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September 11, 2021

I’m writing this on September 10, so I don’t know what tomorrow will bring as we observe the Twentieth year since America was attacked by foreign terrorists intent on destroying our financial system as well as the seat of government and the headquarters of our military.

The succeeded in bring down both high towers of the World Trade Center as well as several other buildings. They succeeded in attacking, but not destroying the Pentagon.

Americans rose to the challenge and prevented the attack on the seat of government by crashing the plane they were on into the ground in Shanksville, Pennsylvania. It’s not an overstatement to refer to all of those people as heroes. We owe them a debt that we will never be able to repay.

As the twin towers collapsed into rubble, I estimated that about 10,000 people were dying at the very moment. That was one time that I was glad to be wrong. A far lesser number died that day, due again to heroic action by public safety officers and other people who sacrificed their lives to save others.

Sadly, the dying from the WTC attacks continues 20 years later. The CDC has a website for people who were affected by the toxic soup that permeated the air that day and for many weeks after.

Sadly, the City of New York is so far refusing to compensate some EMS workers who are suffering the after effects of the toxic exposure. New York City continues it’s long practice of treating EMS workers as Third Class Citizens. Less pay, worse working conditions, fewer benefits, and disdain from many of their bosses at FDNY.

Why the 9/11 Death Toll Is Still Rising Today

According to information supplied to Newsweek by the National Institute for Occupational Safety & Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), 3,946 members of the World Trade Center Health Program, which supports first responders and survivors on-site during and after the 9/11 attacks, have died.

This article was written last year, so the death toll has no doubt increased since then. That’s a lot more deaths than those that occurred on the day of the attack.

After the attacks President George W. Bush vowed to bring the people who planned the attack to justice. When the Taliban refused to turn over Osama bin Laden by the date demanded by President Bush, the United States and other nations went to war.

The Taliban were defeated in short order, and a new government was installed. The US, England, Germany, Australia, France, Canada, and other nations stayed on to conduct an ultimately futile project to rebuild Afghanistan into a modern nation. Note that I am not criticizing any of the people involved in this. It was a worthy goal and much of it went well.

Unfortunately more of it seems to have gone poorly. President Biden precipitously and prematurely pulled out military support for the Afghan military. That included pulling out military forces before evacuating civilian personnel.

That was a recipe for disaster and disaster is exactly what we got. The Afghan military melted away like an bowl of ice cream on a 90 degree day. The Taliban regained control of most of the country and billions of dollars worth is high tech military equipment. Meanwhile, American and allied civilian personnel were trapped and abandoned by a feckless President, cowardly Chairman of the Joint Chiefs of Staff, clueless Secretary of Defense, and morally bankrupt Secretary of State.

All of whom played Mickey the Dunce when it came to explaining how such a catastrophe happened and who was responsible.

The main cost of this debacle is measured in lives lost or permanently disrupted by members of several nations militaries and support services. All of which seems to have sacrificed in vain. That’s the real tragedy of this disastrous turn of events.

The real cost of the loss of billons of dollars of military equipment is the fact that much of it will make it’s way to our nation’s enemies and will cost more lives and misery in the future.

In addition, the incompetent President has allowed thousands of unvetted Afghani and other “refugees” into this country without any sort of vetting. No doubt many of them are legitimate, but I also have no doubt that some of them are disguised enemies who come here to conduct terrorist attacks.

Again, the incompetents with their mitts on the levers of power in this nation will cause death and misery because of their complete inability to perform the basic functions of government. The first and foremost of which is to protect the citizens of the nation against all enemies, foreign and domestic.

I don’t know what tomorrow will bring, but I won’t be even a bit surprised if there is at the least an attempt to attack the United States itself and/or US interests abroad.

I’ll keeping an ear on the news all day tomorrow as I go about my business.

I won’t watch any of the commemoration ceremonies as I need no reminders of what happened that day in the ever receding past.

As far as action, I am making a recurring donation to the Tunnels To Towers Foundation.  They do good things for people hurt fighting the War Against Islamofascism. If that’s not your cup of tea, find another charity you think worthy and donate.

When I say it’s the least we can do for people who made tremendous sacrifices, I mean it’s literally the least we can do.

