In addition to being the title of a song from the 1970s, I’m heading out early this morning for Indianapolis. There, I’ll be joining other like minded folks for the National Rifle Association Annual Meetings and Exposition.
While I’ll be covering the various speeches, I’ll be mostly on the exhibit hall floor checking out the latest in firearms, accessories, and other fun stuff.
I’ll be hanging with Ambulance Driver and other fine folks I’ve met over the years.
I’ll put up some posts with pictures for your reading enjoyment. I’ll also try to post my story about my great mail box adventure. The oddest part of which is that I discovered a road under the road in front of my house.
Yes, that’s as weird as it sounds. With any luck I’ll get that post going before the festivities start in Indianapolis.
Oh, both the President and Vice President are going to speak again this year. That will be a big event which I plan to watch from the media room. Last year the line to get in was long and slooooowwwww. Of course it was the one part of the whole show in which no one could bring a firearm. Which makes sense, of course.
Speaking of firearms, I haven’t seen any breathless media stories about how the NRA is banning guns from the meetings and exhibit hall this year. Or requiring everyone to carry unloaded.
Late in the evening of April 19, 1775 a large contingent (about 700) of British Army Regulars started marching from Boston, MA to the town of Concord, MA.
Their orders were to seize cannon, powder, and shot from the colonial armory located there.
The march started with a short, but disorganized ferry operation across the Charles River to the City of Cambridge, MA.
From there, the soldiers started marching northwesterly towards Concord. An advance column led by Royal Marine Lieutenant Jesse Adair turned right and headed to the town common in Lexington, MA. His intent was to protect the flank of the larger British column marching towards Concord.
A contingent of colonial militiamen were assembling on the common after being warned by Paul Revere earlier in the morning.
A British officer, no one is sure which one rode forth on his horse and ordered the assembled militiamen to “lay down your arms, you damned rebels!”
The militia Captain Charles Parker, order his men to disperse, which some started to do. Most didn’t lay down their arms, since they belonged to the individuals, not the government.
A shot rang out from the British regiment, again no one knows who fired. No militia were injured, but they stopped dispersing and stood to the British. The first colonial volley was powder only, no shot. No so the second volley which injured a couple of British soldiers.
The British soldiers then charged forward with fixed bayonets, injuring eight and wounding ten colonials.
At this point a British Colonel arrived and ordered the troops to assemble and cease firing.
The British then moved on to Concord, took the town, and started searching for the cannon and other items. Three large cannon were found and destroyed, along with shot, flour, and other items.
The main battle took place at the North Bridge in Concord. By this time several companies of militia had arrived from surrounding towns and were ready to do battle.
The British retreated across the bridge and took up defensive positions. One shot rang out from the British side, followed by two more, followed by a larger volley. More firing and after six militiamen had been killed, the militia commanders ordered return fire.
The battle was short, but bloody. It ended with the British retreating back through Lexington to Boston. Along the way, they were harassed by colonial militiamen. The battle went on all day long, with casualties on both sides.
The battle was more or less an accident, but it mattered not. The colonials were branded as traitors, which by British law, they were. America would not be officially born until July of the following year, but in reality the Revolution started on April 19, 1775.
In June of 1775, the British would suffer another defeat at Bunker (actually Breeds) Hill in Charlestown, MA.
There was no turning back now. The colonials would either succeed in freeing themselves from the British or be conquered and the leaders hanged.
Only a couple of states recognize this holiday, which is a shame. This was the day that the journey towards what would become the United States of America started. It should be remembered and celebrated as much as is July 4.
Were it not for the militia at Concord and Lexington, it might well have been several more years, if ever, before the Colonies gained independenc.
Mark Zuckerberg is the CEO of Facebook. Facebook has been very anti firearm and by extension anti Second Amendment for some time. Zuckerberg has made several anti firearms statements on his own and his company has instituted policies and procedures to limit “gun posts” on his website.
I have a small (intentionally) Facebook account under my real name. In addition EMS Blogs has its blogs set up to post to Facebook under the umbrella of the account. At first I was not a big fan, but it does drive some readership to the site, which is good for me.
That is all in the form of disclosure, I guess. The point of this post is to point out a bit of hypocrisy on the part of Mr. Zuckerberg.
San Francisco (CNN Business)Keeping Mark Zuckerberg safe is expensive. Facebook paid its CEO an additional $13 million for his personal security and travel costs in 2018, according to a proxy filing on Friday. That included a new $10 million pre-tax allowance for additional security costs such as security guards, equipment, services and residential improvements.”He is synonymous with Facebook and, as a result, negative sentiment regarding our company is directly associated with, and often transferred to, Mr. Zuckerberg,” said the filing.Like many wealthy CEOs, Zuckerberg receives an official salary of $1 a year. He also did not receive bonuses or stock awards in 2018. However, Zuckerberg’s total compensation jumped from $9.1 million in 2017 to $22.6 million in 2018 in order to cover the increase in security costs for the high-profile CEO.
