Over the years of my career in the field it was common to work as closely as possible with other agencies. This wasn’t always easy where I worked, particularly with the Sorta Big City fire department. It was easier with the Sorta Big City police department for any number of reasons. Sorta Big City EMS and Sorta Big City PD worked more closely on the streets and when I started the fire department had no interest in EMS at all. In fact, a few years before I started in the late 1970s the fire department had refused an offer from the Mayor to take over the emergency ambulance service that a recent state law had required every city to either operate or contract with someone to operate.
While EMS and PD in my city had a very good working relationship, it also became apparent than when push came to shove the police would shove us under the ambulance.
A Pierce County Superior Court judge has dismissed a lawsuit that accused local authorities of negligence after a Puyallup woman was arrested for DUI but actually had suffered a stroke. Jane Carhuff and a family representative sued the city of Puyallup and Central Pierce Fire & Rescue more than three years after her November 2019 arrest for which charges were dismissed, alleging that Puyallup police ignored protocol for DUI testing and firefighters rendered a medical opinion without the necessary expertise.
Those were the allegations, but it doesn’t seem that the case got to a trial on the merits of the claim.
As a result, the 54-year-old postal worker spent more than three hours in custody reportedly acting strangely. A day or so after Carhuff returned home and her condition — alleged to have been the product of drug intoxication — didn’t improve, her family took her to a local hospital where she was diagnosed with having suffered a massive stroke, according to the suit. The delay in receiving medical care significantly worsened Carhuff’s chances of recovery, and she continued to suffer strokes until her death in September 2023, according to the suit and her obituary.
More details of the case,
Officers identified Carhuff as the suspect and learned her whereabouts from family upon visiting her home, leading police to respond to her doctor’s office, the suit said.
The late Mrs. Carhuff was at her doctors office when the police arrived to arrest her.
The following alone should have been enough to prove the families case,
Fire personnel conducted their own medical assessment, instead of consulting with Carhuff’s doctor or taking her to a local hospital roughly 300 yards away, according to the suit. Only Carhuff’s blood sugar was tested after she reportedly referenced being diabetic, the suit said, adding that CPFR concluded that she wasn’t in medical distress but under the influence of an unknown intoxicant.
She’s in her doctor’s office, either waiting or being examined for a chief complaint of apparent altered mental status. The police and fire show up and the fire paramedics conduct and exam. No one thought to ask her doctor what he thought? No one thought it odd that a woman thought it a bit weird that that she went to a doctors office while possibly intoxicated?
The police would have said that they depended on the paramedics medical expertise, but the paramedics clearly did not do an adequate exam. Nor did the ask the doctor or his staff anything about the patient.
Here is another thing, perhaps the most important. Part of the process of obtaining a patient refusal is determining if the patient has the present mental capacity to make in informed and rational decision. That does not mean it’s one that the providers agree with, but it’s one based on an examination to the extent the patient will allow. That the results of the examination are explained to the patient. That the risks and benefits of the proposed course of treatment are explained. That the risks of refusing the propsed course of treatment, up to and including death are explained to the patient and that the patient understands said risks.
In this case a reasonable paramedic (me) would do the following.
Examine the patient as thoroughly as possible. That would include a Stroke Exam.
Ask the doctor his opinion of the patient’s condition.
Ask the patient if she wanted to go to the hospital.
Tell the police that it is very likely that she is having a medical emergency.
Without having access to the Patient Care Report, there is no way of knowing what the paramedics did other than a blood glucose level. That apparently was normal, but is only part of the examination.
The failure to do and document any of the above means that the report was inadequate, not to mention the care.
In a response filed in court, the city of Puyallup did not dispute that Carhuff had been unsteady on her feet and unable to follow simple instructions; that three EMTs who examined her had reported finding no medical problem; or that she was later diagnosed with a stroke.
Here is something else to consider. There is no rule that says that a patient can only have one condition at a time. She could have been having a medication reaction AND a Stroke simultaneously.
We’ll never know because by the time she was seen at a hospital and diagnosed the effects of the medication had likely worn off.
Even though the city and the individuals seemed to have escaped liability for what happened, it was still sloppy medicine. I’m sure there were high fives all around when the judge issued her ruling, but Mrs. Carhuff is still dead and still suffered from the time of her stroke until she died.
We’ll probably never hear more about this as it goes through the appeals process. Which is too bad as it’s a good illustration of bad EMS.
I’m very diligent about maintenance on my truck. Well, mostly diligent as there are a couple of things I’ve missed, but none of the essentials.
Last week I noticed that I was about 300 miles away from the 5,000 mile increment for oil changes. I NEVER miss an oil change, so I called my nearby local shop and made an appointment for this morning for the oil change and a tire rotation.
I showed up at the appointed time, checked in, and gave the keys to the office manager.
I then went outside to finish my coffee and have a morning cigar. I sat there reading, drinking, smoking, and saying hello to people passing by. Not a care in the world, as they say.
About forty minutes later the young man who was doing the work pulled my truck out of the garage and then backed into a parking spot. Or started to when the fun began.
As he backed up, I saw the right front tire detach itself from the vehicle while the five lug nuts rolled merrily down the slight incline. The tire’s bid for freedom was thwarted when the the right front of the truck fell on it.
Hmm. I sat there for a minute watching to see what was going to happen next. The young man got out of the truck, walked around the front and looked at the situation.
