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Not Forgotten

We are almost a quarter of the way into the 21st Century and for most of that time we have been at war with an ideology. We as a nation, that is.

In all that has happened since then, both good and bad, it’s easy to forget that fall day back in 2001 when everything changed. At least for most us, because a good number of people were already fighting that fight while most of the nation was unaware of what was unfolding around the world.

Even for people such as I who followed Islamofascism and were well aware of the previous World Trade Center attack as well as others, this was a shock.

When the news that an airplane had crashed into one of the towers of the World Trade Center the almost universal reaction was that it was a horrible accident.

Then the second plane hit, and it was clear that it was no accident. Then the plane hit the Pentagon. Then a report of a plane crash in rural Pennsylvania. It was clear that we were under attack and were now at war.

What is important is that we not forget what happened that day, that we not forget the people who died, the people who were heroic, the way that the nation came together as a nation.

For Baby Boomers, this was the second “Where were you when…” moment. The first being the assassination of President Kennedy. For our parents, this was the third such moment, the first for them being the Japanese attack on Pearl Harbor on December 7, 1944. For Millenials, now in or approaching middle age, September 11, 2001 will be that day.

Hopefully, it’s the only one, but there are no guarantees in life.

 

 

A Hectic Year

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Just a bit over a year ago my wife and I made a very big decision. By nature, neither of us are very adventurous, we are pretty cautious.

After years of planning, preparing, and waiting, we were finally ready to move from our life long state of residence and head south. Both of us are retired from full time employment, although I do some EMS related consulting. Our children are adults and our son has a family of his own.

Both live in the south and neither are moving back. One of the realities of getting older is that at some point we will need support at some level in some way. That was also part of our calculations, but not the entirety. We had tired of the actions of the politicians in our state, including importing illegal immigrants and bestowing largess on them. Largess paid for with our tax dollars.

Given that we were both raised in our former state, had gone to school here for the most part, worked and raised our kids here, it was not a frivolous decision. It wasn’t even an easy decision although we made it rather quickly.

In May of last year we made the decision that the house was ready to go on the market, that we were ready to sell it, that we were ready to move away from all that we had known. Some of our friends had moved, some were gone, others were planning to move and so there was little to tie us down here.

We found a realtor who was well experienced and did a good job selling the house, calming our nerves when things glitched, and helping us get top dollar for our house.

On the other end, and this was nerve wracking, we were trying to buy a house remotely. We flew down in June and met our realtor in Texas. He came well recommended and he too did a great job guiding us through the different, but still complicated of buying a house.

All the while, we were sorting, selling, donating, throwing out, gifting, 43 years worth of collected “stuff.” The “spirited discussions” Mrs. EMS Artifact and I had over this part of the move put the most stress either of us experienced in almost 45 years of marriage.

At one point we had a well qualified buyer for our house and based on accepting her offer we made an offer on a house in Texas which was also accepted. Then, our “buyer” pulled the rug out from under us be reneging on the deal. Which meant we had to cancel our offer because there was no possible way we could carry two mortgages with no ideal when we would be able to sell our house.

This was when our selling realtor came through like a champ. She reassured us that she could relist the house and find a buyer quickly. And she did. That brought a new problem because the new buyers had a month to get out of their current residence which had been sold out from under them. Our time frame for moving moved from seven weeks to three and a half weeks.

Did I mention how stressful the sorting, selling, donating, throwing out, gifting, 43 years worth of collected “stuff” was? Our dial just went to 11. We mostly got it right, but some stuff that we should have tossed was brought with us where it was tossed in Texas. Some stuff that I tossed, should have come with us as I’ve had to replace some of it.

The good news, and it’s important (for me) to remember that this story has a happy ending, is that we found a house we liked at a good price and we sold our “old” house for enough to pay cash plus have enough money left over to make some repairs which the home inspection on the new to us house revealed would need doing sooner rather than later.

On the Texas end the problem was that the sellers couldn’t be out of the their house before mid November. As a result we spent five weeks living in long term hotels. Not bad, but cramped. We used Homewood Suites in two states and the staffs were very good.

