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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.

In The Exhibit Hall

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I spent a few hours in the exhibit hall, as I always do. As I always am, I was impressed by the selection of items. Most of which are firearms related in some fashion. Even the Kubota display, which was mostly what I’d call farm equipment (small farm), had some ATVs that presumably could be used for hunting or firing range maintenance. Yamaha had generators and ATVs.

There were also a few people selling jewelry. I can’t help but think that even the women, and there are many, who are here aren’t all that interested in jewelry. It’s likely the husbands like me whose wives let them come down here without any complaints or demands. Mrs. EMS Artifact has her gun license, but not all that much interest in shooting. She does have interest in jewelry though, and Mother’s Day is coming up. Pretty smart of those sellers.

As in the past, I’m astonished by the number of 1911 and AR pattern firearms that are offered for sale. As well as the number of accessories and upgrades for those who already own them. Both are well established and respected platforms and I admit to being an oddity among gun owners by not wanting to own a 1911 pattern pistol. I’ve shot a few different ones and they shoot well. One custom built 3.5 inch version was very accurate and had a trigger pull so light that I’d swear if you looked at it, it would fire. Still, it’s just not for me.

I have two AR 15s, one of which I built from scratch just to see if I could. I’ve never fired it as I haven’t taken the time to bring it to gunsmith to have the headspacing checked. I expect to sell it once that has been done.

I also chuckle at the number of parts, including frames and slides, available for Glocks. Why chuckle? Because their marketing motto is “Perfection.”

There are some firearms that I have some interest in, and will likely buy at some point. One is the Springfield Armory XD-E. Built for Springfield in Croatia, it’s a Tradition Double Action (TDA), also known as a Double Action/Single Action (DA/SA) pistol. In that mode, the first shot is usually Double action with a long trigger pull, and the follow up shots are single action, with a much shorter trigger pull. Smith & Wesson made semi autos using this pattern from the late 1950s until just a few years ago.

I held an XD-E at the Springfield display, two of them in fact. One was in .45ACP and the other in 9mm. It’s hard to evaluate the feel of a gun when it doesn’t have ammunition in it. The balance and weight are not like it would be under normal carry conditions. Plus, these are display models and have been worked hard, apparently without any cleaning and lubrication.

Taking all of that into consideration, I observed what published reviews have noted. The double action pull is lonnnnng. I’m used to a longer pull since I do a lot of shooting with my S&W semi autos. Still, the XD-E is even longer. Also, the “Grip Zone” which is Springfields term for the stippled areas on the grip, isn’t really as grippy as one would think.

All of that aside, I’ll probably pick one up. I think that there are some newer shooters who will like the DA/SA action, but won’t be interested in buying older guns that while reliable, might be hard do have repaired if anything breaks.

The other firearm I looked at was the IWI Tavor X95. An Israeli designed bullpup style rifle, it uses readily available AR15 magazines for the 5.56 model. They also just introduced one in 7.62 NATO, and have a shotgun, and 9mm version as well. Not cheap, but well made. It’s on the list for a potential future purchase.

Continuing on, there were knife makers, and while I consider any knife as a purely utilitarian tool. Others consider them works of art, and I appreciate that. Then there were a number of different holster and ammunition manufacturers.

Just about anything that a gun owner could want, and some things that they probably don’t, are on display there. I never even got to the row of hunting lodge outfits, but there are more than a few.

I’ll make another round or two tomorrow and try to get some pictures.

 

Lines

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There was a new Army recruit that frequently drew the ire of his Drill Sergeant. Nothing he did was right, he was always yelled at, he spent most of his time doing extra duty, or peeling potatoes.

Finally, came graduation day and the newly minted soldier ran into his tormentor.

The Sergeant said, “I’ll bet when I die, you’ll come and piss on my grave.”

The Soldier replied, “No Sergeant, when I get out of the Army, I’m never standing in line again.”

I hate lines, but sometimes we have to stand in them. After I finally got into the Dallas Love last night, Ambulance Driver picked me, we had dinner and went back to the hotel. iT was late and the NRA Press Office at the Convention Center was closed.

