You come back inna morning. Ambulance Driver very tired, very upset, very uninspired. Ambulance Driver wasted much psychic energy resisting the overpowering urge to choke the fucking life from someone today.

Ambulance Driver been feeling that way a lot lately, but Ambulance Driver promise to have something good in the morning.

Ambulance Driver also have no idea why he speak in third person with no modifiers. Ambulance Driver puzzled, but hope it clear up soon.

But on a happier note, for any of my EMS readers out there, click that link on my sidebar for the National EMS Museum. Lots of new stuff there, and they’re inviting people to subscribe to their new listserv.

Enjoy!

I’ve been tagged by Angell of Angell’s Secretz as a blog literally oozing with Power of Schmooze.

I’m Schmoozeriffic.

The Schmoozinator.

I’m a third degree black belt in the ancient Chinese art of Schmooze Fu.

I am the inspiration for the lost Dr. Seuss character, Woozle the Schmoozle.

I am the subject of Robert Fulghum’s next book, All I Ever Really Needed To Know About Schmoozing, I Learned From AD.

I am the Swami of Schmoozing, and supplicants scale perilous mountain heights to worship at my feet, begging for a kernel of Schmooze Wisdom.

And here’s my offering to those supplicants desperate for the secret of Schmoozing: Sincerity.

Once you can fake that, everything else is easy.

Flattery also helps, as evidenced by Angell’s shrewd catering to my own raging narcissism. No amateur at Schmoozing herself, that one.

So if y’all will excuse me, I’m gonna put this little memento up there on my ego wall sidebar, and then I’m gonna go out and win some friends and influence people, namely Mrs. Who, Ralphdood, Loving Annie, Katey, and Amanda.

Okay, if ANY of you are having problems reading these posts, please drop me a line. It reads fine in Mozilla Firefox, but for some reason AOL’s browser cuts off the edges. If you have any problems, please drop a note in comments and tell me what browser you’re using.

…because I’m still working on another post and patiently waiting for Matt G. another nameless blogger to finish his part of a collaborative effort. But hey, he was doing quality family stuff this weekend, and that sort of thing I could never fault.

#1 Dinosaur cured a patient’s ills the other day by *gasp* discontinuing a medication regimen! Imagine that!

I went over her med list and recent labs. Noticing that her A1C was 5.7 on metformin only, I figured her diabetes was under pretty good control. Certainly good enough that stopping the metformin for a bit wouldn’t be immediately fatal, so that’s what I did. At the family’s insistence, I also gave her a tiny dose of antidepressant, warning that I thought she’d find the side effects troublesome.

Saw her back the other day: All better.

Indeed, sometimes less is more.

MedicMarch made the short-go in the seizure rodeo the other day. His post is crass, politically incorrect, blatantly sexist, full of inappropriate gallows humor and utterly lacking in sensitivity.

In other words, I peed myself laughing. A sample:

I ride the trembling Land Whale, and grin. The juice should work in a hot second, and all will be well. I can get out of here and eat my dinner.

Thirty seconds later I am still grinning, but it is starting to fade, because with my razor sharp intellect, I have deduced two things.

1. This lady is still seizing, and how!
2. It appears she has become incontinent while I’m on top of her. WORST RIDE EVER! I want a refund.

And for those of you who work on ambulances or ERs and don’t already have mucosal atomizers and EZ IO rigs, I agree with MedicMarch – these are must have items. The MAD is a dandy non-invasive medication delivery device, and the EZ-IO is a great vascular access tool for short term access. If you need a vascular access now and for no more than 24 hours, it’s every bit as good as a central line, and much easier to insert.

One question for you, MM. Did they try the EZ IO in the distal tibia, above the medial malleolus? That site works well for obese patients, unless they have cankles.

And over at the blog written by the object of my eternal lust wholesome devotion, Babs writes about a new phenomenon of artificially created victimhood cultural diversity known as Personality Sensitivity.

