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Something Is Wrong With This Story

I read this story a few days ago.

Police: St. Louis officer killed by colleague in accidental shooting

ST. LOUIS — A St. Louis police officer “mishandled” a gun and accidentally shot and killed a colleague early Thursday, authorities said.

The shooting happened around 1 a.m. at an officer’s home, police Chief John Hayden told reporters during a news conference shortly after the shooting. Two on-duty male officers were at one of their apartments when Katlyn Alix, who was off duty, stopped by, according to police.

A police incident report said the three officers were seated in the apartment living room when one of the male officers “mishandled a firearm and shot (Alix) in the chest.” The male officers, both 29, drove Alix, 24, to a hospital, where she died.

This was a tragedy for the officer and her husband. It’s going to be an ongoing tragedy for the officer who shot her. It’s not going to be too pleasant for the officer’s partner, either.

The officer who did the shooting (allegedly) has already been arrested and charged with Involuntary Manslaughter.

All of that being said, this story seems incomplete. There are a lot more questions than answers in the news reporting so far.

Why were two on duty police officers at an apartment that was outside of their patrol district?

Why was an off duty officer at that apartment in the middle of the night?

What on Earth would induce to responsible adults to play “Russian Roulette”?

The parents of the deceased officer have already retained a lawyer, so we can expect litigation to follow. During discovery, the truth will likely come out and I’m not sure that the family of the deceased is going to like what they are told.

All of which is besides the point. No matter what happens there are two things we know for sure.

Katlyn Alix is dead because at least two people, both police officers, were irresponsible with a firearm.

Firearms are not toys and anyone who owns or uses them does so at their own peril and to the peril of those around them.

Sad and ultimately so unnecessary.

 

Where Is EMS Going?

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And how do we get there?

Recently there has been debate about an education requirement for paramedics beyond just having a paramedic certification. Some, maybe many, people want to require at least a bachelors degree in “Emergency Medical Services” for someone to work as a paramedic.

There are different opinions as to exactly what courses should be required. More biology, more anatomy and physiology, more chemistry, all seem to be popular ideas.

Many people see nursing as the model to which EMS should aspire. After all, they ask, isn’t better education how nurses became recognized as a profession and how pay for nurses improved?

Yes, but that has nothing to do with how EMS is going to advance, if EMS is going to advance.

There are many differences between nursing and EMS. First, the work venue and opportunities. If you work in EMS, in most areas that means you work in an ambulance. Or maybe you’re a supervisor or lower level manager. Sure, there are some systems where there are Community Paramedics, but that’s not wide spread and isn’t likely to become widespread unless and until there is a funding mechanism. Right now, most of the Community Paramedic programs are funded by grants of one sort or another.

Once that funding runs out, if it’s not replaced by another source, we’re likely to see Community Paramedicine disappear once more.

Nursing, on the other hand has a lot of different work venues available. Even within a hospital there are different types of nursing. Some of those don’t even involve direct patient care. There are nurses who do research or work with doctors who do research. There are nurse managers, who do management and administration.

I have a cousin who has a PhD is nursing. She does research into Stroke care and a very small amount of direct patient contact. She works at a major teaching hospital and is well paid. I don’t see that sort of thing happening in EMS. Not that it can’t, just that it won’t.

By the way, there are two different types of Doctorates available for nursing.  This post isn’t about that topic, interested readers can read the short article at the link.

In addition to working in hospitals, there are all sorts of nursing jobs outside of hospitals. Again, many of them don’t involve patient care.

In contrast, being a paramedic mostly involves working in an ambulance doing direct patient care. That’s not likely to change.

Also, in contrast to EMS, nursing in many areas is unionized. I won’t get into that debate here, but it should be noted that EMS systems that are uniionized generally have better pay, benefits, and working conditions.

Nursing also has far more control over who is a nurse than EMS has over who is a paramedic. Which is a problem for EMS. A lot of people who are paramedics identify primarily as something “and” a paramedic. It’s even more prevalent with EMTs. There are a lot of people who have gone through EMT courses and taken the test to get certified. Many of them have no intent or interest in working in EMS, but wanted or needed the certification for some reason.

Even people who are paramedics look at that certification as a means to an end and not as a career itself. Many of them are good paramedics, but they don’t see being a paramedic as their primary career.

I’m up to almost 600 words and still haven’t gotten to the biggest problem with a college degree requirement for paramedics.

Cost. More specifically cost and return on investment.

A Bachelors degree is not inexpensive no matter where you go. A person is going to have to lay out X amount of dollars to get that degree , if indeed one does exist.

