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I Advice - Disaster Medicine- Beyond the ER
Your wedding cake is an important part of your special day and there are thousands of wedding cake stores that you can choose from. The problem is that not all stores are created equal. You may have to be a discriminating shopper for you to find the right wedding cake store.How much for this and that?One of the first questions you should ask your wedding cake store is the price. It’s easy to get carried away by the wedding cake store accessory display. Too many frills however may cost you up to $1000. You may consider ordering a plain cake and buying the decorations and accessories yourself at a craft store.How long will this take?Experts agree that every wedding cake store would usually take up to six months to finish your order. You should however ask your wedding cake store for a guarantee that they can deliver on their specified time especially during peak seasons.What ingredients are you using?There is more to this simple inquiry about cake ingredients. You would want to ask your wedding cake store about cake ingredients not just so you can scrimp and save on the cheapest cake but because cake ingredients are also not created equal. You or some of your guests might have gluten intolerance or nut, egg and milk allergies. Make sure to ask your wedding cake store for alternatives to allergy triggering ingredients.You also need to ask your wedding cake store about taste. Buttermilk generally tastes better than fondant and margarine but can leave a lot of grease with too much shortening. Fondant is more expensive but can give a more elegant l
The key to making these decisions is to identify the critical processes that are required for the provision of essential high acuity medical care. Once these processes are identified specific, measurable parameters must be established to determine if additional resources are needed to bolster that process. This ensures that valuable limited resources are not squandered on processes that are not in danger of collapse as a result of surge. More importantly, as the number of patients under treatment expand it ensures that resources are wisely allocated to maximize the surge capacity.
Resources will always be limited in a disaster because of the very nature by which resources are now obtained. Our "just in time economy" has eliminated most stockpiles from healthcare institutions. Few hospitals have more than two or three days worth of medication, disposable supplies or food on hand at any given moment. They rel
Many people when first starting out in the internet use the free web space offered by their ISP or they go to the free hosting sites. This may seem like a cost saving measure but is it?Firstly if anything goes wrong and it usually does when you least expect it to the options of fixing those problems can be very limited. What happens when your site begins to build a lot of traffic? We have all seen it before when a free hosted site runs out of bandwidth. This mean they have exceeded the limit assigned to them and request that the visitor return later. Remember bandwidth is your monthly allotment of the amount of data that your site can send and receive. Is this the professionalism you want your site to portray?Secondly,are the advertising banners and pop-ads? While some may suit your business, most will not and can detract from your business. Don't forget that pop-ups and banners are a part of free hosting; this is a way of paying for the free service they are providing. While this may not be a problem for personal web-pages if your site is a business orientated then it could lose credibility as it often lacks professionalism.Thirdly, is the name game problem with free hosting as your website is placed in a sub-domain or a folder (www.yourwebsite.freehosting.com or www.freehosting.com/yourwebsite). This can sometimes result in poor search engine rankings. Remember, this part of the internet game is easy for people to search for what you are selling or offering on your website? That is, a domain name that reflects your business which,
Just as patients flow from the field to the hospital decontamination a triage in decontamination arena the science of disaster medicine grew next in the areas of triage and hospital-based decontamination. Soon non emergency room staff were being drawn from their primary duties on the hospital floor to actually step outside the hospital to provide triage and initial treatment in the event of a mass casualty incident. From the triage and decontamination tents disaster medicine moved quickly into the emergency department bringing with it new concepts in toxicology and mass casualty patient care. Lessons drawn from military medical experience and from civilian emergency room experience melded in textbooks as well as discussion groups that inside disaster medicine and within the hallowed halls of the emergency medicine professional organizations.
But in this expanding universe of knowledge the hospital floor and the Intensive Care Unit were all but forgotten. Michael Osterholm and others have discussed the impact of mass casualty events and pandemic influenza on the ability of hospital Intensive Care Units and other high acuity departments to meet the needs of a disaster response. Unfortunately while models created by Schultz and Ramirez had demonstrated that with a small application of behavioral health savvy surge capacities can be increased not only by the required 20 percent under the US Department of Health and Human Services guidelines but by as much as 400 percent, this vast expansion of surge capacity rely in small part on the ability of the inpatient services to accommodate additional admissions. A simple review of historically corrected pandemic predictions compared to hospital capability surveys demonstrates the dangers of not expanding hospital inpatient capacity as aptly as intake capacity has expanded.