The political leadership of our nation betrayed them, but we can’t.

Prostate Cancer Awareness Month

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It’s September, so that means it’s Prostate Cancer Awareness Month (PCAM).

Lung cancer is non sexist, as it kills both sexes indiscriminately. Behind that for men, is Prostate Cancer. Behind lung cancer for women is breast cancer.

For men, due to increased awareness, increased testing, and earlier treatment, the five year survival rate 99%. According to the Prostate Cancer Foundation  (PCF) 1 in 8 men will be diagnosed with Prostate Cancer during their life times.

The good news is that with early treatment most forms of PC can be successfully treated.

Make sure you discuss Prostate Cancer Screening with your Primary Care Physician at your annual physical. You do get an annual physical, right? Screening doesn’t necessarily have to include a digital rectal exam. A Prostate-specific antigen (PSA) test can also indicate that further screening is needed. Again, this should be discussed with your PCP.

You can, and should, donate to the PCF at the link above.

Women are far better at this sort of thing than we are. I’ve yet to see a woman, nor many men for that matter, wearing blue ribbons or wrist bands. Yet, each October the world seems to turn pink for Breast Cancer Awareness Month.

It’s time for us to start taking care of ourselves. After all, the world needs healtht men.

Needs More Cowbell!

Albert Einstein is reputed to have said, “The definition of insanity is doing the same thing over and over and expecting different results.”

People quibble over whether or not he actually said that, and if it’s true. I don’t know if it’s the definition of insanity, but it sure is the definition of stupidity.

I bring this up because we are now at the third, or is it fourth, round of useless attempts to control Covid-19. Now, we’re supposed to be afraid of the “Delta” variant which we are told is super easy to catch and super fatal.

The first is based on assumptions since testing for variants of viruses is neither cheap nor simple. Nor is it necessary as as with the other variants aggressive treatment early results in a pretty quick resolution.

That’s if you’re vaccinated. If you are not, it’s a far more serious disease, but the truth is if you’re not vaccinated the original and other variants can be pretty serious.

I’m not telling anyone to get vaccinated. That is a decision that every adult should make on their own. People should just be aware that the vaccine may not prevent infection with Covid, but at the least it will make the illness less severe in most cases.

A few weeks back I attended EMS rounds put on by one of the nearby hospitals. Of course it was on line only, because hospitals are trying to limit how many people come into the building.

The doctor presenting rounds gave a quick Covid update.

He said that based on what has been seen around the country, the vaccine is 88% effective against the Delta variant. Also, the number of hospitalizations is not up by much. The number of deaths is not measurably higher than all other causes. Even people who do get the disease and are in “high risk” groups aren’t getting as sick as expected.

At least his hospital, and I expect other hospitals, are taking an aggressive approach earlier than they did last year. Waiting doesn’t help, and in fact hurts.

As to pediatrics, the are seeing more kids who have Respiratory Syncytial Virus (RSV), which is the name for the “Common Cold” than anything else.

The CDC is urging government and private entities to revert to the failed preventative strategies that started about March of 2020. Cloths masks, social distancing, and of course plexiglass shields.

Here is what the CDC says about cloth masks.

If you don’t want to read the who study, here is the abstract,

Cloth masks have been used in healthcare and community settings to protect the wearer from respiratory infections. The use of cloth masks during the coronavirus disease (COVID-19) pandemic is under debate. The filtration effectiveness of cloth masks is generally lower than that of medical masks and respirators; however, cloth masks may provide some protection if well designed and used correctly. Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection. Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.

That’s a lot of equivocation in one paragraph. They may work, if made well. If you’ve seen the masks most people are wearing, you know that they are NOT made well.

Even if someone has a “well made” mask, chances are they are not wearing it correctly. It’s not unusual to see people wearing flimsy masks that cover their mouths, but not their noses. The effectiveness of those is about 0%.

Even if work correctly, the effectiveness of those dollar store masks is only a bit above 0%.

Then we have the “mask all kids in school” crowd. Both the CDC and the American Association of Pediatrics are recommending masking all kids age 2 and older. Good luck getting a two year old kid to wear a mask.

