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The Forgotten War Starts

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On Sunday, June 20, 1950 soldiers of the Democratic People’s Republic of Korea (DPRK) supported by heavy artillery fire crossed the 38th Parallel and attacked the Republic of Korea (ROK).

The DPRK troops were battle hardened from fighting the Japanese in World War II and were better trained than the ROK soldiers. The Communists had artillery and tanks, while the ROK troops had none.

The United States had token presence in South Korea, but they were ill equipped and unprepared for combat. After all, World War II was over and the military was in piece time mode. As always seems to be the case, the military was cut to the bone after the war.

By the end of June, Seoul had fallen, the ROK Army had been reduced by almost 2/3, the US troops were in full retreat.

On June 27, the United Nations passed a resolution urging member nations to provide military support and assistance to the ROK. By the signing of the Armistice in 1953 14 member nations of the UN would be fighting along side the US and ROK. The Chinese would come in on the side of the DPRK, and Russia would supply logistics support.

The war was on.

On July 5, a small detachment of the US Army 24th Division “Task Force Smith” attacked a superior force of DPRK troops. Without tank or artillery support the attack was beaten back with heavy casualties. The DPRK troops then pushed south and a several days later defeated the main body of the 24th Division inflicting heavy casualties.

The advance continued throughout August into September. Aircraft of the US Navy and Air Force provided air support and attacked DPRK forces and logistic assets. This had the effect of stretching the supply line to the breaking point. Which in turn allowed the ROK and US forces to hold at Pusan. Most of South Korea was in Communist hands, but that was soon to change.

On September 15, a combined US Army, USMC, and ROK force landed at Inchon. That force drove the DPRK forces back, and eventually recaptured Seoul. By mid October, ROK forces had captured Pyongyang, the North Korean capital.

At which point, China decided to enter the war.

The war went back and forth into the next year.

There is, of course, a lot more to the Korean War than I can cover in a blog post. One very good book is “This Kind of War” by T.R. Fehrenbach. The book covers the first year of so of the war in detail. It’s a must read for anyone who is interested in the history of the war that was known as a “police action.”

 

 

Day of Days

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Unlike Google or almost all of the Fake Stream Media, I can’t let this day go by without comment.

Operation Overlord was the second largest amphibious landing in history. More troops landed at Okinawa, but the impact of the Normandy landings was arguably more widespread. Both had significant impact on the outcomes of their parts of the war.

Today, however is about Normandy and the liberation of France and the eventual defeat of Germany.

There are plenty of books and movies about the landings and the battle to secure the beachhead. Or maybe “landings” since there were five beaches, airborne, and Army Ranger landings as well.

The story is well told in the move “The Longest Day”, a movie of the type that Hollywood used to make. Almost without exception, every movie star that there was wanted to be in on this movie. Richard Burton and Roddy McDowell flew in from Rome where they were  filming “Cleopatra” to do play their roles. For free.

Eddie Albert, of “Green Acres” fame, served in the US Navy during World War II. He landed in a real battle, at Tarawa in 1943. He was awarded a Silver Star for his actions in that battle.

The movie was based on the book of the same name, by Cornelius Ryan. Who also wrote “A Bridge Too Far” which was also turned into a book. Both books and both movies are worth your attention.

I’ll forgo the boring numbers, but the operation was huge in terms of equipment, cost, and most importantly, lives. It was also necessary as the Germans had to be defeated and Europe liberated.

I’ll close with a short clip from the movie portraying the landing on Omaha beach.

4 June, 1940, 1942, 1944

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Three different events on 4 June during World War II mark the progress of the Allies in defeating Germany, Italy, and Japan.

First, on 4 June, 1940 the British Army evacuation of Durnkirk France was completed. “Operation Dynamo” as it was known the was the heroic effort by mostly civilian boat owners to evacuate the British Army from the beach and thus avert a war ending disaster. The British lost most of their equipment and many of their soldiers. Many, but not all and not a majority. Along with much smaller numbers of French and Polish soldiers, they were evacuated back to England.

Britain was at it’s nadir in the war. Germany now controlled most of Europe, withe the exception of the neutral countries. Still ahead were the German air blitz, the submarine war, the Western Desert Campaign. Still ahead was the planned invasion by sea of Britain by German troops.

The United States was still neutral and negotiating to stay that way with it’s main potential ally (at the time) of Japan. Britain and the Commonwealth stood alone and it looked very bleak indeed.

On this date Prime Minister Winston Churchill gave his “We Shall Never Surrender” speech to rally the beleaguered nation.

Here is an excerpt,

I have, myself, full confidence that if all do their duty, if nothing is neglected, and if the best arrangements are made, as they are being made, we shall prove ourselves once more able to defend our island home, to ride out the storm of war, and to outlive the menace of tyranny, if necessary for years, if necessary alone. At any rate, that is what we are going to try to do. That is the resolve of His Majesty’s Government – every man of them. That is the will of Parliament and the nation. The British Empire and the French Republic, linked together in their cause and in their need, will defend to the death their native soil, aiding each other like good comrades to the utmost of their strength.