He then did the logical thing which was to get a floor jack from the garage and jack up the truck. At which point the shop foreman came over and started looking at the situation. I meandered over and he told me that the inner fender well was broken and he would order a new one. Okay, sounded reasonable. I went inside to talk to the office manager who had been out in the boss’s officer discussing something else and missed the excitement. He reassured me that they would fix everything, which is pretty much what I expected him to say.
He also told me that the young man who did the work had been with them for two years and they had not had any issues with his work. I said, stuff happens, and I hope he learned a lesson. The office manager laughed and said yes. He’s a hard worker and I felt a bit bad for him because he must have been embarrassed with this happening in front of the customer.
I’m sure he’ll be fine and next time be sure to torque the lug nuts on all four wheels.
Experience is indeed a harsh teacher. It gives the exam first and then the lesson.
After about 30 minutes the foreman came in and told me that the wheel was back on, but he didn’t like the way the studs looked. Unfortunately (for them) you can’t just replace broken or bunged up threads. No, you have to buy a new four wheel drive hub. Thanks Toyota.
Note that when engineers design parts they have to meet two criteria. First, the part has to be fit for purpose and not fail prematurely. Second, they have to be quick and easy to assemble while the vehicle is being built.
Note that “being easy to repair” is not a criteria.
There is a Toyota V-6 engine that has a great reputation for reliability. Which is good because the starter motor is mounted INSIDE the engine. Imagine how much fun it is to have to remove the top end of a internal combustion engine to replace the starter.
He had already ordered the hub, which the dealer had in stock. I assume they got it from the dealer and not some aftermarket part. He told me that it would be a few hours and offered to have someone drive me home.
Okay, kind of messed up my day as I had some errands to do and now that would have to wait. Still, they were doing the appropriate thing here and not trying to dodge responsibility. I’m going to presume that even if I hadn’t been sitting there watching the event, they would.
About 4:00PM the shop called and told me the truck was ready for me to pick it up. I asked if someone could come to pick ME up and bring me back to the shop, which they did.
I got back and walked in fully prepared to pay for the oil change and tire rotation. The officer manager prepared the invoice, handed it to me, and said “No charge.” I offered to pay because they had done the work and were absorbing the cost of the repairs, but he refused.
I thanked him and left.
Nice people and of course I’ll return again.
The only downside is that by the time I left the shop “rush hour” in my rapidly outgrowing the road system had started. It took much longer to get to the stores I needed to visit and then home than it would have if all had gone according to plan.
When does that ever happen?
Note that the picture with this post is not my truck, but that’s pretty much what it looked like when the tire came off.
This year’s anti Musk/DOGE/Trump protests (riots) are a follow on event to the George Floyd/Black Lives Matter protests (riots) in 2021.
It’s important to keep in mind that the goal of these protests is not “Justice for ______.” The goal is to destabilize and then overthrow the government structure of the United States. That doesn’t mean getting President Trump out of office and replacing him with a Democrat. It means overthrowing the Constitutional Republic that forms the government structure of the United States of America and replacing it with a Socialist Government that restricts individual freedom and rights and centralizes all powers to the national government.
That is what has happened in Formerly Great Britain, Canada, Venezuela, Cuba, and other nations in the post World War 2 society in which we live. One might quibble about England and Canada but it’s really a distinction without a difference.
When I use the term “Socialist” I actually mean Communist as there is no discernible difference between the two in the current world.
Historically, these revolutions, which is what they are, start at universities. Universities are full of young and impressionable people. Upon entering college they are still only half educated and the majority have no strong political opinions.
That makes them ripe for indoctrination by Leftist professors who are recruited for that specific purpose. That recruitment is done by Leftist administrators who control the operations and policies of the majority of colleges and universities. Of course those people were previously indoctrinated at the self same colleges and universities.
Chicken meet Egg.
This interview is from 1984 of KGB agent Yuri Bezmenov who defected to Canada in 1970. In this video clip from the longer interview he explains how they foment a revolution.
People often make the mistake of thinking that with the fall of the Soviet Union, Russia was no longer an enemy. That was naïve as we have subsequently discovered. The seeds of revolution that they planted in the 1950s and 1960 are bearing flowers now in ways that they, but not we anticipated. It almost worked in the 1970s and succeeded to the extent that the Democrats engineered the fall of the South Vietnamese government.
Revolutions always start small and grow as they find more supporters. The revolutionary leaders espouse worthy goals that everyone can agree are wonderful. They are also lies as no Communist government has ever lived up to it’s prerevolutionary promises. It’s a con game on a national scale and once power has been seized the idealists and true believers who helped with the revolution are now problematic.
In this clip Bezmenov explains what happens to the true believers aka traitors after the revolution has succeeded. He also explains who the Communists wanted to target and why.
I doubt that Bezmenov is the person who originated the phrase “Useful Idiots” and I expect it was a commonly used phrase within the KGB.
It’s easy to compare current events to what he revealed in these videos from forty years ago.
Of course it’s not just communists who do this, it’s widely applicable across any number of despotic governments.
Listening to him, we can easily see how the process works and what happens to the people (traitors) who help enemies overthrow duly constituted governments. Of course those people (traitors) won’t believe that it can happen to them because this time will be different.
Well, the calibers and types of guns might be different, but the end result will be the same. Shot and dumped into a ditch. Which they likely had to dig themselves.
Bezmenov defected from his station in India and ended up in Canada. He died in 1993 at the age of 53 from a “massive heart attack.” Of course we’ll never know if that’s what actually happened, but at least he was able to tell the story of how revolutions are planned and executed.
We’ve been warned, but I don’t know if we are smart enough to heed the warning.
