Medical personnel stand at a doctor's meeting, give advice, nurses and assistants, hospital personnel, professionalism.

Equity in Health Care Education: Ethical Distribution of CMS Funding

By Stephen Wood

The number of physicians in the U.S. is shrinking, especially among those who choose primary care. Advanced practice providers, such as Advanced Practice Nurses (APRNs) and Physician Assistants (PAs), are helping to fill that void.

In order to maintain a health care system that can serve our aging population, and one that is aligned with the health care needs and goals of our nation, there is a need for legislative support to fund APRN and PA clinical education in a way commensurate with residency training programs.

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an ambulance parked at the entrance of an emergency department

Equitable and Ethical Access to Care: The Case of Pre-Hospital Blood Administration

By Stephen Wood

The State of Massachusetts is currently reviewing a new protocol for the pre-hospital (i.e., ambulance) administration of blood products to patients with acute hemorrhagic shock.

In the pre-hospital setting, hemorrhagic shock, which is characterized by rapid blood loss that results in potentially fatal oxygen depletion of the vital organs, is traditionally managed by the administration of intravenous fluids. But there is a growing body of evidence spanning several decades that this is not beneficial and, in fact, can be harmful.

In the hospital setting, blood loss is treated by replacing blood, most commonly in the form of packed red blood cells, plasma, and platelets. There is strong data supporting the use of replacement blood products for the management of life-threatening hemorrhagic shock, specifically a reduction in all-cause mortality. Moreover, research has demonstrated the safety, efficacy, and feasibility of pre-hospital blood transfusion. Several states have implemented protocols for pre-hospital blood administration based on this supporting data. There are barriers, however, to initiating this practice at several regulatory and non-regulatory levels. The result is that access to a potentially life-saving intervention is inequitably distributed.

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DUQUE DE CAXIAS,(BRAZIL),MAY,20,2020: doctors take care of patients with covid-19 and an intensive care unit (ICU) at hospital são josé specialized in the treatment of covid-19.

A Novel Approach to Crisis Standards of Care

By Stephen Wood

The provision of scarce resources such as intensive care unit (ICU) beds, antivirals, and ventilators during this pandemic has been an ongoing topic of discussion. Repeatedly, states and hospital systems have considered implementing crisis standards of care, which establish triage protocols for scarce resources.

Though crisis standards of care are meant to provide an ethics-based approach to the complex process of allocating scarce health care resources, in reality, they fall short.

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LOMBARDIA, ITALY - FEBRUARY 26, 2020: Empty hospital field tent for the first AID, a mobile medical unit of red cross for patient with Corona Virus. Camp room for people infected with an epidemic.

The Fourth Wave of COVID-19: The Effects of Trauma on Health Care Workers

This post is the introduction to our newest digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce. All contributions to the symposium will be available here.

By Stephen Wood

On this day one year ago, World Health Organization Director-General Tedros Adhanom declared COVID-19 a pandemic, sounding the alarm about the international threat posed by the virus.

Today, one year later, I fear the end is not in sight. In fact, I believe that we are on the precipice of a fourth wave.

The fourth wave will strike the people on the frontlines of this pandemic — health care workers. It will be the effects of the trauma that health care workers entrenched in this pandemic have faced. And it is likely to have significant and lasting effects on our health care system.

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Busy Nurse's Station In Modern Hospital

Violence Against Health Care Workers: Legislative Responses

By Stephen Wood

COVID-19 and other diseases aren’t the only threat to health care workers. Violence in the workplace is a common occurrence and on the rise.

Despite these troubling trends, the policy response at both federal and state levels has, so far, been lacking.

In a recent survey of nurses, 59% reported that they had been the victims of workplace violence. More than half of those respondents went on to report that they were not satisfied with how the incidents were handled.

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empty hospital bed

COVID-19 Underscores Racial Disparity in Advance Directives

Cross-posted from The Hastings Center Bioethics Forum, where it originally appeared on May 26, 2020. 

