Week 7: Emergency Department Shadowing and Chest Compression Testing

This week flew by.  It started at 7:00 AM on Monday morning by testing several participants in the chest compression study. We have been bringing a mannequin down to the Emergency Department from the Simulation Center to make it easier on the participants, and every time we bring the mannequin through the halls, people think it is a dead person if we keep it covered. If we leave it  uncovered, people wonder why the person is so pale.  These mannequins aren't the kind you would have used in the past for CPR training. The one we use costs about $80,000 and has an array of capabilities. It is hooked up to a computer, and on command it can have a heart attack, get sick, make different sounds, change the size of its pupils, and many more features. They are normally used for training for the residents, doctors and hospital employees so they have practice before doing a procedure on a real person.  We are using this type of mannequin because it has an internal sensor that monitors chest compression depth, chest recoil, hand placement, and compression rate.

Anyways, our main goal for this week was to test as many Emergency Department nurses and EMTs as possible, so we have been coming in at various times to test as many people as possible. The earliest day was at 5:30 AM, but most days we went in around 7:00.  We have now tested 25 people, and we need at least 100. This coming tuesday we will be testing the residents, which will hopefully give us another 10 people, and we will be tracking down people who now work in other departments this coming week. We will also be testing the weekend crew tomorrow morning beginning at 4:30, but the med student I am working with is covering that shift since I am going to the beach for the day. Thank you Peter!

On Tuesday I had my first evening shift in the Emergency Department, and it seemed completely different than the morning.  On Tuesday mornings all of the residents are at Grand Rounds so the PAs cover their shifts, and Tuesday evening was busy.  I followed a resident who was just finishing her first year, and I saw many interesting patients.  I don't get grossed out by blood, but I have found that the self-inflicted traumas do bother me.  We saw 8 traumas from 6-11, and it was a busy night. I wish I could say more about the patients I saw, but because of patient confidentiality I can't. I am really enjoying the time I spend shadowing in the ED.

Week 6: Mesh Terms and MCAT

This past week was busy since I had my MCAT on Thursday. On Monday we worked with the reference librarian to finish out literature search for the intubation study. Peter and I were convinced that we had found everything pertaining to the airway study, but after spending almost two hours with the reference librarian, we learned otherwise. She was a pro at mesh searches! We only found 3 papers that had anything related to our project, but these three papers were very helpful. The librarian turned out to be a Juniata graduate too, which was a cool connection. We also made a few graphics for each study to better explain the experimental design for the next meeting with Dr. Terndrup and the other research students.

On Tuesday we spent the morning with the residents in grand rounds. The were being tested, so I rotated with them through three stations. I watched them read EKGs and ultrasounds, identify eye problems, and I did chest compressions on a mannequin for a resident during a cardiac arrest simulation. I also sat in on the M&M meeting that addresses cases in which a resident could have treated a patient differently for a better outcome. We then made sure everything was ready to begin taking the mannequins from the simulation lab down to the Emergency Department before going home for the day.

On Wednesday we went in at 7:00 to test people's chest compressions in the emergency department. We got 4 people on the first day, which doubled our participants so far. I was supposed to have off today, so I left around 10:00 to go drive to the testing center and prepare for my exam.

On Thursday I had my MCAT, and I was in the Emergency Department on Friday. I saw some pretty interesting patients and got to stand in on some traumas. I'm grateful for the residents who let me follow them around, and I learned quite a bit through their teaching. Next week we will be testing people each morning starting at 7:00 AM.

Week 5: Emergency Department Shadowing and Subject Testing

This week began on Monday in a meeting with a biostatistics professor who is doing the statistical analysis on the airway study I am helping with. The first objective of this study is to determine a scale to accurately measure a person's ability to do a rapid-sequence intubation outside of the hospital. There is currently no scale for this, and current research debates whether or not prehospital endotrachael intubation should be done by EMTs at all. Developing a scale to determine whether or not EMTs can successfully intubate a patient without doing more harm than good will be important to answer whether nor not EMTs should be intubating patients.

Developing this scale, however, is going to be a lot more difficult than I expected. We need to look at variable strength and assessment tool strength. For example, should a question be a simple YES or NO answer, or should it be a proficiency scale. If we choose a scale, should that scale range from 0 to 5 points, 0 to 10 points, -5 to +5 points, etc. Should certain variables be weighted more than others? The power analysis of each question goes beyond my statistics education. Thankfully that's why Dr. Yang is involved.

On Tuesday I spent the day in the Emergency Department observing and screening for patients who could be eligible for the national emergency medicine studies in which Penn State Hershey is participating. While none of the admitted patients qualified from my 7-3 shift, I did see several interesting trauma cases. I couldn't help but make MCAT questions in my head about the cases I was seeing.... "If drug A increases a patient's blood pressure, which hormone is most likely released and from what gland?"

I finally met with Human Resources yesterday, so hopefully I'll get my first paycheck soon. I'm learning that there are definite advantages of being part of such a large institution, but everything takes so much longer to accomplish...

This afternoon the other research students and I have a meeting with Dr. Terndrup to present our progress. Hopefully he is impressed with what we have accomplished so far. As of today I am half done with my internship. The time is flying!

Week 4: Progress

After having to wait for Institutional Review Board approval for 3 weeks, everything started progressing quickly last week. We got IRB approval on Monday, which means that we could begin testing our participants. I still didn't have access to the database we are using, however, but that came on Tuesday. On Wednesday we tested our first participant for the chest compression study. Although we still have about 100 more, it was good to start testing. Unfortunately, the number of people who signed up after we sent an email was really low.... We are looking at bringing a mannequin and laptop down to the emergency department to test our participants, who are all ED employees, in an empty room when they have time. 

I finally got my employee badge on Thursday after 4 weeks of work!

We also began designing the database for the second study we are working in.  This three-year study will begin in July, and our job is to design the data collection tool for it. We designed a preliminary version from Wednesday to Friday, and we have a meeting today (Monday) with a biostatistics professor who is one of the project investigators. Hopefully he likes what we have done!

Last Tuesday we got another tour of the emergency department and an orientation to our job in the trauma bay for the next 6 weeks. We will be taking shifts from 7-3 or 3-11 to troll for newly admitted patients who may qualify for the national studies that Penn State Hershey is participating in. I'm excited for this new task because it will mean spending less time in the library and more time in patient areas. My first shift is tomorrow morning, and i'm looking forward to it.

Week 3: Scheduling

The medical student who I am working with got married last Friday, so he spent the week at the beach with his wife. My main goal was to schedule times with the Simulation Lab to test our study participants. Once I finally was able to arrange a meeting to schedule, the women in the Sim Lab were very helpful. I scheduled various dates during June, and they helped me pick times that would be convenient for the residents, EMTS and nurses so they could come right when their shifts ended. I then created a google spreadsheet and emailed all participants so they could sign up for a time that works for them. Unfortunately, only two people have signed up so far. It looks like my task for next week will be trying to convince more people to participate.

On Tuesday, the medical students and I all had to present our projects and progress to Dr. Terndrup. He is the chair of the Emergency Department and the JC alum who offered the internship. Only about half of the group got to present, so I will be presenting sometime next week.

We had a meeting at the Life Lion hanger on Wednesday. Life Lion is Penn State Hershey's helicopter emergency transport service. We learned about how Life Lion operates and the history of the program. They are expecting a new helicopter in the next few weeks which they are very excited about. I was surprised that their helicopters can be flown with GPS coordinates, much like commercial airplanes. They are the only service that serves Central PA that offers this service. This is helpful in bad weather conditions and allows Life Lion to fly in any kind of weather except for thunder storms and ice.