Too Old To Work, Too Young to Retire

Like Being On A Carousel

2010-01-08T13:58:00.000-05:00

If you're not in EMS, you're going to be bored by what is likely to be an incredibly inside baseball post. In fact, it's so boring that I might fall asleep typing it. As always, you're invited to stay, but you've been warned.

There is a debate raging, well sort of, on a paramedic discussion list regarding the National Registry recertification for paramedics. Actually, this originally started as a question regarding whether anyone had done a study to show if people who had studied biology and chemistry in either high school or college did better on the initial certification exams than those who had not. The conversation wandered all over the place and at one point became a debate over whether the National Registry of EMTs testing procedure had any relevancy to real world performance. (It doesn't) Then the conversation turned ~~lurched~~, ~~veered~~ evolved to the recertification process. Currently there are two options. One is to take and excruciatingly boring 48 hour "refresher" course and 24 hours of additional continuing education, fill out an overly detailed form, have it signed by both your medical director and your training officer (as well as you), submit copies of various certification cards, and a check for a fairly small amount. Certification is valid for two whole years, so every two years paramedics have to sit through essentially the same material. The classes aren't free, and can be pretty expensive depending on where you go to take the classes.

Massachusetts doesn't use or recognize the National Registry process. The commonwealth has a very similar procedure, with less paperwork, but a far higher cost. $150.00 for a two year certification so that we can work. Now, that's not a tremendous amount, but most paramedics and EMTs aren't exactly well paid. Someone like Walt Trachim at Life in Manchvegas has to maintain certification in two states. Which is a whole different story because unlike driver's licenses, paramedic certifications are generally not valid from state to state. Which is what the National Registry was supposed to ensure way back in the mid 1970s when it was founded. So Walt has to maintain two certifications, one for MA and one for NH. NH does recognize the National Registry, as do about 30 other states.

If you're still awake, I'll continue. Well, if you're asleep, just keep on snoozing while I ramble on like Rogue Medic. Just kidding Rogie.

When I first became a paramedic, the National Registry (NREMT) would accept a copy of my MA paramedic certification, along with a copy of my Advanced Cardiac Life Support (ACLS), and CPR cards, as well as fill out the demographic section of the form, get the signatures and of course, send a check. About 10 years ago that changed and the NREMT started to require copies of all of training records that MA kept on me. OK, that's not that tough since MA has that available on line. Print that out, along with copies of ACLS and CPR cards, fill out the form, get the signatures, send the check. Today I found out from a co worker who also maintains NREMT certification that this procedure is no longer acceptable. Now, we must transcribe the training records either by hand or by computer if we use the on line recertification form. More pointless hoop jumping.

There is an alternative. You can opt to take the same certification examination that a student fresh out of paramedic school takes. Yep, take essentially the same test that I took 20 years or so ago. Updated of course, but still a multiple choice, now computerized examination. And submit the test fee, which I'm told is now $110.00 dollars. As opposed to the $20.00 fee if you use the old fashioned method. As of now taking the test is optional, although there are rumors that the NREMT is considering requiring paramedics (and EMTs) retake the test every two years. For the for mentioned $110.00 per test attempt. Which means that if you fail the test, you have to take it again.

For my non medical readers who are still with me, I'd like to point out that Registered Nurses have a far more simple process. They must take a set number of continuing education hours, fill out a form, and send a check to the state. Doctors must complete a number of continuing education sessions, which often seem to involve tax deductible trips to climes conducive to playing golf, fill out a form and send a check. No one expects either profession to retake large portions of their original course material let alone retake their original board exams. So, the more education, skills, and responsibility for patient's well being you have, the less stringent the recertification requirements.

All of the foregoing was prelude for the main points of my post. Or, as Ron White says, "I told you that, so I could tell you this."

The entire process of recertification is a fracking farce.

First, who picked two years as a certification period? What, exactly is it based on? How long is a physician's license valid for? A nurses? Do barbers have to take a hair cutting test periodically? Mrs. TOTWTYTR is a teacher certified in two states. In both states, her certification is valid for five years. During that time she must attend a set amount of continuing education, which is called "Professional Development". She has to be familiar with current theories and methods of teaching. She does not have to retake her teaching certification test during this period.
My daughter is a paralegal. She works under the supervision of a licensed lawyer, but has not state certification to do so. My son is by education an engineer. He doesn't have an engineering license because he went into another field right out of college. However, if he were, his recertification requirements would be far less onerous than are mine.

Not every state has a two year certification period. Texas has a four year certification period and certification or licensing for paramedics. The difference being that for licensure one must have either a two year or four year degree in any field. Texas also offers four options for recertification or license renewal. Four.

I'm using Texas as an example only because I'm somewhat familiar with it.

When my fellow bloggers such as The Happy Medic, Life Under The Lights, or 9-Echo-1 talk about the need to professionalize EMS, I think they miss a key point in the debate. As long as we are treated as none to bright children, who must be continually be retaught the same material, by both state agencies and an entity that purports to be "The Nation's EMT Certification", we are never, ever, going to be regarded as professionals. What point is there in me sitting through lectures that cover much of the same material as I learned 20 years ago. Yes, much of our treatment has changed, but I learn those new treatments as they are added to our protocols. By the time the refresher course comes along, I already know it. How many times do I need to sit through a lecture about the three stages of labor, about fractures, about lacerations? Really, I'm not that stupid, but you'd never know it from reading a course outline for a refresher course.

The fault lies not with the practitioners of EMS, but with those that construct the curricula, devise the certification tests, administer the tests, and issue certifications. Who are the same people who design the continuing education and refresher courses. Until we start agitating for true continuing education and not tired rehashes of what we have been taught before, the true medical professions are going to sneer at us.

