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Operation Detachment

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On this day, in 1945, at 0859 hours, the first wave of USMC infantry landed on the beaches of an island most Americans had never heard of. The military planners of the United States had decided that Iwo Jima had to be neutralized as an enemy base and an airstrip built on the island.

Iwo Jima was a base for Japanese fighter planes that intercepted the B-29 bombers that were targeting industrial sites on the home islands of Japan.

The airstrip was needed as an emergency landing field for damaged planes and a forward medical aid station for injured fliers.

At this point in the war, the Japanese were on defense, desperately trying to stop the Allied forces from reaching the home islands. Their strategy was to make taking each island so expensive in human and financial costs that the Allies would sue for peace short of invading Japan. This strategy would be repeated in April when the United States invaded Okinawa.

The Japanese built deep and interlocking tunnels through out the island and stayed deep inside them during the pre landing bombardment and the initial landings. When the Marines started to advance inland, the Japanese started to attack from the caves and spider holes.

The fighting that followed during the five weeks before the island was secured was nothing short of savage. Five days after the initial landings, the Marines captured Mount Suribachi. A photo taken that day is perhaps the most famous of World War II.

There was still a month of fighting left. Of the six men pictured in the photo, three died in combat on the island.

Even after Suribachi was captured, the fighting continued until March 26th. Of the approximately 21,000 Japanese soldiers on the island, 216 were captured. Another 3,000 escaped initial capture, but died or surrender after major action had ended.

Of the approximately 60,000 Marines and Sailors who landed on the beach 6,800 died and 19,200 were wounded. It was one of the costliest battles in World War II.

Twenty Seven Medals of Honor were awarded to Marines and Sailors who fought on Iwo Jima. Twenty Seven. Of those Twenty Seven, Fourteen were awarded posthumously.

Once the island was secure, Army Air Force fighters were able to escort B-29s bombing Japan and the island served as an emergency landing strip.

In retrospect, some people question whether the results were worth the battle.

Of course, it’s always easy to look back and question decisions made at times of war. It’s much harder to make those decisions when the war is going on and the people deciding don’t know everything that future historians will.

For more on the Battle for Iwo Jima, click on the link.

This Could Be Huge

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The Center for Medicare and Medicaid Services (CMS), which is the federal agency that sets the rules for EMS reimbursement, among other things, has announced a new program for payment. The big news is that for agencies that choose to participate, there will be reimbursement for some non transports and some transports to facilities other than Emergency Departments.

Emergency Triage, Treat, and Transport (ET3) Model

The Center for Medicare and Medicaid Innovation’s (Innovation Center) Emergency Triage, Treat, and Transport (ET3) Model is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare beneficiaries following a 911 call. Under the ET3 model, the Centers for Medicare & Medicaid Services (CMS) will pay participating ambulance suppliers and providers to 1) transport an individual to a hospital emergency department (ED) or other destination covered under the regulations, 2) transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or 3) provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth.

The goal apparently is to relieve over crowding in Emergency Departments by providing alternative care sites for patients who can’t wait for a primary care provider appointment, but still need care.

Transports to free standing urgent care centers will be reimbursed, as will treat and stay home in some cases. The service is centered around ambulance services providing 9-1-1 responses. The language is a little convoluted, but municipal, hospital operated, and apparently private services providing 9-1-1 response, are eligible. Participation is voluntary and will cover an initial five year period.

The key participants in the ET3 Model will be Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers. In addition, to advance regional alignment, local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic areas where ambulance suppliers and providers have been selected to participate in the model will have an opportunity to apply for cooperative agreement funding.

There is the bureaucratese version of what I said.

As I said, this could be a huge change in how EMERGENCY ambulance service is provided in the United States.

A couple of areas where I can see change are in treatment of diabetics who have an episode of hypoglycemia. It’s not unusual now for services to treat and then accept a patient refusal for diabetic patients who suffer a hypoglycemic event. The problem with that is that there is no reimbursement mechanism. As a result, the ambulance service has to absorb the cost of response and treatment. Which in it’s turn means that we all pay a bit more for ambulance transport to make up for the services lost.

I can tell you folks, that isn’t cheap. A few years ago the chief of a small (three ambulances) fire based system told me it cost $1,500.00 each time one of his units rolled out the door. That’s whether they transported or not.

