Joseph F. Clark, Ph.D.

I had my first book signing at the firefighter’s convention Saturday, April 25, 2009 in Indianapolis IN. This conference is huge with over 25,000 people from all over the country. The signing occurred at booth 301 with Firefighters Books (www.firebooks.com) from 11:00 to 1:30. It was great fun talking to new people on the job about their experiences and some of the veterans who had started on the job when I started working on an ambulance. We compared notes regarding the state of different EMS systems and how things worked for them now versus then.

I often got a chance to explain to people that the book, “My Ambulance Education” has education in the title because it impacts on my work as a Professor of Neurology. Currently I am working with multiple research disciplines trying to make diagnostics and therapeutics that can be used in the ambulance and emergency room. One very engaging young man who was a paramedic on a local ambulance service was bemoaning the unfortunate shrinkage of medications that paramedics are allowed to carry and administer. It is tragic that the apparent medical care that paramedics and EMTs can provide is decreasing but I assured him that scientists, myself included, are working to optimize and expand what goes in an ambulance.

My mantra to him and the other very engaging EMTs and Paramedics I talked with was that if you are sitting next to a patient and you wished you could get diagnostic information or a therapeutic device and have ideas as to how this can be achieved; to call me. I handed out a bunch of my university business cards and these health care professionals all seemed to be anxious to communicate and be involved. Many expressed interest in participating in future research projects. I was happy to hear this because, as I explained to them, the best way to get new technology in the ambulances was to have current practitioners be involved in the Research and Development. Several people gave me their contact details wanting to participate in the research coming down the pipe.

The bottom line is that the book signing was fun and having a chance to see the energy and excitement of today’s paraprofessionals who really want to do the best for their patients is really exciting. The truth is; My Ambulance Education continues to educate me.

This Saturday I am doing my first book signing. I’m not deluding myself in thinking it will be a big event. I am attending the FDIC conference (Fire fighters and EMTs) and signing books at one of the booksellers. The conference is in the Indianapolis Convention Center Thursday to Saturday April 22-25th. I’m looking forward to interacting with some EMS troops who are actively in the trenches. My hope is that I can convince them that while I’m not in there with them, I’m trying to improve their lot in life with research and development. Any who are willing to help with the research I’ll try to encourage and make connections with other researchers.
I feel the anticipation of going on a blind date. I hope that the guys still in the trenches will respond to what I tried to do with the book and what I’m trying to do with my research.
There is a lot of good medicine going on in an ambulance and at the scene of a sick or injured patient and hopefully my research will improve the care for those patients. In turn it should also help the EMS personnel by better arming them to do their jobs.

The federal government is spending a lot of time and effort on a federal bailout or stimulus package. Some of this stimulus package money is going to medical research. Over ten billion dollars is allotted to the national institutes of health to fund medical research projects. This money is grant funding that is being done by individuals who spend their lives working to help people. This is not corporate America driven by profit, but some of this work will save lives and almost all of it is for improving the health of Americans.

Why is it that the funding comes with more strings attached and oversight than banks and companies like AIG, or GM? There are no multi billion dollar bonuses for the scientists who make the next cancer drug. However the person designing the latest methods for preventing leukemia will spend half their time trying to get less money than a bank executive’s bonus. To put it simply the salary for GM’s CEO could be given to a quality research today and they will discover a way to save your child’s life tomorrow.

The smartest people in the world used to be rocket scientists or brain surgeons. But if you look at the best and brightest in American universities now, what they are going to do is move money around to put money in their pockets. If you want to know why we are in the financial situation we find ourselves in now it is because of a culture of greed. We rewarded greed and that bred mutual reinforcing of more greed by others. Meanwhile we can’t find good people to train to be the next generation of researchers and technology developers. We have money transfer experts.

Mr. President, if you want to stimulate the economy, save the intellectual base of America or the technology sector for the world economy will be moving off shore and we will need the Chinese federal governments permission to buy their guidance systems for our national defense.

