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EMS In Mass Shootings


What is the proper role of EMS in mass shootings?

Early on in EMT training, then again, in paramedic school, students are exposed to a lot of training scenarios. They cover a wide variety of situations, medical, trauma, and psychiatric emergencies. No matter what the scenario, be it chest pain, a seizure, vehicle collision, fall, or anything else, we teach new students two things.

Is the scene safe? By this mean are there any hazards that might harm the providers? At a vehicle crash, that could be fire, fluids, airbags that might deploy. At fire scenes that means staying out of the collapse area of the building, and not getting hit by debris falling or thrown from the building. It can also mean are there agitated people that might attack the providers. The list goes on and on, so I won’t try to cover all of the possibilities.

Use appropriate Body Substance Isolation (BSI). Which is an amorphous term that means gloves, and masks or gowns if necessary. We used to call that Personal Protective Equipment, and before that Universal Precautions. No matter what term we use, the idea is to protect ourselves from dangers at the scene.

The term “BSI, is the scene safe?”, has become a mantra of sorts and is used at the start of every scenario. The problem is that it’s often little more than a phrase with little actual teaching behind it.

In my days as an instructor, I would sometimes say “No, the scene is not safe.” and then go on to describe a threat. The type of threat didn’t matter, the idea was to get the students to stop and think about what was going on as they were about to enter a scene.

Sadly, I’d often get a blank look and then the student would march on through and start to address the patient. At which point, I’d stop the scenario, fail the student, and tell them they were dead.

In EMS, and likely other professions, we often get into routines and forget the fundamental rules of protecting ourselves. That afflicts experienced and new providers, and some people find it difficult, if not impossible, to understand that there are real world dangers that won’t stop just because someone has called 9-1-1 for a “medical emergency”.

Some 35 or more years ago, back when I was working at the BLS level, my partner and I were dispatched for an “injured person.” We had no details because dispatch didn’t have any, so it might as well have been dispatched as an “Unknown Emergency”.

As we entered the apartment building we stopped at the bottom of the stair case and listened. We listened for about 30 seconds. What we heard was two people arguing at the top of the stairs. One male, one female. We couldn’t make out what they were arguing about, but they were arguing. The scene was not safe, so we made our exit and called for the police to respond.

There are two calls that police hate above all others. One is a “Domestic Dispute”, the other is “Unknown Trouble.” Both have almost unlimited potential to go bad without warning.

This turned out to the the former and once the police quieted the scene, we entered and treated the patient.

I’m sure other crews would have gone in and interrupted the argument. That might have worked out okay, or it might have resulted in an attack on the crew. Going to help someone and ending up on a fight is not how EMS is supposed to work. It happens, because people are often unpredictable, but minimizing the risk is part of what we are supposed to do.

Which brings us to the today’s topic. There has been a lot of controversy over the shooting at Douglas High School in Parkland, FL since it happened almost two weeks ago. It appears, but has not been totally confirmed, that the response by the Broward Count Sheriff’s Department was poor. I’ll leave that to Law Enforcement experts to decide, maybe after the heat dies down.

If it does.

It turns out that the confusion at the scene extended, as it often does, to the EMS response.

Florida emergency medical teams frustrated over ‘delay’ in Parkland school shooting response

Three high-ranking Florida officials close to the law enforcement response at Marjory Stoneman Douglas High School tell Fox News there was a delay in Emergency Medical Service getting into the school in the critical moments after Nikolas Cruz allegedly opened fire, killing 17 people and wounding at least 14 others.

Two separate sources told Fox News some of the EMS teams who requested to enter the school were told they could not. One source said it was the Broward County Sheriff’s Office – which was the commanding office – that ordered some of the EMS crews not to go into the school when they requested to enter.

At any large incident, someone has to be in charge. At Parkland, because it was a crime, it was the Sheriff’s Department. Other responding agencie, LE, Fire, EMS, all are subordinate to the Incident Commander. In this case, it’s possible maybe even likely, that the IC made the wrong decision.

“When you have a police agency saying we don’t want you going in, that’s a problem,” another Florida official said. “The training since Columbine has been [that] first responders, police go in immediately with paramedics.”

This is in fact the doctrine and standard operating procedure for many departments. The problem is that sometimes it just doesn’t happen that way. In 2013 there was a shooting at Los Angeles International Airport (LAX). The specified procedure was that the first responder officers should go in and engage the shooter. Once the initial threat is eliminated, police are supposed to escort and protect EMS personnel to do a search and rescue operation.

Sorta Big City Police and EMS started training for this a couple of years before I retired. The final plan was not released before I retired, but to the best of my knowledge, it is the official plan.