Even though large tracts of Europe and many old and famous States have fallen or may fall into the grip of the Gestapo and all the odious apparatus of Nazi rule, we shall not flag or fail. We shall go on to the end. We shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our island, whatever the cost may be. We shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender, and if, which I do not for a moment believe, this island or a large part of it were subjugated and starving, then our Empire beyond the seas, armed and guarded by the British Fleet, would carry on the struggle, until, in God’s good time, the New World, with all its power and might, steps forth to the rescue and the liberation of the old.

There was still almost five years of horribly difficult war ahead, but this was the point at which the British stood resolute. The invasion of Britain never happened because the Royal Air Force stood fast and defeated the Luftwaffe in the air. That was aided by some stupidity by the German General Staff and Adolph Hitler, but the resolve of the British people was the key element.

Here is the entire speech, which includes a most pessimistic assessment of the situation. Of note is not so much the defeat, but that but for the perfidy of King Leopold of Belgium, the Germans might have been held at bay outside of France. More evidence, if we needed it, that weakness emboldens your enemies.

Two years later, 4 June 1942 came one of the greatest victories in the history of the United States Navy. A thousand miles northwest of the Hawaiian Islands near the pre war refueling stop called Midway, the US Navy sprung a trap on the heretofore unstoppable Imperial Japanese Navy. While there is still debate over the Battle of the Coral Sea, there is no debate over who won at Midway.

The loss of four of the six aircraft carries that had carried out the attack on Pearl Harbor a mere six months prior, along with experienced air crews, and planes was a blow from which Japan was never able to recover. Add to that the losses of crews and planes at Coral Sea, and for at least the short term, the IJN wasn’t able to carry out air offenses.

There was still more than three years of incredibly difficult fighting ahead. There would be the brutal invasion of Guadalcanal, the devastating losses at the Battle of Savo Island, and a succession of island invasions that would cost thousands of American lives before the war won.

The tide was turning, but the issue was still in doubt.

Two years later, on the other side of the world the big news on 4 June, 1944 was the Liberation of Rome. American soldiers under the command of General Mark Clark marched into the city to the cheers of the Italian people. The battle in Italy was far from over and would go on until the end of the war. The Germans fought a series of defensive actions and the fighting was incredibly vicious.

German resistance, along with the mountains and weather made the capture of all of Italy all but impossible. To complicate the problem, the Allies pulled many experienced units out of Italy for the invasion of Southern France. That happened after the invasion of France two days after Rome fell.

The Normandy Invasion became the big news in June as the Allies opened the “second front” in Europe. Not that liberating Africa, Sicily, then most of Italy, didn’t qualify as a second front. It just didn’t satisfy Josef Stalin’s demands for action that would relieve his troops on the Eastern Front. Which is a different story.

So, the Liberation of Rome became a footnote in history instead of the big story of the week of 4 June, 1944.

From bitter defeat to victory encapsulated in three dates four years apart. In a war that could have been prevented almost a decade earlier. What a waste of lives.

It’s all summed up here,

What indeed where they thinking?

 

Failure Is An Option

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After the 1999 Columbine school attack, standard operating procedures (SOP) changed for police. Or were supposed to. The days of setting up a perimeter and waiting the the cavalry in the form of the SWAT team to come and deal with the threat were supposed to be over.

Until Columbine changed the paradigm, these were primarily hostage situations and primarily didn’t take place in schools. Just as the September 11, 2001 plane attacks changed how we viewed “hijackings” and how everyone responded to them.

The new paradigm for dealing with “Active Shooters” was for the first arriving police officers to move into the building, make contact, and engage the shooters. This wasn’t limited to schools, but any venue where there was someone shooting unarmed (for the most part) people.

Following the neutralization of the threat, EMS was supposed to be brought in to the “warm” zone. EMS was supposed to be escorted by police and advance into the building immediately behind the “hot” zone. Conceptually, EMS would advance to where the victims were. At which point they’d stop being victims and start being patients.

Those that were dead, were going to stay dead. Those that were seriously injured, but had survivable wounds would be stabilized (read the bleeding would be stopped) and then evacuated. Those with minor wounds would be brought out and placed in a treatment area.

Sounds great in theory, doesn’t it?

Only it doesn’t always seem to happen. As I’ve mentioned before, at the Los Angeles International Airport shooting back a few years ago, the LA Police Department stopped the LA City and County paramedics from entering the building even though the shooter was in custody. As a result, as at Columbine someone with serious, but survivable wounds bled to death before he could be treated and transported.

Two years ago, at the Pulse nightclub terrorist attack, police initially confronted the shooter, but were told to hold the perimeter for SWAT. There was a serious amount of confusion in this case, and that may have been the correct action. It’s also possible if the police had pressed home their initial attack, fewer people might have died.

You would think that by now, every major police department and even most smaller ones would have a good idea of what to do when someone starts shooting up a building full of innocent victims. Even more so for attacks at schools.

Apparently, you’d be wrong.

Paramedics wanted to enter Parkland school where kids were dying. BSO said no.

Michael McNally, deputy chief for Coral Springs fire-rescue, asked six times for permission to send in specialized teams of police officers and paramedics, according to an incident report he filed after the Feb. 14 Marjory Stoneman Douglas High School shooting that left 17 people dead.