I spent the day at a local high school recently. High school has not changed much since I was there. It was a lot of fun. I talked to anatomy physiology, chemistry and advanced science classes. I tried to give the kids an overview on what it is like to spend 9 years in college to obtain advanced science degrees. I told them about becoming an EMT to pay for college. In one of the classes I went into how the education system in Europe compared to US.
There were some students who were extremely engaged in the day’s presentations. Some of the students were interested in what I do at the University of Cincinnati especially because it is a common destination for local high school students. One obviously very bright student asked me a poignant question as far as if my current research could be treated with an idea she described to me. I complimented her on her idea and admitted that the idea was the subject of a multi million federal grant application right now. She was pleased and I was highly impressed.
All in all it was a great day. I may never know if any of these budding scientists blossom into researchers, but I planted some seeds in a few Juniors and Seniors and will return in a couple years to talk to another crop of students.

I do stroke research and research associated with neurologic emergencies. During a stroke and after some kinds of head injuries one million brain cells can die per minute. As minutes tick by more and more of the brain is irreversibly lost. Ambulance personnel know when this is happening based on their training, but medical technology has not supplied ambulances, paramedics and EMTs with the tools to treat these patients adequately or in a timely fashion. Calls like these are “swoop and scoop” with the highly trained EMS personnel practically relegated to truck drivers. Studies have shown that EMTs can correctly diagnose stroke over 85% of the time but there is no definitive treatment for these patients, they need an ER where the physicians give drugs and provide care. While in the ambulance 1 to 10% of the brain can die. We need research and tools in the ambulance for these patients and EMS personnel.
Instead of just talking about it, some of us are trying to do just that. We are doing and funding research on neurologic emergencies appropriate to ambulance and ED patients. Have your say and visit: http://www.ece.uc.edu/POC-CENT and/or www.josephfclark.com

There are calls on the ambulance that stick with you. “My Ambulance Education” chronicles many of the calls that stuck with me. One memory that sticks with me was not one of my calls but rather a call of a colleague. Ken was a young paramedic and my partner for the day. I arrived for work and he is getting his gear together. Ken informs me that we needed to go to the hospital to follow up on a patient he had had on a previous shift.

Ken said it was a glorious hazy and hot summer day when he and his partner were called to a “swimming hole” for a ‘man down.’ Upon arrival they see a young couple sitting on the shore with the guy resting his head on the girl’s lap. She is stroking his hair talking to him quietly. As Ken tells me this I wonder why he took note of the scene’s background as opposed to getting on with the call.

It soon becomes apparent that the guy was the call. The couple were in their late teens and had been swimming enjoying the great day. Carl, the boyfriend, dove in, hit his head on the bottom and surfaced flailing with his arms, face down in the water. The girlfriend Tonya, with the help of another guy, pulled Carl from the water. They laid Carl’s head on Tonya’s lap as the other guy went for help.

Ken said as soon as he realized he had a possible broken neck victim he exclaimed, “Oh no, you’ve flexed his neck” and tried to pull traction and monitor vitals. Tonya must have been mortified and Carl scared because both became ghostly white realizing that what they had done might have made things worse. Ken and I both knew that with a possible broken neck, such as with Carl, it is best to keep the neck still and straight so that the spinal cord stays in position. Carl’s head was flexed as it rested on his girlfriend’s lap.

According to Ken, Tonya became inconsolable and Carl, largely unable to move, tried to verbally console her. The scene must have been a mess.

Ken paused, shook his head and said to me,

“18 f***ing years old and paralyzed for life.”

Ken also knew that he made the whole tragic event more terrible by inadvertently implying that they had made the injury worse when they put Carl’s head in her lap. It was likely a reflex exclamation from pure emotion on Ken’s part, but the words were said and the damage done. I fully realize that clinically Ken did everything right. But in Ken’s mind, when he blurted out the admonishment about flexing Carl’s neck, he caused unintentional grief to all concerned.

