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Staying Occupied

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Since the world has in many ways ground to a halt, I’ve been looking for things to do to keep busy.

What passes for post retirement work has pretty much stopped as the doctors are to busy to read and respond to reports, the fire stations are all locked down, and the fire fighters whose cases I review are all too busy responding to calls.

I can still do audits, but the slow down has actually allowed us to catch up on outstanding audits, so there isn’t as much of that.

Speaking of reports, the ones from this month have shown an interesting progression. Starting about the second week of the month reports have mentioned “Covid-19” more and more. The downside is that some medics are so obsessed with Covid-19 that they don’t look for other causes for patient’s illnesses.

I’ve caught about half a dozen out of the 200 or so reports I’ve done, where tunnel vision has lead to missing CHF, Sepsis, and in one case a Stroke.

A sort of upside to this is that I have more time to do “retired guy” stuff. Which translates to doing a lot of minor projects, or at least looking for minor projects.

So far I’ve replaced the shower doors on the bath tub. Which not only made Mrs. EMS Artifact happy, she’s been looking to replace them for a couple of years now, but also saved several hundred dollars. She had contacted a company that installs replacements and had received an estimate. The guy who runs the company was supposed to come out and look at the job to finalize the details. He never showed up and never called. That was before all of this started, so he’s just a crappy businessman.

I replaced a front light that went all wonky. It’s supposed to come on automatically after dark when it detects movement. It detects movement, but comes on even during the day. That took about an hour or so.

Painted a closet. This is actually a project I’ve been pecking at here and there for a few years. I decided to paint all of the closets as part of my on going process of getting the house ready against the day we put it on the market and move. I don’t know when that will be, but it will happen.

As with all projects, prep is the key and the hardest part. I spackled all of the cracks and dings in the walls. Then I taped. Then I waited for the spackle to dry. That was day one.

Day two (you don’t want to rush these things), was the painting. Which took about 20 minutes. A couple of hours to wait for the paint to be well dried and I took the tape off, cleaned up and vacuumed.

Bought five bags of top soil, dumped them out, raked it the pile flat, and threw down some grass seed. I might take up watching grass grow if this lock down goes  on for much longer.

Bought two end tables with lamps and assembled them. The first was for the Living Room to replace a torch lamp that the Mrs. didn’t like. She wasn’t sure that she was going to like the new one either, but while I was putting it together down in my den I noticed that it would fit in and replace a lamp and small table I had down there.

As it turned out, she liked the lamp/table combination, so I went out and bought a second one. I managed to stretch that out over two days.

Friday the weather was great, so I went to the range to do some shooting. Amazingly, I was the only person there for much of the time. I figured it might be busy with bored people looking for something to do.

I’ll post a bit about that tomorrow. Or maybe Tuesday.

Saturday was another beautiful day, so I went out in the yard and worked on that all day. Brush clearing, some small tree felling, and burning brush in my burn barrel.

Even though I’m not a huge fan of yard work, there is enough of it to keep me busy in the nice weather. While it’s physically strenuous, it’s mentally relaxing. Once I get out and start, I find that I just keep working at it. I ended up cutting down about a half dozen small trees and then cutting them into sections. One of my neighbors has a wood burning stove and I’ll offer the wood to him.

There are still a few more small trees I want to trim back, but that will have to wait until the weather is clear again. Which, according to the weather guessers could be about a week.

Today will be gun cleaning day. That will include the two I shot the other day and maybe one or two others. Those probably don’t need cleaning, but taking them apart and putting them back together will be fun. I like mechanical things and I like taking them apart and putting them back together.

That’s what I’m doing to keep business while waiting for the world to start again. I do have to wonder what kind of world we’ll return to when this has passed. Will things return to the old normal or will there be a new normal of not getting to close to one another?

I also wonder what the rest of the world is going to do about the Chinese Communist Government’s lying to the rest of the world about this disease?

 

Hysteria

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I’m not making light of the potential for illness and death from the Wuhan Flu virus, but the hysteria has gotten out of control.

The media is treating this like an ongoing terrorist attack. News outlets are spreading wild rumors by the hour. Once one has been debunked, another pops up to take it’s place.

Just about every public activity that you can think of has been cancelled. Restaurants are empty, hotels have emptied, whole states are essentially shut down.