That didn’t happen at LAX in 2013. The police agencies established a perimeter and sent officers in to find the shooter or shooters. Even after the area where the shooting occurred was secured, EMS was not allowed to go in and treat the person who was shot. As a result, he bled to death.

The reason given at the time was that the scene was not secure and thus it was unsafe for EMS to enter. At the time, several different agencies and individuals proposed training all of their EMS employees as “tactical medics” and issuing each one body armor, helmets, and other equipment.

That sounded good until someone got out a catalog and a calculator. It turns out that it would have been very, very expensive to outfit all of the EMS providers of any agency, regardless of size of the agency.

So, what are we to do?

Multiple high-ranking sources told Fox News police officers and deputies were bringing victims out to EMS workers to be treated instead of allowing EMS inside. One fire official said that “sometimes” that’s just how it would happen, but at least one emergency responder wondered if the response was detrimental to the victims.

If this is so, it’s not a bad way to handle the situation. After all, EMS would not be likely to go into a burning building (although they have on occasion) to rescue people. That might happen if the fire department wasn’t yet on scene. The difference being that fire, while not discriminate in who it hurts, does not deliberately hunt down it’s victims. Even so, it’s a far less than ideal situation when EMS goes into known dangerous areas.

The problem in this case is that becoming rescuers takes police officers away from their primary function. Which is to stop the bad guy from killing more people.

As I mentioned in an earlier post, the keys to saving people with survivable wounds is controlling the bleeding and maintaining an open airway. That should be followed by rapid extraction from the scene and transport to a hospital with surgeons.

The airway and bleeding control parts can be taught to just about anyone, as can the extraction. Combine that with prepositioned equipment and a plan and a lot of lives would be saved.

It appears that there was no plan in place for any of this. Or, it there was, it wasn’t implemented. Plans only work if people train on them enough to be proficient. That, and actually using the plan when the time comes.

Again, that didn’t happen. Or at least it doesn’t appear to have happened. This is all the worse because the fire and EMS systems for much of the county come under the purview of the Broward County Sheriff.

There a going to be a lot of lessons learned from the tragedy. One of which is that there has to be a plan in place before the event happens. The other is that when the even does happen, the plan has to be implemented and followed.

Read the complete Fox News article at the link bet a better idea of what did and didn’t happen at the school on the day of the shooting.

Yesterday in World War II History


I was tied up with work and family matters and so didn’t to the post I promised yesterday.

Continuing on with the Battle of Iwo Jima, yesterday marked the 72nd anniversary of one of the most iconic moments in World War II. It might be one of the most iconic moment in Marine Corps history as well.

On February 23, a platoon of Marines captured the summit of Mount Suribachi. Depriving the Japanese of the summit eliminated the observation posts that the Japanese had used to attack the Marines.

The Lieutenant commanding the platoon had brought the battalions American flag with him and ordered it raised by platoon members. A photo was taken by a USMC photographer, but what photograph was not released until sometime in 1947.

The story goes that Secretary of the Navy James Forrestal wanted the flag and said so orders were given to retrieve the original flag and replace it with a larger one.

An alternative suggestion is that the original flag was too small to be clearly scene by Marines down on the lower parts of the island.

Either way, a second flag was dispatched and Marines were directed to raise it. Using a piece of pipe that was part of the battle debris five Marines and a Navy Corpsman raised the flag. Photographer Joe Rosenthal was on the island photographing the battle for the Associated Press and caught the raising on camera.

The photograph was flashed around the world by wire services and published in much of the world on Sunday, February 25.

Almost instantly, it became one of the most famous photographs in United States history. The picture became the model for the United States Marine Corps War Memorial, which was erected in 1954. Rosenthal went on to a long career as a news photographer and editor, dying in 2006.

Three of the six men identified in the picture died during the subsequent fighting on the island. The three remaining men were returned to the United States and engaged in a series of war bond sales rallies.

In subsequent years, it was determined that John Bradley, a Navy Corpsman, was not one of the six raisers of the flag. That determination was made after Bradley and Rosenthal had died and it’s unclear if anyone ever asked them while they were alive who the actual six were.

That aside, the photograph remains as an enduring image of the war in the Pacific and of the determination of the Marines in battle.


Hard To Recruit


One of the biggest changes in EMS over the past several years has been the increased involvement of the fire service. Despite a somewhat famous, but date, TV series that some people adulate, most fire departments were not interested in EMS until the late 1908s or early 1990s.

The reason for that sudden change was the dramatic decrease in large building fires from the mid 1940s on. Better construction, fire alarm systems, sprinklers, and other advances meant that there were fewer fires, they spread more slowly, and were extinguished more quickly.

At the same time, the demand for EMS services was increasing for a number of reasons.