So, this morning, after a hearty breakfast, we walked (closer to waded) over so that I could pick up my media credentials. We figured, incorrectly as it happened, that we’d be there after the rush.

The line was longer than the one in the joke above. No one was particularly happy, but no one threw a hissy fit either. There was some joking about the slow pace of line (slower than tectonic plates), but it was good natured grumbling.

Only one guy jumped ahead in line, apparently to “catch up with his crew”, and no one shot him. No one rioted, no one burned the convention center to the ground.

A good number of the people in line with me are also NRA members. There were some “real media” people in line, but they were fewer in number.

My point is that despite what the Fake Stream Media may want you to think, gun owners are in general among the most polite people out there.

As Robert Heinlein wrote ”

An armed society is a polite society. Manners are good when one may have to back up his acts with his life.”
No matter how long the lines, or how crowded the exhibit hall, I’m confident that no one will be anything other than polite.
Unlike the opposition.

Not So Fast There, Sonny

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Sitting at the airport, minding my own business when there was an overhead announcement. It seems that the flight that was to board ahead of us had a mechanical problem. Passengers will be delayed.

Too bad for them. I went back to my coffee and checking email.

New announcement. Their flight had been cancelled because the planed couldn’t be fixed and there weren’t any spare planes hanging around.

Very bad for them. They were all directed to come to the customer service desk and be rebooked. The stampede headed over and started the process.

At the risk of wrong speak, I have to say that there were five hard working airline staff was trying to get people  onto new flights without undue delay. One of the five had, shall we say, limited ability to speak English clearly. Want to guess which one was on the intercom making announcements?

A Chinese couple behind me was rolling their eyes at how bad he spoke English. They spoke both English and a Chinese dialect flawlessly. Every time this guy made an announcement, people rolled their eyes and asked each other what was said.

But I digress.

I was waiting for my flight to start boarding when my phone alerted me to a text message. Looking down at the phone I read, “This is to inform you that we took your plane to satisfy the other fliers and you are now screwed.” That’s not exactly what was said, but it was definitely the message. Now it was my turn to go up to the customer service counter and find out WTF was going on.

Then, got another text message that said, “We rebooked you for a later, direct flight.” That will only screw up my arrangement with Ambulance Driver who is picking me up in Dallas. I clicked on the link and saw what my boarding order. This that “Want to get Away” airline that lets you pick your own seat. The trick is to get there early enough so that you actually get to sit inside the airplane. I pay the $15.00  for the privilege of checking in early and getting a good seat. My original boarding order was A26, which is prime seat selecting territory. My new boarding order was C39. As they say, “C” stands “Center Seat”, usually between two smelly people. And the one closest to the window has to go to the bathroom every 15 minutes.

So, I went up to the counter and talked to the nice lady. She explained that they don’t have a “waiver” function for their business flier upgrade, so I’d have to fork over $40.00. She did, however give me a $100.00 voucher for a future cancelled flight. I kid about that, part.

So, I decided to call the customer service line for the airline and see if they can refund my feel. Which is where I sit as I type this. The nice young lady wasn’t sure she had a “waiver” key either. I might have to email customer service.

I’m on ignore hold while she checks with someone.

She’s back and busy clicking away on her keyboard.

The verdict is…

They refunded the upgrade fee.

All in all, I did okay on this. Although I still have to sit in the airport for four more hours.

Adventures in travel.

 

I’m A Traveling Man

2

I’m off to the Dallas for the NRA Annual Meetings. I’ll be posting from there with information on new gun gear, the speeches, and whatever else pops into my mind.

After that, it’s off to Austin for some family time with Mrs. EMS Artifact and our lovely daughter. As a bonus, we get to meet her new beau. She seems quite taken with him and I’m happy for her. Still the Dad in me wants to see what he’s all about since it’s only been a couple of months since they met and started going out.

Her ever protective older brother wants a 2,000 word essay from him on the 2016 Presidential election before he approves. He’s afraid that she’ll marry a Democrat.

I have some posts floating around in my head, but haven’t had time to sit down and pound them out on the computer.