Everyone, and I mean everyone has put out statements about their response. I got one from my cable provider informing me that they are making sure that their stores are extra clean, their technicians are taking hygienic precautions, and will provide remote support when necessary. Because wait times for phone support aren’t long enough now.

5.11 Tactical assures me that they are making sure that their facilities are super duper clean. Here’s a hint. I wash all new clothes before I wear them. My wife worked in fashion retail way back and says that only fools don’t do that.

There is panic buying toilet paper. Toilet paper. There is no shortage of it, but people are buying it as fast as it is put on the shelf. Apparently somewhere along the line the rumor started that our toilet paper comes from China and the factories were shutting down.

Which isn’t true. Most of the toilet paper used in this country comes from Canada. Which last I saw was still making it. Along with paper towels.

People are buying non perishable food by the case, items like flour and rice are being sold in 50 pound bags.

The media hysteria is driving political hysteria. No politician, and remember the #1 goal of all politicians is to get re elected, wants to be the one guy that didn’t take every precaution. Schools are closed from two weeks to six weeks depending on location.

If you listen to the media and politicians catching the Wuhan Flu is a death sentence 100% of the time. Most people who have contracted the illness have mild to moderate symptoms and recover fully in a fairly short period of time.

I am hearing stories of a need for hundreds of thousands of ventilators, but not who will need them. You’d also think that every one of the 327,000,000 people in the country is going to need to be tested. Which is not true either.

I’ll leave the politics out of this for the most part, but it’s pretty clear that some people are using this as a weapon for the upcoming election. First, the President acted too hastily in closing off travel from China. Now, he’s accused of acting too slowly.

The Speaker of the House threatened to hold up the response bill if language wasn’t included that restored federal funding for abortion. Which pretty clearly has nothing to do with responding the crisis. It’s just more pork barrel spending by politicians.

The people who are in most danger from this are people over 60 with underlying medical conditions. At the top of that list is people with respiratory illnesses. That’s a fair number of people, so they should try to limit public contact. Next are people with underlying cardiac issues or Diabetes that isn’t well controlled. Of course people being treated for cancer, no matter what their age are really vulnerable, so they should be careful. People who have had organ transplants and are on anti rejection drugs also full into that category.

People over 80, even if healthy are vulnerable.

Kids, again unless they have serious underlying medical conditions, are not at much risk. In fact, so far no one under the age of 10 has contracted the illness. Adults without medical conditions catch it, but some say it’s not any worse that a miserable cold.

Keep in mind that despite any problems with paying for it, we have the best health care in the world right here in the US. Italy? Not so much, which is why their mortality rate is higher. China? Not even close. Iran? 7th Century medicine is not up to the task.

None of the people I know, including my 100 year old Mother in Law, are hysterical about this.

What people with school age children are right now is angry. People are scrambling for child care so that they don’t have to take time off from work. I joked with a former co worker who has children that I was considering opening and over night child care center for people who work in EMS. He asked me if he could sign his kids up before he realized I was kidding. He asked if my wife was willing to drive up to his house and babysit.

Keep in mind that he’s never met my wife, doesn’t even know her name. I’m sure he’ll figure something out, but the point is that the politicians are making these decisions without think through the consequences.

Maybe instead of shutting schools, they should ask the TV stations to stop doing news casts. No, not seriously, but it would be nice if they dialed the hysteria back down to 11.

I can’t help but think that by the end of April we are going to look back and wonder why we were so panicked.

One final thought. The last really big pandemic, before the word even existed, was the Spanish Influenza of 1918. Since then there have been similar panics in 1957, 1968, 1975, and 2009. That doesn’t include the SARS panic, Legionnaires panic, Ebola panic, and MERS.

In the 1975 panic more people died from reactions to the vaccine than from the flu.

Speaking of vaccines, we’ll have one but not until next fall in all likelihood. We’ll probably have effective treatments before that. Both of which are dependent on the FDA actually doing it’s job efficiently.

That’s my rant and it’s the last I’ll post about this.

Reading, ‘Riting, ‘Rithmatic in EMS

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Once upon a time, that phrase was known as “The Three Rs.” It’s archaic, but these days reading and writing seem pretty archaic.

As my regular readers will know, my post field EMS career involves doing a lot of documentation reviews for EMS services. This pays pretty well as a supplement to my pension, but I’m not sure if the potential brain damage from smacking my forehead with my hand is worth it.