Somewhere along the line, the leaders of the fire service decided that taking over ambulance services was a good way to keep fire service jobs. Notice that I didn’t say that it was a good way to improve services, but it was a way to keep jobs.

As a result a number of large fire departments jumped into EMS. In most of the large cities where this happened, nothing improved. Arguably EMS suffered, but that’s actually a story for another time.

At the same time, and for what appear to be much different reasons, a number of smaller fire agencies got into EMS. The reason they did it was because there were no alternatives. In smaller cities and towns, budgets are tighter and departments have to do more.

When I worked in Sorta Big City, the fire department staffed each piece of apparatus with fire firefighters. Which mean that we often had four firefighters on our calls with us. Sometimes we needed them, mostly we didn’t, but it was still nice to have them (usually).

The smaller departments that I work with now or have worked with in the past don’t have that luxury. Luxury being a relative term because at a fire you really want as many people as possible.

In these towns, some quite affluent, the norm is for a fire engine to roll out the door with two firefighters on it. Then two more will respond in an ambulance. Then one will respond with a ladder truck. The shift commander will respond in his car.

If it turns out to be a fire, then staff is called in from home and other towns respond for mutual aid.

Note that the two EMS providers are also EMTs or paramedics, depending on the agency. Or maybe one of each.

A former big city fire chief used to say that modern fire departments are EMS agencies  that occasionally put out fires. While that might not be true in big cities, it’s definitely true in smaller towns.

Stay with me folks, I’ll get to my point (I do have one) shortly.

What the smaller towns do almost unanimously is hire EMS providers who they then turn into firefighters. Fully qualified firefighters, to be clear. Fire departments have found that it’s easier (and less expensive) to hire a EMT or paramedic then send him through the fire academy. Around here the fire academy can be from 9-12 weeks. That’s full time and I have no idea why they keep changing the length of the program, in case you’re wonders.

Which brings me to my point. There are some number of people who become EMS providers at either level with the express goal of becoming firefighters. Which is smart because agencies are always looking for new fire fighters. People retire, get promoted, sometimes sadly die, or decide to go on to other careers. There is always some personnel churn in fire departments big and small.

If I were younger, I’d certainly look at this career path even though when I actually was younger I turned down a fire department job. I’ll spare you the story.

There some number of people who go into EMS because they want to provide medical care to people. That field has an even higher rate of attrition, again for a variety of reasons. One of those reasons is the generally low pay, lousy benefits, and poor work conditions. They love being paramedics, but hate working for low paying services doing mostly routine transfers.

The fire service generally offers better pay, good to great benefits, a pension, a union, and depending on the type of schedule they use, a lot of time off. Oh, and lots of education and training. In the departments with which i work, there isn’t a lot of sitting around. There is some, but they do a lot of training.

There is a lot to be said for working at a small town fire department. Or a bigger town fire department that provides EMS for that matter.

All which makes the following more and more baffling.

No department that I am familiar with can recruit enough paramedics. One agency had a recent opening and sent out a 100 cards to people who had passed the civil service exam. They specified that candidate must be paramedics, so that meant 100 people who had paramedic certification received cards.

They got one reply.

Which means that ninety-nine people didn’t want to go through the hiring process for a job that had better pay, better benefits, better working conditions, a pension, and stability.

What? The? F*ck?

That’s an example from one department. The others have the same issue. One just hired a guy that is still in paramedic school. Which means that he’ll come to the department with zero paramedic experience. Then, he’ll go to the fire academy and be a firefighter with zero experience. Not ideal, but he’s the guy that applied and was hired.

One paramedic/firefighter I talked with told me that a lot of people just don’t want to become firefighters. The truth is that for the most part, there is not a lot of fire fighting going on in many departments. There IS a lot of EMS going on, though.

Weird, just weird.

So, my advice here is for young people who want to become firefighters, become paramedics first. Just make sure that you become good paramedics first, because that is going to be 80% of your job.

Pointless And Illegal


I’ll keep this one short. The man pictured in this video is either an idiot or a liar. Maybe an idiot and a liar. I’m not really sure.
What he purports to do is saw an AR15 in half to symbolize his sorrow at the recent mass shooting in Florida. All well and good except for two things.
First, he didn’t saw the AR15 in half. He sawed the barrel in half, which isn’t destroying the gun. It’s destroying the barrel, hand guards, and gas tube. All of which are commonly available and easy to replace. If he were to place a charged magazine into the gun, he’d be able to (ineffectively) fire the gun.

To actually destroy the gun, he’d need to cut the receiver in half. Technically, to destroy the receiver per the ATF, he’d need to “flame cut” it into three parts using a cutting torch of some type. Since the receiver is “the gun” according to federal law, he’d “have cut the gun in half”.