Does anyone expect that ambulance services, especially privately owned for profit services, are going grant wage increases just because a person has a degree?

“Ahh,” you say, “When every paramedic has a degree, services are going to have to raise wages.”

Would you like to bet on that? Since paramedics have limited job opportunities, there is no incentive to give raises to them.

If I were to be asked by a young paramedic what type of college degree he should get, my advice would be to either get a Bachelors of Science in something like biology or chemistry OR a degree in business administration. Both are far more portable than a specific degree in EMS. Both give a paramedic a route on to professions outside of EMS. There is far more likelihood of a good return on investment with those degrees.

This is not to say that better education is needed in EMS, at both the BLS and ALS levels. That’s not going to happen at the BLS level for reasons I won’t go into. It should and might happen at the ALS level.

As long time readers will know, post retirement I make money in the Quality Improvement end of EMS. A big part of that job involves reading Patient Care Reports. My company rules don’t allow us to score the quality of writing other than as it relates directly to patient care. That is, we can’t correct spelling, grammar, syntax, or anything related to them.

If we were allowed to, I’d be far busier than I already am.

Which is to say that many of the reports are horrendous when it comes to how they are written. I wince at some of what I read in those reports, even if the clinical care is fine. I can only only imagine what the doctors and nurses who read those reports think about EMS providers. Not to mention what the lawyers think when they are reviewing reports for possible litigation.

If I were building a paramedic program, or rather if I were responsible for setting the requirements, remedial English and Mathematics would be added as well as better Chemistry, A&P, and Biology classes. That would be the first part of the program, before we even got to the medicine part. I’d probably add a basic business course as well, so the students could understand the economics of EMS.

That’s the biggest need in paramedic education right now. Produce paramedics that know what they are doing and why, can write a coherent sentence in a report, and understand why EMS operates as it does, then you can talk about making EMS a profession.

As it stands now, EMS on it’s best days is a trade, but spends most of it’s time as a skill set that can be used in a variety of other trades and even a couple of professions.

Starting The New Year With A Bang

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We had unseasonably warm weather in the northeast on New Years Day. Since I had nothing else to do, I decided to head over to my gun club and do some shooting.

I loaded up the range bag with a couple of guns, targets, and other stuff and headed out. I wasn’t sure that I was going to get to shoot, because I expected that other people would have the same idea.

I guess they were all doing something else, or maybe just hungover because there was just one other person there when I arrived. He was packing up and left pretty much as I walked into the range building and started to set up.

One of the things that I like about my club is that there is no requirement for a Range Officer to be present when members want to shoot. There are some pretty reasonable rules and some actual video surveillance, but we are treated like responsible adults.

I set a target on the handgun range and loaded up.

First up was a recently acquired Smith & Wesson CS9. Back in the late 1990s, S&W applied the “Chiefs Special” name to very compact Third Generation semi automatic pistol line. These were, in today’s parlance “sub compact” pistols with a three inch barrel, less capacious magazine, and overall smaller size than the full size or even compact versions of the same guns. I don’t think that they were specifically marketed to police chiefs, but maybe they were.

The firearms were also “Value Line” versions of the Third Generation guns. That meant that they weren’t as smoothly machined as the regular lines, used some plastic parts in none critical parts (if there is such a thing), and didn’t have the quality bluing of the larger guns.

There were other “Value Line” guns, which were intended to compete with the highly successful and less expensive to produce Glock pistols. Functionally, the Value Line guns were Third Generation pistols, they just weren’t as finely finished.

This particular gun was sold to a law enforcement officer, so it was a bit different than the regular production guns. The two major differences were that it was shipped with Novak low profile sights with Trijicon night sight inserts. The other was that it was shipped with an ambidextrous safety.

Since my new acquisition was built in September of 2001, the lamps have long since burned out. Easy enough to fix and I’ll be shipping the gun out Trijicon for relamping.

I’m not a big fan of the ambi safety levers and so I swapped a left side only safety that I had sitting in the parts bin into the gun. The big reason for this trip, other than it’s fun, was to make sure I hadn’t bunged that operation up.

That safety will be coming out and shipped to a gentleman down south for some reworking. He will shave a couple of steps off the lever and then dehorn the edges to make it easier to carry without digging holes in pants and shirts.

Once all of that work is done and the gun is back together, this will become my pocket carry pistol.

The actual shooting was a bit anti climactic. As expected the gun, is very accurate for a 3″ barrel firearm. I’ve tested various bullet weights and it seems to shoot best with 124gr bullet weight. I plan to use Federal HST 124gr Jacketed Hollow Point ammunition.