The policy of my employer is that we’re not supposed to correct spelling or grammar errors in the narratives of the reports we review. Note that if it were, I’d be unemployed because I’m not exactly a whiz myself. I do, however, know how to use spell check and how to look up medical terms on my Smarter than me Phone.

I also know how to use the “Shift” key on my computer keyboard. Which means that I can capitalize when appropriate. I also know how to use punctuation, although I will admit to writing the occasional run on sentence.

Those are skill which a lot of EMS providers seem to have forgotten or maybe just never learned. A friend of mine blames texting in part for this. He opines that young people spend so much time using abbreviations when they text that they forget how to spell or use punctuation. There might be some truth to that.

When I read some of the reports I can’t help but think of the reaction of doctors and nurses  when they read the same report. “F******g paramedics!” comes to mind.

I also am convinced that when they read these reports those people don’t think much of the medical skills of the medics doing the writing. Not mention what people outside of medicine think.

Ambulance Driver and I have discussed the subject of college requirements for EMS personnel, specifically paramedics. I’ve been pretty consistently skeptical because I don’t see a particularly good Return on Investment (ROI) for most college degrees. I have commented that if people are going to go to college as a career advancement strategy, they should take courses that are outside of EMS. That is, they should look at business management, nursing, or some other major that will give them options outside of the EMS career ladder. That’s because career ladders in EMS are more like step stools. That is, there aren’t many steps on that short ladder.

One thing that I do think should be part of a paramedic degree program is English literacy and mathematics. We often joke about “paramedic math”, because it’s pretty easy. Especially if you memorize the formulas and can just plug numbers in. Still, algebra and geometry are good thing to know.

So is being able to put together a medical narrative that has decent syntax, spelling, and grammar. Which skills don’t seem to be all that prevalent in the reports that I read on a daily basis.

I won’t even comment on some of the wacky “treatments” I see because that’s actually my job. The problem being tha sometimes the sentence structure is so bad that I can’t figure out what the hell the medic was thinking or doing.

Since many paramedic programs are now affiliated with colleges, it shouldn’t be all that difficult to add the literacy and mathematics components. Along with classes on actually showing up to work on time. But, that’s a rant for a different day.

I’ll just add that in retrospect, I should have bit the bullet after paramedic school and gone to nursing school. Again, a topic for another post, but having “RN” after ones name opens up a lot of possibilities.

 

Joining The 21st Century

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Striker fired, polymer framed handguns are all the rage these days. Well, truth be told, they’ve been all the range for over 30 years, but the trend in increasing. Every manufacturer seems to have several models and some manufacturers have stopped making metal framed pistols. More will follow as metal framed guns are expensive to make due to all of the machining required.

Law enforcement agencies have pretty much replaced their metal framed guns, with only a few hold outs left. The future is polymer framed and even though I’m not a fan, they do have their purpose.

What is really hot right now are “micro” and mini sized 9mm. Personally, I often carry a sub compact Smith & Wesson Chief’s Special 9mm (CS9). It’s compact, has an aluminum alloy frame, and is 100% reliable as long as the owner maintains it.

The problem is that S&W stopped making them around 2006 or so. Plus, those that have them don’t usually sell them. I was lucky to find one at a reasonable price and I snapped it up.

Many of the major firearms manufacturers have introduced polymer framed striker fired handguns with a similar configuration.

One of those is O.F. Mossberg. Mostly known for pretty good shotguns and rifles, management at the company saw this fast growing segment of the personal defense firearm and decided that they should join the party.

What they’ve come up with is the MC1sc. If you click on that link, you’ll see that there are ten different variations of the MC1sc. There are different variations, but the basics are the same. The major difference is that are two models with a manual cross bolt safety. The one that I got has no safety and thus operates more or less (maybe less) like a double action only revolver.

I picked on up today from a not quite local dealer who had a terrific price on the MC1sc. I won’t quote it, but it’s over $100.00 below the MSRP. If you’re interested, shop around, I have the feeling that a lot of dealers are going be carrying this.

Since it’s been way too cold to go to the range and actually shoot the MC1sc, this is a none firing review.

The gun feels good in my hand, which is important. If the a firearm doesn’t fit your hand comfortably, it’s unlikely to shoot well. The pistol feels solid and well built. In fact, it feel heavier than I expected. Balance is good, even with an empty magazine. With a loaded magazine, I expect it will feel even better. The sights are over sized white dots, which even more my ancient eyeballs are easy to pick up.

