Category Archives: Emergency Management

Academia, Emergency Medical Services, Health Care, Politics, Public Health, Society

Reducing our Health Care Expenditures

With the recent signing into law of the Patient Protection and Affordable Care Act (2010), more affectionately known as ‘Obama Care’, much of the health care discussion has turned from deciding what we should do to how we should do it. Many us acknowledge that the current state of our health care needs reformation; the only problem seems to be choosing the best approach. As a licensed out-of-hospital provider, I am in a unique position to observe patients entering our health care system, being treated by our health care system, and exiting (for good or bad) our health care system. I can see that our health care needs are not being met, and I can see both how patients approach their care and how practitioners approach their patients — inefficiently and ineffectively. We need to resolve these issues.

Canada is a fairly close approximation to the United States in locale, geography, economy, and political ideology (Doran, ca. 2000; “GNI per capita”, 2010). It might make sense for us to look towards Canada to see if they have adopted a plan that we could either emulate, or, in the very least, research for a sense of best practices. Kovner, Knickman, and Jonas (2008) describe Canada as having a national health insurance (NHI) system of health care, in that the system is provisioned by a mix of both public and private contributions. Two benefits of Canada’s health care system include a high life expectancy (77.4 for males at birth) and a low cost ($3,165 per capita, or 9.9% of GDP; Kovner et al., 2008, Table 6.2, p. 165). In comparison, Kovner et al. shows that the life expectancy for males in the United States is 74.8 under a system that costs $6,102 per capita (or, 15.3% of GDP). These numbers are significant because we need to understand what we can expect from our investments, and I feel that the average life expectancy is a great benchmark of a health care system as a whole. One worry that I would have, though, is if we were to adopt the same pharmaceutical cost controls, research and development in the industry may suffer, as well as any other technology burdened by cost-cutting measures. I have to assume that the free market would effectively drive these areas, however.

In order to adopt such sweeping changes of our health care system, both liberals and conservatives would have to negotiate their ideals. I am a fairly conservative citizen who believes in smaller government and spending constraints. If reducing our health care expenditures by realigning the modes and methods of health care delivery was realistic, I could be in favor of such a reform. Political agendas aside, Canada’s health care system is certainly one that we should further consider.

References

Doran, H. (ca. 2000). Politics and political parties in Canada. Internet sources for journalists and broadcasters. Retrieved on April 22, 2010, from http://www.synapse.net/radio/can-pol.htm

“GNI per capita, Atlas method (current US$)”. (2010). Data catalog. The World Bank Group. Retrieved on April 22, 2010, from http://data.worldbank.org/indicator/NY.GNP.PCAP.CD

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Patient Protection and Affordable Care Act of 2010, H.R. 3590, 111th Cong. (2010).

Academia, Health Care, Public Health

Health Promotion: Workplace Health Screening

Cardiovascular disease (CVD), diabetes mellitus (DM), and colorectal cancer (CRC) are all significant health concerns facing us today (Anonymous, 2005; Bagai, Parsons, Malone, Fantino, Paszat, & Rabeneck, 2007; de Koning, 2009; Korhonen, Jaatinen, Aarnio, Kantola, & Saaresranta, 2008; Matthews, Nattinger, Venkatesan, & Shaker, 2007). In the U.S., CRC is estimated to kill 56,000 people per year, while, in the U.K., the numbers are around 16,000. (Anonymous, 2005). CVD is on the decline but is expected to continue to have a global impact, taking off the most years of life, and DM creates a 4-fold increase of dying from CVD (de Koenig, 2009).

Through efforts at targeting healthy lifestyle changes, the mortality of these diseases has decreased over the past few years, but the numbers remain high, and studies suggest that identifying those people with risk factors or early signs of disease helps to both treat for the disease effectively and decrease the overall incidence (Anonymous, 2005; Bagai et al., 2007; de Koning, 2009; Matthews et al., 2007).

As Bagai et al. (2007) point out, health promotion activities focused on screening are notably scarce within the workplace. Researchers, Hamashima and Yoshida, have shown that early detection of CRC is effective at decreasing overall morbidity (as cited in Bagai et al., 2009). Bagai et al. attempted to apply this reasoning within the confines of a typical Canadian work environment by introducing CRC screening to the men and women of the Toronto police force. With workplace screening programs being limited in Canada, Bagai et al. hoped to show the effectiveness of these screening programs, and they were successful, but unfortunately, the participation in the study was limited.

Another study (Matthews et al., 2007) aims at increasing CRC screening among the residents of the Midwestern States in the U.S. The literature seems to suggest that participation in screening procedures is contingent on education and insistence by the physician, specifically.

