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Commotio Cordis

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Commotio Cordis

Last Monday night people watching the Monday Night Football game saw Buffalo Bills Safety Damar Hamlin take a hard, but not brutally hard, hit from a Cincinnati Bengals player.

Hamlin got up started to walk back towards the sideline and then collapse.

Fortunately for Hamlin the training and medical staff from the Bills, with some help from the Bengals staff, quickly got to him and started CPR. An AED was also quickly on scene and he was defibrillated a several times before he was successfully resuscitated and moved to the ambulance.

Hamlin was intubated in the field, no doubt had an IV started, and was probably given Amiodarone or Lidocaine via the IV.

Good work and as it turns out NFL medical teams drill for this stuff during the off season. Just as players work to keep their skills up, so doe the medical teams.

We should all be so fortunate to have such help so close if we need it.

One the immediate medical needs were attended and the game cancelled the speculation started.

How could a young man in top shape, a professional athlete no less, suffer such a medical emergency.

To the uninformed the answer was obvious. IT WAS THE VACCINE!!!!! Evidence? Who needs evidence? We have the Internet and Google School of Medicine.

Now, let me note the following. I am not saying that there appears to be some risk from the vaccines. That happens with every medication. I’m not even saying that there is no possibility that some people haven’t died from vaccine reactions. In my town and the city next door, two under 50 year old police officers died suddenly. In another town a fire fighter in his 30s died suddenly.

Whether there is a connection to the vaccine in their deaths should be investigated. Whether there is a heightened risk of death from the vaccine needs a serious investigation.

What shouldn’t happen is that every death of every person under about 90 be attributed to the vaccine. Make that 96, as I saw someone questioning whether or not 95 year old Pope Emeritus Benedict had had “the jab.” Such terminology show Joy Bahar level stupidity.

But I digress.

The hysteria around that has had an overall effect of discouraging people from getting vaccines of all types. Vaccines have a long history of relieving human suffering. On a medical scale, the various COVID vaccines and their boosters are failures. They don’t stop the spread of the virus, they may even make people more susceptible to contracting it.

Again, that needs to be investigated and the results widely published. That, however is not the point of this post.

What I am reasonably sure of based on having seen the video of Hamlin’s collapse and the play that occurred just before it is this. His cardiac arrest was not based on any reaction to the vaccine. Since the alleged cause of death from vaccine reactions is blood clots, I’m very sure that if a blood clot had caused Hamlin to go into cardiac arrest, he would not have been resuscitated. Whether a pulmonary clot or a clot in his cardiac circulation, he would not have been resuscitated.

There I said it twice.

Here is a good definition of Commotio Cordis,

A history consistent with commotio cordis involves a sudden impact with the anterior chest overlying the heart, followed by immediate cardiac arrest. This is most commonly a baseball; however, any impact may be present in the appropriate circumstances. Ventricular fibrillation may be observed if monitoring or an AED is available. Patients generally have no history of structural heart disease to explain the dysrhythmia, and the injury is not attributable to physical damage to the heart, cardiac contusion, or rupture. Penetrating injury is not the cause for arrest.

Physical exam findings may reveal a contusion overlying the heart, but this often takes time to develop, so it should not be relied upon to confirm the diagnosis. A pulse is not present with ventricular fibrillation, and there is evidence of inadequate organ perfusion (i.e., unconsciousness).

Why was Damar Hamlin able to get up, walk, and then fall over? My guess, and it’s only a guess, is that he had just enough oxygenated and adrenolinized (I made the word up) blood in his body to keep him going for a few seconds before everything just ground to a halt.

Why did he survive? Because the medical and training staff did exactly what is in the text books in exactly the correct order in exactly the critical minute after he collapsed. Add to that his previously mentioned superb condition. No underlying cardiac disease as older people would have.

Again from the previously linked article,

Initial efforts should focus on resuscitation from cardiac arrest due to ventricular fibrillation. This includes closed chest compressions and early defibrillation. If the arrest is prolonged, it may be prudent to provide rescue ventilation and/or medications to improve coronary perfusion pressure (e.g., epinephrine). For an isolated blunt cardiac injury resulting in dysrhythmia, stabilization of the electrical activity may be the only necessary intervention. After resuscitation, appropriate post-arrest care should be implemented.

So what lies ahead for Damar Hamlin? Today, one week after his near death experience he has been discharged from the University of Cincinnati Medical Center and is heading back to Buffalo.

I would expect that he’s going to see at least one cardiologist, maybe more. He may get an implanted defibrillator, but I won’t speculate. He may never play in the NFL again, but again I won’t speculate.

Commotio Cordis is rare and it’s victims are usually on the young side. The possibility is why almost all school athletic events have someone standing by to provide treatment.

Of course the media is as typical overreacting and providing bad information. Of course the media does that all the time, so we shouldn’t be surprised.

This isn’t “unprecedented” although it is rare. Parents shouldn’t panic, but they should make sure that their kids have a thorough physical exam before signing up to play sports. In fact, some athletic programs are starting to require that.

Damar Hamlin had a good outcome from what could have been a tragic situation. I’m happy for him.

It does not one any good to mindlessly speculate about what caused his situation when there is a perfectly valid explanation.

Which was the point of this entire post.

 

A Decade

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A Decade

Today marks a full decade since I last donned my working attire and responded to ambulance calls. The last time I treated and transported an ill or injured patient.

For a while I had misgivings about retiring, but looking back it was the right time to leave. Maybe not a “good” time, but clearly the right time.

I had tired of the daily grind of working the night shift and didn’t want the arguably worse daily grind of working the day shift. After all, on nights work was very straightforward. Answer the radio, go to the call assigned, make contact with the patient, and most of the time take the patient to the hospital.