The problem is that there are no peer reviewed studies showing that masking kids in school prevents Covid in either kids or adults. What does work is vaccinating adults. Sadly, some teacher unions are against vaccine mandates while insisting on remote learning or making the kids wear masks.

Again, I don’t care if teachers get vaccinated or not. However, if they refuse vaccination and refuse to teach in person, a case can be made that they have abandoned their jobs.

Here is a pretty well balanced article on the subject.

The Science of Masking Kids at School Remains Uncertain

Several doctors I spoke with pointed out that the best way to shield children from COVID-19 exposure is through adult vaccination. “Our most effective way of protecting everyone, students and school staff alike, is by vaccinating the adults around them,” said Westyn Branch-Elliman, an infectious-diseases specialist at Harvard Medical School. Ashish Jha, the dean of Brown University School of Public Health, posted a thread on Twitter explaining that the vaccination rate among children under 12 is the same across the country, which is zero, of course. Yet pediatric infection rates right now vary wildly, correlating with how many adults in their area are vaccinated. And evidence suggests that staff-to-staff transmission is more common than transmission from students to staff, staff to student, or student to student.

COVID, of course, is also a disease that tends to have much milder effects on children. “We know that the risk to kids from COVID is vanishingly low. Yes, we’re seeing it, but it’s rare,” said Schecter-Perkins, the emergency-medicine infectious-diseases expert. Out of more than 600,000 American deaths attributed to COVID-19, 361 were for kids and adolescents under age 18. In the much-shorter 2018-2019 flu season, there were 477 pediatric deaths. “We didn’t have mask mandates then,” Schecter-Perkins noted. And “now we’re in a post-vaxx world where adults have had the opportunity to protect themselves, and vaccines prevent severe COVID.

I encourage you to read the entire article.

I’m only familiar with what is going on in my area, but here there are essentially two types of people wearing masks all the time. By all the time I include people sitting in their cars alone, people walking alone on streets, and even a few people outside exercising, again by themselves.

Those groups are the elderly, who are very likely to be vaccinated, and blacks, who were effectively scared out of being vaccinated last year during the Presidential campaign.

Other than that, few people are wearing masks voluntarily. The Governor of my state has refused to issue any mask mandates, leaving it up to each city or town to make their own decision.

Personally, I think it should be up to each individual to weigh the risks and benefits of getting vaccinated, wearing masks, hiding in their basement, or doing anything else they think will work.

I don’t care what people do as long as they don’t tell me what I should do.

We can speculate endlessly what the end game of the people hyping this disease and urging us to adopt the previous failed “preventative” strategies is, but what’s the point?

Do you own research, draw your own conclusions, and then make your decision as to what is best for you.

The Worst Is Yet To Come

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On the weekend of August 14-15 the situation in Afghanistan and particularly Kabul was dire. The Taliban had taken over most of the country and more importantly captured the Presidential Palace and the American Embassy.

The Afghan National Army had cut and run, leaving the Taliban to take over the former American stronghold of Bagram Air Force Base.

People were frantically trying to get to Hamid Karzai International Airport, which is wholly unsuited for the evacuation of large numbers of people and is almost indefensible.

The President and other officials told us that everything was in control, but clearly it wasn’t.

In the almost two weeks we’ve found out the following.

Billions of dollars of high tech US military equipment has fallen into the hands of the Taliban and other terrorist organizations. Reports are much of it is flowing to Pakistan where it will be safe from US bombs and missiles. From there it will be sold or given to nations that are clearly not our friends and are in fact likely to be enemies in the near future. Those nations will be able to reverse engineer all of that technology and then build their own.

Good work General Milley. Well, he’s not alone in this stupidity.

Then, we found out that staff at the American Embassy gave the Taliban a list of American citizens and Afghani allies who they would like to be allowed to access the airport for evacuation. Yes, you read that right, someone from the US State Department handed a “hit list” to our sworn enemies.

American military have been expressly ordered NOT to go outside the airport to help or rescue Americans and Afghanis trying to get to the airport. On the contrary, British, French, and Canadian military personnel went out into the streets of Kabul to rescue their people and even rescued a few Americans along the way.

