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They Laughed, They Cried…

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… they held their lighters aloft and swayed rhythmically. A few women threw their panties on the stage.

You know, the usual.

Seriously, though, thanks to the guys from Lake Land College and Sarah Bush Lincoln EMS for inviting me to speak, and thanks to everyone who attended.

And thanks especially to my hosts, Steve and Shirley Sherwood. You guys know how to make a guest feel welcome.

(Even though your dog peed on me.)

Rock on, southern Illinois, you’ve been great!

Happy EMS Week

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In 1974, President Gerald Ford signed the original proclamation declaring November 3-10 as National EMS Week. The official week jumped around a lot in the beginning; first in November, then in September, finally settling for the 3rd week of May back in 1992.

This year's proclamation reads:
 

In every corner of our country, emergency medical services (EMS) practitioners are hard at work delivering hope and care to Americans in dire circumstances. In the face of chaos and tragedy, their steady hands provide vital, life-saving services, and their calm under pressure delivers comfort to neighbors in need. During Emergency Medical Services Week, we pause to offer our gratitude to these remarkable men and women, whose dedication is fundamental to our society's well-being.

In recent weeks, we have again seen the critical role EMS professionals play in times of crisis. When explosives went off at the Boston Marathon, EMS personnel rushed toward the blasts and, with selfless disregard for their own safety, immediately tended to the injured. Alongside countless volunteers and ordinary citizens, they demonstrated the very best of the American spirit — a spirit that EMS professionals display every day. My Administration remains dedicated to providing these courageous first responders, emergency medical technicians, 911 dispatchers, law enforcement officers, volunteers, and others throughout our health care system with the support they need to aid the American people in their darkest hours.

When Americans find themselves in times of crisis—from car accidents to national tragedies—our robust network of EMS professionals ensures that quality medical care is only moments away. This week, let us recommit to supporting EMS personnel and thanking them for their heroic contributions to our lives.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 19 through May 25, 2013, as Emergency Medical Services Week. I encourage all Americans to observe this occasion by sharing their support with their local EMS providers and taking steps to improve their personal safety and preparedness.

IN WITNESS WHEREOF, I have hereunto set my hand this seventeenth day of May, in the year of our Lord two thousand thirteen, and of the Independence of the United States of America the two hundred and thirty-seventh.

 ~ BARACK OBAMA

 

We've come a long way in a little over thirty years, but we are still in the awkward adolescence of our profession, still full of hope and swagger and dreams, with no clear idea yet of what we want to grow up to be.

So for these seven days in May, we focus our efforts on telling the world how great we are. For some of us, our supervisors and administrators will show their appreciation by handing out a few awards, maybe a grilling burgers for us one day this week. The local Emergency Departments may hand out a few pens or other schwag, maybe buy pizzas for the crews…

… and of course, the night shift will get what pizza remnants are left behind by the day crews, ED nurses and housekeeping staff.

But hey, it's all good. It's a celebration of who we are, and the service we provide, even though, personally, I think we're doing it all wrong.

And at the end of the week, we go back to being the healthcare system's afterthought for the other 358 days of the year.

If it sounds like I'm bitter, I'm really not. I love my job, even when it doesn't love me back.

Tonight, I'll talk to a group of EMS people as part of their EMS week celebration. I'll try to be funny, and educational, and inspirational, and hopefully I'll pull it off. This one holds a little more pressure for me, because it's not that often people show up at an event specificially to listen to me.

But one things always guaranteed to banish the butterflies is the knowledge that you guys are my tribe. The privilege of hanging out with EMS people is what keeps me doing it. I'm just a simple medic who writes a blog. I have no answers, no profound truths to share. But I do understand brotherhood, and I am proud you are part of mine.

Happy EMS Week.

Calling All Parents of Special Needs Children

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I'm putting together a new conference presentation on Children With Special Healthcare Needs, and I figured I'd do a little crowdsourcing to get the parents' perspective on EMS care for their children.

Specificially, what I'd like to know is:

  1. What is your child's medical history?
  2. What, in your view, are your biggest concerns for providing EMS care for your child? What do the medics do that you wish they wouldn't? What do you wish they would do that they don't?
  3. What suggestions would you offer for paramedics when interacting with you as parents, and assessing and caring for your child?
  4. For you parents of children that have one of the autism spectrum disorders, or some other neurosensory processing disorder, what special techniques and tips would you suggest for treating your child?

Please chime in with your comments. I think the parents' input can add a lot to my presentation.

Leavin’ On A Jet Plane

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Headed to Mattoon, IL for a speaking engagement on Monday.

The folks at Lake Land College and Sarah Bush Lincoln Hospital EMS are having me speak at their EMS banquet Monday night at 6:00 pm.

And apparently, my host this weekend will be providing the Four B's: Boating, Beer, Burgers and Brats.

Yeah, it's a tough life I live.

CEU credit for my talks will be awarded, and admission is free. If you're in the area, we'd love to have you attend!

Y'all watch the place for me while I'm gone. Please feed the cat, and the beer's in the fridge.

Here I Come, Illinois!

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For you Illinois EMS types (and anyone else), I'll be in Mattoon, IL to kick off EMS Week.

I'll be giving a (hopefully) humorous and inspirational talk hosted by the nice folks at Lake Land College at 6:00 pm, May 20.

Admission is free, and CEU credits will be awarded! Spread the word to your agencies, friends and colleagues!

Be there, or be a geometric shape with four right angles and four equal sides!

For You EMS Types…

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… Gene Gandy and I have a new article in EMS World Magazine.

Gotta give props to Gene, who did most of the heavy lifting in this one.

Gene Gandy and Ambulance Driver, deconstructing EMS one myth at a time…

For Mother’s Day…

4 comments

… a repost for you.

And if you can hear me, Mom, have a happy Mother's Day.

**********

A Love Song For Joyce

 

There are few things more dismal than an ICU waiting room. People gather in familial clusters, keeping vigil against the specter of death. Books and blankets abound, snacks and cups of stale coffee cluster on tastefully appointed end tables, and the soon-to-be bereaved seek to mask their uncertainty and seek diversion in months-old editions of news magazines. Huddled together for support and security, they share the fear among them, as if spreading it around lightens the collective burden.

But there is always enough fear to go around.

And here I sit in an ICU waiting room, keeping my own vigil. Privacy is something I can only wish for, even here. Some of these familial clusters I have met before, in different circumstances; living rooms, bedrooms, breakfast nooks. Their fear was more visceral, more raw then, not the kind of settled-in dread they’re feeling now. Some of them come over to say hello, perhaps to thank me, only to realize I’m here for my own personal reasons, and so they beat an embarrassed retreat back to their own clans. Others keep their distance, looking at me with accusing eyes.