But every time McNally asked to deploy the two Rescue Task Force teams — each made up of three paramedics and three to four law enforcement officers — the Broward Sheriff’s Office captain in charge of the scene, Jan Jordan, said no.

Initially, you may say that the Broward’s Sheriff Captain was being overly cautious because the situation wasn’t clear. Okay, that’s possible. Then I read this.
“The [BSO] incident commander advised me, ‘She would have to check,’ ” McNally wrote in the report released Thursday by Coral Springs. “After several minutes, I requested once again the need to deploy RTF elements into the scene to … initiate treatment as soon as possible. Once again, the incident commander expressed that she ‘would have to check before approving this request.’ “
Check with whom, exactly? I attended to many drills over the years and more than a couple of actual incidents during my carreer. At all of them the Incident Commander made the final decisions. He or she didn’t “have to check” before making a command decision. If the incident grew very large, then someone else might come in to assume the position of Incident Commander. Then that person made the decision.
I don’t recall any set of circumstances where the IC had to “check” with anyone before giving an order. That’s why the person was the IC.

Even after the shooter had been arrested, the answer remained the same.

It’s not known whether paramedics, who arrived at Stoneman Douglas within minutes of the shooting, could have saved lives. Thirty-four people had been shot inside the school’s freshman building. Gunshot wound victims can bleed out quickly, meaning fast action is necessary. The special RTF teams allow paramedics to treat victims under the protection of police officers in situations where a shooter has been pinned down or fled but has not necessarily been captured.

SWAT medics went in instead, although it’s not clear exactly how many or when.

What this article doesn’t mention is that generally “SWAT Medics” are there for the SWAT officers, not the victims. Depending on the team configuration, the SWAT Medics might go in with the stack. They might be sworn officers or they might not. No matter what the configuration, the SWAT medics were expected to stay with the officers and not break off to treat the victims.

In his report, McNally acknowledged that RTF teams may not have helped in the end — but he said Jordan couldn’t have realized that when she repeatedly denied his requests.

“Later, it was determined that the RTF element may not have aided in any additional care to patients,” McNally wrote. “However, this information was not known at the time of the requests.”

You can’t know if you can help until you get inside to evaluate the situation. There certainly wasn’t a shortage of police officers on the scene. Or paramedics for that matter. There were certainly enough resources on scene.
Medical considerations aside, it seems that Captain Jordan didn’t have a good grasp of the situation. It seems that lack of planning and execution might be an issue for the Broward Sheriff’s Department,
“The command post was inundated with too many people and made it impossible to establish and function,” McNally wrote, echoing criticisms of the disorganization and lack of a unified command structure that plagued BSO’s response to a deadly shooting at the Fort-Lauderdale-Hollywood International Airport last year.
One of the main considerations at a command post is controlling who is there. Each person is supposed to have an identified area of responsibility and place to be inside the area. Milling around aimlessly is not permitted.

Broward County Sheriff No Stranger To Criticism For Past Handling Of A Mass Shooting

A 99-page report of the 2017 Fort Lauderdale Airport shooting, drafted by officials in the department, said that their own agency made mistakes from the start by not taking command of the shooting area at the baggage claim, where the perpetrator killed five people and injured six others.

“During the events, the absence of a clearly defined [incident command] created unnecessary entanglements and unclear responsibilities,” the report revealed.

Keep in mind that these changes take time, especially when new equipment is required. I have to wonder if the agency has even started on the process of replacing their radio system. Which is mentioned in both incidents as adding to the confusion. The training and doctrine issues should take far less time to implement, but it doesn’t seem like that happened either.

Before the 2017 report came out, Israel described his agency’s response to The Sentinel in an interview in April 2017, saying, “Everything was done excellently,” and adding that the situation was more like  “controlled chaos.” The response is similar to Israel’s defense of his own present performance following the Parkland shooting, stating he has given “amazing leadership.”

You can’t fix an issue unless you recognize and admit that you have an issue. Two SNAFU incidents in ten months and the answer is the same each time. Denial is one of the most powerful forces in the universe.

Hopefully, there won’t be a next time for Broward County, but if there is, the response should be more organized and just plain better.

Should be.

Memorial Day

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For some reason, many people conflate Veterans Day with Memorial Day. Veterans Day is a day to thank all military veterans for their service. Memorial Day is a day to remember those who gave their lives in the defense of their country.

While doing research for this post, I came across the following on You Tube. “The Blue and The Gray” was written in 1867 by Francis Miles Finch. The recording gives the history of what inspired Finch to write it, followed by a recitation of the poem. This is from 1912, so it’s a bit scratchy, but it’s clear nonetheless.

There are other poems, music, and even videos in tribute to soldiers who have died, but this one is specific to the holiday and America’s deadliest war.

I have nothing to add.

 

EMS Artifact Versus The Forsythia, Part Deux

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That was a fast month. When last we left our gripping tale, I had dug out most of the Forsythia, cut back some other stuff and had fire pit day one.

Fire pit day two went better as I had the hang of getting the fire going. That involved going to Walmart and buying a couple of fire starter “bricks”. That, along with some cardboard and small twigs and brush, got the fire going well. Once that was started, I commenced to dragging out the larger brush and some saplings I’d cut down.

