Ambulance Today – Winter Edition

The Winter Edition has hit the shelves, its live now in Ambulance Today. Click on the link below to download and read the magazine and my article on page 33, where I discuss the challenges facing emergency medicine educators in The Democratic Republic of Congo (DRC) – ‘From the Africa Desk’ by the Africa Editor, Michael Emmerich.

Ambulance Today – Winter Edition 2017

Besides the above article the magazine is littered with so many other good reads – from Infection Control to Technology in Medicine, Spinal Care and Identifying the Right Care for Older Patients.

To all the followers of this page, if you want to see an article written about any specific aspect of Emergency Care on the African continent, or get me to interview a key role player, drop me a mail. Equally, if you have any news items you would like us to run either in our magazine or on our daily-updated global ambulance news website please make contact.

To my fellow passionate EMS friends across the world, I trust you are enjoying the start of this journey, as we continue to explore this fascinating continent. Till then be safe out there and stay passionate, and for those who are privileged enough to spend time with their families over this holiday period – Enjoy!

Ambulance Today – Autumn Edition

The Autumn Edition has hit the shelves, its live now in Ambulance Today. Click on the link below to download and read the magazine and my article on page 37, An Introduction into the Aero-medical Evacuation Industry in Africa – ‘From the Africa Desk’ by the Africa Editor, Michael Emmerich.

Ambulance Today Autumn Edition 2017

To all the followers of this page, if you want to see an article written about any specific aspect of Emergency Care on the African continent, or get me to interview a key role player, drop me a mail. Equally, if you have any news items you would like us to run either in our magazine or on our daily-updated global ambulance news website please make contact.

To my fellow passionate EMS friends across the world, I trust you are enjoying the start of this journey, as we continue to explore this fascinating continent. Till then be safe out there and stay passionate.

Ambulance Today 1st Article

My first article is now live in Ambulance Today in their Summer 2017 edition. Click on the link below to download and read the magazine and my article on page 57. It will be a quarterly article – ‘From the Africa Desk’ by the new Africa Editor, Michael Emmerich.

Ambulance Today Summer Edition 2017

P57. From the Africa Desk of Ambulance Today Ambulance Today introduces our new segment ‘From the Africa Desk’ by our Africa Editor, Michael Emmerich.

To all the medical people who follow this page, if you have any ideas for special feature articles on ambulance and emergency care care in any part of Africa drop me a mail. Equally, if you have any news items you would like us to run either in our magazine or on our daily-updated global ambulance news website please make contact. I am already busy on my next article outline … so stay in touch to follow our journey across this amazing continent.

To my fellow passionate EMS friends across the world, I trust you will walk this continent with me as we delve deeper into the respective regions in future articles. Till then be safe out there and stay passionate.

Feeling Proud

Feeling very proud at present, I am embarking on another new writing adventure, I have been appointed as the Africa editor for the UK based EMS publication – Ambulance Today, circulation includes, Europe, Canada, the Pacific Rim and now Africa.

At Ambulance Today we are always looking to expand our ambulance news coverage to different parts of the globe, which is why we are proud to launch our new segment ‘From the Africa Desk’ and introduce our Africa Editor, Michael Emmerich.

The Africa Quarterly editorial, that I will be writing, will cover the main regions in Africa, with opinion pieces from various regional role players. Our focus will be on the key regions across the continent; East, West, Central, Sub Sahara and North Africa. I will explore key and relevant NGO’s and the vital role that they play in bringing medicine and emergency medicine to the continent. The first article will be in the Summer Edition (UK Summer), which is in the next week 🙂

To all the medical people who follow this page, if you have any ideas for special feature articles on ambulance care in any part of Africa drop me a mail. Equally, if you have any news items you would like  us to run either in our magazine or on our daily-updated global ambulance news website make contact.

To my fellow passionate EMS friends across the world, I trust you will walk this continent with me as we delve deeper into the respective regions in future articles. Till then be safe out there and stay passionate.

My New Facebook Page :)

Greetings to all my gentle readers and avid followers. For those of you who have a love for poetry, poems, creative writing and life, please visit my new facebook page – by clicking on the link below:

Michael D Emmerich – Poet & Writer

This wordpress page will still feature all my new poems and creative writing articles and will also feed through to the new facebook page. The new page will be a more interactive way of following my writing and poetry; plus as I plan on publishing my poetry anthology this year, it will be a way to order copies (or find out where to purchase online) and get info on readings etc… Thanks for all the support and messages of encouragement over the past year.