That’s a lot of security and a lot of money. It includes a private plane so that Zuckerberg doesn’t have to sit among the unwashed. To be fair, if I had enough money, I’d fly private as well. Still, the plane is part of his security package, so it’s fair game for comment.
A couple of other articles from 2016 say that he has Sixteen body guards at his residence. Probably not all at the same time, but split up to provide 24/7 security to him and his wife.
When the media says “security guards” I don’t think they mean Paul Blart type mall cops. I’d expect that they are ex military or maybe former police officers. Real security and unless I miss my guess, ARMED.
Again to go with the private plane, if I were worth the billions that Zuckerberg is, I’d have a secure house and body guards traveling with me as well. That’s not the problem.
Here is the problem, as I see it. Zuckerberg, with his anti Second Amendment stance is saying that he’s worth protecting, but you, I, and our families are not.
Think about that. You and I are not valuable enough to be able to protect ourselves. That’s because the only way to protect ourselves is to be able to be armed. “Armed” doesn’t necessarily mean a firearm. The Second Amendment in it’s plain text and by Common Law protects the right to bear “arms.” In addition to firearms, knives, chemical sprays, electrical weapons, clubs, even a bow and arrow if one chooses, are all considered arms. They are all “in common use” for self defense. Well, except for a bow and arrow, which once was very commonly in use for self defense.
Since most of us can’t afford to hire Sixteen body guards we generally only have one we can depend on. Ourselves.
I have a lot of respect for law enforcement officers, who have a very tough job. One of the tough parts is that there just aren’t enough of them. I live in a suburban town that once was pretty safe. As demographics and society have changed in recent years that’s changed. Two weeks ago, there was a shooting on the other side of town. Weekly, the police are arresting people for selling drugs, committing assaults, or breaking into houses.
There is no guarantee that when I need the police they will be there in time to help. As they saying goes, “When seconds count, the police are only minutes away.” Minutes might be too long.
In areas more rural than mine, the wait can be longer, sometimes an hour or so waiting for the police or sheriff to come and help.
Zuckerberg doesn’t have to worry about that as his “police” are with him all the time. You and I, dear reader, are not that lucky.
Which is why Mr. Zuckerberg is a hypocrite of the first ranking.
Deshawn Antonio Kelly of Portland, Ore., worked at PDX as a contract baggage handler hired through a third-party when the thefts occurred from August 19, 2018 to September 17, 2018. During that time, Kelly was accused of stealing six guns from bags that had been checked by passengers traveling to and from the Oregon airport.
Fortunately, Kelly was caught pretty quickly or he might have gone on stealing and selling guns. At the least, law abiding gun owners traveling lawfully would be blamed for crimes in which they had no part and no control over stopping.
At worst, airlines would stop accepting firearms in checked baggage.
For those of you who aren’t aware, it is legal to transport firearms as checked luggage provided the owner follows both the TSA and airline rules. Which fortunately, are pretty much similar.
Briefly, the rules are,
The unloaded firearm must be in a secure container.
By secure, we mean locked.
Ammunition must be locked as well. Most airlines allow you to lock that in the same box, but a few don’t.
You must declare the firearm at the airline ticket counter and fill out a card provided to you by the airline staff.
The card either goes in the locked container or is taped on the outside. Which it is depends on factor I won’t bore you with right now.
After that, you follow the directions from the airline staff, which will vary somewhat based on the configuration of the airport.
When you arrive at your destination, you can either pick the bag in which the firearms case is locked up at the carousel OR you will have to find the baggage office and pick it up there.
That’s not too difficult, but there are a few “top tips” to make this easier.
First and foremost is, smile and be polite. The airline staff member you’re dealing with might not be familiar with their own company’s rules. Or the TSA rules either. I always bring, but have yet to have an excuse to use, a copy of the TSA regulations and the airlines specific rules. If there is any question, you can show it to the person in black and white.
Second, buy a good case for your firearms. If packing it inside a regular suitcase, use a cable to secure it to the frame. All suitcases that I’ve used over the past ten years have a metal frame for the pop up handle. That frame is inside the suitcase and pretty sturdy. That makes it just that much tougher to steal the gun case.
Third, take a picture of the suitcase. Actually, that’s a good idea even if you aren’t traveling with a firearm. That way, if the suitcase gets lost, you can show the person to whom you report the loss to exactly what the suitcase looks like. You can even email it to them.
