S A E M
Newsletter of the Society for Academic Emergency Medicine November/December 2007 Volume XXII, Number 6
901 N. Washington Ave. Lansing, MI 48906-5137 (517) 485-5484 saem@saem.org www.saem.org
Fire Fighter Fatality Investigation and Prevention Program
President’s Message The Educational Paradox
John Howard, MD, Director Department of Health & Human Services National Institute for Occupational Safety and Health Centers for Disease Control and Prevention
I fear that I have reached the age where I can look back on the good old days. There are those who would speak of the tremendous educational advances over the last decade: the new priorities for house staff education, freedom from clinical responsibilities to attend educational conferences, work hour Judd E. Hollander, MD limits, “golden” weekends when house staff are freed from clinical responsibilities for consecutive days providing time to rejuvenate. Surely, the logic was that this would improve patient safety. Tired, overworked people make more mistakes than refreshed people…seemed like a no-brainer.
Fire fighters are dying on the job from heart attacks and other cardiovascular conditions. In fact, sudden cardiac death is the most common cause of on-duty fire fighter fatalities. But many of these deaths can be prevented if proper measures are taken. Fire departments, fire fighters, and fire service agencies all have a role to play. That is the conclusion of the NIOSH Alert, Preventing Fire Fighter Fatalities Due to Heart Attacks and Other Sudden Cardiovascular Events. The Alert reviews the findings from 131 investigations conducted by the NIOSH Fire Fighter Fatality and Investigation and Preventions Program. These investigations show that coronary artery disease and sudden cardiac death result from personal and work-related factors. Personal factors can include age, gender, family history, diabetes, hypertension, smoking, high cholesterol, obesity, and lack of exercise. Work-related factors can include exposure to fire smoke, heavy physical exertion, heat stress, and other physical stresses.
The mission of SAEM is to improve patient care by advancing research and education, so in my role I began to think about whether these educational and lifestyle changes have translated into improved patient care. It seems to me that most of the patient care advances over the last 20 years are through research and improved technology, diagnostics and pharmacotherapies. But… there was one question I could not answer, “If we have had improvements in patient care, reduced mortality for some conditions and prolongation of life for others, how is it that physicians have taken a blow to their reputation?” This is an interesting question. Is it possible that the world has just evolved and we have been reduced to a lower stature in society unrelated to anything specific? Alternatively, might it be that some of the educational and lifestyle “improvements” have led us down a pathway of unintended consequences? I think the answer is probably the latter. Although case reports do not provide high level scientific evidence for anything, the following case series led me to generate a couple hypotheses.
In the Alert, NIOSH recommends ways to reduce heart attacks and other cardiovascular conditions. The recommendations include the following: ◆ Routine medical evaluation programs, ◆ Comprehensive wellness and fitness programs, ◆ Proper use of personal protective equipment, ◆ Proper management of the fire scene to reduce hazardous exposures including heat stress. NIOSH is the federal agency whose overall mission is conducting research to prevent work-related injuries, illnesses, and deaths. More information on the Fire Fighter Fatality Investigation and Prevention Program is available at http?//www.cdc.gov/niosh/fire/. Additional information about NIOSH is available at www.cdc.gov/niosh.
Case 1. BB, an elderly male with a very complicated medical history was evaluated in the ED and the decision to admit was made at 5 am on a Friday morning. He was admitted to the night float team. On Monday when I inquired how the patient was doing, the inpatient team informed me they had not seen him in three days. It turns out that at
We encourage you to act on the recommendations in the Alert and to share this information with others. The Alert is available online at http://www.cdc.gov/niosh/ docs/2007-133/.
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“to improve patient care by advancing research and education in emergency medicine”