On this episode we discuss organophosphate poisoning including nerve agents and insectisides. Contributors include Matt Zuckerman, Steve Bird, and Adam Darnobid with a shoutout to Jason Hack.
In a little over a weeks time, a gathering of retrieval practitioners will occur in Cairns, Queensland , Australia. They come from around the globe : New Zealand, USA, Malaysia, Australia. It will be the 24th Aeromedical Society of Australasia and Flight Nurses Australian conference
There will be the inception of a new Aeromedical Simulation Cup competition with 5 teams enrolled.
Master Cliff Reid of Greater Sydney Area HEMS, New South Wales Ambulance has been putting his entrusted team through a hard training regime of intense physical and simulation exercise. Watch their kungfu in this video. It is very strong.
Watch carefully in the above video for use of the iSimulate ALSi product in training with GSA HEMS team. THE CHOICE OF CHAMPIONS IN TRAINING!
Drager Australia for loan of an Oxylog 3000 transport ventilator for the competition.
The competition action is going to be awesome. The GSA HEMS team in training epitomise the Three Rules of PHARM. Who will oppose them? Who can stand up to their resolve?
Train hard, fight easy.
A plastic surgeon is being sued by California State because she charges patients fees in excess of what insurance pays for her services. California’s lawsuit alleges that the doctor poses a “substantial, irreparable, and unjustified threat to the financial livelihood” of her patients.
In addition, the California Medical Board is attempting to revoke her medical license because she is allegedly engaging in “unprofessional conduct” by requiring patients visiting emergency rooms to sign agreements to pay her costs if their insurance companies didn’t.
I’m not going to try to justify the fees that the doctor charges. More than $12,000 to repair a fingertip is a lot of money.
However, with one caveat, I think that the actions taken by the state and the medical board are way out of line.
Suing a doctor and trying to revoke her license because she wants to get paid the asking price for her services? If people don’t want to pay her price, then don’t use her. Go see another “professional.”
You go to work at a new job where you agreed that you would be paid $50/hour. You work 40 hours, and expect to get a check for $2,000 at the end of the week. As you leave work Friday, your boss gives you a check for $200.
“Sorry,” he says, “if you don’t like it, you’ll have to go take it up with the company CEO. That’s all I’m paying you for your work.” The company CEO tells you “we pay other workers $5/hour, therefore we can pay you that much, also.”
You try to sue to get your money, but a court says it is against the law for you to demand to be fully reimbursed for your work because the corporation that reimburses your boss pays $5/hour, therefore it is legally entitled to pay you that same amount. Since you’ve already completed the work, you try to sue the company for your back wages. Then the state files a lawsuit against you because you filed a lawsuit against your employer.
Or imagine going into a lawyer’s office, agreeing to pay the lawyer his fee, receiving the services, then sending the lawyer a check for 10% of the total fee as payment in full. You’d be back in court so fast it would make your head swim.
That is the position this doctor is being put in. She performed the work at the patients’ request, the patients signed a form stating that they would pay her full price for her services, then, when she tried to collect the money from the patient after performing her services, the state stepped in and said that the doctor must agree to the amount a third party wanted to pay her.
The caveat in this whole mess is that the patients should know what they could end up paying the plastic surgeon before she renders her services. If that occurs, the patients get to decide whether or not the costs are worth the perceived benefits. If the patients agree to such costs, then they should be held responsible for paying the agreed-upon price.
The patients refused to have the emergency physician repair their wounds and demanded that they be treated by a “professional”. Now they’re accepting the “professional’s” services without planning on paying her the price that she asked?
Wonder why there are so many specialists who aren’t providing care to emergency department patients?
I also wonder whether specialists would be considered “unprofessional” if they required retainer fees before providing services. Would the state take action against them then? Lawyers do it all the time. No money, no representation.
Looks like a lot of patients are going to be stuck with us all of us sub-”professional” emergency docs for their emergency department treatment in California.
I wonder if this whole “we’ll pay you what WE think is fair” line of reasoning would work when the doctor went to pay her California state taxes …
It’s summer and the BBQ’s are fired up! People are cooking up big, fat, juicy steaks. What does this mean?
Esophageal food bolus impactions!