As I always do, the first thing I read when I got home was to read the manual. Then, I stripped the pistol and cleaned and lubricated it. The manual is full of the usual, and legally required, dire warnings, but it also has detailed stripping, cleaning, and reassembly instructions.

One really nice feature is the “Safe Takedown System.” This system allows the striker to be removed from the back of the slide and so does not require the trigger to be pulled to strip the pistol.

Oh, I forgot to mention a feature for left handed shooters. The magazine release, and safety (if so equipped) can be reversed to make operation easier for left handed shooters. That’s a neat feature that I don’t know if any other gun has.

Cleaning and lubricating the pistol is straight forward as is reassembly. This is where the Safe Takedown System really shines.

Once I have had a chance to get to the range and do some test firing, I’ll write another post with the results.

 

Comments and Ballots

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Commenting

I know that there has been a problem with commenting. The technical team here at First Arriving is working on the issue. In the meantime, if you have a comment you want posted, email me at EMSArtifact@Gmail.com and I’ll append it to my blog post.

Ballots

If you’re a voting member of the NRA, you know that the ballot for Board of Directors has gone out. You’ll find it in the current edition of whatever magazine you receive with your membership. If you get your magazines digitally, I don’t know how you get the ballot.

Anyway, I’d consider it a favor if you’d include James L. Wallace in your votes. Jim is the Executive Director of the Gun Owners Action League of Massachusetts and his full time job is pretty much haunting the halls of the Massachusetts State House. That is literally a thankless task in a state as anti Second Amendment as is Massachusetts.

Personally, I’m voting mostly for new nominees, especially those nominated by outside petition. Jim is not one of them, but he will certainly be a worthy member of their Board of Directors.

Thank you.

 

A Tale From The Old Days

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As my EMS career fades into the past, random conversations start to bring up memories of calls from years ago. I guess some might call it PTSD, but in fact they are just memories. None of them traumatize me, some make me laugh because perspective has given my some idea of the absurdity of life and sometimes EMS.

I was discussing the current foolishness regarding the Opioid Epidemic and how people in pain, especially chronic pain, are being denied medications that could control their pain. One friend mentioned that he always had good results with Dilaudid.

Thus another memory (and blog post) was born.

This goes back to about 1982 or so, pretty early in my full time career. I was working with a paramedic, but we were at the BLS level because there wasn’t any P/B staffing back then. In fact, Sort of Big City had one of maybe three paramedic systems in the the state. There were two community college based paramedic programs and my department ran it’s own confined to existing employees.

For context, my partner was one of those internally trained paramedics, but was assigned as a float to replace other people who were out. This particular day the only opening was for EMTs, so he ended up with me. Lucky him. At this point, I was at least semi competent having a couple of years of solid 9-1-1 experience. Plus he had seniority.

Which meant that I ended up as the “Tech” or as one of my co workers used to call it the “GIB.  “Guy In Back.”

We were sent for a cardiac arrest in one of the outlying parts of Sorta Big City. i don’t recall if ALS was available, but that really doesn’t matter as at that time there was likely only one to cover the entire city. Which meant that they could be anywhere in the city. No matter as we ended up not needing them.

We headed off the hinterlands with all due, maybe too much, haste. We survived the ride and arrived in due time.

We walked into the apartment found a 20 something male who was stone cold dead. His girlfriend was there and was hysterical.

The cops were there, and weren’t hysterical. I think the fire department was still at the station having breakfast.

I was writing the sudden death report and asked the girlfriend a few questions. They’d been drinking the night before and he’d done some Dilaudid as well. “That shit doesn’t do nothing.” was her quote.

I looked over at her now deceased boyfriend and thought that it certainly had done something, but for once in my life kept my yap shut.

The phone rang. It was the girlfriend’s father. She tearfully told Dad that the boyfriend was dead.

There was silence, followed by,

“NO! I DIDN’T KILL HIM!”

She then handed phone to me. I don’t know exactly how I became the designated person, but I’d have to guess my lack of seniority had something to do with it.

The father asked me if I had any idea what had killed the boyfriend. In those pre HIPAA days, I was able to answer that he appeared to have died from a drug overdoes.

The father then asked me if it was possible that his daughter had killed him. No kidding.