The Secretary of State and official spokesmen have all tried to hide the fact that they don’t know where many of the American staff of the embassy or Afghani allies are. Nor do they know if and how they will be able to find and extract them. Despite this they insist that those people are not “stranded.” In fact, they are trying to sell the story that people were told to evacuate weeks ago and decided not to.

If any of those people make it out alive, it will be interesting to hear what they say.

To make things worse, now everyone is pointing fingers at everyone else.

I apologize to my fellow Three Stooges fans for using this picture.

No one is willing to accept responsibility for closing Bagrarm AFB in the middle of the night. No one is willing to accept responsibility for cutting off technical support to the Afghan military, including aircraft maintenance by civilian contractors.

No one is willing to accept responsibility for removing US Military personnel BEFORE evacuating vulnerable civilians.

No one is willing to accept responsibility for allowing high tech military equipment to fall into the hands of our sworn enemies.

The President claims that no one could anticipate the astoundingly fast collapse of the Afghan military and civilian leadership.

Except he was warned back in July that exactly what happened was likely to happen. Instead of planning for the worst case scenario, they la de dahed their way into the worst US defeat since, uh, I don’t know when. People have compared this to the fall of Saigon, but I don’t think that’s accurate.

The closest intelligence failure I can think of was not anticipating the Japanese attack on Pearl Harbor. Although this wasn’t so much a failure of intelligence as it was a failure to appreciate the intelligence and plan for it in advance.

All of that was bad enough. A complete fail on every level by the President of the United States and the stooges he appointed.

Then came yesterday. Terrorists attacked the points of access to the airport and killed numerous people, both military and civilian. 12 US Marines and one US Navy Corpsman providing medical support were killed and 18 were wounded. An untold number,  but probably close to 200 civilians were killed a well.

That’s more US military members killed in one day than in the past several years combined.

After hours of hiding in his basement and eating his favorite ice cream, the Prevaricator in Chief went on TV and incoherently read a prepared statement heavily plagiarized from Bill Clinton.

He promised that the US military would hunt them perpetrators of the attack down and bring them to justice. Of course he has no idea how that will be accomplished, but it sounded like he was in charge.

Sure it did.

He then mentioned that he had a list of which reporters to call in what order. Even though he didn’t say that, it was because he had prepared answers for scripted questions. Even at that, he went off script and off the rails.

Of course White House Press Secretary Raggedy Ann Psaki said that “This is not a day for politics,” as if there is a day without politics being first for this White House.

I don’t know how it can get worse, but I’m afraid it will.

Nor will the United States be immune from this. I fully expect some terrorist attack or attacks around the upcoming 20th anniversary of the 9/11/2001 terror attacks.

I hope that the featured image for this post makes you as angry as it makes me. The President should fire his Cabinet Secretaries and others responsible for this disgrace and then resign.

He won’t of course, because he has a small brain and a large ego and no one around him will tell him he must do the honorable thing. Well, it’s not like anyone around him knows about that either.

 

What If They Held An Insurrection and Nobody Came?

Alternate title is “The Insurrection That Wasn’t.”

Even though the FBI arrested over 570 people who were at the January 6 Insurrection, they haven’t charged even one person with participating in an insurrection.

Keep in mind that there were no guns carried by these so called insurrectionists. Keep in mind that with one exception everyone who died did so from medical conditions. The one exception was Ashli Babbitt. She was shot by a law enforcement officer from we don’t quite know which federal agency.

Babbitt was unarmed when she climbed through a window that someone else broke. Essentially she was killed for trespassing.

This story was posed by Reuters, a very mainstream media outlet, earlier today.

Exclusive: FBI finds scant evidence U.S. Capitol attack was coordinated – sources

 

WASHINGTON, Aug 20 (Reuters) – The FBI has found scant evidence that the Jan. 6 attack on the U.S. Capitol was the result of an organized plot to overturn the presidential election result, according to four current and former law enforcement officials.

Though federal officials have arrested more than 570 alleged participants, the FBI at this point believes the violence was not centrally coordinated by far-right groups or prominent supporters of then-President Donald Trump, according to the sources, who have been either directly involved in or briefed regularly on the wide-ranging investigations.

