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Absent Comrades

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Note that I started this last Saturday, but just got back to it today.

One of the less enjoyable aspects of getting older is losing friends and acquaintances along the way. It’s one thing to lose a friend who is several years older than I am, but it’s not a pleasant thing.

It’s more disheartening to lose a friend my age or younger. I mourn each passing while at the same time feeling blessed to still be around to see my kids do well and my grandkids aggravate their parents.

Yesterday I received word that a younger acquaintance died suddenly from a Pulmonary Embolism. He was what I would characterize as a friendly acquaintance that I’d see here and there at various conferences. He was however a close friend of a close friend

It seems that every year at about this time another person leaves us and heads for that undiscovered country from which no traveler ever returns.

That’s the nature of life, I guess.

So, to all my friends who have departed, thank you for your friendship, conversations, and assistance on a wide variety of issues over the years.

It’s good to have friends, but it’s always with the knowledge that everything ends sooner or later. Except the memories of times good and bad shared with those who are close.

 

An Interesting Thought

I had a chance conversation with an EMS official from another state.

Like everywhere else, EMS in his state is having a hard time recruiting and retaining EMS providers. Some areas offer grants to people who want to take EMT or paramedic training, but can’t afford it on their own. They will receive grants to attend school with the proviso that they work in EMS for a period of time after they are certified. The program has had some success, however often people will leave the field after they have fulfilled their obligation.

A lot of people leave the field to go into law enforcement or go to work at a fire department that doesn’t provide transport just first response service. Others leave public safety altogether and thus the field loses an experienced provider.

There are a number of reasons for this including schedules, pay, benefits, and burn out from dealing with ill, injured, and dying patients on a constant basis. Some don’t want to go through the recertification process which requires refresher courses and continuing education classes on top of that course. The process is time consuming and most providers have to pay for classes. Even agencies such as my former service, which provide paid training have the same issue. A lot of the retraining is tedious and repetitive. It’s the nature of the business, but that doesn’t make any difference.

Personally, I think the time of working 24 or longer hour shifts has passed, but there are those who like the extra time off that those schedules provide. Still, it’s a grind to work nights, weekends, and holidays. Plus some services have mandatory overtime and of course the nature of the world is that providers are mandated when they have something planned for their day off.

The person I was talking with said that he thinks it’s possible that EMS is not suited to a long term career. It’s likely, he said, that after five to seven years it’s reasonable for people to leave the field.

This is not the first time that I have heard this. Back in the 1980s we had an administrator that was hired to reorganize my service. He had a lot of in hospital experience as an administrator, but had never worked in an EMS system.

I got to know him pretty well and we had some interesting conversations. One day we were talking about the lack of a career ladder in EMS. There are only so many supervisory and management positions in even larger systems. Unlike the fire and police services, there are not a lot of none care provider jobs in EMS.

The truth is that for most people the career ladder in EMS is more of a career step stool.

Many of the people I worked with had college degrees and eventually went on to other fields. I worked with EMTs and paramedics that went on to be lawyers, doctors, nurses, police officers, fire fighters, and just about every other field that you can think of.

The administrator said that likely was the normal course of an EMS “career” and advised me to start thinking about moving on to some other field. I already had bachelors and masters degrees, but wasn’t interested in moving on to something else. As a result, that was the best advice I ever got that I didn’t follow. In retrospect, it was likely a mistake.

Several years later I went to paramedic school and became certified. I was talking to a friend one day and he suggested that I should think about medical school. I knew myself well enough to know that the 12 year grind of a pre med degree, medical school, and residency was something for which I was not suited. Even if I could afford the decade plus of having essentially no income, I’d be well into my 40s by the time I was able to practice at the attending level.

My friend had the right idea, but in retrospect it was for the wrong profession. What I should have done was go to nursing school. There are a LOT of opportunities in nursing, many of which don’t require clinical experience. Yes, one has to pay their dues working in a clinical setting, but after a relatively few years research, management, and administrative opportunities arise.

Alas, I was too young and foolish to understand all of that and continued on my career path. Although it may sound so, I don’t regret that because I was in one of the best places to be a career EMS provider. Still, I certainly would have had a different, maybe even better path if I had been wise enough to pursue a nursing degree.

In retrospect, both the state official I spoke with this week and that long ago administer were right. For most people there just isn’t a path to a long term career in EMS.

