Sunday, December 21, 2008

Hospital tanpa Hospitality

18/12/2008 18:54
Hospital tanpa Hospitality
M. Ichsan Loulembah

DALAM tiga bulan belakangan, saya mondar-mandir ke sejumlah rumah sakit. Di Palu, ayah saya dirawat beberapa waktu, hingga akhirnya ia minta dikeluarkan dari rumah sakit utama milik pemerintah, menjelang Lebaran tahun ini.

Di Jakarta, tiga kerabat dekat (adik ipar perempuan, mertua laki-laki dan mertua perempuan) dan putri bungsu, membuat saya memiliki cukup waktu mengamati denyut berbagai rumah sakit. Berikut sekadar catatan dan kesan saya.

Pertama, secara medik, para dokter dan paramedis kita kemampuannya telah lumayan. Terbukti, putri saya berangsur pulih setelah ditangani oleh para juru rawat beserta dokter spesialis.

Di berbagai rumah sakit bahkan diadakan simposium, workshop, seminar, diskusi sampai talk show terkait perkembangan metode dan teknologi kesehatan mutakhir.

Kedua, penataan ruang (baik interior maupun exterior, termasuk berbagai fasilitas penunjang) masih terlalu kaku. Ini meneguhkan kesan angker. Dan, penataan ruang dan wajah arsitektural kaku serta seadanya (untuk tidak menggunakan kata sembarangan) bertalian dengan peluang sehat atau tidaknya penderita.

Betapa sempitnya ruang-ruang di rumah sakit. Toilet (kecuali di beberapa rumah sakit swasta mahal), baik untuk umum maupun kamar rawat inap, tidak terurus secara optimal. Lift yang kusam. Tempat parkir yang ruwet. Tempat penjual minuman, makanan, atau penganan yang penataannya menjauhi estetika.

Ketiga, komersialisasi berlebihan yang memanfaatkan keawaman pasien dan keluarganya. Petugas medis dan staf nonmedis jamak memberikan pilihan memojokkan.

Alih-alih mencari jalan keluar yang efektif, apatah lagi efisien; keluarga pasien lebih merasa ditakut-takuti ketimbang dinasihati. Rentetan nasihat mereka lebih terdengar sebagai jalan buntu ketimbang jalan keluar. Bahkan, ada rumah sakit yang melarang keluarga pasien membawa perlengkapan tidur saat menjaga; karena mereka menyewakannya.

Yang disajikan sejumlah kemungkinan berujung pada aneka jenis layanan (medik ataupun nonmedik), ujungnya terkait dengan naiknya pembiayaan. Jika keluarga pasien terlihat menimbang-nimbang, mereka tak segan menjelaskan aspek-aspek yang menakutkan jika saran tersebut tidak diambil. Sambil menutupnya dengan kalimat, "Kami tidak bertanggung jawab jika situasinya memburuk lho!".

Sekilas, apa yang mereka paparkan terkesan membantu dan bertanggung jawab. Namun, jika dilihat dari sudut keluarga pasien, hal itu gabungan antara lepas tangan dan pemojokan. Kemungkinan dalam kemampuan membayar akan ditelisik dengan rincian yang terlatih dan sempurna.

Rangkaian proses administrasi (bisa dibaca sebagai aktivitas bayar-membayar) berlangsung dalam nuansa transaksi yang kering dan ketat. Sulit membedakannya dengan transaksi di sektor perdagangan atau jasa lainnya.

Terkait dengan kenyataan itu, poin keempat dari kondisi faktual rumah sakit kita adalah merosotnya derajat ketulusan dan keramahan.

Betapa kering senyum mereka (bahkan ketus bagi penghuni kamar rawat murah) saat memeriksa tekanan darah, menanamkan/menyabut jarum infus, memberi obat, dsb. Di beberapa tempat, jika menegur pengunjung, bagian pengamanan segalak satpam bank.

Padahal, inti dari pengelolaan rumah sakit adalah ketulusan dan keramahan. Bukankah proses penyembuhan dan penyehatan tidak semata ditentukan oleh obat, ketrampilan, dan teknologi medis? Apa jadinya hospital tanpa hospitality?

Penulis adalah Anggota Dewan Perwakilan Daerah RI [L1]

Kursus Advance Cardiac Life Support (ACLS)

Training Code: Available Seats: 32 of 32 Duration: 0 days

Price: Rp. 2,500,000

Jadwal ACLS 2009
9-11 Jan 2009 ; 30-1 Feb 2009; 20-22 Feb 2009; 27Feb - 1 Maret 2009; 13-15 Maret 2009; 27-29 Maret 2009; 3-5 April 2009; 24-26 April 2009; 15-17 Mei 2009; 29-31 Mei 2009; 5-7 Juni 2009; 26-28 Juni 2009; 17-19 Juli 2009; 31Juli -2 Agustus 2009; 7-9 Agustus 2009; 9-11 Oktober 2009; 23-25 Oktober 2009; 6-8 Nov 2009; 20-22 Nov 2009; 4-6 Des 2009; 11-13 Des 2009.

Pelatihan diadakan selama 3 hari (Jumat, Sabtu, Minggu) Jam 7.30 - 18.00 WIB
Sertifikat dari PERKI 12 SKP (terakreditasi IDI) berlaku 3 tahun
Cara Pendaftaran : SMS Nama lengkap; Telpon, Alamat, & Keterangan tanggal keikutsertaan ACLS kirim ke nomor Hp 081 317 424 420 dengan Yani.
Pembayaran paling lambat 1 minggu terhitung setelah anda mendaftarkan diri ke Sekretariat.
Ongkos Kirim Modul dikenakan biaya Rp. 50.000,- per pengiriman.


Catatan:
Pendaftaran hubungi Yani, 081317424420
E-mail : register@kursusdokt er.com


---------- Forwarded message ----------
From: yani setyorini <yanijakarta@ yahoo.com>
Date: 2008/12/20
Subject: informasi jadwal ACLS, EKG, BTLS DLL 2009
To: us@perawats1unai. cjb.net


Dengan Hormat,

Bersama ini kami informasikan bahwa untuk Informasi jadwal ACLS, EKG, BTLS, HIPERKES dan lain-lain dapat diakses melalui www.kursusdokter. com dengan contact person yani setyorini telp : 0813 8100 8800 email:yanijakarta@ yahoo.com

Seluruh pelatihan adalah bersertifikat resmi dan diadakan dengan bekerja sama dengan Institusi yang berwenang. Juga tersedia buku-buku kesehatan/kedoktera n dll.
Mohon Informasi ini disebarkan kepada rekan sejawat.

Atas perhatiannya kami ucapkan terima kasih.

Hormat Kami,

Yani Setyorini

Tuesday, November 18, 2008

Qatar Ingin Tambah Tenaga Kesehatan dari Indonesia

Qatar Ingin Tambah Tenaga Kesehatan dari Indonesia

Diah (24) dan Dwi (23), dua kakak beradik yang ikut berangkat ke Jepang, sebagai tenaga kerja profesional untuk posisi pendamping lansia.
/
Senin, 17 November 2008 | 23:09 WIB

LONDON, SENIN - Menteri Kesehatan Qatar Dr. Sheikha Ghalia membahas kemungkinan Indonesia mengirim lebih banyak lagi tenaga kesehatan seperti dokter dan perawat ke Qatar.

Hal itu terungkap pada pertemuan Menteri Kesehatan Qatar dengan Dubes RI Rozy Munir di Kantor Kementerian Kesehatan Qatar yang merupakan kementerian baru, belum lama ini, kata jurubicara KBRI Doha, Ahmad Sudradjat di London, Senin (17/11).

Menurut Ahmad Sudradjat, dalam pertemuan itu Dr Sheikha dan Dubes Rozy Munir membahas kemungkinan Indonesia mengirimkan lebih banyak lagi tenaga kesehatan ke Qatar. Sampai saat ini tenaga kesehatan Indonesia khususnya perawat yang bekerja di Qatar berjumlah 64 orang. Mereka bekerja di pusat kesehatan di bawah naungan perusahan minyak dan gas Qatar.

Dalam pertemuan tersebut, Dubes mengharapkan ada peluang tambahan bagi dokter dan perawat Indonesia di Qatar khususnya dalam kerangka peningkatan kerjasama antarkedua negara di bidang kesehatan.

Menkes Qatar menyambut baik keinginan tersebut. Dalam kaitan itu, dia pun akan mengirimkan delegasi untuk mengikuti 'workshop' kesehatan di Jakarta yang mengambil tema "Peluang dan Kesempatan kerja bidang kesehatan di kawasan Timur Tengah" pada Desember mendatang.