I was careful not to let the fire get too high, lest I become “that guy” who set the woods on fire and caused the fire department to come out and extinguish the fire. And tear up my permit.

I also decided to dig out that one root ball that was left. Which turned into about half a dozen or so root balls of various sizes. Each of which seemed to have a boulder attached. Lot’s of quality time with a pick axe and shovel as I dug around the boulders and pried the root balls out of the ground. I would swear that these things were growing as I dug them out, although that doesn’t seem likely.

Speaking of root balls, I burned the ones that I had dug out the previous days. I tossed them on the fire and watched gleefully as they burned. At least those wouldn’t start sprouting leaves again. I hope.

I carted some of the larger rocks and still wet root balls out into the woods behind my neighbor’s yard. Which he was okay with as long as I carted them way out into the woods.

I also now had a friend’s electric chain saw. He bought it as a yard sale, realized he had no practical use for it and gave it to me. It worked okay except it really needed a new chain. Which I only found out after I had bludgeoned a few small trees to death. Still, it was better than cutting them down by hand. Slightly.

Periodically, I’d stop to throw more brush, root balls, branches, or whatever on the fire. Periodically, I’d also stop to let my heart rate drop below 100 beats per minute. This was starting to be too much like work.

After about four hours of work, I had most of the debris burned, most of the big rocks out in the woods, most of the smaller rocks thrown out into the woods, and had discovered and disposed of a dozen or so baseballs, a similar number of tennis balls, a couple of whiffle balls, and several toy cars. All of which had resided for several years out in the Forsythia wilds.

Oh, and I also picked up a nice contact dermatitis. Which didn’t actually manifest itself for a few days, just about the time I landed in Dallas. Since I had the same thing last year when I attacked this mess, I knew to get some Hydrocortisone and use it liberally. Here we are a month later and most of it is gone. Most of it, but there are still a few stubborn areas that insist on periodically causing me to be slightly itchy.

Next time I do this, if there is a next time, I have to remember to wear one of my Louisiana fishing shirts with the long sleeves. They breath, so it doesn’t get too hot and they block the sun. And, hopefully whatever gave me the dermatitis.

Did I mention the thorns? Mixed in with the Forsythia were some thorn bushes, more like thorn trees. The stems or whatever they are called were the diameter of a shovel handle. The thorns themselves were about the size of a Ka Bar blade. Man, those things hurt like hell and left ugly cuts.

I also bought several bags of top soil at a big box store and got several five gallon buckets of prime top soil from a friend’s compost pile. All of which are spread on top of the sandy soil in the back yard to fill in holes and make seeding easier.

Seeding will take place in the fall, along with applying fertilizer. One the advice of a garden specialist (really) I will defer using my handy dandy roto tiller? Why, you may ask. Because it will dig up some deeply buried you know what and it will just start growing again.

Here is what the area looks like, so far.

As you can see, it’s a pretty large area. All of which I used to have to mow, but which became overgrown over the years. Some of the green in the dirt patch grew up literally overnight. Which means that the dirt I got from my friends compost pile is very fertile. It also means I’ll have to do more weed control during the summer.

I’ll spare you part three of this story, unless of course it turns out really well in the spring. Or really poorly.

 

Medications We Don’t Use Any More

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Looking back over my career in EMS, I realized I could fill a drug box with medications that we don’t use any longer.

Some of these were used before I was a paramedic, but I was working as an EMT so I saw them in use and then be dropped.

Much of these were used before evidence based medicine made its debut in EMS.

They fell out of favor for a variety of reasons. Some had serious adverse effects, some were found to be not beneficial to the patient, some were replaced by better medications, and one stopped being made. At least one is back in favor. Many were used in the hospital even though EMS stopped using them.

In no particular order and with my unscientific observations, here they are.

Isuprel (Isuproterenol) This was used to generate some sort of cardiac electrical activity. It did that, but I don’t recall seeing it ever generate any actual cardiac activity. Generally, the medics gave it as a last ditch effort to resuscitate a patient.

Levophed. (norepinephrine bitartrate) Also known as “Leave ’em dead”. That should give you a hint of how well it worked. It was used when there was electrical activity, but no discernible blood pressure or pulse. I was discarded in EMS over 30 years ago, but was resurrected from the trash heap of EMS a couple of years back. Paramedics used to guesstimate the infusion rate, but now it’s only given with a pump.

Pitocin. It is used in the hospital to induce labor in women who are due, but aren’t going into labor as expected. It was used in EMS to stop post partum bleeding, but given the rarity of severe post partum bleeding, it really didn’t have much benefit. No one in EMS has ever wanted to induce labor, as we’d much rather that the birth take place in a nice clean hospital.

Decadron. An IV infused steroid that was used for acute spinal cord injury. The idea being that infusing a steroid early on would limit swelling in spinal cord injury and maybe reverse of prevent paralysis. There is some evidence that this works in the hospital, but given the short transport times my system had, it was felt that it would be better for the patient to prioritize transport to a trauma center over treatment on scene. The demise of Decadron coincided with the initiation of formal trauma centers in Sorta Big City.

Bronkosol. The first nebulized Beta Agonist for treatment of Asthma and COPD. It was mostly Beat 2 (lungs), but had significant Beta 1 (cardiac) effects that sometimes made it dicey to use. Some patients, particularly older ones, had hypertention and tachycardia. Neither of which are particularly good for older patients. Still, it was better than other treatments.