My son always says that starting with the first day on a new job, one should be looking forward to their next job and planning to get there. He’s a smart kid.

My advice to anyone entering the field of EMS is to think of it as an intermediate step on a career path to something better. EMS gives one a great deal of education and experience which can be applied to other fields. EMS requires multi tasking, analyzing a problem, and developing and implementing a plan to fix a problem. That’s a valuable skill in any field.

It’s certainly something to think about and you body will thank you for it years later.

Gone To Texas

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I’m in central Texas for the next week or so.

I’m at a conference, meeting with a staff from a new client agency, having Thanksgiving with our lovely daughter, and meeting her new beau. Also doing some scouting for potential relocation sites as we’re thinking of leaving the frigid northeast and moving south.

Texas is high on the list as well a couple of other southern states. Not Florida, since neither of us are all that impressed. I at least like the new political atmosphere in the state, but a lot of friends and relatives have moved down there. It’s hard to explain by Mrs. EMS Artifact and I don’t want to move 1,000 plus miles to live near the same people that we live or lived near now.

If that makes sense.

Anyway, we’re going to drive around a couple of days when I’m not busy with work related activities and see what some cities and towns look like.

Hmm. There’s actually movie titled “Gone To Texas.” Now I’ll have to find it on line somewhere and watch.

That’s it for now, I’ll comment on other stuff as time permits.

Things Fall Apart

1919 was time of great turmoil in the world. The Great War was ending, the Irish Revolution was beginning, the Communists were in charge in Russia, and anarchy seemed loose in the world.

Williams Butler Yeats released a poem titled “The Second Coming” that summed up the mood of the world. I quote only the first part as it’s most relevant to the topic of today’s post.

Turning and turning in the widening gyre   
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere   
The ceremony of innocence is drowned;
The best lack all conviction, while the worst   
Are full of passionate intensity.
Sure seems familiar, at least to me.
Consider the following stories from around America.

NEW ORLEANS — Attacks on medics, pandemic burnout and competition from the private sector contributed to 40% turnover at New Orleans Emergency Medical Services last year, officials told the City Council Friday.

With more than one-fifth of the jobs vacant, the agency is well below an industry standard for responding to the most urgent 911 calls.

EMS leaders said they’re doing their best to juggle an onslaught of calls, and they expressed optimism about a recent pay increase. Still, they said they’re swimming upstream against industry-wide staffing issues.

“More work is needed, and we anticipate persistent staffing challenges over the next few years,” EMS chief Bill Salmeron said at a council budget hearing.

The full story is at the link, it’s an interesting lead. My former agency has a smaller, but significant problem with retention of both BLS and ALS providers. They are always advertising  an in house EMT program as well as posting openings. Part of that is a foolish, but long standing, residency requirement in a city with some of the highest rents and home prices in the country.

Then there is this,

California sheriff’s office stops all daytime patrols due to ‘catastrophic staffing shortage’

A California county sheriff’s office announced that it will stop its daytime police patrol due to a “catastrophic staffing shortage throughout the agency.”

Tehama County, which is located north of Sacramento and has a population of 65,000, will suspend daytime patrol services starting November 20.

Ending the patrols could prove dangerous considering that Red Bluff, the county’s most populated city, has a violent crime rate higher than 97% of other U.S. cities, according to Neighborhood Scout.

Think about that. A law enforcement agency is stopping uniformed patrol during daylight hours because they can’t staff the agency. Further in the article the Sheriff states that he is having difficulty recruiting and retaining officers.

Imagine that. In an atmosphere of “defund the police” over the past 2 1/2 years people don’t want to be police officers.

Speaking of which,

24 Boston police officers to become city firefighters this year in large uptick

Boston Police Patrolmen’s Association President Larry Calderone said the department is “losing officers to the fire department at an alarming rate because, at the end of the day, it’s a great job.”

“Great wages. Great working conditions. No forced overtime. A great quality of life and, arguably, greater respect,” Calderone said in a statement to the Boston Herald. “The officers leaving will tell you they’re sick and tired of being taken for granted and disrespected by the never-ending criticism associated with the ‘defund the police’ movement.”

This summer, the BPPA complained about at least five officers being forced to work 24 hours straight to manage events.

I can’t think of anything to add to that.

Just when I thought that I had nothing to add, this also from Boston.