I sit here surrounded by the members of my family, alone yet not allowed the comfort of solitude. I am not one of these people any more. I divorced myself from them long ago. My sisters are here, and their families. My oldest sister is sobbing piteously, a crying jag that has lasted for three solid days. Sometimes it seems as if she has been crying for most of her forty-four years. She has always been ruled by her emotions. My father is here as well, looking forlorn and feeble. He sits there next to my aunt, lost in his own private Hell. His hands sit limply in his lap, trembling with Parkinson’s disease.

Inattention tremor, my education and training tells me. Inattention tremor, bradykinesia and hypophonia, all caused by loss of dopamine-producing cells in the substantia nigra. Replacement therapy with Sinemet or similar drugs will only slow the progress, not cure the disease. Eventually, he’ll become bed bound and rigid, and the disease will settle a blank mask over his features.

A different part of my brain tells me that he’s not there yet, because the fear on his face is palpable. He’s wondering what he’ll do once Mom is gone. That part of my brain is wondering where my Daddy went, the Daddy of my childhood, the Daddy that used to quiet my fears. That man isn’t here any more, either.

I want to go to Dad, to comfort him in some way, but doing so would only bring on more crying, more unwelcome histrionics from my sisters. I want to get Dad out of here, if only for a little while, but that will have to wait until Terry gets here, if he indeed gets here in time.

My mother is dying.

My mother has been dying for thirty years, if you listen to her talk. Throughout my childhood, it was her children who were killing her. Occasionally, it was her grouchy husband. Other times, it was life in general. Mom was an extraordinarily persecuted woman. She was, among other things, a Professional Martyr.

But this time it’s for real. My sister Sheri had called me a month ago, breaking the news. At the time I had chalked it up to Sheri being Sheri. Like I said, she has always been ruled by her emotions. Genetic traits in my family are strengthened with each successive generation, not diluted. In the case of fucked up X chromosomes, my oldest sister rolled snake eyes in the DNA craps game. Every bad trait of Mom’s, she inherited in spades. Mom was worse than Grandma.

I suppose we should be thankful Sheri has birthed only boys. A daughter would be too frightening to contemplate.

But a second call from Sheri three days ago made it real. Aside from being an unwelcome second phone call in a one-year span, it also bore the unsettling news that Mom had been admitted to the ICU.

Okay, so apparently a doctor also thinks Mom is sick. Sick enough to need intensive care.

I walked into the ICU maybe 12 hours after Mom had been admitted following her lung biopsy. The Missus and I walked right past the waiting room, avoiding my family gathered there. I knew the security code to get into the ICU, so I let myself in even though it wasn’t normal visiting hours.

“Well hello there, AD!” one nurse greeted us cheerily. No one even questioned my presence there, despite the fact that I was not in my uniform. Several nurses asked about upcoming ACLS classes. Everyone was perky and cheerful.

“Actually, I’m here to see about my mother,” I told them. “She’s in Bed Six.”

“Oh. I’m…I’m sorry. I didn’t connect the names,” the charge nurse stammered, embarrassed. No one else said anything, and an awkward silence followed.

“Can we go in and see her?” I asked politely. “I know it isn’t visiting hours…”

“No, go right in,” the nurse interrupted. “I was just going to bring her a popsicle, but I’ve got some charting to do here…you can just bring it to her yourself. Take all the time you need.”

If it can make an ICU nurse somber and solicitous, it’s bad.

“Well, look who’s here!” Mom greeted me with a grin. “My prodigal son and my favorite daughter-in-law! How long has it been since I’ve seen or talked to you, five years?” Despite the hearty greeting, her voice was harsh and strained, muffled by the oxygen mask.

More like three years, Mom.

“How ya’ doing, Mom?” I asked softly, pulling a chair next to her bed. I stole a glance at the telemetry monitor mounted above her bed.

Atrial fibrillation. Since when did she have atrial fib? Pulse oximetry is only 84%, despite the non-rebreather mask. BP only 90/50.

“I’m dying,” she said matter-of-factly. “I won’t make it out of this hospital. You kids have finally killed me.” The last sentence delivered with a wink and a grin.

“Want something cool to wet your whistle, Mom?” The Missus asked tenderly, sitting beside her on the bed and unwrapping the popsicle. Mom nodded weakly and The Missus gently slid the mask up onto her forehead and fed her tiny bites of the popsicle.

She leaned close to Mom, winked mischievously and whispered, “Remember the first time I ever saw you eat a popsicle?”

Mom’s eye snapped open wide and she chuckled. The laughs began as the big, rolling belly laugh that I knew so well, and ended with painful, wracking spasms of wet coughing. A suction unit gurgled quietly in the background, and I could see a chest tube draining bloody pus into a collection chamber.

I remember that day. It was maybe thirty minutes after you met her for the very first time. She was the first, and only, girlfriend I had ever allowed to meet my parents, and then only because she insisted that my parents be a part of our wedding. In ten minutes you were cackling like old girlfriends, and then you proceeded to show The Missus how a wife pleasures her husband, using a popsicle to demonstrate. The Missus had been shocked at first, then you both dissolved in a fit of giggles. She told me later that now she knew where I had inherited my sense of decorum and my internal censor.

“I won’t be doing that any more, I’m afraid,” Mom had answered hoarsely after the coughing fit had passed. “I’m too old for that, anyway.”

“What did the doctor say, Mom?” I pressed. “Sheri didn’t make much sense when she called me, and she doesn’t understand medical terminology.”

“He said I’m dying,” Mom repeated, as if I were still a child. “I believe his exact words were ‘advanced pulmonary fibrosis of a particularly aggressive nature’ or some such bullshit.”

“Did you get a second opinion?” I asked desperately. “Maybe another doctor might – “

“Charge me money to tell me I’m dying, but using different language? No thank you. I know I’m dying. I’ve felt it for the past month.”

“Maybe another doctor somewhere else, Mom,” I argued. “Somewhere with better hospitals. I can arrange an ambulance to take you to Houston – some of the best hospitals in the country not eight hours away. Hell, I’ll go with you myself…”

Listen to me.” she scolded. “I have less than 30% of my lung capacity left. I’m taking steroids in doses that would kill a horse, they have my stomach so irritated I could shit through a screen door, and I’m only getting worse. So grow up and accept it. I. Am. Dying. I’ve already signed a DNR, so it’s out of your hands.”

“You’re giving up, Mom. Don’t give up. Not while you’re still strong enough to bitch at me like I’m a five year old.”

“What should I do,” she coughed, “Wait until I’m too weak to make my wishes known, and rely on my kids to make the right decision? You might be perfectly willing to let me die, but Sheri won’t. You know it and I know it.”