Not only does this correlate to the thought that the primary care physician has an important role in screening and detecting disease, but in order for workplace screening programs to be successful, the physicians need to make the recommendation that the patient uses the screening programs available to him or her.

Korhonen et al. (2008) used the waist circumference criteria (women: 88 cm; men: 102 cm) set forth by the American Heart Association and the National Heart, Lung, and Blood Institute to assess the effectiveness of at-home screening for CVD and DM risk by using a simple questionnaire and a tape measure. Taking very little time and requiring little expertise, this process could be incorporated with any workplace screening program to increase its efficacy.

Increasing these screening programs, particularly within the workplace, should target the population most at risk to CRC, CVD, and DM. Targeting specific risk groups to educate about these diseases should ultimately lead to a higher survivability, decreased incidence, and lower morbidity rates. More research should be aimed at studying the effects of more targeted workplace health screenings to understand how this tool could be best implemented to provide better screening for CVD, DM, CRC, and, perhaps, other pathological processes.

References

Anonymous. (2005). Colorectal cancer: Not an embarrassing problem. Lancet, 366, 521. doi:10.1016/S0140-6736(05)67030-4

Bagai, A., Parsons, K., Malone, B., Fantino, J., Paszat, L., & Rabeneck, L. (2007). Workplace colorectal cancer–screening awareness programs: An adjunct to primary care practice? Journal of Community Health, 32(3), 157-167. doi:10.1007/s10900-006-9042-4

Cyranoski, D. & Williams, R. (2005). Health study sets sights on a million people. Nature, 434, 812. doi:10.1038/434812a

de Koning, H. J. (2009). Testing at home—the screening of the future? European Journal of Public Health, 19(1), 5–6. doi:10.1093/eurpub/ckn120

Geltman, P. L., & Cochran, J. (2005). A private-sector preferred provider network model for public health screening of newly resettled refugees. American Journal of Public Health, 95, 196-199. doi:10.2105/AJPH.2004.040311

Korhonen, P. E., Jaatinen, P. T., Aarnio, P. T., Kantola, I. M., & Saaresranta, T. (2008). Waist circumference home measurement – a device to find out patients in cardiovascular risk. European Journal of Public Health, 19(1), 95–99. doi:10.1093/eurpub/ckn090

Matthews, B. A., Nattinger, A. B., Venkatesan, T., & Shaker, R. (2007). Colorectal cancer screening among Midwestern community-based residents: Indicators of success. Journal of Community Health, 32(2), 103-120. doi:10.1007/s10900-006-9038-0

Smith, G. D., Ebrahim, S., Lewis, S., Hansell, A. L., Palmer, L. J., & Burton, P. R. (2005). Genetic epidemiology 7: Genetic epidemiology and public health: Hope, hype, and future prospects. Lancet, 366, 1484-1498. doi:10.1016/S0140-6736(05)67601-5

Academia, Health Care, Public Health

The Impact of Stages of Life on Health

During our lifetimes, we are met with all kinds of obstacles to overcome, whether in business, society, or in moral dilemmas. None as true as in our health and wellness. During each major stage of life, there are many health challenges and risks that must be met and overcome. The importance of identifying challenges in each developmental stage of life is crucial to the promotion and adoption of healthy changes in behavior (Green, 1984). I will explore how lifestyle and behavioral choices, as well as social determinants of health, can impact these health risks and challenges as they relate to the various life-stages. Kolbe (as cited in Green, 1984) indicates a number of “health-related types of behaviors” (p.218), some of which I will address for each life-stage and transition between life-stages. As we transcend each stage of our lives, new and evolving concerns obstruct our path to wellness. We tend to approach our health from the present, the here and now, but it starts before our birth and, with genetics, possibly before conception.

Once we are conceived, we are locked into the care of our parents to be. Whether a mother and father, a single working parent, a single drug-addicted parent, caring grandparents, foster care, the State, or a host of other possibilities, each is suggestive of the environment to which we will be born and/or raised. This environment will surely shape our health from within the womb and health professionals are tasked with providing directed education to the parents-to-be to give the child the best chance of a healthy development.

The importance of maternal health to the fetus has become a focus in public health over the last century, but emerging research is showing how best to approach this topic. “Two principal threats to infant health are low birth weight and congenital disorders including birth defects” (Green, 1984). Though technological advances are proving helpful in high-risk pregnancies (Blincoe, 2007), prevention and education is still key. A recent literature review (Slama et al., 2008) has identified some links between environmental toxins and neonatal health, calling for more specialized research in this area. Exposure by pregnant women to toxins, such as that from pharmaceuticals, cigarette smoke, and contaminated fish, pose significant threats to the fetus (Gwiazda, Campbell, & Smith, 2005; Landrigan, Kimmel, Correa, & Eskenazi, 2004). Family violence towards the mother-to-be also serves a significant threat to children in utero. A study by Amaro, Fried, Cabral and Zuckerman (1990) reveals that women who have a poor support structure, a history of depression, and current alcohol and illicit drug abuse are more prone to be victims of violence, which threatens the pregnancy.