For those interested, here is the entire Bezmenov interview.
I get emails from EMS1 pretty much daily. Occasionally I’ll take a peek at an article or two. Either they no longer allow comments or you need to create an account to comment. Either way, I’m not commenting. After all, I have a blog. Also, I don’t want my email to be spammed more than it is.
You should read the article as I’m only going to quote a few snippets to which I’ll respond. I don’t want to over quote and have them threaten to sue me.
Keep in mind that at the start of COVID I had been retired from active EMS work for seven. I still had many contacts in EMS especially at my former service. I also attended rounds regularly and knew a lot of medics at my client services. I’d see them often before COVID and we could be honest with each other. All of that is just to let you know where I got my perspective.
When a novel coronavirus began to spread across the globe and within the U.S., paramedics and EMTs faced an unrelenting wave of uncertainty. While guidance and best practices shifted rapidly to keep up with researchers’ evolving knowledge of the virus, it began to spread rapidly, overwhelming EMS systems with skyrocketing call volumes and forcing providers to make life-or-death decisions.
This is pretty much true, but we know that much of the “best practices” were actually made up on the fly and often not for medical reasons. What is true is that EMS systems were overwhelmed. Not just with patients, but lack of resources. Just before everything shut down I was talking with one of my former bosses who was the #3 person in the command staff. He told me that he was worried because of EMTs and paramedics started getting sick it wouldn’t be long before he couldn’t field enough units to meet demand. He also knew that every other service was going to face the same challenges so “mutual aid” would be none existent.
When the first community-spread case of COVID-19 in New York State was identified in New Rochelle, paramedics and EMTs rose to the challenge. Among them was then 28-year-old Alanna Badgley, a paramedic with Empress Emergency Medical Services in Yonkers, who found herself in an unexpected spotlight — featured on the cover of “Time” magazine as part of a special report, highlighting the “Heroes of the front lines.”
My initial reaction was surprise that Time Magazine still existed even then. But I digress. I’m again quoting this for perspective. MS Badgley was a two year paramedic at the time, so hardly a seasoned veteran. Her commentary should be considered with that in mind.
The pandemic didn’t just expose weaknesses in the healthcare system — it magnified the operational problems EMS had long faced. “All of the cracks in the foundation got exposed,” Badgley said. “Funding issues, retention issues, recruitment problems — everything got worse.”
Again true. Anyone who was symptomatic and tested positive was sent home for two weeks at that time. I know, or maybe I should say suspect, that there was some gaming the system by people who needed a break. Which is fine, but it also put more demand on the people still working. Again, this is not a positive.
A paramedic at one of my clients, and she was a good paramedic and a nice person, walked off the job in the middle of her shift. She just wrote out a resignation letter, brought all of her equipment to headquarters and dumped her gear and the letter on the chief’s desk.
She got out of medicine entirely.
Perhaps even worse is the number of providers who are still working, but only going through the motions. “Line and Ride” medics have always existed, but I’ve seen more and more reports that reflect that the medic is only doing the bare minimum to get through a call without getting “dinged” by the QA Police.
Some of them are trapped like birds in a gilded cage. That is their pay and benefits make it hard to leave for a new field. Fire fighters in particular seem to be afflicted, but no doubt it goes on in other fields. For fire fighters, the only salvation is that if they accrue enough seniority they can transition to an engine, ladder, or heavy rescue unit and minimize their EMS contact.
“If there’s one good thing that came out of this, it’s that we’ve made progress in destigmatizing mental health in EMS,” Badgley noted. Peer support teams, telehealth therapy options and a broader cultural shift toward acknowledging provider stress have all gained traction in the last 5 years.
This is what happens when you’re two years or so into your career. You have no long term perspective. CISD and Peer Support have been around since the late 1980s. Not everyone has it yet, but I suspect that’s more prevalent amongst the private services. Doing that properly is expensive. The fire and police services were well ahead of EMS in this regard, but there is much more parity now. All of which is to say that she’s overstating the case and reporter isn’t curious or maybe smart enough to do some research.
As a union leader representing EMS providers in one of the hardest-hit regions, Badgley understood the significance of the opportunity to speak with “Time”, but didn’t anticipate its lasting impact. “I knew people around the world would see it, but I underestimated how long that recognition would resonate,” she reflected.
More identity politics than anything else. I’ll address “impact” for a bit.
Here is what I saw. People left EMS in droves. Some just quit, others found other jobs. Good providers with enough time in to retire and collect their pension did so. That lasts to this day because it’s hard to get people to get into EMS now. If you look on Facebook, you’ll see services big and small, public, private, and volunteer advertising for jobs. Of course that isn’t just in EMS. Thanks to the protests in 2020 and defunding the police cities soon realized that they needed more police officers. Again, those that could retire did, others moved to other areas more welcoming to police. To a lesser extent that happened in the fire service.
Another effect of COVID was that a lot of people got used to not working. There was a lot of “free money” floating around and people grabbed it when they could. Even after the money ran out, no one wanted to go back to work. And it wasn’t just in emergency services. Retail stores were more or less self serve, even for paying customers.
Not exactly a positive.
Another silver lining from the COVID-19 pandemic has been the increased recognition of EMS. “Before COVID, I heard ‘ambulance driver’ way too often. Now, people say EMT or paramedic more. They understand that we’re part of the healthcare system,” Badgley noted.
That awareness has translated to legislative momentum. In New York, where Badgley works, the governor has included EMS initiatives in the executive budget for 4 years straight. But the fight for sustainable funding and recognition as an essential service continues.