‘At a Breaking Point’: Boston EMS Seeing Record Low Staffing Levels

Big and small cities, towns, counties are having trouble hiring public safety personnel. It used to be routine in my state to have 15,000 people sign up for the police and fire civil service exams. Getting one of those jobs was highly competitive and they were  highly sought after. Once hired, unless they were fired, firefighters and police officers rarely left before they were eligible to retire.

Not any longer.

Defund the police comes to Burlington, Vermont

Note that the link goes to what is essentially a blog post about an article in the New York Times. Since the article is behind a paywall, I won’t link to is. As a result any quotes are from the blog post, not the original article. That said, on with the quotes.

Consider if you will the city of Burlington, Vermont population 44,781. Burlington is a beautiful place where Bernie Sanders got his start in politics and where even the ice cream is progressive (Ben and Jerry’s). Until very recently, crime was barely an issue in Burlington. Most years there was not a single incident involving gunfire and the mostly white, very progressive populace invested in a park at the center of the city which they dedicated to people they lost during the pandemic. But lately something has changed. All around the city, people’s bicycles started to disappear. Not just a few but hundreds of them missing from porches and backyards.

Bike theft is not exactly the crime of the century. On the other hand, bicycles are NOT cheap these days. Even entry level “Department Store Bikes” are in the $300.00+ range.

This quote is from the comments at the original New York Times article. It was pulled out and quoted in the blog post above. Read it carefully, because it gives a window on a potential future.

An important factor to understand is how police departments are staffed. Originally at roughly 95 in 2018, that was made up of 50 patrol officers and then 45 supervisors, detectives, domestic violence officers, etc. All most all of the police leaving have come from patrol officers. Now at about 60 total, only 15 are patrol officers, so it’s actually a 70% drop from 50 to 15.
This is fairly typical across the country – when you hear of departments being down such and such, the impact is actually far far greater than immediately apparent.

Lots more reactions like these but this reader just says what the Times only insinuates.

Read this article carefully and the take away is the citizens are effectively resorting to vigilantism to solve the bike theft problem. Sure, they are not physically harming anyone now, but it is clear if the police will not or cannot protect lives and property — in this case property — people will take matters into their own hands. If you think this is better than effective law enforcement, think again.

A question that liberals frequently ask about property crimes is, “Are you willing to kill someone over mere property?”

The alternative question, which seems to be asked more and more is, “Are you willing to die in order to steal someone else’s property?”

Then there is this,

I’ve been warning for a while that the breakdown of law and order won’t go as they hope. Ultimately, the police are there to protect criminals from the populace, not the other way around. Get rid of the police, and armed vigilantism is what you’ll get. And what you’ll deserve.

I’ve been warning for a while that the breakdown of law and order won’t go as they hope. Ultimately, the police are there to protect criminals from the populace, not the other way around. Get rid of the police, and armed vigilantism is what you’ll get. And what you’ll deserve.

Vigilantism started in San Francisco in 1851. Citizens fed up with the inability of the small number of law enforcement officers to control crime due to the explosive growth of the city.

WHEREAS it has become apparent to the citizens of San Francisco, that there is no security for life and property, either under the regulations of society as it at present exists, or under the law as now administered; Therefore the citizens, whose names are hereunto attached, do unit themselves into an association for the maintenance of the peace and good order of society, and the preservation of the lives and property of the citizens of San Francisco, and do bind ourselves, each unto the other, to do and perform every lawful act for the maintenance of law and order, and to sustain the laws when faithfully and properly administered; but we are determined that no thief, burglar, incendiary or assassin, shall escape punishment, either by the quibbles of the law, the insecurity of prisons. the carelessness or corruption of the police, or a laxity of those who pretend to administer justice.

In the end, the Vigilance Committee may well have caused more harm than good, but when people see a breakdown in civil society they will react in what they consider the only possible ways.

Add to that the questionable integrity of the 2020 and 2022 elections in states and cities controlled by the Democrat Party and the mood among a good number of Americans is pessimistic to say the least.

Add in that in some large jurisdictions criminals are released without bail almost as soon as they are arrested and elected prosecutors are refusing to prosecute large swarths of “quality of life” crimes and it will be very possible that citizens will take the law into their own hands.

After all, who is going to stop them? The non existent police forces?

We’re entering a dangerous time in our country and things can easily get out of control.

Veterans Day

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That’s today in case you are wondering there is no mail.

This is a day thank all veterans of all ages whether they fought in a war or not.