I said nothing. She was becoming angry, and all too many of our conversations for the past twenty years have been angry. I just held her hand and sat by her bed until she dozed off, and then The Missus and I slipped quietly out of her room.

I made my entrance into the ICU waiting room, greeting relatives with whom I felt no kinship. I was struck by how frail and tiny Dad felt when I hugged him. I hugged or shook hands with everyone, pretended to be interested in family gossip, and prayed for it all to be over soon so I could get away from these people.

I settled into my own isolated niche with The Missus at my side, who was wise enough to leave me alone with my thoughts. She stayed next to me, squeezed my hand occasionally, and allowed me my silence.

Later that first day, Bodie, Mike and Reggie showed up. I was comforted by the fact that my family was there – the family I had chosen. My wife, and my partners. They spent the next three days keeping vigil with me, missing work and family commitments, losing salary money. God I loved those guys.

I spent those days sorting through my feelings for my mother, and by extension, my entire family.

You see, as my mother went, so went our family.

My father worked long hours at his small business when I was growing up. He always came home tired and cranky. In my teen years, we rarely got along.

My mother was the one who taught me how to catch a baseball. My Mom taught me how to ride a bike. My Mom taught me how to swim.

My Mom also taught her children that mediocrity was acceptable, and that excuses were more valuable than doing the work. She taught us that our failures were always someone else’s fault, and in so doing, taught us how to repeat those failures for the rest of our lives.

I made straight A’s throughout school. When I was a kid, Mom used to reward me for those A’s – a dollar here, a quarter there, more when Dad’s business prospered – until one day in the fourth grade when the rewards stopped. She needed the money to reward my twin sister for B’s and C’s. Her reasoning? “It comes so easily for you, and you don’t need the motivation.”

She was right about that. There would soon come a time when everything I did was entirely self-motivated. I craved neither my mother’s approval or even her acceptance.

She taught us how to laugh. There was much joyful giggling in my childhood.

She also taught us emotion without reason. That lesson crippled my sister Sheri, who learned it all too well.

My Mom taught me how to stand up to a bully. When I was eight, the neighborhood bully beat me up and stole my new Boy Scout knife. It wasn’t the first time he had beaten me up. I still bear an inch-long scar on my right temple as testament to his cruelty.

“You go over to his house, and you get that knife back, or you will deal with me,” Mom had ordered. “You better decide who you’re more afraid of.”

I marched tearfully over to the bully’s house, knocked on his door, and dealt out the worst fear beating I’ve ever administered. How bad was it? I beat a ten-year-old unconscious, that’s how bad it was. But I got my knife back, and I was never afraid of David Young again.

My Mom was also the one who invited that enemy into our home and gave him the opportunity to steal my knife in the first place. She invited him to join our Cub Scout den, and this after he had left me with seven stitches in my temple.

My affinity for people and my love of medicine, I got from Mom. I inherited those gifts from her. She was a fifty-year-old housewife with a GED who decided to go back to school and become a nurse. I used to proofread and edit her essays when she was in nursing school.

I learned CPR by playing hooky from junior high school and tagging along with Mom to LPN class. The nursing students used me as a practice assessment dummy for an entire summer.

When I was a high school sophomore in 1984, I used that knowledge to help revive a man who had choked and arrested at a hotel restaurant. It was my very first save, and the very first time I saw paramedics in action.

When Mom took her licensing exam that year, back in the days before electronic testing, she got a perfect score. One of only eight people to have ever done so in this state, I might add.

Mom also taught me the value of sarcasm. Our car stalled once at a red light in rush hour traffic. A jerk in the car behind us kept leaning on his horn while Mom vainly tried to start the car. Eventually, she got out, walked back to the man’s car and knocked on his window.

“Sir, I was wondering if you could help me,” she said politely, in her best helpless Southern belle voice. “You see, my car won’t start…and I was wondering…if you might come up and see if you can get it started…while I sit back here and honk your fucking horn for you.”

The guy apologized for being an ass, helped Mom push the car off the road, and stayed there with us for thirty minutes in the July heat until we got the car started.

Mom could also be a profane, shrieking harpy who could be heard cursing like a sailor throughout the entire neighborhood.

She rented a house trailer to a black woman in the 70′s, and then stood up to our white neighbors who demanded that she terminate the lady’s lease.

When I was seven, she caught me with a Chick O Stick I had stolen from the neighborhood grocer. She marched me back down there and made me confess my crime and promise to sweep his store after school for a week to make restitution.

When I was fifteen, I also watched her purloin the seat from a toy tractor at Wal Mart, because the one she had bought for my nephew was missing the same part.

My cousins always adored her because she was the crazy Cool Aunt who let them get away with stuff.

To her kids, she’d deal out syllable whippings when we misbehaved. Ever had a syllable whipping? Imagine someone grabbing you by one arm, and whipping you with a switch with the other hand, all while you run in a circle, desperately guarding your hindparts and trying to get away. She’d swing with every syllable, and when Mom was mad, she had a bad tendency to get long-winded.

Many was the time I ran in a circle through the disciplinary equivalent of Hamlet’s Soliloquy – “Don’t-you-e-ver-do-that-a-gain-do-you-hear-me-you-lis-ten-to-me-while-I’m-talk-ing-to-you-I’m-your-moth-er-damn-it-and-I-will-be-o-beyed…”

There were also many times where I had to intervene for fear she’d beat my demonic twin sister to death.

She told riotously funny jokes until we‘d collapse in giggle fits, laughing until our stomachs hurt.

She’d also sit alone in the dark for days on end, eating white bread and staring vacantly at soap operas. And some days, she’d contemplate suicide.

My mother was the Barbara Mandrell of psychiatric disorders. She was bipolar before bipolar was cool.

She’d let my twin sister get away with murder, because she was a Troubled Child.

She also had an aggravating tendency to walk in at the culmination of hours of torture at the hands of my twin sister, at just the precise moment I’d finally snap and retaliate.

“Oh, so you two wanna fight, huh?” she’d muse. “Well, I’ve got the cure for fighting. When you get done, you won’t wanna fight any more, believe you me!”

She’d then proceed to the hedge and gather three diabolical switches, test them for proper flexibility and tensile strength, and then hand one to each of us.

“Go ahead and fight,” she’d exhort us. “Work out all that aggression. And if you don’t fight, you get a whipping from me.”

I’d spend the next five minutes getting lashed by not one, but two psychotic females.

She would mortify me in front of my friends with her mouth and her antics…

…but they kept coming back because I had the coolest Mom in the neighborhood.