Apparently, if someone doesn’t care for my irreverent, scatological and sometimes entirely inappropriate sense of humor, they are the ones guilty of insensitivity, because, well, that’s just me being me.

I feel so…empowered.

Y’all read and enjoy.

Once upon a time, in a parish far, far away, there was a Little Ambulance Service That Could.

Little Ambulance Service was started by some former employees of Big Greedy Ambulance Service, who got tired of running transfers in Big City while their own parish remained uncovered. Mind you, this was a big parish they left uncovered – 962 square miles, in fact. With no ambulance closer than forty minutes away.

So Mom and Pop, with the encouragement of some disgruntled local citizens, decided to strike out on their own. With a $10,000 investment, two ancient ambulances with very new paint jobs, and a few loyal friends who defected with them, they started the Little Ambulance Service That Could.

The early times were lean. They started with precious little lead time – a weekend of contemplation, actually. They had no money, no billing system, no education program, no benefits, and no plan to be able to pay their employees, other than hoping hard work and idealism would eventually pay off. Very few EMTs would have even considered working for them.

Oh, but these were not ordinary employees. They shared the naive but admirable conviction that patients should be at least as important as money. They left behind their benefits packages, job security, nicer equipment and trucks, even their financial security, in the hopes that the Little Ambulance Service actually could. They still had a healthy measure of idealism, and considered EMS a higher calling.

And they collectively put their money where their mouths were. They knew they wouldn’t be able to pay their bills, at least not at first. And they did it anyway, saying all the while, “I think I can, I think I can…”

And Mom and Pop, shortly after opening the Little Ambulance Service That Could, hired a brand new, green-as-grass Ambulance Driver who held the unshakable conviction that he was destined to be The Greatest Paramedic Ever.

Luckily, Mom and Pop saw some kernel of potential hidden behind Ambulance Driver’s ego, and they put him to work driving one of those ancient Ford ambulances desperately in need of suspension and steering work.

They had big, gas-burner Ford engines, and they could fly. If you asked Ambulance Driver to take a top-heavy van ambulance down a rural highway at 120 mph, nowadays he’d think you were crazy.

Back then, he thought it was fun.

But in between adrenaline rushes, Mom and Pop were able to teach Ambulance Driver a few things. They taught him their version of the EMS Holy Trinity:

1. Patients
2. Partners
3. Profits

“Take care of the first two,” they said, “and we’ll take care of the third, because the first two make the third possible anyway.”

“Keep your priorities in order,” they reminded the rookie Ambulance Driver.

It wasn’t hard, except for those times the bill collectors called and you were rudely reminded that the noble experiment will not last long without #3.

So The Loyal Employees would go to Mom and Pop, hat in hand, and ask for money because, you know, they hadn’t been paid in four months. And Pop would sigh, ask you how much you absolutely needed, and write a check.

Then, when you called him the next day to thank him for scrounging the cash somehow, you discovered that his home phone had been disconnected because he had paid you with the money for his phone bill.

Makes it easier to work for a guy like that.

The first year, The Loyal Employees subsisted on produce from Grandmom and Grandpop’s vegetable garden, and fish from Uncle’s fish farm, and the frequent roadkill deer. We kept an alert ear tuned to the Sheriff’s Office frequency to listen for accidents involving deer.

No, I am not kidding.

After that first year, things got better. Paychecks started trickling in with more and more frequency. Mom and Pop sent Ambulance Driver to paramedic school, EMT instructor school, CPR instructor school and a whole bunch of other instructor schools. And Ambulance Driver’s skills and knowledge began to approach his ego.

Money was still tight, but the Loyal Employees buckled down and said, “I think I can, I think I can, I THINK I CAN...”

…and the Little Ambulance Service That Could began to thrive. In the first year, they surpassed the run volume that Big Greedy Ambulance Service had in their best year.

And Yogurt Mogul, the owner of Big Greedy Ambulance Service, twirled his mustache and hatched evil plots, and vowed to squash the Little Ambulance Service That Could.

