- There's a personal injury lawyer here that bills himself as the "tough, smart lawyer." Like you'd otherwise hire a dumb, wussy lawyer? #
- Since I Never Watch Network Television…: … I never watched One Tree Hill or Scrubs, and thus have never heard of C… http://bit.ly/cPjscS #
- Bigfoot, Aliens, and Occult Spinal Injury: Question: What do the above things all have in common?
Answer: All of t… http://bit.ly/9UZ5w3 # - How Desperate Is Toyota Motors?: Desperate enough to extend credit to someone like me, apparently.
After being tur… http://bit.ly/atKOs6 # - I'll save you some groundhog courtbouillion. Get the rice ready.
# - The Credit Union Gods Have Smiled Upon Me…: … and I shall be car shopping today with considerably broader options … http://bit.ly/ddw7kN #
- If the wait time is the biggest factor in choosing an ER, you don't need an ambulance. This ain't a restaurant, and I ain't the maitre d'. #
- Ambulance Driver’s Aimless Tweets: *Sigh*: Lately, seems like everybody I know is dead.
A month or so back, I got … http://bit.ly/avMZgh #
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… I never watched One Tree Hill or Scrubs, and thus have never heard of Citizen Cope.
Thanks to my friend Valerie, now I have.
Give him a listen, you might like him.
Question: What do the above things all have in common?
Answer: All of them are things in which some people desperately wish to believe, despite the utter lack of credible evidence of their existence.
Now, before you roll your eyes and say, “There goes AD again, making unsupported blanket statements just to make his point,” I will cop to just a little hyperbole:
Bigfoot may actually exist.
I’ve seen plaster casts of his feet, after all, and that Patterson film looked pretty convincing to me.
But one thing that I’ve never seen, never treated, never even heard of in fifteen years of EMS, is a spinal injury not accompanied by readily detectable signs and symptoms.
That’s what occult means, after all. Hidden, as in “never had a clue until we looked at the x-rays.”
Yeah, I know every EMT has a colleague who dates an ER nurse in another city who works with the nurse who treated the guy that walked into the ER under his own power with an unstable hangman’s fracture who, had he even turned his head this much (fingers held about an inch apart for dramatic emphasis), would have been paralyzed for life!
Just like the guy who was painting his house in the nude, and somehow fell off the ladder and wound up lodging a paintbrush handle in his rectum, just about every EMT has heard some variation of the occult spinal injury story.
Hell, I’ve even told that story to my students, back when I actually believed there was some benefit to spinal immobilization.
Now, I’m not so sure.
Few EMTs understand the rationale behind spinal immobilization, or since immobilization is rarely possible, more accurately referred to as spinal motion restriction. When you’re trying to convince the belligerent drunk behemoth that he’s strapped to a rigid board for his own good, and he continues to demand that you “Get this Goddamn thing offa mah neck!” while writhing beneath your three straps and your flimsy cardboard or styrofoam head blocks, true immobilization is an academic exercise at best.
What we do instead is document our steps to restrict spinal motion, including everything we did to convince the belligerent drunk behemoth that strapping him to a board isn’t our idea of fun either, but still necessary.
First, spinal cord injury can basically be divided into two broad categories: primary and secondary.
Primary cord injury occurs at the time of the accident. It’s done. Nervous tissue is contused, destroyed, what have you, and it happens when the accident occurs. Immobilization is a moot point for such injuries. Keeping them still is not going to reverse or even limit that damage.
What spinal motion restriction proposes to limit is something we call secondary cord injury, which occurs after the fact. It may result from post-injury cord inflammation and ischemia, or bony fragments impinging on previously undamaged sections of cord, or worsening an existing primary cord lesion. Restricting movement in patients with spinal cord injury limits the potential for further damage.
At least, that’s the theory.
And that’s all it is really, a theory. Peruse all the medical literature out there, and you will find little, if any, evidence that restricting spinal motion actually accomplishes what it proposes. In fact, the best information you will find merely confirms that, at best, it does no harm.
Moreover, we have just about zero evidence that restricting movement for patients with spinal fractures and no cord injury – the patients who are neurologically intact – does any good at all. The vast majority of those patients have stable fractures, and thus gain no benefit from being strapped to a rigid board.
What you will find, however, is an increasing body of evidence that the practice is not a benign, precautionary procedure at all. It does indeed cause harm, and all for the theoretical benefit of reducing secondary cord injury.