By Stephen P. Wood

During a recent shift, I was the primary provider for a man in his 70s who was brought in by ambulance with respiratory failure. He had been sick for two days with a fever and a cough, weak and short of breath. The chest x-ray performed at his bedside revealed the diffuse, fluffy markings that are familiar signs of pneumonitis from COVID-19.

After giving him oxygen to improve his breathing, treating his fever, and running tests that are standard for COVID-19 patients, I clicked the admission button to cue him up for a bed. My patient and I then discussed goals of care and had a frank discussion about advance directives. He did not have an advance directive, but he knew he did not want to be resuscitated. He did not want to be put on a ventilator, go on dialysis, or receive artificial nutrition. He was quite clear and did not hesitate about these decisions. We signed the advance directive and filed it away in his chart.

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a crowd of people shuffling through a sidewalk

Lost in the Shuffle: The Impact of COVID-19 on Immigrants in Need

The recommendations for healthy people who have symptoms consistent with COVID-19, the illness caused by the corona virus called SARS-Co-V2, is to stay at home, get plenty of rest, drink fluids and control fever and body-aches with a non-steroidal medication. For people with pre-existing medical conditions, the elderly or those with more serious symptoms, an evaluation by a healthcare provider is warranted. This is a reasonable recommendation given that for most healthy people, the symptoms are uncomfortable but not life-threatening. There is a population however, that regardless of the severity of their illness, may stay at home and not seek medical care, even when things are serious. Fear of arrest and deportation is a real issue for undocumented immigrants and calling an ambulance or going to a hospital can put them at risk for these actions. The result is that some very sick people may not seek appropriate medical care. In addition, they may be taken care of by people that don’t have the appropriate personal protection, putting even more people at risk.

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a pill in place of a model globe

When it comes to opioids, it’s all about turf.

By Stephen Wood

When it comes to selling opioids, turf matters. Access to customers and geography play a role in the day to day sales of opioids. This often means selling in areas where there is a wanting and willing customer base with funds to spare. It also means picking a spot, a corner, where enforcement is low or where corruption can overcome most legal problems. The delivery can’t be too conspicuous. It needs to be hidden from plain sight, done in the shadows or alleyways where no one is looking. It’s a craft and when done right can lead to fistfuls of cash in the hands of the distributor, the dealer.

This may sound like a street-level drug deal, but it isn’t. It’s the tactic many American pharmaceutical companies are taking in response to increased regulation on prescription opioids. Like the stealth and shadowy moves of a street-level dealer, American pharmaceutical companies have moved their turf to new, mostly naïve markets to sell their wares. They have done this to escape the federal regulations that have limited their market; a response to the opioid crisis that has seen hundreds of thousands of lives affected by substance use disorder or lost to overdose.

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Photograph of commercial fishing vessels

How Thailand’s Fishing Industry and Your Tuna Melt Are Linked to Human Trafficking

By Stephen Wood

I used to be averse to mayonnaise and I still am for its use as a condiment or in dishes like coleslaw or potato salad. My grandmother made our potato salad with oil and vinegar and lots of garlic and our coleslaw was vinegar-based too. I would tell friends that I was allergic to mayonnaise so that they wouldn’t slather it on my bologna sandwich or make me eat chicken salad. I’m not sure why this is the case; mayonnaise is made from stuff I like — eggs, salt, and vinegar — and when homemade can be really delicious. It’s just weird. But something changed that. I wanted to eat tuna. Not the blue or yellow-fin tuna that you grill as a steak or to enjoy as sushi, but canned tuna. This transition happened when I moved out of my family’s home and into an apartment. I was working and living on my own and soon realized I needed to eat on the cheap. I wasn’t used to eating on the cheap. I like lobster, escargot, flank steaks, and good wine. But I was broke and on a budget so I decided that I was going to brave it and eat canned tuna. With mayonnaise. I perfected a recipe. It has tuna, mayo, celery, onion, cumin seeds, and salt. It’s topped with shredded cheese and toasted and it is delicious. I’ve overcome my aversion to mayonnaise for this one thing, and also occasionally deviled eggs. But there is a problem.

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