Yogurt Mogul went on an advertising blitz, spread baseless lies and tried all manner of hollow PR propaganda in an effort to crush The Little Ambulance Service That Could.

But the loyal Employees persevered, and in the second year, they doubled their first year’s run volume.

In the third year, they doubled that.

And Yogurt Mogul gnashed his teeth and drank lots of Maalox and wondered what he was doing wrong. He could not fathom that the people of the parish would actually care more about kindness and professional care than they did about rude and apathetic EMTs with nicer uniforms, trucks and equipment. Yogurt Mogul vowed to break the Little Ambulance Service That Could, even if it cost him millions to do it.

He never did. Shortly thereafter, Big Greedy Ambulance Service was swallowed up by Soulless Corporate Behemoth EMS, and the managers looked at their existing run volume and said, “This is not good. We are getting our asses kicked.”

And so they pulled up stakes and left, and the people of the parish rejoiced and said, “We love you, Little Ambulance Service That Could, for you are truly our ambulance service.”

And the Little Ambulance Service That Could grew and became strong. Missed paychecks became a thing of the past. Newer trucks were bought, newer equipment was bought, and many of the Loyal Employees were sent to schools.

An Education Department was formed. New protocols were written, giving the Loyal Employees greater freedom and discretion to practice their art than at any ambulance service in Louisiana.

And the Loyal Employees were grateful, and strove to render care worthy of such trust.

The Little Ambulance Service That Could became recognized as one of the top ten AHA Training Centers in Louisiana, despite having 1/4 the number of instructors of any other center in the top ten.

Two of the Loyal Employees were recognized as National EMT of the Year. Several others, including Ambulance Driver, won lesser awards. And even though the honor was theirs alone, Ambulance Driver was secretly proud of having taught those two Loyal Employees how to become EMTs.

The Little Ambulance Service That Could became a desired place to work. It became known as a place where an EMT could learn and grow, and be afforded respect and trust.

And then one day the Little Ambulance Service That Could got too big for its britches. Mom and Pop began to dream about bringing their brand of care to other areas. The Loyal Employees were rather skeptica
l, but they undertook the mission with characteristic zeal. After all, they knew what it was like to live in an area served by Big Greedy EMS. They knew they could do better.

And new employees were hired, but they were different. They didn’t believe in the EMS Holy Trinity that Mom and Pop had preached to the first Loyal Employees. Many of them were Not So Loyal Employees, and they whispered lies and spread hate and discontent toward the Loyal Employees.

And in so doing, they exposed the glaring weaknesses that the loyal Employees had suspected from the beginning.

Mom and Pop were not good business people. As long as The Little Ambulance Service that Could was happy caring for its own little territory, this didn’t matter. But when Pop’s aspirations grew, the Little Ambulance Service That Could had to become a business, and that spelled the beginning of the end.

You see, Pop’s reach always exceeded his grasp. He was full of great and noble ideas, and sadly deficient in the ability to make them work. And he could not find it in himself to assign the loyal Employees a task and leave them to it. He couldn’t resist meddling.

He was a good man, but he was a poor boss. Neither Mom nor Pop knew how to discipline employees properly.

Nor reward them, for that matter.

Pop wasn’t afraid to spend money, but he spent it in all the wrong places. He would shell out $50,000 for a computer program, but scrimp on salaries and cardiac monitors.

He was a horrible fiscal manager. Bills from suppliers went unpaid simply because Pop forgot to pay them or lost the invoices. Revenue from Ambulance Driver’s classes slowed to a trickle because Pop neglected to send out the bills. To many creditors, we became known as the Little Ambulance Service That Couldn’t Pay Its Bills. Sadly, the truth was that the word should have been Wouldn’t.

Once Pop publicly chastised Ambulance Driver for seven missing patient care reports. “Each one of those reports represents lost revenue that we could use for raises and new equipment,” he admonished. “You should be setting an example for everyone here.”

One week later, Ambulance Driver found his missing patient care reports at the bottom of a mountain of paperwork on Pop’s desk, and that same week the billing department had to write off $154,000 in revenue…from a couple of years’ worth of Pop’s incomplete patient care reports.

