Recently I’ve been reading discussions and research into patient outcomes as it relates to BLS care versus ALS care. The results of this research are pretty sobering. First, some background. Many people know what an ambulance is and think they know what an EMT is; however, I’ve spoken to ER physicians who didn’t realize there was a difference between an EMT and a paramedic. It’s important to differentiate. Since I’m most familiar with the US differences, this post will focus on that, however I know in Canada and the UK there are some differences and I’m happy if my colleagues from those countries could shed some light.

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If you should be in Rome, live in the Roman manner; if you should be elsewhere, live as they do there.

The idea of living as an expat, especially on a Caribbean island, is pretty romantic. The reality, though not nearly as rosy, is so much more interesting. I’ve officially been an expat for 9 months now. I’ve been here long enough to experience the underside of the beast, especially in my line of work. Unlike many expats who work in tourism or hospitality, (providing visitors with great food or guiding them to a wonderful dive site), I see mostly locals, many times on their worst day. I certainly care for tourists, it’s rare a day goes by without treating at least one cruise ship passenger, but more than half my calls are for locals. What makes working with and caring for, the local population difficult is although they speak English, our customs and approach to life is different. I’ve had to adopt a “when in Rome” attitude. I remember reading about U.S. Special Forces, when they initially entered Afghanistan following 9/11, becoming frustrated with sitting down and having tea with village elders before getting down to business. The thing is, that’s how the Afghans do business. Continue Reading

Holidays on a Caribbean island

Working as a paramedic, or in any hospitality/healthcare/service industry job, has its perks. For me, I only work 16 days a month (in a job I love no less) vs. a 9-5’er working 20. For my wife, among other perks, she gets to dive for free on her days off. One flip side to that, we work on holidays. As a college professor of mine once said about the hospitality industry, we work when everyone else is off. During the holidays, we sometimes work even more. My poor wife has been on 6 day, 13-14 hour work day weeks lately and it’s kicking her ass. With that kind of schedule, we had to find some time to dive and enjoy ourselves.Continue Reading

Stop posting your boarding pass online

I saw this originally in a Huffington Post article and followed it through to this blog.  Anyway, there are some “common-sense” security measures my wife and I have started taking when we travel.  We do put timers on our lights so it appears we’re home in the evening.  We hide and lock valuables and we have stopped posting on social media that we’ve left town, we post stuff once we’re back instead.  One thing I didn’t realize though was thieves could steal your information off the barcode or QR code on your flight tickets, via pictures posted to social media.  I’ve actually gotten away from tickets altogether and just download the QR code onto my phone, but if you have paper tickets, avoid posting pictures of them online.  There’re some scary things people can do with the information in their own barcode if they have criminal intentions, but if someone gets hold of your information, they could potentially discover quite a bit about you.  Probably the most frustrating thing though, they could cancel any future flights you’ve scheduled.  Although it might seem like overkill, once you’re done with your trip, it’s probably a good idea to shred the tickets.

Decompression illness- part 1

Diagnosing decompression illness (DCI) is kind of a nightmare.  It’s usually a diagnosis of exclusion.  Many times the patients’ complaints are vague.  “My left arm hurts,” might be one.  Could it be a heart attack, could it be an overuse injury, or is it dive related?

DCI encompasses both decompression sickness, DCS (the bends) and barotrauma (to include arterial gas embolism or AGE). The difference is usually onset. Continue Reading

Quick Getaway

Our wedding anniversary was this past weekend and unfortunately my wife had to work.  We did have lunch together and I whipped up dinner for us.  We’re not big on gifts though, our philosophy is we’d rather spend our money on experiences.  So, seeing as we were both off from work on Tuesday and Wednesday, we snuck over to Cayman Brac for 2 nights to see the island and do some diving.  How else do you celebrate an anniversary when you live on a Caribbean island?  You go to another island of course!

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Witnessing an underwater snow storm

Tonight my wife and I went diving with hopes of witnessing a rare event, the annual coral spawning.  Last year we saw it, but it was a total fluke.  This year we worked hard to time our dive with the spawning.  You see, coral spawning occurs once per year, over the course of several nights, for about half an hour.  Then it’s over for another year.  If you dive on the wrong day and/or time, you’ll miss it.  Last night we dove from 8:30p until 9:30p and didn’t see anything (friends of ours dove at 10:30p and saw it, others witnessed it earlier at 7:30p, just luck of the draw).  Tonight we dove at 9:30p and most of the dive was uneventful…until about 10:20p. We figured we had missed it again and began ascending to complete our safety stop when my wife started going nuts. Continue Reading

“Just think good thoughts”

The great thing about living abroad is immersing in a culture which is by definition, foreign.  Even though we live somewhere where English is spoken and the US dollar is accepted, there are still cultural differences, both good and bad, that require we adjust.  For one thing, there’s less of an emphasis on work and meeting deadlines than in the States.  That’s not to imply a poor work ethic, lazy people are found everywhere, more, it’s an attitude that little in life is truly an emergency, if it doesn’t happen today, it’ll get done tomorrow…or you know, soonish.  That can be frustrating for someone who needs a little more structure in their world; actually, it can be frustrating even if you’re not that structured.Continue Reading


We get thousands of cruise ship passengers visiting us weekly.  In fact, on busy days we can see our country’s population nearly double due to the influx of cruise ship passengers.  This article caught my eye and besides the obvious (this PhD candidate seriously built a “vomit machine” for her thesis? That’s awesome!), was the fact that norovirus can spread like wildfire, especially on a cruise ship. Here’s more evidence to explain why.  Although a small fraction of cases occur on cruise ships, norovirus continually makes headlines, recently on 2 different cruise ships.

Even though a tiny percentage of particles are aerosolized when someone vomits (0.2%), only 18 viral particles are needed to spread infection.  Further, individuals infected with norovirus can transmit the disease for two weeks following their recovery. Thoroughly cleaning contaminated surfaces and practicing good hand hygenie are important to stopping the infection cycle.

The best defense is the simple measures, cover your cough and wash your hands.  And if you’re on a cruise ship and you come down with a case of norovirus, maybe stay on deck and vomit over the rail.

For more info:

Can you say “Geneva Convention” 10x quick?

So my wife and I have jobs, a place to live and a car.  The next thing on our To-Do list is getting a drivers’ license.  Shouldn’t be too tricky, right?  In the States, if you’re licensed to drive in one state, it’s usually valid through reciprocity in another.  Similarly, under the Geneva Convention (I feel like a spy or diplomat every time I get to say “Geneva Convention” and actually mean it), residents from signatory countries can apply and receive a drivers’ license.  A road test isn’t required (which they may want to rethink when you’re moving from a country that drives on the right to one that drives on the left), but a written exam is. Continue Reading