
EM/EMS physician, EM at @christianaEMed, EMS w/ @GFACEMS, Creator EM Basic podcast-Airway Nerd, Olympic weightlifting, proud supporter of PPP @pppforpatients
Philadelphia, PA
Joined December 2011
- Tweets25.4K
- Following907
- Followers15.4K
- Likes18.9K
To be fair, emergency medicine people are a different breed 😂
The full story here is NUTS 🤯
TLDR dude hikes 6.5 hours to avoid a helicopter medical bill impaled while his friends make kebab jokes…
> 32yo ER nurse named David is day-hiking Montana’s tallest mountain with his boys
> He slips on a rock near the top and full-on impales himself on his own trekking pole that goes clean through his lat with like 8 inches sticking out both sides
> nurse brain kicks in immediately, checks himself, realizes nothing vital got hit and he can still breathe fine
says screw the helicopter bill and just starts hiking the entire 10 miles back down with the pole still stuck in him
> takes SIX AND A HALF hours, friends are spotting him the whole way, one even runs ahead to warn families so kids don’t see this gnarly shit
> about 4 miles from the car they realize they’re actually gonna make it… and start cracking kebab jokes 😂
> dude never complained once, stayed in weirdly high spirits the whole time
> walks himself all the way to the trailhead, gets the pole pulled out later at the hospital, and already says he’s going back next year to finish the summit
This was tweeted less than an hour after Ruth Bader Ginsburg died
May he have the day he deserves
No matter your political beliefs or party affiliation, some moments rise above politics.
Please join me in praying for Senator Mitch McConnell as he faces what may be the greatest battle of his life. In times of illness and uncertainty, compassion should always triumph over division.
May God grant him strength, wisdom, comfort, and peace, and may his family be surrounded by hope and grace. AW
Story time
Young female with lower abd pain- bladder scan checked for some reason- >1,000 mls
Me-that’s odd, grabs POCUS-yup looks like a huge bladder
Foley ordered but ED is busy-nurse comes up later and says “she drained like maybe 20 mls”
Me-what???
Dx: huge torsed ovary
Pointing to the NRBM and oxygen regulator set at 15 LPM as the reason why the patient desaturated during the intubation attempt
The difference between software engineering, aviation, bridge building and medicine is we know how a computer works, how a plane flies, and how to build a bridge 😂
unavailable
Steve Carroll DO MEd retweeted
600 Programs. 39,000 Graduates. 500 Unregulated Hours.
According to U.S. Department of Education data reviewed by Bloomberg Businessweek, more than 600 schools offered advanced nursing degrees in 2022. That is three times the number of medical schools in this country. In that same year, 39,000 nurse practitioners graduated from those programs, a 50 percent increase from 2017.
That explosion did not happen because we found a way to produce better-trained clinicians at scale. It happened because there is money in it. Bloomberg documented dozens of nursing students and professors saying programs are graduating thousands of students not properly prepared to care for patients. Institutions that offer primarily online training gave out the most degrees. The former director of the country's largest NP program acknowledged she could not recall ever denying a single applicant.
NPs are required to complete a minimum of 500 hours of supervised clinical training before licensure. According to Bloomberg's review, those hours are often unregulated. Many online programs do not even help students find clinical placements. John Canion, an emergency medicine NP and one of the loudest reform voices within the profession itself, testified at the AMA State Advocacy Summit that programs have no meaningful oversight of how those 500 hours are spent. He stated that programs cannot confirm whether a student was ever in a clinical setting, sat in a broom closet, or even showed up.
To put 500 hours in context: the Texas Department of Licensing and Regulation requires 1,000 hours of supervised instruction before it will license a cosmetology operator. Someone who will be diagnosing illness, ordering diagnostic studies, and prescribing controlled substances is held to half that standard.
The fastest initial NP licensure programs now run 12 months. Vanderbilt and others openly advertise one-year pathways for BSN-prepared nurses. A physician completing residency has between 12,000 and 16,000 hours of supervised clinical training, built through a nationally standardized accreditation system with no online pathway and no accelerated option. There are no online medical schools. The hours-in-training gap is at minimum 16 to 1.
Many programs now also offer direct-entry tracks for applicants with bachelor's degrees in unrelated fields and no clinical experience, preparing them for licensure in as little as three years. This is not the traditional pathway of an experienced bedside nurse earning an advanced practice credential. It is a production model built around enrollment revenue, not patient outcomes.
When Bloomberg published its investigation, the American Association of Nurse Practitioners responded by accusing the publication of cherry-picking negative information. Attacking the journalism instead of addressing the substance tells you everything you need to know about where the profession's leadership stands on the underlying problem.
“Doctor-like work”
Sigh…
I can’t…
Employers are clamoring for workers who can do doctor-like work but who are trained faster and can cost them less. on.wsj.com/4wOliEy
An anonymous helicopter pilot spoke up and brought this to everyone’s attention and sparked positive change
Their account went dark and the post was deleted- I hope they did not suffer any career consequences for speaking up and advocating for sick children
Laurelhurst community agrees to ‘fully support’ Seattle Children’s helicopter landing efforts kiro7.com/news/local/laurelh…
Steve Carroll DO MEd retweeted
I watched the 1st meeting day of RFK Jr’s handpicked committee of vaccine advisors that encapsulates the proceedings. It was utterly depressing. 1/
This is what a true public servant and hero looks like
Monarez: "On the morning of August 25, Secretary Kennedy demanded two things of me that were were inconsistent with my oath of office and the ethics required of a public official. He directed me to commit in advance to approving every ACIP recommendation regardless of the scientific evidence. He also directed me to dismiss career officials responsible for vaccine policy without cause. He said if I was unwilling to do both, I should resign."
Glad you came around on this
But you could have said this during Trump’s first term as this was the extremely predictable consequence…
😂😂😂
To be fair, his tenure lasted about 10 Scaramucci units
"'Dr. Prasad did not want to be a distraction to the great work of the FDA in the Trump administration and has decided to return to California and spend more time with his family,' HHS spokesperson Andrew Nixon told STAT." 😂
statnews.com/2025/07/29/vina…
Shame on docs who sell out to make a few bucks by doing “peer to peer” reviews for insurance companies
I want you to get out your medical school personal statement and see how it aligns with what you are doing today
If you won’t put your name behind it, you’re in the wrong
I’m sharing an actual recent peer-to-peer call that shows what physicians and patients face when trying to get a surgery approved. This call felt as absurd as it sounds.
The peer-to-peer call was to advocate for surgery to prevent and treat lymphedema for a patient with breast cancer. Her risk is high and we can perform a surgery to lower it.
The doctors from the insurance company on the call were an ophthalmologist with a subspecialty in oculoplastic surgery and a plastic surgeon who currently has a cosmetic practice. Neither doctor has ever performed lymph venous bypass…the surgery I was trying to get approved for my patient.
Neither doctor would provide their name or license number.
At the conclusion of the call, the doctors told me that they didn’t have the power to make a determination or decision to perform the surgery. They were just there to inform me of United’s decision to deny it.
The Medical Decision was not up to the doctors on the call. It had already been made by United.
So here I am, appealing again.
Medical decisions should be made by doctors who are well informed and patient-centered. Patients deserve access to the care that they paid for with their premiums.
Continuing that yearly reminder for every July 1st
For the new interns- Let’s Gooooooo!




















