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Gun Laws and Science

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A recent study by physician and a PhD in Science of two laws passed in CA in 1991 shows no correlation between either Comprehensive Background Checks (CBC) or a 10 year ban on firearms purchases by people convicted of misdemeanor acts of violence.

California’s comprehensive background check and misdemeanor violence prohibition policies and firearm mortality

The simultaneous implementation of CBC and MVP policies was not associated with a net change in the firearm homicide rate over the ensuing 10 years in California. The decrease in firearm suicides in California was similar to the decrease in nonfirearm suicides in that state. Results were robust across multiple model specifications and methods.

I give them credit for publishing data supporting the null hypothesis. Which is that background checks, often touted as the answer to firearms violence, don’t decrease violence. The researchers looked at 10 years of data following the implementation of the two laws and found no net change in the rate of homicides OR the rate of suicides. Suicides did decrease, but at the same rate as non firearms suicides.

I don’t give them credit for using this lack of effectiveness of a 27 year old law as an excuse to call for more gun control in the form of a “Permit to Purchase.” Whatever that is.

I also found a link to Doctors for Responsible Gun Ownership.

Since gun owners are often worried about how to answer questions about firearms by their physicians, there is a nice article,

What to Do When Your Doctor Asks About Guns 

You may encounter the question in your health plan’s standard health appraisal questionnaire. Even though it may not be of your doctor’s making, it’s still part of your permanent medical record. Or your doctor may have a personal prejudice against gun ownership, shaped by her training in medical school or residency. Either way, it is important for people to know some very important facts:

• Doctors receive absolutely no training about firearm safety, mechanics, or tactics in medical school or residency. They are completely unqualified by their training to advise anyone about guns.

• Gun ownership is a civil right. A doctor’s abuse of his position of trust to pressure you to give up that civil right is professionally and morally wrong. In some states it is illegal. You DO NOT have to tolerate it.

• You as a consumer have great power in the doctor-patient relationship. Do not be afraid to use it.

The article goes on to list several options to register your displeasure with you doctor (or a spouse or child’s doctor) prying into your personal business. If this is an issue you’ve had, you will want to read this article.

Sadly, it’s no longer possible to just be a “patient.” We have to be informed consumers of medical services and as such need to make sure our medical providers are serving our interests, not those of the insurance providers, state regulators, or their employers.

For Want Of A Holster

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This story popped up the other day. No pun intended.

Man without gun license accidentally shoots himself in genitalia in Marion

MARION, Ind. – A man accidentally shot himself in his genitalia in Marion, according to the city’s police department.

That’s not really funny, but I bet a lot of people laughed.

There, the man told officers that he was on a walkway near a Girl Scout cabin when the Hi Point 9mm handgun on his waistband (without a holster) began to slip. When the man reached down to adjust the gun, he says it discharged.

The obvious question is what was this man doing near a girl scout cabin. I’m sure the police will be looking into that.

The less obvious question is; Why didn’t he have a holster?

The answer is because if you don’t have a license to carry a firearm and ditch the gun when the police are approaching you, you might not have time to ditch the holster. Having an empty holster can lead to awkward questions from the police, and provide them with enough to obtain a search warrant. So, a lot of people who aren’t supposed to be carrying firearms don’t use holsters.

I’ve seen this a few times over the years. That is, I’ve seen people with firearms and no holsters AND I’ve seen people who have shot themselves in the genitals or thigh because they were wearing sweat pants or some other pants with no belt. If you’re not used to carrying a firearm (at least legally) and the gun is not securely holstered, it’s very likely that you will put your finger inside the trigger guard and on the trigger.

Bad things happen that way.

Ask Plaxico Burress. Not that I believe his story completely, however he did try to grab a falling pistol and did shoot himself.

Just like our unnamed victim in this story.

Also, like our unnamed victim, Burress didn’t have a license to carry a firearm. Also, being New York City, he didn’t have a permit to even possess a firearm. Even worse, Burress lived in New Jersey. New York City is stingy with licenses for it’s own residents, never mind people from across the Hudson. Not that New Jersey is much better than New York when it comes to licenses and such.