The onus is on us to improve our lot, not to rely on others to control our future. If we do, 20 years from now some now young guy is going to be an old, cranky medic railing on about how lousy the EMS education system is.

Those Who Forget The Past

2010-01-07T18:40:00.002-05:00

From the movie, "Tora, Tora, Tora",

[Telephone conversation from the radar station to the Information Center]
Pvt. Elliot: Sir, this is Private Elliot at Opana Point. There's a large formation of planes coming in from the north - 140 miles, 3 degrees east.
Lt. Tyler: Yeah? Well... Don't worry about it.
[Click!]

And then later in the movie,

Lieutenant Kaminsky: [to Captain John Earle, who demanded confirmation of the attack before doing anything] You wanted confirmation, Captain? Take a look! There's your confirmation!
[Earle, horrified, looks out and sees several ships in flames]

From today's news,
White House: Hey, We Told Counterterror Chief to Go Skiing

Not to mention that the President continued his vacation in, ironically, Hawaii.

As Glenn Reynolds has been known to say, "The country is in the very best of hands."

The Blog Of The Tacticool Pants

2010-01-06T08:03:00.027-05:00

It's not everyday that a woman emails me and asks me if I want to get into her pants. Well, she didn't exactly put it that way, but I have a vivid imagination.

Since Ambulance Driver ~~stole~~ borrowed my "action adventure pants" line for his interview (as well as the wiping out disease and pestilence line, he has a memory like a tape recorder), I'll just have to stick to referring to them as Tacticool Trousers. They of course refer to themselves as the Tactical Pants Blog where they talk about tactical pants and other stuff. The current top post is about tactical pens. Yes, tactical pens. That collect DNA. And break windows. One would hope that they write too.

Since I'm a sucker for tacticool stuff, I'm linking to their blog, so I can keep current. I'm still holding out for a tactical stethoscope.

The Stupid Party

2010-01-05T16:23:00.000-05:00

Which is what an ever larger number of disgruntled conservatives are calling the Republican Party. The GOP has taken one wrong step after another over the past four years. Disgust was so high that it culminated in the 2008 defeat of Senator John McCain and enough Republican Congressmen and Senators to give put both the Executive and Legislative branches of the government in Democrat hands. Which some conservatives thought might serve as a wake up call (AKA dope slap) to the Republican Party.

The Tea Party movement of last year, which is continuing this year, was also a not subtle message, albeit directed primarily at the party in power. Americans are getting more than a little fed up with tax and spend and spend and spend policies from either party.

The Democrats have done their best to help push Americans to the right. Obamacare, TARP, Stimulus, and over the past few months national security issues have all energized conservatives, and an increasing number of independents. If only it weren't The Stupid Party, the Republicans could seize upon these issues and make significant gains in the 2010 mid terms.

State Senator Scott Brown is making a serious, credible run for the open US Senate seat from Massachusetts. His opponent, Attorney General Martha Coakley is a straight line Democrat who follows the national party lead on every issue. This could be a crucial election and a Republican win in what has been a Democrat seat for over forty years could go a long way to boosting GOP morale and sending a clear message to Washington, DC. Sadly it seems that the leaders of the GOP intend to concede this seat to the Democrats and are not devoting any significant resources to helping Senator Brown win.

National Security. The botched terrorist bombing attack on a Northwest Airlines plane on Christmas Day, the successful homicide bombing of a CIA outpost in Afghanistan, the "enhanced", but ridiculously intrusive and ineffective security measures ordered by the TSA, and President Feckless' clueless response to these events is a golden opportunity for the GOP to make national security one of the top two issues in the upcoming elections. After a year of treating this War against Islamic Fascism as if it were a bank robbery, Americans are once again starting to worry about the safety of this country. The Democrats have always been regarded as weak on defense and national security and have done nothing to dispel that reputation.

Health care. Back room deal making by Democrats that scored large victories by describing a "Culture of Corruption" are angering an ever growing number of Americans. Most of whom don't want the government meddling in health care or even health care funding. So far, the Republicans, with one or two Quisling exceptions have stood firm on this. It's a good start, but only a start.

Taxes. The so called "Bush Tax Cuts" are set to expire this year. The large increase in taxes for most working Americans is going to be a big issue, but no one seems to be paying attention to it right now. Especially the Republican Party.

Spending. Is out of control, especially spending on useless social programs. No one, even most true conservatives don't want to deal with this because it's such a political hot potato. Which is too bad, because entitlement programs are going to be the downfall of this country. Well, if our lax border security and nonserious national defense posture doesn't do it first.

This is a great, dare I say once in a generation, opportunity for the GOP to take back control of the Congress, or at the very least balance the power the parties have. Sadly, I don't think that they have any idea of how to do it.

Blog Humor

2010-01-04T21:43:00.000-05:00

While looking through my referrals, I came upon this one which came from a search. The term "respiratory concealed carry states" brings to mind all sorts of humorous mental pictures.

It's generally better to conceal your lungs, they work better that way.

Oh, and try "reciprocity concealed carry states", I think that's what you meant.

Or maybe not.

My Snow Thrower Hates Me

2010-01-04T09:39:00.002-05:00

A couple of years ago a very close friend gave me a snow thrower. Not a new one, but one that he had owned for a few years. He kept it in pretty good shape for it's age and the only reason he was giving it up was because a relative was giving him a newer, bigger, better one because said relative was buying a pick up truck with a plow. It's a Murray, which is a brand, not this specific machine's name.

