EMS Artifact

Not The Way To EMS

EMS Artifact

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September 14, 2023

I’ll preface this by saying we only know what the family is alleging. The EMT and town have yet to respond and there has been no reply from the town itself.

Arguendo, as the lawyers say, lets stipulate that the facts as presented by the family are accurate.

Maine family files $2M wrongful death lawsuit after patient falls from cot

MEDWAY, Maine — The wife and grandson of a man in respiratory failure watched an EMT pronounce him dead after dropping him from a gurney outside his Maine home, according to a recently filed lawsuit.

Before Kenneth D. LaPorte, Sr. stopped breathing, the EMT who responded to his medical emergency forced him to walk an “unreasonable distance” to the ambulance parked outside his home at around 3 a.m. when he was “experiencing low oxygen levels” of around 74% on April 16, 2022, the lawsuit says.

Letting a patient with an acute illness walk any distance is poor care absent some unusual circumstances. Which don’t appear to be present here. 74% is pretty much incompatible with life and encouraging a patient to walk is going to place severe stress on their cardiorespiratory system.

Then, the EMT placed LaPorte on a gurney — but never strapped him to it — before she went to get an oxygen tube, according to the complaint, which says as she untangled the oxygen tubing, LaPorte stopped breathing.

When the EMT lifted the gurney, LaPorte’s family watched him fall off, hit his head on the ambulance’s bumper and again on the ground, the complaint says.

Again, a serious lapse of patient care. Typically, providers are required to bring the appropriate equipment and a method to “convey” the patient to the ambulance. Since the patient was on home Oxygen a reasonable and prudent provider would make sure that was provided before moving the patient.

Straps are required before moving the patient specifically to prevent them from falling off the stretcher.

After the Medway Ambulance Service arrived at LaPorte’s home, the ambulance’s driver brought a medical bag inside the house but the EMT wouldn’t use it, according to the complaint.

“I do not need the bag, take it back out,” the EMT told the driver, the complaint says.

The EMT is accused of failing to record LaPorte’s vital signs before having him walk to the ambulance while in respiratory distress, according to the complaint.

Total fail there. When I read an ambulance report, I check to see what time the vital signs were first obtained. If it’s more than two minutes after initial patient contact, the provider had better have documented a good reason.

CPR is more effective on a flat service (gurney), rather than on the earth.”

I’ll quibble and say not necessarily, but it’s just a quibble. The bigger issue is the patient falling off the stretcher, not where the CPR was done.

Oh, and I don’t know anyone in EMS, at least east of the Mississippi that calls and ambulance stretcher a “Gurney.” I don’t even know what a Gurney is although I guess that it’s some term some writer heard along they way and thought was cool. I’ve heard them called “the bed,” “cot,” or even a “stretcher” and one former partner called it “The Slumber King,” but never a Gurney.

Neither major ambulance stretcher manufacturer uses the term “Gurney.”

Back on point. I don’t know who is liable in this case as it’s unclear if the ambulance service was run by the town or is a private service who provides service to the town. I’m sure it will all be straightened out in court and it’s likely that someone’s insurance company will settle before it goes to trial.

It’s doubtful that the family made up this story, but it might not be as bad as the article portrays. Likely we’ll never know.

I’d sure like to get a chance to read the ambulance report, but that’s not going to happen.

In any case, the optics of this are horrible.

Twenty Two Years

EMS Artifact

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September 11, 2023

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On September 11, 2001 I was sitting at a different desk, using a different computer, and was in a different city than the one where I am typing this.

I felt fairly dreadful as I had some sort of cold or other RSV and my plan was to sleep away most of the day. I was listening to Don Imus on the radio and reading through news on my computer. Imus mentioned something about a plane hitting one of the towers of the World Trade Center in New York City.

At first a lot of people thought it must be a light airplane of some type, maybe a news helicopter, maybe some other small plane.

Then the second plane hit and I knew that we were at war with somebody. Or rather, somebody was at war with us. Then the report of a plane hitting the Pentagon came in and a while later the report of a plane crashing in Shanksville, Pennsylvania.

I watched TV for a while then went to bed to try to shake the cold.

The world had changed in those minutes and then the hours while I slept.

We went to war, won, then lost the peace. I’ll keep politics out of this because it’s not a day for politics.

It’s a day for remembering the sacrifices of both the public safety providers and the regular everyday people who didn’t live to see the sunset on that day. It’s a day for remembering the sacrifices of the people who are still dying twenty two years later from diseases caused by the carcinogens carried in the choking dust of the debris. I knew or knew of half dozen or so people who responded to the site of the towers that day who have subsequently died. More no doubt will die in the coming years.

While we and our children lived through that day and won’t forget where and what we were doing that day, to my grandchildren it’s a remote historical event. I wonder if the schools teach about that day, and if they do what they teach about it.

