Subclinical Thyroid Disease Is Associated with Increased Mortality in the Elderly

Clinical Thyroidology Jul 2016, Vol. 28, No. 7: 196-199.


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Off-duty Wash. medics save crash victim

By Emily Gillespie
The Columbian

VANCOUVER, Wash. — Scott Jensen was on his way home from work Tuesday evening when he saw a vehicle cross the centerline and head toward him on state Highway 503. He slammed on his brakes, but couldn't prevent the collision.

"I remember right before he hit me and the ambulance," the 29-year-old Amboy resident said.

It's what he doesn't remember that makes him tear up with gratitude. He doesn't remember other motorists stopping and running toward his burning Dodge Durango. He doesn't remember being pulled from his vehicle before it became engulfed in flames.

When he learned what happened to him, he jumped at the opportunity to meet two women who helped save his life.

From his hospital bed at PeaceHealth Southwest Medical Center, he hugged his saviors: Kim Detter and Hiedi Poulson.

"I owe you everything, thank you," he said through tears. "I don't know what else to say."

But both women knew what to say: that they were happy to help.

Detter, 36, of Battle Ground was driving in front of Jensen's Durango and saw the crash play out in her rearview mirror.

A 2015 GMC Yukon driven by 20-year-old Travis Starks of Portland was traveling south on the highway at about 5:40 p.m. when he crossed into the northbound lanes to pass traffic, according to the Washington State Patrol.

A northbound 2015 Toyota Rav 4 driven by Igor Skobkariov swerved into the right lane to try to avoid the crash. The Yukon still struck the left corner panel of the Rav 4, but Skobkariov escaped injury, State Patrol Trooper Will Finn said. The Yukon continued on and struck Jensen's Durango. Flames quickly erupted from the Durango's driver side.

Starks admitted to investigators that he smoked methamphetamine and marijuana earlier in the day and a drug recognition expert determined he was impaired, Finn said. Samples of Starks' blood were obtained and will be evaluated. The vehicle was stolen from a Portland car rental business, according to court records.

Starks made his first appearance in Clark County Superior Court on Wednesday on suspicion of vehicular assault, possession of a stolen vehicle and driving without a valid driver's license. His bail was set at $35,000.

Detter and Poulson missed becoming victims of the crash themselves by mere seconds.

"I don't know how I was missed," said Detter, who works as a medical assistant. "I just pulled over, grabbed my medic bag and ran."

Poulson, a 38-year-old combat medic with the Oregon Army National Guard, drove up to the scene and had the same reaction: help.

She pulled her car over, put the air conditioning on for her son and ran to the burning car.

"I was terrified, but I knew there was a man alive in there," she said. "I'm running up to the vehicle, and I'm absolutely afraid but I don't have a choice. … I couldn't not do it. There's no way I could not help that man."

Poulson was met by a man and the two worked to get Jensen out of the back passenger-side window. Somehow Jensen had freed himself from a safety restraint and had gotten himself in the back seat, Poulson said.

"I just reached inside and he looked at me and I just started pulling as hard as I could because the whole thing was just in flames," she said. "At one point, I had to back up because it was so hot, and then I just went back in. … It was going to go at any second and we had to get him out."

Moments after they got Jensen out of the vehicle, the Durango was consumed by fire.

"I just heard this explosion and felt the heat from it," she said. "It was intense."

Poulson began her trauma assessment and Detter stood by, handing her scissors to cut his clothes and gauze to treat his wounds.

"I'm so glad she was there," Poulson said. "Anything I needed, she gave to me. She was like my right hand."

When they saw Jensen get taken away in an ambulance, both women went home, cleaned up and worried about how he was. They didn't know the identity of the man who helped pull Jensen to safety.

Poulson said she didn't sleep well Tuesday night.

"I could still feel how stuck he was, how hard I was pulling," she said. "I remember the look on his face and the fear that this thing is going to explode and we're all going to die."

Detter called the hospital and learned through hospital staff that Jensen wanted to meet them.

Jensen winced through the pain to hug the women. He suffered three broken ribs, a lacerated liver, a gash to the face and many burns and bruises.

"I'm just a giant bruise," he quipped.

Seeing Jensen smile was enough to make the two women happy.

"He's alive and he's OK and that makes everything worth it," Poulson said. "All the training I've done, every night away from my family, everything I've gone through — it was worth it."

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Ohio health network adds EMS vehicle fleet

The network is adding 17 ambulances and 2 MICUS for interfacility transports

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Quiz: Where should you take your long-overdue vacation from the station?

Every EMT on this planet deserves a vacation. EMS is a stressful job. Whether you can actually take one is a different story.

It's OK to dream, though, and when the time comes for your long-overdue break, this quiz will show you exactly where you should take your next vacation from the station.

Related articles:

Quiz: Why do so many EMTs have a 'Type A' personality"

Paramedic uses vacation time to help disabled children

Heroes Vacation Club brings affordable vacation rentals to first responders

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Non-Certified Firefighter/EMT Trainee - Marion County Fire Rescue

MARION COUNTY FIRE RESCUE 2631 SE 3RD STREET OCALA, FLORIDA 34471 Updated: July 05, 2016 Classification: Non-Certified Firefighter/EMT Trainee Marion County Fire Rescue will be conducting a hiring process for 22 Non-Certified Firefighter/EMTs; job posting opens July 1, 2016 and will remain open until August 5, 2016. Testing is conducted through National Testing Network (NTN). Work Schedule and Starting ...

