Back in the mid to late 1980s, my service had a few instances where crews left the cabs of their ambulances unlocked and as a result those ambulances were stolen. Most were recovered, a couple of people were arrested. One was totaled when the thief crashed into a bridge abutment and since he fractured his femur, he couldn’t run away.
After that unfortunate incident the bosses decided that enough was enough and from about 1985 onward every department vehicle was equipped with an anti theft switch. The first ones were manually activated and even if the keys were left in the ignition stepping on the brake pedal would cause the engine to stop running. Later on they were easier to use and crews were told to flip a switch in console and then turn the ignition off and most importantly take the key out.
I only remember once in between then and when I retired in 2012 having a vehicle stolen. That was because the paramedic ignored the part about take the key out.
The chase, which involved a California Highway Patrol helicopter and several ground units, ended after spikes were deployed and police vehicles surrounded the suspect in the stolen truck.
The city-owned F-150 pickup truck was stolen the evening of May 19 from Sacramento Fire Department Station 12, on the 4500 block of 24th Street in South Land Park .
Granted, this was parked inside the station not at a scene. It does however bring up two questions.
Was the station wide open? Could someone just walk in and take whatever they wanted, including a vehicle?
Was there a reason that the key needed to be in the ignition?
This might not help if a vehicle is parked in it’s garage or other place, but it certainly will make scenes more safe when on responses. Besides it will avoid those oh so embarrassing situations when the crew comes outside with a patient on the stretcher only to find an empty spot where just moments ago the ambulance was sitting waiting to be stolen.
Eighty-two years ago the Japanese Imperial Navy had a very bad morning. It had started out fine with Japanese bombing Midway Island and causing significant damage. In return the initial attacks by American planes were ineffective.
At 9:20 Devastator Torpedo Bombers flying off of the USS Hornet attacked and every plane was shot down with no hits. Only one member of the attack survived. Similarly Devastators from the E USS Enterprise and USS Yorktown suffered heavy casualties with no effective hits.
A combination of Japanese fighters and ship based anti aircraft fire had stopped the torpedo attacks, but their efforts had diverted their attention from another threat. The losses of American pilots was not totally in vain. First, the Japanese were undisciplined in their attacks, so weren’t in position to intercept the American dive bombers that were not overhead. The attacks had also distracted the Japanese from rearming their planes and properly storing bombs and torpedoes.
That all changed starting at 10:20 when Dauntless dive bombers started scoring hits on the Japanese aircraft carriers. Within a few minutes the Kaga, Akagi, and Soryu were on fire and would sink later in the day.
The aircraft carrier Hiryu would follow later in the day and other ships would be damaged or sunk for the next couple of days as the shattered Japanese fleet withdrew.
Perhaps more important than the ships and airplanes themselves were the almost complete loss of experienced Japanese pilots, aircrew, maintenance crews. Unlike America, which had a policy of returning experienced crews to the United States to train new pilots and air crew, the Japanese pretty much sent people to combat until they died.
The United States lost the USS Yorktown which had been heavily damaged at the Battle of the Coral Sea and been repaired in record time and sent to fight again at Midway.
That’s the short story, the long story is several books long. I recommend just about any of them for those interested in what turned out to be one of the most crucial victories in the history of naval warfare.
The other day was June 4, 1944. The Germans were driven out of Rome by Allied troops. In late 1943 the Fascist government of Benito Mussolini collapsed and he was arrested. He escaped, but that’s a story for another day. Italy now joined the Allies in fighting against their former partner Nazi Germany. The Germans retaliated harshly and Italy was now treated as a captured nation.
The Allied assault started in January of 1944, but Rome was not freed until June 4. The fighting was on some of the worst terrain for combat in some of the worst weather in Europe. The American 5th Army and British 8th Army were the major Allied forces and both nations suffered heavy casualties. Rome was an open city by the time the Allies entered and a good deal of the German troops had retreated and would fight on until May of 1945 when Germany surrendered.
The Liberation of Rome would have been the biggest story of the month of June except for that other invasion which was labeled the “Invasion of Europe.”
