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The Great Crusade Begins

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Soldiers, Sailors and Airmen of the Allied Expeditionary Forces:

You are about to embark upon the Great Crusade, toward which we have striven these many months. The eyes of the world are upon you. The hopes and prayers of liberty-loving people everywhere march with you. In company with our brave Allies and brothers-in-arms on other Fronts you will bring about the destruction of the German war machine, the elimination of Nazi tyranny over oppressed peoples of Europe, and security for ourselves in a free world.

Your task will not be an easy one. Your enemy is well trained, well equipped and battle-hardened. He will fight savagely.

But this is the year 1944. Much has happened since the Nazi triumphs of 1940-41. The United Nations have inflicted upon the Germans great defeats, in open battle, man-to-man. Our air offensive has seriously reduced their strength in the air and their capacity to wage war on the ground. Our Home Fronts have given us an overwhelming superiority in weapons and munitions of war, and placed at our disposal great reserves of trained fighting men. The tide has turned. The free men of the world are marching together to victory.

I have full confidence in your courage, devotion to duty, and skill in battle. We will accept nothing less than full victory.

Good Luck! And let us all beseech the blessing of Almighty God upon this great and noble undertaking.

Salary Emergency

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Salary Emergency

A short history to set up the main part of the article, On March 17, 1996, NYC*EMS was assimilated merged with the Fired Department of New York City (FDNY) by order of then Mayor Rudolph Giuliani. As Mayor Giuliani did some very good things for the residents and visitors to New York City. This wasn’t one of them. It the joining together of two different agencies with two different missions, two different cultures, two different shift schedules, different uniforms, and two different salary structures. Oh, and two different unions, but that’s a whole other story.

To say that there was a period of adjustment would be perhaps the understatement of the 21st Century. It merger was fractious for several years, but as time passed and the “old guard” on both sides of the merger retired or moved on to other jobs, the new normal began.

Some things improved, some stayed the same, arguably some got worse. EMS and fire suppression still seem to operate as two different agencies, which makes sense.

Perhaps the biggest disparity then and now was salary. I don’t know if it’s still true, but for a long time while I followed these festivities and EMT getting hired by the fire suppression part of the operation was considered a “promotion” not a hiring.

To be sure, this is not unusual in EMS at all. After San Francisco merged it’s EMS system with the fire department, there were three different salary scales for paramedics. The lowest pay scale was for single role paramedics who were not cross trained as fire fighters. Next up on the scale was for cross trained paramedics who still were only allowed to work on ambulances. The highest paid paramedics were fire fighters who didn’t work on ambulances or provide more than BLS care at scenes.

Hmmm. I could go on and on, but will only mention that there are still fire based systems that are looking at hiring single role paramedics to work on their ambulances. For less pay, fewer benefits, more work. That’s an incentive, right? Right?

All of this has been compounded by a nationwide shortage of people who want to become paramedics or EMTs and work on ambulances. That was starting to happen before COVID, but since then has become a crisis in most parts of the country. Private, third service, fire based, it doesn’t matter. EVERYONE is having problems finding people to work. I am presuming that the problem is as bad for volunteer services, but can’t swear to it.

I won’t go into the various plans being implemented to change that other than to say that some will help the problem, some won’t, some will lower standards for medical care, some will not. At least I hope they won’t.

One to our main story. After Twenty Nine years of pretending that there is no pay disparity at FDNY EMS, the New York City Council has decided that there is a “Salary Emergency.”

This article is from “The Chief” which bills itself as “A Voice For Workers.” Note that most of the content is behind a paywall, but they put this in front of it. The article is short, so I’m only going to post what I think is the key point.

Salary Emergency

The historically out-of-kilter EMS wages mean it’s increasingly harder for the city to recruit and retain medically trained and experienced first responders. In 2024, city EMS personnel responded to more than 600,000 calls for life-threatening medical emergencies, the kind that can kill.  But on a recent day, just 70 percent of the city’s target for EMS ambulances were in service, while the number of fire trucks in service was over 90 percent. Soon, hundreds will be moving from the EMS to the firefighting side.

Imagine that, people want to leave a lower paying job with better benefits and a lighter work load for one that is, in a word, better.

Keep in mind that FDNY ambulances are supplemented by a combination of hospital based (voluntary), private, and even volunteer ambulance services. The article doesn’t tell us if the 70% is just city ambulances are all 9-1-1 ambulances.