Infancy is the most crucial of the developmental stages for cognitive, social, and emotional development (Centers for Disease Control, 2009). The environment in which the infant development takes place is a key determinant to the level of neonatal and infant health. Lead, as well as other environmental toxins and notwithstanding comprehensive abatement programs, still threatens the development of infants and young children (Gwiazda et al., 2005; Landrigan et al., 2004). As infants develop into toddlers and young children, the threat focus shifts from indirect toxin exposure to direct accidental poisoning and physical trauma.

As children start to walk and gain enough strength and ingenuity to open doors and containers, there is an increased risk of accidental poisoning by household goods (Hockey, Reith, & Miles, 2000). Though accidental poisoning has been mitigated to a degree by the “Mr. Yuck” campaign (Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, 1971/2009) and the introduction of childproof containers, many poisonings still occur, some being purposeful by loved ones (Davis et al., 1998) but most are accidental. Poisoning included, trauma remains the leading cause of childhood death (Green, 1984, p. 225; Harkins, 2009).

The transition into puberty comes with a change in physiology, both in the body and in the brain. Adolescents must contend with a new found, and usually intense, libido. With this, the adolescent faces the threat of early pregnancy and a host of sexually transmitted diseases. Though public health education efforts seem to be effective on some levels, teenage pregnancy and STD’s remain a constant concern.

Green (1984) also finds that teenagers also find themselves expanding and exploring their environments with their increased autonomy. Increased risk-taking attitudes typically lead to a high likelihood of trauma, which, as is true for younger children, remains the leading cause of death for adolescents, though the associated poisoning is attributed more to recreational and experimental illicit drug use and abuse.

Transitioning into adulthood, the health focus begins to shift towards disease processes and away from trauma, except for, perhaps, motor vehicle and occupational incidents. Green (1984) supposes that this is from a “curtailed freedom [and] increased responsibility for lifestyle” along with “reduced parenting roles, changing bodily functions, [and] reduced activity” (Table 3). It is within these years that other responsibilities can seem to outweigh those of health, probably attributable to a high sense of health as active teenagers and a perceived need to be successful within their personal economy. This loss of health focus can certainly lead to disease processes, such as atherosclerosis, hypertension, and obesity, which can, in turn, lead to an early stroke or heart attack. It makes sense to consider that behavioral health changes within the early adult years can impact the later adult and senior adult years.

As we age towards our retirement, our picture of health tends to become more obvious. Many of us will suffer from hypertension, coronary artery disease, diabetes, and elevated cholesterol levels. Some of us will have already suffered a heart attack or stroke, and some others might soon. At this point in life, it is imperative to have frequent check ups with a physician who will probably attempt to control most of the underlying risk factor diseases mentioned above with pharmaceuticals. Though we can try to adopt healthier behaviors, by the time we reach our senior years, most of the physiologic damage is irreparable. There is some promise, however, as “the elderly are found in evaluative research studies to be as much if not more responsive to behavioral change supports than younger patients or subjects” (as cited in Green, 1984, p. 228).

One of these changes is osteoporosis, or a weakening of the calcium bone matrix. As we grow through childhood, our bones are formative and calcium is readily bonded within the bone structure providing the skeletal framework for the rest of our lives. The elderly suffer the most from any calcium deficiency, as the threat of simple fall can lead to a catastrophic injury requiring surgery for correction or a permanent fracture if the person does not have strong enough bones. This will most certainly result in the loss of the person’s ability to maintain his or her activities of daily living which can result in having to rely on residential nursing care. A lifetime of cigarette smoking, heart disease, or generally poor health can lead to the same degree of disability requiring the same type of care.

Skilled nursing facilities, though important for the continual care or rehabilitation of the elderly and infirm, have risks for the in-patient just as any other treatment might. Skilled nursing facilities are a vector of a number of nosocomial infections, usually medically resistant, which can and often does lead to a serious condition known as sepsis, a life-threatening infectious condition that overcomes the bodies ability to self-regulate. Sepsis is largely fatal. Confinement in a nursing facility is also associated with an increased incidence of depression and loss of constitution (Green, 1984).

As we have discussed some of the more prominent challenges that we face at each stage of our lives, we need to understand some of the determinants that affect our health. So long as we are aware of these, we can change our lifestyle and behaviors to minimize the impact of some of the negative determinants. In my opinion, the most important determinant of health is the availability of clean water, then perhaps, the availability of whole food and decent shelter. I feel that these are most important because they are the most difficult to correct as an individual. Following these, I feel that the availability of comprehensive health care is important.