Think of that next time someone complains about how expensive an ambulance is.

Under this model, the EMS system can bill for the response and treatment, even without a transport.

Another thing that this will likely allow EMS systems to do is respond to cardiac arrest calls, treat, and terminate resuscitation in the field.

Everyone who has worked in EMS for more than a short period of time has responded to a cardiac arrest and transported a patient that they knew was not going to be resuscitated. It ties up resources in the field and the ED as well endangering the public. Some systems already do field terminations, but don’t get reimbursed for it, so again there is a cost that is absorbed by the rest of the public.

This could tie in with and provide payment for the Community Paramedicine projects that are going on around the country. As of now, they are being funded either by hospitals, grants, or in a few limited cases medical insurance companies. Up until now, CMS has had no mechanism to pay for this type of care.

Also, this could be a career extender for creaky old paramedics that can still do most of the job, but for whom lifting and moving patients is no longer possible.

It will be interesting to see how this works out over the next several years, but it could bring about a sea change in how and where EMS is delivered in the United States.

NYPD Versus The First Amendment

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NYPD to Waze: Stop snitching on our checkpoints!

“Police reported ahead” is a common phrase heard on a drive using the crowd-sourced navigation app Waze. Added to the app in real time by nearby users, it’s one of numerous alerts sent to drivers about upcoming obstacles on a route. Many users view it as a harmless way to avoid getting speeding tickets, but others use the app to point out police checkpoints, including those setup for DUI prevention. The New York Police Department (NYPD) wants it to stop.

Written about by the The New York Times and reported by Streetsblog, the NYPD sent a cease-and-desist letter to Waze’s owner, Google. It insisted the app’s capabilities should not be allowed and could even be considered illegal.

“Individuals who post the locations of DWI checkpoints may be engaging in criminal conduct since such actions could be intentional attempts to prevent and/or impair the administration of the DWI laws and other relevant criminal and traffic laws,” NYPD Deputy Commissioner for Legal Matters and lawyer Ann P. Prunty said in the letter.

I don’t have sympathy for people who drive drunk, but I have less sympathy for those who think that they can attack the Bill of Rights. NYPD is already well known for it’s antipathy to the Second and Fourth Amendments, and now they seem to want to add the First to their list of Civil Rights they want curtailed.

In a different age, and maybe even now, drivers would flash their headlights at oncoming traffic to warn of police ahead on the road. Whether it was a speed trap or DWI check point, it didn’t matter. Smart drivers would check their speed and make sure that they weren’t doing anything that would attract undue attention from the police.

We can debate whether that’s obstruction or enhanced safety, but one thing is for sure. It’s protected speech under the First Amendment. There have been court cases in Missouri, Ohio, and Florida where judges have said exactly that. They’ve dismissed cases and enjoined police from pulling over and ticketing drivers for flashing their headlights.

The feature in Waze that NYPD doesn’t like is the same thing, only the 21st Century version.

I use Waze a lot, for several reasons. First, is that it warns of heavy traffic ahead of me and offers alternate routes. Which is another thing some police departments don’t like. That is because  the alternate routes can increase traffic on otherwise quiet streets. Which in turn engenders complaints by the residents and the police have to “do something.” “Something” is likely to be enhanced traffic enforcement, wherein more drivers are stopped and if not local residents, are likely to get traffic tickets.

Secondly, Waze warns me when there is a traffic problem ahead. Some of the work I do is time sensitive as it involves transporting human organs for transplant. I don’t want to sit in traffic unnecessarily while a patient and surgical team are waiting for an organ. Unlike what you see on TV and movies, most organ transplants don’t involve helicopters and Igloo coolers. They involve drives, some short, some longer.

It helps to know that there is a major accident ahead on the Interstate and an alternate route is better.

I’ve used Waze to navigate the maze that is New York City (Manhattan) traffic for just such a transport. I’d likely still be there if I didn’t have it.

Third, yes it does often warn of police activity ahead. Which could be a speed trap, traffic stop, or just an officer sitting by the side of the road.

If I were still active in EMS and had to operate in an area with which I was unfamiliar, I’d use Waze in preference to a stand alone GPS. The real time traffic data is worth the amount (small) of data usage incurred.

