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Things I Read Part 3

In Part 1, I groused about over use of Blood Glucose Level (BGL) checks in patients that don’t need them. Of course shortly after that I came across a case where the patient absolutely should have had his BGL checked.

Briefly this was a male in his mid 30s who had a seizure. When EMS made contact, the patient was no longer actively seizing. He was post ictal, which is a generic description of the mental state of a patient after the seizure has ended.

The range of post ictal states can range from unresponsive, to sleepy, to slightly irritable, to wildly violent.

This patient was sleepy until the medics decided to pick him up and move him to the stretcher. At which point he became wildly violent. He fought with the medics, the firefighters, and the police on scene.

Once on the stretcher, he calmed down and became sleepy. So, the medics decided to continue their assessment. At which point, he started fighting again. The medic who wrote the report documented that they were unable to start an IV (understandable), and unable to place EKG electrodes for cardiac monitoring (also understandable). They administered 6mg of Versed which made the patient barely manageable. That’s well within their protocols.

The report documents that the patient continued to buck the restraints and try to get off the stretcher. That’s a bid odd, but not inordinately so, when Versed is used. Ativan is actually a better drug, but is not authorized in the state where the medics work.

Up to this point, they were doing things within the protocols and care was appropriate.

Here is where they went off track.

They didn’t perform a BGL. The medic didn’t explain why he didn’t do one, but he didn’t. That’s a major deviation of the protocols and one that absolutely needs explanation.

The only thought that I had was that they just didn’t think of it. Most medics will do a BGL when the start an IV. Technically, they are supposed to do a separate finger stick with a lancet and get the reading that way.

Medics can debate for hours whether there is a real difference between a finger stick (capillary) or IV (venous) Blood Glucose Level and whether the difference is significant. This is much like theologians debating how many angels may dance on the head of a pin.

In truth, it’s going to be pretty close no matter which method you use. The important part is to actually get a reading.

While obtaining a BGL on every patient may drive me nuts, there’s no rule against it. I just think it’s an indicator of a lazy provider who doesn’t or can’t think the situation through.

On the other hand, not getting a BGL when it’s indicated by good clinical judgement or the protocols is going to get a call flagged for further review. Many EMS and a few law enforcement careers have been ended by the “It’s just a drunk” syndrome when encountering a patient with an Altered Mental Status.

My last observation, or if you prefer gripe, in this series is overuse of IV fluids.

There are several indications for administering boluses of IV fluids. Generally so called Normal Saline is the fluid of choice, but there are others that are used in some systems. Normal Saline is good for several things, although it’s use has been curtailed for trauma patients in many situations over the past few years.

It’s good for Septic patients. In fact, in the EMS setting it’s the best treatment we have for Sepsis and it’s also the one that’s used first in the hospital.

Briefly, in Sepsis the underlying problem is dehydration. The treatment for dehydration is… hydration. That is IV fluid. That is not dependent on blood pressure, as there are several markers for Sepsis other than that.

Hyperglycemia is another good indication for Normal Saline.

Shock, to a limited extent depending on the underlying cause is another good use for saline.

All of which I see on a regular basis when I’m reading ambulance reports.

The problem lies with the other things I see. While it has many uses, there are sometimes when Normal Saline can be dangerous to the patient.

Think of Normal Saline as a medication. All medications have indications, doses, contraindications, and adverse effects. There are no “harmless” medications.

In the case of Normal Saline, the things that should give a provider pause before administering doses of Normal Saline are patients with a history of Congestive Heart Failure, Hypertension, cardiac arrhythmias, any  sort of cardiac pump disease, among others.

Given large doses of Normal Saline to patients with medical histories like those can have serious adverse effects.

The one that always comes first in my mind is pushing fluid into the lungs. Lungs are designed to hold air and fluid overload will displace air and make it much harder for the patient to breath. This isn’t a huge risk in most younger patients, but may elderly patients have minimal cardiac and/or respiratory reserves so an amount of fluid that someone in their 20s, 30s, or even 40s will tolerate with no adverse effects could well kill a person in their 60s, 70s, or older.

Like every other medication, it’s important to know not only it’s benefits, but the draw backs to using it.

Which will bring me to my last complaint, at least for now.

When I was a young medic and even before that when I was a younger EMT a wise older (like his late 30s) medic told me that medications have specific indications and if I understood a medication list, then I’d have a pretty good idea of what the patient’s medical history was. That would be true even if the patient or other people on the scene couldn’t give me any information.