Upcoming topics,

What’s Changed in EMS.

The Second Most Dangerous Thing in EMS

EMS Artifact versus the Forsythia, Part II

Some Days I Just Want To Bang My Head On My Desk

Plus, I’m sure I’ll post something about current events and stupidity in the world in general.

Until then, a musical interlude.

Not A Victim, A Hero

1

Early in the morning James Shaw Jr. was sitting in a Waffle House restaurant when a criminal, who shouldn’t have had a gun, started shooting patrons. Ultimately four people were killed and others injured.

Mr. Shaw reacted instinctively and wrestled the rifle away from the shooter. He then dragged the shooter outside where they separated and each went in a different direction.

He doesn’t think of himself as a hero, but then heroes never do. What he did was save several lives, even if that wasn’t his plan when everything started. That’s where the instinctive part comes into play.

He doesn’t seem to have had a plan, he just saw what needed to be done and did it.

Man fought gunman: He ‘was going to have to work to kill me’

The man who wrestled the gun away from the Waffle House shooting suspect in Tennessee said Sunday if he were going to die, the gunman would “have to work to kill me.”

Police are calling James Shaw Jr. a hero for saving lives in the busy restaurant, but the 29-year-old Nashville resident said he only made a split-second decision to challenge the shooter and called it a “selfish” act to avoid being killed.

Selfish? Maybe, but I wouldn’t call it that. I’d call it heroic, even if Mr. Shaw doesn’t see himself that way.

When Shaw’s father went to visit him in the hospital before he was released, he had one piece of advice for his son: “Don’t do that again.”

“I take no pride in him charging a loaded gun,” James Shaw Sr. said. “I do take pride in him helping save the lives of other people.”

After the son’s release from the hospital, the family went to church together.

The Shaws, and all of us, have something to be thankful for.

Amateur Gun Smithing

0

I’ll start this post on with one of those “Don’t try this at home” warnings. At least don’t try this at home and blame me if something should go wrong.

As all but the most casual reader of this blog will know, I have a fondness for the Smith and Wesson semi automatic pistols. Not the newer polymer framed reliable but bland M&P guns, but the older all metal Third Generation pistols.

Starting in the late 1980s, these were among the first wave of semi automatic pistols that replaced revolvers in many law enforcement agencies.

They are well designed, well built, utterly reliable, and accurate. Oh, and expensive. By the mid 1990s, Glock semi automatics had started to displace S&W weapons in police holsters. Glocks are reliable, accurate (for the most part), and well built. I don’t think that they are particularly well designed since they have a combination of no magazine safety and require the trigger to be pulled in order to field strip.

The biggest advantage of Glock was cost. The injection molded receiver (frame) of the Glock is far less expensive to manufacture and can be made in less time. As a result a lot more Glock frames can be produced in a work day than can metal frames.

That is despite the fact that S&W owns the most CNC machines on the east coast. In the days when they offered factory tours I went often and always marveled at the ability of the factory to turn out lots of frames in a relatively short time. The problem is that demand for 1911 pattern pistols, revolvers, and AR15 pattern rifles takes up a lot of machine time. Cost is less of a an issue for those items because the target market is different and likely smaller.

Law enforcement firearm sales are a huge market and very competitive. This drove S&W to develop polymer frame pistols. I’ll let the interested reader research that, including some legal unpleasantness with Glock.

Commercial sales of the Third Generation semi autos pretty much ended in 2006. There were still some available in the supply chain, but for the most part they were being phased out. A few larger LE agencies retained their pistols and S&W even made some for those client agencies who insisted on metal over plastic.

Alas, those days are coming to an end as agencies such as NYPD, CHP, RCMP, and others are replacing their pistols with polymer framed guns.

The good news in all of this, at least for those in most of the country, is that surplus pistols are starting to show up at reasonable prices. These guns have been well maintained by certified armorers, and are carried a lot, but shot very little. If you are interested in one, now might be a good time to buy.

All which falls into the “I told you that, so I can tell you this.”, category.

The guns are relatively easy to work on as long as you have a minimal set of mechanical skills and some quality tools. As it happens, I have both, especially the minimal set of mechanical skills.