Traffic tickets aren’t really about public safety, they are about revenue generation. With few exceptions, people stopped  by the police for traffic violations aren’t creating a risk to the public.

But I digress.

So, NYPD has demanded that Waze stop allowing it’s users to post the locations of DWI check points. The problem being that Waze doesn’t have specific categories for “Police Reported Ahead.” You press the police icon and your choices are “Hidden”, “Visible”, or “Other Side.” “DWI checkpoint” is not on that list. In effect, what NYPD wants Waze to do is remove the entire “Police” function.

My guess is that there are far more traffic stops, speed traps, and other enhanced enforcement activities that the NYPD engages in that they don’t want people warned about. Activities that generate a lot of revenue for the City of New York.

Here is the official reply from the Waze parent company, Google.

Google released a statement saying, “We believe that informing drivers about upcoming speed traps allows them to be more careful and make safe decisions when they are on the road.”

Sufficiently vague and generic that no one can really complain. After all, who isn’t in favor of “safe decision?”

Or the First Amendment, for that matter. I think NYPD is on the losing end of that argument in this case.

Of Bullets And Penetration

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I was in my, ahem, reading room perusing the January copy of Shooting Illustrated when I came across an article titled,

The Terminal-Performance Triangle: Measuring Ammo Effectiveness  by Ricchard Mann.

I don’t know Mr. Mann, but I have to believe he knows what he’s talking about or he wouldn’t be writing for Shooting Illustrated. Maybe I’ll get to meet him at the NRA Annual Meetings in April. I’ve read some of his other articles and he certainly appears knowledgeable.

So, who am I to question an article by him? Well, nobody, at least not in the world of guns and shooting. I have, however, treated a good number of people who were shot over my years in EMS.

Because of that, in part I agree with Mr. Mann when he comments about the effectiveness of bullets in personal defense. Unlike on TV and in the movies, people who are shot do not generally fall down dead, let alone fly across the room as in this shoot out from “Last Man Standing.”

Look starting at about 0.41 to see what I mean,

The law of physics just don’t allow for that sort of thing, although it does look cool on the big screen.

Newton’s Third Law of Motion tells us,

For every action, there is an equal and opposite reaction.

All of which is to say that if people went flying when they were shot, the shooter would go flying in the other direction. Especially if the firearm that they are using is not an auto loader.

Back to the article,

Established on good intentions, and because of the infamous 1986 Miami shootout, the work of the FBI has driven the design and manufacture of defensive-handgun ammunition ever since. All because a single and lethal hit from a 115-grain Silvertip (oh, the irony) fired from a 9 mm did not incapacitate a bad guy fast enough. The bullet stopped in the lung, just short of the heart.

The 1986 Miami shootout was infamous because two FBI agents were killed, five others were wounded, and while the two suspects were killed, they weren’t killed or even stopped very quickly. Additionally one of the suspects had a rifle and the other had a shootgun. It took 12 shots to kill one suspect and six to kill the other.

The investigation after the shooting named inadequate stopping power as one of the reasons that it took so many shots to stop the suspects. There was also serious criticism of the tactics and lack of preparation, but I’m not going to go into that here.

As a result of the investigation and subsequent tests, the FBI decided to adopt a 10mm round and new semi automatic handguns by Smith & Wesson. The round and the guns themselves proved to be problematic and the FBI returned the guns to S&W. Meanwhile, S&W developed the .40 S&W round, which used the same bullet as the 10mm, but with a shorter case and less powder. That round was eventually adopted by the FBI for most Special Agents.

Following the lead of the FBI, many law enforcement agencies adopted the .40S S&W round and a variety of handguns to shoot it out of.

Meanwhile, back at the ammunition manufacturers, development on new bullets and powders was proceeding apace. 9mm ammunition became far more potent than it had been heretofore, as did other rounds. One of the biggest developments was in the shape, deformability, and expansion of the bullets.

When I was young, revolver ammunition was mostly .38 Special with bullets made of lead and weighing in at 158gr. That was the standard law enforcement round and the one that I learned to shoot on. As did a lot of other people. 9mm wasn’t considered a serious self defense round because it had a reputation for over penetration. The standard 9mm round had a 147gr full metal jacket bullet that came out of the barrel at high velocity. The worry was that a round that hit a person would continue through and hit anyone who happened to be behind the the intended target.