Menteri juga mengharapkan perlunya peningkatan kemampuan bahasa Inggeris dan Arab di kalangan calon tenaga kesehatan Indonesia yang akan dikirimkan ke Qatar. Dalam pertemuan yang berlangsung dalam suasana akrab itu Menteri juga mengungkapkan rasa kekagumannya terhadap potensi wanita Indonesia, karena banyaknya kaum wanita yang menjadi pejabat di kementerian, kabinet, di gubernuran, dan juga menjadi bupati di Indonesia.

Diakuinya di kawasan di Timur Tengah, kondisi tersebut belum dapat diterima secara baik, terutama oleh kalangan ulama konservatif.


AC
Sumber : Antara

Friday, November 14, 2008

Danger at the Door



The EMS Contrarian
by Bryan E. Bledsoe

Danger at the Door

I am a proponent of EMS personnel having a more independent practice. The days of calling “Rampart Hospital” for an order of “D5W TKO” is a thing of the past. I truly feel that most of our educational programs are strong enough to support independent decision-making by EMTs and paramedics. But it is important to remember that independent decision-making also requires one to take responsibility for their decision and actions. This is somewhat of a new concept for EMS personnel.

One area where independent decision-making has been delegated to EMS personnel is selective spinal motion restriction (spinal immobilization). There is an excellent body of research that shows that the application of an established protocol allows EMS personnel to accurately and safely determine which patients should be immobilized and which should not. We have added it to our textbooks and many EMS systems have adopted it.

Spinal immobilization is uncomfortable and can cause complications in certain patients. Thus, like any other skill or procedure, it should be used when the patient stands to benefit from it. That is, when the patient has the possibility of a spinal injury. Certainly, with spinal injuries, we want to be extremely cautious and should have a high index of suspicion. Likewise, we don’t want to subject a patient to unnecessary discomfort and pain.

Unfortunately, a few trauma centers are reporting an increasing number of patients with spinal injuries who were not immobilized by EMS. At one hospital (on the east coast), 13.5 percent of patients with a documented spinal injury were not immobilized in the prehospital setting. The trauma outreach coordinator, an experienced paramedic, reviewed each case and found that each patient had met the criteria for spinal immobilization in the prehospital setting. That is a scary figure. Although it is just one hospital in one state, I have heard increasing talk amongst EMS medical directors about their concerns with the application of spinal immobilization.

Now, let’s look at this a little more closely. In the system where 13.5 percent of patients with spinal injury were not immobilized, a policy was in place to allow EMS personnel to determine who should be immobilized and who should not. The premise is that all patients should be immobilized unless they meet the criteria to bypass immobilization. The protocol requires that EMS personnel complete a structured, standardized exam (e.g. altered LOC, spinal pain or tenderness, neuro deficit, distracting injury). If the patient meets any of the established criteria, they must be immobilized.

So in 13.5 percent of the cases, EMS personnel performed an exam and came to the conclusion that immobilization was not necessary. Thus, from a negligence standpoint, this was an act of commission and not an act of omission. A jury would probably look more unfavorably on an act of commission. In reality, what this tells me is that some EMS personnel are NOT properly applying the protocol or applying it selectively. The protocol only works if applied in a standardized fashion—the same, each time and objectively—to ALL trauma patients.

EMS personnel want more autonomy, but autonomy requires integrity. Integrity is what you do when nobody is looking. Medicine requires an extremely high degree of integrity; shortcuts in medicine can harm people. In emergency medicine, we assume a patient has a severe injury until proven otherwise. It is the only safe way to approach things in a short period of time. This same adage holds true in EMS.

Quality monitoring in EMS should detect issues such as this — this is how the trauma system detailed above discovered the 13.5 percent miss rate — but quality monitoring must be applied uniformly and EMS personnel must be given the results on a regular and constructive basis. Personnel who are taking short cuts and making clinical assumptions should be counseled. This spinal immobilization trend may well turn out to be like the trend we saw in the late 1990s with unrecognized esophageal intubations. It cannot be tolerated.

There are many of us working to improve EMS. More pay and more independence are needed, but these come with the associated responsibilities. It is frustrating in that every time we make some progress, EMS finds a way to shoot itself in the foot and set things back. Let me close with this: Every time you are using a selective immobilization protocol, assume that the patient is a member of your immediate family. Apply the protocol systematically and uniformly. If in doubt, immobilize. Please, let’s not take another step backwards.

" src="http://www.ems1.com/data/img/btn_go.gif" align="absmiddle" border="0" height="16" width="16"> Related Resource: Spinal Assessment Protocol — Maine EMS


Bryan E. Bledsoe, DO, FACEP, EMT-P is an emergency physician, paramedic and EMS educator. Dr. Bledsoe is the principal author of the Brady paramedic textbooks and others. He has more than 20 years publishing experience and has more than 900,000 books in print and has written more than 400 articles. He is a prolific writer, popular lecturer, and EMS researcher. Dr. Bledsoe is currently developing a distributive educational program for initial EMS education through the University of Nevada Las Vegas and online continuing education through Paramedic.com. Dr. Bledsoe maintains residences in Midlothian, Texas and Las Vegas, Nev. To contact Dr. Bledsoe, email bbledsoe@earthlink.net.

Wednesday, November 12, 2008

Medical Study Resources

yang berminat ngisi waktu dengan games/quiz/puzzle/fill in blanks/matching/scramble,etc silahkan coba link dibawah ini

(contoh)
http://www.studystack.com/fillin-9409

bisa pilih kategori sendiri (nurse/EMT/pharmacology/USMLE/bla bla bla)
klo lincah bisa donlod free software juga :)

Saturday, November 08, 2008

Cinta Suami, Sadarkan Perempuan Koma 30 Tahun

Cinta Suami, Sadarkan Perempuan Koma 30 Tahun
Sabtu, 8 November 2008 | 09:03 WIB

BEIJING, SABTU - Seorang perempuan sadar dari koma selama 30 tahun berkat cinta yang tak tergoyahkan dan perawatan telaten suaminya di E'zhou, provinsi Hubei.

Para dokter percaya cinta Chen Dulin, yang baru-baru ini terpilih sebagai salah seorang suami teladan di provinsi tersebut, telah menolong Zhao Guihua sadar dari koma panjangnya.

Paru-paru, jantung dan tekanan darah Zhao stabil setelah ia menjalani pemeriksaan menyeluruh.

Zhao jatuh koma setelah satu kecelakaan tiga dasawarsa lalu, tapi Chen tak pernah putus asa buat istrinya dan merawatnya di rumah setelah sang istri menjalani dua operasi.

Sejak itu, Chen telah telah menggunakan alat penyemprot dan pipa plastik untuk memasukkan susu, kue dari telur dan makanan cair lain ke dalam perut Zhao.

Kini, Chen, yang sudah berusia 77 tahun, tetap mengutarakan cinta kepada istrinya setiap hari.
ABD
Sumber : Antara

Friday, November 07, 2008

Four Key 'Points to Ponder' for Your Safety

Safety Zone
Rick Patrick
2008 Oct 19

Point I
Safety is personal. Regardless of the tools and training provided by your organization and/or employer, only you can make the choice of being safe. Where do you place safety in the scope of your daily duties? Nothing super cedes your safety -- NOTHING!

Point II
Seatbelts work. Do you wear your seat belt? Do you wear it when responding to emergency incidents in the fire truck, ambulance or other vehicle? Do you wear it in the back of the ambulance? If you answered no to any of these; ask yourself why? Could I have done and should I do anything different? Every time you don't wear a seat belt equates to a near-miss situation -- every time.

Point III
Personal protective equipment (PPE) must be provided by emergency service organizations for all applicable tasks warranting a risk of injury.

EMS providers performing tasks indicative of the risk of injury (extrication, patient removal from a vehicle, rescue activities in general, risk of fire, etc.) and functioning in any capacity in the danger zone of an incident, such as motor vehicle collisions, should be protected by wearing PPE. This includes coats, pants, helmets, gloves, eye protection and protective foot wear. Nothing super cedes personal safety -- NOTHING!

Point IV
Responding safely, functioning safely at the scene and returning safely are essential for everyone's safety on every incident … period.

Read more articles by Rick Patrick

Richard W. Patrick
Richard W. Patrick, MS, CFO, EMT-P, CHS III, FF, is the retired Deputy Fire Chief of Estero Fire Rescue District in Estero, Fla. He has more than 29 years' experience in emergency services. He's the former Director of EMS Programs and Emergency Service Initiatives for VFIS, a division of Glatfelter Insurance Group, York, Pa., where he remains as a consultant. Rick is a nationally known leader, educator, lecturer, author, speaker and consultant in EMS

UK woman threatens paramedic with AIDS

By Emily-Ann Elliott The Argus

SOUTH EAST COAST, UK — A woman with hepatitis C smeared blood on a paramedic's face and told him he would be infected with AIDS, the South East Coast Ambulance Service NHS Trust has revealed.