I’m skeptical. The news media and some government agencies still refer to EMS providers as “First Responders.” Inside EMS, First Responders are the people who get to the site and do what they can while waiting for the ambulance to arrive.
Two things drove the creation of First Responders. The first thing was to use it as a tool to stop the response time clock. Once the First Responders got to the scene the magical and mythical 8:59 response clock stopped. I won’t go into who came up with that, why, or how other than to say it was based on long disproven “science,” but lives on in EMS.
The other reason was to give fire departments that wanted to get their foot inside the EMS door without having to actually commit to doing EMS. In an era where there were fewer fires to fight, it was a job retention program.
Note that the article doesn’t say if the Governor has succeeded in getting those EMS initiatives through the New York legislature and funded. That would be interesting to know and if it had happened, it would be news.
In that spirit, Badgley co-founded the EMS Sustainability Alliance, an organization working toward long-term solutions for recruitment, retention and workforce well-being. “We’re still a young profession. That means we have an opportunity to shape it into what we want it to be,” she said.
It’s a very nicely designed website, but it’s not overloaded with useful content. As to the above quote, I guess it’s a young profession in some terms, but if we use the EMS Systems Act of 1973 as the birthdate of modern EMS, we’re not that young. Sadly, many of the problems that the act was intended to solve still exist and a few are worse.
Here is the first question. Is EMS a profession? Or more accurately, is being an EMS provider of any level a profession? Or is it a trade as some people believe? Or, is it a skill set?
Think about that. I know EMS providers (all levels) who work on ambulances. I know some that work in hospitals. The US Coast Guard has EMTs. Every US Air Force Pararescue Jumper (PJ) is a nationally registered paramedic. Every US Navy SEAL Team has at least one paramedic. I know several police officers who are EMTs and a smaller number that are paramedics.
When it comes to EMS services, there are about 50 different system designs in the United States and Canada. I could create a list of the ones I know of, but it would be a blog post of it’s own.
Every paramedic who is also a Fire Fighter identifies as a “Firefight/Paramedic’ even though 80% of the run volume for most fire departments is EMS.
As to unions, the fire, police, and some EMS agencies have unions. The military obviously don’t, nor do volunteers.
The problem isn’t so much that EMS is a young profession at all. The problem is that EMS isn’t unified in any sense other than locally.
The emotional approach to improving EMS doesn’t work. Never has, never will. EMS more and more is data driven and EMS has to prove using hard numbers that it’s worth more money. We suck at that.
EMS has to decide what it wants to be when it grows up and if it even wants to grow up.
The original title for this post was “COVID Almost Destroyed EMS,” but that seemed overly dramatic. The title came from the song linked below. Listen to the lyrics and you’ll understand the message in the song and why I chose the title.
Moving across, well technically halfway, across the country is a big undertaking. In our case it involved a lot of clearing out of old property, getting the house sold, packing, finding a moving company, finding a new house, buying the new house, arranging to have our remaining property moved to our new location, unpacking, getting utilities turned back on, finding new doctors and new dentist.
None of that was particularly difficult, but did involve a lot of detail and a lot of communications. Some of the research into that started before I was even sure we were going to be able to move. None of it bears retelling here and my only advice is to do research and have a plan. And a back up plan as well. As General Dwight D. Eisenhower said, “The plan is nothing, planning is everything.”
Just about a year ago we were pretty much “settled in” in terms of what we needed to do. Mrs. EMSArtifact and I were driving through the Texas countryside, seeing the sights and discussing our new state.
I joked that it was “Almost like we moved to a new state.” Mrs. EMSArtifact said, “It’s easier to think of it as moving to a new country so much is different.”
She’s right, there is a huge difference between most red Texas and completely blue Massachusetts. What follows are some of the differences, listed and discussed without judgement. Some things we love, some things we like, some things we just tolerate. I don’t think that Texas cares about our opinions and I’m sure that Texas isn’t going to change to suit. Doesn’t matter because here we are and here we are going to stay.
Things you need to do when you move to Texas.
You need to establish residency. It’s not enough to own a property, even if you live there. You need to establish residency to get the available property tax exemptions.
In our case we needed to do that before January 1, 2024. Which in essence gave us less than a full month as we closed on our new house just before Thanksgiving, but couldn’t move into it until after Thanksgiving.
To establish residency, you pretty much need a Drivers License or state ID. So, we had to get TX DLs. The first hitch is that in order to do that you need to either have first registered your vehicles or sign an affidavit swearing that you don’t own a vehicle.
So, here is what you need to do to register a vehicle in Texas.
First, you need proof of INsurance. More on that later. You have to contact your insurance and tell them that you now have a new state and need a quote for insurance. After they give you the quote and you wake up from fainting at how expensive it is you print out your INsurance cards and go to an inspection station.*
The inspection station does the inspection, you pay them for that, and they enter the system into the state system. You then drive to the county tax collector office and pay the registration and other fees. Some of that is an excise tax based on the value of your vehicle. It’s not cheap.
After you pay them, they will give you your new inspection/registration sticker and your “tags.” Which we call license plates.
In Texas, the most important part of this process is getting your INsurance. Even though registration is only valid for one year, people drive around with valid INsurance, but and expired inspection/registration sticker. Technically, you have a year after expiration, but I’ve seen inspection/registration stickers five years out of date.
If you get stopped by the police, the first two things they ask you for are DL and INsurance.
Once you have registered all of your vehicles, you can then go to a Department of Public Safety (DPS) License office and get your license. There is a whole list of things you can use to prove you are you, readers can look them up.
