How the crises of healthcare and education are related | LinkedIn

How the crises of healthcare and education are related.

Utah Backcountry Skiing: Avoiding Early Season Avalanches

Early season words of wisdom from experienced backcountry skier, ski mountaineer, professional guide, snow safety officer, and my brother-in-law, John F Mletschnig. John has skied mountains all over the world including: VT, NH, ME WA, WY, CO, ID, UT, AK, Antarctica, Canada, and New Zealand, to name a few.

Utah Backcountry Skiing: Avoiding Early Season Avalanches: Nearly every winter season the story is the same; avalanche burials with often fatal consequence. I suppose it is somewhat late to be writin...

Aboard Life Star - 1

A little footage from a recent trip with our local HEMS EC - 145 and my buddy flight nurse Nick Mancini.

Backpacking versus Thru-hiking

Backpacking versus Thru-hiking @ Backpacking Light

Kathmandu Critical Care Nursing Project 2011

This is a documentary of my mentor, colleague, and friend Joe Niemczura. In the summer of 2011, on his third trip to Nepal, he taught a critical care course to 190 practicing nurses in Katmandu. He is a professor of nursing at the University of Hawaii School of Nursing and Dental Hygiene and the author of The Hospital at the End of the World.

just a nurse

Any illusions of infallibility were quickly dispelled upon joining the profession of nursing. Never have I been more acutely aware of my ability to make mistakes than in my first months in the ICU, and the stakes were high. The seasoning of a nurse takes years and growth follows an often unpredictable pattern as if guided by Brownian Motion. I am forever grateful to all of my colleagues for their patience, mentoring, tough love, and preventing me from killing anyone.

We spend thousands of hours educating ourselves and thousands of dollars obtaining and maintaining various credentials, certifications, and professional memberships. We miss soccer games, recitals, beach days, and Christmas with our families (there are precious few of these). We are subjected to long hours, stress, violence, missed lunch breaks, abuse, medical residents, assault, full bladders, battery, bodily fluids, various forms of excreta, being perceived as someone not smart enough for medical school, infectious disease, surgical residents and many other occupational hazards. We do this for little pay. There is chatter within the ranks, but most of us accept this. Many of us love what we do. We chose nursing.

Imagine spending 12+ hours giving everything you have to save someone's life, drawing on all of your education and experience. Is it possible that while managing the care of an unstable patient and attending to the emotional needs of a distraught family that you make a mistake? Could you forget to chart a critical intervention that you performed. Did you click the wrong box out of the hundreds available in the endless strata of the computerized chart? Did you chart an item in only one of the three places it "needs" to be charted? Did you effectively justify the rapid titration of the 15+ continuous IV infusions? Did you follow protocol when checking the 16 units of PRBCs, 8 FFPs, 10 PLTs, DDAVP and cryoprecipitate? Did you fail to carry out orders or followup on laboratory results in a timely manner? Did you forget to chart a turn, the head of bed > 45 degrees or oral care performed?

You probably did all of this well. You are just a nurse

If a medical malpractice case goes to trial:

1. Inconsequential errors WILL have consequences.
2. You will NOT be held to the standard of your profession.
3. You WILL be held to the standard of public opinion.
4. You will NOT be judged by a jury of your peers.
5. You WILL be judged by a jury with no understanding of the complexity of your role.
6. You WILL be discredited as a person
7. You WILL be discredited as a professional.
8. You WILL have your life turned upside down.
9. You WILL run the risk of losing your job.
10. Your colleagues WILL look at you and treat you differently.

As a group, nurses give every day, in a role that transcends all facets of their lives. Nurses are human and prone to errors in a system that is designed to fail. Most are not grossly negligent. Most do their best. Most are immensely effective and have an amazing opportunity to impact the lives of many. This is a gift I relish and a responsibility I accept. I am just a nurse.

Brian M. Wilson, BSN, RN, CCRN

New Hampshire

True North

Outdoor egotism expose' - A humorous look at life in the backcountry and those that take themselves just a little too seriously:

Profiling HURT

A documentary by filmmaker Barry Walton, follows Mark Gilligan as he prepares for and attempts one of the toughest 100 milers around, the HURT 100. During my 8 years in Hawai'i, I was stoked to have the Makiki Mauka Trail System in my backyard. These were my home trails and where I completed my first ultra marathon of note; the HURT Trail 100.

More information about the Hawaiian Ultra Running Team (H.U.R.T.) can be found here.

Climber Rescued on Cascade Mountain in Banff National Park

Amazing first hand footage by two skilled rescuers.