It was not, and is still not, unusual for patients no to know what a a particular medication was for. If you asked why the patient took a medication, the answer often would be “Because my doctor told me.” This doesn’t mean that the doctor didn’t tell the patient why they were prescribing a medication. It very likely meant that the patient forgot, or didn’t understand and was afraid to ask questions, or maybe didn’t listen in the first place.

The best current example of that is a newer drug called Eliquis. Depending on your TV viewing habits you may have seen a commercial for that medication. It’s prescribed for one thing and one thing only. Atrial Fibrillation not caused by a heart valve problem. That’s what the advertising says.

So, if I were working in the field and saw that on the medication list, I’d be looking for an irregularly irregular pulse and if the patient complaint indicated an EKG, I’d be looking for Atrial Fibrillation.

If the patient list included Metoprolol, I’d be looking for Atrial Fibrillation or Hypertension, maybe both as part of the Past Medical History.

There are a lot of medications out there. Even in the years since I retired several newer medications have come on the market. No one is going to be able to remember them all. That’s where a Smart Phone comes in handy. Even in the last few years of my active field career, I’d turn to my phone and type in an unfamiliar medication name to see what it was for.

Not only would it tell me what it was for, but I could find out if any of the medications I might plant to administer would result in an adverse or allergic reaction.

It’s better to avoid an adverse reaction than have to treat the patient for one on top of whatever there original complaint was. At a minimum it means some risk to the patient and more work and documentation for the provider. At maximum, it can cause the patient significant harm and a loot more documentation, possible remediation, possible career ending actions by an employer or regulatory body.

EMS can be a hard field to work in, but it’s a lot harder if you don’t pay attention and don’t use your brain while you’re doing it.

Things I read Part 2

I meant to get this out earlier in the week, but work responsibilities and a couple of other things delayed it until today.

So, I mentioned a couple of things that I see in case reviews that I irk me. Well, the part about moving hypotensive patients inappropriately more than irks me. It’s a practice that clearly has the potential to harm a patient. The BGL check is more irksome than anything else, but it makes me wonder what some paramedics are thinking. Or even if.

So, on to part 2 of things I read.

I read a lot of reports where the patient had either a limb lead EKG or a 12 lead EKG and I can’t figure out what the clinical indication was. I first have to explain that when I was trained and educated there was no such thing as a 12 lead EKG in the field. Paramedics just didn’t to them.

At the time a lot of physicians felt, and some still do that a paramedic can’t interpret a 12 lead EKG. Most can, some can’t. I also have to editorialize about the accuracy of the computer based interpretation of 12 leads. It’s not good. I’m not alone in that opinion as a physician I know who runs a one day intense 12 lead class shares the same opinion.

His advice is to look at the computer interpretation, but over read that with your own assessment. Given the choice, I wouldn’t turn on the computer interpretation, but I think that from a risk management perspective that train has left the station.

Even after we started doing 12 lead EKGs in the field, very often I would only do limb leads first and then if the patient clinical impression indicated that a 12 lead was indicated, I’d perform one. I wouldn’t do one just because I happened to have a patient of a certain age.

Some complaints require a 12 lead EKG. The older the patient, the more inclined I’d be to do a 12 lead. An older patient, let’s say 50 older, who presented with syncope, chest pain, or dyspnea would automatically get a 12 lead. We had a lot of education regarding “Anginal Equivalency” and how often a patient having a cardiac event didn’t present with the traditional mid sternal chest pain.

On the other hand, an 18 year old male who is having an anxiety reaction and feels “nervous” very likely isn’t going to be a cardiac patient.

Nor is the person who was just shot in the chest. Yet, I’ve read reports where the medic delayed getting a patient to a trauma center to do a 12 lead EKG. I’d always ask them what they were looking for. “Because the hospital wants one.” is not an acceptable answer.

My practice, and the practice of just about every medic I worked with was to reserve EKG monitoring for trauma patients to the ones that I expected to intubate during transport. Not once did a doctor say anything to me because I brought a patient into a trauma room without an EKG strip.

Today’s cardiac monitors do far more than monitor EKG rhythms, perform 12 leads, pace, and defibrillate. In addition to Oxygen saturation, they can read Carbon Monoxide (it’s an option), and Carbon Dioxide and of course provide often inaccurate blood pressures. One of my former co workers sometimes derisively referred to our cardiac machine as the “Symptom Checker.” He was a bit on the sarcastic side, if you didn’t guess.