The subject of today’s post is the S&W 457, which was part of the “Value Series” of semi automatics. These were an attempt by S&W to produce a less expensive pistol while retaining the all metal design. There were a variety of models, some of which were variations of existing designs. The 457 was different in that there was really no direct analog in the regular series of guns.

The 457 is a seven shot .45ACP semi automatic with an alloy frame. It came in a few different variations. The early guns were alloy frame with carbon steel slide. Then came the 457S with a silver colored frame and stainless steel slide. There were some made in Double Action Only (DAO) configuration, but they are rare and never seem to come up for sale.

Like all Third Generation guns, they are reliable, accurate, well designed, and easy to shoot well.

I was never a big fan of the .45ACP, but a friend convinced me that I should have one. Having no interest in 1911 pattern guns, but a lot of interest Third Generation pistols I started looking for a compact version. Which lead me to the 457. I bought one, shot it, and found it as accurate and easy to shoot as my 9mm guns. I don’t carry it much, but it’s there if the mood or need strikes me.

I’ve been looking for a stainless version, but on the rare occasions when they show up, the prices are outside of the reasonable range.

A couple of months ago while searching for a stainless gun, I came upon a black alloy version for a very reasonable price. I wasted no time buying it. I had no particular reason for that, but since the price was so good, I didn’t need one.

After I got it home, I started to think. Thinking is dangerous.

Since I’ve never seen a DAO version, let alone one for sale, I thought it would be an interesting experiment to see if I could convert one.

I asked around on a couple of shooting forums and found someone who gave me advice on how to do a conversion. In fact, this was how S&W modified the gun for customers who wanted it.

I went shopping on Ebay and bought some parts so I could keep the original parts in order restore the gun to original condition.

The parts needed are a hammer, sear (should be changed as a set), and firing pin retainer. That firing pin retainer replaces the safety/decocker on the Traditional Double Action (TDA) guns.

That is required to make the conversion work is filing down the single action notch on the hammer. This is done slowly, by hand, until the notch is gone and the bearing surface is smooth. Not a great picture, but I am NOT taking this apart again.

Reassembly is not difficult, but it is a bit fiddly. It helps if you have three hands or a couple of assembly aids. I don’t have three hands and only found out about the assembly aids after I was all done.

Then the frame is reassembled with the new trigger and sear. The safety/decocker is then removed and replaced with the firing pin retainer. For good measure I cleaned out the firing pin channel and put in a new firing pin spring, along with a main spring.

Here is the result. The silver colored part is the firing pin retainer. Carbon steel ones are supposed to exist somewhere, but no one has ever seen one for sale.

Once everything was back together, it was off to the range for some testing.

Staring out with just a single round loading I test fired. Success! The gun went bang when expected, the shot hit the target where it should, and the slide cycled properly. Testing continued with two and then three rounds. After that, I shot a fifty round box of range fodder.

The results were… acceptable.

A couple of things to note with the DAO trigger pull. It’s long, very long. Which is how the double action trigger pull is be design. I’m used to the first round trigger pull being long, but it took some time to get used to the long trigger pull every time. Which is why some shots weren’t exactly where I intended them to be.

The factory DAO guns have a prestaged hammer to shorten the trigger pull, but the ones that were originally designed as TDA don’t. At least that’s what other people who have done this conversion tell me.

After a bit of practice, the large hole in the center of the target appeared, which is what I wanted to happen.

The other thing is that after a while, that long trigger pull started to take a toll on my forearm muscles. That’s a range problem and if I should ever have to use this gun to defend my life the statistics tell me that I’ll fire about 3.5 rounds.

If I can ever find a stainless version of the 457, I expect to move the conversion parts to that and sell off one of the black guns.

I’ll close with the previous disclaimer. Don’t attempt this unless you’re comfortable with taking firearms apart. There are some very useful videos on Youtube, at least for now. Also, be sure to keep the original parts in case you ever want to revert the gun back to original configuration.

Oh, if you should find yourself with the opportunity to buy a S&W Third Generation gun, be careful. They tend to be addictive.

 

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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