Second. What he did was create a “Short Barrel Firearm”. Those are regulated by federal and in many states, state laws. Building one without the requisite forms filled out and fees paid is a crime. It’s a very serious federal crime.

If the ATF were of a mind, they might be inclined to pay him a visit. A visit that he wouldn’t like at all. Violations of the National Firearms Act are crimes which the federal government considers very serious.

Here are video star not only commits a crime, he provides incontrovertible evidence for the entire world. Another victory for Social Media, as it were.

I think he, and the world, would be better off if he didn’t have any guns.

Upper Lip Stiffener Needed


The British have long had a history of stoicism. After all, they ruled half the planet at one time, ruled the seas with the greatest navy until after World War I, and of course withstood the London Blitz and near annihilation of their army at Dunkirk.

The term “Keep a stiff upper lip” is attributed to the British because of this, even though the term might have originated in the former colony that beat their lips quite a bit back in the late 18th century.

It appears that there is a need for a bit of upper lip stiffening required in Great Britain these days.

I found a story about a nasty note found on an ambulance in England. It seems that someone was a bit put out that the EMS crew had the temerity to park in someone’s “spot” while on a response. Said spot being on a public street in the West Midlands.

I originally saw the story on an EMS site, but as is often the case, the Daily Mail newspaper had the best story on the incident.

Stunned paramedic gets angry note from neighbour saying they ‘couldn’t give a s**t if the whole street collapses’ as they demand ambulance is moved

Not the most concise headline I’ve ever seen, but it conveys the sense of the story.

Paramedics were left stunned after finding an angry note demanding they moved their ambulance during a 999 call, with the message: ‘I don’t give a sh*t if the whole street collapses’.

The message was written by a woman who was annoyed that an ambulance was in a resident’s parking bay on Sunday morning.

West Midlands Ambulance Service said the resident also verbally abused staff members during the emergency call-out in Tunstall, Stoke-on-Trent, Staffs.

Okay, that’s bad, but it’s not the worst thing I’ve ever heard of on an ambulance call. It’s not like they were shot at, stabbed, or even beaten. All things that happened to me or my coworkers over the years. No, just a nasty note and some harsh words. Ignore it and move on.

Nope. One of the paramedics took a picture of the note and texted it about. Eventually, it hit the smart phone of Paramedic Katie Tudor. Who reposted it with the comment “So upset to be sent this by one of our crews this morning!” The exclamation point is intended to tell us how upset she was.

Eventually (again) it reached the screen of an Assistant Chief Constable. Who at first didn’t seem to think that there was an actual crime involved.

We find out from Fox News that the woman was later arrested on “suspicion of public order offenses.”

As I mentioned to a friend of mine, we had a couple of cases over the years where patient’s families or bystanders thought that it would be a good idea to get into the ambulance and move it on their own.

It wasn’t, not at all.

That, however is different from a note or “verbal abuse” from an idiot. The best response to which would appear to be “piss off”. Or something similar.

Apparently there is a plague of rampant nasty note writing going on in England.

Why, last November someone left a note on an ambulance windshield. Oh, the horror.

I’m not suggesting that it’s okay for people to be nitwits. I am suggesting that people in EMS don’t need to respond in kind, let alone get a serious case of trembly upper lip over it.

Paramedic was so upset that she  had to take a “selfie” and send it in to the Daily Mail.

As I said, some upper lip stiffening needs to be performed.

Considering some of the crimes that the British Police DON’T prosecute, this one seems rather silly.

On This Day In World War II History


1945. The USMC landed on the Japanese held island of Iwo Jima. The ensuing battle went on for about a month before the Japanese were defeated. Two Japanese soldiers hid out and didn’t surrender until 1951.

This was a no holds barred fight to the death for the Japanese. Although the commanders knew that they were destined for defeat, they committed their 21,060 troops to holding off the Marines for as long as possible. In the end, 18,000 Japanese soldiers died. The Marines suffered 6,800 dead and 19,200 wounded of the 60,000 dedicated to the fight. One Third of all Marines killed in World War II died on Iwo Jima. In addition to the Marines, 245 sailors of the 133 Naval Construction Battalion (Seabees) were killed or wounded on Iwo Jima.

The island was strategically important for two reasons. First, it’s airstrips served as bases for fighter planes attacking American B29s bombing the Japanese homeland. Second, once captured, it could be used as an emergency landing strip for damaged B29s and other aircraft carrying out those attacks.

Necessary, but incredibly vicious.

The story of the battle is far to complex for this blog and far too well detailed elsewhere for me to even attempt a complete history. I’ll have a post or two more about significant events during the battle, but you should go and read about the battle yourself.