The problem in urban areas is that so many people are moving in that it can be six months before you can get a DL. Which means if you come late in the year, you might miss a whole year of property tax exemptions. I was lucky because the very nice young lady at the county tax collector office told me that I could go on line and search for offices with open appointments. She cautioned that it could be well over and hour drive.
She was right, but I found consecutive appointments for myself and Mrs. EMSArtifact. We drove down at the appointed time, went through the process and got our temporary licenses. It seems that they don’t print them on the spot, they print a paper temporary and then the regular license is mailed to you. You can also register to vote, which we did.
We also had to register with our HOA. Never had one in our old neighborhood. This is not mandatory, but is well advised if you want to know that’s going on. We did, so we did.
Another thing we had to learn was how to pronounce some proper names properly.
For instance.
Burnet – Burnit
Manor – May Nor
Elgin – El Gin with the G in Gin pronounced like the G in Gun.
Manchaca. No one seems to know. It’s either Man-Shak or Man-Chack-Ka. Seems to depend on the day of the week.
Since there is no X in Spanish and Spanish is the secondary language everywhere and the primary language in some areas, X is pronounced as an H.
So, Mexia is pronounced Mahaya.
Takes a while to get used to that.
Geography can be a challenge. A city can be in two counties, which complicates things. Then there is the city itself and the Extraterritorial Jurisdiction (ETC) where the residents pay some taxes to the city, but sometimes don’t get any services from the city. Where you live in the Certificate of Convenience and Necessity (CCN) determines from whom you get your water.
In my city there are three entities that provide water. You don’t get a choice, whoever has the CCN for you area provides your water. One is the city water department, the other two are Special Utility Districts (SUD). In our city and the ETJs, the city provides sewage and trash pick up.
If you are in an unincorporated area, you might get your water from a (Municipal Utility District).
Electricity is deregulated in Texas. A state agency (ONCOR) generates the electricity, but you can’t buy it from them. You buy it from independent companies that act as brokers and compete on price.
Natural Gas is regulated and the state has a monopoly. Our neighborhood has propane instead of natural gas, which is uncommon.
All of these are quasi governmental entities.
Then there is law enforcement. City police have jurisdiction inside the corporate limits of a city. The County Sheriff has jurisdiction in unincorporated areas of the county. The Department of Public Safety (DPS) State Troopers have jurisdiction all over the place. Texas Game Wardens and Alcohol Beverage officers are “State Police” and spend most of their time doing Game or Alcohol related enforcement. However, they are certified police officers and can even pull you over for speeding or arrest you on a warrant.
Constables? Depends on the county, but a lot of what they do is property foreclosure related. At least in my county.
Texas Rangers are the Texas version of the FBI.
Got all that?
I mentioned that some cities are in two counties. That means that there is a city police and potentially two different county sheriff’s offices. Oh, and two District Attorneys and two County Attorneys. I don’t think all Counties have County Attorneys and I’m not quite clear what they do.
Then there are the schools. Schools are operated by the Independent School District (ISD) in the city. These too are quasi governmental bodies and are completely independent of the city in which they are located. Hence the name. Oh, mostly they have their own police departments. Again, fully certified law enforcement officers, they just work for the ISD.
Where you live determines which ISD your children will attend. It doesn’t have to be in the same city or even county. Cities can sometimes annex unincorporated areas and Austin traditionally has done a lot of that until last year when the laws were changed and people in an annexed area can vote themselves out of the city. Whether that will stop them or not remains to be seen.
We’re not done yet.
Outside of the major cities, the fire departments and some EMS systems are operated by Emergency Service Districts (ESD). Again, quasi governmental entities that are created by the voters in their areas.
Every county has ESDs, some have a lot of them. Travis County, which is where Austin is located, has seventeen ESDs. Not all of them have fire departments, some exist solely to collect taxes and then pay other ESDs to provide fire and EMS first response services.
Some cities are covered by more than one ESD, since the ESD is created by people who are willing to pay for better emergency services. There is a small ESD that used to provider fire services, but now pay Austin Fire Department to do that.
ESDs are completely independent of any cities that they may provide service too. So are ISDs for that matter.
Speaking of police, my former state was an outlier in that every city or town housed their own prisoners until the prisoners made bail or saw a judge. For that matter, that is the only state that has no bail bondsmen. The court magistrate comes out and sets bail for people arrested during off hours. Or he doesn’t and they sit in a cell until they go to court.
In Texas, the county sheriff runs the jails and prisoners are brought there for holding until they make bail. Which means they have to go before a judge. That’s normal in much of the country, so didn’t take much getting used to. Not that I’ve ever been arrested.
Back to Texas. Then there are the roads. Cities are responsible for city streets, counties for county roads, and Texas DOT for state highways, Farm to Market roads, and others. Except the toll roads. They are operated by a number of, hold on, quasi governmental entities that don’t raise taxes, but charge exorbitant tolls.
Driving itself takes some getting used to. A lot of drivers are very aggressive down here. Those are the same people who then go on Facebook and complain about how expensive their car insurance is.
When I say “aggressive” some of them drive like Kamikaze pilots on the highway, then like Demolition Derby drivers in the parking lots.
I learned early that it’s not good to be the first car stopped at a red light. You have to wait two to three seconds before you move because of those people who just have to blast through. Then they go on Facebook and complain about how slow people drive and how expensive their insurance is.
Non toll road maintenance is inconsistent. Back roads in particular usually need lots of work, but don’t get it because lots of people don’t live on them.