Creativity is life🙂

PS: been working on more than a few poems, which will be posted shortly 🙂

 

 

Courage Under Fire

an absence of fear

the ability to suppress

or maybe

there are values of more import

grace, valour, hope



bear defeat

never lose heart

remain calm

capture courage

push on

get up

again and again



consume whatever

life throws your way

let grace possess you

remain calm, rational

even under attack

courage is grace under fire



in spite of consequences

you can only be

a victim of yourself

not others

discipline your mind

be tenacious, persevere

hope always remains

 

© 2016 Michael D Emmerich

New Medical Writings

Feeling very proud; I have been approached by a Canadian based medical site to submit articles for publication. They are a Pan-Access worldwide collective of experts and non-experts creating a discussion about infection control and prevention using their  online publication forum, http://www.InfectionControl.tips

Check out my profile and my first article cleared for publication (working on the next few)

http://infectioncontrol.tips/author/memmerich/

Managing Infection Control in a Disaster

TECHNOLOGY IN MEDICINE

TECHNOLOGY IN MEDICINE

Past, Present and a Possible Future – Help or Hinder

Published in Sanguine, journal of the ECSSA June 2015

Technology in Medicine, a topic many in EMS chat about, and if we have been in service for 20 years plus, we have then been privileged (or cursed) to see significant changes across the board with regard to equipment, patient care, protocols and drug therapies. Many of us have actively pushed for change and new equipment; be it with regard to fluid therapy, bleeding control, pain management and airway management. As one who has been active in certain areas pushing for change, we sometimes miss the most crucial approach to patient care; neatly summed up by Hippocrates (400-ish BC)

Cure Sometimes. Treat Often. Comfort Always

The classic approach to patient care has always been underpinned by the following:

  • Arrive at a diagnosis by patient consultation and physical hands on examination

  • Confirm ones diagnosis via various diagnostic devices

  • Reaffirm ones diagnosis by means of special investigations

Will technology change this approach for better or the worse?

If we look back at history, we see that not all new technologies have been readily accepted by the medical community. Many were viewed (are viewed) with suspicion. In the 1930’s some doctors doubted an X-ray image of the chest was as reliable as a physical examination. Devices threatened to replace the diagnostic expertise of the traditional doctor. Many doctors have valued their clinical experience over machine-produced information. Other technologies initially failed because doctors or patients found them impractical. The ECG was only useful when it became portable and reliable enough to be used at the patient’s bedside.

We need to also seriously review our progress in Medical Technology with regard to changes that offer only incremental benefits but at much higher patient care cost. The focus must be on evidence-based product development, manufacturers have to be able to show their products and new technologies will add value to their customers. Does new technology automatically translate into better patient care and most importantly improved patient outcomes.Plus we need to ask the question; who is their customer, the patient or the medical practitioner? If we as practitioners treat our patients as customers, they will act like customers, we need to be very careful of venturing into a quagmire such as this.

The entire patient/medical practitioner relationship is also changing, as the patient has access to a wider range of medical information, our patients are possibly smarter (maybe). Patients have access to more medical information, with the end result, that at times, they might be less trusting and prone to ask more questions of their medical practitioner. As practitioners we must be open to this new questioning patient and be willing to answer more questions than we did in the past.

Taking cognisance of all of the above: what is the health care practitioner to do?

There is an acknowledged gap in the “bench to bedside” cycle of medical discovery and its implementation in clinical practice, which can mean a gap of years changing “what we know to what we practice”.Hence the treatment of patients in an emergency setting should not only be concentrated on developing new technologies, but must also involve proper training and skills development; medical talents needs to be honed. New technologies MUST always mandate new skill sets, protocols and procedures.

An area of import in my opinion in medical development is patient information. The more information we have on the patient at hand, will allow us to render more appropriate patient care. Information and knowledge management is critical in helping with the decision making process and thereby improving patient care. Many medical practitioners believe that patients should take an active role in managing their own health information, because it fosters personal responsibility and ownership and enables both the patient and practitioner to track progress outside scheduled appointments and at times of a medical emergency. Patient smart cards is one way to grapple with this issue of information. It will allow patients to upload their health records via a flash drive and carry their information with them in their wallet. Information may be accessed through cloud-based storage and encrypted systems anywhere in the world, or plugged into medical smart readers. Medical practitioners can update to cloud technology in real time and the patients own medical doctor can be alerted to changes in the cloud files.

Another key area where technology can aid us in having more information at our fingertips is via a “differential” diagnosis or problem list, which is accessed via the cloud and links to our patient file and further information we input. After we have reviewed the patient “history” and examination. (e.g. is this appendicitis? a urinary tract infection? constipation? inflammatory bowel disease?) The practitioner must then troll his memory banks and innate knowledge base, or one may need to consult texts/online sources to check up/confirm their thinking. Cloud based technology could aid us and speed up the confirmatory differential diagnosis. As their is no doubt much room for improvement in the current approach, with many practitioners currently relying on their tacit knowledge base at the frontline which, while mostly effective, is subject to human error. Once the differential diagnosis or problem list is drawn up, then a related treatment plan could be formulated, and treatments in the form of procedures and/or prescriptions for medications may be suggested by our cloud database.