On This Day In WW II History


1942. Franklin Delano Roosevelt, the four term President who lead the United States deeper into the Great Depression and foisted the Ponzi Scheme known Social Security on the American public put the screws to over 100,000 Japanese-Americans.

He signed Executive Order 9066 which dispossessed the Japanese on the West Coast of the US and ordered them transferred to “Internment Camps”. A smaller number of Americans of German and Italian descent were also interned, but it was the Japanese that bore the brunt of the order. They were transferred far from their homes, many, if not most, lost their homes, businesses, and other property. The were interred until December 1944, when they were released to pick up their lives.

In 1990, President George H.W. Bush signed a bill into law which apologized and paid compensation for the losses suffered almost 50 years before.

We can argue that in the hysteria following the December 7, 1941 attack on Pearl Harbor by the Japanese that it was reasonable to think that some of those people might be enemy agents. I’ve never read that there were any prosecutions for that, but I do know that there were active Nazi supporters in the US before the country entered the war. In those cases, the FBI investigated and people were prosecuted. As individuals. For specific crimes.

Keep in mind also, that the majority of immigrants to this country were from Germany. Not from Britain, not from France, not from Italy. From Germany. Which would have made rounding up all Americans of German ancestry impossible.

I won’t delve into all of the allegations of racism, because it’s not necessary. Even if there were not racism, it is distinctly Un American to round people up with no proof of wrong doing. Why, we’re told that about people whose coreligionists have conduct several acts of terrorism here in the US and against US interests abroad.

If it’s wrong now, it was wrong then, right?

Ironically, many young Americans who happened to have ancestors from Japan did the last thing I’d do under similar circumstances. The volunteered to join the US Army and fight against the Axis. The US did not use them in the Pacific Theater, although having fluent Japanese speakers might have been helpful. Instead, after training, the 442nd Infantry Regiment went to Italy to fight there.

From mid 1944 until the end of the war the 14,000 men of the unit suffered 9,486 injuries which resulted in Purple Heart awards. Twenty One members of the regiment were awarded the Medal of Honor. It was one of the most decorated American units in Army history. It was staffed by men deemed untrustworthy by the President of the United States.

Think about that next time someone waxes all nostalgic about FDR.

Mass Shooting


Please note. If you came here from Facebook and saw a picture of a revolver, the revolver was not part of the post. The new blogging platform requires a “Featured Image” or Facebook will pick one at random from the images stored on my blog. I’ve changed the image and hopefully FB will update it.

Or, as the media prefers to call the, “Active Shooters” seem to be far more prevalent than they used to be. That might be, but it’s more likely to be that the media overplays them for maximum effect.

First, let me discuss a few of the things floating around in the mediasphere.

No, there have not been “Eighteen School Shootings” since the beginning of the year. The definition of “School Shooting” seems elastic, to say the least.

No, the most and deadliest mass shootings have not occurred in the United States. In fact, nations with very strict gun control have a higher fatality and occurrence rate.

No, banning “Assault Rifles” won’t solve this problem.

Yes, the FBI seems to have screwed up, but exactly how isn’t really clear. No, the FBI Director shouldn’t step down. Keep in mind that if the FBI had arrested or even entered the shooter’s name into the NICS system, there would be people crying out that he was being racially profiled. Also, the Broward County Sheriff’s Department hasn’t exactly covered itself with glory.

The FBI needs to do a better job following up and worry less (not at all) about being racially insensitive.

No, we shouldn’t “make it easier” to strip people of their Second Amendment Rights in the name of public safety. The process in place now is fine, it’s the application that is failing. Anyone adjudicated too dangerous to be out in public with weapons should be committed to a mental health in patient facility. The problem being  that there aren’t enough of those. We need more mental health beds in either private or state run psychiatric hospitals.

Oh, there weren’t thousands of people protesting in Florida this weekend. How do I know? Because when “thousands” of people are protesting, the photographers take long distance shots to show the size of the crowd. They don’t do close ups of maybe thirty people holding up signs. Yet, I haven’t seen anything other than close shots.

Finally, this is not the fault of the NRA, the President, or me. Or any other gun owners except for the guy who did the shooting.

Speaking of which, the murderer was a classic “Rampage Shooter” in that he had a specific target area, maybe specific targets, and didn’t much care about killing people who just happened to be at the scene. He’s a bit unusual in that rampage shooters usually kill themselves or surrender when law enforcement, or any armed person, confronts them.

The killer certainly gave enough warning signs if people were paying attention. It is incredibly difficult to get expelled from a public school in this country. Yet, he managed to do just that.

I’m over 400 words into this and I’m not even close to my main subject. This might be a two part post.

All of the foregoing has been mostly stage setting for the main points of this post.

Fox News  has the timeline of the event here. Note that the shooting started at 2:21PM. It was over three minutes later.