It seems that it was all for naught, as the religious fanatics in charge of Afghanistan are now back in charge. Plus they are inviting the same, or worse, types of terrorists back into the country. Pakistan, which gave aid and support to the Taliban now finds that it is in a low level border war with their former allies. Thousands of coalition troops and civilian support personnel were killed and it seems that their sacrifices were in vain.

A friend with absolutely no sense of history says that the first thing governments should do before going to war is decide if they can afford to pay for it. I correct him and say that the first thing governments should do is decide if they can afford the cost in lives of young men. For that is the real cost of war. I know that young women are now involved in war fighting, but that’s still a small percentage of the losses because men do most of the heavy fighting. So, forgive me if you think I’m a misogynist.

We seem to have given up on a war that we absolutely can’t afford to lose.

It’s a somber anniversary for a lot of reasons, but mostly because it seems that so many people no longer care about what happened back then.

Moving On

Everything Else

EMS Artifact

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August 28, 2023

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Mrs. EMS Artifact and I have decided that it’s time to pull up stakes and leave the state in which we’ve lived our entire lives so far. This has been a long time in the making and until a few months I wasn’t sure it would actually happen.

The story started almost eleven years ago when I retired from my EMS career. I’ve long wanted to leave the state and resettle somewhere more in concert with the lifestyle I wanted to live. Mrs. EMS Artifact’s statement was that she’d go wherever I wanted, as long as it was with me. At the time I had three or four states in mind. All were somewhere in the south, where the politics were closer to ours, guns were not treated as a threat, there was no winter. Well, at least no winter like that in the cold northeast.

When we started this process our son and his family lived in New Jersey, our daughter lived local to us. That changed over the next couple of years when our son moved to Alabama and our daughter moved to Texas. Which, incidentally she’d wanted to do since she was about ten. Everyone was aware of that except her father. Always the last to know.

At the time, my Mother in Law as a healthy 95, but she was still 95 and my wife was her support system. So, we agreed that we’d do nothing until she no longer needed us. No big deal, I figured. Ha! She lived until the ripe old age of 102, not dying until fall of 2021.

I passed the time with part time work, exercise, dieting, and generally trying to stay healthy. That part worked and worked pretty well. I also started getting the house ready to be sold even though it was not going on the market. One of the things one learns when one owns a house is that there is always something that needs to be done. Unless the home owner has a lot of money, he learns to do a lot of things on his own. Not necessarily well, but well enough. Working and raising kids often means that repairs are sufficient to keep the house running, but are not done well. “Mickey Mouseing” is the term we used to use.

Over the years I leaned some carpentry, some plumbing, some electrical, how to maintain the yard, even how to fix the whole house AC if the repair was simple enough. With a life long friend, I replaced windows and doors. I painted when necessary even though I hated and still hate to paint. I also learned how to landscape, and again that’s something for which I didn’t care.

One of the luxuries of being retired is that I now had time to go back and fix the repairs the right way. I also had money, now that the kids were out and on their own to pay people for some things.

Herewith is the list of projects I either did or had done to the house. First is the expensive stuff I paid other people to do.

Replace our boiler and oil tank. Here in the cold northeast, we use oil to heat water which is circulated around the house in pipes and radiators. Well, some people use natural gas to heat air that is circulated around the house to heat it. Replacing that required moving heavy and dirty stuff, knowing plumbing, electrical systems, and then moving new heavy stuff in and hooking it up.

Painting the house inside and out. Then, the next year having it repainted due to a particularly harsh winter in which it snowed every day in February. Every. Damned. Day. Which meant running the snow blower every day. During that we had ice build up and when the ice melted it destroyed the exterior paint and some water leaked into the freshly painted rooms. Fortunately, the insurance company paid for that. Insurance didn’t pay for the new windows, though.

Trees cut down and the wood removed. Not little trees.

Roof replacement. It was time and after the winter two years before every snow storm was anxiety inducing. Definitely no a do it myself job.

Whole house generator. Another complex project that involved gas piping, extensive electrical work, inspections by the town. We did that after having multi day power outages that only happened in cold weather.

More trees cut down and the wood removed. Not little trees. Not only is there danger of a parts of trees falling on me, but even worse parts of trees could fall on the generator. Can’t have that.

Replaced the central air conditioning. Again not a do it myself job.

Insulation and air sealing the day after the AC was replaced.

Tree branches cut back.

Had second bathroom built. Another job that was more complicated than it appeared at first. Another not DIY project. Not cheap, but worth it.

New railings for the front steps.

That’s the stuff I paid other people to do. Here is the stuff I did either by myself or with my friend.

Landscaping. Not my favorite activity at first, but I kind of grew (no pun intended) to enjoy the physical labor.