The Italian theater of war doesn’t get nearly as much attention as it deserves. Many of the hard lessons learned at the cost of many lives were used during both the Normandy invasion and the invasion of southern France in August 1944.
It would be nice if politicians would stop throwing young Americans lives away for nothing more than to score political points.
A friend complains that “We can’t afford to go to war, we don’t have the money.” I remind him that the real cost of war is in lives lost, ruined, or permanently altered, usually in negative ways.
Which is all I have to say today other than “Thank you” to those who gave up their futures for ours.
I recently reviewed two calls for one of our client agencies. Both call were responded to by the same two medics. Both patients were similar in some regards and the mistakes made were very similar.
Here is some of the relevant report, with Protected Health Information (PHI) removed or changed. Note that I’m not using the built in quotation function on the blogging platform, but you’ll be able to identify the text.
Here is the first report.
A3 dispatched to above address for a 68 year old pt not feeling well. Upon our arrival found a 68 y/o male ambulatory outside of him home with crew of FD. Pt was in no obvious signs of pain or distress. Pt stated his stomach has not felt right for the past x2 days. Pt denied any recent illnesses/injuries/surgeries. Pt denied any change in eating habits and states he has been drinking fluids appropriately. Pt had no other stated complaints. PMHx, Meds and allergies as noted.
Past Medical History: Hypertension
Medications: Aspirin Metoprolol
Allergies: None Known
The vital signs were,
BP 158/72
Mean Arterial Pressure 101
Heart Rate 78,
Pulse Ox 97
Respiratory Rate 16
Exam was not remarkable, including the abdominal exam.
Treatment consisted mostly of a ride to a nearby community hospital.
What, you may ask did they do incorrectly? That’s a qood question because on the surface this seems pretty straight forward, but it’s not. While typically EMS providers are taught that Acute Cardiac Syndrome (ACS) presents with chest pain or discomfort, that’s not always the case. A good percentage of cardiac patients have “atypical” complaints and that’s where experience and looking past the obvious differentiates a clinician from a technician. In this case as soon as I read a sort of vague abdominal discomfort I immediately looked for the attached 12 lead EKG. The problem being that there wasn’t one. Epigastric discomfort is a common atypical presentation of ACS. It’s usually associated with either a Myocardial infarction or Angina effecting the right side of the heart.
So, the first mistake was not looking past the obvious. This is not some sort of secret in medicine. Epigastric distress is right there in their protocols along with several other things that for years were just not recognized. So, this gentleman with a not very complicated medical history is possibly having a serious cardiac issue. IF it were recognized by the crew it could have been treated. That said you don’t treat what you don’t recognize.
As baseball great Yogi Berra said, “You can observe a lot by watching.” People joked about a lot of things he said, but this one was spot on. If you aren’t looking for something, you’ll never see it. In this case it would be reasonable to apply the stickies and hook up the cardiac monitor. A 12 lead EKG would have been interesting to look at, but alas they providers didn’t perform one. Nor did they place an IV line in case treatment was needed. Nor did the give the patient aspirin to chew.
Unfortunately for me and my readers I have no way to find out what happened to the patient. At least I know that he made it to the hospital alive.
Case number 2 involves the same crew. Which is not encouraging.
Herewith are the pertinent parts of their report. I apologize for the all caps narrative. Among other issues, this young lad can’t see to find the Caps Lock on his device,
“A3 D/P TO A/A FOR A 79 YOM REPORTED HYPERTENSION AND STOMACH DISCOMFORT. UOA TO SCENE PT WAS FOUND SITTING UPRIGHT IN CHAIR IN HOME STATING THAT ON AND OFF FOR THE PAST 12 HOURS
HE STARTS TO GET PAIN IN HIS STOMACH ACCOMPANIED WITH BILATERAL ARM WEAKNESS AND EXPERIENCING PAIN IN HIS JAW . PT STATES IT WOULD COME ON FOR 5-10 MINUTES AND THEN SUBSIDE.