Emergency Medicine must continue its current academic trajectory, to keep pace with the challenges that technology brings to our patient care. If academic training lags behind the technology curve our practitioners and therefore our patients will be the poorer. We must ensure that there is now technology/practitioner gap as we continue to push the boundaries in improving our patient care. The danger of technology, is that it has the ability to make us lazy and self reliant. It has become noticeable in certain areas of emergency medicine how our reliance on technology has allowed us to forget the three cornerstones of good medicine, diagnosis, confirmation and reaffirmation; of which the diagnosis and confirmation are reliant on us having a hands on approach to our patients (which is becoming a dying art). Good solid diagnostic skills will always be an essential tool of medicine, especially emergency medicine, we forget this at our and our patients peril.

EMS – You Can Never Leave

Last thing I remember I was running for the door

I had to find the passage back to the place I was before

“Relax,” said the night man, “We are programmed to receive

You can check out any time you like but you can never leave”

EAGLES – Hotel California

EMS is like the Hotel California: “You can check out anytime you like… but you can never leave” the memories, faces, successes and failures will always be with us. They dim at times over the years, but they are always there. I read a thought provoking and honest analysis on being a paramedic a few months back and have been mulling over her post, digging through ramblings from my field journals and the skeleton of a story I have been working on for about 2 years… these all prompted me to ramble further…

The blog post that triggered this article is: Unless you’ve been there, you wouldn’t understand: A Paramedics farewell to the job. Posted on February 10, 2015 by Di McMath

https://dimcmath.wordpress.com/2015/02/10/unless-youve-been-there-you-wouldnt-understand-a-paramedics-farewell-to-the-job/

One of the key issues for me is the ability/or lack thereof to detach from what we are doing and seeing; this drags one into the massively dehumanising temptation of EMS. I do feel that this dehumanisation is both inexorable and dangerous – as practitioners we need to know how to halt or slow it down. After 30 years of emergency medicine practise; I am still not entirely sure if we can entirely halt the process, which is why we can never fully check-out.

Being a fan of the poetry of Wilfred Owen, and as I reread his poems on a regular basis, I was drawn back to his poems during this thought process and found some further insight on reading “Insensibility”:

And some cease feeling

Even themselves or for themselves

Dullness best solves

The tease and doubt

The poem plays along the interesting juxtaposed lines of detached versus involved, and the varied degrees of these mindsets. Those of us in the profession have over the years dabbled with both approaches, the trick is for each individual to find his/her own balance. That is all part of the process of slowing down the dehumanising process. Finding this balance is key, if we do not, then we are doomed to keep repeating the mistakes of our past (mistakes as regards emotions and those of a clinical nature).

Emergency Medicine has the ability to dehumanise and diminish or renew and expand our powers of feeling. It is our choice to decide which path to follow. We realise soon on in our profession that this is one of the many choices that we have to make. How we deal with this choice determines how we deal with another key critical decision we as practitioners in the field are confronted with at numerous times in our career. Who lives or dies, or why do some people die despite our best efforts; and the pain of admitting defeat and saying okay, we need to stop now, the patient is deceased.

It is on these crucial scenarios, that I have to agree with the title of Di’s blogpost:

Unless you have been there you wouldn’t understand – Its sounds trite, but it is so true.

Trying to explain this process of immediate Triage, that at times needs to be done in very short time frames, less than a minute, is very difficult. Those are some of the choices we can never walk away from, and even when we do make them we cannot stop thinking about “What If?” the curse and bane of every paramedic. The cursed ability to second guess yourself long after the fact on an ongoing basis. It is here where we as emergency medicine practitioners are faced with the dehumanising and diminishing or the renewing and expanding of mental and medical health.

The goal of our profession should be a living force in the quest for and prevention of human suffering, but that sometimes comes at the cost of our own mental health. As we enter, continue in and exit this amazing profession, lets consider the cost to those we have served and continue to serve. All we can do as practitioners is warn, and that is why the practitioner needs to be truthful.

MOTOR VEHICLE ACCIDENTS – A GROWING PUBLIC HEALTH BURDEN

My latest Blog post for This Week in Global Health:

http://www.twigh.org/twigh-blog

Road Traffic Crashes do not just happen! They are caused by Fatal Moves (actions) by a driver. The message is simple – DON’T DO FATAL MOVES!” @FatalMoves

1990 to 2010: Deaths from road traffic injuries increased by almost half.

The largest category of fatal events are transport related. In 1990, according to Global Burden figures, these were the 10th leading global killer. By 2013, they were fifth! Ahead of malaria, diabetes, chronic obstructive pulmonary disease, cirrhosis or any kind of cancer. In part, this is because of progress against these diseases. But it also because as incomes have risen worldwide, more people are buying, and crashing, motorbikes and cars.