No guns, no bombs, not swords, no beheadings. Not even a JV team for the crowd that just took over an entire nation in South Asia.

FBI investigators did find that cells of protesters, including followers of the far-right Oath Keepers and Proud Boys groups, had aimed to break into the Capitol. But they found no evidence that the groups had serious plans about what to do if they made it inside, the sources said.

Again, essentially trespassing. Yet, some of these people have been held without bail since January or February. At the same time, people arrested for murder in some states have been released with GPS monitoring (which is easily defeated) and then promptly committed more crimes.

Of the 570+ people arrested, 40 have been charged with engaging in some sort of conspiracy.

Reuters breathlessly tells us,

It was the most violent attack on the Capitol since the War of 1812, forcing lawmakers and Trump’s own vice president, Mike Pence, to scramble for safety.

Somehow they forgot to mention a bomb detonated by the Weather Underground in 1971. Or the 1983 bombing at the US Senate.

They also don’t seem to recall that in 1954 four Puerto Rican separatists show five Congressmen INSIDE the Capitol.

Remember the initial reports were that rioters beat a Capitol Policer to death with a fire extinguisher. Then it was that he died later on from those injuries. Then it was that he had a stroke caused by the stress of watching the “rioters” do… nothing.

Every other person who died did so from medical conditions not related to the riot.

Some federal judges and legal experts have questioned whether the Justice Department is letting defendants off too lightly.

Maybe because they know that they can’t prove any case for that. It’s odd that judges are urging more serious charges as opposed to overseeing the course of the case.

Prosecutors have also not brought any charges alleging that any individual or group played a central role in organizing or leading the riot. Law-enforcement sources told Reuters no such charges appeared to be pending.

Again, maybe because there was no evidence of this.

Maybe, just maybe, it was just a large rally where a small number of people got carried away and acted like idiots. If everyone who did that was charged with a crime, we’d need 1,000 more prisons.

Curiously enough, no one seems all that interested investigating why Ashli Babbitt was killed.

And some people wonder what a lot of people who were likely to have been at the January 6th rally distrust the federal government.

Maybe they should just call the whole thing off and stop wasting our money. They’re going to need that to investigate what I expect to be a wave of terror attacks inside the US over the next couple of months.

And, unlike this investigation, that’s no joke.

A Debacle

NOTE: In the first version of this post I neglected to mention the true disgrace of this debacle. That is the lives sacrificed or changed forever by US Military personnel and others trying to put lipstick on the pig known as Afghanistan.

Afghan official says troops surrender Bagram air base to Taliban; base is home to prison housing 5,000 inmates

This will make it much harder, if not impossible, to evacuate military and civilian personnel from the country. Several thousand American and coalition civilian and military personnel are now in extreme danger of being killed or captured by the Taliban.

Afghanis who helped us as translators or other support personnel will be slaughtered along with every member of the family. The Taliban will take great delete in recording this and releasing the video to the world.

The Biden Administration has had a major number of disasters in a short time in office, but this is the worst.

America is humiliated on the world stage because the President of the most powerful nation on earth signaled his intentions well in advance and an emboldened enemy took full advantage of it.

I can’t say I blame the Afghan Army for cutting and running. After all, it’s what we’re doing to them. Cutting and running with our tails between our collective lengths.

Afghanistan is not a nation, it’s a collection of warring tribes that are surrounded by nations. We spent a couple of Trillion dollars trying to turn it into a nation and failed spectacularly.

This so bad that even CNN can’t run cover for President Biden.

Taliban takes control of Kabul’s presidential palace

Once they are in control, the Taliban will invite Al Qaeda and ISIS in to use the country as a haven for training and rest. While the Taliban itself may not be able to reach the US or US interests, these other groups will.

General Mark Milley should be Court Martialed for his incompetence. President Biden should , but won’t be impeached.

I won’t be at all surprised if there are attacks on September 11 on the Twentieth Anniversary of the attacks on the World Trade Center and Pentagon. I also won’t be at all surprised if US intelligence agencies completely fail to anticipate and uncover these attacks before they happen. Too busy searching for non existent “White Supremacists” who aren’t planning anything more threatening than marches in US cities.

