Pearl Harbor and today’s military

I’m trying to up my blogging volume, but my results have been less than stellar. I don’t think I’ll have time to blog every day, so I’m aiming for once a week. As a result, I’ll probably cover more than one subject a day. Here goes.

Pearl Harbor. Today marks the 76th anniversary of the Japanese attack on Naval and Army assets stationed at Pearl Harbor, Territory of Hawaii. This was one of the worst, in terms of moral, defeats in US history. It was also the worst single defeat suffered by the United States Navy. Ultimately, it lead to a humiliating defeat for the Empire of Japan. The military was moving towards, but not completely on, a war footing when the attack happened. After the declaration of war by Congress on Dec. 8, 1941 that pace became determined and in some ways frantic. The result was the largest military in the world, fighting wars on multiple fronts and winning on all of them.

A strong defense is necessary to deter nations that would wage war from doing so. Unfortunately, America as a nation needs to re learn that very expensive lesson every generation or so. Isolationism didn’t work in 1917, or 1939, or for that matter June of 1950. America is not a warlike nation, so our political leadership tends to neglect the military until there is a war that needs to be fought.

We once again learned that lesson on September 11, 2001. The Clinton administration had used the excuse of the “peace dividend” that came about after the fall of the Soviet Union to undo the rebuilding done by the Reagan and Bush administrations after four years of neglect by the Carter administration. After September 11, the US spent a lot of time, money, and lives fighting yet another war not of our choosing. We can debate all day whether we needed to go to war (we did), or rather if we needed to go to war with whom we did when we did, but we went and made substantial progress during the eight years of Bush 43.

Only to have most of that thrown away by eight years of Obama, a President who apparently didn’t think we needed to sustain a war that we had won and one that we could win. Again, we can debate the strategy, but as General Patton once observed, it’s foolish to pay for the same real estate twice.

Now, just about a year into the Trump administration we see the results of eight years of purposeful neglect of the US military. First, much of the military hardware we own is in need of repair, updating, or replacement. Sequestration meant that much of what was needed was not done because money needed to be shunted to operations and thus maintenance and training were shorted. We see that now in things like ships colliding at sea, a higher rate of plane crashes, shortages of personnel in critical fields (pilots), and officers resigning their commissions far short of when they would be expected to retire. Just this week a B1B Lancer bomber couldn’t participate in an exercise over South Korea due to a mechanical problem. Something meant as a show of force to North Korea turned to be an embarrassment.

Once more, we’re going to have to spend money and likely lives to rebuild our military.

A quick side note. The last surviving member of the US Army Air Force who participated in the Doolittle Raid on Tokyo, Lt. Col. Richard Cole, turned 102 last September. Cole was the co pilot for then Colonel Doolittle. Every day we lose another person who put his or her life on hold to save the world from despots.

President Trump

Still pretty happy that he won. Actually, more happy than I was on election day last year. I voted for him somewhat reluctantly, but there was no real alternative. He’s disrupted the norm in Washington, D.C. by actually doing what he promised. Shocking for a politician. The economy is up, standing of the nation is up, we’re likely to get tax reform, and maybe even national reciprocity for concealed carry. Maybe. Add to that changes in the administrative state, federal judgeships, and foreign relations, and we  have a pretty successful first year.

Yes, his Tweets still sometimes set my teeth on edge, but they do even worse things to the opposition.

Yesterday, he announced that the US would fulfill a 25 year old promise and move the embassy in Israel to Jerusalem. Just as with every other nation we have relations with, the embassy will be in that nations capitol. The reaction from the Left was as expected. Faux outrage.

My son surprised me with a text yesterday after the announcement, “Finest day of the Trump Presidency”. I was surprised because I never thought that as politically astute as my son is, I didn’t think this was an issue that he would pay attention to. I’m not sure if there are wider implications to that, but I think most Trump voters will feel as he does.

Sadly, the Democrats and some in the GOP, have decided that maintaining the phony baloney jobs is more important than doing what is in the interest of the American people and the nation. Hopefully, that will change, but it will be a battle.

EMS

Why does nothing in EMS ever seem to change? Sure equipment changes, vehicles change, but EMS itself doesn’t change. In most ways it’s a skill set in search of a trade or a profession. “Community paramedicine” seems to be a buzzword more than an evolution, let alone a revolution.