The Broward County Sheriff’s Department didn’t respond until 2:53PM. The timeline doesn’t say when the first call or text came into the dispatch center, but this seems like a long time to me.

CNN tells us that Columbine (1999) changed how police respond to mass shootings. Would that this was true, but it really doesn’t seem that way. What is supposed to happen now is that the first responding units enter the school and attempt to make contact with and engage the shooter. That didn’t happen at Columbine, but it also hasn’t happened as recently as last year. It didn’t happen in 2013 when a man shoot a TSA officer at Los Angeles International Airport. In that case, LAPD placed a cordon around the area and stopped paramedics from entering the terminal until after it was “secure”. Which resulted in the TSA officer bleeding to death from a survivable wound. Which also happened to a teacher at Columbine in 1999.

It didn’t happen in 2016 at the Pulse nightclub shootings in Orlando, FL. In that case again, fire and EMS were excluded from the command post and only brought in after the damage was done and the shooter was killed.

It doesn’t appear to have happened last Wednesday either. The SWAT Team arrived, the school was cordoned off, and the non injured students were brought out with their hands on their heads. It appears after that was done, EMS went in to look for survivors and evacuate the wounded.

I’m not sure that sending EMS into the “warm zone” of an Active Shooter incident is particularly wise. Unless they have an armed police escort, it seems like just bringing more potential victims to the scene. The police have shown time and again that protecting and assisting EMS at these incidents is not a priority. Stopping the bad guy seems to be, but only after the situation is “contained”.

During that time period victims with potentially survivable wounds are going to bleed out and die. The military has shown that most casualties who don’t die immediately die from blood loss.

Usually, it’s preventable blood loss.

Which is why the military trains all of their people, at least the ones that might go into combat, in Basic Life Saving and Combat Life Saving. This isn’t confined to medics, but is widely taught.

Which brings us to today’s topic.

We need to do that in high risk areas. Keep in mind that I am not talking about acts of terrorism, although this same approach might work there. It depends on how the attack is being carried out. We know that rampage shootings follow a pattern and are usually over within a few minutes. Which doesn’t mean that the police, fire, and EMS are going to be there right away. There is going to be some time lag, even if everyone arrives promptly and enters the active area right away.

Minutes, sometime many minutes, will go by.

Which means that the victims and their potential saviors will be all there is for some period of time.

Which means that venues that are identified at higher than average risk should have people trained and equipment cached to “Stop The Bleeding”.

There’s even an organization that is dedicated to doing this. BleedingControl.Org  is a collaboration of the American College of Surgeons, FEMA, the National Association of EMTs, and ironically perhaps, the Federal Bureau of Investigation. These groups developed “The Hartford Consensus” which developed the program.

Stopping the bleeding is the best way to increase survivability. Having the people who are already on scene do the stopping is the best way to stop the bleeding.

Schools, hotels, malls, movie theaters, and other venues should train their staff and buy the necessary equipment. There should also be pre designated rallying points where the patients can be brought for extraction. Oh, and equipment to do that. You can buy kits of various sizes from BleedingControl people, but you can probably find them from other sources as well.

This company HILT makes patient moving devices that might be useful as well.

Note that I have no connection with either BleedingContro or HILT and there might be other training and equipment vendors These are just two that I’ve come across.

In order to become an instructor, one has to take the course and then apply to the BleedingControl organization. There is a course coming up in the near future near me and I plan to take it. Then, I hope to teach it.

It’s easy to blog about solutions, but it’s meaningless unless one does something about it.

All EMS providers, regardless of their experience or training levels can help in this project.

If you know of other courses or equipment vendors, please let me know in the comments and I’ll add the information to this post.

One last thing. This training can come in handy in a lot of non shooting circumstances as well. It’s always nice when training spans several different areas.

Firearms and Marijuana


Let me start by saying that firearms and any intoxicating drug or substance don’t mix. As my longtime readers might remember, I enjoy a glass of good Scotch now and then. Well, more now than then, but that’s a different story. One thing that I don’t do when I plan to consume adult beverages is carry a gun. I’m careful about with whom and where I drink since I don’t like not being able to defend myself. On the other hand, the consequences of being convicted of “carrying a fire arm while under the influence” in my state are a permanent loss of Second Amendment Rights.

Wow, that’s a big disclaimer. On to our subject for today.

Several states, including mine, have legalized Marijuana use for either medical or recreational use. Some states are going so far as to vacate convictions going back decades if they involved “mere” possession of Marijuana.

I have no opinion on that as long as people using the drug don’t drive or do other dangerous activities that might endanger me or my loved ones. I don’t know if it’s more or less dangerous than smoking cigarettes or drinking alcohol containing beverages, and I don’t much care. That’s their business, not mine.