This will make another good excuse for lock downs and trying to confiscate firearms from law abiding American.

And don’t think for a second that our enemies, especially China and Iran, aren’t taking note of this. Taiwan, Australia, and even Japan should be very wary right now. New Zealand likely less so because from what I’ve seen of their leadership, they won’t mind being a Chinese vassal state.

If anyone told me I’d be typing this sort of thing even a year ago, I’d laugh at them. That’s who much things have deteriorated in so short a time.

I fear for our Republic.

But, as the saying goes at least we won’t have to worry about mean Tweets.

Feel free to comment and call me deranged, but check back at the end of the year to see how wrong I turned out to be.

Of Masks And Men, Epilogue

A brief update to my previous post. This is Michael Osterholm PhD, MPH speaking on CNN. He’s one of the President Biden’s top advisors on Covid 19. He says the exact thing I said in my previous post. Only N95 masks can protect the wearer from the virus. Notice that he says that people in the midwest, where he is, can smell the smoke from the fires on the west coast.

Smoke particles are larger than a virus, so if the smoke can get through, the virus can get through.

Ignore the people who got their degrees from the Internet School of Medicine and believe a real scientist.

Remember that Anthony Fauci and Deborah Brix (both MDs) assured us that scarves or bits of cloth across the face would stop the virus. Nope.

 

Of Masks and Men

I laugh, derisively, at friends and relatives who try to lecture me on medical topics. I’m obviously not a doctor and never pretend to be. On the other hand, I spent a lot of time working with and learning from doctors. Those doctors included some men and women who were professors of medicine at a couple of pretty good medical schools.

It was a fringe benefit that I took for granted and thought was the norm in EMS. Boy, was I wrong. What I learned was far above what most paramedics learn in school or afterwards when they are out in the real world.

I point this out not to brag about how smart or well educated I am. Rather it’s just point out that I know some medicine.

Some people I know don’t let their lack of medical knowledge stop them from making sweeping pronouncements. My sister is one. She only stopped wearing a mask at the beginning of June because she believed everything that the CDC said, even if it was ridiculous on it’s face.

She still carries one of those masks that look like a surgical mask, but isn’t sterile and isn’t medical grade. Sometimes she wears the cloth masks that come in packages that clearly state that they are not medical and offer no protection.

It’s mask theater, nothing more.

Boiled down to their essentials, there are three kinds of masks that were in general use during the panicdemic.

The first is the National Institute for Occupational Safety and Health (NIOSH) approved N95 mask. NIOSH is part of the Centers for Disease Control and specifies standards for many medical devices. A properly fitted N95 mask will stop 95% of viruses and other small particles. They are used in medical and non medical settings such as construction.

For all of it’s faults, the Food and Drug Administration (FDA) does a good job describing various types of masks. Note the following,

N95s respirators regulated under product code MSH are class II medical devices exempt from 510(k) premarket notification, unless:

The respirator is intended to prevent specific diseases or infections, or

The respirator is labeled or otherwise represented as filtering surgical smoke or plumes, filtering specific amounts of viruses or bacteria, reducing the amount of and/or killing viruses, bacteria, or fungi, or affecting allergenicity, or

The respirator contains coating technologies unrelated to filtration (e.g., to reduce and or kill microorganisms).

They aren’t inexpensive and the aren’t comfortable to wear. Plus each individual needs to be fit tested to make sure that the mask seals properly. Quite frankly, they are a pain in the ass to wear for extended periods of time.

The function of N95 masks is to protect the person wearing it. If you want to avoid contracting Covid 19 or other virus or bacteria disease, this is what you wear. It’s actually what I wore early on before I realized that the virus didn’t pose the threat that was advertised. Which is a post for probably never, but definitely not today.

Note also, this from the FDA website,

General N95 Respirator Precautions

People with chronic respiratory, cardiac, or other medical conditions that make breathing difficult should check with their health care provider before using an N95 respirator because the N95 respirator can make it more difficult for the wearer to breathe.

Some models have exhalation valves that can make breathing out easier and help reduce heat build-up. Note that N95 respirators with exhalation valves should not be used when sterile conditions are needed.