Once I was done with that pistol, I put up a fresh target and took the next pistol out of the case.

This is a Springfield Armory XDE, also in 9mm. I’m not a big fan of polymer frame guns, but this one is a bit different. I also bought it as a travel gun for occasions when I go out of state. I did that because unlike my no longer produced Third Generation semi autos, the XDE is easy to replace in the event it is lost, stolen, or for some reason taken by the police during an investigation.

I got a really good deal on this gun over the summer from a dealer I’ve done a fair amount of business with. All I needed was an additional magazine and well made Kydex holster to complete the package.

One of the reasons I selected this specific model is that it’s functionally very similar to the Third Generation S&W firearms. First shot is double action, follow up shots are single action. The manual of arms is similar, with two differences. First, the safety and decocker functions are different. The XDE safety lever is pretty much in the same location, but it moves down for decock and then up for safety. It can, at least in theory, be carried with the hammer cocked, but safety engaged. Well, it can be carried with the hammer cocked and safety NOT engaged, but that’s not something I would do.

Of course it can be carried with the hammer down and the safety not engaged, which is how I generally carry my Third Generation firearms. It can be carried with the hammer down and safety engaged, which again I don’t recommend.

Carrying with the chamber empty, as advocated by some people, is right out. Feel free to convince me I’m wrong in the comments.

This gun is very easy and comfortable to shoot. It’s also very accurate. The only modification I’ve made or will make is to put some Talon Grips grip tape on. It makes the grips a bit more “grippy” and covers up the rather silly “Grip Zone” logo molded into the factory grips.

The XDE doesn’t seem to care one bit about bullet weight. I’ve fired 115, 124, and 147gr range ammo through it without a hitch.

I’ll probably use 147gr JHP for personal defense, since the firearm is accurate with it and has a long enough barrel for good expansion.

Pictures to follow when I have a few minutes.

That was my New Years Day, how was yours?

 

Day of Infamy

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As the attack on Pearl Harbor on this day in 1941 fades into history and the people who were there leave us, a theme has grown up that the American response to the attack by the Empire of Japan was somehow racist.

Sure, there was a lot of propaganda after the start of the war that was very harsh on the Japanese. Americans of Japanese descent were interned under the guise of what we now call “national security.” At the time, it no doubt seemed a reasonable step.

We had been attacked without formal declaration of war by the Japanese. Understand that such was not their intent, but they were inept in how they decoded, typed, and delivered the message. The effect was of an unprovoked “sneak attack.” The Japanese had a history of simultaneously declaring war and attacking, which is what they were planning for Pearl Harbor.

It’s odd, but the people crying “racism” either don’t know or don’t care that there was plenty of “racism” on the part of the Japanese.

Their treatment of prisoners of war was despicable. Japan, not being a signatory of the Geneva Convention of 1929 were not bound by its terms. Which does not excuse the starvation of,  the summary executions, or casual torture of prisoners of war.

Even worse was the treatment of civilians in areas captured by the Japanese military. Look up the Rape of Nanking, the Japanese Domination of Korea, or the Treatment of Civilians by the Japanese.

The Japanese were the provocateurs of the war in the Pacific, not the victims.

The war that followed in the Pacific and Asia was brutal. It was almost four years before the Japanese surrendered. At that, it took the destruction of two Japanese cities by Atomic Bombs before they finally, and in many cases reluctantly, surrendered.

It all started Seventy Seven years ago today.

Well Meaning, Not All That Well Informed

I came across a report from the Citizen’s Budget Committee of New York. This is not a city agency, but is comprised of concerned citizens who want to help the cities and state of New York operate more efficiently.

Founded in 1932 the Citizens Budget Commission (CBC) is a nonprofit, nonpartisan civic organization devoted to influencing constructive change in the finances and services of New York State and New York City governments. A major activity of CBC is conducting research on the financial and  management practices of the State and the City and their authorities.

The report that drew my attention is,

Reviving EMS
Restructuring Emergency Medical Services in
New York City

If you’re at all interested in EMS, you should read the report. If you’re interested in EMS in the City of New York, you really should read it.

The report is well structured and has some good suggestions. None of which will be adopted by the fire fighters who run EMS in New York City.

It also lacks any sense of history of how EMS in New York City operated in the past or operates now.

For those who don’t remember, until March of 1997, EMS in New York City was operated by the Health and Hospitals Corporation. That corporation also ran, and still does, the city owned hospitals.

Rudy Guilliani, then Mayor of New York City, decided to “merge” EMS with the fire department. There is a lot of speculation about the reasons he decided to do this, but no matter because he did it.

