Geriatrics and the GEMS Diamond

The process of aging is often misunderstood. Some clinicians are fantastic at working with older populations while others find it challenging. The GEMS diamond is an easy way to remember key elements when working with geriatric populations.

First and foremost, it’s essential to remember that older patients have many of the same thoughts, ideals, and motivations as younger adults. They enjoy independence, freedom, and autonomy. Treating them as children is one of the greatest mistakes any practitioner can make

The GEMS Diamond is an easy acronym to remember the following four points when assessing an older patient:

  • G – Recognize the patient is a geriatric patient and keep in mind they often present atypically. Remember that they deserve respect (as with all patients), and anticipate the presence of normal changes that present themselves with the natural aging process.
  • E – Environmental Assessment. Take a quick look at the patient’s home or surroundings. Is the home well kept or is it cluttered and dirty. Is there adequate heat present? Is the exterior of the home in need of major repair? Is the home safe and secure? Take a quick look around for hazardous that may present themselves like unventilated oil and gas heaters, broken windows and glass, excessive clutter. Does the place smell like feces, urine, or rotten food? If there are pets do they look like they’re well taken care of? Is the place riddled with empty liquor bottles (remember, alcohol is the number one drug of abuse in geriatric populations). Are there medication bottles laying around and are these out of date (keep in mind, poly-pharmacy and drug interactions are a major concern for older patients). If the patient has a caregiver or is residing in a nursing facility, does the care appear to be adequate for the patient’s needs? Is the patient sequestered to only one part of the home? Watch for signs of elder abuse.
  • M – Medical Assessment. Most geriatric patients have a myriad of health concerns which makes assessing them intrinsically more complex. Often times chronic ailments mask acute signs and symptoms, so vigilance on the part of the practitioner is essential. Getting a solid medical history from all geriatric patients is essential, regardless of their chief complaint.
  • S – Social Assessment. Does the patient have a social network? Humans are social beings and being social is important to our health, wellness, and survival. Lack of social interaction often leads to depression which is more common than you think in geriatric populations. Look at things like how the patient is toileting, dressing, bathing, and eating? Is the patient able to take care of themselves and if not, are they being adequately taken care of by their caregiver? Is the patient getting enough food? Do they have regular access to food and bathing? Ask the patient and also do a critical assessment.

Geriatric patients have special needs that need to be managed in a mindful and graceful way. If you approach them with an attitude of patience, caring, and compassion you will be well on your way to making a profound positive impact in their health, welfare, and lives.

Endotracheal Intubation – Is it in my patient’s best interest? How can I tell?

Endotracheal Intubation is the gold standard when it comes to securing a patient’s airway. Intubation is a specialized skill that requires repetition and practice to become proficient at, but knowing when to intubate, and sometimes more importantly when not to intubate, is even harder.

When evaluating if intubation is appropriate we ask ourselves questions like:

  • “Do I need to place an endotracheal tube in order to protect this patient’s airway or will a less invasive airway adjunct work as well or better?”
  • “Do I need to tube this patient because I predict they will have an upcoming complication?” (such as inhalation burns injuries)
  • “Do I need to intubate this patient to obtain an airway for them?”
  • “Does this patient need to be intubated in order to maintain their airway?”
  • “What if I can’t intubate and can’t ventilate? What then?”
  • “Is intubation going to cause more harm than good?”

Dr. George Kovacs is an industry leader when it comes to airway management and one of my favorite mentors. In this lecture he helps answer many burning questions about airway management. If you’re interested in exploring the human and psychological factors surrounding airway management you will most likely find this lecture invaluable. Enjoy and please let me know what you think.

Ebola Virus Cure?

When querying a cure for Ebola, many looked towards the world of imunology. Very few envisioned an Ebola Virus filter, yet company in San Diego just successful treated a critically-ill patient with Ebola.

The Hemopurifier was used in the treatment of the patient at Frankfurt University Hospital. It was reported that 242 million copies of the Ebola virus were captured within the filter during the patient’s treatment who now remains Ebola free.

Aethlon will soon begin the first U.S. clinical studies of the device, which can also be used to treat HIV and Hepatitis C


Desolation Sound, Nunavut, Canada


Durban Island in Desolation Sound is a rare and beautiful place to visit. A former D.E.W. Line site, Durban Island (also known FOX-E) is one of the most remote places on earth. Although even in July the backdrop is barren and half frozen, the area is actually teaming with wildlife like Narwhals, Walrus, Seal, Goose, and of course the ever popular Polar Bear. In the photo above our friend Annie prepares barbecued seal amidst a world class backdrop.