Even though much of Texas is a hub for technology, it is still very much at heart an agricultural state and so some of the roads are best driven in trucks. Or maybe tractors.
Depending on where you live, you can go from a city to farm or ranch land in 10 minutes. I love driving about that far from my house and seeing cows and horses grazing in the fields. It makes me smile every time.
Law enforcement on roads depends on where the road is. Of course if an agency has primary jurisdiction, that doesn’t mean that other agencies can’t pull people over.
Finally the weather. All I’ll say is that where we are there is not enough snow to shovel. Every once in a while I walk into the nearby Lowes or Home Depot and ask where they keep the snow blower parts. The blank looks remind me that we live in the right place.
It’s just Texas being Texas and it a long time to get here, but we’re home.
Here’s a musical finale,
*Texas stopped doing inspections January 1, 2024 except for emissions inspections in 16 counties. Guess who lives in one of those?
Where was I? Oh yeah, pontificating about new paramedics.
First a confession. I have two college degrees, the higher one being a Master of Public Administration (MPA). Which you would think would be beneficial in getting promoted to supervisor or manager. Nope, not at all.
In fact, about the only EMS related benefit that I got in all the years since I got that MPA is that it allowed me to become a Licensed Paramedic in Texas. That, plus taking the excruciating EMS Jurisprudence class that every certified Texas ECA, EMT, AEMT, Paramedic, Licensed Paramedic has to take to become and remain certified or licensed.
The best way to learn to be a paramedic is to respond to calls. Even routine Interfacility Transfers can help you improve your skills. If nothing else you can improve your interviewing skills.
A former co worker went on to be a police officer. I saw him about three years after he graduated from the police academy and he told me that he was in line to be made a detective. I mentioned that it seemed pretty quick and he told me that his agency liked to have paramedics as detectives because we’re good at asking questions and getting people to tell us things that they might not want to discuss. Interesting.
It’s good to practice building a rapport with your patients. It’s also a good practice to build rapport with your co workers, bosses, staff at various facilities. If they trust you, you’ll be surprised at what they might reveal.
Also, improve your examination skills. Doing things like listening to breath sounds on a manikin, no matter how realistic is not like listening to lung sounds on a patient. Once you know what normal sounds like, you will know what abnormal sounds like. Then you can start to learn what various adventitious breath sounds can tell you about your patient.
Go to as many classes as you can find time and money to attend. I’m not talking about the various “merit badge” courses offered by that large national EMS organization.
Very often local hospitals will offer a variety of classes open to EMS providers. Sometimes they even offer a free meal and who doesn’t like that?
Attend classes that you think might be above your level of education or training. You’ll likely learn things that will help you understand some of the things you were taught in paramedic school, but weren’t really comfortable with.
If possible, pick subjects that you weren’t all that good in and don’t find all that interesting. There’s a good chance you’re going to run into a situation where that will be important information.
If you can take cardiology courses, especially those with a concentration on EKG interpretation do that too. All too many paramedics are content to accept whatever the computer based interpretation says is going on. Every doctor I’ve ever discussed this with says that the computers are frequently incorrect and that they always overread the EKG to be sure of what’s going on.
Unlike what we were told in paramedic school sometimes you do have to treat the rhythm.
Know your protocols and Standard Operating Procedures. A lot of medics have a vague understanding of their protocols and that frequently leads to me having to “have a chat” with them about what happened on the call. To compound that problem experienced paramedics and some instructors will let you in on “street paramedic tricks.” For the most part they are shortcuts, often taken by lazy paramedics to avoid the more complicated appropriate treatments. At best these don’t help the patient and in some cases they can cause potential or actual harm.
A medical helicopter operation with which I am familiar has their crews pick a protocol out of their extensive protocol book, read it, and discuss it at the start of their shift. Everyone in EMS should know how to treat Acute Coronary Syndrome, but all too often people miss the subtle clues present with atypical presentations. If you miss those, you miss treating the patient and can cause an adverse outcome.
As boring as they are, read your agency operations manual. You need to know the rules before you can know when and how to skirt them. The goal being to do a better job despite silly rules.
Just remember that your boss never makes a new rule when someone does something smart.
I’m going to go back to education for a minute. So, I suggested business classes with English composition and mathematics included. That will help you whether you want to stay in EMS or move on. Many people in EMS decide that they want to move on for any number of reasons. Some just get burned out, which is always a risk.
That degree in business management is a hedge against having no place to go outside of EMS. You can even work in EMS and something else while you work to transition out.
Looking back, the one regret I have is that I never went to nursing school. By the time I realized the doors that a BSN opened to paramedics it was too late to go back to school and expect a Return On Investment. A lot of what you learn in paramedic school applies to nursing school. If your paramedic program had a college level Chemistry and/or Anatomy and Physiology course, you might be able to transfer some credits. Every nurse I’ve ever discussed this with has told me that Organic Chemistry was the hardest part of nursing school. Once they passed that course, the rest was relatively simple.
If I’d known then, what I know now…
There are nursing career paths that don’t require contact with patients.
I mentioned having an exit strategy, or “Plan B.” Something might happen and you won’t be able to continue in EMS. Well, unless you want to take a pay cut and work in dispatch. Which is less than ideal. I started in dispatch and got out into the field just as quickly as I could.
Which brings me back to non EMS specific education programs. If you already have a Bachelor’s degree of some flavor, a Master of Business Administration is a viable option. In addition to the medical and operational parts of EMS, there is a business side. That’s true whether you are in private, public, or volunteer EMS. Someone has to figure out where the money goes and where the money comes from. Or should come from.