I told him that it didn’t appear likely. I then handed the phone back to the daughter and went back to writing my report.

At least we didn’t have to wait for the “police surgeon” to come out and make his determination. That fell to the police and as I recall some unlucky officers spent their entire 8 hour shift (minus lunch break) waiting for that person to come out and declare the person officially dead.

The “police surgeon” was eliminated a few years after this, but to the best of my knowledge the police still have to wait on scene until the Medical Examiner makes his decision.

That was, as I said, in 1982. I remember the address and could drive there today.

I remember my partner who helped me out about 9 years later when I was a paramedic intern and partially clueless. He was a great paramedic and teacher.

I remember the 1979 Ford F350/Modular Ambulance with single rear wheels, not dualies. I remember almost rolling over at a rotary on the way to the call. In fact, the rotary and tree we almost hit are still there. The ambulance in the Featured Photo is very similar to the ambulance I was in that day. Not exact, but close enough for you to see what the “state of the art” was back then.

I vaguely remember the girlfriend. She was fairly attractive, blond, not to bright. I don’t remember the dead guy other than that he was mid 20s, white, and deceased.

I don’t remember what I had for breakfast this morning.

And You Thought I Was Joking

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A couple of weeks ago, I posted an article about Uber safety issues in South America.

I closed by commenting that your mother’s advice not to get into a car with a stranger was wise, but was also the Uber business model.

Today, I saw this article and realized that maybe it wasn’t so funny after all.

Uber: Over 3,000 sex assaults reported on rides in 2018

Over 3,000 sexual assaults were reported during Uber rides in the U.S. in 2018, according to an eye-opening company safety report released Thursday.

That number includes 235 reported rapes in the ride service’s 1.3 billion trips in the U.S. that year. The previous year, 2,936 sexual assaults were reported across 1 billion trips.

Additionally, nine people were murdered and 58 were killed in car crashes, the report found.

There’s more detail in the article and car crashes are a risk no matter who is driving, but still it seems unwise for people, especially young women, to get into a vehicle with a complete stranger.

“I suspect many people will be surprised at how rare these incidents are; others will understandably think they’re still too common,” Uber CEO Dara Khosrowshahi tweeted Thursday. “Some people will appreciate how much we’ve done on safety; others will say we have more work to do. They will all be right.”

Well, there’s a semantically null statement. No doubt carefully crafted by a lawyer or public relations hack.

When riding with strangers, stay alert, stay off your phone, be aware of your surroundings. I also sometimes put the destination into Waze on my phone just to be sure we’re not “getting lost.”

Keeping track of your surroundings and route is a very good idea. Also, you may want to “share your ride” so someone else knows what you’re doing.

The bottom line is that this is not a risk free activity. Nor, of course, is a ride in a taxi. Both are arguably safer than hitch hiking.

 

Day of Infamy

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The following is an excerpt from A Dawn Like Thunder: The True Story of Torpedo Squadron Eight which is the story of Torpedo Squadron Eight at the Battle of Midway 4 June, 1942. It helps to set the scene for what happened six months after the attack on Pearl Harbor on this day in 1941. I’ll write more about that in a post in 4 June next year.