Metaproterenol. This was the replacement of Bronkosol. It was supposed to have fewer side effects, but it still had some risk. We used this for patients that for some reason couldn’t take Albuterol, which was the replacement drug. Albuterol is still used and is very effective.

Verapamil. This was used to treat Atrial Fibrillation. It worked for that, but had serious side effects. Using this drug always made me nervous as hell. It’s still used, but not in EMS. At least I don’t think it’s still used in EMS. It’s a calcium channel blocker and had to be administered slowly to avoid adverse effects. One of which was acute hypotension. Which could be very hard to reverse. Also, it could not be used in cases where the rhythm might actually be Ventricular Tachycardia. So, we never used in case of wide complex tachycardia. The reason being that if it was VT, then the patient would go into refractory Ventricular Fibrillation. As in it would kill them. Just as Cricket players never want to got LBW, you never want to put your patient into refractory VF.

Bretylium. This was an anti arrhythmic used to treat Ventricular Tachycardia or Ventricular Fibrillation that didn’t respond to Lidocaine. Note, it would not work if the patient had been given Verapamil in error. Nothing would work if the patient was in refractory VF. Which is why it’s called refractory. It could be used on patients with pulses, but had the nasty side effect of sometimes inducing vomiting.

It was eventually removed because it wasn’t proven to actually work. Plus, there was an ongoing shortage of the raw materials from which it was made. I don’t know what the secret ingredient was, but it matters not as it’s out of production.

High Dose Epinephrine. This was used in cardiac arrest in the vain hope that it would restore a pulse to patients in Asystole. It didn’t although it did restore electrical activity. The truth is you could get electrical activity out of a piece of hamburger if you dumped enough Epinephrine into it. It’s use was mercifully short lived in EMS.

Valium. It’s still used in some systems, but my former system dropped it some time back. It was mostly replaced by Ativan, which is now out of the drug boxes as well, replaced by Versed.

All three are benzodiazepines, used either for procedural sedation or to treat seizures. The main different being in how long they last. For reasons that escape me, the doctors want EMS to only use short acting benzos.

Lasix. We used to use a lot of Lasix. It’s a diuretic, which means that it increases urine production. We used to use it for treatment of Congestive Heart Failure. It had no real adverse effects, but as it turned out, it didn’t work very well. As it turned out, CPAP and Nitroglycerine work a lot better. About ten years ago, there was a Lasix shortage and nobody noticed. At least nobody noticed in EMS, and patient who were on oral Lasix found some other medications that worked better.

Morphine. Originally, this was used along with Lasix as part of the CHF treatment regimen. It too was found to be ineffective. It was also used for cardiac chest pain. It was effective, only our protocol didn’t allow us to use enough of it to really relieve the pain. The doctors, and I’m not making this up, were afraid that we’d overdose the patients and they’d stop breathing. Or maybe that we’d overdose them and their blood pressures would drop. Ironically, we had treatments for both issues.

As it happens, Fentanyl is much better at relieving cardiac chest pain, orthopedic injury pain, and pain from burns. Which Morphine, at least in the doses we’d give, wasn’t very good at.

On a side note, the Morphine Syrettes that US soldiers were issued in World War II contained 30mg of Morphine. Our protocol allowed “up to” 10mg, but there’s was intramuscular and ours was intravenous. As it happened, there were several cases of overdose during World War II. Which may, may note have, affected the restrictions on our use.

Thiamine. We gave thiamine (B12) as part of the “Coma Cocktail” that came directly out of the Emergency Room. The Coma Cocktail was Narcan, Dextrose, and Thiamine. This was in the days before there were glucometers, so it was given blind. The Thiamine was administered to prevent Wernicke-Korsakoff syndrome. I’ll let you look that one up. Eventually, and I mean after my 35 years of active EMS, it was removed from the protocols because no one could recall a case of Wernicke-Korsakoff syndrome. Or spell it.

Two more drugs that are still used, but might not be for long.

Atropine. Used to be widely used in Asystole and Pulseless Electrical Activity (PEA). It’s not used in either any longer as there was never any evidence it worked. It’s still used in symptomatic bradycardia, but I’ve never been convinced it works all that well there, either.

Epinephrine. It’s used for Asystole, Ventricular Fibrillation, severe bradycardia, severe Asthma, and anaphylaxis. It’s use in Asystole is questionable and there is a large trial going on in London to see if it actually works.

There are probably others that I’ve forgotten, but those are the big gone and forgotten in EMS drugs. Who knows? Some of them may come back again. Or not.

Essential Oils in EMS

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I thought I’d put up an actual EMS related post since this is an EMS related blog.

This article,

La Crosse Ambulance Service Using Essential Oils Instead Of Opioids

came across one of my news feeds while I was on vacation. I sort of laughed and moved on to other items. Then I saw another article about the opiod crisis and how some doctors are dealing with their chronic pain patients. That is, patients that have chronic pain, not patients that are chronic pains. I’ll post a link to that in a bit.

From the first article,

Dr. Chris Eberlein, medical director for Tri-State, said he noticed paramedics were often giving small doses of narcotics like fentanyl to patients who ended up not needing a prescription for pain medication.