The Fire Commissioner has sounded the alarm over the situation, Harry Siegel: Fire commish sounds alarm: EMS about to collapse.

Note that I typed my preamble before I read this article,

The job comes with a limited number of use-them-or-lose-them sick days, a big pay disparity with other uniformed service workers, a culture that’s nearly as isolated as a firehouse is intimate and a rapidly churning workforce mostly there because it’s a four-year backdoor to becoming a firefighter.

By the way, the term “backdoor” is usually used as an insult, but Harry Siegel is probably too dumb to know that.

In a phone conversation on Thursday, he elaborated about “what’s been sort of the tale of two cities” inside the FDNY between fire operations and EMS operations: “They’ve never adequately been merged. They wear the same patch, but they hardly operate under anywhere near the same conditions,” Tucker said, adding that EMS members “still do a phenomenal job despite the setup.”

Commissioner Tucker understands the problem, but has about no capacity to fix any of it unless the Mayor and City Council are willing to spend a lot of money. I won’t be surprised if someone, probably on the City Council proposes that New York City just contract the whole mess out to some private ambulance company. Which, of course, will make things a lot worse, but it will be cheaper. Or something.

Here is one last link for your reading pleasure. It’s also from “The Chief” and is also in front of their paywall. It’s from 2024 where the Mayor says he wants to fix the inequities at EMS. Oddly, he’s done nothing about it since then.

Adams, Kavanagh express support for EMS pay parity

Note that the Commissioner last year is not the Commissioner this year. Apparently the tenure at that job is measured with a stop watch, not a calendar.

I’ll close by saying that the problems in New York City may be extreme, but it’s not the only such case. I’ll even say that it’s not uncommon. Can think of several large city EMS systems, not fire based, that have similar problems. In those agencies it’s common for EMTs or paramedics to work for a couple of years and then try to get hired by fire departments. Back to better pay, better benefits, better schedules, better retirement, and so on.

Private services are even worse.

I don’t know if or when the situation will get better.

 

The Older Shooter

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The Older Shooter

As we age things change. Some for the better, some for the worse. For the better, we get discounts on some things we buy, easier access to other things, and sometimes people even valued our experience and opinions. On the other hand, it gets harder to keep off weight, muscles and joints are not as flexible as they used to be, eyesight can get worse, and coordination can become an issue.

As a I sometimes say when people call it the “Golden Years,” that’s not gold, its rust.

Getting older means that there are going to be more challenges to being able to shoot. That will affect all varieties of shooting, hunting, target/competition, and of course self defense.

Until fairly recently there was little to no information or advice available to aging shooters. It was mostly “get better glasses,” “find an easier gun to shoot,” or even “if you don’t feel safe stay home.”

In 2016 the much maligned National Rifle Association came out with it’s first class for “The Aging Defender” as they called it. This was presented in a class at the 2016 NRA Annual Meeting. The session was presented by Dr. Joseph Logar PT, DPT. He is an experienced Physical Therapist and Certified Functional Strength Coach.

I took this course and still use many of the techniques that Dr. Logar demonstrated. I also work out and stretch on a regular basis, which help with both strength and balance.

Unfortunately, this is only available to those who attend the NRA Annual Meeting. It would be great if the NRA could video a session and make it available to members. In the meantime, here is a link The Aging Defender from 2020  in “American Rifleman” . It’s course, but it does provide some helpful hints. It seems to be available to those without NRA membership, at least I didn’t have to log in to anything to access it.

This is another NRA article  Self-Defense for the Aging Shooter, again with free access.

The NRA has an Adaptive Shooting Program which seems to be more oriented to shooters with physical disabilities. Which I understand, however there are a lot of long time, and some not so long time shooters who are getting older and can use some help. I’ve belonged to a couple of gun clubs in a couple of different states and one constant is that many of the members, maybe most, or older men. Many are retired and have plenty of time to shoot, but some find it challenging. To say the least.

I think it’s a mistake by the NRA to lump older shooters in with disabled shooters. As an older shooter I don’t need to be reminded that I can’t do everything that I could even ten years ago. Believe me, we all know that even if we don’t admit it.

One last link to free NRA material for older shooters, Tips For Senior Shooters. This article is written by an older, very experienced shooter and has some practical ideas for making it easier to shoot as we age. I particularly like his comments about hearing protection as I too recently upgraded my hearing protection to a similar product.

The February/March issue of Concealed Carry Magazine, which is published by the US Concealed Carry Association has an article on Adaptive Self Defense. The on line version of the magazine is available only to members and membership is an adjunct to buying their insurance plan.