The patient was given a two-month custodial sentence for the offence which happened in Hove in September as the paramedic attempted to treat her.

The health threat to the paramedic is believed to be negligible, but the prosecution has been highlighted as part of this year's NHS Security Awareness Month.

The service recorded 69 assaults against its staff between April 2007 and April 2008 and has warned it takes a zero-tolerance policy towards violence and abuse against its staff.

Other prosecutions include a 17-year-old male who was given a three-month referral and ordered to pay £50 compensation after biting and bruising a paramedic in Uckfield in August 2008 and a man was recently jailed for four years for possession of an imitation firearm with intent to cause fear of unlawful violence after threatening a paramedic in Worthing in September 2005.

Paul Sutton, the service's chief executive, said: "We want to ensure that our staff can provide the care they need to, and patients can receive this, in an environment that is safe and secure.
"It's simply not acceptable that staff perceive abusive behaviour towards them as just a part of the job. They deserve to be able to serve their local communities in safety."

This month security specialists will visit ambulance staff to educate them on what to do if they become a victim of violence and the options available to them when dealing with abusive people.
David Dixon, South East Coast Ambulance's security management specialist, said: "We will be working throughout Security Awareness Month and beyond to raise awareness among our staff so they understand they don't have to accept abusive and violent behaviour.

"We have achieved a number of successful prosecutions this year by working with the police and Crown Prosecution Service.

"We also want staff to know that there are alternative measures available to us such as private prosecutions, civil action and ASBOs which can be taken against those who threaten them."

Monday, October 27, 2008

Delegate Specifically

Delegate specific tasks to specific people using appropriate supervision.

So this can't be simply, "keep an eye on Mr. Smith in Room 12." Delegation has to be specific. So we have to define parameters that we're assessing for. We have to define accountability and measurement of those parameters to a specific person who is able to manage that task. In other words, if you have an aide that is going to be taking vital signs you don't want to tell them, "can you please take vital signs on Mr. Smith every 15 minutes because I need to know if she has a transfusion reaction?" Instead you need to say to her, "please take vital signs on Mr. Smith every 15 minutes, I'm looking for a transfusion reaction and I will check the vital signs that you get every 15 minutes to make sure that they remain in the normal range".

You don't want to give a specific parameter to somebody who doesn't know how to interpret that information. So for example, you couldn't tell the aide, "come back and tell me if her temperature goes up." Okay, well her temperature didn't go up but she's hypotensive and tachycardic; you see, that wasn't a good delegation. We need to define specific accountability and specific parameters. By doing so you will decrease your chance of liability, you'll increase accountability for the things that happen with your patients, and you will improve outcomes.

Best wishes,

David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

Wednesday, October 22, 2008

Presentasi Prof. William A. Cohen dihadapan Staf dan Dosen UNAI

Fri, 07/25/2008 - 07:00

Siapakah Prof. William A. Cohen? Dr. Cohen is President of the Institute of Leader Arts. He has spoken and given workshops for small groups of managers and executives, and given keynote addresses to audiences of up to 15.000 in size. He has presented on four continents, and executives from more than 50 countries have heard him speak. His academic leader roles have included president of two private universities, and department chairman and institute director at a public university. He has taught in the graduate schools of California and Claremont Graduate University as well as three years with Touro University International, a fully accredited online university.

Dr. Cohen is also a retired major general from the U.S. Air Force Reserve and has held executive positions in several companies including Director of Research at Sierra Engineering Company, Manager of Advanced Technology Marketing at McDonnell Douglas Astronautics Company, and President of Global Associates.

Graduating from West Point, Dr. Cohen flew 174 combat missions in A-26 aircraft in the Vietnam War. His military awards include the Distinguished Service Medal, the Legion of Merit, the Distinguished Flying Cross with three oak leaf cluster the Air Medal with eleven oak leaf clusters.
Among his 53 published in 18 languages and over 100 articles resulting from his research, are the best sellers The Stuff of Heroes: The Eight Universal Laws of Leadership (Longstreet Press, 1998) and The New Art of Leader (Prentice Hall Press 1990,2000). The latter was named a Best Business Book of the year by Library Journal. The former was nominated as one the 10 best management books for the year 1998 by Management General and appeared as number four on the Los Angeles Times best seller list. Both books have been recommended by a host of world class leaders including from the U.S. Congress, astronauts, generals and admirals , presidents of unions and trade associations and CEOs of Fortune 500 companies. His textbooks have been adopted by more than 200 colleges and Universities around the world. His latest book comes from Dr. Cohen being Peter Drucker’s first executive PhD student. His latest book is A Class with Drucker : The Lost Lessons of the World’s Greatest Management teacher. The book has already set a record for the highest foreign rights sales for translation in the history of the 45 year old publisher.

Dr. Cohen’s awards includes the Outstanding Professor’s Award at California State University Los Angeles (1982), the Freedoms Foundation of Valley Forge George Washington Honor Medal for Excellence in Economic Education (1985), and the California state University Los Angeles Statewide Outstanding Professor Award (1996). He was the first business professor honored with the latter. In 1999, he was the first business professor honored with the latter. In 1999, he was named one of four “ Great Teachers in Marketing” by the Academy of Marketing Science from nominees from around the world. In 2002 he received and honorary Doctorate in Humane Letters from the International Academy for integration of Science and Business in Moscow, Russia. Dr. Cohen has served on various city, state, national, corporate, and trade boards and boards of directors. His biography is contained in Who’s Who in America, Who’s Who in the world, and other national and international directories.

In addition to his BS in engineering from the United States Military Academy at West Point, he has and MBA from the University of Chicago, an MA and PhD in management from the Peter Drucker School of Management at Claremont Graduate University, and has completed all coursework for a second PhD in psychology. He is a distinguished graduate in residence of the prestigious Industrial College of the Armed Forces in Washington, D.C.

Sdr. Hans S. Mandalas, MBA, alumnus Fekon UNAI memfasilitasi kunjungan Dr. Cohen Ke kampus Universitas Advent Indonesia.
Dr. Cohen didampingi oleh Prof. Nurits Cohen (istri Dr. Cohen), Sdr. Suwanto, MBA.
Dalam kunjungan singkatnya beliau menyampaikan pelajaran yang sangat berguna dengan judul, “How to Apply The Loss lessons and Wisdom of Peter Drucker in School”.

1. What everybody knows is frequently wrong
People frequently make erroneous assumptions, look at the source, if possible, peel the onion to find the originator, don’t believe it until you investigate the situation yourself.
2. You mutbuild your own self-confidence
Prepare yourself for success and avoid fear of failure, Don’t think of any situation as a failure, but rather as a learning experience. Develop expertise outside of your own field, Use positive imagery, Behave confidently even if you are uncertain.
3. If you keep doing what made you successful in the past you are going to eventually fall.
Change is inevitable, stay flexible and be prepared for change, Obselete your own products, create your own future, If you are in business, you must innovate.
4. Approach problem with your ignorance-Not your experience
Solving Problems: Ask questions, Question your assumptions, Consider many different possible solutions and test if possible.
5. You can’t predict the future, but you can create it.
Don’t worry about the future-no one can predict it exactly, Decide on your objectives, Do a situational analysis and look at your resources, Develop a plan, Take action and create the future, adjusting your plan as needed.
6. Workers must be led, not managed
There must be a leader incharge!, Motivate each worker according to the individual and the situation, Ethics and integrity are crucial, Why Drucker admired the military over other organizations, Treat all workers as if they were volunteers, because they are.
7. All businesses must based on Innovation and Marketing.
Implemention of the marketing concept is primary for any business, The objective of a business is not to create a profit, it is to create a sustainable customer, Startegy and Tactics are not the same and poor marketing strategy cannot be overcome by good marketing tactics, Customer pay only for what gives them value and value can only be determined by research and by knowing one’s customer.

Dr Cohen terkesan dengan keteraturan dan kerapihan dari kampus UNAI, dan keramah-tamhan dari stados, setelah menikmati makan siang, dr. Cohen dan rombongan kembali ke Jakarta.