PT WAS TAKING HIS OWN BLOOD PRESSURE AND STATES THAT IT WAS HIGH. PT STATES HE WAS SEEN THE WEEK PRIOR AT {nearby community hospital} FOR THE SAME ISSUE AND WAS DIAGNOSED WITH COPD BUT PT
DENIES SOB AT THIS TIME. PT ASSISTED TO STRETCHER SECURED AND TAKEN INTO A3 FOR FURTHER EVAL/TRANSPORT ”
This one is a bit more slippery because they did obtain a 12 lead EKG. Nine of them to be exact, but some were not clear enough to read. The provided noted some ST Depression in Leads V4 and V5 (chest leads). The problem with that is that those are not contiguous despite the number. Also, when I read the EKG (and I’m much more experienced that the two medics combined) I noticed that actually the anomaly was present in four chest leads, not just two.
Note that this too is a complaint of abdominal pain, but along with that there is pain in his jaw and weakness in both of his arms. It would be helpful if the medic had said which side of the jaw, but that’s not particularly critical. Once I read that complaint I went looking for the EKG (found) IV (found) and the Aspirin (nope). For more than twenty years now Aspirin has been recognized as a critical component of treatment for chest pain. Not that it make the pain go away, but that it makes the blood cells a bit more slippery and reduces clotting of red blood cells.
In this case, for reasons not clear to me they bypassed three hospitals with emergency cardiac catheterization labs and drove about half an hour to a fourth. Fortunately for the patient and them, nothing bad happened. There was something going on, however even to me it isn’t clear exactly what.
Sometime something that appears simple is far from simple. There were times in my field career that I’d look at a patient and get a funny feeling in my stomach. “Gut instinct” we’re told it is, but I don’t know how my gut can tell that a patient is about to fall of a clip. I don’t know how it does, but it does. In both of these cases, I’d have had that feeling in my stomach and would have treated these patient more aggressively than they were inclined to.
Does this make me a super smart paramedic? No, just one that pays a lot of attention to subtle clues.
In Journalism, or what passes for it these days the “lede” of a story is the first paragraph. The way that print stories and to an extent electronic media stories are constructed the most important part of a story is the first paragraph. That’s the lede of the story.
When newspapers were the primary method by which people got the news the practice was to put the most important part of the story first and then with each paragraph less important parts of the story were added. There were two reasons for this. First, readers often had short attention spans or maybe limited time to read articles. Second, if another publication picked up the story they may want to shorten it for various reasons. Since everyone knew how articles were constructed it was easy to just lop off the lower paragraphs.
Those are legitimate uses, but there is another way to use that method to build an article for publication. If you put the most important last, then you can fashion your story so that readers will understand it they way you want them to. If’s a form of lying, but a very subtle one.
Put a minor point, but one that supports your preconceived notion of how the public should understand the story first, then way down near the end put the part that undermines your position. In the news business this is called “Burying the Lede.”
It was impossible for the AP to determine the exact role injections may have played in many of the 94 deaths involving sedation that reporters found nationally during the investigation’s 2012-2021 timeframe. Few of those deaths were attributed to the sedation and authorities rarely investigated whether injections were appropriate, focusing more often on the use of force by police and the other drugs in people’s systems.
This would be the key information that people should know. Which is that despite the scary headline, the ace reporters at Associated Press are just assuming that they were caused by Midazolam (Versed). Note also that few of the deaths were attributed to drugs. What they don’t tell you is that everyone of the people who died had a complete and in depth autopsy performed. Anyone who dies in police custody gets and autopsy to determine the cause of death.
The AP wants us to believe that Ketamine is a safer drug to use, but Ketamine too has potential adverse effects. Especially if the patient already has drugs in their system. Some of the systems with which I work have withdrawn Ketamine from their medication list. Others have opted not to use it believing that Versed and another medication, Haldol, work better and have less potential to cause harm.
The Eric Jaeger quoted in the article is more than a paramedic. He’s a paramedic and a lawyer who has lectured at many EMS conferences. Knowing that I have to wonder if he was quoted out of context. His statement regards any form of sedation and there is no reason to believe that he thinks that Versed is any more dangerous than any other sedative.