This paper is based on research conducted primarily in developed Western society; therefore, it does not address the problem of extreme poverty and other determinants of health attributed to it. One example of this is provided by Kiapa-Iwa and Hart (2004) who show an increase risk of health with a prevalence of high-risk pregnancy and STD’s in the impoverished region of Uganda. Whether we are discussing Britain’s Liverpool, the Mid-west United States, or Uganda, we must admit that a focus on education and prevention, such as safe-sex programs, safe storage of medications and firearms, defensive driving, and others, seem to be the most effective means of mitigating some of the more controllable health determinants for parents and children, as well as adolescents. Older adults and seniors need to have a comprehensive program directed by their physician, including a healthy diet, exercise, and controlling medical problems such as hypertension and diabetes to increase their health status.

References

Amaro, H., Fried, L. E., Cabral, H., & Zuckerman, B. (1990). Violence during pregnancy and substance use [Abstract]. American Journal of Public Health, 80(5), 575-579. doi:10.2105/AJPH.80.5.575

Blincoe, A. J. (2007, October). Doppler sonography: Improving outcome in high risk pregnancy. British Journal of Midwifery, 15(10), 650-653. Retrieved from http://www.britishjournalofmidwifery.com/

Centers for Disease Control. (2009, May 7). Child development. Retrieved from http://www.cdc.gov/ncbddd/child/default.htm

Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center. (1971/2009). About Mr. Yuck. Retrieved from http://www.upmc.com/Services/poisoncenter/Pages/about-mryuk.aspx

Davis, P., McClure, R. J., Rolfe, K., Chessman, N., Pearson, S., Sibert, J. R., Meadow, R. (1998). Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Archives of Disease in Childhood, 78, 217-221. doi:10.1136/adc.78.3.217

Green, L. W. (1984). Modifying and developing health behavior. Annual Review of Public Health, 5, 215-236. doi:10.1146/annurev.pu.05.050184.001243

Gwiazda, R., Campbell, C., & Smith, D. (2005, January). A noninvasive isotopic approach to estimate the bone lead contribution to blood in children: Implications for assessing the efficacy of lead abatement. Environmental Health Perspectives, 113(1), 104-110. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1253718/pdf/ehp0113-000104.pdf

Hockey, R., Reith, D., Miles, E. (2000, July). Injury bulletin: Childhood poisoning and ingestion [Injury Bulletin No. 60]. Queensland Injury Surveillance Unit. Retrieved from http://www.qisu.org.au/modcore/PreviousBulliten/backend/upload_file/issue060.pdf

Harkins, D., (2009). Pediatric trauma in the spotlight. Journal of Trauma Nursing, 16(3), 123-125. Retrieved from http://content.ebscohost.com/pdf23_24/pdf/2009/39B/01Jul09/ 44454466.pdf

Kiapi-Iwa, L., & Hart, G. J. (2004). The sexual and reproductive health of young people in Adjumani district, Uganda: Qualitative study of the role of formal, informal and traditional health providers. AIDS Care, 16(3), 339-347. doi:10.1080/09540120410001665349

Landrigan, P. J., Kimmel, C. A., Correa, A., & Eskenazi, B. (2004, February). Children’s health and the environment: public health issues and challenges for risk assessment. Environmental Health Perspectives, 112(2), 257-265. doi:10.1289/ehp.6115

Slama, R., Darrow, L., Parker, J., Woodruff, T. J., Strickland, M., Nieuwenhuijsen, M., …Ritz, B. (2008). Meeting report: Atmospheric pollution and human reproduction. Environmental Health Perspectives, 1161(61), 791-798. doi:10.1289/ehp.11074

Academia, Health Care, Public Health, Society, Technology

Direct To Consumer Advertising: Patient Education

Today, we are familiar with mass-media marketing of prescription drugs not only to physicians but to patients as well, known as direct-to-consumer advertising (DTCA). Though, many argue that a better informed patient allows for more autonomy in physcian-directed care (Buckley, 2004; Lyles, 2002; Sumpradit, Fors, & McCormick, 2002), “the evidence for DTCA’s increase in pharmaceutical sales is as impressive as is the lack of evidence concerning its impact on the health of the public” (Lyles, 2002, p. 73). Concerns abound regarding the ability of the physician to direct the care of a patient driven by DTCA. Many researcher’s, including Buckley (2004) and Green (2007) believe that many physicians prescribe medications solely on the request of the patient without providing guidance or education to the patient.