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5 costly EMS documentation mistakes

Here are the five EMS documentation mistakes that deny patients coverage they deserve and EMS agencies fair compensation for their services

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5 costly EMS documentation mistakes

By Steve Johnson

One of the most frustrating scenarios for EMS agencies is the denial of coverage for ambulance transport for far too many patients.

In the vast majority of cases our clients share with us, the primary reason patients are deprived of coverage is not that ambulance transport was medically unnecessary. Rather, it's that some crew members either don't understand or simply don't care about their professional responsibility to carefully and completely document the patient's condition at the time of transport on their patient care report.

Most simply, EMS providers need to stop using vague, meaningless words, conclusory statements and phrases that do not accurately convey — in appropriate clinical terms —the true condition of the patient at the time of service.

Here are the five most common EMS documentation mistakes we see and how EMS providers can stop making these costly mistakes.

1. Facts surrounding the dispatch undocumented
Many times when an ambulance responds to a 911 call, that simple fact is missing from the PCR. And in way too many chart reviews or audits, we find no dispatch determinants or other clear indication of the patient's reported condition at the time of dispatch.

Dispatch information, including the patient's reported condition at the time of dispatch, has been a critical component of good quality patient care documentation since 2002. How is it that so many organizations still don't have this critical piece of their patient care clearly and consistently documented on the PCR some 14 years later"

Organizations, whether their dispatch is internal or external, need to ensure that they have dispatch protocols, approved by their medical director, that are clearly understood at all levels of the organization. Dispatchers then must clearly communicate to the crews the patient's reported condition, which crews must clearly document on their PCR.

2. Insufficient narrative of the patient's condition at the time of transport
Far too frequently we see PCR narratives that do little more than state where the patient was picked up from, where they were delivered to and some statement that indicates that the crew left the patient no worse off than they found them — such as, "patient transported without incident."

This is especially true in the case of non-emergency transports.

For every transport, whether emergency or non-emergency, the PCR narrative must state the facts accurately, objectively and completely so that the reader can answer the question: Was transport of this patient by means other an ambulance contraindicated"

Other questions that should never go unanswered for the reader include the patient's mobility status, as well as the patient's ability to assist with the transfer to and from the stretcher and how that transfer was accomplished-and why. The PCR narrative must also answer how the patient's ability to care for themself compares to the patient's normal condition.

Also answer, what prompted the patient to call for an ambulance" When did the patient's problems start" How have the patient's symptoms evolved"

We suggest that ambulance services obtain and crew members read, whenever possible, hospital admission summaries for the patients they transport.

That doesn't have to be all the tests that were performed and the final diagnosis, but simply the history of present illness and summary of the patient's condition upon arrival. These admission summaries will often provide concrete examples of how professional medical records are expected to be written and the information that may be missing from their PCR for that same patient.

Many times if crews had taken the time to understand their patient's presentation, and documented those findings, the ambulance service would have far less problems verifying and supporting the care they provided when seeking reimbursement.

3. Vague explanation of specific interventions and procedures performed
Too many times we find nothing more than "per protocol" to explain why a cardiac monitor was applied, an IV was initiated or some other procedure was performed. Just like the ambulance service must be medically necessary to be reimbursed by Medicare and other payers, the treatments provided must also be medically necessary.

Interventions and procedures should be performed in response to specific patient assessment findings, not simply because some protocol exists. Crew members must understand that the patient's PCR is part of that patient's medical record, not simply an internal document.

Crew members should not assume that those reading their PCR know their organization's protocols. The medical findings that suggest the need for each intervention, as well as the patient's response to that intervention, should be clearly documented.

4. No explanation for EMS-specific care and treatment
This is important with regard to two areas. First, is clearly explaining the transport itself and the service or care the patient required during the transport that could not be provided other than by trained medical professionals in an ambulance.

Second, in the case of a patient being transported from one facility to another, what specific services does the patient require that are not available at the facility of origin"

Simply stating, "Transported patient for higher level of care" tells the reader nothing. The PCR must make clear the care the patient required at the destination facility and why that care could not be provided in the facility of origin.

In addition, the PCR must show what professional medical care the patient required during transport to that facility.

5. Inadequate description of patient complaints or findings
The most common example of an inadequately described or quantified complaint or finding is with regard to a patient's pain. EMTs and paramedics should always describe a finding or complaint of pain by documenting completely the Onset, Provocation, Quality, Radiation, Severity and Time (OPQRST), as well as the patient's pain rating on a scale of zero to 10.

The word "pain" on a PCR is a trigger to remind the EMS provider to fully describe and document that pain.

Hemorrhage is another common finding that is inadequately described. Always describe the location and size of any wound, and quantify of blood loss.

Again, these are just two examples. Good PCR documentation will not just state conclusions or findings. It always describes and quantifies those findings accurately, honestly and objectively.

These five mistakes represent the most common documentation shortcomings we see on PCRs. Sadly, it is due to poor or incomplete documentation, and not an actual lack of medical necessity for an ambulance, that far too many patients are deprived of the coverage they deserve and too many ambulance services are deprived of fair compensation for the care they provide.

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