Indiana doesn’t require a permit for mere possession of a firearm.  Indiana does, however,  require a permit to carry a pistol concealed or openly. So, the headline in the original story is correct, the man was unlicensed.

Fox News, which seems woefully ignorant of English sometimes had this headline for essentially the same story.

“Indiana man with unlicensed gun accidentally shoots self in genitals, police say”

People are licensed, inanimate objects are registered. Well, not in Indiana which doesn’t have registration requirements for firearms. Our unnamed victim may or may not have been legally allowed to possess a firearm in his home or some other places. I wouldn’t bet on on that, but it’s possible.

Speaking of Fox News. Here is a prime example of not straying into area about which you know nothing. Not at all related to today’s topic, but it’s a good reminder that sometimes you have to “Stay in Your Lane.”

Fox also used a stock photograph of a 1911 pattern firearm, not the el cheapo Hi Point 9mm that the man was carrying. In a prior day, that would be called a “Saturday Night Special”, but that sorry story is for another day.

I don’t know that we’ll see any more news stories about this incident, but I’d guess that the Marion PD will have more conversations with the unnamed victim. At which point he will likely be a named defendant. Which might not be the first time he’s interacted with the criminal justice system.

Oh, and the Marion Police Department did put up a Facebook post on the incident. Because everyone puts items like this on their Facebook page.

There are four take home lessons here.

  1. If you are going to carry a firearm, make sure you have the correct license or permit.
  2. Buy a holster.
  3. Don’t hang around girl scout cabins.
  4. Be familiar enough with any firearm you plan to carry to NOT put your finger on the trigger when you don’t intend to.

Guns aren’t toys, guns are tools that serve a number of purposes. Like lots of tools, if handled carelessly they can cause injury or death. Just like a snow blower or even a table saw.

 

The Myth Of The “Ditch Doctor”

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A meme that predates the Internet and goes back at least to the days of “Bulletin Board Services” (BBS) is that paramedics “Do everything that an ER doctor does, but we do it in a ditch on the side of the road.”

To which I say, bullshit.

I don’t know any good paramedic that believes that, not a one. In fact, I don’t know if I know any crappy paramedics that believe that either.

The truth is that paramedics have limited knowledge. Even the best two year Associates Degree programs barely scratch the surface of medical education. An experienced paramedic who spends a lot of time going to classes, reading, and talking with doctors might know more about a few specific illnesses than an intern or junior resident.

That’s not the same as doing (or knowing) everything that an ER doctor does. Not even close

Here is a graphic representation.

Paramedics know this much,

about this much,

about medicine.

Overly confident, but not well educated, paramedics that pose the real threat to paramedics. It’s easy to get in over your head if you “don’t know what you don’t know” as the saying goes.

I was never a “throw everything in the drug box as the patient” type of paramedic. It was drilled into me during my training that it’s easier to do harm than good with many of the medications we carry on ambulances.

Back when we Sort Big City EMS was training up for the use of Rapid Sequence Intubation, one of the doctors who did our lectures reminded us that we used two of the three drugs then utilized for execution by lethal injection.

Think about that for a minute. We had drugs that could render a patient unconscious and chemically paralyze them as part of the process of intubation. If we couldn’t succeed in intubating the patient, then we ran a risk of serious harm.

That was well over 25 years ago and I’ve never forgotten the class or the doctor.

As Clint Eastwood once said,

Of course in cases like this, if we made a mistake, we weren’t the ones that were as risk of dying.

Back to the arrogance of the “Ditch Doctor.”

I never once treated a patient in a ditch, but that’s mostly because I worked in an urban setting and ditches generally didn’t end up with cars in them. Except that one time when a driver managed to drop his car into a ditch being dug for installation of a main sewer line. He wasn’t injured, but his car certainly was.

I did intubate a patient on the first floor of a house that was on fire, but the fire was actually on the second and third floors. The fire department had rescued the patient who had inhaled a large volume of smoke and more solid debris from the fire. A touch intubation, but certainly nothing that an Emergency Physician shouldn’t have been able to do.