Yes, last shift I saw not one, or two, but three people with porterhouse jammed in their gullets. The GI guy on call got lucky with one which I managed to get to pass with Glucagon but the other two required emergent trips to endoscopy.
Remember to chew your food thoroughly!
Gday – slow week for Broome Docs – a few other big projects on the go, and a spot of fishing!
For a while there has been a few of us in the rural areas contemplating a new type of Trauma / Critical Care training course.
We have all done the APLS, EMST, ATLS…….. and know that the training is OK, but comes up short when we go back home and are faced with reality. These courses are entry level, safe-practice based and valuable – however, they often ar not up to date with evidence, new trends in practice and tend to be a bit heavy on the theory / written word style of teaching.
So what do we want in a course? There is now a survey out there to try and answer this: what do we – senior, front line docs want in a weekend training course?
Amit Miani and Andy Buck (both ED guys with interest in teaching) have created this survey https://www.surveymonkey.com/s/edexamtrauma in order to hopefully create the ultimate educational experiencefor you – the doc on the ground.
So if you are an Aussie doc and want to help create a better type of training – please take 5 minutes to complete the survey.
For 19 years since residency, I have worked in one facility and one facility only. I have paced its halls and touched its walls, known every crack and heard every sound. I have seen life and death, laughed and cried there. And yet, I began to have a wandering eye…
Actually, I needed a little more immediate cash. I began to flirt with…locums!
So, after some phone calls, some furtive, flirtatious e-mails, some letters and forms, I found myself at Hospital #2! It was exciting and terrifying. We had never met in person, I had only read about it online.
I packed a bag, and left my town behind. When I saw Hospital # 2, I was intrigued. Not what I expected, but not bad. Certainly, available….if you know what I mean!
And after quick introductions, we spent the night together.
It wasn’t easy at first; the charting was odd, and the layout new. The staff nice and professional, but not the ones I knew so well. But it worked.
The next morning I left, rested and came back to do it all again! I felt an odd kind of liberation, like a new man. I had believed I could only practice in one place, that I would only be loved and accepted by one facility.
How wrong I was! I am a good doctor; and my skills go with me wherever I go; now matter how many times I cheat on my old, tried and true place of employment.
I’m home now; back to the routine. But with a new found sense of adventure. I feel free, I feel stronger…and I feel a little naughty (and a bit more financially stable) after my romp with Hospital #2.
Call me ‘hospital ho,’ but I’m going back again next month.
Because with one son going to college next year, and a few more kids behind, with reimbursements down and partners unwilling, and unable, to give up shifts, I’ll keep cheating….and getting paid for it. As long as the money is good.
Welcome to the striking 72nd edition!
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
Stumbled on another fairly new EM tumblr The Emergency Medicine Resident Blog By Bob Stuntzs a US emergency physician with a keen interest in resident education. You can follow Bob on Twitter @BobStuntz and check out some of his recent posts below:
- "Intellectuals solve problems, geniuses prevent them."
- "No problem can be solved from the same level of consciousness that created it."
That's it for now...
Hopefully this roundup of the world of electronic emergency medicine and critical care education for everyone helps you to deal with anyone, anything, anywhere at anytime for at least another week! If you'd like to suggest something for inclusion in the next edition of The LITFL Review, email kane AT lifeinthefastlane.com
LITFL Review EM/CC Educational Social Media Round Up