This year, as last, it crosses my mind that some veterans of the various 21st Century wars the US has engaged in regret their decision to serve.

That includes the ones who suffered grievous injuries both mental and physical, but also those that suffered no adverse effects other than the separation from Kith and Kin, lost job opportunities, missed holidays, missed births of their children, missed everything.

Since the end of World War 2, the political leaders of this country seem to have lost the will to actually win a war. The Korean “Police Action” is still going on, in Vietnam defeat was snatched from the jaws of victory, Desert Storm  stopped without deposing Saddam Hussein, Operation Iraqi Freedom deposed and ultimately executed Hussein, but that war went on far longer than it should after “victory” was declared.

Afghanistan shows what happens when you fail to utterly destroy an enemy’s ability to wage ware as well as his will to fight. 20 years of “nation building” among a people who had no desire to build a nation or defeat their enemy resulted in more lives lost, billions of dollars wasted, equipment turned over willy nilly to the enemy, and the people who did want to build a nation and fight the enemy abandoned to their fate.

As a result, decades long allied nations are rearming themselves as they look over their shoulders to see if their “American Allies” are there to back them up.

For those who think that we should withdraw from world an isolate ourselves, I say that the world is too small, travel is too easy, and being isolated from much of the rest of the world by two big oceans means absolutely nothing in the Twenty First Century.

Despite all of the foregoing, people still sign up for and stay in the military. Not as many as used to and not as many as should, but maybe enough.

I admire them, but I also don’t blame those that don’t who see what the military and civilian leadership have done to the military services over the past twelve or so years.

So, veteran or active duty, I salute all of you.

 

 

Bad Medicine

This will be a short post with a link.

My advice to those still working in the field is,

“Don’t do this.”

Denver firefighters suspended for getting woman pronounced dead even though she was alive

Two Denver firefighters will serve unpaid suspensions for asking a doctor to pronounce a living woman dead even though they hadn’t assessed her or looked at her.

I don’t know how the system in Denver is designed, but I know that “Denver Health” is the EMS provider. Why two firefighters were making this determination is beyond me.

Why they listened to a police officer and then decided that calling medical control for permission to declare death is incomprehensible.

Henry relayed the police officer’s description of the woman as though he had made the observations, saying “she is bloated and obviously dead,” according to the letter. The doctor asked Henry whether the woman had a pulse or if there were signs of trauma and Henry said no, despite not having assessed her or looked at her himself.

At the least Henry lied about having examined the patient and the findings.

You can read the rest of the article to see what disciplinary action was taken against each of them.

Personally, I think both should have been fired, at least based on the article. We all know that the media is not always accurate in their reporting, but if this accurate it’s more than a mistake.

It’s deliberate malfeasance of office.

Modern Technology

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This story is about my Internet and Cable TV provider. They also provide my landline phone, but that’s Internet Protocol (IP) based and in a few years land line phones will be as much a relic as rotary dial phones.

As you might guess, I like the internet. At least when it works. The world of information and misinformation is at my fingertips. I can do research and find information on just about everything.

I’m old enough that when I was in high school and had to do research I had to go to my city’s public library. If it was something complex, I had to take public transit and go into the big city and use their library. The world was contained in paper books, paper magazines, and paper newspapers.

As a society we killed a lot of trees in our quest for knowledge.

Oh, I had to type my research papers on a typewriter. Tap…Tap…Tap…Tap… Backspace, Backspace, White Out, Tap… Tap… You get the point.

The internet changed all of that. When I went to paramedic school Personal Computers (PC) were less than ten years old and expensive. I bought one through a friend who had a friend who ran a company selling repossessed equipment from businesses that went bankrupt. Being able to type up a lot of material and then print it out made school a lot easier.

I started on line communications before Al Gore invented the internet. Dial up modems were the rage and we even had a second phone line just for that. Hi tech I tell you.

I even built some of my own computers under the tutelage of a electronic whiz friend of mine.

All of which is to say that I have some computer and internet technical capabilities and can usually find my way around a technical stuff.

Which brings me to last week. My Internet Service Provider (ISP) sent me an email offering me a newer and faster modem. No upcharge because they are cycling out their older equipment and want everyone to have new equipment.

Sign Me Up! Faster internet, terrific. Oh, and faster video streaming over my Roku equipped TVs. Even better.

So, I filled out the on line form and they shipped my new Modem/Router out via UPS. I’d have been happy to drive the ten minutes to my nearest store to pick it up.