“We started reviewing ‘Why are they giving narcotics?’ and really it came down to the fact that they didn’t have many other things they could do in the ambulance ride,” Eberlein said.

Huh? I have to think that the good Doctor was referring to things that they can do to treat pain, as opposed to just things they could do to while away the time until they arrived at the hospital.

So, they decided that aromatherapy using essential oils would be be a viable alternative. I’m a bit skeptical, buy I’m old enough to remember when aromatherapy consisted of “smelling salts.” Not just old school, but ancient school, that.

I’m also skeptical that the relatively low doses of opioids that most systems allow their medics to administer are going to instantly cause addiction. We’re talking about medicine here, not Lays potato chips.

Pain control alternatives include positioning, splinting, ice (or cold packs), and elevation. All of which are well established.

If the medics from La Crosse Ambulance are giving low doses to patients with minor pain, then they need re education on the indications for opioid use. Many systems have adopted the non opioid pain medication Toradol, which is given via the Intramuscular route. It reduces pain by reducing swelling. Pretty much like Motrin, but much more potent.

Other systems have decided to add oral medications such as Motrin or Tylenol (both of those are brand names) to their medication boxes. The problem with those is that they are orally administered. If you want to see an anesthesiologist go crazy, then give a patient who might need surgery anything by mouth six hours before they go to the Operating Room. It’s bad enough that they have to operate on trauma patients with bellies full of beer and Chinese Food, so giving patients oral medications that probably won’t work anyway just drives them berserk.

More wisdom from Dr. Eberlein,

“Before you get in, you get a nice whiff of diesel fume or exhaust in the back. And then you’re in this very sterile-like environment, bleachy smell, plastic smells,” Eberlein said.

I guess the good doctor hasn’t been in an ambulance lately. That diesel smell not only shouldn’t be inside the ambulance, it should be all diesely at all. Ironically, the process of reducing diesel exhaust creates a very bleachy smell as a by product. I’ve never heard of bleachy or or plasticy smells causing pain. Nausea maybe, but the way most EMS providers drive and ambulances ride is enough to cause nausea. And not just in patients.

It all seems kind of New Agey and silly to me.

Then there is this,

Chronic pain patients angry over ‘opioid contracts’

Many doctors around the country are now asking patients with chronic pain to sign a document agreeing to certain conditions before they’ll prescribe an opioid pain medication.

As part of these “opioid contracts” or “pain contracts,” patients agree to random urine drug screens, opioid pill counts, and other conditions. Violation of the terms can result in patients no longer being prescribed opioids by that medical professional.

The contracts, also known as “opioid treatment agreements,” are one tool among many aimed at reducing the misuse of prescription opioids such as oxycodone, hydrocodone, and codeine.

They’re also intended as a way to inform patients of the risks of prescription opioids.

“It is really meant to be used as a clear way to establish an understanding of [opioid] treatment guidelines and expectations of the patient and physician,” said Dr. Kavita Sharma, a board-certified pain physician with New York-based Manhattan Pain & Sports Associates.

I’ll cut through all this BS here and state that this is not for the patient’s benefit. It’s to keep the doctors out of trouble with law enforcement and limit their liability risk. I’d be willing to bet that these “contracts”, which are actually non enforceable agreements, were written by lawyers. Or maybe doctors who are also lawyers.

Drug tests are usually limited to some employees and convicted criminals. I rather doubt that my ninety-nine year old Mother in Law is out on the street scoring more opiods because she’s become addicted to Tramadol.

If a doctor really wants to explain the risk, benefits, and alternative treatments, then they should sit with the patient and take the time to explain the risks, benefits, and alternatives. Not have them sign a dumb “contract” which many of the patients may not take the time to read or even understand if they do read them.

“There are a variety of responses, but generally patients either say yes, of course, or they are clearly offended, refuse, and decline to continue their care with me,” said Dr. Britt Ehlert, a general internist practicing with Allina Health in Minnesota.

My doctor is one of the “sit and explain the risks, benefits, and alternatives” doctors, so I don’t foresee him (or a nurse practitioner in his office) shoving a form in my face and telling me that if I don’t sign it, I don’t get pain medication. Which I generally don’t use except immediately post surgery. Other doctors have different approaches, I guess.

Critics have raised several concerns about opioid treatment agreements.

One is a lack of evidence showing that they’re effective.

2010 review of previous studies, published in the Annals of Internal Medicine, found “weak evidence” that opioid treatment agreements reduce opioid misuse by patients with chronic pain.

It’s passing strange how doctors are all about “evidence based medicine” until a study shows that something they favor doesn’t work. Then it’s a different story.

Of course medicine (or somebody) brought this all about because somewhere along the line patient satisfaction became more important than patient treatment. Hospitals and doctors live in constant fair that their “patient satisfaction” scores will fall and since those are often tied to reimbursement, doctors are under pressure to aggressively treat pain in their patients.

Since pain is subjective it becomes difficult to treat properly. The 0-10 pain score is useless in the real world. Yet, it’s used to judge what type and how much medication a patient should be given.