Most global road traffic deaths occur in low and middle-income countries and are rapidly increasing because of the growth in motorisation. Mortality rates caused by traffic related injuries are increasing in low and middle-income countries and they account for 48 percent of the world’s vehicles but more than 90 percent of the world’s road traffic fatalities. Pedestrians are most often affected, followed by car occupants and motorcyclists. Alcohol plays a key factor in the drivers and pedestrians, notably in South Africa, where as many as 65% of all pedestrians have increased blood alcohol levels. Conversely, traffic deaths are decreasing in high-income countries, Sweden is an excellent case study that we will review further on in this article.

10 countries are responsible for 600,000 road traffic deaths annually (see the MikeBloomberg link in the references below, to see if your country is on the list). Each year, 1.3 million people die in car accidents, so these 10 countries are responsible for nearly half of all road deaths! India tops the list for the highest overall number of road deaths, followed by China and the U.S.

If public health leaders are to catch up on accident prevention, the Global Burden of Disease study (Lancet links below) findings can help them see where and how. “Now that somebody’s done the work and we recognize that there’s a difference we may not have seen before, we can go to work and ask why,” said Dr. Schauben

Besides the rapidly rising fatalities we must also take cognisance of the rising number of injured persons and their cost on the (Global) health burden. Road-traffic crashes were the number one killer of young people and accounted for nearly a third of the world injury burden, a total of 76 million DALYs (Disability Adjusted Life Years) in 2010, up from 57 million in 1990. Most of the victims were young, and many had families that depended on them, who know have to rely on other sources of support, in most instances, the state.

What does the current research then tell us about this rapidly rising burden on global public health; transport injury prevention shows that collective action is as important as individual efforts. Motorcycle helmets, car seatbelts and sober drivers are important, but so are safe vehicles, consistent law enforcement and a reliable infrastructure. Thanks to a combination of insufficient, nonexistent or poorly enforced safety laws, poor infrastructure and a lack of enforcement and corrupt enforcers, the bulk of the countries globally keep aiding and abetting in the deaths of over 1.3 million persons annually! Only 28 countries, representing 449 million people (7% of the world’s population), have adequate laws that address all five risk factors (speed, drunk driving, helmets, seat-belts and child restraints). Over a third of road traffic deaths in low and middle-income countries are among pedestrians and cyclists. However, less than 35% of these countries have policies in place to protect their road users.

India has the dubious distinction of registering the highest number of road fatalities in the world (250,000), despite the fact that its population is much smaller than neighboring China and there are more vehicles on the roads in the USA than in India. “A large proportion of these deaths can be prevented by simple measures. The most important of these is strict enforcement of traffic rules, which is conspicuous by its absence in our cities as well as on highways,” says the Times of India, and this would be true of the top 10, and also of the country where I reside, South Africa, where 47 persons die each day!

Further compounding the cost of the traffic fatalities is the actual real cost impacting on the affected countries economies; many who cannot afford to have the extra burden on their already strained public health budgets. The economic cost of road collisions to low and middle income countries is at least $100 billion a year! The risk of dying as a result of a road traffic injury is highest in the African Region (24.1 per 100 000 population) It’s such a big problem, in fact, that the U.N. feels it needs an entire decade to fix it. In 2011, the U.N. launched a “Decade of Action” that aims to “stabilize and then reduce” global road traffic fatalities by 2020.

Is there any good news? Sweden is one success story, in 2013 only 264 people died in road crashes, a record low. How have they done this? Planning has played the biggest part in reducing accidents. Roads in Sweden are built with safety prioritised over speed or convenience. Low urban speed-limits, pedestrian zones and barriers that separate cars from bikes and oncoming traffic have helped. Globally we need to reduce human error, or eliminate the opportunity for drivers to make fatal moves; human error can even further be reduced, for instance through cars that warn against drunk drivers via built-in breathalysers and making the implementation of safety systems, such as warning alerts for speeding or unbuckled seatbelts/child-seats, compulsory on all new vehicles, built in any factories across the globe.

Individually we need to be aggressive in safe and sober driving habits and not allow our friends and family to place themselves, their passengers and fellow pedestrians at risk by not looking kindly on their unsafe driving practises. Bad and drunk driving should become as unpopular as using a cellphone while driving.

References:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961682-2/fulltext

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962037-6/fulltext

http://www.worldlifeexpectancy.com/cause-of-death/road-traffic-accidents/by-country/

http://apps.who.int/gho/data/node.main.A997

http://apps.who.int/gho/data/node.main.A998

http://mikebloomberg.com/Bloomberg_Philanthropies_Leading_the_Worldwide_Movement_to_Improve_Road_Safety.pdf