The article is mostly about mental preparation and equipment choices for older shooters and is geared to self defense options. At times Concealed Carry Magazine goes a bit overboard on the “Tacticool” stuff, but this story has solid advice regarding being aware of ones physical limitations, situational awareness, equipment choices, and training.

Situational Awareness simply explained is being aware of your surroundings. Even older people are apt to get thoroughly immersed in their smart phone can become distracted. I see it often among all age groups at gas stations. A place like Sam’s Club or Costco is relatively low risk, but gas stations with attached convenience stores seem like asshole magnets. In that vagrants and other unsavory characters seem to hang around them looking for victims to mug.

Many years ago I stopped at gas station near a large airport to top off the gas on my rental car. It was after dark and airports are often not in desirable areas. After I paid and started pumping gas I spent the time looking around with my hand in a pocket holding on to my carry revolver. While I wasn’t sure that I’d be accosted it was a distinct possibility. It would be more likely to happen if I was like some of the other customers who were looking at the pump handle with my back turned to the street or parking lot. Predators like the unaware.

Training can be going to the range and practicing or it can be taking a formal defensive shooting course. Some of which are rather expensive, but some are very reasonably priced.

I’ll quote the closing paragraphs from the article for consideration.

 If you are disabled or ill, your ability to defend yourself doesn’t disappear. You are not helpless; you can still protect yourself, your family and your friends.

 It starts by being smarter than the wolves. Build an effective strategy and practice it. Work on strengthening yourself. Seek out as much training as possible and spend as much time as you can at the range. If you are honest with yourself and prepare accordingly, you can stay safe. Repeat after me: Prepare, perceive and protect. Commit these three Ps to memory and practice them daily.

There is now equipment that is well suited to the older shooter and anyone who has issues with grip strength. Smith & Wesson has several new guns with easier to cycle slides, less recoil, options for better sights, and other enhancements.

The Enforcer is a good choice for self defense for older people and comes with a variety of options to make it more effective. It has a built in mount for Red Dot sights and there is a Crimson Trace Laser version as well. I quibble a bit with their term of “Micro-Comact” for this gun, but it is concealable and lightweight. There are other models that have similar features and other manufacturers may have similar models, but S&W seems to be leading the market right now.

Maglula makes the Uplula semi auto pistol magazine loader. They are great for loading magazines at the range or loading the magazines you use with your self defense pistol. I’ve started using one for all of my range trips as tiring out my hands loading magazines has an adverse effect on my shooting.

Human predators are like predators in the wild. They seek out the weak and infirm because they are easier to overcome and kill. Muggers and other violent criminals may not kill their intended victims, but they can still overpower them because they are usually younger, more fit, and more agile than their targets. Firearms and less lethal weapons are the equalizers here as they allow the older defender to improve their odds of surviving an encounter.

Getting older doesn’t mean becoming defenseless. You just have to be smarter about it and prepare ahead of time.

Victory In Europe

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Victory In Europe

May 8 is the anniversary of Victory in Europe Day. It celebrates the formal end of the war in Europe and complete surrender of the German military.

Adolph Hitler committed suicide on April 30, 1945, but the actual surrender took over a week as elements of the German Army continued a futile defense against the rapidly advancing Soviet Armies.

The Soviet Armies crushed all defeat in and around Berlin over the next several days. They also raped about 80,000 German women along the way. Additionally, the Soviet troops looted buildings and murdered an unknown number of Germans.

The German Instrument of Surrender was signed at 22:43 German time on May 8.

It reads,

The German High Command will at once issue orders to all German military, naval and air authorities and to all forces under German control to cease active operations at 23.01 hours Central European time on 8 May 1945…

The war that Germany had started on September 1, 1939 by invading Poland on a false pretext was finally over in Europe.

For England and Europe, the war was almost six years long. For the United States World War 2 started with the attack on Pearl Harbor on December 7, 1941. In both the Atlantic and Pacific, the issue was in doubt for several years.

In some ways the war had started earlier with other events. On October 3, 1935, Italian troops invaded Ethopia after a border incident between Ethopia and Italian Somaliland. Mussolini ordered Italian troops to attack Ethopia. Italy won due to it’s superior weaponry and in part because Britain refused to intervene on behalf of Ethiopia.