As a paramedic, I hear the concerns of patient’s regarding physician refusals to prescribe name-brand drugs to patients. These patients are almost militant about their beliefs of their illness and that the physician should honor the requests of their patients. While these patients never seem to find a resolution, I also see many people who trust in their physicians’ role and, with education, discuss with their physicians the possibilities and concerns of advertised medications. As one secondary data analysis (Sumpradit et al, 2002) suggests, though there is no demographic difference in the propensity of patients to ask their doctor for a medication based on DTCA alone versus seeking more information from their doctor, those with chronic conditions and who have poorer perception of health status tend to engage their physicians more often to clarify information garnered from DTCA’s.

I feel that DTCA is can be an empowering tool for the patient as long as it is educational, honest, and forthcoming. Empowering the patient to take an active role in his or her medical care is very important, but this empowerment comes with responsibility to be as fully educated as possible, allowing the physician his or her role in the relationship as the ultimate patient advocate, which some physicians lack.

References

Buckley, J. (2004). Pharmaceutical marketing: Time for change. Electronic Journal of Business Ethics and Organization Studies, 9(2), 4-11.

Green, J. A. (2007). Pharmaceutical Marketing Research and the Prescribing Physician. Annals of Internal Medicine, 146(10), 742-748.

Lyles, A. (2002). Direct marketing of pharmaceuticals to consumers [Abstract]. Annual Review of Public Health, 23, 73-91.

Sumpradit, N., Fors, S. W., McCormick, L. (2002). Consumers’ attitudes and behavior toward prescription drug advertising. American Journal of Health Behavior, 26(1), 68-75.

Academia, Culture, Emergency Management, Emergency Medical Services, Health Care, Technology

Improving Traffic Safety for Emergency Responders

The Emergency Medical Services (EMS) is an occupational field wrought with opportunities for workers to become ill, injured, or succumb to death while performing the functions of their job (Maguire, Hunting, Smith, & Levick, 2002). In the mid-1980’s, Iglewicz, Rosenman, Iglewicz, O’Leary, and Hockmeier (1984) were among the first to perform research into the occupational health of EMS workers by uncovering unhealthy carbon monoxide levels in the work area. This appears to have been the impetus for further research into uncovering some of the causes and contributing factors of illness and injury incidents, as well as safer alternatives to current work practices.

One of the more recent efforts to protect EMS workers relates to traffic-related injuries and fatalities of EMS workers while responding to calls and working on the scenes of traffic accidents. As important it is for the EMS workers to be able to get to the scene of an emergency and work without threat of injury, the safety of the community is important to consider. Solomon (1990) realized the need to improve safety in this area and recommended changing the paint color of emergency apparatus to more visible lime-green. Emergency workers were continuing to fall victim to “secondary incidents” at roadway scenes (Cumberland Valley Volunteer Firemen’s Association, 1999). An analysis of EMS worker fatalities between 1992 and 1997 reveals an occupational fatality rate that continues to exceed that of the general population (Maguire, Hunting, Smith, & Levick, 2002).

Across the pond, in the United Kingdom, efforts were also underway to improve the visibility of police vehicles by considering various paint design schemes, including the Battenburg design: alternating blocks of contrasting colour (Harrison, 2004). Harrison concluded that the half-Battenburg design showed promise as it increased visibility and recognition of police cars in the United Kingdom, and the United States National Institute of Justice was considering research on the efficacy of the Battenburg design here in the United States to promote officer safety. EMS administrations are known for paying special attention to the bandwagon, that is they frequently make changes based on inconclusive and sporadic evidence. This is the case with recent ambulance designs.

Many ambulances in the New England, as well as other parts of the country, are being designed with the half-Battenburg markings applied to the sides of the vehicles in attempts to improve the safety of EMS workers. Unfortunately, we may find that these markings might have an unintended effect of confusing other drivers and causing more problems. A recent study found that Harrison (2004) was correct in that the Battenburg design assisted British drivers in quickly identifying British police vehicles, but the “effectiveness of the ‘Battenburg’ pattern in the UK appears primarily related to its association with police vehicles in that country” (Federal Emergency Management Agency, Department of Homeland Security, 2009, p. 6) having little effect on the recognition potential of American drivers.

Perhaps with the evolving data, we can begin using an evidence-based approach at helping the EMS worker perform his or her job safely at traffic scenes.

References

Cumberland Valley Volunteer Firemen’s Association. (1999). Protecting Emergency Responders on the Highways: A White Paper. Emmitsburg, MD: United States Fire Administration.

Federal Emergency Management Agency, Department of Homeland Security. (2009). Emergency vehicle visibility and conspicuity study [Catalog No. FEMA FA-323]. Emmittsburg, MD: United States Fire Administration.