And many of the Not So Loyal Employees, having been trained and educated by Ambulance Driver, took their new skills and education and went to work for more money elsewhere. A couple of the Loyal Employees saw the handwriting on the wall and left, too.

The Loyal Employees that remained began to complain. They questioned why they had to make do with used equipment when Pop’s paid a local garage $330 for each and every oil change on the fleet. Ambulance Driver wondered aloud what the mechanic did to earn four times the salary of any of the field crews, when the ambulances still sputtered and had crappy steering and brakes.

And dark clouds gathered over the Little Ambulance Service That Could, but the Loyal Employees soldiered on, even though they began to voice their complaints more forcefully.

Ambulance Driver was the most vocal among them. When he saw Mom and Pop doing something stupid, he called them on it. When they wasted money on frivolous things, he questioned why it was necessary. When they punished all the Loyal Employees for the acts of a few of the Not So Loyal Employees, he protested indignantly.

When several of the Loyal Employees incurred huge medical bills, only to discover that their health insurance premiums had not been paid, Ambulance Driver said nasty things. He told Mom and Pop that he didn’t give a rat’s ass that Pop had stopped withholding premiums from the paychecks, he still hadn’t told anyone that the insurance had been canceled, and that Pop was ethically and morally responsible for those Loyal Employees’ medical bills.

When Mom and Pop hired so many people that the office staff far outnumbered the field crews, Ambulance Driver complained.

When more of the Loyal Employees left, Ambulance Driver pointed out that the Little Ambulance Service That Could was becoming the last refuge for lazy and incompetent EMTs that had been fired from everywhere else.

Eventually Ambulance Driver pointed out enough of these things that Mom and Pop fired him. He wasn’t so surprised, because he knew that people eventually get tired of being told how stupid they are, particularly when it’s true, but he had fooled himself into believing that being one of the original Loyal Employees afforded him a greater degree of trust and tolerance.

Even Ambulance Driver would have never suspected that they’d fire him with his wife on unpaid maternity leave and his daughter in the NICU. But they did.

Ambulance Driver became very bitter, and he twirled his mustache and vowed to crush the Little Ambulance Service That Could, because it was no longer the service he remembered. It had become just like Big Greedy Ambulance Service, only much less organized.

Eventually he realized that the people who fire an employee who generated $60,000 in net revenue to save a $40,000 salary were not to be hated, but pitied for not grasping simple arithmetic.

Once they parted ways, Ambulance Driver flourished while the Little Ambulance Service That Could floundered. Ambulance Driver became an instructor/medic/speaker/writer, a Real Man of Genius, but he is ashamed to admit that he gloated a bit at seeing the Little Ambulance Service founder without him and the other Loyal Employees.

But secretly he also hoped that the Little Ambulance Service That Could would eventually overcome the ineptitude of Mom and Pop and flourish once again, because Ambulance Driver was still a Loyal Employee at heart, even though he worked for Soulless Corporate Behemoth EMS by then.

Alas, it was not to be. Ambulance Driver heard today that the Little Ambulance Service no longer Could, because they had been sold to a competitor with a reputation for fraud and shoddy care.

Just as well, I suppose, because in the past couple of years, the Little Ambulance Service That Could had developed an equally unsavory reputation.

Meanwhile, Ambulance Driver still seeks a small service that with heart and potential, with Loyal Employees that can embrace the lessons he learned from Mom and Pop in the very beginning. He still thinks he can make it work.

A few posts back, I mentioned a fatal ambulance crash and stated that my man Jay G. would not do well driving an ambulance, given his level of road rage and the idiocy of some drivers when they see the lights and hear the woo woo box.

I can imagine him stuck behind Granny Foo Foo on her Sunday drive, veins popping out on his forehead and spittle flecking the windshield of his shiny new black Dodge Ram as he screams impotently at somebody, anybody, to move their ever-loving land barge OUT OF THE WAY.