Friday morning UPS dropped off the new Modem and I eagerly got right to the project. I powered down the old Modem/Router and unplugged all of the cables. I plugged the cables into the new box and then powered it up.

That’s about a five minute process and I just watched the light on the box change colors and blink or not blink during the process.

Great! Everything seemed to be fine. I logged onto a couple of websites on my desktop (yes I still have one) computer.

Great.

I picked up my phone pressed TALK to get a dial tone and heard nothing. Odd.

I then tried to connect my smart phone to the WiFi and got nothing. Very odd.

My ISP has decided that it’s more efficient, which I think means less expensive for them, to use an app on either an iPhone or Android phone. Soooo, I downloaded the app onto my phone and launched it.

Only nothing seemed to work. I clicked on the “Chat” button for technical support. It launched sent my some what were supposed to be humorous messages and then… went blank.

I hunted on line and found the phone line for customer support. Only, you can’t talk to a person, you have to press a series of buttons, hope you don’t disconnect yourself, and then they will send a link to your smart phone for a chat.

That actually worked and the person on the other end helped get the WiFi working. Great. Now I can wireless connect my laptop, tablet, or even my phone to the Internet. Mrs. EMS Artifact was happy that her iPad was connected.

All was well with the on line world, only it wasn’t.

I tried to log on to my ISP account and couldn’t. Not because I forgot my sign on information, but because the router settings on my ISP provided router would not let me get to the ISP home page to log on.

Every time I tried, I just go a “page not found” error. Hmmm.

Then, I tried to stream some TV via Roku. Nope, the router settings would not allow ISP provided streaming app to connect to the ISP servers. Everything else worked, Amazon Prime, Netflix, Hulu, Roku TV, etc… But not the ISP provided streaming app.

I called customer support again and this time the system connected me with a real person somewhere on Earth. I think on Earth. Apparently if you use chat some number of times the customer service computer figures you’re either a total idiot or this is a problem the automated chat system can’t fix.

I explained the problem to the very nice lady and we spent about an hour troubleshooting the issue. She finally admitted that it was above her level of expertise and that someone would text me directly to help. About half an hour later I got a text with a phone number to call.

I called and another nice person tried to help me with the problem, but to no avail.

The first insurmountable problem was that the person couldn’t comprehend my sign on problem. Every time I brought it up she said that she’d have security reach out to me to fix that. No matter how I explained that it was a problem reaching the website itself she just didn’t understand. That problem was NOT in the on line manual that they have to refer to.

We moved on to the Roku issue. I got my daily steps in by running up and down the eight stairs to the kitchen were the closest Roku box was located. After about an hour of that, the nice lady on line said that the next tier of text support thought it was an issue with the TV and I should reset that.

I asked how that would fix the other two TVs, my tablet, my wife’s iPAD, and my laptop not being able to stream.

“Oh.  I’m going to put you on hold for just a minute and transfer you to a higher tier because this is above my level.” Great.

Twenty minutes of computer generated “music” later the same nice young lady came back on the phone and said that they were refusing to pick up the call? WTF?

It was then that she decided that a tech needed to come out and look at the problem directly.

Okay.

Sunday.

Okay. Make sure that he has a spare modem because I think it’s a hardware problem.

“Most assuredly he will have a new modem.”

Okay. Make sure that he has a description of exactly what the problem is.

“Most assuredly. I am typing notes into the record so that he can see them before he comes out.”

I thanked her and hung up.

Total time between text and phone talking to three different people and an automated chat?

Six hours.

Sunday rolled around and right on time a van pulled up and a human emerged. That’s a win right there.

The tech was a nice young guy named Alex. From Romania originally.

I asked him if he had been told what the issues were?

“You can’t get on line.”

I asked if he had brought a spare modem.

“No.”

Sigh.

So, I demonstrated the Roku issue and the not being able to get to the ISP website issue.

He sat down at the computer and tried to get to the ISP address so he could log on as a tech.

Nope.

I told him that I was going to go up stairs for a minute if he didn’t need me (he didn’t).

About five minutes later I heard him yell out “WHAT THE FUCK?!”

He came up stairs and told me that he had a modem that was the next level up from mine and that he’d install that at no upcharge because my brand new modem/router was bad out of the box.

He installed that, set it up, and like magic I was able to get to the ISP website and log in.

Win #1.

I then had to reinitiate the Roku boxes and again like magic, they worked.

