Not five minutes ago, I just had a chat with a paramedic from Saudi Arabia who seeks to immigrate to the good ol’ USA, and practice his craft over here. He had a million questions about certification, paramedic schools, reciprocity, and so on.

I’m afraid I didn’t leave him with a good impression of the fragmentation of EMS in the United States, but still, how neat is it that two guys from different cultures and countries can communicate so easily, limited by little more than our language barriers and typing skills?

As-Salamu  Alaykum, Khaled. May you find success in your endeavors here in our country.

… you step onto the Road, and if you don’t keep your feet, there is no knowing where you might be swept off to.”

I sense the hand of my archenemy Sumdood in this.

I’m sure the young victims were just sitting in their car, minding their own business, holding their weekly Bible study and drinking a wholesome glass of milk, when all of a sudden and for no reason, Sumdood just started bustin’ caps.

They should have known better. Standing around minding your own business is one of the most dangerous things you can do in a city.

Business Week ranks Louisiana as the nation’s laziest state.

I’ve always said that hard work and diligence pay off in the future, but loafing pays off right now.

Britain’s NHS begins to drastically ration care in response to economic crisis.

There’s a word that I vaguely recall that may apply here… right on the tip of my tongue… now what was it?

Oh, yeah. Unsustainable.

Drastic cuts in services, rationing care, terminally ill patients being told to fend for themselves (death panels? What death panels?), hospitals and nursing homes closing…

… wow, that’s pretty grim. I’m sure glad that sort of thing isn’t likely to happen with the system we have in place over here.

Oh, wait a minute…

Kelso: “I swear to God, I’m gonna punch his lights out.”

AD: “Take a deep, cleansing breath. Get in touch with your inner child. Go to your Happy Place.”

Kelso: “Knocking him the fuck out would be my Happy Place.”

AD: “Sorry, your window to do that was back when he still had his hands around your throat. That’s self defense. Now that we’ve got him restrained, it’d be retaliation. And retaliation is a non-no.”

Kelso (hopefully): “You gonna let me ride in with him? He’s a Status Four, right?”

AD: “He is, but I’ll ride in with this one. You still haven’t gone to your Happy Place.”

Kelso (still angry): “Dude what the fuck is this ‘Happy Place’ you keep talking about?”

AD: “A midget on a stick horse, a lingerie-clad blonde with a pitcher of beer in each hand, and Apollo Creed playing piano and crooning Carpenters tunes. And when we’re done with this call, we’re going to have to address these gaping holes in your pop culture education.”

Indianapolis Fire Department EMS and Wishard Hospital EMS to merge.

When I first read the story, my initial reaction was, “Finally, a cost-saving EMS merger that makes sense.” It would seem that Indianapolis Fire Department is on board with it as well:

“There are some things that this service is going to be able to do that are a lot different from what we do currently and I think they’re going to be a lot different than a lot of places around the country do,” said IFD Division Chief Scott Issacs.

Usually, this is the exact opposite path most often taken by public officials. Cash-strapped cities, looking to cut costs, seek to merge EMS and the fire department, and usually to the detriment of paramedic morale and patient care. Sometimes the fire department doesn’t want the merger – making for really bad care – and sometimes they openly lobby for it, seeing EMS as a viable revenue source and a way to justify current staffing levels in an era of ever-dwindling fires. Problem is, even when they want EMS, the fire departments see it as a means to an end, and not their core mission.

Looks like Mayor Greg Ballard and Indy Fire took just the opposite approach, though, and good on ‘em. The article states that Indiana University Medical School will take an active role in training and education, which should make for the strong medical direction that is essential for a premier EMS system.

I know that Tam, Caleb and Roberta have serious misgivings about Ballard and his anti-Second Amendment leanings, but at least when it comes to structuring an EMS system, it seems like he’s got his head on straight.

AD: “I’m not so sure the pink shirt and the purple pants is such a good idea.”

KatyBeth: “But they’re my two favorite colors!”

AD: “Yeah, but they don’t really match, honey.”

KatyBeth: “You said I don’t have to match, as long as I wear complementary colors. That’s what you said.”

AD: “Crap, I did say that. But I meant that olive drab or desert tan goes really well with basic black.”

KatyBeth: “Yeah well, I’m wearing pink and purple.”

AD (sighing): “I suppose it’ll be okay. I doubt we’ll run into many fashionistas at the gun show.”

… Episode Six is up at Confessions of an EMS Newbie.

Enjoy.