At no time did I think to myself that this was some great accomplishment, although the ED physician at the hospital was impressed enough to write a letter commending my partner and me.

The point of all of this is that paramedics should be careful about their bragging. We’re not any sort of doctor, let alone a “Ditch Doctor.” Our job is to keep the patient alive, what I call temporizing, until we can get them to the real doctor.

Very rarely do we “save a life.” That happens, but not often. By my count, and I worked in a very busy system, I responded to one call a month or so where my care made a big difference in the patient’s life. Most of those were either respiratory or trauma related. As to trauma, keeping the patient’s figurative head above water was the goal. Keep them viable enough so that the surgeons could do their magic.

Respiratory patients were people that we could help, but most of the time they didn’t need treatment as much as they needed to be in the hospital. As a BLS co worker used to say, “Transport is part of the treatment.” Sometimes it, along with our observations and reports, was the most important part of the treatment.

As time moved on, that equation changed somewhat towards the treatment end as we got CPAP, better medications, 12 lead EKGs, a better idea of what was important for Strokes and Sepsis. Still, very rarely did we “cure” a patient and eliminated the need for transport.

The good news is that there really is a Ditch Doctor that does things that no ED Physician can do,

The List Grows

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For many years most states prohibited their citizens from exercising their Second Amendment Right to carry a firearm for self defense (or any other legal purpose). Some states allowed that exercise, but with a complicated process to receive a permit or license. That started to change in 1987 when Florida enacted a law allowing for citizens to obtain a permit to carry a concealed firearm.

In the 31 years since other states have followed suit and enacted concealed carry laws. Concealed carry is now fairly common, although not particularly widespread in most states. Now, every states has some provision for concealed carry, although it’s extremely difficult and expensive in some states.

At the time that Florida passed it’s concealed carry law, there was one state that allowed residents and visitors to carry a firearm with no license or permit required. Vermont was alone among states that had no licensing requirements. Anyone over the age of 21 could carry a firearm for legal purposes without the need for a “permission slip” from the state.

In 2003, Alaska ditched it’s licensing requirements and became the second “Constitutional Carry” state. Since then the trend has accelerated.

Since then Arizona (2010), Arkansas (2013), Idaho (2016), Kansas (2015), Maine (2015), Mississippi (2016), Missouri (2016), New Hampshire (2017), North Dakota (2017), West Virginia (2016), and Wyoming (2011) have enacted laws. A few of those states limit this to residents and as commercials often say “some restrictions may apply.”

Which brings us to 2019. The Kentucky legislature has passed a bill, which the Governor has said he will sign, removing the permit requirements for concealed carry. In Oklahoma, the Governor has signed a bill, which will take effect on November 1, doing the same. Finally, the Governor of South Dakota has signed a bill removing the permit requirements for concealed carry in that state.

That brings to sixteen the number of states that don’t have permit requirements for concealed carry of firearms.

The funny thing is that most people who don’t follow these matters probably know nothing about it. The passage of all of these laws in accompanied by comparisons to “Dodge City” and proclamations that “blood will run in the streets” if people who are not legally barred from possessing firearms can carry a firearm for self defense without a state approved license or permit.

Yet, none of that “wild west” catastrophe has come to pass. Nothing seems to have changed, except that maybe crime rates have gone down.

Odd how that works.

While some states are working hard to enact further restrictions on firearms owners, it seems that some states have figured out that law abiding people aren’t the major cause of crime in America.

Who would have ever figured.

I added this graphic to the post. Originally, I used it as the “Featured Image” which is seen on Facebook. Unfortunately, it doesn’t animate properly on Facebook, so I’m posting it here.

How NOT To Do EMS

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A friend who knows that I have a blog sends me news articles from time to time. Today, he sent me a link to this story. Apparently, there is a thread on it somewhere on Facebook, but my footprint there is pretty minimal so I have no idea where it is. Besides, EMS threads on Facebook are either boring or devolve into a contest to see who can make the most snide and stupid comments.