Hitting unintended targets is bad. Well, it’s worse than bad as even if the intended target is a bad guy and the shooter is defending his or her life, bad things are going to happen to the shooter if he hits an innocent person.

Which brings me to the point of Mr. Mann’s article,

It’s true, it will neither deform nor expand, and the wound cavities will be narrow. But, it’s very likely that, had the bad guy in Miami in 1986 been shot with hardball ammo from a 9 mm or .45 ACP, the round would have made it to his heart, and all this silver/magic-bullet development during the last 30 years might have never occurred. At the most-basic level, the terminal-performance triangle is made up of penetration, expansion and velocity. Hardball may not be sexy, but lack of penetration—the most-important side of that triangle—should not be a concern. And those made of silver should work just fine on werewolves.

Lack of penetration is, as he points out, bad. That being said, over penetration could well be much worse. If I’m in a self defense situation there are a few things I want to happen.

First, I want to hit the intended target.

Second, I want the round or rounds I have to fire to stop the person who is attacking me. Not necessarily to kill them, but to stop them from killing me.

Third, I don’t want the rounds to go through the intended target and off into the wild blue yonder.

Looking at the triangle, penetration is a function of velocity and bullet shape. Sufficient penetration is important, avoiding over penetration is even more so. A round with a good balance of penetration and expansion will cause enough injury to make the attacker stop.

Interestingly, Mr. Mann wrote this article for Shooting Illustrated in July of last year.

Personal-Defense Ammo: Top Picks from the Experts

Finally, you’d expect these loads—selected based on years of experience—to have something in common? I’ve tested them all, and other than their ability to penetrate at least 12 inches, they don’t. Penetration ranges from 12 to 20 inches and expansion from 1.2 to 2.2 times bullet diameter. Then there is velocity and energy variances, which range from 940 to a high of 1,240 fps, and from294 to 423 ft.-lbs., respectively.

Does this mean some of our contributors are wrong? No, just that their experiences have created differences of opinion. As Shooting Illustrated’s Ammo editor, my opinions differ, as well. You’ll find either 135-grain Hornady Critical Duty or 124-grain Remington Black Belt +Ps in my 9 mms, and DoubleTap’s 160-grain TAC-XP Mann load in my .45s.

In that article, he asks nine associates from Shooting Illustrated what they carry for self defense ammunition. All of them have good resumes` and certainly know more about shooting than do I. Each of them carries a hollow point round of some variety. Mr. Mann mentions at the end of the article that he carries one of three different rounds. All of them use hollow point rounds. One of them is a round that I use on one of my 9mm guns for a number of reasons. Again, I won’t go into that here.

As do some of the other people cited in the July article, I try to match the round to the particular gun. Some guns “like” a particular ammunition more than others. It’s important to practice with any firearm you think you might use for self defense and find the ammunition that works best for you and the firearm.

I think any expert will tell you the same.

As I’ve Long Suspected

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The TSA Is in the Business of ‘Security Theater,’ Not Security

A tell-all from a former Transportation Security Agency worker confirms pretty much every awful thing you’ve suspected of the ineffective and invasive airport pat downs. That’s okay, though: the TSA’s main purpose isn’t security so much as “Security Theater.”

 

Harrington readily notes that these reactionary policies, as they stand, are ineffective at actually stopping terrorism, as potential attackers can simply change tactics. But this is in many ways an effective way to combat the perception of American insecurity. Terrorism is, by definition, an act that seeks to create fear in its target. By battling those specific fears of shoe and underwear bombs, the TSA can claim some success on the security stage. However, now that Harrington has blown the lid on that theater, don’t expect anyone at the TSA to take a bow.

Wrong. Everyone I know who travels by commercial airline anywhere considers TSA security to be a sick, perverted, useless joke. Mrs. EMS Artifact frequently comments that the terrorists must be laughing their asses off when they see airport security in action.

Note that to date, the TSA has not stopped one terrorist. Not. One.

Abusing the traveling public doesn’t do a thing to make people feel more secure. A couple of years ago, before she got Pre Check, Mrs. EMS Artifact was selected for “additional screening.” Her crime? She beeped when she went through the scanner.