Except for in a few areas where law enforcement doesn’t actually comply with the law or the Constitution (cough, New York, New Jersey), flying with firearms are not particularly difficult. The key is to pack them carefully, follow the TSA and airline rules, and as I said before, be polite to the airline staff.
That polite thing goes beyond just this topic. When there are glitches in your flight plans, being polite, sympathetic, and complimentary to the person upon whom you are depending for redress and assistance usually helps.
I prefer to be right behind a person who was a PITA and got nothing from the airline as a result. I smile, make a supportive comment about how hard this is for the airline staff, and ask for help in a polite way. It’s amazing how much discretion those folks have and how much more willing they are to help if you treat them decently.
As I type this, I’m watching the video below. It’s a “how not to” provide EMS. The patient in the video died after the paramedic and EMT allegedly refused to treat him. The deputy drove the man, Paul Tarashuck, to a closed gas station some distance away.
Tarashuck then proceeded to walk out into traffic where he was struck and killed by a motor vehicle.
We have video below of the entire encounter from the time the ambulance arrived until the late Mr. Tarashuck was escorted to the police cruiser.
To be clear, the deputy isn’t completely blameless in this incident either. I’m sure his department is going to review its policies on this sort of thing.
The EMS crew (and maybe the deputy) made a basic mistake that no EMS provider of any level of training or experience should make.
They assumed that the patient was drunk or on drugs. They never got beyond trying to get his name. No examination, not even vital signs.
At best what they did is known as “Anchoring Bias.” Which means that they had a preconceived notion of what was wrong with the patient and just never moved on from that.
That’s not the worst thing they did. Even being snarky and nasty to the patient isn’t a fireable offense. It’s wrong, but on the scale of things that they (allegedly) did wrong, it’s probably at the bottom of the list.
It’s hard to know who is in charge on this call, because the uniforms give us no clue. We also can’t see much of what is going on because the deputy is standing behind a broom and so his body camera isn’t showing us much.
The thing that they shoved up his nose is likely an ammonia inhalant or “smelling salts” if you prefer. Many systems stopped using them years ago because there are a lot of potential adverse effects. Not only did they use them, which might be allowable in their system. They used them inappropriately by shoving the capsule up his nose. That’s the white object sticking out of his nose.
I’ve lost track of the number of times that they asked his name. For whatever reason, they didn’t seem to be able to get past that. They did take a set of vital signs.
As the contact progressed the providers became less patient. There came a point where one of them should have gotten into the front of the ambulance and driven to the hospital.
That’s not what they did. Instead, they let the patient go into the custody of the deputy.
Here is what the providers allegedly did,
1. Health care treatment was unreasonably discontinued.
2. The termination of health care was contrary to the patient’s will or without the patient’s knowledge.
3. The health care provider failed to arrange for care by another appropriate skilled health care provider.
4. The health care provider should have
reasonably foreseen that harm to the patient would arise from the
termination of the care (proximate cause).
5. The patient actually suffered harm or loss as a result of the discontinuance of care.
This is the classic definition of Patient Abandonment. It is about the worst thing that you can do if you are an EMS provider.
At it’s best, this is an undocumented patient refusal, but that’s stretching that term almost to the breaking point.
Or maybe beyond.
In order for a patient refusal to be valid, the first thing that providers need to establish is that the patient is competent to refuse. There is a process for that, and the providers in this video did absolutely no steps in that process.
There was no way for the EMS crew to know that Mr. Tarashuk had a history of mental illness and was having a schizophrenic episode. What they did know, or should have, was that he was not oriented and obviously could not make an informed decision regarding being transported.
What they should have done is transported him to the hospital for examination and possible treatment.
What they should have done at the least is check his blood glucose level to see if he was hypoglycemic. That’s EMS 101 for patients that don’t answer questions appropriately (or at all).
This happened back in September and the latest report, from last month, says that the paramedic is still working “at a lesser capacity.” Whatever that might mean.
A couple of notes about the process of recording the encounter.
The deputy was wearing a body cam. Which is fine from a law enforcement standpoint, but not so much from an EMS standpoint. Which probably puts the EMS providers at more risk than the police officer. It would have been appropriate to ask the deputy to turn off his camera while he was in the ambulance. Or step outside.
That aside, the larger issue is that EMS providers should always act as if they are being recorded. It’s really that simple. Patient privacy laws apply to EMS providers, probably not to police officers, and definitely NOT to bystanders and patients.
This video seems to be pretty clear cut, but it’s not at all uncommon for random people to record snippets of what is going on and then release the video to the Internet. Or the news media for that matter.
