2. Effective Care Resources

• The U.S. Department of Health and Human Services (HHS), Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program website: effectivehealthcare.ahrq.gov,  The National Clearinghouse Guidelines at guidelines.gov site that was managed by AHRQ was closed due to insufficient funding July 16, 2018.  An archive list is available with original links, the titles can be looked up to find the original source provider. The Clearinghouse screened medical practice guidelines for quality and offered summaries and other commentary. I made some copies and will add links as it is organized. Here are the basic categories of primary source guidelines:

Guideline Summary Categories included 15 areas of medical practice:

1. Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . 23 files : Cardiology [archive list]
2. Critical Care  . . . . . . . . . . . . . . . . . . . . . . . 24 files : Critical Care [archive list]
3. Emergency Medicine   . . . . . . . . . . . . . 39 files : Emergency Med [archive list]
4. Family Practice . . . . . . . . . . . . . . . . . . . . 170 files : Family Practice [archive list]
5. Geriatrics  . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 files : Geriatrics [archive list]
6. Infectious Diseases . . . . . . . . . . . . . . . . . 24 files : Infectious Disease [archive list]
7. Internal Medicine . . . . . . . . . . . . . . . . . . 158 files : Internal Med [archive list]
8. Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  47 files : Nursing [archive list, 7/16/18]
9. Obstetrics & Gynecology  . . . . . . . . . .  50 files : Ob & Gyn [archive list, 7/16/18]
10. Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 files : Oncology [archive list]
11. Orthopedic Surgery . . . . . . . . . . . . . . . . . 24 files : Orth. Surgergy [archive list]
12. Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 files : Pediatrics [archive list]
13. Physical Medicine & Rehabilitation . 28 files : Phys Med & Rehab [archive list]
14. Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 files : Psychiatry [archive list]
15. Surgery  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 files : Surgery [archive list, 7/16/18]

• The U.S. Effective Health Care Program reviews research articles on a  variety of medical and health related topics and provides research summaries for consumers, clinicians & policymakers on the topics: [2] 

• The American Red Cross website:  redcross.org/participantmaterials 
• The non-profit organization offers training courses on a variety of health and safety topics. Their course guides are available for purchase in print form or available for free download in pdf form. Topics include: 

1. Administering Emergency Oxygen; 
2. Babysitter’s Training;
3. Basic Life Support for Healthcare Providers;
4. Bloodborne Pathogens Training; 
5. CPR/AED for Professional Rescuers (CPRO); 
6. First Aid, CPR and AED (Spanish versions available); 
7. Life-guarding;
8. Wilderness and Remote First Aid.

• A pdf of the Swimming and Water Safety Manual (2009) by the American Red Cross organization is also available on their website. redcross.org/SwimmingWaterSafety.pdf
• The American Red Cross training for water safety instructors includes basic boating safety information however more frequent boaters would benefit from a more focused course such as those offered by the U.S. Coast Guard. 

• The U.S. Coast Guard boating website offers course guides for several different types of boating and water sports: uscgboating.org/recreational-boaters/boating-safety-courses 

A few safety tips at the most basic level - not intended to replace a boating safety course: 