On days it was all that, plus a worse commute, more traffic in the city, and of course… bosses. On nights I had one boss, but on days the full cast of managers was usually around to “help” with doing the same job I had been doing for almost 35 years.

Unlike some friends, I’m just not a guy who can sit around and watch the calendar move forward. On the other hand, I didn’t want to be tied down to a set schedule. For that reason a job at a place like a hardware store was out. They expect part timers to cover the unpopular shifts. Or they did then, now they don’t care what shift someone works if they will just come to work.

But I digress.

As I said, I had some misgivings about leaving the only job I’d had as an adult. I mentioned this to a former co worker shortly after I retired and he had an interesting reply. “You don’t miss the job, you’re nostalgic for the job.” He went on to suggest that if I somehow magically could unretire, I’d regret it in three days.

In retrospect, he was right. Nor did I care to go to work for a private ambulance service doing transfer work. When another friend suggested that I might want to do that, I told him that if I wanted to continue working on an ambulance I’d have stayed with my much better paying city job.

As it happened my last partner set me on the path to my post retirement career. Towards the end of my time with Sorta Big City EMS we were talking about my future plans. I mentioned the possibility of teaching EMT courses, but he said that wouldn’t be a good fit for me.

He said that I had way too much real world experience and knowledge to be able to teach what is in the textbooks with a straight face. I laughed for two reasons. First it was funny. Second it was true.

Just as lawyers to to law school to learn the law, but not how to lawyer, EMS providers go to school to learn a lot about illnesses and patient care. They do not however, learn of what the real world of EMS consists.

Burns, stabbings, heart attacks, diabetic incidents, and generally acute illnesses are taught in school. What isn’t taught is how to talk to a patient. More importantly, neither is how to listen to a patient and how that can tell you a lot about why they really called.

Students are taught to diligently copy down a list of patient medications, but not how to use that information to help figure out what might be wrong with the patient.

Students are taught that chest pain should be considered cardiac until proven otherwise, but until recently the text books didn’t cover the reality that many patients never have chest pain.

That is the kind of thing an experienced paramedic or EMT understands from experience. Remember, experience is often something you have about five seconds after you needed it.

I treated a lot of patients and made a lot of mistakes over the years. Most of them were minor and fortunately none that I know of actually harmed a patient.

Also, I was fortunate enough to work in a system where it was common to have daily contact with our medical director and other physicians with university affiliations. Due to that, I had a lot more opportunity to learn from accomplished physicians from  highly regarded hospitals and medical schools.

I sure benefited from that and learned much more than the typical EMT or paramedic is likely too. Free and high quality education, there is little better than that.

Maybe it’s conceit, but I thought it would be a waste to walk away from all of that accumulated experience and education and not share it with newer providers who hadn’t had the luck to work in a system where clinical excellence was valued.

I tried a formal EMS school for a while, but the owner didn’t appreciate me deviating from the established curriculum and although the pay was very good for a part time, supplemental job, I just wasn’t happy there.

As luck would have it, I stumbled onto a job where I could mostly make my own hours, work with people who were already certified and working in the field, and use my knowledge and experience to improve their patient care.

It also gives me something to look forward to each day.

As I look back over the last ten years and beyond, it occurs to me that I’ve been very fortunate.

My current boss likes what I do and how I do it. The providers I work with seem to like they way I approach what is often the least liked part of EMS. I make some money and meet some nice people.

Perhaps the best part is that I never have to work a weekend, holiday, or night shift. Nor do I have to stand outside in the cold at a fire or other standby event.

I refer to this as “work like activity” because I get paid, but don’t have to carry people up or down stairs, lift a stretcher (not that anyone does that any more), nor enjoy all the sights and smells of EMS.

I’m a lucky man.

Day of Infamy

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Day of Infamy

It’s now 82 years since the Japanese mad what in retrospect was a huge mistake by attacking US Navy, Marine, and Army bases on the island of Oahu in the territory of Hawaii.

Although the Japanese had planned to time their declaration of war with the onset of the attacks on Hawaii and the Philippines, their bureaucratic ineptitude resulted in the declaration being delivered after the start of the attack.

Diplomatic protocol aside, I’m not sure that there would have been much difference in the effectiveness of the attack, but it might have infuriated the American public a bit less.

The attack surprised most Americans, many of whom were not quite sure where Pearl Harbor was. For that matter, a lot of people were blissfully unaware of the war in Asia that had been going on since 1937.

Japan expected a quick victory in Asia and a rapid capitulation of America and allied nations in the pacific. For several months nothing much happened to contradict that belief, but that’s a story for another day.

The Japanese paid a horrific price for their attack, but they had earned it. That might be harsh, but it’s definitely true.

In 1943 film director John Ford produced and directed a documentary (now referred to as propaganda) about the attack. The original documentary, available on Amazon Prime the last time I looked was about 80 minutes long and had a lot of anti Japanese content. By today’s standard it’s considered hopelessly racist. That aside, it has some allegations that were probably known not to be true at the time.

As they say, the truth is the first casualty of war.

People can debate propaganda all they want, but the truth is all combatant nations engage in it to some extent or another. Whether anyone believes it or not I can’t say.

Anyway, here is the edited version of the film, which shows much of the devastation as well as the rescue and recovery efforts. I include it because it is part of the historical record of World War 2.

 

Absent Comrades

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Due to a technical issues, I’m reposting this from Thanksgiving.

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

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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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Gone To Texas

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

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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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Veterans Day

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

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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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Modern Technology

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.

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