ENSIGN WILLIAM EVANS JR., AGE 23
PILOT, TORPEDO SQUADRON EIGHT
NORFOLK, VIRGINIA

December 7, 1941

My dear family,
What a day—-the incredulousness of it all still each new announcement of the Pearl Harbor attack the unreality of a fairy tale. How can they have been so mad? Though I suppose we have all known it would come sometime, there was always that inner small voice whispering —- no, we are too big, too rich, too powerful, this war is for some poor fools somewhere else. It will never touch us here. And then this noon that world fell apart.
Today has been feverish, not with the excitement of emotional crowds cheering and bands, playing, but with the quiet conviction and determination of serious men settling down to the business of war. Everywhere little groups of officers listening to the radio, men hurrying in from liberty, quickly changing clothes, and reporting to battle stations. Scarcely and officer seemed to know why we were at war and it seemed to me there is a certain sadness for that reason. If the reports I’ve heard today are true, the Japanese have performed the impossible, have carried out one of the most daring and successful raids in all of history. They knew the setup perfectly —- got there on the one fatal day—-Sunday—-officers and men away for the weekend or recovering from Saturday night. The whole thing was brilliant. People will not realize, I fear, for some time how serious this matter is, the difference of labor and capital is an infectious virus and the public has come to think contemptuously of Japan. And I fear that is a fatal mistake. Today has given evidence of that. This war will be more difficult than any war this country has ever fought.
Tonight I put away all of my civilian clothes. I fear that the moths will find them good fare in the years to come. There is such a finality to wearing a uniform all of the time. It is the one thing I fear—-the loss of my individualism in a world of uniforms. But kings and puppets alike are being moved now by the master—-destiny.
It is growing late and tomorrow will undoubtedly be a busy one. Once more the whole world is afire—-in the period approaching Christmas it seems bitterly ironic to mouth again the timeworn phrases concerning peace on earth—-goodwill to men, with with so many millions hard at work figuring out ways to reduce millions to slavery or death. I find it hard to see the inherent difference between man and the rest of the animal kingdom. Faith lost—-all is lost. Let us hope tonight that people, all people throughout this great country, have the faith to once again sacrifice for the things we hold essential to life and happiness. Let us defend these principles to the last ounce of blood—-but then above all retain reason enough to have “charity for all and malice toward none.” If this world ever goes through this again—-mankind is doomed. This time it has to be a better world.

All my love,
Bill

I don’t know that, in all of my reading about the attack on Pearl Harbor, I have ever read a better description of the shock that America felt on that long distant December Sunday. America was violently and instantly shaken out of it’s pre war innocence and lethargy.

There was a threat to not only our nation, but all of the civilized people of the world along with others who had never heard of Japan or even America.

Millions of lives would be lost before the war ended in September of 1945. Millions more, including that of my father, who survived the war, would have the trajectory of their lives unalterably and permanently changed.

America and the rest of the world would never, ever, be the same.

Alas, Ensign Evans would not live to see the end of the war or the better world that he had hoped victory would bring. He, along with most of his fellow officers and sailors in Torpedo Eight would die during the first hours of the Battle of Midway.

The Navy would win a decisive victory at Midway and set the United States and it’s allies on a course that would bring victory, but victory at a great cost in the lives of young men who woke up on December 7 in a nation at peace, but went to bed in a nation about to play it’s part in fighting and winning the greatest war in the history of the planet.

Which is why we should pause today and remember that long ago day when America went to war.

Stupid And Arrogant

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Harsh post title, but after reading the following article in the Boston Globe, I think it might be too kind.

Rhode Island EMS crews brought patients to the hospital with misplaced breathing tubes: None of them survived

Go ahead and read the entire article. It’s long but worth reading. If you’re in EMS, you should be shaking your head, or maybe banging it against your desk, when you’re done. I’ll post a few excerpts with my commentary.

Spoiler Alert;

It won’t be a positive commentary.

In the summer of 2018, Dr. Nick Asselin was doing research on cardiac arrests in Rhode Island when he made a horrifying discovery.

Hospital records showed patients had been arriving by ambulance with misplaced breathing tubes, sending air into their stomachs instead of their lungs, essentially suffocating them. At first, he said, there were four cases, then seven. More trickled in.

By the time Asselin presented his findings to a state panel in mid-March, he’d identified 11 patients with so-called esophageal intubations that had gone unrecognized by EMS providers over the previous 2 ½ years. All 11 had died.

11 patients killed by incompetence with arrogance on top. There is, as I was taught many years ago, no disgrace in missing an intubation. We’ve all done it from time to time. The disgrace is in not recognizing it, not using technology that has been available to EMS for close to 25 years, and not following in a clearly spelled out protocol provided by the state EMS regulators.

Here is the pertinent section of the Rhode Island Statewide EMS Protocols, section 7.03, Step # 10.

Confirm proper placement of the ETT utilizing standard methods (presence of
breath sounds, absence of gastric sounds)
and quantitative waveform
capnography (a colorimetric EtCO
2 device may be used for initial confirmation
of placement if waveform capnography is not immediately available).

Straightforward. It’s done thousands of times a day across the nation and in Canada too. It’s done even more in hospital operating rooms. In fact, that’s where first encountered End Tidal Carbon Dioxide monitoring. In a hospital operating room when I was a paramedic student back in 1990.  It was sometime in the early 2000s when ETCO2 spread to EMS, but a few years previously, “colormetric ETCO2” was introduced and used by most EMS systems.

Although apparently not in Rhode Island, at least not consistently.