Case in point:

Nothing says “We hire incompetent dipshits and don’t properly train them” like a 19 year old driving an F-350 pulling a 25 ft. enclosed trailer at 20 MPH down the center of the road. When there’s a parade of cars 30-something deep, you’ve bought yourself a world of bad pub.

There’s a lot more, but suffice it to say that it would not do to put Jay in a large, heavy vehicle equipped with a PA system.

Bad, bad idea.

Heh.

Elisabeth Kübler-Ross wasn’t nearly as funny.

…but we do get our share of feminine admirers.

That is, unless you’re a hunka hunka burnin’ love like moi.

Then it’s Chick Central 24/7, baybee!

That’s how long, on average, our Doc spent at the bedside yesterday doing assessments and patient histories.

Forty. Minutes.

Now, Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut ain’t a big hospital by any means, but when you have only four ER beds, space is at a premium. You gotta move some asses through those beds, or things get backed up. I’m all about thoroughness, and frankly I really don’t trust a doc who spends five minutes at bedside with a complex patient…

…but forty freakin’ minutes???

I conceived a child in forty minutes, and thirty five of that was foreplay. Hey, I’m a giver.

Tolstoy wrote a chapter of War and Peace in forty minutes.

Michelangelo did a rough sketch of the Sistine Chapel in forty minutes. It was just tracing it on the ceiling and filling in the colors that took years.

God created woman in forty minutes. And thirty minutes of that was convincing Adam to part with an arm and a leg. Finally, they compromised and settled on a rib.

Ford could build a Model A in less than forty minutes, once they got the assembly line figured out.

In a little known historical fact, Oppenheimer built two A-bombs in less than forty minutes. It just took a few years to figure out what to name them. When they did, Fat Man and Little Boy were the best they could come up with; perfect examples of design by committee. Personally, I liked Oppy’s first choice: Take That, You Fuckers and Want Some More, Bee-yotch?

Yet it somehow takes our Doc an average of forty minutes of questioning a patient to discern what may be causing his sore throat and fever. If he had ordered the Rapid Strep Test in the beginning, he’d have definitive results in twenty minutes and still plenty of time to hear the patient’s views on US foreign policy in the Middle East and who he thinks should have won American Idol.

Instead, I’ve got ambulance stretchers with sick people parked in the hallways, more sick people in the waiting room, and Doc is sitting on a stool in Room Four, carefully transcribing the favorite color of Mrs. Toe Pain.

Hey Doc? I need that fucking bed. And while you’re at it, don’t bogart the chart. I got stuff to write.

The shortest bedside time he had last night was the bartender with the finger laceration. Twenty-five minutes, four stitches. Now that’s not blazingly fast, but I can deal with it.

But then, he takes the chart, writes discharge instructions, tells the guy what he’s writing, then explains what he has written. This exercise took another twenty minutes.

Now, you may ask, “What on Earth did he write that took another twenty minutes?”

Keep wound clean and dry.

Make appointment with PCP to have sutures removed in 5-7 days.

Take Keflex as directed.

Twenty agonizing, soul-searing minutes to write and explain those three sentences.

To top it off, the guy was allergic to Keflex! I had it written right there in his chart! This of course prompted another discussion as to what other antibiotic allergies the guy might have, what symptoms the guy had with these allergic reactions, what antibiotic he had received in the past without having a reaction, culminating with a shot of Rocephin and new discharge instructions.

Of course, those new instructions had to be re-written on an entirely new form.

By my watch, another eight minutes of that. My administration of the Rocephin shot took about thirty seconds, and that was including pulling it out of the dispenser, reconstituting it, and sticking a cute little Garfield bandaid on his hairy ass afterwards.

Naturally, Dr. Glacial Creep wanted the guy to stay for the standard fifteen minute shot time afterward. I think he glimpsed his funeral in my eyes however, and quickly agreed when I suggested, through clenched teeth, that the patient could safely spend those fifteen minutes in the waiting room.

