First Aid

My daughter's school band performed at Disney's California Adventure Park yesterday. It was a great performance and a pretty incredible experience for the kids. They got to hang out at Disneyland all day and work with Disney Performing Arts behind the scenes.

My wife and I decided to go see the kids, but we were being good parents and allowed our daughter some semi-freedom. Rather than being official chaperones, we stayed in the same hotel and went to the parks on the same day. Our daughter knew we were there and knew we were available if she needed us. Of course, we were doing well if we got so much as a text to let us know how she was doing.

Until a kid got sick.

One of the children in our daughter's group got dizzy on a ride. Feeling nauseated, he started to panic a little. The poor guy has a history of anxiety and panic attacks. By the time our daughter got us on the phone and we got to him, he was having mild spasms in his hands and complaining of numbness and tingling all over; classic signs of a panic attack.

It was unseasonably hot in Anaheim yesterday. The sun was shining and there wasn't really a breeze. It's conceivable that this young man could have been suffering from a mild heat illness. Indeed, that's what we assumed we would find as my wife and I made our way to the kids.

Disney security thought the same thing. There were two security officers with the kids. They asked when we got there if we were chaperones. We confirmed that we were not official chaperones, but that we were parents from the same group. My wife, an EMT, started asking the boy questions while I was speaking to the security officer in charge. He explained that since the young man was complaining of some chest pain (a complaint he never repeated to any medical personnel, including my wife or me) the protocol was to send for a nurse.

The security officers were actively trying to cool the boy off. They brought soaked towels to put on his head and neck. They brought bottles of water for him to drink. There was one of those spray bottles with the fan on it there. It still had the price tags on it, but it had water in it and I got the impression that the security officers snagged it to use for him. While we waited, a third security officer showed up with a patio umbrella, clearly borrowed from a nearby outdoor dining area. The main security officers realized the questions my wife was asking the young man were medical in nature. He asked if we were medically trained and we identifed ourselves as a paramedic and an EMT.

It took an inordinately long time for the nurse to arrive. The first aid office for Disney's California Adventure is near the front of the park. We were about 500 yards from there. 500 yards of running the gauntlet through the crowds with a wheelchair bearing a gear bag. I estimate it took her 7 minutes from the time we arrived and the security officers had already been there for a while by that point.

The nurse was very pleasant. The security officer identified us as off-duty medics right away and she listened as my wife gave her a report. We stepped aside and continued to call chaperones. The nurse did a cursory evaluation and loaded him up in the wheelchair. My wife went to meet with the chaperones and bring one to the first aid office while I stayed with the young musician.

There are a few things that helped us identify his condition as being more about panic and less about heat illness. The most important one is that his condition resolved without any real treatment. The security officers were really great. They brought him shade, water and cooling towels. But you couldn't take away the heat of the asphalt he was laying on. His rapid pulse slowed as he calmed down and began to feel better. If his pulse had been fast because he was dehydrated, it would not have gotten better as my wife helped him by soothing his nerves.

I was disappointed in the fact that no one from Disney took vital signs. The first aid office is set up like a mini clinic. There are beds arranged with curtains for a modicum of privacy. There's an automated blood pressure machine on wheels parked in a corner. One nurse took his temperature, but no one took a blood pressure. If there was any serious concern about his condition, vital signs are the minimum that should have been performed.

The Disney nurse said their protocol is to observe the young man for an hour and not let him have anything by mouth. I'm not sure why she didn't want him to drink anything. Water would have been a good idea. However, it wasn't going to hurt him to not drink. It just wasn't going to help him, either. This brings me back to the vital signs. How can she make a decision to not allow him to drink anything whithout doing a proper assessment?

Maybe they just didn't want him to puke. The first aid office is brand new and for the moment it smells nice in there.

When a chaperone from the group finally arrived -- another parent -- he turned out to be a doctor. I won't say what his specialty was, but suffice it to say he is not an emergency physician. He was pleasant enough when he arrived, but when he learned the young man hadn't had anything to drink, he got snotty.

"Why not?" the chaperone asked. The only people in the room who knew he is a doctor are him, my wife and me. The nurse is walking into this one blind.

"Because the nurse says so," she said.

"Well the doctor says he needs some water." At this point my wife has to introduce our chaperone to the nurse as a physician, because in his sarcastic retort he didn't really identify himself. It was more of an assumption that his sparkling personality would proclaim his superior knowledge base. "And put some salt in it," he added.

Salted water? Really? It's time to step in. I pointed out that the young man's complaints had almost entirely gone away. Doctor/chaperone nodded at me and pinched the boy's fingernail. "He has very slow return," he said. He was trying to defend the water idea.