Still, he had a point. Which brings me to my point. Some paramedics over rely on the readings from these very expensive machines and don’t perform their own clinical evaluation.

A few years ago I did a presentation for BLS providers on using ALS assessment skills at the BLS level. Everything I told them could be done without a cardiac monitor. In fact, the only pieces of equipment that they would  need were a stethoscope, BP cuff, and glucometer.

What that assessment required was looking at, touching, listening to, and on occasion smelling the odors emanating from the patient. If you do that as a provider at any level you’ll discover that the “Symptom Checker” is an aid, but not  replacement for examining your patient.

Henry J.L. Marriott MD in the Eighth Edition of Practical Electrocardiography wrote,

“The  electrocardiogram should be considered confirmatory clinical impression, and should not supersede it. If the patient is suspected clinically of having sustained a myocardia infarction, he should be treated accordingly even if his tracing is completely normal.”

The Eight Edition was published in 1988 and has been superseded by the Thirteenth Edition. I should probably pick up a copy, but it’s not an inexpensive book. It is a good teaching tool, though. I also don’t know of anything that would negate his statement. EKGs are still essentially the same although the technology for acquiring them has improved.

Put another way “Treat the patient not the monitor.” Yes, that’s an EMS cliche, although I think of it an axiom. If a patient looks sick, they are sick and should be treated as such.

A good paramedic can walk into a room, look at a patient, and know that they are sick. He or she may not know what is wrong, but they know that something is wrong. The History of Present Illness (HPI) and Physical Exam (PE) will likely help determine what treatments need to be done immediately and which hospital to go to.

The bottom line is that there is no guarantee that the cardiac monitor/symptom checker is going to magically diagnose the patient for you. It’s poor form to over rely on technology instead of knowing what you are doing.

If a patient has symptoms consistent with Acute Coronary Syndrome, then treat them as if they have Acute Coronary Syndrome.

The last thing I’ll mention today is Intravenous skills. I first will note that the patient population that EMS is seeing seems to have aged considerably over the last eight years. Then again, so have I.

Older people often have fragile veins do to a combination of underlying medical problems, the changes to both skin and vascular structure as we age, and often medications that patient are taking.

It’s no great sin to “miss” an IV. I certainly missed more than my share over my years in the field. Just don’t make excuses. About 90% of the reports I read where a medic misses an IV blames it on “poor vasculature.” This is alien to me as I never felt the need to justify a missed IV.

To a down stream reader, be it a doctor, nurse, QI reviewer, or anyone else, it looks like the provider is making an excuse for missing an IV. It also looks like the provider is blaming the patients veins for being fragile.

I laugh, but not in mirth, more in the line of derisive laughter when I see that. Our guidelines don’t allow us to make editorial comments on writing style, so I can’t put a comment in the auditing notes.

Speaking of which, we don’t audit for spelling, syntax, or grammar. If we did, it would take an hour to do each audit.

That said, in the context of professionalizing EMS by improving education if it were up to me I’d require entry level English and Math classes before would be paramedics to go on to the Anatomy and Physiology portion of school.

That’s Part 2 of this. I think I will do a Part 3 just on respiratory assessment. It’s a key skill that should be fundamental, but is lacking at both the ALS and BLS levels from what I read.

 

Things I Read

It’s been a bit over eight years since I last worked on an ambulance. Since then the only times I’ve been in one was when I was talking to a paramedic from one of my client agencies.

Mostly what I do is read ambulance reports. Between auditing, doing case reviews with providers, and doing quality improvement for our own auditors, that can be 75 or more a week. Have mercy on my poor eyes.

Sometimes the things I see on a report make me scratch my head. Other times, they make me want to bang my head on the desk. Once in a while I’ll read a report and think “WTF were you thinking!”

It’s not all doom and gloom because truth is that most of the reports indicate that the medic or EMT knew what he was doing and did it properly. Despite what some of the providers at our client agencies may think, we do not get paid more we  write up an infraction.

As a friend of mine who is a retired police officer used to say when he was accused of writing a ticket to meet a quota, “We don’t have quotas, we have all the business we can handle as is.”

Anyway, here are a few of the recurring themes I see when I read reports. I mention these as pointers and tips for medics to keep in mind. Sometimes, in the heat of a call, it’s easy to forget something basic that needs to be done.

That’s why it’s good to rehearse in your mind what you are going to do when you contact your patient. Keep in mind that all of the various Emergency Medical Dispatch systems are imperfect. They will tell you that they are, but nothing involving humans talking over a telephone is perfect.

