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Medical Commission Thoughts

Protect Your Eyes This 4th of July

Jason Cheung, MD
Washington Medical Commissioner

Happy Fourth!! Have you ever wondered why we commemorate Independence Day with fireworks each year? Apparently our second president, John Adams, started the tradition. In a letter to his wife Abigail on July 3, 1776, he declared that that the signing of the Declaration of Independence should be a "great anniversary festival" and "solemnized with pomp and parade, with shews, games, sports, guns, bells, bonfires and illuminations from one end of this continent to the other from this time forward forever more." The next year, the Philadelphia Congress was all over it. In the evening of July 4, 1777, the city of Philadelphia was beautifully illuminated with a grand exhibition of fireworks which began and ended with 13 rounds of rockets to symbolize the 13 states. The tradition lived on but little did John Adams know that today’s fireworks can be a medical hazard. 

Firework related injuries spike each year around July Fourth. Of the 10,500 firework injuries that required treatment in the emergency rooms in 2014, as reported by The U.S. Consumer Product Safety Commission, 7,000 (67%) occurred within the one month period between June 20 to July 20, 2014. 
The hands and fingers were, not surprisingly, the most common body part to be damaged, accounting for 36% of all the injuries. The eyes, were the second most common on the hit list – a whopping 19%. The victims were mostly male (76%) and young (35% were less than 15 year old). A consortium of international studies also showed that bystanders were almost as likely (47%) to be injured as the individuals that set off the fireworks. 

The most common ocular injuries related to fireworks are corneal abrasions (42%) and eye contusions (26%). While they can be quite painful, they are fortunately temporary and patients generally recover without any long-term problems. However, life-changing permanent damage such as rupture of the eyeball, retinal detachment, chemical and thermal burns, intraocular foreign body, can occur in up to 18% of cases. 4% of fireworks-related ocular trauma required enucleation (removal of the eye) - a chilling fact for a seemingly benign summer fun. 

Firecrackers are the worst offender, causing 25% of all fireworks-related ocular injuries. They blast off in unpredictable trajectory, with an uncanny ability to land on the eyes. Sparklers can burn at 2000 degrees Fahrenheit, 10 times hotter than boiling water. Children holding them directly in front of their face are at high risk of thermal burns to their eyes. Bottle rockets and roman candles are two other types of fireworks that have a high incidence of ocular trauma.

The American Academy of Ophthalmology advises that the best way to avoid a potentially blinding fireworks injury is by attending a professional public fireworks show rather than purchasing fireworks for home use.
For those who attend professional fireworks displays and/or live in communities surrounding the shows:

  • Respect safety barriers at fireworks shows and view fireworks from at least 500 feet away.
  • Do not touch unexploded fireworks; instead, immediately contact local fire or police departments to help.

For those who decide to purchase consumer fireworks because they live in states where they are legal, the Academy recommends the following safety tips to prevent eye injuries:

  • Never let young children play with fireworks of any type, even sparklers.
  • People who handle fireworks should always wear protective eyewear that meets the parameters set by the American National Standards Institute and ensure that all bystanders are also wearing eye protection.
  • Leave the lighting of professional-grade fireworks to trained pyrotechnicians.

If an eye injury from fireworks occurs, remember:

  • Seek medical attention immediately.
  • Do not rub your eyes.
  • Do not rinse your eyes.
  • Do not apply pressure.
  • Do not remove any objects that are stuck in the eye.
  • Do not apply ointments or take any blood-thinning pain medications such as aspirin or ibuprofen.

Learn from history. Losing eyesight from fireworks is rather senseless. Have a safe and happy Fourth of July!

The Washington Medical Commission (WMC) was recently recognized for its outstanding outreach, education and patient safety efforts by the Administrators in Medicine (AIM) and the Federation of State Medical Boards (FSMB). The Administrators in Medicine, an organization comprised of the executive directors from the 70 medical boards nation-wide, selected the WMC for their “Best of Boards” award. This award honors best practices and recognizes the board for its hard work. The WMC was recognized for its work on revising the opioid prescribing rules and its public outreach work to include a new website and this consumer-oriented newsletter.

The FSMB selected three Commission individuals for awards. Amelia Boyd and Mike Farrell were selected by FSMB for their Award of Merit and Dr. Warren Howe received the John H. Clark Leadership award.

Ms. Boyd was recognized for her work on engrossed substitute House bill 1427 requiring all of the prescribing boards and commissions to create and modify rules regarding opioid prescribing for every type of pain.  Mike Farrell was recognized for his 27 years of exceptional service to the Commission in a variety of capacities. Dr. Howe was selected for his transformational leadership of the Commission as he facilitated the Commission’s rebranding and outreach efforts.