123Sonography.com -- Academic Life in Emergency Medicine -- A Life at Risk -- All LA Conference -- Al Sacchetti’s Youtube -- Broome Docs -- CCM-L.org -- CLIC-EM -- Critical Care Perspectives in EM -- Dave on Airways --DrGDH -- Dr Smith's ECG Blog -- ECG Academy -- ED Exam -- EDTCC -- EKG Videos -- EM Basic -- EM Core Content -- EMCrit -- Emergency Medical Abstracts --EMERJENCYWEBB - Emergency Medicine Cases -- Emergency Medicine Education -- Emergency Medicine News -- Emergency Medicine Ireland -- Emergency Medicine Updates --Emergucate --EM Literature of Note -- empem.org -- EMpills -- Emergency Physicians Monthly -- EM Lyceum -- EMProcedures -- EMRAP -- EMRAP: Educators' Edition -- EMRAP.TV -- ER CAST -- Free Emergency Medicine Talks -- GMEP -- Gmergency! -- Greater Sydney Area HEMS -- HQmeded.com -- ICU Rounds -- Impactednurse -- Intensive Care Network --iTeachEM - Keeping Up With Emergency Medicine -- KeeWeeDoc -- LipheLongLurnERdok -- MDaware -- MD+ CALC -- MedEDMasters -- Medical Education Videos -- Medicina d'urgenza -- Medicine for the Outdoors -- Micrognome -- Movin' Meat -- Neurointensive Care -- Pediatric EM Morsels -- PEM ED -- PHARM -- Priceless Electrical Activity -- Procedurettes -- PulmCCM.org -- Resus.com.au -- Resus.ME -- RESUS Room -- Richard Winters' Physician Leadership -- SCANCRIT -- SCCM Blogs -- SCCM Podcast -- SEMEP -- SinaiEM -- SinaiEM Ultrasound -- SMART EM -- SonoSpot -- StEmylns -- Takeokun -- The Central Line -- The Ember Project --The Emergency Medicine Resident Blog -- The NNT -- The Poison Review -- The Sharp End -- The Short Coat -- The Trauma Professional's Blog -- The Underneaths of EM -- ToxTalk -- TJdogma -- Twin Cities Toxicology -- Ultrasound Podcast -- UMEM Educational Pearls -- Ultrasound Village
I’ve been backing off of some of my social media posting. I will still make comments, still put up links now and then. But I’ve had an epiphany of sorts. While I love a good argument, and while I find it vital to engage in the ‘marketplace of ideas,’ I quite frankly have more important things to do.
A few days ago I saw a gentleman in the ER who had knee pain. He was in his 60s, and I looked at his painful knees; they were rough, and thickly calloused over his knee-caps. They weren’t really swollen, but they were tender.
‘Are you a roofer? Or do you install flooring?’ I asked. I figured he had worn his knees down over years of hard work. I’ve seen it before.
‘No sir,’ he replied humbly, ‘I pray a lot.’
A smile crossed my face, and his. And I told him that was wonderful. I did, gently, suggest that God might also understand if he would pray from a chair, and he agreed with a laugh.
Sitting, typing away in discussions and arguments, posts and reposts, links and counter-links, I think I’m doing something important. And sometimes, it’s true. Truth has to be defended. And yet, as I type and argue, my patient was wearing his knees down in prayer.
God must love that man and his knees. I doubt he’s nearly as impressed by my typing or clever turns of phrase.
And of course, there are other reasons for me to use my time more wisely. They are my wife, and my rapidly maturing children. Time is a fixed quantity. What we give to one thing, we take from another. How do I want to look back on my life? As a man with lots of time logged online? Or as a man who relished and cherished every second of his life with his family? Is it better to share, to link, to friend, or to hug, to laugh, to run, to hide, to play and to talk with the flesh and blood children and beautiful wife before me?
I love social media. I enjoy all of my contacts and friends! And I’m grateful for their ideas, and that they read my own. But let’s all have a little perspective. Let’s all spend a little more time in prayer, in studying scripture. And in loving, fiercely and passionately, the human beings right before us.
Maybe, when the kids are grown, there will be more time for social media. Of course, by then, we should perhaps be praying even more!
It was a particularly thick document.
As I stood and leaned over the stapler to get all my body weight over the palm of my hand, I realised I had assumed a sort of CPR stance. Shoulders over hands. Elbows locked. Bending from the hips.
One hard compression, CLACK-AK, and I checked to see if the stapler had penetrated the breadth of the papers.
Almost, but not quite there. Perhaps a pre-cordial thump was required.
But my extreme stapling pose must have released some muscle memories.
I miss that stance.
I have been taking a sabbatical from nursing for the last few months. Blowing out some rather recalcitrant cobwebs and refilling the sloshings of a tank at low mark.
I have been working on an eHealth project, a clinical portal.
The clinical portal is an application that integrates a whole bunch of discrete electronic patient management systems together in a sort of one-stop-shop for the clinician.
It is interesting work, a great bunch of people, more money than I was earning before and promise of more work and another pay rise at the end of the 6 months if I want it.
And soon I will have to think about letting them know if I intend to stay on. At least a while longer.
My head is telling me to stay. Less stress, more money, regular hours. I get to wear nice clothes to work. I smell nice.