(this article was copied from www.unai.edu ; please refer to its official website for more complete information about Universitas Advent Indonesia - Bandung)

Sunday, October 19, 2008

Benefits outweigh risks for air medical crews

Benefits outweigh risks for air medical crews

By Robert Mitchum and Judith Graham
Chicago Tribune


AP Photo/Paul Beaty
A Dupage County Emergency Management worker is comforted near the wreckage of a helicopter crash in Aurora, Ill. Four people, including a 13-month-old girl, were killed when a medical evacuation helicopter crashed overnight in the Chicago suburb of Aurora, authorities said early Thursday.

AURORA, Ill. — For medical professionals who climb on board helicopters hundreds of times a year, the job can mean dark, urgent flights through uncertain landscapes, emergency landings in cow pastures and medical equipment bouncing to and fro because of choppy winds.

But air medical transport also grants its workers the rush of flying above the world and the indescribable feeling of saving the lives of people who might not otherwise have been reached in time.

That is what has kept Mary Jo Dunne, 53, working as a flight nurse for 23 years on more than 2,000 flights with the University of Chicago Aeromedical Network, even as she hears all too frequently of medical helicopter crashes like the one that killed four people in Aurora.

"That will be on my mind when I get in the helicopter because of the loss of people, but I don't think we ever project that as being us," Dunne said. "For a very long time, my thinking has been clear that this isn't an inherently dangerous job. The benefit we're providing the patients should outweigh the risks."

Dunne and other air medical workers said Thursday that the latest accident, which follows a dozen other U.S. crashes in the last year, rattled them emotionally but did not shake their resolve to continue offering a unique and essential service.

"The focus is on the patient. I don't even realize what's going on around me," said Amanda Bostjancic, 28, a pediatric nurse for the intensive-care unit at Advocate Hope Children's Hospital in Oak Lawn.

Dangerous situations do arise, but Dunne said she puts absolute trust in her pilots. When thick ice on a helicopter's windshield forced an emergency landing several years ago, "the pilot had us on the ground before we realized what was happening," she said.

That wasn't the last challenge. "We had a patient on board, so I had to slog through a field full of cows to get to a phone and call a ground ambulance," Dunne said.


Paramedics, physicians and nurses who fly on air ambulances in the Chicago area cited several reasons for their career choice: the challenge of treating critical patients in an extreme environment, the unpredictability of each day's work, the independence of working closely with a small team.

"It's definitely a kind of adrenaline rush," said Cindy Rahilly, clinical operations assistant for the pediatric neonatal transport team at Hope Children's Hospital, who did air transports for about two years. "You're picking up a very critical patient. And because the doctor isn't with you, you have a lot of autonomy."

Dania Lees, 32, said she was obsessed with flying at a young age and got hooked on air medical transport from her first fly-along as a medical student at the University of Chicago.

"The minute I got up there, I said, 'This is what I want to do,'" said Lees, now a physician at Loyola University Medical Center in Maywood. "Not only the thrill of being able to fly, but to go and take care of a patient and fly them back to where you're confident they'll get the care they're going to need."

Dunne said the daily joy of seeing the world from a vantage point few experience is why she still works the 24-hour shifts the job demands even after two decades in the business.

"There isn't a minute that goes by that I don't enjoy flying," Dunne said. "The sunrises and sunsets. The cityscape, the farmlands in snow and moonlight. ... It's breathtaking and beautiful. The theater in which we practice is so beautiful it's beyond belief."


LexisNexis Copyright © 2008 LexisNexis, a division of Reed Elsevier Inc. All rights reserved.

Oncology Nurse

Oncology Nurse

Closing date: 31 Oct 2008
Location: Iraq - Baghdad

ESSENTIAL JOB DUTIES/SCOPE OF WORK:

The purpose of the program is to contribute to the strengthening of medical staff‘s technical and managerial capacity and optimize patient outcomes through intensive on the job medical education and professional development.

The Oncology Nurse is required to help increase medical staff access to relevant and effective medical education and professional development nationally through face-to-face, hands-on practical trainings and relevant managerial training.

He/she will be required to support the overall training program in the respective field as well as work with the program leadership to ensure the development of a well trained and integrated clinical and managerial team of Iraqi professionals. This will include the development of a training program and materials and the delivery of the training to professionals in Iraq. Coupled with this, he/she will be required to support development of quality assurance policies and procedures and recommendations to the MOH on national quality standards for personnel and facilities. This may involve engaging the appropriate association and/or developing standards for licensing/credentialing and accreditation.

Duties and responsibilities
1. Curriculum development
2. Facilitation of meetings with MOH officials regarding the curriculum and ensuring final approval by the MOH
3. Development of training manuals and materials
4. Training delivery and oversight of on-the-job programs
5. Trainee evaluation
6. Conduct review of the current clinical specialty systems in place and draft national clinical improvement recommendations
7. Identify and assist medical specialty societies to establish 5 year specialty driven training program
8. Review current quality assurance programs and provide recommendations for improvement and institutionalization
9. Review current quality standards for personnel and facilities and provide recommendations for improvement related to licensing/credentialing and accreditation

QUALIFICATIONS:

(Training/education/experience/physical demands required; provide 6-8 requirements)
- The qualified candidate will be an Oncology Nurse professional with 10+ years clinical experience in providing oncology services
- Training experience of medical professionals is required
- Strong organizational and supervisory skills
- Strong interpersonal skills and the ability to work within different cultural environments
- Honest, hard working and a self-motivated person
- Ability to work within a team structure or in isolation, flexible, and can cope with stressful workloads and working with limited resources
How to apply
Go to IMC website, www.imcworldwide.org
Reference Code: RW_7KAKKS-54

CBFA Program Oficer - American Red Cross (Banda Aceh)

American Red Cross (Banda Aceh)

Advertised: 9-10-08 | ReAlerted: 16-10-08 | Closing Date: 7-11-08

The American Red Cross Tsunami Recovery Program (TRP) had been established to direct the organization̢۪s response to the South Asia tsunami disaster. The TRP activities focus on integrated community recovery and preparedness interventions in tsunami affected countries in Asia and East Africa in collaboration with Red Cross and non-Red Cross partners. Please visit www.redcross.org/tsunamirelief

The Indonesia TRP Delegation operates from offices in Banda Aceh, Calang, Lamno. It also has liaison offices in Jakarta, and other areas in Aceh province in collaboration with the Indonesian Red Cross.

The American Red Cross seeks dynamic individuals to fill the :

CBFA Program Officer
(Aceh - Banda Aceh)

Responsibilities:

  • To assist the CBFA Program Coordinator overseeing the management and implementation of Indonesian Red Cross (PMI) Community Based First Aid (CBFA) Program
  • To provide timely input to AmCross CBFA Program Coordinator regarding achievement of targets and modification of program objectives as needed
  • To assist the CBFA Program Coordinator to review and provide technical assistance to PMI on CBFA training content and ensure that objectives of training are met
  • To conduct field visits to project sites to collect information and to ensure project activities meet specified objectives
  • To prepare data and information for monthly narrative report to AmCross CBFA Program Coordinator
  • Attendance at meeting in capacity of translator when needed
  • Translation of both written and spoken Indonesian and English languages
  • Submit field trip/training reports in relation to technical assistance with PMI NAD Chapter and branches.
  • Work closely with CBFA Sr.PO to ensure all respective objectives regarding program implementation are met
  • Any other duties as requested by the Program Coordinator

Requirements:

  • University degree required, degree in nursing or public health is preferred
  • Familiar with community-based approach
  • Excellent verbal and written English skills required
  • Able to clearly and accurately translate from English to Bahasa and Bahasa to English
  • Ability to work well under pressure and meet deadlines
  • Computer skills, Microsoft Office preferred
  • Experience working with an NGO is an asset

Please submit your application and curriculum vitae to put Job title in Subject line. Only applications in English and short listed candidates will be notified. Applications submitted after Oct 17, 2008 will not be considered.

Scoring Stroke Risk

A simple scoring system was recently published defining characteristics of patients with TIA that would increase their risk for stroke within seven days. The method is called the ABCD Scoring System. Scores are assigned for the following
variables:

A - Age: greater than or equal to 60 years = 1 point
B - Blood pressure: systolic greater than 140mmHg, or diastolic greater than 90mmHg = 1 point
C - Clinical features: unilateral weakness = 2 points; speech disturbance without weakness = 1 point
D - Duration of symptoms: greater than or equal to 60 minutes = 2 points; 10-59 minutes = 1 point

Totals:
Less than or equal to 4: the risk of stroke within 7 days is very low (0.4%)
5 points: the risk of stroke within 7 days is 12.1%
6 points: the risk of stroke within 7 days is 31.4%

Now that we know which patients are most likely to have a stroke within a short period of time after TIA, it is time to teach those patients the signs and symptoms of stroke so that they will seek treatment promptly. If your patient presents to the Emergency Department within the first hour of stroke symptoms thrombolytics and angiography may be possible, later presentations limit treatment choices.