Well, perhaps it’s the 100-pound girlfriend we’re tending to, the one with the nasty shiner on her eye.

Maybe it’s the 5 pound Chihuahua laying paralyzed on the floor that you stomped.

Maybe it’s the two heartbroken children crying because they’re taking Daddy to jail. Again.

I’d say that if the hose and smell of vinegar fit, then…

**********

There are times in this job, the job you took because you’re more driven than most to protect and heal, that everything you believe about manhood and justice wars with what society and the legal system says justice should be.

This is one of those times.

So tonight, rather than follow my instincts, I’ll channel my rage into dry, clinical prose, and I will meticulously, objectively document every single aspect of the hurt you inflicted. And I’m going to pray that every period, comma and quotation mark ensures that you will spend your days being sodomized by men larger and tougher than yourself.

And damn your black fucking soul, I can still see your little boy’s face as he cried that they were taking Daddy away. God only knows what kind of psychic torment you have inflicted on the kid in the past, and will continue to do well after you’ve gone to prison.

I still can’t help but think that seeing Mommy cap Daddy the first time he punched her would have resulted in less psychological trauma than seeing you abuse her for years.

… episode 5 of the Confessions of an EMS Newbie podcast is up.

Ron and I talk about why gloves are not as important as eye protection, why 12-lead EKGs only have 10 wires, and the proper application of the Modified Scrotal Lead, among other stuff.

It’s Confessions of an EMS Newbie, the podcast all the cool EMT kids listen to!*

* Okay, maybe not all the cool EMT kids. In fact, if you’re listening, you’re probably a dork.

But you’ll be an especially well-informed dork, and that’s gotta count for something, right?

Ambulance Driver: “So, did you feel it?”

Kelso: “Feel what?”

AD: “That guy’s hernia. It was incarcerated. You didn’t notice how hard and inflamed it was?”

Kelso (uncomfortably) : “Well, I saw you assess him. I’ll take your word for it.”

AD: “Geez, what are they teaching you kids these days? Don’t you even do your own assessments? One day you’ll be evaluating someone with a hernia, and it’d be helpful if you knew the difference between a simple, reducible hernia and one that’s incarcerated and necrotic.”

Kelso: “Ummmm…”

AD: “My advice is to march your ass back into that triage room, and palpate that guy’s junk thoroughly. That’s the only way you’re gonna learn.”

Kelso: “I would, but that violates EMS Rule #4: Handle no one’s genitalia but your own. You taught me that one yourself.”

AD: “You are indeed growing wise, young Padawan.

Kelso: “So why did you handle his junk?”

AD: “Because I didn’t have a seasoned partner to teach me the rules before I fondled my first patient. Once you’ve crossed that particular barrier, there’s no going back.”

For those of you who demonize Dr. Henry Wang for his medical studies critical of the ability of paramedics to safely perform endotracheal intubation, read the panel discussion on JEMS.

As you can see, the man is a proponent of allowing paramedics to continue using the procedure, as are all of the other panelists. They all agree, however, that we need to get better at it, and utilize it more appropriately. If we don’t, we’re likely to see this skill either removed from our skill set, or limited to a few very highly trained paramedics.

A good first step would be debunking the myth that endotracheal intubation is the gold standard of airway management. Optimal airway management is gauged by a desirable outcome – adequate oxygenation and ventilation – and not a particular piece of equipment. If your greenest EMT-B Newbie can sustain his patient’s adequate oxygenation and ventilation with nothing more than an oropharyngeal airway and positioning, then he has achieved the gold standard of airway management.

Airway management is a continuum of care, people.

Once the majority of paramedics abandon the notion that our talleywhacker size somehow corresponds to our willingness to use a laryngoscope, we might actually be able to take the steps necessary to get better at it.

… I’m thankful.

I was tagged by The Gregarious Loner a while back with this meme, and today seems like the proper day to list the things for which I am thankful. It’s good to reflect now and again on what is good about our lives, and I for one probably don’t do it often enough.

10. My health. I’m overweight and out of shape, and after losing 78 pounds by making better eating choices, fell off the wagon and gained 40 of it back. Still, I have cholesterol levels anyone would be happy with, a blood pressure I don’t deserve, and my immune system attacks squirrels in the back yard. And all it will take is losing those 40 pounds again, and I’ll be back to a resting heart rate of 44 and a BP of 100/70.  For that, I am thankful.

9. My career. So few can say that they have found their purpose on this Earth, and be lucky enough to fulfill it. Every day I climb into that rig, I’m doing just that.