"Cool." I thought because my then 12 year old Toro CCR Light seemed to be getting a little bit tired. Over the past few years I replaced the pull cord, repaired the coil/plug wire, primer bulb, fuel lines, drive belt, scraper, skids, auger blades, and cleaned the carburetor. Frankly, I thought I was on borrowed time just because of it's age and my not so good habit of using it well above the snow depths it was intended for.

My friend told me that the carburetor on my new to me snow thrower was a bit finicky, but he also showed me how to adjust it on the fly. The first winter I had it, we had little snow. So little that I think I used the snow thrower twice. When spring came, I did all the things one is supposed to do to put up a snow thrower for the summer. Then, during the summer I brought it to a small, local, shop to have a tune up done, including fixing the carburetor. Much hilarity ensued as here it was July and I was dropping off a snow thrower. Well, given how I'm kind of a last minute guy most of the time, I thought it was funny too.

Tempus fugited and in late October the snow thrower guy called me up and said he wanted to drop off the machine. Arrangements were made over he came. I paid him and he mentioned that the work had been done, but the carburetor was still a bit "touchy". Touchy turned out to be, well, exactly as bad, if not worse than it had been before. Unfortunately, the guy had gone of out business in the mean time. I muddled through last winter using the finicky machine and my trusty, now 14 year old Toro. Spring came and the snow blower was put in the shed with a mental note to find a new place to bring it to have the finicky carburetor looked at. As these things do, summer passed, then early fall, then "Oh shit" season. In late October I called a not too distant power equipment shop with a good reputation and was told to bring it on over.

"Six weeks.", said the nice man behind the counter. There was a charge, to be credited towards the repair, for diagnosis. Very fair, because I know that you, my faithful readers will be shocked to learn that people have been known to bring a piece of yard equipment in for repair and then "change their mind" once they know what needs to be fixed.

Some more time went by and now it was the week of Christmas. I came home to a message from the power equipment shop that the machine was ready. Eagerly I drove over paid for the new carburetor and other minor repairs and went outside to wait for the nice young man to bring my machine out to my truck. And waited. And then waited a bit more. Finally, I walked out back to where they store the repaired the machines and found the young man, busy at work on my "repaired" machine. Seems that the auger cable had frozen. He worked on it, sprayed some sort of lubricant on the cable and got it working. We loaded it in the truck and off I drove to home.

Got home, unloaded the machine, and started it up. The engine sure sounded sweet, so I decided to push back a couple of snow banks along the driveway. Which is when I discovered that the auger cable had frozen again. I sprayed some WD-40 on the cable and used a heat gun to dry the water out. Well, actually I think I used the heat gun first. Either way, the auger cable was now free, so I attacked the snow bank. Which is when the engine died out. Which is what the original problem was. Sigh...

A quick phone call to the shop and the nice man said to bring it on back. Only I couldn't get back over there until the day before Christmas. They were only open until Noon, so I had to get over there early. Between dropping my daughter off at the train station and going to get Part II of my root canal, I dropped the machine off. The nice man behind the counter told me that they would see what they could do and that I should check back before Noon. Off I went to get my root canal, which at this point seemed less painful than dealing with my snow blower.

After the endodontist was done with me, I drove back to the power equipment shop. Sure enough, they had found that the carburetor needed some fine tuning. Plus they fixed the auger cable, which hadn't been frozen before I first dropped the machine off. The nice man told me that the snow blower was "kind of tired" due to it's age, but that it should be OK if I didn't over do it with hitting the snow banks. Reasonable, as this is a fairly old machine.

The first snow storm the machine worked OK. It doesn't like really wet, heavy, snow, but who does? Once it warmed up, it worked OK. My thought was that I could get one or two more seasons out of it and then in the spring, when prices tend to be lower, I could buy a new one.

We're in the midst, or maybe at the end, of a multiple day snow storm. Light, but persistent snow since late Friday. This required clearing the driveway yesterday. The Murray did a credible job clearing the drive, balking only at the heavy slushy stuff at the end of the driveway. Still, a bit of patience and it was done.

Today, more of the same. Another three to four inches of snow, requiring more clearing. I wheeled the Murray out of the garage and it started on the second pull. "This is a good omen." I thought. I started clearing the driveway, taking my time. I got to the end of the drive, where the snow plow had left a small berm and started nibbling away at it. Which is when the Murray stalled. "No problem, I'll just restart it and go a bit more slowly." I grabbed the pull cord and gave a mighty tug. Which didn't start the motor, but did result in the pull cord separating, leaving me holding the handle and a length of cord. I think I heard the machine snicker at me, but I'm not sure.

The damned thing hates me.

Hopefully, I can repair this myself, the pull being easily removable. If not, I'll borrow my neighbor's snow thrower for the rest of the year and give in come the spring and buy a new one. Maybe not even a "new to me" one, but a real live out of the box new one.

Back now. I was able to fix the pull cord on the second attempt. I didn't even have to go out as I had a spare cord in the garage. Goodness knows why. The first attempt failed because I didn't wind the recoil assembly enough in the right direction. Took it apart again and corrected that.

All back together and back outside to test it out. Ran great, even though it still doesn't like that heavy wet stuff. Well, ran great until it ran out of gas. Off to the nearest gas station to fill up the gas can. Then back to finish the driveway.

In the meantime the town snow plow came by and pushed snow back into the driveways. And took off my neighbors new mail box.

Oh, my now 16 year old Toro still starts and runs every time.

I think I know what brand I'm going to buy when the time comes.

Welcome to winter in New England.

Two Separate Issues

2010-01-03T16:19:00.000-05:00

Mom of 9 cries foul

There are two issues here. If the hospital in fact screwed up, then the hospital should pay. That's an issue for the justice system to deal with.