Harrison, P. (2004). High-conspicuity livery for police vehicles [Publication No. 14/04]. Hertfordshire, U.K.: Home Office, Police Scientific Development Branch. Retrieved from http://scienceandresearch.homeoffice.gov.uk/hosdb/publications/road-policing-publications/14-04-High-Conspicuity-Li12835.pdf

Iglewicz, R., Rosenman, K.D., Iglewicz, B., O’Leary, K., & Hockmeier, R. (1984). Elevated levels of carbon monoxide in the patient compartment of ambulances. American Journal of Public Health, 74(5).

Maguire, B.J., Hunting, K.L., Smith, G.S., and Levick, N.R. (2002). Occupational fatalities in emergency medical services: A hidden crisis. Annals of Emergency Medicine, 40(6), 625-632. doi: 10.1067/mem.2002.128681

Solomon, S.S. (1990). Lime-yellow color as related to reduction of serious fire apparatus accidents: The case for visibility in emergency vehicle accident avoidance. Journal of the American Optometric Association, 61, 827-831.

Academia, Culture, Emergency Management, Emergency Medical Services, Health Care, Public Health, Society

Volunteerism

Living in such a small community as I do, there is little need for grassroots organizations to assist in the health and welfare of the community. Most of the organizations that are available in my community are business-based, healthcare focused institutions.

Day-Kimball Hospital (http://www.daykimball.org) is the center of healthcare and wellness in Northeastern Connecticut. Partnering with the community, Day-Kimball Hospital provides a host of services through its many facilities to provide outreach programs which help to make a healthier community. Employment and volunteer opportunities are available within the hospital for those with a desire to help promote health and wellness within the community.

There are two other local agencies, United Services (http://www.unitedservicesct.org) and Quinebaug Valley Youth and Family Services, which have partnered to provide a community-centered approach to the psychological welfare of adults, adolescents, youths, and their families. United Services, Inc. also provides employee assistance programs to workers of participating local businesses. Providing psychiatric consultation services for addiction and recovery, family violence, and family structure support, these agencies promote social change as both entities themselves and through their contact with members of our community.

The town of Killingly, Connecticut, also offers a Little League program where children can learn to play baseball and softball while learning the values of sportsmanship, loyalty, courage, and commitment. This program helps to promote social change through encouraging positive mentor relationships at a young and impressionable age. Little League is also an outlet where interested parties can help through sponsorships, umpiring, coaching, or just attending games and showing support for the program and the kids.

I have volunteered most of my life through the volunteer fire departments in my area, and I still do. I am an active member of the South Killingly Fire Department where I serve as a mentor and instructor in Emergency Medical Services. As an experienced paramedic, the least that I can do for my community is to ensure that those who will come after me are trained appropriately and to a high standard. Though my full-time job requires me to provide the same service in the same area, I enjoy a different role with South Killingly Fire Department which allows me the freedom to help others in a different manner than usual within the same occupational field.

Volunteering with others instills teamwork, dedication, and other core values that lend especially well to the promotion of positive social change. I am glad to help.

Academia, Emergency Management, Health Care, Public Health, Writing

Summary – Public Health Theory: Social Cognitive Theory

Building on Social Learning Theory, Social Cognitive Theory (SCT) (as cited in Bandura, 1989; U.S. Health and Human Services, National Institutes of Health, National Cancer Institute, 2005) has been a mainstay in psychology since 1986 when Albert Bandura explored the relationship between the individual, his or her personal traits, the physical environment, and society, and how each of theses factors impact and influence the others. Since this time, SCT has shown to have increasing applicability across the spectrum of health education. Using SCT to focus on these relationships, the health practitioner can understand that individuals are able to overcome obstacles to their health with an increased sense of responsibility, motivation, and control (U.S. Health and Human Services, National Institutes of Health, National Cancer Institute, 2005). By allowing an individual to understand that they can shape their environment just as their environment shapes them, the individual regains their locus of control, motivation, and sense of self.

A dynamic process, SCT has been used successfully to assess treatment techniques, improving on areas lacking in benefit. Brand and Nyland (2009) identify that 30-35% of patients with anterior cruciate ligament repair do not recover to their preinjury level of activity participation; however, they have identified that, using SCT, bolstering pre- and postoperative self-efficacy levels could ultimately improve a patient’s return to the preinjury activity level. Analyzing and identifying psychological factors which inhibit a sense of self-efficacy, allow the health practitioner more opportunity to improve overall success in surgery and rehabilitation.

In recent years, innovative researchers have been exploring other positive roles where SCT may be employed, including the creation of internet-based grief counseling programs. Dominick et al., (2009) show that identification of an individual’s grieving style can assist with forming adaptive cognitive therapies which, even provided in an online format, can assist the uncomplicated griever by positively affecting attitude, self-efficacy, and increasing knowledge about their personal grieving style.