8. Financial security. I’m not rich, and likely never will be, and if I missed a paycheck, I’d probably be eating ramen noodles and sleeping with the A/C off until I caught up. But I’m paid a living wage, and many paramedics have to work multiple jobs to earn even that. Were I more fiscally responsible, I’d be far more secure, and that is something I aim to improve. But if The Borg kicked me out of the hive tomorrow, I’d have a job the very next day. For that, I am very thankful.

7. Boiled crawfish. Truly, it is the food of the gods.

6. The Sportsman’s Paradise. Yes, this time of the year feels like a sauna in southwest Louisiana. Mostly Cajun calls it “eighty by eight,” when the temperature reaches 80 degrees and the relative humidity reaches 80% by 8:00 am.

And next month, it’ll be even worse.

Yet, with a short drive in my truck, I can catch crabs, shrimp, speckled trout or redfish in the Gulf  – even now, with the oil spill -  swim or jet ski in one of dozens of placid lakes and rivers, or take my daughter to feed marshmallows to a living dinosaur.

I can duck hunt the coastal marshes or the flooded pin oak flats of north Louisiana, or find whitetail and feral hogs within walking distance of any place I’ve ever lived. Had I need to rely on hunting and fishing to feed myself and my family, I could easily do so.

5. Beer. Enough said.

4. Friends. It may surprise many of you to know that I am a solitary person. I don’t have many friends, and I don’t socialize much. But I have a few friends, brothers from another mother like JB and TOTWTYTR and Mule Breath, that even though we be separated by thousands of miles, I can call on and know that they will be there.

I have other friends, some of them yet unmet, that I have met through this wonderful thing we call the internet. Some of them are gun bloggers, and some of them are med bloggers, and some of them just lurk and read. Yet still we share a common sensibility, and my life is richer for having known them.

I have an ex-wife who, despite all the hurt that has passed between us – both my fault and hers – is still one of my best friends, and a trusted partner in raising the child we made together. We grew apart, but we never stopped caring, and she knows that I have her back.

And she has mine. For that, I am grateful.

3. Cajun culture. Many people assume that since I live in south Louisiana that I am a Cajun. Actually, I’m a redneck, and there is a difference between the two: both of them grow up having sex with the livestock, but those Cajuns tend to get emotionally involved.

All kidding aside, I am lucky to live among a people with such a love of food and family, and for whom music is in their very bones. They are the warmest, most hardworking people you will ever meet. They don’t just enjoy life down here, they devour it, and greedily suck the marrow from its bones.

And did I mention the food?

2. My country. She is much less free than the United States of my father and grandfather, and for my daughter I fear she will be even less so. We elect leaders who are unworthy of her shining promise, and we often take her for granted. Yet despite all her flaws, she is still the greatest nation on the face of the Earth, and the beacon of freedom for people the world over.

I am southern by birth, Louisianian by heritage, and American by the grace of God.

And today, on her 234th birthday, she may be showing a few scars, but she’s still a pretty grand old girl.

1. My daughter. Many parents are rudely yanked into adulthood by the responsibility of raising the child they created. All too many dodge the responsibility entirely.The rest of us muddle through on mistakes and good intentions, and fervently pray that the mistakes we make aren’t big ones.

All my life I have wanted a child of my own, and almost eight years ago, God granted my wish with a perfectly imperfect little creature that has taught me more about resilience and courage than I could hope to learn in a lifetime otherwise.

Some of us have parenthood show us who we really are. I got a child to teach me who I could be.

And for that, I will be forever grateful.

Episode 4 of the Confessions of an EMS Newbie podcast is up.

I suppose I'm the portly guy with the porn star moustache and the clipboard.

EMS newbie Ron Davis and I discuss the EMS approach to airway management and whether BLS maneuvers are effective at managing most airway problems, the value of thorough documentation as lawyer repellent, and how to make the most of your EMS ride along.

If you’re an EMS newbie who subscribes to the podcast, drop us a comment or question, and we’ll try to cover it in a future episode.

And if you’re an EMS newbie who doesn’t subscribe to the podcast, what the heck are you waiting for, an engraved invitation?

It’s Confessions of an EMS Newbie, the podcast where we discuss everything from sex in EMS to how to apply a nasal cannula without looking like an oxymoron. You should give it a listen!

Whatever you do, don’t get sick today.

If you absolutely must get sick, avoid your major teaching hospitals, because today is traditionally the day when the baby residents first spread their wings, and learn how to doctor on real patients.

Like you.

For the first time on their own.

*Shudder.*