The problem for these people is that while Marijuana use might be legal in their states, it is still illegal under federal law. A lot of people are complaining because Attorney General Sessions has instructed the employees of the Department of Justice to enforce the laws as written. People have complained that he is just a rigid old fool who insists on enforcing an unpopular law.

People seem to have gotten use to the President and many federal officials picking and choosing what laws they will enforce, as well as against whom they will enforce those laws. The previous Administration made a practice of this and many people thought it was okay. Fortunately, in several cases the Supreme Court of the United States disagreed. In a surprisingly large number of those cases, the vote was unanimous.  Which means that the laws need to be enforced as written. The alternative of course is to repeal laws that are no longer relevant. Which would require the other two branches of the federal government to actually do their jobs.

Good luck, and don’t hold your breath waiting.

Back to Marijuana. Federally, its use, possession, growing, or sale, is illegal. The federal government still prosecutes that, and some local agencies do as well.

So, how does this all relate to firearms?

Simple. People who use Marijuana in any form for any reason are violating federal law and are prohibited from possessing firearms or ammunition.

Those you you who have purchased firearms from Federal Firearms Licenses (FFL) are all too familiar with the ATF 4473 form. For those of you who don’t own guns and have no interest, the 4473 is a form that must be filled out any time someone buys a firearm of any type from a gun shop. There are no exceptions, no “loopholes”, no tricks to avoid going through the process. Whether you buy a .22 rifle or shotgun from a Walmart store or a $3,500.00 1911 pistol from a high end dealer, it’s the same process.

The 4473 is a long, hard to fill out, form that is mostly still done on paper. It’s a pain in the neck to do and simple mistakes often require redoing the whole form. One of the questions on the form is “11e”. Here is the text of the question,

“Are you an unlawful user of, or addicted to, marijuana or any other depressant, stimulant, narcotic drug or any other controlled substance?” “The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.

Note that the part in bold was added by the ATF in 2016, while Barack Obama was still President.

The issue for would be gun owners is two fold. Or maybe I should say that this is a two pronged fork. Either way, no matter how a marijuana user answers this, he potentially has a big problem.

First, if he answers “Yes”, the dealer is NOT going to proceed with the sale. The dealer isn’t even going to call the phone number used to run checks under the National Instant Criminal Background Check System (NICS). This systems is run by the FBI and as the name suggests, runs instant checks to see if there are reasons that a gun sale should not proceed. I won’t get into the problems with NICS today because they are not pertinent to the subject at hand.

If the potential buyer answers “No”, but is a habitual user of marijuana, then he has lied on a federal form. (U.S. Code 18 Section 1001). That’s prosecutable whether or not the person actually purchased a gun. The lie itself is a crime.

For my EMS readers who might not be directly interested, Dawn Nguyen illegally bought two firearms in 2010. On her 4473 she lied about a number of things, including her answer to Question 11e. She also lied on Question 11a, which asks if the person purchasing is the actual buyer or transferee. In this case, she was buying the two firearms for one William Spengler, Jr. Spengler couldn’t buy guns on his own because he was at the time a convicted felon and thus a “Prohibited Person.”

On Christmas Even 2012, the now late Spengler murdered his sister, set his house on fire, and then shot and murdered two volunteer fire fighters.

Back to the main post.

While it is unlikely that a person who lies on a 4473 about this will be caught, there is a possibility that he or she will. Besides that, it’s not inconceivable that some states might enter medical marijuana card information into their databases. Pennsylvania, which is decidedly pro gun state, was going to do something along those lines as well as rescind the concealed carry licenses of people with marijuana cards. In the end, the state decided not to do that, but it still doesn’t change federal law.

Even though Pennsylvania isn’t doing this, that doesn’t mean that the federal government and New York, Massachusetts, California, and other similarly anti firearm states won’t enforce these laws.

The easy fix for this would be for the federal government to just decide not to enforce the law. The correct fix for this is for the Legislative and Executive branches of the government to change the law.

I wouldn’t expect that to happen in the foreseeable future. As a result, people who use or possess Marijuana for any reason will remain at some legal peril.

There’s a good explanation of the various laws at the website of the Wallin and Klarich legal firm. A much more detailed description of the various laws involved. I recommend it to the reader who wants more information.

The Hardest Thing In EMS


EMS is hard. Really hard. EMT school isn’t that hard, unless you want it to be. Then it’s hard. The hard part comes after you finish the program and have to take the Cognitive and Psycho-Motor tests. Those tests are difficult, but not because they are challenging. They are difficult because the Cognitive part is based on questions which may or may  not have “right” answers. They have “best” answers, which might not be even close to correct and are sometimes worded so arcanely that you have to decipher the question before you can answer.