He took the old modem and the old new modem and said he’s turn them in so I didn’t have to return them to the ISP.

A win all around. For seven hours.

About 10:00 I decided to go to bed since the time change had screwed up my internal clock. I went up to the bedroom and tried to put on the NBC over the air channel.

Nope. No OTA channels could be watched.

Great.

A little on line research resulted in the information that the ARRIS XB7 modem/router would randomly not let people watch OTA TV over Roku. Apparently this has something to do with IP Port Addresses. It’s beyond me.

The XB7 is widely used and sure enough there are plenty of comments on the web about Roku connectivity problems. I know of two Canadian ISPs that use it

I gave up and put “Lone Star Law” and watched until I fell asleep.

This morning I had a class scheduled with a client department, so I couldn’t waste any time with customer non support. I planned on tackling that when I got home.

When I woke up, I turned on the TV and planned to watch something on one of the cable only channels. I was greeted with the activation screen for the ISP once more. I typed the numbers into the activation page on my ISP home page and like magic OTA TV came on.

I went upstairs to the spare bedroom and turned that set on. Again, like magic, OTA TV appeared.

When I got back home, I checked out the TV in the bedroom. It worked as it was supposed to.

I have no idea what transpired overnight while I was sleeping, but I’m not going to question it. I’m just going to enjoy my new Modem/Router.

Oh, and the $70.00 credit that they told me that they would get for my loss of service. Which they actually did.

Modern technology is great when it works, but when it doesn’t it’s aggravating and frustrating to try to get it fixed. My ISP, like everyone’s is cutting costs when it comes to customer service.

The result is no service most of the time.

Winter Is Here

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Technically, it won’t start until December 21, but up here in the northeast, despite a nice week ahead winter is here.

The leaves are falling and by mid November the trees will be bare and all we’ll have to look at until sometime in April is drab gray tree trunks and limbs. Oh, we’ll have some amount of snow through the winter and that will make it quasi festive for a few hours.

It’s not at all unheard of for there to be snow on the ground by Thanksgiving, let alone in time for Christmas. Which we don’t celebrate and so a white Christmas is just another day I have to get the snow blower out and clear the driveway.

In addition to the snow blower, I’ll drag out my roof rake, shovels, rock salt, sand, ice scrapers, winter clothes, and boots. Each year I hate the cold more and more.

Most of the time I finish clearing the driveway just in time for a snow plow to come along and block the end of the driveway with yet more snow.

In addition to leaves falling, the temperatures will start to drop, which means that outdoor activities will come to an end until sometime in April.

I’ll be constrained to riding my exercise bike in the family room while my road bike sits in the garage with gradually deflating tires. Nor will I be able to sit out on my deck, enjoy a good cigar, watch TV, or anything else, again until sometime in April.

So, you might ask, why do we stay here?

Part of that is habit. We both grew up here, most of our friends and relatives grew up here, we’re used to the familiar surroundings.

Yet, that is changing. Several friends have moved out of state at least part of the year. Others have moved out permanently. A couple have died, which is the natural course of life, but doesn’t make it any better. One friend is in the late stages of a shockingly fast progressive Dementia and may not see another spring.

My son, daughter in law, and grandkids live in South Carolina. My daughter lives in Texas and is in a very serious relationship with a young man who might end up being my son in law.

So, Mrs. EMS Artifact and I have decided to start the process of getting the house ready to be sold and finding a new place to live. It’s a bit daunting to consider a move like this after living all of my life in the same state.

The question really is to where will we move?  That’s not completely settled, but we have some ideas. Of course the state of the economy, a decrease in the value of our house, rising interest rates make it all the more of a challenge. We’ll figure it out, but I’m sure we’ll have some angst along the way.

Stay tuned.

 

Overwhelmed

Not me, but EMS as a profession certainly seems to be.

Here are a few data points from here and there.

One private service is offering up to $40.00/hour for paramedics based on years of experience. They are still unable to fill empty slots.

Fire based services are also having trouble filling slots despite the generally better schedule, pay, benefits, and working conditions. In my state anyone who wants to be a fire fighter pretty much only has to become a paramedic, take the fire exam, and they will be offered a job, probably several.

Once hired, these brand new, ink still wet, paramedics are being placed on ambulances with little to no field mentoring. That’s good for me because I get to spend a lot of time teaching them what paramedics generally learn after they start treating patients under the guidance of an experienced medic.