National Health Care Decisions Day: The Importance of Advance Directives

Kathleen O’Connor, Public Member

My friend did not die and if she had it would have been a mess to sort out her affairs. Worse yet, she could have died a death in a manner she did not want or faced extreme measures she would have refused if she were conscious. She is an intelligent and lively person, and luckily has numerous friends. But she was poorly organized. She had no advance directives. Advanced directives usually come in the form of a living will or some type of written document that designates a person to make decisions if the patient is unable or unconscious. Without advance directives no one could speak for her when she could not. She could have died in ways she most feared.

I got the call from Harborview because I was listed as her emergency contact. She was stable but unconscious. The hospital needed to make care decisions. I couldn’t make them legally as I was not her legal representative. I had a key to her home so I went to search for her legal records which she kept in the freezer. Nothing. Only an old address book, a birth certificate, bank account and stock records.

She is one of 63% of Americans who don’t have advance directives. Without them, a person’s death is in someone else’s hands.


I knew what she did and didn’t want in such an emergency. She was 80 and quite clear with everyone about how she wanted to die. Her only sister had died several years earlier and she was not on speaking terms with her ex-husband. They never had children. I, and several other friends, were aware of her wishes if an emergency ever happened. We were all good friends but did not pry. None of us knew anything about her legal affairs. We could not be her legal representative as we were not named. And so, while we were the best of friends, I could not speak on her behalf because neither I, nor anyone else, could legally make decisions for her if she was unable without advance directives.

I knew she wanted an autopsy and wanted to donate her body to science. I knew she did not want to be on life support. However without designating someone to handle those wishes, without advance directives, the hospital had to make those decisions. Without naming someone to be her health representative, people she did not know would make those decisions for her. Those decisions may not be the ones she would have wanted.

Luckily, my friend survived. She is one of 63% of Americans who don’t have advance directives. Without them, a person’s death is in someone else’s hands. Decisions such as: palliative or hospice care, life support, DNR, organ donation, feeding tubes, ventilator and donating her body to medical science would be made by medical staff. Luckily she lived.

Physician offices and hospitals have advance directive forms. Medicare began reimbursing physicians for advance-care planning counseling in 2016, so advance directive can be as easy as your next checkup or you could get a health representative and complete your advance directives as soon as today. has easy-to-read directives. Other organizations, such as Aging with Dignity, promote family conversations by starting with “Five Wishes” they want for the end of life.

My friend is alive and well and has an advance directive. Discuss your advance directives with your loved ones and make sure they are documented.


You’ve Come a Long Way Baby, But Still Have Further to Go!

Karen B. Domino, MD, MPH
Medical Commissioner, Physician at Large


Today (February 3) is National Women Physicians Day, a day to celebrate woman physicians and honor the birthday of Elizabeth Blackwell, MD.  In 1849, Dr. Blackwell was the first woman to receive a medical degree in the United States. She spent her life advocating for gender equality in the medical profession.  After I first read the story of Dr. Blackwell’s remarkable courage when I was a child, her ground-breaking career has always inspired me.  Representation of women in the field of medicine has certainly come a long way since Dr. Blackwell’s time!


Most of the increase in women physicians has occurred since the later part of the 20th century. According to data from the American Association of Medical Colleges (AAMC), only 7% of medical school graduates in the mid-1960s were women. The proportion of women graduating from medical school increased to 25% by 1980 and by 2000 women were 43% of medical school graduates. During the past 10 years, nearly half of the medical school graduating class are women. This vast influx of women has into the pipeline dramatically increased the numbers practicing women physicians, now 36% of practicing physicians (data from the American Medical Association).  Although the top specialty choices for female residents are obstetrics and gynecology, family medicine, pediatrics, and psychiatry, representation of women in surgical and internal medicine specialties is increasing (AAMC).


Despite the welcome opportunities for women in medicine, disparities remain, especially in medical leadership. Women account for only 18% of hospital CEOS, 16% of medical school deans, and 15% of medical school departmental chairs (AAMC). These powerful positions set the mission and control financial resources. A lower proportion of women than men are full professors in medical schools, with more women clustered at the associate professor and assistant professor ranks. Women in academics don’t obtain research grants, publications, and leadership positions at the same rate as men, advancements necessary to move up the medical school pyramid. Women physicians in community practice also tend to earn less than men, even after accounting for specialization and billings. Implicit gender and maternal bias, system-wide policies that disadvantage women, and sexual harassment are thought to have contributed to the gender disparities in medical leadership. Changes in these barriers are essential to increase reduce gender disparities in medicine.


Women physicians can also learn from successful women in business to help reduce gender inequality.  An intriguing article was published last week in the Proceedings of the National Academy of Sciences (Yang, PNAS Latest Articles, Jan. 22, 2019, Epub ahead of print). This study found that successful women didn’t just network like men. Instead, they also relied upon circles of other women for support, advice, strategies, and championing of women’s ideas/accomplishments. Networks of women physicians can improve leadership opportunities for the younger woman now in the pipeline. Let’s celebrate this special day by taking steps to continue to increase opportunities for women in medicine!

The Legacy of Women Physicians

April Jaeger, MD
Representing Congressional District 5