Pay for full time, non firefighter, EMS providers is dismal. Working conditions and benefits are worse. Do any fire based EMS systems have their crews drive around in pointless, computer generated circles waiting for calls that might never come? I doubt it. Yet, private systems and some municipal, non fire based systems do just that. As I’ve observed before, System Status Mismanagement is the equivalent of cutting 6 inches off the bottom of your blanket, sewing it on the top end, and then announcing that you’ve made the blanket 6 inches longer. Add to that the need to ask for permission to drive 100 feet to a building with a bathroom, no place to eat a meal that isn’t inside your vehicle, and calls that never seem to end. No wonder people flee EMS to go to other fields after short tenures. The constant churn of staff might be good for the companies, because it keeps salaries at the lower end of the scale, but it’s bad for the “profession”, not to mention for the patients. There is more than a little value to experience in EMS as in medicine in general. Would you rather have a physician that has completed a residency and has some years of experience, or a physician that is still in his residency?

Vehicle safety is a big issue in EMS, with lots of ideas and new  gadgets to make ambulances “safer”. Here’s my simple idea. Slow the f*** down. If we are to believe the various “card” triage systems, we can accurately determine over the phone who is sick and who isn’t. Sure.

Still in most of the country, an ambulance and a fire truck are sent lights and siren to calls even if it’s a relatively minor “emergency”. Depending on system structure, it  could be an ambulance, an intercept vehicle, a fire truck, and a fire supervisor. Once someone arrives, in theory they should be able to tell the other units to slow down. Nice theory. I used to tell people that most of the time, once we arrive the emergency (if there was one) is over. Not always, but in many responses our job was as much to sort out and calm the chaos as to provide actual medical care.

In my last few years I bucked the trend, and in some cases the orders, in my agency where it was assumed that all transports were to be lights and siren. That’s not what the SOP said, as was pointed out to me by the chief when I complained about being ordered to transport a completely stable patient lights and siren. True, but that’s what was enforced by supervisors. I finally had enough and just ignored everyone who told me that we “had to” transport lights and siren.

The real reason that management tacitly approved of lights and siren transports was unit availability. Traffic in Sorta Big City was always a problem, a legacy of street laid out by cows wandering through the then countryside. Sorta Big City became a thriving big city during my tenure and that has accelerated since my retirement nigh on five years ago. Lots of new buildings, no new streets. A street that was barely adequate in 1990 is overwhelmed with traffic in 2017.

Sorta Big City has become a victim of the success of it’s service, the growth of the city, some city policies revolving around residency requirements, and incredible traffic congestion. A two mile transport through the city could take up to 30 minutes without lights and sirens. The best solution would be to double the number of units on the street, but that’s a practical impossibility. Cost aside, retention is an issue even for a service that has excellent (for EMS) pay and benefits. The work load for an agency that has 8 hour shifts as the norm is incredible. 12-16 calls per shift for a BLS crew.

As a result, staff leaves rather quickly. Paramedics who have gone through the rigorous promotional process successfully are highly sought after by suburban fire chiefs looking for experience medics who they can turn into firefighters. Pay for a 48 hour week is about what they would make for a 40 hour week at SBC EMS, benefits are the same, and the work schedule is far less hectic. Do the math as they say.

So, I understand the realities, but a lights and siren transport might be necessary for logistic reasons, but that doesn’t mean that the crews should drive like maniacs to get to the hospital.

It’s even worse if this sort of driving is done by EMS providers doing routine interfacility transports. The vast majority of those are pretty stable patients, but some providers just can’t resist flicking that switch and exceeding the laws of physics with their often top heavy, slow to stop, and not the most nimble steering vehicles. And that’s if the vehicle is kept in tip top condition.

Again, the solution is know the condition of your patient, and not to drive like a maniac. There is no excuse to get halfway to a call or halfway to the hospital because you got into an accident.

Trust the old, retired paramedic on this one.

Blogging

I’m not the only person who has slowed down on my blogging. Even the prodigious Ambulance Drive posts far less frequently. Of course he now writing a lot over at EMS 1 and of course he’s also doing a lot more podcasting. I saw him a few weeks ago at the Texas EMS Conference and meant to discuss podcasting with him. I’ll see him again next month at the memorial service for EMS icon Lou Jordan and will bring it up then. Who knows, maybe I’ll start doing podcasts.

My point is that blogging might be a dying art form, to be replaced by podcasts, Facebook (yech), and even Twitter (yech). Which accounts for part of my drop off in blogging. We’ll see how that progresses.

Enough rambling for today. I’ll try to keep to my goal of posting at least once a week. Maybe even more often if the mood suits me.