These days, few departments have the time or money to do that, so the new hires are sent right to the ambulance. This is not particularly good for either the provider or the patient.

As I’ve said many times before, getting a paramedic license is just getting a ticket to actually learn how to treat patients. For you downhill skiers, it’s the Bunny Slope of EMS if you get my meaning.

At that, fewer people are taking the fire exam overall.

Some fire departments are hiring people who are basic EMTs and paying for them to go to paramedic school.

Traditionally, a person stayed with his fire department for an entire 30 or so year career. No more. As one chief officer described it, “It’s like musical chairs, only there are more chairs than players.”

A good number of experienced paramedics are transferring to other fire departments that do not have ambulances. They are getting an annual stipend because they are paramedics, but don’t actually do more than first responder duties.

At least one fire district has added ambulance availability to it’s morning radio/availability checks. Traditionally that only included engines and ladder trucks, but now some departments are reporting that they can not send an ambulance for mutual aid on medical calls. They are just too busy trying to cover their own cities or towns.

There is some talk of starting up regional non transporting “fly car” systems. Which used to be common in my state, but died out through the 1990s into the early 2000s as fire based services started to provide ALS care.

Everything goes in cycles, I guess.

Some areas of my state have reverted to the long discarded staffing system of one medically trained crew member and an first aid trained ambulance driver. That system started to die in the mid 1970s just before I became a full time EMS provider. Now, it’s coming back to help relieve staffing shortages.

As a result, there is more stress and work load on the single provider as what the driver can do in terms of care is strictly limited.

Some private services have taken advantage of the emergency regulation changes and are trying to convince the state regulatory agency that this should be a permanent change. Which will of course drive more people out of EMS as they get burned like an electric vehicle under salt water.

My former employer is now reporting zero available ambulances at various times during the day. The private services that used to provide back up 9-1-1 service are no longer doing so because they are too overwhelmed with their own emergency and Inter Facility Transfer (IFT) calls.

Patients are being held additional days in Emergency Departments because the hospital has no available beds and the private services that do their transfers are booked solid days in advance.

One large non profit teaching hospital has started it’s own ambulance service at two of it’s larger facilities.

Why did this happen? There are a few reasons.

  1. COVID. Since the pandemic started requests for ambulances have gone up. No one is quite sure of why since COVID transports aren’t a huge part of either emergency or IFT calls. Of course if providers test positive they are barred from working for some period of days. Early one, that was two weeks, but now it’s often less time. The additional work load has driven some providers to just leave the field entirely.
  2. No one seems to want to work. At least not in EMS. When fast food restaurants are paying as much to start as an EMT would make, why take the harder job.
  3. The population is aging. Baby Boomers are all approaching or at retirement age. Which means that a lot of providers are no longer working in EMS. Like me. I’m in good physical condition for my age, have minor ailments, and could theoretically work on an ambulance. But I don’t have to and do want to. I’ve done my service and now perform easier EMS related tasks.
  4. People are living much longer and using EMS more often. It’s now fairly routine to see patients over 100 years old. When I started in EMS I might see one or two a year. Now, services are seeing that number every week if not more often.
  5. Ironically electronic Patient Care Report  (ePCR) systems take longer than the old pen and paper reports to write. That often increases at hospital time. They are great data collection tools, but in addition to more time, they provide far less useful clinical data.

I’m pretty pessimistic right now as are people who work in the field and the managers who have to try to find and retain EMS providers.

I’d like to think that maybe this will get better, but I can’t see how or when.

Japan is starting to use robots to provide care in nursing homes. Is there a role for robotic EMS providers?

We may well find out.

.45 ACP

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A couple of years before I retired I worked out of a station that was in the same building at a police unit. Separate facilities, but we shared a parking lot.

One evening my partner walked into the station and handed me one round of .45 ACP FMJ. Apparently some officer returning from a range trip had dropped the round and not noticed it.

I thanked my partner, but told him that I didn’t have any handguns in .45 ACP. “Well, I guess you’ll have to go out and buy one, won’t you?” was his reply.

I had no valid refutation to that, so I started thinking about it. I already had a small, but growing number of S&W Third Generation semi auto pistols in 9mm and was very comfortable with the design and Manual of Arms.

So, I started looking around both in stores and an on line forum that I spend too much time hanging around on .