EMS systems are expensive, even volunteer services. While salaries and benefits are bigger parts of the cost in paid EMS, everything in EMS costs money. Vehicles, fuel, maintenance, a building, rent, utilities, on and on. Someone needs to figure all of that out.
That’s my advice. Consider it for what it’s worth.
There is a recurrent debate on various EMS related forums regarding college degrees in EMS. A lot of my friends are very much in favor of that, but I’m very much skeptical of the utility and Return On Investment for paramedics who earn degrees.
The problem is what degrees will advance careers and more importantly, which will increase salaries enough to offset the cost of a college degree?
The truth is that EMS specific programs don’t provide paths to either career advancement or more pay. In fact, the one offered by Columbia Southern University specifically says,
Multiple factors, including prior experience, geography and degree field, affect career outcomes. CSU does not guarantee a job, promotion, salary increase, eligibility for a position, or other career growth.
This might be in part so that people can claim deductions on their income tax, if that’s still allowed by the IRS.
Total cost for the Bachelor of Science Degree in EMS is $32,400.00. The website doesn’t say if that includes books or other fees, but I’d guess it doesn’t.
Keep in mind that a BS degree is a good place to start, but what the degree is in is more important. If I were to give advice, I’d suggest a more generic degrees such as a Bachelor’s degree in business. For that matter, any degree in business management is helpful in EMS and just about any other career field.
Case in point. A close friend is a now retired dentist. He graduated from dental school in about 1975, took his boards, and bought into an established practice. I’ll attest that he was a very good dentist as he was mine for close to 30 years. Once he was settled in his practice, this is what he did.
He went back to school and took courses in how to run a business. The truth is most doctors and most dentists aren’t very good at running the all important business side of their practice. Some hire business managers, but my friend didn’t have the money to do that so he took community college level courses and learned how to run his business as he built his practice.
He ended up building the most profitable dental practice in the eastern half of his staff. He had a stable patient base, a reliable staff of hygienists, brought his younger brother on board as another dentist. All because he learned to run a business.
Just about anyone can do something similar no matter what their field.
So, where does a new paramedic go for education? If you don’t need a BS degree, check out your community college.
Here is what they say about their Associated Degree in Business Administration.
Earn your associate degree in business administration at ACC and learn what it takes to have a successful career in any industry. Basic business knowledge is the foundation for any profession, whether you want to be an artist, entrepreneur, sales executive, or business leader.
Which brings me to another point about paramedic programs and paramedics in general. I base the following on over twelve years of doing EMS Quality Improvement. That means I read anywhere from 50-75 EMS charts in a week.
Here are my two main observations. First writing skills are sadly deficient among EMS providers. My employer does not allow me to correct bad spelling, none existent sentence structure, or lack of punctuation.
I’ll be the first to admit that I am not the greatest speller in the world. In fact, I live by spellchecker. That said, I know how to put an sentence together. I could and maybe will write some posts with creative spelling and terminology.
So, my second piece of advice here is learn to write a well structured narrative. Just about every EMS PCR system has a plethora of check boxes and drop down lists that cover assessment, treatment, patient outcome, hospital destination, and so on.
The one part of an EMS report that needs to be in narrative form is the “History of Present Illness.” The story that the patient, family member, bystander, or other witness tells the providers often determines what the medic or medics will do.
The problem there is that the stories are so varied there is no drop down list that can capture all of the information related by the above people. The saying we use is “You just can’t make this up.”
The other problem is mathematics. There is what we call “paramedic math” and now with phones with calculators and even medication calculation apps built in it’s even easier. Still, you need to have the basics of mathematics in your brain just in case.
Even if you don’t plan on a degree, take a couple of courses to fix your weak spots.
Now, more medical advise. You go to paramedic school to learn paramedicine, but you don’t really learn how to be a paramedic. As I tell new medics, passing the paramedic exam is your ticket to start learning how to be a paramedic.
To quote Winston Churchill after the Battle of Britain, “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
Your job now is to learn all the things that they probably don’t teach you in paramedic school. Or if they did, they did a lousy job of it.
First, learn the common medications that our patient base takes. Our patient base, another thing they don’t teach well in paramedic school, is elderly patients. Elderly patients are the largest consumer of medical services, including EMS.
Almost every report I read has a list of common medications that are prescribed for patients. There is also a list of allergies, which is a good practice. That said, I’ll see a list of a dozen or so medications, and under PMH I’ll see “Diabetic” or “Hypertension” or “Cardiac.” I’ll glance at the medication list see a couple of medications and know that the PMH is woefully incomplete.
The good thing is that the list of common meds isn’t horribly long. Once you look up a medication and see what it’s for, you’ll remember that. After you see that same medication 100 times, you won’t even have to think about it.
When I’m doing a class for medics at a new client I’ll tell them this and then ask them if they know what Sildenafil is used for. I have yet had anyone raise their hand to tell me. Going back to our bread and butter of patients (the elderly) a good number of them have this prescribed for them. I’ll leave it to the reader to look that up.
Here is another thing that they don’t teach in paramedic school. Patients lie. Why they lie is less important than the fact that they may not be completely honest. Especially if they are taking Sildenafil and their wife doesn’t know that they are taking it. I had that happen once because the patient’s wife was standing their when we asked. Patient said no and we gave Nitroglycerin for his chest pain. Fortunately nothing bad happened to him.
Lesson learned, sometimes a patient doesn’t want to say things that family members might hear.