First, I cut back Forsythia that had taken up about 1/5 of our back yard. Forsythia is pretty, but it’s invasive if not trimmed back diligently. During that time I was working, I just didn’t have the time to do that and the forsythia continued to grow. Kind of snuck up on me. This involved cutting the bushes, then digging up the roots, then burning the bushes and the roots. Then burning the ashes, just in case. Then dumping the ashes way back in the woods. By the way, roots seem to love to grow around rocks. So, often I’d have to dig out pretty good sized rocks to get the roots out. As with northeast farmers a couple of hundred years ago, the dug out rocks were dragged to the edge of the tree line.

Then top soil, grass seed, fertilizer, water. For reasons I don’t understand, it takes about three years for grass to take root in my yard. It’s a journey not a destination. This became a spring ritual as I cut back more brush and expanded the size of the grassy area. The last part of this was just this last spring when I had a stump grinder come in and remove the stumps from the cut down trees that were now not at the edge of the grassy area. That required more top soil, more grass seed, and more water. I don’t expect to be here in two years when that area is completely filled in. I’ve lost track of the amount of top soil I’ve spread over the years to improve the condition of the soil, but it was a lot of it. Several yards, I’m sure.

I’ve fixed, replaced, or refinished just about every interior door we have. That is not hard per se, but it is fiddly as the saying goes. In some cases I re aligned doors so that they closed properly. Not hard, but time consuming. Now that I had the time I could do the job correctly. I actually smiled several times when I finally got a door to close tightly and without sticking.

Painting and patching here and there. Another benefit of having time is that I could do the preparation properly. Just about every job will be easy if the prep is done right. That includes painting, carpentry, electrical, and well everything

Painting including removing the basement windows, sanding and derusting the frames and once again painting them. This was actually a good project to do during the panicdemic when there wasn’t much else to do.

I painted the inside of the garage. The garage, like a lot of them, had never been painted. The walls and ceiling showed their age, so I painted them with gray primer. Raw plaster sucks up primer and it took several days and seven gallons to get the job done. This was actually one of the first jobs I did after I retired.

Fast forward to last year and I repaired or replaced all of the hardware on the garage door and painted the interior side. A stupid little thing, but I felt it needed to be done.

I replaced just about every wall switch and electrical outlet in the house. Just because they were all over 50 years old and original to the house. A little preventative maintenance.

Finally, the last few weeks I’ve been patching and touching up various small areas around the house. That includes painting the stoop on the back stairs so that it didn’t look like it… needed to be painted.

All of this was to get the house to the point where it wouldn’t need a lot of work when the time came to sell it and move.

That time has come. Today we signed on with a real estate agent who will sell our house. She’s optimistic that it will sell quickly as there is not a lot of inventory in our town and our town has come to be a hot property over the past few years.

Now, what we have to do is clean, sort, pack, toss, forty three years of accumulated “stuff.” This was our “starter home” from which we are finally ready to move.

Next week we’ll travel to Texas near where our daughter lives. We’ll be looking at properties although we are not yet able to commit to buying anything. Now that our parents and older relatives are gone, we are the older family members that will eventually need a support system. Our daughter has agreed to be the point person, although we expect that our son and daughter in law will pitch in if and when necessary.

Where are we going?

Texas. Where we expect to be quite happy.

Know anyone who needs a snow blower?

“The Chicago Way”

EMS Artifact

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August 26, 2023

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Paramedics, EMTs Claim Chicago-Area Ambulance Company Illegally Forced Them to Pay For Red Light, Speed Camera Tickets

Paramedics and EMTs working for the large private firm Elite Ambulance say the company illegally deducted the cost of red light and speed camera tickets incurred on the job from their paychecks.

In a class action wage theft lawsuit filed Wednesday in Cook County court, plaintiffs say instead of contesting the tickets, which were incurred during emergency calls while running with lights and sirens, the company charged the cost of the moving violations against employees’ pay without their consent.

Of course there is “going through a red light” and “running a red light.” The former requires coming to a stop, making sure that there is no cross traffic, and then proceeding. The second is just driving through like it’s a green light. For the sake of argument I’ll stipulate that the providers involved did the first. If so, then the ticket should have been cancelled when the police officer reviewed the video.

Ha!

Generally, these red light cameras are operated by private companies that send the still or video to a police officer from the department for review. The officer is supposed to view the still or video and decide if it’s a valid infraction. If so, a ticket will be issued technically by the police agency. “Supposed” and “technically” are in scare quotes because more than one the company, with the agreement of the department just sort f skipped the review part. There was a case, I think in Ohio, where the police officer who was supposed to do the reviewing signed off on violations when he was on vacation and other times when he wasn’t on duty.

Oh that.

This was so bad in Ohio that the state Supreme Court essentially banned them because the process that most cities in the state used for appeals was Unconstitutional.

