Joint Base Lewis-McChord, its affiliated clinics and dental clinic are located at Fort Lewis, Washington, near the city of Tacoma. Madigan AMC is one of only three designated Level Two trauma centers within the U.S. Medical Command.

Tacoma is a progressive city of 200,000 nestled between Seattle and the state capital of Olympia. The region offers the attractions of larger metropolitan areas, with a hometown feel. World-class museums, hotels and theaters draw thousands to downtown Tacoma while the shores of the Puget Sound and Mount Rainier inspire outdoor enthusiasts. The Broadway Center for the Performing Arts, Chihuly Bridge of Glass, Emerald Downs Racetrack, Emerald Queen Casino, Fort Nisqually Living History Museum, Lakewold Gardens, and the Mount Rainier Scenic Railroad represent a small sampling of the region's varied entertainment options. The city offers excellent schools, universities, parks, festivals and regional shopping centers.
Tacoma-Pierce County Chamber of Commerce
Madigan Army Medical Center
Joint Base Lewis McChord

Duties:

MAJOR DUTIES:

1. Conducts a variety of polysomnography tests: Nocturnal polysomnography (NPSGs), Split Night Studies, Maintenance of Wakefulness Test (MWT), Multiple Sleep Latency Test (MSLT), Positive Airway Pressure Titration (PAP), Actigraphy, Upper Airway Pressure Monitoring, Oxygen Titration and Portable Studies.

Prepares, calibrates, interfaces, and operates all equipment used in polysomnographic procedures. The equipment will include 32 channel polysomnographs with both AC and DC amp1ifiers; computerized non-invasive monitoring system for multiple simultaneous physiological measurements of sleep and respiratory parameters; computerized non-invasive scoring system for analysis of sleep and respiratory parameters, non-invasive respiratory induction plethysmograph to measure rib cage and abdomen compartmental volume excursions; pulse oximeters and respective strip chart recorders; analyzers for oxygen saturation and carbon dioxide levels; continuous positive airway pressure system: air and oxygen flow meters; vacuum pumps; rigidity meter and mercury strain gauge; video tape recorder, monitors, sequential switcher and zoom lens controller; esophageal influx meter and probe; advanced high performance microprocessor and peripheral hardware; and, other specialized equipment required to provide diagnosis of sleep disorders. Applies advanced ventilator techniques such as continuous positive airway pressure (CPAP).

Explains procedures, and positions patient to insure patient comfort for optimal recording of EEG. When possible, anticipates and corrects patient discomfort, mechanical and electrical interference (artifacts). Scans and examines environment of recording to detect and eliminate possible sources of artifacts, recognizes artifacts as they occur in real time; works rapidly to diagnose and eliminate artifacts, in order to preserve the integrity of recording. Employs established sterile techniques when conducting polysomnography procedures in Intensive Care Units. Selects from a wide variety of electrodes and determines the best suited for each individual case situation. Recognizes artifacts, patient movements and diagnostic findings and makes changes in recording techniques and parameters to optimize display of the phenomenon in question.

Monitors patient, diagnostic equipment, recording and video equipment throughout the night; obtains artifact-free data and tracings; record significant observations such as sleep stage, heart rate, respiration rate, oxygen saturation level, body position; presence and/or absence of sleep apnea, snoring, nocturnal myoclonus, nocturnal seizures, bruxism, cardiac arrhythmias, night terrors; maintains proper equipment function and data collection; responds appropriately to all situations involving patient care; maintains proper oxygen and CPAP setting. Sleep stages PSGs in real time (i.e., as the test is occurring) with greater than 90 percent accuracy to laboratory standard. Is capable of measuring for and adding additional EEG electrodes as requested for seizure montages or other non-routine scalp electrodes. Organize and prepare completed patient chart, tracing and other significant data, and present to chief technologist and medical director.

Removes all electrodes and transducers from patient upon termination of study. Cleans, disinfects and sterilizes electrodes and all other equipment used during the study per laboratory standards. Posts calibrate all the equipment used for the polysomnographic procedure. Makes minor repairs to equipment used for sleep disorders evaluation.

Distinguishes artifactual and cerebral sources of encephalographic findings. Annotates any changes in recording parameters or conditions on the test tracing as they occur. Recognizes clinical manifestation of different types of seizures as they occur and performs behavior testing to assess the degree of responsiveness during the recording. Annotates seizures, abnormal sleep behavior and significant respiratory events on the electroencephalographic records in real time (i.e., as the test is occurring). Performs multiple sleep latency tests, and polygraphic overnight polysomnography (i.e., simultaneously monitoring two patients for polysomnography or one patient on long-term video EEG seizure monitoring and one undergoing polysomnography).

Recognizes sleep apnea, sleep movements, nocturnal seizures, and parasomnias such as nocturnal myoclonus and rapid eye movement (REM) behavior disorder; makes adjustments in recording parameters to optimize performance of sleep studies. Instructs trainees and fellows in polysomnography techniques.

2. Performs operator maintenance of EEG equipment (e.g., disassembles machine, cleans and oils parts and makes repairs or replaces parts) as required. Sharpens, cleans and sterilizes electrodes.

Interprets data obtained from all night recording. Analyzes approximately 1000 pages of information for sleep stages (according to the Rechtschaffen and Kales Sleep Scoring Manual); heart rate and arrhythmias; respiration rate and pattern; oxygen saturation level; pH level; myoclonic activity; seizure activity; thoracic and abdominal movement pattern; tidal volume changes, tumescence activity; EOG activity; bruxism; specific EEG patterns; awakenings/ arousals; and other significant observations. Inputs information into a computer for complete analysis and summation of data. Delivers summaries to clinical coordinator or medical director. Explains any deviation from standard operating procedures.

3. Calibrates and maintains in proper working order complex respiratory equipment such as mechanical ventilators, oxygen analyzers, pulse oximeters, capnographs, respirometers, blood gas analyzers, co-oximeters, and percussors.

Applies a good understanding of the basics of aseptic technique to avoid infection of patients and self, utilizing universal precautions. Employs various bacteriostatic agents and techniques to clean, disinfect, and sterilize equipment.

Maintains established stock levels of supplies, assists with the ordering and pick up. Maintains work area in clean and orderly condition.

4. Participates in continuing in-service education programs for departmental employees. Attends and participates in professional meetings and workshops to develop an awareness of new techniques and procedures. Upon approval, will independently experiment with alternate and revised methods and procedures to improve techniques.

Greets patient and reviews study process. Prepares patient for electrode and transducer application. Applies electroencephalogram (EEG) electrodes based on the International 10-20 electrode placement system. Applies electro-oculogram (EOG), electromyogram (EMG) and electrocardiogram (EKG) using Rechtschaffen and Kales standardization manual. Applies thoracic and abdominal transducer; SAO2 pulse oximeter ear or finger probe; mercury strain gauges; pH probe; nasal/oral electrode; and, other diagnostic electrodes and equipment. Ensures patient comfort and proper function of applied electrodes and transducers.

Prepares and organizes patient rooms with supplies and equipment required for appropriate polysomnographic procedure and electrode application. Prepares and organizes patient charts with all the appropriate forms and questionnaires.

5. Acts as shift leader on a rotating basis and prepares patient assignments for other therapists, dividing workload and assigning other tasks as necessary. Makes independent judgment about coverage of emergency situations within guidelines provided by supervisor.

Performs other duties as assigned.