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The List Grows

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

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

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

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

NYPD to Waze: Stop snitching on our checkpoints!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But I digress.

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

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

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

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

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

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

Of Bullets And Penetration

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

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

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

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

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

Look starting at about 0.41 to see what I mean,

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

Newton’s Third Law of Motion tells us,

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

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

Back to the article,

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

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

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

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

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

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

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

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

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

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

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

First, I want to hit the intended target.

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

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

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

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

Personal-Defense Ammo: Top Picks from the Experts

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

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

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

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

I think any expert will tell you the same.

As I’ve Long Suspected

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

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

 

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

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

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

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

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

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

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

That didn’t last long at all.

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

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

 

Hygeine In EMS

This story appeared on line the other day,

Many paramedics ignore hand hygiene rules, study finds

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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