Of course the aggregate data from which AP drew their conclusions was not published.
The articles linked to are no better and just as one sided.
None of the experts quoted addressed how public safety professionals can protect themselves while trying to keep out of control people from harming themselves or the public? If the police had let any of these people go and they subsequently died, we’d be reading about that instead of this.
In the case cited in this article the reporter mentions that Mr. Jackson took Methamphetamine. That’s an illegal drug and one that can make people extremely violent. Having worked most of my career before sedation was used I can attest that having the physically restrain people exposed everyone to the risk of serious injury. One medic I worked with suffered a broken neck and was never able to return to work because of her injury.
Note also that in the linked article AP spends considerable space attacking the very same Ketamine that they seem to laud in the first article. Oh, and the mention the Versed is used as part of the cocktail used to execute people. True, but it’s used to help ensure that the person dies without pain. I won’t go into the other drugs used as part of lethal injection, but they are commonly used for medical reasons and in and of themselves not especially dangerous.
We now know one thing for sure. Reporting by Associated Press is not to be trusted.
I’ve probably mentioned somewhere along the line that I prefer old movies to current ones. Some of my favorite movies were produced before I was born. Some were produced when my now deceased parents were young and well before they were married.
I like those movies because unlike current movies they depended on the talent of the cast to produce an interesting story. Most of those films were shot in black and white because color film was much more expensive back then.
John Ford was a master director more because he was great at framing shots than he was great at directing the actors. In fact most of the actors who worked with him didn’t like him at all and vice versa. There were a few exceptions, Ward Bond being one. I’ll talk more about Bond in another post.
Ford had an unofficial cast of stock actors who were in many of his films. They’d often play similar characters and thus were actual character actors. Ward Bond was the most frequent member of the this group, but there were others.
The other day I was watching (once again) Fort Apache from 1948. The stars of the film were John Wayne and Henry Fonda. There were many of Ford’s regulars in the cast including Bond, Hank Worden, Victor McLaglen, and Jack Pennick.
Pennick was born in 1895 and had a varied career. A US Marine in World War 1 Pennick worked later on as a horse wrangler. Which is where he met Ford and started working for him as both an actor and a military technical advisor.
During World War 2, Pennick was in the US Navy and became in a photographer in Ford’s photographic unit as part of the Office of Strategic Services. He also was a drill instructor for many of the OSS recruits that came directly from civilian life.
After the war he appeared in a number of Ford’s films including Fort Apache. In 1960 he worked as a technical advisor on another John Wayne/John Ford film “The Alamo.”
Over the years Pennick appeared in over 140 films from 1926 until 1962. His last role was as an uncredited character in the film “How The West Was Won.” Fittingly that segment was directed by Ford and starred John Wayne.
Just another character actor who added a lot of character to the films he was in. The little known performers who made big contributions to cinema.
The first 72 Hour Rule says to wait no less than 48 hour and ideally 72 hours before believing any reports on the Main Stream Media or the Internet about a large scale incident.
As soon as the first coverage gets out, the whacky internet rumors start. Remember that the Main Stream Media (MSM) lives by getting stories out first. He who breaks a story gets the most eyeballs and advertising money. It doesn’t matter if those eyeballs are on broadcast TV, cable TV news, blogs, websites, or even print.
Getting the story out quickly and accurately used to be the rule, but that’s gone now. When you put something out in the days of print you had to live with your mistakes pretty much forever.
This happened before I was born, but is still infamous to this day.
Harry S. Truman, president-elect, holds up an edition of the Chicago Daily Tribune with the erroneous headline “Dewey Defeats Truman”.
Ooops.
Now, if something is said or published incorrectly, the story can be “stealth edited” so that if you look at it later there is no trace of the earlier incorrect story. That happens on TV and cable news as well. If there was a clip saved to a website, it ill be deleted and replaced with the correct story. That’s fine except that there will be no notation that a previous story was incorrect.
