Wednesday, August 29, 2012

It's war

So I sat through a class this week that has been given to all military personnel for the past through years, called Tactical Combat Casualty Care (TCCC). The course was being taken by a variety of students, including two cops, five paramedics, two paramedic students, six firemedics, and a prepper.

The instructor introduces the course, and says how topical and important it is, because of spree shooters, and how they present a great risk to rescuers. He then mentions that the recent shooting in New York, and holds it up as an example of why the course is so important.

So I pointed out to him that 10 of the 11 people shot in the incident were shot by the responders. He argued with me and told me how wrong I was, until another student backed me up. His comment at that point was "Oh well, casualties of war."

That is the mentality that is present in the police force, summed up in one conversation.

Friday, August 24, 2012

Taking ownership

One of the struggles that I have as an EMS educator and as a practitioner is laziness. That is, too many people in the medical field want to take the easy way out. They want to do the minimum that will not get them fired or sued, and then move on to the next task.

I have seen incompetent doctors, paramedics, nurses, and other supposed professionals do what is in their own best interest, and not what is in the patient's best interest. In many cases, that means blindly following some algorithm or procedure, without applying even the smallest bit of thought to what is actually going on with the patient.

As an educator, I even see this all of the time. Paramedic students who are being asked to learn the underlying physiology and mechanisms of a patient, to better treat and help that patient, frequently complain that the class is too hard. They just want to learn protocol. They want to practice cookbook medicine.

I teach paramedic classes at a two year, private college. As a part of ongoing QI, the school looks at a list of data. They look at the passing rates of graduates taking state board exams, the completion rates of the students taking the courses, and they also do a quarterly opinion poll where the students get to rate the instructors. There are four instructors who work in the paramedic education department.

In this poll, the students complained that two of the instructors simply read the power points to them. I always hated that as a student, and I have always tried to avoid that. I really believe that the instructors who teach that way are doing so because they are not familiar with the material.

The complaints in the poll about my class were that it was too difficult, that they only want to learn: "if you see symptom A, give drug Y" and not have to learn anything about the underlying processes. I was told by the department head that I have to "dumb down" my classes, so that the poll numbers look better. It looks like I will have to teach cookbook medicine from now on.

I am ready to go back to the clinical environment. I have been teaching for eight years, and retired from paramedicine for 9 months. I am ready to get out of academia.I don't want to create technicians, I want to create professionals. It looks like I am trying to deliver a product that no one wants.

Sunday, August 19, 2012

Getting help doesn't make you a threat

2003

Three minutes after the initial call to 911, we arrived at the front of a small, well-kept house, a typical one for the area. There are toys scattered about the yard, undoubtedly left there by a small child.

The first through the door, I arrive in a rush and take in the scene. Even now, nine years later, that image is burned into my memory as clearly as if it were yesterday. There is a small child lying on the couch in the living room, a small pitiful figure, his skin is a mottled gray. He is covered in water and appears lifeless.

An adult male is standing next to the couch. He is soaked from the waist down, his clothing disheveled; his eyes red-rimmed, he looks like a wild man. I will not find out that this man was the child’s uncle for another fifteen minutes.

I pick up the child, and he is cold. He does not stir, even when I harshly pinch his arm. I move to the door, to the safety and privacy of the truck.

On the way out to my ambulance, I quickly look him over. He is about three years old, 12 kilos or so. Lying lifeless in my arms, he doesn't appear to be doing very well. He isn't breathing and has no pulse. My mind already computing drug dosages and accessing protocols, I reach for my radio and called in a “code” to the dispatch center.

I place my lips over the child's mouth, and give gentle breaths. Chest compressions. Breaths.

We arrive at the truck, and I select the proper sized ET tube, and slide it down his throat. My partner begins squeezing the bag, and I start an IV.

I place him on the monitor, and I note that he is in asystole. Not good.

I knew then that we had already lost the battle.

As the helicopter flew away, taking with it the small, pitiful body once so full of life, so precious to all who knew him, his Uncle approached and asked me what he should tell his brother. He wanted to know how to tell a man that his baby boy drowned in a backyard pool while his Uncle took a shower.

I was in therapy for that call for a while. It was hard to deal with. I even took anti-depressant medication for about 6 months. It was tough living with the ghosts of that call. I still get teary eyed sometimes when I think about that day, about what I could have done differently. Normal reactions, I think, to such a tragedy.

There are those who would deny me the right to own a firearm because I feel pain at the loss of a child. They wish to see people lost their rights without a hearing or a trial, simply because I sought help when I needed it. Millions of Americans seek therapy, or take anti-depressants, and own firearms. None of them killed anyone yesterday.