When the lessons of the disaster field office are applied to businesses these businesses learn first to determine what is the goal of their organization. In the intensive care unit and other high acuity areas of the hospital the goal is the same as it is in a field disaster hospital, the preservation of life. In the environment of the intensive unit triage has already taken place for you. These patients are already determined to be critical and further triage can only serve to determine which individual's care will utilize so many resources as to endanger the care of two or more other individuals. In this circumstance it is the absolute moral and ethical obligation of those providing the care to make a resource-based decision. When the continued care of one patient will utilize sufficient resources to endanger the care or life or two or more others then the care of that one patient, then that one patient must be reassigned to the expectant (black tag) treatment area. This is not a do not resuscitate order (DNR). This is simply a statement of available resources. Patients are constantly re-triaged based on available resources and current medical conditions. A critical patient upon the loss of vital resources may temporarily be moved to an expectant category until resources or conditions are such that the patient may be re-triaged back to a critical or possibly has improved sufficiently to be "downgraded" to triage category yellow (urgent).
On the other hand, if treatment of an ICU or a high acuity patient does not utilize sufficient resources to endanger the care of two or more other individuals then that high acuity care should and in fact must continue as an ethical and moral imperative.
The key to making these decisions is to identify the critical processes that are required for the provision of essential high acuity medical care. Once these processes are identified specific, measurable parameters must be established to determine if additional resources are needed to bolster that process. This ensures that valuable limited resources are not squandered on processes that are not in danger of collapse as a result of surge. More importantly, as the number of patients under treatment expand it ensures that resources are wisely allocated to maximize the surge capacity.
Resources will always be limited in a disaster because of the very nature by which resources are now obtained. Our "just in time economy" has eliminated most stockpiles from healthcare institutions. Few hospitals have more than two or three days worth of medication, disposable supplies or food on hand at any given moment. They rely
Multiplying with 11Multiplying by 11 is very easy and very interesting also.For Example take 12345 x 11Just forget about 11 and concentrate on 12345Step 1 Take last digit of 12345 (i.e. 5) to the answer: Ans 5Step 2 Add last digit of 12345 with immediate neighbori.e. 5+4=9take it to answer Ans 95Step 3 Add Next two neighbors of 12345i.e 3+4=7take it to answerAns 795Step 4 Add Next two neighbors of 12345i.e 2+3=5take it to answer Ans 5795Step 5 Add Next two neighbors of 12345i.e 1+2=3take it to answerAns 35795Step 6 Take first digit of 12345 to answer :Ans 135795So Answer is 135795Example:120342 x 11Lat digit taken to the answer 120342 Ans 2 Last digit added to neighbor 120342 Ans 62 Next two neighbors added 120342 Ans 762 Next two neighbors added 120342 Ans 3762 Next two neighbors added 120342 Ans 23762 Next two neighbors added 120342 Ans 323762 First digit taken to the answer 120342 Ans 1323762So the Answer is 1323762 In case of carry, the carry is added to the total of neighborsExample:226987 x 11 Lat digit taken to the answer 226987 Ans 7 Last digit added to the neighbor 226987
But in this expanding universe of knowledge the hospital floor and the Intensive Care Unit were all but forgotten. Michael Osterholm and others have discussed the impact of mass casualty events and pandemic influenza on the ability of hospital Intensive Care Units and other high acuity departments to meet the needs of a disaster response. Unfortunately while models created by Schultz and Ramirez had demonstrated that with a small application of behavioral health savvy surge capacities can be increased not only by the required 20 percent under the US Department of Health and Human Services guidelines but by as much as 400 percent, this vast expansion of surge capacity rely in small part on the ability of the inpatient services to accommodate additional admissions. A simple review of historically corrected pandemic predictions compared to hospital capability surveys demonstrates the dangers of not expanding hospital inpatient capacity as aptly as intake capacity has expanded.