From: Rothwell, P.M., et al. (2005). A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischemic attack. Lancet, 366: 29-36.
Best wishes,

David W. Woodruff, MSN, RN, CNS
President, Ed4Nurses, Inc.
www.Ed4Nurses.com

Thursday, July 10, 2008

Reading Emergency Medical Services Literature

Reading Emergency Medical Services Literature

By Jim Upchurch

It is important to have a basic understanding of research study prior to interpreting research articles and abstracts. Dr. Jim Upchurch and Jeri D. Pullum illustrate the significance of scrutinizing EMS research articles.

Introduction
Emergency Medical Services (EMS) literature is the printed word concerning EMS. This includes articles, books, computer software and WebPages. The literature can be divided into two broad categories: research literature and non-research literature. Both serve an important purpose. Research literature helps to direct the practice of EMS by showing us what works and what doesn’t. The non-research literature may also change our EMS practice through the spread of information concerning various topics in EMS. These topics can be educational, personal opinion, survey data, etc. The article you are currently reading is non-research literature with the intent to describe two categories of EMS literature and offer an approach to effective reading.

EMS is a broad field dealing with the medical care provided for patients who become suddenly ill or injured. The field includes both out-of-hospital and in-hospital emergency healthcare providers. There are publications devoted entirely to EMS, such as JEMS and Prehospital Emergency Care, and there are general medical journals that regularly print articles about EMS. Until the past decade, virtually everything that was considered literature was in print form: books, magazines, journals and newspapers. A growing source for literature is the Internet. Readers must apply the same critical reading skills to Internet sources as they do to print sources.

Those who know the literature gain a better understanding of the field and can use that information to continually improve their out-of-hospital medical practice.

Research Literature
According to Webster, research is the careful, systematic study and investigation in some field of knowledge, undertaken to discover or establish facts or principles. Our interest is in the field of medicine. Articles published on medical research can be thought of as a snapshot of the medical topic being investigated. This snapshot gives us one view of a problem. Sometimes that single view is so powerful as to change our patient approach through just one study. One example is the investigation of penetrating chest trauma and treatment with the Military Anti-Shock Trousers (MAST), now often referred to as the Pneumatic Anti-Shock Garment (PASG). This study was done in Houston, Texas, several years ago, and clearly demonstrated that patients who were shot or stabbed in the chest died more often when MAST were applied than when they were not. This one study has changed the way we treat penetrating chest trauma in the field. However, the benefit of MAST or PASG in other situations remains unanswered due to a lack of research. It often takes several research projects or snapshots to give us a good picture of the subject under investigation.

What is EMS research literature? Research articles are generally published in medical journals that are issued several times a year. This helps to distribute the results of medical research faster than waiting for textbooks to be released or updated. Prehospital Emergency Care is currently the only medical journal dedicated to out-of-hospital medicine. EMS research articles are also found in the Annals of Emergency Medicine and occasionally in other medical journals. EMS research occupies a very small space in the overall field of medical research. Other research not specifically EMS also can impact out-of-hospital practice. The ongoing research in the treatment of heart disease is one major example.

So, what is a ‘good’ research article? It is one that gives us a true snapshot of the subject studied. The first step toward finding these articles is to look in a refereed medical journal. The author(s) published in these journals must work their way into the journal by passing one or more in-depth reviews of their article. The reviews are performed by one or more experts on the research subject contained in the article. It can take a year or longer before the article is accepted for publication. Journals that require a review process will identify this fact inside their journal. Prehospital Emergency Care and Annals of Emergency Medicine are two examples of refereed medical journals. After obtaining an article to read (or perhaps, one provided by your medical director), how do you get the most from your reading? First, you will need access to a dictionary (English and medical). It is important to look up words that are unfamiliar; otherwise, an important message from the article may be lost. A terminology gap can exist between what the author writes and the reader’s word memory bank. Dictionaries help close the gap. Other useful tools may include medical texts, drug references, etc. Next, it is helpful to understand how a research article is put together. In general, research articles are divided in to the Study Objective or Introduction, Methods, Results, Discussion and Conclusion. All but the Discussion is briefly covered at the beginning of an article. This is called the Abstract. The remainder of the research article discusses all divisions in detail.

The Study Objective or Introduction contains the research question. This part of the article should clearly describe what is being studied. Background information and a discussion of related studies (literature review) may also be provided here.

Methods is a description of how the study was conducted. Retrospective and prospective methods are frequently used. Retrospective studies use previous patient contacts to look for answers to the study objective. This is accomplished by reviewing medical records from a hospital or ambulance or from a database like the trauma registry. A prospective study is set up before patient contact. An example is the MAST study mentioned earlier. MAST was applied on one day but not the next. Patient response to treatment with and without MAST was documented in a prospective manner.

The Results section describes the data collected by the researchers and whether it meant anything. By time you get to this point in the article, you should have a fair understanding of what the researchers are looking for. Statistics help determine if the results of the study were real or due to outside influences. This is called statistical significance. There are different statistical tests used to calculate statistical significance. The selected test method should be identified along with the results. Statistical significance is important but does not guarantee clinical significance. Clinical significance is whether the study shows an impact on patients. The authors should identify the clinical significance they found.

The Discussion should be straightforward and review the study up to this point. Look for a description of the limitations of the study. This is a clue that the author(s) are trying to present a true picture of their findings.

Finally, the Conclusion should contain the author(s) response to the Study Objective based on the research. This may be included in the Discussion.

Non-research Literature
Non-research literature can take many forms: reporting on practices in the field, product reviews, announcements of new procedures, or feature stories on unusual or noteworthy people, agencies or events.

A critical reader can gain much valuable information from these articles. Product reviews help readers make informed decisions about purchases. Reporting on practices in the field helps readers stay up-to-date and helps determine whether practices in their own areas need updating. Feature stories can provide motivational material or can spawn ideas of how to adapt innovations to improve local EMS services.

As with the research article, critical reading is important to gain the most from the non-research article. Although there is nothing wrong with reading for entertainment, the critical reader can improve comprehension through guided reading. You can perform a self-review of the information you read by answering the following questions.

Who wrote the article? The critical reader should check the writer’s credentials. The credentials should support the notion that he or she has some knowledge of the topic under discussion. For example, an article on surgical airways written by a social worker probably should not carry much weight (unless the social worker is also a paramedic, R.N. or M.D.). However, that same social worker writing an article on critical incident stress is more likely to be useful. Also, the critical reader will pay attention to the credentials of other sources the writer is using for information. All this helps the reader shape an opinion about the article. Many feature stories are project reports and are often submitted by someone involved in the project. There is nothing inherently wrong with this practice, but without the strict scientific standards that are required of research articles, some writers involved in the project may paint a biased “rosy” picture. The critical reader should be suspicious if the writer fails to acknowledge any adverse circumstances, results or features.

What is the writer’s perspective? A physician may have a different view of the subject than an emergency medical technician, nurse or non-medical author. Medical professionals are not the only people who can write about EMS; people with many different backgrounds can offer great insight into various EMS topics. But their perspective is bound to be different.

What is the article’s perspective? Does the writer presents various points of view? Obviously, an article about a controversy in the field should include all viewpoints. This consideration applies to other topics as well. A product review should note poor features of the product, as well as the good features, indicating an unbiased evaluation. Critical readers can gain valuable insight from weighing opposing viewpoints for themselves or from understanding what does or does not work.

What are the credentials of the source: the journal, magazine, newspaper or Web site? The critical reader should find out how long the source has been operating and who publishes it. A critical reader can get a good sense of the tone of the source by evaluating its contents over time. Web sites, in particular, can come and go in the blink of an eye. That does not mean that a new magazine or web site is automatically suspect, but the critical reader realizes that such sources have not had time to establish a reputation. Publishers can range from professional organizations, industry groups with specific special interests, educational institutions, or communications organizations. The publisher’s philosophy influences the types of information published and exerts at least some editorial control.

Does the author describe reading objectives and resources used in their work? You should be informed early on what it is you will gain by spending the time to read the author’s creation. Resources utilized by the author should be recorded in the offering.

Does the information apply to you? The reader should consider both how well the information applies to his or her particular situation and the age of the information. The reader should look carefully at how the reported situation is both similar to and different from his or her own experience. Further, the reader must evaluate whether the information is dated or if it still applies.

Does the author use correct grammar and spelling (yes grammar!)? If the text does not flow well it may be the result of poor sentence structure and/or spelling. A writer who does not take the time to use correct grammar and spelling may not have taken the time to develop good content. And speaking of content, the ideas presented should flow in a logical manner.