Allegedly, this was going to result in a unified fire department that would deliver EMS more efficiently than the existing EMS system that was run by people with medical backgrounds.

It was a merger with one willing partner and one unwilling partner. Much as the Borg used to merge with the Federation in Star Trek, The Next Generation. In fact there was a website that used that as a theme for the merger. Kind of funny, but kind of sad.

Once the agencies were merged fire department management decided to change everything about EMS. Well, everything but the things that mattered. They changed the uniforms, changed the color scheme and lettering on the ambulances and other vehicles, decided to change the radio call sign structure, and how ambulances responded. They also started to implement “Paramedic Response Units”, which were non ambulances staffed with paramedics. These are called “fly cars” in some parts of the country.

That lasted about a year or so, maybe a bit less. I forget exactly why, but after that the PRUs disappeared, the old call sign structure and deployment plan reappeared.

Neither response times nor cardiac arrest survival rates improved.

The problems that existed at the time of the merger were too many calls and too little resources, money was spent lavishly of fire suppression but niggardly on EMS, there were “frequent fliers” who took up a lot of resources, but didn’t really need ambulances.

In other words, what goes on in much of the United States when it comes to EMS.

So, what did the Committee find in it’s investigation,

Avoidable use—ambulance use for chronic conditions like diabetes, asthma, or addiction—is  partculiarly pervasive and costly, and for many of these patents, the ER is not the ideal treatment site.33 In addition there is evidence that a subset of patents with chronic conditions, called “frequent fliers,” are prone to recurrent EMS use, relying on ambulances and ERs for routine care.34 One study of urban EMS systems examined repeat  Utlization for three chronic conditions: acute alcohol intoxication, seizure disorder, and respiratory illness. Among these diagnoses researchers found
4.3 percent of patents accounted for 28.4 percent of transports.
35 The publicly available EMS data do not allow for tracking of  Frequent fliers; while the hospital intake and ambulance billing data would allow for such an analysis, the FDNY does not track the data in that manner.

There is nothing new in this paragraph. Nothing that EMS systems large and small don’t deal with on a daily basis. Also, patients with chronic conditions often deteriorate and have acute episodes. Missing one of those will get EMS on the front page of the newspapers, and not in a good way.

Here is what the committee recommends,

Many cites have begun to implement programs to reduce unnecessary  EMS use. Some programs, such as one in Reno, Nevada, use nurses to take 9-1-1 calls to assess whether the patent requires emergency care, and to link callers with non-ER resources when appropriate.52 The City of Houston has implemented a telehealth program in which arriving EMS staff assesses whether a situation is a genuine emergency and can consult an emergency physician via video. If the physician confirms there is no emergency, EMS staff works with the patient to connect to appropriate sources of care.53 In Dallas, the EMS department makes proactive community health visits to frequent fliers and has seen an 82 percent reduction in enrolled patents’ use of EMS.

What the committee doesn’t seem to consider is that an ambulance still has to go to the call. Doing the consultation can take longer than transporting the patient. Oh, and there is currently no revenue stream for non transports.

Oh, someone should tell the committee that “frequent fliers” is a pejorative term. I always advise clients to use “Valued Repeat Customer.”

The committee also recommends staffing ambulances with one paramedic and one EMT. Called “P/B” staffing, this is used in many areas. What no one knows is if one staffing pattern is better than another.

It’s incredibly difficult to compare different EMS systems because there are something like 50 different models of EMS delivery in the United States. I won’t go into even a few because I could write ten blog posts and not even scratch the surface of the topic.

Here is another committee recommendation,

Reducing the role of fire engines in medical incidents will not create savings without scaling back the number of engine companies. The City should conduct a thorough assessment of the location, coverage, and workload of fire companies; while nonmedical, nonfire emergencies have been on the rise, the precipitous decline in  fires and dramatic changes in building density and demographics since many fire houses were built have reduced workloads of several fire companies. Such an 15 assessment should identify where companies could safely close without jeopardizing response times to any type of emergency.63 For every fIre engine company closed, the city would save $7.2 million annually, enough to fund 10 additional ambulance tours each day.64

Good luck with that. The fire fighters union, which I believe is still separate from the EMS employees union, will fight that until the death. I know of only one city, Baltimore, that did that sort of thing. I think they did it by attrition, not layoffs. Nor can FDNY move firefighters without EMS certification to ambulance duty.

Back to the PRUs. FDNY reimplemented them on trial basis in 2016 in the Bronx. Which resulted in fewer ALS ambulances being available. So, more BLS units were fielded to make up for that shortage. The paramedic on the PRU did an initial assessment to see if the patient needed ALS. Unsurprisingly (to me) FDNY found out that only 30% of their patients actually needed ALS. They also found out that much of the time first response engines were not needed and provided no significant medical care.