The problem is twofold. First, the kid had fine capillary refill. I doublechecked using his toes, which were closer to me. If anything, they should have refilled even slower than his fingernails. They took no longer than a second to return color completely. Second, if the young man did have slow capillary refill that would be an indicator of significant shock, a condition not remedied through drinking a glass of salted water. Plus, all of his other complaints -- hand cramps, numbness and tingling -- had gone away without anything more than the soothing voice of a momma figure.

Ok, time to leave. The young man was now in the hands of an official chaperone as well as the questionably capable hands of a very pleasant Disney nurse and an arrogant physician, both of whom find it perfectly appropriate to make decisions affecting their patient without actually conducting a history or physical assessment.

Overall, I have to give Disney a 'C-' on this medical response. The security officers were wonderful. If, indeed, the young man was suffering from heat illness -- which I doubt very much -- they were working to actively cool him off. They were attentive and did a great job prioritizing and focusing on this sick guest.

Where Disney dropped the ball was on the medical side. The nurse was absolutely sweet. She was great company and we talked for quite a while during this hour long encounter. Unfortunately during that entire time, no one took a single blood pressure. I'm not entirely sure than anyone other than my wife and the doctor/chaperone even counted a pulse, but I might have missed it.

Either way, the young man made it to the performance and now his story will be a little more interesting than the rest of his bandmates. I don't know if he had to drink any salted water.

There are two schools of thought on healthcare and money:

1. It doesn't matter what it costs when we need to get help.
2. I don't want to go bankrupt simply because I got sick.

The feds released prices from hospitals around the country today. Interestingly, but not surprising to me, there's no rhyme or reason to healthcare pricing. A heart attack in New York might be way cheaper than one in rural Texas. Or, it might be much more expensive.

I've thought for years that speaking frankly about the cost of ambulance transportation is not only ethical, it should be required. Unfortunately, there are a lot of pressures on healthcare providers not to mention cost.

Sometimes it can be construed by the patient as a commentary on their perceived ability to pay. If you subscribe to the first line of thought above, you might be offended when your caregiver brings up money. If you are more in line with number 2, you might be grateful that someone took your costs into account.

I'm not sure what, if anything, this information is going to do for healthcare costs. I do know that something needs to change. Look at the information on the NYT interactive hospital charges to see if your town is average, expensive, or a deal.

• New hospital data shows giant swings in prices - Vitals

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In your life, you can probably count on one hand the number of pivotal mentors that have guided your journey through life. Somewhere at the very top of that list for me, near my parents, is a man named Mark Lockwood. Almost 18 years ago, Mark invited me to lunch after meeting me only a few times. He had a proposition for me: how would I like to take over the EMS program at the local junior college?

Mark saw something in me and I owe him for the best parts of my career. Without my experience as a teacher, I'm not so sure I would have become a writer. I learned a lot from him.

If you want to be an educator in emergency medical services today, you have to take a class on how to teach adult learners. In that class, you will learn all sorts of tricks to motivate and educate. You'll learn how to surprise your students and get them to think. You'll learn how to inspire them and make them want to listen to you. It's all based on science and there's plenty of research to back it all up.

Mark Lockwood was doing all that stuff 25 years ago. He did it because it made sense to him. It worked.

He was a take-no-prisoners kind of teacher. You didn't get any slack in Mark's class. You were going to laugh and you were probably going to cry. At the end, almost without knowing it, you were going to be an EMT. If you passed Mark Lockwood's class, you would definitely pass the certification exam.

He was a fire chief and a paramedic. He was a reserve deputy sheriff and park ranger. He loved HAM radio and had his call sign on his license plate. His motto -- nay, more like a mantra -- was "Improvise, adapt and overcome."

Mark ended his watch tonight, peacefully after a short illness. I don't know where he came down on religion and the afterlife, but I wouldn't be surprised if his version took him to another galaxy. Mark was the consummate Trekker (Trekkie in his day) and he ended every encounter with the same goodbye, accompanied by the Vulcan salute.

So here's to you, old friend. I hope you got everything you wanted in a life cut short. I hope you are proud of your accomplishments. Many of us can credit you with launching our careers. The patients we saved and the new caregivers we mentored may not have even known your name, but you touched their lives just the same.

Your time on this world is over, but may your soul live long and prosper.

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We have wasps.

These are miserable, evil little critters. They usually leave us alone, but they just look evil. They have that sleek, mean look of an efficient assassin.

They're also hard to kill.

My daughter found one in the bathroom one night. It was just crawling around on the floor near the bath mat. At first I thought it was injured.