Now, where do we find these articles? JEMS and EMS Magazine are major contributors to the written word on EMS. The articles are generally well written by experienced writers and provide useful information. Other sources include various web sites, Fire based journals, Search and Rescue journals, and occasionally medical journals other than Prehospital Emergency Care or Annals of Emergency Medicine.

Summary
With the information overload provided by the Internet and the many publications that address EMS, it is important to develop a sense of what is worth your valuable reading time and to get the most from what you do read. The reader who can keep an open mind but remain skeptical has the most to gain from regular and studied reading of the EMS literature. Hopefully this introduction will point you in the right direction. So read!

References
Rowntree D. Statistics Without Tears: A Primer for Non-Mathematicians. New York: Charles Scribner’s Sons; 1981.

Cuddy PG, Elenbaas RM, Elenbaas JK: Evaluating the medical literature. Part I: abstract, introduction, methods. Ann Emerg Med. 1983; 12:549-555.

Elenbaas JK Cuddy PG, Elenbaas RM: Evaluating the medical literature. Part III: results and discussion. Ann Emerg Med. 1983; 12:679-686.

Huck SW. Reading Statistics and Research, 2nd ed. New York: Addison Wesley Longman; 2000.

Merriam-Webster’s Collegiate Dictionary. Springfield, MA: Merriam-Webster, Inc. 1999; 995.

CO-AUTHOR
Jeri D. Pullum. Jeri has spent the past 15 years working with rural EMS providers, primarily on training projects for the Critical Illness and Trauma Foundation. She has designed, produced and authored numerous interactive computer-based training programs and contributes substantially to both the development of grant projects and in overseeing their completion. Using her background in print journalism and bachelor’s degree in journalism from the University of Montana, Jeri writes and edits scripts, training materials, proposals, reports and newsletters. She was an editor for a daily newspaper and worked for several years for a video production company. Jeri has a master’s degree in distance education and instructional technology. You can contact her at jpullum@bresnan.net.

Jim Upchurch MD, MA, NREMT practices in Montana and is board certified in Family Practice with added qualification in Geriatrics. He has a master’s degree in education and human development and is licensed as a paramedic. Dr. Upchurch is a ‘Legacy’ member of the American College of Emergency Physicians. Since 1985 his practice has focused on emergency medicine and EMS while providing the full spectrum of care required in a rural/frontier environment. He provides medical direction for BLS and ALS EMS systems, including critical care interfacility transport; and for the Incident Medical Specialist Program, USDA Forest Service, Northern Region. Dr. Upchurch has served as American Heart Association ACLS Regional and National faculty for Montana and currently represents Montana on the Council of State EMS Medical Directors of the National Association of State EMS Officials. Contact him via e-mail at upchurch@mcn.net.

Criminalizing Medical Errors

Criminalizing Medical Errors
By Mike McEvoy

Example scenario: While treating a 31-year-old heart failure patient, a paramedic mistakenly pushes 4 milligrams of intravenous norepinephrine instead of the intended lookalike vial of 1 milligram of bumetanide (Bumex®). The patient immediately develops a supraventricular tachycardia, becomes hypertensive, and deteriorates into ventricular fibrillation. Resuscitative efforts are unsuccessful; the patient is pronounced dead on arrival at the ED. After learning of the error from local media accounts, the district attorney launches a criminal investigation. A grand jury returns a felony indictment against the paramedic involved in the error.

Every medical provider fears making an error that harms a patient. The possibility of criminal prosecution adds to those fears — loss of personal freedom, property, certification or licensure, and potential loss of livelihood. Today, with increasing frequency, human errors in health care are being criminalized. The results may have far reaching consequences on the practice of medicine, nursing and EMS.

While the public and our legal system seek to blame and punish people who make fatal mistakes, health care experts and advocates believe that criminal prosecution of medical providers ultimately does far more harm than good. Such actions, they argue, will ultimately drive practitioners to stop reporting errors, and discourage recruitment and retention of a profession already in short supply.

The fact of the matter is that a fatal medication or procedural error could happen to any nurse, paramedic, EMT or physician. How then, should these tragic circumstances be dealt with? What leads society to criminalize medical mistakes? What role can you and I play in affecting how medical errors are managed?

Medicine is not the only profession susceptible to criminal indictments for mistakes. In September 2006, two U.S. pilots flying an executive jet clipped the wings of a commercial airplane over Brazil. The resulting crash was the worst aviation accident in the history of Brazil and killed all 154 people aboard the 737 airliner.
Criminal charges were later filed against the U.S. pilots involved(1). Like health care authorities, aviation safety experts commented that the charges would have a "chilling effect … on getting people to come forward and admit mistakes. We need to focus not on putting people behind bars, but rather on finding out what went wrong and why, and then to prevent its reoccurrence." (Kenneth Quinn, Flight Safety Foundation).

'Criminal human error'
History illuminates when and how safety experts and the criminal justice system arrived at their present day impasse. Attorney David Marx, writing in The Just Culture Community News and Views newsletter(2), calls this juncture the "birth of criminal human error." Marx traces the birth in the U.S. to a 1952 Supreme Court decision in the case of Morissette v. United States, 342 U.S. 246.

In December 1948, while deer hunting on an abandoned air force bombing range, Morissette salvaged 3 tons of abandoned bomb scrap metal. He did this in full view during broad daylight believing it was abandoned, and did not think he was stealing.

When the government charged him with theft, his attorneys argued for dismissal on the grounds that there was no evil or criminal intent, which they believed the law required(3). Justice Jackson, writing for the court, described a paradigm shift in defining the word "criminal," which until that time typically conjured up images of evil intent or intent to cause harm.
Jackson described how the industrial revolution had introduced powerful, complex machines with potential to cause significant harm not previously possible except by the hands of man or animal. He pointed out that automobiles became an instrument by which human behavior could inflict major damage. With the industrial revolution, vast harm became able to be caused from great distances. In response, legislatures started criminalizing acts where "evil intent" was no longer a necessary element. Criminal negligence was born.

Since the industrial revolution, many types of human error have been criminalized, especially where public health or welfare is at stake. Marx points out that today's convicted criminals are not all folks with "evil intent," but include those who breach a duty to others that our government labels "criminal." The Clean Water Act makes polluting waterways criminal. People who leave a child or pet in an unattended vehicle during hot summer months are likely to face criminal charges.

Unavoidable events
Considering the potential scope of actions that could expose any one of us to prosecution, statistics demonstrate a predictable randomness that would pronounce such events unavoidable. The only question is which one of us it will happen to next. And when egregious harm befalls an innocent victim, human nature is to react to the seriousness of the outcome. What firefighter is not happy to see criminal charges brought against an arsonist? What medic is not pleased to see a drunk driver marched off to jail?

Yet to effectively deal with errors, particularly medical errors, we need to suppress our natural reactions and try to ignore outcomes during the time it takes to analyze the circumstances that led to the error.

The greater question, as it pertains to medical providers, is why human error has become not only a violation of rules and regulations, but a criminal act when it threatens the safety of citizens. Are prosecutors becoming overzealous? Are lawyers running out of control? Are our elected officials so frustrated that they’ve turned to criminal law to protect society? Or is it perhaps the systems we designed and manage that are heading us in this direction? Probably no single one of these explanations accounts entirely for where we are today, but several will determine where we go in the future.

No one of us is perfect. As human beings, we are destined to make mistakes. The Just Culture Organization, working to improve patient safety, believes that medical systems often fail to recognize human beings have not one, but two "intentions" related to anything we do. But while we acknowledge human intention toward the outcome, we frequently overlook human intention toward the action or behavior that leads to the outcome.

Undoubtedly, few medical providers intend to hurt their patients — the outcomes. But what about their intentions toward their actions? Did the paramedic in our opening scenario consciously disregard what he knew to be a significant and unjustifiable risk to his patient? If he did, the Just Culture model would call that behavior "reckless" and that is precisely the question they believe should be applied when considering criminal charges in medical errors.

The belief that punishment or criminal charges are unjustified merely because a health care provider did not intend to cause harm flies in the face of accountability, our legal system and good patient safety.

Provider's intentions
When investigating medical errors, our systems must carefully weigh the provider's intentions toward their behavior for recklessness. Regularly, we need to look for risky behavior and coach providers to straighten up and fly right.

Reckless behavior, on the other hand, should be punished. Yes, you read that correctly: some behaviors need to be punished. Perhaps our failure to consistently address reckless practices has prompted attorneys, prosecutors and legislators to take up our slack themselves.