The other issue is the state (taxpayers) paying for people to have children that they couldn't otherwise afford. If Mrs. TOTWTYTR and I had decided that we wanted to have four kids, I wouldn't be able to go to my boss and tell him to give me more money so I could afford them. If you doubt me, try it with your boss. Nor should someone on the dole be able to. Or, I should say, they shouldn't be able to tell the taxpayers that they have to subsidize them.

When you pay for something, you tend to get a lot of it. We pay for poor people to have children, so they have a lot of them. If we changed the system so that someone on welfare only got $x.x a month, no matter how many children they had, then they would have fewer children. The women would learn to be more responsible about using birth control. Or about having sex for that matter.

Whether we should totally dismantle the current welfare system and either not replace it or replace it with a more rational system that limits benefits to people who need them and only for a limited time is a debate for another day.

Northeast Blogger Dinner

2010-01-03T11:58:00.003-05:00

Most everyone made it, despite the weather. Which wasn't that bad after all, however the usual idiot drivers were out in full force. In fact, they probably called in reinforcements. Not only did I drive by several cars and SUVs that had slid off the road, but I saw one vehicle with MA plates that seemed to have been stopped by the New Hampshire State Police for... speeding. You just can't get any dumber than that.

Once through the rolling obstacle course known as Interstate 93, I made it to Jillians and met the group. All the usual suspects, lead by the ~~maniacal~~ gracious JayG. Lissa was there, with the very nice Mike. I sat down next to JD and his lovely wife and across from
Bruce who had arrived just before me. Just up the table was Bore patch and the lovely Mrs. Bore patch. I met The Other Jay, up from Florida to work at the Winter Classic. Nice guy, interesting work, more interesting stories. Added to the blogroll.

The short story is food was eaten, drinks were consumed, tales of derring-do shared, opinions opined. As JayG mentioned, the long table we ate at was not conducive to mingling and chatting. We repaired to billiards room were several spirited games were played with various levels of skill. In my case, a low level, but I did win one game by default when my opponent scratched whilst trying to sink the Eight Ball. Ironically, he won one game when I did the same thing.

Double Trouble gave me a cigar in repayment for one that I had given him during the Summer Blogger Shoot. Problem is that he gave me one that's much better than what I gave him. Now I must reciprocate and this could end up like an arms race as we try to balance things out. Not that I mind swapping cigars with friends, mind you.

Speaking of which, it's sad to note the New Hampshire has gone all Nanny State on us by prohibiting consenting adults from smoking in bars and restaurants. Much better to let those establishments that want to have some or all of their business open to smoking do so and let the free market decide. Oh well, progress I suppose. If that's what you call it.

All too soon I had to leave, although a good number of others had to go early due to the long rides they had. I saddled up and headed back south, having a mostly uneventful ride, dodging being hit by a car careening across the highway only once. The roads in New Hampshire were surprisingly poorly plowed. I've been driving those roads for over 30 years and don't remember seeing them so snowy, especially compared to Massachusetts roads. Maybe that's a reflection of the Democrats controlling the budget and deciding that social programs are more important. Just a guess, probably a wrong one.

It seems like everyone had a great time and everyone wants to do another get together sooner than next year. We'll just have to let our own little community organizer put another one together. :)

First Casualty Of The New Year

2010-01-01T18:43:00.003-05:00

Predicting the future is incredibly hard. Well, predicting it accurately is hard, which generally doesn't stop people from doing it.

That being said, I don't think I'm going out on too long a limb by predicting that the first 2010 casualty in the War Against Islamic Fascists will be Janet Napolitano. I wouldn't be at all surprised if she quietly resigns over the next few days, maybe even over the weekend while no one is paying close attention.

Hillary Clinton is laying low hoping that no one points a finger at her, and it's likely she'll continue to serve in obscurity for another year or so. At which point she'll resign to gear up her 2012 campaign to unseat President Obama.

A New One Just Begun

2010-01-01T18:20:00.000-05:00

Happy New Year to all my readers. 2009 wasn't the best of years, but it also wasn't the absolute worst of years either. I rediscovered my love of being a paramedic and helping to make people get better, I have a new grandson, some new friends, and some new gunnie acquisitions.

2010 will no doubt bring change, personally and professionally. I plan to continue blogging and there might be some changes to the blog as well.

Oh, 2010 is going to be very interesting politically as well.

The great journey continues.

Fiddlng While Massachusetts Burns

2009-12-31T08:00:00.002-05:00

In a couple of weeks there will be a special election to fill the seat vacated by the death of Senator Ted Kennedy. The two main contenders are current MA Attorney General Martha Coakley (D)and state senator Scott Brown (R). The odds on favorite is Coakley, in this, the most liberal of states. Coakley is quite liberal and frankly soft on crime. Unless of course there are political points to be scored by sending an unpopular defendant to prison, not withstanding guilt or innocence. But I digress. Brown is conservative, at least by MA standards, while Coakley is liberal, but in this state considered "centrist".

Coakley is also likely defeatable if Brown runs and good campaign and gets some outside funding help. Which Coakley is definitely getting because the Democrats know that a defeat in this, the most liberal of states, will be a harbinger of bad things in the 2010 mid terms.

Sadly, the Republican National Committee seems to be made up of cowards, afraid to invest money, time, or staff in an effort to win a key seat. Which is too bad and bodes no good for the party or the nation.

As with the crumbling defenses in Germany in 1944, this is an opportunity that will not present itself for another generation. The right man, in the right place, at the right time, and for the lack of money and effort this seat will slip away and be lost to Republicans.

The RNC needs to stop being risk averse and invest the money, time, and effort to help Scott Brown win this seat.

I'll leave you and the RNC with this thought from General Patton.