She taught my Cub Scout den how to dance. We were at that socially awkward age where you first start to notice girls, but still haven’t figured out how to approach them. We had a school dance, and all of us were stressing because none of us knew how.

“Dancing is easy,” Mom had said, “just pretend you’re drying off after a shower.”

“Huh?” said a dozen eight-year-old boys.

“You just do The Towel,” she explained, and then proceeded to demonstrate, to my utter mortification. My five-foot-nothing, 300 pound mother grabbed an imaginary towel, stood up and showed us how.

“You pretend you’re drying your lower back, like this,” she said, while shimmying her hips.

“Mom, please don’t…”

“And then you pretend you’re drying your shoulders,” she said, striking a disco pose straight out of Saturday Night Fever.

“Okay Mom, I think we get the idea…”

“And then you dry between your legs,” she’d say, doing a pelvic thrust.

MOM!”

Mom was also a noted philosopher, quoted by no less an American luminary than Paul Harvey:

Joyce in Louisiana writes:

“I’m just a simple woman, unable to grasp the nuances of science, geopolitics or world affairs. We are embroiled in a war in Vietnam that I do not understand, and we are impeaching a President whom I no longer trust.

Yet this I do know: Why, in a country that has been able to land a man on the surface of the moon, must we continually be forced to purchase hot dogs in package of ten, while hamburger buns come in packages of eight?”

Who says all the world’s great philosophers are dead?

My Mom said it first, folks. And she changed the world. You can now get hot dog buns in packages of ten.

Three years earlier, my Mom took me out for dinner on my birthday. We didn’t talk much even then, but after dinner she took me for a drive. She had something to say.

She told me that night that my twin sister and I were not our Dad’s biological children. Our father was her teenage sweetheart, a man whom she had an affair with after she married Dad.

My twin sister had known for fifteen years. My entire family had known, except me. And now she wanted me to build a relationship with this man.

“There’s no hole in my life he needs to fill,” I told her nastily. “I know who my father is – the man who fed me, clothed me and disciplined me when I needed it. The man who has been here for thirty years. Don’t expect me to feel some kinship with a man just because he fucked another man’s wife over thirty years ago. I don’t even feel a kinship with you.”

We didn’t speak again until that moment by her hospital bed, three years later.

I spent the next three days reliving every memory of my childhood – good and bad. I found some forgiveness in my heart, and mom granted me her own. In the balance, the good times outweighed the bad.

The day before she died, she had my Dad and her teen sweetheart to her bedside, and made them reconcile their differences. She told them she wanted the only two men she had ever loved to find some common ground with each other, to harbor no bitterness after she was gone. Because they both loved her, they agreed.

Mom grew steadily weaker, but kept her sense of humor until the very end.

In one moment when we thought she was too far gone to hear, Terry and I stood on either side of her bed holding her hands, both of her estranged sons come back home. Terry whispered, “Mom, I sure wish I could switch places with you.”

Mom cracked one eye open and whispered back, “Yeah, I wish you could switch places with me, too.”

Those were the last words I heard from her before she died.

After her funeral, The Missus and I took her nieces skiing on the lake. The eldest of them was celebrating a birthday, and I couldn’t see canceling a birthday party. The kids deserved their fun.

“Are you sure you’re okay with this?” The Missus had asked me as we lay there on a beach towel, basking in the sun.

“Yeah, I’m okay with this,” I assured her as I watched the kids trying to dance to some hip hop music I’d never heard before. “Mom would roll over in her new grave if I canceled a kid’s birthday party.”

You’re sure?” she asked, squeezing my hand.

“Yep, I’m positive,” I replied firmly, getting to my feet. “and I don’t know about you, but I’m tired of watching those spastic nieces of yours try to dance. You really are some countrified white girls. Somebody needs to teach them how to do The Towel, and I’m just the man to do it.”

Overheard On The Bolance

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AD (reading directly from dispatch notes on our data terminal): “Patient is a 34-year-old female who swallowed a handful of Flintstones vitamins, and now feels as if some of them are stuck in her throat.”

Partner: “How ironic it would be to choke to death on vitamins…”

AD (continuing): “Patient states she is no longer choking but her throat is still scratchy.”

Partner: “… and why is a woman her age eating Flintstones vitamins? Why not One-A-Day, or Centrum?”

AD (sagely): “I’ll bet it was a Dino. You know, the long tail. Gets hung up.”

Partner: “And why call an ambulance for it, fer Chrissakes?”

AD: “Ours not to reason why, son. Ours to simply head that way, and don’t spare the horses. A life hangs in the balance.”

Overheard On The Bolance

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Gas station clerk: “He’s drunk, and trespassing. When I asked him to leave, he made like he was going to sit on one of the concrete pump barriers, pretended to fall off of it, and now he won’t stop screaming.”

AD: “What’s your name, sir?”

Patient:“AAAUGH! AAAARGH! WOOOO! GAWD HAVE MERCY!”

AD: “Luther, is that you?”

Patient (nodding) “WAAUGH! LAWDY JESUS HAVE MERCY, I’M DYIN’! AAARGH, THE PAIN!”

AD: “Howdy, Luther, long time no see. Didn’t recognize you with the beard. Where you hurtin’?”

Patient: “WAAUGH, MY HIP! AARGH, THE HEARTBREAK OF PSORIASIS! LAWDY JESUS LAWDY JESUS LAWDY JESUS!”

AD (taking him gently by the arm): “Let’s get you on the stretcher and on the way to the hospital, Luther.”

Patient (angrily pulling away): “DON’T FUCKIN’ TOUCH ME! AAAUUGH!”

AD (tiredly): “Okay, Luther, your choice. Get on the stretcher if you want to go to the hospital. You’ve got ten seconds, and then we put you on the stretcher.”

Patient: “OOOHH, THE HUGE MANATEE!”

Cop (losing patience): “Buddy, you either get your ass on that stretcher right now, or I’ll put you on it myself, and I promise I won’t be as gentle as these guys.”

Patient (complying, with no evidence of limp or inability to bear weight): “WAAUGH, THE AGONY!”

AD (to partner, before closing the rear doors): “Luther T. Malingerer, 1125 Fydalla Ho Expressway, DOB 4-1-1955, history of alcoholism, hypertension, and status dramaticus.”

Cop (wryly): “Frequent flier?”

AD: “Actually, I haven’t seen him in three years. Used to live with a 18-year-old prostitute, get drunk and mad at her, and punch the wall. Must have broken his hand about twenty times. I only recognized him by the way he carries on.”

Cop: “When you can recognize your patients by the way they scream…”

AD (sighing): “… it’s time for a change of scenery. Or a change of patients.”

Finally, A Reality Show I Can Watch!