Just like the airport security scene from High Anxiety . They detained her for 20 minutes trying to figure this out, including asking her three times is she was SURE that she’d never had a knee replaced. Like that’s something you’d forget.

I do think that Harrington is full of fertilizer when he says people from the Middle East were profiled for extra security. From my observations, it was always white people, particularly elderly ones, who were selected for sexual abuse. Well, them an nubile young females. Wouldn’t seem to me to be two demographics high on the list of potential terrorists, but I didn’t go through the intense four week TSA training course, so what do I know?

Creating the TSA was a knee jerk reaction to the September 11, 2001 terrorist attacks. Originally “officers” were supposed to be non union and non civil service, so that it would be easier to terminate bad employees.

That didn’t last long at all.

There is really no reason that the TSA can’t be dissolved and the functions contracted out to private contractors, selected locally by airport authorities.

Maybe then we’d have real airport security, or at least some accountability if we don’t.

 

Hygeine In EMS

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This story appeared on line the other day,

Many paramedics ignore hand hygiene rules, study finds

Paramedics have a “remarkably low” rate of compliance with hand hygiene standards, which could put patients at risk for deadly infections, according to a new report.

For the study, researchers observed 77 paramedics in Finland, Sweden, Denmark and Australia as they dealt with 87 patients. The paramedics’ compliance with basic hygiene was high: short, clean nails at 83 percent; hair short or tied back at 99 percent and no jewelry worn at 62 percent.

But many ignored World Health Organization guidelines in five situations when cleansing with soap and water or an antiseptic rub is needed. Too many relied instead on gloves, suggesting they care more about protecting themselves than patients, the study authors said.

77 paramedics, 87 patients, and from that they draw general conclusions.

Unfortunately, there is no link to the original study and no information as to what organization conducted it.

There seems, at least from my reading, to be a lot of false assumptions and bad information in the article. There is also nothing to suggest that this is the same in the US as it is in the systems studied.

We wear gloves for two reasons. The primary one is to protect ourselves from becoming infected by the patients. The second, and lesser, is to prevent contaminating our equipment and thus possibly infecting the current or a future patient.

If anything, in the US we wear gloves too often, don’t remove them promptly, and don’t reglove when we should. I worked with people who “double gloved, but I always felt it was pointless from a protection standpoint and made it harder to perform some tasks.

I, and a lot of the people I worked with would go through a couple of pairs of gloves on a call. If they got bloody, or torn, or contaminated with “yuck”, off they’d go and on would go another pair.

One thing that drove me crazy is when the EMT that was driving us to the hospital kept his gloves on while driving. Which meant that we had to decontaminate the cab of the ambulance. Or, sometimes they’d take the gloves off and drop them on the cab floor. More than once I retrieved a pair of used gloves and dropped them on the front seat of the BLS ambulance that assisted us. Crude, maybe a bit childish, but it got the message across.

I’m not making it up when I say I had a partner that put on gloves to answer the radio when we were dispatched. She was a bit odd in many ways, so I just laughed at her.

One thing that I do agree with in the article is that we often put gloves on when they are not needed. On some calls, because I was running the call and not going to touch the patient (the luxury of having an adequate number of personnel on a call), I wouldn’t put gloves on.

On a note from the article, if you’re putting your gloves on after touching bodily fluids, you’re not putting the patient at risk, you’ve already put yourself at risk.

One thing that is not clear from the article is that the researchers actually understand that the risk of contamination FROM the patient is much higher than the risk of contamination TO the patient.

As to the risk of cross contamination, the only times I’ve seen providers touch more than one patient without changing gloves was at a Mass Casualty Incident. Especially if it’s something such as the Boston Marathon Bombing for example, patients are going to be moved quickly and there wouldn’t be time to change gloves. In that case, anyone with an open injury is going to get antibiotics at the hospital, so the point is moot.

One area that many providers can improve is in cleaning equipment after calls. I was a bit of nut about that. After every ALS contact, the EKG and all other cables got cleaned, my stethoscope got cleaned, the stretcher got cleaned, and any areas that the patient might have touched got cleaned. Sheets and blankets were changed after every call.

I don’t know that everyone I worked with was that thorough, but most of them were.