Ice climbing the Moonflower Buttress - Mt Hunter, Alaska

A well crafted and inspiring video by AMGA certified Rock and Alpine Guide Silas Rossi and his buddy Peter Doucette. The Moonflower Buttress is an ice/mixed (Grade VI - M7 -WI6) on Mt. Hunter in the central Alaska Range.

After 8 years in Hawai`i I am stoked to be back to winter and all it has to offer. I find myself bringing down the hammer on trail runs and hitting the heavy weights in preparation for the linking of tele-turns and a few pitches of waterfall ice.

Find Silas on his website Alpine-Logic and his blog Alpine Logic Blog.

Running with the Devil

In some respects the dust of our relocation from Hawai'i to Connecticut is beginning to settle and I happily find myself in the mood to grind a few hilly miles. This weekend I will be heading to Mountain Creek Resort in Vernon Peak, New Jersey to participate in the 12 Hour version of the Running with the Devil trail race. Vernon Peak is home to the Diablo Mountain Bike Park and is reputedly the best MTB terrain park in the region.

The route will ascend ~ 933 feet over one mile on intermediate ski terrain and descend the same elevation and distance on Black Diamond ski terrain. I am looking forward to a smooth 12- hour effort and anticipate hot and sweaty steep and steady ups and downs.

I am banking on the BIT mileage for some of my durability and have focused on quality, high-intensity workouts since arriving in CT. I have done numerous hill repeats, stairs, barefoot beach runs and some moderate tempo "long-runs" in the range of three hours, which is actually pretty short. I have done each of these with and without a 25 pound pack.

My LR strategy has been to warm up with an easy 30 minutes then go anaerobic and/or threshold and empty the tank before completing the remaining 1 to 2 hours of race-paced running or hiking. I have supplemented my program with free weight, body weight and pack weight strength training exercises.

More than anything I am excited to get outside, meet some people from the neighboring trail running community and have some fun!

Somewhere Over the Rainbow - Israel "IZ" Kamakawiwoʻole

The Musings of M.N. Muench

Here is a link to a BIT trip report penned by my partner-in-crime, ultra-runner and talented author M.N. Muench.

http://runningovertheedge.blogspot.com/2010/06/2seas2summits.html

The Big Island Traverse - Just the Facts

The Big Island Traverse was an epic adventure through the realm of the gods providing us with ample opportunities to push our physical and mental limits. My mind reels and my body aches as the full gravity of our journey emerges into consciousness. There were good times had and lessons learned and there are stories to tell, but not today.

Travel Day #1
Start - 1745 on May 19, 2010
End - 1230 on May 20, 2010
Route - Ascent from Holei via Chain of Craters Road to Escape Road to Crater Rim Trail to Mauna Loa Road to Pu'u ula'ula.
Time on feet - 18:30
Distance Covered: ~42 miles
Elevation Change- Sea-level to 10,035 feet

Travel Day #2
Start -0600 on May 21, 2010
End - 0130 on May 22, 2010
Route - Ascent form Pu'u ula'ula to Mauna Loa Summit with descent of the Mauna Loa Weather Observatory Road to Pu'u Huluhulu
Time on feet - 19:30
Distance Covered: ~37 miles
Elevation Change- 10,035 feet to 13,677 feet to 6,632 feet

Travel Day #3
Start -0830 on May 22, 2010
End - 1630 on May 23, 2010
Route - Ascent from Pu'u Huluhulu to Mauna Kea Access Road to Onizuka Visitor's Center to Humu'ula Trail to Pu'u Wekiu (Mauna Kea Summit) with return descent of Mauna Kea Access Road to Pu'u Huluhulu and descent of the Saddle Road to Mamalahoa Highway to Waimea to Kawaihae Road to Spencer Beach Park.
Time on feet - 32:00
Distance Covered: ~79 miles
Elevation Change- 6,632 feet to 13,796 feet to sea-level

Total Time: 94 hours and 30 minutes
Total Time on Feet: 70 hours
Total Distance: ~ 158 miles
Average Packweight: 23#

The Power of Denial

'AOLE MAKOU E HO'OHIKIWALE KELA

As a critical care nurse I often see denial in its ugly maladaptive form. The 27 year old methamphetamine addict with a heart more effective at holding helium at a kid's birthday party and tied to a string than circulating a sufficient volume of oxygen laden blood. Sadly, this is often a sealed fate. The sole family member and DPOA that is determined to push on and continue care despite the patient's wishes and clear evidence of medical futility. The ICU is a form of torture is these cases and is one of the greatest challenges ICU RNs and MDs face. You learn to accept this as part of the ICU and do your best to educate family members with honesty and tactfulness. This is an art. Our medical and nursing establishments bear great responsibility and need to take a hard line; we can do amazing things, but there is still much we cannot fix. I find many family members expectations of medical care grossly unrealistic. I meet all of this with compassion and empathy and realize that in the ICU we truly see people at their worst and sometimes paradoxically at their best.