Pain and anxiety.
Vomiting and aspiration.
15% reduction in respiratory capacity, and that’s in healthy, non-obese people.
Increases in intracranial pressure.
Pressure necrosis to occiput, sacrum and heels.
All of these things are possibilities when we strap someone to a spine board, and all for a clinical benefit more theoretical than proven.
Here at The Borg, we have a spinal clearance algorithm of sorts. Like all spinal clearance algorithms, it relies on the presence of a very reliable indicator of serious injury: pain. Sure, there are other indicators of neurological compromise that we assess, but the big one is pain.
If someone breaks their neck, pain will result. Not just the diffuse “Man, my neck kinda hurts,” pain that you commonly see in cases of acute insurance-itis, but specific, midline posterior cervical spine tenderness above the area in question.
Of course, there are other elements that point toward spinal cord injury that need be assessed as well – focal neurological deficits, for example. Just the other night I boarded a male motorcyclist who straightened out a curve, based on nothing more than his complaint of numbness and tingling in his hands. It could have been nothing more than cold weather and crappy riding gloves, but it could also have been the telltale signs of a cord lesion.
He swore his neck didn’t hurt, and I found no signs of injury at all – thank God for muddy, grassy fields! – but I boarded him anyway. Of course, after a two-hour wait on the board in a busy ED, it was determined that he didn’t have any spinal injury, and he was taken off the board.
The presence of pain is what makes an occult spinal injury not occult at all, and in all my years in EMS, I have never encountered a single reliable patient with an unstable spinal fracture that didn’t have it.
Not one.
Now, not every patient is reliable, hence the other elements of the spinal clearance algorithms that assess mental status and potential distracting injuries. If the patient is deemed to be unreliable due to organic or chemical impairment, or the fact that he seems to be focusing all his attention on his broken leg rather than your fingers walking down the back of his neck, we restrict spinal motion anyway, just as a precaution. It’s the prudent thing to do.
Well, that is, if you believe that boarding and collaring someone is actually beneficial for a patient with spinal cord injury. There is at least one well-constructed study out there that shows otherwise, in which spinal injury patients who were immobilized had significantly worse neurological outcomes than those who were not. I wrote about it a couple of years ago. Go read that post, and then come back.
Either there's an entire ward full of people in halo devices, or most of these boards were unnecessarily applied.
Recently, Baylor College of Medicine released another study that says much the same thing.
For patients with penetrating trauma like knife or gunshot wounds, there is no reason to immobilize if the patient is neurologically intact. Nonetheless, it’s common practice in many EMS systems to collar and board shooting victims, even if the time spent immobilizing in the field doubles the patient’s chances of dying.
By God, we’re gonna save you from being paralyzed, even if it kills you!
The National Emergency X-radiography Utilization Study was designed to develop a specific set of clinical assessment criteria that would help cut down on the number of unnecessary cervical spine x-rays in Emergency Departments around the country. It has been validated in many thousands of patients, and generally speaking, those clinical assessment criteria are more accurate than x-rays in ruling out cervical spine fractures.
Of course, NEXUS is rarely used as it was designed. It’s been my observation that the Emergency Department physicians use it to clear patients off our board, but the patient still gets the x-rays anyway. Now you may ask, why do they remove patients from our boards, when we obviously boarded them for a reason, using the same set of criteria?
The reason is that many EMS spinal clearance algorithms, including the one used by The Borg, do not use NEXUS, but instead are modeled after the Canadian C-Spine Rules, which note a higher incidence of spinal injury in patients over age 65, and patients who have sustained significant injury above the clavicles.
Of course, these two additional criteria don’t mean that the patient has a spinal injury, they just suggest that we look at these patients a little more carefully. EMS often adds an additional criterion, the nebulous and subjective “significant mechanism of injury.”
Rather than use MOI as it was intended – as a conceptual tool to tell us where to focus our assessments – EMS tends to use it as the assessment. We place all of our faith in the mechanism, and precious little in our actual assessment findings. We’ve built an entire belief system around it.
This misplaced faith in mechanism of injury is what transforms a useful clinical tool like a spinal clearance algorithm into just another poorly written protocol, where we shoehorn patients into a set of unnecessary treatment steps that offer no benefit.
The state of Maine, pioneers in the use of a statewide field spinal clearance algorithm, has been using NEXUS criteria for ten years now. Everyone from the newest EMT to the most seasoned medic can apply it. Several years ago, they dropped mechanism of injury from the list of assessment criteria because MOI was too unreliable an indicator of injury.