What happened to our belongings and furniture you may ask. Well, most of our existing furniture was left behind in one way or another. What were taking along with clothes, kitchen stuff, towels and linens, tools, parts, and all the other stuff went into storage at the moving company.

The first big day came, selling the house. Unlike the last time in 1980, nothing was done in person. All documents are signed on line via Docusign or whatever it’s called. The checks were paper though. Buying in Texas is a completely different process than in our old state. Lawyers are generally not used in most of the south. There are title companies that handle the paperwork and money transfers. A side note, I don’t know what those commercials about how easy it is to steal a title are about, but our title was over twenty pages long and required multiple pages be signed and every page be initialed. It required witnesses and it also required the title company representative to stamp it with her state required seal.

Once we notified the moving company that we had a place to move in to, we had to wait another week for the truck to make its way south. That happened just after Thanksgiving.

In the meantime we moved a small amount of belongings into the house, I set up the WiFi and cable TV equipment. We set up an account with an electricity broker, established a water, sewer, and trash account with the city. We started getting familiar with our city and where everything was. There is a Lowe’s and a Home Depot across the street from each other and less than a mile from our house. That came in handy.

The morning of the move in, as if we didn’t have 1,000 things to do, our main sewer line backed up. I was lucky because the plumber that I called in a panic came right out, identified the problem, and made a temporary repair.

After all that was done, it was time to register vehicles and get our driver’s licenses. We needed to do that before the New Year because property tax exemption applications must be filed by then or they will be delayed a year.

Everything got done, but everything  is a process. As Mrs.EMS Artifact said one day “It’s easier to think of Texas as a different country than just a different state.”

So, here we are ten months later. All of the repairs have been done to the house, we’re officially Texans, we see our lovely daughter and her boyfriend frequently, I’m a Texas licensed paramedic and we’re settled in. Both of us have met new people and some will become friends. I finally realized that the friends I have can never be replaced, but it’s always good to make new friends.

It wasn’t an easy process, but it was clearly worth it. The only lasting (maybe) effect is that my Thyroid Signaling Hormone (TSH) is up a bit. Reading about it, it seems that one of the causes can be stress.

I wonder how that happened? My new Primary Care Physician isn’t overly worried about it and it’s likely it will return to normal.

 

Stay In Your Vehicle

I don’t know if there are more road rage incidents or the media is just giving more coverage to the ones that occur. “Road Rage” can be anything from one driver giving another the finger for some slight real or imaged, cutting others off in traffic, or even murder.

This is a case, allegedly, of the last.

ELGIN MAN CHARGED WITH MURDER FOLLOWING FATAL ROAD RAGE SHOOTING ON U.S. HIGHWAY 290 EAST

Elgin, Texas was the scene of a deadly confrontation Tuesday night following what is believed to be a road rage incident. According to CBS Austin, court documents revealed that 34-year-old Fabian Salas has been arrested and charged with the murder of Joseph Duane Stanczyk. Salas, who is in Travis County Jail on a $1 million bond, is accused of fatally shooting Stanczyk in the head after a physical altercation on U.S. Highway 290 East.

So far, no one is quite clear on what started this, but witnesses stated that the drivers were cutting each other off until they came to a traffic light. At which point the victim and then the suspect alighted their vehicles and started to fight in the middle of the street.

At some point Fabian Salas felt that his life was in danger (at least that’s what his attorney will claim) and shot Joseph Stanczyk in the head.

I do not know what happened here. I don’t know who is justified and who isn’t. I don’t know what will happen at the inevitable trial. Oh so many things I don’t know.

Here is what I do know. Note that this is not legal advice as I don’t have a license for that sort of thing. It is what I’ve learned over the years from various classes I’ve attended.

First, and perhaps most important, if you get out of your vehicle and confront the person who offended you, you have pretty much given up any claim of self defense.

If you are involved in something like this, stay in your vehicle. If either, or better yet, both of these men had stayed in their respective vehicles one would still be alive and one would not be in the Travis County jail awaiting trial for his life.

The other thing I know is that if something like this happens, it’s not in the shooters best interest to talk to the police without a lawyer present. A seemingly innocent statement can be used as evidence that you committed a crime.