I wonder what humans could accomplish without the power of denial. It certainly serves the purpose of softening the blow and giving us time to adapt to varied insults. It also allows us to dream big. My mind naturally gravitates toward the grandiose and enjoys mixing concoctions not fit for eating or drinking by most. It is not that these concoctions are inedible, just that they are not very palatable at first. They are a delicacy and you have to want to try them.

Having not completed the Big Island Traverse route or the distance, much remains uncertain and I still have great, although lessening, amounts of denial, Soon to be replaced with the rich and powerful wonders of reality. I am mentally and physically prepared and simply excited to hit the trail. A great experience lies ahead and I look forward to a potent exchange with nature at her best. Thanks to all of my family and friends and see you in a few days.

A Hawai'i Capstone - The BIT

At sunset on May 19, 2010, ultrarunner and friend Mike Muench and I will begin our journey across the island of Hawai'i. The Big Island Traverse (BIT) is an approximate - 160 mile, unsupported fastpack traversing the island from sea-level on the southeastern shore, beginning at Holei Sea Arch; ascend Mauna Loa (13,677 feet) and Mauna Kea (13,796 feet); and eventually descend to sea-level on the northwestern shore, ending at Pu'ukohola Heiau and Spencer Beach Park.

The Big Island Traverse begins at ~sea-level and ascends through coastal plain, desert, rainforest, sub-alpine and alpine zones and will cover a wide variety of terrain including: dirt, asphalt, and concrete roads and highways; single-track trail consisting of soil, grass, cinder, sand, and seemingly endless miles of razor sharp `a`a and undulating pahoehoe lava flows.

Multiple environmental hazards exist with extremes of weather and temperature, varying from hot and dry and hot and humid at lower elevations to subfreezing temperatures in the alpine zones. Intense, high-altitude and low-latitude sun, high winds, driving rain, snow, blizzard and whiteout conditions may be encountered.

The most common, possible pathophysiological conditions include: poor air quality and respiratory compromise; soft tissue and orthopedic injuries, such as lacerations, abrasions, strains, sprains and fractures; fluid and electrolyte imbalances, such as dehydration and hyponatremia; heat illness and thermal injury including: burns, photo injury (photo-ophthalmia), heat cramps, heat exhaustion, heatstroke, frost-nip, frostbite and hypothermia; and the continuum of altitude illnesses including: acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE).

The ability to travel, pace and daily mileage may be affected by a multitude of conditions; therefore, we have chosen to divide the BIT route by region rather than by travel days and are equipped to bivy anywhere along the route. BIT Regions 1 through 4 are as follows:

BIT Region #1 - Hawai`i Volcanoes National Park:

Start and End Points: Holei Sea Arch to Muana Loa Lookout
Elevation: ~50 feet to 6,662 feet
Route and Features: Chain of Craters Road; Escape Road; Crater Rim Trail; Kilauea Visitor Center; Mauna Loa Road; Kipukapuaulu Campground; Muana Loa Lookout
Total Milage: ~35.7

BIT Region #2 - Mauna Loa:

Start and End Points: Muana Loa Lookout to Saddle Road - Hwy 200 Elevation: 6,662 feet to 13,677 feet to ~6,632
Route and Features: Mauna Loa Trail; Pu'u'ula'ula (Red Hill Cabin 10,035 feet); Mauna Loa Cabin (13,250 feet); Mauna Loa Summit (13,677 feet); Mauna Loa Weather Observatory (11,150 feet); Mauna Loa Observatory Road; Saddle Road (~6,632 feet)
Total Mileage: ~42.4

BIT Region #3 - Mauna Kea

Start and End Points: Saddle Road to Mauna Kea Summit to Saddle Road
Elevation: ~6,632 feet to 13,796 feet to ~6,632 feet
Route and Features: Saddle Road; Mauna Kea Access Road; Onizuka Visitor Center (9,300 feet); Mauna Kea Trail; Pu`u Wekiu (Summit - 13,796 feet); Mauna Kea Trail; Onizuka Visitor Center; Mauna Kea Access Road; Saddle Road
Total Mileage: ~40.4