So far, no one has seen an inordinate percentage of quadriplegics tooling around Bangor or Portland in their motorized wheelchairs, and we’ve heard no reports of juries awarding record monetary damages for the patients who weren’t collared and boarded. It may just be that they’re on to something up there that other EMS systems around the country would do well to copy.
The Borg have a spinal clearance protocol, but its benefits are diluted because they insist on immobilizing anyone with a significant MOI, or patients over age 65, or patients with an injury above the clavicles. Not “exercise due caution” in these patients, mind you, just “immobilize.”
No ifs, ands or buts, no exercising clinical judgment, no consideration of what’s best for your patient, just immobilize. Strap ‘em all to a board, and let the radiologists sort ‘em out.
Now imagine yourself, say, at a bar. You’re flirting with the waitress, nursing a Coke because you’re drew the short straw for designated driver, when all of a sudden and for no reason, Sumdood clocks you right in the mouth. Splits your lower lip and knocks out a tooth, the bastard.
But you’re pretty badassed yourself, and you didn’t even leave your feet. You’re more pissed than anything, really, and would like nothing more than to exact a little revenge, but Sumdood, as he always does, has vanished like a wisp of smoke. Your buddies cluck sympathetically at your mangled lip and missing tooth.
“Dude,” they say, “you oughta get that checked out. Call an ambulance or something. You’re gonna need stitches and everything.”
So then the ambulance arrives, crewed by Rookie Partner and a burly but nonetheless rakishly handsome and devilishly charming paramedic, namely… me, Ambulance Driver.
“Yep, that’ll need stitches,” I agree as I examine your face. Other than the split lip and missing tooth (carefully stashed by your buddy in his go cup filled with a White Russian because it has milk in it, and everyone knows you’re supposed to put dislodged teeth in milk), there isn’t a mark on you. Your pupils are fine, you didn’t lose consciousness, your neck doesn’t hurt when I palpate it, and you’re moving all your limbs appropriately. I even have you close your mouth and smile, checking for malocclusion of your teeth that may tell me you’ve suffered a fractured jaw.
You’re moderately impressed by my thoroughness, and thankful that The Borg employs such dedicated and skilled medics. They’re a pretty damned impressive outfit, you’re thinking. They’ve got their shit together. I’m in good hands, you’re thinking.
And then I say it.
“Um,” I say apologetically, “to take you to the hospital, we’re gonna have to put a collar around your neck and strap you to a board.”
“But I didn’t hurt my neck!” you protest. “Why is that necessary?”
“We have to,” I repeat, mentally biting my tongue to keep from agreeing with you wholeheartedly. “It’s, um… well, it’s the protocol. It’s for the best, really.”
“So you’re saying that strapping a guy with nothing but a split lip to a board is actually in his best interests?” you ask dubiously. “Dude, what have you been smoking?”
But hey, the guy has an injury above the clavicles, and the protocol clearly states that I’m required to immobilize that guy.
That’s a scene I am forced to repeat, day in and day out, several times a shift. And I am faced with the choice of explaining to my patient that my medical director is not a monosynaptic, booger-eating dullard, just that he writes protocols designed to be used by medics that are, or I can follow the protocol as written and have the patient think I’m the monosynaptic, booger-eating dullard.
Either way, it doesn’t reflect well on The Borg, or EMS in general.
Ironically, the same medics who immobilize everyone in the belief that if it keeps even one patient from being paralyzed… are the same medics who are card-carrying members of the No Neck Fits Everyone Society, and believe that three straps are all that’s necessary to properly secure a patient to the board.
Now, being an ornery type who refuses complete assimilation into the Hive Mind, I rebel at doing unnecessary and potentially harmful things to my patients, and carefully explain to them that they have the right to refuse any medical treatment that we offer *wink wink, nudge nudge*. Sometimes I just refuse to follow the protocol, and I get my pee pee whacked for it fairly regularly.
But a great many of my colleagues don’t even go that far, and simply follow the protocol blindly, never questioning the wisdom (or lack thereof) behind it. Some of them even tell the patient things like, “If you want to go to the hospital on my rig, you have to go on the board.”
That’s a practice that doesn’t just flirt with the legal definition of coercion, it gives it a naked lap dance and slips its cell number and hotel key into Coercion’s pocket. It’s wrong, and we shouldn’t make our patients submit to painful and unnecessary treatments just to get the help they seek.