Ken and I went to the hospital and he looked up the details on Carl. The prognosis was bad. Carl was paralyzed with minimal use of his hands from fractures to the fourth and fifth cervical spine vertebrae. There was little to no hope for a normal life and Tonya had not been allowed to visit him because his parents and family must have felt it was her fault. Ken felt terrible and I wondered if he would want to go visit Carl. To my knowledge he did not visit Carl and we do not know how things turned out for Tonya. It was a tragic call that forever changed multiple lives.

Even though I was not on that call, it has stuck with me all these years.

Drunks are a part of the job. That is the theme of one of the chapters in “My Ambulance Education” but it is also a statement of the obvious for ambulance and emergency personnel. I would however like to mention that a majority of drunks who are given quality care by emergency service workers are not recalcitrant and tend to be apologetic and grateful. The problem comes from frequent flyers, people who consistently get drunk and cause damage to themselves and others. Regardless of if they regret their behavior when drunk it is a reason for their behavior but never an excuse. So, while dealing with intoxicated individuals is part of the job and something we all must deal with, there is an overriding need of society to take steps to manage excessive drinking because it leads to countless deaths and injury.

So I’m looking at a shelf of books in my office and realize that most of them were published pre 2000. In the electronic age, most of my educational media is electronic. Now it seems I have more e-books and e-journals than paper anything. Less and less of what I do involves ‘hard copies’ of material. People have gone to paperless offices, but what do I do with the books on my shelf? Some of them are the Ph.D. theses of students who put them together as part of their degree. My Ph.D. thesis is on that same shelf. Do we stop printing the academic works of masters and Ph.D. dissertations?

When I received my Ph.D. I gave a printed copy of my thesis for my parents. My mother still displays that document on her bookshelf. If a thesis is electronic what will parents do? Perhaps they will put the thesis thumbnail on their home page.

That is just sad.

Did you know that not every firefighter is a paramedic? Also, not every paramedic is a firefighter. Every time you see an ambulance that ambulance may have EMTs alone or paramedics. I’m talking about Advanced Life Support versus Basic Life Support. ALS and BLS ambulances both have skilled people providing medical care at different levels of training and both will transport patients to a hospital as quickly as practicable. ALS trained paramedics receive thousands of hours of training and can give drugs during a medical emergency. EMTs are able to administer BLS care along using a defibrillator to tend to patients. More seriously sick or injured patients generally need an ALS ambulance. If you break an ankle on a ski slope you need a BLS ambulance. If your loved one clutches their chest with great pain during a heart attack you need an ALS ambulance. In either case the 911 operator can help decide if an ALS or BLS ambulance is needed. The key however, is to call the ambulance and let them take care of you. In the recent tragedy of Natasha Richardson the ambulance was purportedly turned away, which may have been a tragically lethal event because of a traumatic brain injury. Remember the people on the ambulance are para-medically trained, so give them a call and tell them what is wrong.
Check out this recent story: http://www.cnn.com/2009/HEALTH/03/26/head.injury.emergency/index.html

There is a big difference between the medicine that occurs in the streets with ambulance personnel and the emergency medicine that is practiced in emergency departments. Despite the differences there is a closeness between those people and their respective disciplines. Both sets of people who work these jobs see humanity at its best and WORST.

When humanity is bad it is real bad. The medicine that occurs in the streets is in some ways, harder to come to grips with because people and their environment are enmeshed in all sorts of tragic ways. The obvious example is a car accident where metal and glass trap victims and crush flesh. EMS personnel: police, fire and ambulance will see this scene and sear it into their brains while they work to get the victim free of the tangled mass and provide care with the goal to get that person to an emergency room.

In the emergency most of the debris has been removed. The exception is when stuff is still stuck in the person, say via impalement. Nonetheless, the sights, sounds and smells are tempered in the ER. This tempering does not in any way diminish the significance of the work in the ER, it is just a different side of the same coin. Both groups of people form integral links in a chain of health care and emergency medicine and I am proud to have been part of these disciplines.