SCT’s adaptive and dynamic nature allows for the health practitioner to analyze a problem and apply the theory’s constructs to change as much or as little as necessary for the development of a working solution with specific focus and control. In this way, SCT allows program development to follow a structured and informed methodology allowing a higher percentage of success.

References

Bandura, A. (1989). Social cognitive theory. In R. Vasta (Ed.), six theories of child development. Annals of child development, 6, 1-60. Greenwich, CT: JAI Press.

Brand, E. & Nyland, J. (2009, May). In D. L. Johnson (Ed.), patient outcomes following anterior cruciate ligament reconstruction: the influence of psychological factors. Orthopedics, 32(5), 335-340.

Dominick, S. A., Irvine, A. B., Beauchamp, N., Seeley, J. R., Nolen-Hoeksema, S., Doka, K. J., Bonanno, G. A. (2009). An internet tool to normalize grief. Omega: Journal of Death & Dying, 60(1), 71-87. doi:10.2190/OM.60.1.d

U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. (2005, September). Theory at a Glance: A Guide for Health Promotion Practice (NIH Publication No. 05-3896). Retrieved from http://www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf-5aa48ee1da4d/TAAG3.pdf

Emergency Management, Politics, Public Health, Technology

Revisiting My Goals

When I applied to Walden University, there were some choices that I needed make in regards to which program I would enroll in. I relied on my past experience and some of my current goals to direct me to the Bachelor of Science degree in Computer Information Systems (BSCIS) with a concentration in Information Systems Security (ISS), a process which truly motivates me. Revisiting my goals and lending them power to help navigate the world of academia, I needed to ensure that these goals still held true. The first assignment in the Introduction to Information Systems class afforded me the opportunity to do just that, while this assignment will allow me to review my goals once again.

My affinity towards positive social change (Schadone, 2009) is unwaivering, as is my desire to achieve a position in the field of disaster management. I do feel, however, that my chosen degree program is ill-prescribed to prepare me for such ambitions. Though there has been a great incentive to involve the engineering sciences into public policy administration (Connolly, 2009), my experience with the BSCIS degree, even with the ISS concentration, leads me to believe that the curriculum does not satisfy my current needs or goals. I do believe that a career in Information Systems Security would provide an opportunity to reach many of my goals, but other academic directions would provide a more solid foundation for me to build upon.

As of this writing, I have decided to research other avenues of academia which might be better suited to providing the core educational opportunities that would benefit me the most. I have decided that the B.S. in Health Studies with a concentration in Health Administration would be a better fit at this time. I hope to use this degree to propel me forward into an opportunity to earn an MPH with a concentration in Emergency Management and, ultimately, a Ph. D. in the same.

As the H1N1 influenza virus reminds us all about the 1918 “Spanish Flu,” there is an undertone of personal responsibility and preparedness in the event of a pandemic (Bornstein & Trapp, 2009), of which conditions are favorable. I plan to take personal responsibility in this and other potential disasters to position myself as an expert in the field helping to promote plans and policies to mitigate and respond effectively to such incidences. Though, I am versed in the computer sciences, I feel that my position as a health official would be better utilized in these times of crisis. Perhaps one day in the future I will return my focus on computing, but until then, my social conscience and sense of community seem to be my only defining factors.

References

Bornstein, J., & Trapp, J. (2009, June). Pandemic Preparedness: Ensuring Our Best Are Ready to Respond. IAEM Bulletin, 26(6), pp. 6, 14. Retrieved August 22, 2009, from http://www.iaem.com

Connolly, J. (2008, September). Bridging the gap between engineering and public policy: A closer look at the WISE program. Mechanical Advantage, 19. Retrieved August 22, 2009, from http://www.asme.org

Schadone, M. F. (2009). Information Systems and Me: My Professional and Career Goals. Minneapolis, MN: Walden University.

Emergency Management

A Datastore Discussion

O’Brien and Marakas (2007) explain the importance of disaster recovery in regards to a company’s computing resources, “Many firms could only survive a few days without computing facilities. That’s why organizations develop disaster recovery procedures and formalize them in a disaster recovery plan.” This is the basis of the business plan submitted in a subsequent assignment (Schadone, 2009) in which the focus is mitigating computing loss and recovering.

Information Technology relies on the acquisition, storage and retrieval of pertinent data. The development of a business plan leads one to require the adaptation of a data schema to manage the influx of information which could be useful to a growing company, if not required within the functioning business. Figure 1 reveals the core data schema for tracking customers and their needs. This schema is certainly not all-inclusive but provides a framework which can be built upon depending on the corporate direction and specific requirements.
This information can be utilized, obviously, to provide for the clients’ needs, but it can also be utilized to provide increased organization and specific solutions based on measured metrics. As figure 1 shows acquisition and storage of demographic information, it also allows for the assignment of specific roles. These roles can allow a portal application to provide only the most needed system monitors for each role, including role-specific alerts and notifications. Also, greeting the client by name, dependent on login data, provides an air of security prompting the user to logout when the session is complete. This demographic data can also be useful in providing personalized support by allowing support personnel access to each contact’s information and provide a basis to create a schema specific to Online Support Systems based on customer needs. Whether storing preferences or previous form entries, a personalized use of collected data can simplify processes for the user making the user more efficient in the end.