Back to Chicago,

A judge will need to certify the lawsuit as a class action. Elite’s website says it has 2,000 employees and 175 ambulances working in the Chicago area and Northwest Indiana, meaning the class size and dollar amount of any judgment against the company could be significant.

Of course it could take years and Elite could claim bankruptcy to avoid paying. That said, discovery of the process that Chicago uses to determine if a violation is valid should be interesting.

The paramedics and EMTs Canon eventually came to represent began discussing the alleged wage theft during an organizing drive. Last month, workers at Elite filed for a union election with the National Labor Relations Board.

I won’t get into the debate whether unions in EMS are good or bad, but it’s interesting that the company started to increase enforcement during the drive to certify an election to determine if they will have a union. From my years involved in this sort of thing I know that the government takes a dim view of an employer that attempts to interfere with organizing efforts by employees attempting to bring a union into their workplace.

As the title says it’s “The Chicago Way.”

An Ever More Dangerous Job

EMS Artifact

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August 22, 2023

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When I first started in EMS back in the late 1970s there were dangers on the job. Patients were sometimes violent due to alcohol, other drugs, psychiatric problems, or just because they were violent assholes.

Back then most of the EMTs and paramedics were men, some were used to fighting, some were veterans who had hand to hand combat training. Most of us were in our early to mid 20s and in reasonable shape. After all, we needed some amount of strength to carry patients down and up stairs, lift the stretchers in and our of ambulances, and perform other tasks.

We had police on scene for calls with active or potential violence, in dangerous areas, and any other call the dispatchers thought needed police. Also, it was only a few years from when the police were the emergency ambulance in Sort of Big City. As a result, the police liked EMS workers because we had taken over one of the jobs that they hated more than just about any other that they did.

We were also allowed, although not encouraged, to defend ourselves from violence by patients or others on scene. Sometimes family members were mad because they thought we moved too slowly or took to long to get there, leave, or “do something.”

It was very rare for a patient to have a handgun, which was fortunate. It was NOT rare for people to be armed with knives of various types. Homeless people seemed to favor steak knives for some reason but “Buck Knives” and other types were not uncommon. At one time during particularly difficult negotiations with our municipal employer the union officers put together a “knife board” that displayed various weapons that we had removed from patients. That did not go over well with management, but we made our point.

Unlike other systems, ours actively discouraged family members from riding the patient compartment unless the patient was a smaller child or there was some other reason that it was beneficial to have a family member or friend ride in the back.

It was not unusual to restrain patients in the back of the ambulance or even on scene before we put them in the ambulance. We were allowed to use handcuffs and even received sporadic training in their application. We also had different types of “soft” restraints to use.

If a crew called for immediate assistance not only would the police come, but the next nearest ambulance would also respond. Sometimes more than one additional ambulance would respond. And a supervisor as well if one was available.

Things changed over the years. First, we were told that we had to limit or avoid physically stopping patients from attacking us. One boss suggested that providers jump out of ambulances if a patient or other person started to be violent.

Okay, then.

A few years after I retired, handcuffs were forbidden by management. We were still allowed to use soft restraints and ALS crews could use chemical restraints. The problem being that mostly patients had to be restrained before medication could be administered.

The composition of EMS providers has also changed. There are more women now, and also smaller statured people of both sexes. In and of itself that’s not a bad thing as long as they can perform the necessary functions. In general, the younger generation doesn’t fight as much as that sort of thing is discouraged. “Use your words, not your hands.” seems to be a common refrain.

Which, after 554 words brings me to today’s story. Which actually happened last month, but is still current.

NYC EMS worker was trying to calm patient before he screamed ‘f–k you’ and stabbed her: prosecutors

The EMS worker stabbed by a disturbed man last month was just trying to calm him down before he yelled, “F–k you!” whipped out a kitchen knife from his boot and attacked, Manhattan prosecutors said Monday.

I’m not criticizing the young lady because that’s how she was trained. Use “verbal descalation” techniques is the phrase. Which is a fancy way of saying “Use your words…” Only it didn’t work and result in serious injuries to the young EMT.

There is no information here about what went on at the scene or if the police were present. For us way back then it was common to search or ask the police to search a person who was agitated for weapons before we put them in the ambulance. When a person is verbally agitated and threatening, it’s prudent to put them in restraints and have a police officer ride in the back of the ambulance. That’s IF a police officer is on scene. Which from what I’m reading elsewhere is often a problem in NYC because there are not enough police to cover the city and respond to calls.

The alleged assailant stabbed Fatum six times in the chest, thigh and arm with the knife during the July 19 attack.

She suffered “significant” blood loss and nerve damage in her thigh which required two surgeries, authorities said.

Fortunately the young EMT was not murdered by this, shall we say, career criminal.

