I can, I can, I can Break my Writer's Block!

Peppersass - The Original Little Engine that Could climb Mt. Washington in New Hampshire

I have writer's block. Or maybe I am just crippled with fear. Fear that nobody will read what I write, or that my ideas aren't good enough. Or that once I start writing, I will run out of ideas to write about, so I don't start. I have a growing list of topics that I am planning to blog about or would have liked to blog about, but the current event has already passed.

I finished collecting all of the data for my dissertation last month and all that stands between me and my PhD is writing and a LOT of it! Instead of being thrilled that I am so close to achieving the ultimate accomplishment after 30 years of education, I am terrified and doing everything under the sun except writing.

How am I going to break this writer's block? Well I've been thinking myself silly! And doing everything but writing myself silly! I can't possibly watch any more Gray's Anatomy or The West Wing! Maybe I should watch some more Emergency? I can always garner some ideas from such an excellent show, right?!

As I just advised one of my former EMT students, I need to just begin writing, it doesn't matter if my words make sense, or are in complete sentences, or are even spelled correctly. I just need to start free-form writing. Data-dumping as my father used to call it when I was a toddler and I was so excited to tell him about my entire day when he returned home from work.

Ah, I feel much better now, I just wrote the previous four paragraphs in less than 10 minutes. Spent barely any time editing. And I have broken my writer's block. I can write, I can write, I can write! Just like The Little Engine that Could!

Active Learning in an Accelerated EMT Course

No, I haven't died or abandoned my blog. I've been teaching an accelerated EMT class! Enough said. This was my first time teaching an accelerated EMT class and I'm talking Monday through Friday 8am to 3pm for 6 weeks straight. No, this wasn't an academy class, there was no selection process to choose the most prepared students. And yes it did take me two weeks to recover! Given the time constraints of the class, I chose to bite the bullet and employ a 100% active learning teaching strategy. I am completely convinced that I learned more than my students, but they will never believe me, because every single student who completed the course, if all goes as it should today, will pass the final test to become Maryland certified EMTs.

Sometimes EMS outsiders really do get us, such as a waitress at Dirty Harry's Restaurant and Bakery in Fenwick Island, Delaware, who introduced me to the new version of the "Eye Pad."

The past two months of my life have been a roller coaster ride of emotions as I fought to stay awake one more hour preparing another activity to help my students engage with the lessons for the next day; as I struggled to find ways to help my students who wanted lectures to understand why it was a complete waste of their time and mine; as I counseled students who were struggling in the class due to misguided study skills; and as I coordinated all of the usual duties of a primary instructor. But now that it's all said and done and I've recovered, Maryland has 17 new talented EMTs, and I can't wait to start my next class.

Memorial Day, Disasters, & Guts

Today is Memorial Day and I made sure to remind all of my fellow Maryland Advocates for EMS to remember not only our fallen veterans, but the veterans that return from service and struggle to join our EMS profession as there is no easy transfer of military medical credentials to civilian EMS credentials. I encouraged them to contact our senators and representatives to support Senate Bill # 1533 and House Resolution #4124 which will provide grant funding to states to develop transition certification programs for military medics. You too can encourage your senators and representative to support this important legislation by sending them a letter through the National Association of EMTs Capwiz.

United States Armed Forces Recruiting Center, Times Square New York, New York

But what I didn't realize until I read Firegeezer's Morning Lineup post is that today is also the 35th anniversary of the Beverly Hills Supper Club fire in Southgate, Kentucky, a suburb of Cincinnati. In Amanda Ripley's book, The Unthinkable: Who Survives When Disaster Strikes - And Why? she describes how a busboy, the low-man on the totem pole, alerted over 1,300 patrons in the Cabaret room to the rapidly spreading fire in the Supper Club. Walter Bailey was only 18 years old, and he was convinced that he was going to lose his job, but he marched right up onto the stage, interrupted the opening act, told the guests about the fire, and pointed out the exits in the room.