The Psycho-Motor tests are, or at least were, like scripted plays. Again, they often have no connection to real world EMS. They are a sort of Kabuki Dance which one must pass in order to prove that you aren’t a danger to the public.

Or something.

I’ve often referred to the EMT (or paramedic) exams as being the “Bunny Slope of EMS.” All that passing allows you to do is start the process of learning how to treat patients. This is the Affective Domain of learning. Which you can read about here. I think of the Affective Domain as the “putting it all together” domain. It’s where you take the book learning, the learning of the skills, and put them into practice. This is hard and many people just can’t do it. I worked with a number of providers, especially paramedics who were way smarter than am I. They could talk about medical theory in far more detail than I ever could. They even understood Axis Deviation and Hemi Blocks. I can learn those, and have. Several times. I just can’t retain that.

What those other folks could never do was put that all together when standing or sitting in front of a sick patient. I used to call it “Vapor Lock”, but other called it “Analysis Paralysis.” I was lucky, I guess, in that I could usually put what I was seeing, hearing, and all too often smelling (yech) together and figure out what was going on with a patient. And then devise and implement a treatment plan on the spot.

There were medics far better at it than I was, but I did my best to learn the intangible things from them and treat my patients well.

One of the highest complements we ever gave people was “He (or She) can recognize a sick person.”

That’s hard, but it’s still not the hardest thing in EMS.

This is.

Unlearning old untruths.

Far too many providers in this field refuse to keep current on the state of the science in EMS or medicine in general. In the last ten years a lot has changed in EMS.

The barbaric practice of strapping patients with possible spinal injuries to hard boards, driving them over often bumpy roads to hospitals, and then leaving them on those boards at the hospital, sometimes for hours, has finally been debunked. Not only did that “treatment” not help patients, it caused demonstrable harm. Patients with respiratory illnesses, especially the elderly, found it hard to breath and sometimes got ill. Patients that had minor aches from falls or low speed collisions, had significant pain, sometimes with attendant neurological deficits after being “treated”.

Finally, the science caught up with what just about every field provider knew. This was a poor practice that was meant only to protect cowardly medical directors and risk managers. It had nothing to do with medicine and was a horrible practice.

Most, if not all EMS systems, have abandoned the practice, yet there are providers who insist that we are going to fill the streets with quadriplegics in electric wheelchairs because we have stopped performing a vital treatment.


For most of the 1990s and well into the current century, stupid medical directors insisted that ALL patients that needed Oxygen be given high concentration doses via non rebreather masks. The pin headed logic was that EMTs and paramedics were incapable of assessing patient respiratory status. Thus, the only viable treatment was to flood their systems with Oxygen. Besides, the Chicken Soup School of EMS told us that it couldn’t hurt and might help. Then the science started to turn. Physicians started to study the effects of high levels of cellular Oxygen and found out that it not only didn’t help, it definitely caused harm.

All of those Stroke, Seizure, and Cardiac patients that we were giving boatloads of Oxygen to were suffering from the effects of the release of free radicals. Stroke patients in particular were prone to extension of the Stroke because of the effects of Oxygen.

Still, it took a number of years for EMS systems to change protocols and more time before individual providers were convinced that this was the right course of action.

Trendelenburg, Traction Splints (in most cases) and giving high doses of Dextrose to hypoglycemic patients have started to follow the same path. Those will take more years as the dinosaurs retire and younger, hopefully better educated, providers not only take to the field, but take to the classrooms and teach the new science.

It’s hard to let go of the old “truth” and embrace new ideas, techniques, and procedures. Hard, but important. All too many providers believe that once they have finished their class, passed the test, and received “their card” that all they have to do is go to a refresher (now renamed “National Continuing Competency Requirements) class and listen to some boring lectures that repeat the misinformation of the past. Go to some other boring classes, keep up your CPR and ACLS cards (you can sleep through those classes) and you are a “minimally competent” provider.

Just lovely.

I have a friend who used to work for one of the state OEMS regulatory agencies. We used to joke that one day we were going to start out own EMS company. We’d call it “MMS Ambulance Service”. Meets Minimum Standards Ambulance Service. Our motto was going to be “We’re minimally competent”. Not exactly confidence inspiring, but that seems to be the goal of both individual providers and many systems.

They seem to mistake mediocrity for excellence.

If you want to be more than just minimally competent, you have to work at it. First you have to be willing to take some classes beyond what is minimally required. Then, you have to be willing to case off old ideas as they become outdated and proven wrong. Finally, and this might be the toughest part, you have to stand up to mediocrity and laziness amongst your fellow providers.

See? I told you EMS was hard.

Good luck.

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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