A highly intoxicated partygoer who chooses to drive themselves home does not intend to strike and kill a pedestrian. But when such an incident happens, the courts will likely find the behavior — driving drunk — was intended, and consciously disregarded a significant risk to others.
Recklessness that harms others is criminal, and society sends the guilty to jail. Health care providers should not enjoy special exemption from the rules that govern the rest of society.
Our regulatory systems need to do a better job of dealing with providers who aren't living up to professional standards. Using the criminal justice system to accomplish this should rarely be necessary.

Speaking at the Society of Critical Care Medicine's 2007 Congress in Orlando, Lucian Leape, a Harvard physician and founder of the National Patient Safety Foundation, told the audience that problem health care providers are not bad people but, "our friends and colleagues whose performance poses a potential threat to patient safety.

Our failure to insure that all of our colleagues are competent and safe is ethically indefensible, and we have to do something about it." Dr. Leape continued, "We are the only ones capable of judging and taking action with our peers. We have to take the responsibility."

Equally important are our safety systems. Many error investigation models, the Just Cause model included, see two inputs for every adverse outcome: the system we design around the provider and the behavioral choices they make within that system.

Some systems facilitate risky behaviors; others fail to implement safeguards to reduce risks. In 1998, a Denver nurse was indicted for criminally negligent homicide in the death of a newborn from a dose of penicillin. The Institute for Safe Medication Practices (ISMP) investigating the case found more than 50 deficiencies in the hospital medication-use system contributed to the error(4). Had any one of them been corrected, the error would not have reached the infant.

Protecting patients, providers
Safety systems are critical to protect patients and providers. Too often, safety nets are lacking or non-existent. Human beings will continue to make mistakes. System operators, administrators, manufacturers and regulators own responsibility for the environment of care.

When two drugs are packaged in lookalike vials, the department has an obligation to prevent potential errors. While we often focus on individuals involved in errors, the fire service and EMS community collectively are responsible to gather and analyze near miss reports and feedback from the streets to improve patient safety. Without strides in meeting that obligation, future criminal focus may well take aim at chiefs, administrators, medical directors and system operators.

The increasing trend toward criminalizing medical errors is very likely to discourage health care providers from reporting errors, hurt recruitment and retention, and bring important patient safety initiatives to a screeching halt. EMS providers, like our physician and nursing colleagues, need to step forward and take a more proactive role in how medical errors are managed.
We need to look for risky behavior before they result in errors, and consider whether recklessness contributed to errors that do occur. We must begin to hold our systems accountable for their contributions to errors in the environment of care.

Until we manage to convince the public, our legal system and legislators that we take mistakes seriously, they will continue attempts to fix our problems themselves with legislation, regulations and criminal charges.

Far better outcomes could be had if we, the people who know health care, lead change from within. It's time to begin — we owe it to our patients and each other.

References:
1. ISMP Medication Safety Alert! Criminal prosecution of human error will likely have dangerous long-term consequences. 2007; 12(5):1-2.
2. The Just Culture Community News and Views. The Criminal Edition. Marx, D, Cassidy, KM. Eds. January/February 2007.
3. Morissette v United States, 342 U.S. 246 (1952)
4. ISMP Medication Safety Alert! Since when is it a crime to be human? 2006; 11(23):2.
________________________________________
Mike McEvoy is the EMS Coordinator for Saratoga County and the EMS Director on the Board of the New York State Association of Fire Chiefs. Formerly a forensic psychologist, he is a clinical specialist in Cardiac Surgery and teaches Critical Care Medicine at Albany Medical College. Mike is a paramedic for Clifton Park-Halfmoon Ambulance, chief medical officer for West Crescent Fire Department, past chair and current member of the New York State EMS Council. He is the fireEMS editor for Fire Engineering magazine and recently published a book titled "Straight Talk About Stress for Emergency Responders." Mike is a popular speaker at fire, EMS, and medical conferences and in his free time, is an avid hiker and winter mountain climber

Wednesday, July 09, 2008

SPMI Sr. Program Officer

The American Red Cross Tsunami Recovery Program (TRP) had been established to direct the organization’s response to the South Asia tsunami disaster. The TRP activities focus on integrated community recovery and preparedness interventions in tsunami affected countries in Asia and East Africa in collaboration with Red Cross and non-Red Cross partners. Please visit www.redcross.org/tsunamirelief

The Indonesia TRP Delegation operates from offices in Banda Aceh, Calang, Lamno. It also has liaison offices in Jakarta, and other areas in Aceh province in collaboration with the Indonesian Red Cross. The American Red Cross seeks dynamic individuals to fill the :


SPMI Sr. Program Officer
(Aceh - Banda Aceh)

Responsibilities:
Providing ongoing on- and off-site technical assistance to PMI and American Red Cross YRSH Program Manager
Providing technical assistance on school health programming
Assisting sites in implementing the program through on-site coaching, mentoring, trouble-shooting
Providing training and supervision in all components of management, program and administrative procedures
Discover partnering possibilities/opportunities for PMI with local government agencies for PMI to sustain Health and Nutrition promotion in the future also facilitate and support development of partnership
Identify training needs within PMI teams and support ARC instructional unit to develop, organize and facilitate relative trainings
Technical assistance in supporting PMI for program exit and document best practices and lesson learned for PMI ABDYA and Aceh Utara.
Creating a continual system of feedback, sharing and quality improvement of program interventions
Accessing and/or developing resources for program use (e.g., manuals, how-to Instructions, exemplars, etc.)
Liaison and networking with local GOs and NGOs
Technical Assistance to PMI to develop strategic partnerships to institutionalize Health Strategic Maintain and update Project database, ensure validity of data and good filling system
Responsible for monthly and quarterly report as well as weekly report
Assist Project Manager in Monitoring related to Program and finance status at field level
Whenever needed, represent Program Manager in events related to Program
Requirements:
Good interpersonal Skill.
Medical degree or related background and have experience in Nutrition and Health Promotion issues.
Minimum 3 years experience in managing programs, community development work, past experience in community based program is preferred
Minimum 2 years experience in school health program
Ability to train and manage staff
Excellent relational, administrative, written and oral communication skills
Proficiency in English (written and spoken)
Proficiency in computers especially MS office, capability in database program.
Ability to take initiative, think creatively and work collaboratively
Result oriented and make things happened
Able to work efficiently under time pressure.

Please submit your application and curriculum vitae to hr@amredcross.org
put Job title in Subject line.
Only applications in English and short listed candidates will be notified.

Tuesday, June 24, 2008

Medical Training Specialists

Medical Training Specialists

Dubai
The Emirates Group is a highly profitable business with a turnover of approximately US$ 11 billion and over 36,000 employees(and growing rapidly towards 50,000 over the next 3 years). The Group comprises of Dnata, the successful Airport Ground Services and Travel Industry division, and Emirates, the Group's rapidly expanding and award winning international Airline. Within the Group there are a diverse range of businesses offering a wide spectrum of career opportunities, all of which can be explored through the Group's dedicated careers website. Emirates global network now sees it flying to over 100 destinations across 6 continents, and with aircraft orders worth over Emirates currently operates a modern fleet of 116 wide-bodied aircraft and it has orders worth over US$ 60 billion for 242 more of the latest aircraft, including 8 Boeing 777 freighters., with many more destinations coming on line. With the Group now hiring over 6,000 new staff every year, essential to business success will be the ongoing employment of high quality people to join our multi-cultural team of over 145 nationalities. Dubai, a tourism centre and modern cosmopolitan city with high standards of healthcare, education and leisure pursuits for residents offers one of the most desirable lifestyle locations in the world. In addition to lifestyle and tax free salary benefits, the Emirates Group also offers professional development opportunities to help employees develop new skills and grow their careers successfully. These are both internal through e-Learning and leadership development courses and external through relationships with tertiary institutions globally, including Executive education programmes at world class Business Schools and Universities. The Position: The Training Specialist will be responsible for competency based Occupational Health and First Response Training programs, to a multi-cultural audience within the Emirates Group. He/She will also ensure that training is aligned to corporate objectives and complies with International standards and regulations.

Salary & Benefits:
We offer an attractive tax-free salary, paid in Dirhams, the local currency of the UAE. The Dirham is linked to the Special Drawing Right of the International Monetary Fund. It has been held constant against the US dollar since the end of 1980 at a mid-rate of approximately US$1= Dh3.66. Besides travel benefits normally associated with an airline, more information on employee benefits is available within the 'Working Here' section of this site. By viewing the 'Dubai Lifestyle' section in the site you can also consider the benefits of Dubai as a location to live and work in.

Experience and Qualifications:
A recognised professional qualification in nursing or the health sciences with a training qualification equivalent to City & Guilds International Certificate in Teaching & Training.
A minimum of 5 years experience as a health care professional and educator with IT literacy.