Kelly is also urging me to stay, threatening to beat me repeatedly over the head with the Huon Pine rolling pin that we found on holidays in Tasmania many years ago, if I go back to the madness.
It sits in the top draw under the stove. Easy reach.
But my heart is in the emergency department.
Amongst all the stress and speed and crush. Amongst the daily bullshit battle to deliver quality care. Amongst the crazy as a wheel.
Amongst all that.....there is an inextinguishable incandescence of nurses and doctors and wardsmen and clerical staff who all are bound by that space.
Their work is phosphorous. And I miss them.
To understand the technological implications for medical education – who better to learn from than the real educators, the teachers on the frontline…
Many of the problems we are facing in hospitals and Universities with the use of social media #FOAM and online collaborative resources – are already being tackled in schools with the students. I was able to relate to every issue raised during this rapid-fire presentation and equate it to our current technological translation issue.
Adam Bellow [Twitter - Website] presents his Tech Commandment’s rapid-fire 140 slide presentation at the #140edu in New York. Well worth a watch. Hopefully it will start a new collaboration between medical educators and school based educators.
“We can’t use facebook and Twitter in schools because they are dangerous…it is ironic that some of the greatest sources of education and learning such as YouTube and Twitter are blocked in over 90% of
“Collaboration” is THE 21st Century Skill. Collaboration is the way we have to learn to work together and our students will learn to work together and our students will learn to work together in the future. That is the most important thing we can teach them.”
Today was great day in the ER (sarcasm). I was working triage and we had over 90 patients sign in over a 9 hour period. Working triage means that I try to get labs and x-rays going on the more complex cases and discharge the easy cases. All the easiest cases fell into 2 categories: sick for 2 hours or sick for at least 2 months — except for one case. I called a 42-year-old gentleman back from the waiting room. He took a seat on my triage bed. As usual, I asked “what brings you in to see us today?” ”I don’t feel good.” I then questioned with “Oh, for how long and tell me the story.” He goes on to tell me how he has had cold like symptoms for 3 weeks now and it is not getting any better. He has not tried anything or sought medical care before now. The reason he was coming in to the ER today was that he finally got the day off and did not have anything else to do (this is the normal reason people come in at this ER). So I start my exam. I listen to his heart and lungs. Then I look in his ears with an otoscope. Everything is looking normal – surprise, surprise. I then ask the patient to open his mouth so I can use the otoscope to look at his throat. I position the otoscope, like normal, about 8 inches away from his mouth when I asked him to open up. He proceeds to open his mouth and lean forward placing the entire head of the otoscope INSIDE his mouth and close his lips around it. It looked like he had an extra-large dumdum sucker in his mouth. After I pulled the otoscope out of his mouth, I just sat there looking at the otoscope wondering what I was going to do it. At the same time, I was trying to think how many people’s ears it had been in and how many more people it will come in contact with. I had never seen an otoscope used like a lollipop. I included pictures below to see if you can see any similarities that would make you want to stick an otoscope in your mouth.
Amit Maini (from ED Trauma & Critical Care) and I are working on an exciting new trauma education project. To help with our research we're doing a survey to assess the trauma learning needs of medical professionals from all specialties. If you complete the survey you can go into the draw to win a $50 iTunes, JBHiFi or Myer gift card (Australian residents only eligible for prize, but responses from all over the world will still be greatly appreciated!).
So if you've got a spare 5 minutes we'd really appreciate it if you could take the time to give us your feedback in this easy to complete survey. Thanks!Click here to take the survey. Thanks!
On November 12th, 2012 the 1st International Emergency Medicine Faculty Development and Teaching Course will begin in Baltimore, Maryland, USA. This course is dedicated to helping physicians from outside the US learn valuable skills in faculty development and medical education. Course content is being prepared now, and it is going to be spectacular. Did I say spectacular? Because I meant superb, superior, excellent…you get the point. The faculty at The University of Maryland Department of Emergency Medicine is delighted to be able to bring this exciting course in medical education to fruition and to “share with the world.” The course is going to be a cutting-edge educational extravaganza.
Course faculty includes:
The course is a week-long journey through medical education, teaching skills, and faculty development skills. Participants who come to the course will get lots of perks for attending the course, including establishing a relationship with Emergency Medicine faculty for ongoing mentoring. Course attendees are really in for an exciting, lively, and interactive week.