Japan invaded Manchuria in September of 1931 and China in 1937. On September 12, 1937 Japanese planes attacked and sank the USS Panay on Yangtze River. The Panay was a US gunboat, killing three people on board and injuring 48 people on other US flagged ships. Japan claimed that their pilots had not seen the US flags on the ships, however photographic evidence contradicts that.

In some ways these precursors were the shape of things to come while much of the world wanted nothing but peace.

The Victory in Europe not the end of World War 2. The war would continue through the spring and summer of 1945 until Japan surrendered unconditionally on September 2, 1945 when the Instrument of Surrender was signed on board the battleship USS Missouri in Tokyo Harbor. Japan had ceased fighting on August 15 (August 14 in the US) 1945.

Depending on which date you pick World War 2 could be considered to have lasted almost 15 years.

Shaving Cream In A Can

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The post title is not some sort of Joy Bahar in a spandex suit joke. It’s a story about how great ideas are sometimes rewarded and sometimes not so well rewarded.

My late Father in Law as a bit of curmudgeon sometimes. Given that his family last just about everything during the Great Depression and he never made as much money as he probably should have, I can’t blame him.

He was a Master Electrician and given that he was born in 1915 you might say he got in on the ground floor of the trade.*

He worked at the trade until World War 2 came along. Although the military probably needed electricians, he was draft deferred because being a Master Electrician was classified as exempt. Instead of going into the military, he ended up working at an armory where artillery was made. When he told me this way back when I was first married, I thought it odd that they had him wiring cannons for electricity. He carefully explained, using small words, that his job was to wire the big machines that made the tools to make the machines that made the parts of the big guns.

Forging, casting, machining, all needed electricity to power the equipment.

Oh.

He was also a tinkerer and quasi inventor. He often came up with ideas to make equipment in the armory safer or more efficient. One idea was to put a shroud around the big pully that turned the belt on an air compressor. Since it was wide open there was more than a little risk that someone would get their clothes, hands, or something else caught in the machine.

The Colonel in charge of the armory like they idea and they built the cage as my Father in Law suggested. He got a nice letter from the Colonel thanking him for his suggestion. In fact, he got several nice letters from the Colonel for coming up ideas to improve efficiency and safety.

When the war ended, so did the job. The military didn’t need more artillery, in fact they had way more than they needed since there wasn’t an enemy to blow up any longer.

After working here and there for a few years he ended up at a large company that makes grooming equipment. Mostly for men, but now also for women. Back then they were known for making razors for men, along with things like shaving brushes and shaving soap. They also made shaving cream.

Once again he was hired to wire machines that made things, in this case razors and accessories. I won’t mention the name since the company is still in business and bigger than ever. The interested reader can probably figure it out, but don’t bother asking because even though everyone involved is long dead the company is still around.

At his new employer, he continued his habit of thinking of ways to help make the equipment and the process more efficient and safer. The company had suggestions boxes at various places around the plant and to encourage employees to come up with ideas the company not only offered nice letters, but they would give the employee a bonus if they adopted his idea.

The bonuses were from mostly from $5.00 to $25.00. That might not seem like much now, but back in the 1950s it was a decent sum.

He submitted several ideas, some of which were not accepted, but many of which were. I saw the letters not too long before my Mother in Law died. She was saver of just about everything in and when I heard this story she had all of the letters going back to World War 2. For the record this was in 2019 when she turned 100.

One of his suggestions was that they should put a suggestion box near the lunch counter in the plant where he and many others had their lunches. That way they wouldn’t have to walk any further and it would be easier to drop suggestions in the box.

That was a $5.00 suggestion, along with the nice letter from his boss.

One day he was at a drug store for some reason or another and he watched as the soda jerk pulled on a lever and whipped cream came hissing out into a glass.

BTW, “soda jerk” was the term because they would “jerk” on the handle, not because they were jerks. But, I digress.

Father In Law was struck by inspiration. What if they could put shaving cream into a can with compressed air and a push button on the top? Then men wouldn’t have to use soap and a brush to lather their face. They could just use the foamy stuff that came out of the can.

He wrote up the suggestion and it was an instant hit. It was in fact a $100.00 hit as that’s the amount of the bonus that he got. For an idea that made his employer millions, well now billions, and I expect that the boss got a raise and a promotion.

In addition to the $100.00 bonus, he got a nice letter, and was told that because he was an employee the company owned any ideas that he came up with. If he didn’t like it, he could leave and find a new job.

He didn’t. He stayed on for about another thirty years and continued to wire machines, some of which made the very product that he had invented.