All so stupid and useless. One life lost, another likely ruined. Salas is going to spend every penny he has defending himself against a criminal charge that may land him in prison for the rest of his life. If he can’t afford to hire a good lawyer, he is going to have to trust his life to a public defender who may or may not be competent to defend a murder charge.

Just stay in your vehicle, lock your doors, roll up your windows, and if you think you’re in danger, call the police. Unless the attacker breaks into your vehicle and is in a position to injure or kill you’ve now put yourself in a good position to be able to successfully claim self defense.

Oh, if you wave at someone in traffic, be sure to use all five fingers.

July 4, 1776

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When, in the course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume, among the powers of the earth, the separate and equal station to which the laws of nature and of nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty, and the pursuit of happiness. That, to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed. That, whenever any form of government becomes destructive of these ends, it is the right of the people to alter or to abolish it, and to institute new government, laying its foundation on such principles, and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness.

Prudence, indeed, will dictate that governments long established should not be changed for light and transient causes; and, accordingly, all experience has shown, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed.

But, when a long train of abuses and usurpations, pursuing invariably the same object, evinces a design to reduce them under absolute despotism, it is their right, it is their duty, to throw off such government, and to provide new guards for their future security. Such has been the patient sufferance of these colonies; and such is now the necessity which constrains them to alter their former systems of government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute tyranny over these states. To prove this, let facts be submitted to a candid world.

He has refused his assent to laws the most wholesome and necessary for the public good.

He has forbidden his governors to pass laws of immediate and pressing importance, unless suspended in their operation till his assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other laws for the accommodation of large districts of people, unless those people would relinquish the right of representation in the legislature; a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved representative houses repeatedly, for opposing, with manly firmness, his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected; whereby the legislative powers, incapable of annihilation, have returned to the people at large for their exercise; the state remaining in the meantime exposed to all the dangers of invasion from without, and convulsions within.

He has endeavored to prevent the population of these states; for that purpose obstructing the laws for naturalization of foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new appropriations of lands.

He has obstructed the administration of justice, by refusing his assent to laws for establishing judiciary powers.

He has made judges dependent on his will alone, for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of new offices, and sent hither swarms of officers to harass our people, and eat out their substance.

He has kept among us, in times of peace, standing armies, without the consent of our legislatures.

He has affected to render the military independent of and superior to the civil power.

He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his assent to their acts of pretended legislation:

For quartering large bodies of armed troops among us;

For protecting them, by a mock trial, from punishment for any murders which they should commit on the inhabitants of these states;

For cutting off our trade with all parts of the world;

For imposing taxes on us without our consent;

For depriving us, in many cases, of the benefits of trial by jury;

For transporting us beyond seas to be tried for pretended offenses;

For abolishing the free system of English laws in a neighboring province, establishing therein an arbitrary government, and enlarging its boundaries, so as to render it at once an example and fit instrument for introducing the same absolute rule into these colonies;

For taking away our charters, abolishing our most valuable laws, and altering fundamentally the forms of our governments;

For suspending our own legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.

He has abdicated government here, by declaring us out of his protection, and waging war against us.

He has plundered our seas, ravaged our coasts, burnt our towns, and destroyed the lives of our people.

He is at this time transporting large armies of foreign mercenaries to complete the works of death, desolation, and tyranny, already begun with circumstances of cruelty and perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the head of a civilized nation.

He has constrained our fellow citizens, taken captive on the high seas, to bear arms against their country, to become the executioners of their friends and brethren, or to fall themselves by their hands.

He has excited domestic insurrections amongst us, and has endeavored to bring on the inhabitants of our frontiers, the merciless Indian savages, whose known rule of warfare is an undistinguished destruction of all ages, sexes, and conditions.

In every stage of these oppressions, we have petitioned for redress, in the most humble terms. Our repeated petitions have been answered only by repeated injury. A prince, whose character is thus marked by every act which may define a tyrant, is unfit to be the ruler of a free people.

Nor have we been wanting in attentions to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred, to disavow these usurpations, which would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our separation, and hold them, as we hold the rest of mankind, enemies in war, in peace friends.