References

O’Brien, J. A., & Marakas, G. M. (2007). Introduction to information systems (14th ed.). New York: McGraw-Hill/Irwin.

Schadone, M. F. (2009). Disaster Response and Mitigation – IT: A Business Proposal. Minneapolis, MN: Walden University.

Figure 1.
Datastore Chart

Emergency Management

“Disaster Response and Management – IT” (DRAM-IT)

With the growing focus of disaster mitigation, response and recovery, companies that rely on information systems need to prevent and minimize the impact of disasters (whether natural or man-made) to their infrastructure. Society’s focus is to regain a sense of normalcy which requires a functioning economy, thereby increasing the need for companies to recover quickly.

By providing expert philosophies, procedures, systems and tools, DRAM-IT can ensure that the client will transition seamlessly from pre-disaster to post-disaster with no negative long-term effects.

We start with employee-focused health, safety and security. We believe that the employee is the first defense against failure. Employees should be healthy and not have their minds occupied by other domestic problems (e.g. family welfare) which is why in times of a disaster affecting the community, we contract with armed security agencies to provide force security for key employees and their families. This focus allows other employees to take care of their own before returning to work. The same security force will provide on-site perimeter security allowing employees to feel safe while aiding in recovery efforts. But, before the incident occurs, we will create processes to assist each employee in staying healthy and fit, both physically and mentally, including the creation of medical response teams to manage on-site medical emergencies until EMS can arrive.

Data loss can be immeasurable and therefore cannot be tolerated. After performing a forensic analysis of current IT practices, DRAM-IT will offer methods of securing data with redundant distributed arrays with cryptographic and hashing intelligence ensuring the data has not been and cannot be manipulated. Along with distributed storage, we can offer distributed processing to ensure the business keeps running without a need for direct input by employees.

During a disaster, the focus needs to be on initiating recovery processes and requires interfacing with local authorities to be part of the solution. We will provide the internal Incident Command structure which will integrate with the local, State, and Federal efforts to ensure pooling of resources. We are also committed to the community. The faster the individual entities of a community can recover, the faster the community as a whole can heal.

With DRAM-IT Systems Mitigation, Response and Recovery, we can ensure that you can concentrate on what is important… we’ll take care of the rest.

By providing an all-encompassing approach to disaster management, our clients can be assured of continuous critical systems processing, ensuring business continuity throughout the disaster.

Table Title: Examples of Structure and IT needs
Functional Area (See Figure 7.23) Supporting Information Systems (See Figure 1.6)
Example: Human Resource Management Example: Transaction Processing Systems
Command Executive Information Systems
Operations Decision Support & Strategic Info Systems
Tactical Knowledge Management & Expert Systems
Logistics Specialized / Transaction Control Systems
Finance Specialied / Transaction Control Systems

Subject: Investment Opportunity – “Disaster Response and Management – IT (DRAM-IT)” 02/25/14
To Whom it May Concern

I am writing you as an entrepreneur in support of the community. We have faced a number of disasters recently and our economy continuously suffers. I hope to provide a host of services to companies which are key to the community infrastructure. My goal is to be able to assist these key companies in recovering from the disaster internally and allowing the economy a maximized benefit in a minimal amount of time.

As a critical care paramedic who has worked with FEMA response teams in the past years, I have the experience and education to know what is crucially important during a disaster. As a computer programmer and IT professional, I know how to apply my knowledge to critical business systems ensuring a smooth transition during the various phases of a disaster, whether large or small, internal or external.

I wish to be able to provide mitigation training, on-site employee health programs, redundant communications, secure data storage and retrieval with distributive data processing, personal and protective security and adaptive processes and philosophies that can overcome even the most destructive of forces. We will initially be focused on consulting with the promotion of best-practices in mind. During the disaster phase, we will respond directly as Incident Command Teams that will be fully self-sufficient for over 72-hours to ensure the response and recovery are as smooth as possible.

The unfortunate reality is that this endeavor will require a large amount of start-up capital. We must first hire and train appropriate personnel who can then consult to client companies and ensure they can operate effectively during and after a disaster. We also need access to distributive networks with which to operate. These will undoubtedly be fee-based services, but initial investments of processor-time and storage would be invaluable. Investing in this opportunity is investing in the community.

Sincerely,

Michael Schadone