When the MV Dali hit the Francis Scott Key Bridge in the middle of the night last week most people awoke and saw the story with some alarm. Initial reports were that numerous cars were at the bottom of the bay, which turned out to be false.
Shortly after the story broke, the whacky rumors started. Putin ordered the attack as revenge for the US blowing up the Nordstream Pipeline. A Muslim terror group did as revenge for US support for Israel. The US government did it to uh, do something or other. The Harbor Pilots had panicked and hit a secret button to kill power to the ship on purpose.
Self proclaimed experts decreed that the tug boats pulled away prematurely for some unknown reason.
It was a few days before the story came out that the ship had had power system problems. The ship despite being built only in 2016 had a history of shoddy maintenance and had had problems before.
Most of the crew were Indian nationals working under contract and the officers were all licensed merchant mariners.
Oh, and ships hit bridges and docks with distressing regularity.
The problem with silly rumors is that people will believe them because conspiracy theories can be tailored to account for any false information.
Remember dimwit Rosie O’Dumbell claimed that fire had never melted steel before September 11, 2001. Fat dimwit Michael Mooreon produced a movie blaming Pres. G.W. Bush for the tragedy. In his case, his lie filled money made the so called socialist millions of dollars. Yet, people believe that unmitigated BS.
Back when I was working as a paramedic I lived by the motto, “Don’t just do something, stand there.” Which meant do just do something because you could. There is a lot more potential for harm than help in just about every piece of EMS equipment we have, including our vehicles.
The point being to make sure you know what’s going on before acting. In a large event like the Key bridge crash it’s going to take a while to sort out what actually happened versus what the media tells you. That’s even if the media isn’t making shit up to get on the air.
The second 72 Hour Rule says that in a wide scale disaster you need to be prepared to survive for 48-72 hours before help gets to your area. That’s particularly if the federal government is the help for which you are waiting. It doesn’t matter who is in control in Washington, DC it’s going to take that long. The story line in the media will be different depending on which political party is in control, but the fact remains.
If the disaster is large enough it’s very likely that the local and state resources will be unable to respond. Their local resources may be overwhelmed or degraded to the point where they can barely (if at all) able to help themselves and will have no resources to spare. That includes law enforcement, fire suppression, and medical. Medical includes EMS, hospitals, clinics, pharmacies, and even individual practitioners. Public Safety personnel are not immune to floods, fires, blizzards, earthquakes, or tornadoes. In addition to possibly being killed or disabled, they have families, friends, and residences to worry about.
Make sure you have a sufficient supply of food, water, medications, and shelter to last up to 72 hours. Have a generator of some sort to provide power so you can heat or cool your living space in some degree of comfort. Have firearms to protect yourself and your family as the police instead of being minutes away could be hours away or just not coming.
Have first aid supplies and know how to use them in case someone gets ill or injured.
Don’t forget your pets. One of the biggest post Katrina complaints was that there were no provisions to treat, transport, or shelter people’s pets. In the years following Katrina FEMA bought (meaning you and I paid for it) all sorts of vehicles and equipment to rescue pets. This is not an internet story as I saw those vehicles in 2006 when I went to a FEMA training course.
Now, they have all sorts of information on the FEMA website, but other than dogs for Urban Search and Rescue they don’t seem to have all of the equipment that they used to. Nobody can waste money like the government.
So, there are the two 72 Hour Rules. One is not to believe what you hear right after a disaster, the other is to prepare to be self sufficient after a disaster.
For what it’s worth, I once suggested that the functions of FEMA should be contracted out to Walmart. Which might explain why I was never invited back to another FEMA event.
I’ll dispense with the lame joke about how they are just Falcking around.
ALAMEDA COUNTY, Calif. —In a recent and strongly worded letter, the managers of two Bay Area cities demanded improvement from Falck, the private ambulance company tasked with responding to emergencies in Alameda County.
The officials from Livermore and Pleasanton alleged poor performance and delayed response times that were “outside of those dictated” by Falck’s contract. In sum, the letter reported that ambulances were late to about one in every six medical emergencies in their cities.