In sum, I think that this article is over blown and if there was an actual study, it was poorly structured.

Pretty typical of the Main Stream Media reporting on medical issues. Flashy, scary headlines without much substance.

 

Something Is Wrong With This Story

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I read this story a few days ago.

Police: St. Louis officer killed by colleague in accidental shooting

ST. LOUIS — A St. Louis police officer “mishandled” a gun and accidentally shot and killed a colleague early Thursday, authorities said.

The shooting happened around 1 a.m. at an officer’s home, police Chief John Hayden told reporters during a news conference shortly after the shooting. Two on-duty male officers were at one of their apartments when Katlyn Alix, who was off duty, stopped by, according to police.

A police incident report said the three officers were seated in the apartment living room when one of the male officers “mishandled a firearm and shot (Alix) in the chest.” The male officers, both 29, drove Alix, 24, to a hospital, where she died.

This was a tragedy for the officer and her husband. It’s going to be an ongoing tragedy for the officer who shot her. It’s not going to be too pleasant for the officer’s partner, either.

The officer who did the shooting (allegedly) has already been arrested and charged with Involuntary Manslaughter.

All of that being said, this story seems incomplete. There are a lot more questions than answers in the news reporting so far.

Why were two on duty police officers at an apartment that was outside of their patrol district?

Why was an off duty officer at that apartment in the middle of the night?

What on Earth would induce to responsible adults to play “Russian Roulette”?

The parents of the deceased officer have already retained a lawyer, so we can expect litigation to follow. During discovery, the truth will likely come out and I’m not sure that the family of the deceased is going to like what they are told.

All of which is besides the point. No matter what happens there are two things we know for sure.

Katlyn Alix is dead because at least two people, both police officers, were irresponsible with a firearm.

Firearms are not toys and anyone who owns or uses them does so at their own peril and to the peril of those around them.

Sad and ultimately so unnecessary.

 

Where Is EMS Going?

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And how do we get there?

Recently there has been debate about an education requirement for paramedics beyond just having a paramedic certification. Some, maybe many, people want to require at least a bachelors degree in “Emergency Medical Services” for someone to work as a paramedic.

There are different opinions as to exactly what courses should be required. More biology, more anatomy and physiology, more chemistry, all seem to be popular ideas.

Many people see nursing as the model to which EMS should aspire. After all, they ask, isn’t better education how nurses became recognized as a profession and how pay for nurses improved?

Yes, but that has nothing to do with how EMS is going to advance, if EMS is going to advance.

There are many differences between nursing and EMS. First, the work venue and opportunities. If you work in EMS, in most areas that means you work in an ambulance. Or maybe you’re a supervisor or lower level manager. Sure, there are some systems where there are Community Paramedics, but that’s not wide spread and isn’t likely to become widespread unless and until there is a funding mechanism. Right now, most of the Community Paramedic programs are funded by grants of one sort or another.

Once that funding runs out, if it’s not replaced by another source, we’re likely to see Community Paramedicine disappear once more.

Nursing, on the other hand has a lot of different work venues available. Even within a hospital there are different types of nursing. Some of those don’t even involve direct patient care. There are nurses who do research or work with doctors who do research. There are nurse managers, who do management and administration.

I have a cousin who has a PhD is nursing. She does research into Stroke care and a very small amount of direct patient contact. She works at a major teaching hospital and is well paid. I don’t see that sort of thing happening in EMS. Not that it can’t, just that it won’t.

By the way, there are two different types of Doctorates available for nursing.  This post isn’t about that topic, interested readers can read the short article at the link.

In addition to working in hospitals, there are all sorts of nursing jobs outside of hospitals. Again, many of them don’t involve patient care.

In contrast, being a paramedic mostly involves working in an ambulance doing direct patient care. That’s not likely to change.

Also, in contrast to EMS, nursing in many areas is unionized. I won’t get into that debate here, but it should be noted that EMS systems that are uniionized generally have better pay, benefits, and working conditions.

Nursing also has far more control over who is a nurse than EMS has over who is a paramedic. Which is a problem for EMS. A lot of people who are paramedics identify primarily as something “and” a paramedic. It’s even more prevalent with EMTs. There are a lot of people who have gone through EMT courses and taken the test to get certified. Many of them have no intent or interest in working in EMS, but wanted or needed the certification for some reason.