1. ALWAYs bring life-preservers or other flotation devices in case of a boating accident. Seat cushions in many small water craft are designed to float and may serve in place of a life jacket or other fitted life preserver. Wood and fiberglass float so debris from an accident might float. Whether you can find your life preserver, a seat cushion, or floating piece of debris by the time you need it, is something only Davy Jones may know - so wear your life preserver and if you are the captain of your ship - make your passengers wear theirs too.        My father served in the military and his rule for the car and canoe was that the ship doesn’t move until it is fully prepared - oil, gasoline, windshield wiper fluid, and safety belts fastened for all riders in a car, and life preservers on for everyone in the canoe. We canoe-primitive camped from young ages - like backpacking except with a canoe to haul the stuff between campsites, so easier than backpacking. It was fun. We also all attended swimming classes at the local YMCA starting in the wading pool with bubble floats designed for babies and toddlers. - Everyone can benefit from feeling safe in the water, fears can be overcome with the help of an instructor and practice: "Why you should learn how to swim - it could save your life": (usnews); YMCA, Find your "Y", for locations of a YMCA near you: (YMCA)         When I was a parent driving my own little ones around in a car my father shared his reasoning with me regarding the seatbelt rule - of course the car would "go" without someone’s seatbelt being fastened, at that time. Now seatbelts are automated and cars actually will not work without the driver and passenger seatbelts in place - my father was ahead of his time. Anyway, he said the driver is the most important person to have wear a seatbelt because the driver has to maintain control of the car in case of an accident and there is not time to fasten a seatbelt in most/many types of car accidents - having since tested that theory, I do fasten my seatbelt whenever driving or riding in a car,even if it isn’t an automated seatbelt, but he convinced me at the time to develop better habits since I had such precious cargo on board (his grandkids). He had a firm policy and he stuck with it and shared it, knowing that gravity works, often at speeds faster than your reaction time.
2. If your boat does start to sink or is sinking - don't swim to it. For reference, in case you missed it, see the movie The Titantic. The survivors are the ones who swam away from the sinking ship. Like water swirling around a drain, the sinking ship pulls whatever is in the water nearby along down with it due to the turbulence in the water.
3. Mixing alcohol and water sports can be lethal - you may not care about taking the risk for yourself but do you want to feel responsible if your actions result in someone else being harmed?
4. If you are out on the water and a lightning storm appears on the horizon - don't panic, and do start paddling for shore - the nearest shoreline if the storm is already upon you. You are probably better off in the boat than in the water, especially if you are wearing rubber soled boat shoes or tennis shoes and are sitting on a plastic seat cushion. Metal is a danger in a lightning storm but so is the large body of water surrounding your boat. If you are in the water and lightning is about to strike, take a deep breath and duck under water - good luck. Fish survive because they are under the surface: (sciencenetlinks.com/zapping-fish)

Land bound outdoor recreational vehicles can also be dangerous and safety programs for snowmobiling and other off road vehicles likely exist. 

• At a state level, the Michigan Department of Natural Resources offers a training program for volunteers to be certified as Recreational Safety Instructors. michigan.gov/dnr 

•  A pdf from the Alzheimer’s Association, alz.org, Dementia Care Practice Recommendations for Assisted Living and Nursing Homes. [7] 
• An infographic from casey.org. titled Elements of Effective Practice for Children and Youth Served by Therapeutic Residential Care. [9] 
• A review: Effectiveness and Implementation of Evidence-Based Practices in Residential Care Settings, by Sigrid James, PhD, MSW, Qais Alemi, MPH, MBA, and Veronica Zepeda, BA. [11] 
• An Executive Summary regarding the effective use of psychiatric residential facilities and the best practices to look for when assessing a facility is available in a pdf: Appropriate and Effective Use of Psychiatric Residential Treatment Services by Dave Ziegler, Ph.D. for Jasper Mountain. [12] 

Effective self care can involve learning both the recommendations from research and others’ experiences and learning to recognize internal signals from the body – queasy stomach, wobbly walk, slurred speech, — give the keys to the bartender or close friend and sleep it off. 

Excess alcohol may also cause a depressed mood or a more aggressive mood so recognize that violence or self injury in oneself or a friend may be more of a risk when under the influence of alcohol. Sleeping it off is the safest strategy because coffee or other methods suggested for rapid sobering up have not been found to be truly effective. Roughly, it takes the body about one hour to process an ounce equivalent of hard liquor (5-6 ounce wine, 12 ounce beer) so if it was a twelve pack, then plan ahead and call in absent from the next day’s work, and then maybe turn off the phone to prevent making any other unfortunate calls. 

• For more information see: servingitright.com/alcohol_effects 

 Effective self care can serve as a safety warning when someone recognizes that what they are feeling is similar to what they felt in their body during a previous experience that had negative consequences. An example would be the medications Xanax or Valium, or other benzodiazepines, which may be prescribed as an anti-anxiety medication, however they affect the brain and body very similarly to alcohol and taking a benzodiazepine medication when also drinking alcohol can make the “drunk” symptoms much worse.

• More information on benzodiazepine addiction: webmd.com

One of the topics reviewed by the U.S. Effective Health Care Program is on alcohol use disorder and medications that have been used in research trials for treating adults with the condition: Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings,  effectivehealthcare.ahrq.gov