“The expectation of our community is a quicker ambulance response when 911 is called,” the letter read.
About 90% of the complaints at my former employer were about response times, not patient care issues. People don’t much care what we DO as long as we show up quickly.
The accepted “standard” response time in EMS is 8 minutes and 59 seconds. This is based on the inaccurate and obsolete premise that that is the maximum time a person in cardiac arrest can survive without CPR. There was never any data to support it, but so called “experts” in EMS latched on to it and set it as a standard.
One of the ways that private services under municipal contract use to meet that standard is by sending fire department first responder to stop the clock. The fire service organizations that represent fire fighters and fire chiefs latched on to this starting in the mid 1980s for one reason. Jobs. At the time smoke detectors and fire sprinkler systems were cutting the number of fires that needed to be responded to and some cities were talking about cutting back on fire department staffing.
So the two organizations which I won’t name came up with the idea of fire first response to medical calls. Note that the people who came up with the idea were not the same people who were going to be getting up at all hours of the night to go to medical calls for which they were poorly trained. If they were trained at all. Thus was born the fire service “Stare of Life” where in the fire fighters stood around while the officer got on his radio to ask for the ETA of the ambulance.
Although firefighters are often the first responders on a scene, they are not technically allowed to transport patients to the hospital — even in emergency situations. Because Falck has an exclusive contract with the county, only their ambulances are permitted to conduct such transports.
According to Woerner, that often creates a situation in which firefighters end up waiting on the scene 15, 20, or even 25 minutes for an ambulance to arrive, even with critically injured patients.
“In my world, it’s not acceptable,” Woerner said of Falck’s delayed response times.
Be careful what you ask for, you just might get it.
Some observers think a better system would be the “alliance model,” a public-private partnership where the county EMS agency contracts with the fire departments, which in turn manages the ambulance system. The system is used successfully in Contra Costa County , and San Diego just recently reached an agreement with Falck to take over billing and staffing in a similar model.
San Diego had a previous incarnation of this type of system with a different private ambulance service. I forget which one and it might now be out of business. Then again San Diego has always had weird EMS delivery models.
But I digress.
“Response times are only important and influence clinical care and patient outcomes in a small fraction of cases,” spokesperson Troy Espera wrote in a statement.
This is 100% accurate. It’s also 100% irrelevant. Why?
Because as stated above all people who call for an ambulance care about is that someone gets there fast.
Although Oakland only represents 30 % of the population, 50 % of the call volume in Alameda County comes from the city.
I’ve never been to Oakland and with luck will never go to Oakland. I know little other than it’s baseball and football teams have fled to other areas. One other thing I know is that Oakland has a lot of poor people. Poor people utilize, some say abuse, EMS for a bunch of reasons that I won’t go in to. It’s not just Oakland, but every city of any size anywhere in the country.
All sorts of alternatives have been tried to sending ambulance that essentially function as taxi cabs, but if anyone has found one that works I’ve not heard about it.
{Hayward Fire Chief Garrett} Contreras
“Our residents shouldn’t have to have an understanding on how this all works,” [Hayward Fire Chief Garrett] Contreras said. “The expectation the public has is that when there’s a problem, we’re going to fix it. So let’s fix it.”
Hate to break it to you Chief, but you are not part of the solution, you are part of the problem.
Thus has it ever been, thus it seems it will always be as time goes by.
This is getting very concerning. It seems that at least once a week I’m reading a story about a disastrous EMS incident. Sadly, I could rename this blog “The Journal of Iatrogenic Medicine” and have plenty of material.
This is a story from down in Texas right next to Austin.
In the autopsy report, pathologist Satish Chundru said Samerigo received a cricothyroidotomy, an incision through the skin on the throat, that he did not need. It also said that after Samerigo received two doses of the nerve-blocking agent midazolam intranasally, he could have only survived if an airway was established. When one was not established, it compromised his heart and led to his death, according to the report.