Even people who are paramedics look at that certification as a means to an end and not as a career itself. Many of them are good paramedics, but they don’t see being a paramedic as their primary career.

I’m up to almost 600 words and still haven’t gotten to the biggest problem with a college degree requirement for paramedics.

Cost. More specifically cost and return on investment.

A Bachelors degree is not inexpensive no matter where you go. A person is going to have to lay out X amount of dollars to get that degree , if indeed one does exist.

Does anyone expect that ambulance services, especially privately owned for profit services, are going grant wage increases just because a person has a degree?

“Ahh,” you say, “When every paramedic has a degree, services are going to have to raise wages.”

Would you like to bet on that? Since paramedics have limited job opportunities, there is no incentive to give raises to them.

If I were to be asked by a young paramedic what type of college degree he should get, my advice would be to either get a Bachelors of Science in something like biology or chemistry OR a degree in business administration. Both are far more portable than a specific degree in EMS. Both give a paramedic a route on to professions outside of EMS. There is far more likelihood of a good return on investment with those degrees.

This is not to say that better education is needed in EMS, at both the BLS and ALS levels. That’s not going to happen at the BLS level for reasons I won’t go into. It should and might happen at the ALS level.

As long time readers will know, post retirement I make money in the Quality Improvement end of EMS. A big part of that job involves reading Patient Care Reports. My company rules don’t allow us to score the quality of writing other than as it relates directly to patient care. That is, we can’t correct spelling, grammar, syntax, or anything related to them.

If we were allowed to, I’d be far busier than I already am.

Which is to say that many of the reports are horrendous when it comes to how they are written. I wince at some of what I read in those reports, even if the clinical care is fine. I can only only imagine what the doctors and nurses who read those reports think about EMS providers. Not to mention what the lawyers think when they are reviewing reports for possible litigation.

If I were building a paramedic program, or rather if I were responsible for setting the requirements, remedial English and Mathematics would be added as well as better Chemistry, A&P, and Biology classes. That would be the first part of the program, before we even got to the medicine part. I’d probably add a basic business course as well, so the students could understand the economics of EMS.

That’s the biggest need in paramedic education right now. Produce paramedics that know what they are doing and why, can write a coherent sentence in a report, and understand why EMS operates as it does, then you can talk about making EMS a profession.

As it stands now, EMS on it’s best days is a trade, but spends most of it’s time as a skill set that can be used in a variety of other trades and even a couple of professions.

Starting The New Year With A Bang

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We had unseasonably warm weather in the northeast on New Years Day. Since I had nothing else to do, I decided to head over to my gun club and do some shooting.

I loaded up the range bag with a couple of guns, targets, and other stuff and headed out. I wasn’t sure that I was going to get to shoot, because I expected that other people would have the same idea.

I guess they were all doing something else, or maybe just hungover because there was just one other person there when I arrived. He was packing up and left pretty much as I walked into the range building and started to set up.

One of the things that I like about my club is that there is no requirement for a Range Officer to be present when members want to shoot. There are some pretty reasonable rules and some actual video surveillance, but we are treated like responsible adults.

I set a target on the handgun range and loaded up.

First up was a recently acquired Smith & Wesson CS9. Back in the late 1990s, S&W applied the “Chiefs Special” name to very compact Third Generation semi automatic pistol line. These were, in today’s parlance “sub compact” pistols with a three inch barrel, less capacious magazine, and overall smaller size than the full size or even compact versions of the same guns. I don’t think that they were specifically marketed to police chiefs, but maybe they were.

The firearms were also “Value Line” versions of the Third Generation guns. That meant that they weren’t as smoothly machined as the regular lines, used some plastic parts in none critical parts (if there is such a thing), and didn’t have the quality bluing of the larger guns.

There were other “Value Line” guns, which were intended to compete with the highly successful and less expensive to produce Glock pistols. Functionally, the Value Line guns were Third Generation pistols, they just weren’t as finely finished.

This particular gun was sold to a law enforcement officer, so it was a bit different than the regular production guns. The two major differences were that it was shipped with Novak low profile sights with Trijicon night sight inserts. The other was that it was shipped with an ambidextrous safety.