Every time the FTO Drone whacks me on the pee pee for not immobilizing someone needlessly, he’s almost apologetic about it. “It’s not you, AD,” he’ll say as I’m taking the online spinal immobilization tutorial for the umpteenth time, “it’s all these other yahoos who aren’t using their heads at all. If we’re going to discipline them for it, we can’t let you get away with doing the same thing.”
And he’s right. Discipline needs to be applied uniformly, even if it occasionally requires that a good medic who exercises his brain receive the same punishment as the bad medics who didn’t.
Of course, they could also re-write the protocol to allow more freedom to exercise clinical judgment, and hire medics worthy of that level of trust.
Like, you know, ones that don’t believe in Bigfoot, aliens and occult spinal injury.
Desperate enough to extend credit to someone like me, apparently.
After being turned down by everyone from Ford Motor Credit to Benny the loan shark, my credit union came through with financing terms. I was waffling between a 2006 Toyota Tacoma SR5 4×4 with 91k miles (but in excellent condition with tons of extras), and a brand new 2010 Tacoma 4×4, which I could have had for 2% lower interest than I’d get with the used one, and 72 month financing, to boot.
In the end, having a new vehicle with a 100k mile factory warranty for only $100 more in monthly notes was just too good to pass up.
So I went to the dealership this morning to sign the buyer’s agreement, and they asked if I’d like to try getting approved through Toyota Motor Credit. “What the hell,” I figured. “One more hit to my credit record won’t be too bad, and this is the last time I’m going to be financing anything for a long time. They’ll probably turn me down, but I still have the credit union to fall back on.”
Well, not only did they approve me, but at an interest rate so much better than my credit union that I could finance the truck for 60 months for only $70 a month more in payments. That will save me roughly $7,000 over the term of the loan.
So thanks, Toyota Motor Credit!
Hopefully, I’ll have pics of Frankenhoopty II by the end of the week!
… and I shall be car shopping today with considerably broader options than I had just three days ago.
More to come soon, and actually some EMS posts!
That is, as soon as I procure a ride…
- *Sigh*: Lately, seems like everybody I know is dead.
A month or so back, I got a Facebook friend request from the … http://bit.ly/c6KL3M # - Thinking of starting my own one-man play, ala "The Vagina Monologues." Working title: The Penis Soliloquy. #
- As Usual, The Truth Is Somewhere Between The Extremes: Most of the EMS internet forums have been abuzz lately with… http://bit.ly/9ejU3Q #
- I need to patent a hand-held nebulizer with a cigarette port, perfect for the COPDer too short of breath to smoke. I'd make a fortune! #
- It’s a Bird, It’s a Plane, It’s a…: … mid 90’s Mercury sedan equipped with nine video screens!
Yes, you read tha… http://bit.ly/dtd8Nr #
- Dear Dispatch Drone,: I realize that it has been so long since your assimilation into the Collective that you have… http://bit.ly/dvwzv2 #
- RIP, Frankenhoopty: 2000-2010: Sure was a good truck. The search for Frankenhoopty II continues…
Sorry no blog pos… http://bit.ly/aVSKSZ # - A Triage Nurse Not To Be Trifled With: Got this e-mail from a good friend who is a nurse in a major metropolitan E… http://bit.ly/acczc9 #
- Long, Cold Day: Spent the day on my motorcycle, tooling around from one auto dealership to the next, looking for a… http://bit.ly/biAiJm #
- Going truck shopping today. On a motorcycle. In 50 degree weather. With poor credit. Something tells me I'd better bring a tube of KY. #
- We are now 1.5 hours into Lent, and still dealing with drunks. Call me cynical, but I don't think these folks are devout Catholics… #
- It's Fat Tuesday, and my trauma shears are glowing pale blue. Sumdood is on the prowl. Either that or fibromylagia orcs. Whichever. #
- I think I'm working in one of Napolean's original ambulances. Somebody scratched "D.J. Larrey wuz here" on the wall behind the suction unit. #
- Feelings… whoa whoa whoa feeeeellliiinngs… I'm taking requests, people! #
- Ambulance Driver’s Aimless Tweets: Eff. Em. Ell.: Driving KatyBeth home from the Ex Wife’s house last night, I tot… http://bit.ly/bxTC3g #
Lately, seems like everybody I know is dead.