When the lessons of the disaster field office are applied to businesses these businesses learn first to determine what is the goal of their organization. In the intensive care unit and other high acuity areas of the hospital the goal is the same as it is in a field disaster hospital, the preservation of life. In the environment of the intensive unit triage has already taken place for you. These patients are already determined to be critical and further triage can only serve to determine which individual's care will utilize so many resources as to endanger the care of two or more other individuals. In this circumstance it is the absolute moral and ethical obligation of those providing the care to make a resource-based decision. When the continued care of one patient will utilize sufficient resources to endanger the care or life or two or more others then the care of that one patient, then that one patient must be reassigned to the expectant (black tag) treatment area. This is not a do not resuscitate order (DNR). This is simply a statement of available resources. Patients are constantly re-triaged based on available resources and current medical conditions. A critical patient upon the loss of vital resources may temporarily be moved to an expectant category until resources or conditions are such that the patient may be re-triaged back to a critical or possibly has improved sufficiently to be "downgraded" to triage category yellow (urgent).
On the other hand, if treatment of an ICU or a high acuity patient does not utilize sufficient resources to endanger the care of two or more other individuals then that high acuity care should and in fact must continue as an ethical and moral imperative.
The key to making these decisions is to identify the critical processes that are required for the provision of essential high acuity medical care. Once these processes are identified specific, measurable parameters must be established to determine if additional resources are needed to bolster that process. This ensures that valuable limited resources are not squandered on processes that are not in danger of collapse as a result of surge. More importantly, as the number of patients under treatment expand it ensures that resources are wisely allocated to maximize the surge capacity.
Resources will always be limited in a disaster because of the very nature by which resources are now obtained. Our "just in time economy" has eliminated most stockpiles from healthcare institutions. Few hospitals have more than two or three days worth of medication, disposable supplies or food on hand at any given moment. They rel
Enlargement of liver in infantsSome children suffer from and enlarged liver at the age of nine or ten months and they start getting weaker and weaker. They are breast-fed. What is the reason for enlargement of liver?The mothers of such infants subsist on cereals, ghee and sugar alone. They should take more milk, vegetables and fruits to be able to produce healthy milk for the child.NosebleedA father writes: My son suffers from nosebleed: it is frequent occurrence with him. Twice in the week I find him suffering from it. Can anything help?Children whose diet is deficient in calcium suffer from nosebleed. If the diet includes mil, oranges, green vegetables and other calcium bearing substances nosebleed will automatically vanish after some time.An immediate expedient is to wash the face of the child with cold water. A bandage half an inch thick and two inches broad should be wetted with water and applied to the spinal column of the sufferer from nosebleed for fifteen to twenty minutes to give immediate relief.White spot on nailsA patient asks: I have white spots on my nails. How can the condition be cured?White spots on the nails indicate calcium deficiency. Take leafy vegetables and milk in adequate quantities; the while spots will give place to a healthy glow on the nails.Weakness after urinationSomeone writes: Everyone I pass urine, I feel lethargic and weak. What does it indicate?Have your urine examined: the symptoms are those of diabetes, which is a disease of assimilation. Str
When the lessons of the disaster field office are applied to businesses these businesses learn first to determine what is the goal of their organization. In the intensive care unit and other high acuity areas of the hospital the goal is the same as it is in a field disaster hospital, the preservation of life. In the environment of the intensive unit triage has already taken place for you. These patients are already determined to be critical and further triage can only serve to determine which individual's care will utilize so many resources as to endanger the care of two or more other individuals. In this circumstance it is the absolute moral and ethical obligation of those providing the care to make a resource-based decision. When the continued care of one patient will utilize sufficient resources to endanger the care or life or two or more others then the care of that one patient, then that one patient must be reassigned to the expectant (black tag) treatment area. This is not a do not resuscitate order (DNR). This is simply a statement of available resources. Patients are constantly re-triaged based on available resources and current medical conditions. A critical patient upon the loss of vital resources may temporarily be moved to an expectant category until resources or conditions are such that the patient may be re-triaged back to a critical or possibly has improved sufficiently to be "downgraded" to triage category yellow (urgent).