As a general rule, I try not to make judgements on popular media accounts of EMS calls. Or much of anything else for that matter. This case is a little different because there is video, extensive video as a matter of fact, of what went on during the call.

Interestingly, and maybe damning to the police, their body camera video has been deleted and “technical difficulties” have caused the dash cam video to be lost. That is not going to help the police case, but that’s outside my area of expertise.

Cops took man to DUI test, not hospital, after crash, lawyer says. He died days later

A 58-year-old Charleston, South Carolina, man had eight broken ribs and other internal injuries when he was taken off an ambulance and given a sobriety test, according to the attorney for the man’s family. Nathaniel Rhodes lost consciousness at the police station, video shows, and he died four days later.

Police had a form that said Nathaniel Rhodes did not want to be taken to the hospital, but it was signed by a police officer, not Rhodes, attorney Justin Bamberg said in a press conference Monday that was broadcast live over social media.

I will say that I dislike intensely when lawyers try a case on TV. It smacks of a maneuver to engineer a settlement or some other action without due process. That being said, it’s very suspicious that the police officer signed what I’ll call as a patient refusal, not the patient.

Here is the back story. Or as much of it as I’ll share since I don’t want to violate the “fair use” standard.

Rhodes got into a car crash in August 2018, WCBD reports, and police say he had an open container in the car. Officers gave Rhodes roadside sobriety tests and then took him to the station for a breathalyzer test, according to WCBD.

There is a police station video in the article, which I urge the reader to view in it’s entirety.

This is a great video on just about everything you should NOT do on an EMS call.

The crew appears to be pretty nonchalant in their approach to the patient. The female EMS provider is a paramedic, her partner is an EMT. Which means that no matter what, she is in charge of the call. She seems pretty tentative in her approach to the patient.

The first problem is that she didn’t do a complete physical exam. In her defense, it’s not clear that she knew that Mr. Rhodes had been in a crash for some time. Still, she seems to have gone straight to what a former partner of mine referred to as “the symptom checker.” His use of the terms was derisive because as time went on, it seemed that our medical director was more interested in “numbers” than what the paramedics actually thought was going on.

Instead of immediately starting an examination, she starts asking Mr. Rhodes all sorts of questions. Her partner is, well who knows what her partner is doing. What he should have been doing was asking the questions and gathering information while she concentrated on patient care.

The medic lifts up Mr. Rhodes shirt after he tells her his right side hurts. She doesn’t do any sort of examination, most especially listening to breath sounds. She seems focused, or maybe obsessed with asking Mr. Rhodes about his seizure medications. About three minutes into patient contact, she hasn’t done anything to assess the patient.

At that point she finds out about the accident. Which is what we used to call “a clue” in EMS. There is a break in the video and next thing we see is that she has the cardiac monitor out and is checking his blood glucose level. Which is about the only thing she did right. After seeing that his blood glucose level is in the acceptable range, she does a bunch of other useless stuff.

She still hasn’t examined him, especially his breath sounds, perfusion status, or really his mental status.

This brings up to a pet peeve of mine. During my career I never had a cardiac monitor with a blood pressure cuff built in. Which means that I, and all of my co workers had to take manual blood pressures. The thing that requires is actually touching the patient. You can learn an awful lot about a patient’s condition by actually, you know, touching him.

After what we’ll call the examination is done, the crew gets ready to take Mr. Rhodes to the hospital. The medic tells him that they can’t get the stretcher into the booking area. That actually appears to be true. It’s also pretty stupid, but not their fault. I expect that will be one of the changes that will come out of this.

The EMT whines that he has a bad back and can’t lift Mr. Rhodes. Yeah, sure.

At that point the video ends, but the story just begins.

It’s obvious that this was not the crew that responded to the accident. During the course of the investigation that is ongoing as I type this, that crew can expect to be interviewed and their report examined. It would be interesting to see what they wrote, but I don’t expect that to be made public. What I’d like to know is what they wrote about the patient refusal. Both their examination, what they told the patient, and how the police officer came to sign for the patient.