Saturday, August 18, 2012

Robin Hood

So there is this member of Spain's Parliament that uses his immunity to become a self-styled Robin Hood, claiming to rob the rich to give to the poor. Of course, he ignores the true story of Robin Hood. You see, Robin Hood didn't rob from the rich to feed the poor, he robbed from the government and returned the money to the people.

The very antithesis of Socialism.

Friday, August 17, 2012

TSA self justification

The TSA claims that they have confiscated a large number of dangerous articles, including 821 firearms; a live 40mm high explosive grenade; a bottle wrapped in black electrical tape and filled with flash powder, three M-80 fireworks; a black powder flask filled with 5oz. of black powder; an explosively-viable cannonball; a live blasting cap; and a grenade launcher.

Of course, the picture that they provided was of four different handguns. I am betting you that most of this article is complete bullshit. Why does the media only report what they are told in press releases, instead of going out and doing some investigative reporting?

Wednesday, August 15, 2012

Vacation

This is a prescheduled post. I left for vacation yesterday, to stay on the beach and do some sightseeing and SCUBA diving. This is a mini-trip. I will be back by Thursday evening.

Sunday, August 12, 2012

Signs, everywhere signs

Florida Hospital is a large chain of hospitals located in Florida. In fact, with 22 campuses located throughout the state, it is the largest chain of hospitals in Florida. A non-profit hospital, it is operated by the Seventh Day Adventist church. There are many things that the hospital prohibits on their campus, such as pork products. They are so strict, that the lease for the portion of land that is leased to Wendy's  prohibits the restaurant from serving bacon or ham.

Every one of the hospitals is posted with the following sign:


The sign is misleading. Chapter 790 only prohibits weapons and firearms in a pharmacy, and even so, law enforcement and those licensed to carry concealed weapons are exempt. Since you are prohibited from carry firearms unless you fall into either of those categories, that particular law is redundant. There are no laws prohibiting a person with a concealed weapons permit from carrying a weapon in a hospital, nor do signs carry the force of law in this state.

Even so, the law prohibiting weapons in a pharmacy does not extend to the entire hospital, just to the portion of the hospital that is the pharmacy. This sign is deliberately misleading, which indicates to me that the SDA church is being less than honest when it comes to this signage. 

I ignore the sign and enter with my weapon anyway.

Saturday, August 11, 2012

Cops are still a waste of money

Being retired, I still speak with quite a few of the people that I used to be professionally associated with. I was speaking with a Deputy Sheriff who was telling me a story that I cannot believe.

First, let me set the stage: There is a neighborhood in Osceola County Florida called Buenaventura Lakes. Locals refer to it as BVL. The BVL community continues into Orange County, but whichever side of the county line you are on, BVL is a high crime area where the majority of citizens don't speak English as a primary language, murders and other violent crimes are common, and the reality police shows have filmed more than one episode. Gangs are prevalent, and you don't want to be caught in this area after dark. The western edge of this area was my primary response area for eight years. I saw more than a few serious crimes in that area.

Early one recent morning, the Osceola County Sheriff's department was responding to the report of a dead body in the road in the vicinity of BVL boulevard and  Osceola Parkway. After a thirty minute search, they located the body in the middle of the road, but the body was located a half mile north of the Orange County line, where BVL Boulevard becomes Landstar Blvd. This means that the body was clearly outside of the jurisdiction of the Osceola deputies. The man had been killed elsewhere, and then dumped from a moving vehicle into the road. The deputies decided to secure the crime scene, call the Orange county Sheriff's department, and wait to turn it over to them, so that the Orange deputies could work the scene.

They were told that the Sheriff's office doesn't work dead bodies in the road, because this was likely a pedestrian accident, and that the deputies should call the Florida Highway Patrol. The Orange sheriff's office said they didn't have the manpower. Calls the SO also doesn't respond to, due to lack of manpower: Reports of shots fired, suspicious persons, auto accidents, noise complaints, and other "non serious calls."

Orange county Sheriff's office is the department that wouldn't investigate when checks were being stolen from my mailbox and being deposited in the thief's bank account, and they cited manpower issues. It appears as though those issues have not subsided.

Except that I drove six miles to work yesterday, and I saw no less than six motorists get pulled over for traffic offenses. The Orange County sheriff's office doesn't have the manpower to respond to a dead body in the middle of the road, but they can sure as hell write you a $254 ticket for running a red light.

Thursday, August 9, 2012

Threats

So I was one of the evaluators for a class of paramedics. This was not a class that I had a lot of contact with, because I was gone to grad school during most of their time there. I think that I may have covered three or four lectures for that class, and that is it.