A good rule of thumb here is that that generally acute pain (such as in EMS patients) is under treated and chronic pain is over treated. The real problem is figuring out how much and what type of medications should be used. Maybe someday we’ll have a non addicting pain medication that is really effective.

Essential oils are not that medication. In fact they aren’t medications at all.

Just keep in mind that the real “Essential Oils” are Gun, Motor, and Cooking.

 

Friends, Family, Vacation

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It’s good to have friends. Ambulance Driver rearranged his work schedule to drive me from Dallas to Austin. Which is part of why I haven’t posted in a few days. The reason for going to Austin was to meet with my wife and daughter. Our daughter moved to Austin just about four years ago. So, we decided to tack on a vacation after I went to the NRAAM. The result was that I just didn’t have time to write the posts I’ve had in mind. More on that later.

Back to friends. One of the highlights of going to the NRAAM is seeing friends that live in other parts of the country. Dallas was especially good since bloggers Lawdog, Old NFO, Phlegm Fatale, and Better and Better, all live in Texas. I don’t get to see any of them enough, so look forward to the opportunities. I didn’t track the number of times I was asked when we’re moving to Texas, but it was more than one. There are reasons with which I won’t bore my readers.

Oh, I was remiss in not originally noting that OldNFO gifted me with a copy of his latest Gray Man novel, “Twilight”. Which was good since I finished “Partners” while waiting for my long delayed flight to Dallas. Yes, this is an unabashed plug for a friend’s books.

I also ran into Weer’d Beard who I haven’t seen in a while. Then there was this character. Who doesn’t blog much anymore, but managed to elevate himself from a crazy blogger to a respectable member of the gun publication industry.

Plus I got to make a new friend, Annette Evans, competitive shooter, instructor, and writer. I bought a copy of her book “The Dry Fire Primer” and intend to incorporate her information into my training routine. A very impressive and engaging young lady. The book is well worth buying and reading. If you Facebook, you can find her at “Beauty Behind the Blast”.

Lots of eating went on as well, but that’s what friends do when they get together. Lots of stories were swapped, but I won’t say too much about those because they were stories among friends and not blog posts. Interestingly, there was a discussion of a book full of stories that probably were better off not told. Of course those stories can be told if you’re retired, or anonymous, or in some cases, if the statute of limitations has passed.

The time to depart Dallas came all too early. As stated Ambulance Driver rearranged his schedule in order to drive me down to Austin, but that meant an early Sunday departure. After more eating and lie swappingearnest and serious discussion.

The ride to Austin was uneventful, which considering what I-35 looks like, was good.

Once in Austin, I picked up the rental car and went to the daughter’s apartment. Big doings there as we were going to have dinner with her new boyfriend. I was given a list of permissible topics (no politics, no interrogations about his “intentions”). I had been informed that he is a gun owner, hunter, and is “building a rifle.” All of which were permissible, but we never got around to discussing.

One of my missions was to try to fix the HVAC fan in my daughter’s car. Not having a working blower motor is a bad thing in the Austin heat. Ahhh, the Austin heat. Which baked the last of winter out of my increasingly aging bones.

The fan mission was a success. It took me about half an hour to take out the old one and install the new one. Ahhh, cool air!

The other mission was installing a new car stereo, with back up camera, in her car. I’ve been doing stereo and two way radio installations since the mid 1970s, so this was not particularly new territory. The new wrinkle was a gizmo that retains the factory clock controls, and another one that retains the functionality of the steering wheel controls. I did all of the pre wiring at home on my work bench, which was a very wise decision. Still, there was some trepidation on my part as I had to figure out which tools I needed to bring with me and had little margin for error.

Everything was pretty easy, with no more than the normal number of “oh shit” moments as parts fell into places where they didn’t belong. Nothing broke, everything worked on the first try. I only had to make two auto parts store runs for connectors, wire, and good electrical tape. The stuff I brought with me wouldn’t stick in the heat of Austin, probably due to age.

I also had Dad time while my daughter helped me with the work. I like Dad time and don’t get enough of it since she lives 2,000 miles away.

Oh, the boyfriend. He’s a nice guy. I expect I’ll get to see him again, but I’m still not sure how serious they are. I’ll know when I know, I guess.

Since my daughter is gainfully employed, Mrs. EMS Artifact and spent the days vacationing. One day we drove up to Marble Falls and looked at the town, houses, neighborhoods, and the Blue Bonnet Cafe. The food was good, the staff friendly, and the pie delicious. House prices are not through the roof (yet)

Another day we wen to the Texas Military Forces Museum at Camp Mabry in Austin. A very well done museum with a lot of interesting artifacts in a compact space. Being a former fashion design teacher, Mrs. EMS Artifact was estimating how much time it would have taken to hand cut and sew the uniforms from the early days of the the Texas Republic. She also pointed out the reproductions because machine stitching looks completely different than hand stitching. When not doing that, she was asking me intelligent questions about various military artifacts. After almost 40 years of marriage, she still surprises me on an almost daily basis with her comments and questions about things in which I never expected her to have any interest. She asked me to explain how a muzzle loading cannon was loaded, fired, and then hauled back into position to be fired again.

