tgokh

Not the OP, but having worked on the EMS side of a fire department, I can give some insight (though my department was much smaller than OP's):

1) Usually each fire engine is staffed with 3-5 firefighters. A minimum of four is really idea, but due to staffing/budget issues, many departments only have 3 people on each engine. The crew on each engine is usually one chauffeur/engineer/driver (who drives the fire engine and operates the water pumps), one officer (in-charge of the crew), and one or more general firefighters.

In most departments, each crew of 3-5 works for 24 hours and then has 48 hours off (or 24/72, or something similar), there are multiple groups of firefighters that all work on the same physical fire engine. Today, the "A shift" crew of Engine 1 might be staffing the fire engine numbered 1, but tomorrow, a different "B shift" crew will staff the same engine and operating under the name "Engine 1"

On a somewhat related note, the organizational/command structure of the fire department depends largely on size. My department/county had several on-duty battalion chiefs who each oversaw a handful of engines/trucks. FDNY, on the other hand, has ~50 battalion chiefs, each overseeing ~6-10 fire crews, and has higher organization into ~10 divisions and 5 borough commands.

2) It depends on the type of fire/call. If it's an automatic fire alarm or medical call that comes in 20 minutes before shift change, the out-going crew is expected to run the call to completion. However, if there's a large fire/major incident, the command staff usually coordinates shuttling of crews on and off scene to maintain adequate staff on scene, but get tired crews home and fresh crews there.

3) For any large fire, multiple fire engines/trucks from our department will be dispatched. There are standard protocols that determine how many and what types of units are dispatched for each incident. If the needs of the call overwhelm our department, or if the incident is close to our jurisdictional line, the command staff on the scene can call for mutual aid for neighboring departments. Most fire departments have automatic aid agreements with neighboring cities/counties so that the dispatch centers can talk to each other send the needed units

I believe the apps only pull whatever information is in the barcode on the back of the idea - only law enforcement can actually check the ID against the DMV database.

I scanned the 2-D barcode on my license using a generic barcode reader on my phone, and it's a PDF417 barcode that contains all the information that's printed on my id (number, name, address, license type, physical descriptors, dates, organ donor) as well as a few other fields (revision number of the card format, and an inventory control number that looks like the concatenation of the DL number, state name, license type, and some other fields)

A Holter is essentially an EKG that's left on for a longer period of time. If a patient is coming in with chest pain and your want to evaluate for a heart attack, you really just need a single EKG (and ideally, an older EKG to compare to) to look for the characteristic EKG changes, and blood work to look for signs of damage to the heart muscle. It's really an instantaneous yes/no decision since if the answer is yes, you're likely going to the cath lab or the operating room within minutes (we're often judged on our "door to balloon time", meaning the time from the patient entering the ER to the time the stent is deployed in the heart)

There are other heart conditions that manifest intermittently for which a Holter can help diagnosis. There are a few companies out there working on innovative approaches to make the Holter less cumbersome -- I think iRhythm's ZIO patch was the first on the market and there's several more now. There also some interesting evidence that more subtle signs in the EKG or even unrecognizable-to-humans features of the electrical signal can help proactively predict heart attacks before they happen, but I think that's not yet validated or ready for clinical use. If those type of metrics/analyses prove useful, you could make a case for using Holter-type monitoring to identify a heart attack before it happens

You're spot on with your previous post, but just wanted to add a note to anyone reading that if you've been having intermittent chest pain or discomfort for weeks/months, it still could be a heart problem (or reflux or a host of other things) that needs to be checked out. You could have a partial blockage of a coronary blood vessels (the blood vessels that provide blood/oxygen to the heart muscle itself) that provide insufficient blood flow, either when you're active, or randomly.

(this is not medical advice!)

Cool product -- especially like the idea of medication reminders in the watch. Is the silver thing on the face of the watch the second electrode for your EKG?

My undergrad degree's in biomedical engineering, and I've been a self-taught coder since middle school. I'm currently pursing my PhD in engineering in addition to my medical degree, and working on using computational simulations and analytics to improve our understanding of how electrical abnormalities occur in the heart. I've always been interested in startups but haven't actively been involved in one. My goal is to work in a academic setting where I do both clinical medicine and research, and hopefully help translate research work to the clinic by working with startups that are my or other people's research findings.

It's probably worth going to a doctor to get an EKG and get checked out. If your heart beat is irregular (either the time between beats seems random, or you have pauses or early beats), it could be a sign of an electrical disturbance in your heart.

(this is not medical advice - go see a doctor!)

While a low reading on one of those meters (coupled with symptoms) is likely a good sign that something's wrong, I think it's quite possible for the pulse oximeter to read normal even if you're having a heart attack. There's a saying in medicine that "time is muscle" because the longer you wait to "fix" an obstruction in a coronary artery, the more likely that region of heart tissue is to die. However, tissue death is not (usually) sudden, so even if you're experiencing a significant heart attack, the heart may be pumping sufficiently and the lungs functioning normally to give you a normal oxygen reading

(this is not medical advice)

I'm assuming you mean people can be having an MI, or experiencing angina for quite some time, not actually in cardiac arrest

A lot of people equate a heart attack with cardiac arrest, where the heart actually stops pumping blood and the patient suddenly collapses, but in reality, a heart attack refers to a complete blockage of blood flow to part of the heart, and is sometimes colloquially to refer to inadequate blood flow (the term is never really used clinically).

Also, heart attacks can present very differently in different people. A large number of people (especially women) have atypical presentations that may not include the classic sub-sternal chest pain, so the symptoms often get ignored or missed.

Definitely agree with this. Figure1 is great for focused learning, but Twitter has allowed me to hear about random clinical pearls, interesting cases, the latest research, and the ensuing discussions between active clinicians.

Depends on what content you're looking for, but off the top of my head, here's a variety of type of EM-related people/accounts. The first two are teaching resources. The rest are active (both clinically and on Twitter) clinicians or EM-focused students.

@emcrit

@epmonthly

@MDaware

@precordialthump

@seth_kelly

@mcsassymd

anything tagged #FOAMed (Free Open Access Medical education – often has an EM focus)

It may not necessarily be the best option for the OP's daughter, but it is possible to do a PhD that uses data science as a tool rather than the focus. There's a lot of interesting work going on in academia using data science in a variety of fields (like medicine) related to predictive analytics (predicting hospital readmission, predicting therapy outcomes), time series analysis (analyzing EKGs, and other vital sign data) etc. A masters would likely allow you to work on similar projects, but if the goal is a PhD, there are certainly application rather than theory focused research groups across the country