So, here is where the arrogance starts to pile on top of the stupidity.

Jason M. Rhodes, the state Health Department’s EMS chief, recommended a way to tackle the problem that aligned with national standards: restricting the practice of placing those tubes to paramedics, the most highly trained EMS providers. Rhode Island is the only state in New England, and among a minority nationally, that allows non-paramedics to intubate patients.

But a coalition of Rhode Island’s EMS practitioners, municipal fire chiefs and a city mayor pushed back. They said the “ET tube,” as it’s known, saves lives. Taking it away, as one fire chief put it, “would be a sin.” A lobbyist for the firefighters union lambasted the doctors for not consulting more of its members before proposing such changes, saying, “We’re the experts … not the doctors!”

In the end, the board didn’t restrict the practice to paramedics, instead requiring that all providers — paramedics and EMTs alike — consider less invasive measures before inserting a breathing tube.

The emphasis is mine, not in the original article.

First, the fire chief is wrong. Ironically, there is some study evidence that use of ET Tubes in the field decreases survival. It’s not clear why that is, but placing the ET Tube in the esophagus instead of the trachea and not realizing it clearly does not help.

Then, there is the lobbyist for the firefighters union. Really? YOU know more about medicine than the doctors? I’ve known some very sharp fire service EMS providers, but not one of them has ever stated that he’s an expert and a doctor isn’t.

I’ll grant that many emergency medicine doctors who don’t have a role in EMS systems still don’t know enough about EMS.Still, this clown saying that EMT Cardiacs, a provider level that I thought went out in the 1990s, know more than doctors is ridiculous. Oh, and arrogant.

Consider, but not actually attempt.

Moving on,

Until recently, Rhode Island was the only state in New England where 911 call takers were not trained to provide guidance over the phone on how to perform CPR. That changed this year after The Public’s Radio and ProPublica reported on the deaths of a 6-month-old baby in Warwick and a 45-year-old woman in Cumberland after 911 call takers failed to give CPR instructions to the family or other bystanders.

Rhode Island now has a new 911 center director, and by late winter, all 911 call takers are expected to be trained in emergency medical dispatch, which includes providing CPR guidance over the phone.

So, not just EMS, but apparently EMS dispatch is years, no decades, behind the national standard for 9-1-1 call takers.

By the way, and I ask this question of students a lot, who decides medical “standard of care?”

That’s sort of at trick question and the answers I get are some variation of “doctors”, “medical committees” or something else that sounds like an organized process.

Here’s the answer I got from a paramedic/lawyer friend with extensive experience in EMS litigation.

“Juries.”

Standard of Care comes from litigation when a medical case, including EMS, goes really bad and someone sues someone.

Who wants to be “that guy” whose actions caused a new “standard of care?”

Not me.

There’s a description of how this epidemic of misplaced ET Tubes was discovered. I won’t quote it here, but again read the entire article, especially if you’re in EMS.

You can, and should, read about fire chiefs, fire union officials, and politicians doing the damnedest to impede progress in improving medical care in Rhode Island.

As we used to joke about the fire department in Sorta Big City “150 years of tradition, unimpeded by progress.” If you think I’m kidding, you didn’t witness the battle to get all fire fighter to wear their SCBA packs when they went into a burning building.

But I digress.

There is a lot of “rice bowl protecting” going on among the opponents to improving care and patient outcomes. It seems like the fire lobby is worried about private ambulance services trying to horn in on their sinecures.

A couple of more quotes to set up my closing comments,

At 6:03 a.m., Kerry Duarte’s 911 call was patched through to the dispatcher at the Pawtucket Fire Department. Within eight minutes, an EMS crew had arrived at the Goff Avenue apartment and began CPR, according to hospital records provided by the family to The Public’s Radio and ProPublica. Paula Duarte had no pulse and her heart rhythm was asystolic, or flatline.

The EMS crew continued CPR for 11 minutes before one of the crew members — a licensed EMT-Cardiac — performed what he later described in his run report as a “successful intubation.” The placement of the tube was “confirmed 3 times … by 3 different personnel,” according to a copy of the report attached to the hospital record.

and,

he doctor removed Duarte’s endotracheal tube and reintubated her. Then she was given more CPR and more medication. At 7:02 a.m., she was pronounced dead.