BIT Region #4 - Upcountry

Start and End Points: Saddle Road to Spencer Beach Park
Elevation: ~6,632 feet to Sea-level
Route and Features: Saddle Road - Hwy 200; Mauna Kea State Park; Saddle Road; Mamalahoa Hwy (Hawai`i Belt Road); Waimea; Amamalahoa Hwy (Kawaihae Road - HI 19); Akoni Pule Hwy (270); Pu'ukohola Heiau and Spencer Beach Park
Total Mileage: ~42.7

BIT Total Mileage: ~161.2

Big Island Traverse Gear List

CLOTHING ITEMS - WORN

1. Patagonia Capilene-1 SS
2. Marmot Heniker Short
   
3. Smartwool Adrenaline Light Micro
   
4. Inov-8 Terroc 330
   
5. GoLite Visor
6. Rx Glasses/Sunglasses
7. Multifunction Watch

CLOTHING ITEMS - CARRIED

1. Patagonia Capilene - 1 LS
2. Under Armour Cold Gear Tights
3. Smartwool Adrenaline Crew
   
4. Patagonia R2 Jacket
5. Marmot Evolution Glove
6. Black Diamond Beanie
7. Old School Bandana
   

INCLEMENTS - FOULIES

1. GoLite Phantasm Jacket
2. Arc'teryx Alpha SL Pants

PACK

1. Black Diamond Infinity 50
2. Black Diamond Pure Carbon Poles
3. Granite Gear Dry Block Medium x 2
   

SLEEP SYSTEM

1. Marmot Arete Down Sleeping Bag
2. Marmot Alpinist Bivy
3. Patagonia Down Sweater Hoody

KITCHEN

1. Snow Peak Lite Max
2. IsoPro Canister 8 oz
3. Snow Peak 600 ml Titanium Mug
   
4. MSR Titanium Spoon
5. Platypus 3 liter Bladder
   
6. Platypus 1 liter soft Bottle
7. Ultimate Direction Fast Draw Plus
8. Lighter
   

PANTRY

1. Hammer Nutrition Endurolytes - 100
   
2. Hammer Nutrition Perpetuem ~ 16 Servings
3. GU - 12 Packets
4. Sport Beans - 6 Packets
5. Zone Perfect - 4 bars
6. Hammer Nutrition - 2 bars
7. Cliff Mojo - 4 bars
8. Justin's Organic Peanut Butter - 2 packs
   
9. 1st Endurance Ultragen - 8 servings
10. Mountain House - ProPak - 4 Entrees
11. Starbucks Via Ready Brew - 15 packs
    

NAVIGATION - UTILITY

1. Map
2. Black Diamond - 1 watt LED Headlamp
3. AAA Batteries - 6
4. Fenix L2D 180 Lumen Flashlight
5. AA Batteries 6*
6. Miniature CD Signal Mirror
7. Miniature Multi-Tool
8. 3 mm Accessory Cord - 10 feet
9. Duct Tape affixed to hydration bladders
10. Small Tube of Super Glue - 1
    

MEDICAL KIT - HYGIENE

1. TP - 1 pack
2. Baby Wipes - 5
   
3. Dr. Bronner's Soap - 1 ounze
   
4. Water Proof Matches - 5
   
5. Kinesys Sunscreen - 1 oz
6. 2 Toms Sport Shield- 1
   
7. Skin Prep - 4 Packets
8. Iodine Prep - 4 Pads
9. Benzalkonium Chloride Wipes - 6
10. 2x2s - 4
11. 4x4s - 2
12. Steristrips 1"
13. 2" Compression Wrap
14. 3.0 Nylon Sutures - Straight Needle
15. Antibiotic Ointment - 1 packet
16. Rx - 6
17. Ibuprofen 800 mg - 12
18. Dexamethasone 4 mg - 4
19. Acetazolamide - 150 mg - 8
    
20. No Doz Caffeine Caplets - 10
21. Diphenhydramine 25 mg - 2
22. Imodium AD - 2
23. Rolaids Travel Pack - 1
24. Aqua Mira
    

Speed is a relative concept

I love to run trails fast! The ability to cover large distances in a short amount of time is exhilarating and satisfying. Bounding down steep, muddy, rocky and rooty trails is pure joy and I suppose a bit decadent. It is a dance on the edge. It is a dynamic interaction between brain, heart, lungs and legs. It is an interface between man and the natural world. It is a connection to a better place. It involves sufficient and acceptable levels of risk. My friend Harald likes to muse about how I "turn off my brain" on descents. I suppose in some respects this is true. On the best days, when everything comes together without perceived effort, running becomes meditative and restorative.

