As Earth Day approaches, Clinician Reviews would like to shine a spotlight on clinicians who work hard to protect patients from environmental hazards, such as lead poisoning and pesticides. Other PAs and NPs work at the national and global level to track and prevent public health threats such as West Nile virus, HIV/AIDS, and pediatric asthma.
As more people recognize the intricate link between the environment and human health, interest in public health programs is increasing, according to a recent article in the Washington Post. At least one PA program, at George Washington University, offers a joint PA/public health degree.
For clinicians who are analytical and interested in health policy and who want to “do good” for the world, getting involved in public health may be an excellent career move. Perhaps the talented colleagues profiled below will inspire others to get involved and make a difference.
How a Single Question Saved Lives
Iowa emergency department (ED) PA Mark S. Johnson, PA-C, MPAS, MT (ASCP), saved nearly 100 lives when he discovered carbon monoxide poisoning in a local apartment complex.
It all started when two Bosnian immigrants, a mother and her 20-year-old son, walked into the ED at Ottumwa Regional Medical Center with a roster of vague complaints: headache, congestion, and earache. Johnson began to treat this as a routine upper respiratory case. He had the prescription in hand, and was about to send the patients home, when something stopped him. And he is glad he paid attention to that gut feeling.
“I thought to myself, ‘Well, it’s winter in Iowa,’ and they did have headaches,” Johnson said. So, he asked a few more questions. He learned that the mother’s apartment was located right next to the furnace room. The patients also told Johnson that workers had just been repairing the furnace. This information prompted Johnson to order a carbon monoxide test for both of them.
That testing revealed slightly elevated carbon monoxide levels for both the mother and son. Johnson then asked the woman’s younger son and her boyfriend to get tested. Their CO levels were also elevated. What had started as a seemingly routine case became a more clear-cut instance of carbon monoxide exposure.
“The levels were not toxic,” Johnson recalls. “But they were high enough to cause the headaches.”
Johnson called the maintenance man at the patients’ apartment complex. He, in turn, called the gas company. Their tests revealed—sure enough—that the furnace was not working properly. Carbon monoxide levels were high throughout the three-story building.
At that point, the local fire department evacuated the building. Paramedics checked carbon monoxide levels and told residents to stay away for several hours until the building had been aired out.
For a brief while, it looked as if all 100 of the apartment building residents might be headed to the Ottumwa Regional Medical Center’s 11-bed ED for testing; Johnson was glad the fire department handled that situation in the field. “The nurses I work with would never have let me live that down,” Johnson jokes.
Johnson hopes other clinicians will hear his story and stop to consider environmental causes of illness more carefully. “Before you dismiss something, go through your differential—just as you’re taught in school,” he says. “Go through that list of things you don’t want to miss.”
For example, if a patient has already seen 20 specialists and still complains of migraines, it could be a case of carbon monoxide exposure. It makes sense to ask about his/her furnace and whether there is a carbon monoxide detector in the home.
Johnson tends to dismiss the praise and attention he’s been getting from reporters who call him a hero. “I was kind of humbled by it,” he says. “Since this happened, I appreciate my work more, and I try to take the time to really listen carefully, because it might save somebody later on. You never know.”
Recognizing The Perils of Pesticide Exposure
A few years ago, a group of clinicians was eating lunch in a small health center near Tampa, Florida. Suddenly, a steady stream of farm workers started coming in with nausea, vomiting, chest pain, and respiratory problems.
The ED snapped into triage mode, separating the sickest from the less severely ill patients, who lined the hallways. The clinicians later learned the 84 farm workers they treated were working in a cauliflower field that had recently been sprayed with the chemical Phosdrin. Thirteen of the workers who had the greatest exposure to the pesticide stayed in the hospital for a week before recovering.