To be fair, the company did treat him pretty well. He got free health care for the rest of his life and when he died my Mother In Law got free health care as well.

You might think that this was just family lore, which is what I thought when I first heard this story. It wasn’t, as I saw the letter from his boss because my Mother In Law never threw anything out.

That’s a story for another day.

*I apologize for that pun and will try not to write any more although I often find them irresistible.

Miscarriage Of Justice

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Why is Patrick “Tate” Adamiak in federal prison?

According to this article ATF lied to convict sailor now serving 20 years in prison for selling legal gun parts

The Bureau of Alcohol, Tobacco, Firearms and explosives (ATF) lied to get a conviction.

Patrick “Tate” Adamiak never sold a single real firearm—not one—even though he sold thousands of dollars per month of military gear and gun parts legally on his former website.

Adamiak was one of Gun Broker’s top 500 dealers, until the ATF decided to target him personally and lie under oath about the facts of his case. Now, unless someone quickly rights this unconstitutional wrong, Adamiak will be held in federal prison until 2042.

Adamiak, clearly, is the type of American most people admire.

An active duty US Navy Master-At-Arms with the rank of Petty Officer First Class when he was arrested and charged with the following,

  • Counts 1 and 2 concerned the PPSh-41 receiver, which is not a firearm under current federal law.
  • Counts 3 and 4 concerned his M203 and M79, which are Title 1 firearms that were legally transferred by an FFL. Neither had a 40mm barrel affixed. Adamiak had 37mm barrels for both, which are legal and not subject to National Firearms Act (NFA) regulation.
  • Count 5 concerned two inert RPGs, which were missing all of the parts to make them functional and had holes drilled directly into their chambers.

He was convicted on all counts even though his expert witness, a retired ATF agent, testified that none of his possessions met any classification of a weapon.

President Trump has issued a lot of pardons since he reassumed office, I can’t understand how or why Adamiak has not been on the list.

Read the entire linked article for the details of his ordeal. There is a link to donate to his Give, Send, Go account.

I’m posting this under the Firearms and Civil Rights categories as it appears to me that Adamiak’s civil rights have been violated by the federal government that he has sworn to protect.

Patient Assessment

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I knew and worked with some great paramedics. I learned a lot from partners and others over the years and they helped me improve my ability to assess and treat patients.

The truth is that you can’t effectively treat patients if you don’t know  what is wrong with them. I also worked with some “throw everything in your drug box” medics who often didn’t know exactly what they thought they were treating. They were like automobile technicians that used the so called “parts cannon” to try to fix a problem without diagnosing the issue.

By the way, paramedics diagnose. The doctors unions don’t like that and for the most part medics use other terms, but it’s still a diagnosis. The best of the several medical directors I worked for over the years once said “Of course paramedics diagnose. How else do you know what you’re treating?”

There are several steps to making a diagnosis. Sometimes those steps happen almost simultaneously as you walk in the door and look at the patient. From ten feet away you can tell the patient is sick and from his appearance you can even figure out what the problem is. It’s still important to do a proper assessment, but it’s confirmatory, not discovery.

The paramedic school I went to had an Anatomy and Physiology course built in. It was a college level program as the same university also had a well regarded nursing program and the same instructor taught our program.

Some of my fellow students asked him when we were going to get to abnormal A&P and all these years later I remember his answer. “Once you know normal A&P, you will know abnormal A&P when you see it.

Part of assessment is knowing what’s normal and what isn’t. For example normal breath sounds are quiet, almost silent. So, anything that is noisy is abnormal and we are left to figure out what is causing that and then apply our protocols. I’m often surprised how often paramedics default to giving a bronchodilator when the problem is fluid in the patient’s lungs. That’s a lack of understanding both anatomy and physiology.

That’s a lot of writing to get to the point of this post.

EMS1 has a pretty good article on using OPQRST as part of the assessment.

Go ahead and read it,

How to use OPQRST as an effective patient pain assessment tool

The description of what each component is very good, but I do have a quibble with the pain scale. I’ve never used the 1-10 scale because it tries to quantify what is clearly subjective. My 10, is your 5, and the guy down the roads 2. Then there is always the person who says it’s an 11. Maybe they are fans of Spinal Tap, but often it’s an exaggeration.

I once asked a patient if his chest pain was like an elephant sitting on his chest. He replied “No, it’s more like a German Shepard sitting on my chest.” That gave me an approximate idea of how severe his pain was and I was able to proceed from there.