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My buddy Jeff B comes up with a fine idea.

Now, how can we pitch this to the networks?

Might As Well Join In

3 comments

Overheard At The NRA Annual Meeting

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Vendor: “The Blastomatic 3000 is the ultimate solution to your tactical needs. It is ideally suited to take down a knife-wielding mugger at bad breath distance or a Hadji at 1000 yards. It slices, it dices, and it’s made from 100% distilled hippie tears.

Ambulance Driver: “What’s the chance of me getting one for T&A for a month or so?”

Vendor: “…”

TOTWTYTR (apologetically): “He means ‘T&E’. You’ll have to forgive him, we don’t take him out in public very often.”

AD: “Why do people act so offended when I mention tonsils and adenoids?”

Notes From The NRA Annual Meeting

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Conservative estimates of roughly 70,000 attendees, and 620 vendors. Attendee count may be as high as 100,000.

Our President would have us believe that 90% of Americans support expanding background checks, yet only five people could be found to stage an anti-gun protest. Seriously, they were well outnumbered by the press filming and interviewing them, and the small gaggle of NRA members engaging them in polite debate. Some of our gunblogger friends, namely Breda and Alan, left them slack-jawed and stammering, unable to respond to a logical counter-argument to their talking points.

Meanwhile, at the show:

  • Everybody -and I mean everybody - is making AR15 platform rifles these days. I saw substantially more brands and vendors selling AR15s than at last year's meeting. Another trend I'm noticing is makers positioning the AR15 as a hunting and sporting arm in their advertising. Everywhere you looked, their was some photogenic model bedecked in camouflage wielding an AR15 in the woods. Smart marketing? I think so. Broadening the gun's appeal can't hurt.

While most vendors are still struggling to meet demand, prices seem to have dropped from "OMFG, are you friggin' serious?" to a mere "Say, that's a little steep."

Also, Black Rain Ordnance makes some schweeet lookin' AR15s:

 

  • I coon-fingered a Smith & Wesson Performance Center M&P, with a lightened and crisper 4.5 pound trigger and a supposedly improved trigger reset. As far as TOTWTYTR and I could tell, the only difference between that and the standard M&P was the lightened trigger pull. Frankly, the trigger reset still sucks. I mentioned as such to the rep, and inquired whether they had considering just licensing Apex Tactical trigger parts for the Performance Center guns. That suggestion was met with a disdainful sneer and a backhanded comment about inferior aftermarket conversions.

I've got news for you, Mr. Performace Center Director. Apex Tactical makes better trigger parts for your guns than you can.

  • Looks like I'll have some T&E guns for Blogorado this fall, including a sweet custom 1911 and a hot new rimfire varminter. More news to come as negotations continue…
  • Nothing says "coexist" like a restored VW Microbus fitted with a GE 7.62 minigun. Bravo, Magpul, Bravo.

The hula girl wielding an AR15 was a nice touch.

  • Anybody familiar with the Shooter's Arms Corp 1911 pistols imported from the Philippines by American Tactical Imports? This one is their Thunderbolt model:

From what I saw, it was nice and tight, trigger was crisp and adjustible. Other features included forward slide serrations, Picatinny rail, ambidextrous safety, extended slide release, fully adjustible sights, checkered mainspring housing and front strap, bobbed hammer, beveled magwell, and extended beavertail, all for a MSRP of $875.95. For $25 more, you can get the Enhanced version with ported slide and barrel.

Didn't look like the feed ramp was polished, and the thing has a damned full-length guide rod that makes baby JMB cry, but the interior of the gun seemed devoid of obvious tool marks, as least as far as I could tell without field stripping it.

It likes like a nice gun for the price, but the proof is in the shooting. Anyone with direct experience with them, chime in with your comments, please.

They also had a nice double stack compact 1911 with 12+1 capacity, the Fatboy:

 
The finish was not gorgeous, but it looks worse in the photo than it really was. MSRP was $699.95.

Headed out to the Gunnie Prom right now, where hopefully I will find food, booze and good conversation in abundance. More to come tomorrow!

NRA Annual Meeting

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Just checked in to the World Congress of Bitter Clingers NRA Annual Meeting in Houston, picked up my press credentials, and will be headed to the show floor in a few moments.

Picked up TOTWTYTR at the airport yesterday and took him to the trap range for a brief wingshooting tutorial. A few things became immediately apparent:

  1. Wobble trap is much more challenging than regular trap.
  2. Wobble trap with a 40 mph wind at your back is really challenging.
  3. I need to pattern the new Remington 887 as soon as possible. I know it's a poor craftsman who blames his tools, but not only couldn't I hit the broad side iof a barn with that gun, I doubt I could have hit the ground with it if I dropped it. Not only did I not cover myself in glory in those two rounds of wobble trap, I turned out quite possibly the worst shooting performance in my entire life. It messed with my head so much that, by the time I switched to my 870, I couldn't even hit easy shots with that. To add insult to injury, I lost the front bead on the 887 before I left the first station. Remington is going to hear about that, and if this gun patterns as poorly as I suspect it will, I'm sending the damned thing back.

Last night, a crowd of us hit Ragin Cajun for crawfish and seafood. Kelly's Theorem of Cajun Restaurants states, "Ye shall know them by their gumbo."

If the gumbo is so thin you can see through it, or loaded with enough cayenne to make it unpalatable, the rest of the meal is going to suck. I'm happy to report that Ragin Cajun does it right. Not only was the gumbo good, the oysters were huge and salty, and the crawfish were good, if a bit on the small side. Lies were told, stories were swapped, and a good time was had by all.

I haven't laughed so hard in a looooong time.

 

I'll post more later today, but in the meantime, look for my pics and updates on Twitter (@AmboDriver), or just search for my posts under the hashtag #nraconvention.

 

Miscellaneous Musings

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  • I'll be at the NRA Annual Meeting in Houston from Thursday through Sunday. I'll be picking up TOTWTYTR from the airport at noon, and hopefully we'll get to do a little skeet shooting at American Shooting Center to prepare him for Epic Duck Hunt 2013. Anyone who'd like to join us, just drop me an email here or message me on Facebook.
  • With the installation of a red dot sight on her AR15, KatyBeth has rediscovered her love of shooting. Now that she can whack a target with minimal help from me (other than steadying the shooting sticks), she's digging it, big time. A couple of weeks ago, she asked me for a pistol for her birthday. So last week, when The Girlfriend and I were out shopping, I bought her a Walther P22 with laser sight and took her shooting with it as soon as we got home.

Yeah, I know Katy's birthday isn't for another six months, but who can resist a smile like this?