Oh, and of course he was out on bail at the time of the attack from a previous arrest for carrying a knife also stashed in his sock.

At least this time he is being held and not released back onto the street to try and kill someone else.

If I were to be asked, which I won’t be, I’d add situational awareness and risk assessment to EMS training. What they do now is clearly insufficient.

I recommend reading the entire article and watching the video which is fairly graphic.

I won’t be one bit surprised if this young lady opts to find another career path because she’s definitely not getting paid for the amount of risk she is facing.

Japan Surrenders

History

EMS Artifact

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August 15, 2023

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August 15, 1945 Japan agrees to surrender if the allies will allow the Mikado can stay on the throne.

The previous offers of Japan to surrender had included a proviso that they be allowed to keep captured territory and not suffer any consequences.

America responded by dropping Atomic bombs on Hiroshima and Nagasaki.

Despite what revisionist historians claim the Japanese Army refused to accept the surrender and attempted to destroy the records and keep on fighting. They planned to put the Mikado under house arrest and kill the civilians that had convinced him to agree to the Allies terms.

Emperor Hirohito made the official announcement on the radio on August 15 via a pre recorded statement.

An invasion that would have caused half a million Allied and millions of Japanese casualties had been averted. Additionally, the British and Commonwealth nations were able to cancel a planned invasion of Malaya, saving more lives.

The actual surrender ceremony took place in Tokyo Harbor on September 2, 1945 aboard the USS Missouri.

There Are Downsides To Retirement

EMS Artifact

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August 13, 2023

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Don’t get me wrong, I love being retired. Well, retired from nights, weekends, and holidays, because I still do some work. Or what I refer to as “Worklike Activities” because I get paid pretty well to do something I enjoy, In addition to not involving nights, weekends, or holidays it also doesn’t involve heavy lifting. Literally.

I like being able to take time off pretty much on my own schedule. I like sleeping at home at night. I like eating regular meals uninterrupted by dispatchers.

I also like getting paid by my former employer to stay home in bad weather.

It’s mostly good.

Then, there are the downsides which pop up now and then.

I miss the camaraderie of the people I used to work with. Before COVID I would take advantage of the social engagements my former fellow employees used to hold. I’d go as often as I could and see former co workers still active and retired. COVID killed a planned “old timers” social function and we are just now starting to discuss actually doing that.

I miss being able to go to department training since much of that has moved on line and what isn’t has been restricted to active members because of “health concerns.” That might ease up after the summer, but since the training director retired a few months ago, it’s not clear. I still get more than enough on line continuing education, but I still enjoyed seeing the ever decreasing number of people I worked with.

Time moves on and after 10 1/2 years and counting of being retired 75% of the department might know me as a name, but not as a person. I see former department members who have moved on to some of my client fire agencies. We don’t have that much in common, but we do have some things. The training has changed, but the basics haven’t. I know who trained them because those are mostly now senior people, some of whom I trained and all of whom I worked with.

The department has changed, mainly because of city politics and there is nothing that will change that. As I said the other day to a now retired boss, it’s no longer our problem. He laughed and agreed.

Lately, the whole dynamic has changed and not in a way I like. Last year a co worker who started on the job when I did and retired about a year before I did died. I thought he was a few years older than I, but it turned out that he was three months older. Yikes. As happens, a lot of retirees (old guys) showed up for his Wake and funeral.

A few years before that two people who retired died a few months after their well earned retirement. Both were close to me in age and both had worked hard during their careers to help patients and improve the department. Both were good folks and deserved that retirement only to be robbed of it by illness and death.

Then, a week ago, we were informed that another retiree, one with whom I had worked for 30 years and who retired about five years ago died of cancer. He and I worked together on and off over the years and for several years worked different shifts at the same station.

He was really enjoying his retirement and looked forward to his son getting married in the near future. Which would likely have meant grandchildren in the near future and he’d love that.

The “Celebration of Life” was this past week and again mostly attended by retirees who had worked with him for years, plus the department Honor Guard. It was a moving ceremony and the testimonials by family and friends were well crafted and beautiful.

Then yesterday afternoon, we were informed that a still active, but close to retirement department member had died suddenly. No details of what happened yet, but in truth it doesn’t matter. Another hard working friend gone too soon.

I know that it happens to everyone and some day (too soon) it will happen to me. Still, I feel that my friends were all cheated out of what they had earned.

Known To Each Other

EMS Artifact

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August 7, 2023

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Mass shooting at Muncie, Indiana street party leaves one dead, multiple people wounded, police say

A “mass shooting” at a large street party in Indiana early Sunday morning left one person dead, police said. A hospital said 19 people were being treated for injuries at its facility.