So, here the the things big and small that I see and which give me an “Ice Cream Headache.”

Universal Blood Glucose Checks. My state’s protocols are quite clear on when those should be done on patients. 1) Altered Mental Status. 2) Suspected Stroke.

Those both make a lot of sense. AMS covers a lot of territory, so there is some degree of latitude. For example a person who is suspected of being drunk could be a diabetic with hypoglycemia. You don’t want to be the medic or EMT who sent a person off to a jail cell because he was “Just a drunk.” only to find out that he died from hypoglycemia. That is, as we say, a career limiting move.

The Stroke protocol is also clear. Very similar to the “Just a drunk.” scenario is thinking that someone is having a Stroke, calling a Stroke Alert and then finding out at the hospital that they were hypoglycemic. That’s not as bad as the first scenario, but you are going to get a talking to from someone.

With that having been said, some EMTs and medics seem to think that the only needed indications are that the patient has finger and the provider has a lancet. I can’t for the life of my understand why a 20 year old man who twisted his ankle and needs a trip to the hospital should have his Blood Glucose Level checked. Even if he is a diabetic, if he is sitting up talking to you, makes sense, and has no indication that he is in need of Glucose, there is no reason to stick a needle in his finger so that you can get a number to put in your report.

A more serious issue is treatment of hypotensive patients. When I read a report that says that a patient, especially an older one, has a very low blood pressure and the next sentence says that the crew picked the patient up and sat him in a chair, I know what to expect the next line to say.

It will often, but not always, say that the patient became dizzy or passed out. The medic always seems to be mystified that this happened. In a recent case a crew did that and the patient not only passed out, but he went into cardiac arrest. Where he stayed despite their best efforts.

I am not saying that sitting that poor man with a blood pressure of 78/50 up is the proximate cause of his demise, but I won’t be surprised if a personal injury lawyer does. Fortunately, I have never been called to court to testify about a call I audited. At least not yet.

Now, the city I worked in had and still has some older housing stock. Some of that goes back to the years before World War 2. Well before. Buildings with three stories and no elevator are the norm. Buildings with four or five stories and no elevator are not at all unusual. As a result I know what a pain (literally) it can be to carry someone down narrow stairs that have a lot of twists and turns. Believe me, I feel the effects of over more than 30 years of doing that every morning when I get out of bed.

Still and all, there is a proper way to move a hypotensive patient and a wrong way. The proper way involves a lot more work, but it’s better for the patient. Which is what we are supposed to be here for.

There is a section of the basic EMT course that covers “Loads, Lifts, and Carries.” It’s fairly early in the program and it’s rather important. EMT students learn the proper way to move patients, restrain (for safety) patients, carry patients, and get them in and out of the ambulance. It’s not mentally difficult, although it can be physically.

As a result, every EMT and paramedic knows the proper way. So, they can’t claim bad training. They can claim bad education if no one every taught them the physiology of shock, but that’s covered in EMT programs as well.

So, my default position is that they are lazy. Pure and simple. Of course, I can’t write that in a review. I have to keep the language pretty dry.

“Patient was found at contact to have a BP of 78/50. Medics sat the patient up and placed him in a stair chair. Patient became unconscious.” Pretty dry, but all but the dumbest person can understand what that means.

Okay. I’m a bit over 1,000 words so I’ll post part 2 tomorrow or the next day.

 

2021

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2020 was a pretty bad year. I can’t say it was the worse year I ever had, but it was annoying and infuriating. Or rather, many of the people were annoying and/or infuriating.

The response of the much of the government AND a lot of private organizations was inadequate and aimed at the wrong targets. Not to mention that some of those government and private entities used it to advance political agendas.

We were lied to early on and lied to more later on. I won’t go into all of the fudging of numbers done by people upon whom we should have been able to depend, but it’s there.

Politics were nasty and will get nastier. The election was stolen from the rightful winner. If you’re racing to your keyboard to tell me that it was all on the level, don’t bother. I can read, and I can count a bit too. Math doesn’t lie.

Back to the pandemic. Since I’m retired and only work a bit on the side to keep from being overwhelmed by boredom, my income didn’t go down by much. On the other hand, there are a lot of small businesses that are gone and will never come back. Their former owners will likely never recover financially. Or emotionally in many cases.

Depression, suicides, and drug overdoses hit record numbers. Speaking of record numbers, murders hit record numbers in cities where the police were “defunded.”