Anyway, for the final, there is a written exam and twelve practical stations. There are stations that evaluate a candidate's knowledge of cardiology, ACLS, and general medicine. Two of the stations are proctored by physicians, and the physician walks you through a medical scenario to see if you know your stuff. One of the students failed one of these physician medicated scenarios, and I went to explain to him that he had failed, and why. Once this is complete, we give the student a chance to try another scenario. A student can fail two stations and retest them. Fail three, or fail the retest, and you fail the entire year of paramedic school. While I was explaining this to the student, he got angry and belligerent, and began yelling at me. I didn't feel like dealing with it, so I told him that he would have to speak with the director of the school.

The next day, I was told to retest him. During the scenario, he stated that he wanted to give Dopamine. Since Dopamine is given as an IV drip, I asked him how to mix and administer the drug. He said that he would add 400 mg of the drug to a 500mL IV bag, and this would give him a concentration of 1600 micrograms per mL. The problem is that this results in a mixture that is only 800 micrograms per mL, meaning that the drug was mixed incorrectly at half strength. When I told him that he failed because he mixed the drug incorrectly, he began yelling at me and told me that it was unfair to give him a problem where he had to do drug dose calculations, and accused me of failing him on purpose.

I pointed out that it was his decision to give that particular drug, and when you decide to give a drug, you should know how to do so. He complained loudly to the other instructors that were there, and said how unfair it was that I treated him like that.

When I left the school last night, there was a note under my windshield wiper that said "You are gonna pay for what you did"

I teach a night class tonight, and I leave after my students at 10 pm tonight. Good thing I am armed, and good thing that the classes I teach are not in a location where I am prohibited from carrying a concealed weapon. It is also good that the school's director knows that I carry a weapon, and has no policy against it.

Wednesday, August 8, 2012

Men are killers

So now movie theaters are not allowing men to carry bags into the theater. Women can, but men cannot. Why? Because all men with bags can be a shooter.

This is a million dollar lawsuit in the making. I wish they were local to me, I could use the money.

LA Times and PSH

OK, so the LA Times has their panties in a twist because a man in Ohio brought a loaded gun to a screening of Batman. After the cops arrested him, they found "eight rifles and handguns as well as "survivalist's gear" such as gas masks and bulletproof vests." They also flip out because he is "believed to have spent time in the military." He also sat in a seat that had its back against the wall where he could see the exit, giving himself a tactical advantage, according to police.

Wow.

I saw Batman. I was carrying a handgun. A search of my home would reveal far more than 8 firearms, and a lot of 'survivalist gear.' I even spent six years in the military. I have books on electronics, explosives, chemistry, poisons, and many other topics that could be made to look sinister. So what?

Since when did being a veteran mean that you were a murderer? Since when did carrying a concealed weapon mean that you were going to go on a rampage? Sitting in the back row of a theater makes you the enemy? Is the press in this country completely stupid?

Be sure to enjoy life

As a prepper, I frequently spend time preparing for the bad times that are to come. We must remember that we need to take the time to enjoy life, lest it become not worth preparing for. EM Forster once said "Those who prepare for all the emergencies of life beforehand may equip themselves at the expense of joy."

Do not prepare for emergencies of life at the expense of the enjoyment of  it.

Tuesday, August 7, 2012

India wants US to have stornger gun laws.

In the wake of this week's shooting at the Sikh temple, the Indian External Affairs Minister wants the US to have stronger gun control. Because strong gun laws like the ones in India prevent massacres like the one in Mumbai, or something. You remember Mumbai: the shooting rampage where over 200 people were killed, and 300 injured, while the police cowered in fear, don't you?
What about the gun control in India?

 Did it prevent the killing of 60 Hindus in a fire that was set by Muslims in 2002? Or the dozens of Muslims killed in the fire set my Hindus in 2011?

Does it prevent the honor killings performed in India when a person dresses in clothes not fitting their caste?

What about the thousands of baby girls who are murdered by their parents because they want a boy?

To the Indian Minister: Fuck off. Mind your own laws before you lecture us about ours.

Monday, August 6, 2012

Carry a gun

Never confront a person who is breaking into your car or home, unless you have a gun in your hand, or they just might kill you.