Muncie police responded to multiple reports of gunfire on the city’s east side just after 1 a.m., The Star Press reported. Police said in a news release that there was no active threat to the community and that “multiple” victims were injured, including some critically.

These things don’t happen in a vacuum. The key words here at “large street party” and “early Sunday morning.”

Along with “after hours house party” these are events that happen in certain hours and certain places.

As everyone’s mothers say, “Nothing good happens after midnight.”

As a veteran of many night shifts on weekends, I can attest that this is true.

WTTV quotes a witness who claimed his nephew was the block party’s disc jockey as saying, “Stranger comes up and decides to take it personal on somebody he knows in the crowd.

I’m not quite sure if this person was an eye witness or a second hand one, but his words ring true. People who are intent on committing violent crime care not about hurting innocent bystanders.

The combination of people out late at night, drugs, alcohol, and often rival gangs encountering each other is a recipe for violence.

In this case, as far as we know only one person was armed, but I won’t be surprised to find out that there was more than one shooter on scene. None of whom were particularly careful about how or where they shot.

According to the station, Delaware County Prosecutor Eric Hoffman said in a statement that, “There are far too many guns on the street, and I certainly question the wisdom of someone having a huge outdoor party with several hundred people, including juveniles, carrying on into the early morning hours. Let’s take a dose of reality. This is not the Vegas strip or Times Square. This is a residential neighborhood.”

While Prosecutor Hoffman is right about people “…carrying on into the early morning hours.” he is wrong in saying that “There are far too guns on the street.” The problem isn’t guns, it’s criminals with guns. They’d still be criminals if all they had were golf clubs.

An arrest has been made.

Suspect arrested in Muncie mass shooting that killed 1, wounded at least 17

MUNCIE, Ind. — Muncie police have made an arrest in a weekend shooting that killed one man and injured at least 18 others at a block party.

Police arrested 36-year-old John L. Vance in connection with the shooting, Muncie Mayor Dan Ridenour announced at a vigil for the victims Tuesday.

A spokesperson said Vance was preliminarily charged with several felonies and that the arrest is being forwarded to the Delaware County Prosecutor’s Office. Vance is facing two counts of aggravated battery, possession of a firearm by a serious violent felon and criminal recklessness. He has not been charged with murder of Joseph Bonner, who was killed in the shooting.
Vance’s previous criminal history includes convictions for domestic battery, dealing in cocaine, unlawful possession of a firearm by a serious violent felon and battery resulting in bodily injury.

Well known to the Muncie Police is my guess. Note that he is legally prohibited from owning firearms. A “Prohibited Person” as they say. Which status didn’t stop him from obtaining a firearm of some sort and using it to continue being a violent criminal.

Confusingly the Mayor said that the victim wasn’t specifically targeted even though there was an altercation between the suspect and the victim before the shooting.

After the shooting, police had to separate people in a Muncie hospital’s parking lot who were arguing and officers had to clear a path at the hospital’s entrance for anyone needing medical attention to enter, Criswell said.

The primary trauma center where I worked often had to call the city police when a “gang related” shooting patient was transported to their facility. In addition to the histrionics of family members, there was frequently a risk that a rival gang member would attempt to get into the hospital and finish the job. This never happened in my city that I know of, but it was not for lack of effort.

Speaking of histrionics by family members, more than once we had someone try to enter our ambulance claiming to be the victim’s cousin. Which was interesting as often they only knew their “cousins” street name, not their given one.

We often had to resort to locking the patient compartment from the inside and having someone drive us a few blocks from the scene so we could evaluate and stabilize our patient. So, there is a strong potential for EMS to become involved in some very unpleasant interaction with some people with a propensity for violence.

There is a failure on several levels. The police, the property owner, various other government agencies. It is not a failure of gun control as crime, not guns, are the problem.

And as always, if you are an EMS provider be aware of your situation, surroundings, and the people who are on scene. Things can go sideways quite quickly.

A Clear Reading Of The Law

EMS Artifact

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August 3, 2023

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Or at least a clear reading of the Constitution of the United States makes it obvious that the Framers of the Constitution had two key concerns based on their experience as subjects of the British Crown during colonial days.

We see this in the order of the first ten amendments to the newly adopted Constitution of the United States of America.

The British colonial authorities did everything that they could do to suppress free speech. Then, as now in some quarters, opinions which were unfavored were suppressed with public censure, confiscation of materials, and in some cases imprisonment. The only form of mass communications back then was the written word. Whether expressed by speech or by printing press publications critical of the ruling authorities was suppressed when found.

The Framers saw this as such a threat that the First Amendment was written. It prohibited Congress from making laws prohibiting free speech, free expression of religions, and public demonstrations against government actions. Over the years, legislation and more importantly common law decisions have expanded the right from just the spoken and written word to radio, TV, telegraphs, moving pictures, the internet, and so on. None of those were foreseen by the Framers, but their intent was clear.