We're gonna keep fighting. Is that CLEAR? We're gonna attack all night, we're gonna attack tomorrow morning. If we are not VICTORIOUS, let no man come back alive!

Coulda, Shoulda, Woulda

2009-12-30T21:13:00.000-05:00

Watching Rudy Giuliani on TV I'm reminded of how essentially unlikable he is. Here is a guy who did a mediocre job of running New York City for about much of the 1990s. If not for the attacks of September 11, he would have left office in early 2002 and been quickly forgotten. Since then he's made a career out of being some sort of "security expert" and anti terrorism guru. He's also considered, but not actually run for, several offices from US Senate to Governor of New York to President and lately back to US Senator.

The truth is he's a mediocre politician with a messy personal life who has and continues to capitalize on an attack on an American city. He was barely qualified to be Mayor and actually he probably peaked before then. I and a lot of people in EMS still won't forgive him for taking EMS in New York and putting it under the fire department. Which has not done a single thing to improve either the delivery of EMS or the pay and benefits of the people who work for them. I'll save the rest of that rant for another day.

In any case, he's not likely to shut up and go away, but one can wish.

No Use Pretending

2009-12-30T15:22:00.000-05:00

I've been critical of VP Dick Cheney commenting on the Obama Administration in the past. It would be unseemly except that the Obama Administration has made criticizing, nay, demonizing President Bush the centerpiece of their administration.

Today there ia a controversy over comments that VP Cheney made in which he said essentially the same thing that I've been saying for a while. That is, that the Obama Administration is completely unserious in it's anti terrorism strategy and tactics. Treating attacks such as the December 25 airplane bombing attempt as crimes, and not the acts of war that they are. It's an unserious strategy by an increasingly unserious President. One who seems completely bored by having to actually, you know, make serious decisions and be responsible for them. One who seems far more concerned with the trappings of the Presidency than the responsibilities of the Presidency.

Cheney's past comments have been met with criticism from many Democrats and some members of the media, who say he would be better off following the example set by former President George W. Bush, who has remained largely silent on the actions of his successor.

Because we know that President Bill Clinton, President Jimmah Carter, VP Al Gore, never, ever, engaged in unseemly criticism of President G.W. Bush when he was in office. They never, ever, made comments to the foreign press impugning his judgment, his principles, his intelligence, or his commitment to protecting the nation from all enemies, foreign and domestic.
Typically of the Democrats their response comes from someone from one of their campaign committees,

Responding to the criticism, Democratic Congressional Campaign Committee Chairman Chris Van Hollen said Republicans have become "out of touch in their efforts to score political points and even raise money off the terror plot to blow up a plane and kill innocent Americans on Christmas."

Out of touch? That pretty much sums up President Obama, not the Republicans in this case.
For at least the next three years we are going to be subjected to the Obama Administrations unserious strategy in dealing with this war. Too many soldiers and too many civilians are going to die over that time because our tactics and strategy are based on the belief that blowing up an airplane, ship, or building is essentially the same as robbing a bank. It's not and this country needs to adopt a policy of treating these terrorists as spies and saboteurs of a foreign power. Which is what they are. Stop lawyering this war and start fighting it.

Heartwarming Christmas Story

2009-12-27T13:52:00.002-05:00

This story came just a bit too late for me to include it in The Handover, but it's so heartwarming I want to share it with you, my faithful readers. Everything you are about to read is true. Only the names have been changed to protect the innocent.

We stopped by one of the local Emergency Departments just to say hello. I was ~~chatting up~~ having a professional discussion about advances in EMS with one of the physicians I've known for a few years. While I was sitting at the long desk height work table where the physicians do their notes, I noticed a very compact infusion pump lying there. I took a quick look at it because I'm always interested in new technology that might be useful for EMS (really). I asked the doctor about it and she said it wasn't an ED unit and she didn't even know what type of equipment it was. Then she said, "Read the note." I flipped the device over and there was a sticky note on the back. Here is what it said, as best as I can remember it.

My husband and I were so happy with the care you gave us that we decided to return this pump that we stole when we were here. Merry Christmas.

Tis the season!

The pump in question is a specialized one for infusing a drug called Flolan. List list price on the pump is about $600.00, so it's a not throwaway device. These fine folks must have had it for a while because the Biomed inspection sticker had an expiration date of September '09.

Heartwarming, that's what it is.

Could It Be Terrorism?

2009-12-26T10:58:00.001-05:00

Actually, could it NOT be terrorism is a better question. Yes, it's terrorism, and yes it's because Al Qaeda, Inc. questions the US and President Feckless' commitment to beating them.

Passengers help foil attack on Detroit-bound plane

The commotion began as Northwest Airlines Flight 253, carrying 278 passengers and 11 crew members from Amsterdam, prepared to land in Detroit just before noon Friday. Travelers said they smelled smoke, saw a glow, and heard what sounded like firecrackers. At least one person climbed over others and jumped on the man, who officials say was trying to ignite an explosive device.

Give this man a medal. He didn't sit on his thumbs waiting for "the authorities" to handle the situation, he took action. No doubt we'll hear how he shouldn't have jumped to conclusions. Personally, I hope he gave this wannabee terrorist a good ass kicking while subduing him. A kicking contest with the guy's gonads would be about right.

The White House said it believed it was an attempted act of terrorism and stricter security measures were quickly imposed on airline travel. Dutch anti-terrorism authorities said the U.S. has asked all airlines to take extra precautions on flights worldwide that are bound for the United States.

Stricter security measures, eh? No doubt more 80 year old ladies in wheel chairs and cute teenage girls will need to be thoroughly searched. Also, all military personnel will be forced to strip down to their skivvies. We can't be too careful, you know.