She needs work on, well, pretty much everything, but she was able to ventilate a 12-pack of soda cans, shooting one-handed. Most importantly, she did it by herself. We'll have plenty of time to work on grip and trigger squeeze later.

So, come November, I'll just have to get her another birthday gift, like, say, a brick of .22 LR. Hopefully, it won't cost as much as the pistol by then.

  • While we're bragging upon my kid, she accompanied me to my last speaking gig at the Missouri ICE Conference. This is a 10-year-old kid, and she endured a 12-hour drive, each way, and sat through every one of my talks without a peep. Hell, she even took notes better than most of my EMT students, and charmed the conference organizers. I wish I could have seen the look on her 4th grade teacher's face when Katy came home and asked her, in all seriousness, "So, I know what you teach us in the cognitive and psychomotor domains, but what suggestions would you give for teaching in the affective domain?"
  • Most people want to be liked, and I am no exception. But if I paid attention to some speaker evaluations, I'd be convinced that I am A) an arrogant bastard, B) possessed of a totally inappropiate sense of humor for an EMS instructor or conference speaker, C) a foul-mouthed buffoon, D) an idiot with nothing educational to offer, or E) all of the above.

    Instead, I console myself with the fact that those evaluations are outnumbered 25:1 by those who like what I do.

    And judging from the handwriting and verbiage, a small handful of attendees who hated my guts and vowed to never attend another lecture I ever presented… attended all six of my lectures. I guess some people are just gluttons for punishment.

  • I think I'm going to like my new Remington 887. Hopefully, I'll be able to post a new range report on it after tomorrow, but my first impressions are generally positive. My only beef is that the action isn't nearly as smooth as my 870's, but nothing will fix that but time and lots of shooting. Although perhaps, I can speed up that process a bit with the application of some Clover valve-lapping compound to the action rails. It works pretty well to smooth up a stiff bolt-action rifle, so I see no reason why it shouldn't do the same for a sticky pump shotgun.

Originally, the plan was to convert my 870 into a home defense shotgun, but I can't bring myself to modify a hunting gun that points and swings so naturally. Instead, I think I'll have it refinished in Cerakote, and I'll send my Browning BPS off to have it converted to a home-defense shotgun. The dearth of aftermarket tactical accessories for the BPS will make that an extensive custom gunsmithing job, but luckily I know a good one who can do the work on the BPS and the 870.

That is, if I can liberate my 1911 from him first…

 

 

For You EMS Types and EKG Nerds…

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Overheard at the Bolance Station

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Day Medic: “Dude, it’s 6:20! Best get started on your beauty regimen, because I’m ready to get up outta here!”

AD: “Fear not, Ma’am. I shall be in uniform and ready to save lives at the duly appointed time, for my beauty regimen does not take long.”

DM (looking dubious): “…”

AD: “When you start with a baseline of beautiful, all that is left is polishing the masterpiece. And no, that’s not a euphemism for masturbation… but it should be.”

DM: “I think I may be sick.”

Overheard In The Nursing Home

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Nursing Home Nurse: “Her lung sounds are really diminished and I can’t get an oxygen saturation on her. She needs to go to the ED for evaluation.”

Ambulance Driver: “Howdy, young lady. How you feelin’ tonight?”

Patient (pleasantly): “Just fine, young man. I’d really rather go back to sleep than go to the hospital.”

NHN (patronizingly): “You have to go to the hospital, sugar. You’re sick.”

Patient (bewildered): “I don’t feel sick!”

AD: “No problems breathing at all?”

Patient (taking a deep breath to demonstrate): “Nope, fit as a fiddle!”

NHN: (forcefully): “You have to go to the hospital.”

AD: “Actually, no, she doesn’t.”

NHN: “Her lung sounds are severely diminished and I can’t even pick up an oxygen saturation!”

AD (peering more closely at the nurse): “Uh, Ma’am? You think that might be because she’s wearing dark nail polish and your stethoscope is missing its diaphragm?”

NHN:SHE HAS TO – huh? Oh… so it is.”

AD (to patient): “Sign here, dear. Have a good night.”

The By Gosh and By Gum Club

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When I trained retrievers professionally, I used to get a steady stream of business from members of the By Gosh and By Gum Club, whose club motto went something like, “By gosh, it seemed like a good ideer, so by gum, that’s the way I done it.”

They were the guys who thought the way to introduce their Lab pup to gunfire was to take him out to the gun range and tie him to the truck bumper while everyone shot, or throw their pups in the lake to teach them to swim.

God bless those guys, because I made a fair bit of money teaching their traumatized pups not to fear gunfire or water.

It was pretty rough on the poor dogs, though. And sometimes, the damage was too great to repair.

In those cases, a few of the club members dropped their memberships and looked for better ways to do things, but many just blamed the failure on their dogs or the trainer they hired to clean up their mess, and went on to traumatize other dogs and plague other pro trainers.

It occurs to me that the By Gosh and By Gum Club has chapters in every EMS system in the country.

By gosh, that’s what was in the textbook, so by gum it must be right.”

What they never realize is that a whole bunch of that textbook was written by an earlier generation of the By Gosh and By Gum Club.

“By gosh, it stands to figger that a feller with a broke neck ought not to move it, so by gum we’ll strap ‘em to a board to make shore that don’t happen.”

Some of them learn better and drop their club membership, but others will continue to do things the same way the rest of their careers, ignoring every piece of evidence that shows theirs was the wrong way.

Still just as rough on the patients as it was on the dogs, though.

Idle Observations From The Bolance

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Wouldn't it be nice if response times were like cellular rollover minutes?

"Yeah, boss, I know it took us three hours to get to Frankie Frequent Flier's chronic gout pain, but you see, there was a Mel Brooks movie marathon on AMC, and we had a dispatch-to-balloon time of 34 minutes on that acute myocardial infarction last week. So we're good, right?"

It would take a better dispatch and triage system than might as well just flip a coin MPDS, but if we could come up with some realistic response time standards for the truly time-sensitive emergencies, we could provide quality EMS with half the staff at twice the salary, and subcontract out all the Alpha and Omega calls to the local cable company's call center:

"What's that, Sir? You've been bitten by a brown recluse spider? Hold one moment, Sir, your call is important to us… [insert eleven minutes of Barry Manilow and Neil Sedaka music]… Sir, are you still on the line? Looks like we can get a BLS ambulance to you next Tuesday, between the hours of noon and 5:00 pm."

When my legion of flying monkeys completes my quest for world domination, that's the way we're gonna do it.

These Are Your Protocols? How… Quaint.

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In the recent mass stabbing at Lone Star College in Harris County, TX, fourteen people were transported to local hospitals by EMS. A blog reader pointed me to the CNN.com story on the event, and the associated photo gallery. There are a couple of video clips, as well. You EMS folks, go look at the photos and video, and come back and tell me what's wrong with those pictures.