This is getting a bit long, so I’m going to break it into two posts. I’ll publish this one now and start on Part II afterwards.
This is the first anniversary of our officially moving to Texas. As in a year ago today we closed on our house in a nice community north of Austin.
It was a journey to our destination. A long journey. I’ll try to make the story shorter.
This all started in 2012 when I retired from my career with a municipal EMS agency. I started what has become my second career as a Quality Improvement specialist and consultant. Not full time, but enough to keep me busy and supplement my pension.
Mrs. EMS Artifact was still working, which was a result of taking a few years off to raise our kids and so delaying her retirement. We decided that when we were both retired, we’d look at moving to another part of the country. Where was open ended since family obligations meant it would be at least a couple of years.
Fast forward to 2014. Our daughter decided to move to Texas after graduate school. Apparently I was the only person unaware of this. In the meantime our son and his family had moved to Alabama. Still we couldn’t move ourselves, although we’d been to Austin several times and liked the area.
Fast forward now to 2021. COVID and all that going on and in the midst of that my 102 year old Mother in Law died. She had a good run right up until the end, but it ends for everyone at some point.
Mrs. EMS Artifact being the responsible of the two sisters ended up settling her mother’s affairs. Sans help from the person I now refer as “my wife’s former sister.” Yes, there’s a story to that as well, but you wouldn’t believe me if I told you.
Through all of this on every trip we took we scouted potential relocation sites. Alabama, Texas, Tennessee, South Carolina, even Georgia. Our fall back was New Hampshire, but only if everything went sideways because I hate snow and cold weather.
Fast forward to the spring of 2023. Mrs. EMS Artifact walked into my office and said, “I’m ready, where are we moving.” My answer was what she should have expected, but she was a bit taken aback when I said “Texas.” She blinked, thought about and say “Okay.”
Have I ever mentioned that she’s way better than I deserved?
Then began a busy seven months. I had spent considerable time since I retired getting the house ready to be saleable. Not ready to be sold, because that was never assured, but fixing the things that pile up over the years of owning a home. I had the time now, being semi retired. I also had enough skill to do some small and some not so small projects. I’ll forego that list because it’s long and includes carpentry, land scaping, painting, electrical work, more painting, a bit of plumbing, more painting. With the painting goes prep work.
All of which was to make the house look fresh and improve the all important “curb appeal.”
We contracted with a realtor recommended by a close, close friend who retired from being a realtor. The realtor was very experienced and after looking the house over told us that it was in great shape for a 60 year old house. We picked a date to put the house on the market and in the meantime we flew down to Texas to meet with a realtor there. We saw a lot of houses in a week, but found nothing we said “YES” to.
We flew back and kept in touch with both realtors.
The house went on the market. The house got an offer within 24 hours. We accepted the offer. Based on that we found a house in Texas and made an offer, which was excepted.
Then the weirdness began. Our “buyer” hired a home inspector who kept asking to come back “To check one more thing.” After almost two weeks of that, the buyer decided that there were too many problems with the house and backed out. The fact was that she just changed her mind, but having her phony home inspector make shit up potentially meant that we’d have to pay someone to fix the “problems.”
It was a bad day, but after talking to our lawyer, we signed the release. We also had to exercise our contingency on the house we had wanted to buy.
Our realtor did a great job resolving the phony issues, putting the house back on the market, and getting two offers. We picked the lower of the two which was still substantially more than the original “buyer” had offered.
The good parts of the offer were more money and the buyer would waive the home inspection.
Of course there was a bad part, as there always is. Their current residence was being sold, actually had been sold and they had to be out by October 25. Just about three weeks away.
We had planned to close on the sale and move mid November. Which meant that our 6-7 week time frame was cut in half. Three weeks to finish sorting, packing, selling, giving away, trashing, Forty Three years of “stuff.” We had already hired a mover and just had to let them know the date, so that was one problem out of the way.
That was a stressful three weeks. So stressful that there was a pretty good chance we would be moving, but not as a couple.
Somehow, it all got done. Everything got packed up, we found a house in Texas, we sold the house in MA. Once we had closed, all that remained was to wrap up some loose ends and head south. We left MA as residents for the last time on November 8 and on November 12 we took up temporary residence in a Homewood Suites. Forward Operating Base Homewood Suites as it were.
From there we actually got to see our soon to be new to us home for the first time. The home inspection had been done beforehand and we knew what might have to be done in advance.
From FOB Homewood Suites we started setting things up. Internet/TV, electrical service, set up an account with the city for water, sewer, and trash. Set up an account for gas. All the things we’d last done Forty three years ago, but all done differently than what we’d done before.
Then came the big day. November 22, 2023. Documents were signed, checks passed, more documents signed. Again done much differently than the first time we bought a house.
Only one problem left. I had to call the moving company and tell them it was time to ship our stuff down to us. That wouldn’t happen for another week or so, so we stayed at FOB Homewood Suites for another week or so, but made daily trips to our new house to get things set up.
Then came the big day. November 28. The moving truck pulled up exactly on time, three men got out and started moving furniture and 140 boxes of various sizes. Plus all the other stuff that goes with a house.
We were home.
The year since has flown buy. There’s a lot to do when you move to a new state halfway across the country. One day we were talking about all of the things Texas does it’s own way. I joked to Mrs. EMS Artifact that it’s like we moved to a totally different state. She replied, not joking, that it’s easier to think of it as moving to a totally different country.
Which Texas was and who knows, might be again some day.
Won’t matter to us. Here we are and here we will stay.
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.
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.