All FDA-cleared N95 respirators are labeled as “single-use,” disposable devices. If your respirator is damaged or soiled, or if breathing becomes difficult, you should remove the respirator, discard it properly, and replace it with a new one. To safely discard your N95 respirator, place it in a plastic bag and put it in the trash. Wash your hands after handling the used respirator.

N95 respirators are not designed for children or people with facial hair. Because a proper fit cannot be achieved on children and people with facial hair, the N95 respirator may not provide full protection.

As I said, they are not very comfortable to wear for long periods of time.

Early on these masks disappeared because hospital central supply managers were ordering them as fast as they could find them.

Do not confuse them with KN95 masks which are good for dust and some fluids, but not virus and bacterial protection. If you’re sanding down some woodwork for painting, they’ll keep the dust out of your nostrils and thus your lungs, but that’s it.

Which brings us to real surgical masks. Those masks are designed to protect other people from the person wearing the surgical mask. Surgeons and others working in Operating Rooms wear them to protect the patient, not protect themselves from the patient. Before sterile technique was discovered, many surgical patients died from post operative infections. Maybe MORE people died from post operative infections. This of course was before the discovery of Penicillin and other anti biotics. What is a fairly simple to treat infection these days was a life threating event in those days.

From yet a different FDA website we get this,

Surgical masks: A mask that covers the user’s nose and mouth and provides a physical barrier to fluids and particulate materials. Surgical masks intended for medical purposes are considered medical devices. The mask meets certain fluid barrier protection standards and Class I or Class II flammability tests. Surgical masks are also tested for biocompatibility and are considered personal protective equipment (PPE). While surgical masks may be effective in blocking splashes and large-particle droplets, they do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the mask and your face. Surgical masks are not respiratory protective devices (unlike respirators).

So, surgical masks will NOT protect unmasked people from infected people who wear them. Nor will they protect the wearer from, well, anything. Note also that I have no idea what kind of masks hospitals are requiring visitors and patients to wear. Next time I happen to be near one, I’ll stop at an entrance and grab one to take a look. I have the sneaky suspicion that they too are mask theater.

If you don’t believe me, read this from the website linked above.

I wish my landscaper could do hedging like that.

Note also that if a mask is advertised as being “FDA registered” it does not mean that it is FDA approved. Here is what the FDA has to say about registration.

FDA Registration

Owners or operators of places of business (also called establishments or facilities) that are involved in the production and distribution of medical devices intended for use in the United States are generally required to register annually with the FDA.

It’s important to understand:

When a facility registers its establishment and lists its devices, the resulting entry in the FDA’s registration and listing database does not denote approval, clearance, or authorization of that facility or its medical devices.
So a mask marketed as “FDA Registered” may well not be approved and may well be useless.
Which brings us to the last class of face mask, which I call “fashion masks.”
The FDA addresses them with this comment,

Bad Care

As I mentioned in my last post, from time to time I’ll post about some of the bad care that I see as a Quality Assurance Auditor. Our goal where I work is not to punish providers, but to use cases that are not up to the standards set for quality care as educational purposes.

During the meetings with the paramedic, we go over the deficiencies we find and point out better ways to provide care. In most cases, the paramedic takes our suggestions and we see steady improvement in both their care and their documentation.

So here is the carefully redacted report, or at least the parts that are pertinent. I’ll add notes below the image.

The patient was a 74 year old male.

Here are the things that I noted as deficient in this report.