Sunday, August 5, 2012

PECF

The reason why nothing ever changes in this country is because the politicians in this country are not chosen by the voters. They are chosen by the people who really run things.
A good example of this is the way that campaign financing is set up. The presidential election fund is a fund that the Federal government has used since 1976 to fund election campaigns of presidential candidates. Presidential candidates of the major parties are given about $90 million of tax dollars for their campaign, plus each major party gets another $15 million in public funds. Minor party candidates get some funding, but it is in no way a level playing field.
A major party is defined as any party that received more than 25% of the votes (I believe it used to be 15%) in the previous election. You can see the beauty of this: there are only two major parties, because you need money to get votes, but the only way to have votes is to spend money to get them. This ensures that the only two major parties are the Democrats and the Republicans.
The two parties have primary campaigns, but the powers that be in the party have more to say about who wins than the voters do: think about it, how many debates was Ron Paul allowed to participate in?
This means that the party leaders of the two parties are the ones who decide who the president will be, not the people. The people who are in place will thus ensure that no one upsets the apple cart, so that the parties continue business as usual, giving our money to the powers that be.

Here is how the Presidential campaign fund grants break down (millions of dollars):
YearRepublicansDemocrats Other
2008$103$35$0.88
2004$90$116$0.89
2000$107$110$20.5
1996$117$87$29
1992$82$91$2.4
1988$91$86$0.94
1984$58.5$74.6$0.19
1980$54$44$4.2
1976$33.5$39.2$0.9


Some things here are interesting:
In 2008, Obama turned down the funds, because of restrictions on reporting and funding that come with taking the cash.
In 2000, the Reform party was not able to get the major party status funding, because Perot only captured 8.4% of the vote in 1996, but they were able to get primary funding from the
In 1996, it was the Reform party that managed to score with the campaign cash as a major party, after securing 18.9% of the popular vote in 1992, due to Ross Perot being their candidate in that year.

Saturday, August 4, 2012

The Squad of Geeks are idiots

Last Saturday, my computer died. I mean, I would push the power button, and nothing happened. I figured that it was either a problem with the power supply or the motherboard, but which was it? I took the power supply into the store that has squads of geeks, and they tested it, and told me that the power supply was working properly.
I ordered a new motherboard ($200) from Newegg. It came in on Thursday, I tested the system, and nothing. I wound up going to the same store on Friday and bought a new power supply. I am now back up. Thanks geeks, for the extra $200 expense.
At least my computer is back up.

Friday, August 3, 2012

Clueless Medics

I got a call from a paramedic at 1 in the a.m. this morning. She works for an ambulance service that responds as a second tier to the fire department, and transports any patients that the firemedic deems is not serious enough for them to handle. The call went like this:
"I need your help. My supervisor won't answer the phone, and I don't know how to handle this. I am on scene of a single vehicle rollover that shattered a telephone pole, and the driver is a 26 year old female who woke up in the grass and didn't remember the crash, or how she got out of the vehicle. She states that she had a single glass of wine, is otherwise appropriate, and is refusing medical care and transport. She states that she doesn't want to be on a backboard or have a C collar. Her vitals are: HR 162, BP 126/78, RR 16. The fire department allowed her to sign a refusal, but I don't think that's right. The other medics here from the fire department are telling me that I'm being too much like a "rookie." What should I do? She is in SVT, and had an accident."
The first thing that you need to know is that this particular medic only got her license 4 months ago. She is a very bright woman, but has no experience. I advised her to talk the lady into going, and if there was no other way, agree to not immobilize her if she agrees to go, and just document that she refused being immobilized. I also told her that she was not likely dealing with SVT, the patient was likely bleeding internally, was in compensated shock, and getting her to the trauma center was a high priority.
Enroute to the hospital, the woman began complaining of abdominal pain, and her abdomen became rigid and distended. It turns out that she had some significant bleeding.
Medics: This is one of the dumbest refusals I've heard of a medic taking. Lazy medics make me angry. Make fun of the new medic for confusing shock and SVT all you want, but at least she was smart enough to know what a sick patient looks like.

Wednesday, August 1, 2012

Funny calls

Every person who works EMS has a story about a patient who had an object stuck in an orifice. It never ceases to amaze me how many people cook or clean their home in the nude, and wind up with household items wedged in an orifice.
I saw a man with a birthday candle wedged in the end of his penis, where he had placed it for his boyfriend's birthday, so he could blow out the candle. There was the guy with the wire coat hanger, the woman and the glass Coke bottle, and the guy who claimed that a home invader held a gun to his head, and forced him to insert the wooden handle of a BarBQ fork in his rectum, leaving only the metal tines protruding.
By far the winner in this is the unknown medical that we ran to a house only two blocks from the station. We arrived to find a man holding his groin, and it turns out that he had a keyring wrapped around the base of his penis. The member had swollen to the point where it was nearly the diameter of a grapefruit, and was an angry purple color. He said that the ring had been on there for nearly 16 hours. We tried ring cutters, but the keyring was spring steel, and wouldn't even scratch it.
We took him to the hospital with an ice pack for pain, and turned him over to the staff. We found out later that they had to send a nurse to the local hardware store for some metal cutters to get the thing off of him.