The BIT has necessitated a change in my normal training routine. Getting back to shouldering a pack and pack weights over six pounds has taken some time to adjust, both physically and mentally. There have been many days on the trail carrying a 35# pack (140%) when trail-runners come cruising by. I suppose it twists my ego a bit, as I think to myself "Hey, I am a trail-runner, and I usually go as fast or faster than you." I just give my usual hello and receive a smug smile in return. No matter.

With 3+ weeks and one long-run remaining until our departure I am am confident in my ability to succeed. I feel mentally and physically strong. Pack weights of 20 to 27# are manageable and I am able to average 3 to 4 mph with significant climbs and challenging terrain. Altitude is still a variable and our plan for rapid ascents only makes this more potent. A risk we are prepared to take.

Big Island Traverse Gear List

There is purity in self-sufficiency, and it seems this is a dying sentiment. The Big Island Traverse is an unsupported fastpack, meaning that all gear and supplies, with the exception of water, will be carried at all times during the trip. Depending on availability, water will be procured at limited locations along the route. In drought conditions, it may become necessary to cache water at prescribed locations, such as the Mauna Loa Lookout and the Saddle Road, and/or to carry large volumes into the backcountry.

The Big Island Traverse requires preparation for a wide range of weather and temperatures, thus necessitating a fairly large kit. Ideally gear choices balance functionality and durability with lightness of weight and cost. My gear choices are based on my experience and personal preferences, some of which are planned and accepted trade-offs. The preliminary gear list is as follows:

CLOTHING ITEMS - WORN

1. Patagonia Capilene-1 SS
2. Cloudveil Journey Trail Short
3. Smartwool Adrenaline Crew Sock
4. Montrail AT Plus GTX
5. GoLite Visor
6. Rx Glasses/Sunglasses
7. Multifunction Watch

CLOTHING ITEMS - CARRIED

1. Patagonia Capilene - 1 LS
2. Under Armour Cold Gear Tights
3. Patagonia midweight hiking socks
4. Patagonia R2 Jacket
5. Marmot Evolution Glove
6. Black Diamond Beanie

INCLEMENTS - FOULIES

1. GoLite Phantasm Jacket
2. Arc'teryx Alpha SL Pants

PACK

1. Black Diamond Infinity 50
2. Black Diamond Pure Carbon Poles
3. Granite Gear Dry Block Medium

SLEEP SYSTEM

1. Marmot Arete Down Sleeping Bag
2. Marmot Alpinist Bivy
3. Patagonia Down Sweater Hoody

KITCHEN

1. Snow Peak Lite Max
2. IsoPro Canister 8 oz
3. MSR 600 ml Titanium Pot
4. MSR Titanium Spoon
5. Lighter

PANTRY

1. Platypus 3 liter Bladder
2. Platypus 1 liter soft Bottle
3. Ultimate Direction Fast Draw Plus
4. 100+ Hammer Nutrition Endurolytes
5. Hammer Nutrition Perpetuem 32 Servings
6. GU - 12 Packets*
7. Sport Beans - 6 Packets
8. Zone Perfect - 12 Bars
9. 1st Endurance Ultragen - 8 servings
10. Mountain House - ProPak - 4 Entrees
11. Instant Espresso

NAVIGATION - UTILITY

1. Map
2. Compass
3. Black Diamond - 1 watt LED Headlamp
4. AAA Batteries - 6
5. Fenix L2D 180 Lumen Flashlight*
6. AA Batteries 6*
7. Miniature CD Signal Mirror
8. Miniature Multi-Tool
9. 3 mm Accessory Cord - 10 feet
10. Duct Tape affixed to hydration bladders
11. Large Tube of Super Glue

MEDICAL KIT - HYGIENE

1. TP and Baby Wipes
2. Biodegradable Soap*
3. Water Proof Matches - 1 Book
4. Kinesys Sunscreen - 1 oz
5. 2 Toms Blister Shield - 4 Packets
6. Skin Prep - 4 Packets
7. Iodine Prep - 4 Pads
8. BNZLKCL Wipes - 4
9. 2x2s - 4
10. 4x4s - 2
11. Steristrips 1"
12. 2" Compression Wrap
13. 3.0 Nylon Sutures - Straight Needle
14. Antibiotic Ointment - 4 packets
15. Rx - 6
16. Ibuprofen 800 mg - 12
17. Dexamethasone 4 mg - 2
18. No Doz Caffeine Caplets - 10
19. Diphenhydramine 25 mg - 2
20. Imodium AD - 2
21. Rolaids Travel Pack - 1
22. Aqua Mira