An easy kill -- or so I thought.

I took the bath mat, a pretty, braided cloth thing, and tried to squish the offensive little bugger. When I looked, it laughed at me.

I could hear it.

Then I tried again, this time with my foot trying to squash it against the tub. So hard, in fact, that I hurt my toe. I looked...

More laughing.

Now it got serious. My daughter brought me a shoe and I brought it down upon this evil doer and smited it thusly.

Except I didn't smite it. Squished it, yes, but no smiting here. When I looked again, it was still moving.

It was a ZOMBIE WASP!

Wasps can sting over and over again, unlike a honey bee. It made me wonder as I stood there -- building up the courage to cover the still wiggling spawn of Satan with a wad of tissue and drop it in the toilet -- if it stings me, will I become a zombie, too?

I'd take anaphylactic shock over zombie-ness any day.

Well, by now I have two daughters standing behind me watching Dad battling the Evil Zombie Wasp. I can't fail in front of my girls. I am Dad, a superhero by all accounts, and I must vanquish the villain or forever dash the hopes and dreams of two little girls.

Or at least be ridiculed forever by my two sarcastic daughters.

So I take a deep breath and grab the flailing Evil Zombie Wasp with my Magical Wad of Toilet Tissue, fully expecting to feel its Incredibly Painful Zombie Sting. Alas, the magical toilet paper worked and I was protected! I dropped the Evil Zombie Wasp into the toilet and flushed quickly. Just in case, I also closed the lid.

My daughter was free to jump in the shower and the younger one headed back to bed. I, SuperDad, successfully vanquished my foe.

Zombie Wasps of the universe, beware!

Removing bee stingers is about speed not technique

 

(c) Dimas Ardian/Getty Images

One of the most common first aid myths is how to remove a bee stinger. For decades, we've been taught that bee stingers must be scraped off rather than pulled out. Actually, it doesn't matter -- they just have to be removed quickly to cut down on any reaction.

The thought process is that pinching the sac attached to the bee stinger in order to pull it out will squeeze all the venom into the victim. The thing is: bee stingers aren't built like that.

As it turns out, bee stingers have a little pump that pushes the venom through the stinger into the skin. When you grab the venom sac, the pump slams shut.

Bee stingers are tiny and most of the time they can be simply brushed off, so no pinching, pulling or scraping is necessary. Don't worry about how you remove a stinger, just get it out of there.

• Best Way to Remove a Bee Stinger
• How Big is a Bee Stinger?
• Bee Sting Treatment

As a kid, I was told that once you had chickenpox you were golden. It's over. You had completed your rite of passage through elementary school.

Shingles follows a nerve on one side of the body

 

 

(c) Jose Luis Balarezo Gardiol

Nobody told me the virus that causes chickenpox could rear its ugly head again later in life. For some, the virus hides in the body until it sees an opportune time to reappear as shingles.

Shingles starts with itching and burning, usually on the chest or back. Maybe a fever or some weakness, but not every time.

The rash will form usually within a couple days. The rash is the same chickenpox bumps we got when we were kids, except it won't cover the whole body, only one side. Either the rash will spread over half the face or it will be a narrow band running around one side of the ribcage or waist from spine to sternum.

It hurts. Bad. Sometimes for years.

The rash scabs over and disappears within three or four weeks, just like chickenpox. But, it attacks the nerve bundle that it follows and makes the area very tender and sensitive to touch. The faster you get in to see the doc and get on medication, the faster the pain should go away.

See the doc within 3 days of the rash appearing.

If you know someone with an active shingles rash, it might be contagious. Shingles is the same virus as chickenpox, so if you haven't had chickenpox or the vaccine, you could catch shingles from the blisters and any drainage from the blisters.

On the flip side, if you've had chickenpox, shingles shouldn't be contagious.

• He Thought His Shingles was a Spider Bite

I was working on an article and got to thinking about how often I, and other first aid instructors, suggest putting patients in the recovery position. The idea is simple: put them on their sides to let puke drain out.

You see, if you're lying flat on your back -- a position known as supine -- and you vomit, it all just bubbles up and gets in the way of you taking a breath. The next thing you know, you're sucking stomach contents into your lungs (medically known as aspiration).

The recovery position is the alternative that somebody came up with when I was a baby EMT more than...well...more than a few years ago. You never wanted to let a puking patient lie flat on his or her back. Likewise, you didn't want to put them face down because then you can't see if they're choking. The compromise was to put them on their sides.

In the ambulance, patients are loaded head first. The EMT or paramedic sits on the patient's left. There's a wall to the right. We were always taught if we had to roll the patient into the recovery position (called the lateral recumbent position by hoity-toity medical peeps), we should roll the patient to the left so we can suction out any remaining emesis and keep an eye on our patient's condition.