Neither George Floyd nor Breona Taylor should be considered heroes. I’ll leave it at that. I’m sure I’ll get a lot of hate comments, but I frankly don’t care.

So, even though 2020 is over calendars are just the way humans mark time. It’s arbitrary and this being the first day of 2021 doesn’t mean that the misery is over. In fact, there are those who are actively trying to extend the misery. If you break down the virus totals by state, you’ll find that the states with the harshest restrictions are also the states with the highest rates of infections, hospitalizations, and deaths.

Is that a coincidence?

On one hand, we are told that hospitals and their staff are overwhelmed. Staff is depressed and exhausted. On the other, we are treated to hospital staff performing elaborate dance routines. I’ve been overworked and exhausted in the past, and the last thing I felt like doing was dancing. I felt like taking a shower and getting some sleep.

I know, I sound overly cranky, but what I’m seeing and what I’m hearing from people working doesn’t match what I’m being told by the media and government officials.

Back to time and 2021. Just because we flipped over pages in a calendar doesn’t mean that all of our woes are over. There is some likelihood that the problems of 2020 are just going to keep on.

Think about that.

Ripples of Battle

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In 2003 author, historian, and former professor of the classics Victor Davis Hanson published “Ripples of Battle.”

In that book he picked three historic battles spanning a couple thousand years and explained how those battles continued to ripple through history.

As was trying to figure out what to write on the 79th anniversary of the Japanese attack on military and civilian facilities on the island of Hawaii, I came across this article.

Remains Of Four Pearl Harbor Sailors ID’d as Nation Marks 79th Anniversary of Attacks

Seventy Nine years after the attack, the work of identifying those killed continues. There aren’t that many survivors of the attack still with us. In fact, even the children of relatives of those killed are becoming more rare as the “Boomer” generation starts to pass from the scene.

Still, the military works to identify and honor those who died a Sunday morning long ago.

Three of those who were identified had served on the USS Oklahoma. Two of those were brothers. The fourth served on the USS West Virginia.

The Oklahoma was salvaged, but was too badly damaged to be returned to service. The West. Virginia was salvaged, repaired, and returned to service in late 1944. Which was in time to participate in several Pacific campaigns leading to the defeat of Japan.

There are of course many memorials to those who died on December 7, 1941. Perhaps the most famous is the USS Arizona memorial. The ship still rests on Battleship Row where she sank during the attack.

Inside the memorial, there is a large wall with the names of those who died, but whose bodies could not be recovered.

Long after everyone who was alive at the time and even those who were born shortly after the end of the war are gone, these memorials will still be there for new generations to visit and honor those who died to preserve a nation.

 

Thing That Goes Bang

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A few, well maybe more than a few, years ago I bought a used Marlin 336. It was in very nice condition and I had long wanted a lever action gun for range use and at some point, maybe hunting. The only modification I made to the rifle was replacing the original lever with a “wide loop” style that is a bit easier on my hand. I have no John Wayne pretensions and besides, he used Winchesters. It’s just a more comfortable way to get my hand in the loop to manipulate the action that way.

I shot it a few times and a friend gave me a low end scope to put on it. As I recall it was a BSA Deerslayer 9×40 scope. Now, I know that real rifle shooters will kind of laugh at that because cheap scopes are like cheap antennas on expensive radios.

About 10 years back I had an opportunity to shoot a Barrett 50 Caliber rifle. I think the owner told me that it cost about $10,000.00, but I’m not 100% sure. I do remember that he told me that he had a $3,000.00 Leopold scope on it. He said that wasn’t even a top end scope, but it was sufficient for his shooting. His shooting was at 600 yard ranges on his farm in Iowa.

I wasn’t even close to good enough to shoot that far out, but he did let us shoot at about 100 yards. It was amazing how accurate that rifle and scope were. We were shooting 12 gauge shotgun hulls and easily picking them off. It was also impressive what a .50 caliber bullet will do to a red brick at 100 yards. Pink dust was all that was left.

But, I digress as I so often do.

Back to my rifle. After a few trips to the range I was able to hit targets at about 100 yards, but then the scope fell apart and I had to stop shooting it. It wasn’t a defect, just the age of the scope. Apparently something dried out and the lenses fell apart.

I replaced that with another Deerslayer a couple of years ago, but never got around to taking it to the range and sighting it in.

I know that basics of sighting in a rifle from the Appleseed course I took some years ago. I’m not an expert, but have sighted in a couple of other rifles.