I have only one problem with OPQRST. I can’t remember it. This presented a problem as I’d miss something in my assessment because I forgot one of the questions.

I mentioned this one day to one of my fellow paramedics. She was a very good paramedic, if a bit rough around the edges and I learned quite a bit about patient care by working with her.

She told me she used to have the same problem until someone gave her a different mnemonic. It worked so well that I still use it when reviewing PCRs.

Here it is. LOCDIT.  Compare it to OPQRST and you’ll see it’s just a different way to approach the same issue.

Location. Where is the pain and does it radiate anywhere?

Onset.  Did it come on suddenly or over a period of time?

Character. Is the pain sharp or dull? Alternatively you can ask the patient to describe it using their own words. This might not work well if the patient can’t give concise answers and sort of rambles on.

Duration. When did it start? Is it constant or intermittent?

Intensity. As mentioned, I’ve never been a fan of the 1-10 scale and even less so the “Smiley Face” pictogram. Use the initial pain level, however you determined it as your baseline for treatment. After each treatment, ask again if the pain has changed at all.

Treatment. Did the patient do anything to treat the pain? Did it help or make it worse?

That’s it. LOCDIT. You might find that it helps you better organize your assessment of patient complaints. While it’s geared to pain it can also be adapted to a complaint of Dyspnea.

President Trump, Second Act

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President Trump, Second Act

I voted for President Trump in 2016, although not with much enthusiasm. When he came down the golden elevator in 2015 and announced that he was going to run for President, I figured that it was some sort of publicity stunt or maybe going to be a reality show.

My son, who is politically astute and admired Trump the businessman told me that he was serious and that he would win the Presidency. I was skeptical to say the least.

I was also wrong as candidate Trump went on to beat 16 well established Republican politicians and won the nomination.

He won quite handily if it was a surprise. His opponent who had chastised him for not pledging to concede if she won, still has not conceded that he won. Talk about a sore loser.

He was duly inaugurated and gave a speech that I thought was very good, but all of the Fake Stream Media said was dark or apocalyptic.

He then set about being President and did what few politicians in history have ever done. He did exactly what he said he would do. How odd.

Being a business man, not a career politician was both a plus and a negative. The plus was that he didn’t look at things like a politicians. The negative was that he didn’t look at things like a politician.

He picked his Cabinet and many other appointees based more on their support and loyalty than on their qualifications. In this he made the first and perhaps biggest mistake of his Administration.

He picked a lot of Washington, DC insiders. Most of them were part of the DC “go along to get along” crowd that were more interested in being invited to A List parties than doing what the President wanted.

Sen. Jeff Sessions was a reasonably good Senator and Trump loyalist, but compromised because he’d been the Senate for a long time. His replacement, Bill Barr was arguably worse because he too was a DC insider.

Or maybe Vice President Pence was the worst pick, but at the time it probably seemed like a good idea. Sometimes good ideas turn out to be bad choices.

The list goes on, Rex Tillerson, Mike Pompeo, John Bolton, Gen. Jim Mattis. The list goes on and includes some people did very well in their jobs. It really doesn’t matter though, as only a few were invited back when President Trump reentered the White House in January of this year.

After the stolen 2020 election, President Trump had four long (for us) years to evaluated his mistakes and plan his return. There was plenty to think about and plenty to plan for.

This time he’s more politically savvy, although still not a politician. He has consistently picked outsiders whom he has more thoroughly vetted before nomination.

His first pick, before the election was terrific. J.D. Vance is part of the new wave of Republicans. No more trying to appease the unappeasable Leftist media. Like the people below VP Vance takes no BS and when necessary has a sharp tongue. It’s a refreshing change from previous wimpy Republicans.

Marco Rubio, for Secretary of State. He has cut and slashed his way through the State Department. No whispering to foreign diplomats that should just wait President Trump out.

Pam Bondi for Attorney General. Despite people complaining about her not releasing the “Epstein List” she’s actually enforcing the list. She’s busy and has kept her subordinates busy putting violent criminals in prison.

Pete Hegseth for Secretary of Defense. A guy that served and visits military bases and then works out and runs with troops.

Kristi Noem for Secretary of Homeland Security.

Robert F. Kennedy for Secretary of Health and Human Services. I am strongly disinclined to like any of the Massachusetts Kennedy’s, but he may be the exception that proves that rule. I don’t know if I like all of his positions, but he is thought provoking. No ties to the medical establishment means that he is not subject to pressure from the various doctor’s lobbies.

