena said.
Galvin said she hopes her accomplishments inspire others.
There are some requirements to become a certified EMT that Galvin said she probably won't be able to accomplish such as running up five flights of stairs carrying equipment or dragging an adult from a room.
Instead, she plans to use her new skills working at a hospital.
Galvin has also recently tried skydiving.