About a week later another member posted a S&W 457 with little wear, complete with box and seven magazines for about $475.00. Considering what other similar handguns go for it seemed like a pretty good deal.

A trip was made, money was exchanged for the handgun, box, and magazines.

In due course I made a trip to the range and ran the gun through it’s paces. For $475.00 the 457 shot very well. On a subsequent trip to TX a couple of friends shot it and one offered to buy it. He’s a good friend, but I wasn’t about to part with this fine handgun.

A little history is in order. The 457 was introduced late into the life cycle of the Third Generation guns. The first Third Gens were introduced in 1988 and 1989 and over the next several years a dizzying selection of guns in 9mm, .40S&W, and .45ACP were introduced. So many that S&W introduced a model selection wheel for salesman to demonstrate the multitude of caliber and feature options that were available.

Here is a picture of one. There are a few in existence, but they are collector items. “Ephemera” is the term usually used.

I’ve never seen one in person and wouldn’t pay the exorbitant price that they bring when they show up.

Back to the guns. The regular Third Generation guns were well designed and beautifully built semi automatic pistols. Many police departments in the United States and other nations bought or specified them for their officers. New York City used several variations and only within the last few years were they removed from the authorized weapons list. Los Angeles still authorizes officers to carry them. The list is long and I won’t bore you with it.

Then, in the mid 1980s, something cataclysmic happened. An Austrian guy named Gaston Glock revolutionized the entire gun industry by introducing a pistol with a frame made of polymer, not any sort of metal alloy.

The advantage to the Glock was that it was a lot cheaper to manufacture.

The beautiful S&W semi autos used a frame forged out of steel or an aluminum alloy. One the castings were forged, they had to be hand machined in multiple steps on multiple machines. Each milling machine was set up to do one operation as this was before the advent of CNC machines.

The slide, barrel, and other parts were similar between Glock, S&W, Berretta, and other manufacturers, but the frame was the big cost differential.

S&W started to lose contracts to Glock because the largest customers, police agencies, were required to buy the lowest cost pistol that met all of their specifications. Glock was built to do just that at a cost below what S&W could offer.

As an answer, S&W came up with what they called the “Value Line” pistols. Ironically, the Value Line pistols used essentially the same frame as the standard line guns. There were a few fewer machining steps, some plastic parts instead of metal, but over all there wasn’t much difference.

Where S&W cut cost was somewhat ironically in the slide machining and finish. The slide is more blocky on the Value Line guns, the sights are cheaper, the finish on the black guns appears to have been applied with a Sharpie, and the ambidextrous safety/decocker lever was replaced by a left side only version.

It was of little avail and slowly the Third Generation guns were phased out of production. The standard line guns were removed from the commercial catalog around about 2006 and the Value Line guns were removed just a bit later. Police departments could still order both regular and Value Line guns as long as they could order in sufficient quantity.

All of that ended a few years ago and the remaining spare guns were sold to the civilian market where they commanded premium prices. That, however is a story not germane to today’s post.

Back to the 457. I’ve had a number of them over the years selling of one I had in order to buy a newer production gun. I even lucked into one of the relatively rare stainless steel versions. Same aluminum alloy frame, but the slide was made of Stainless Steel. The machining of the slide had the same blocky machining as the steel versions which makes them look, uh, chunky.

I decided that I wanted something just a bit different for my 457 so I enlisted the services of a gun smith I know who does custom slide work on Value Line guns in various calibers and configurations. After discussing the subject we came up with a plan.

If I could find a steel, not stainless steel, slide he would perform custom machining to make my Ugly Duckling a lovely Swan. After a few days of searching I found a suitable candidate on Ebay. Now, even though they are putatively anti gun, they will allow the sale of most gun components This slide was one of those and it was much cheaper than I expected to find one.

Off went the slide and associated parts for a make over.

I won’t go into cost details because the truth is I have more money into this than I ought to have spent. That said, I’m very happy with the result and in it’s way it is a work of art.

It’s also a practical pistol to carry for self defense and shoots quite well.

The work that was done includes stripping the frame down, thinning the sides by making “Scallop Cuts”, adding front serrations, sharpening the existing rear serrations, fitting a better rear sight with a “U” notch cut into it, and refinishing the slide, extractor, and safety/decocker in a rich black using a technique he found on line.

Here it is,

Even a chunky, low price, “Value Line” firearm can be turned into a beautiful work of art by a skilled gunsmith. Who is actually more of an artist in metal than anything else.