A month or so back, I got a Facebook friend request from the ex-girlfriend of my best friend in high school. I hadn’t seen or heard from her in twenty years, and hadn’t heard from Rickey in almost as long.
Rickey and I were asshole buddies from my sophomore year in high school on, even though we went to different high schools 100 miles apart. We chased girls and drank beer and did all the things teenage boys do, and when we graduated high school, we found an apartment in LaPlace, Louisiana, within easy staggering distance of the local watering holes.
We worked our jobs during the day, partied like mad every night, and sowed every single wild oat that *I* had. In 1986, I was bringing home close to $600 a week, and still I moved back to Monroe close to two years later, broke and with $8,000 of credit card debt.
Rickey, on the other hand, still had plenty of wild oats left to sow. We lost touch with each other, and the last I heard, he had moved to Florida some time in 1989.
Over the years, I tried several times to track him down, but it seemed that he had dropped off the face of the Earth. Last year, I found a few self-published books of his on Lulu. I bought and read them, and gleaned that he’d had some substance abuse problems after we lost touch, and spent a few years in the Louisiana prison system.
Seems he was driving drunk, and killed a pregnant woman. Spent eight years in some very nasty places, doing time for two counts of vehicular homicide. He lost his wife, his three kids, basically everything.
After he got out, he tried to put his life back together, tried to atone for what he’d done, tried to reconcile with his children and become the father he’d wanted to be before he succumbed to drug addiction.
From reading his books, he didn’t have much success at that.
But from reading his poetry and prose, amidst all the pain and remorse, I could still see more than a glimmer of the man he once was. He was vibrant, and talented, and a great friend. Prison had knocked him down, but it hadn’t broken him. He was clawing his way back.
I dropped him an e-mail at the contact address on his Lulu page, but never heard from him. Then, several months later, his ex-girlfriend messaged me, and with a little searching, we discovered his obituary. He died in 2008, apparently by his own hand.
We also discovered his son.
He looks a lot like Rickey did. And he’ll never know the man his Dad was before addiction changed him into something else. Neither will his sisters.
Then, today, I just learned that another friend and former co-worker died a few hours ago. He was my age, perhaps a bit younger. We’d always worried about his weight; he was far larger than I, and hypertension ran in his family. I took care of his father when he had his stroke. But the size of his body was more than matched by the size of his heart. A kinder and more giving man, I have never known.
Yesterday, Thomas had a heart attack at the wheel of his car. He left behind a wife and his first child, barely a month old. She will never know what a wonderful man her father was, save for tales from her mother and his friends.
Requiescat in pacem, Rickey Haltom and Thomas Kaheiki III. You will not be forgotten.
Most of the EMS internet forums have been abuzz lately with the story of the Pittsburgh man who died before EMS could reach him, after his wife called 911 ten times in 30 hours.
As usual, most EMTs who read it were quick to crucify the EMS crew based on nothing more than news reports and public statements from the city’s Public Safety Director.
Turns out, the Public Safety Director may have his own agenda, and as usual, the reporters story left out any facts that didn’t fit the critical tone of the story.
TOTWTYTR has a comment from someone who works in the system who adds some valuable perspective to the news accounts.
Never judge a story based entirely on media accounts, folks. If I had a dollar for every time I read a news account of a call I ran, and wondered if the reporter was actually at the same scene I was, I’d be a rich man.
Accuracy and objectivity is the exception for today’s news media, not the rule.
… mid 90’s Mercury sedan equipped with nine video screens!
It's not the crack habit that makes RP a shaky photographer, but doing without it on duty.
Yes, you read that right. NINE video screens: One on each visor, one on the roof console between those two, one in the headrest of each front seat, a larger screen in the seat back between those two, and three more mounted in the rear seat head rests.
I’m not quite sure of the purpose of the screens mounted in the rear seat. Perhaps they were to entertain the other motorists.
And where was this rolling monument to bad taste and too much disposable income headed, you ask?
Why, to the local charity hospital ER, naturally!
I only wish I were kidding.
I realize that it has been so long since your assimilation into the Collective that you have long ago lost the capacity for independent thought.
I realize that, as a veteran dispatcher, the real world has faded to a gauzy, ephemeral shadow realm nibbling at the borders of that pool of light cast by your computer screen.
I also acknowledge that, as a former street medic, the lobotomy necessary to be assigned to dispatch was not your choice.
But for pity’s sake, man, pull your head out of your ass, you mouth-breathing, monosynaptic, booger-eating dullard.