Keep in mind that this is a non medical publication, however that description is a bit confusing, at least to me. The description of the cricothyroidotomy is correct, but the description of Midazolam is confusing. Midazolam, better known as Versed is a drug somewhat similar to Valium. It’s has somewhat different effects, but a nerve block is not one that I ever knew about.
It is used for procedural sedation, anesthesia, seizures, and acute behavioral emergencies. So, I don’t know Mr. Samerigo actually received Midazolam or received a neuromuscular blocking drug of the type to induce chemical paralysis during surgery or other procedures requiring that.
Although I know what a cricothyroidotomy is and have done one, I don’t know why or even where in the patient contact that was done. In reference to the airway, that is what a cricothyroidotomy is supposed to provide. It is also not the first type of airway that I’d consider UNLESS the patient had either severe facial injuries or his jaw was clenched so tightly that an oral airway couldn’t be placed. Even then, I’d consider a nasal airway before a surgical airway.
The Texas Department of State Health Services investigated the 2023 incident and found that the paramedic, Hiram Edmundo Ortega, violated state codes related to providing emergency medical services. On Sept. 13, the department sent Ortega a notice of intent to revoke his license.
The Texas Department of State Health Services (DSHS) is pretty aggressive in investigating and disciplining EMS practitioners. If you read the state codes linked above you’ll see that there are a lot of things for which EMS practitioners can be disciplined. It’s not a surprise that they decided to revoke Mr. Ortega’s license.
The article then goes on to cite a lot of recent difficulty with EMS in Pflugerville. I’m not going to quote any of that, but you should definitely read it.
Just to help you out in many parts of Texas outside of major cities voters agree to create Emergency Services Districts (ESD). An ESD is a government entity, but operates independently. So, although they call themselves the Pflugerville Fire Department, they are not a city agency. PFD doesn’t provide transport, they provide first response. They then hand off the patient to whoever the transporting service. At one time it was Austin/Travis County EMS, but there were complaints that ATCEMS had long response times. The ESD known as Pflugerville Fire Department tried it’s hand at running an ambulance service, but the taxpayer complained about the cost and the ESD opted to contract with a private service.
For a very short time, they used Acadian Ambulance Service, however there were complaints (again) that Acadian took too long to respond. The city of Pflugerville also complained about the cost.
The ESD then contracted with Allegiance Mobile Health, which while not nearly as big as Acadian has widespread operations in Texas. There website says that they provide 9-1-1 services to a variety of cities, counties, and other places in Texas.
Allow me to editorialize on EMS in general, not specifically this case.
EMS is expensive to operate. While a top quality ambulance for emergency responses can cost over $250,000.00 if fully equipped that’s not the most expensive part of the operation. Neither is additional equipment or supplies. Or insurance, for that matter.
The most expensive part of an EMS system in paying EMTs and paramedics to work on those ambulances. The work is not easy and EMS has a high burnout rate. Even without that people often leave to find jobs that pay more, they like better, or give them more time off. Or some combination of those.
EMS system operators will cut corners where they can. One of those is on paying their EMTs and paramedics. To have a good service you need to have good care providers. To have good care providers who will hang around for a while you need to pay them well and give them benefits. If you don’t you’ll have a lot of turn over and a lot of inexperienced care providers in critical roles.
Low pay is common in the private service industry, along with poor benefits, and a hard schedule. There is a lot of turnover as providers look at better job options in and out of EMS.
There is no good and cheap EMS. You can have good EMS, but it will cost you. You can have cheap EMS, but it will likely end up costing you even more.
Sadly, that’s a lesson that is only learned the hard way and all too often the lesson doesn’t stick.
We went for friends son’s wedding. The bride is from NYC and so that’s where the wedding was. We had been invited well before we knew that we were going to be able to make the move from the northeast to Texas. Although it probably wouldn’t have made a difference as they are good friends, it was small wedding, and were happy they invited us.
We flew out of Austin to Dallas Fort Worth and then to LaGuardia. No direct flights from Austin to LaGuardia that fit our schedule as we were invited to the rehearsal dinner as well.