On the other hand, if treatment of an ICU or a high acuity patient does not utilize sufficient resources to endanger the care of two or more other individuals then that high acuity care should and in fact must continue as an ethical and moral imperative.
The key to making these decisions is to identify the critical processes that are required for the provision of essential high acuity medical care. Once these processes are identified specific, measurable parameters must be established to determine if additional resources are needed to bolster that process. This ensures that valuable limited resources are not squandered on processes that are not in danger of collapse as a result of surge. More importantly, as the number of patients under treatment expand it ensures that resources are wisely allocated to maximize the surge capacity.
Resources will always be limited in a disaster because of the very nature by which resources are now obtained. Our "just in time economy" has eliminated most stockpiles from healthcare institutions. Few hospitals have more than two or three days worth of medication, disposable supplies or food on hand at any given moment. They rel
There is no doubt that having a bad credit history or a bankruptcy on your record can greatly affect your ability to get a mortgage, and the down payment and interest rate requirements of that mortgage loan. With some shopping around, however, it is possible for even the most credit challenged among us to live the American dream with a home of their own.The effect a bankruptcy has on your credit varies according to how long ago the bankruptcy was discharged. For instance, a bankruptcy which was discharged less than one year ago means that the borrower will qualify for a D loan. These D loans generally require a down payment of 30%, and high interest rates as well.Those who can wait a year after the bankruptcy filing to apply for a mortgage can qualify for a B or C loan instead. These loans feature lower down payment and interest rate requirements than the D loan.Regardless of your bankruptcy status, any mortgage lender will want to see a reliable payment history, including payments on rent, loans and credit cards. Those lenders who have sufficient cash reserves, generally enough for six to twelve months, are generally considered a lower credit risk and may therefore qualify for lower interest rates and down payment requirements.It is important to shop around for a quality sub-prime lenders, since not all lenders are the same. Some lenders may be able to qualify you for a B loan, while others will require you to take out a C loan. The only way to be sure what type of loan you qualify for is to shop around and request quotes from several different lenders.e of two or more other individuals. In this circumstance it is the absolute moral and ethical obligation of those providing the care to make a resource-based decision. When the continued care of one patient will utilize sufficient resources to endanger the care or life or two or more others then the care of that one patient, then that one patient must be reassigned to the expectant (black tag) treatment area. This is not a do not resuscitate order (DNR). This is simply a statement of available resources. Patients are constantly re-triaged based on available resources and current medical conditions. A critical patient upon the loss of vital resources may temporarily be moved to an expectant category until resources or conditions are such that the patient may be re-triaged back to a critical or possibly has improved sufficiently to be "downgraded" to triage category yellow (urgent).
On the other hand, if treatment of an ICU or a high acuity patient does not utilize sufficient resources to endanger the care of two or more other individuals then that high acuity care should and in fact must continue as an ethical and moral imperative.
The key to making these decisions is to identify the critical processes that are required for the provision of essential high acuity medical care. Once these processes are identified specific, measurable parameters must be established to determine if additional resources are needed to bolster that process. This ensures that valuable limited resources are not squandered on processes that are not in danger of collapse as a result of surge. More importantly, as the number of patients under treatment expand it ensures that resources are wisely allocated to maximize the surge capacity.