Counting the hour he spent in the waiting room waiting for a bed, the poor guy spent a grand total of two hours and eighteen minutes in our lovely facility. For four stitches.

And that was Doc’s fastest time.

To make matters worse, he’d grab the chart in his greedy little paws while he carefully documented the patient’s entire life history, from zygote to present day, including the time in grade school when they were picked last at Red Rover that left them permanently scarred emotionally, and then, ONLY THEN, would he write his fucking orders. And the orders were always the same anyway.

After four hours of this, the nurse and I devised a system. We would assess the patient, do all documentation possible to that point, order all pertinent labs and radiology studies ourselves, and usher the patient to a room. Anyone that looked even remotely sick got an IV, blood drawn and urine collected, without question. If you wheezed, you got a neb treatment. If you had a fever, you got Tylenol. If you were in v-fib, you got defibrillated.

Then, and only then, would we inform the doc of the presence of a new patient and hand him a clipboard containing only the forms that he personally needed to complete, with the applicable signature blocks highlighted in yellow.

That’s a helluva way to run a fucking railroad, folks.

In fifteen minutes, I have to be back at work to spend another glacially slow twelve hours with the same doctor.

Shoot. Me. Now.

…but the women who do it are more than capable. What they lack in upper body strength compared to the male hosedraggers, they more than make up for in wit and oversized copper alloy huevos. Case in point:

While in South Carolina, this conversation took place:

NY Firefighter: I see you’re wearing a Maltese cross. Who do you know that’s a firefighter?

Me: ….uh….ME.

NY Firefighter: Oh……good answer!

Me (internal monologue): This guy is now thinking: “Crap. I just blew my chance to get laid tonight.” No, buddy. You really never had a chance…

Heh. Good one, Detail Medic.

…when my friend Matt G. does his interview on Blog Talk Radio tonight at midnight, CST. That’s in less than three hours, so y’all have time to pop a few Vivarin and come up with some good questions. Show the boy some love!*

*And to feed his raging Sitemeter envy, be sure to tell him Ambulance Driver sent you.

“Why don’t you have the siren on?” the nurse practitioner asked my partner.

“Because this isn’t an emergency,” I answered.

“It is an emergency,” she insisted. “This is a 26-week preemie we’re dealing with here!”

“Who has yet to be delivered, and has an Ob-Gyn and numerous experienced nurses in attendance,” I point out.

“We need to get there fast! I insist you turn on the lights and sirens!”

“The hospital is maybe five minutes away, and it’s hardly even rush hour. Traveling hot will buy us maybe 30 seconds, if that. What it will do, is dramatically increase our chances of getting in a crash.”

“You can either turn on the lights and sirens,” she huffed, “or I’m calling Dr. So and So and she’ll make you turn them on.”

Now normally, that’s my red flag. You don’t climb into my rig and tell me how to operate. Ain’t happenin’. Just not done. And I could give a rat’s ass whether you’re a famous neurosurgeon or a nurse practitioner with delusions of competency. That rig is my domain, and no profession knows it better.

But in this case, I humored the ignorant heifer and turned on the woo woo box and the cherries. I knew that if she got the doctor on the phone, I’d win, because the doctor in this case was an eminently reasonable person, and not the type to second guess the EMT behind the wheel.

But all it would have accomplished was to leave to NP with egg on her face and bruised feelings, and after all, we were only talking about 30 seconds, one way or the other. It was also worth considering that I was the airway man on the NICU Transport Team that day – no respiratory therapist on duty. We’d need to work together smoothly, so I went along to get along.

As luck would have it, she got an object lesson in the use of seat belts and the dangers of emergency response driving when a black Toyota Camry panic stopped in front of us not thirty seconds later. My partner nailed the brakes and took evasive action, and managed to keep from making the Camry a hood ornament, but the nurse practitioner wound up kissing a little Formica – the hard way.

As she sat on the floor of the rig, blood dripping from her lips and nose, my partner and her co-workers explained to her why she should have had her ass perched in a seat and buckled in, and why we don’t run hot unless it’s absolutely necessary. My partner’s language was considerably less diplomatic than that used by her fellow nurses.