Just like Walter Bailey, I wish all new EMTs had the courage to stand up and do what's best for their patients' in spite of the lectures they will endure from jaded and bitter senior EMTs and paramedics. Sometimes new EMTs need to learn the ways of the streets, but sometimes senior EMTs and paramedics need to be reminded by fresh blood why they chose this profession and to do what is ultimately best for the patient!

Why do Cultures Respond to Disasters Differently?

Laurel, Nebraska

This semester I traveled around the country quite a bit because I wasn't teaching any of my own classes, just assisting with several other instructor's classes. Over Spring Break I went as far south as New Orleans and rode the Crescent train into Atlanta, passing through Laurel, Mississippi on the way. In an effort to check off some states we've never seen, my best friend and I flew into Detroit, rented a car and drove north until we crossed the Mackinac Bridge into the Upper Peninsula of Michigan. The whole point of the trip was to make it to St. Paul, Minnesota for a high school buddy's wedding so we drove along Lake Michigan then across Wisconsin into Minnesota. But we didn't stop there, because we were so close to the Dakotas, so we kept on driving and made it as far west as eastern North Dakota, South Dakota, and barely into Nebraska to see Laurel, Nebraska. Then we had to book it back across Iowa, Illinois, and Indiana to catch our flight home in Detroit so I wouldn't miss my blogging class. On another extended weekend trip, we explored Vermont and New Hampshire. So now the only states I have left to see are Oklahoma, Arkansas, Rhode Island, Hawaii, and Alaska. Not bad I'm thinking!

Through all of my travels this semester and all of the interesting people I met, one of the most intriguing questions I was left pondering was: Why did the people of Vermillion, South Dakota respond so differently to the disaster of a flood compared with the people of New Orleans, Louisiana, who have built an entire city and culture around the constant danger of floods?

On the far shore of the Missouri River is the original site of Vermillion, South Dakota. On the horizon is the current location of the town of Vermillion, South Dakota.

Vermillion, South Dakota
Vermillion, South Dakota was founded in 1859 along the banks of the Missouri River in southeast South Dakota. Today the town boasts a population of slightly more than 10,000 people and has been home to the University of South Dakota since 1862. In 1881, an flood comprised of melting snow and ice swept down the Missouri River and destroyed Vermillion. Following the Great Flood of 1881, the residents of Vermillion almost unanimously voted to relocate the town to the top of the bluff above the Missouri River. I'm going to have to estimate the Vermillion town population in 1881. The best I can do is refer to the following document which listed 211 votes cast on the issue of building a city hall in 1884. Presumably only men were allowed to vote, so a rough estimate of approximately 200 men agreed to relocate a town with a population of at least 400 adults and probably many more children in 1881. This is no small feat to get that many adults to agree to do the same thing. Many were giving up their land and prime business locations. The document also outlines some of the conflicts about these exact issues that ensued following the move of the town up onto the bluff. These residents must have been severely traumatized in order to be sufficiently motivated to relocate their entire town. But they had a nearby location at a higher elevation and there was plenty of land on which the town could relocate. The Missouri River where it flows through Vermillion is not navigable, so Vermillion was not a port town and therefore most of the town's business could be conducted safely away from the river.

New Orleans, Louisiana

This tree in front of a New Orleans church has been bedazzled.

New Orleans was founded in 1718 and was a French and Spanish outpost until Napoleon sold it to the United States as part of the Louisiana purchase in 1803. Americans found it a strange place as the native Creoles spoke French, practiced Catholicism, and had some interesting traditions. During much of the 19th century immigrants from all over the world flocked to New Orleans at rates only exceeded by the immigration rates of New York City. New Orleans has been battered by Tropical Storms and Hurricanes since Jean Baptiste le Moyne founded the city in 1718. Prior to modern weather forecasting people had to ride out the storms praying for their survival. During most of the early recorded storms death rates averaged around 200 people per storm. This must have seemed like just another everyday threat to the people of New Orleans who lived in the tropics and were constantly exposed to infectious diseases like malaria and yellow fever.