The first step I use is to go to our indoor range and use a laser bore sight to get the scope “on the paper.” My light is not all that expensive, but it’s worked well enough. The reason I use the indoor range is because it’s dark compared to the outdoor ranges. So, I did all of that got, the cross hairs lined up with the dot from the laser. Cool.

Outside I took a target and back up paper out to the 100 yard range and stapled them up. The back up paper was from a stack of architectural drawings someone donated to the club. It’s a nice white piece of paper that will show me where my rounds are actually landing. As I said, the bore sight is just supposed to get me on the paper and then I can dial in from there.

Supposed to.

I set up my spotting scope and lined it up with the target. I set my rest down, set the rifle down, and took out a box of .30-30 rounds.

Understand that someone who really know what he is doing can get a rifle sited in with three rounds. I’ve seen it done.

I am not that person.

I fired my first shot, got up and looked through the spotting scope. I saw a nice white piece of paper and my target. Neither had any holes in them. I had missed the three foot by three foot target entirely.

Hmmmmm.

I tried a couple of more shots with the same results. Finally, I noticed that I was hitting the berm over the top of the target. What?

So, I started experimenting by aiming at the bottom of the target frame. Ahhhh, now I was on the paper, but way, way, low. Interestingly, I was not off horizontally, just vertically.

So, I dialed in some vertical correction until I was near where I should be. Once I had that done, I hit the orange dot in the middle of the five dot pattern.

Not being one to make my life too easy, the only targets I had were NRA small bore rifle targets. Those are supposed to be used at 50 yards. At 100 yards, they look like little dots.

Once I had everything dialed in where it should be, I started working on the basics. Lock my off hand into the sling. Keep my off hand lightly on the fore end, not too tight. Use that to pull the stock into my shooting side shoulder. Concentrate on the target. Exhale and hold my breath. That’s actually pretty hard, by the way. Feet flat on the floor. Then squeeze the trigger and don’t drag my trigger finger across the bottom of the stock.

Oh, and keep the sights on the target after the shoot.

Easy.

Well the concept is easy, but the execution is far less.

It was a fun, frustrating, and informative 90 minutes.

It’s a skill like any other and I have to remember to practice as often as I can. That’s if I can find ammunition. This is hunting season and although my state restricts deer hunting to shotguns, a lot of people who live here go to other states.

I’ll have to keep my eyes open for rifle ammunition when ammunition starts to show up again. IF ammunition starts to show up again, but that’s a topic for another time.

Shooting is fun, but hitting what you shoot at is a lot more fun.

The picture with this post is not of my rifle, but it is identical to it.

The Battle Against Covid

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I expect I’ll get some negative comments here, but that’s never stopped me before.

We are doing far better against this virus than the media and general public believe.

The lock downs might have been necessary early on when science really didn’t know what was going on. It was reasonable back in late February to be pessimistic about the prognosis moving forward. Certainly we were mislead by the Chinese Communist government as to what was going on in the country of origin.

The World Health Organization (WHO) was either woefully ignorant or deliberately vague in their statements on the virus. Maybe both.

What we knew then lead us to believe that this was a very deadly virus that could kill anyone it infected.

We know better now, or should. We know that people seventy and older have elevated risk. The more comorbidities a person has, the more ill and likely to die they are. People eighty five and older, independent of of all other factors have a higher mortality rate.

Children and young adults have a much greater chance of surviving. In fact, many of them don’t een know that they are infected until they are tested. People under 60 share similar results.

Which means that our approach of making everyone quarantine until summer started and then imposing ridiculous and economy crushing restrictions on businesses had done nothing to save lives and in fact has resulted in increased mortality in America.

Between people afraid to go to the hospital when they are sick with other illnesses, people who lost their jobs and couldn’t afford medications, people who became depressed and killed themselves, people driving like maniacs, and other causes, it’s likely that more people died from non Covid causes than from Covid itself.

Here is a pretty good article on why the death toll from Covid appears to be higher than it actually is. Note that this was from May and the over counting continues to this day.

U.S. COVID-19 Death Toll Is Inflated

“The case definition is very simplistic,” Dr. Ngozi Ezike, director of Illinois Department of Public Health, explains. “It means, at the time of death, it was a COVID positive diagnosis. That means, that if you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death. It means, technically even if you died of [a] clear alternative cause, but you had COVID at the same time, it’s still listed as a COVID death.”