I'll wait.

 

Okay, we all back?

If you answered, "Why are those penetrating trauma victims spinally immobilized?" you win the cement bicycle and a two-night's stay at Buford's Bed and Breakfast, Tire Repair and Oil Change in that lush vacation destination of LaDonia, TX.

Now, with the caveat that every medic is an expert about some other medic's call, I wonder if the ambulance crews who responded are aware of the research that discourages prehospital immobilization of penetrating trauma victims:

We performed a retrospective analysis of penetrating trauma patients in the National Trauma Data Bank (version 6.2). Multiple logistic regression was used with mortality as the primary outcome measure. We compared patients with versus without prehospital spine immobilization, using patient demographics, mechanism (stab vs. gunshot), physiologic and anatomic injury severity, and other prehospital procedures as covariates. Subset analysis was performed based on Injury Severity Score category, mechanism, and blood pressure. We calculated a number needed to treat and number needed to harm for spine immobilization.

In total, 45,284 penetrating trauma patients were studied; 4.3% of whom underwent spine immobilization. Overall mortality was 8.1%. Unadjusted mortality was twice as high in spine-immobilized patients (14.7% vs. 7.2%, p < 0.001). The odds ratio of death for spine-immobilized patients was 2.06 (95% CI: 1.35-3.13) compared with non-immobilized patients. Subset analysis showed consistent trends in all populations. Only 30 (0.01%) patients had incomplete spinal cord injury and underwent operative spine fixation. The number needed to treat with spine immobilization to potentially benefit one patient was 1,032. The number needed to harm with spine immobilization to potentially contribute to one death was 66.

(emphasis mine)

It would seem that, given two groups of penetrating trauma patients, well-matched for mechanism, injury severity scores and blood pressure, the act of strapping a patient to a rigid board makes them twice as likely to die as simply placing them on the stretcher.

By performing prehospital spinal immobilization, you will harm or kill 16 penetrating trauma patients for every 1 it will potentially benefit.

I say "potentially" because there is still zero evidence that spinal immobilization to a rigid board does any good at all, even for people with broken necks.

Either there's a whole bunch of people upstairs wearing halo devices, or we're boarding way too many people.

 

Cy Fair Volunteer Fire Department, the primary response agency at the incident, is a combination paid/volunteer department that serves the Cypress and Fairbanks communities of unincorporated Harris County, TX. With over 500 members (200 paid) and 12 stations, they bill themselves as the United States' largest volunteer fire department.

In other words, this ain't some rooty-poot, half-assed, mom-and-pop ambulance service firmly stuck in the 1980's.

No, this is a major metropolitan EMS system firmly stuck in the 1980's.

Now, I'm going to give the Cy Fair medics the benefit of the doubt. Plenty of good medics are stuck in systems with ancient, outdated protocols that force them to do ineffective and potentially harmful stuff to patients every day. It is what it is.

Some might even say that it's easy to have liberal, progressive protocols at a smaller department. When you only have a couple of hospitals to convince, and a medical director who knows all his crews personally., training and education are a fairly simple matter. I knew that to be the case at The Little Ambulance Service That Could, when I wrote what were, at the time, the most progressive and advanced prehospital treatment protocols anywhere in our state. We could do anything short of opening the cranial cavity without direct medical orders, and we were good at what we did.

In 1997, after the Airway Call From Hell, I did a weekend's worth of research and developed an RSI protocol and airway management training program for that service. We implemented it a week later, and were using it for nearly a year before the state got wind of it, and shat their bureaucratic pants. Ultimately, after a couple of years percolating through the bureaucracy and my current employer throwing their not-insignificant support behind my proposal, RSI was added to the state EMS scope of practice.

But when you have 2000 medics to train, educate and monitor instead of 20, change comes slower. It wasn't too many years ago that my fellow Borg drones had to call for permission to start an IV, or do BLS CPR while the medic got on the phone to a hospital and begged for permission to implement ACLS protocols.

Thankfully, that is no longer the case, and The Borg has an extensive system in place to train, QA and educate their crews, and protocol revisions are an ongoing thing. We get minor changes frequently, and a major revision every few years. Things like equipment upgrades and protocol revisions to keep pace with current medication shortages are an almost monthly thing.

All this is to say that, if you've got good crews and a medical director who trusts them, change can come pretty easily, even in a big EMS system.

But what if your medical director is the EMS equivalent of Bigfoot or the female clitoris; lots of men have heard of it, but very few have every actually found one? What if your medical director has never even met the vast majority of the crews whose medical practice he is responsible for delegating, much less been actively involved in their training, QA and supervision?

I'm guessing that's how you get restrictive protocols, and wind up still doing things that were proven not to be beneficial ten or twenty years ago.

With a little digging through online public records by a couple of friends, I found Cy Fair's medical director.

Since 2008, he has been listed as medical director for 137 EMS agencies or entities in south Texas.

Of those, he is listed as the current medical director for 71 ambulance services or entities that provide EMS or EMS training. He let 48 licenses expire in those five years, and another 18 services he directed voluntarily surrendered their business licenses, either by going out of business or to avoid disciplinary action.

Busy man, that doctor.

Then again, not as busy as he used to be. Maybe he decided that a full-time medical practice and serving as medical director for 137 ambulance services was stretching himself a little too thin, and he cut it back to a more manageable 71.

Call me a wild-eyed conspiracy theorist, but I think I see a big part of the problem.

Wait… What?

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From Pravda MSNBC: Senators: Deal Reached On Background Checks.

Two key senators have reached a deal to expand background checks to firearms sales at gun shows and on the Internet, sources close to the negotiations said early Wednesday.

Um, guys? You already can't buy guns on the Internet without a background check. Go to one of the Internet sellers, Gunbroker, what have you, and purchase a gun. Said gun has to be shipped to a local FFL, who then does the standard background check, has you fill out a ATF Form 4473, the whole nine yards.

No background check, no gun.

The article is short on details (and facts, and accuracy, but hey, it's MSNBC), but it would seem that what senators Manchin and Toomey (R), State of Cowardice, propose is an expansion of background checks that really doesn't expand background checks.

I suppose that's better than the other kind of anti-gun legislation, the kind that stop gun crime without really stopping gun crime.

The New Partner

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After a year as my partner, teaching her, molding her in my likeness, and seeing her become strong in the ways of the Force, Nitrous has moved to a day shift that will allow her more time for family responsibilities.

Tonight marks my second shift with my new partner. He’s a pleasant guy, conscientious, seems eager to learn. He’s been an EMT for close to a year, but has precisely 80 hours of street experience thus far.