Here is a glimpse of what attendees will receive and be exposed to during the course:
The course starts on Sunday November 11th with a meet and greet dinner cocktail reception
Small group sessions and short lectures geared towards making you a more effective teacher and more productive faculty member
Exciting, dynamic, award-winning speakers and great topics
Interactive sessions not reliant on Power Point
Sessions on the use of social media in medical education and using technology to teach
Project mentoring-you bring the project, we bring the mentoring
Daily networking lunches where you will meet key players in The University of Maryland System
Course content on a USB drive
Handouts and pertinent articles
1st 10 registrants receive a free Doceri license
Free daily give-a-way prizes
Tours of the University of Maryland Hospital and Shock Trauma
One-on-one mentoring from Emergency Medicine faculty
Course certificate for participation in the live course
Mentoring from faculty even after the course is over and you have gone home
The course is aimed at international emergency physicians but is open to physicians from ANY country. Check out the course website to find out more information and to register for the course.
So, what are you waiting for? Seriously…go to the course website and check out the superb course we are putting on in Maryland.
Hi folks. I am pleased to do another interview with my mate in Cincinnati, Dr Bill Hinckley.
On this episode we talk about AMPA, Air Medical Physician Association. You should all join if you fly or do critical care transport work. I signed up straight after the interview.
We talk about some cool HEMS transport of STEMI patients to PCI research him and his mates have been doing. Here are the abstract links :
Acad Emerg Med. 2012 Feb;19(2):153-60. doi: 10.1111/j.1553-2712.2011.01273.x.
We finish up talking on prehospital USS and an airway trauma case.
Right Click and Choose Save-as to Download the Podcast.
I meant to link to this Storify piece by David Corbet on the remote delegate experience of NOT attending a major medical conference using the social media tools of Twitter and Storify to share and reverberate his experiences.
This is FOAM again – our reach is long, and our message is simple, useful and free.
Mike Cadogan (@sandnsurf on Twitter, http://lifeinthefastlane.com , https://gmep.imeducate.com) is taking mighty leaps for mankind in creating a grand unifying resource for medical education (and particularly Emergency Medicine and Critical Care) by running with the FOAM concept germinated at ICEM 2012 over a pint or two of Guinness. He has coalesced the world of EM/CC blogging here: http://lifeinthefastlane.com/2012/08/foam-emcc-bloggers/
For those who say, “FOAM, what’s that?” I will explain – we believe FOAM is the future of medical education and asynchronous learning, and stands for Free Open Access Meducation
This 53 year old man is an ex-smoker, with HTN well controlled by a single agent. He presented to the ED under duress from his wife and GP with intermittent atypical pain which is sometimes worse with exertion, has a slight pleuritic variation, and radiates to shoulders. He mentions a more severe pain 2 days ago lasting a couple of hours with onset at rest.
Today has one more big announcement for the EM Basic podcast. Today is the launch of the EM Basic App for Apple and Android phones. This app will allow you to stream all episodes of EM Basic and has the added benefit of having the show notes or the articles for the Essential Evidence episodes all in one place.
The cost? Only 4.99 for a great resource to have handy on shifts. Don’t worry- the podcast will still be available for free on iTunes and on this website but hopefully you will find this app useful to your everyday practice. If anything, just know that it will help support the podcast as we start bringing you weekly content. As always, email me at firstname.lastname@example.org with any comments or suggestions about the app.
To access the PDFs for each episode, click the letter “e” in the bottom right hand corner of the episode page.
If you want to listen to a podcast on all of the details about accessing the app here it is:
For Apple users:
Warning- there is no “EM Basic” app in the Apple App store- follow these directions to find the app.
1. Go to the app store and search for “podcast box.” This is a free app that you download onto your device.
2. Once you have installed podcast box, open it up and either search for “EM Basic” on the front page or go to the “categories” button on the bottom, go to Science and Medicine, and click on EM Basic.
3. The app will ask you to confirm the purchase and you will be asked for your Apple ID password. You will be charged as an “in App purchase” and you will get immediate access to everything in the app.