In the spirit of the post-response performance critique, I’d like to point out that the time to message us with the correct directions to the scene is while we are still on the way, not five minutes after we have pressed the “AT SCENE” button on the data terminal. Because by then we’re, you know, already inside the house, usually trying to explain why we wandered around the neighborhood aimlessly for ten minutes, without coming right out and saying that our dispatcher has the cognitive ability of a garden slug.
I’d also like to point out that the “unconscious 2-year-old” you sent us for is a far cry from the “80-year-old with weakness” that we actually found, both in pathology and pucker factor.
Now, before you blame those mistakes on miscommunication from a panicked caller, keep in mind that I have long experience with your dispatch style, and I spoke to the 911 caller in question. He was calm, and perfectly lucid.
You, on the other hand, have not been lucid since the first Clinton administration.
With companies as large as The Borg, I suppose it is inevitable that we assimilate an occasional intellectually inferior bioform into the Collective. Usually, such a mistake only makes for a momentary “DUHR” ripple through the Hive Mind.
But you, however, are so irredeemably stupid that I cannot help but conclude that, were we to purge you from the Hive, the IQ of the Collective would instantaneously increase to the point that a 911 system and a Dispatch Hive would become obsolete.
We’d all be so smart that we’d be able to telepathically sense an emergency, and the nearest Borg unit would automatically head that way, without the need for directions from the Central Hive.
We’d be totally unstoppable, but for you.
Love and kisses,
Ambulance Driver
Yeah, that'll buff right out.
Sure was a good truck. The search for Frankenhoopty II continues…
Sorry no blog posts for the past couple of days. Amongst the searching for new vehicles and a lending company reckless compassionate enough to approve a financing agreement for me, tonight is the first shift in a very long while where my UHU stands a good chance of reaching 1.0.
For you non-EMS types, UHU means Unit Hour Utilization, which basically means I’ve transported a patient an hour for the past 12 hours. That’s in between responses where we got canceled en route, or got refusals, or just an endless series of post changes which had us wandering around the city like the dizzy kid playing Pin The Tail On The Donkey.
In other words, they’re riding my ass like a rented mule, folks. Hopefully I’ll post something meaningful this weekend…
Got this e-mail from a good friend who is a nurse in a major metropolitan Emergency Department:
Had a triage about an hour ago; a family of five were stuck in an elevator for 20 minutes or so. Once out, they demanded to come to the ER for an evaluation. No, there were obviously no injuries.
So… I put them all in one small room and shut the door.
I LOL’ed.
Spent the day on my motorcycle, tooling around from one auto dealership to the next, looking for a replacement for the dear, departed Frankenhoopty.
I haven’t felt so much rejection since back when I was writing Anna Nicole Smith fan letters.
Still, progress is being made, and even though I haven’t yet found Frankenhoopty II, at least now I know what is possible and what’s a pipe dream.
I’d like to thank all of you who have hit the tip jar, or just called, commented or emailed, including at least three of you who offered to give – GIVE! – me a car. You guys seriously rock.
More to come soon, folks.
- Eff. Em. Ell.: Driving KatyBeth home from the Ex Wife’s house last night, I totaled my truck.
Took a curve too fas… http://bit.ly/9DzvKb # - How Very… Interesting: It would seem that the professor at University of Alabama – Huntsville who wigged out and s… http://bit.ly/a6OJLn #
- EMS Rule 14: Paramedics do not run. We mosey, stroll or saunter, and someof us may even sashay. But we never, ever run. #
- Made Of Win…: … with a side of Awesomesauce.
Take every sugary pop hit you’ve ever heard from the 80’s.
Now totall… http://bit.ly/aorWvi # - Chronicles of EMS: The Premiere: Free video streaming by Ustream
Great job, Happy Medic and 999 Medic. Can’t wait … http://bit.ly/8YufIw # - Unexpected advantage of wearing CPAP for sleep apnea: the puppy's farts aren't nearly so heinous when you breathe through a HEPA filter. #
- Saving Lives, Stamping Out Disease And Pestilence: “Incident assigned.”
Rookie Partner glances at the mobile data … http://bit.ly/cZG5bC # - Chronic Hickory Deficiency (noun): Common behavioral problem in adolescents, often misdiagnosed as ADHD. Easily cured with topical hickory. #
- Tweetstipated again. If this keeps up, I'm going to have to eat more high fiber snark. #
- Coming Soon, To A Town Near You…: … it’s me!