I expect that at least one police officer is going to lose his job. Maybe more depending on what the investigation reveals.

I expect that the EMS crew will also be fired, although maybe not. The medic failed to do a proper examination and seems to have “under appreciated” the severity of the injuries Mr. Rhodes suffered. The fact that Mr. Rhodes died is prima facie evidence that he had serious injuries. Were they unsurvivable injuries? Maybe, but we won’t know that for a while, if ever.

Maybe nothing that the crew could have done would have changed the outcome for Mr. Rhodes, but that’s not going to get them off the hook.

Then their is the matter of their state certification. I have little doubt that the providers will be subject to an investigation into their actions on this call. The fact that there is video showing much of their interaction with Mr. Rhodes, including audio, is not likely to help them.

This video is difficult to watch as an EMS provider. For non medical people, it might not look too bad, but there are several lapses in following protocols and judgement. EMS instructors should use this video to teach their students what not to do.

Nothing is going to bring Mr. Rhodes back, but maybe seeing this video will help students understand what not to do on an EMS call.

We can only hope.

 

You Can Always Count On New York City

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For dumb ideas, that is.

NY considers changing sound of first responder sirens

NEW YORK — If two New York City lawmakers get their way, the long, droning siren from police cars, fire trucks and ambulances that has been part of the city’s soundtrack for generations — WAAAAAhhhhhhh — would be replaced by a high-low wail similar to what’s heard on the streets of London and Paris — WEE-oww-WEE-oww-WEE-oww.

Their reasons for the switch: The European-style siren is less shrill and annoying and contributes less to noise pollution.

People frequently complain about siren noise.That is until they need the people who are riding in those noisy machines are coming to help them. Then it’s the sweetest sound in the world.

I also remember when the use of the “European High Low” sound was discouraged because it was too European and disturbed some people who had left there in the wake of World War II. Most of those people are gone and to be frank, I never met a person who complained about that. Still, it is ironic in a way.

I also remember a woman who complained about the “Yelp” siren that was very popular at one time. Her contention was that the sound bounced off of buildings in Sort of Big City differently than the long wail that the two New York City “law makers” are complaining about.

“Europeanizing” New York sirens would not change the decibel level — still topping out at roughly 118 — but would lower the frequency and thus make the sirens less shrill but still ear-catching enough to grab attention.

“The alternating high-low siren required by this legislation is not as piercing,” adds co-sponsor Carlina Rivera, a Manhattan Democrat.

Since the purpose of the siren is to warn other motorists than an emergency vehicle is approaching, I have to wonder if this is a plus. Modern cars are very well sound proofed and sirens often can’t be heard inside. I’m probably a bit more alert for this sort of thing than most motorists, but it’s still easy not to hear a siren until the vehicle is very close.

That’s what the “Rumbler” siren does. It’s so low pitched that it shakes the ground in front of the emergency vehicle. Think of some of the knuckleheads you see (and hear) driving by with their car stereos blasting at 800 db and “bass” at maximum. Same concept only the speakers are mounted outside the vehicle.

One of the ambulances I was assigned to way back, well about 10 years back, had an early version of the Rumbler. It was not only effective at moving traffic in front of us, but I discovered that it drove an annoying partner of mine crazy when I used it. 🙂

At community board meetings, Mount Sinai’s Emergency Medical Services Director Joseph Davis played various siren options to find out which one locals preferred.

“People hated them all,” Davis said, “but the ‘high-low’ was least intrusive. It didn’t have that piercing sound.”

I repeat, the piercing sound is a feature, not a bug. Besides, half the pedestrians I see have ear buds stuck in their ears and can’t hear anything anyway.

Half the drivers I see these days seem to have their heads firmly planted somewhere else and don’t hear or see anything outside of their vehicles.

I don’t know if New York City will pass this “law”, but it won’t surprise me if it does happen.

It also won’t surprise me if it doesn’t change the number of complaints about siren noise by the self absorbed citizens of the city.