Intelligence and anti-terrorism officials in Yemen said they were investigating claims by the suspect that he picked up the explosive device and instructions on how to use it in that country. The officials spoke on condition of anonymity because they are not authorized to speak to the media.

You don't say. The original home of the Wahhabism and terrorists get training and equipment there. Can't be.

President Barack Obama was notified of the incident and discussed it with security officials, the White House said. Officials said he is monitoring the situation and receiving regular updates from his vacation spot in Hawaii.

Let me just conclude by saying this. If it were President George W. Bush and he was on vacation the media would be howling about him not returning to the White House immediately to deal with this. President Vacation is OK to stay in Hawaii and rest, though.

In case I'm being too subtle about it, I'm pissed. Now, law abiding Americans will be treated even worse by the stooges at TSA under the guise of "national security". Once again, the barn door will be open, the horses gone, and the Department of Homeland Security will be reacting to yesterday's threat.

I'll say it one more time, although I shouldn't have to. The only way to defeat an enemy is to remove it's ability to wage war and destroy his will to do so. Indictments won't cut it.

One last warning. If you comment about how this is America's or George Bush's fault or anything about Israel and Palestine, don't expect to see those appear. I'm sick of people pretending that there is any cause other than that these people hate us because they hate western civilization and want to impose their 12th century world view on all of us. Those that they don't want to kill outright that is.

Iowahawk Strikes Again

2009-12-24T13:42:00.000-05:00

The ~~mildly~~ deranged Dave Burge strikes again with It's a Wonderful Bill

CLARENCE: No, George, she never married. Because you never became Senator, you never met her through that escort service. Mary remained here in Bedford Falls working as a simple call girl, and now she has to pay for her chlamydia drugs from her own pocket.

Not to mention, as Ambulance Driver would say, her own Fibromyalgia drugs.

Addition To The Blogroll

2009-12-24T12:52:00.000-05:00

Grouchy Old Cripple I used to read this blog every day, but at some point stopped. No reason, I just stopped. I rediscovered the blog today so, I'm adding him to the blog roll.

How Many Is Too Many?

2009-12-24T08:00:00.079-05:00

This post is a response to comments over at Medic 999's blog.

Since Mark's post was about his experiences riding as an observer with San Francisco Fire Department I decided to move my part of the debate over here so as not to tie up his comments section. For the full context you should read his post and the comments and then come back here. My post is specific to the comments by Ben Waller. Or if he prefers Chief Waller.

A paramedic on every engine hasn't been proven to improve patient survival, although it certainly does increase system costs. "If it saves even one life..." doesn't play anymore, from either a financial or patient survival standpoint. There isn't even any data to show that more or earlier ALS increases cardiac arrest survival. What has been proven increase cardiac arrest survival is good, early, CPR along with good, early defibrillation. You don't need paramedics for that, in fact you don't even need EMTs. There is ample evidence that trained lay people can do CPR and operated defibrillators. For this purpose "lay people" includes fire personnel who are not trained at either the BLS or ALS levels, but mostly applies to non public safety people. Some systems use police officers (one or two) as first responders, so you can't even say that the fire department is required.

Nor is there any research, to the best of my knowledge at least, what the optimal number of people in a resuscitation is. Keeping in mind that "The plural of anecdote is not data" I can only rely on the comments of two of my MD mentors. Both felt, that based on their experience (combined about 80 years) two paramedics and two EMTs were best. Again, just their comments, but something to think about.

Nor, Chief, does your comment about the number of people utilized in a hospital resuscitation hold any weight. In the hospital they have access to doctors, nurses, respiratory technicians, xray technitions, and various aids. In the field we have EMTs and paramedics. Or paramedics and EMTs. Take your pick. On the rare occassions we need it, we have access to medical control via phone or radio. Eleven people, all with one of two certifications aren't going to help. As I mentioned in my last comment, I have two medics, two EMTs, and usually three first responder/fire fighters. One of which is an officer, who generally doesn't do CPR. There are also police there, but they are there for investigative and scene control purposes, we never used them for CPR.

Of course there are EMS systems in other countries where doctors do respond to EMS calls. Ask Princess Diana how well that type of system works.

If you need to provide a "privacy screen" chances are you're spending way too much time on scene. In my system we'll generally move a patient at a public scene in the ambulance as soon as medically feasible. We usually don't do ALS outside in the street or more than we have to in a public area inside a building. It's ABCs, then move to the ambulance. Transport is not the only thing we do, but it certainly is one of the more important things that we do. Transport is part of the treatment.

We're not part of the FD, but we work with them on a regular basis. When we need them, they are great to have. But the truth is that on the vast majority of calls we don't need them. You can read my thoughgs here and here on when the fire department should and shouldn't respond so I won't repeat them here.

I'll quote one comment from Chief Waller directly, so as to better refute it.

I'd like to see some evidence for your claim, and your definition of whom "the best systems in the country" are. And, if you don't responde to fires in San Fransisco, then your comments about their system are moot.

The evidence for my claim is science, Chief. USA Today isn't exactly a peer reviewed study, but they did a series of articles about EMS a couple of years back.
The method: Measure how many victims leave the hospital alive This article is actually very accurate for a mass media outlet. They reference the "Utstein Template" which systems such as Seattle, Boston, and other "cutting edge" systems too small to measure use. Briefly, Utstein looks at patients with ventricular fibrillation as the presenting rhythm who survive to hospital discharge neurologically intact. Just getting the patient to the hospital with a pulse doesn't cut it. San Francisco, (Utstein survival rate a not shabby 22%) could do better, so it doesn't seem like adding more fire fighters is the key here.