I’ve often said before that the Second Amendment is the shoulders upon which the First Amendment stands. The Framers knew that a free people could only remain free if they had the means to defend themselves against over eager government officials intent on shutting them up.

Several years ago Marko Kloos wrote “Why the Gun is Civilization” on his blog “The Munchkin Wrangler.” I can’t find the original post, however it’s been republished several times and it is available at https://www.corneredcat.com/article/ethical-questions/why-the-gun-is-civilization/

Here is in excerpt and I encourage you to read the entire not that long post.

Human beings only have two ways to deal with one another: reason and force. If you want me to do something for you, you have a choice of either convincing me via argument, or force me to do your bidding under threat of force. Every human interaction falls into one of those two categories, without exception. Reason or force, that’s it.

In a truly moral and civilized society, people exclusively interact through persuasion. Force has no place as a valid method of social interaction, and the only thing that removes force from the menu is the personal firearm, as paradoxical as it may sound to some.

When I carry a gun, you cannot deal with me by force. You have to use reason and try to persuade me, because I have a way to negate your threat or employment of force. The gun is the only personal weapon that puts a 100-pound woman on equal footing with a 220-pound mugger, a 75-year old retiree on equal footing with a 19-year old gangbanger, and a single gay guy on equal footing with a carload of drunk guys with baseball bats. The gun removes the disparity in physical strength, size, or numbers between a potential attacker and a defender.

Personal defense against threats from any source is the basis of the Second Amendment. Not hunting, target practice, or competition self defense.

It is popular among critics of the Second Amendment to complain that the Framers never contemplated firearms other than those the existed at the time of the ratification of the Constitution. Maybe, maybe not. History teaches us that technology advances and the world was on the very verge of what is known as the “Industrial Revolution.”

Which finally, almost 600 words in brings me to my point.

The current administration has launched an all out, unconstitutional assault on the Second Amendment. Following the Supreme Court decision in New York State Rifle and Pistol Association (NYYRPA) v. Bruen ruled that New York’s law requiring a “proper cause” for issuance of a permit to carry a piston in public was contrary to the Second Amendment.

The constitutional right to bear arms in public for selfdefense is not “a second-class right, subject to an entirely
different body of rules than the other Bill of Rights guarantees.” McDonald, 561 U. S., at 780 (plurality opinion). We
know of no other constitutional right that an individual may exercise only after demonstrating to government officers
some special need. That is not how the First Amendment works when it comes to unpopular speech or the free
exercise of religion. It is not how the Sixth Amendment works when it comes to a defendant’s right to confront the
witnesses against him. And it is not how the Second Amendment works when it comes to public carry for selfdefense.
New York’s proper-cause requirement violates the Fourteenth Amendment in that it prevents law-abiding citizens
with ordinary self-defense needs from exercising their right to keep and bear arms. We therefore reverse the judgment
of the Court of Appeals and remand the case for further proceedings consistent with this opinion

The Opinion of The Court was written brilliantly by Justice Thomas. One of the things that the decision does is remove the second class status of the Second Amendment. The entire opinion, along with the concurrence and dissent is worth taking the time to read.

In the wake of Bruen several states have enacted legislation in attempt to circumvent the rulings handed down. All of these laws are being challenged in various federal courts. None of them have been finally decided, but several have been decided at the district or circuit levels with mixed results.

One that is of much interest is Mock v. Garland. Mock is the name of the lead plaintiff, not what they are doing to Garland. Although it works either way.

On August 1 the Fifth Circuit Court of Appeals, which covers Texas, Louisiana, and Mississippi issued a ruling reversing a lower court ruling on a motion for an injunction of the Bureau of Alcohol, Firearms, Tobacco, and Explosives (ATF) final rule on pistol braces. The order instructs the district court judge to reconsider the initial decision not to issue an injunction. Judge Willet of the Fifth Circuit issued a concurring opinion suggesting that this rule not only exceeds the authority of the ATF, but violates the Second Amendment as well.

It will take years for the courts to sort out the various state and federal laws, rules, and regulations regarding firearms, however I believe that much of the current framework will be found to violate the Second Amendment. At long last, the Second Amendment will take its place as a first class amendment.

EMS Is A Dumpster Fire

EMS Artifact

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August 2, 2023

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EMS has always been a field with a lot of turn over. Unless a provider worked for a fire based or other government run service pay, benefits, working conditions were all far worse than other fields that paid more. Even some of the government based systems treated their EMS providers as second class citizens.

Starting in early 2020, the situation got dramatically worse. During what I call the “panicdemic” the stress and demand on all levels of medicine increased to never before seen levels.

Hospitals and providers were overwhelmed with unprecedented new procedures.

I won’t get into the current debate over whether any of that was necessary, some of it, or none it.