Assorted very wealthy  business men in assorted finance and business related positions.

Tulsi Gabbard as Director of National Intelligence. I’m sure she’ll want to have a word or two with whoever decided to enroll her in “Quiet Skies” as a potential security threat.

And the number one person you wouldn’t want to meet in a dark alley, Tom Homan in charge of stopping illegal immigration and deporting people here illegally.

There will be missteps and errors along the way, but this Trump Administration will be more successful than the first one. He has already made major changes and every time the opposition announces that this time he wall fall flat on his face, he wins.

It’s going to be a fun four years. Well, for me at least.

Truly Bad Medicine

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Truly Bad Medicine

Over the years of my career in the field it was common to work as closely as possible with other agencies. This wasn’t always easy where I worked, particularly with the Sorta Big City fire department. It was easier with the Sorta Big City police department for any number of reasons. Sorta Big City EMS and Sorta Big City PD worked more closely on the streets and when I started the fire department had no interest in EMS at all. In fact, a few years before I started in the late 1970s the fire department had refused an offer from the Mayor to take over the emergency ambulance service that a recent state law had required every city to either operate or contract with someone to operate.

While EMS and PD in my city had a very good working relationship, it also became apparent than when push came to shove the police would shove us under the ambulance.

Which beings me to today’s story.

A Puyallup woman’s DUI arrest for a stroke turned into a legal battle. Here’s what happened Read more at: https://www.thenewstribune.com/news/local/article302391644.html#storylink=cpy

A Pierce County Superior Court judge has dismissed a lawsuit that accused local authorities of negligence after a Puyallup woman was arrested for DUI but actually had suffered a stroke. Jane Carhuff and a family representative sued the city of Puyallup and Central Pierce Fire & Rescue more than three years after her November 2019 arrest for which charges were dismissed, alleging that Puyallup police ignored protocol for DUI testing and firefighters rendered a medical opinion without the necessary expertise.

Those were the allegations, but it doesn’t seem that the case got to a trial on the merits of the claim.

As a result, the 54-year-old postal worker spent more than three hours in custody reportedly acting strangely. A day or so after Carhuff returned home and her condition — alleged to have been the product of drug intoxication — didn’t improve, her family took her to a local hospital where she was diagnosed with having suffered a massive stroke, according to the suit. The delay in receiving medical care significantly worsened Carhuff’s chances of recovery, and she continued to suffer strokes until her death in September 2023, according to the suit and her obituary.

More details of the case,

Officers identified Carhuff as the suspect and learned her whereabouts from family upon visiting her home, leading police to respond to her doctor’s office, the suit said.

The late Mrs. Carhuff was at her doctors office when the police arrived to arrest her.

The following alone should have been enough to prove the families case,

Fire personnel conducted their own medical assessment, instead of consulting with Carhuff’s doctor or taking her to a local hospital roughly 300 yards away, according to the suit. Only Carhuff’s blood sugar was tested after she reportedly referenced being diabetic, the suit said, adding that CPFR concluded that she wasn’t in medical distress but under the influence of an unknown intoxicant.

She’s in her doctor’s office, either waiting or being examined for a chief complaint of apparent altered mental status. The police and fire show up and the fire paramedics conduct and exam. No one thought to ask her doctor what he thought? No one thought it odd that a woman thought it a bit weird that that she went to a doctors office while possibly intoxicated?

The police would have said that they depended on the paramedics medical expertise, but the paramedics clearly did not do an adequate exam. Nor did the ask the doctor or his staff anything about the patient.

Here is another thing, perhaps the most important. Part of the process of obtaining a patient refusal is determining if the patient has the present mental capacity to make in informed and rational decision. That does not mean it’s one that the providers agree with, but it’s one based on an examination to the extent the patient will allow. That the results of the examination are explained to the patient. That the risks and benefits of the proposed course of treatment are explained. That the risks of refusing the propsed course of treatment, up to and including death are explained to the patient and that the patient understands said risks.

In this case a reasonable paramedic (me) would do the following.

Examine the patient as thoroughly as possible. That would include a Stroke Exam.

Ask the doctor his opinion of the patient’s condition.

Ask the patient if she wanted to go to the hospital.

Tell the police that it is very likely that she is having a medical emergency.

Without having access to the Patient Care Report, there is no way of knowing what the paramedics did other than a blood glucose level. That apparently was normal, but is only part of the examination.

The failure to do and document any of the above means that the report was inadequate, not to mention the care.