I'm baffled by your statement that if I'm not a San Francisco fire fighter, I can't comment on their response to medical calls. Mark isn't a fire fighter anywhere, but this whole series of articles is about his observations while riding with them. As your profile tells me, you're not a San Francisco fire fighter either, but somehow your comments are valid? Explain that if you would.

Finally, I know you're all about the "all hazards" out of what I call the IAFF/IAFC playbook, but can you show me any science to back that up? To me "all hazards" sounds about as scientific as "the golden hour", which is not very much.

Feel free to comment here, Chief. The stage is yours.

Thoughts From My Daughter

2009-12-23T12:51:00.000-05:00

She sent me an email this morning. I can't say that I disagree with her thoughts even a little bit because I had pretty much the same ones.

Here's the email with a link to the story.
Sen. Anthony Galluccio headed back to court

First of all...really? Is that the best excuse you could come up with Gallucio? REALLY? Spend your time in home confinement coming up with better lies.

Second...some of the comments are hilarious.

As Mrs. TOTWTYTR frequently reminds me, no DNA testing is needed to determine paternity. She's a chip off the old block.

Accused Is Not The Same As Guilty

2009-12-23T10:30:00.029-05:00

This is a very disturbing story. IF the allegations are true.

EMTs accused of ignoring ailing woman suspended

NEW YORK - Two emergency medical technicians accused of refusing to help a pregnant woman who collapsed in the coffee shop where they were taking a break were suspended yesterday, and Mayor Michael Bloomberg called their behavior inexcusable.

Very serious allegations. Note that nitwit Mayor Michael Bloomberg has done what nitwit politicians generally do. He's declared them guilty before the investigation has really even begun.

Here's another headline,

Mayor rips EMTs who refused to help dying pregnant mother

A furious Mayor Bloomberg yesterday blasted two EMTs who allegedly refused to help a dying, pregnant mom because they were on break at a Brooklyn coffee shop.

"It was unconscionable, [an] outrage, pick some adjectives and stick it in," the fuming mayor said at a news conference a day after The Post broke the scandal involving tragic mom Eutisha Revee Rennix, 25.

I am not, repeat not, making light of the serious nature of these allegations. What I am pointing out is that Mayor Bloomberg does neither the City of New York, nor the EMTs any good by leaping to conclusions and rushing to judgment.

The fire department no doubt has a disciplinary process in place that has some elements of a judicial procedure. That is, there will be a hearing, witnesses, testimony, cross examination, and a determination. I'd expect that if it is found that these EMTs did what they were accused of, they'll be terminated. I'd not be surprised if the State of New York has a proceeding to revoke their certifications. The problem is that the Mayor of the New York City, their ultimate boss, has already proclaimed their guilt. Which could well give them grounds to appeal the decision because it's been tainted by his proclamation. It would not be the first time that a loose lipped politician has sunk a solid disciplinary case by not STFU. How do you think it might look in, oh about 18 months or so, if an arbitrator, hearing officer, or judge decides that the two EMTs were in fact in the wrong, but their right to a fair and impartial hearing was denied because of the feel good at the moment utterances of a politician?

Mayor Bloomberg, here is some advice. No one ever got into trouble by keeping their mouth shut. I know it's hard for a politician to do that, but sometimes it's really the best course of action.

Like just about everyone else, I don't know what really happened or who said what. That should come out in the investigation at which time a determination of responsibility can be made and discipline, if warranted, can be meted out. Mayor Bloomberg, like everyone else, should wait for the results of the investigation. Of course it's unlikely that he'll do that.

Did I mention that he's a nitwit? And I don't need an investigation to prove that, he's done that by opening his mouth.

Residents of New York City, you got the Mayor you deserve.

That is all.

Lightning Strikes... Twice!

2009-12-22T10:22:00.001-05:00

The other day I was listening to "Willie's Place" on SiriusXM radio and heard a very nice cover of "Night Life", composed by Willie Nelson. It's been recorded by Willie Nelson, B.B. King, Ray Price, and a zillion other singers. This version, however, was song by, uh, Leon Russell. Yeah, that Leon Russell, the one whose voice I once said makes Ernest Tubb sound like Jim Reeves. This song just fit his voice and the arrangement very well. I liked it, I really liked it.

My thought was that, as I've been known to say, even a blind squirrel finds an acorn once in a while.

This morning driving home from work I heard a very nice cover of "Sweet Dreams Of You" composed by Don Gibbs, sung by Faron Young, Willie Nelson, Patsy Cline, Emmylou Harris, and, gulp, Leon Russell.

Yeah, that's two good songs by Leon Russell. Now I'm faced with the prospect that there are more.

Here, for your dining and dancing pleasure, is Don Gibson singing his song.

No Leon Russell cover on Youtube, so here is Patsy Cline's cover.

That's probably the most famous, with Faron Young's a close second. Russell's isn't third, or even fourth, but it's credible none the less.

You Want Heartwarming? I'll Give You Heartwarming!

2009-12-19T20:43:00.003-05:00

The ~~most~~ only heartwarming thing about Christmas is that I generally work for someone else so they can get the night off. Especially medics with small kids, so they can be with them. Before you get all misty eyed, keep in mind that they pay me back by working on a day that I need off. I'm altruistic, but I'm not silly.

Anyway, holidays are generally a pain in the butt to work. I haven't worked Thanksgiving Day in over 20 years and hope never to again. What happens on Thanksgiving? Family fights. People actually fighting over things like who gets the drumstick. Really. About 25 years ago, two brothers fighting over who got the drumsticks. One stabbed the other with one of those big forks. Not a real serious injury, but one brother ended up in the hospital, the other in jail. Neither got a drumstick.