Besides, if you roll them to the right, you'll have to clean the wall. Yuck!

Of course, if both crew members were still with the patient when the need to roll the patient into the lateral recumbent position (also called the lateral decubitus position by even hoitier and toitier medical peeps) then the proper direction to roll the patient depends on which crew member is higher ranked. You always point the puke fountain at the lower ranking individual.

The recovery/lateral recumbent/lateral decubitus position works fine in an ambulance or a hospital with trained healthcare professionals at bedside armed with the proper suction devices. On the other hand, all by itself the recovery position might not be good enough to work as advertised. The idea is to let the goopy, soupy stuff out. If you gotta roll them all the way to their bellies to get the job done, so be it.

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Earlier this month there was a study published about distracted driving. The author, an insurance group, says that of approximately 6,500 traffic fatalities identified as being the result of "distracted driving," 62% were from drivers claiming they were "lost in thought." The insurance group extrapolated from that figure that daydreaming on the road is dangerous.

I agree. I'm just too skeptical to think it's completely true.

The problem with daydreaming is that it's only self-reportable. There's no way to objectively measure how much you were concentrating on driving before you ran into the car in front of you. Because of that, there's no way to give you a citation for DWD: Driving While Daydreaming. You can, however, be cited for using your cell phone or having your dog in your lap. You're already at fault for the accident, why admit to behavior that further gets you in trouble?

You don't. You blame it on a wandering mind.

I think there's certainly a portion of accidents out there that fall into the "daydreaming" category. But I didn't fall off the turnip truck yesterday. I've spent a quarter of a century staring through the windshield of an ambulance, and that has given me a harder outlook on human behavior.

The second biggest category of distracted driving in this study was mobile phone use -- texting, talking, surfing, whatever. The point of all this: hang up and pay attention, you're driving!

• Daydreaming while driving more dangerous than texting, study claims
• FAQ on Car Accidents

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As I sit here watching the footage from the explosions at the Boston Marathon, it makes me wonder how well emergency services around the world would respond to such a tragedy. This is what we train for and from what I can see of Boston's emergency services, they did a great job.

One thing it drives home is that no matter how secure we think we are, something could always happen. We take it in stride when it's a weather event, but as this unfolds I'm sure the Boston Police will be taken to task for the explosion. I hope that doesn't happen.

There's just no way to secure an entire city. Two of the explosions were near the finish line, but they could have just as easily been at the start line or any number of popular viewing points along the route. I really hope this doesn't result in unecessary increases in security at other events.

I just ran my first half marathon a couple weeks ago and my wife is a regular runner. One of the wonderful things about these events is that you can just walk up to the course and cheer on the racers. It would be terrible if this led to ridiculous increases in security.

My heart goes out to the runners, families, spectators and responders. I hope they find those responsible and move quickly to bring life back to normal.

• Multiple Casualty Incidents
• Treating Multiple Wounds
• Emergency Medical Leadership

We had family from out of the country visiting this week. They left this morning to fly back home and it got me to thinking about airplane travel.

The last couple times I flew I made a point of finding the automated external defibrillator (AED) on the plane. I figure if someone on the flight suffers a cardiac arrest, I want to have the right equipment.

I've been on a train when the crew asked for a "doctor" to assist an ill passenger. I have a friend who's been on several flights and train rides (indeed, he was with me on the train that time) when the crew asked for a doc or someone to assist.

If I had my way, flight crews would first ask for paramedics, then if none were available, switch to doctors. Helping someone in a cramped space with dozens of onlookers in less than optimal conditions is pretty much the job description of a paramedic. Some docs can muddle their way through such an alien patient care experience -- a couple of docs delivered a baby on an airplane and it was national news -- but we do it every shift.

Interestingly, when the train crew asked for medical assistance, they didn't specify a doctor. When my friend and I showed up, however, they wanted proof that we were paramedics. The doctor who showed up after us needed no such proof. I guess if you're going to impersonate a medical professional, go big.

I figure with all the traveling I do, I'd better be ready in case there's a need (although I still rarely carry my paramedic card with me). Flight attendants have some first aid training, but the fancy case full of medical supplies on each airplane flying over the United States is only useful if you have a passenger trained to use the stuff.

The next time you're on a plane and hear the flight attendant over the loudspeaker ask if there's a doctor on board, speak up and request a paramedic instead -- especially if you're the patient.

• In Flight Emergencies
• Be Prepared for an Emergency On Board
• What First Aid Supplies can You Bring on an Airplane?