Neither is a surprise to anyone who has spent any amount of time working in EMS, especially in a city of just about any size.

There is a lot of number crunching going on in this report, but I get the feeling that no one talked to anyone who actually provides EMS care in New York City. Some of what the committee recommends probably would work, but won’t be implemented for a number of reasons. Some of what they recommend might be implemented, but won’t have the intended affect.

In ten years or so, someone will be putting out another report that will point out the same problems and make similar recommendations.

Read the report and please comment either here or on Facebook. If you work for FDNY as an EMS provider, I’d really be interested to hear your thoughts on this.

Catching Up

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Some random thoughts because I haven’t had time to post much of late. A combination of travel, work, and laziness when I’m not traveling or working.

Random thoughts, in no particular order.

November 10 was the 243rd birthday of the United States Marine Corps. Here’s hoping for many, many more.

By the way, the US Navy was born on October 13, 1775, a little less than a month before the US Marines. No coincidence, that.

November 11, was Veterans Day. It was also the 100th anniversary of the end of World War I. The “War to End All Wars” as it was called. As if.

Thank you to veterans past and present. That includes my late father, all of my uncles, and several parents of friends, including a couple of older women who enlisted in World War 2 and later wars.

Our county is only what it is, and still here, because of their dedication, hard work, and sacrifice.

I’m off to Texas for the Texas EMS Conference. If you’re in EMS and can afford to travel, it’s a very good show. It’s almost as large as the two “national” EMS shows and for my money much better. Even though most of the attendees and some of the speakers are from Texas, there are people from all over there as well.

Plus, it’s a time of year when I get to reconnect with people I don’t see nearly enough.

I won’t get to be there all that long this year as I have to be back in the frigid northeast to help Mrs. EMS Artifact set up for Thanksgiving. We’re hosting for the first time in several years. We’ll have some close friends and relatives over for the day. That includes my 99 year old Mother in Law who can’t travel to see her other daughter for the holidays.

It also includes my daughter, who lives in Texas and who we don’t get to see often enough.

Speaking of EMS. It seems to be continuing along apace without my active participation as a field provider. Which is what we should expect when we retire. The number of people that I worked with who are still there dwindles by the day. Now, about six years after my retirement, fully half of the people there wouldn’t know me if they saw me. And Vice Versa. I still see some of my old co workers from time to time. A couple even thank me for teaching them a thing or two about EMS in the real world.

Ironically, I see more of them at client agencies from time to time. People who moved on to other jobs and brought their EMS skills with them.

I like to flatter myself that by doing teaching and consulting, I’m still contributing to the advancement of EMS.

EMS still has pretensions of being a profession, but it’s more likely to be a trade. It’s most likely to be a skill set, especially at the BLS level. Think about how many people are EMTs as part of, but not a primary part of, their job. A smaller number, but probably larger percentage of paramedics fall into the same category.

There are Fire Fighter/Paramedics, whose jobs consist of 80% EMS and 20% fire suppression and HazMat mitigation. Yet, I’ve never met one who calls him or her self a “Paramedic/Fire Fighter.”

The same goes for the much smaller number of police officers who are also paramedics.

If you look at organizations that purport to represent EMS providers, many of them operate on the premise that EMS providers are also something else. I’ve seen organizations that have a Star of Life and a Maltese Cross blended together in some fashion.

Because there aren’t any organizations that represent fire fighters, right?

So, the Democrats took back the House. Good luck to them, as they appear to be as organized as a dumpster fire. I have complete faith in them to screw up and lose control of the House in 2020.

Speaking of dumpster fires, what the hell is going on in Florida? They can’t seem to get voting right no matter what they do. Maybe it’s time to seriously reconsider how voting is administered and votes are counted. The state is a national laughing stock. Maybe it’s an international laughing stock. Far less developed countries seem to be able to manage their elections with less drama.

Okay, I’ve vented my spleen enough for one day. I expect I’ll find some good blog material at the conference. In the mean time, visit some of the fine bloggers on my blog roll.

Roy Clark

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One of the greatest musicians in Country Music died today. Best known as a virtuoso guitar player, he also played the banjo, fiddle, mandolin, harmonica, and other instruments.

And he could sing as well.

Best known as the host of “Hee Haw”, first on CBS and then in syndication, he performed all over the world in concert.

Here is a nice story about him on Fox News.

Here is an example of his talent with the guitar.