Ebola in Newfoundland

With the world still struggling to understand Ebola infections and if they’re truly leveling off or if we’re just becoming desensitize to the gross media attention, Newfoundland health officials continue to prepare for the worst. “Most of the equipment that’s required is already on site.” Says Minister Steve Kent “There’s more equipment that’s ordered, that’s on the way. That’s expected next week. So this is an evolving situation. And it’s one that’s changing daily. Training is a high priority and it started several days ago throughout our health system.” A few odds and ends are still on back order, but that’s to be expected given the fact everyone on the planet is currently trying to order this gear from a limited number of suppliers at the same time. Dr. Faith Stratton, Newfoundland’s Chief Medical Advisor, continues to claim the risk of an infection is low, but the potential severity of an outbreak in the Province would be devastating.
 Published on Jun 26, 2014
VICE News Exclusive: Part 1 of “The Fight Against Ebola” –

*West Africa is being plagued by a new outbreak of Ebola — a terrifying disease that causes its victims to bleed to death from the inside out. Ebola has no cure, and the latest epidemic is spreading fast.

**VICE News visited Liberia, where many feel the new outbreak began, borne from the bushmeat markets of Lofa. Western scientists feel that the consumption and preparation of meat from monkeys, fruit bats, and other forest animals is behind the transmission of Ebola, and possibly a new supervirus, which if left uncontrolled could kill a third of the world’s population.

Snowkite Nunavut catches wind in the Canadian Arctic

Snowkiting in the windy Hamlet of Pangnirtung Nunavut

Published Monday, March 04, 2013

Dozens of multicoloured kites zigging and zagging across Pangnirtung Nunavut skyline belong to the territory’s fastest-growing crew of adventure-sport enthusiasts: the snow sailors.

“We get some pretty good winds here in Pangnirtung. You get yourselves on skis with a parasail and go floating around the fiord,” said hamlet administrative officer Ron Mongeau about the fastest growing adventure sport on the planet.

“Sometimes you’re down on the ice, sometimes you’re up in the air.”

Snowkiting brings more and more new participants every year, but the speed, remoteness and relative newness of the sport mean the hamlet’s youth committee wanted to partner with a pro instructor to teach a safety “crash” course and work with the organization in developing a world class annual wind-sports festival in the tiny community.

“We’re making sure that anyone who’s going to be out on the fiord snow-sailing has basic first aid,” said Mange.

Martin Hanzalek, lead instructor at the Newfoundland Snowkite School, has travelled extensively throughout the Canadian Arctic teaching wilderness first aid programs, ice safety courses, avalanche awareness programs, and snowkite workshops and clinics. He was on the ice last week teaching a dozen or so Pangnirtung snow sailors. Before that he was doing the same thing in Iqaluit.

Beginners don’t put their skis or snowboards on initially when learning the basics of snow-kiting. They first need to learn how to control their kite. Once comfortable with basic flying, they slip into their snowboard or skis and start working with the wind allowing their kite to propel them along the ice and snow. Once the basics are learned the sky is literally the limit. Snowkiters can start catching a little air off a snow drift, riding in stronger winds with larger kites, and even using the kite to pull them up the various snow covered slopes that backdrop Pangnirtung and the entrance to the National Park.

“There’s a really active group here,” Martin Hanzalek said about the increasing popularity and momentum growing around the “none-consumptive and self-propelled” mode of Arctic travel. “Pangnirtung as a venue is one of the nicest places on the planet to take advantage of the sport.”

With Auyuittuq Park as a backdrop, reliable wind conditions, and new regular air-links between Baffin Island and Greenland, the sky’s the limit for the popularity of the sport and special interest groups are taking advantage of the opportunity every year. Hanzalek says his group is looking at creating a joint partnership between Canada and Greenland to conduct a snowkite expedition across the Greenland ice cap which will tie in cultural elements between the two Arctic communities. 

“There are a lot of exciting ideas in the plans,” said Martin Hanzalek, giving one example of how every spring a dozens of people snowkite the prevailing winds across Greenland during optimal conditions in the spring. “It’s a fantastic way to see the planet’s second-largest ice cap and connect with some of the communities.” says Hanzalek.

The adventure sport could have potential adventure-sport-tourism spinoffs for Pangnirtung. Many who do the Greenlandic sojourn by snowkite already fly there via Iqaluit, where colourful sails are already a common sight on the bay. In Pangnirtung, Mongeau even sees the possibility down the road of a snow-kiting festival.

“It has really created a buzz in the community,” he said. “Every year we’re trying to attract more and more youth to it. It’s very popular right now and we’re really hoping it’s going to continue to grow.”

Some videos and more information about snow-kiting in Pang can be found on Hanzalek’s blog and on the hamlet’s website.

Organic Farming in Eastport Newfoundland


Newfoundland Organic Farm reviews consistently rated the produce at Eastport Organics as some of the best in the province. Jason Bull, owner of the organic farm, uses 100% natural inputs to cultivate fantastic produce right here in Newfoundland on the Eastport Peninsula. “You wouldn’t see me anywhere close to a greenhouse” says bulk as he waters the spinach and mustard greens “I grow everything from seed and I am super careful when handling the plants. If a plant gets stressed it won’t taste as good. I keep my plants happy”.