What this means is that there is a vast difference between dying “of” Covid and dying with “Covid.” The United States uses “dying with” as the standard while the rest of the world uses “dying of” Covid.

Here is an article that outlines the WHO standard versus what is used in the US.

COVID and the CDC

How does one determine the severity, danger, or threat to society that a SARS virus poses? In the past, the CDC determined the severity of a SARS virus by looking at evidence and incidence of pneumonia and acute respiratory distress syndrome. A SARS case was designated to be “severe respiratory illness” if a patient had the following:

  • Temperature higher than 100.4°F (38°C), AND
  • One or more clinical findings of lower respiratory illness (e.g., cough, shortness of breath, or difficulty breathing) AND
  • Radiographic evidence of pneumoniaOR
  • Acute respiratory distress syndromeOR
  • Autopsy findings consistent with pneumonia or acute respiratory distress syndrome without an identifiable cause

For some reason, the CDC has abandoned their long standing criteria of requiring a death to include pneumonia or ARDS. The rest of the world still requires those components to be present for a death to meet the “died with Covid” criteria.

The numbers are not the issue per se. The issue is that in order for the numbers to be valid, the criteria need to be standardized in order for the results to be valid.

Garbage In, Garbage Out as they say in the computer worlds.

So, an approach that may well have been prudent early on is now shown to be ineffective at preventing deaths while at the same time increasing non Covid deaths.

Another link describing the discrepancy in US versus WHO criteria. This one might be a bit more clear.

Are America’s Wuhan virus death rates lies, damn lies, and statistics?

It’s entirely likely, though, that if the CDC were suddenly to start counting virus deaths in America according to the WHO standard, which would drop the death count from 200,000 (“Trump is going to kill you”) to 86,000 (“it’s just a bad flu season”), the tech giants would scream more loudly than anyone else.

And of course, the number of deaths from the virus would drop even more if we were able to subtract all the other deaths that found their way into the statistics because someone died from another cause entirely, but tested positive for the virus:

If I were a suspicious sort, which you all know I’m not, I might suspect that there is a financial incentive to pad the numbers. As in the government will send money to states and hospitals that have high rates of “Covid deaths.”
I don’t know that that is the case, but I do know that our “Covid death” count is inflated compared to the rest of the world. If you don’t believe me, maybe you’ll believe Doctor Birx.

Dr. Deborah Birx, the response coordinator for the White House coronavirus task force, said the federal government is continuing to count the suspected COVID-19 deaths, despite other nations doing the opposite.

“There are other countries that if you had a pre-existing condition, and let’s say the virus caused you to go to the ICU [intensive care unit] and then have a heart or kidney problem,” she said during a Tuesday news briefing at the White House. “Some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death.

“The intent is … if someone dies with COVID-19 we are counting that,” she added.

Two last points for those who are still reading.

First, there is some very sloppy reporting of the latest “surge” in Covid cases. If you read the reports in the popular media, you would not be wrong in believing that every positive tests results in someone going to the hospital with many dying.

It’s not true. Because of the much wider testing being done today a lot of asymptomatic cases are being discovered. Many of those people would not even know that they were “infected” if not for the test.

Look at some of the “infections” among professional athletes. They test positive not because they don’t feel well, but because it’s policy. They are then required to self quarantine even though they are not the least bit ill. Most professional athletes are very health and fit and fit into the “young” demographic least likely to get sick and die.

Accurate reporting would break the test results down as follows,

Tested positive.

Tested positive and were ill.

Tested positive, were ill, and admitted to the hospital.

Tested positive, were ill, were admitted to the hospital, and went to the ICU.

All of the above and died from Covid 19.

If you’ve seen that, please let me know because I’ve yet to see a story that contains all of that data. Or any beyond “tested positive.”

Finally, there is this.

Great Barrington Declaration.

I won’t be surprised if you’ve never heard of it as it’s received no news of this. For a while over the weekend, Google suppressed it’s search results so that it didn’t show up. It’s since been restored with Google claiming that their ranking algorithms took a while to catch up to the reality.

You can make your own decisions on that, but I don’t use Google as my search engine because I think that they put their thumb on the scale too often.

This is the conclusion of the declaration, but the entire document is not long and you should read it.

Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.

The list of signatories is diverse representing several nations and several political view points. One thing that they have in common is that the lock downs and restrictions in nations around the world are harming far more people than they are helping.

The science, as some people admonish us, is settled on Covid 19. It was not as bad as was projected and the consequences of the efforts to “fight” it are far worse than the benefits.