He’s currently in the paramedic class, so I’ll likely only have him for a year or so until he gets his own rig somewhere.

In the past 18 hours with the new guy, though, I have noticed a couple of things:

1. He has this distressing habit of calling me “Sir.”

2. He drives like a geriatric sloth with a Quaalude habit. Seriously, the way dude drives, he needs a calendar, not a speedometer.

After questioning him about #2, I discovered that he has poor night vision. That’s a bit of an impediment, seeing as how he works a night shift.

Accordingly, he shall henceforth be known as Mister Magoo.

As it is written, so shall it be done.

SMACSS

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While the IT geeks may call it Scaleable Model Architecture for CSS, Dave Statter refers to it as Social Media-Assisted Career Suicide Syndrome.

And I gotta tell ya, there are  lot of EMS folks on the Internet who, if not actively trying to commit career suicide, are definitely sending out cries for help.

There was Captain Greg Not So Smart engaging in a pointless dick-measuring contest which wound up on YouTube, giving Miami Dade Fire Rescue a black eye in the process.

There was FDNY EMS Lieutenant Timothy Dluhos engaging in racism, anti-Semitism, sexism and a whole lot of other -isms on Twitter, doubtless convinced that no one would ever discover he was the Bad Lieutenant. When he was found out, he collapsed in a blubbering heap, moaning that his life was over.

Yep, at least as far as his career with FDNY is concerned.

We had Joseph Cassano of FDNY doing pretty much the same thing, putting his father, FDNY Commissioner Salvatore Cassano, in the awkward position of either  firing his own son or defending his freedom to behave like a douche while representing himself as an FDNY EMT. The junior Cassano expressed remorse and resigned soon after the story went public, saving his daddy the trouble.

Last week, the New York Post featured a story about FDNY EMS personnel posting scene and patient photos online:

In addition to uploading racist rants and Nazi nonsense, EMS Lt. Timothy Dluhos also posted pictures of patients, including one of a heavy-set woman with a snarky caption Photoshopped over her wheelchair: “Wide Load.”

Publicizing photos of the ill, injured or dead without permission is a violation of city rules and federal privacy laws, but some first responders can’t resist snapping shots of people they’re supposed to be helping.

The photos of grisly corpses, gruesome wounds or humiliating circumstances provide fodder for mocking and gawking.

Some responders splash the images on social-media pages or collect them in “gore books,” a twisted hobby of voyeurism that has been part of the emergency-worker culture for years.

On Wednesday, a Facebook user identifying himself as FDNY EMT Anthony Palmigiano posted a snapshot of a man with a gaping neck wound on a Facebook group page called EMT/Paramedic, calling it a “table saw injury."

First of all, not every EMS internet forum condones such behavior. The EMT/Paramedic page on Facebook mentioned in the Post story is run by Kenya Nixon, one of my former EMT students. I follow that page and several others on Facebook in addition to the usual complement of blogs, discussion boards and Twitter feeds.

They post photos on those pages. They tell war stories. They bitch, moan and complain. They share educational scenarios. They engage in raucous EMS humor, which isn't for the faint of heart. They discuss current EMS issues. They link to all sorts of industry news and commentary.

But what they don't do is post stuff that violates patient confidentiality, and they enforce a code of conduct on their pages.

That's important. We'll come back to that later.

Virtually all of the administrators of those forums have dealt with people who object to their content. Sometimes it's an EMT who has appointed himself Internet Hall Monitor and Arbiter of Good Taste and Decorum, but more often it's a non-EMS person who has seen one of their posts in a friend's feed, and objected to the content. Most of these administrators has spent a night or two in "Facebook jail," due to Facebook's "suspend first, investigate later" policies, even though the page admins pro-actively remove fan photos and content that are deemed inappropriate.

Personally, I don't mind the photos, provided they're not derogatory and don't compromise patient confidentiality. Most of the page admins post those photos and direct the discussion toward appropriate medical care. It's not gore simply for the sake of gore.

But a great many people who are not in the healthcare professions do not understand that. Whenever you post something, keep that in mind.

When participating in social media, have a care what you post, and who you follow. Social media decorum for EMS and public safety personnel can be summed up in three rules:

  1. There is no such thing as anonymity on the Internet.
  2. Don't be a douche.
  3. If you ignore #2 and think that you are safe because you use a pseudonym or blog anonymously, refer to #1.

It's really just that simple. If what you say on the Internet would earn you a punch in the nose if you said it in person, don't say it. And if you persist in saying things other people may find offensive, you had damned well better take care to assure that none of what you write can be associated with your employer.

The First Amendment only protects you from government infringement on your right to free speech. It doesn't do beans to shield you when your employer decides your online shenanigans reflect poorly on their department.

I get daily requests for "Likes" from various Facebook EMS page admins. Some I like, and actively follow. Others I avoid like the plague.*

The best way you can tell which ones to avoid is how they handle complaints and dissent. If the page administrators are rude, obscene and insulting, it's a virtual certainty that most of the fans are as well, and people with whom it would be unwise to associate. I was appalled at reading a recent EMS forum on Facebook, and seeing the response by page administrators to those who objected to the mean-spirited tenor of the discussions.

Among those insulted were a state EMS director, a hiring manager for a large EMS staffing firm, and the operations director for the largest EMS system in a certain state.

And those are just the people who publicly objected, not the ones who lurked, made a mental note, and moved on.

Here's a helpful hint: If you call an agency hiring manager a "cunt," or a state EMS director a "fucking wannabe douchebag" and accuse him of being "butt buddies" with the operations manager who also objected, or condone such comments from your readers or fans…

… they're not the only ones reading, nor are they the only ones offended.

I guarantee you, your managers or future managers are reading as well. Right now, you are in the "cry for help" stage of Social Media-Assisted Career Suicide Syndrome.

Do yourself a favor, and stop being a douche before you stick that keyboard in your mouth and pull the trigger.

 

 

 

 

 

 

*And for God's sake, don't ever confuse me with those other "Ambulance Driver" sites out there. I was here first. I am not them, nor will I ever behave in such a fashion.

 

 

Hey, Joe Biden?

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Here’s a couple of 10-year-old girls with one of those scary AR15 rifles that are too complex for women to operate:

20130407-181907.jpg

For a weapon too complex for women to operate, they were certainly having fun perforating Coke* cans with it, and doing so safely.

I’d have given them a double-barreled shotgun to learn with, but it kicks too much for the one with cerebral palsy, and the one with ADHD just thought the AR15 was way cooler.

*Actually, it was a 12-pack of Dr. Thunder, but in the South everything’s a Coke.


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