emergency care


Elderly Man (Me) Found In Snow With Punctured Lung But Still, At 79, I Ski

Author Ralph Gilbert, who suffered a punctured lung in a ski accident, and his son, Keith, his rescuer (Courtesy)

Author Ralph Gilbert, who suffered a punctured lung in a ski accident, and his son, Keith, his rescuer (Courtesy)

By Ralph M. Gilbert
Guest Contributor

Traumatic pneumothorax: the presence of air or gas in the pleural cavity, which impairs ventilation and oxygenation, caused by a severe trauma to the chest or lung wall. Symptoms are often severe, and can contribute to fatal complications such as cardiac arrest, respiratory failure, and shock.

Every time I tried to lift my head the sky began to spin. Then I felt the nausea. I knew that I had to get up out of the snow but after a few attempts, I just lay back, exhausted. Suddenly, a spray of powder was kicked onto my face as a young ski patrolwoman executed a hurried skid stop. She bent down and put her cold face next to mine:

“Sir,” she said looking into my unfocused eyes. “Are you all right? Do you know where you are, sir? Where are you, sir?”


I realized that she wasn’t asking a particularly hard question, but I just couldn’t come up with an answer.

“I don’t know,” I replied.

She helped me to my feet.I looked around and saw the other skiers.

“I’m skiing…right?”

She radioed for help. The next thing I knew, I was being leaned back into a toboggan. Fighting the nausea and afraid that I would have to throw up, I asked to be tipped over momentarily before they restrained me to the sled for my ride down.

I regained consciousness in a strange hospital ER.

A young woman was standing over me. She asked: “Do you really think, sir, that a man of your age should be skiing alone in the glades?”

I hated that question. I found it particularly humiliating. As an intrepid, former U.S. Army trooper, I didn’t want to be talked to that way, especially by a woman who asked me the same questions my wife often asked.

Tests indicated a concussion. Upon release, I was told to buy a new helmet (each helmet can absorb only one crash), and not to ski for a week. I took only one day off, which I thought was plenty. I then purchased a new helmet and two days later I was back up on my skis again.

My next accident a few years later was to be worse, much worse.

Age denial? Not So Much

Before I tell you that story, I’d like to note that I’m not in total age denial. Now 79, I spend less and less of my après-ski time trading embellished ski stories with my buddies in smoky bars. These days, when we go on our annual ski trip, I can be found at night alone in my little room, carefully applying ice packs and winding compression bandages around my ill-treated joints.

I reject the idea, however, that I am suffering from any age-related diminution of muscle tone, balance or endurance. My ski dreams are still intact even if my body is not. I do realize that I should avoid the super steep double black diamond trails that I once traversed. But I just can’t resist.

Why? By story’s end, I’ll try to explain.

Male Bonding

Each year, twelve of us, former army buddies at Fort Bliss, Texas go on a ski trip together. We had trained as Nike Missile crewmen back in 1958 during the Cold War. Our job was to join with others to protect the City of New York.Stationed in a darkened radar van, we were to monitor our radar screens for Russian bombers. Our Nike Missiles were buried in concrete shafts near us. Our vantage point was Spring Valley, New York, which otherwise is known for kosher chickens and Hassids. If we saw any Russians in the air we were to electronically challenge them, then shoot them down. Continue reading

What If Our Health Care System Kept Us Healthy?

Rebecca Onie is the cofounder of Health Leads, the Boston nonprofit that helps doctors “prescribe” basic necessities (housing, food, heat in winter) to low-income patients, in addition to just medications.

In her recent TEDMed talk, she asks some radical question: What if our health care system actually kept us healthy? What if doctors could truly prescribe solutions, not just drugs? What if ER waiting rooms around the country weren’t just places to watch the clock and read old copies of Good Housekeeping, but rather, were transformed into service-oriented, patient-centered hubs where, in a brutal New England winter, a family could go and a volunteer could help that family get the heat turned back on? Listen to Rebecca’s talk and get inspired:

Why An Emergency Medic Might Ask About Your Race

In his column yesterday, The Boston Herald’s Howie Carr makes it sound like Massachusetts medics are so busy these days filling out forms about their patients’ race that they may ignore the medical emergency at hand.

Howie’s rants are often enjoyable to read for their inflamed wrath, but this one struck me as so oddly lopsided that I asked the Department of Public Health what was up. Howie included just this from the Department of Public Health statement: “Patient health and safety must always be an EMT’s highest priority. Collecting this information must not delay nor prevent patient assessment or the provision of care.”

Here’s the whole statement, which makes clear that this sort of collection of patient data is a national norm, not a PC liberal plot:

Patient health and safety must always be an EMT’s highest priority. Collecting this information must not delay nor prevent patient assessment or the provision of care. State regulations (105 CMR 170.347) require EMTs to collect a variety of background information from patients, including their name, address, age, race and ethnicity, past health history, and medications that they are currently taking. Of course, if a person objects to responding, they have the option not to respond.

For years, more than 25 states — representing every region of the country — have been collecting this data and submitting it to the National EMS Information System (NEMSIS), and the other 25 states have committed to doing so.

NEMSIS is funded by the U.S. National Highway Transportation Safety Administration (NHTSA) in order to standardize collection of EMS data by creating a uniform data set that is used to compare and assess the quality of provision of EMS across the country. Similar data is collected in other areas of the health care system, such as hospitals and nursing homes. The NEMSIS system will catch the EMS sector up to the rest of health care in terms of having data-driven assessment available, and provide a valid way for looking at what EMS is doing, what are patient outcomes, and how EMS can be improved. Massachusetts is in the early stages of data collection and has not yet begun submitting data to NEMSIS.

Clearly, collecting data on race is a way of detecting disparities in how patients of different races are treated. Howie writes: “This is about a sick obsession by the liberals with somehow proving “disparities,” which there certainly are in this country, only they’re exactly the reverse of what the moonbats would have you believe they are.”

In actual fact, the data on disparities suggest that they’re not only real, they’re deeper than many of us might suspect. Here’s a post of ours on a national Massachusetts General Hospital study that found black and Hispanic patients were treated differently for chest pain. And here’s an overview of racial disparities in health from the CDC, an institution not generally considered a bastion of political correctness.