More SMACSS

Social Media Assisted Career Suicide Syndrome is a phrase created by Dave Statter of Statter911. That term goes under the “I wish I thought of it first” file. At least I wish I put it on line first, because I came up with a similar “Social Media Assisted Career Syndrome” term sometime in the past, but still probably not before Dave.

By the way, if you’re interested in fire stuff, or EMS stuff related to fire stuff, Dave’s blog is a good place to go.

As any of you who have read my blog for a while know, whenever there is some sort of bad thing in EMS, I always want to find out what the real story is before making judgement. From a long career in EMS, I know that initial reports and media stories are often inaccurate. At the least inaccurate, sometimes deliberately slanted.

Having seen EMS management take a cynical attitude of “We’ll fire them first and then do an investigation after.” approach I am at the least skeptical.

I could regal you with stories of people I worked with who were disciplined first and then had their salary and status restored later because of sloppy work by management.

Which brings me to today’s blog post.

Paramedic hurt patient on purpose, then bragged about it on Facebook, state says

Two years ago an East Tennessee paramedic bragged on Facebook that he intentionally drilled into a patient’s bone without anesthesia, then allegedly told other first responders this was a “teachable moment” on how to deal with troublesome patients.

The paramedic also instructed another first responder to insert a plastic breathing tube deep into the same patient’s nose but told her to coat the tube with alcohol-based hand sanitizer instead of lubricant.

“If you should ever find yourself drunk in my ambulance, do not become belligerent,” the paramedic wrote on Facebook during the incident. “I have a drill and I ain’t scared for a second to use it.”

The State of Tennessee has already had a hearing and revoked his paramedic certification, so there has been an extensive hearing on the matter.

Just in these three paragraphs, Stokes indicts himself for being a Certified EMS Dumbass.

First Stokes used a Intraosseous (IO) drill to administer Narcan. I have never, ever, heard of that being done that way. Which doesn’t mean that it hasn’t or can’t be done. It’s just a stupid thing to do.

Here is an EMS “Top Tip”. Narcan can be administered in several ways, including IO, but in my experience the least invasive way is the best. Nasal administration is the least invasive, but it’s onset of action is a bit slow. IV or IO is the most invasive. The problem with that, from a patient management standpoint is that patients wake up fast and they wake up mad. That’s when they want to fight because you, the life saving paramedic, have ruined their high. Forget that you also probably saved their life, you now have a made patient with an IV in their arm.

Things can, as the saying goes, go sideways in a hurray. In cases like that, paramedics and patients can get hurt.

If you do an IO insertion, the very first thing that you do is then inject Lidocaine through it. Why you may ask? Because while the actual insertion doesn’t hurt more than an IV, once the paramedic starts to push fluid or medications through the IO, the pain is excruciating. When we first started using IO for treating patients, we didn’t have a protocol for Lidocaine. One day we had a patient who was unconscious and had no IV access. So, my partner whipped out our IO “gun” and drilled into the patient’s leg. No reaction. We then hooked up an IV bag full of “normal saline” and started to run some in. THAT woke the patient up and he was not very happy.

After that, we got a new protocol which included Lidocaine for all patients getting IO insertions, unless they were in cardiac arrest.

So, right there we have two strikes on Mr. Stokes. Okay, a strike and a half because per protocol IO Narcan is an appropriate route of administration. It’s just not too smart.

Then we have this,

After the bone injection, Stokes told the other AEMT to insert the breathing tube, known as a nasopharyngeal airway, which extends into a person’s nose and reaches into the back of their throat.

The AEMT initially questioned this decision, insisting that the patient “had a good airway,” but Stokes told her “that he would explain later,” according to state records. The AEMT then began to put lubricant on the nasal tube, but Stokes “stopped her and instructed her to use hand sanitizer” instead.

Once the tube had been coated in hand sanitizer and inserted into the patient’s nose, Stokes removed it — revealing it was not necessary — and told the AEMT this had been a “teachable moment on how to deal with belligerent patients,” according to state records.

I find myself in the uncomfortable position of defending one part of this, but only one part. I don’t think it was unreasonable to insert a nasopharyngeal airway (NPA) into this patient. It’s a non invasive airway, used by EMS providers at all levels. I’ve used one, although it wasn’t my preferred BLS level airway device. Perfectly acceptable.

The part that isn’t acceptable is using hand sanitizer instead of the proper lubricant. Which is more slippery than hand sanitizer and doesn’t have alcohol.

Stokes’ excuse is that he was taught that by an “army surgeon” while he was working in Afghanistan. I’ve been fortunate to sit in on some military medical training. It’s far different in some case than what we do (and can do) in civilian medicine. I can, sort of, see where someone might have to use a “field expedient” lubricant under combat circumstances.