We spent another day in Dripping Springs and Bee Cave, again checking things out. Bee Cave is very nice, but very, very expensive. Dripping Springs is getting there, but there are still a few bargains left. This is not one of them. I’m not making light of this, it’s fortunate that no one was killed or injured. Still, the on line listing we saw made no mention of the fire. Nice house, just about a year old when struck by lightning and gutted by fire. Essentially the lot is for sale, although it has improvements, a driveway, and a pad upon which to build.

Thursday came all too soon and it was time to head home. We went to the airport at the appointed time, dropped off the rental car, and headed to the terminal. We prepared to board the plane when there was a slight problem. One of the Flight Attendants was missing. As always, they apologized for the delay, but said that they had no idea where she was or why she wasn’t there.

Great.

After about half and hour, they announced that they had found her. She had overslept and would be along in 15-20 minutes.

Bull shit. If she was sleeping behind the counter at the gate, she couldn’t be there in 15-20 minutes. Mrs. EMS Artifact marched up to the counter area and asked about a voucher for our trouble. The lady behind the counter said that they didn’t do that unless the delay was going to be three hours or more.

Fifteen minutes later, they announced that everyone on the flight would get a voucher.

We took off about two hours later than scheduled, vouchers in hand. At this rate, the airline might want to consider paying me to fly on the competition.

We finally got home late on Thursday, opened the mail, cleaned the litter boxes, fed the cats, an collapsed into bed. I’ve been catching up on work like activities and other things since and finally sat down to compose this tonight.

I’ll continue reporting on the NRAAM tomorrow. The speeches, the protests, more guns, are all on the menu.

 

Shotguns

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I don’t know if this is the influence of former VP Joe Biden, but there are a lot of new shotguns hitting the market. A couple of years ago, Charles Daly introduced introduced a couple of triple barrel shotguns, and the traditional shotgun manufacturers have introduced “tacticool” versions. They also have some lever action design shotguns.

Remington got in the act with a magazine fed version of the venerable 870, the 870 DM.  DM stands for detachable magazine. Advertised for law enforcement or home defense use, it features quick change magazines. The gun comes in “Tactical” and Magpul versions, with different stocks and other bolt on accessories. It’s an interesting idea, but I don’t know if it will negatively effect the vaunted 870 reliability. I also don’t know if it’s a practical home defense gun.

Mossberg has a similar version of their 590 series shotguns. These feature 10 and 20 round detachable magazines. I don’t think I’d really want to lug around a shotgun with 20 rounds in the magazine. I’m thinking that a belt felt version can’t be far off.

Tavor has a shotgun version of their bullpup design shotgun. In addition to being a bullpup design, the TS12 has three rotating magazines. Depending on the type of shell this arrangement offers up to 15+1 round capacity. Definitely not a duck, skeet, or trap gun. This is meant for self defense and law enforcement use.

Two of the magazines are accessible for loading or unloading at the same time, one from the left side, one from the right.

This is not a light weapon and becoming comfortable with the manual of arms for it would likely take lots of practice.

 

Kel Tec makes that KSG which also uses a multiple magazine system. Two magazines, one on each side, with a selector switch to choose which magazine you want to use.

I will digress a bit to say that there are some advantage to having multiple magazines. The big one is that you can load each with different types of shells. Not a bad idea, as long as you remember which one you’re selecting.

One of the more intriguing multiple magazine guns came from SRM. Their gun is another bullpup design, but with a detachable four tube magazine. You could, if the need arose, carry a loaded spare magazine and instead of laboriously reloading, just swap a new magazine in. The gun has a MRSP of around $1,800 and the magazines are a bit more than $100.00 each, so it’s not cheap.

I also looked at a couple of guns from UTAS. One is the existing UTS15 pump action shotgun. This gun puts the magazines (two) on top of the barrel. That leaves room below the barrel, where the magazine usually goes, for a tactical light option. That light is an optional built in unit with the switch inside, not hanging off the bottom or side of the gun. There is a three position magazine selector switch. It’s a bit counter intuitive as pushing the lever to the left, causes the right magazine to feed, and vice versa. Putting the selector switch in the middle cause the tubes to alternate rounds. As always, it’s important to become familiar with a firearm before you HAVE to use it. Plenty of range time is in order with any new firearm.

 

 

Besides, going to the range is fun, right? Or it should be.

I also got to see a pre release version of their UTS15 A. The A stands for automatic, because this is a semi automatic shotgun. The 15 A uses some of the same features as the semi auto version, but also features a quick release bolt cover for clearing an malfunctions that might occur.

The dual magazines seen from above. The magazine selector is the lever just below. I have no practical purpose for this gun, and it’s pretty expensive. Still, I found myself wanting one.

One interesting item not in the Exhibit Hall was from Aridusindustries. This is a quick detach shell carrier for  Remington and Mossberg shotguns. The idea is to allow shooters to have multiple carriers loaded with shells and be able to swap them out as needed. There are other products as well, all intended for the shotgun market. This is start up company, so if you’re into shotguns, it’s worth a look.

That’s a quick look at some of the newest products for shot gunners. Tomorrow I’ll have a couple of handgun pictures and notes. And, if I can get it to upload, a catchy video of some innovative marketing.

All About Me

After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it?

I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs.

I still write about EMS, but I'm adding more and more non-EMS subject matter.

Thanks for visiting.

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