This little anecdote was prompted by a couple of e-mails from readers about the following incident:

A Wilton paramedic was killed early this morning when an ambulance he was riding in collided with a pickup truck at the intersection of Route 4 and Potato Road, police say.

Allan Parsons, 46, was tending to a patient in the back of the Med-Care ambulance, en route from the Rumford area to Central Maine Medical Center in Lewiston. Parsons died at the scene, according to the Androscoggin County Sheriff’s Department.

Now, I have never worn the uniform of one of our country’s armed services, and I’ve never worn a star or badge…

…but I do understand brotherhood, and thus any time we lose an EMT, cop, firefighter or soldier, I grieve the passing of a person I have never met. We weren’t partners, nor were we coworkers or friends.

But we shared a common ethos, and that makes us brothers.

I grieve the loss of Alan Parsons, but I also pray for his partner, the man they hit, and the patient they had in their rig. Their suffering has only begun, and some of them may yet die.

After such a tragedy as this, the natural reaction is to assign blame. In the comments section following the Sun Journal story, there are EMTs defending the actions of the ambulance driver, others assigning blame to the man they hit, and others still who are incensed at what they perceive to be a pattern of reckless driving among the local EMTs.

I could write a treatise here (or plagiarize a few oft-cited studies) on the risks and dangers of lights and siren response, how little time it actually saves, and how so few of our calls are actually that time sensitive. Emergency response is dangerous, period. We should only do it when it is absolutely necessary, and then only when we anticipate that the benefits outweigh the risks. EMS managers and public officials owe it to the EMTs that serve their community to develop a reasonable policy on the use of emergency lights and sirens.

I could also defend the EMTs, and cite local ordinances until I’m blue in the face. Problem is, most of the citizenry either don’t know those ordinances, or don’t care, and those ordinances often vary from one municipality to another. I will say this: in most cases, the use of emergency lights and sirens merely requests the right-of-way, and emergency responders must exercise due regard for the safety of other motorists. In some places, the top speed is defined by statute. In others, it’s more ambiguous – that whole ‘due regard’ thing. Under some road, weather and traffic conditions, you may be able to safely put the hammer down and see where the engine governor kicks in on your Powerstroke diesel. In others, practicing due regard may mean creeping along at 25 mph in a 45mph zone.

Until you’ve been behind the wheel of an emergency vehicle on a hot response, you have absolutely no idea of just how foolhardy, stupid and just plain dangerous other drivers can be. People absolutely lose their minds. Pick your worst day of road rage as a commuter, and you can multiply it times ten when you’re driving an emergency vehicle that has the handling characteristics of an ocean liner, knowing that a six-year-old isn’t breathing at your destination. My boy Jay G would have an aneurysm if he drove an ambulance.

On the other hand (what is that, three hands now?), I’ve been that motorist surprised by an ambulance. Sometimes sound can be hard to localize, and with today’s stereo systems and modern car soundproofing, the ‘bolance can be mighty close before you hear it. You don’t even have to be yakking on the cell phone to be taken by surprise. If you’ve ever wondered why an ambulance has to run through empty streets in a quiet neighborhood at 3 am, with their sirens wailing, waking the entire neighborhood, know this:

Some calls require lights and siren response per department policy. The EMTs have no choice in the matter. They can’t even turn off the siren and use the lights only. Insurance carriers and risk managers would have a cow.

Some companies have utterly ludicrous driving policies. I once worked for Huge Soul-less Corporate Conglomerate EMS, a company that had a zero-tolerance driving policy. Get caught driving without a seatbelt, or get caught blowing through a red light or stop sign, even on an emergency response, and you get fired. Period.

Now that in itself, I agree with. Only this company required you to stop and clear each individual lane of traffic.

Yeah, you read that right. With lights and siren blazing, we’d stop at the red light, look both ways, assure ourselves of the intentions of the other drivers, and only then could we proceed into the intersection…only to repeat the fricking process for each individual lane.