  1. The crew performed a 12 lead EKG, which was good. Unfortunately, the medic who wrote the report (the tech) didn’t attach a copy. That’s actually a minor lapse, but it’s important for down stream readers including doctors and nurses at the hospital to have an EKG to refer to when they do their own EKG. That way they will be able not only to see what the medics saw, but to compare it for changes in the EKG which would indicate if the patient was getting worse or better.
  2. The medic did not document the patient’s Past Medical History, Medications, or Allergies. Since   the patient may not remember any of that, it’s important to note as the hospital doesn’t want to give the patient a medication that might harm him.
  3. There is no physical exam of the patient. That includes skin condition, respiratory condition, lung sounds, evaluation of peripheral edema, respiratory rate, or even if the patient currently has chest pain.
  4. The doctors office may have started an IV, given Aspirin, or treatment for the chest pain. We’ll never know since none of that was documented in the report. There are also no vital signs as obtained by the doctor’s office, so there is no means of comparing them with what the providers obtained.
  5. The heart rate is pretty fast, which should be of concern as there are a number of reasons, none particularly good, for tachycardia. The medic notes the EKG rhythm as being “NSR” which is “Normal Sinus Rhythm.” Clearly this is not as it’s above the upper limit for NSR which is 100 beats per minutes.
  6. The patients respiratory rate is also a bit above the normal range. The CO2 level is a bit below the normal range. Both of those, along with the tachycardia, should be of concern.
  7. The patient reports chest pain and increased Work of Breathing (WOB) on exertion. Since we don’t know his medical history or medications, there is no way to know if this is typical for him or a change in his condition.
  8. The term “non diagnostic” means that there are no changes to the EKG that would indicate a cardiac event. One of the things auditors do is “overread” the EKG to confirm the medics impression. Mostly paramedics are pretty good at interpreting EKGs, but still it’s important to confirm that.

I will note that the crew did transport to the appropriate facility, which is sometimes an issue, but not here,

Since the medical record is at best incomplete, we can only work on the premise that the care was also incomplete. There is more than a bit of likelihood that the patient may have suffered some harm as necessary treatment was not administered by the paramedics on the call and responsible for providing care.

There is always the possibility that proper care was delivered, but there is no way of determining that from the report.

The EMS Coordinator for the agency will likely have a sit down with the medic who was the tech and discuss the report and the lapses in care.

It sounds harsh, but as I said, the goal is not to punish or embarrass the provider, but to provide education to improve both his delivery of care and the documentation of that care.

 

 

Journal of Iatrogenic Medicine

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I mentioned that I’m going to add a category “Journal of Iatrogenic Medicine”, and this is the introduction.

Iatrongenic is harm induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures. In other words, by accident. The provided, whether doctor, nurse, EMS provider, or anyone else didn’t mean to cause harm, but they did.

In EMS when we see it we find that very often it is done by a provider who failed to recognize what was wrong with the patient, or the cause, or the correct course of action to treat the problem. That can be either using the wrong medication, device, or diagnostic procedure. It can also be an incorrect dose of a medication, or placing a piece of equipment incorrectly.

No matter what the cause, the patient suffers some degree of harm. Examples are giving a patient a medication to which he or she is allergic, or one that is incompatible with a medication the patient already takes. Or placing an endotracheal tube in the esophagus instead of the trachea.

It can even be a simple error such as sitting a patient with low or no blood pressure into a “stair chair” to move them out to the ambulance. The risk there is that they will lose what little blood pressure they have and pass out or worse.

Or not interpreting patient breath sounds correctly and giving an incorrect or no treatment.

I could probably write another 1,000 words just listing common medical errors, but I think you get the point. Except for putting a patient in a stair chair, doctors and nurses have done all of what I listed also.

Part of my job is to read patient care reports to look for errors large and small. Small errors are corrected during periodic reviews. Larger errors are reported to the system medical director and he determines if he or she considers it a large error and what action is needed.

Every EMS system in the country has a set of protocols for providers to follow when examining, diagnosing, treating, and transporting patients. Some states impose one set of protocols on every EMS system, some do it by county, and a couple allow each EMS system medical director to determine their own protocols.

My job entails reading reports and determining if the provider understood what was going on with the patient, what the correct course of treatment is, providing that treatment correctly and safely transporting the patient to the most appropriate facility for further treatment.

Then they have to write a report that explains all of that.

The approach I take, because it’s the approach the owner of the company wants, is to treat all of this as educational.

Which is all I’ll say about that since I don’t want my readers to fall asleep.

Because I read a lot of reports I come across some real doozy’s from time to time. Those are the reports that I’ll feature in posts about Iatrogenic Medicine.

In case anyone is worried, I will carefully vet each report that I write about so that there is no Protected Health Information revealed. When I quote text, all identifiers will be removed.

I’ll dissect the reports, what was done wrong, what the correct course of action was, and anything else I think is valuable.

That’s it in a nutshell. I should get the first post up in a day or so.