Yeah, I know it’s not the traveling production of Cats you were hopin… http://bit.ly/cw0BiX # - Seen In The Emergency Department: Go to pretty much any Emergency Department, and you will see some version of “Th… http://bit.ly/aDcHWs #
- WHOOOOO DAAAAAT??: Saints 31, Colts 17.
Right now, Mostly Cajun is a sad clown, but for the rest of Louisiana, it’… http://bit.ly/cOJIzj # - Superman wears Drew Brees pajamas! #
- Ambulance Driver’s Aimless Tweets: What Has It Got In Its Pocketses, Precious?: Since all the other cool kids are … http://bit.ly/9OuGQ0 #
So I’m out of a truck, and for the next few weeks I’ll be commuting on the bike (in February! BRRRRR!) until I can scrape together the down payment on another ride. Unfortunately, the divorce chronicles have wrecked my credit, so I’ll be patronizing one of those “We finance anyone!” (while raping them mercilessly on interest) car lots.
But enough poormouthing. I’m healthy, my kid is uninjured, and I have about a gazillion readers and friends who have expressed their support, monetarily and otherwise. That alone is worth more than a 10-year-old Dodge Dakota.
Even better, I got to walk a beautiful blonde down the street for a Valentine’s Day lunch date. While we were eating, she noticed my glum look and asked if I was sad about my truck.
“I’m sorry I couldn’t take you to the movies like I promised,” I answered.
“None of that matters, Daddy,” she reassured me. “All that matters is that we’re both okay.”
Now I ask you, is that not the coolest kid ever? I have the bravest, most mature and level-headed 7-year-old in the known universe, and despite her maturity, there’s not a mean or cynical bone in her body.
I’m a lucky man.
Driving KatyBeth home from the Ex Wife’s house last night, I totaled my truck.
Took a curve too fast, went through the ditch and hit a utility pole. I was driving within the speed limit, but too fast for road conditions. The impact caved in the driver’s door and the roof all around the driver’s side of the truck, right where my head should have been. By all rights I should be dead.
KatyBeth and I are okay, with no injuries to speak of. She was asleep in the front passenger seat when it happened, wearing her lap belt with the shoulder restraint looped behind the headrest (yes, I know she should have been on a booster seat for the restraint to fit properly).
After the accident, I checked her out physically to make sure she was okay, and just held her in my arms and whispered thankful prayers until help could arrive to get us out of the vehicle. KatyBeth only cried for a couple of minutes, more scared than anything, and didn’t want me to put her down for a while.
I had to deal with the local police in the aftermath of the wreck, however, so I sat her in the front seat of the officer’s cruiser while I fished out registration and insurance papers (liability only, hence the title of this post). She was fine when I left her, but when I went back to check on her five minutes later, she was crying again.
“What’s wrong, little girl?” I blurted as I scooped her up, wondering if there was something I’d missed. “Are you hurt? Show Daddy where you’re – “
“I’m okay,” she sobbed, patting me on the back gently. “I just want to make sure that you’re okay.”
That’s when I lost my shit.
It would seem that the professor at University of Alabama – Huntsville who wigged out and shot three faculty members has done this before.
The report goes on to say that the police chief in Braintree at the time ordered her released to her mother and ruled the shooting an accidental death.
Three shots fired.
At least one in the chest.
Yep, sounds totally accidental to me. No need to investigate that, no sir.
</sarcasm>
… with a side of Awesomesauce.
Take every sugary pop hit you’ve ever heard from the 80’s.
Now totally re-imagine it as metal. What you get is Rock Sugar.
I’m so damn confused, I may wind up at a ‘Til Tuesday reunion concert, throwing Slayer horns and bellowing, “Rock ‘n Roll!”
Hat tip to Anarchangel.
Free video streaming by Ustream
Great job, Happy Medic and 999 Medic. Can’t wait to see the next episode.
One of these days, you’ll have to come ride with The Borg.
“Incident assigned.”
Rookie Partner glances at the mobile data terminal, whoops happily, and puts the truck in gear.
“What is it?” I yawn.
“Stabbing/gunshot wound,” RP grins. “Finally, something good!”
Before I can answer, the radio crackles, “Headquarters to CCT 4.”
Sighing, I key the mike. “CCT 4, gourd head.”
“CCT 4, the scene is safe. The patient accidentally stabbed herself in the leg.”
RP visibly deflates, groaning his disappointment.