Here is the iTunes link for podcast box:
For Android users:
Warning- I have not yet seen the app function on an actual Android phone. If there are problems, email me ASAP at email@example.com and I will fix it as soon as I can
Here is a link to the app on Amazon.com:
If you need directions on installing apps from Amazon on your Android- go to this link which has a short video and written directions on how to do it:
What better way to spend a weekend than analysing the world of #FOAM in emergency medicine and critical care?
Key pages updated include:
Yes, it is that time of the year again when we update our database pertaining to the world of EMCC (emergency medicine and critical care)
We started the collaboration project back in 2008 when we first reviewed the medical blogging ecosystem – and oh how that landscape has changed. For once where there was an arid land with dry scrub, now doth a veritable forrest grow.
Tor Ercleve 2012
Initially it was easy to find the few medical blogs in active existence and review their content, author and structure. When LITFL was but a seedling, the medical blogosphere was populated with 76 blogs spanning all specialties. These were mainly single author (73) personal blogs (68) with the exception of a few notable education based blogs (such as @DrVes - Clinical Cases blog). Indeed, there were only 9 blogs which ran predominantly educational content and most (56) blogs were written anonymously. In fact there was little way of actually determining either the credentials of the original author or the country of origin of the blog (until the advent of twitter that is…). LITFL followed most of these trends starting out as a personal medblog – sandnsurf.medbrains.net with no way of determining the authors real name or location
The 2012 review has seen significant changes in the medical blogging ecosystem and as a result only includes the rapidly growing field of emergency medicne and critical care blogs and podcasts. Our review covers 130 blogs in 17 different countries.
Such is the rate of growth that our manual data entry of the podcasts has become overburdened to the point of exhaustion and we now have to have submission forms for new EMCC blogs and individual EMCC podcast episodes. We have revamped the searchable podcast database and users are now able to search by blog name, geographic location, language and topic keywords to find the most appropriate podcast for them. We have made a good start on the database with >1800 podcasts now listed!
Whilst reviewing the EMCC blogs and podcasts we have made some significant changes to the way we display the blogroll.
- Addition of Blog based Pages on Twitter, Facebook, Google Plus, Vimeo, YouTube and iTunes
- Addition of RSS feeds and iTunes subscription feeds
- Removal of blogs with no discernable signs of life for >6months
- Updating the podcast database and adding new submission forms for the latest podcasts
Interesting findings form the survey include
- EMCC blogs and podcasts have grown from 67 to 130 over the past 18 months
- Increasing participation and information dissemination through social media
- 77% – Twitter (100/130)
- 42% – Facebook (55/130)
- 20% – Google + (26/130)
- 15% – Media account such as YouTube or Vimeo (20/130)
- …but interestingly 9% (12/130) failed to provide a valid RSS Feed for blog content
- A legal disclaimer now exists on 86% of sites
- An increasing number of blogs (21%) now have multiple authors
- Audiovisual learning is on the rise with 20% of EMCC bloggers employing external multimedia and iTunes
- There is better identification of authors with 94% of blogs and podcasts citing the full name, credentials, contact form and geographical location of blog authors
- Blogging is an increasingly global collaborationwith over 17 countries represented:
- USA (75), Australia (22), Canada (5), UK (4), New Zealand (4)
- France (1), Chile (1), Germany (1), Croatia (1), Italy (3), Spain (3), Ireland (1), Israel (1), Malaysia (1), Latin America (1), Sweeden (1), Singapore (1), Scandanavia (1)
I am not sure exactly why there are so many EMCC blogs in existence, or why they are appearing with such rapidity. Maybe it is because a lot of our work is frontline, public, diverse and altruistic that there are so many stories and so many educational resources being shared freely and without reservation using the language of #FOAM.
If you think we have missed an awesome new EMCC emergency medicine and critical care blog…let us know…
To stop the potential for information overload the next stage is to re-instate the live ’mixed feed‘ from all the blogs. This was initially created using Yahoo pipes and worked well for the first year or so, but was surpassed by the emergence of Medworm and the Feedly embedable unifying feed. Unfortunately Feedly has stopped allowing the iframe embed and Medworm has stopped being updated (and is now not accepting submissions from new blogs).
We are still trying to find a solution to getting back a page which has a single feed for all the EMCC blogs. Any bright ideas gratefully accepted! Our current options include:
vive la FOAM