It’s impossible to know whether Duarte could have survived if she’d been properly intubated. Duarte had been unconscious for about 30 minutes before the ambulance arrived, the EMS report said.

and,

But unlike the 11 other patients who arrived at hospital emergency rooms with misplaced breathing tubes, Duarte’s case was reported to the state Health Department, triggering a formal investigation.

A month after Duarte died, the state Health Department issued a stern warning to state emergency medical service providers. The notice referenced the 11 other cases, saying they represented an “unacceptable high rate” for such errors. It reiterated that providers should try other means before inserting a breathing tube.

finally,

The department’s investigation into Duarte’s case found that the EMT-Cardiac who intubated her, Wesley J. Meyer, “never attempted” to use a device to monitor the patient’s exhaled carbon dioxide levels, according to a consent order he signed in September. The state’s protocols require that the device be used.

Meyer wouldn’t answer questions about the case, telling a reporter who came to his door, “I don’t want to talk about this.”

While the state said that Meyer engaged in “unprofessional conduct,” it noted that those breaches were “tempered” by the fact that Meyer had already taken steps to “retrain himself on the relevant subject matter,” and that his past performance in EMS is “unblemished.”

Meyer’s EMT license was placed on two years’ probation; his 30-day license suspension was “stayed,” meaning he can continue to practice uninterrupted, according to a state Health Department spokeswoman.

To recap, an EMT-Cardiac places an ET Tube in the esophagus of a young lady in cardiac arrest. He fails to follow the protocol regarding tube confirmation. Then, either through laziness, stupidity, or some other motive, he writes an inaccurate report.

The state agency responsible for oversight lets him slide because he did some self remediation. He gets not even a slap on the wrist. No suspension of his EMT certification, not required remediation under supervision of a neutral party, nothing. Nothing at all. Unless you count two years of unsupervised “double secret probation” and a 30 day suspension of his certification, which was “stayed.”

In my daily work doing Quality Improvement reviews for fire based EMS systems not in Rhode Island, I emphasize education and fight against any sort of punitive action for medical mistakes. Which is how I was educated and trained for over 30 years. Medical mistakes happen, that’s just inevitable. What’s important is that you acknowledge those mistakes, learn from them, and make sure that you don’t make them again.

Denying that you screwed up, having your fire chief, mayor, or some other pinhead puff out his chest and claim the doctors are trying to stop providers from “saving lives”, is none of the above. It’s protecting yourself with complete disregard for the well being of patents.

I have to wonder if this article will lead any of the survivors of those 11 victims to contact lawyers?

Discovery, as the saying goes, would be interesting.

 

 

 

Yet, They’ve Made A Business Out of It

1

Uber to test recording audio of trips in effort to improve security

 

Uber is testing out a new audio-recording feature in Mexico and Brazil as part of the ride-hailing app’s efforts to improve safety.

The feature was first unveiled at an event in Sao Paulo, Brazil, earlier this month, and will allow drivers and riders to record audio of their trip “before or during the trip in some regions,” according to an Uber blog post in Portuguese.

Notice that this is being tested in countries that don’t have the anti wiretapping laws that we have in the US. That is, they have no Fourth Amendment protections against search and seizure. I’ll not bore you with the entire history of that, but suffice it to say that since the 1930s, recording people’s conversations without consent or a warrant is illegal in most cases. At least in America.

On to the main point of this brief blog post.

Earlier this year, a South Carolina college student was killed after getting into a vehicle she mistook for her Uber ride. This prompted the company to push out an alert for riders to check the license plate, make and model of the vehicle — as well as the name and picture of the driver — to confirm it’s the correct person picking them up.

Uber has an unsatisfactory history of vetting it’s drivers. In fact, it pretty much has no history of vetting it’s drivers. Now, I’m not a pretty young, female college student and I don’t use ride services very often. Which doesn’t mean that the unwary can’t become victims of other crimes. Which is why I’m wary when I’m using a ride service. Unless circumstance prevents it, I’m also armed. Yes, I know that violate Uber’s terms of service, but who gives a … dang? That aside, I don’t bury my head in my phone when I’m riding and I do have Waze open to make sure we’re going to the location I specified.

All of that being said here is on thing that you should keep in mind if you are using this type of service.

Uber’s business model is based on ignoring advice that your mother gave you when you were young.

“Don’t get in a car with a stranger.”

Your mother knew what she was talking about.

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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