New Orleans is located in the Mississippi River delta. Originally the settlements of New Orleans were on elevated strips of land in the delta, but the delta is not stable land and the land upon which New Orleans was built has been sinking since. New Orleans is bordered by Lake Pontchartrain on the north, Lake Borgne on the east, and the ever disappearing tidal marshes on the Mississippi River delta to the south buffer New Orleans from storm surges in the Gulf of Mexico. Early settlers of New Orleans didn't have higher, drier ground to easily relocate to after each Tropical Storm or Hurricane flooded the city as all of southern Louisiana was bayou. New Orleans was a port town and had a rapidly growing population of immigrants with little resources to move inland.

Fire Engine in New Orleans St. Patrick's Day Parade

But that was then, since Hurricane Katrina devastated the gulf coast in 2005, I have sought to understand why so many reasonably-minded and intelligent people choose to live in a city that is on average 9 feet below sea-level and in constant danger of flooding from Tropical Storms and Hurricanes. I'm not one for the party scene, but after just a little time in New Orleans even I began to understand why so many people still live in New Orleans. There is something magical about New Orleans and it's unique culture. For a complete lack for better words, I'm going to resort to the cliche Cajun saying "Laissez Les Bons Temps Rouler!" or "Let the Good Times Roll!"

How do you Teach Diabetes?

Recently I had the rare opportunity to teach two small groups of EMT students everything there was to know about oral glucose for over an hour each. I taught my normal lesson by reviewing the protocols for BLS administration of oral glucose using the Round-Robin Review teaching strategy and having the students practice their medical assessments using Scenario-Based Learning with diabetic emergencies. But then, because I had so much extra time, I decided to ask the students if they knew the difference between Type 1 and Type 2 Diabetes. I heard responses such as, "Type 1 you are born with, Type 2 is when you can't eat sugar."

My mother was diagnosed with Type 1 Diabetes on October 5th or 6th, 1982. My parents can't remember the exact date, but they do remember that they had tickets to an Oak Ridge Boys concert that night and they missed the concert despite my mother's protests that she was fine and that she'd check into the hospital in the morning. I was 19 months old and my mother had suffered three miscarriages since I was born. Besides the miscarriages and her hypothyroidism she was otherwise healthy. Her doctors discovered her hyperglycemia while trying to identify the cause of her third miscarriage.




I decided to spend the extra time with my students educating them about the differences between Type 1 and Type 2 Diabetes. We discussed how Type 1 Diabetes is an autoimmune disorder in which the body's immune system kill's the insulin secreting Beta Cells in the islet's of Langerhans of the pancreas; whereas Type 2 Diabetes is characterized by insulin resistance in which the body's cells are resistant to the normal binding of insulin, which prevents glucose from entering cells at normal levels. Uncontrolled, both types of diabetes lead to an increased concentration of glucose in the blood stream or hyperglycemia. We discussed how Type 1 Diabetics are dependent on insulin to live, but how many Type 2 Diabetics can manage their disease through low glycemic index diets, exercise, and sometimes medications such as metformin, which increases the binding affinity of insulin; or sulfonylureas such as glyburide, glipizide, glimepiride, acetohexamide, tolbutamide, tolazamide, and chlorpropamide, which stimulate the production of insulin. However, some Type 2 Diabetics also depend on insulin to live as they must greatly increase the concentration of insulin in their bodies in order to achieve sufficient binding of insulin to cells for glucose uptake to occur.

We discussed how a great majority of patient's with a diabetic emergency are insulin dependent diabetics, who either took too much insulin or ate too little food. I also emphasized how insulin is a hormone and reminded the students that while some diabetics may not check their blood sugar regularly, others may be caught off guard due to natural hormonal fluctuations within the body affecting their blood sugar.

My mother has spent just shy of 30 years diligently managing her Type 1 Diabetes, and not once has she ever needed the assistance of 911, but my mother is lucky in that she is relatively lucid with a blood glucose level around 30mg/dL and she always had her two children around (both EMTs in training from our youngest years). I learned at a very young age when to give my mother orange juice or gel icing, my address, how to call 911, and to explain that my mother was a diabetic.