No Wonder They’re Bankrupt

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In the EMS Artifact, there is a hierarchy. Since there is only me and Mrs. EMS Artifact, it’s fairly short. It’s probably more accurate to describe it as “division of labor.” Which in itself is an archaic, totally non PC way to describe the domestic duties of men and women.

In our hierarchy, I am in charge of auto repair, litter box cleaning, snow clearing, electronic purchase and repair, and of course, home repair. For example, this week I got to choose the contractor for our new roof.

On the other hand, Mrs. EMS Artifact is in charge of color schemes, linen and towel purchases, gift selection for the grand kids, and of course, the kitchen. Not that I can’t cook (a bit), but she’s better at it. Except for grilling outside, that too is my domain.

Oh, I also get to select the single malt and cigars. Since the Mrs. doesn’t drink or smoke cigars, that doesn’t really count.

Back to my story. One of the things that Mrs. EMS Artifact is in charge of is buying appliances and arranging for repairs that I can’t do. Which is most of them.

She happens to like buying appliances from a large national retailer that has been around for a long time, but has fallen on hard times of late. I won’t name them, but you can probably figure out who I mean by the post title.

Along with selecting the appliances, she also made the decision to buy the service plans. Which, for the most part has worked out over the years. There have been some hitches over the years, but overall the company has been pretty responsive. We’ve got a refrigerator and a dish washer replaced under the service plan. In the case of the dish washer, they replaced it because they couldn’t find a cosmetic part that had cracked. Yes, for the price of plastic piece of trim, they ended up giving us a credit to replace the entire machine. That included most of  the installation cost, but I won’t bore you with the details.

On to the current story. The stove. At the bottom of most stoves is a drawer wherein you can stuff pots and pans that aren’t being used. This is called the “utility” drawer. In the case of our stove, the handle on the utility drawer was plastic and held in place with a couple of rivets. As luck would have it, back in mid October the plastic handle cracked. Ooops.

The Mrs. called the handy dandy 800 number for service and got a person with an unpronounceable name and a questionable grasp of English. Hello global economy. The Mrs. explained the issue and asked of the person on the other end of the phone could order the part and have it shipped to us. She figured that I, being pretty handy, could replace a piece of plastic held in by to plastic rivets.

No, the person on the other end of the phone explained, they couldn’t to that. A service call was required and the highly trained service technician would have to verify that the handle was broken and order the part on his laptop. Great.

So, an appointment was made and on the appointed date within a two hour window, a highly trained service technician arrived to look at the stove.

“The handle is broken. I need to order one from the depot and when it comes you can call for another appointment for someone to come out and replace it.”

Wonderful.

So, the highly trained service technician started up his ancient laptop computer, went online and ordered the parts. Along with two rivets to attach it to the drawer itself. He then printed out a receipt on an ancient thermal printer. The receipt was almost 100 yards long and had some ridiculously high prices on it.

He then left to go another service call.

A week or so later, a small package arrived. It was the two rivets, but no handled. A few days later, the handle arrived. The Mrs. called the 800 number and made an appointment for a highly trained service technician to install it.

On the appointed day, within a two hour window, a different service technician showed up to install the handle. He opened the box and discovered that the plastic handle had come pre broken from the warehouse. In fact, it was more broken than the broken handle it was supposed to replace.

So, he started up his ancient computer, reordered the part, and left us with a receipt and instructions to call for yet another appointment when the part came in.

Time passed, and we were getting on towards Thanksgiving without the handle making an appearance. Since were hosting Thanksgiving last year, the Mrs. was busy cooking and baking and using the stove. Which included opening and closing the utility drawer. Which in it’s turn meant that the rather thin front of the drawer warped and would no longer sit on the rest of the drawer as designed.

Mrs. EMS Artifact once again called to inquire where the parts might be. This time she got “Lucky”, as he told her his name was. His grasp of English was a bit better, other than referring to the rivets as “Riv As.” Whatever.