Resources will always be limited in a disaster because of the very nature by which resources are now obtained. Our "just in time economy" has eliminated most stockpiles from healthcare institutions. Few hospitals have more than two or three days worth of medication, disposable supplies or food on hand at any given moment. They rel
In August the news is supposed to slow. This month, however, has been as busy as any other month for important news. Bill Frist, Senate majority leader, ended this session of Congress by announcing his support for stem cell research. Wasn’t that debate big six months ago? Didn’t Ron Reagan, Jr. stand up at the Democratic National Convention and speak in support of stem cell research last summer? Where was Dr. Come Lately then? Dr. Frist is trying to position himself as a moderate who loves the people so that he can run for president in 2008. Did you see him at NASCAR Cola-Coca 600? He looked about as comfortable as Ralph Nader in a Hummer.Israel is pulling out of the Gaza strip. Hamas, a militant organization that is labeled as a terrorist organization by our State department, claims that their campaign of terror has worked, and they will continue the violence. Israel’s Prime Minister, Ariel Sharon, seems to understand that Israel has to give up something if they are going to move the peace process along. Sharon is showing the kind of strength that we would like to see in our politicians.As attacks on our troops continue in Iraq, the anti-war movement has finally found a face to put to its words. Cindy Sheehan is that face. The beauty of Ms. Sheehan’s message is its simplicity. She simply wants to know why her son had to die. What was the noble purpose? So far, the Bush administration really has not had any good answers. They cannot use the WMD argument since more and more evidence is coming out that the intelligence community had significant doubts before the
The key to making these decisions is to identify the critical processes that are required for the provision of essential high acuity medical care. Once these processes are identified specific, measurable parameters must be established to determine if additional resources are needed to bolster that process. This ensures that valuable limited resources are not squandered on processes that are not in danger of collapse as a result of surge. More importantly, as the number of patients under treatment expand it ensures that resources are wisely allocated to maximize the surge capacity.
Resources will always be limited in a disaster because of the very nature by which resources are now obtained. Our "just in time economy" has eliminated most stockpiles from healthcare institutions. Few hospitals have more than two or three days worth of medication, disposable supplies or food on hand at any given moment. They rely on regular re-supply from vendors, who themselves maintain only limited warehouse storage. In the event of a large scale disaster needs quickly exceed resources (the very definition of a disaster) and supply chains break down. With resources even further limited essential processes fail and a disaster becomes a catastrophe as the ability to respond is lost.
The frugal application of resources to essential processes in the provision of healthcare combined with a continuous re-triage of patients ensures that precious resources are utilized in a fashion which maximizes their impact and benefit.
This lesson has already been implemented in virtually every hospital in the United States, but it has not been implemented in a patient care area. Information technology departments utilize the constant monitoring of key operational processes with clear and well-defined parameters to determine how best to dynamically shift available resources. Your information technology professionals speak in terms of "bandwidth" rather than "bed space" and "memory allocation" rather than "ventilator availability." However, with well over a quarter century experience in process analysis and resource allocation, your information technology professional is an invaluable resource in the method of evaluating your essential processes and resource allocation.
Virtually every supplier of data management equipment and software, from imaging to electronic medical records to registration and accounting software are utilizing this process to ensure continuity of their part of the operation. Patient care component is the only portion of hospital operation that has not learned to triage itself.
A careful evaluation of the healthcare process utilizing these information technology techniques will quickly show that in addition to those items already on our resource list including medication, food, bandages and other disposable supplies the most valuable and most limited resource is the healthcare professional themselves. It has been said that it takes at least seven years to grow a doctor, at least two years to grow a nurse or a respiratory therapist and many more years to ensure the experience necessary to operate in these professions and every other patient care profession with any degree of expertise.
The loss of a healthcare professional through injury, illness, or stress has a significant negative impact upon both operational capacity during a disaster as well as the short and long-term recovery following the disaster. Lose just one of these professionals and you impact the care of thousands or even tens of thousands of patients into the future.
Ensuring the resilience of healthcare professionals within the high acuity arenas of the hospital is the single most effective and most efficient means of expanding surge capacity beyond the emergency department.
There are six areas of human functioning:
* Physical
* Emotional
* Intellectual
* Social
* Behavioral
* Spiritual.
Each of these areas of human functioning have a corresponding form of resilience, a canteen which is filled in the time between disasters and drawn from during the response to a disaster. These six canteens of resilience are:
* Physical
* Emotional
* Intellectual
* Relationship (social)
* Functional (behavioral)
* Spiritual.
Physical resilience is exactly as the name would imply. It is the physical capacity to continue working in light of physical and even emotional stress. Physical resilience is enhanced through the maintenance of good health and a healthy lifestyle. Eating a balanced diet both at home and at work, including during the disaster; regular exercise; and adequate rest, even during the disaster, are essential to "filling" your canteen of physical resilience and maintaining that resilience while responding to a disaster.
Emotional resilience deals directly with what we feel and how we respond to it. The old saying "attitude counts" was never more true than when filling your canteen of emotional resilience. Loving and being loved, including loving yours
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