Since the vast majority of the public has no knowledge of EMS or medicine in general, it’s easy for a video to portray something in a negative light and have the general public immediately condemn what ever actions the person making the recording didn’t like.
That happens to the police on a daily basis and is the reason that a lot of officers are wearing body cameras. Interestingly, the number of civilian complaints has dropped since body cameras have become common with police officers.
The debate now is whether that’s because police are behaving more appropriately or because people are less likely to make a BS complaint if they know that the police will have video of the events.
I’ll let you guess which way I think.
No, the answer is NOT body cameras for EMS. I can think of no easier way to end an EMS career than to have a video of a patient encounter.
We deal with a lot of very ill people and often they act out inappropriately when they are feeling horrible. Or family and friends act out inappropriately.
Which is why we have to be careful when dealing with uncooperative patients and belligerent family. Recording them is likely to make the situation worse, even if they record us.
Be careful if someone whips their cell phone out and starts pointing it at you. The only thing that you can be sure of is that they are NOT doing that for your benefit.
It’s most important to be more professional than you normally are when the patient or family is acting out at a scene.
I’ll close by reposting my five keys to a long and successful EMS career.
Answer the radio, pager, or phone when dispatch calls.
Go to the call.
Be nice to the people at the call.
Take the patient to the hospital.
Give the patient a nice, warm blanket.
If you do those five simple things, you’ll likely spend little to no time writing incident reports.
I learned that the hard way, so you don’t have to.
For many years, whenever someone talked about a “shortage” of paramedics, I would have a snarky reply.
“There is no shortage of paramedic. What there is a shortage of is paramedics that are willing to work for horrible wages, crappy benefits, and sit on street corners for hours between calls while having to ask for permission to drive half a block to use a convenience store rest room.”
For years, that was a true statement for EMTs and paramedics who worked for most private and some government operated EMS systems.
Lately though, there is indeed a shortage of paramedics and to a lesser extent EMTs.
Some of my clients are so short of paramedics that they will hire EMTs and pay for them to go to paramedic school. Others are hiring paramedics with no field experience, none, to work in busy 9-1-1 systems.
All of my client agencies are fire based. That means good pay, great benefits, a pension when you retire, and actual stations that the crews go back to between calls. Oh, did I mention that they are all union? Which means that providers have protection if they are accused of wrong doing.
Even if an applicant is already a paramedic, they still have to go to the fire academy. Which means that they get paid to go to school.
Despite that, agencies just can’t find enough qualified applicants to fill openings.
We can debate, and many have, whether or not fire departments should be providing ambulance transport and ALS services. That’s not today’s topic and the reality is that fire departments do provide those things.
I should mention that inexperienced paramedics are actually good for me and the work I do. The problem is, that I don’t know that it’s good for patient care.
Anyone who has spent any time in EMS knows that much of what we learn as providers comes after we’ve taken the course and passed the certification exams. You really only get good at EMS by doing calls. Lots of calls.
The problem also exists as the BLS level. One local service has applied to the state regulatory agency for authorization to staff some ambulances with one EMT and one First Responder. The First Responder would have first aid training and be restricted to driving. So, in reality, it would be an EMT and an Ambulance Driver.
I know that some states, particularly those that work in rural areas staff that way. This service is not one of them. They also pledge that they will only do this for transfers of non acute patients.
Being the cynical guy I am, I can only think that this is a foot in the door towards lowering staffing standards.
An a guess, and it’s just that, part of the problem is the economy. It’s roaring along right now and there are more jobs than people to fill them. Everywhere I go, I see “Help Wanted” signs. Some are for good jobs, some are for entry level jobs. No matter, those jobs compete with jobs in EMS for people to fill them.
Think about that for a minute. If you were job hunting and there were two jobs open One job involved working with sick or injured people, being away from home for long hours, including holidays and weekends, with not so great pay and benefits, and often having to work late. The other has the same pay, fixed hours, minimal or no weekend or holiday hours, and having a comfortable place to work. Which would you choose.
Back when EMS was new and exciting, many people went into the field out of a desire to help. Back then, we thought that EMS would get better, become a profession, and be respected by the public.
That doesn’t seem to be the case these days. More and more, EMS is a stepping stone to a “real” career. Some of those are in medicine, but many aren’t.
I don’t have any answers to this, but someone has to figure it out. If not, we’re going to end up back in the pre EMS days of minimally trained and experienced providers whose main job is to drive people to the hospital.
Without a solid base of trained and experienced providers, all the fancy and expensive equipment in the world is useless.
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.
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.
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.
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.
If you are going to carry a firearm, make sure you have the correct license or permit.
Buy a holster.
Don’t hang around girl scout cabins.
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.
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,
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,
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.