In a response filed in court, the city of Puyallup did not dispute that Carhuff had been unsteady on her feet and unable to follow simple instructions; that three EMTs who examined her had reported finding no medical problem; or that she was later diagnosed with a stroke.

Here is something else to consider. There is no rule that says that a patient can only have one condition at a time. She could have been having a medication reaction AND a Stroke simultaneously.

We’ll never know because by the time she was seen at a hospital and diagnosed the effects of the medication had likely worn off.

Even though the city and the individuals seemed to have escaped liability for what happened, it was still sloppy medicine. I’m sure there were high fives all around when the judge issued her ruling, but Mrs. Carhuff is still dead and still suffered from the time of her stroke until she died.

We’ll probably never hear more about this as it goes through the appeals process. Which is too bad as it’s a good illustration of bad EMS.

 

 

 

My Free Oil Change

EMS Artifact
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My Free Oil Change

I’m very diligent about maintenance on my truck. Well, mostly diligent as there are a couple of things I’ve missed, but none of the essentials.

Last week I noticed that I was about 300 miles away from the 5,000 mile increment for oil changes. I NEVER miss an oil change, so I called my nearby local shop and made an appointment for this morning for the oil change and a tire rotation.

I showed up at the appointed time, checked in, and gave the keys to the office manager.

I then went outside to finish my coffee and have a morning cigar. I sat there reading, drinking, smoking, and saying hello to people passing by. Not a care in the world, as they say.

About forty minutes later the young man who was doing the work pulled my truck out of the garage and then backed into a parking spot. Or started to when the fun began.

As he backed up, I saw the right front tire detach itself from the vehicle while the five lug nuts rolled merrily down the slight incline. The tire’s bid for freedom was thwarted when the the right front of the truck fell on it.

Hmm. I sat there for a minute watching to see what was going to happen next. The young man got out of the truck, walked around the front and looked at the situation.

He then did the logical thing which was to get a floor jack from the garage and jack up the truck. At which point the shop foreman came over and started looking at the situation. I meandered over and he told me that the inner fender well was broken and he would order a new one. Okay, sounded reasonable. I went inside to talk to the office manager who had been out in the boss’s officer discussing something else and missed the excitement. He reassured me that they would fix everything, which is pretty much what I expected him to say.

He also told me that the young man who did the work had been with them for two years and they had not had any issues with his work. I said, stuff happens, and I hope he learned a lesson. The office manager laughed and said yes. He’s a hard worker and I felt a bit bad for him because he must have been embarrassed with this happening in front of the customer.

I’m sure he’ll be fine and next time be sure to torque the lug nuts on all four wheels.

Experience is indeed a harsh teacher. It gives the exam first and then the lesson.

After about 30 minutes the foreman came in and told me that the wheel was back on, but he didn’t like the way the studs looked. Unfortunately (for them) you can’t just replace broken or bunged up threads. No, you have to buy a new four wheel drive hub. Thanks Toyota.

Note that when engineers design parts they have to meet two criteria. First, the part has to be fit for purpose and not fail prematurely. Second, they have to be quick and easy to assemble while the vehicle is being built.

Note that “being easy to repair” is not a criteria.

There is a Toyota V-6 engine that has a great reputation for reliability. Which is good because the starter motor is mounted INSIDE the engine. Imagine how much fun it is to have to remove the top end of a internal combustion engine to replace the starter.

He had already ordered the hub, which the dealer had in stock. I assume they got it from the dealer and not some aftermarket part. He told me that it would be a few hours and offered to have someone drive me home.

Okay, kind of messed up my day as I had some errands to do and now that would have to wait. Still, they were doing the appropriate thing here and not trying to dodge responsibility. I’m going to presume that even if I hadn’t been sitting there watching the event, they would.

About 4:00PM the shop called and told me the truck was ready for me to pick it up. I asked if someone could come to pick ME up and bring me back to the shop, which they did.

I got back and walked in fully prepared to pay for the oil change and tire rotation. The officer manager prepared the invoice, handed it to me, and said “No charge.” I offered to pay because they had done the work and were absorbing the cost of the repairs, but he refused.

I thanked him and left.

Nice people and of course I’ll return again.

The only downside is that by the time I left the shop “rush hour” in my rapidly outgrowing the road system had started. It took much longer to get to the stores I needed to visit and then home than it would have if all had gone according to plan.

When does that ever happen?

Note that the picture with this post is not my truck, but that’s pretty much what it looked like when the tire came off.

 

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