We, therefore, the representatives of the United States of America, in General Congress assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the name, and by authority of the good people of these colonies, solemnly publish and declare, that these United Colonies are, and of right ought to be free and independent states; that they are absolved from all allegiance to the British Crown, and that all political connection between them and the state of Great Britain is and ought to be totally dissolved; and that, as free and independent states, they have full power to levy war, conclude peace, contract alliances, establish commerce, and to do all other acts and things which independent states may of right do. And for the support of this declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our lives, our fortunes, and our sacred honor.

Signed by,

John Adams (MA), Samuel Adams (MA), Josiah Bartlett (NH), Carter Braxton (VA), Charles Carroll of Carrollton (MD), Samuel Chase (MD), Abraham Clark (NJ), George Clymer (PA), William Ellery (RI), William Floyd (NY), Benjamin Franklin (PA), Elbridge Gerry (MA), Button Gwinnett (GA), Lyman Hall (GA), John Hancock (MA, President), Benjamin Harrison (VA), John Hart (NJ), Joseph Hewes (NC), Thomas Heyward, Jr. (SC), William Hooper (NC), Stephen Hopkins (RI), Francis Hopkinson (NJ), Samuel Huntington (CT), Thomas Jefferson (VA), Francis Lightfoot Lee (VA), Richard Henry Lee (VA), Francis Lewis (NY), Philip Livingston (NY), Thomas Lynch, Jr. (SC), Thomas McKean (DE), Arthur Middleton (SC), Lewis Morris (NY), Robert Morris (PA), John Morton (PA), Thomas Nelson, Jr. (VA), William Paca (MD), Robert Treat Paine (MA), John Penn (NC), George Read (DE), Caesar Rodney (DE), George Ross (PA), Benjamin Rush (PA), Edward Rutledge (SC), Roger Sherman (CT), James Smith (PA), Richard Stockton (NJ), Thomas Stone (MD), George Taylor (PA), Matthew Thornton (NH), George Walton (GA), William Whipple (NH), William Williams (CT), James Wilson (PA), John Witherspoon (NJ), Oliver Wolcott (CT), George Wythe (VA)

 

It’s Hard Enough To Recruit Without This

On the one hand, EMS is probably better off with Leon Price. On the other hand, filing criminal charges when there was no intent is definitely not going to induce people to go into EMS as a career.

Charges dropped against former Pa. dispatcher who didn’t send ambulance in 2020 death

Despite Titchenell’s pleas, as her mother, Diania Kronk, was unresponsive and turning yellow, Dispatcher Leon Price stated he would send an ambulance but repeatedly insisted on needing her mother’s consent, even though she was unable to speak, KDKA reported.

Yeah, that’s pretty dumb. Not the fact that Mrs. Kronk was unable to speak, but it’s not the dispatcher’s job to determine if the patient is willing to go to the hospital or competent to make the decision to refuse to go. That’s what the on scene personnel are supposed to do.

A week before trial, Greene County District Attorney Brianna Vanata dropped the criminal charges against then-911 dispatcher Leon Price in the death of Diania Kronk. The charges were filed by Dave Russo, the former district attorney in the county.

Maybe an election year issue?

Price remains employed by the county, but the article doesn’t tell us what job he has. Hopefully nothing where decision making is involved.

Mrs. Kronk’s family is suing in federal court for “callous refusal of public emergency medical services.” Which doesn’t seem like a federal offense or anything that a local court shouldn’t be able to handle. I hope that they aren’t the victims of a callous law firm. Of course if it ever gets to trial we’ll probably not ever hear of it.

Sadly, we seem to be drifting towards a European view of what is and isn’t a crime. Which means that while stupidity is not a crime, nor should it be, stupid people shouldn’t be in EMS.

I’m just going to use my generic EMS Artifact featured image as I refuse to use the staged by her lawyers picture of the daughter holding a picture of her mom.

The moral of the story is that if someone calls 9-1-1 for an ambulance, send the ambulance. I know that we see a lot of dumb calls in EMS, but that’s not going to change in the foreseeable future. If nothing else, it gives us good stories to tell over a few beers.