Since my new acquisition was built in September of 2001, the lamps have long since burned out. Easy enough to fix and I’ll be shipping the gun out Trijicon for relamping.

I’m not a big fan of the ambi safety levers and so I swapped a left side only safety that I had sitting in the parts bin into the gun. The big reason for this trip, other than it’s fun, was to make sure I hadn’t bunged that operation up.

That safety will be coming out and shipped to a gentleman down south for some reworking. He will shave a couple of steps off the lever and then dehorn the edges to make it easier to carry without digging holes in pants and shirts.

Once all of that work is done and the gun is back together, this will become my pocket carry pistol.

The actual shooting was a bit anti climactic. As expected the gun, is very accurate for a 3″ barrel firearm. I’ve tested various bullet weights and it seems to shoot best with 124gr bullet weight. I plan to use Federal HST 124gr Jacketed Hollow Point ammunition.

Once I was done with that pistol, I put up a fresh target and took the next pistol out of the case.

This is a Springfield Armory XDE, also in 9mm. I’m not a big fan of polymer frame guns, but this one is a bit different. I also bought it as a travel gun for occasions when I go out of state. I did that because unlike my no longer produced Third Generation semi autos, the XDE is easy to replace in the event it is lost, stolen, or for some reason taken by the police during an investigation.

I got a really good deal on this gun over the summer from a dealer I’ve done a fair amount of business with. All I needed was an additional magazine and well made Kydex holster to complete the package.

One of the reasons I selected this specific model is that it’s functionally very similar to the Third Generation S&W firearms. First shot is double action, follow up shots are single action. The manual of arms is similar, with two differences. First, the safety and decocker functions are different. The XDE safety lever is pretty much in the same location, but it moves down for decock and then up for safety. It can, at least in theory, be carried with the hammer cocked, but safety engaged. Well, it can be carried with the hammer cocked and safety NOT engaged, but that’s not something I would do.

Of course it can be carried with the hammer down and the safety not engaged, which is how I generally carry my Third Generation firearms. It can be carried with the hammer down and safety engaged, which again I don’t recommend.

Carrying with the chamber empty, as advocated by some people, is right out. Feel free to convince me I’m wrong in the comments.

This gun is very easy and comfortable to shoot. It’s also very accurate. The only modification I’ve made or will make is to put some Talon Grips grip tape on. It makes the grips a bit more “grippy” and covers up the rather silly “Grip Zone” logo molded into the factory grips.

The XDE doesn’t seem to care one bit about bullet weight. I’ve fired 115, 124, and 147gr range ammo through it without a hitch.

I’ll probably use 147gr JHP for personal defense, since the firearm is accurate with it and has a long enough barrel for good expansion.

Pictures to follow when I have a few minutes.

That was my New Years Day, how was yours?

 

Day of Infamy

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As the attack on Pearl Harbor on this day in 1941 fades into history and the people who were there leave us, a theme has grown up that the American response to the attack by the Empire of Japan was somehow racist.

Sure, there was a lot of propaganda after the start of the war that was very harsh on the Japanese. Americans of Japanese descent were interned under the guise of what we now call “national security.” At the time, it no doubt seemed a reasonable step.

We had been attacked without formal declaration of war by the Japanese. Understand that such was not their intent, but they were inept in how they decoded, typed, and delivered the message. The effect was of an unprovoked “sneak attack.” The Japanese had a history of simultaneously declaring war and attacking, which is what they were planning for Pearl Harbor.

It’s odd, but the people crying “racism” either don’t know or don’t care that there was plenty of “racism” on the part of the Japanese.

Their treatment of prisoners of war was despicable. Japan, not being a signatory of the Geneva Convention of 1929 were not bound by its terms. Which does not excuse the starvation of,  the summary executions, or casual torture of prisoners of war.

Even worse was the treatment of civilians in areas captured by the Japanese military. Look up the Rape of Nanking, the Japanese Domination of Korea, or the Treatment of Civilians by the Japanese.

The Japanese were the provocateurs of the war in the Pacific, not the victims.

The war that followed in the Pacific and Asia was brutal. It was almost four years before the Japanese surrendered. At that, it took the destruction of two Japanese cities by Atomic Bombs before they finally, and in many cases reluctantly, surrendered.

It all started Seventy Seven years ago today.

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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