If you’re one of my friends with a more widely read blog (that would be all of you), I’d appreciate it if you’d link to this. I’m not patting myself on the back, but I think the information is pretty well laid out.

Thanks.

Nineteen Years Ago

I’m sitting in the same place I was Nineteen years ago. The desk, chair, even the TV I’m watching are different than the ones I was using that day. I don’t remember what I had on TV, if anything, but I saw a post on line by someone on some forum about a plane crash into one of the World Trade Center towers in New York City.

I turned the channel to Fox News and there was an image of the top floors of one of the towers burning furiously. The commentators were trying to figure out what had happened. A wayward small plane? A wayward military jet? That had happened to the Empire State Building shortly after the end of World War 2.

As I, and millions of other people watched, we got our answer. A commercial jetliner slammed into the other tower. That was no accident, it was an act of terrorism, and act of war. The nation watched dumbfounded as the towers burned and the ultimately collapsed. I was on the phone with my partner from work and we both estimated that around 10,000 people had been killed in when those buildings when they fell.

Fortunately, we were wrong. Due to the valiant, and all too often fatal, efforts of police officers, fire fighters, EMTs, paramedics, and others thousands of people who otherwise would have died were evacuated in time.

The FAA had already ordered every airplane flying over the US to land immediately at the nearest airport. While that was happening we had no idea how many passenger liners had been turned into cruise missiles and by whom.

Then, another plane flew into the Pentagon. Then another crashed into the ground in Somerset County, PA. Passengers on that plane fought with the terrorists and thwarted their plan to crash into the U.S. Capitol Building. Their actions cost them their lives, but saved the lives of hundreds, maybe thousands more.

The US has changed drastically since then. We’ve been in what can be considered a persistent state of war. Then President G.W. Bush warned us that it would be a long time before we won, but we would win. I have to say that we are finally winning, but we have not yet won.

It all seems like a long time ago and maybe it was. One thing I do know is that we should never forget what happened that day and what has happened since. A lot of people who were at the scene or rushed to the scene to try and help have also died. The toxins in the air have caused cancers, respiratory illnesses, cardiac illnesses, digestive tract illnesses, and other ailments. Many have died from those illnesses, and many more will. They too were victims of the attacks, especially in New York City.

The long dead terrorists are still killing people. The war is still not over.

For my kids, this is history that they lived through. For my grand kids this is something that they will ask their parents about and hopefully learn about in school. Many people would rather we forget this attack on our nation and its people, but hopefully we won’t.

Japan Has Enough

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It took two Atomic bombs and a raging, almost violent, discussion in the Japanese War Cabinet, but on this day in 1945 the Emperor of Japan spoke to his nation by radio.

He declared that continue to fight the war would be futile and result in the death of more Japanese subjects.

With that, World War 2 was over.

The formal Instrument of Surrender was signed by all parties on September 2, 1945 in Tokyo harbor. The surrender was unconditional except that the Emperor would not be deposed or subject to trial for war crimes.

Many of the other high ranking Japanese officials were not so lucky. They were tried, convicted, and hung for various crimes against both military personnel and civilians.

The United States then embarked on rebuilding Japan and establishing a democratic government in its former enemy.

 

In EMS, Some Things Never Change

While desperately looking for something to watch on TV while I worked out, I came across this interesting movie from 1933. 1933, is a long time ago, but some of the things in the movie made me laugh because they are still pretty much the same to this day.

Early in the movie “Steve” and his intern partner “Joe” go on an ambulance call. When the arrive, there is a woman screaming almost incoherently. Joe starts to move into the apartment when Steve stops him.

Steve tells him about sick people, “They’re always at the top floor and they always weigh 300 pounds.”

This made me laugh out loud because it was true then and it’s still true. Although 300 pounds good well be on the light end these days.

The plot is a bit thin, but the movie is still enjoyable for the historic background.

Another funny bit is was Steve and his date are driven Lights and Sirens to a restaurant. I never did that exactly, but I can say that I hitched a ride now and then when I was in Sorta Big City off duty. That doesn’t count the times we gave Sailors on leave (it always seemed to sailors) who had imbibed a bit too much rides back to their ships. A couple of times that saved them from encounters with the local police as  well, but that’s a different story.

Anyway, you can watch the movie here or on You Tube.

Enjoy.

Oh, by the way, “Bill Boyd” went on to considerable fame in western movies. If you don’t recognize the name, you might be too young to appreciate this film.