Day of Days

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I’ve posted and linked to this Article from The Atlantic Monthly before. First published in November 1960 it is now behind a paywall so readers are required to pay to read it on line. Well, sort of, but more on that in a minute. First here is a short excerpt from the article.

Unlike what happens to other great battles, the passing of the years and the retelling of the story have softened the horror of Omaha Beach on D Day.

This fluke of history is doubly ironic since no other decisive battle has ever been so thoroughly reported for the official record. While the troops were still fighting in Normandy, what had happened to each unit in the landing had become known through the eyewitness testimony of all survivors. It was this research by the field historians which first determined where each company had hit the beach and by what route it had moved inland. Owing to the fact that every unit save one had been mislanded, it took this work to show the troops where they had fought.

Here is a link to a PDF version of the original printed on paper article. Please read it in it’s entirety while it’s still on line.

First Wave At Omaha Beach

Among the soldiers landing on Omaha Beach that day were Thirty-four young men from Company A, 116th Infantry Regiment, 29th Infantry Division. By the end of the day Nineteen of them would be dead. Four more would die in the following days. Bedford, VA proportionally suffered more losses than any other town in the United States.

Which is why the National D-Day Memorial is located in Bedford. It is well worth the drive out into the countryside to visit.

The generation that waged that war to destroy enemies of civilized society is quickly fading from the scene. Those of us who are from a younger generation bear the responsibility of keeping the memory of their lives and heroism alive.

Today I’ll be ensconced in my aptly named “Lazy Boy” recliner watching “The Longest Day.” Time permitting I’ll watch episode two of “Band of Brothers” which is “Day of Days.” From which I borrowed the title of this post.

 

 

How Hard Is It?

Back in the mid to late 1980s, my service had a few instances where crews left the cabs of their ambulances unlocked and as a result those ambulances were stolen. Most were recovered, a couple of people were arrested. One was totaled when the thief crashed into a bridge abutment and since he fractured his femur, he couldn’t run away.

After that unfortunate incident the bosses decided that enough was enough and from about 1985 onward every department vehicle was equipped with an anti theft switch. The first ones were manually activated and even if the keys were left in the ignition stepping on the brake pedal would cause the engine to stop running. Later on they were easier to use and crews were told to flip a switch in console and then turn the ignition off and most importantly take the key out. 

I only remember once in between then and when I retired in 2012 having a vehicle stolen. That was because the paramedic ignored the part about take the key out. 

Which is why this astounds me,

Video released of pursuit of stolen Calif. FD EMS vehicle

SACRAMENTO, Calif. — Dramatic video released Tuesday shows the intense pursuit of a stolen Sacramento Fire battalion chief’s truck through city streets.

The chase, which involved a California Highway Patrol helicopter and several ground units, ended after spikes were deployed and police vehicles surrounded the suspect in the stolen truck.

The city-owned F-150 pickup truck was stolen the evening of May 19 from Sacramento Fire Department Station 12, on the 4500 block of 24th Street in South Land Park .

Granted, this was parked inside the station not at a scene. It does however bring up two questions.

  1. Was the station wide open? Could someone just walk in and take whatever they wanted, including a vehicle?
  2. Was there a reason that the key needed to be in the ignition?

Here is a company that specializes in emergency vehicle kill switches. In fact, I believe that they invented the concept. 

This might not help if a vehicle is parked in it’s garage or other place, but it certainly will make scenes more safe when on responses. Besides it will avoid those oh so embarrassing situations when the crew comes outside with a patient on the stretcher only to find an empty spot where just moments ago the ambulance was sitting waiting to be stolen.

Some video from the pursuit,

https://news.sky.com/video/police-chase-stolen-fire-engine-11758254

Here is a news story from all the way over in Florida back in 2021,

Florida firetruck stolen while crew responded to call

If I worked for a company that sold anti theft devices for emergency vehicles I know who I’d be calling today.

A Day in 1942, Another in 1944

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Eighty-two years ago the Japanese Imperial Navy had a very bad morning. It had started out fine with Japanese bombing Midway Island and causing significant damage. In return the initial attacks by American planes were ineffective.