Such is, however, not the case in the back of an ambulance in Chattanooga, TN, even with that city’s problem with gang violence.

At best, I *might* tell someone about that sort of thing after the call was over. I certainly wouldn’t advocate doing that sort of thing.

Then there is this,

State records say Stokes then began to conduct a “drill,” quizzing the AEMTs on what could be wrong with the patient. The AEMTs responded by saying he was suffering from an “obvious overdose” and that there was no time to “conduct class” when they needed to hurry to the hospital.

I hate when I read or hear a media report that “paramedics rushed the victim to the hospital.” The inference of course is that is all that was done for the patient. Toss in the back of the ambulance and then drive like The Three Stooges to a hospital.

Opioid overdoses are pretty routine to treat. So much so that some families of addicts have Narcan kits in case their family member should overdose.

That being said, the time to do some “drilling” of students is before or after a call, not during. After the call, while at the hospital or elsewhere, you go over the case, ask questions, solicit answers and do your teaching. Not during the call.

Finally there is this,

State officials interpreted the letter as Stokes encouraging a full revocation of his license, but Stokes now argues a “null and void” finding is a lesser discipline than a revocation, which he says will prevent him from pursuing a career as a nurse.

A nurse? I rather doubt that the nursing profession wants or needs Mr. Stokes. He exhibited poor judgment in the first place by doing the things of which he was accused. He compounded his error by posting about it on Facebook. Then, he didn’t attend his hearing. I don’t know if he had an attorney or not, but if I had to guess, I’d say no.

Almost as dumb as the foregoing, he then gave an interview to the media. That didn’t help, not one bit.

As always, if Mr. Stokes or anyone comes forward to show me that the course of action he took that day was correct and appropriate, I’ll delete this post and put up another one announcing his vindication.

Side By Side Comparison

A couple of months ago, I posted about a new gun that I bought. It’s a very nice Springfield Armory XDE in 9mm.

Anyone who reads my column on a regular basis knows of my fondness for Smith&Wesson Third Generation semi automatic pistols. I have a small collection and a pre rail 3913TSW is my go to carry gun most days.

The XDE is for times when I’m out of state traveling and don’t want to bring the hard to replace 3913TSW with me. If something happened to it, it would be almost impossible to find a replacement as they weren’t made in large quantities.

I decided to do a side by side comparison of the XDE and the 3913TSW. I brought three boxes of ammunition, the guns, and some targets to the gun club.

The targets were B29 reduced size silhouette.

The ammunition was as follows,

UMC 115gr FMJ, Blazer Brass 124gr FMJ, and American Eagle 147gr FMJ. I put 25 rounds of each through both guns and compared accuracy.

First up was the XDE filled with the UMC 115gr. On my prior trip to the range, I used up a random box of 115gr UMC in the XDE. I was pleasantly surprised by the accuracy of what I consider a very light round. In contrast, my 3913TSW never performed all that well with this ammunition. Impact was always well below point of aim.

Recently I learned that I was using the wrong point of aim for the type of sights installed on my gun. The correct one is counter-intuitive, but it is in fact the correct one.

I should note that I do have a tendency to pull to the right side of the target. When I slow down and concentrate on the fundamentals, it improves greatly. It is evident here in some of the targets.

To my surprise the ammunition did not perform as well as my previous test. Not horrible, but more spread than I’d previously seen.

Not bad, but the pull is obvious. I’d call this acceptable for self defense shooting at close range. The grouping is okay, at least I think so.

The 3913TSW was up next. To my surprise aiming with the top of the site a bit higher up corrected the low hit situation I’d seen before. There was a bit more spread of the shots, but more of them hit the center ring. Not that I expect to go back to 115 gr for this gun, but I don’t have to be scared of it either.

On to the XDE with 124gr ammunition.

A couple of down and out fliers in the first magazine, for reasons unknown. Again, once I bore down a bit and spent time on the fundamentals accuracy improved.

Still a bit of pull to the right, but not bad. The grouping is pretty reasonable. Certainly, this is an acceptable bullet weight for personal defense carry. A 124gr JHP will be a fine choice.

Next, back to the 3913TSW with 124gr ammunition. I was a bit disappointed with the results when compared to previous outings with 124gr ammunition.

Interestingly, at least to me, the 3913TSW didn’t do quite as well as the XDE. At least in terms of consistency. A few more X ring hits than with the XDE, but more spread of hits. Again, acceptable, but I can do better with more practice and attention on fundamentals. (That seems to be a theme)

Now for the XDE with 147gr ammunition.