Lucky told her that in fact the handle was en route and that when it arrived, along with the “Riv As”, she should call to… well, you get the point. She mentioned the warped drawer front and Lucky told her the technician would look at it when he came out to install the handle.

In due time, the handle, along with two more “Riv As” arrived, a call was made, an appointment, yada, yada, yada.

A third technician arrived, opened the package to find the handle was in good shape. He then looked at the drawer front and said, “I can’t install this, the front is warped. I’ll order you a new drawer.” Turns out, the drawer and front panel are different parts and can’t be ordered as an assembly. In fact, the drawer isn’t available any longer. “NLA” as the term goes.

The technician went on line and found out that the front was available only in black or stainless, not white as was the original. Mrs. EMS Artifact gave him the go ahead to order a black door even though it would tend to make the stove look like a LAPD police car.

The part was ordered and the technician immediately got a “backordered” message.

Did I mention that Thanksgiving was now a pleasant memory and we were hurtling towards Christmas and a New Year?

For some reason, the service company had my email address as the contact and so every few days, I’d start to get an email telling me that the part was on back order and they’d let me know when it was being shipped.

Eventually, I got an email from “parts recovery” asking if there were any parts left over from the repair which I would like to return. “DELETE”

After about a month of this, another phone call was made and another technician came out. He didn’t have a laptop computer. He had a smart phone with an app. Of course the screen was so small that I wasn’t sure what he was looking at. He told us that we, duh, needed a new drawer front and that he would order it again. Yeah, yeah, we’ll call when the part comes in…

He went on his way and the receipt came to me via email. Ahhh, the 21st Century.

Now, I was getting two sets of messages about the back order.

One day a package showed up. Much too small to be the front panel, it was another set of “Riv As.” Then another package showed up. It also was much too small to contain the drawer front. It contained four little sheet metal screws to hold the panel on.

Then in two days, I received two emails telling me that the part was back ordered.

That was the last straw. Did I mention that the Mrs. used to work in customer service? Not for this big company, but overall customer service has a few bedrock principles. One of which is that when you complain, you need to tell the company exactly what you want them to do.

Mrs. EMS Artifact is persistent among other things. She called the 800 number and asked to speak to a supervisor. She was on hold for over an hour. Fortunately, we have a phone with a speaker – phone option and she watched TV while ignoring being ignored. At long last, a supervisor picked up the phone and a longish conversation ensued.

The supervisor wasn’t much interested in providing a voucher to replace the stove because she insisted that they needed to come out and look at it once more. The Mrs. reminded her that under the terms of the agreement, they had three tries to fix an appliance and then were required to issue the voucher. The supervisor told her that a tech had only come out once and so they had two more bites at the apple.

Mrs. EMS Artifact averred that since this had been going on since October and it was now early February, enough was enough.

The supervisor only relented when I printed out a few of the back order emails and offered to send them to her via fax. At that point, she told Mrs. EMS Artifact that they had 48 hours to decide on the final disposition of the case and that they would call back 48 hours hence.

72 hours later, it was a case of “When the phone don’t ring, you’ll know it’s us.” So Mrs. EMS Artifact called and was told that the replacement had been authorized about 71 hours ago, but no one had called.

A voucher was issued on a Thursday afternoon and 30 minutes later we were at the store ordering a new stove for delivery Monday.

On Saturday I was having breakfast with a group of friends. One of those friends is a retired appliance repair man. He still does some work on the side to supplement his pension and thus can order parts from a few different distributors. During this debacle at some point I had sent him the model number and told him what the part was.

He reported to me that he had called two different parts distributors and both had reported that the drawer front was readily available. In three colors. WHITE, black, stainless. I told him that we had a new stove coming and we all laughed.

At which point he said, “No wonder they’re going bankrupt.”

The stove came and was installed in good order on Monday.

On Tuesday, I received and email informing me that the drawer front was still on back order.

I expect a UPS truck to pull up in front of the house any day now and deliver part.

Obviously, one hand part of this company does not know what the other part of the company is doing.

File under “Stuff you can’t make up.”

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.

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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