Stop-go-stop-go-stop-go.

I wanted to post a disclaimer on the side of the rig that said:

“No Ma’am, I’m not an idiot and I’m not trying to fake you out. My company policy requires that I behave like a blonde at a flashing red light, not to mention leave my ass vulnerable in the intersection four times as long, in the interests of safety.”

If you want to place blame for this tragedy, blame Fate. Don’t assume the EMTs were being reckless and don’t presume the other driver was drunk or careless. It was an accident.

All we can do is pray for the injured and the dead, hope to learn from the accident, and take reasonable steps to avoid them in the future.

That’s who our Founding Fathers were, you know. And they had the uncommon courage to rise up against, at the time, the most powerful nation on Earth.

And they won.

The 231 years since has seen the Founding Fathers’ noble experiment in self determination nearly destroy itself in civil war, begin its ascendancy in one world war and literally change the face of civilization in another.

Along the way, we have become a beacon for the rest of the world, in things both good and bad.

We have become the poster nation for shallowness, self-absorption and obsession with material wealth. Much of the world considers us morally bankrupt.

We also possess a generosity of spirit like no other people. No other nation gives so freely of its resources, yet flagellates itself so mercilessly for not doing more. The only other superpower built walls to keep its people in, and now America is considering walls of its own to keep people out.

And I wonder if that’s a good thing.

One thing I do know, with each passing Independence Day, we sacrifice a few more of the ideals upon which this nation was founded. We lose a little more freedom every day, and often for the best of intentions.

And it seems that the only people protesting our slide into irrelevance are viewed as…

…rebels and malcontents.

Personally, I think we just need more of them.

Brian Bateman: hometown boy, good guy, and winner of the 2007 Buick Open. I know a few homies from Neville High School who are whooping it up right now, hollering, “That’s my boy!”

Congratulations, Brian. I’d imagine all of Monroe is proud of you.

Tom Reynolds of Random Acts of Reality has been dealing with a rash of stabbings of late in his London ambulance district. The other night, he cared for one innocent youth in, as he calls it, a “pre-stabbed” state:

The police arrived at the house moments after we got there, as he wasn’t seriously injured I told the police that they could get their interview done before we took the boy to hospital.

Of course, it wouldn’t be as simple as that – he started off by claiming that he didn’t know where he had been ‘hanging out’. He also didn’t know who he had been with, what type of car the assailants had been driving, what they had looked like or even his friend’s home address or phone number. He wasn’t going to tell the police anything.

I’m guessing that if the kid gave the cops any info at all, the assailant was a guy named Sumbloke.

Aside from my everlasting lust and desire wholesome devotion for BabsRN, there are a couple of Nursing Thugz I read daily.

Monkeygirl of Musings of a Highly Trained Monkey is an ER nurse who spends her nights thwarting natural selection in an Emergency Department, and during daylight hours sleeps in an ornate coffin deep in the hospital catechombs. From her blog profile:

I have the attention span of a gnat and no tolerance for stupidity. Which means that working night shift in the ER is both a blessing and a curse.

Fear her, for she is powerful. And damned funny too.

Generic Nurse K of Crass Pollination is another of the Thugz keeping it real in the ER every day.

From her profile, she offers:

High-quality urban emergency nursing care, primary care, drug-seeker support services, physician handwriting interpretation, arrangement of rapid ambulance transfers to detox, bus tokens and cab vouchers, Stage 4 malignant cynicism, and concierge service. Free carwashes are available from 8-4:30 in ambulance bay #1.

As you can see, she’s witty, intelligent, and sometimes, downright merciless.

But in a good way, of course.

She frequently battles with the Speaker For All Nurses, a self-appointed arbiter of All Things Good In Healthcare. Stop by her blog and receive an object lesson in how to flay someone with a huge persecution complex and a holier-than-thou attitude. The way Nurse K steers this nutjob around with the enormous stick protruding from her ass is priceless.