“Smell that?” I grin evilly.
“Yeah, I know,” he mutters. “Smells just like a BLS, non-emergent transport to you. Again.”
“Sometimes you’re the windshield, sometimes you’re the bug,” I tell him. “I’ve been the bug for the past week.”
“Still, maybe it’ll be something good,” he says hopefully. “A lacerated femoral artery or something…”
“It will be a small and superficial wound,” I predict. “She was probably sitting at the kitchen table, cutting open the cellophane wrapper to her Jimmy Dean breakfast sausage, when an unexpected sneeze caused her to poke herself in the leg. You’ll probably be able to cover the wound with a Bandaid.”
“Dude, I would be so pissed.”
“If it turns out to be a little superficial cut,” I suggest, “you oughta just smile reassuringly… and then stick a Bandaid on it.”
“You don’t think I will?” RP challenges.
“I double dog dare ya.”
**Five minutes later**
Disgruntled Patient: “Thass all I gits, a muhfuckin’ Bandaid?”
Rookie Partner: “That’s all it needs, Ma’am.”
Disgruntled Patient: “I ain’t called no ammalance fo a muhfuckin’ Bandaid! Ain’t y’all got nothin’ better’n dis?”
Rookie Partner (innocently): “Well, we do have some with Daffy Duck on ‘em, if you’re a Looney Tunes kinda gal.”
I almost did a spit take.
… it’s me!
Yeah, I know it’s not the traveling production of Cats you were hoping for, but you gotta take what you can get.
I’ll be in Boston on March 1-2, then TOTWTYTR and I will be in Baltimore on March 3-6 for EMS Today.
On March 18-21, I’ll be in Columbus, NE speaking at the NEMSA Spring Conference.
On April 15-17, I’ll be in Minot, ND, speaking at the North Dakota EMS Rendezvous and Trade Show.
All suggestions for blogmeets in Boston, Baltimore, Columbus or Minot will be seriously entertained.
See y’all there!
Go to pretty much any Emergency Department, and you will see some version of “The Board.”
Usually a big whiteboard, often a swanky electronic display, The Board usually lists the patients and their respective rooms (usually initials only, to protect confidentiality), the doctor and nurse assigned to that patient, and status updates on their current condition, such as “awaiting CT results” or “admit to ICU Bed 16″ or some such.
Last night, one of our Emergency Departments had the following status update posted for no less than four patients:
Heh. “Metabolize to freedom.”
That’s a nice medical euphemism for it!
Saints 31, Colts 17.
Right now, Mostly Cajun is a sad clown, but for the rest of Louisiana, it’s laissez les bon temps rouler!
Tonight, the rest of the world discovered what Saints fans knew since 2006: Superman wears Drew Brees pajamas.
Incidentally, if you have your myocardial infarction in south Louisiana, during halftime of the Super Bowl when the Saints are down 10-6, you will get the shortest door-to-balloon time EVAR.
- What Has It Got In Its Pocketses, Precious?: Since all the other cool kids are doing it, here’s mine:
Truck keys,… http://bit.ly/bl9s3G #
- Saints Super Bowl Special! Anyone who calls 911 during the game tomorrow, gets a free 14 gauge IV… in the corpus cavernosum! #
- Congrats to Rickey Jackson for making the Pro Football HOF. Saints' Dome Patrol – most feared linebacker quartet ever on one football team! #
- Overheard On the Bolance: Rookie Partner: “I’ve got enough homemade chili for both of us, but I’m afraid to give y… http://bit.ly/d1Cyiu #
- For You EMS Types…: … there is more of my puckish humor on display in a new Top Ten List on EMS1.
Enjoy! http://bit.ly/daebsu # - Sorry folks, I've been tweetstipated lately. #
- EMS 2.0: Where’s Our Martin Luther?: For you EMS types, particularly the ones who are involved in the ongoing disc… http://bit.ly/cyXxfd #
- Chapters, Part Two: Read Part One here.
**********
December, 1988
Ask a man why he hunts with a dog, and you’ll ge… http://bit.ly/9FYV6z # - “Do, or do not. There is no try.”: Yoda’s wisdom is applicable to all endeavors, not just becoming a Jedi Knight.
… http://bit.ly/bH90Uu # - Ambulance Driver’s Aimless Tweets: Dear Jenny McCarthy…: … you can go back to showing your tits and doing bad talk… http://bit.ly/dh4pdh #
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