How will DACA repeal impact our healthcare?

Like other American’s, I’ve been following the news on the Deferred Action for Childhood Arrivals (DACA) program, especially now that the Trump Administration decided to cancel it.  People disagree with the program for a number of reasons, although the libertarian-leaning Cato Institute estimates rolling DACA back would cost the government $60 million and cause a 10-year loss of $280 billion.  From a strictly economic perspective, it makes sense in my mind to keep the program.  Still, there may be compelling reasons beyond simple economics to keep or repeal the program.  I wanted to explore DACA from a public health perspective. People have some strong opinions on the best way to handle illegal immigrants and trying to tease out the public health implications also requires addressing the economic consequences too.  Those economic concerns are part of what drives people’s strong emotions, but it’s near impossible not to discuss them in relation to public health.    Continue Reading

It’s just a flesh wound

It’s been a few days since the video of that Utah nurse being arrested has come out.  I’ve been ruminating on it a good deal.  I think part of the shock, at least for me, was the physical violence unleashed in a situation that didn’t call for it.  The police could’ve pushed past her and found someone else to lead them to the patient.  She wasn’t physically barring them from the patient.  They could’ve escalated things higher, “ok, you’re not going to help me, where’s your supervisor” kind of thing.  When asked why they were taking it out on this nurse, that she was “just the messenger,” the police said, “because she’s the one who has told me no.”  So you move on and find someone who will tell you yes.  Like a judge. Continue Reading

You will respect my authoritah!

Wow.  I just watched the video about the nurse getting arrested in Utah.  If you haven’t seen it, it’s pretty disturbing.  There’s a 20-minute version that in my opinion doesn’t make the police look any better.  One thing that disturbed me was the overall attitude that the police were either going to get what they wanted or arrest this nurse for obstruction.  Now I’m not an attorney or a cop, but I am a fairly reasonable human being.  I’m someone who tries, not always successfully, to build consensus and collaborate.  Even if the police have a legal right to the blood draw, which it seems they do not, but if they did, how does arresting someone who is following a legitimate policy reasonable? Continue Reading

BTS & the Diver Medic Course

Last week I had the pleasure of attending an EMT-Diver course sponsored by The Diver Medic, an organization created by Chantelle Newman.  Working in the Caribbean on a dive destination island, we see our share of dive related calls and any opportunity to learn and improve I jump at.  The fact that this was in NJ, in March where the temperature reached 24F wasn’t on my mind when I signed up.  This was the second time this course was offered and was taught by Sandy Shaw, a local EMT and dive instructor.  The first course was offered as a pre-course to DEMA, the professional dive show held annually either in Las Vegas or Orlando.  This time, the course was scheduled just before Beneath the Sea (BTS), the annual dive show held in Secaucus, NJ.Continue Reading

Finishing Nursing School

Uggg, the slog is over.  I love being a paramedic, but I also like options.  Becoming a registered nurse seemed like the most logical step.  I graduated paramedic school in 2006 and started nursing school in 2008, which was an utter disaster.  I did great in clinical but the classroom killed me.  Part of it was switching from a medic perspective to a nurse perspective, which isn’t always aligned.  By 2009 I had failed out. Continue Reading

The Right Care

Today was kind of rough, from an emotional, what the hell is going on in the world, kind of way. It wasn’t especially busy, nor were the patients especially sick. We transported a guy to the hospital who could’ve driven himself. Then we cared for a young woman having a miscarriage. Then we responded to a low-speed MVC where the patient didn’t need a hospital. Then we brought a patient in, who by all accounts isn’t a great person and watched as the ER doctor treated him like a jerk. Oddly, it’s that call I just can’t shake today, and I’m bothered more by what I didn’t do, then what I did.

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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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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


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:


Working in the prehospital medicine field, I subscribe to a few different journals and online resources to stay current.  One of those resources recently had a headline, “What’s a more dangerous infectious disease threat than Ebola?”  That kind of headline grabs my attention, so, figuring I should know what’s a more infectious disease threat than Ebola, I clicked the linked and was brought to an article about Chikungunya, aka Chik.  I’ve heard about this mosquito borne illness before, it’s actually made its way to the Caribbean and every so often there’s a notice about it in my local hospital.  What I didn’t know is it has now made its way to the United States, so I thought it might be a good topic to explore.Continue Reading