At 9:20 Devastator Torpedo Bombers flying off of the USS Hornet attacked and every plane was shot down with no hits. Only one member of the attack survived. Similarly Devastators from the E USS Enterprise and USS Yorktown suffered heavy casualties with no effective hits.

A combination of Japanese fighters and ship based anti aircraft fire had stopped the torpedo attacks, but their efforts had diverted their attention from another threat. The losses of American pilots was not totally in vain. First, the Japanese were undisciplined in their attacks, so weren’t in position to intercept the American dive bombers that were not overhead. The attacks had also distracted the Japanese from rearming their planes and properly storing bombs and torpedoes.

That all changed starting at 10:20 when Dauntless dive bombers started scoring hits on the Japanese aircraft carriers. Within a few minutes the Kaga, Akagi, and Soryu were on fire and would sink later in the day.

The aircraft carrier Hiryu would follow later in the day and other ships would be damaged or sunk for the next couple of days as the shattered Japanese fleet withdrew.

Perhaps more important than the ships and airplanes themselves were the almost complete loss of experienced Japanese pilots, aircrew, maintenance crews. Unlike America, which had a policy of returning experienced crews to the United States to train new pilots and air crew, the Japanese pretty much sent people to combat until they died.

The United States lost the USS Yorktown which had been heavily damaged at the Battle of the Coral Sea and been repaired in record time and sent to fight again at Midway.

That’s the short story, the long story is several books long. I recommend just about any of them for those interested in what turned out to be one of the most crucial victories in the history of naval warfare.

The other day was June 4, 1944. The Germans were driven out of Rome by Allied troops. In late 1943 the Fascist government of Benito Mussolini collapsed and he was arrested. He escaped, but that’s a story for another day. Italy now joined the Allies in fighting against their former partner Nazi Germany. The Germans retaliated harshly and Italy was now treated as a captured nation.

The Allied assault started in January of 1944, but Rome was not freed until June 4. The fighting was on some of the worst terrain for combat in some of the worst weather in Europe. The American 5th Army and British 8th Army were the major Allied forces and both nations suffered heavy casualties. Rome was an open city by the time the Allies entered and a good deal of the German troops had retreated and would fight on until May of 1945 when Germany surrendered.

The Liberation of Rome would have been the biggest story of the month of June except for that other invasion which was labeled the “Invasion of Europe.”

The Italian theater of war doesn’t get nearly as much attention as it deserves. Many of the hard lessons learned at the cost of many lives were used during both the Normandy invasion and the invasion of southern France in August 1944.

 

Memorial Day 2024

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It would be nice if politicians would stop throwing young Americans lives away for nothing more than to score political points.

A friend complains that “We can’t afford to go to war, we don’t have the money.” I remind him that the real cost of war is in lives lost, ruined, or permanently altered, usually in negative ways.

Which is all I have to say today other than “Thank you” to those who gave up their futures for ours.

Easy To Miss – If You Are Not Looking

I recently reviewed two calls for one of our client agencies. Both call were responded to by the same two medics. Both patients were similar in some regards and the mistakes made were very similar.

Here is some of the relevant report, with Protected Health Information (PHI) removed or changed. Note that I’m not using the built in quotation function on the blogging platform, but you’ll be able to identify the text.

Here is the first report.

A3 dispatched to above address for a 68 year old pt not feeling well. Upon our arrival found a 68 y/o male ambulatory outside of him home with crew of FD. Pt was in no obvious signs of pain or distress. Pt stated his stomach has not felt right for the past x2 days. Pt denied any recent illnesses/injuries/surgeries. Pt denied any change in eating habits and states he has been drinking fluids appropriately. Pt had no other stated complaints. PMHx, Meds and allergies as noted. 

Past Medical History: Hypertension
Medications: Aspirin Metoprolol
Allergies: None Known

The vital signs were,
BP 158/72
Mean Arterial Pressure 101
Heart Rate 78,
Pulse Ox 97
Respiratory Rate 16

Exam was not remarkable, including the abdominal exam.

Treatment consisted mostly of a ride to a nearby community hospital.