Questions about the origin of the virus, treatments, preventative measures, treatments such as intubation, and whether the vaccines work, didn’t work, or were even dangerous will rage on for years. We may never know the truth about what happened or why. So, I’ll ignore that.

At first my former medical director, with whom I maintain some contact felt that the whole thing would be over in a few weeks. Actually, so did I. In fact if you look back I predicted that. Both of us underestimated the hysteria that would grip much of the world. Or, at least most of the world with the internet, cable TV news, and politicians eager to grab control of large sections of the economy.

In EMS drastic changes took place. Among my fire based clients sleeping accommodations had to be completely revamped. The view that had double bunk rooms had to reconfigure offices and training spaces as sleeping quarters. Department members were essentially confined to quarters between runs. No dinner as a group, no training for almost a year, no other group activities.

Providers at all services had to follow the hospital procedures of wearing masks and gowns at all times when on duty. A two person ambulance crew sitting in the same cab had to mask up, wear gloves, and in many cases face shields both during and between calls.

And of course everyone who coughed once called 9-1-1 for an ambulance convinced that they were going to die from COVID. My state instituted two new protocols which allowed EMS providers to refuse service to people who had tested positive but were not acutely ill. I read more than one report where a provider had not only refused transport, but refused to even exam a patient before telling them to “suck it up” and only call if they were too sick to move. That’s a direct quote from a PCR I audited.

Procedures were also changed so that only one provider would make initial contact and were not required to bring more than a bare minimum of equipment. If they brought anything.

In my state staffing requirements were “temporarily” changed so that only one state certified provider was required, along with one driver. How retro.

Some of the private companies are still working under those waivers. Remember there is nothing more permanent in government than a “temporary emergency.”

Crews were doing twice the normal call load and it wore them down. Add to that the fact that if a provider tested positive, even if they were asymptomatic, they were sent home for two weeks (with pay) until they tested negative. That meant that other providers had to work forced overtime to fill slots on ambulances.

How bad was it? One fire fighter/paramedic I knew quit her fire job. IN THE MIDDLE OF HER SHIFT!

She just had one call too many, went back to the station, hand wrote her resignation, and then tossed that along with her turn out gear, uniform, and other equipment on the shift commanders desk.

While this was going on a good number of providers reached their agencies retirement requirements and did just that. Retired, leaving yet another hole to be filled. I will be frank here. If I were still working when this started and was able to retire I would have done the same.

Another straw on the camel’s back. Agencies were required to give unlimited and compensated time off to their employees who “Didn’t fee safe” working during the pandemic. Gee, I wonder if anyone anywhere might have stretched that definition like Lizzo in Yoga Pants?

Some hospitals added to the problem. They would require EMS crews to stay in the ambulance with the patient for up to an hour while the prepared a “COVID room” for the patient.

Not only did this put added strain on the EMS crew, it was very, very likely to be violation of the Emergency Medical Treatment and Active Labor Act (EMTALA). This is a federal law passed back in the 1980s that sets strict requirements for when a patient must be seen in an Emergency Department.

If only I had listened to my mother and gone to law school. Sigh.

All of that lead to shortages of EMS providers throughout public and private systems.

Private systems finally had to increase pay rates and improve benefits to retain and attract new EMTs and paramedics. Some started to run their own EMT classes and allowed people to enroll for free. Some even paid people to take the courses.

The fire service started to hire EMTs and encourage them to go to paramedic school with the promise of instant advancement to paramedic upon receiving the certification card. Imagine being a brand new EMT, going to school for some period of time, and then suddenly being the paramedic in charge of an ambulance? For that matter, imagine being the patient of that paramedic?

Keep in mind that this is good for me as it increases my work hours since there are so many new providers with next to new experience, no orientation to their new role, and no supervision.

Think of it as the “EMS Artifact Full Employment Act.” I kid you not, 2021 and 2022 were good years for me and the IRS.

Fire departments were so desperate for paramedics that they had to “adjust” some of their hiring requirements. Paramedics with marginal scores on the fire exam were offered jobs ahead of non paramedics who scored much higher on those exams.

A good number of those people were hired, went to the fire academy, and after a year or so decided that “The fire service isn’t for me.” They left or were encouraged to leave and a year of time and a significant amount of money were expended with no benefit to the taxpayers.

One department I’m familiar with has started to hire EMTs and then paying to send them to paramedic school. After that, they still have to go to the fire academy to be firefighter certified. So, they get paid for about a year to be trained before they can work as paramedics.

The net effect here is that there are fewer experienced EMS providers working now than four short years ago. That can’t be good for patient care, not good at all.

Will EMS ever recover? Maybe, but it will be years before we know. In the mean time, just hope that you get a paramedic with dry ink on his or her certification card.