To Apply:
To express your interest in the above vacancy please apply on-line by clicking below, and complete our application form. We will then consider your application and contact you should we wish to shortlist you for an interview. Should you not receive an invitation for an interview within 5 weeks please assume that on this occasion you have been unsuccessful. We will retain your details for 12 months unless advised otherwise and re-consider you for future opportunities as they arise. Please also note that if you are not shortlisted you can also update your application at anytime and apply for other opportunities. Thank you for your interest in a career with the Emirates Group.

Job Reference No : L&DO/LF/10821

Closing Date : 06-Jul-2008

Friday, June 20, 2008

Occupational Health Nurse

Occupational Health Nurse

Job number: 460750
CSG: Uranium & Olympic Dam
Site: Olympic Dam
Business / Project: Olympic Dam
Job type: Full Time - Permanent
Location: AU - South Australia

Think Zero Harm
At BHP Billiton, our vision for sustainable development is to be the company of choice - creating sustainable value for shareholders, employees, contractors, suppliers, customers, business partners and host communities. Central to our vision is our aspirational goal of Zero Harm to people, the environment and the community.
Further to this our people are our most significant asset and number one priority and therefore Zero Harm drives all our operations. A demonstrated commitment to health and safety leadership is a pre-requisite for being considered for any opportunities or career advancement within the business.

Think Place
The future has never looked more exciting at Olympic Dam, Australia's largest single underground mine and minerals processing operation. A copper/uranium mine, Olympic Dam is located 560 kilometres north of Adelaide and processes ore through to final, refined products of international standing - all on the one site. Nearby Roxby Downs is a modern, fully-equipped township of around 4,500 people which boasts top-class recreational, civic and educational facilities. This is a great place for young professionals to live and work and make their mark - it is also an excellent place for families, with a quarter of the population comprised of school age children.

Think Opportunity
The Occupational Health Nurse is a residential role at Australia's largest underground mine and reports to the Senior Occupational Health Nurse.

Think Purpose
You will deliver on-site injury management, medical and health assessment, treatment and health promotion to all employees across site. You will be responsible for maintaining comprehensive medical records of all injuries and illnesses, both written and electronic. You will be required to maintain effective communications with all Olympic Dam personnel on occupational health matters. Your responsibilities will include -
• Providing effective initial return to work management for BHP Billiton personnel following work and non-work related injury or illness
• Providing medical assessment and treatment to all personnel accessing the Olympic Dam site,
• Conducting pre-employment, exit and periodic medical assessments,
• Conducting Fit For Work (FFW) testing as required,
• Conducting health promotion initiatives in line with the Olympic Dam Health Promotion Program,
• Maintaining effective documentation including patient notes, electronic data entry and meeting the requirements of the Federal Privacy Act 1988,
• Completing daily tasks to ensure functional management of the medical centre as directed by the Senior Occupational Health Nurse.

Think Requirements
To be considered, you will be a Registered Nurse, hold a current practicing certificate in South Australia and have general nursing experience or experience in a casualty department. While it is preferable that you have an industrial or mining background, we are also interested in speaking with RNs whose career goals include moving into OH. You will have the ability to deliver key health training programs to employees and be competent in Microsoft Office. A Diploma in Occupational Heath Nursing will be highly regarded. You are a highly motivated professional who can be relied upon to display integrity and provide consistently fair assessments. Your communication skills are excellent and you work well when confronted with deadlines and pressure situations. Setting clear goals and priorities is second nature to you.
This role provides an opportunity to contribute your skills to our business in a meaningful way while developing your career with a true mining industry leader.

Previous Applicants need not reapply.

Think Apply
Apply online at http://jobs.bhpbilliton.com by 5pm Sunday 29 June, 2008.

Enter Ref No 451761 to easily locate the position.

Enquiries may be directed to Vicki Sires on 08 86718499.

Advertised:19 Jun 2008 Cen. Australia Standard Time
Closing date:29 Jun 2008 5:00pm Cen. Australia Standard Time

BHP Billiton has an overriding commitment to safety and environmental responsibility.

Wednesday, June 18, 2008

What speed is safe on emergency runs?

What speed is safe on emergency runs?

June 17, 2008
By Dana Wilson
The Columbus Dispatch
Copyright 2008 The Columbus Dispatch

DELAWARE, Ohio — George Haggard was waiting for his wife to arrive home so they could go out to dinner when he heard the sirens blaring along Liberty Road.

He was shocked when, instead of her Dodge Caravan, an ambulance stopped at the end of his driveway along Carriage Road, near Powell. The medics told him Dorothy, 67, had been in a car crash.

"They said, 'Your wife is on a backboard in the back,' " Mr. Haggard, 70, recalled.

Her injuries mostly were minor, so he followed the ambulance to the hospital. Later, his wife described to him how her vehicle was hit by a deputy sheriff's cruiser.

It was just before 6 p.m. on June 5, and Mrs. Haggard was driving south on Liberty Road when she heard emergency sirens. She pulled off to the right berm. Heading north on the same road, Delaware County Deputy Charles Gannon Jr. lost control of his cruiser, according to the State Highway Patrol.

The cruiser went off the road, then sideswiped a Liberty Township ambulance stopped in traffic. The cruiser veered off the road again, then struck Mrs. Haggard's van, pushing it into a GMC Sierra also along the berm.

A fifth car that veered off the road to avoid the cruiser hit a tree instead.

Gannon, 33, later told troopers that he was en route to an emergency call and estimated he was traveling between 50 and 70 mph. The posted speed limit on Liberty Road is 45 mph.

The State Highway Patrol cited Gannon for operating a vehicle without reasonable control, a misdemeanor. His driving privileges at work have been suspended pending an internal review, Sheriff Walter L. Davis said.

"We'll look at everything," Davis said. "We understand that we have to be responsible. We understand that we have to, first and foremost, use good common sense and good judgment."

The crash, Gannon's second on-duty wreck, raises the question of how fast is too fast for an emergency vehicle.

The patrol says that depends on a number of factors, including the nature of the call, traffic, weather and time of day.

"He was cited for the crash, so they believe that there was some type of negligence, but it's a tricky call," State Highway Patrol Sgt. D.J. Smith said. "There is no, per se, 'You can only go this fast.'

"Firetrucks and medics cannot go 10 miles above the posted speed limit and must stop at red lights and stop signs, Liberty Township Fire Chief John Bernans said.

He said first-responders must evaluate every call and practice common sense.

"Are you running 90 miles an hour on a broken ankle versus a heart attack?"

Gannon said he was responding to a report of a suicidal person on June 5.

Mrs. Haggard was badly bruised in the crash and suffered torn rib cartilage. Drivers or passengers in two other vehicles suffered minor injuries.

"What he did is put my wife's life in jeopardy by a poor decision," Mr. Haggard said of Gannon. "If you're going to save a life, you don't want to endanger other people, too."

Friday, June 06, 2008

Nurse - CESVI - Cooperazione e Sviluppo Onlus (CESVI)

Nurse
NGO

Location: Zimbabwe (Harare)

Closing date:
30 Jun 2008

DURATION:
12 months, renewable

REQUIRED COMPETENCIES

Nurse graduate Previous experience in developing Countries Previous experience in the management of Health Projects Knowledge of Italian Minister of Foreign Affairs procedures Willingness to move within the Bindura e Mazowe districts, Zimbabwe Fluency in written and spoken English Fluency in written and spoken Italian

DESIRABLE COMPETENCIES

Very flexible, patient and with a positive attitude
Dynamic and willing to take initiative to complete assigned tasks

WORK CONTEXT

- Cesvi has worked in Zimbabwe for the last eight years and is present in the sectors of the fight against HIV/AIDS and malaria, OVCs and sustainable natural resources management.
- The Country Programme has a portfolio of ca. 6m Euro, and is financed by EC, Italian MFA and private donors. Cesvi has established partnership with a large number of local NGOs and state actors.

JOB DESCRIPTION

The collaboration will start on July 2008
The main duty station will be Harare
The person will respond to the Project Coordinator

Main tasks:

Ensure the implementation of the activities, writing reports and attending to financial management
Draw up activities planning Assure an efficient office organization and a correct registration of the project documentation
Guarantee the project reports respecting the deadline required by her/his referent
Guarantee the conservation and management of the reserved information
Assure the flows of information in accordance with the HQs indications that are needed to support the Fund Raising activities and the social and economical reports

Vacancies Contact
To apply, please visit this page:
http://www.hr.cesvi.org/impaginaposizione.asp?idposizione=313
Reference Code: RW_7F5F2F-74

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