Some spread, but more hits on center than with the other ammunition. Overall, pretty good, or at least pretty average. Certainly acceptable, but not as good as the 124gr ammunition. I think that the XDE will, at least for now, be carried with 124gr ammunition. Maybe that will change after more experience with it.

Last up, the 3913TSW with 147gr ammunition.

I think this is the best grouping of all of the tests. I take no credit for this, I just think that the gun was designed around this weight of bullet. It certainly seems to be most accurate with 147gr ammunition. Which was the standard law enforcement 9mm round back when the Third Generation guns were being designed.

Reasonably good accuracy overall. A very good choice for personal defense carry.

A couple of final thoughts.

The XDE is a very nice handgun, but it’s not a Third Gen. One of my excuses for some of the shot placement is that it’s considerably lighter than the 3913TSW. Not that that gun is heavy, but the alloy frame does add some weight and at least for me that improves balance.

I’m sure that when I get the XDE to the range more often, I’ll get used to the balance. Recoil is very manageable, so the lighter weight doesn’t hurt in that regard.

Of course, I’ve shot the 3913TSW and other Third Generation guns a lot more than the XDE.

More range time is needed in general, but particularly with the XDE.

The controls on both guns are similar. The XDE has a thinner profile, which some people don’t like. I like it because it aids with concealability. I’ve had some thinning done on the TSW, and it’s much better than as it came out of the factory.

I prefer the TSW, but won’t be embarrassed to carry the XDE when I’m on the road.

 

The Dying Continues

Seventeen years ago, almost exactly as I sit typing this terrorists flew two planes into the World Trade Center towers in New York City. This was followed shortly after by a plane crashing into the Pentagon. The passengers of United Airways Flight 93 stopped a similar attack on the Capitol building in Washington, DC. They did that at the cost of their lives.

America was suddenly at war with an enemy few really understood. We’re still at war, and still many people don’t seem to understand with who or why.

I’m not going to go into that today, because today is a day to reflect on the start of the current war, not to discuss it’s tortuous route ever since.

The attacks on the WTC killed almost 3,000 people including people in the towers, police, fire, EMS, and the people on the airplanes.

That was just the first day. I say that because people who were in the area where the towers stood that day are still dying and will continue to die for years to come.

Still Counting: 9/11’s toxic legacy haunts first responders

It’s not too long an article and has a lot of good information. There is some use of the “Retrospectroscope” to talk about what was done that shouldn’t have been and wasn’t done that should have been.

As a country we’ve learned a lot about emergency response to a large scale terrorist event. The people who died that day and are dying to this day paid for those lessons with their lives. Another part of the cost of this war that we are in.

Thousands of firefighters, police, construction workers and people who worked or lived near Ground Zero have become sick since then. Hundreds have since died after breathing in a witch’s brew of asbestos and other toxins. Counting the dead will continue for years to come.

D

“I think it’s in some ways our Chernobyl. The difference with Chernobyl is that there, vast swatches of land are not habitable because of radiation,” Dr. Jacqueline Moline, director of the Queens World Trade Center Clinical Center, said. “Chernobyl was not a terrorist attack. Most terrorist attacks don’t have a death toll that has a lasting impact in terms of health impact.”

When the World Trade Center tumbled, it didn’t simply fall to the ground or vanish. The conflagration filled the air with toxic particles.

“You’re talking 220 stories of office building on top of the other buildings that collapsed, with computers, fluorescent lightbulbs, phones, desks, metal chairs,” said Michael O’Connell, a 25-year-old firefighter on 9/11. “All of that was incinerated into pure dust. All we found was concrete, steel and rebar. You didn’t find a telephone, a lightbulb, a chair. Nothing.”

A now deceased friend of mine was there and took time to send out an email a couple of days later while he was finally taking a break. He described a landscape from another planet. Something not to be believed. Yet it was all real.

Within a few years, he too was sick and he died about five years ago. He never mentioned it, but reading this article, I’m confident that he died as a result of the toxic mix in the air.

Someone else I know less well will soon die from stomach cancer. I have other friends who were there in the first days and I fear that some of them will suffer and died as well.

Another friend worked for the New York City Office of Emergency Management. His office was in the WTC complex and he was right there when the planes hit. He didn’t evacuate until right before the towers fell and he almost didn’t get out alive.

He now has Sacoidosis and is waiting and hoping.

If you were at the World Trade Center and don’t know about the World Trade Center Health Program, then go to the link and read. If you qualify, sign up.

The dying started on September 11, 2001. It will continue for decades.