We breezed through TSA in Austin and didn’t need to go through TSA at DFW. No, they came to us for a “random” ID and boarding pass check. Not us specifically, but everyone on the plane. Six TSA officers and two plainclothes DHS officers. Some people were “randomly” stopped a second time just beyond the entry to the Jetway.
We made it to LGA on time and took an Uber to the hotel. 10 miles, 35 minutes, $65.00 plus tip. It’s New York City, so that’s to be expected. Of course Uber costs more because NYC makes Uber drivers get cab driver’s licenses.
The hotel was nice, but the rooms were about the size of a large walk in closet. As a friend joked, it’s so small that you have to go outside to change your mind.
I went out to get a cup of coffee and on the way back walked by a pile of laundry and a guy sleeping on an army cot under about three blankets. I know from working with a lot of homeless people that some of them just refuse to go into shelters, but this seemed a bit extreme. Sleeping on the sidewalk in Manhattan on an army cot.
My wife and I had the same impression of the city. It’s dirty, noisy, even the high end buildings look like they need a pressure washing. Traffic is a mess as the city has turned traffic lanes into bike lanes. Roads have one lane for motor vehicles, one for bikes, and one for buses. Then people wonder why traffic doesn’t move. Bikes and scooters are everywhere. Frankly and bluntly, it’s like some Third World shit hole.
No one seems to speak English and there are few, if any, native New Yorkers in Manhattan. I don’t know where they are, but they aren’t there.
There are police, but not a lot of them. I haven’t been in NYC for years, but before the Plandemic there were cops walking beats all over the place. Not now. Now there are one or two police cars sitting on the side of the road with their lights on and two officers sitting in side.
Something else I noticed was jaywalking. Pedestrians in NYC used to obey the no crossing lights, but that seems to have gone out the window.
One thing I will say is that the food in NYC is very good. The rehearsal dinner was great, the breakfast I had the next morning in a hole in the wall restaurant was tasty and not expensive. I was lucky to find a seat in the restaurant as it was a tiny place with five or six two seat tables. A lot of people were sitting outside in the 35 degree temperature eating in little huts (for lack of a better term) with three walls and no heat. In what is supposed to be the most sophisticated city on the planet.
The wedding was a lot of fun. We got to talk to friends we haven’t seen since we moved and don’t quite know when we’ll see them again. My oldest friend and his wife were also invited and we got to see them as well. Plans were made for them to come down to Texas for a visit in the spring.
Sunday morning we got up, got dressed, packed and took another Uber ride to the airport. We once again breezed through TSA and headed for our gate. We were early, but I prefer to
arrive early rather than miss a flight. We had breakfast and sat down to wait. The gate agent announced that they were looking for two people to sit in the emergency exit row. Normally they
charge extra for that, so Mrs. EMS Artifact went up and volunteered us. For some odd reason we got the window and aisle seats and were separated by a passenger who paid for the center seat.
When we were called to board, once again we had a “random” extra, bonus, screening from the TSA. This time they also wanted to see peoples laptops and tablets. They also had a bonus canine, which I surmise was an explosive sniffing dog. They once again gave extra screening to some people for no obvious reason.
That slowed down the boarding process and we ended up pushing back from the gate about 15 minutes late. The weather was cold with snow/rain falling intermittently, so we went to the de icing station. Twice. Then we waited some more. All told, we were about an hour late in taking off.
As a result, we were going to miss our connecting flight in Dallas. I kept checking the airline app to see what our options were and all of a sudden it became moot because our connecting flight was now delayed. By four hours. Great. More sitting around an airport.
We landed in Dallas about the time we were originally scheduled to land in Austin and landed in Austin about the time I had planned to be in bed at home. The bonus was that we got a free upgrade to First Class. Of course being a forty five minute flight we got no drinks or snacks, but the seats were comfortable.
All in all, I can’t see a reason that I will ever go to New York City again. It offers me nothing that I want and everything that I don’t.
I have one more trip planned to the northeast, but I don’t have the exact dates picked out yet. After that, I’ll be content to be home in Texas.