What, you may ask did they do incorrectly? That’s a qood question because on the surface this seems pretty straight forward, but it’s not. While typically EMS providers are taught that Acute Cardiac Syndrome (ACS) presents with chest pain or discomfort, that’s not always the case. A good percentage of cardiac patients have “atypical” complaints and that’s where experience and looking past the obvious differentiates a clinician from a technician. In this case as soon as I read a sort of vague abdominal discomfort I immediately looked for the attached 12 lead EKG. The problem being that there wasn’t one. Epigastric discomfort is a common atypical presentation of ACS. It’s usually associated with either a Myocardial infarction or Angina effecting the right side of the heart.

So, the first mistake was not looking past the obvious. This is not some sort of secret in medicine. Epigastric distress is right there in their protocols along with several other things that for years were just not recognized. So, this gentleman with a not very complicated medical history is possibly having a serious cardiac issue. IF it were recognized by the crew it could have been treated. That said you don’t treat what you don’t recognize.

As baseball great Yogi Berra said, “You can observe a lot by watching.” People joked about a lot of things he said, but this one was spot on. If you aren’t looking for something, you’ll never see it. In this case it would be reasonable to apply the stickies and hook up the cardiac monitor. A 12 lead EKG would have been interesting to look at, but alas they providers didn’t perform one. Nor did they place an IV line in case treatment was needed. Nor did the give the patient aspirin to chew.

Unfortunately for me and my readers I have no way to find out what happened to the patient. At least I know that he made it to the hospital alive.

Case number 2 involves the same crew. Which is not encouraging.

Herewith are the pertinent parts of their report. I apologize for the all caps narrative. Among other issues, this young lad can’t see to find the Caps Lock on his device,

A3 D/P TO A/A FOR A 79 YOM REPORTED HYPERTENSION AND STOMACH DISCOMFORT. UOA TO SCENE PT WAS FOUND SITTING UPRIGHT IN CHAIR IN HOME STATING THAT ON AND OFF FOR THE PAST 12 HOURS
HE STARTS TO GET PAIN IN HIS STOMACH ACCOMPANIED WITH BILATERAL ARM WEAKNESS AND EXPERIENCING PAIN IN HIS JAW . PT STATES IT WOULD COME ON FOR 5-10 MINUTES AND THEN SUBSIDE.
PT WAS TAKING HIS OWN BLOOD PRESSURE AND STATES THAT IT WAS HIGH. PT STATES HE WAS SEEN THE WEEK PRIOR AT {nearby community hospital} FOR THE SAME ISSUE AND WAS DIAGNOSED WITH COPD BUT PT
DENIES SOB AT THIS TIME. PT ASSISTED TO STRETCHER SECURED AND TAKEN INTO A3 FOR FURTHER EVAL/TRANSPORT

This one is a bit more slippery because they did obtain a 12 lead EKG. Nine of them to be exact, but some were not clear enough to read. The provided noted some ST Depression in Leads V4 and V5 (chest leads). The problem with that is that those are not contiguous despite the number. Also, when I read the EKG (and I’m much more experienced that the two medics combined) I noticed that actually the anomaly was present in four chest leads, not just two.

Note that this too is a complaint of abdominal pain, but along with that there is pain in his jaw and weakness in both of his arms. It would be helpful if the medic had said which side of the jaw, but that’s not particularly critical. Once I read that complaint I went looking for the EKG (found) IV (found) and the Aspirin (nope). For more than twenty years now Aspirin has been recognized as a critical component of treatment for chest pain. Not that it make the pain go away, but that it makes the blood cells a bit more slippery and reduces clotting of red blood cells.

In this case, for reasons not clear to me they bypassed three hospitals with emergency cardiac catheterization labs and drove about half an hour to a fourth. Fortunately for the patient and them, nothing bad happened. There was something going on, however even to me it isn’t clear exactly what.

Sometime something that appears simple is far from simple. There were times in my field career that I’d look at a patient and get a funny feeling in my stomach. “Gut instinct” we’re told it is, but I don’t know how my gut can tell that a patient is about to fall of a clip. I don’t know how it does, but it does. In both of these cases, I’d have had that feeling in my stomach and would have treated these patient more aggressively than they were inclined to.

Does this make me a super smart paramedic? No, just one that pays a lot of attention to subtle clues.