Depressed and suicidal patients. Again over 20 years ago I was working (back in my BLS days) and we got sent to a call for a depressed person. I spent 20 minutes talking this guy out of the closet in which he was hiding. I had him all set to go when a nitwit supervisor showed up, pointed to the patient, and asked "Is this the nut job?" THAT'S when the fight started!

Cardiac Arrests. Nothing like Grandma keeling over into the stuffing to ruin a holiday feast. Nothing like having your son drop dead and fall into the Christmas tree to set the mood. Nothing like having one of your idiot partners tell the family that he hopes they didn't buy anything they can't return in response to the inquiry as to Dad's condition.

Did I mention the drunks? Really, can't you folks celebrate any holiday without getting knee walking drunk? Christmas isn't the worst, New Year's Eve is. Which I generally end up working because it's impossible to get that night off. Sort Of Big City has a big New Year's celebration, which is just another excuse for people to get drunk. Let me tell you ladies, no matter how sexy your little cocktail dress is, no matter how well your make up looked, no matter how much you spent to get your hair coiffed, it's all for not if you pass out and vomit all over yourself. I don't think that even a guy who spent the last 20 years in prison would be interested. Even the pointy little party hat that some wag perched at a jaunty angle on your head won't help. Although it is good for a few laughs. I sent her off to the nearest ER, hat and all, where it just happened that a close friend of mine was doing triage. Even though no one told him, he knew that I was involved in this someway, somehow. Sometimes, you just have to do that sort of stuff.

The good part is that with the exception of New Year's Eve, it's not very busy. What we lack in volume, we make up for in weirdness, though.

Oh, and on Christmas Eve, everything is closed by 7:00PM. I mean everything, you can't even find a decent cup of coffee in most places. Sort Of Big City has ONE Dunkin Donuts that's open. Well, not everything, the Chinese restaurants are all pretty much open. At least there's that.

It might not be heartwarming, but it's the reality of working in EMS during the holidays.

Oh, did I mention the time the crazy guy in a wheelchair attacked two of our EMTs? They ended up throwing his Christmas tree at him so that they could escape. As the ran out the door, one of them did wish him a Merry Christmas. You may think of people in wheel chairs as frail, but this guy was built like an Olympic weight lifter from the waist up. And nasty. I met him a few months later when he attacked my partner when we called to assist him. But, I digress.

The State Of Public Education

2009-12-18T18:40:00.001-05:00

Mrs. TOTWTYTR came home from school today and told me that one of the other teachers had been called to an "emergency" meeting with one of the administrators. Seems the other teacher had chastised one of her students for talking like a "dirty pig". Which meant that he was swearing in class, although I don't know if said swears were directed at the teacher or just general conversation.

The teacher brought a union representative with her, just in case. Which turned out to be a good thing. Seems the student had complained to his mother who called the school and complained that his feelings were hurt and his self esteem harmed.

The union representative advised the teacher that the best course of action was an apology. From the teacher to the student, not the other way around. Seems that the "proper" way for the teacher to handle this was to send a note to the school office and request that one of the assistant principals come down to the room to speak with the student. If that didn't work, the student could be given a detention.

Oh, the student is classified as "special needs" for behavioral problems and so is a protected class of person.

Ambulance Driver has named this particular type of disorder "Chronic Hickory Deficiency". Unfortunately the lad's Mom didn't apply the treatment when he was younger and the teachers can't do it now. So, he'll just turn into one of society's problem children. No discipline in school or at home now, he'll probably end up making license plates for the state before too long.

Doomed. We're doomed I tell you.

Random Thoughts

2009-12-18T13:47:00.001-05:00

Or what passes for thoughts.

There are no bad submarine movies. I don't know if there even any mediocre ones.

Tiger Woods is in the rough right now. I don't think he has a club that will help him out.

Doing Cocaine to cure "the worst headache of your life", might cure it, but not in the way you figured.

Calling Obama inept is an insult to inept people. Speaking of which, what happened to all the "love" we were supposed to get from other countries because he was elected? I'm not feeling it.

I'm really starting to dislike Comcast. I pay a lot for Internet and email, and yet when I use their not so great webmail client, I get bombarded with ads for all sorts of crap that I don't want or need. I sent them an message on their "Tell Us What You Think" page, but of course they didn't respond.

The hardest thing in the word to do is throw out trash barrels. The trash guys won't take them unless you're standing their to tell them to. Their story (which I can believe) is that every time they take them, the home owner calls town hall and complains that they took their trash barrels.

75% of people are full of bull shit 90% of the time. They'll promise to do something, but won't follow through. I guess the adage should be "If you want something done at all, do it yourself." Maybe I'm just old fashioned, but when I tell someone I'm going to do something for them I do it or I have a damned good reason why I couldn't.

The ~~Soviets~~ Russians are now chiming in on "Climategate". Seems they think that the United Kingdom climate research scientists were fudging data too. One has to wonder if the ~~Soviets~~ Russians know more about how the "stolen" data was obtained and released than they are admitting. As police detectives say, "Follow the money." My guess is that the ~~Soviets~~ Russians don't think much of the whole Carbon Footprint thing and want to drive a stake in it's heart. Or that it will hurt their economy more than the United State's.

It's surprising how small an opening it takes to cause a big draft and make a room cold. And how easy it is to fix.

Makes My Head Hurt

2009-12-15T10:09:00.000-05:00

If you're one of my readers that doesn't visit my friend JayG at his blog MArooned, please hop over and take a look at one of his posts from today.

First Amendment? What First Amendment?

This is Olympic Class Stupidity. No, it's Stupidity Hall of Fame, Lifetime Achievement Award stupidity. In fact, it's so stupid I'm adding a Sumdoap Chronicles tag to this post.

Go read and comment.

Arrrrrghhhhh!